Live births after late-term abortion are no exception

The study was based on all second trimester abortions (13,777) performed in the hospitals of Quebec between 1989 and 2021. In Quebec, the law does not stipulate a maximum time limit for performing an abortion. The researchers found that abortions performed during the second trimester of pregnancy due to fetal anomalies doubled between the period 1989 - 2000 and 2011-2021. At the same time, they observed a significant increase in live births following a second-trimester abortion: the rate of 4.1 live births per 100 abortions in 1989-2001 climbs to 20.8% for the 2011-2021 period.

This is particularly true for abortions between 20 and 24 weeks of amenorrhea (18-22 weeks of pregnancy): in this case, more than one fetus in five is alive at the time of expulsion (21.7%). The study points to two reasons for this: on the one hand, doctors are not always encouraged, when the fetus has not yet reached 22 weeks, to carry out pre-abortion foeticide by lethal injection into the fetal heart or thorax, or via the amniotic fluid. However, there are cases where abortion-induced labor, even before this stage, does not result in fetal death, and the fetus is expulsed alive. On the other hand, a foeticidal injection may lack effectiveness when fetuses are smaller and therefore harder to reach. However, even if the occurrence of a foeticidal injection divides by three the “risk” of a live birth after abortion (all methods combined: delivery or morcellation), the fact remains that in 5% of cases, the fetus is born alive despite the lethal injection.

The researchers also studied the management of these newborns in intensive care and palliative care. A quarter of them were admitted to intensive care, and only 5.5% received palliative care. Yet recent studies show that the fetus may feel pain as early as the fourth month of pregnancy (EIB News). It goes without saying that these very premature babies, born of abortions between 3 and 6 months of pregnancy, could experience real discomfort, even severe pain linked to lack of oxygenation.

The authors recommend more widespread encouragement of pre-abortion foeticidal injections as early as the 20th week of amenorrhea (18th week of pregnancy). They also advocate better counseling for mothers on “the risk of live birth, the use of foeticidal injection, and the provision of palliative care.” In their view, these efforts could help mitigate the psychological impact of a live birth in the context of an abortion, both for the family and for healthcare professionals.

It's surprising that the major Quebec and Canadian media haven't covered the release of this major study and the very worrying results it reveals.

Commentary:

The authors' aim is to reduce what they call “the risk of live birth” after late-term abortion, by insisting on the need to extend the use of foeticidal injection. However, to consider the live birth of a fetus as a “risk” seems paradoxical, to say the least, even if we understand that this outcome is not desired in the context of an abortion. The study in no way addresses the question of how to reduce the number of late-term abortions, in a context where selective abortions due to fetal anomalies are increasing drastically, in parallel with the development of prenatal screening techniques (NIP-test, ultrasound technology, fetal echocardiography, etc.).

This study is also of particular interest to the medical and political debate in Belgium on extending the abortion deadline to 18 weeks of pregnancy.
In this context, the following points should be noted:

• 7415 abortions between 13 and 17 weeks of pregnancy were recorded between 1989 and 2021 in Quebec hospitals, an average of 230 per year. This is for a population of 3 million, less than that of Belgium. Of these abortions, 3.4% or 253 resulted in live birth.
• The study showed that in 48% of second trimester abortions in Quebec, i.e. almost half the cases, there was no medical indication on the fetal side, nor any medical emergency on the maternal side. In these cases, the abortion took place for “personal or unspecified” reasons, on a healthy fetus.
• The viability criterion as a “natural” limit to the legal extension of the abortion delay, seems less and less relevant given the possible recourse (and encouraged by the scientific literature) to foeticidal injection.
• The study shows that even systematic recourse to foeticide injection would not prevent all live births, notably because of the size and mobility of the fetus.
• There is real concern about the psychological impact on the woman, her family and healthcare professionals of an abortion in which the fetus emerges alive.

For further information on the extension of abortion in Belgium, see the EIB dossier “ Extending abortion beyond 3 months of pregnancy: medical, psychological and ethical issues ”.