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Self-induced abortion

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A self-induced abortion (or self-induced miscarriage) is an abortion performed by the pregnant woman herself or with the help of other, non-medical assistance. Although the term includes abortions induced with legal over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, sometimes more dangerous means. Such practices may present a threat to the health of women.[1] If the abortion does not result in termination of the pregnancy, damage to the fetus can occur.

Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last menstrual period).[2][3] In recent years, significant reductions in maternal death and injury resulting from self-induced abortions have been attributed to the growing use of misoprostol (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of post-partum hemorrhage, stomach ulcers, and induction of labor.[4] The World Health Organization has endorsed a standardized regimen of misoprostol to induce abortion up to 9 weeks of pregnancy. This regimen has been shown to be up to 83% effective in terminating a pregnancy.[5]

Methods attempted

Women in India are reported to use the following to induce abortion:

  • Lifting of heavy weights;
  • Consumption of mutton marrow;
  • Consumption of dried henna powder;
  • Consumption of carrot seed soup;[6]

There are a number of narratives that have described self-induced abortions. Many of the following methods present significant danger (see below) to the life or health of the woman:

  • physical exertion designed to bring about a miscarriage
  • bellyflopping onto a hard surface, or throwing herself down a flight of stairs
  • attempted removal of the fetus with a steel wire coat-hanger or similar device inserted into the uterus through the cervix (the historical use of this method has led to instances of its use as a symbol of the pro-choice movement, illustrating dangers of barring medically-administered legal abortion)[7][8][medical citation needed]
  • attempted piercing of the fetus with a knitting needle, crochet hook, hat pin, bobby pin or similar device inserted into the uterus through the cervix
  • insertion of a rubber tube or catheter into the uterus and attempting to suck the fetus out, or, alternatively, blowing air into the uterus to cause a miscarriage (if the tube or catheter pierced a blood vessel, this would sometimes lead to air embolism, which could be fatal[medical citation needed])
  • ingesting abortifacients, vitamin C megadosage, pennyroyal or other substances believed to induce miscarriage
  • douching with substances believed to induce miscarriage, such as turpentine, clorox bleach, or lye, all of which could cause intense chemical burns (beginning in the 1960s, many women used Coca-Cola for this purpose, although its utility is at best dubious)
  • vaginal pessaries
  • yoga
  • acupuncture at points linked to miscarriage
  • hypothermia (many women would lie for periods of time in snowbanks, which could be fatal to them) or hyperthermia (women would lie in tubs filled with hot or even scalding water for periods of time, often while simultaneously drinking gin)

In a letter to the New York Times, gynecologist Waldo L. Fielding wrote:

The familiar symbol of illegal abortion is the infamous "coat hanger" — which may be the symbol, but is in no way a myth. In my years in New York, several women arrived with a hanger still in place. Whoever put it in — perhaps the patient herself — found it trapped in the cervix and could not remove it...However, not simply coat hangers were used. Almost any implement you can imagine had been and was used to start an abortion — darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off.[8]

Charles Jewett wrote The Practice of Obstetrics in 1901. In it, he stated, "Oil of tansy and oil of rue are much relied on by the laity for the production of abortion, and almost every day one may read of fatal results attending their use. Oil of tansy in large doses is said to excite epileptiform convulsions; quite recently one of my colleagues met such a case in his practice."

In the 1994 documentary Motherless: A Legacy of Loss from Illegal Abortion, Louis Gerstley, M.D., said that, in addition to knitting needles, some women would use the spokes of bicycle wheels or umbrellas. "Anything that was metal and long and thin would be used," he claimed. He stated that a common complication from such a procedure was that the object would puncture through the uterus and injure the intestines, and the women would subsequently die from peritonitis and infection. Later in the film he mentioned that potassium permanganate tablets were sometimes used. The tablets were inserted into the vagina where they caused a chemical burn so intense that a hole may be left in the tissue. He claimed the tablets left the surrounding tissue in such a state that doctors trying to stitch up the wound couldn't do so because "the tissue was like trying to suture butter." Dr. Mildred Hanson also described the use of potassium permanganate tablets in the 2003 documentary Voices of Choice: Physicians Who Provided Abortions Before Roe v. Wade. She said, "the women would bleed like crazy because it would just eat big holes in the vagina."

