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Setting the Record Straight on Abortion in the Wake of the Presidential Debate

— We should expect more from our elected officials

MedpageToday
 A photo of President Joe Biden Donald Trump during the debate on June 27, 2024.
Kass is an emergency medicine physician and was formerly a regional director at HHS.

There's no easy way to say this, but the current U.S. presidential nominees are having a difficult time articulating coherent thoughts about abortion. Despite employing scores of advisors on both sides of the aisle, neither of these frontrunners seem to understand -- or effectively communicate -- the fact that there is no such thing as abortion after birth, period. And yet, here we are again, reminding anyone who will listen what abortion actually looks like.

Amid the dumpster fire that was the June 27 Presidential debate, there was an especially appalling dialogue between President Joe Biden and former President Donald Trump on the topic of abortion access in the U.S. between CNN moderator Dana Bash and both nominees was filled with inaccuracies and hyperbole. The abortion discussion opened with Bash asking Trump about his role in overturning Roe v. Wade, to which he boastfully claimed responsibility (in true Trump fashion) for the loss of universal protections for abortion access in this country.

Bash: Former President Trump, you take credit for the decision to overturn Roe v. Wade, which returned the issue of abortion to the states.

Trump: Correct...And what I did is I put three great Supreme Court justices on the court, and they happened to vote in favor of killing Roe v. Wade...

And that might be the most accurate representation of abortion policy from the entire debate. It is absolutely true that Trump and his appointed justices are responsible for the loss of federal protection for abortion services in this country.

Bash also probed Trump on SCOTUS' recent ruling on the abortion pill, mifepristone. Trump claimed that the Supreme Court voted to protect access to the medication, when in fact what happened was that the court (in a unanimous opinion) declared the plaintiffs had no legal standing to bring the case and dismissed it (this has no bearing on other litigation in lower courts that also challenges FDA authorization of mifepristone).

Trump: First of all, the Supreme Court just approved the abortion pill. And I agree with their decision to have done that, and I will not block it.

Trump then pivoted to what was objectively the most grossly inaccurate claim during the debate, one which he insisted on bringing up over and over again: the idea that children are born and then murdered in the name of "abortion."

Trump: The problem they have is they're radical, because they will take the life of a child in the eighth month, the ninth month, and even after birth – after birth.

If you look at the former governor of Virginia, he was willing to do this. He said, we'll put the baby aside and we'll determine what we do with the baby. Meaning, we'll kill the baby.

Abortion can be induced (with medication or procedure) or spontaneous (usually due to pregnancy conditions that were non-viable). abortion refers only to pre-viability pregnancy terminations, so the entire conversation about "post-birth" abortions is, on its face, inaccurate...but let's dive in a bit deeper.

Roe v. Wade, the decision that federally protected access to abortion services up until the point of viability (around 24 weeks), was a floor not a ceiling. Nine states and D.C. have on abortion services, and others allow for exceptions after 24 weeks if the life of the mother is at risk. Decisions to end pregnancies after 24 weeks are rare and among the most gut-wrenching that patients and their physicians pursue, often due to new devastating health information about the developing fetus. Despite the of these decisions, those who look to restrict choice and misrepresent reproductive healthcare spread false information about how and when these choices are made.

There are conditions, like preeclampsia or a new cancer diagnosis, that would require an otherwise normal pregnancy to be ended early to save a mother's life, but if those are diagnosed in the eighth or ninth month, the baby is simply delivered -- not murdered. It's absurd that I have to reiterate that the murder of babies is illegal in every U.S. state and has nothing to do with abortion.

The inflammatory, "he can take the life of the baby...even after birth," claim was restated multiple times by Trump in an apparent attempt to scare voters into the idea that there must be gestational limits on abortion to keep innocent babies safe. To state it clearly again: in the rare case that pregnancies are terminated during the third trimester, it is often in the face of devastating (and new) information presented to the patient and her family. In no case is the patient, or the pregnancy, better served by arbitrary and absolute limitations on the options available to physicians providing this care.

President Biden did a poor (and often incoherent) job of countering this "they kill babies after birth" narrative during the debate. He appeared confused regarding the necessity and timing of pregnancy termination, leaning to a statement that appeared out of touch with the gravity of the decision at hand.

Biden: And if I'm elected, I'm going to restore Roe v. Wade.

Trump: So that means he can take the life of the baby in the ninth month and even after birth, because some states, Democrat-run, take it after birth. Again, the governor – former governor of Virginia: put the baby down, then we decide what to do with it.

So he's in – he's willing to, as we say, rip the baby out of the womb in the ninth month and kill the baby.

Nobody wants that to happen. Democrat or Republican, nobody wants it to happen.

Biden: He's lying. That is simply not true.

President Biden failed to correct the record in real time, appearing to believe that just declaring, "He's lying," would be enough to convince debate watchers that Trump was lying through his teeth.

Historically, candidates for president have been able to more eloquently describe these scenarios. It doesn't require a medical degree to understand. For example, in 2019, democratic Presidential candidate Pete Buttigieg offered this response when asked a similar question about gestational limits on abortion:

Moderator Chris Wallace: You would be okay with a woman well into the third trimester to obtain an abortion?

Buttigieg: These hypotheticals are set up to provoke a strong emotional reaction...

Wallace: These aren't hypotheticals -- there are 6,000 women a year who get an abortion in the third trimester.

Buttigieg: That's right, representing less than 1% of cases a year.

Let's put ourselves in the shoes of a woman in that situation. If it's that late in your pregnancy ... it's [almost to the point] that you've been expecting to carry it to term...Families ...then get the most devastating medical news of their lifetime. ... That decision is not going to be made any better, medically or morally, because the government is dictating how that decision should be made.

In the end, this debate will be remembered for many more issues than the exchange on abortion, but we cannot gloss over the substance of what occurred. The desire for one presidential candidate to spread misinformation about abortion in the U.S. and the inability of the other to counter those lies in real time should be concerning to those of us who expect accuracy and honesty from our elected officials.

is a practicing emergency medicine physician, and formerly a regional director at HHS. Her research and policy interests include the expansion of reproductive healthcare and the intersection of federal and state policies in supporting healthcare access and funding.