Why Prohibit Late Term Abortions

Introduction

Late abortions (after 24 weeks gestational age) are extreme by any national and international comparison. Just seven of the 50 States in the US permit unrestricted abortion after 24 weeks.1 Internationally, only five of the 198 countries, independent states, and semi-autonomous regions with populations exceeding 1 million permit abortion after 24 weeks.2 Three of the five nations that permit late abortion are notorious human rights abusers: China, North Korea, and Vietnam. Colorado should not aspire to join the ranks of the few states and countries that dehumanize the late term fetus and permit the killing of these most vulnerable human beings. Colorado should also not jeopardize the health of Colorado women by allowing the unregulated out-patient practice of late abortion which is known to pose serious risks to the health and life of the woman.3

Late abortion is predicated on the notion that a woman’s right to bodily autonomy trumps the fetus’ right to life. Both prolife and prochoice advocates would agree that a woman’s autonomy is an extremely important value; however, both sides differ on whether autonomy supersedes another human being’s fundamental right to life. These competing rights are why proponents of access to late abortion go to extreme lengths to minimize the humanity of the fetus. They refer to “terminating the pregnancy” as if the termination could occur without killing a vital, developing human being. Orwellian language is utilized to refer to the crushed and dismembered fetus as “products of conception” or simply “POC”. A recent series on abortion rights by the Editorial Board of The New York Times refers to the developing human merely as a “cluster of cells” as if her brain, heart, circulatory system, appendages, hands/feet and nervous system were immaterial.3 Even the preferred term “fetus” is an attempt to dehumanize the developing human. OB-GYN physicians commonly refer to the “baby” during a woman’s wanted pregnancy, but abortionists will rarely refer to the “fetus”, much less use the term “baby”, when counseling a woman on abortion.

There is little doubt that there is a bipartisan consensus that late abortions should be regulated. According to a 2018 Gallup poll, only 18% of Democrats, 13% of Independents, and 6% of Republicans believe that third trimester abortions should be legal.5 The polling presumably reflects the public’s widespread recognition that late abortion kills a human being not materially different than a newborn infant and that late abortion represents a substantial medical risk to the pregnant woman.


Is the 24 week fetus a human being?

Human embryology has long attested to the fact that human life begins at fertilization and that human development is a seamless, continuous process that continues for years past birth. A primordial heart develops in the human embryo by the third week (post fertilization) and begins to pump blood by the fourth week.6 Rapid development of the brain occurs in the fifth week. By the eighth week, the embryo has distinctly human characteristics, developed the beginnings of all major organ systems, and demonstrates purposeful limb movements. During the 17th week, the mother can feel the fetal movements.

Fetal surgeries, in which the fetus is operated on by specially trained fetal surgeons and anesthesiologists, have been pursued as early as the 19th- week gestation (post last menstrual period).7-8 Fetuses have been born in the 21st-week gestation with excellent neurodevelopmental outcomes.9 Based on studies performed on infants born at 24 weeks gestation between 2004 and 2011, 58-77% survive with active treatment.10-11

While there is considerable debate concerning when the fetus can experience pain, it is very likely that a 24-week-old fetus can experience pain – perhaps more intensely than an infant or adult. Some researchers argue that a functional mesodiencephalon is all that is required and that a fetus as young as 15 weeks gestation can perceive pain.12 Because inhibitory descending serotonin pathways in the nociceptive system mature only after birth, the fetus might be even more sensitive to pain than infants or adults. Other researchers insist that functional thalamocortical circuitry is required for conscious perception of pain.13 However, even for these latter researchers, there is good evidence that the thalamic pain fibers reach the cortex on or near the 24th week. Thalamic projections reach the visual subplate at 20-22 weeks, the visual cortex at 23-27 weeks, and the auditory cortical plate at 24-28 weeks.13-14 Given these findings, it should be assumed that the 24-week-old fetus could feel pain.

Besides neuroanatomy, there are other observations that support the notion that a fetus can experience pain. As early as 18 weeks gestation the fetus exhibits pituitary-adrenal, sympathoadrenal, and circulatory stress responses to noxious stimuli.14 Even more provocative is the observation from 4-D ultrasounds that fetuses as young as 24 weeks exhibit facial expressions consistent with pain or distress.15-16 Furthermore, preterm infants at the lowest limit of viability have “profound, acute adverse reactions” to major painful stimuli.17

Late second trimester and third trimester fetuses display a number of other advanced cortical functions. The fetus’ sensorimotor behavior demonstrates the same characteristics later observed in the child’s behavior.18 They show curiosity or intrinsic motivation to explore their body and environment, perform repetitive actions to elicit sensations, react to sensory inputs, display intentionality, and demonstrate goal directed movements.18 It has also long been recognized that the fetus can respond to sound as early as 19 weeks.19 The fetus specifically responds to her/his mother’s voice. At 25 weeks fetuses have been observed to mimic their mother’s resuscitation of a nursery rhyme by opening and closing their mouths.18 Furthermore, a newborn human shows preference for her/his mother’s voice and for musical pieces to which she/he were previously exposed, which confirms a capacity for a fetus to learn in utero.20 Studies have shown that prenatally acquired acoustical memory can persist at least as long as 6 weeks.21

Fetuses in utero with gestational ages of 24 weeks or greater are biologically indistinguishable from infants born at 24 weeks. They have developed all the essential organ systems, they can perceive pain, they can demonstrate sophisticated behaviors, they can respond to and learn from familiar sounds, and they can undergo curative operative therapies as independent patients. The only difference is location. Location should not be the determinant of human value. A human’s inalienable right to life, proclaimed in our Declaration of Independence, has not, and should not be, contingent on location.

Who chooses late abortion and how common is the practice?

There is very limited information available in the United States regarding who pursues very late abortions. Most studies suggest women have late abortions for similar reasons that they have early abortions with several caveats.22-24 Age and educational level were not associated with abortions after 16 weeks but black women and women with higher incomes were more likely to have late abortions in one Guttmacher sponsored study.22 Another study which was based on the baseline Turnaway data concluded that “among women without fetal anomalies, reasons for seeking abortion are not different whether women sought abortion early or late in pregnancy.”23 They did not find a statistically significant difference between early and late second trimester abortions based on finances, parity, timing of pregnancy, degree of interference with future opportunities, emotional/mental preparedness, health related reasons, prospects for the baby, level of independence/maturity, influences from family/friends or the inability to contemplate adoption. A second study based on the Turnaway data suggested statistically significant differences in the age of the woman (younger patients, later abortions OR 2.7) and time that pregnancy was recognized (before 8 weeks, earlier abortions OR 0.1).24 They also found that women who had late abortions faced more logistical delays (finding a provider, raising funds, and travel costs). Both Turnaway studies excluded abortions for fetal anomalies or life endangerment.

