Abortion is now banned or severely restricted in 14 states in the US, the outcome of a decades-long campaign by anti-abortion advocates. In many states, abortion is no longer seen as a health procedure, but a morality issue. Pennsylvania’s Doug Mastriano – once a state senator, now running for governor – is one of a number of Republican politicians who has called for murder charges for people who defy abortion bans.
In 13 of those 14 states, abortion is banned even in the earliest stages of pregnancy.
These images, supplied to us by the MYA Network, a network of clinicians and activists who came together earlier in the pandemic when some states tried to classify abortion as “non-essential” medical care, show what tissue in the first nine weeks of pregnancy actually looks like.
Above is early pregnancy tissue, at four weeks of pregnancy.
Dr Joan Fleischman, part of the MYA Network, uses a gentle handheld device that removes the tissue. This more delicate type of extraction keeps it intact.
Above is pregnancy tissue extracted at five weeks.
Sometimes, patients want to see the tissue after an abortion. “They are stunned by what it actually looks like,” says Fleischman. “That’s when I realized how much the imagery on the internet and on placards – showing human-like qualities at this early stage of development – has really permeated the culture. People almost don’t believe this is what comes out.”
Above is tissue removed at six weeks, when misleadingly named “fetal heartbeat” bills outlaw abortion.
“Clinicians date pregnancy from the first day of your last period, to help predict the due date. But you’re not pregnant for those first two weeks,” says Fleischman. So someone with a six-week pregnancy may have very little time after a missed period to get abortion care in states with a six-week limit.
Many images on the internet and in textbooks show development to be quite far along at this stage.
“A lot of early pregnancy images are driven by people who are against abortion and feel that life begins at conception, or by prenatal enthusiasts who want women to be excited about their pregnancy. What about people who aren’t?” she asks.
Above is pregnancy tissue at seven weeks. There is still no visible embryo. The gestational sac is not yet half an inch. “I have been in the training field, and medical students and clinicians who see it are also shocked. That is how pervasive this misinformation is,” Fleischman says.
Patients may come in for an abortion fearful at this stage, having read through forums or looked at images online. “They’re expecting to see a little fetus with hands – a developed, miniature baby.” Often, she says, “they feel they’ve been deceived.”
This image shows decidua (tissue to support the pregnancy) and the gestational sac (which would eventually become the amniotic sac, which supports the fetus). If we looked closer, under a microscope, would we see more human qualities?
“If you zoom in on anything, including sperm and an egg getting fertilized, it’s just an incredible thing to watch. But that’s very different from the everyday ways we see life. That perspective to me is the most relevant – but it is somehow absent from our consciousness,” says Fleischman.
Above is a gestational sac removed at eight weeks of pregnancy. While these images relate to early pregnancy, the network does not differentiate between a “good time” and a “bad time” to have an abortion, nor does it dismiss how emotionally fraught losing a pregnancy at any stage, including early pregnancy, can be. But they want people to know what is actually being removed in early pregnancy.
“Abortion is medical care. Every single person who makes this decision is complex. But this information, showing tissue in the first 10 weeks, is literally absent from our common understanding of what is going on, and people deserve accurate information.”
This image shows the gestational sac of a nine-week pregnancy. This is everything that would be removed during an abortion and includes the nascent embryo, which is not easily discernible to the naked eye. Showing this tissue can be a relief to patients. “Often people don’t speak to anyone about getting an abortion. They make a very quiet, private decision because they’re afraid to see people’s reactions. And then I do this simple procedure that’s a few minutes longer than a Pap test. For those who choose to look at the tissue, you can literally feel the tension come down. People have been on this emotional roller coaster. And they’re like, ‘You’re kidding. This is all that was?’” says Fleischman.
Finally, above is a number of gestational sacs on one petri dish, showing the progression in growth from five weeks of pregnancy to nine weeks. The sac grows 1mm a day.
Talking about why we don’t see these images more often, Dr Michele Gomez, who is part of the MYA Network, says: “I do think there are some clinicians who are concerned about patient’s reactions. But it’s not really our right or our responsibility to decide how people will respond to this. We’re just putting out the information and the facts to counter the misinformation. To say: this is not something that’s scary, or dangerous, or violent. It’s just a picture of something that’s in your body.”
This article was amended on 19 October 2022 to include the detail that at nine weeks the nascent embryo is not discernible to the naked eye.
