A doctor’s story shows ‘late-term’ abortion access is politically charged – but crucial
- Written by: Prudence Flowers, Senior Lecturer in US History, College of Humanities, Arts and Social Sciences, Flinders University
In the United States, around 1% of abortions occur after 21 weeks. Yet these abortions are intensely vilified. Recall Donald Trump’s graphic and false claim that US laws allowed doctors to “rip the baby out of the womb in the ninth month, on the final day”.
For two decades, Dr Shelley Sella provided abortion care in the US into the third trimester of pregnancy: that is, after 26 weeks gestation. Her new book Beyond Limits offers an intimate account of health care and politics, written from the front lines of America’s abortion wars.
Review: Beyond Limits: Stories of Third-Trimester Abortion Care – Shelley Sella, MD (Random House)
In Australia, abortion after 20 weeks gestation is also statistically rare – and most Australians agree that people need abortions after 20 weeks for a variety of medical and social reasons. However, in the last year or so, the focus on later abortions seems to be intensifying here, along with misinformation.
Every Australian jurisdiction but the ACT has a legal gestation limit (ranging from 16 to 24 weeks), after which two doctors must agree the abortion is necessary.
Yet a common claim made by abortion opponents like Tony Abbott and Barnaby Joyce is that Australia’s laws allow abortion “for any reason” “right up to the time of birth”.
Last year, the SA parliament narrowly voted down a so-called forced birth bill that would have banned abortion from 28 weeks. Simultaneously, during the Queensland state election, MP Robbie Katter boasted he would table legislation aiming to reduce the state’s gestation limit to 16 weeks or even a “clean repeal” of decriminalisation.
During this time, Senator Jacinta Price insisted abortion after the first trimester was “late term” – and called for abortion to be on the national agenda.
“Late-term abortion”, neither a medical or clinical term, has been a touchstone for US anti-abortion activism and lobbying. That rhetoric frequently dominates how this procedure is discussed – and not just in the US.
Humanising the issue
Sella’s book is part memoir, part activism – and at its core is the fundamental belief that empathy and understanding can overcome stigma and stereotype.
She aims to humanise the complicated, often desperate circumstances that mean people need abortion care later in pregnancy. She argues the procedure is “never, ever a casual decision”.
Quoting the mother of a young rape victim, Sella reminds us: “You don’t know the story until you are the story.”
Sella was born in New York City in the mid-1950s, the daughter of two Israeli immigrants in an “unhappy household”.
From the ages of 12 to 15, she writes, she was sexually abused. When Sella was 14, she missed her period for several months. She remembers, “I absolutely knew I would kill myself if I were pregnant.” Although she managed to find a community clinic and learned she was not pregnant, this visit, including a painful pelvic exam, compounded her feelings of shame, fear and isolation.
Throughout the book, Sella returns to these experiences in her early teens, framing them as underpinning her approach to health care and interest in abortion. Her goal was always “to treat patients as I would have wished to have been treated as an abused, frightened girl – that is, with understanding, an open heart, and compassion”.
Sella first encountered abortion in her early twenties through her involvement in second-wave feminism and the women’s health care movement. She trained and briefly worked as a midwife before becoming an OB-GYN.
In her early 40s, feeling professionally unfulfilled, Sella decided to focus on abortion provision. Her life was then transformed by a chance conversation about abortion and midwifery with Dr George Tiller, the owner of a Kansas clinic that was one of three in the country that provided third-trimester abortions.
Superficially, they were an unlikely pair. Sella was an “obstinate” Jewish lesbian and Tiller was “prickly”, “deeply patriotic” and a devout Lutheran. But they developed a profound rapport – he became both mentor and like a “second father”.
Tiller’s oft-repeated motto was “trust women”. When training Sella, he emphasised the physical, emotional and spiritual needs of later abortion patients.
Dismantling stereotypes, fighting stigma
Later gestation abortions occur after a significant adverse medical diagnosis, or because of the complex and often traumatic circumstances of the woman or pregnant person. Sella believes patient stories are vital in helping people understand the importance of both this type of care and access to abortion more broadly.
Drawing from her diary to offer vivid composite portraits of patients, Sella explores the nuances of why people seek a third-trimester abortion.