Many people are under the impression that most late term abortions are necessitated by terrible fetal anomalies or life endangering conditions. Hillary Clinton famously made this assertion during a debate with candidate Donald Trump. This assertion was widely debunked by fact checkers.24-25 Diana Foster, Professor at the University of California San Francisco’s Bixby Center for Global Reproductive Health stated that “there aren’t good data on how often later abortions are for medical reasons”. Her opinion, based on the limited research and discussions with fellow researchers in the field, was that abortion for fetal anomalies “make up a small minority of later abortions”.25 There are other sources including investigations, blog posts, interviews and documentaries that suggest it is not hard to schedule a late abortion or uncommon to abort an entirely normal fetus after 24 weeks gestation.26-29 In Colorado, the Boulder Abortion Clinic advertises elective abortions (for any reason) to 26 weeks and then to 36 weeks for “medically indicated terminations”.30 (Anecdotal evidence suggests that the Boulder Abortion Clinic is willing to consider later abortions for normal fetuses).26,29,31 For those women who do have fetuses with likely life-limiting genetic or congenital abnormalities, perinatal hospice offers a holistic, humane, and compassionate alternative to late abortion.32

There is no mandatory reporting for abortion numbers, indications or complications in the United States. Consequently, it is difficult to objectively assess the practices of late term abortionists and the patients they serve. It is also uncommon for an independent expert to review late abortionists’ practices. In a rare move that resulted in significant controversy/litigation, Kansas Attorney General Phil Kline had Dr. Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins School of Medicine, review redacted records of prominent third-trimester abortionist, George Tiller. Dr. McHugh reported that he found instances where abortions were obtained for “trivial reasons” (like a desire to play sports) and for psychiatric reasons (such as adjustment disorder, anxiety, and depression) that could have been more appropriately remedied without resorting to late abortion.33

To obtain Colorado-specific abortion data is extremely difficult. The Colorado Department of Health collects an (admittedly) incomplete survey of abortion providers (since it is not mandatory and there is no enforcement mechanism). In their 2017 Report of Induced Terminations of Pregnancy, 285 abortions were performed after 21 weeks gestation in Colorado.34 The Guttmacher Institute pegs the rate approximately 24% higher (based on previous data).35 Assuming the CDPHE underestimation is uniformly distributed amongst all gestational ages, this would translate into approximately 353 abortions after 21 weeks in the last reporting year.

Few Colorado abortionists admit performing late/third trimester abortions. The exception is Dr. Warren Hern from the Boulder Abortion Clinic. In a number of newspaper and magazine stories, the impression is given that he only performs late abortions for fatal fetal anomalies and life-endangering conditions of the mother.36-37 However, Dr. Hern has admitted that 70% of his abortion practice is for normal fetuses.38 In those 30% of abortions performed for fetal anomaly, he reports that Down Syndrome is his most common indication (24%). Potentially treatable structural anomalies are included in his series (such as spina bifida, aortic stenosis, abdominal wall abnormalities, urinary obstruction, extra digits, fused digits, deformed hands or feet, scoliosis, and cleft lip/palate).38

How often is it medically necessary to abort a fetus to preserve the life or health of the mother? Dr. Diane Foster from the University of California San Francisco states that the number is very hard to characterize.25 Although there is almost no literature on the subject, one Maternal-Fetal Medicine expert concludes that this is an exceedingly rare event, perhaps encompassing as few as 4 extremely uncommon conditions: pulmonary hypertension (primary or Eisenmenger’s syndrome), Marfan’s syndrome with aortic root involvement, complicated coarctation of the aorta, and peripartum cardiomyopathy with residual dysfunction.39 These would all likely be adjudicated long before 24 weeks gestation. Dr. Hern has said that he is unaware of a situation where abortion was necessary (as opposed to delivery) to save the life of a mother in the third trimester.40

Late abortions are performed for the same reasons that early abortions are performed. There may be more abortions for fetal anomalies late in pregnancy, but this is still likely a small proportion overall. Late abortions occur commonly in Colorado, but figures are inaccurate and lack some demographic and medical detail. Abortions to preserve the life of the mother are a very rarely, if ever, indicated in late abortion. Perinatal hospice offers an alternative to late abortion for families confronting a fetus with a likely terminal diagnosis.32


How are late abortions performed?

There are many different abortion techniques and remarkable procedure variability among physicians performing late second trimester and third trimester abortions. This reflects the lack of consensus in the abortion community.

Generally, beginning at 16 weeks gestation, Dilation and Evacuation (D&E) replaces sharp curettage and suction curettage as the surgical abortion procedure of choice.41 During D&E, cervical dilation is achieved over one or more days by osmotic dilators and misoprostol to facilitate the subsequent mechanical destruction and dismemberment of the fetus. Parts of the fetus grasped/torn from her/his torso are then easily removed through the dilated cervix. A large-bore vacuum curette is used to remove the placenta and remaining tissue. Administration of a pre-procedure feticide such as intraamniotic/intrafetal digoxin, intracardiac potassium chloride or transection of the umbilical cord sometimes proceeds the D&E.

Dilation and Extraction (D&X) is similar to the D&E procedure except that a suction cannula is utilized to evacuate the brain after delivery of the fetal body/legs through the dilated cervix.40 The ensuing collapse of the head facilitates its passage through the cervical canal. In the popular vernacular this procedure is referred to as “Partial-Birth Abortion”. In order to comply with the Partial-Birth Abortion Ban Act of 2003, fetal demise must be ensured prior to the procedure. This is accomplished using a pre-procedure feticide or by transection of the umbilical cord.

During an Induction Abortion, labor is induced using mechanical means and/or by chemical means .40 The fetus is then delivered intact. To remain within the framework of the law, fetal demise is achieved prior to delivery using a feticide.

Abortion proponents make the claim that fetal death during abortion is more compassionate and painless than natural fetal/infant death in instances where the fetus has a terminal diagnosis. However, there are no published studies comparing the pain/suffering induced during abortion vs. natural fetal/infant death.

During D&E, there are estimates that only one half of fetuses are killed prior to the dismemberment procedure.42-43 It is hard to imagine that dismemberment would be less painful than natural death in conjunction with advanced perinatal hospice/palliative care services.

Even for those fetuses who are killed before they are dismembered or delivered, there could be substantial suffering. A highly concentrated potassium infusion can cause intense intravascular burning in normal patients.44 Even though an intracardiac infusion of potassium can kill a fetus within 2 minutes, It’s impossible to ascertain whether the fetus experiences intense pain prior to its demise.45 Intraamniotic or intrafetal digoxin is the more commonly used poison to achieve fetal demise.46 A digoxin overdose in older humans causes intense nausea, vomiting, abdominal pain, visual disturbances and delirium.47-49 Digoxin kills by causing severe bradycardia culminating in asystole, but it does not kill quickly. It can take up to 4 hours for intrafetal and up to 24 hours for intraamniotic digoxin to achieve asystole.50-51 Women are routinely told to anticipate “kicks” for hours after the feticide is administered.52 The visual, gastrointestinal, neurological and cardiac manifestations of digoxin toxicity could arguably represent fetal cruelty. Indeed, if this same methodology was utilized in a death penalty case, it would be considered “cruel and unusual punishment”.

In more candid moments, even abortion advocates sometimes characterize late abortion procedures on fetuses as “morally abhorrent”.53 It is a form of intimate human violence which is unparalleled in medicine. The only reason that it persists is that the violence is hidden within the confines of the uterus. When the mother (and the broader public) are shielded from the reality of the carnage that is being inflicted on the fetus, it is easier to rationalize its utility. Since there are no studies on the pain associated with late fetal abortion, to regard this as a painless, humane procedure is either wishful thinking or horribly misguided.

What is the risk to the woman undergoing a late abortion?

