The End of “Surgical” Abortion?

By Randall K. O’Bannon, Ph.D., NRL-ETF Director of Education & Research

Randall K. O'Bannon, Ph.D.

Randall K. O’Bannon, Ph.D.

Visit the website for Planned Parenthood, the nation’s largest abortion provider, and look for “surgical abortion” in the “Abortion” section of their “Health Services and Information” heading. You won’t find it.

Oh, it’s not that they don’t do surgical abortions. They do, to the tune of tens of thousands, probably hundreds of thousands a year. (The remainder of their 330,000 abortions are chemical—e.g., RU-486—abortions.)

But unless you are watching very carefully, you would miss that, like a lot of others in the abortion industry, PPFA uses the term “surgical abortions“ less and less frequently.

The aim of the abortion establishment obviously isn’t to limit abortion but the exact opposite: to vastly expand the number of clinics, add to the ranks of abortionists, and fatten their bottom line.

De-emphasizing surgical abortions allows the abortion industry to promote a new product—chemical abortions—that is intended to make abortion seem a matter of “simply” taking a couple of pills. This has expanded the pool of doctors willing to perform abortions and resulted in new women considering abortions at the same time cutting costs.

And then there is the capacity to decentralize abortion, to move it beyond the giant metropolitan abortion mills. Chemical abortions that employ drugs like RU-486 and prostaglandins like misoprostol don’t require the special equipment, special surgical training, or additional space for operating, recovery rooms, etc. (1)

By contrast, modern computer technology can turn even the smallest storefront center in the most isolated town into an abortion clinic. Abortion pills are dispensed remotely by an abortionist on the other end of a web-cam back at a big city mega-clinic.

The risks for women are tremendous, but the chemical route offers even small time clinic operators the chance at what seems like easy money.

The landscape has changed so quickly that bioethicists like Arthur Caplan asked in a recent column “Are Surgical Abortions Becoming ‘Old Technology’?” (Medscape, 6/5/13).

The number of chemical abortions performed in the United States has grown steadily since the government approved RU-486 for sale in September 2000. As of 2008 chemical abortions comprised around 15-16% of all abortions—and were growing. Chemical abortions increase profits and abortion “providers” and realize one of the abortion industry’s most important objectives: reach so-called “underserved populations.”

But the remainder of these are still surgical abortions. While that number will continue to decline as a percentage of all abortions, surgical abortions will continue to represent the majority of abortions done in the U.S. for the foreseeable future.

Certain women are allergic to the powerful chemical abortifacients or have conditions that make their use a particular personal risk. Other women simply want to get the abortion over with and don’t want to endure the ardor of days or weeks of cramping, pain, or bleeding. Yet others show up at the clinic at a later gestational age where abortionists don’t feel the drugs would be effective (though there are researchers experimenting with the use chemical methods in the second and even third trimesters).

But there are other reasons the term “surgical abortion” is disappearing.

For one reason, women (like men) find the idea of surgery intimidating. In the abortion context, they do not like the cutting, the scraping, the anesthesia, the possibility of injury. The elimination of all this was a selling point for chemical abortions which helped ease the way for acceptance. (2)

Clinics are obviously trying to address and assuage these fears. On the one hand they explicitly try to argue in their descriptions of the procedures that “no cutting is involved” (Aaron’s Women’s Clinic, Houston TX). Or they can say that in a vacuum aspiration “There is NO cutting or scraping of the uterus” (Northside Women’s Clinic, Atlanta, GA).

The South Jersey Women’s Center still calls these surgical abortions (which they are), but tries to distinguish these from ordinary surgical procedures. “No cutting or incision is necessary and the procedure takes only 5 to 7 minutes.”

Planned Parenthood avoids the term “surgical” and tries to call these “In-Clinic Abortion Procedures.”

New York OB/GYN AssociatesTM classifies these as “Non-Surgical Abortions” because they “do not involve any scraping or scarring of the uterus.” They say that “There is no cutting during an Aspiration Abortion.” They maintain that “There is no scraping, no scaring and no damage to the uterine wall.”

Both the chemical and aspiration methods they advertise “are designed to naturally release a woman’s pregnancy in a gentle and safe way, which does not cause damage.”

However there is more to this than just calming fears and apprehensions. The abortion industry has found it increasingly difficult to find doctors willing to perform abortions or to add abortion to their practices. By re-defining the abortion procedure as “non-surgical,” this opens up the performance of abortion to a whole new set of medical practitioners.

