Assignment (Scholarly Paper)

Medical Perspectives about Abortion

Faculty: Mam Shahla Arshad

Submitted by

Assad Ullah Tahir

Roll #: 48

Semester 6th KMU/INS

 Medical perspectives about abortion

Abortion is one of the most difficult, controversial, and painful subjects in modern American

society. The principal controversy revolves around the questions of who makes the decision

concerning abortion the individual or the state; under what circumstances it may be done;

and who is capable of making the decision. Medical questions such as techniques of

abortion are less controversial but are sometimes part of the larger debate.

Abortion is not new in human society. A study by anthropologist George Devereux (1955)

showed that more than three hundred contemporary nonindustrial societies practiced

abortion. Women have performed abortions on themselves or experienced abortions at the

hands of others for thousands of years (Potts et al. 1977), and abortions continue to occur

today in nonindustrial societies under medically primitive conditions. However, modern

technology and social change have made abortion an essential component of modern

health care. However, abortion has become a political issue in American life and a flash

point for disagreements about the role of women and individual autonomy in life decisions.

The classic definition of abortion is "expulsion of the fetus before it is viable." This could

include spontaneous abortion (miscarriage) or induced abortion, in which someone (a

doctor, the woman herself, or a layperson) causes the abortion. Before modern methods of

abortion, this sometimes meant the introduction of foreign objects such as catheters into

the uterus to disrupt the placenta and embryo (or fetus) so that a miscarriage would result.

In preindustrial societies, hitting the pregnant woman in the abdomen over the uterus and

jumping on her abdomen while she lies on the ground are common techniques used to
induce an abortion (Early & Peters 1990). Although these methods can be effective, they

may also result in death of the woman if her uterus is ruptured or if some of the amniotic

fluid surrounding the fetus enters her blood stream. From the Colonial period to the early

twentieth century in America, primitive methods such as these were used along with the

introduction of foreign objects into the uterus (wooden sticks, knitting needles, catheters,

etc.) to cause abortion, frequently with tragic results (Lee 1969).

In modern American society, abortions are performed surgically by physicians or other

trained personnel experienced in this technique, making the procedure much safer than

when primitive methods were used. The goal of induced abortion still remains the same:

Interrupt the pregnancy so that the woman will not continue to term and deliver a baby.

One problem with the classical definition of abortion is the changing definition of viability

(the ability to live outside the womb). Premature birth is historically associated with high

death and disability rates for babies born alive, but medical advances of the twentieth

century have made it possible to save the lives of babies born after only thirty weeks of

pregnancy when the usual pregnancy lasts forty weeks. Some infants born at twenty-six to

twenty-seven weeks or even younger have survived through massive intervention and

support. At the same time, abortions are now sometimes performed at up to twenty-five to

twenty-six weeks of pregnancy. Therefore, the old definition of viability is not helpful in

determining whether an abortion has been or should be performed (Grobstein 1988).

Reasons for Abortions

There are probably as many reasons for abortions as there are women who have them.

Some pregnancies result from rape or incest, and women who are victims of these assaults

often seek an abortion. Most women, however, decide to have an abortion because the

pregnancy represents a problem in their lives. Some women feel emotionally unprepared to

enter parenthood and raise a child; they are too young or do not have a reliable partner

with whom to raise a child. Many young women in high school or college find themselves

pregnant and must choose between continuing the education they need to survive

economically or dropping out to have a baby. Young couples who are just starting their lives

and want children might prefer to develop financial security first to provide better care for

their future children. Sometimes people enter into a casual sexual relationship that leads to

pregnancy with no prospect of marriage, but even if the sexual relationship is more than

casual, abortion is sometimes sought because a woman decides that the social status of the

male is inappropriate.

Some of the most difficult and painful choices are faced by women who are happily

pregnant for the first time late in the reproductive years (thirty-five to forty-five) but

discover in late pregnancy (twenty-six or more weeks) that the fetus is so defective it may

not live or have a normal life. Even worse is a diagnosis of abnormalities that may or may

not result in problems after birth. Some women and couples in this situation choose to have

a late abortion (Hern et al. 1993, Kolata 1992).

In some cases, a woman must have an abortion to survive a pregnancy. An example is the

diabetic woman who develops a condition in pregnancy called hyperemesis gravidarum

(uncontrollable vomiting associated with pregnancy). She becomes malnourished and

dehydrated in spite of intravenous therapy and other treatment, threatening heart failure,

among other things. Only an abortion will cure this life-threatening condition.

In other cases, an abortion is sought because the sex of the fetus has been determined

through amniocentesis or ultrasound examination and it is not the desired sex. This is more

common in some cultures than in others. In the United States, it is exceedingly rare, and the

request for abortion in this situation may be precipitated by the risk of a sex-linked

hereditary disease.

Risks of Abortion

Abortion has become not only the most common but also one of the safest operations

performed in the United States. This was not always the case. In the nineteenth and early

twentieth centuries, abortion was quite dangerous; many women died as a result.

