Abortion

An abortion is a medical procedure (also called induced abortion)^[1] that ends a pregnancy before birth. It can be done surgically or with medicine. A sudden miscarriage (also called spontaneous abortion),^[2] sometimes called an early pregnancy loss^[2] is when pregnancy ends early. An early birth is when pregnancy ends early, after 37 weeks.

In humans, a developing embryo usually takes about 40-42 weeks to grow and be born. A premature baby can born as early as 38 weeks. The different stages are called trimesters. Normally, this occurs about forty weeks after the mother's last menstrual period. Most women won't notice their menstrual period stopped until well after 12 weeks due to periods being abnormal and not always on schedule. This developing human is called an embryo for the first eight weeks of the pregnancy, and foetus for the rest of the pregnancy. Abortion causes the embryo or foetus to die.

When an abortion occurs naturally, it is often called a miscarriage. Humans can also choose to end the pregnancy before birth takes place. This is called an induced abortion. The term abortion often refers only to an induced abortion.

In both types of abortion, the embryo or foetus usually comes out of the womb. This is called a complete abortion. In some cases, the embryo or foetus remains inside the womb. This is called a missed abortion. Surgery is needed to remove the embryo or foetus from the womb so the woman does not get an infection.

Different countries have different laws regarding induced abortion. While abortion is illegal in many countries, there are often exceptions that permit it in cases such as family incest, rape, the foetus having severe disabilities or the mother's health being at risk. Still in many countries even after rape can take place a person would be forced to give birth.

Spontaneous abortions

Names

People say there has been a spontaneous abortion or miscarriage when the embryo or foetus is lost due to natural causes before the 20th week of pregnancy. A pregnancy that ends this way, but that is between 20 and 37 weeks old is known as premature birth if the baby is born alive. If the foetus dies in the womb after 20 weeks, or while it is born, this is known as a stillbirth. Premature births and stillbirths are generally not considered to be miscarriages.

How common they are

Spontaneous abortions (miscarriages) are common. About fifteen percent of pregnancies end in spontaneous abortion. In many cases, the woman is not even aware she was pregnant. The pregnancy is only a few days or weeks old and the woman believes the miscarriage is just her menses. About twenty-five percent of all women will have a spontaneous abortion during their lives.^[3]

Most miscarriages occur very early. Between ten and fifty percent of pregnancies end with a miscarriage, where the mother or the doctors are aware of it. These figures depend on the age and health of the pregnant woman.^[4] Most spontaneous abortions occur so early in the pregnancy that the woman is not even aware that she was pregnant. One particular study showed that 61.9% of pregnancies end in miscarriage before 12 weeks. In 91.7% of these miscarriages, the woman did not know she was pregnant.^[5]

The risk of spontaneous abortion decreases sharply after the 10th week of pregnancy,^[6] with a loss rate between 8.5 weeks LMP and birth of about two percent; pregnancy loss is “virtually complete by the end of the embryonic period."^[7]

Risk factors

Those people who have already had several spontaneous or induced abortions run a greater risk of having a spontaneous one. Those with certain diseases, and those over the age 35 also run a greater risk. Other causes for abortions can be the infection of either the woman or embryo/ foetus, or their immune response. Certain diseases or an accidental trauma can also cause a spontaneous abortion. Putting the woman under trauma or stress to cause miscarriage is considered induced abortion. Some countries call this feticide.^[8]

Cause

Most miscarriages are due to problems with the copying of chromosomes, but some are caused by environmental factors. When a human is conceived, it gets 23 chromosomes from its mother and 23 from its father. If it does not get the right number its development happens wrong (it does not grow right.) It may have many bad birth defects.

Most embryos and foetuses with chromosome problems will not live for a long time. They die very early. There are a few chromosome problems that babies can sometimes be born with. For example, Down syndrome happens when there are three copies of chromosome 21. (Usually people have 2 of every chromosome.) This is called trisomy 21 (tri- means 3.)

