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 not resulting in live birth 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, especially in the United States. This article focuses on induced abortions.

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 subcatagorized into therapeutic abortion and elective abortion.

• Therapeutic abortion: An abortion requested because the pregnancy poses health risk to the pregnant woman (gravida).
• 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 gravida herself.
• Forced abortion: An abortion performed without the consent of the gravida.

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. Data collected from women in 27 countries suggests that 34 of 35 abortions are elective:^[1]

• 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 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.

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.^[2] 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.^[3]

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.

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

• Main article: Premature birth

A recent study indicated a higher chance of premature birth after an aborted pregnancy. Women with a previous induced abortion had 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. Abortion is likely a factor for premature birth, associated with premature rupture of membranes, incorrect position of the fetus on the placenta and spontaneous early labor.^[4] Earlier studies had shown an increased risk of preterm birth associated with abortion, but had failed to establish a conclusive link.^[5]

• 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. ^[6]

• A study in the Medical Science Monitor^[7] 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.^[8]

Debate on abortion laws

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. The complex issue usually focuses on the legal status of induced abortions. Advocates for making or keeping induced abortion illegal are usually termed Pro-Life. Advocates for making or keeping abortion legal are usually termed Pro-Choice.

Current status of abortion law

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 certain reasons. Abortion laws vary widely by nation, with some countries allowing nearly total liberalization (examples including 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 (see Abortion in the United States), 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).

The ongoing debate

Pro-choice stance

The pro-choice stance usually appeals to several ideals, such as the rights of privacy and bodily integrity, which state that any person should be free to choose what to do with his or her body without government interference. Further arguments include issues of gender equality. and reproductive rights. Pro-choice advocates also 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 fetus. Finally, many pro-choice advocates argue that abortions should be legal to prevent self-induced abortions. Organizations supporting the pro-choice stance are usually considered liberal. Pro-choice groups include the National Organization for Women, American Civil Liberties Union and Planned Parenthood.

Pro-life stance

The pro-life stance usually appeals to several ideals, such as universal human rights and the protection of the innocent. Pro-life advocates hold that the unborn human is an innocent person, and that the circumstances of conception do not justify a denial of human rights. They hold that killing the unborn is the same as killing any other innocent person (murder). This view holds that the perceived problem of an unwanted child should be solved through adoption, not the violence of abortion. Pro-life advocates often promote the culture of life, which holds the right to life as the most fundamental of all rights. The pro-life stance is often part of a larger advocacy against euthanasia, unjust war and most capital punishment. This stance argues that a society should be judged by how it treats its weakest members, among whom are those still in utero. Pro-life groups include the Catholic Church, Feminists for life and Carenet.

Common Ground

One issue where both the pro-choice and pro-life camps find common ground is the pressure felt by pregnant women. The shared belief is that many pregnant women feel pressure that makes abortion seem to be the only reasonable option, and not a true choice. Advocate groups on both sides have worked on some combination of improving information pregnancy prevention, improving access to birth control, and funding and improving adoption services.

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, while the majority of feminist groups are pro-choice. Further complicating the debate is the issue of paternal rights, involving what rights and responsibilities the father has regarding the unborn offspring in question.

Related topics

• Abortion in the United States
• History of abortion
• Morality and legality of abortion
• Partial-birth 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
• ^ Moreau, C. et al, "Previous induced abortions and the risk of very preterm delivery", BJOG. 2005; 112(4):430-7
• ^ 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
• ^ Ciganda C, Laborde A., "Herbal infusions used for induced abortion", J Toxicol Clin Toxicol. 2003; 41(3):235-9
• ^ Education For Choice – Unsafe abortion

External links

Pro-life links

• Just Facts: Abortion
• Unsafe Abortion Today
• Excerpts from Embryology Textbooks
• Feminists for Life
• Vatican II: Gaudium et Spes, paragraph 51 – Official Catholic Doctrine
• CareNet
• National Right to Life

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