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Revision as of 15:10, 16 June 2005 by Tznkai (talk | contribs) (More fixups)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)Abortion is the termination of a pregnancy associated with the death and expulsion of the embryo or fetus from the womb. When an abortion occurs naturally or accidentally, it is called a spontaneous abortion (or miscarriage), but if the development of the fetus or embryo is deliberately aborted it is an induced abortion. Abortion induced because the pregnancy poses a health risk to the gravida (pregnant woman) is known as therapeutic abortion, while abortion induced at the request of the gravida is known as elective abortion. An induced abortion preformed by the pregnant woman is refered to as self-induced abortion.
Methods of inducing abortion
Depending on the gestational age of the developing offspring, abortion can describe a number of different ways to destroy and remove the embryo or fetus from the womb.
Chemical abortion
Chemical abortion is a method used to induce abortion by ingesting drugs, usually during the first nine weeks of pregnancy. Very soon after a sperm and ovum fuse, forming a zygote, the Morning-after pill can be taken as an abortifacient to prevent the resulting embryo from implanting in the uterus, thereby aborting any further development of the embryo. 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, which occur in about two percent of all patients who desire to terminate their pregnancy. About 10 % of abortions in the United States and Europe are induced in this way.
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
Some herbs are effective abortifacients. Using herbs in this way can cause serious side effects, including multipe organ failure and other serious injury (Ciganda C, Laborde A., "Herbal infusions used for induced abortion", J Toxicol Clin Toxicol. 2003;41(3):235-9) and are not reccomended 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 good chance for inducing an abortion. Both accidental (misscarriage) and deliberate abortions of this kind carry criminal liability in many countries.
Health risks
Complications
- 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. Studies have found that in developed countries where abortion is legal, the risk of serious physical complications of an abortion is less than one percent. 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
- 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 % 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 %. Abortion appeared to increase the risk of most major causes of premature birth, including premature rupture of membranes, incorrect position of the fetus on the placenta, and spontaneous early labor. The only common cause of premature birth not linked to abortion was high blood pressure. Earlier studies had shown an increased risk of preterm birth associated with abortion, but had failed to establish a conclusive link.
- 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 (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 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. (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).
Abortion law
Main Article: abortion law
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. A human right to self-determination, regardless of gender, is recognised by most countries, often in their constitution. A human right to life is recognized by all countries. 25 countries have officially recognized this right being from the moment of conception in the "American Convention on Human Rights", which the United States has signed, but not ratified.
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 some reasons. Abortion laws vary widely by country, with some countries allowing nearly total liberalization (extreme examples being 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, 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).
Debate on abortion
Main article: Morality and legality of abortion Opponents of abortion are usually termed Pro-Life, while advocates for abortion rights are usually termed Pro-Choice.
Pro-choice stance
The cornerstone of the pro-choice stance is the issue of 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. Similar views are shared by groups ranging from American Civil Liberties Union to Planned Parenthood.
Pro-life stance
The pro-life stance treats the human fetus as a person with human rights, and considers the abortion of the fetus tantamount to murder. The Catholic Church is one of the best known champions of the pro life stance. The culture of life is a view shared by many pro-life believers, seeing abortion, euthanasia and war as part of the culture of death. Similar views are shared by many groups including Feminists for Life and Carenet.
Pressure on women
One issue where both the pro-choice and pro-life camps find common ground is the pressure felt by pregnant women. The shared belief that many pregnant women feel pressure that makes abortion seem to be the only reasonable option. Both groups have worked hard to open up alternative options to abortion.
Rape, incest and health
Pro choice advocates 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 unborn child. Pro-life advocates consider the unborn human to be an innocent person who should not suffer due to the circumstances of conception, and suggest that alternatives such as adoption should be considered.
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.