Dr. David Reuben mentions that many African women use a carved wooden abortion stick to induce, which has often been handed down.[9]

Attempts to insert hazardous objects into the uterus are particularly dangerous, as they can cause punctures leading to septicemia. Ingesting or douching with harmful substances can have poisonous results. Receiving blows to the abdomen, whether self-inflicted or at the hands of another, can damage organs. Furthermore, the less dangerous methods – physical exertion, abdominal massage, and ingestion of relatively harmless substances thought to induce miscarriage – are less effective, and may result in the fetus developing birth defects. However, abdominal massage abortion is traditionally practised in Myanmar, Thailand, Malaysia, the Philippines, and Indonesia.[10][11]

The prescription synthetic prostaglandin drug misoprostol – used in the U.S. to treat gastric ulcers – is often used as an abortifacient in self-induced abortion in Latin American countries where legal abortions are unavailable, and its use has also been observed in immigrant populations in New York.[12] Although proponents of this method deem it to be safer than those using insertion of objects or chemicals into the uterus, they also note that failure to effect an abortion by this method can lead to the child being born with serious birth defects. Furthermore, the drug causes a drastic drop in blood pressure, and women may hemorrhage as a result of misusing the drug for the purpose of abortion.[13]

Current medical procedures are significantly safer than traditional at-home methods,[14] and are in fact safer than childbirth.[15]

Rates

Methods of inducing abortion vary globally. An estimated twenty-five million unsafe abortions occur each year.[16] Approximately 69,000 women die of unsafe abortion each year, though not all as a result of self-induced abortions.[17]

Survivors of self-induced abortion can have long-term consequences related to their health. From 1995 to 2003 the number of total abortions including those supervised by medical personnel and those that were self-induced declined.[1] While maternal morbidity and mortality from unsafe abortion has continued to increase due to population growth, in Latin America, from 2005 to 2012, there was a 31% decrease in the number of complications from unsafe abortion, from 7.7/1,000 to 5.3/1,000. Researchers believe that this may be due to the wide availability of misoprostol in Latin America[18].

History

The practice of attempted self-induced abortion has long been recorded in the United States. Turn-of-the-20th-century birth control advocate Margaret Sanger wrote in her autobiography of a 1912 incident in which she was summoned to treat a woman who had nearly died from such an attempt.[19]

A study concluded in 1968[20] determined that over 500,000 illegal abortions were performed every year in the United States, a portion of which were performed by women acting alone. The study suggested that the number of women dying as a result of self-induced abortions exceeded those resulting from abortions performed by another person. A 1979 study noted that many women who required hospitalization following self-induced abortion attempts were admitted under the pretext of having had a miscarriage or spontaneous abortion.[21]

WHO estimates that approximately 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47,000 women and disabilities for an additional 5 million women. Almost every one of these deaths and disabilities could have been prevented through sexual education, family planning, and the provision of safe abortion services. Abortion pills, which began be used by women themselves in Brazil in the 1980s, can prevent many of these deaths from unsafe abortion.[22]

Law

Although Roe v. Wade[23] made abortion more readily available throughout the U.S., it remains a crime in most jurisdictions for a woman to attempt to perform an abortion on herself. In May 2005, Gabriela Flores – a 22-year-old Mexican immigrant farm worker and mother of three living in Pelion, South Carolina – was charged under such a statute, which carried a maximum penalty of two years in prison. She had induced abortion at roughly 16 weeks by ingesting misoprostol under the brand name Cytotec, an ulcer medication with abortifacient potential. She was sentenced to 90 days in jail. Mississippi classifies self-induced abortions as deaths which affect the public interest, requiring that physicians report them to the local medical examiner. By contrast, New Mexico's "Unborn Victims of Violence Act" exempts self-induced abortion from the criminal liability the act creates.[citation needed]

