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Doctors, Activists Weigh Abortion Ruling

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Doctors, Activists Weigh Abortion Ruling

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The abortion debate erupts again after the Supreme Court, in a 5-4 vote, upholds a federal law banning a procedure called "intact dilation and extraction." A doctor and activists on both sides of the issue talk about what the decision means.

REBECCA ROBERTS, host:

This is TALK OF THE NATION. I'm Rebecca Roberts in Washington. Neal Conan is away.

Abortion remains one of our most divisive issues. The debate erupted again last week when the Supreme Court, in a five to four vote, upheld a federal law banning a procedure called intact dilation and extraction. Critics call it partial birth abortion. The procedure is one of several available to doctors who perform second trimester abortions. We're going to be talking to a doctor about what this means for the medical profession, and we'll talk with activists on both sides of the issues about the implications of this decision and what their political strategies will be going forward.

And later in the program, a remembrance of former Russian President Boris Yeltsin, who died today at the age of 76.

But first, the new Supreme Court ruling on abortion. What does it mean? And whether you're pro-life or pro-choice, how do you think your side should fight this fight going forward? Join the conversation. Our number here in Washington is 800-989-8255. That's 800-989-TALK. Our e-mail address is talk@npr.org, and you can comment on our blog at npr.org/blogofthenation.

We're joined now by NPR health policy correspondent Julie Rovner. Julie, thanks for joining us.

JULIE ROVNER: My pleasure.

ROBERTS: So just to be absolutely clear, second trimester abortions have not been outlawed.

ROVNER: No, second trimester abortions have certainly not been outlawed, only this one particular contested procedure. And there of course is some dispute about how that bleeds into other procedures and whether or not this might cover some other procedures, but certainly the law as written was intended to cover only one particular procedure. So there are, as you mentioned at the top, many other procedures that doctors can use to do second trimester abortions.

ROBERTS: And how common is this one procedure that was banned?

ROVNER: Well, that's certainly up for discussion, but by all accounts, the vast, vast majority of abortions, more than 90 percent, are done in the first trimester of pregnancy, so we're immediately only talking about a universe of less than 10 percent. Within that, this is thought to be only a small number of those. It's not clear exactly how many, but if there's about a million abortions done per year, we're talking about perhaps, at the most, a couple of thousand. So it's not the number of abortions we're talking about here, it's really more about the legality and about the issue of where abortion rights stand as a legal concept.

ROBERTS: So expand on that a little bit more. Where does the controversy lie if it's a relatively rare procedure?

ROVNER: Well, the controversy lies really in will abortion be legal and whether Congress can put limits on the legality of abortion. And indeed what's important about this decision is that for the first time the Supreme Court has allowed Congress to ban a specific procedure. That has not happened in the 34 years since Congress - excuse me - since the Supreme Court legalized abortion in Roe v. Wade.

Also, this is the first time that the Supreme Court has allowed a restriction on abortion that did not allow an exception for the health of the pregnant woman. That even though there was an enormous amount of testimony and there were three different cases that got - well, there were two cases that got to the Supreme Court, but there were three separate cases that challenged this law after Congress passed it in 2003 - there was an enormous amount of medical testimony from doctors that said in certain cases this is an appropriate procedure to protect the health of the pregnant woman, the Supreme Court said, no, we don't really find that. And in fact if you have a case where you think, doctor, that this would be needed to protect the health, then you will have to come challenge this law for that particular case. So they would have to make, literally, an individual case-by-case challenge. The court said we will not allow a facial challenge, a challenge to the law before the fact.

ROBERTS: Because the language in the law itself says this is never medically necessary.

ROVNER: Yes, Congress had a series of findings - in fact, that was what allowed them to get around the previous Supreme Court decision on this issue, which came in 2000, in what had been a virtually identical law from Nebraska that the court struck down, a previous Supreme Court. In fact, the one change was the resignation of Sandra Day O'Connor, who was replaced by Judge Alito, and in fact that proved to be the deciding factor. It changed a five to four decision striking down the Nebraska law to a five to four decision upholding the federal law.

And in fact the real change in the federal law was this group of findings. They didn't want to have to have a health exception, which is one of the reasons the Nebraska law was struck down, so they had these findings that said a health exception is not necessary because this is never medically necessary. And interestingly, within the decision, the justices said some of these findings aren't exactly medically accurate, like one of the findings in the congressional - in the actual law says this isn't taught in medical schools. And in fact the testimony at some of the trials found that, well, it is taught in medical schools, but they kind of glossed that over.

