Abortion

1. Abortion Chapter 7

2. The Abortion Issue • Abortion: • The artificially induced expulsion of an embryo or fetus from the uterus • Miscarriage: • Spontaneous abortion that occurs naturally • The history of abortion in the U.S. • Mid-1800s: Prior to 20 weeks was legal • 1900s: All states made abortion illegal • 1960s: Laws started to change to remedy violations of the right to privacy

3. Current Legal Status • 1973 Roe v. Wade • U.S. Supreme Court ruled: • Pregnancy divided into three trimesters • 1st trimester - up to pregnant woman and her doctor • 2nd trimester - state may regulate • 3rd trimester - state may regulate and bar all abortions that are not life threatening to mother • U.S. Congress barred use of federal Medicaid funds • 17 states provide nonfederal public money • Current issues • 2007 • Gonzales v. Carhart - Supreme Court upholding the Partial Birth Abortion Ban Act • 2008-2010 • Several states pass legislation requiring women seeking an abortion to undergo ultrasound procedures and be given the chance to view the images

4. Public Opinion • Pro-life: The fertilized egg is a human being from the moment of conception and, therefore, an abortion is murder. • Any women having sex knows pregnancy is possible; she has a moral obligation to carry the pregnancy through • Women unable or unwilling to raise the children should consider placing them up for adoption • Abortion has destructive effects on our traditional morals and values

5. Public Opinion • Pro-Choice: There are distinct stages of fetal development and that preserving the fetus early in pregnancy is not the ultimate moral concern. • Women should have the right to make their own decisions • If not legal, then unsafe and unregulated practices would occur • Women would be divided into those who could afford an abortion and those who could not

6. Public Opinion • U.S. public opinion seems to change depending on the situation • Many approve legal abortion when health or welfare consequences could result • The issue in later pregnancy is the question of when the right of the fetus takes precedence over the woman’s rights

7. Figure 7.1 Public opinion about abortion

8. Personal Considerations • Legal arguments • Moral arguments • Short- and long-term ramifications • What resources are available? • Adoption options

9. Figure 7.3 distribution of abortions by the woman’s age and by the weeks of gestation, 2006

10. Figure 7.4The reasons women choose abortions

11. Methods of Abortion • Two categories • Surgical - 87% of all U.S. abortions in 2005 • Medical – 13% of all U.S. abortions in 2005 • Emergency contraception pills or IUD not abortifacients

12. Suction Curettage • Also known as dilation and curettage or D&C • Performed from the 6th to 12th weeks • Used in about 90% of all abortions • Cervix is cleansed, then gently and gradually stretched over a 24-hour period • After dilation, a tube connected to a suction machine gently empties the uterus • After suction, doctor uses a curette (narrow metal loop) gently scrapes the walls of the uterus • Entire curettage takes 5-10 minutes • After a few hours in recovery, the woman can return home

13. Figure 7.5 Suction Curettage

14. Manual Vacuum Aspiration • Manual Vacuum Aspiration (MVA) • Done up to 10 weeks of gestation • Gentle suction of a syringe; no electric pump • Significantly cheaper than suction curettage • Can be performed by nurses or midwives • Ideal for low-resource settings • As safe as suction curettage

15. MULTI-FETAL PREGANANCY REDUCTION (MFPR) • Multi-Fetal Pregnancy Reduction (MFPR) • Reduces the number of fetuses in a multiple pregnancy • Usually performed during first trimester • Fetal heart injected with potassium chloride • Improves maternal pregnancy outcomes

16. Abortion After the First Trimester • One in ten abortions is performed after the 12th week of pregnancy • D&E used from 13 to 24 weeks of pregnancy • Dilation and Evacuation (D&E) • Two steps: • 1) Cervix is dilated overnight at home • 2) Next day, uterus is emptied using surgical instruments and an aspirating machine

17. Abortion After the First Trimester • Intact dilation and extraction (known as partial birth abortion) • Surgical procedure where intact fetus is removed from the uterus; performed rarely (0.17% of all abortions) • Became illegal in 2007 by the Supreme Court ruling of Gonzales v. Carhart • Labor Induction • Rarely performed; used for late abortion • Prostaglandins (chemicals) used to induce labor • Causes contractions to begin • Causes a stillbirth to occur within 6-24 hours

18. Medical Abortion • Medical Abortion • Used very early in pregnancy within 49 days of the last menstrual period. • Choose to use a combination of drugs to end the pregnancy • Advantages and Disadvantages • Drugs used: • Mifepristone • Blocks the effect of progesterone • Misoprostol • Induces contractions • Methotrexate • Stops the embryonic or fetal cells from dividing

19. Medical Abortion • Mifepristone–Misoprostol method • Initial dose of mifepristone • Two days later take dose of misoprostol • Effective rate is 92-95% • Side effects • Follow-up procedures

20. Medical Abortion • Methotrexate with prostaglandin • Methotrexate stops the embryonic or fetal cells from dividing • About 80-85% of women will abort within 2 weeks • Up to 95% will abort within 30 days

21. Complications of Abortion • Possible physical effects • Fever above 100º F • Abdominal pain or swelling, cramping, or backache • Abdominal tenderness • Prolonged or heavy bleeding • Foul-smelling vaginal discharge • Vomiting or fainting • Incomplete abortion • Unsafe abortions

22. Possible Psychological Effects • Possible feelings after having an abortion: • Guilt • New strength in having made and carried out an important decision • Relief • Regret • Depression • Sense of loss • Negative feelings about sex • Relationship may end • Anger • Bitterness

23. Table 7.1 Abortion Risks

24. Abortion Chapter 7