Abortion up to 24 weeks involves debate over fetal viability, say doctors

The Constitutional Court of Colombia approved, on Monday (21), the decriminalization of abortion performed up to the 24th week of pregnancy in the country. This means that, until this period, no woman who decides to carry out a voluntary termination of pregnancy will be penalized for doing so.

From the 6th month, however, the procedure will only be allowed within the three situations authorized since 2006: in cases of rape, if the mother’s life is in danger or due to fetal malformation that makes her life unfeasible.

The termination of pregnancy until the 24th week is not the equivalent of the abortion of an unwanted pregnancy by the woman’s choice, say doctors consulted by the sheet.

The discussion revolves around the lack of evidence on fetal viability. Some doctors consider that after 20 weeks, a fetus can be considered viable. This, in practice, indicates that it is possible for a baby with this time of gestation to be born and, with advances in medicine, to survive and develop. Other doctors, however, believe that this period should be extended to up to 24 weeks.

Because of this, countries have different rules. In general, where permitted, abortion is performed until the 14th or 16th week. A minority (1.3%) of abortions occur after the 21st week, according to data from the US Centers for Disease Control and Prevention.

In England, abortion has been allowed since the 1960s for broad social or economic reasons, including risk to the life of the mother or fetus, up to the 24th week. In the Netherlands, abortion is permitted by the woman’s wishes at any time up to the 21st week; already between weeks 21 to 24, it is allowed for medical reasons with the written consent of two doctors.

In the United States, states have different rules for terminating a pregnancy, and in some cases the procedures are performed until the 21st week if the fetus is unviable.

In Brazil, abortion is only allowed in three situations: rape, fetal anencephaly or risk to the woman’s life. In all three cases, until the 22nd week, it can be performed at specialized medical services, explains Daniela Pedroso, a psychologist at the sexual violence outpatient clinic at the Pérola Byington hospital.

“We at Pérola Byington serve mostly women who are victims of sexual violence. The desire to have an abortion is not based on a personal or maternity issue for the woman, but because of the trauma experienced by that violence”, she says.

The gynecologist, obstetrician and former professor at the Faculty of Medicine of Jundiaí, Thomas Gollop, explains that the longer term is the “most generalized way of not putting obstacles” in the decision for an interruption.

“With the amplitude, we try to give the best possible assistance in serious situations, because it is rare that any problem of malformation or congenital disease will appear after the 24th week.”

It is during this period, between 20 and 24 weeks, that the second morphological examination is performed, which can detect a more serious health problem in the growing baby.

The doctor adds: “with the most advanced techniques of molecular diagnosis, the special situations, of interruption in late pregnancy, will become increasingly rare too”, he says.

According to Gollop, it is also more frequent to terminate the pregnancy of girls and adolescents who have suffered sexual violence in the later period of pregnancy. “It is more common for victims of sexual violence to seek medical help only at a later date. This is not the norm, but it is seen frequently,” he says.

After the 6th month, for the doctor, the interruption already represents a more complicated procedure and, therefore, each case must be studied in a particular way.

Already the gynecologist and president of the National Commission on Vaccines of Febrasgo (Brazilian Federation of Associations of Gynecologists and Obstetricians), Cecilia Maria Roteli-Martins, does not agree with the abortion until the 24th week.

“From 20 weeks onwards, abortion is no longer spoken of, but premature. A 24-week fetus is viable, although extremely premature. In obstetric practice, I consider this decision a catastrophe”, he says.

According to the doctor, to proceed with the interruption of a pregnancy in this period, surgical techniques are necessary to induce the death of the fetus.

“If a woman goes into premature labor at six months of pregnancy, obstetrician practice says that it is essential to preserve the maternal-fetal binomial; for this, drugs and anesthesia are used, which do not harm the fetus. pregnancy, at this stage, according to practice, I am against it”, he says.

According to her, talking about abortion at 24 weeks from the obstetrician’s point of view is not correct and, although there may be cases in which there is an interruption due to fetal malformation, decriminalization also makes it possible to open up to procedures by the woman’s late decision.

Daniela Pedroso, on the other hand, points out that the scientific literature in the last 35 years shows that the psychological consequences for women are lower when abortion is performed in a legal way than the other way around. “The traumas are not related to the abortion itself, but to the lived experience. Therefore, having medical and legal assistance makes this procedure less harmful from a psychic point of view”, she says.