Abortion

Abortion is the termination of a pregnancy associated with the death and expulsion of the embryo or fetus from the womb. In medicine, all terminations of pregnancy are defined as abortions. In common parlance, the term miscarriage is applied to all spontaneous (non-induced) abortions. The ethics and morality of induced abortion has become the subject of an intense debate, especially in the United States. This article focuses on induced abortions.

Types of Abortion

• Spontaneous abortion: An abortion due to accidental trauma or natural causes. Also known as a miscarriage.
• Induced abortion: Deliberate (human induced) abortion.

• Therapeutic abortion: An abortion requested because the pregnancy poses health risk to the gravida (pregnant woman)
• Elective abortion: An abortion requested for any other reason by the gravida.
• self-induced abortion: As its name implies, any kind of induced abortion performed by the pregnant woman herself.

Reasons for induced abortions

Women have many reasons to seek an abortion. Some use it as a form of birth control, others seek an abortion because they are victims of rape and still others because of their physical health.

According to the Alan Guttmacher Institute, there were 1.31 million abortions in the US in 2000, and cases of rape or incest accounted for 1.0% of abortions in 2000. Another study ^[1] revealed that women in 27 countries reported the following reasons for choosing an abortion:

• 25.5% – Want to postpone childbearing
• 21.3% – Cannot afford a baby
• 14.1% – Has relationship problem or partner does not want pregnancy
• 12.2% – Too young; parent(s) or other(s) object to pregnancy
• 10.8% – Having a child will disrupt education or job
•   7.9% – Want no (more) children
•   3.3% – Risk to fetal health
•   2.8% – Risk to maternal health
•   2.1% – Rape, incest, other

Methods of inducing abortion

Depending on the gestational age of the developing embryo or fetus, different methods of abortion can be preformed to remove embryo or fetus from the womb.

Chemical abortion

Main article: Chemical abortion

Chemical abortion comprimising 10% of all abortions in the United States and Europe, is a method used to induce abortion by ingesting drugs, usually during the first nine weeks of pregnancy. The Morning-after pill must be taken very soon after the sperm and ovum fuse, forming a zygote, aborting any further development of the embryo by preventing from implanting in the uterus. Further into the pregnancy chemical abortion is accomplished by administering either methotrexate or mifepristone (RU-486) followed by administration of misoprostol. Approximately eight percent of these abortions require surgical follow-up, usually by vacuum aspiration (See below). Methotrexate may also treat undiagnosed or concomitant tubal pregnancies, which occur in about two percent of all patients who desire to terminate their pregnancy.

Surgical abortion

In the first fifteen weeks, suction-aspiration or vacuum abortion are the most common methods, replacing the more risky dilation and curettage (D & C). Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses suction produced by an electric pump to remove the fetus or embryo. From the fifteenth week up until around the eighteenth week, a surgical dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Dilation and suction curettage consists of emptying the uterus by suction using a different apparatus. Curettage refers to the cleaning of the walls of the uterus with a curette. Dilation and curettage (D & C) is a standard gynaecological procedure performed for a variety of reasons, such as examination.

As the fetus grows, other techniques must be used to induce abortion in the third trimester. Premature delivery of the human fetus can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late abortions can be brought about by the controversial intact dilation and extraction (intact D & X) which requires the surgical decompression of the fetus's head before evacuation and is controversially termed "partial-birth abortion". A hysterotomy abortion, similar to a caesarian section but ending with a dead fetus, can also be used at late stages of pregnancy.

Other means of abortion

Some herbs are effective abortifacients. Using herbs in this way can cause serious side effects, including multipe organ failure and other serious injury (Ciganda C, Laborde A., "Herbal infusions used for induced abortion", J Toxicol Clin Toxicol. 2003;41(3):235-9) and are not reccomended by physicians. Many herbal recipes were compiled and published in medieval times under the name of Peter of Spain.

Physical trauma to a pregnant woman's womb can cause an abortion. The severity of the impact required to cause an abortion carries high risk of injury to the pregnant woman, without good chance for inducing an abortion. Both accidental (misscarriage) and deliberate abortions of this kind carry criminal liability in many countries. [2]

Health risks

Even in regulated legal clinics, there is a small risk of serious complications from the most common surgical abortion procedures. These risks include perforated uterus, septic shock, sterility, and death. The exact risk and type of complications depend on the abortion method as well as the clinical and hygienic conditions.

