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An abortion is the premature termination of pregnancy ending in the death of the embryo or fetus. A pregnancy that ends early, but where the embryo or fetus survives to be born as an infant is instead a premature birth. In medicine, a pregnancy that ends because of an accident or natural causes is qualified as a "spontaneous abortion", while a pregnancy that ends because of deliberate interference with that pregnancy is qualified as an "induced abortion." Spontaneous abortions are also refered to as miscarriages. In common parlance, the term "abortion" is used exclusively for induced abortion.

The ethics and morality of induced abortion have 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. Unless otherwise specified, this article shall use strict dictionary definitions of related terminology, as opposed to colloquial or implied meanings.

Abortion terminology

The intense and virulent debate surrounding the subject of abortion has created a number of linguistic pitfalls, where the use of certain terms carries implications beyond their actual definition. A common example of these linguistic traps is the use of the word "human", which is often used with the word "person" interchangeably. While it is uncontested that an embryo or fetus contains unique DNA and is of the species Homo sapiens, there is intense disagreement as to whether an embryo or fetus is a person. Similar implications surround the use of the terms life and death. In biology, life and death are applied to all levels of the organism, from individual cells, to organs, to the whole organism. The term "life" and the term "existence" are frequently used interchangeably, and can imply that an embryo that is "alive" is not merely existent, but is a person. The term unborn is also frequently used to refer to the embryo or fetus. Often this is in the context of "unborn child" or "unborn baby". The use of the term "unborn" is controversial because of its frequent use in the abortion debate.

In medicine, the following terms are used to define an abortion:

  • 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 further subcategorized into therapeutic abortions and elective abortions.
    • Therapeutic abortion: An abortion perfomed because the pregnancy poses physical or mental 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, in most cases 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 an error prone process, the body may 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.

Induced abortions

The term "abortion" is usually used by lay people to refer to induced abortion. Induced abortions are sought for a number of reasons, 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:[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 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. Misoprostol may also be used alone to induce abortion; however the need for surgical intervention is slightly elevated (about 10%), compared to the 8% of medical abortions using a combination of medications. Surgical intervention is primarily vacuum uterine aspiration (See below). Methotrexate may also treat undiagnosed or concomitant ectopic 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 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 and bleeding. In many cases, such abortions lead to death.

Physical health

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 because of possible response bias.
According to the National Cancer Institute (NCI), it is "well established" that "induced abortion is not associated with an increase in breast cancer risk." 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

The medical literature has not conclusively shown that abortion affects mental health.

"[The US Surgeon General in 1989] conducted a review of the more than 250 studies in the literature pertaining to the psychological impact of abortion. Every effort was made to eliminate the bias that surrounds this controversial issue. It was not possible, however, to reach any conclusions about the health effects of abortion."[4]

Research on the risk of clinical depression associated with abortion has been inconclusive:

  • 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 trauma." 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.[7] However, in all fairness, not all PTSD is necessarily from abortion. Labor Law Talk has this commentary on the paper: "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. Visits to dentists are often a problem, but women often still try to get to them and to avoid all events in life that might lead to re-traumatization." [8]

See also: Abortion trauma syndrome

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 personhood starts at conception consider this to be 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.

History of abortion

Main article: History of abortion

According to anthropologist George Devereux, (induced) abortion has occurred from ancient times forward. Abortions were induced with sharpened sticks, poisonous herbs, abdominal pressure, special exercises, and other techniques. Many ancient texts contain specific recipes for abortificants, or even descriptions of specialized medical instruments designed to remove a fetus from the womb. Along with changes in medical science, there have been changes in the societal norms and laws that governed abortion.

The debate

Main article: Abortion debate

Throughout the history of abortion, induced abortions have always been a source of considerable debate and controversy regarding the morality and legality of abortion. An individual's position on the complex ethical, moral, and legal issues has a strong relationship with that a given individual's value system. 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 (and thus law's) legitimate authority. Another signifcant factor is that of an individual's religious beliefs. Most of the world's major religions find abortion either morally wrong or at least distasteful, for more see the religion and abortion article.

