When this happens, it is called a miscarriage. Humans can also end the pregnancy on purpose before birth takes place. This is called an induced abortion. Its legality can depend on specific conditions such as incest, rape, severe fetal defects or the mother's health being at risk, although it depends on where the laws are.
Difference between an embryo and a foetus
A developing human takes about thirty-eight weeks to grow and be born. Normally, this occurs about forty weeks after the mother's last menstrual period. This developing human is called embryo for the first eight weeks of the pregnancy, and foetus for the remaining thirty-two.
Types of abortions
There are two kinds (or types) of abortion. Sometimes, things go wrong during a pregnancy. These things may lead to the death of the embryo or fetus. Depending on what time in pregnancy they happen in, such abortions are called miscarriage or stillbirth.In some cases finishing the pregnancy might be very dangerous for the pregnant woman. Giving birth might also be very difficult for her, she may have many worries, or she might not want to have a baby at all. In such cases, things can be done to end the pregnancy on purpose. This is called an induced abortion.
In both types of abortion, the embryo or fetus usually comes out of the womb. This is called a complete abortion. In some cases, the embryo or fetus remains inside the womb. This is called a missed abortion. Surgery is needed to remove the embryo or fetus from the womb so the woman does not get an infection.
Spontaneous abortions
People speak of spontaneous abortion or miscarriage when the embryo or fetus is lost due to natural causes before the 20th week of pregnancy.A pregnancy that ends this way, but that is between 20 and 37 weeks old is known as "premature birth" if the baby is born alive.
If the fetus dies in the womb after 20 weeks, or while it is born, this is known as "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages.
How common they are
Spontaneous abortions (miscarriages) are common. About fifteen percent of pregnancies end in spontaneous abortion. In many cases, the woman is not even aware she was pregnant.The pregnancy is only a few days or weeks old and the woman believes the miscarriage is just her menses. About twenty-five percent of all women will have a spontaneous abortion during their lives.
Most miscarriages occur very early. Between ten and fifty percent of pregnancies end with a miscarriage, where the mother or the doctors are aware of it. These figures depend on the age and health of the pregnant woman.
Most spontaneous abortions occur so early in the pregnancy that the woman is not even aware that she was pregnant. One particular study showed a rate of pregnancy in exposed ovulatory cycles of 59.6%; with 61.9% of conceptuses lost before twelve weeks. 91.7% of these occuried subclinically, without the knowledge of the mother.
The risk of spontaneous abortion decreases sharply after the 10th week of pregnancy, with a loss rate between 8.5 weeks LMP and birth of about two percent; pregnancy loss is “virtually complete by the end of the embryonic period."
Some people are more likely to have a spontaneous abortion
Those people who have already had several spontaneous or induced abortions run a greater risk of having a spontaneous one.Those with certain diseases, and those over the age 35 also run a greater risk. Other causes for abortions can be the infection of either the woman or embryo/fetus, or their immune response.
Certain diseases or an accidental trauma can also cause a spontaneous abortion. Putting the woman under trauma or stress to cause miscarriage is considered induced abortion. Some countries call this feticide.
Cause of spontaneous abortions
Most miscarriages are due to problems with the copying of chromosomes, but some are caused by environmental factors. When a human is conceived, it gets 23 chromosomes from its mother and 23 from its father.If it does not get the right number its development happens wrong (it does not grow right.) It may have many bad birth defects.
Most embryos and fetuses with chromosome problems will not live for a long time. They die very early. There are a few chromosome problems that babies can sometimes be born with. For example, Down Syndrome happens when there are three copies of chromosome #21. (Usually people have 2 of every chromosome.) This is called trisomy 21 (tri- means 3.)
Symptoms of spontaneous abortions
The most common symptom is bleeding from the vagina. This can be very little blood (less blood than a normal menses.)It can be very much blood (much more than a normal menses.) Some women have bad pains in their low abdomen when they have a miscarriage. This is sometimes like the pain of menses. It can be much worse.
Or a woman may have no pain at all. If the pregnancy is many weeks old, the woman may see the embryo or fetus when it comes out. But if it is less than 12 weeks old a woman may not see anything but blood.