Studies have found that in developed countries where abortion is legal, the risk of serious physical complications of an abortion is less than 1%. In countries where abortion is illegal, this percentage is much higher, although the exact figure is unknown. This is likely due to the inherently dangerous nature of unregulated illegal surgery by doctors of dubious skill.

Use of "traditional medicine" methods (overdoses of various drugs, inserting various objects into uterus) for abortions is also dangerous. Serious complications from abortions done outside of professional clinics may include infections, bleeding, and in many cases lead to death.

Physical health

• Premature Birth: Recent studies revealed a substantially greater chance of premature birth for the next baby after an aborted pregnancy. Overall, 40% of women who had had an abortion are more likely to have a very pre-term delivery (less than 33 weeks) than those without such a history. The risk of an extremely premature baby (less than 28 weeks) is 70%. Abortion increase the risk and is one of most major causes of premature birth, including premature rupture of membranes, incorrect position of the fetus on the placenta, and spontaneous early labor. The only common cause of premature birth not linked to abortion was high blood pressure. ^[3]

Earlier studies had shown an increased risk of preterm birth associated with abortion, but had failed to establish a conclusive link. ^[4]

• Main article: abortion-breast cancer (ABC) hypothesis

The abortion-breast cancer (ABC) hypothesis posits an association between having an abortion and a higher risk of developing breast cancer. The proposed mechanism is based on the increased estrogen levels found during early pregnancy, which initiate cellular differentiation (growth) in the breast in preparation for lactation. The ABC hypothesis states that if the pregnancy is aborted before full differentiation in the third trimester, then more "vulnerable" undifferentiated cells would be left than prior to the pregnancy, resulting in an elevated risk of breast cancer. The majority of interview-based studies have indicated a link, some are statistically significant, but there is debate as to their reliability.

The most recent meta-analysis of 53 epidemiological studies published by Dr. Beral et al. in The Lancet in March 2004 found no ABC link; those findings have been disputed by Dr. Brind, a leading scientific advocate of the ABC hypothesis. Nevertheless, gaps and inconsistencies remain in the research as the "ABC link" continues to be a politicized issue.

• A specific complication that can arise, especially with repeated abortions by a dilatation and curettage, is the development of Asherman syndrome.

Mental health

Research has been carried on the question of whether abortion is associated with increased risk of clinical depression, but the results are mixed.

• According to one study of 1,884 women conducted by the National Longitudinal Survey of Youth, women whose first pregnancy ended in abortion are 65% more likely to be diagnosed with clinical depression around eight years later.
• Another study of 2,525 women revealed that women who had an abortion were more likely to report depression or lower satisfaction with their lives. However, they also often reported rape, childhood physical and sexual abuse, and violent partners. After controlling for the history of abuse, partner characteristics, and background variables, abortion was not related to poorer mental health. ^[5]

• A study in the Medical Science Monitor^[6] stated that, "Consistent with previous research, the data here suggest abortion can increase stress and decrease coping abilities, particularly for those women who have a history of adverse childhood events and prior traumata." In the study, 65% of post-abortive American women and 13.1% of Russian women experienced multiple symptoms of increased arousal, re-experiencing, and avoidance associated with posttraumatic stress disorder (PTSD). According to the study, 14.3% of American and 0.9 % of Russian women met the full diagnostic criteria for PTSD.^[7]

Abortion law

Main article: abortion law

Abortion has been a controversial subject throughout history due to the moral and ethical issues that surround it.

Both Human rights and constitutional rights are major issues. A human right to self-determination, regardless of gender, is recognised by most countries, often in their constitution. A human right to life is recognized by all countries. 25 countries have officially recognized this right being from the moment of conception in the "American Convention on Human Rights", which the United States has signed, but not ratified.

Historically, some cultures have offered legal protection to unborn human offspring. Abortion has been banned and otherwise limited. Almost two thirds of the world's women currently reside in countries where abortion may be obtained for some reasons. Abortion laws vary widely by country, with some countries allowing nearly total liberalization (extreme examples being the United States, China and Russia), and others banning abortion under any circumstances. In the United States, the Supreme Court has held that state laws restricting abortion contradict an implied constitutional right of privacy, while the German Supreme Court struck down state laws legalizing abortion, holding that they contradict the constitution's human rights guarantees. There are also countries that do not have any laws restricting abortion, such as Canada (see Abortion in Canada).

