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Abortion

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An abortion is the premature termination of pregnancy ending in the death of the embryo or fetus. In medical science, all terminations of pregnancy not resulting in childbirth are defined as abortions. In common parlance, the terms miscarriage or stillbirth are applied to spontaneous (non-induced) abortions. The ethics and morality of induced abortion has become the subject of an intense debate in the past 50 years, in various areas of the world including the United States of America, Canada and a number of countries in Europe. While abortions can be performed and occur in any animal that gives birth, this article focuses exclusively on abortions performed upon humans.

Abortion definitions

  • Spontaneous abortion: An abortion due to accidental trauma or natural causes. Also known as a stillbirth or miscarriage.
  • Induced abortion: Deliberate (human induced) abortion. Induced abortions are subcategorized into therapeutic abortion and elective abortion.
  • Therapeutic abortion: An abortion perfomed because the pregnancy poses health risk to the pregnant woman (gravida).
  • Elective abortion: An abortion perfomed for any other reason.

Spontaneous abortion

Main article: miscarriage

Spontaneous abortions, known more commonly as miscarriages, occur frequently. Up to 78% of all conceptions may fail, most of which occur even before pregnancy is confirmed. 15% of all confirmed pregnancies end in a miscarriage. Most miscarriages occur very early in a pregnancy. Since early embryonic development is a very mistake ridden process, the body will spontaneously abort if a fetus is not viable (i.e., due to genetic deformities, such as most cases of trisomy), or when the womb is unable to support the development of the fetus. A spontaneous abortion can be caused by accidental trauma, while trauma with the intent to cause miscarriage is considered an induced abortion. Some states have laws increasing the criminal liability of a person who causes a miscarriage during an assault or other violent crime.

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. Women from 27 nations reported the following reasons for seeking an induced 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

In many areas of the world, especially the developing nations or where induced abortions are illegal, many women choose or are forced to perform abortions on themselves. These self-induced abortions are commonly unsafe abortions as described by the World Health Organization. Furthermore, some abortions are induced because of societal or legal pressure, such as under China's one-child policy. These policies and societal pressures can lead to sex-selective abortion and infanticide, which is illegal in most countries, but difficult to stop.

Methods of inducing abortion

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

Chemical abortion

Main article: Chemical abortion

Chemical abortion, clinically known as medical abortion, comprises 10% of all abortions in the United States and Europe. Chemical abortion is a method used to induce abortion during the first trimester. Chemical abortion is accomplished by administering either methotrexate or mifepristone (RU-486) followed by administration of misoprostol. About 8% of medical abortions require surgical follow-up, usually by vacuum aspiration (See below). Methotrexate may also treat undiagnosed or concomitant tubal pregnancies.

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

Certain herbs are considered by some to be effective abortifacients. Using herbs in this way can cause serious side effects, including multiple organ failure and other serious injury, and are not recommended 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 necessarily inducing a miscarriage. Both accidental and deliberate abortions of this kind carry criminal liability in many countries.

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. The risks of abortion should be counterpointed to the risks of childbirth.

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 or by persons with no or insufficient medical training.

Use of "traditional medicine" methods (e.g., overdoses of various drugs and 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

A recent study suggested a higher chance of premature birth after an aborted pregnancy. Women with a previous induced abortion supposedly have a 50% increased risk of a very pre-term delivery (less than 33 weeks), and the risk of an extremely premature baby (less than 28 weeks) was 70% higher. When put in context of the overall risk of preterm birth – if the findings are accurate – it would increase risk from a 10% chance before an aborted pregnancy to approximately a 15% chance after an aborted pregnancy. According to the study the increased risk of an extreme premature birth rose from 1.5% to 1.9%. Abortion may be a factor for premature birth, and according to the study is associated with premature rupture of membranes, incorrect position of the fetus on the placenta and spontaneous early labor.
Other sources have linked many of the above complications to bacterial vaginosis and concluded that abortion is not a likely factor.
The controversial 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.

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.
  • A study in the Medical Science Monitor 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, or 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.

Emergency Contraception

Main article: Emergency contraception

Emergency contraception refers to forms of birth control that can be used after sexual intercourse. Birth control primarily prevents pregnancy by preventing fertilization. However, some forms of birth control, especially if used immediately prior to or after intercourse, can potentially prevent implantation of a fertalized egg, causing the death of the embryo. Those who believe that life starts at conception consider this morally equivalent to an abortion. The most controversial of these forms of emergency contraception is currently the morning-after pill, which is legal in a number of countries and has recently been legalized in the United States and in Canada.

The debate

Main article: Morality and legality of abortion

Throughout the history of abortion, induced abortions have always been a source of considerable debate and controversy. An individual's personal stance on the complex ethical, moral, and legal issues has a strong relationship with that individual's value system.

A number of major ethical, moral and legal issues coincide with abortion, making it a very complex issue. A person's position on abortion may be best described as a combination of their personal beliefs on the morality of induced abortion, and that person's beliefs on the ethical limit of the government's legitimate authority.

In debate, whether friendly discussion or political positioning, the arguments on abortion usually seek to change either an individual's beliefs on the correctness of an induced abortion, or the correctness of laws permitting or restricting abortion. Arguments on morality and legality tend to conflux, confusing the issue at hand.

Abortion debates, especially pertaining to the legal ramifications of abortion laws, are often spearheaded by advocacy groups. These groups tend to fall into one of two camps, with people in favour of legal abortion being described as pro-choice, while those against legal abortion are described as pro-life. Both pro-choice and pro-life are loaded terms, designed to make opposition unappealing (anti-choice and anti-life). Individuals are also usually classified or self-described as pro-choice or pro-life. See also list of pro-choice organizations and list of pro-life organizations.

In reality, both pro-choice and pro-life are too simplistic to encompass the full complexity of the debate. A person may be personally uncomfortable with and morally opposed to abortion (thus being pro-life) while believing the option of abortion should remain legal (thus being pro-choice as well). In addition, an individual will likely have a stance that is in between the extremes of abortion being always/never moral and/or legal depending on the circumstance. For example, the same individual described earlier may believe that the abortion of a fetus with Eisenmenger's syndrome is morally correct, but also believe that partial-birth abortions should be illegal.

The abortion debate covers a number of issues, including but not limited to: human rights, constitutional rights, privacy, gender equality, religion, parental responsibility and individual liberty. Some of the most significant and common issues are:

  • The beginning of personhood: sometimes phrased ambigiously as "the beginning of life", when is an unborn human considered a person? See also fetal personhood.
  • Universal human rights: Is aborting an unborn human a violation of human rights?
  • Circumstances of conception: How important are the circumstances of conception to the ultimate fate of the embryo or fetus? Does pregnancy induced by rape or incest or by poor or non-existent birth control use change the permissibility of abortion?
  • Alternatives to abortion: Is adoption a viable and fair alternative to abortion?
  • Limit of government authority: Are laws controling abortion violations of privacy and/or other personal liberty rights?

These issues, and others, are treated in more detail within the main Morality and legality of abortion article.

The abortion debate, especially in the United States, has a prominent place in political campaigning. Liberal groups tend to be in favor of making or keeping abortion legal, while conservative groups tend to be for making or keeping abortion illegal. These positions may be part of a more general stance on stem-cell research, capital punishment and euthanasia. Other closely related issues with political importance are the culture of life, adoption and feminism.

Related topics

Sources

External links

Pro-life links

Pro-choice links

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