Late abortion is associated with significant morbidity and mortality. The precise magnitude of the risk associated with abortion can’t be reliably gleaned from the CDC or state databases because reporting abortion numbers and related complications is not consistently state mandated and never federally mandated. Furthermore, abortion procedures in the US are not linked to other sources of health data such as birth or death certificates making meaningful estimates of mortality rates nearly impossible. Since the system is voluntary and physicians are reluctant to disclose serious complications (including death), underreporting is also a major problem.54 There have been multiple instances documented where abortion related deaths were not captured by the official state/federal databases.54

Even using the admittedly inadequate medical claims/surveillance data, late abortion poses a substantial risk compared to early abortion in both relative and absolute terms. Using California Medicaid billing data, Emergency Department visits and complications were 2.5 times more likely following a second trimester abortion compared to a first trimester abortion.55 Data from the national Abortion Surveillance System indicate that while the overall risk of death from abortion was 0.7/100000 induced abortions, the risk of death increased exponentially (by 38%) for each additional week of gestation.56 CDC researchers found that gestational age was the strongest predictor of abortion-related-mortality.3 In absolute terms, the risk goes from 0.1 deaths/100000 for surgical abortions < 9 weeks to 8.9 deaths/100000 at > 20 weeks.57 To put this in perspective, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) compiled a 5/12 year database of over 1 million out-patient surgeries performed in ambulatory surgery centers.58 The death rate was 2/100000 for patients that were, on average, significantly older than patients undergoing late abortion. This is only 22% of the mortality rate seen in late abortion. The Canadian counterpart, the Canadian Association for Accreditation of Ambulatory Surgical Centers (CAAASF), conducted a survey that pointed to a death rate of approximately 1/100000 which represents only 11% of the risk of late abortion.59 The risk must be viewed in the context of strict oversight of ambulatory surgical centers in Colorado and the absence of oversight or regulations pertaining to abortion facilities in Colorado.60 Media Trackers reported that “while standard healthcare and out-patient surgical clinics in the state fall under the authority of the Health Facilities division of the Colorado Department of Health and Environment for regular licensing and regulation, Planned Parenthood (and other abortion providers) are not held to the same standard”. Not only does late abortion represent a significant mortality risk to women but the lack of health/safety oversight potentially compounds that risk.

Mortality studies that are based on countries with linked birth, pregnancy, abortion and death registries give an even more stark view of the risk from abortion. In Denmark, the 180-day mortality associated with late abortion (>12 weeks) was 55/100000.61 This is far worse than US surveillance data would suggest and places it in a league with neurosurgery (lumbar discectomy 60/100000), and abdominal surgery (laparoscopic appendectomy, inguinal herniorrhaphy 20/100000, laparoscopic cholecystectomy 200/100000).62-65 While this study is not adjusted for socioeconomic factors, marital status or psychological history, they suggest that mortality risk for women undergoing late abortion might be substantially underestimated in the US.

Some have tried to claim that a legal induced abortion is much safer than childbirth.66 However, others have pointed out that these studies are inherently biased and plagued with differences in ascertainment of deaths, duration of susceptibility to mortality, lack of accounting for gestational age and inappropriate comparators.54 The relative risk of pregnancy associated death between delivery and abortion may be better assessed by looking at countries with linked birth/medical/death databases. A systematic review and meta-analysis suggested that based on 11 studies from three such countries, termination of pregnancy is a marker for reduced life expectancy.67 They found that within a year of their pregnancy outcomes, women experiencing pregnancy loss (from either abortion or natural loss) were twice as likely to die compared to women giving birth. In Denmark this adverse mortality rate persisted for 10 years.61 While there could be confounding variables complicating this analysis, the notion that abortion leads to better health outcomes is unlikely (and certainly speculative without more rigorous research).

The morbidity associated with abortion also increases with gestational age.68 A large retrospective study from the University of California San Francisco suggested that the complication rate for second trimester abortions was 9.8% (including cervical laceration, hemorrhage, uterine atony, anesthesia complications, uterine perforation, disseminated intravascular coagulation, and retained products of conception). Major life-threatening complications (complications requiring hospitalization, transfusion, or further surgical intervention) occurred in 1.7% of patients. Any of these complications increased with each additional week of gestation beyond 20 weeks. Unfortunately, there are no published studies specifically addressing the likely extremely high morbidity/mortality associated with third trimester abortions.

Long-Term health effects of abortion are controversial.3 Retrospective studies suggested a correlation of abortion with breast cancer. Better, case control studies suggested no correlation. There appears to be an association of abortion with postpartum hemorrhage in later pregnancies, but the mechanism is undefined. Late abortions may result in an increased risk for premature birth in subsequent pregnancies (aOR= 1.13, 99% CI 0.91-1.4). This trend becomes statistically significant for women who have had multiple abortions. Researchers have found a dose-response relationship between the number of prior abortions and the risk for extreme premature birth. Since black women have, on average, more late abortions and more multiple abortions, one might speculate that the scourge of increased infant mortality (tied largely to premature birth and low birth weight infants) in the black community could be partially caused by abortion.

The adverse effects of abortion on mental health is particularly controversial. Recent reviews cited by abortion proponents rely heavily on the methodologically flawed Turnaway study to conclude that abortion is not associated with new mental health disorders.3 However, a more balanced review of the literature suggests several consensus opinions regarding the nexus between abortion and mental health: “1) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion, 2) the abortion experience directly contributes to mental health problems for at least some women, 3) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion.”69 The reason that this is a particularly urgent issue is that studies suggesting high long-term mortality outcomes from abortion point to markedly increased rates of suicide, accidents, and homicide. 61 ,67, 70

Conclusions:

Late abortion is extreme by any measure and should be prohibited. Very few countries in the world permit abortion after 24 weeks. Most Americans, regardless of their political affiliation, feel that abortion should be illegal in the third trimester. There is irrefutable scientific evidence that a 24-week fetus demonstrates all the fundamental characteristics of more developed humans, including the ability to perceive pain and perform sophisticated sensorimotor behaviors. The reasons women choose late abortions are similar to the reasons that women choose early abortion. Most late abortions are probably performed on normal fetuses. For those tragic situations where a fetus has a life-limiting prognosis because of genetic or congenital fetal abnormality, perinatal hospice offers a compassionate, life-affirming alternative to abortion. Late abortions are violent procedures that commonly involve the crushing and dismemberment of the fetus. Late abortions pose a substantial morbidity and mortality risk to the pregnant woman, which is further exacerbated by the lack of regulatory oversight. Long term sequelae of abortion include the risk for future premature birth and adverse future pregnancy outcomes. There appears to be a substantially increased risk of early mortality in women who have abortion compared to women who deliver babies. This may be related to worse long-term mental health outcomes for women who choose abortion.


References:

1.State Policies on Later Abortions. (2019, January 1). Retrieved from https://www.guttmacher.org/state-policy/explore/state-policies-later-abortions. January 10, 2019

2.Lee, M. Y. H. (2017, October 9). Is the United States one of seven countries that ‘allow elective abortions after 20 weeks of pregnancy?’. The Washington Post.

3.Committee on Reproductive Health Services. The Safety and Quality of Abortion Care in the United States. Washington DC: The National Academy Press, 2018.

4.The Editorial Board of the New York Times. (2018, December 28). A Woman’s Rights. The New York Times. Retrieved from https://www.nytimes.com/interactive/2018/12/28/opinion/abortion-murder-charge.html. January 10, 2019.