Treatment of spontaneous abortions
Sometimes no treatment is needed. Sometimes doctors do a surgical abortion. This is the same kind of surgery that is done for induced abortions. Sometimes doctors give women medicines to help the miscarriage finish without needing surgery.Induced abortions
An induced abortion is when things are done to end the pregnancy on purpose. These things are normally done by doctors. In countries where abortion can be done legally, it is often done by specialists who know a lot about women's bodies (gynecologists).Abortions done illegally are often performed by people without this special knowledge. This makes them more dangerous. Such abortions are usually called unsafe abortions, back-alley abortions or DIY abortions, mainly because the risk to the health of the mother is much higher than with abortions carried out by skilled doctors.
Medical reasons for an abortion
There can be medical reasons, why an abortion is performed. These include:- saving the life of the pregnant woman
- preserving the woman's physical or mental health
- ending a pregnancy that would result in a child being born with severe birth defects, which would be fatal, or which would increase the risk of the child dying at an early age.
- reducing the number of fetuses to lower the health risks associated with a multiple pregnancy (like twins)
Kinds of induced abortions
There are two different kinds of induced abortions. The type of abortion that is done depends on a few different things, like what the woman wants, what her doctor thinks is best, and how far along a woman is in her pregnancy (how long she has been pregnant).One type of induced abortion is called a "medical abortion" or a "medication abortion". In this type of abortion, a doctor gives the woman one or two medications that will end her pregnancy. A medication abortion can only be done early on in the pregnancy.
This is because the medications that are used work best when they are started as early as possible, and after a woman has been pregnant for about two months, the medications usually do not work very well. Because of this, medication abortion usually is not used after a woman has been pregnant for 9 weeks.
Some of the benefits (or reasons why some women choose this type of abortion) are that it can be started as soon as a woman realizes she is pregnant; it does not require anesthesia; and the woman does not have to have a procedure in a hospital or clinic to have the fetus removed, like with the other kind of abortion that is done.
After a woman is given the medication or medications that end her pregnancy, the abortion happens like a "spontaneous" abortion or a miscarriage. (The woman passes the fetus, along with the blood and tissue that have built up in the uterus, from her vagina.)
The most common medications that are used for medication abortions are mifepristone and misoprostol.
First, a doctor gives the woman mifepristone, which is sometimes also called "RU-468" or "the abortion pill". This drug blocks the hormone progesterone in the body.
Without progesterone, the embryo cannot survive. The lining of the uterus becomes thinner, and the embryo cannot grow or stay attached to the lining of the uterus. After a few days, a doctor gives the woman misoprostol.
This makes the uterus contract (or get smaller) and the embryo is expelled from (or pushed out of) the uterus through the woman's vagina.
Sometimes, another medication, called methotrexate, is used along with misoprostol in medication abortions.
A woman is given methotrexate, usually as a shot in a doctor's office, and the drug stops the embryo from staying attached to the lining of the uterus. Then misoprostol is given a few days later.
With the second type of abortion - called "surgical abortion" or "in-office abortion" - a doctor does a procedure that removes an embryo or fetus from the woman's uterus.
This kind of abortion can be done in different ways, depending on how long the woman has been pregnant. Surgical abortion is simpler, and there are less problems that can happen, if it is done earlier on in the pregnancy. The most common form is called an "aspiration abortion" or a "suction curettage."
This can be done in a doctor's office or clinic. First the woman's cervix (the top part of the uterus) is dilated (or made bigger). A medical tool is used to suction out everything inside the woman's uterus, including the fetus.
If the woman has been pregnant for more than 12 weeks, the doctor first has to dilate the cervix (or make the cervix bigger), usually by putting small sticks into the cervix to help it open up. If another tool, called a curette, has to be used to scrape out tissue that is still inside the uterus, then this form of abortion is sometimes called a "dilation and curettage" (or "D&C").
Risks and complications
A pregnancy that ends without a child being born also may cause some problems to the woman this happens to. There are two broad groups of things that can happen:- Things that affect the mental health of the woman: Some women need counseling and therapy after an abortion.
- Things that happen to the body of the woman.
Physical problems
Abortion is safer than childbirth if it is done before the 16th week of pregnancy and it is done by a professional.Certain methods of abortion are pretty safe, and complications are rare. Generally, stopping a pregnancy that has gone on longer is riskier.
Women usually feel a small amount of pain during first-trimester abortion. In a 1979 study of 2,299 patients, 97% reported having some amount of pain. Patients rated the pain as being less than earache or toothache, but more than headache or backache.