ROBERTS: Well, for more on this medical issue we turn to Dr. Nancy Stanwood. She's assistant professor of obstetrics and gynecology at the University of Rochester Medical Center and a member of Physicians for Reproductive Choice in Health. She joins us from member station WBUR in Boston. Welcome, Dr. Stanwood.

Dr. NANCY STANWOOD (Obstetrics and Gynecology, University of Rochester Medical Center): Thank you, Rebecca.

ROBERTS: So explain this specific procedure to us, the one that was banned in the federal act and upheld by the Supreme Court.

Dr. STANWOOD: Well, I think it's important, first of all, to keep in mind that there are many things in medicine that are unpleasant, such as amputating a gangrenous leg or draining a large abscess, but that they must be done well and safely, and that doctors must have appropriate training and have appropriate reign within their medical practice to provide such procedures safely and carefully so that when we come to talking about this particular procedure within the spectrum of abortion care it is a part of how we take good, safe care of women, and it needs to continue to be a part. Unfortunately, the Supreme Court has now stripped that away.

ROBERTS: So under what circumstances is the procedure performed, and what does it entail?

Dr. STANWOOD: It's generally done in the second trimester, as is clear from the previous coverage, and it all depends upon the intraoperative findings as far as the degree of dilation of the cervix. The main surgical principle is that you want to empty the uterus as safely and quickly as possible, so that in the case where an intact procedure is allowed, it is safer and more - and it's quicker. So that's why it can be a surgical preference.

ROBERTS: So without getting too graphic here, when we say an intact procedure, it means developing the fetus in one piece as opposed to taking the fetus apart in the womb.

Dr. STANWOOD: Yes.

ROBERTS: Which is legal.

Dr. STANWOOD: Yes, and continues to be legal, we believe, although some aspects of this law are actually much more vague than your introduction may have led other people to believe.

ROBERTS: So what are the benefits to this procedure over others? The ban says it is never medically necessary. Do you agree with that?

Dr. STANWOOD: I do not. Congress was wrong, and Congress is not made up of physicians, and they did not appropriately assess the medical evidence. And the American College of Obstetricians and Gynecologists, which represents 90 percent of OB/GYNs in the United States, was a part of the suit against this, as far as filing an amicus brief and part of the testimony, as far as saying that in certain circumstances for some women this is the safest procedure and needs to continue to be a part of medical practice.

ROBERTS: And what might those circumstances be?

Dr. STANWOOD: Again, you want to empty the uterus as quickly and safely as possible so as to preserve the woman's physical makeup and capacity to have children in the future. And when an intact procedure is possible, it's generally faster and safer.

ROBERTS: But what...

Dr. STANWOOD: And there are also circumstances that can be somewhat emergent where time is particularly of the essence. For example, if a woman is very sick with an infection in her uterus or if she's hemorrhaging from her uterus with a pre-viable pregnancy, the safest way to take care of her is to empty her uterus as quickly as possible to avoid needing to do massive transfusion or an emergency hysterectomy. And so to not be able to do that, because this is only her health at risk as opposed to her life, is really - it puts doctors in an appalling position of trying to decide what's best for the patient as opposed to what's legally safe for the doctor.

And I think as a follow-up point, it's important to realize that the whole dichotomy of separating out health from life really is not how we practice medicine. We try and preserve health so that people don't get to a place where they're just about to die. So, as a physician, if I'm doing an emergency case and I feel like I need to act quickly, how close do I need to have her get to death to then say, well, I'm doing this to save her life and it's not for her health? That's just so incredibly appalling as a physician to think that I need to wait until she's almost on death's door.

I think one clinical scenario that's important to keep in mind, and I mentioned it earlier, there's a condition in pregnancy where sometimes the placenta can separate unexpectedly and quickly before the normal birth process has occurred. It's something called abruption. And I personally have been called into the hospital in the middle of the night to perform an emergency abortion on a pre-viable pregnancy for an acute abruption.

And in the middle of doing that, trying to prevent my patient from hemorrhaging, I don't want to have to stop and think about, oh, do I need to call a judge? Do I need to take extra time to make sure that I'm following this law and let her hemorrhage more and need more transfusion and have a higher risk of HIV infection from massive transfusion or a higher risk of needing an emergency hysterectomy? That is just bad medicine, and it puts doctors in an untenable position, and it puts women at risk unnecessarily.

