Abortion

What is abortion?

"Abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death." [1]
It means that abortion is either the expulsion of an already dead fetus or embryo (without intention), or the intentional removal of a still living fetus or embryo.
We will focus on induced abortion, which is the intentional removal of the uterus' content.

What is the difference between a human embryo and fetus?

Most pregnancies last between 39 and 40 weeks (9 months) from the beginning of the last menstruations. Duration of pregnancy is divided into 3 stages called trimesters. The first trimester lasts about 12 weeks, the second covers from the 13th to the 28th week and the third lasts from the 29th week until birth. (See Annex 1)

• Embryo: During the first trimester (about 3 months) the organsim is called an embryo.
• Fetus: From the beginning of the second trimester to birth, the organism is called a fetus.

Why does the embryo become a fetus at three months?

The limit of three months (12 weeks) is not universal, some put it at 8,10 or 14 weeks. In general, this period between the 8th and the 14th week of pregnancy is the moment when the the major structures and organs of the organism have been formed.

Is abortion a form of contraception?

• Definition of contraception: Different methods used in order to avoid temporarily the fertilization

According to this definition, abortion is not a contraceptive form because the fertilization has already occurred.
As this definition doesn't consider abortion as a contraceptive form, we could define it as a process which ends the pregnancy.

• Another definition of contraception: Different methods used in order to avoid having a baby.
  

According to this second definition, abortion is a form of contraception because it inhibits having a baby.

What are the different forms of abortion?

Induced abortion

An induced abortion is a pregnancy which is voluntarily aborted and this can be done by using different methods. The method used depends mainly upon the gestational age of the fetus. But the method chosen also depends on the medical resources, the regional availability, the legality and the doctor's preference for using a specific procedure. This abortion can be performed by using surgery or medicines.

• Feticide:

A more particular type of induced abortion is the intentional trauma (=physical injury potentially resulting in secondary complications). This trauma is often called feticide and causes miscarriage. Feticide is more precisely described as the destruction of the embryo or fetus in the uterus. One can kill the embryo or fetus by punching or hitting the abdomen of the women. This act is considered as a murder in many countries and is severely punished.

Spontaneous abortion

A spontaneous abortion is generally known as a miscarriage. It is when an embryo or a fetus is lost before the 20th week of gestation due to natural causes. Most miscarriages occur very early in pregnancy and sometimes so early, that the woman is not even aware that she was pregnant. The risk of spontaneous is all in the sudden strongly reduced after the 8th week of gestation.

• The causes of spontaneous abortion:

Between 10% and 50% of pregnancies result in miscarriages, depending on the health and the age of the pregnant woman. The women who have already endured several spontaneous or induced abortion, those with chronic diseases and those who are over 35 years old, have a greater risk to have their pregnancy ending in miscarriage. Spontaneous abortion can also be caused by the infection of either the woman or the fetus, or by accidental trauma (=physical injury potentially resulting in secondary complications).

What is gestation and what is the gestational age?

We call gestation the carrying of an embryo or a fetus inside a female. Females can have one or more gestations during pregnancy. This explains why some women have twins or triplets. And what we call gestational age is the age of a fetus from the first day to the day the pregnancy arrives to its term.

How is abortion performed?

Surgery

Surgical abortion is the removal of the uterus' content by surgery. It is more commonly used. There are different sorts of surgical abortions. The method generally depends on the gestational age of the organism.
See Annex 2)

• Manual or Machine Vacuum Aspiration (MVA)

In the first trimester of pregnancy, one can simply suck up the tissues in the uterus (with a tube).

• Dilation and Curettage (D&C)

For D&C, one dilates the cervix and uses a sharp instrument (curette) in order to clear the uterus. When vacuum aspiration or medicine didn't work entirely, one use this method in order to remove the rest. It's rarely used as a full method because of the high bleeding risks.

• Dilation and Evacuation (D&E)

In the second trimester, one use this method, which is a combination of vacuum aspiration, dilation and curettage, and the use of other instruments (like forceps for example).

Medicines

Medical abortion means that the mother takes medicines (swallows pills) in order to end the pregngancy. It is only possible during the first trimester of pregnancy; later on, surgical abortion is the only possibility. However, it becomes less effective at the end of the first trimester (after the 7th or 9th week).

• Mifespristone

Mifespristone (also called the abortion pill or RU-486) is a special anti-abortion agent which blocks the progesterone hormone necessary for pregnancy.

• Methotrexate

Taken in the early pregnancies, Methotrexate inhibits the implantation of the embryo in the uterus (which occurs during the first weeks after conception).

• Misoprostol

A second drug has to be taken (hours or days) after mifepristone or methotrexate, which will cause the contraction and the emptying of the uterus.

Until when (in pregnancy) is abortion allowed?

