The word abortion comes from the Latin abortio, which means to abort, miscarry, deliver prematurely. The Latin word abortus means “miscarriage, premature, untimely birth”. In medicine abortion means ending a pregnancy prematurely.
An abortion can happen spontaneously as a result of complications during a pregnancy, or it can be induced. An induced abortion carried out to preserve the health of the mother (gravida) is a therapeutic abortion. An abortion carried out for any other reason is called an elective abortion.
Most people use the word abortion to mean an induced abortion of a human pregnancy. For example – the pregnancy was aborted in order to save the mother’s life – the pregnancy was terminated deliberately.
When referring to a spontaneous abortion most of us use the term miscarriage. For example, the mother miscarried as a result of the car accident – she had not intended for the pregnancy to end.
The majority of elective abortions are carried out during the first three months of a pregnancy – during the first trimester. They are carried out by a health care professional in a clinical setting.
- – generally used to mean an induced termination of pregnancy (termination intentional).
- – generally used to mean a spontaneous termination of pregnancy (termination not intentional).
- – induced termination of pregnancy to protect the mother’s health or life.
- – induced termination of pregnancy for any other reason.
What is a medical abortion? A medical abortion is one that uses a drug to terminate the pregnancy. Medical abortions can only be done during the first nine weeks after conception. The drug, mifepristone (Mifeprex), is taken orally in pill form – it blocks progesterone. Without progesterone the lining of the uterus will thin and the pregnancy will end.
After taking mifepristone the woman comes back to the doctor a few days later and takes misprostol (Cytotec). Misprostol makes the uterus contract and empty. Some women will bleed after taking misprostol; this bleeding can go on for up to a couple of weeks.
When a woman has a medical abortion she will experience strong cramps, similar to those she might feel during a bad menstrual period. She may also experience upset stomach and/or diarrhea. The painful cramps can be relieved with Tylenol (paracetamol, acetaminophen) or ibuprofen. If a woman experiences the following she should let her doctor know immediately:
- Bleeding that requires more than two sanitary pad changes in one hour
- A high temperature that lasts more than four hours
- The pain is still strong after taking painkillers
How effective is medical abortion?
Mifepristone, as medical abortion drug, is about 97% effective. If it does not work the woman and the doctor may consider surgical abortion.
What is a surgical abortion?
The doctor removes the lining of the womb, either by MVA (manual vacuum aspiration) or D&C (dilatation suction curettage). Both procedures use suction. With MVA a handheld tool is used, while D&C is carried out with a suction machine and tools.
MVA can only be carried out during the first ten weeks of pregnancy, while D&C can only be done between week 4 and the end of week 13.
For both MVA and D&C the doctor injects the cervix with a numbing agent, the cervix is then stretched open with a dilator and a tube is inserted. The uterus is emptied through this tube.
Most women say that surgical abortion feels like strong menstrual cramps. The woman is given painkillers after the abortion and goes home to rest. It is common for bleeding to occur intermittently for a few weeks after the pregnancy is terminated.
Surgical abortion is almost 100% effective.
If the medical or surgical abortions are carried out by a trained doctor in a clinical setting, they are usually very safe. The probability of complications is extremely small. A woman’s chances of getting pregnant again are not usually affected after the abortion.
In the past a number of herbs were said to possess properties that would induce abortion, such as tansy, pennyroyal, black cohosh and the extinct siphium. In some parts of the world herbs are still used. Using herbs to trigger a miscarriage is extremely dangerous, causing multiple organ failure and even death. Attempting to cause abdominal trauma to the abdomen to achieve an abortion can cause serious internal injury, and may not succeed in its final aim. In most parts of the world such methods are illegal.
The first recorded proof of induced abortion is from the Egyptian Ebers Papyrus, 1550 BC. Chinese documents show records of royal concubines who had abortions in China at around 500 BC. Chinese folklore talks about Emperor Shennong prescribing mercury to induce abortions five thousand years ago.
A number of methods were used in the past, such as the administration of abortifacient herbs, inserting sharpened implements, and other techniques.
Until the 18th to 19th centuries the Christian church allowed elective abortions until quickening – the moment when the mother could feel her fetus moving inside her. During the 18th and 19th centuries various doctors, churchmen and social reformers urged authorities to ban all forms of abortion. During the 20th century various women’s rights groups, health care professionals and social reformers pushed for a repeal of abortion bans. While the majority of Western nations have legalized abortions, it is still very much a controversial theme.
Making abortions illegal does not stop them from happening. In Nigeria, where abortions are against the law, except to save the life of the woman, 610,000 abortions are carried out each year. 40% of Nigeria’s abortions still take place in established health facilities and are carried out by doctors, while 60% are done by untrained non-physician providers. It is estimated that one in eight maternal deaths is attributable to abortions in Nigeria. (International Family Planning Perspectives, 1998, 24(4):156-164).