ROBERTS: So what would you do if that situation arose tomorrow? Would you be tempted to perform this procedure regardless?

Dr. STANWOOD: Well, fortunately, we have a few more days before the ban goes into effect, because it's 25 days, probably, after the decision. So tomorrow would be a hypothetical. But, honestly, I don't know, because it really ends up being an after-the-fact assessment by whatever prosecutor might want to try and come and get me to say, well, it was really only her health. She wasn't on death's door yet. And to have to argue that in court, to say, well, OK, I was only trying to, you know, prevent her from getting to death's door as opposed to saving her from death's door, that is just incredibly inappropriate in medicine.

ROBERTS: Let's hear from Katie in Louisville. Katie, welcome to TALK OF THE NATION. Katie, you're on the air.

KATIE (Caller): Yes, my question would be - am I actually on the air?

ROBERTS: Yes, you are, ma'am.

KATIE: OK, I'm sorry, because I've got a - I need to turn down my radio.

ROBERTS: Yes, please.

KATIE: My question would be are you sure that it's always a medically safe procedure as far as future pregnancies? I've been on both sides of the debate. I did have an abortion at age 18, but later on in life, I had a baby that died of Turner Syndrome in utero. And my doctor, Dr. Weeks(ph), very clearly explained to me that if he did a similar procedure to remove my baby rather than have me deliver her after she had already died, that it could jeopardize my later ability to become pregnant...

Dr. STANWOOD: Yeah, Katie...

KATIE: ...so it doesn't seem like there's 100 percent agreement in the medical community...

Dr. STANWOOD: Well, actually, Katie, the...

KATIE: ...about whether or not these types of procedures are safe. So I just want to try to understand it from that point of view because I am against taking a baby this late in pregnancy. I don't really feel like it's fair that, you know - my baby was a person because I wanted her, and she was that far, you know, into the second trimester...

ROBERTS: Well...

KATIE: ...but then if someone doesn't want the baby, then it's not. And I understand that (unintelligible)...

ROBERTS: Let's give Dr. Stanwood a chance to answer your question. Thanks, Katie.

Dr. STANWOOD: Well, Katie, I'm - first of all let me express how sad I am that you had to go through that experience of losing a pregnancy. I take care of many patients with that exact same issue, and take them through that grieving process. But let me tell you that the medical evidence says that the counseling that your physician gave you at the time is really not accurate. We know that surgical abortion is comparable in safety to labor induction abortion, and that for some women it can actually be safer, particularly if they've had a cesarean section in the past. So that - it's not that there's disagreement in the medical community, it's that some people in the medical community might not be up to date on the most recent facts.

ROBERTS: We're talking about what's next in the abortion debate after the Supreme Court upheld the Partial Birth Abortion Ban Act. We're taking your calls at 800-989-TALK, or you can send us e-mail. The address is talk@npr.org.

I'm Rebecca Roberts. It's TALK OF THE NATION from NPR News.

(Soundbite of music)

ROBERTS: This is TALK OF THE NATION. I'm Rebecca Roberts, in Washington.

Last week's decision by the Supreme Court upholding the federal Partial Birth Abortion Ban Act has immense political implications. Both sides in the abortion debate are preparing for a reenergized debate. Still with me are NPR's Julie Rovner, our health policy correspondent, and Dr. Nancy Stanwood. She's assistant professor of obstetrics and gynecology at the University of Rochester Medical Center. And as always, we want to hear from you. What does this Supreme Court decision mean? Whether you're pro-life or pro-choice, how do you think your side should fight this battle going forward? Give us a call at 800-989-TALK, or send us e-mail: talk@npr.org. You can also weigh in on our blog: npr.org/blogofthenation.

To get a perspective on what impact the decision has on both sides of this debate, we're joined first by Charmaine Yoest. She's vice president for communications at the Family Research Council. She joins us here in Studio 3A. Welcome.

Ms. CHARMAINE YOEST (Vice President for Communications, Family Research Council): Hi, Rebecca. It's good to be here.

ROBERTS: So are you happy with this ruling?