It is not a coincidence that in the last year we have seen both the appearance of a study and a push in the California legislature claiming that nurse practitioners, certified nurse midwives, and physician assistants can perform suction aspiration abortions as well as doctors (NRL News Today, 2/20/13 and 5/29/13). It is notable the California bill specifically tried to redefine these as “non-surgical” abortions. (3)

If the suction or vacuum aspiration abortion is reclassified as a “non-surgical” abortion, it gives clinics offering just chemical or aspiration abortions the opening to argue that they are not technically “ambulatory surgical centers” and hence are not covered under many of the new state laws regulating clinics.

It is interesting that in the recent discussion over proposed clinic regulations in Texas, Barbara Levy, vice president of health policy for the American College of Obstetricians and Gynecologists specifically tried to tell a reporter for the Austin American-Statesman that abortions were “minimally invasive” procedures that didn’t involve surgical cutting (Austin American-Statesman, 7/8/13).

“We call these procedures, not surgeries,” Levy told the Austin American-Statesman. “I don’t even think it’s appropriate to talk about [abortion] as a surgical procedure.”

But this is only a difference in language, not in procedure. Whatever the label, the abortion is deadly for the child and poses certain risks for the mother. In fact, her risk could be greater if done by a less trained, less experienced medical practitioner.

Promoters of the idea that these are “non-surgical” try to employ the rationale that because they do not cut tissue to enter the woman’s body but enter through the birth canal, these are somehow, strictly speaking, not surgery.

This not only misrepresents the basic nature and the level of the invasiveness of the standard aspiration abortion (and the involved risk), but totally ignores what happens to the child’s body.

To enter the woman’s uterus, the abortionists must first open or dilate her cervix. This can be done mechanically with a metal or plastic rod that is bent and tapered at one end that is inserted into the cervical opening and is pushed forward to widen the opening. A gripping tool called a tenaculum may be used to hold the cervix in place while the abortionist manipulates the dilator.

Once sufficiently widened, the abortionist inserts a plastic tube called a cannula with an open angled or notched end. Suction is applied and this dragged across inside of the mother’s uterus, where it grabs and vacuums in parts of the baby and surrounding tissue, drawing everything into a collection bottle, the contents of which can be released and examined later to ensure completion of the procedure.

It is a violent end for the baby, and the idea that there is “no cutting” involved in this process as the child is ripped apart limb from limb is ludicrous.

Furthermore, the mother’s cervix or uterus can be perforated by forceful, misdirected manipulation of the dilator or cannula.

Contrary to the reassurances of the clinics, there may indeed be further “cutting and scraping.” The National Abortion Federation’s 2009 abortion manual, Management of Unintended and Abnormal Pregnancy, says nearly 50% of abortionists in North America determine “completeness” of the abortion by using a sharp curette (a loop shaped steel knife) to check for any remaining tissue in the uterus, which is then followed by a second suctioning.

Such abortions are not “gentle” or simple. To reduce (but not eliminate) risk, they require skilled, trained operators who know how to perform basic surgical techniques. A woman in the hands of an unskilled operator can bleed to death or contract a dangerous infection from missed, retained tissue.

The effort to drop “surgical” from the abortion catalogue may serve the interests of the abortion industry, but it will not make these safer for moms or any less deadly for their babies.

Finally, consider this.

The claim that “no cutting” is involved appears to rest on a contention that the baby, who is definitely cut, is not a part of the woman’s body. Yet abortion’s defenders fail to explain how this claim is compatible with their long time assertion that a woman should be free to abort because it is “her body, her choice.”

If the fetus is really just part of “her body,” then cutting is clearly done to her body and the claims of those trying to recast these as “non-surgical” abortions are clearly false.

If the child is not part of her body, as the promoters of this new definition seem to contend, then the old slogan of “my body, my choice” is based on a false premise and the whole logic of the pro-choice movement is undermined.

They can’t have it both ways.


(1) That is, unless things go wrong, which they often do – but then those become problems for the doctors at the local ER.

(2) When the chemical method fails, which it frequently does, this often means women end up undergoing surgery nonetheless

(3) It should be noted that there were, in fact, more complications in the non-physician group than among the physicians, but this conclusion was downplayed by the researchers).


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