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Scientific explanation of abortion
The Electronic Encyclopedia (TM)
(C) 1988 Grolier Electronic Publishing, Inc.
abortion
An abortion is the termination of a pregnancy before the fetus is
viable, or capable of living outside the womb. An abortion may be
spontaneous or induced. The term miscarriage is sometimes used as a
synonym for spontaneous abortion. Voluntary pregnancy termination is an
act with ethical and legal ramifications.
Medical Aspects.
Spontaneous abortion occurs when the embryo fails to develop, when
there is complete or incomplete expulsion of the products of
conception--the embryo or fetus, and placenta--or when the fetus dies
prior to 20 weeks from the woman's last menstrual period (LMP). If fetal
death occurs at 20 weeks or more after the LMP, it is termed a late fetal
death or a stillbirth.
Perhaps as many as three-fourths of conceptions are spontaneously
aborted, but most of those abortions occur before the woman's pregnancy
can be confirmed, prior to 6 weeks after her LMP. Spontaneous abortions
constitute about one-fifth of confirmed pregnancies and about one-tenth of
all hospitalizations for pregnancy in the United States.
A woman whose pregnancy is spontaneously aborted may experience
cramping and blood loss similar to that of a normal menstrual period,
heavier cramping or blood loss, or pains closely resembling those of
childbirth, depending on the gestational age of the fetus and other
factors.
Induced abortion is a procedure intended to terminate a suspected or
known pregnancy and to produce a nonviable fetus at any gestational age.
Most induced abortions in the United States are performed in the first
trimester--within 12 weeks of the LMP. The technique for virtually all
first-trimester pregnancy terminations utilizes a procedure called vacuum
aspiration or vacuum curettage. The cervix is dilated with a series of
graduated, usually tapered dilators or a type of dried seaweed, called
laminaria, which expands as it absorbs moisture. After dilation, a hollow
plastic tube with a hole near its end is inserted into the uterus. The
embryo or fetus and placenta are drawn into the tube through vacuum
pressure. For sharp curettage, a procedure seldom used today, a hollow,
spoon-shaped knife, or curette, is used instead of the vacuum tube to
scrape the uterine walls.
Second-trimester induced abortion involves a more complicated
procedure. If the pregnancy has progressed to no more than 16 weeks since
the last menstrual period, the most common technique is dilation and
evacuation, a method that is similar to vacuum aspiration. The next most
common procedure is injection of fluid into the amniotic sac; usually,
however, this procedure is postponed until after the 16th week to reduce
the risk of injection outside the amniotic cavity. Fluid injected into the
cavity may be either a saline solution or the hormone PROSTAGLANDINS.
Comparative studies of abortion techniques have determined that surgical
evacuation techniques, especially up to 17 weeks' gestation, are safer
than instillation techniques. Rarely used techniques for second-trimester
abortion include hysterotomy (surgical incision of the uterus) and
HYSTERECTOMY, used when medically indicated.
Legal Aspects.
The Electronic Encyclopedia (TM)
(C) 1988 Grolier Electronic Publishing, Inc.
Although discouraged by most major religions, induced abortion has
been practiced in every culture since ancient times. During the 19th
century several countries passed laws prohibiting abortion to protect
women from the dangerous methods then in use. The USSR legalized abortion
in 1920, but in response to a rapid drop in the birthrate, the USSR
reinstituted restrictions in 1936. So many complications from illegal
abortions occurred, however, that restrictions were withdrawn in 1955.
Most Eastern European countries legalized abortion during the next 10
years. Japan liberalized its abortion law in 1948 to decrease its
population growth. Scandinavian countries began to liberalize their laws
in the 1930s, although most still restrict reasons allowed for the
abortion. Great Britain liberalized its abortion statute in 1967. Today
most of the world's population live where abortion is either legal or
conducted openly.
In the United States legal induced abortion was generally unavailable
until 1970, when a few states liberalized their abortion laws. Early in
1973 the U.S. Supreme Court declared most restrictive abortion laws
unconstitutional because they violated the woman's right of privacy. Since
then abortion has been generally available throughout the United States.
The 1973 Supreme Court cases ROE V. WADE AND DOE V. BOLTON left the
decision to have a first-trimester abortion to the woman and her
physician. States could pass regulations to insure the safety of
second-trimester abortions, and they could prohibit third-trimester
abortions altogether.
Congress passed the Hyde Amendment in 1976, which severely restricted
federal funds for abortions, although many states continue to fund
abortions for indigent women. Since 1973 the U.S. Supreme Court has ruled
on several local and state regulations, upholding those requiring parental
notification for a minor's abortion and parental or judicial consent for
an abortion for someone under age 15.
Impact of Legalization.
During the 1960s an estimated 200,000 to 1,200,000 illegal abortions
were performed each year in the United States. Deaths from illegal
abortions amounted to one-fifth of all deaths and hospitalizations related
to pregnancy and childbirth. Morbidity and mortality from illegal
abortions began to decline in the 1960s, but after 1973, mortality and
hospitalizations dropped dramatically, in part due to improved training
for abortion providers, increased familiarity with treatment of
complications, and safer techniques. Legalization stimulated development
of more convenient and lower-cost health service. More than 60 percent of
abortions were in hospitals in 1973, but more than 70 percent were in
freestanding clinics in 1980, about one-half of which were outpatient
procedures.
Legalization raised concerns about long-term health consequences of
abortion. Studies to date have found that risks of spontaneous abortion,
preterm delivery, and low birth weight for a second pregnancy following
vacuum aspiration are no greater than risks for a first pregnancy. Other
health risks, including a suggested association between abortion of the
first pregnancy and breast cancer in later life, have not been adequately
studied.
Ethical Aspects.
The Electronic Encyclopedia (TM)
(C) 1988 Grolier Electronic Publishing, Inc.
Opponents of legalized induced abortion believe that human life
begins at conception and that abortion is the intentional killing of a
human being and is thus morally wrong. Members of the "right to life"
movement have lobbied for a constitutional amendment on the rights of the
unborn. The counterpart to this position is the "pro-choice" stance. Its
proponents generally believe that human life begins when the fetus can
survive outside the womb. Before then, since the fetus is not a separate
human, it is considered morally acceptable to terminate the pregnancy.
Supporters of liberalized abortion laws also argue that legal abortion is
safer to the woman than illegal abortion and relieves the psychological
and social problems associated with bearing an unwanted child.
Carol Hogue
Bibliography:
Centers for Disease Control, Abortion Surveillance: Annual Summary
1979-1980 (1983); Hogue, C., et al. "The Effects of Induced Abortion on
Subsequent Reproduction," Epidemiologic Reviews (1982); Nathanson, B. N.,
Aborting America (1979); Tietze, C., Induced Abortion: A World Review,
1983, 5th ed. (1983).
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