5.Trimesters Still Key to Abortion Views. (2018, June 13). Retrieved from https://news.gallup.com/poll/235469/trimesters-key-abortion-views.aspx. January 10, 2019.

6.Moore, KL, Persaud, TVN, and M Torchia. The Developing Human: Clinically Oriented Embryology. 2013. Elsevier Saunders. Print.

7.Moldenhauer JS and Adzick NS. Fetal Surgery for myelomeningocele: After the Management of Myelomeningocele Study (MOMS). Seminars in Fetal & Neonatal Medicine 2017; 22: 360-366.

8.Graves CE, Harrison MR, and Padilla BE. Minimally Invasive Fetal Surgery. Clin Perinatol 2017; 44: 729-751.

9.Ahmad KA, Frey CS, Fierro MA, Kenton AB, and Placencia FX. Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks’ 4 Days’ Gestation. Pediatrics 2017; 140(6): e20170103.

10.Rysavy MA, et. al. Between Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants. NEJM 2015; 372: 1801-1811.

11.Sharp M, French N, McMichael J and Campbell C. Survival and Neurodevelopmental Outcomes in Extremely Preterm Infants 22-24 weeks of gestation born in Western Australia. J Paediatr Child Health 2018; 54(2): 188-193.

12.Sekulic S, et.al. Appearance of fetal pain could be associated with maturation of the mesodiencephalic structures. Journal of Pain Research 2016; 9: 1031-1038.

13.Lee SJ, et.al. Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. JAMA 2005; 294(8): 947-954.

14.Ferschl M, et.al. Anesthesia for In Utero Repair of Myelomeningocele. Anesthesiology 2013; 118(5): 1211-1223.

15.Reissland N, Francis B, Mason, J. Can Healthy Fetuses show Facial Expressions of “Pain” or “Distress”. PLoS ONE 2013; 8(6): e65530. Doi:10/1371/journal.pone.0065530.

16.Bernardes S, et.al. On the feasibility of accessing acute pain-related facial expressions in the human fetus and its potential implications: a case report. Pain Reports 2018; 3: e673

17.McPherson C, Inder T. Perinatal and neonatal use of sedation and analgesia. Seminars in Fetal and Neonatal Medicine 2017; 22: 314-320.

18.Fagard J, et.al. Fetal Origin of Sensorimotor Behavior. Frontiers in Neruorobotics 2018; 12:23.doi:10.3389/fnbot.2018.00023.

19.Hepper PG, Shahidullah BS. Development of Hearing. Archives of Disease in Childhood 1994; 71: F81-F87.

20.Gerhardt KJ, Abrams RM. Fetal exposures to sound and vibroacoustic stimulation. J Perinatol 2000; 20 (8 Pt2): S21-30.

21.Granier-Deferre C, et.al. A Melodic Contour Repeatedly Experienced by Human Near-Term Fetuses Elicits a Profound Cardiac Reaction One Month after Birth. PLoS one 2011; 6(2)L e17304. doi:10.1371/journal.pone.0017304.

22.Biggs MA, Gould H, and Foster DG. Understanding why women seek abortions in the US. BMC Women’s Health 2013; 13: 29.

23.Pappas S. (2011, December 16). Study Reveals Who Gets Late-Term Abortions. Live Science. Retrieved from https://www.livescience.com/17529-trimester-abortions.html , on January 10, 2019.

24.Foster DG and Kimport K. Who Seeks Abortions at or After 20 weeks. Perspectives on Sexual and Reproductive Health 2013; 45(4): 210-218.

25.Llevitan D. (2015, September 29). Clinton Off on Late-Term Abortions. Fact Check.Org. Retrieved from https://www.factcheck.org/2015/09/clinton-off-on-late-term-abortions/. On January 10. 2019.

26.Pavone, F. (2019, February 4). LISTEN: Undercover Call Catches Abortion Clinic Offering to Kill Baby at 32 Weeks. Retrieved from https://www.lifenews.com/2019/02/04/listen-undercover-call-catches-abortion-clinic-offering-to-kill-baby-at-32-weeks/. Retrieved February 4, 2019.

27.Vial, B. (2019, February 8). What It Was Like to Get a Later Abortion. Retrieved from https://www.teenvogue.com/story/what-it-was-like-to-get-a-later-abortion. Retrieved February 8, 2019.

28.Tolentino, J. (2013, September 20). Interview with Dr. Retrieved from https://www.thehairpin.com/2013/09/interview-with-dr/. Retrieved February 10, 2019.

29.Shane, M and Wilson, L. (Producers) & Shane M and Wilson, L (Directors). 2013. After Tiller (Documentary). USA. Roco Distributors.

30.Boulder Abortion Clinic Abortion Services Overview. Retrieved from http://drhern.com/en/abortion-services/abortion-procedures-overview.html. Retrieved February 10, 2019

31.Kirchoff, C. (2019, February 19). Undercover: Late Term Abortion Clinics Exposed. Retrieved from https://www.louderwithcrowder.com/undercover-late-term-abortion-clinics-exposed/. Retrieved February 19, 2019.

32.Perinatal Hospice & Palliative Care. Retrieved from https://www.perinatalhospice.org/. Retrieved January 10, 2019.

33.Barstow D. (2009, July 25). An Abortion Battle, Fought to Death. The New York Times. Retrieved from https://www.nytimes.com/2009/07/26/us/26tiller.html. January 10, 2019.

34.Colorado Department of Public Health and Environment, 2017 Report on Induced Terminations of Pregnancy.

35.Guttmacher Institute. State Facts About Abortion Colorado. Retrieved from https://www.guttmacher.org/sites/default/files/factsheet/sfaa-co.pdf. January 10, 2019

36.Richardson JH. (2009, August 5). The Last Abortion Doctor. Esquire. Retrieved from https://www.esquire.com/news-politics/a6117/abortion-doctor-warren-hern-0909/. January 10, 2019.

37.The Editorial Board of the New York Times. (2018, December 28). Women’s Rights Part 3: The Cost of Complacency About Roe. The New York Times. Retrieved from https://www.nytimes.com/interactive/2018/12/28/opinion/pregnancy-women-pro-life-abortion.html?module=inline. January 10, 2019.

38.Hern WM. Fetal diagnostic indications for second and third trimester outpatient pregnancy termination. Prenatal Diagnosis 2014; 34: 438-444.

39.Goodwin TM. Medicalizing Abortion Decisions. First Things. Retrieved from https://www.firstthings.com/article/1996/03/003-medicalizing-abortion-decisions. Retrieved on January 10, 2019.

40.Hern WM. September 9, 2015. Personal Communication.

41.Cunningham, FG et. al., Williams Obstetrics. McGraw Hill. 2014. Print.

42.Denny, CC. Induction of fetal demise before pregnancy termination: Practices of Family Planning Providers. Contraception 2015; 92(3): 241-245.

43.White, KO et.al., Second-trimester surgical abortion practices in the United States. Contraception 2018; 98(2): 95-99.

44.FDA. Potassium Chloride Injection. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019904s014lbl.pdf. Retrieved January 10, 2019.

45.Ovender L, Moodley J. Late termination of pregnancy by intracardiac potassium chloride injection: 5 years’ experience at a tertiary referral centre. S Afr Med J. 2012; 103(1): 47-51.

