Abortion can be termed as the ending of pregnancy by expelling or removing a fetus from the embryo or uterus prior to viability. An abortion may take place spontaneously, where it is often termed as a miscarriage, or it may be deliberately induced. The word abortion mostly refers to a human pregnancy’s induced abortion. Following viability, the relevant process is known as a pregnancy termination. In the developed nations, an induced abortion in conformity with the law is regarded as one of the safest medical procedures. Nevertheless, unsafe abortions lead to 5 million hospital admissions and about 47,000 maternal deaths annually worldwide. About 44 million abortions are carried out throughout the world every year, and marginally below half of them are carried out unsafely. The abortion rate of occurrence has become stable in recent years, due to rise in access to contraceptive services, as well as family planning education. Forty percent of women worldwide have access to lawful induced abortions.
There is a long history of induced abortion through a number of methods, which include herbal abortion-inducing drug, physical trauma, sharpened tools, as well as other traditional methods. Contemporary medicine uses surgical procedures and medications. The prevalence, legality, religious and cultural status of abortion differs considerably all over the world. The abortion’s legality can rely on particular conditions, for instance rape, incest, defects of a fetus, socioeconomic factors, high disability risk or the risk of a mother's health. There exists a divisive and prominent controversy over the ethical, legal and moral issues of, in several parts of the world. The opponents of abortion postulate that fetus or embryo is a human, who has the right to live and they equate it to killing. The proponents of abortion rights, on the other hand, stress that a woman has the right to choose whether to abort or not.
About 205 million pregnancies happen every year globally. More than a third of them are not deliberate and approximately a fifth is ended in induced abortion. Majority of abortions arise from unintentional pregnancies. Intentional abortion of a pregnancy can be carried out in a number of ways. The manner chosen is often dependent on the embryo or fetus’ gestational age, which grows bigger as the pregnancy advances. Certain procedures may as well be chosen because of regional availability, legality, as well as the preference of the patient or doctor. The grounds for procuring induced abortions are normally characterized as either elective or therapeutic. An abortion is medically termed as a therapeutic abortion when it is carried out with a purpose to save an expectant woman’s life, to avoid harming the mental or physical health of a woman, or to selectively decrease the fetuses’ number to lower health risks linked to multiple pregnancies. On the other hand, an abortion termed as voluntary or elective if it is carried out at the woman’s request for reasons that are non-medical.
Spontaneous abortion, which as well referred to as miscarriage, is the unplanned embryo or fetus expulsion prior to the 24th gestation week. Termination of pregnancy prior to 37 gestation weeks leading to a live-born infant is referred to as preterm birth or premature birth. If a fetus loses life in the uterus following viability, or in the course of delivery, it is normally called stillborn. Stillbirths and premature births are usually not regarded as miscarriages even though these terms’ usage can at times overlap. It is just 30%-50% of conceptions advance beyond the first trimester. Most of the pregnancies that do not advance are aborted prior to the awareness of the conception, and several pregnancies are aborted prior to detection of the embryo by the medical practitioners. About 15% to 30% of known pregnancies are lost in miscarriages that appear clinical, based on the health and age of the expectant woman. The common spontaneous abortion causes in the course of the first trimester is the fetus or embryo’s chromosomal abnormalities, which accounts for at least half of sampled early pregnancy abortions. Other causes may include diabetes or hormonal problems, infection, vascular disease, as well as uterine abnormalities. Progressing maternal age together with previous spontaneous abortions history of the patient are the two resulting factors linked to spontaneous abortion’s greater risk. A spontaneous abortion may as well result from accidental trauma. Deliberate trauma or stress intended to cause miscarriage is regarded as feticide or induced abortion.
These are the abortions that are induced by aborticide pharmaceuticals. They became an optional abortion method with the accessibility of analogs of antiprogestogen mifepristone and prostaglandin in the 1980s and 1970s respectively. The most widespread medical abortion regimens in the early first-trimester use mifepristone together with gemeprost or misoprostol up to nine weeks, methotrexate together with an analog of prostaglandin up to seven weeks, or an analog of prostaglandin alone. Combination regimens of misoprostol and mifepristone work quicker and more effectively at later gestational ages than combination regimens of misoprostol and methotrexate while combination regimens are more effectual than misoprostol alone. In abortions performed very early, up to seven weeks, medical abortion by use of a combination regimen of misoprostol and mifepristone is regarded as more efficient than surgical abortion, particularly if clinical practice excludes detailed review of aspirated tissue. Medical regimens in early abortion by use of mifepristone, followed by vaginal or buccal misoprostol after 24–48 hours are 98% efficient up to nine weeks. Medical abortion regimens by use mifepristone together with an analog of prostaglandin are the most frequent used methods for abortions in the second-trimester in the majority of Europe, Canada, India and China, contrary to the United States where 96% of abortions in the second-trimester are carried out surgically through evacuation and dilation.
Up to 15 gestation weeks, vacuum aspiration or suction-aspiration is the most frequently used induced abortion’s surgical methods. Manual vacuum (MVA) comprises of removal of embryo or fetus, placenta, as well as membranes through suction by use of a manual syringe as electric vacuum aspiration makes use of an electric pump. These techniques vary in the mechanism employed in the application of suction, depending on the age of pregnancy, and whether there is a need of cervical dilation. MVA may be employed in the very early pregnancy, and cervical dilation is not required. Dilation and curettage, which is the second most frequent surgical abortion method, is a standard gynecological process carried out for several reasons, including uterine lining examination for a likely malignancy, abnormal bleeding investigation, and abortion. This procedure is recommended by the WHO only when there is unavailability of MVA.
