Abortion, in its most common usage, refers to the voluntary or induced termination of a pregnancy, generally through the use of surgical procedures or drugs.
Medically, the term also refers to the early expulsion of a fetus or embryo by natural causes ("spontaneous abortion" or miscarriage), which ends one in five of all pregnancies, usually within the first thirteen weeks, or to the cessation of normal growth of a body part or organ. What follows is a discussion of the issues related to deliberately induced abortion.
Since 1972, the medical definition of pregnancy in the United States requires that implantation has already occurred. According to this definition, emergency contraceptives do not interfere with pregnancy.
The "morning-after pill" or "emergency contraceptive pill" is actually two pills that are most effective if taken 12 hours apart within 72 hours of sex. They work by affecting ovulation, fertilization, or implantation. In cases where the egg has already been released, if conception occurs the zygote may successfully implant regardless of emergency contraception use. There is no fetotoxic 'backup chemical' found in current formulations of emergency contraception: if ovulation occurs, conception will probably follow and the emergency contraceptive will have failed. Some studies suggest that emergency contraceptives can thin the uterine lining and thus interfere with the implantation of a zygote. If this hypothesis is true, then the effect would similarly occur with normal birth control pills taken regularly as well. These drugs (i.e. the morning after pill and all hormonal contraceptives) are potentially abortifacient. It is fairly common for conception to occur but implantation to fail, even without the use of emergency contraception or birth control.
Methods of abortion
Depending on the stage of pregnancy, abortion can describe a number of different ways to eliminate the fetus or embryo. Chemical abortion (or Medical Abortion as opposed to Surgical Abortion) is a method that is used when it is induced during the first nine weeks. The procedure consists of administering either methotrexate or mifepristone (RU-486) followed by administration of misoprostol. Approximately eight percent of these abortions require surgical followup, usually by vacuum aspiration (See below). Methotrexate may also treat undiagnosed or concomittant tubal pregnancies which occur in about 2% of all patients who desire to terminate their fetus or embryo. About 10% of abortions in the United States and Europe are induced medically.
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 embryo by suction using a manual syringe, while Electric vacuum aspiration or EVA abortion uses suction produced by an electric pump to remove the 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 is cleaning the walls of 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 size increases, other techniques must be used to induce abortion in the third trimester. Premature expulsion of the fetus can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with saline or urea solution. Very late abortions can be brought about by the controversial intact dilation and extraction (D & X) or a hysterotomy abortion , similar to a caesarian section, and requiring the surgical decompression of the fetus's head before evacuation. This procedure is also controversially termed "partial-birth abortion."
Possible side effects
Postabortion psychological issues
Research has been carried out on the question of whether abortion is associated with increased risk of clinical depression, but the results are mixed. According to a study of 1,884 women conducted by the National Longitudinal Survey of Youth, women who did not carry their first pregnancies to term are 65% more likely to be diagnosed with clinical depression around eight years later. However, other studies did not support a conclusion that depression may be caused by abortion. For example, a 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 said 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).
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.
Postabortion physical issues
- The exact risk and type of complications depend on the abortion method as well as the clinical and hygienic conditions. Studies 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 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 very dangerous. Serious complications from abortions done outside of professional clinics may include infections, bleeding, and in many cases lead to death.
- A specific complication that can arise, especially with repeated abortions by a dilatation and curettage, is the development of Asherman syndrome.
- The Abortion-Breast Cancer (ABC) hypothesis is based on the fact that during early pregnancy, hormone levels increase significantly. This initiates cellular differentiation (growth) in the breast preparing 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 a debate as to how reliable they are given that the controversial nature of abortion may create recall bias. The most recent meta-analysis published in The Lancet (March 2004) of 53 epidemiological studies concluded that there was no ABC link. Nevertheless, gaps remain in the research and the "ABC link" is still a hot campaigning issue in anti-abortion circles.
Main Article: Abortion law
Abortion has been a controversial subject throughout history due to the moral and ethical issues that surround it. It has been regularly banned and otherwise limited, though abortions have continued to be commonplace in many areas where it is illegal. Almost 2/3 of the world’s women currently reside in countries where abortion may be obtained on request or for a broad range of social, economic or personal reasons. Abortion laws vary widely by country, with some countries allowing nearly total liberalization, and others banning abortion under any circumstances. There are also countries that do not have any laws restricting abortion, such as Canada (see Abortion in Canada).