Pregnancy itself is not a harmless condition, women can die during pregnancy. The maternal

mortality rate (the proportion of women dying from pregnancy and childbirth) is found by

dividing the number of women dying from all causes related to pregnancy, childbirth, and

the puerperium (the six-week period following childbirth) by the total number of live births,

then multiplying by a constant factor, such as 100,000. The maternal mortality rate in the

United States in 1920 was 680 maternal deaths per 100,000 live births (Lerner & Anderson

1963). It had fallen to 38 deaths per 100,000 live births by 1960 and 8 deaths per 100,000
live births by 1994. Illegal abortion accounted for about 50 percent of all maternal deaths in

1920, and that was still true in 1960. By 1980, however, the percentage of deaths due to

abortion had dropped to nearly zero (Cates, 1982). The difference in maternal mortality

rates due to abortion reflected the increasing legalization of abortion from 1967 to 1973

that permitted abortions to be done safely by doctors in clinics and hospitals. The changed

legal climate also permitted the prompt treatment of complications that occurred with

abortions.

The complication rates and death rates associated with abortion itself can also be

examined. In 1970, Christopher Tietze of the Population Council began studying the risks of

death and complications due to abortion by collecting data from hospitals and clinics

throughout the nation. The statistical analyses at that time showed that the death rate due

to abortion was about 2 per 100,000 procedures, compared with the maternal mortality

rate exclusive of abortion of 12 deaths per 100,000 live births. In other words, a woman

having an abortion was six times less likely to die than a woman who chose to carry a

pregnancy to term. Tietze also found, that early abortion was many times safer than

abortion done after twelve weeks of pregnancy (Tietze and Lewit 1972) and that some

abortion techniques were safer than others. The Centers for Disease Control and Prevention

in Atlanta took over the national study of abortion statistics that had been developed by

Tietze, and abortion became the most carefully studied surgical procedure in the United

States. As doctors gained more experience with abortion and as techniques improved,

death and complication rates due to abortion continued to decline. The rates declined

because women were seeking abortions earlier during pregnancy, when the procedure was
safer. Clinics where safe abortions could be obtained were opened in many cities across the

country, improving access to this service.

By the early 1990s, the risk of death in early abortion was fewer than 1 death per 1 million

procedures, and for later abortion, about 1 death per 100,000 procedures (Koonin et al.

1992). The overall risk of death in abortion was about 0.4 per 100,000 procedures,

compared with a maternal mortality rate (exclusive of abortion) of about 9.1 deaths per

100,000 live births (Koonin et al. 1991a, 1991b).

Physical and Psychological Effects of Abortion

Studies of the long-term risks of induced abortion, such as difficulties with future

pregnancies, show that these risks are minimal. A properly done early abortion may even

result in a lower risk of certain obstetrical problems with later pregnancies (Hern 1982;

Hogue et al. 1982). An uncomplicated early abortion should have no effect on future health

or childbearing. If the abortion permits postponement of the first-term pregnancy to after

adolescence, the usual risks associated with a first-term pregnancy are actually reduced.

Psychological studies consistently show that women who are basically healthy can adjust to

any outcome of pregnancy, whether it is term birth, induced abortion, or spontaneous

abortion (miscarriage) (Adler et al. 1990). It is highly desirable, however, to have strong

emotional support not only from friends and family, but also from a sympathetic physician

and a lay abortion counselor who will be with the woman during her abortion experience.

Most specialty abortion clinics now have abortion counselors who help women talk about

their feelings before the abortion and to provide specific information about the procedure
and its risks. This counseling is crucial not only in providing proper emotional and social

support but also in helping the woman understand what she needs to know about the

procedure and prevention of complications. Women who have this kind of support, as well

as support from family and friends, generally have few psychological problems following

abortion. On the other hand, women who have received hostile, punitive messages about

the pregnancy and the decision to have an abortion are likely to experience high levels of

stress during the abortion and in later years. These women may have a lingering sense of

guilt for having decided to follow through with the abortion procedure.

Denial of abortion can have serious adverse consequences for the children who result from

the pregnancies their mothers had wanted to terminate.

 References:

Adler, N.E., David, H.P., Major, B.N., Roth, S.H., Russo, N.F., and Wyatt, D.E. (1990).

Psychological responses after abortion. Science 248:41-44.

Bates, M. (1993). Woman shoots abortion doctor. The Denver Post, August 20.

Cates, W., Jr. (1982). Abortion: The public health record. Science 215:1586.

Booth, M. and Briggs, B. (1993). Abortion doctor says his life is threatened. The Denver Post,

August 13.

David, H.P., Dytrych, Z., Matejcek, Z., and Schuller, V. (1988). Born Unwanted:

Developmental Effects of Denied Abortion. New York: Springer-Verlag.

Devereux, G. (1955). A Study of Abortion in Primitive Society. New York: Julian Press.

Early, J.D., and Peters, J.F. (1990). The Population Dynamics of the Mucajai Yanomama. San

Diego: Academic Press.

Forrest, J.D. and Henshaw, S.K. (1987). The harassment of U.S. abortion providers. Family

Planning Perspectives 19:9-13.

Gavin, J. (1993). Hern: Rein in abortion opponents. The Denver Post, August 21.

http://www.drhern.com/news-a-publications/26-abortion-medical-and-social-aspects.html