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.

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

Spontaneous abortion

Induced abortions

• 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 pressures, such as stigma of disabled persons and similar eugenic ideals, or laws, 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

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 can 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

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

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

• Main article: 'Abortion-breast cancer (ABC) hypothesis

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, and some have been demonstrated to be statistically significant, but there remains 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. Joel 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 and undisputed complication that can arise, especially with repeated abortions by a dilatation and curettage, is the development of Asherman syndrome.

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."

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.
• 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 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. 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." [1]

See also: Abortion trauma syndrome

Emergency contraception

History of abortion

The 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, philosophical, biological and legal issues have a strong relationship with that 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 scope and responsibility of legitimate governmental and legal authority. Another major factor for many individuals is authoritative religious doctrine. See religion and abortion for more.

Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. Those in favor of laws prohibiting abortion describe themselves as pro-life. Those against laws restricting abortion describe themselves as pro-choice. Both "pro-choice" and "pro-life" are loaded terms, designed to cast their position as advancing a general concept ("life" or "choice") that has broad support. Both terms are euphemisms designed to evade the use of the term "abortion", such as being "anti-abortion" or "pro-abortion". Individuals are also usually classified or self-described as pro-choice or pro-life, despite the range of intermediate opinions.

In debate, whether friendly discussion or political positioning, the arguments on abortion usually seek to change either an individual's beliefs on the moral permissibility of an induced abortion, or on the jutification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand. In debate, a major complication is the terms of debate. Among the ambigous terms discussed in the terminology section of this article, the choice of terms used to frame the debate is hotly contested. This can be a deliberate attempt to gain an advantage using rhetoric, or merely the result of an individual's view point. Common examples of these terms include:

• The induction of abortion itself: this can be described merely as a procedure / choice, or as killing / murder.
• The object of the procedure: is it merely the termination of a pregnancy or the killing of a human being?
• The choice: who has the choice? Is there actually ever a choice being made?
• The embryo, fetus, or unborn child: is the human entity in the womb a tiny unborn child or a part of the mother-to-be's body?
• The begining of life: when does human life or human personhood begin?

Public opinion

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. Public opinion varies from poll to poll, and by country:

• One 2005 poll, which asked a sample of Americans to choose between two undefined labels ("pro-choice" and pro-life"), found that a majority (54%) prefer the label "pro-choice", while 38% prefer "pro-life". In the same poll, 30% said that they would like to see Roe vs. Wade overturned; 42% said abortion should be harder to obtain; 9% thought abortions should be easier to obtain, and 47% said ease or difficulty should remain the same.[2]

• A similar 2004 poll revealed that a majority of Americans (53%) think that "Abortion destroys a human life and is manslaughter." A majority (58%) said they thought abortion was morally unacceptable "when the mother's life is not in danger". [3]

• A 2003 poll indicated a majority (57%) of Americans support legal abortion only in circumstances, such as "when the pregnancy was caused by rape or incest" or "when the woman's physical health is endangered". [4]

• A recent poll of Canadians, conducted in April 2005 by Gallup, found that 52% of those polled want abortion laws to "remain the same," 20% want the laws to be "less strict," and 24% would prefer that the laws become "more strict." An earlier Gallup poll, from December 2001, asked, "Do you think abortions should be legal under any circumstances, legal only under certain circumstances or illegal in all circumstances and in what circumstances?" 32% of Canadians responded that they believe abortion should be legal in all circumstance, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. See Abortion in Canada.

• In Ireland abortion is strongly opposed by a majority of the electorate and is largely forbidden.

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, controversially ruling that such laws violated 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, recognizing "the right to life of the unborn." (see Abortion in Ireland).

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 are used as justification for laws controlling 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 the existence or absence of laws controling abortion. In 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 perform:

• 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.

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 1978 American Convention on Human Rights states, in Article 4.1, "Every person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception." The Convention is considered binding only for the 24 of 35 member nations of the Organization of American States who ratified it. The Inter-American Commission on Human Rights found that the words "in general" left room for individual nations to determine their own abortion legislation. [5]

• 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 nonbinding document was adopted by at least 179 countries at the United Nations International Conference on Population and Development held in Cairo, Egypt.

• The 1995 Beijing Platform for Action states, in paragraph 96, “The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence.” The nonbinding document has been adopted by 189 countries at the United Nations Fourth World Conference on Women held in Beijing, China. It calls upon nations in which abortion remains illegal to reconsider laws that punish women, but does not specifically advocate the legalization of abortion.

Related topics

• Abortion in Canada
• Abortion in the Republic of Ireland
• Abortion in the United States
• Adoption
• Nuremberg Files
• Partial-birth abortion
• Pregnancy
• Religion and abortion
• Selective reduction
• Self-induced abortion
• Sex-selective abortion and infanticide
• Wrongful abortion

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

External links

Informational links

• Abortion Statistics and Other Data
• Abortion Laws of The World
• Abortion Policies: A Global Review
• Just Facts: Abortion

Pro-choice links

• Planned Parenthood
• The Alan Guttmacher Institute
• Catholics For A Free Choice - (Excommunicated from the Roman Catholic Church)
• The National Coalition of Abortion Providers
• WomenonWaves.org
• National Abortion Federation
• Religious Coalition for Reproductive Choice
• I'm not sorry.net

Pro-life links

• Unsafe Abortion Today
• Abortion Alternatives
• Excerpts from Embryology Textbooks
• Feminists for Life
• Vatican II: Gaudium et Spes, paragraph 51 – Official Roman Catholic Doctrine
• CareNet
• National Right to Life
• It Is Time To Abort Abortion: Issues Of Choice

Referenced By