Abortion

Medically, the term also refers to the early expulsion of a embryo or fetus by natural causes ("spontaneous abortion" or miscarriage), which ends approximately 10% of all pregnancies, usually within the first thirteen weeks, or to the cessation of normal growth of a body part or organ. What follows is a discussion of the issues related to deliberately induced abortion.

Methods of abortion

Depending on the gestational age of the developing embryo or fetus, abortion can describe a number of different ways to destroy and remove the fetus or embryo from the womb. Chemical abortion (or Medical Abortion as opposed to Surgical Abortion) is a method that is used when it is induced during the first nine weeks. The procedure consists of administering either methotrexate or mifepristone (RU-486) followed by administration of misoprostol. Approximately eight percent of these abortions require surgical followup, usually by vacuum aspiration (See below). Methotrexate may also treat undiagnosed or concomittant tubal pregnancies which occur in about 2% of all patients who desire to terminate their fetus or embryo. About 10% of abortions in the United States and Europe are induced medically.

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 embryo by suction using a manual syringe, while Electric vacuum aspiration or EVA abortion uses suction produced by an electric pump to remove the 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 is cleaning the walls of 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 intact dilation and extraction (D & X) or a hysterotomy abortion, similar to a caesarian section, and requiring the surgical decompression of the fetus's head before evacuation. This procedure is controversially termed "partial-birth abortion".

Ingestion of drugs, such as RU-486 and the morning-after pill, are dealt with in detail in other entries.

Health risks

Complications

• Even in regulated legal clinics there is a small risk of serious complications, including death, from the most common surgical abortion procedures. These risks include perforated uterus, septic shock and sterility.

• The exact risk and type of complications depend on the abortion method as well as the clinical and hygienic conditions. Studies 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 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 very dangerous. Serious complications from abortions done outside of professional clinics may include infections, bleeding, and in many cases lead to death.

Mental health

Research has been carried out on the question of whether abortion is associated with increased risk of clinical depression, but the results are mixed. According to a study of 1,884 women conducted by the National Longitudinal Survey of Youth, women who did not carry their first pregnancies to term are 65% more likely to be diagnosed with clinical depression around eight years later. However, other studies did not support a conclusion that depression may be caused by abortion. For example, a 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 (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.).

A study in the Medical Science Monitor said 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. (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).

In keeping with the paper, it should however be noted that many day to day tasks cause problems for sufferers of PTSD, especially as a result of child abuse.

Physical health

• Premature Birth: A study appearing in the British Journal of Obstetrics and Gynaecology by Dr. Caroline Moreau of the Hôpital de Bicêtre in Paris recently revealed a substantially greater chance of premature birth for the next baby after an aborted pregnancy. Overall, women who had had an abortion were 40 per cent 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 – one born at less than 28 weeks – was raised even more sharply, by 70 per cent. Abortion appeared to increase the risk of most major causes of premature birth, including premature rupture of membranes, incorrect position of the foetus on the placenta and spontaneous early labour. The only common cause of premature birth not linked to abortion was high blood pressure. Earlier studies that were significantly smaller in scope had shown that the risk of preterm birth increased with the number of abortions but had failed to establish a conclusive link. [1]

• Main Article: Abortion-Breast Cancer (ABC) hypothesis

The Abortion-Breast Cancer (ABC) hypothesis is based on the fact that during early pregnancy, hormone levels increase significantly. This initiates cellular differentiation (growth) in the breast preparing 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 a debate as to how reliable they are. The most recent meta-analysis published in The Lancet (March 2004) of 53 epidemiological studies concluded that there was no ABC link. Nevertheless, gaps remain in the research and the "ABC link" is still a hot campaigning issue in pro-life circles.

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

Abortion law

Main Article: abortion law

Abortion has been a controversial subject throughout history due to the moral and ethical issues that surround it. Limitations of the constitutional right to self-determination of women are one of the core issues of the philosophy of law. Abortion has been regularly banned and otherwise limited. Almost 2/3 of the world’s women currently reside in countries where abortion may be obtained on request or for a broad range of social, economic or personal reasons. Abortion laws vary widely by country, with some countries allowing nearly total liberalization, and others banning abortion under any circumstances. There are also countries that do not have any laws restricting abortion, such as Canada (see Abortion in Canada).

Paternal rights

Some have argued that abortion also involves rights for prospective fathers. For a discussion of this topic, please see the Oklahoma Law Review, "Abortions of the Paternal Prerogatives Of Unwed Natural Fathers," 2000.

Abortion as a political issue

Abortion has sometimes been a bitterly-fought battle in politics, particularly in the United States. The real 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, they ruled that states could not forbid a woman to terminate her pregnancy in the first three months (the first trimester) of her pregnancy.