46.Society of Family Planning Clinical Guidelines. Induction of fetal demise before abortion. Contraception 2010; 81: 462-473.

47.Pincus, M. Management of digoxin toxicity. Australian Prescriber 2016; 39: 18-20.

48.Yang, EH, Shah, S and Criley, JM. Digitalis toxicity: A fading but crucial complication to recognize. The American Journal of Medicine 2012; 125(4): 337-343.

49.Moffett, BS, et.al., Serum digoxin concentrations and clinical signs and symptoms of digoxin toxicity in the pediatric population. Cardiol Young 2016; 26(3): 493-498.

50.Nucatola, D. Roth, N, and Gatter, M. A randomized pilot study of the effectiveness and side effects of two doses of digoxin as fetocide when administered intraamniotically or intrafetally prior to second-trimester surgical abortion. Contraception 2010; 81: 67-74.

51.Borgatta, L. et., al., Relationship of intraamniotic digoxin to fetal demise. Contraception 2010; 81: 328-330.

52.Finn, M. (2017, February 7). I had a Late-Term Abortion. President Trump and Pro-lifers have no Right to call me a Murderer. Slate. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019904s014lbl.pdf. Retrieved February 7, 2019.

53.Douthat, R, Goldberg, M, and Leonhardt D. (2019, February 7) The New York Times - The Argument: The Abortion Debate [Audio Podcast]. Retrieved from https://www.nytimes.com/2019/02/07/opinion/the-argument-abortion-medicare-for-all.html?emc=edit_ty_20190207&nl=opinion-today&nlid=6448792420190207&te=1. Retrieved February 7, 2019.

54.Thorp, JM. Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later. Scientifica 2012; Article ID 980812.

55.Upadhyay, UD et.al., Incidence of Emergency Department Visits and Complications after abortion. Obstetrics & Gynecology 2015; 125(1): 175-183.

56.Bartlett, LA, et.al., Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol 2004; 103(4): 729-737.

57.World Health Organization, Safe Abortion: technical and policy guidance for health systems . 2012.

58.Keyes, GR et.al., Mortality in Outpatient Surgery. Plast Reconstr Surg 2008; 122: 245-250.

59.Ahmad, J. et.al., Assessing patient safety in Canadian ambulatory surgery facilities: A national survey. Plast Surg 2014; 22(1): 34-38.

60.Media Trackers Colorado. Planned Parenthood Clinics Not Regulated by Colorado Health and Medical Standards. March 18, 2013. Retrieved from https://www.redstate.com/diary/pwatson/2013/03/18/colorado-planned-parenthood-clinics-not-regulated-by-standard-state-health-and-medical-guidelines/. Retrieved on February 16, 2019.

61.Reardon, DC and Coleman, PK. Short and long term mortality rates associated with first pregnancy outcome: Population register based study for Denmark 1980-2004. Med Sci Monit 2012; 18(9): PH71-76.

62.Pugely, AJ, et.al., Outpatient Surgery reduces Short-Term Complications in Lumbar Discectomy. Spine 2013; 38(3): 264-271.

63.Frazee, RC et.al., Outpatient Laparoscopic Appendectomy: Is it Time to End the Discussion? J Am Coll Surg 2016; 1-5.

64.Saleh, F et.al., Safety of laparoscopic and open approaches for repair of the unilateral primary inguinal hernia: an analysis of short term outcomes. The American Journal of Surgery 2014; 208: 195-201.

65.Rao, A, et.al., Safety of Outpatient Laparoscopic Cholecystectomy in the Elederly: Analysis of 15,248 Patients Using the NSQUIP Database. J Am Coll Surg 2013; 217: 1038-1043.

66.Raymond, EG and Grimes, DA. The Comparative Safety of Legal Induced Abortion and Childbirth in the United States. Obstetrics and Gynecology 2012; 119(2): 215-219.

67.Reardon, DC and Thorp, JM. Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis. Sage Open Medicine 2017; 5: 1-17.

68.Ledeerie, L et.al., Obesity as a Risk Factor for Complications after Second Trimester Abortion by Dilation and Evacuation. Obstet Gynecol 2015; 126(3): 585-592.

69.Reardon, DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. AAGE Open Medicine 2018; 6: 1-38.

70.Jalanko, E. et.al., Increased risk of premature death following teenage abortion and childbirth – a longitudinal study. Eur J Public Health 2017; 27(5): 845-849.

Hern Closes Late Abortion Clinic

By Thomas Perille MD • April 30, 2025
This is cause for celebration. Warren Hern was an outlier in the field of medicine that itself is an outlier. It is the only medical specialty that is devoted to killing human beings rather than restoring health or ameliorating suffering. Hern famously compared humans to a spreading “cancer” on the earth. It is not surprising that he devoted his career to using abortion as a form of population control. He considered pregnancy a disease and felt that no justification was needed to pursue abortion at any time for any reason. The fact that 70% of his late abortion practice targeted healthy women carrying healthy fetuses was often underappreciated or misrepresented by the media. One can hope that the fact that he could not find another physician to assume his grisly late abortion practice may be a sign of hope that the era of unlimited, unrestricted, and unregulated abortion may be nearing an end.

Open Letter to Govenor Polis on Public Medicaid Funding for Elective Abortions

By Thomas Perille MD • April 22, 2025
April 17, 2025 Governor Polis, Democrats for Life of Colorado implores you to consider the fiscal implications of signing SB25-183 into law. Research from the Guttmacher Institute published in 2024 demonstrates that in states where Medicaid pays for elective abortions, 62% of abortions are Medicaid abortions. If you apply this figure to Colorado, this means that SB 183 will create a huge financial liability for the Colorado Medicaid system at a time when the state is straining to contain a greater than 1-billion-dollar budget deficit. CDPHE reported that there were 10,368 abortions on in-state residents in 2023. The legislative council’s fiscal note on SB 183 estimates a $800 Medicaid reimbursement for medication abortions and a $1300 Medicaid reimbursement for surgical abortions. The legislative fiscal note also divides abortions into 50% medication and 50% surgical in calculating the state’s financial commitment. This would translate into a total cost of $6,749,568 for the estimated 6428 abortions (using the 2023 CDPHE numbers). If you use Guttmacher estimates for the number of abortions in Colorado, the number would be at least 40% higher. The fiscal liability doesn’t stop with the monetary payment for elective Medicaid abortion, since the Legislative Council adds the loss of $1,721,497 federal matching dollars. This will make the total estimated state’s obligation at $8,471,865 using the more conservative CDPHE numbers. And you can’t count on the misleading Legislative Council analysis for cost savings from “averted births”. This is an overly simplistic analysis for many reasons. Up to 20-30% of miscarriages occur after 6 weeks. This means that many of these “averted births” would have ended in miscarriage and not cost the state the cost for funding an abortion. Most births won’t be “averted” because these women will go on to have pregnancies that go to term later in their reproductive life. We know that the risks of pregnancy complications correlate directly with maternal age. These “delayed” rather than “averted” births, will increase Medicaid costs because of the increased risk of gestational diabetes, preeclampsia, and premature births in these later pregnancies. It is also well established that surgical abortions increase the risk for premature birth in subsequent pregnancies, including extreme premature births. To the extent that this legislation increases surgical abortions, it will markedly increase Medicaid Neonatal Intensive Care Unit costs. Furthermore, there is good data that suggests that women undergoing abortions seek mental health services at a much higher rate, which also will increase Medicaid costs. There is evidence that subsidizing abortions for lower income women, increases abortion rates which will, in turn, increase Medicaid abortion costs. The Legislative Council used a tiny study from Louisiana to estimate the number of additional abortions that will be performed when public funding is available. The Louisiana study demonstrated that only 1% of Medicaid eligible women who were pregnant (and didn’t already abort) would have considered abortion if the state had providing funding. This means the immediate impact on increasing abortion access will be extremely small but likely increase over time. The Legislative Council failed to acknowledge that Louisiana low-income women have very limited access to private abortion funding. This is in stark contrast to the robust private funding for abortion from the Cobalt Fund and the National Abortion Federation funds here in Colorado. Consequently, you can’t rely on the experience in Louisiana to project Colorado’s costs. SB 183 will simply be shifting abortion costs for low-income women from private sources (Cobalt/NAF) to Colorado taxpayers. We are very concerned that Medicaid already fails to reimburse pregnancy services adequately which results in maternity deserts. This new elective abortion financial obligation will likely further compromise pregnancy services and other higher Medicaid priorities. The multimillion-dollar increase in state funding that is necessary to pay for elective Medicaid abortions stands in contrast to the “zero” fiscal impact that Amendment 79 was purported to have based on the Bluebook verbiage. If voters understood that they were voting for a multimillion-dollar tax increase to pay for abortion, it is safe to say that more than 38% of the Colorado electorate would have voted against the amendment. We are opposed to using public funds for elective abortions. However, even if you thought this was required for “equity” purposes, this is not the time or the fiscal circumstances that justify such an expensive measure. Thanks for your consideration. Thomas J. Perille MD FACP FHM President, Democrats for Life of Colorado