Ms. YOEST: Oh, we're very happy. This is the first time in 34 years that we've seen any kind of limit put on abortion, and so we see this as being very common sense and upholding where the vast majority of the American people are. Over 70 percent of the American people support this legislation. And when it passed, it passed with bipartisan support in Congress after hearing, you know, vast quantities of research and testimony. So we're very, very pleased.

You know, the bottom-line is it doesn't affect Roe v. Wade at all, and so abortion is still legal through all nine months of pregnancy in this country. So obviously, as a pro-lifer, we would like to see something more far-reaching than that, but we see it as a very common sense first step.

ROBERTS: Do you see this as an encouraging sign that this court might be willing to take a new look at Roe versus Wade?

Ms. YOEST: Well, I don't know. I - there's differences of opinion on that because, you know, in terms of parsing out some of the different areas in the decision, you know, when you ask if I'm happy about it, you know, one of the caveats I'd have to put out there is that the reasoning that Justice Kennedy put forward is he said that one of the reasons that it was OK to prohibit this particular method of abortion is that there are so many other methods available. So even within the decision, he made the point that I just made, which is that abortion is still fully legal. You're still perfectly able to end the life of the - of a viable baby right up to the moment of its birth. You just can't deliver it feet first and crush the skull.

ROBERTS: On the other hand, as you said, this is the first time in 34 years that a major restriction has been imposed so...

Ms. YOEST: Right.

ROBERTS: ...are there signs for encouragement for your movement, do you think?

Ms. YOEST: Absolutely, absolutely. You know, it offers the opportunity to see upholding partial birth abortion bans at the state level. It also offers an opportunity to move forward on another arena that we have been very interested in, which is full disclosure to women. We think that there's a real area of need here where - women come back to us all the time and say, I just didn't know ahead of time. And, for example, one area that we're looking at is requiring sonograms ahead of time. And, you know, women will come back and say, you know, I wish I'd been able to have all the information before I had the procedure, and a lot of times they don't.

ROBERTS: Nancy Stanwood, do you think women are lacking in information before they have these procedures?

Dr. STANWOOD: No, I don't. I think that the tenets of informed consent within medical practice are very clear, and that I and my colleagues uphold them. I think one thing to keep in mind is that if we're talking about full disclosure, well, if a woman wants to continue a pregnancy, maybe she needs to understand that continuing pregnancy and delivery is more likely to kill her than having an abortion. When you look at maternal mortality rates, for every million births in the United States, 140 women die. For every million abortions, only six women die. So if we want to look at the flipside of full disclosure, maybe women need to sign consent to continue their pregnancy.

Ms. YOEST: That's a horrible way of looking at it.

ROBERTS: Let's take a call from Denise in Wichita. Denise, welcome to TALK OF THE NATION. Denise, you're on the air. Let's try Jim, in Rochester. Jim, welcome to TALK OF THE NATION.

JIM (Caller): Thank you, hi. Well, first, the main thing that I think I'm concerned about is the way you introduced the topic, and it really troubles me, the whole idea of whose side are you on and how should your side go forward. I think this is a - this is really one of the main problems we're having with the larger debate. I don't really have a side, because I think like most people that I know, I am very, very strongly pro-life and very, very strongly pro-choice. I don't know what those terms mean.

ROBERTS: Well, explain that to me, Jim. How do you feel that you can be both?

JIM: I think you have to be both. Anybody that cares about humanity is certainly in favor of life. We're not in favor of death. We're not, on the other hand, in favor of limiting people's choice. That's what it is to live in a democracy. So I think the terms of debate automatically polarize people in ways that are really not helpful.

And I think on top of that I am concerned about the way the, you know, the terms of the debate are turned way, way quickly away from the actual situations that the average person who's undergoing this procedure go through. And I think - it was really helpful to me last night to hear Larry King and having president - former President Clinton on. His viewpoint, I thought, was reasonably measured.

I mean, he vetoed this thing twice because of the lack of the physicians' ability to overrule it under certain kind of extreme circumstances. He gave a couple of examples that I won't go into. I'm sure your physicians there would be able to do it better than I could, anyway. But he gave a couple of examples of where it really is not an unrealistic thing at all. It's horrifying that the woman has to go through this, and it's certainly no doubt painful for the child. But, I mean, there's some times when it's maybe the lesser of the evils that are possible...

ROBERTS: Jim, to your point about...