Opponents of abortion are usually termed Pro-Life, whilst proponents of abortion rights are usually termed Pro-Choice. 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 was not considered a mainstream political issue in Great Britain. However, in the runup 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, a move supported by both the Anglican and Catholic Churches, and leading figures in other parties. More radical UK Christian groups such as Christian Voice view such reductions as inconsequential and wish to see abortion outlawed completely. Any review would, however, still be subject to a 'free vote' by Members of Parliament – 'free' meaning that Members would not be required to support their party's policy, if any, on the subject.

Debate on abortion

Main article: Morality and legality of abortion

Pro-choice-stance

The cornerstone of the pro-choice movement is 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, but similar views are shared by groups ranging from American Civil Liberties Union to Planned Parenthood.

Pro-life movement

The pro-life movement states that the human fetus is a human person with human rights, and that the right to life is the premier right. Some Pro-life supporters connect abortion to war and characterize it as a institution of violence that harms women and children. Well-known organizations like the Catholic Church are pro-life, but similar views are shared by many groups including Carenet (with its 850 pregnancy care centers).

Though members of both political parties come down on either side, the Republican Party is often seen as being pro-life, since the official party platform has a pro-life plank. In contrast, the group Democrats for Life is marginalized within the Democratic Party.

Feminism and abortion

Historic feminism

Early feminists took the view that abortion was a horrible tragedy, a disastrous crime, and a male-supported instrument to further power over women.

Elizabeth Cady Stanton termed abortion infanticide. Mattie Brinkerhoff characterized abortion as destroying the life of an unborn child, and evidence that a woman "has been greatly wronged." Victoria Woodhull, the first female US presidential candidate, affirmed that "[t]he rights of children as individuals begin while yet they remain the foetus." Caroline Elizabeth Sarah Norton wrote of "infant butcheries" and "ante-natal child murder," describing abortion as interfering with "the right of the unborn to be born." Mary Wollstonecraft suggested outright that abortion violated the laws of nature and Matilda Joslyn Gage suggested it was one of the greatest wrongs against women and that it was committed by men. Alice Paul, author of the first Equal Rights Amendment in 1923, said simply "Abortion is the ultimate exploitation of women." Susan B. Anthony referred to it as "child murder" and said:

"Guilty? Yes. No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh, thrice guilty is he who drove her to the desperation which impelled her to the crime!"

However, groups like Feminists for Life continue to advance the views of the early feminists by rejecting the notion that abortion is ever a right.

Current Feminism

This historical pro-life stance is no longer shared by most feminist organizations. Most feminists oppose limitations of women's rights, and consider abortion laws as limitations on the right to self determination.

Other Debates

The "rape, incest and health" debate

Pro-choice politicians often argue that abortion should be widely available because some women become pregnant due to rape (to include incest) or have pregnancies that threaten their health.

Pro-life advocates offer two responses. First, the fetus is an innocent party who should not suffer because of the circumstances of her conception. Secondly, they will note that a very small percentage of abortions are performed for "Rape, Incest or Health."

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

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

Source: Bankole, Akinrinola; Singh, Susheela; Haas, Taylor. "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries." International Family Planning Perspectives, 1998

Legislative effectiveness debates

Some pro-choice advocates prefer to advance the position that re-criminalizing abortion will be ineffective; in their view, abortions would continue, but under difficult and unsafe conditions. They argue that re-criminalization would increase the suffering of an already vulnerable segment of the population. The estimated number of abortion procedures per year prior to 1973 ranges from to 100,000 to 1,000,000, compared to the official CDC statistic of 1,186,039 in 1997, (1997 being the last year data is available). The abolition of abortion, these advocates maintain, could be as ineffective and dangerous as the abolition of alcohol. This view assumes that because abortions would be performed in any case, the state has a duty to keep abortion legal to ensure the safety of women.

Pro-life advocates counter that the effectiveness argument is a red-herring; it disregards the moral issues, especially the unborn child's right to life. They object to parallels to Prohibition as presuming a moral equivalency between abortion and alcohol consumption. They note also, that Prohibition considerably reduced American consumption of alcoholic beverages and hospital admissions for liver disease. They hold that, likewise, criminalization of abortion would deter many abortion procedures and save lives, and also that the legalisation of abortion does not significantly increase women's safety.

Related topics

• Chemical abortion
• Fetal protection
• History of abortion
• Morality and legality of abortion
• Religion and abortion
• Roe effect
• Sex-selective abortion and infanticide
• Selective reduction

External links

Politically neutral links

• Just Facts: Abortion – Science of the fetus, history of U.S. abortion law, Gallup poll and other media information.