Will paying for abortion save the state money?

By Tom Perille MD • March 24, 2025
The campaign to use public taxpayer funds to pay for elective Medicaid abortions has been a sham from the beginning. During the Amendment 79 campaign for the constitutional right to abortion, the Legislative Council’s Blue Book disingenuously stated that “the measure will have no fiscal impact”. This was an attempt to deliberately mislead Coloradans. Now the pièce de resistance, SB25-183 claims that by paying for elective Medicaid abortions, the state will save hundreds of thousands of Medicaid dollars from “averted births”. The Legislative Council made their projection based on a tiny study from Louisiana where 12 pregnant Medicaid women said that lack of public funding was “part of why (they) have not had an abortion”. The Council ignored the fact that only two of these 12 (1.2% of all Medicaid women interviewed for the study), would have still considered abortion if the state paid. Furthermore, in contract to Louisiana, Colorado has generous private funding available for both in-state and out-of-state women seeking abortion. The Legislative Council analysis was clearly designed to produce the desired “cost savings” reported. They offset the millions of dollars of abortion costs with the money from “averted births”. However, they ignored critical facts in this oversimplified analysis. The principal flaw is that “averted births” are illusory since most Medicaid women will simply pursue births later – when the risks of complications and associated Medicaid costs will be higher. It also ignores the number of pregnancies that would have ended in natural miscarriage, the increased costs for premature birth in subsequent pregnancies for women who had surgical abortions, and the increased cost of mental health treatment for those who seek abortion rather than childbirth. Aside from the moral issue, the state will suffer the fiscal consequences of the ill-advised public funding of elective abortion.

Outrage after Abortion Advocates Vote Against Women's Health and Safety

March 20, 2025
I am angry. More than angry, I am sad that our state legislators place allegiance to their “tribe” over the health and safety of the women of Colorado. On Tuesday, March 11, the House Health and Human Services Committee rejected HB25-1252 which would have instructed the Colorado Department of Health to develop evidence-based guidelines to ensure the health and safety of women seeking high risk second and third trimester abortions. The committee heard testimony that 10% of second trimester abortions have complications and 1.7% suffer serious, life-threatening complications. They heard that one in 50 women who had second trimester abortions through the University of Colorado required hospitalization. They heard that mid second and third trimester abortions are riskier than natural childbirth. They heard that the risks of dying from a late abortion are greater than the risk from dying from a procedure at an ambulatory surgical center. Every healthcare facility that poses this kind of risk to women is licensed, regulated, and inspected by the Colorado Department of Health. Late abortion is the only exception. The most heart wrenching testimony concerned the February death of an 18-year-old woman, Lexie. She died of complications from her second trimester abortion at the Fort Collins Planned Parenthood. At this same facility, 911 records documented at least three other emergency transfers already this year. My fel low Democrats have no problem regulating the energy/gas industry to safeguard the health of Coloradans. Do they only regulate industries with which they aren’t politically aligned? Tom Perille MD

Statement on the Passage of Amendment 79 - The Right to Abortion in Colorado

November 14, 2024
We want to extend our sincere appreciation for the thousands of people who came together for a cause greater than themselves. The diverse group that opposed unrestricted, unregulated abortion reflected the broad-based coalition formed by Prolife Colorado that defies any simple characterization. We are Democrats, Independents, and Republicans from every race, and ethnicity. We are young and old, rich and poor, native and immigrants, religious and secular. We are defined by our common belief in the value and dignity of every human being and not by any demographic. Amendment 79 passed but that does not mean we failed. We have begun the long and arduous task of educating Coloradoans about the reality of abortion in our state. Few knew that abortion late in pregnancy on healthy women with healthy babies was common. Few knew that high risk second and third trimester abortion clinics were unregulated in our state and that women’s lives are in jeopardy. Few realized the implications of unrestricted abortion on the privileged relationship between parents and their teen daughter. Many underappreciated the fiscal impact of using public funds to streamline access to abortion through all nine months of pregnancy. Our only regret is that we didn’t have the money to share our message more broadly so that every Coloradoan could make an informed choice. The proponents of the measure raised 18 times the money we did largely from the abortion industry and wealthy out-of-state donors. They used their money to spread the myths that “abortion was healthcare” and that abortion saved women’s lives. They frequently tried to conflate elective induced abortions with miscarriages, ectopic pregnancies and treatment for life-threatening complications of pregnancy. We know that not a single women’s death has been the result of abortion restrictions and that recent highly publicized deaths in Georgia and Texas reflect the anticipated complications of drug-induced abortions compounded by physician negligence. We will continue to build a culture that respects every human life here in Colorado and envision a future where women are offered the support and the resources, they need to choose life. Women without financial resources and women of color should not feel that their only path to a successful life is through abortion. We will fight to remove the inequities in pregnancy care throughout our state and remove barriers for women facing unplanned pregnancies during their education and early careers. And yes, we look forward to the day when Coloradoans will vote to remove Amendment 79 from our constitution. Because life matters.

What is "progressive" about Amendment 79?

