An abortion is the termination of a pregnancy before the end of the 28th week of pregnancy. Such a termination is against the law if it does not come within one or more of the four categories mentioned in the Abortion Act 1967 and if the termination is not carried out under the conditions mentioned in the Act. In other words, if the Act is obeyed, then a pregnancy may be terminated lawfully, but if the Act is not obeyed then it is still unlawful, or criminal, to procure an abortion before the end of the 28th week of pregnancy.
According to the Act it is not a legal offence for a registered medical practitioner to terminate a pregnancy if ‘two registered medical practitioners are of the opinion, formed in good faith’ that
1. the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated; or
2. the continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated; or
3. the continuance of the pregnancy would involve risk of injury to the physical or mental health of any existing children of the family of the pregnant woman greater than if the pregnancy were terminated; or
4. there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
It is also specified that an abortion must be performed in a National Health Service hospital or an approved place, with the provision that an emergency operation might have to be performed elsewhere.
All abortions that do not conform with the Abortion Act 1967 are illegal. Although the number of illegal or backstreet abortions has been drastically reduced since the Act came into force, there are undoubtedly some illegal abortions still being performed.
The question of abortion has always given rise to a great deal of social, religious and legal differences of opinion and while the Abortion Act 1967 may have legalized abortion when it is carried out under special circumstances, it certainly does not lessen the magnitude of the problems that surround the whole subject. The Act itself has clarified the legal position of the termination of pregnancy, but it has already caused a certain amount of criticism as well as an increasing number of medical and legal problems.
Methods of Inducing Abortion
The damage or destruction of the fertilized ovum even before implantation is theoretically an abortion. Intrauterine contraceptive devices may cause this to happen and it is likely that the so-called ‘morning-after’ (or ‘once only’) pill does lead in many instances to the destruction and loss of a fertilized ovum. The possible use of large doses of hormone during the second half of the menstrual cycle to induce abortion means that these must be taken before any possibility of pregnancy can be proved and also before the suppression of the first menstrual period.
There are no drugs that can be administered to cause abortion safely and certainly. The prostaglandin group of hormones is now in common use for abortion. They are used for abortion, between 14 and 24 weeks when they are given either by an abdominal injection into the uterus or by a catheter inserted through the cervix. It is likely that in the near future prostaglandins will be given as vaginal pessaries for abortion in the earlier weeks of pregnancy. Other drugs may be used as abortifacients but generally have serious side-effects.
The safest method of inducing early abortion is by operation, of which there are several types.
Dilatation and evacuation was the accepted method of abortion before the 14th week of pregnancy. It was popular for many years. The cervix was dilated to an appropriate size and the products of conception were removed by currettage.
Vacuum aspiration has almost taken over from dilatation and evacuation, since it is considered to be more efficient and to give rise to fewer complications. The cervix is dilated and the products of conception are then removed from the cavity of the uterus by suction using a special aspiration curette.
Hysterotomy (abdominal). Most gynaecologists would agree that a pregnancy can only be terminated from below (that is via the vagina) up to the end of the 13th, or perhaps the 14th, week of pregnancy. Thereafter the vaginal route is increasingly dangerous and where prostaglandins are not available, or there is another complication, abdominal hysterotomy is indicated. This means that a miniature Caesarean section is performed and an incision is made in the uterus, the products of conception removed and the uterus repaired. Following this operation the patient has to recover as though from any other major abdominal operation, and since a scar is now present in the uterus this will need close observation in future pregnancies. Hysterectomy means the removal of the uterus (or womb). This particular operation is seldom performed to terminate a pregnancy.
The Dangers of Abortion
The dangers of abortion are still seriously underestimated. Deaths following abortion form one of the major factors among the causes of death during pregnancy in Great Britain. Abortion accounts for 8.1 per cent of the number of pregnant women who died in Great Britain in 1976, when there were 6 deaths following abortion, but this is only one particular aspect of the dangers of the operation. The other dangers are:
Injury or damage to the uterus or other organs at the time of operation. This particular danger should occur infrequently but it must be remembered that the termination of a pregnancy is a particularly difficult operation and such injuries are bound to occur occasionally even in the most skilled hands.
Retained products of conception. If a small portion of the pregnancy remains within the uterus, then retention of part of the products of conception may, and probably will, give rise to two further complications, those of haemorrhage and sepsis. Haemorrhage is heavy bleeding following soon after the operation. The first sign of sepsis is usually the onset of pain. If the sepsis becomes severe or if it remains untreated then the future fertility of the woman may be jeopardized.
The long term effects may be numerous and they may be either mild or dramatic. Recurrent abortion may occur as a direct result or indirectly due to damage to the upper part of the canal of the cervix. Infection may give rise to pelvic pain and discomfort, and may spread to the Fallopian tubes causing infertility. Caesarean section may have to be performed because the uterus has been previously scarred. Postpartum haemorrhage may occur if the placenta becomes unduly adherent to the inside of the uterus over an area from which the endometrium has been completely removed.
Psychological ill effects. Very little is yet known about the psychological ill effects of termination of pregnancy. Such ill effects, however, do have to be weighed against those of allowing a pregnancy to continue.