Symptoms

The most common symptom is bleeding from the vagina. This can be very little blood (less blood than a normal menses.) It can be very much blood (much more than a normal menses.) Some women have bad pains in their low abdomen when they have a miscarriage. This is sometimes like the pain of menses. It can be much worse. Or a woman may have no pain at all. If the pregnancy is many weeks old, the woman may see the embryo or foetus when it comes out. But if it is less than 12 weeks old a woman may not see anything but blood.

Treatment

Usually, no treatment is needed for a miscarriage. However, sometimes some pregnancy tissue remains in the womb after the miscarriage and must be removed. Sometimes doctors do a surgical abortion. This is the same kind of surgery that is done for induced abortions. Doctors can also prescribe women medicines that can help the miscarriage finish without needing surgery.

Induced abortions

An induced abortion^[1] is when things are done to end the pregnancy on purpose. These things are normally done by doctors. In countries where abortion can be done legally, it is often done by specialists who know a lot about women's bodies (gynecologists). Abortions done illegally are often performed by people without this special knowledge. This makes them more dangerous. Such abortions are usually called unsafe abortions, back-alley abortions or DIY abortions, mainly because the risk to the health of the mother is much higher than with abortions carried out by skilled doctors.

Reasons

There can be medical reasons why an abortion is performed. These include:^[9]

saving the life of the pregnant woman
preserving the woman's physical or mental health
ending a pregnancy that would result in a child being born with severe birth defects, which would be fatal, or which would increase the risk of the child dying at an early age
reducing the number of foetuses to lower the health risks associated with a multiple pregnancy (like twins)

Types

There are two different types (kinds) of induced abortions. The type of abortion that is done depends on a few different things, like what the woman wants, what her doctor thinks is best, and how far along a woman is in her pregnancy (how long she has been pregnant).

One type of induced abortion is called a "medical abortion" or a "medication abortion". In this type of abortion, a doctor gives the woman one or two medications that will end her pregnancy. A medication abortion can only be done early on in the pregnancy. This is because the medications that are used work best when they are started as early as possible, and after a woman has been pregnant for about two months, the medications usually do not work very well. Because of this, medication abortion usually is not used after a woman has been pregnant for 9 weeks.^[10] Some of the benefits (or reasons why some women choose this type of abortion) are that it can be started as soon as a woman realizes she is pregnant; it does not require anesthesia; and the woman does not have to have a procedure in a hospital or clinic to have the foetus removed, like with the other kind of abortion that is done.^[11] After a woman is given the medication or medications that end her pregnancy, the abortion happens like a spontaneous abortion or a miscarriage would. The woman passes the foetus, along with the blood and tissue that have built up in the uterus, from her vagina.

The most common medications that are used for medication abortions are mifepristone and misoprostol.^[11] First, a doctor gives the woman mifepristone, which is sometimes also called "RU-468" or "the abortion pill". This drug blocks the hormone progesterone in the body. Without progesterone, the embryo cannot survive. The lining of the uterus becomes thinner, and the embryo cannot grow or stay attached to the lining of the uterus. After a few days, a doctor gives the woman misoprostol. This makes the uterus contract (or get smaller) and the embryo is expelled from (or pushed out of) the uterus through the woman's vagina.^[11] Sometimes, another medication, called methotrexate, is used along with misoprostol in medication abortions. A woman is given methotrexate, usually as a shot in a doctor's office, and the drug stops the embryo from staying attached to the lining of the uterus. Then misoprostol is given a few days later.^[11]