October 29, 2024
It is becoming more common for ideologues to gaslight the American public to promote their agenda. The latest example is the abortion industry’s attempt to have Coloradoans suspend their common sense, human decency and compassion to place Amendment 79 into the Colorado constitution. State law already protects access to abortion, but they would have us believe it is “progressive” to endorse this constitutional amendment. Amendment would enshrine unrestricted, taxpayer funded abortion into the state constitution. It would prohibit the government from “denying, impeding or discriminating” against the right to abortion. This goes far beyond Roe which was overturned by the Dobbs decision. Roe permitted regulation of abortion in the second trimester to ensure the health and safety of women and allowed states to recognize their compelling interest in protecting the life of a viable baby in the third trimester. Amendment has neither of these important features. If abortion is considered a fundamental constitutional right (unlike any other medical procedure), then a fetus, wanted or unwanted, has no constitutional rights under Amendment 79. Nobody could infringe on the exercise of abortion – no matter the circumstances. Late abortions are common in Colorado. While abortions after the limit of fetal viability only represent 3.2-3.4% of abortions each year, they account for hundreds of abortions. And we know that approximately 70% of these late abortions are performed on healthy women with healthy babies. Amendment 79 would prevent legislators from ever curtailing abortion late in pregnancy for social and economic reasons. The amendment does nothing to address the real needs of women facing financial challenges that forces them to consider late abortion. It leaves them only one regrettable choice. Is it progressive to focus solely on abortion access and forego the hard work necessary to make pregnancy more equitable for low-income women? The Colorado Department of Public Health and Environment licenses, regulates, and inspects thousands of health care facilities in the state to ensure public health and safety. The striking exception is second and third trimester abortion clinics. Abortion extremists pejoratively refer to any laws that regulate abortion clinics as TRAP laws. In their worldview the only motivation for such laws is to impede abortion access. They ignore the fact that second trimester abortions have a 10% complication rate and pose a 1.7% risk of life-threatening complications. While first trimester abortions are relatively safe procedures, the risk of dying from abortion increases by 38% for every additional week of gestation beyond 8 weeks. You would think we would have learned the danger of unregulated/uninspected abortion clinics from the Gosnell tragedy. Dr. Kermit Gosnell was responsible for the injury and death of countless women spanning decades because of the lack of governmental oversight at his Philadelphia abortion clinic. If Amendment 79 passes, legislators will be precluded from instituting prudent health/safety regulations for abortion clinics in Colorado. There would be nothing preventing a Gosnell-like horror in our state. Is it progressive to prioritize abortion access over the lives of women? A 22-week baby born prematurely enjoys all the rights and benefits of other Colorado citizens. Yet, a 22-week, pain-capable fetus in utero can be literally torn apart limb by limb during the D&E procedure favored by most abortionists in Colorado. Later in the second trimester and during the third trimester that fetus can be killed by poisoning before it is extracted during a D&X procedure. Digoxin is commonly utilized. Digoxin can cause hours of agonizing nausea, vomiting, and delirium before eliciting death. Is it progressive to define a human’s value and dignity based solely on their location or to sanction such excruciating deaths? Parental notification prior to a minor’s abortion is current law in Colorado. Guttmacher and other abortion advocacy organizations consider parental notification laws as impediments to abortion access. Amendment would eliminate this. The adolescent brain is still developing prefrontal connections that help modulate their subcortical emotional and impulsive responses to stressful situations, such as unplanned pregnancies. Without parental notification, our teen daughters may face these challenges with more input from their peers, teachers, or counselors than from the parents who love and know them best. And if parental notification is eliminated, sex traffickers will have an easier time eluding law enforcement as they coerce their young victims to have abortions. Is it progressive to remove parents from the most consequential decisions in their daughter’s lives or enable human traffickers? With Amendment 79 in the state constitution, abortions for any reason would be legal. Studies from the US and other countries document the extent that sex selection abortions occur, A Colorado late abortionist recently admitted that he has performed sex selection abortions. Is it progressive to allow abortion for blatantly sexist reasons? We know the answer. No, it is not progressive to promote unrestricted, unregulated abortion in Colorado. Abortion access is already ensured in Colorado. Amendment 79 is unnecessary, inhumane and potentially dangerous. Frances Rossi and Tom Perille MD - Founding members of Democrats for Life of Colorado