JIM: ...so, you know, I think that kind of more measured, more nuanced discussion is a lot more helpful than whose side are you on, which I think is really not helpful at all.

ROBERTS: Well, then to your point about language, if we are talking about people who think abortion should be legal and people who think abortion should not be legal, what language do you think we should use? What would you prefer to hear?

JIM: Are you saying not legal, ever, under any circumstances? I know very, very few people that believe that. I know very, very few people, on the other hand, that believe that no matter what, no matter how gruesome, no matter how painful and, you know, even if it's just a matter of personal preference - gee, I got pregnant, and I really don't want to do that anymore, you know, some flippant -I changed my mind when you're dealing with a human life - I mean, those things - very few people I know take those extreme positions, so - and I think that's what I'm driving at. I think we need to kind of pull in our rhetoric a bit so that we don't divide unnecessarily on these terms.

ROBERTS: Jim, thanks for your call.

Ms. YOEST: I have...

Dr. STANWOOD: Well, Jim, this is Dr. Stanwood, and I think as a follow-up to that...

Ms. YOEST: Well, you...

Dr. STANWOOD: ...there's the common sense, common ground position of preventing unplanned pregnancies. Certainly we're never going to be able to prevent the tragic complications that can occur in some pregnancies that require an abortion. But we need to take a look at common sense, common ground measures to reduce unintended pregnancies...

ROBERTS: Let's get Charmaine Yoest in here...

Dr. STANWOOD: ...Half of all pregnancies in the United States are unintended, and we need to have better contraception.

Ms. YOEST: You know, Nancy...

ROBERTS: Dr. Stanwood, let me get Charmaine Yoest in here. She's been trying to say something.

Ms. YOEST: Nancy, the reason that I started with the fact that 70 percent of the American people support this legislation is because I agree with the caller. You know, the vast majority of the American people see this as being a very small step, and it really highlights for me just how radical the pro-abortion movement is, that just, you know, just saying that this one thing where you cannot kill a baby as it's being delivered is something that they're still willing to defend. And, you know, Nancy is really, really glossing over the vast majority of research.

This came before Congress. It's now come before the Supreme Court. It also went through a lawsuit where extensive research was put out, extensive testimony. Nancy is one doctor who is putting out a lot of disinformation here today. We can put plenty of doctors out - including the American Medical Association -who have testified and said, categorically, there's never a medically necessary reason to do this procedure. And so, you know, I just really have to call into question her biases here as someone who does...

Dr. STANWOOD: Well, Ms. Yoest, I think that...

Ms. YOEST: ...as someone who does perform this procedure.

Dr. STANWOOD: Well, Ms. Yoest, I think that, obviously, we seem to be from polar opposites of this discussion. But I think that it's important to remember that I am not alone in this, and that the American College of Obstetricians and Gynecologists that represents 90 percent of OB/GYNs in the United States was opposed to this ban, so I think that's important to keep in mind.

Ms. YOEST: Well...

Dr. STANWOOD: And I think one other thing that's important...

Ms. YOEST: Well, I just want to put on the record, because you had 25 minutes before I came on the air, that there is a significant body of evidence and testimony in front of the court opposing everything that you've said about the medical necessity of this procedure.

ROBERTS: Well, given that there is this disagreement, even just among the women on this program...

Ms. YOEST: Right.

ROBERTS: ...what about the question of whether or not Congress should be in the business of making medical decisions? If there is disagreement, why should it be written into the law?

Ms. YOEST: Well, because we did have an opportunity to have medical experts on both sides testify on the issue. And when you have a procedure like this that is so barbaric and so violent, it's in the public's right to have an interest in defending a defenseless life, the baby that doesn't have a voice in public policy. And, you know, it's really, really, really troubling to me that we've come this far in the 21st century to even see people defending this procedure.

ROBERTS: Let's take a call from Matt, in Trenton, Michigan. Matt, welcome to TALK OF THE NATION.

MATT (Caller): Did I just get cut off?

ROBERTS: No, Matt, you're here.

MATT: Oh, I'm sorry.

ROBERTS: You're live on the air. I need you to turn down your radio, though.

MATT: Yeah, it's off.

ROBERTS: Thanks.

MATT: I had a couple of quick questions. I mean, the pro-choice argument is usually centered around the woman's health, and so my question would be of the million or so abortions that are performed every year, how many of them are actually medically necessary as opposed to being just the choice of the woman as pretty much a contraceptive measure?

