- Spontaneous abortion: An abortion due to accidental trauma or natural causes. Also known as a 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.
A pregnancy that terminates early, but where the fetus survives to become a live infant is instead a premature birth. A pregnancy that ends with a infant dead upon birth due to causes such as spontaneous abortion is termed a stillbirth.
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.
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Spontaneous abortion
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:- 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
Some women, poor or uninformed, choose not to go to a legally approved place to get an abortion, their only other choice being to turn to untrained, and often unsafe, providers. These abortion providers levy fees based on the ability to pay, degree of guilt felt, and extent of secrecy desired. After the anxiety and expense of choosing this alternative, women are often left with serious disabilities and sometimes suffer fatal consequences from incomplete or septic procedures. Sometimes, in this case, the woman doesn't see any other way to take the baby's life right after it is born.
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.Medical Abortion
Medical Abortion, sometimes called chemical abortion, comprises 10% of all abortions in the United States and Europe. Medical abortion is a method used to induce abortion during the first trimester. Medical 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. Hysterotomy abortion can be performed vaginally, with an incision just above the cervix, in the late mid-trimester.
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. 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.
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.
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.
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.
- 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 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."
- 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."
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