ALL YOU NEED TO KNOW ABOUT ABORTION...social and ethical issues

Abortion, termination of a pregnancy before birth, resulting in the death of the fetus. Some abortions occur naturally because a fetus does not develop normally or because the mother has an injury or disorder that prevents her from carrying the pregnancy to term. This type of spontaneous abortion is commonly known as a miscarriage. Other abortions are induced—that is, intentionally brought on—because a pregnancy is unwanted or presents a risk to a woman’s health, or because the fetus is likely to have severe physical or mental health problems.

Induced abortion, the focus of this article, is one of today’s most intense and polarizing ethical and philosophical issues. Modern medical techniques have made induced abortions simpler and less dangerous. But in the United States, the debate over abortion has led to legal battles in the courts, in the Congress of the United States, and state legislatures. The debate has spilled over into confrontations, which are sometimes violent, at clinics where abortions are performed.

This article discusses the most common methods used to induce abortions, the social and ethical issues surrounding abortion, and the history of the regulation of abortion in the United States.

a]  Drug-Based Abortion Methods

 

Drug-based abortion, also known as medication abortion, typically requires that a woman take two types of drugs within the first weeks of a confirmed pregnancy. In one method, a pregnant woman first takes the drug mifepristone, also known as RU-486, which blocks progesterone, a hormone needed to maintain the pregnancy. About 48 hours later, she takes another drug called misoprostol. Misoprostol is a prostaglandin (a hormone-like chemical produced by the body) that causes contractions of the uterus, the organ in which the fetus develops. These uterine contractions expel the fetus.

Another type of drug combination that induces abortion is the use of misoprostol with methotrexate, an anticancer drug that interferes with cell division. A physician first injects a pregnant woman with methotrexate. About a week later, the woman takes a pill containing misoprostol to induce uterine contractions and expel the fetus.

These drug-based abortion methods effectively end pregnancy in approximately 96 percent of the women who take them and are most effective when performed very early in a pregnancy. These methods require no anesthesia. However, the use of drugs to induce abortion has not been widely adopted by women in the United States for a number of reasons. These drugs can cause unpleasant side effects—some women experience nausea, cramping, and bleeding. More serious complications, such as arrhythmia, edema, and pneumonia, affect the heart and lungs and may cause death. Perhaps the primary deterrent is that these drug-based abortion methods require at least two visits to a physician over a period of several days, and these methods are no cheaper than a surgical abortion. 

b]  Surgical Abortion Methods

 

Legal surgical abortion, when done by a trained provider, is essentially 100 percent effective. A number of surgical methods can be used to induce abortions. To end a pregnancy before it reaches eight weeks, a doctor typically performs a preemptive abortion or an early uterine evacuation. In both procedures a narrow tube called a cannula is inserted through the cervix (the opening to the uterus) into the uterus. The cannula is attached to a suction device, such as a syringe, and the contents of the uterus, including the fetus, are extracted. Preemptive abortion uses a smaller cannula and is performed in the first four to six weeks of pregnancy. Early uterine evacuation, which uses a slightly larger cannula, is performed in the first six to eight weeks of pregnancy. Both types of abortions typically require no anesthesia and can be performed in a clinic or physician’s office. The entire procedure lasts for only several minutes. In preemptive abortions the most common complication is infection. Women who undergo early uterine evacuation may experience heavy bleeding for the first few days after the procedure.

Vacuum aspiration is a procedure used for abortions in the 6th to 14th week of pregnancy. It requires that the cervix be dilated, or enlarged, so that a cannula can be inserted into the uterus. Progressively larger, tapered instruments called dilators may be used to dilate the cervix. During the procedure, the cannula is attached to an electrically powered pump that removes the contents of the uterus. In some cases, the lining of the uterus must also be scraped with a spoonlike tool called a curette to loosen and remove tissue. This procedure is referred to as curettage. Vacuum aspiration may require local anesthesia and can be performed in a clinic or physician’s office. Minor bruising or injuries to the cervix may occur when the cannula is inserted.

Dilation and curettage (D&C), performed during the 6th to 16th week of pregnancy, involves dilating the cervix and then scraping the uterine lining with a curette to remove the contents. A D&C often requires general anesthesia and must be performed in a clinic or hospital. Possible complications include a reaction to the anesthesia and cervical injuries. Since the development of vacuum aspiration, the use of D&C has declined.

After the first 16 weeks of pregnancy, abortion becomes more difficult. One method that can be used during this period is dilation and evacuation (D&E), which requires greater dilation of the cervix than other methods. It also requires the use of suction, a large curette, and a grasping tool called a forceps to remove the fetus. D&E is a complicated procedure because of the larger size of the fetus and the thinner walls of the uterus, which stretch to accommodate a growing fetus. Bleeding in the uterus often occurs. D&E is often performed under general anesthesia in a clinic or hospital. It is typically used in the first weeks of the second trimester but can be performed up to the 24th week of pregnancy.

               

SOCIAL AND ETHICAL ISSUES

Abortion has become one of the most widely debated ethical issues of our time. On one side are pro-choice supporters—individuals who favor a woman’s reproductive rights, including the right to choose to have an abortion. On the other side are the pro-life advocates, who may oppose abortion for any reason or who may only accept abortion in extreme circumstances, as when the mother’s life would be threatened by carrying a pregnancy to term. At one end of this ethical spectrum are pro-choice defenders who believe the fetus is only a potential human being when it becomes viable, that is, able to survive outside its mother’s womb. Until this time the fetus has no legal rights—the rights belong to the woman carrying the fetus, who can decide whether or not to bring the pregnancy to full term. At the other end of the spectrum are pro-life supporters who believe the fetus is a human being from the time of conception. As such, the fetus has the legal right to life from the moment the egg and sperm unite. Between these positions lies a continuum of ethical, religious, and political positions.

This combination of medical ambiguities and emotional political confrontations has led to considerable hostility in the abortion debate. For many people, however, the lines between pro-choice and pro-life are blurred and the issue is far less polarized. Many women who consider themselves pro-life supporters are concerned about possible threats to reproductive rights and the danger of allowing the government to decide what medical options are available to them. Similarly, many pro-choice individuals are deeply saddened by the act of abortion and seek to minimize its use through better education about birth control, and, in particular, emergency contraception, birth-control methods that prevent pregnancy after unprotected sexual intercourse.

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