And then the second question I have is, is it necessary in all states in this country that you must be a board-certified medical doctor to perform abortions? And I'll take my answers off the air.

Ms. YEOST: Well, he raises a really interesting point, and this is another point that I want to get out there about the medical necessity, is Nancy keeps talking about extreme hypothetical situations that involve the physical health of the mother. But let's take the state of Kansas, for example. In their reporting on this procedure, of the 182 times that the partial-birth abortion was performed in one year, every single one was done for the mental health of the mother on a viable infant.

And so that's really important for people to understand here, that we are talking about situations that involve the mental health of the mother, which encompasses a very, very large - there's no way of pinning down exactly what that is. And so when you have a situation where many doctors are saying that delivering a baby feet first is dangerous to the mother, you're looking at a procedure that's absolutely indefensible.

ROBERTS: Nancy Stanwood, what about his second question about board-certified medical doctors performing abortions?

Dr. STANWOOD: Yes, you need to have a medical license to practice medicine, including to provide abortions within the context of general reproductive health care.

But I think one point that's important to put in context here is who decides. And I think one thing that resonates with the American public is the whole case of Terri Schiavo and Congress legislating medical care. And so why is it that Congress gets to suddenly become a doctor and say what's medically necessary and what's not, when there's disagreement within the medical community or when the majority of physicians who work in reproductive health feel that this is dangerous to have no health exception?

I think that's a very important question for your callers to consider as far as who decides. Is it the doctor in consultation with the patient and the family or is it Congress?

ROBERTS: We are talking about the Supreme Court decision upholding the Partial-Birth Abortion Ban Act last week, what that means on the abortion debate. The number to call: 800-989-TALK. That's 800-989-8255. Or you can e-mail: talk@npr.org. You could also comment on our blog. It's at npr.org/blogofthenation.

My guests are Julie Rovner, NPR's health policy correspondent; Dr. Nancy Stanwood, assistant professor of obstetrics and gynecology at the University of Rochester Medical Center; and Charmaine Yeost, vice president for communication of the Family Research Council. You're listening to TALK OF THE NATION from NPR News.

And let's take another call. This is Joe in Rochester, New York. Joe, welcome to TALK OF THE NATION.

JOE (Caller): Hi, thank you very much for taking my call. I would like to ask the guest from the Family Research Council why she sounded so disturbed at the mention of the mortality rate from live births being actually higher than the mortality rate of abortions, why you would be so disturbed with that being disclosed to the patients or being mandated to be disclosed to the patients if you want them just to have a sonogram as well. And I'll take my comments off the air. Thank you very much.

ROBERTS: Thanks for your call.

Ms. YEOST: I wasn't disturbed by it. I was amused by it, because it's straight out of the talking points from Planned Parenthood and NOW in their defense of abortion. And as someone who has a PhD in public policy, I'm very well aware of how easy it is to manipulate statistics. And that one I find to be particularly reprehensible.

Dr. STANWOOD: Well, Ms. Yeost, actually those statistics are right from the Center for Disease Control and Prevention, which is part of our government. So...

Ms. YEOST: Yes, but the context that...

Dr. STANWOOD: ...I'm not making those up. Those are directly from the CDC.

Ms. YEOST: I didn't say you were making them up. I said you were manipulating them.

Dr. STANWOOD: I'm simply stating them.

Ms. YEOST: Abortion is a very - is the most unregulated health care procedure in this country today.

Dr. STANWOOD: No, you're mistaken on that.

Ms. YEOST: Well, I think that your bias is evident there.

Dr. STANWOOD: Yours may be also.

Ms. YEOST: And the statistics on abortion and abortion deaths are hugely underreported.

ROBERTS: And Charmaine Yeost, as an activist on this issue, what is your next step? Where do you go from here?

Ms. YEOST: Well, the good news on this case is that it does open up more possibility for defending the state-level bans on this procedure. And also informed consent for women. You know, maybe Nancy and I can agree on getting more information to women before they have these procedures.

ROBERTS: Charmaine Yeost is vice president for communication at the Family Research Council. She joined us here in Studio 3A. Thank you so much for your time.

Ms. YEOST: Thank you.

ROBERTS: And to get the other side of the activist argument we're joined by Nancy Northup. She's president of the Center for Reproductive Rights. She joins us from member station WBUR in Boston. Thanks for coming.

