Abortion
From Encyclopædia
An abortion is the termination of a pregnancy by loss or destruction of the fetus before birth. An abortion may be spontaneous or induced. The latter is an act with ethical and legal ramifications.Medical AspectsSpontaneous abortion, or miscarriage, 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. Most occur before the woman's pregnancy can be confirmed, prior to 6 weeks after her LMP. They constitute about one-fifth of confirmed pregnancies and about one-tenth of all hospitalizations for pregnancy in the
United States. The woman 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.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. After dilation of the cervix, 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.Second-trimester induced abortion involves a more complicated procedure. If the pregnancy has progressed to no more than 16 weeks since the LMP, the most common technique is dilation and evacuation, a method that is similar to
vacuum aspiration. The next most common procedure, injection of fluid into the amniotic sac, usually is postponed until after the 16th week in order to reduce the risk of injection outside the amniotic cavity. Fluid injected into the cavity may be either a saline solution or hormones called PROSTAGLANDINS. Comparative studies of abortion techniques have determined that surgical evacuation techniques, especially up to 17 weeks' gestation, are safer than instillation techniques. Hysterotomy (surgical incision of the uterus) and
hysterectomy may be used when medically indicated.In France during the 1980s an abortion-inducing
drug called RU 486 was proved 85 percent effective during the first six weeks after LMP, especially when used with prostaglandins. By the early 1990s the
drug remained licensed only in France, China, and the United Kingdom. There has been a push by individual U.S. states to allow the
drug to be tested and made available for continuing research into its uses against diseases such as cancer.Legal AspectsAlthough 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. Between 1920 and 1967 the USSR, most Eastern European and Scandinavian countries, Japan, and
Great Britain legalized abortion. About half of the
world's people live in countries where abortion is available on request, and another fourth live in areas where abortion is permitted to protect the woman's health. The most restrictive policies tend to be found in fundamentalist Islamic countries and countries of sub-Saharan
Africa and Latin
America. In several of these countries, however, medical practitioners provide abortions without being prosecuted. In the 1980s about 40 to 60 million induced abortions occurred each year; about 33 million of them were legal.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 could prohibit third-trimester abortions. Since then further restrictions have been legalized. In the 1989
case of Webster v. Reproductive Services, the Supreme Court upheld a
Missouri law that prevented the performance of abortions by public employees or in taxpayer-supported facilities. In 1990 the Court ruled that states may require teenage girls to notify both parents before obtaining an abortion or else request a judicial hearing. A 1991 administrative decision barred federally funded clinics from mentioning abortion as an option, but this restriction has been somewhat eased.A
number of state legislatures have voted on bills that would outlaw abortion except in
cases of rape,
incest, or to save the mother's life, but most have not passed or have been vetoed by the
governor. Severely restrictive laws have been passed in several states as part of an effort to produce a Supreme Court decision reversing Roe v. Wade. In 1992 the Court upheld the 1973 ruling but permitted states to place further restrictions on abortions, such as parental or spousal notification and a 24-hour waiting period before the procedure.The Hyde Amendment passed by Congress in 1976 severely restricted federal funds for abortions, although many states continue to fund abortions for indigent women. In 1988 the Reagan administration banned federal funding of research using fetal tissue obtained from induced abortions, a ban extended by the Bush administration in 1989.Impact of LegalizationIn the 1960s, deaths from illegal abortions amounted to one-fifth of all deaths related to pregnancy and?childbirth in the
United States. After the 1973 decision, mortality and hospitalizations dropped dramatically, in part due to improved training and the use of safer techniques among abortion providers. Legalization also stimulated development of more convenient and lower-cost service. By the 1980s the majority of abortions were in freestanding clinics, and about one-half were outpatient procedures. About 27 per 1,000 U. S. women of childbearing age had induced abortions each year, a rate higher than in other industrialized Western
nations but about half the worldwide rate.Studies of long-term consequences of abortion show 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 and have been unable to link abortion with long-term psychological problems.Ethical AspectsOpponents of legalized abortion believe that human life begins at conception and that abortion is the intentional killing of a human being. Members of the "right to life" movement have lobbied for a constitutional amendment on the rights of the unborn. Opposing this position is the "pro-choice" stance, which stresses the woman's right to choose to continue or terminate a pregnancy. "Pro-choice" supporters also argue that legal abortion is safer than illegal abortion and relieves the psychological and social problems associated with bearing an unwanted child.Carol HogueBibliography: Barry, Robert L., Medical
ethics (1989); Butler, J. D., and Walbert, D. F., eds., Abortion,
medicine and the Law (1986); Ficarra, Bernard, J., Abortion Analyzed (1989); Glendon, M. A., Abortion and
divorce in American Law (1987); Ide, A. F., Abortion Handbook, 2d ed. (1987); Rodman, Hyman, et al., The Abortion Question (1990); Rosenblatt, Roger, Life Itself: Abortion in the American Mind (1992); Schwartz, S., The Moral Question of Abortion (1990).
