Dear Alabama Voter, I’m an OB/GYN and Roy Moore is wrong about “ninth month” abortions.

Dear Alabama Voter,

I am an OB/GYN who trained to do abortions almost as late as they can go. For several years I practiced in a state with no gestational age limit, meaning I could technically have done “due date” abortions. While I don’t do abortions anymore I think it is fair to say that I know more about this subject than Roy Moore and Doug Jones and pretty much everyone else except perhaps three or four other people in the United States.

You may be surprised to know that I would like fewer abortions. Not because I think abortion is morally wrong, but because prevention is the best medical care. I suppose you and I are like two people who want pie, just for different reasons. I have too many apples and so instead of throwing them away I decide to make an apple pie because I like making pies. You love to eat apple pie, but have no apples. Same goal, different reasons. I really see our views on abortion that same way. We are allies not enemies.

I want to tell you about these “due date” or “ninth month” abortions you may have been hearing about. From what I’ve read online I’m not sure Roy Moore and his campaign are telling you the truth. The way they talk about abortion you’d think women are showing up in droves for abortions in their ninth month because they are bored or because OB/GYNs are standing on street corners luring pregnant women away from delivery rooms and into abortion suites. That is most definitely not happening!

Only 1.3% of abortions happen at or after 21 weeks (due date is 37 weeks and beyond), so abortions that happen later in pregnancy are the exception not the rule. We know that 80% of this 1.3% are for birth defects (so wanted pregnancies) and the rest are health of the mother (again, a wanted pregnancy), rape, and a very few might be for none of these reasons. Most of these abortions happen before 24 weeks.

Abortions that happen after 24 weeks are almost all due to birth defects.

These are expensive procedures and while health insurance sometimes pays for birth defects, health of the mother, and rape they don’t pay any other reason. If you don’t have insurance an abortion is $2,000-$2,500 at 20-22 weeks. Most people just don’t have that kind of money. After 24 weeks the price jumps a lot. At 32 weeks an abortion costs about $25,000. Women who are getting these later procedures are usually paying up front because the providers often don’t accept insurance. These women are desperate to do the right thing health wise and then hope maybe their insurance will pay something afterwards. The cost alone should tell you these procedures are rare indeed. The amount these women pay is also evidence of their desperation and the thought they have put into their decision.

You might wonder why these abortions happen after 24 weeks, why couldn’t they happen earlier? Well, sometimes it takes a while to get the lab tests back. Sometimes an MRI is needed and then another one a few weeks later or perhaps there is travel to meet with a team of specialists.

Why not just go through with the pregnancy?

Some women just can’t bear continuing. Imagine everyone touching your belly asking if you are having a boy or a girl and you know your baby has no brain? I have heard that story. It breaks people.

Sometimes the plan was to let nature take its course, but the pregnant woman falls ill and needs to be delivered prematurely for her health. Sometimes we induce her labor (technically an abortion, but I know people don’t think of it that way) and give comfort care for her baby after birth. Sometimes we do what you might know as a surgical abortion. The surgical abortion is always faster and may be safer depending on a variety of factors. Sometimes pregnant women get very ill very quickly.

Other times the plan is to deliver whenever it happens and as the due date approaches the pregnancy is laying horizontally (we call that a transverse lie). When the pregnancy isn’t head down or feet down it can’t come out the vagina with labor. The options are a C-section or a surgical abortion. Some women don’t want a C-section in this situation for baby who can’t live. I think you can understand that.

I know these things because for several years these women called me. They poured their very sad stories about their wanted pregnancies that had taken a devastating turn to me, a complete stranger, over the phone. I am not one to judge what another woman can bear.

Imagine getting the worst news of your life. Years of choices have been taken away in an instant. You don’t get to choose onesies or brands of diapers or clothes for the first day of school or the best pose for the school photo. When a woman has a pregnancy that has gone horribly wrong it is like being in an airplane that is going to crash in the worst way. Whether you have an abortion or go to term and have a delivery is like deciding do you crash in water or on land. Who am I to say which is the better landing? Who is Roy Moore to lie about that?

No matter what Roy Moore or his surrogates say there are no women coming into hospitals getting “ninth month” abortions for no reason or for fun. Doug Jones is not advocating for more abortions or pleasure abortions. The cost alone should tell you that idea is ridiculous.

I know from science and from what I have seen with my own eyes that banning abortion doesn’t work. When abortion is illegal women resort to devastating things like sticks, and coat hangers, and bleach, and horrible men and women in dirty rooms with filthy instruments. You may have had a grandmother or a great-aunt or even an aunt who felt that was her only option.

About 85% of abortions in the United States are what we call elective, meaning they are not for birth defects, health of the mother, or rape. The best way to prevent these abortions is free access to long-acting reversible contraception (IUDs, implants, and the depo provera shot). Studies tell us this works very well! Go science!

Another way to reduce abortion is high quality, accessible and affordable health care. When women take prenatal vitamins before they get pregnant they’re less likely to have a baby with a birth defect. When women space their pregnancies by at least a year the pregnancy is less likely to have a complication. When women get prenatal care their diabetes and high blood pressure and other health conditions get managed and so they are more likely to have healthy pregnancies. Healthy pregnancies = fewer abortions.

Very few pregnant women get abortions after 24 weeks and almost all of them are for birth defects. These are women trying to make the best medical decisions for themselves and for their families. I have counseled these women. They may be heartbroken, but they are so very thoughtful and they are brave. For Roy Moore to imply otherwise disrespects these women. It is also cruel and is, quite frankly, a lie.

Jen Gunter MD, FRCS(C), FACOG, DABPM, ABPMR (pain)