Local and general anesthesias are used during the abortion.
Psychological problems
Few studies have been done to see if an abortion affects the woman psychologically, or mentally. Those that have been done give contradictory results.One study looked at 13.000 women who had become pregnant even though they did not want to. The study found that having an induced abortion does not increase the risk of getting mental health problems; the group that was compared were women who also did not want to have a baby, but who did not have an abortion.
Other studies showed similar results: women who had an abortion did better in school or at work after the abortion. Another study showed that women who had an abortion had a higher self-esteem and felt better than those who did not.
Many women who had an abortion felt better afterwards, they also felt relieved. They would do it again in a similar situation.
A study done in New Zealand in 2006 showed that many women who had an abortion developed severe depressions up to 4 years after they had the abortion. They were also more likely have problems with alcohol and illegal drugs than those women who did not have an abortion.
The person who oversaw the study later told media that given these results it would be very hard to say that having an abortion has no psychological effects on the womam who has is. He called the abortion "a traumatic experience".
Other problems
Both spontaneous and induced abortions have some risk for the woman.If a bad thing happens because of a surgery or medicine that a doctor gives, or because of a miscarriage, it is called a complication.
Complications of abortions can be infection, bleeding, pain. There may or may not be problems getting pregnant again; this is still being researched.
In places where induced abortions are legal less than 1% of induced abortions have a bad complication. If doctors do induced abortions, the risk to the woman is less than the risk of complications of childbirth (giving birth to a baby).
In places where induced abortions are legal, less women have complications of induced abortion than in places where induced abortion is illegal.
This is because induced abortions that are not done by doctors have much more risks. For example, after induced abortions became legal in the United States in 1973, less women died from having abortions.
In the United States in 2000, 11 women died from the complications of legal abortion. The risk of death from a legal abortion is 1/100 of the risk of an appendectomy.
The risk of death from an injection (shot) of penicillin (an antibiotic) is bigger than the risk of death from a legal abortion.
There can be emotional problems for the woman after a spontaneous or induced abortion. She may feel sad, angry, or guilty that she had a miscarriage or asked for an abortion. She may think she has done something that made the miscarriage happen, or that having an abortion was the wrong thing to do, and because of this she may feel intense grief. There are many places where women can get help dealing with these feelings.
Some women who have induced abortions may get criticism from friends or family who have different beliefs. When scientists look at this in research studies, however, they do not usually see that women have emotional problems after induced abortions.
Numbers and reasons for induced abortions
The number of induced abortions done are different for different parts of the world. This is also true for the reasons why women decide to have an abortion. Estimates are that about 46 million induced abortions are done worldwide, every year. 26 million of them occur in places where abortion is legal, 20 million happen in countries where it is illegal to have an abortion.Some countries, like Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100) have a low rate of induced abortion. Others, like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. Overall, there are 26 induced abortions per 100 known pregnancies.
Methods used for abortions; times when abortions are done
Abortion rates vary. The length the pregnancy has gone on, and the method used to do the abortion influence these rates. According to data collected in the United States, 88.2% of abortions were done in the first twelve weeks of pregnancy, 10.4% between week 13 and week 20 of the pregnancy. The remaining 1.4% were done in week 21 or later.90.9% were done by curettage, 7.7% were medical abortions (using drugs, mifepristone in most cases), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy).
The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the U.S. during 2000 - 0.17% of the total number of abortions performed that year. Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 and 19 weeks, and 1.5% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.
In 1998, a study was done in 27 countries. This study wanted to find the reasons, why women wanted to end their pregnancy. It found that women often gave one of the following reasons:
- Worries about their work or their education.
- Not sure about how to pay for the child they were going to have.
- Worries about the stability of the relationship with their partner.
- Feeling that they were not yet mature enough to have a child.
Women who had an abortion in Finland and the United States usually did not state that the pregnancy posed a risk to their health.
In Bangladesh, India and Kenya, however, more such women thought the pregnancy was a risk to their health. 1% of women in the 2004 survey-based U.S. study became pregnant as a result of rape and 0.5% as a result of incest.
Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception at the time of becoming pregnant.
Inconsistent use was reported by 49% of those using condoms and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.
The Guttmacher Institute estimated that "most abortions in the United States are obtained by minority women" because minority women "have much higher rates of unintended pregnancy."