The abortion’s health risks are based on whether the process is done in a safe or unsafe manner. According to the WHO, unsafe abortions are the ones carried out by individuals who are not skilled, using hazardous equipments or under unhealthful facilities. Lawful abortions carried out in the developed world are one of the safest medical procedures. In the United States, the maternal death risk from abortion is 0.6 for each 100,000 procedures, rendering abortion around 14 times safer than childbirth. The abortion-related death rate risk rises with age of gestation, but it is still less than that of childbirth for at least 21 gestation weeks. In the first trimester, vacuum aspiration is the safest surgical abortion method and may be carried out in an abortion clinic, primary care office, or hospital. There are rare complications, which can include infection of the pelvis, perforation of the uterus, as well as retained conception products that need a second procedure for evacuation. Preventive antibiotics, for instance metronidazole or doxycycline, are characteristically administered prior to elective abortion, since they are considered to considerably decrease the postoperative uterine infection risk. Complications following abortion in the second-trimester are the same as those following abortion in the first-trimester, and are based on the method selected.
There is a small disparity in regard to efficacy and safety between medical abortion by use of a combined regimen of misoprostol and mifepristone, and surgical abortion by use of vacuum aspiration, in abortions done during the early first trimester up to 9 gestation weeks. Medical abortion by use of the misoprostol, an analog of prostaglandin alone, is less efficient and causes more pain than medical abortion by use of misoprostol and mifepristone combined regimen or surgical abortion. A number of supposed abortion risks are enhanced by anti-abortion groups, though this lacks scientific evidence. For instance, the issue of relationship between breast cancer and induced abortion has been researched at length. Key scientific and medical bodies, which include, the US National Cancer Institute, the WHO, the Royal College of Obstetricians and Gynaecologists, the American Cancer Society among others have reached the conclusion that abortion does not result in breast cancer, even though such a relationship proceeds to be furthered by anti-abortion groups.
Likewise, prove demonstrates that induced abortion has nothing to do with mental-health problems. The American Psychological Association has made a conclusion that one abortion does not cause a threat to the mental health of women and that women have no more likelihood of having mental-health problems following an abortion in the first-trimester than following a full term unwanted pregnancy. Abortions carried out following the first trimester due to abnormalities of the fetus are not believed to result in mental-health problems. A number of suggested negative psychological impacts of abortion have been cited by anti-abortion proponents as a different condition known as post-abortion syndrome that is not known by any psychological or medical organization.
There has been controversy, debate, as well as activism arising from induced abortion. A person’s stand regarding the complex moral, ethical, legal, philosophical, and biological issues that encircle abortion is frequently associated with their value system. Abortion opinions may be depicted as being a mixture of beliefs concerning morality of abortion, beliefs concerning the proper degree of authority of governments in public policy, as well as beliefs regarding the responsibilities and rights of the woman who wants to have an abortion. In private and public debate, contentions given against or in favor of abortion get focus on the basis of either validation of laws allowing or limiting abortion or induced abortion’s moral acceptability. Debates on abortion, particularly concerning laws of abortion, are frequently led by proponent groups of one of these two stands. Groups of anti-abortion who prefer greater lawful limitations on abortion, which include a total prohibition, in most cases depict themselves as pro-life while groups of abortion rights who oppose such lawful limitations depict themselves as pro-choice. In general, the pro-life argues that an embryo or fetus is a human being with a right to life. This makes abortion morally similar to murder. The pro-choice argues that an expectant woman has some reproductive rights, particularly the option whether to carry a pregnancy to term or not.
Annas, George J.; Elias, Sherman; . "24. Pregnancy loss." In Obstetrics: Normal and Problem Pregnancies, by Steven G. Gabbe, Jennifer R. Niebyl and Joe Leigh Simpson. London: Churchill Livingstone, 2007.
Cockburn, Jayne, and Michael E. Pawson. Psychological Challenges to Obstetrics and Gynecology: The Clinical Management. Springer, 2007.
Culwell, K. R., M. Vekemans, U. de Silva, and M. Hurwitz. "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion." International Journal of Gynecology & Obstetrics 110 (2010): S13–16.
Grimes, D. A, and M. D. Creinin. "Induced abortion: an overview for internists." Ann Intern Med 140 , no. 8 (2004): 620–6.
Grimes, D. A., and G. Stuart. "Abortion jabberwocky: the need for better terminology." Contraception 81 , no. 2 (2010): 93–6.
Hammond, C., and S. T. Chasen. "Dilation and evacuation." In Management of unintended and abnormal pregnancy: comprehensive abortion care, by M. Paul, E. S. Lichtenberg, L. Borgatta, D. A. Grimes, P. G. Stubblefield and M. D. Creinin. Oxford: Wiley-Blackwell, 2009.
Jasen, P. "Breast cancer and the politics of abortion in the United States." Med Hist 49 , no. 4 (2005): 423–44.
Sedgh, G., S. Singh, I. H. Shah, E. Åhman, S. K. Henshaw, and A. Bankole. "Induced abortion: Incidence and trends worldwide from 1995 to 2008." The Lancet 379, no. 9816 (2012): 625–632.
Templeton, A., and D. A. Grimes. "A Request for Abortion." New England Journal of Medicine 365, no. 23 (2011): 2198–2204.
World Health Organization. Dilatation and curettage. Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. Geneva: World Health Organization, 2003.