Last Updated:  30 August 2015

 

What is Abortion?

Where and When Are Abortions Performed?

Abortion Methods

What About Ectopic Pregnancy?

What About Other Treatments for Sick Women in Pregnancy?

 

 What is Abortion?

"Abortion" means the deliberate ending of a human pregnancy.  However, there are different kinds of abortions and terms that may be used when referring to an abortion.  It is important to understand these terms and how they may be used.

As it is used in everyday language, "abortion" is understood to mean a deliberate ending of a pregnancy, either through a surgical or medical procedure, with no intention to produce a viable baby and which could take place at any time during the pregnancy.  On this site, "abortion" refers this meaning.  This kind of procedure that deliberately ends a pregnancy and aims at the death of the embryo or fetus is also known as a direct abortion.  Other procedures that deliberately end a pregnancy before viability but where the aim is not the death of the embryo or fetus may be referred to as indirect abortions.

The medical community also uses certain terms when referring to an abortion.  A "spontaneous abortion" means a miscarriage and an "induced abortion" means the ending of a pregnancy "brought on intentionally by medication or instrumentation".1  Therefore what is medically referred to as an "induced abortion" is what we commonly understand to be an "abortion".  Induced abortions may be direct abortions or indirect abortions depending on whether the aim of the procedure is the death of the embryo or fetus.

The standard medical definition of an [induced] abortion is the ending of a pregnancy before an embryo or fetus is viable (capable of surviving outside the womb).  However, induced abortions occur after viability also, well into the 2nd or 3rd trimesters and although these may be called a 'late termination of pregnancy' or a 'delivery' or a 'birth' by the medical community, they are nevertheless still what is generally understood to be an 'abortion' if the intention of the procedure is to produce a nonviable fetus (a fetus incapable of surviving outside the womb).

The U.S. Center for Disease Control and Prevention (CDC) in collecting data on abortion in the USA, defines legal induced abortion as:

"a procedure, performed by a licensed physician or someone acting under the supervision of a licensed physician, that was intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age."2

As mentioned earlier, there are differences in the aim of some abortions where the intention is not the death of the embryo or fetus.  These procedures may be necessary to treat the woman, e.g. for a life-threatening condition in pregnancy. To distinguish between these different kinds of abortions, they are called either direct or indirect abortions.  

A direct abortion aims at the death of the embryo or fetus.  This kind of abortion is what the general public commonly understands an "abortion" to mean.  Procedures that are always direct abortions (by their very nature) are vacuum aspiration and dilation & extraction (D&E) abortions.

An indirect abortion does not aim (as an ends or by its method) at the death of the fetus, although this may be likely or inevitable.  These are carried out due to a serious threat to the mother's life, e.g an ectopic pregnancy, cancer of the uterus, pre-eclampsia.  Due to the aim of an indirect abortion, some people do not consider these procedures an "abortion".  Nevertheless they do meet the definition of an abortion but it is important to recognise the difference with these kinds of abortions. Procedures that may be used to perform an indirect abortion are an inducation of labour, removing the uterus (hysterectomy) or the abortion pill, RU486.  (RU486 arguably causes the embryo to detach from the woman without directly attacking the embryo itself).  Note that these procedures are not indirect abortions, however, if the aim of the procedure is to cause the death of the embryo or fetus.

In summary, to determine which medical procedures in pregnancy are or are not direct abortions or what is generally understood to be an "abortion", it is important to consider the aim or intent of the procedure.  The intent in an abortion is always the death of the embryo or fetus through medical or surgical means and not to take possible action to preserve the life of the baby.

 

 Where and When Are Abortions Performed?

Both medical abortions and surgical abortions are usually performed by an abortionist in a clinic or hospital or a woman may carry out instructions to perform a medical abortion early in a pregnancy at home.  An abortionist is any person who intentionally carries out an abortion or gives a woman pills and instructions for an abortion, including any doctor, nurse, midwife or clinician.  

In most countries where abortion is legal, abortions may be performed at any time during a pregnancy.  Statistics available indicate that approximately 90% of abortions are performed in the first trimester (up to 14 weeks gestation).3  Some countries or states or territories restrict abortions after certain time in a pregnancy, such as after 20 weeks gestation (since LMP) usually with exceptions (e.g. risk to woman's life or if the baby has an abnormality).  The physical risks to the woman from abortion significantly increase as the pregnancy progresses.

Some forms of birth control are known to act as abortificants (may cause an abortion), while for others, such as emergency contraception it is still unclear whether they may be abortificants.

 

Abortion Methods

Abortions are usually described as either surgical abortions or medical abortions.

Surgical Abortion methods include: 'Manual Aspiration' (also called 'Menstrual Extractions'), 'Vacuum Aspiration', 'Suction Curettage', 'Sharp Curettage', 'Dilation and Curettage (D&C)', 'Dilation and Evacuation (D&E)', 'Dilation and Extraction' (IDX) - also referred to as 'Partial Birth Abortion', 'Induced Abortion', 'Hysterotomy' or 'Hysterectomy'.

Medical Abortion methods include: the Abortion PillMisoprostol or Prostaglandins (which induce labour) taken orally/vaginally or chemicals are injected either into the amniotic sac or the fetus to directly cause the death of the baby or premature delivery of the baby resulting in death.

 

What About Ectopic Pregnancy?

Treatment for ectopic pregnancy is not considered an abortion by some because the intent of the treatment, which is unavoidable, is to save the life of the mother, not to destroy the embryo.  At present there is no possible way to save the life of an embryo that needs to be removed because of an ectopic pregnancy.  The aim of the procedure is not the death of the embryo, although it is inevitable. If the method to remove the embryo directly causes death of the embryo, it is a direct abortion.  If the method does not directly cause the death of the embryo, it is an indirect abortion.  

There are therefore ethical debates about the types of treatment used for an ectopic pregnancy.  The options are:

  • surgically remove the diseased part of the fallopian tube holding the embryo,
  • remove the embryo from the tube via an incision, or
  • administer the drug methotrexate which interferes with the rapid cell growth of the embryo, causing death
  • administer RU486 which causes the embryo to detach from the wall of the fallopian tube.  

Both use of methotrexate and cutting out the embryo from the tube may be considered direct abortions as both methods can directly kill the embryo, but removing the diseased part of the tube holding the embryo or administering RU486 may considered indirect abortions because the embryo dies only due to indirect causes after removal from the mother.

 

What About Other Treatments for Sick Women in Pregnancy?

Other medical procedures to treat the mother, such as early induction of labour for eclampsia or chemotherapy for cancer, where the baby is not directly attacked (and efforts are made to save the life of the baby too) are not considered abortions (direct abortions) even if the baby dies.  These are indirect abortions.  The baby dies due to indirect causes after unavoidable treatment is carried out to save the of the mother.

 

 

Footnotes:

 

1 Induced abortion: http://medical-dictionary.thefreedictionary.com/abortion

2  Centers for Disease Control and Prevention. "Abortion Surveillance - United States, 2007", Morbidity and Mortality Weekly Report 60, no. 1 (Debruary 25, 2011), p. 2. Available at http://www.cdc.gov/mmwr/pdf/ss/ss6001.pdf 

MMWR - Morbidity and Mortality Weekly Report. Nov 29, 2010. Centers for Disease Control and Prevention (US Dept. of HHS).  http://www.cdc.gov/mmwr/pdf/ss/ss6208.pdf . Retrieved July 22, 2014. For selected states, the total percentage of abortions that occurred less than 14 weeks gestation was 91.9%, which equated to 475,950 out of 518,088 babies aborted in those states in 2010.  

 

 

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