Abortion Overkill

October 22, 2024
This piece was originally published in the Colorado Springs and Denver Gazette Perspective Column September 22, 2024 by Tom Perille MD (DFLCO President) and Wendy Smith What would it mean if the only medical intervention that is recognized in the Colorado Constitution’s Bill of Rights was abortion? And what would it mean if abortion was the only medical intervention that couldn’t be constitutionally excluded in private and public health insurance? Not access to basic medical care. Not pregnancy care. Not life-saving cancer treatments. Not mental health treatment. Not care for those addicted. Not affordable pharmaceuticals. Only abortion. That is what those who are pushing Amendment 79 (“Right to Abortion”) hope to accomplish. Not only would abortion at any time in pregnancy for any reason using any method become a fundamental right, but anything that “impeded” or “discriminated” against access to abortion would be prohibited. The people of Colorado have a right to know the profound and dangerous implications of such a measure which won’t be reflected in the Blue Book language. In a poll conducted in July by the Strategy Group, 71% of Colorado voters were unaware that abortion is currently legal under all circumstances in our state. Abortion access is guaranteed in Colorado law. Amendment 79 would do nothing to change that reality. Coloradoans have the right to know that with the amendment in the constitution, the people of Colorado and those working for them in the legislature could do nothing to regulate or restrict abortion in the future– even if those changes represented the overwhelming consensus of Coloradoans and protected the health and safety of women. There were between 468-486 late abortions after the limit of fetal viability (21 weeks) reported to the CDPHE in 2022 and 2023. Guttmacher estimates that there were 71% more abortions in 2023 than CDPHE reported making 500 a conservative estimate of the total number of post-viability abortions each year in Colorado. These babies can “kick” their mother, respond to her voice/touch, acquire her taste preferences, and feel pain while in the uterus. They can survive if born prematurely. Babies born at 22-weeks and later can be found lovingly cared for in neonatal intensive care units and nurseries across the state. Based on research from Boulder abortionist, Dr. Warren Hern, 70% of his late abortions are performed on healthy women with healthy babies. That translates into an estimated 350 healthy babies aborted late in pregnancy each year in Colorado for financial and social reasons. Coloradoans have the right to know that Amendment 79 does nothing to address the real needs of these women and simply streamlines access to one, tragic and regrettable choice. With Amendment 79 in place, legislators would be unable to restrict even the most extreme abortions on healthy women with healthy babies in the third trimester. Colorado parents are currently notified at least 48 hours in advance of their minor teen’s pending abortion. The abortion industry, their research allies (Guttmacher), and aligned medical professional organizations (ACOG) all consider parental notification before a minor teen’s abortion to be an impediment to abortion access. Coloradoans have the right to know that banning parental notification would be one of the most immediate consequences of Amendment 79. In practical terms, this means that the people that know and love the teen the most may be unaware of their pending abortion and unable to support their daughter. Even worse, teens may be pressured by peers or an abortion clinic counselor to pursue an action that is inconsistent with their wishes and core values. Parents may be blindsided by the potentially severe physical and mental health consequences of their teen’s abortion. And sex traffickers would be able to hide their nefarious trade by pursuing abortions for their teenage victims without the safeguard of parental notification. Trafficking is a multi-million-dollar criminal enterprise in Colorado. Victims rarely self-identify. Anyone who works with domestic minor sex trafficking knows that the very definition of trafficking involves force, fraud and/or coercion. It is also well known that girls who are trafficked often view their trafficker as their “boyfriend”, lacking the maturity and discernment to know they are being trafficked and in danger. If they refuse to do what the trafficker wants, they are often subject to physical and mental abuse until they submit. There is a growing concern over forced abortion, especially with the availability of medication and telehealth abortions. These girls are not free to choose. Without the safeguard of parental notification, minors may be exposed to continued risk. Keep in mind, minors can be brought across state borders by anyone for abortion, just to be released back to the trafficker/perpetrator. For this reason, parents have a right to know when their daughter is considering abortion so that they can seek help and intervene. Most states have regulations that pertain to abortion clinics and promote the health and safety of women. Colorado is not one of them. The abortion industry pejoratively refers to any regulation that specifically applies to abortion providers as TRAP laws. They view them as impediments to abortion access. Even though thousands of medical facilities and agencies are licensed, regulated and inspected by the Colorado Department of Public Health and Environment, second and third trimester abortion clinics are the glaring exception. This omission is especially perplexing since second trimester abortions have a 10% overall complication rate and 1.7% life-threatening complication rate. The risk of having a complication increases for each additional week of gestation. Furthermore, the risk of dying from an abortion increases 38% for each week of gestation beyond 8 weeks. We should heed the lesson from other states that have tragically witnessed the maiming and death of women when government oversight is lax or non-existent – such as Pennsylvania and Dr. Gosnell. Coloradoans have a right to know that if Amendment 79 passes, the state will be unable to impose prudent health and safety regulations for abortion clinics which may jeopardize women’s health and lives. Another goal of Amendment 79 is to facilitate publicly funded abortions. Currently, Colorado Medicaid only pays for abortions in circumstances of rape, incest, and threats to the life of the mother. If Amendment 79 passes, the prohibition against public funding in the constitution will be removed and the state will be able to underwrite elective abortions for Medicaid patients. In states where public funding for abortion is already law, they spend millions of dollars subsidizing abortion for in-state and out-of-state women. Coloradoans have the right to know that this may take precious tax dollars away from other medical priorities like pregnancy services and mental health. It may even divert money from non-medical budgets for education, affordable housing, and the environment. There is already inadequate private and public support for pregnant women in our state. One of the few shining exceptions is the 58 pregnancy resource centers. They provide millions of dollars of uncompensated care to women during and after challenging pregnancies. However, because they typically don’t offer abortion services or refer for abortions, the abortion industry has been targeting these charitable organizations. Coloradoans have the right to know that the ability of pregnancy resource centers to assist pregnant women in need may be jeopardized by the passage of Amendment 79. Under Amendment 79, the right to abortion would become absolute. Coloradoans have the right to know the implications of such an extreme position. It would strip all rights and protections from the developing fetus, even those that are wanted. The legislature couldn’t proscribe abortion methods that are especially cruel such as second trimester D&E (dismemberment) abortions on pain capable fetuses. It would jeopardize the conscious rights of medical professionals across the state who maintain medical/scientific, moral or religious objections to elective induced abortions. Since the amendment forbids “discriminating” against a woman’s desire for an abortion, even physicians and nurse practitioners who perform abortions would be unable to refuse abortions for reasons they may view as morally repugnant – such as aborting a fetus solely because of their sex (which is already occurring) or because of the ethnicity/race of their father. Abortion access is already guaranteed in Colorado law. Making the right to abortion the only medical procedure recognized in our constitution is extreme and ties the hands of Colorado citizens and legislators. It goes far beyond the abortion rights promulgated in the Roe decision. Coloradoans have the right to know that Amendment 79 would have these many unintended consequences. Given the facts, we hope that Coloradoans reject Amendment 79.

Colorado Needs to rethink changes to Assisted Suicide Law

By Thomas Perille • March 1, 2024

Science is not immune from politics and ideology 

By Tom Perille • January 31, 2024
We should recognize ideological conflicts of interest in clinical research just as we recognize financial conflicts of interest in clinical research. It doesn't negate the studies, but tells us about potential biases and requires us to look more closely at the methodology and reporting.

Post Roe in Colorado - Initiative 89 and the right to unrestricted abortion  

By Tom Perille MD • January 23, 2024
Cobalt and other proabortion organizations are currently circulating petitions to have Initiative 89 appear on Colorado 2024 ballot. They have the money to pay circulators to get the necessary signatures so there is little doubt it will be on the ballot in November. The ballot initiative is deceptively drafted to make it appear that the primary issue is correcting an “unintended consequence” of Amendment 3. Colorado constitutional Amendment 3 narrowly passed in 1984. It prohibited the use of state public funds for induced abortions unless the life of the mother was in jeopardy. Initiative 89 backers are highlighting the lack of funding for state employees for abortions in cases of rape, incest, issues that “gravely endangers the patient’s health” or when there is a “fatal fetal condition”. They also point out the lack of an exception for state Medicaid funding for issues that “gravely endangers a patient’s health” or for a “fatal fetal condition”. What are they not saying? There already is an exception for the pregnant woman’s life which would encompass anything that “gravely endangers the patient’s health”. They are trying to blur the line between an exception for a condition that jeopardizes a woman’s life and any complication that requires treatment during pregnancy but does not threaten her life. Similarly, Medicaid already offers reimbursement for abortions related to rape or to save the mother’s life. It does not have an exception for the nebulously defined “health” of the mother, which can be treated in the normal course of obstetric practice, or for fetal conditions. A “fatal fetal condition” is a pejorative phrase with little resemblance to reality. For instance, Trisomy 18 is often referred to in this manner. The problem arises because the condition may be as much as 90% survivable if treated with standard interventions (employed on infants without Trisomy 18 diagnoses). It doesn’t mean that there aren’t life threatening fetal conditions or that some infants will have significant disabilities but describing these fetuses as “fatal” is a way to dehumanize them and justify the abortion decision. If they were really motivated to remove the barriers to the < 4% of abortions that occur for reasons of rape, incest, life of the mother, and life-limiting fetal conditions, why doesn’t Initiative 89 simply ask Coloradans add these exceptions to Amendment 3s language? The answer is clear. They want to evoke an emotional response which will override Coloradans’ qualms about unrestricted abortion. Their arguments gloss over the main purpose of Initiative 89 – to make abortion access a constitutional right without any gestational limits for any reason and to use public funding to subsidize it. They would like the public to be unaware of the fact that hundreds of healthy viable (>21 weeks) fetuses gestating in healthy women are currently aborted in Colorado. And that at least one late term abortionist (Warren Hern) has publicly acknowledged that he does abortions for absolutely any reason – including for sex selection. If the public had an inkling of the magnitude of the slaughter of prenatal humans purely for social and economic reasons, they would be appalled. There are so many other legislative initiatives that could be undertaken to provide support for pregnant women and their families so that they don’t feel compelled to consider abortion. Why don’t we focus our efforts on these life-affirming alternatives to the violence of abortion? DFLCO will be participating with Pro-Life Colorado, the state-wide umbrella organization uniting prolife groups, to defeat Initiative 89. DFLCO members should begin talking to their prochoice friends and writing letters to the editor of local media shedding light on the deceptive nature of Initiative 89 and the Trojan horse it represents for constitutionally protected unrestricted abortion. If your contacts don’t recoil at the reality that hundreds of healthy viable fetuses are being aborted for reasons as abhorrent as sex selection, then Colorado is in worse shape than any of us recognize. Initiative 89 should have no place in Colorado.
Show More