Second Trimester Abortion: Women's Health And Public Policy - Reproductive Health Matters Journal Supplement 2008 16(31)

Main Category: Abortion
Also Included In: Sexual Health / STDs
Article Date: 09 Sep 2008 - 3:00 PDT

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Second trimester abortion raises complex issues regarding methods, values, stigma, the burden on providers of service delivery and the sometimes complicated reality of women's lives and decisions. This issue of Reproductive Health Matters grew out of a conference on second trimester abortion convened in London in 2007 by the International Consortium on Medical Abortion and attended by 90 expert clinicians and advocates from all over the world.

There will always be women who need abortions after 12 weeks of pregnancy. While the specifics may differ, women all over the world have largely the same, often multiple reasons for second trimester abortion. They tend to be quite young women with little awareness of pregnancy symptoms, poor women who need time to raise the money to pay the higher costs of a second trimester abortion, women who do not know where to seek help, those who come up against barriers created by the health system, women who only learn of foetal indications in the second trimester, and women whose personal situations are complicated and whose reasons for seeking abortion are often compelling.

Despite this, women are often treated punitively for what are seen as 'late' abortions. In many countries, legislation prohibits or restricts the grounds for second trimester abortions. But laws that create barriers to obtaining an abortion, though failing to stop women having them, often force women to risk their lives doing so. There will always be women who need abortions after 12 weeks of pregnancy, but the numbers diminish greatly by 20 weeks, and become rare after 24 weeks. It is not the law that makes this happen, but women themselves.

Abortion-related deaths have been declining globally in the past three decades because many more countries now have safe, legal abortion. Abortion methods have become substantially safer and simpler, more providers have been trained, and women with complications are more likely to seek and to receive medical help, even where abortion is still legally restricted.

Second trimester abortions carry relatively more risk and account for a greater proportion of complications than first trimester abortions, even when the procedure used is safe, the provider skilled and the quality of care high. This is because abortion procedures and pregnancy itself are riskier as pregnancy progresses. Nevertheless, even throughout the second trimester, abortion in safe conditions by a skilled provider is very safe.

This issue calls for the need for second trimester abortion to be met in a safe, timely and sympathetic manner. Abortion should be legal at the woman's request up to 24 weeks and on therapeutic grounds after that, and no other barriers or hurdles should be imposed on women seeking second trimester abortion. In-depth, country-based research is needed, to bring out the facts on second trimester abortion, as evidence of why it should be treated as a legitimate form of women's health care and supported in public health policy.

Papers in this supplement cover the law and safety of second trimester abortion; women's and providers' perspectives; policy, politics and values; moving from unsafe to safe service delivery; currently recommended methods; methods that should go out of use; and recommendations for advocacy and action from the ICMA conference.

Titles include:

- Second trimester abortion: women's health and public policy
- A critical appraisal of laws on second trimester abortion
- Who is excluded when abortion access is restricted to twelve weeks? Evidence from Maputo, Mozambique
- Reasons for second trimester abortions in England and Wales
- Termination of pregnancy for fetal abnormality: the perspective of a parent support organisation
- A week in the life of an abortion doctor, Western Cape Province, South Africa
- Second trimester abortion provision: breaking the silence and changing the discourse
- Decision-making after ultrasound diagnosis of fetal abnormality
- Fetal pain: do we know enough to do the right thing?
- The choice of second trimester abortion method: evolution, evidence and ethics

Other articles focus on countries such as Cuba, India, Mongolia, Nepal, the Netherlands, USA and Vietnam.

Reproductive Health Matters is published twice a year, in May and November, in English. There are also editions once a year in other languages, i.e. Arabic, Chinese, French, Hindi, Portuguese, Russian and Spanish. The journal covers laws, policies, research and services that meet women's reproductive health needs. Each issue focuses on a main theme and includes feature papers, topical papers on other subjects and a round-up of information from the published literature.

Reproductive Health Matters