Ms. NANCY NORTHUP (Center for Reproductive Rights): Thank you.

ROBERTS: What was your reaction to the Supreme Court decision?

Ms. NORTHUP: Well, the reaction was it was quite shocking that the court, just newly comprised only a year ago with the new justices on it, would undo 30 years of Supreme Court precedent. And that very important Supreme Court precedent is that women's health has to come first when you're regulating abortion. And so I would disagree most strongly with Ms. Yeost, your past guest, who just said it doesn't affect Roe v. Wade at all.

In fact, the Supreme Court's decision last week, you know, kicked a pillar out that was very strongly in place as part of Roe v. Wade, and that is that you can't jeopardize women's health when you're regulating abortion.

ROBERTS: But if there are other ways of performing second trimester abortions, why is this ruling so controversial?

Ms. NORTHUP: Well, both as a medical fact, which Dr. Stanwood has talked about. Doctors want to use the safest procedures for their particular patients. And then as a legal matter, that the court in turning its back on putting women's health first is really opening the door for a whole host of restrictions that are going to jeopardize women's health and that are going to put more hurdles between a woman and her ability to have an abortion in the second trimester.

I also want to make clear, there was another real misstatement that Ms. Yeost made. And that was her saying that, you know, abortion is legal in all nine months. That is not the case.

I mean, Roe itself was a decision that looked at both women's health and life and constitutional rights to make decisions, but also looked at the value of the developing life of the fetus and said we're going to permit abortions before the fetus is viable - can live outside the woman - but we're going to allow states to criminalize it after, as long as there's an exception for the life and health of the woman.

So most states can and do criminalize abortion in the third trimester, as long as there are these exceptions. And it is not a, you know, advocacy position of pro-choice organizations to try to overturn those laws. So this notion that it's legal in all nine months is meant to make the American public think that people are having abortion in the third trimester for, you know, any other reason under the sun. And that's just not the case.

ROBERTS: When we come back from a short break, we'll talk more about what the Supreme Court's decision means for doctors and both sides, all continuum of the abortion debate. And more of your calls or e-mails: talk@npr.org. I'm Rebecca Roberts. It's TALK OF THE NATION from NPR News.

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ROBERTS: But right now we're talking about what's next for the abortion debate after the Supreme Court's decision to uphold the federal Partial-Birth Abortion Ban Act. Our guests are guests are Julie Rovner, NPR's health policy correspondent; Dr. Nancy Stanwood, assistant professor of obstetrics and gynecology at the University of Rochester Medical Center; and Nancy Northup, president of the Center for Reproductive Rights.

Nancy Northup, if you see this decision as the first step in a potential challenge to Roe v. Wade, what is your policy strategy going forward?

Ms. NORTHUP: Well, it's not just the first step. Unfortunately it's the next step, because the court has been backsliding on the protections of Roe v. Wade ever since the Planned Parenthood v. Casey case in 1992. But it is important backsliding that the court did last week.

And one of the options to respond to it is for states and the federal government - not under this administration - but for states to pass freedom of choice acts. And those are laws which are a backstop to the Supreme Court's eroding protections. They basically codify the protections of Roe v. Wade and say that there's a fundamental right for women to choose or refuse birth control or abortion.

And so these states can provide a way to protect women when the U.S. Supreme Court has, you know, abandoned them. And there are seven states that have such laws, and I think we're going to see those laws pass in other states that want to be strong protectors. What's tough, though, is there are states that are so strongly anti-choice that their women are really left high and dry.

ROBERTS: Why not use this issue - this particular case, this particular procedure that is used relatively rarely, that people find abhorrent - as a signal that you're willing to compromise? Why not say we acknowledge that this procedure should be outlawed, but we hold the line on something else?

Ms. NORTHUP: Well, I think, as Dr. Stanwood has so well talked about today, you're certainly not, when a doctor's talking about an individual patient, going to say that you're going to compromise her health. And when you're talking about the constitutional law, the protection, the notion that a woman should be able to get the best health care that she can, should also not be compromised.

Again, we're not talking about abortions in the third trimester. We're talking about abortions as early as 12 to 15 weeks, when the Roe v. Wade decision does say that this is a time in which the decision is to be made by the woman in consultation with her doctor and other supportive members that she wants to speak with about it.