• 0-12 weeks

In Switzerland (and most European countries), until the 12th week of pregnancy, abortion is a personal and legal choice (this law was voted in October 2002 [2]).

• 13-birth

From the 13th week until the end of pregnancy, to have an abortion, it must medically be proved that the procedure is necessary in order to avoid some severe physical or psychological troubles for the mother. In that case, the health of the mother in danger is considered as more important than the life of the fetus or embryo.

According to which criteria did one fix this limit?

• In most European countries, abortion must occur during the first trimester of pregnancy.
  

This is probably because the unborn organism is an embryo. Therefore it cannot survive out of its mother, it's not a full and dependent organism yet, it's only a part of the mother. Moreover, abortions in the first trimester are safer to perform for the mother and easier for the doctors. With abortions in the second or third trimester, there are more risks for the mother's health. (The more one waits to have an abortion, the more these risks increase;a performance could even result in the mother's death.)

• However, in the UK for example, abortion is allowed until the 24th week, the end of the second trimester (it's the highest legal limit in Europe).
  

This is probably to leave more time to women to make such a difficult choice.

At what age is abortion allowed?

• Adults

In Switzerland, adult women (at least 18 years old) are allowed to have abortions.

• Minors

In Switzerland, minors (less than 18 years old) are allowed to have abortions even without the consent of their parents. Those who are under 16 must have a consultation in a special centre.

In Switzerland, abortions are allowed at every age. However, if the pregnant woman is not capable of judgment, her legal representative (parents, for example) makes the decision for her. [3]

Why do certain women decide to have an abortion?

The evident answer to this question is, because they don't want to be pregnant. What's interesting to know, is what factors are at the origin of such a difficult decision.

• cultural factors: the feeling of being to young to be a mother, marriage "obligatory" before children
• family factors: objection or rejection of the family, already many children or as many children as wanted,
• professional factors: baby would affect career or studies
• couple factors: no or not enough support from the father, relationship problems with the father, baby resulting from a one night stand, hope of saving the relationship
• financial factors: poverty, unemployment, incapacity to afford a(nother) child
• other factors: pregnancy endangering the maternal or fetal health, no wish of children, baby resulting from a rape or incest, Down syndrome baby, sex selective abortion

The reason why a woman choose to have an abortion is complex and often depends on several factors.
For further information on the reasons why certain women use contraceptives, see [[4]]

Are there physical or psychological consequences for the mother?

Physical consequences

• Pain

Most women, who had an abortion, feel pain after the intervention (the younger the woman is, the more painfull she 'll feel). Cramping and cutting are the most common pain feelings.

• Bleeding

Irregular bleedings are usual after an intervention, especially if it was a medical abortion.

• Secondary infertility

Induced abortion increases the risk of secondary infertility. Secondary infertility is the incapacity to have another baby after one or several births.

Psychological consequences

Emotional reactions after abortion aren't very alarming if they don't last. Most women may feel sad, angry, guilty, relieved, etc during several weeks. Of course, not all women are affected the same way: some have no problems at all, while others continue to suffer months and even years after the abortion.

• Post-Abortion Syndrome (PAS)

PAS is probably a form of Post-Traumatic Stress Disorder (PTSD)[5] It isn't an official illness i.e. some believe it exist, others don't.
Men can suffer form the syndrome as well as women. The symptoms of it vary, but in most cases there're: denial, guilt (which generates the need to make things good again, "repair") and depression (which sometimes leads to suicidal thoughts). Patients also show other symptoms, like repetitive dreams and nightmares about abrotion, for example. Other behavior troubles can be linked with this syndrome: eating disorder, drug or alcohol abuse, self punishment.

Are there consequences for the embryo or fetus?

The evident and wanted consequence of abortion is the "death" of the embryo or fetus.
Some physicians believe one should anesthetize the unborn organsim as well as the woman, to ensure it is not suffering from the procedure.

Can an embryo or a fetus feel pain?

There are three major opinions answering this question.

• Yes

Some "pro-life" physicians believe that the organism can feel pain very early in pregnancy: already several weeks after fertilization. In fact, the embryo begins to develop pain sensors only few weeks after the conception.

• Yes but later

Some physicians believe that the organism can feel pain, but only at the end of the pregnancy, during the third trimester of fetal life. In fact, until the end of pregnancy, the fetus' central nervous system is not complete, there are still "missing pieces" that do not function.

• No

Some physicians believe that the organism cannot feel pain until it is born.

What are the Pro-Life's and the Pro-Choice's arguments?

Pro-Life: against abortion, for life

• Right to exist

Pro-life groups, consider the fetus as a human being with a fundamental right to life. Pro-life individuals generally believe that human life starts either from fertilization or implantation until natural death. For them, the right for life (of everyone even the unborn organism) is fundamental. The intentional destruction of life is seen morally and ethically wrong.

