House Passes Abortion Ban at 20 Weeks

Disclosures

May 13, 2015

The House today passed a Republican-sponsored bill that would outlaw abortions at 20 weeks of gestation based on the disputed premise that fetuses that young can experience pain. The vote of 242 to 184 closely followed party lines.

"We have no higher obligation than to speak out for those who can't speak for themselves, to defend the defenseless," said House Speaker John Boehner (R-OH) shortly before the vote on the Pain Capable Unborn Child Protection Act. "That's what this bill does. Because we know that [it's] wrong to inflict pain on an innocent human being."

The American College of Obstetricians and Gynecologists (ACOG) maintains that the preponderance of scientific evidence indicates that fetuses do not likely experience pain before the third trimester.

Ten states have already passed 20-week abortion bans, setting a different standard than that set by the landmark Supreme Court decision of Roe v Wade in 1973. In that case, the high court ruled that states may ban abortion — except when necessary to preserve the mother's life or health — once the fetus reaches viability, but not before. Most obstetrician-gynecologists put fetal viability at about 24 weeks from the first day of the woman's last menstrual period (LMP), according to ACOG.

Underscoring this divergence in timing, a federal appeals court in 2013 struck down a 20-week abortion ban enacted by Arizona, saying that it violated a woman's right to abort a pregnancy up until fetal viability.

Today's vote on abortion in the Republican-controlled House, like many on the Affordable Care Act, may be merely symbolic. There are enough Democrats in the Republican-controlled Senate to filibuster the bill, and President Barack Obama can veto it.

The House passed an almost identical bill in 2013. That bill, like today's, made an exception for abortions past 20 weeks of gestation to save the life of a mother, and for pregnancies resulting from rape or incest against a minor. Under that bill, victims of rape would have been required to report the crimes beforehand to the appropriate law enforcement agency.

When Rep. Trent Franks (R-AZ) reintroduced the bill this year, opposition arose in GOP ranks to this reporting requirement. The bill passed today omits that provision, but does require adult victims of rape to receive counselling 48 hours prior to an abortion.

The House vote on the Pain Capable Unborn Child Protection Act comes exactly 2 years after a jury in Philadelphia, Pennsylvania, found abortion provider Kermit Gosnell, MD, guilty of murdering three infants and illegally performing numerous abortions beyond the 24-week gestational limit set by the state. Prosecutors said that many fetuses were aborted alive only to have their spinal cords severed with a pair of scissors. Several House members who spoke in favor of the bill said the measure would guard the unborn from the likes of Dr Gosnell.

ACOG: "There is No Science Behind the Bill"

Earlier today, before the House vote, an ACOG executive denounced the bill in a telephone press briefing that also featured leaders from the Planned Parenthood Action Fund and NARAL Pro-Choice America.

"There is no science behind the bill — just bias," said Hal Lawrence III MD, ACOG's executive vice president and CEO.

Dr Lawrence noted that while the vast majority of abortions occur in the first trimester, preserving women's right to second-trimester abortions, especially after 20 weeks, is critical. Such women "generally are facing a complex, painful situation," he said. "If anything this calls for empathetic care, not persecution and restrictions."

Claims that 20-week fetuses can feel pain, he said, "have been...repeatedly discounted by science."

ACOG previously has asserted that "pain perception requires conscious recognition or awareness of a noxious stimulus." Such awareness depends on functional thalamocortical connections that do not appear until 23 to 30 weeks into gestation. Higher levels of fetal stress hormones in response to invasive procedures do not prove the existence of fetal pain, contrary to what bill supporters contend, because these stress responses "can be elicited by nonpainful stimuli and occur without conscious cortical processing," according to the society.

As evidence, ACOG cites a literature review published in JAMA in 2005, and findings by the Royal College of Obstetricians and Gynecologists in the United Kingdom in 2010.

Dr Lawrence today also criticized the bill for not exempting sometimes lethal fetal anomalies from the 20-week ban. Many of them are not regularly detected — or easily detectable — until after 20 weeks, according to ACOG.

Another bone that ACOG picks with the bill is its calculation of gestational age back to fertilization. ACOG calls that an inaccurate dating method because the time of fertilization can be hard to pinpoint. The society maintains that LMP gestational age is the standard for the specialty, and the medical profession in general.

Twenty weeks postfertilization is the equivalent of 22 weeks LMP, according to the Guttmacher Institute, a nonprofit think-tank on sexual and reproductive health rights.

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