See also

References

  1. ^ a b Haddad, Lisa B; Nour, Nawal M (2009). "Unsafe Abortion: Unnecessary Maternal Mortality". Reviews in Obstetrics and Gynecology. 2 (2): 122–126. ISSN 1941-2797. PMC 2709326. PMID 19609407.
  2. ^ Worrell, Marc. "About the "I need an abortion" project — Women on Web".
  3. ^ Sage-Femme Collective, Natural Liberty: Rediscovering Self-Induced Abortion Methods (2008).
  4. ^ Wood, Alastair J. J.; Goldberg, Alisa B.; Greenberg, Mara B.; Darney, Philip D. (2001). "Misoprostol and Pregnancy". New England Journal of Medicine. 344 (1): 38–47. doi:10.1056/NEJM200101043440107. PMID 11136959.
  5. ^ "Gynuity Health Projects » Abortion With Self-Administered Misoprostol: A Guide For Women".
  6. ^ Khokhar, A.; Gulati, N. (2000). "Profile of Induced Abortions in Women from an Urban Slum of Delhi" (PDF). Indian Journal of Community Medicine. 25 (4). Chandigarh, Republic of India: Indian Association of Preventive & Social Medicine: 177–80. ISSN 1998-3581. OCLC 60622662. Retrieved 11 July 2009.
  7. ^ Tom Strode, "Berkeley sends coat hangers to Congress", LIFE DIGEST (December 15, 2009).
  8. ^ a b Waldo L. Fielding, M.D., Tony Cenicola, ed., "Repairing the Damage, Before Roe", The New York Times (June 3, 2008).
  9. ^ Reuben, David (c. 1971). "Abortion". Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask) (17th ed.). Bantam. pp. 323–324. ISBN 0-553-05570-4.
  10. ^ Malcolm Potts, Martha Campbell, History of Contraception Archived 17 December 2008 at the Wayback Machine, Vol. 6, Chp. 8, Gynecology and Obstetrics, 2002.
  11. ^ Population Policy Data Bank maintained by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Thailand: Abortion Policy.
  12. ^ John Leland: "Abortion Might Outgrow Its Need for Roe v. Wade", The New York Times, 2 October 2005.
  13. ^ Kathy Simmonds, Susan Yanow, Use of Misoprostol for Self-induced Abortion Around the World.
  14. ^ Grimes DA; Benson J; Singh S; et al. (2006). "Unsafe abortion: the preventable pandemic" (PDF). Lancet. 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724. {{cite journal}}: Unknown parameter |name-list-format= ignored (|name-list-style= suggested) (help)
  15. ^ Raymond, Elizabeth G.; Grimes, David A. (1 February 2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology. 119 (2). doi:10.1097/AOG.0b013e31823fe923. ISSN 0029-7844.
  16. ^ "Preventing unsafe abortion". World Health Organization. Retrieved 2 March 2018.
  17. ^ Grimes DA, Benson J, Singh S, et al. (November 2006). "Unsafe abortion: the preventable pandemic" (PDF). Lancet. 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724.
  18. ^ Singh, Susheela (August 2015). "Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries". BJOG. 123–9. doi:10.1111/1471-0528.13552. PMC 4767687 – via onlinelibrary.wiley.com.
  19. ^ Margaret Sanger. An Autobiography. (New York, W. W. Norton & Company, 1938).
  20. ^ Richard Schwarz, Septic Abortion (Philadelphia: JB Lippincott Co., 1968).
  21. ^ Bose C., A comparative study of spontaneous and self-induced abortion cases in married women. J Indian Med Assoc. 1979 August; 73 (3-4): 56-9.
  22. ^ DeZordo, Silvia (January–March 2016). "The biomedicalisation of illegal abortion: the double life of misoprostol in Brazil". Hist. cienc. saude-Manguinhos. Vol 23, No. 1. ISSN 1678-4758. {{cite journal}}: |volume= has extra text (help)
  23. ^ Roe v. Wade, 410 U.S. 113 (1973).

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