Abortion is an issue that for a long time evoked much public debate. Abortion generally refers to a pregnancy whose end result is not a live birth. Medically this includes both miscarriages (spontaneous abortions) where the death of the foetus occurs before the gestational age of twenty weeks and induced abortions. Legally and in common parlance, the term abortion usually refers to the process of inducing the death of a foetus or embryo at some point in the pregnancy. Some of the questions raised in the debate about abortion include women’s right to protect their bodies, the State’s responsibility in protection of the unborn child, the involvement of parents and spouses in decision-making about abortion and the conflict between the rights of the child and the mother. Sexuality is also an issue of discussion when abortion comes up.
This is because the abortion debate goes into issues of how the pregnancy came about and the use of contraception that would have prevented the pregnancy. Presently abortion is legalized but different states have various degrees of restrictions. There are various reason for abortions and over time the rate of abortions has been on the increase.
Spontaneous abortion commonly referred to as miscarriages involves the expulsion of the fetus or embryo as a result of trauma or natural causes. Many miscarriages occur due to chromosomes replicating incorrectly and sometimes due to environmental factors. When a pregnancy ends due to natural causes before the twentieth gestational week this is referred to as spontaneous abortion, when it ends between the twentieth and thirty seventh week or at delivery the fetus is referred to as a stillborn.
Miscarriages usually happen early in the pregnancy and often this is so early that the woman may not have been aware of the pregnancy. A study revealed that about 61.9 per cent of conceptuses were lost before the age of twelve weeks and up to 91.7 per cent of these occurred subclinically, that is without the mother knowing that she was pregnant (Edmonds, Miller, Williamson, Wood and Lindsay, 1982).
The risk of spontaneous abortion is generally greater in those who have had previous abortions either spontaneous or induced. This risk however decreases greatly following the tenth week of the Last Menstrual Period (LMP) (Rodeck and Whittle, 1999). Other risk factors associated with spontaneous abortions include maternal age above thirty five, systemic diseases, infections and trauma.
Induced abortion can be carried out using various methods. Often the method used depends mainly on the gestation of the fetus or embryo. Other factors that may come into play include regional availability, legality and preferences of the doctor and patient. Procuring an abortion can be done for either therapeutic or elective reasons. Therapeutic reasons include saving the pregnant woman’s life, preservation of the woman’s mental and/or physical health and reduction of health risks the woman faces especially due to multiple pregnancy (Roche and James, 2006). Another reason that may lead to termination of pregnancy is if the child to be born has been diagnosed to have a congenital disorder that is likely to be fatal or have a high morbidity (Roche and James, 2006). When performed for other reasons other than these it is usually considered elective. Some of the reasons that may lead to elective abortions include a desire to stop or delay childbearing, concerns regarding interruption of one’s education or career and issues of instability either financially or with regard to the relationship. Perceived immaturity is also a reason often given especially where the pregnant mother is a teenager (Bankole, Sing and Taylor, 1998).
Suction-aspiration is the most commonly used method in the first twelve weeks of pregnancy. It can be either Manual Vacuum Aspiration (MVA) or Electric Vacuum Aspiration (EVA). MVA involves removal of the fetus or embryo using a manual syringe by suctioning while EVA involves the use of an electric pump (United Nations Department of Economic and Social Affairs, 2001). MVA can be done very early in pregnancy and usually does not require that the cervix be dilated. When the pregnancy has progressed until the fifteenth week to about the twenty-sixth week, the method used is dilatation and evacuation (D;E) (United Nations Department of Economic and Social Affairs, 2001). D;E involves dilatation of the cervix followed by the use of surgical instruments for suctioning of the uterus to empty it (United Nations Department of Economic and Social Affairs, 2001). Dilatation and Curettage (D;C) is a gynaecological procedure usually performed for a variety of indications such as examination of the uterus for malignancy and investigations to detect abnormal bleeding. It is also a common method of surgical abortion. The World Health Organization recommends that D;C be used only when MVA is not available (World Health Organization, 2003). Other surgical methods used to conduct abortions include induction by intact dilatation and extraction which involves surgically decompressing the head of the fetus before it is evacuated from the uterus. This is sometimes referred to as partial-birth abortion. It has been banned in the US by the federal courts. If the pregnancy is in its later stages a procedure requiring abdominal surgery may be carried out. It is referred to as hysterectomy abortion and is very similar to a caesarean section ().
Non-surgical abortions (medical abortions) are effective in the first trimester of pregnancy though they form the smaller proportion of induced abortion. Most doctors use surgical methods. A common regimen includes mifepristone or methotrexate then a prostaglandin such as gemeprost or misoprostol. These when used up to the forty ninth day of gestation about 92 per cent of women are able to have a complete abortion without the need for surgical intervention (Spitz et al, 1998). Misoprostol is sometimes used on its own but this has lowered efficacy and when medical abortion fails, the abortion is completed using surgical means such as manual aspiration.
In regions where there are barriers to access of safe abortion women sometimes resort to unsafe methods. These unsafe methods are often carried out in places where standards of professionalism and sanitation are lacking. Back-alley abortions may result in complications such as sepsis, haemorrhage, incomplete abortion and internal organ damage. The health effects of an abortion carried out in proper conditions and at the appropriate gestation are usually minimal and have very little potential for complications (World Health Organization, 1997). Complication risk is associated with greater gestational age and sometimes this is a factor in some back-alley abortions.
Bankole A, Sing S and Taylor H, 1998, Reasons Why Women have Induced Abortions: Evidence from 27 Countries, International Family Planning Perspectives, volume 24, issue 3, pp 117-127
Edmonds KD, Miller JF, Williamson E, Wood PJ and Lindsay KS, 1982, Early Embryonic Mortality in Women, Fertiliy and Sterility vol 38, issue 4, pp 447-453
Rodeck C and Whittle M, 1992, Fetal Medicine: Basic Science and Clinical Practice, Elsevier Health Sciences, Fourth edition
Roche NE and James D, 2006, Therapeutic Abortion, eMedicine, retrieved from http://www.emedicine.com/med/topic3311.htm
Spitz MI, Bardin WC, Benton L and Robbins a, 1998, Early Pregnancy Termination with Mifepristone and Misoprostol in the United States, The New England Journal of Medicine, volume 338, issue 18, pp 1241-1247
United Nations Department of Economic and Social Affairs, Population Division, Abortion Policies: A Global Review, United Nations Publications, ISBN 9211513510
World Health Organization, 2003, Managing complications in pregnancy and childbirth: a guide for midwives and doctors, Department of Reproductive Health and Research retrieved from http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html
World Health Organization, 1997, Medical methods for Termination of pregnancy, WHO Technical Report Series 871