ROBERTS: Nancy Northup is president of the Center for Reproductive Rights. She joined us from member station WBUR in Boston. Thanks so much.

Ms. NORTHUP: Thank you.

ROBERTS: Still with us is Julie Rovner, NPR's health policy correspondent and Dr. Nancy Stanwood, assistant professor of obstetrics and gynecology at the University of Rochester Medical Center.

Let's take a call. This is Joan in New York City. Joan, welcome to TALK OF THE NATION.

JOAN (Caller): Hi, I just wanted to bring up a couple of things. One, there's certain times that the babies have defective situations. Anywhere from different RH factors, which can affect a woman if she has certain cardiac diseases, or a baby's born with the brain outside of its head, no brain, or a three-chambered heart. And that child's just going to die in pain afterwards.

And also different religious traditions, such as Shintoism and Judaism, have a different relationship with the mother's health than, say, fundamentalist Christians. And the life of this mother is to be preserved.

ROBERTS: And so what are you suggesting, Joan?

JOAN: Well, I'm just saying that you can't just apply one rule to certain operations in terms of the baby's health. If the baby has genetic defects, it affects the mother's health. And, the mother has a health condition such as an extreme cardiac condition - one that dilation and extraction might be healthier for her in order to preserve her life, because an operation might kill her, basically.

ROBERTS: Joan, thanks for your call. Nancy Stanwood, is the situation different if the fetus can't possibly survive?

Dr. STANWOOD: Well, certainly. In counseling my patients - when they come with a devastating prenatal diagnosis, it's very important that we map out their options. There are some patients who may choose to continue the pregnancy and deliver at term. But there are some women and families who find it emotionally too burdensome to continue, knowing that the baby is only going to die later. And so they make the choice to have an abortion in the second trimester.

ROBERTS: Julie Rovner, given that there - this is obviously not, you know, an either-or issue, there is this sort of gray area in between. What are the sort of legislative or policy prospects of finding some middle ground?

ROVNER: Well, certainly, we've seen a lot of efforts - really, in the last year or two - to develop a middle ground. And obviously, you know, we've heard from some of the callers - I get frustrated with the two sides who seem so polarized, you know. It's either all or nothing. And they really are kind of searching for this, you know, place in the middle. And, of course, a lot of those efforts do center around preventing unwanted pregnancies and reducing the need for abortion. Indeed, a lot of these bills are called, something like the reducing the need for abortion act.

The problem with them, though, is that they center mostly on contraception and a lot of the people who oppose abortion have problems with contraception, too. So they get a little bit touchy. So there has yet to be a real sort of solid center there around these bills. But there are certainly a lot of efforts going on to find something - and certainly the presidential candidates - and I think it's safe to say presidential candidates, both Democratic and Republican Party would like to desperately to find the middle ground that they can be in.

Neither one of them, you know - quickly, very quickly, last week, the Democratic presidential candidates - all of them said, you know, we don't like the decision. And the Republican candidates - all of them, including Rudy Giuliani, who support abortion rights - all said, oh, yeah, we like this decision. But in general, you know, abortion pulls the candidates to either pole, and they don't like that. They all would like to be back in the middle on this. So everybody would like to find a middle ground. Nobody has done that yet.

ROBERTS: So do you think this decision is forcing candidates to talk about an issue that otherwise they'd stay away from?

ROVNER: I think it absolutely is going to do that. I think it certainly - what we've seen in the past is big abortion decisions like this have tended to bring the issue back to the forefront. And they've actually tended to energize the opposite side. So, in this case, one would think that this would energize the abortion rights side. But in this case, because it has opened the doors, we've heard to, perhaps, more restrictions, I think it's going to energize both sides, I think, which is going to upset a lot of politicians who would just as soon, as we get into a very heated presidential race - and obviously a very contested, you know, congressional race with Congress so close - I think politicians, you know, of all stripes are saying uh-oh.

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ROBERTS: Julie Rovner is NPR's Health Policy correspondent. She joined us here in studio 3A. Thanks so much, Julie.

ROVNER: You're welcome.

And Dr. Nancy Stanwood is a member of Physicians for Reproductive Choice and Health. She's also assistant professor of Obstetrics and Gynecology at the University of Rochester Medical Center. She joined us from member station WBUR in Boston. Thank you so much.

Dr. STANWOOD: Thank you.

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