Debate on abortion

Main article: Morality and legality of abortion

The opinions towards abortion is mixed. Opponents of abortion are usually termed Pro-Life, while advocates for abortion rights are usually termed Pro-Choice.

Pro-choice stance

Main article: Pro-choice

The cornerstone of this stance is the issue of reproductive rights, which its proponents argue encompasses the right of a woman to choose to have an abortion. Most of the arguments are characterized by an appeal to privacy rights and gender equality. Well-known activist organizations like the National Organization for Women are generally pro-choice. Similar views are shared by groups including American Civil Liberties Union and Planned Parenthood.

Pro-life stance

Main article: Pro-life

This stance treats the human fetus as a person with human rights, and considers the abortion of the fetus killing an innocent human being, making elective abortion murder. The Catholic Church is one of the best known champions of the pro life stance. The culture of life is a view shared by many pro-life believers, seeing abortion, euthanasia and war as part of the culture of death. Similar views are shared by groups including Feminists for Life and Carenet.

Pressure on women

One issue where both the pro-choice and pro-life camps find common ground is the pressure felt by pregnant women. The shared belief that many pregnant women feel pressure that makes abortion seem to be the only reasonable option. Both groups have worked hard to open up alternative options to abortion.

Rape, incest and health

Pro choice advocates often argue that abortion needs to be widely available because some women become pregnant due to rape or incest or have dangerous pregnancies such as ectopic pregnancies or conditions such as Eisenmenger's Syndrome that threaten the health of a woman and/or the unborn child. Pro-life advocates consider the unborn human to be an innocent person who should not suffer due to the circumstances of conception, and suggest that alternatives such as adoption should be considered.

Abortion as a political issue

Abortion has been a bitterly-fought political issue, particularly in the United States. The controversy in the U.S. started in 1973 with the case of Roe vs. Wade, when the Supreme Court ruled abortion to be a constitutionally protected right. Specifically, it ruled that states could not forbid a woman to terminate her pregnancy in the first three months (the first trimester) of her pregnancy. The United States Supreme Court is largely considered the gatekeeper of abortion rights in the United States, and as a result, the possibility of the balance of the Court shifting towards a more conservative body became an issue in the 2004 US Presidential Election. In many other countries, abortion is less of a political issue. For a long time, it has not been a mainstream political issue in the United Kingdom. In the lead up to the 2005 General Election, Michael Howard, the leader of the Conservatives, stated that he, personally, might support a reduction in the limit from 24 weeks to 20 weeks, but the issue was not included in the party's manifesto for the election.

Other views

Early feminists took the view that abortion was a horrible tragedy, a disastrous crime, and a male-supported instrument to further power over women. Since then, the feminist movement has split into Pro-life feminists and other mainstream feminist groups.

Further complicating the debate is the issue of paternal rights, involving what rights and responsibilities the father has involving the unborn in question.

Related topics

• History of abortion
• Morality and legality of abortion
• Religion and abortion
• Sex-selective abortion and infanticide
• Selective reduction
• Self-induced abortion

Sources

• ^ Bankole, Akinrinola; Singh, Susheela; Haas, Taylor. "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries." International Family Planning Perspectives, 1998
• ^ Dr. Caroline Moreau of the Hôpital de Bicêtre in Paris, British Journal of Obstetrics and Gynaecology
• ^ http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/05/15/nabort15.xml
• ^ Denious, J. & Russo, N. F. (2000). The Socio-Political Context of Abortion and its Relationship to Women's Mental Health. In J. Ussher (Ed.). Women's Health: Contemporary International Perspectives (pp. 431-439). London: British Psychological Society.
• ^ http://www.medscimonit.com/medscimonit/index.php - Medical Science Monitor
• ^ Vincent Rue, Priscilla Coleman, James Rue, David Reardon (2004). Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit, 2004; 10(10): SR5-16

External links

Pro-life links

• Just Facts: Abortion
• Abort 73
• Gaudium et spes – Official Catholic Doctrine
• Explaining the Catholic Church's Teaching on Abortion
• Atheist and Agnostic Pro-Life League
• Feminists for Life
• The National Right to Life Committee

Pro-choice links

• Planned Parenthood
• The Alan Guttmacher Institute
• Catholics For A Free Choice
• The National Coalition of Abortion Providers
• WomenonWaves.org
• National Abortion Federation
• Religious Coalition for Reproductive Choice