User:Tznkai/workshop/Induced abortion

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An induced abortion is the deliberate, premature termination of pregnancy resulting in the death of any or all carried embryo(s) or fetus(es). Induced abortions are further classified as either elective or therapeutic.


Contents

[edit] Induced abortion in brief

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 pushed 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.

[edit] 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.

[edit] Chemical Abortion

Main article: Chemical Abortion

Effective in the first trimester of pregnancy, chemical abortions comprise 10% of all abortions in the United States and Europe. The process begins with the administration of either methotrexate or mifepristone, followed by misoprostol. While misoprostol may also be used alone to induce abortion, the need for surgical intervention is slightly elevated to about 10%, compared to the 8% when medications are combined. When surgical intervention is neccessary, primarily vacuum uterine aspiration is used.

[edit] 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, can also be used at late stages of pregnancy. Hysterotomy abortion can be performed vaginally, with an incision just above the cervix, in the late mid-trimester.

[edit] 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] 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]

[edit] Health risks

As with most surgical procedures, the most common surgical abortion methods carry the risk of serious complications. These risks include: a perforated uterus, perforated bowel or bladder, septic shock, sterility, and death.

Accurately assessing the risks of induced abortion is difficult due to a number of factors. These factors include a lack of uniform definitions of terms, and difficulties in follow-up.

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.

[edit] Physical health

Each phase of the abortion carries separate risks, and practitioners are not in agreement as to the best methods of mitigating those risks. The degree of risk depends upon the skill and experience of the practitioner; maternal age, health, and parity; gestational age; pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care. A highly-skilled practitioner operating under ideal conditions will have a very low rate of complications, whereas an inexperienced practitioner in an unsanitary, ill-equipped and ill-staffed facility will typically have a high complication rate.

Some practitioners advocate using the minimal possible anesthesia, so that patient pain can alert the practitioner to possible complications. Others recommend general anesthesia in order to prevent patient movement which might cause a perforation. General anesthesia carries its own risks and most public health officials recommend against its routine use in abortion due to an increased risk of death.

Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester of pregnancy.

Instruments are placed within the uterus to remove the pregnancy. These can cause perforation or laceration of the uterus, and damage to structures surrounding the uterus. If the uterus is perforated, surrounding structures, especially the bowel, may be pulled through the perforation into the uterus. Partial evisceration can result, with its attendant risks, including peritonitis and the need for a colostomy.

Laceration or perforation of the uterus or cervix can result in amniotic fluid embolism, with the resulting risk of disseminated intravascular coagulopathy, shock, and death.

Incomplete emptying of the uterus can cause fever, hemorrhage, and infection, which if not promptly diagnosed and treated can lead to sepsis and death. Another risk is failure to diagnose ectopic pregnancy, which can lead to rupture, infection, hemorrhage, sepsis, and death. Use of ultrasound verification of the location and duration of the pregnancy prior to abortion, with immediate follow-up of patients reporting continuing pregnancy symptoms after the procedure, will virtually eliminate this risk. In some cases, the abortion will be unsuccessful and the pregnancy will continue. Most practitioners recommend a second procedure to terminate the pregnancy due to the possibility that the abortion attempt had caused injury to the fetus.

The sooner a complication is noted and properly treated, the lower the risk of permanent injury or death.

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.

[edit] Mental health

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

"George Walter, an employee of then US Surgeon General C. Everett Koop, conducted a review of more than 250 studies in the literature pertaining to the psychological impact of abortion. Walter conducted the review at the request of Koop, who was being pressured by then US President Ronald W. Reagan to produce a report. Walter consulted primarily with researchers from the Alan Guttmacher Institute and the Centers for Disease Control, and used primarily studies recommended by researchers in favor of easy access to legal abortion. Walter submitted the report to Koop, who instructed Walter to shelve the report. Koop submitted a letter to Reagan indicating that the research was inconclusive. However, Walter released the report under Koop's name. Thus, public debates in the US as to the safety of legal abortion remain muddled. Opponents of abortion cite Koop's letter finding the evidence inconclusive, and those favoring the availability of legal abortion cite Walters' report, released under Koop's name, and attributed to Koop. "[4]

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

  • 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

[edit] History of abortion

Main article: History of abortion

According to some anthropologists, (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 govern abortion.

[edit] The abortion 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, 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 justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.

[edit] Public opinion

Political sides have largely been divided into absolutes. The abortion debate, as such, tends to centre around individuals who hold strong positions. However, public opinion varies from poll to poll, country to country, and region to region:

  • Australia: In a February 2005 AC Nielsen poll, as reported in the The Age, 56% thought the current abortion laws were "about right," 16% want changes in law to make abortion "more accessible," and 17% want changes to make it "less accessible." [9] A 1998 poll, conducted by Roy Morgan Research, asked, "Do you approve of the termination of unwanted pregnancies through surgical abortion?" 65% of the Australians polled stated that they approved of surgical abortion and 25% stated that they disapproved of it. [10]
  • Ireland: A 1997 Irish Times/MRBI poll of the Republic of Ireland's electorate found that 18% believe that abortion should never be permitted, 35% that one should be allowed in the event that the mother's life is threatened, 18% if her health is at risk, 28% that "an abortion should be provided to those who need it," and 5% were undecided. [11]
  • Canada: 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.
  • The United States: A CNN/USA Today/Gallup poll in August 2005, which asked Americans if they considered themselves to be "pro-choice" or "pro-life," found that 54% of answered "pro-choice" while 38% answered "pro-life." An ABC News/Washington Post survey, in August 2005, asked, "Would you like to see the Supreme Court make it harder to get an abortion than it is now, make it easier to get an abortion than it is now, or leave the ability to get an abortion the same as it is now?" 42% of respondents said abortion should be "harder" to obtain, 9% that it should be "easier" to obtain, and 47% that ease or difficulty of access should remain the "same." A July 2005 Pew Research Center poll asked Americans about Roe vs. Wade and found that 29% want it overturned while 65% do not. [12]

[edit] Abortion law

Main article: Abortion law
International status of 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, 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. The right to life, the right to liberty, and the right to security of person are major issues of human rights that are sometimes used as justification for the existence or the absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate 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.

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.

[edit] Related topics

Wikiquote has a collection of quotations related to:

[edit] 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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