Generally, the abortion debate is cast in terms that make women's rights the sole issue. Some, however, have argued that abortion also involves substantial paternal rights. For a discussion of this topic, please see the Oklahoma Law Review , Abortions of the Paternal Prerogatives Of Unwed Natural Fathers, 2000.
Abortion as a political issue
Abortion has sometimes been a bitterly-fought battle in politics, particularly in the United States. The real controversy in the US started in 1973, when 7 out of 9 Supreme Court Justices ruled in favor of abortion in the case of Roe vs. Wade. Specifically, they ruled that states could not forbid a woman to terminate her pregnancy in the first three months (the first trimester) of her pregnancy.
Opponents of abortion rights are usually termed Pro-Life, whilst proponents of abortion rights are usually termed Pro-Choice. 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.
There have been a number of murders and related crimes (such as bombings) committed in the U.S. by those opposed to abortion, mostly directed at abortion providers. Such violence, however, is denounced by the mainstream pro-life movement.
In many other countries, abortion is less of a political issue. For a long time, it was not considered a mainstream political issue in Great Britain. However, in the runup 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, a move supported by both the Anglican and Catholic Churches. Any review would, however, still be subject to a 'free vote' by Members of Parliament - 'free' meaning that Members would not be required to support their party's policy, if any, on the subject.
Debate on abortion
The cornerstone of the pro-choice movement is 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. The pro-choice movement tends to regard abortion as a form of birth control, freeing women from the physical and emotional burden of sex. Feminists often suggest that men are already free of pregnancy and do not have to carry children at all, and so abortion is merely an equalizer in this regard. Furthermore, the perspective tends to view any encroachment onto the subject by male pro-life advocates as chauvinism.
Mainstream feminist organizations like the National Organization for Women are generally pro-choice, but similar views are shared by groups ranging from American Civil Liberties Union to Planned Parenthood.
Pro-life feminists connect abortion to war and characterize it as a male-dominated institution of violence against both women and children. Early feminists took the view that abortion was a horrible tragedy, a disastrous crime, and a male-supported instrument to further power over women.
Elizabeth Cady Stanton termed abortion infanticide. Mattie Brinkerhoff characterized abortion as destroying the life of an unborn child, and evidence that a woman "has been greatly wronged." Victoria Woodhull, the first female US presidential candidate, affirmed that "[t]he rights of children as individuals begin while yet they remain the foetus." Caroline Elizabeth Sarah Norton wrote of "infant butcheries" and "ante-natal child murder," describing abortion as interfering with "the right of the unborn to be born." Mary Wollstonecraft suggested outright that abortion violated the laws of nature and Matilda Joslyn Gage suggested it was one of the greatest wrongs against women and that it was committed by men. Alice Paul, author of the first Equal Rights Amendment in 1923, said simply "Abortion is the ultimate exploitation of women." Susan B. Anthony referred to it as "child murder" and said:
- "Guilty? Yes. No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh, thrice guilty is he who drove her to the desperation which impelled her to the crime!"
While these views are now uncommon among mainstream feminist organizations, Feminists For Life explicitly and aggressively opposes abortion.
Legislative effectiveness debates
Some pro-choice advocates prefer to advance the position that illegalization of abortion will be ineffective; their stance as to the ethics of abortion illegalization is that it would not reduce number of abortion procedures, but only increase the difficulty and decrease the safety of the procedures undergone. They argue that illegalization would thus unnecessarily increase the suffering of an already vulnerable segment of the population. The estimated number of abortion procedures per year prior to 1973 ranges from 1,000,000 to 100,000 (Iowa right to life committee) compared to the CDC's 1997 statistic of 1,186,039, (1997 being the last year where privacy laws allowed national tracking). The abolition of abortion, these advocates maintain, could be as ineffective and dangerous as the abolition of alcohol. They argue that it would provide an unregulated profit center for illegal organizations but little real change in the number of procedures performed. This argument makes the issue one of legislative effectiveness in ethics, assuming that because abortions will be performed in any case, the duty of the state becomes the establishment and maintenance of order in the medical disciplines and the alleviation the suffering of pregnant women who choose to undergo abortion.
Pro-life advocates sometimes rebut this by stating that Prohibition considerably reduced American consumption of alcoholic beverages and hospital admissions for liver disease. They hold that, likewise, criminalization of abortion would deter many abortion procedures and save lives.
Politically neutral links