Some women have an abortion because the society they live in pressures them to.
- In certain parts of the world, disabled people have problems to fit into society.
- The sex of the child might influence the status of the mother; often, mothers who bear boys have a higher social status than those who bear girls.
- In many parts of the world, raising a child is a very difficult task for a single (unmarried) mother.
- Certain countries, like China have measures to control their population growth.
Abortion and the law
In some countries like Ireland and Somalia it is legal only to save the life of the woman. If a woman is raped in Ireland and becomes pregnant, she cannot get an induced abortion. In some countries like Chile and El Salvador, abortion is never legal, including in cases where the woman risks dying from continuing the pregnancy.
In countries where induced abortion is not legal many more women die from abortion. Women still get induced abortions, but they cannot get them in safe hospitals and clinics. These induced abortions have more complications than abortions done by doctors.
Women who live in places where abortion is illegal, or heavily frowned upon sometimes travel to other places where an abortion can be done legally, so they can have an abortion. This is a form of medical tourism.
Opinions about induced abortions
Induced abortion is a subject that is controversial. Each person has a system of moral values. Based on their system of morals, people have different opinions about it. Religion can also influence this opinion.Different opinions around the world
A number of opinion polls have been carried out around the world. They have tried to find out what people think about abortion. Results were different for different countries, but also varied with the questions that were asked.In May 2005, a survey was done in ten European countries. The people were asked, if they could agree with the statement:
"If a woman does not want children, she should be allowed to have an abortion". The highest level of approval was 81% in the Czech Republic; the lowest was 47% in Poland.
A poll was done in November 2001. The poll asked people in Canada in what circumstances they believed an abortion should be permitted.
32% responded that they believe abortion should be legal in all circumstances, 52% that it should be legal in certain circumstances, and 14% that it should never be legal.
A similar poll in April 2009 surveyed people in the United States about abortion; 18% said that abortion should be "legal in all cases", 28% said that abortion should be "legal in most cases", 28% said abortion should be "illegal in most cases" and 16% said abortion should be "illegal in all cases".
In a Gallup poll taken in July of 2011, however, 47% of Americans identified themselves as pro-life and the same percentage of Americans identified themselves as pro-choice. A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.
Of attitudes in South America, a December 2003 survey found that 30% of Argentines thought that abortion should be allowed in Argentina "regardless of situation", 47% that it should be allowed "under some circumstances", and 23% that it should not be allowed "regardless of situation".
A March 2007 poll about abortion in Brazil found that 65% of Brazilians believe that it "should not be modified", 16% that it should be expanded "to allow abortion in other cases", 10% that abortion should be "decriminalized", and 5% were "not sure". A July 2005 poll in Colombia found that 65.6% said they thought that abortion should remain illegal, 26.9% that it should be made legal, and 7.5% that they were unsure.
Religious views
Many religions have a view on abortion. These views span a broad spectrum from acceptance to rejection. Most religions generally oppose abortion.Can the embryo or fetus(baby) feel pain?
It is currently unclear from what moment the embryo or fetus can feel pain. This is also used in the debate about abortion.Many researchers think that a fetus is unlikely to feel pain until after the seventh month of pregnancy. Others disagree. At about twenty-six weeks of pregnancy, certain connections are made in the thalamus of the growing fetus.
Developmental neurobiologists suspect that these connections may be critical to perception of pain by the fetus. However, legislation has been proposed by pro-life advocates requiring abortion providers to tell a woman that the embryo or fetus may feel pain during an abortion procedure.
Researchers from the University of California, San Francisco published a study in the Journal of the American Medical Association. The study analyzed data from dozens of medical reports and other studies.
The researchers concluded that fetuses are unlikely to feel pain until the third trimester of pregnancy. However a number of medical critics have since disputed these conclusions.
There are certain connections in the thalamus of the fetuse. These connections develop at about twenty-six weeks of pregnancy. At the end of the 20th century there was an emerging consensus among developmental neurobiologists that these connections are very important when it comes to the perception of pain in the fetus.
Other researchers such as Anand and Fisk have challenged this late date, positing that pain can be felt around twenty weeks. Pain can have many different aspects: It might be purely relying on sensory input, but it might also involve emotions and thought.
For this reason, it is perhaps impossible to know exactlly when the embryo or fetus feels pain, even if it has developed the links in the thalamus.
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