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abortion

Ending of a pregnancy before the fetus is developed sufficiently to survive outside the uterus. Loss of a fetus at a later stage is termed premature stillbirth. Abortion may be natural (miscarriage) or deliberate (termination of pregnancy).

Deliberate termination

In the first nine weeks of pregnancy, medical termination may be carried out using the ‘abortion pill’ (mifepristone), which acts against the hormones sustaining the pregnancy, in conjunction with a prostaglandin to stimulate uterus contractions. There are also various procedures for surgical termination, such as dilatation and curettage, depending on the length of the pregnancy.

Worldwide, an estimated 150,000 pregnancies are terminated each day by induced abortion. One-third of these abortions are performed illegally and unsafely, and cause one in eight of all women's deaths during pregnancy.

Abortion as birth control

Abortion as a means of birth control has long been controversial. The argument centres largely upon whether a woman should legally be permitted to have an abortion and, if so, under what circumstances. Another aspect is whether, and to what extent, the law should protect the fetus.

Those who oppose abortion generally believe that human life begins at the moment of conception, when a sperm fertilizes an egg. This is the view held, for example, by the Roman Catholic Church. Those who support legal abortion may believe in a woman's right to choose whether she wants a child, and may take into account the large numbers of deaths and injuries from unprofessional back-street abortions.

Others approve abortion for specific reasons. For example, if a woman's life or health is jeopardized, or there is a strong likelihood that the child will be born with severe mental or physical disability, an abortion may be recommended. Other grounds for abortion include pregnancy resulting from sexual assault such as rape or incest.

The anti-progesterone pill RU486 was developed and first used in 1989 in France. A success rate of 95% is claimed for its use in conjunction with a prostaglandin. In September 2000, the US Food and Drug Administration approved RU486, the drug mifepristone, to be sold as Mifeprex by Danco Laboratories. It is approved in the USA to be used by a women from the moment she knows she is pregnant until seven weeks after the start of her last menstrual period.

Legal restrictions In the USA in 1989, a Supreme Court decision gave state legislatures the right to introduce some restrictions on the unconditional right, established by the Supreme Court in an earlier decision (Roe v. Wade), for any woman to decide to have an abortion. In November 1995 the US House voted to ban the unusual abortion procedure known as intact dilation and evacuation, which is used for abortions after 20 weeks.

In 1997 legal abortions declined to the lowest level in almost twenty years, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. There was a 3% decrease from the previous year, bringing the total to 1.18 million abortions, that is, 305 abortions per 1,000 live births in 1997.

The strictest US state law on abortion came into effect on 13 May 1998 in Wisconsin. It calls for life in prison for any doctor who performs a late-term abortion. Wisconsin's six abortion clinics immediately stopped this procedure in which the brain is removed from the fetus. Early-term abortions remain legal. As of May 1998, a federal appeals court was still to rule on whether the state could enforce such a strict penalty.

Miscarriage Some women habitually abort within the first few months of pregnancy. In some cases this is due to laxity of the neck of the womb, allowing it to open early. An endocrine disturbance has been suggested, but the results of hormone treatment do not support this theory. The first sign of abortion is vaginal bleeding. At this stage abortion is threatened but not inevitable. Later, rhythmical pains are felt, accompanied by opening of the cervix (neck of the womb) and a feeling of bearing down. The uterus may empty completely with cessation of bleeding and relief of the symptoms, but often the uterus fails to empty completely and life-threatening bleeding follows.

Threatened abortion is treated by keeping the patient lying down and rested. In most cases a normal pregnancy ensues. Inevitable abortion requires rapid evacuation of the uterus, sedation of the patient, and replacement of blood loss. The main complications of abortion are haemorrhage and septic infection.

'X' case Burger, Warren Earl Christian ethics infanticide mifepristone

National Organization for Women Rehnquist, William Roe v. Wade RU486