The modern face of abortion, where it is performed legally, is outlined by DrMuiris Houston, Medical Correspondent
Fifty million abortions take place worldwide every year. Twenty million of these are performed illegally; an estimated 75,000 women die from unsafe abortions each year.
In Europe, abortion is completely prohibited in the Republic of Ireland and Malta. Abortion is limited in Portugal, Spain, Switzerland and Northern Ireland. It is permitted on socio-economic grounds in Finland, Hungary and Britain.
In most other European countries, it is permitted on demand up to a certain pregnancy length with relatively little restriction.
What are the methods by which a pregnancy is terminated in countries where abortion is legal? There are broadly two categories - medical and surgical. The indications for each largely depend on the length of the pregnancy; other factors include the preference of the woman; the facilities available and the training of the doctor.
Methods of Abortion:
Medical - Using Drugs: mifepristone; gemeprost, misoprostol methotrexate, a combination of such drugs, surgical vacuum aspiration, dilatation and curettage [D&C], dilatation and evacuation [D & E].
Different Methods according to Length of Pregnancy:
Up to nine weeks gestation: early medical abortion involves the use of drugs to cause a miscarriage. Mifepristone - an anti-progestogen drug - blocks the action of the hormone that makes the lining of the womb hold onto the fertilised egg. Misoprostol, given 48 hours later, causes the womb to contract. The lining of the womb breaks down and the embryo is discharged as bleeding takes place. Early medical abortion does not require an anaesthetic.
Five to 15 weeks of pregnancy: vacuum aspiration literally involves a suctioning of the womb. A thin plastic tube is inserted through the neck of the womb and either an electric vacuum applied or a hand-held plastic syringe used to evacuate the uterine contents. Dilatation of the neck of the womb is also required after nine weeks' gestation. A local or general anaesthetic is used.
Thirteen to 22 weeks of pregnancy: surgical dilatation and evacuation \ is the preferred surgical method. Unlike D&C, which includes the use of a sharp instrument to scrape out the lining of the womb, D&E means the contents are evacuated in a less invasive way. Usually involves a general anaesthetic.
Twenty to 24 weeks: late medical abortions involve the use of misoprostol alone or in combination with mifepristone, given more than once. Drugs may also be injected directly into the womb. A local anaesthetic is required.
Complications:
The medical complications of abortion include bleeding, infection, incomplete abortion, laceration to the neck of the womb, perforation of the womb and the possibility of a clot travelling to another part of the body.
The later the abortion the greater the risk of side effects; the rate of complications is 3-5 per cent after 12 weeks with a death rate of nine to 12 women per 100,000.
Later Effects:
There is no evidence that an uncomplicated abortion affects future fertility or the outcome of future pregnancies. Some studies have suggested a link between abortion and the subsequent development of breast cancer; this has not been proved beyond doubt. Psychiatrists are divided on the psychology issues surrounding abortion.