With the second type of abortion - called "surgical abortion" or "in-office abortion" - a doctor does a procedure that removes an embryo or foetus from the woman's uterus. This kind of abortion can be done in different ways, depending on how long the woman has been pregnant. Surgical abortion is simpler, and there are fewer problems that can happen, if it is done earlier on in the pregnancy. The most common form is called an "aspiration abortion" or a "suction curettage."^[12] This can be done in a doctor's office or clinic. First the woman's cervix (the top part of the uterus) is dilated (or made bigger). A medical tool is used to suction out everything inside the woman's uterus, including the foetus. If the woman has been pregnant for more than 12 weeks, the doctor first has to dilate the cervix (or make the cervix bigger), usually by putting small sticks into the cervix to help it open up. If another tool, called a curette, has to be used to scrape out tissue that is still inside the uterus, then this form of abortion is sometimes called a "dilation and curettage" (or "D&C") or dilation and evacuation.^[12]

Risks and complications

A pregnancy that ends without a child being born also may cause some problems to the woman this happens to. There are two broad groups of things that can happen:

It affects the mental health of the mother
It affects the physical health of the mother

Physical problems

Abortion is safer than childbirth if it is done before the 16th week of pregnancy and it is done by a professional.^[13]^[14] Certain methods of abortion are pretty safe, and complications are rare.^[15]^[16] Generally, stopping a pregnancy that has gone on longer is riskier.^[17]^[18]

Women usually feel a small amount of pain during first-trimester abortion. In a 1979 study of 2,299 patients, 97% reported having some amount of pain. Patients rated the pain as being less than earache or toothache, but more than headache or backache.^[19]

Local and general anesthesias are used during the abortion.^[20]

Psychological problems

Few studies have been done to see if an abortion affects the woman psychologically, or mentally. Those that have been done give contradictory results. One study looked at 13.000 women who had become pregnant even though they did not want to. The study found that having an induced abortion does not increase the risk of getting mental health problems; the group that was compared were women who also did not want to have a baby, but who did not have an abortion.^[21] Other studies^[22] showed similar results: women who had an abortion did better in school or at work after the abortion. Another study showed that women who had an abortion had a higher self-esteem and felt better than those who did not.^[23]^[24]

Many women who had an abortion felt better afterwards, they also felt relieved. They would do it again in a similar situation.^[25]^[26]

A study done in New Zealand in 2006^[27] showed that many women who had an abortion developed severe depression up to 4 years after they had the abortion. They were also more likely to have problems with alcohol and illegal drugs than those women who did not have an abortion. The person who oversaw the study later told media that given these results it would be very hard to say that having an abortion has no psychological effects on the woman who has it. He called the abortion "a traumatic experience".^[28]

Numbers and reasons for induced abortions

The number of induced abortions done are different for different parts of the world. This is also true for the reasons why women decide to have an abortion. Estimates are that about 46 million induced abortions are done worldwide, every year. 26 million of them occur in places where abortion is legal, 20 million happen in countries where it is illegal to have an abortion. Some countries, like Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100) have a low rate of induced abortion. Others, like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. Overall, there are 26 induced abortions per 100 known pregnancies.^[29]

WHO estimated in 2001 that every year, about 210 million women get pregnant, and that there are about 135 mililon live births. The remaining 75 million cases are miscarriages or induced abortions. About forty percent of pregnancies are unplanned, and about a fifth of the pregnant women decide to end the pregnancy early. This results in about 42 million abortions per year. About 20 million of these are legal, the rest are against the law. Most of the illegal abortions are performed by those who are not medically qualified, often with poor hygiene, which often threaten the lives of the women. The WHO estimated that about 47.000 women died in 2008 because of illegal abortions. This number was lower than the estimate of 1990, mainly because in South America, women opted to take drugs to end the pregnancy.

Methods used for abortions; times when abortions are done

Abortion rates vary. The length the pregnancy has gone on, and the method used to do the abortion influence these rates. According to data collected in the United States, 88.2% of abortions were done in the first twelve weeks of pregnancy, 10.4% between week 13 and week 20 of the pregnancy. The remaining 1.4% were done in week 21 or later.

90.9% were done by curettage, 7.7% were medical abortions (using drugs, mifepristone in most cases), 0.4% by "intrauterine instillation" (

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]