THE ABORTION DECISION : ‘Viability’ Called ‘Non-Issue’ Affecting 1% of Abortions

Only about 1% of all abortions in the United States are performed at more than 20 weeks of pregnancy--the point at which the Supreme Court ruled Monday states may require testing to determine whether the fetus could survive outside the womb.

For that reason, physicians said Monday that the court’s endorsement of testing for so-called viability will affect few women. But they argued that such testing is unreliable and there is little evidence that most fetuses could survive before 24 to 26 weeks.

“It’s largely a non-issue,” said Dr. David A. Grimes, a professor of obstetrics and gynecology at the USC School of Medicine. “You see all this enormous attention focused on pre-viable infants and late abortions. . . . These are aberrations, unique situations.”

The court ruled, among other things, that the state of Missouri had the right to require physicians performing abortions on women who are at least 20 weeks pregnant to conduct medical examinations and tests to make sure that the fetus is not viable.

Viability is considered significant because the court ruled in 1973 that the state’s right to regulate abortion begins at the point of viability. That is, the state could intervene to protect potential life once the fetus could survive outside the womb. The court estimated at that time that a fetus became viable at no less than 24 weeks.

According to the federal Centers for Disease Control, 89.4% of all abortions done in 1985, the most recent year for which statistics are available, were done before the 13th week of pregnancy. Another 9.8% were done between 13 and 20 weeks.

Only 0.8% of all abortions were done at 21 weeks or more, CDC statistics show. Grimes of USC said another study of abortions during a two-year period in Georgia found just three abortions done after 24 weeks. Two were done for medical reasons because the fetuses were found to be developing without a brain.

As for testing to determine whether a fetus might survive after less than 24 to 26 weeks in the womb--the generally accepted lower limit of viability--experts said the use of certain tests remains controversial and they are often ineffective in assessing survivability.

“To be able to predict viability on the basis of tests we have now is utterly ridiculous,” said Dr. Keith P. Russell, a past president of the American College of Obstetricians and Gynecologists. He called viability testing “a moot point.”

Most medical experts say the point of viability remains at between 24 and 26 weeks in spite of technological advances since 1973. While the chances of survival of infants born severely prematurely has risen, physicians say the lower limit of viability has not dropped.

Experts also objected to the court’s view that states may ban abortions in public hospitals--a step they said could result in fewer physicians learning how to do abortions since most physicians receive their practical training in public hospitals.

Dr. Keith P. Russell, past president of the American College of Obstetricians and Gynecologists, predicted abortion training “won’t exist. It’s like any other thing: If you’re not properly trained, the mortality and morbidity associated with the procedure is high.”

USC’s Grimes said banning abortion from public hospitals “will tend to isolate abortion practice from the mainstream of reproductive medicine. If abortion services are squeezed out of public hospitals, it makes it look like an aberrant kind of medical practice, which it is not,” Grimes said.