• Punishment

Pro-Life groups argue that if a woman has an abortion, she's actually punishing the wrong person, her innocent child. They argue that a baby should not pay for someone else's fault (forgetting contraception, for example) or for someone else's crimes (conception resulting from a rape).

• Post-Abortion Syndrome

Pro-life groups argue that if a woman has an abortion, she'll endure severe psychological troubles caused by the abortion. Therefore, on should forbid the intervention to protect the mother (as well as her child, of course).

• Relationship between induced abortion and breast cancer

Some anti-abortion extremists argue that induced abortion increases the risk of having breast cancer. In the USA, "Women who choose abortion suffer more and deadlier breast cancer" was a campaign by the Christ's Bride Ministries. However, this assumption is false: recent scientific experiments have shown that there's no link between them.

Pro-Choice: for abortion and the women's choice

• Right to choose

For Pro-Choice groups, the woman's right to decide for her own, to control her own body, is fundamental. They strongly believe that women should have access to safe and legal abortion and in the same way, that women should'nt be forced to have an abortion if they don't desire to. Pro-choice individuals show that ethically and politically, women should have the entire control of their pregnancy.

• Unborn cell or tissues

Many Pro-Choice individuals consider that life begins at birth and therefore, that abortion isn't an act of killing since the unborn organism isn't a full human being but a mass of tissue.

• Clandestine abortion

Pro-Choice groups argue that even if abortion becomes illegal, women would still try to have abortions by paying for illegal interventions or by doing it themselves. These two options are of course very dangerous for the mother, who may experience severe injury and even death.

• Child abuse

Pro-Choice groups think that if abortion is made illegal, more children will be abused. In fact, they think that if one forces a woman to have her child, this woman is likely to abuse or neglect her unwanted child. In this case, Pro-Choice individuals believe, it is better for a child to die, than to have an unhappy life.

What are the ethical issues of abortion?

Most of the ethical questions about abortion are the result of the following question.

When does person hood begin, can abortion be considered as a murder?

There are several possible answers to this questions, all depending on the individual beliefs about the beginning of life.

• Pro-Life answer

For Pro-Life groups, life begins at the organism's conception or implantation in the uterus. Since the unborn organsim is considered as a full human being, abortion, which is the ending of a human's life, is considered as a murder.

• Pro-Choice answer

For Pro-Choice groups, life begins at birth. Since the unborn organism isn't considered as a full human being, they don't consider abortion as a murder, but simply as the removal of the tissues in the uterus.

• In General

When an abortion attempt has failed and the fetus is at least 19 weeks old, the baby born is still living (it can cry, breath and its heart beats) and dies of lack of care. In this case, the doctors in charge of the abortion could be charged with infanticide. See also feticide [[6]]

What are the religious views about abortion?

Religious views about abortion often play an important role for individual opinion about abortion and the beginning of life. In some countries, these religious views even influence abortion legislation. Some religions tolerate abortion, but most don't. Here's a short overview.

• Judaism

The jewish law defines when a fetus becomes a person: at birth ("when the head emerges from the womb"). Until then, it is considered as a "partial life", a (very valuable) part of the pregnant woman. Therefore, in some special cases, Judaism, except some Orthodox groups, "allows" the access to abortion for a woman.

• Christianism

• Catholicism

The Roman Catholic Church defines the unborn organism as a full human being from conception to death. It is a gift of God. Therefore, it is strongly opposed to abortion under any circumstances and threatens any catholic having (mother) or performing (doctor) abortion with excommunication.

• Protestantism

There are a lot of different Churches among Protestantism. Most of them share the catholic view about the beginning of life and are opposed to abortion. However, they generally recognize that there can be certain circumstances under which, the abortion is necessary. Moreover, most of these Churches preach compassion for the woman.

• Islam

In Islam, life is considered as a trust from God which can only be mastered by Him. Therefore, abortion is not allowed, except if the pregnancy endangers the mother's life. This is the only situation where abortion could be considered.

References

news.bbc.co.uk
pubhealth.info/abortion/ab1/rPage4116.html
women.webmd.com
members.aol.com/abtrbng/feticide.htm
afterabortion.com
encarta.msn.com
judaism.about.com
www.wikipedia.org
www.medicinenet.com/miscarriage
www.pregnancy.org/pregnancy/fetaldevelopment1.php
www.religioustolerance.org
www.ncbi.nlm.nih.gov
www.plannedparenthood.org
www.allaboutlifechallenges.org
www.medicalnewstoday.com/articles/26918.php
www.abortionfacts.com
www.svss-uspda.ch
www.request.org.uk
www.crescentlife.com
www.jamaat.org
www.leaderu.com
www.guttmacher.org
www.childrenbychoice.org.au

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