Proponents of Colorado’s Proposition 115 ballot measure to ban abortions at 22 weeks gestation say a 22-week cutoff is reasonable because that’s when a fetus is viable.
In reality, it’s much more complicated.
The website for the Due Date Too Late campaign states that “at 22 weeks gestation a baby can survive outside the mother’s womb when they are born prematurely,” but that claim ignores existing medical research that shows it’s not common for 22-week old fetuses to survive outside the womb with good developmental outcomes.
The claim also ignores a key reason why many women seek abortions later in pregnancy: a lethal fetal diagnosis.
Prop. 115 contains no exceptions for a fetal diagnosis–or for rape, incest, or a non-fatal threat to a patient’s health. The measure states that an abortion after 22-weeks is only lawful in cases where it’s “immediately” necessary to save the life of a pregnant patient, but some doctors and legal experts believe this exception is much too narrow to offer any meaningful protection for women experiencing life-threatening complications from pregnancy.
“An anencephalic baby, a baby for which the brain simply doesn’t develop, has a zero percent chance of surviving outside the womb at any age of gestation and this proposition has no exception for that, so clearly fetal viability is not a consideration here,” said Dr. James Monaco, a cardiologist in Denver, during a press conference organized by the No on 115 campaign earlier this month.
Monaco said it’s “misleading” to claim that infants born at 22 weeks can survive with good developmental outcomes.
“This statement is similar to saying you can jump out of an airplane without a parachute and survive,” Monaco said. “It’s true, it’s not expectation, and it’s both cruel and dangerous to set that as an expectation for women who are experiencing high risk pregnancies.”
Denver area OB/GYN Dr. Aaron Lazorwitz stressed the fact that fetal viability varies between pregnancies.
“Viability is not a yes-no situation, there is not a one day and now your pregnancy is viable,” Lazorwitz said. “I have cared for women with pregnancies with questionable viability out to 26 weeks gestation because there are fetal and maternal conditions that affect viability and it’s a discussion with us as the OBGYNs, with the neonatologists, with the specialists, because every pregnancy is unique, every woman is unique, and this proposition takes away our ability to treat patients as the unique individuals that they are.”
The Due Date Too Late campaign declined to comment on this story.
Proponents of Prop. 115 often point to rare circumstances where infants born very prematurely have been able to survive with good health outcomes to make broader claims about fetal viability.
In an August email to the Colorado Times Recorder, Dr. Thomas Perille, medical advisor to the Due Date Too Late campaign and president of Democrats for Life of Colorado, noted a study regarding the care of an infant born at 21 weeks and four days who survived, who was, at least at the time of publication in 2017, the most premature known survivor to date. Due Date Too Late’s claim, shown in the tweet above, that a baby born at 21 weeks has a “good chance at survival” is misleading at best.
In a Colorado Politics op-ed published in March, Perille pointed to a different reason for selecting 22 weeks as the measure’s gestational cutoff: polling.
“For [Proposition 115], 22 weeks was selected because national polling would suggest that there is broad consensus that late abortion should be restricted,” Perille wrote, adding that “in some centers, 70 percent of fetuses born at 22 weeks survive.”
Perille appears to get that number from a study published in the Journal of Pediatrics in 2019 that is considered one of the most promising for showing good outcomes for periviable infants. In that study, for a group of 20 infants born at 22 weeks and 50 infants born at 23 weeks at highly-equipped Neonatal Intensive Care Unit (NICU) in Iowa, 78 percent survived. Of those who survived, 64 percent had no or mild impairment at 18-22 months.
But those numbers far exceed most published norms.
Several studies on fetal survivability, shown below as compiled by the American College of Obstetricians and Gynecologists, show that infants born at 22 weeks have anywhere from a 5 percent to a 40 percent chance of survival, and that those who do survive at that gestational age have about a 30 to 60 percent chance of severe or moderate disability.
Abortion foes argue that advancements in neonatology, like those shown in the Iowa study, provide a compelling reason for banning abortion at the earliest possible age of viability.
A former Neonatal Intensive Care Unit (NICU) nurse who now works in an abortion clinic offers a different perspective.
Alyssa* told the Colorado Times Recorder that she knew from the time she was 15 years old that she wanted to work in women’s health, and for the first five years of her nursing career worked in NICUs across the country before taking a job at an abortion clinic.
“In the NICU we care directly for babies, but a huge part of the job is working closely with the parents,” Alyssa said. “I realized very quickly how fiercely parents love and protect their children. So I trust pregnant people when they say, for whatever reason, they cannot or do not want to give birth, and decide to have an abortion.”
Alyssa said she feels that “people think of ‘pro-choice’ and automatically assume ‘anti-baby,'” but that for her, neonatology and abortion care are “all part of the same spectrum of care for women and their families.”
“A baby born at a ‘peri-viable’ age still has a very long road ahead in the NICU,” she said. “Birth is not a guarantee of health, survival, or quality of life.”
Alyssa also emphasized that the initiative doesn’t account for fetal anomalies and lethal fetal diagnoses.
“I have had the privilege of working in some of the most advanced NICUs in our country,” Alyssa said. “I am in awe of the capabilities we now have, and am even more in awe of the brilliant physicians, nurse practitioners, nurses, RTs, and other healthcare team members who give hope to families every day. There are some conditions that are simply not compatible with life. No amount of advancement or medical brilliance will change that. Those families should be given options.”
*A pseudonym was used out of concern for her privacy