Induced Abortion

Induced abortion is the deliberate termination of pregnancy in a manner that ensures that the embryo or fetus will not survive. Attitudes of society toward elective abortion have undergone marked changes in the past few decades. In some situations the need for abortion is accepted by most people, but political and medical attitudes regarding induced abortion have continued to lag behind changing philosophies. Some religious concepts remain unchanged, resulting in personal, medical, and political conflicts.

About one-third of the world's population lives in nations with nonrestrictive laws governing abortion. Another third live in countries with moderately restrictive abortion laws, ie, where unwanted pregnancies may not be terminated as a matter of right or personal decision but only on broadly interpreted medical, psychologic, and sociologic indications. The remainder live in countries where abortion is illegal without qualification or is allowed only when the woman's life or health would be severely threatened if the pregnancy were allowed to continue.

An estimated 1 out of every 4 pregnancies in the world is terminated by induced abortion, making it perhaps the most common method of reproduction limitation. In the U.S., estimates of the number of criminal abortions performed prior to legalization of the procedure ranged from 0.25-1.25 million per year. The number of legal abortions now being performed in this country approximates 1 abortion per 4 live births. In 1997, there were 1.33 million induced abortions compared to 3.88 million live births.

The procedures being used in the U.S. for legally induced abortions during the first trimester are relatively safe. Table 33-2 shows that first-trimester legal abortions are consistently safer for the woman than if she used no birth control method and gave birth. Note also in Table 33-2 that whereas the number of maternal deaths related to births steadily increased from 5.6 to 22.6 per 100,000 women as age increased, age-related increase in number of deaths per 100,000 women per year from legal abortions was insignificant.

In general, the risk of death from legal abortion is lowest when it is performed at 8 menstrual weeks or sooner. Table 33-3 shows the relationship between death due to legal abortion and the gestational age at the time of the procedure.

Paracervical anesthesia has replaced general anesthesia in many health settings, resulting in fewer complications related to anesthesia. Midtrimester abortion techniques are still problematic and are associated with a higher mortality rate. Hysterectomy carries a far greater risk than induction of labor by amnioinfusion or dilatation and evacuation.

Legal Aspects of Induced Abortion in the United StatesThe United States Supreme Court ruled in 1973 (1) that the restrictive abortion laws in the U.S. were invalid, largely because these laws invaded the individual's right to privacy, and (2) that an abortion could not be denied to a woman in the first 3 months of pregnancy. The Court indicated that after 3 months a state may "regulate the abortion procedure in ways that are reasonably related to maternal health" and that after the fetus reaches the stage of viability (about 24 weeks) the states may refuse the right to terminate the pregnancy except when necessary for the preservation of the life or health of the mother. Still, much opposition is raised by various "right-to-life" groups and religious groups. In spite of this opposition, over 1 million procedures are still performed annually in the United States, with about one-third being performed on teenaged women. This dramatically emphasizes the inadequacy of sex education and the need for greater availability of adequate contraceptive methods in order to avoid such pregnancy wastage.