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 individual's beliefs on the moral 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 at least 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). Both terms are euphemisms designed to evade the use of the term "abortion", such as being "pro-abortion' or "anti-abortion". The inducing of abortion itself is alternately referred to as a "procedure" by some and "murder" by others with differing views. Likewise, the use of the word "choice" is often considered controversial, regarding who should and does have a choice, the embryo/fetus, the mother and father, the woman alone or someone else? Individuals are also usually classified or self-described as pro-choice or pro-life, despite the range of intermediate opinions. See also list of pro-choice organizations and list of pro-life organizations.

Political sides have largely been separated into absolute extremes —either seeking to make all abortion illegal, or to permanently remove laws restricting all forms of abortion. Likewise, debate tends to center around individuals with strong positions, and pro-choice and pro-life advocates. In general, the public seems to hold moderate positions. Strong public support for statements such as "Abortion destroys a human life and is manslaughter" and strong support that abortion should be illegal "When the woman or family cannot afford to raise the child" would seem to indicate strong opposition to abortion. At the same time however, circumstances such as "When the pregnancy was caused by rape or incest" and "When the woman's physical health is endangered" have strong public support for legalization.

Abortion law

Main article: Abortion law
International status of abortion law

The Soviet Union (1920) and Iceland (1935) were some of the first countries to generally allow abortion. The second half of the twentieth century saw the liberalization of abortion laws in many other countries. In 1973, The U.S. Supreme Court struck down state laws banning abortion after it was ruled that these laws were in violation of an inferred right to privacy in the U.S. Constitution. The Supreme Court of Canada, similarly, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under in the Canadian Charter of Rights and Freedoms. Ireland, on the other hand, added an amendment to its Constitution in 1983 by popular referendum recognizes "the right to life of the unborn."

Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. Two major issues of human rights provide philosphical justification for the laws on abortion. The right to life and the right of personal liberty, both championed by human rights documents such as the Universal Declaration of Human Rights, are used as justification for either the allowance or the restriction of abortion. Many countries in which abortion is legal, require that certain criteria be met in order for an abortion to be obtained, sometimes including a trimester cutoff for the window in which abortion is still legal to preform:

  • In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
  • In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessitated before it can be performed.

Other countries, in which abortion is illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A handful of nations ban abortion entirely, such as Chile, El Salvador, and Malta.

In addition, multi-national and international treaties, conventions, and laws may either serve as the justification for national laws, or international law may actually be enforced on and within a nation. There is an inherent difficulty in the enforcement of international law due to the issue that state sovereignty poses. As such, the effectiveness of even binding multinational efforts to legislate the rights to life and liberty in general, or abortion in specific, is difficult to measure. Examples of such efforts that have or might have bearing for abortion law, nationally or internationally, include:

  • The 1994 Programme of Action states, in paragraph 8.25, "In no case should abortion be promoted as a method of family planning. . . Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process. In circumstances where abortion is not against the law, such abortion should be safe." The document was adopted by at least 179 countries at the United Nations International Conference on Population and Development held in Cairo, Egypt.

Sources

  1. ^ Bankole, Akinrinola; Singh, Susheela; Haas, Taylor. "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries." International Family Planning Perspectives, 1998
  2. ^ Moreau, C. et al, "Previous induced abortions and the risk of very preterm delivery", BJOG. 2005; 112(4):430-7
  3. ^ http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/05/15/nabort15.xml
  4. ^ Beral V, Bull D, Doll R, Peto R, Reeves G; Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries. Lancet. 2004 Mar 27;363(9414):1007-16. PMID 15051280
  5. ^ Koop CE. Post abortion syndrome: myth or reality? Health Matrix. 1989 Summer;7(2):42-4. PMID 10294679
  6. ^ 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.
  7. ^ http://www.medscimonit.com/medscimonit/index.php - Medical Science Monitor
  8. ^ 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
  9. ^ Ciganda C, Laborde A., "Herbal infusions used for induced abortion", J Toxicol Clin Toxicol. 2003; 41(3):235-9
  10. ^ Education For Choice – Unsafe abortion
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