Abortion

Abortion is the termination of pregnancy after the fertilized egg is implanted in the endometrium and before the foetus can survive outside of the uterus. It can be spontaneous or induced. There are various methods for induced abortion, and it can be safe or unsafe, legal or illegal, complete or incomplete.

Spontaneous abortion or miscarriage is the termination of pregnancy naturally, without an external intervention, and before 20 weeks of gestation. After 20 weeks, it is considered a premature birth. A clinical follow-up is fundamental to prevent it from becoming an unsafe abortion, which can occur if the procedure is not completed. Spontaneous abortion is involuntary.

Induced abortion is the voluntary termination of pregnancy through an external intervention. In many cases, the pregnant woman or person does so in full exercise of their rights. It is a complex decision that involves many aspects of each person’s reality. Ideally, this decision should be made without external judgements.

However, other times it occurs when the pregnant woman person is forced to do it against her wishes because of specific circumstances. Below, an explanation of these cases:

1. Forced abortion occurs without the consent of the pregnant woman or person. It is prevalent in contexts of armed conflict and, to a lesser extent, in ecclesiastical environments. Often, the person’s partner demands it.

2. Therapeutic abortion is induced due to medical reasons. In other words, the health or life of the pregnant woman or person are at risk. For safety reasons, it is performed up to 22 weeks of gestation or if the foetus weighs less than 500 grams. It must be done with the person’s informed consent. It is also known as termination of pregnancy for medical reasons.

3. Indirect abortion happens when the pregnant woman or person undergoes a medical intervention which results in the death of the foetus as an unwanted consequence. Indirect refers to the fact that the goal of the intervention is not to terminate the pregnancy, rather to treat or save the life of the pregnant woman or person (Bertran Prieto, 2020). Dr. Anibal Faúndes—FIGO representative and WHO advisor—argues that it is unethical to prohibit the termination of pregnancy to save the life of the pregnant woman or person as this violates their right to life and the healthcare professional’s right to act in defence of their patient’s life (WHO Nicaragua, 2020).

In terms of the procedures used to perform an abortion, they are classified in the following way: 

1. Medical abortion—also known as medication abortion ornon-surgical abortion—uses a combination of misoprostol and mifepristone. Ideally, both should be used. However, it can be done solely with misoprostol, in case obtaining mifepristone is difficult due to availability or price. It can take place in a clinic, in a private medical office, or in a hospital with the help of health professionals.

When a person uses the medication in their own home or in a safe place, without the need of medical intervention, it is known as self-administered medical abortion. It is not recommended for pregnancies over 12 weeks. This is a safe, private, and effective way to terminate a pregnancy if the person follows the necessary indications and addresses any warning signs. Self-administered abortion prevents the person from being exposed to the possible stigma from resorting to a clinic. It is also a good option for people who live in remote places. 

Medication for abortion can be administered in the following ways:

• Orally: pills are swallowed immediately.
• Buccal: pills are placed between the gums and the cheeks; they are swallowed after 30 minutes.
• Sublingual: pills are placed below the tongue and swallowed after 30 minutes.
• Vaginal: the pills are placed in the furthest part of the vagina; the pregnant woman or person is told to lie down for 30 minutes.

Some organizations provide a step-by-step guide for the process. The World Health Organization (WHO) and the International Federation of Gynaecology and Obstetrics (FIGO) recognize that pregnant women and people around the world must have legal and safe access to these medications, as well as the necessary information to self-administer an abortion. They must also be allowed the possibility of receiving medical care free from stigma, sanctions, or health injuries should they require it or want it at any point in the process. Health systems must provide this information and support mechanisms, as well as ensure the quality, availability, and accessibility of the medications and post-abortion care.

2. Surgical abortion consists of intrauterine methods. In other words, abortion is performed through the cervix, which connects the vagina with the uterus. Methods include:

• Manual vacuum aspiration (MVA).
• Electric vacuum aspiration (EVA).
• Electric vacuum aspiration (EVA).
• Dilation and curettage (D&C).
• Dilation and evacuation (D&E).

This could also refer to an abortion that takes place in later stages of the pregnancy. In this case, the process involves an incision in the uterus to extract the foetus.

Abortions can also be classified as safe or unsafe, complete or incomplete, and legal or illegal. Below, an explanation of these categories:

1. Safe abortion and unsafe abortion. 

Safe abortion or abortion without risks refers to a procedure performed by health professionals and according to WHO guidelines and regulations. It can also take place at home with the care of an expert through the phone and with the possibility of being treated in a hospital or clinic if necessary. The majority of safe abortions do not result in negative effects on the person’s health or the risk of death. 

Countries such as Bangladesh use the term menstrual regulation to provide safe abortions. This method consists of evacuating the endometrial tissue without confirming pregnancy through a laboratory test or ultrasound in women who have recently missed their period (WHO, 2012). 

In contrast, unsafe abortion or risky abortion refer to abortions performed by a person without the necessary skills to conduct this procedure or who do so in an environment that does not meet the minimum medical standards. These methods do pose a risk to the life or health of the person who undergoes the procedure.

Although technological progress has increased the possibilities of accessing safe abortions, unsafe abortions are still performed. Most of these unsafe procedures (98%) take place in developing countries. Barriers to access safe abortions include legislative and political restrictions; elevated costs associated to this service; the availability of the service and of competent professionals; and the attitudes of health service providers and from society in general. This situation disproportionately, and specifically, affects adolescents and young people. 

2. Complete abortion and incomplete abortion.

A complete abortion is a procedure where the embryo or foetus, as well as the endometrial tissue, is correctly expelled or extracted.

In an incomplete abortion, part of the products of conception remain in the uterus. This can lead to an infection and can be very dangerous.

3. Legal abortion and illegal abortion.

Legally speaking, some countries completely ban abortion. In most of them, some specific grounds for abortion are allowed. These include: 1) risk to a pregnant woman or person’s life or physical or mental health; 2) when the foetus has a congenital disorder incompatible with life outside of the womb; 3) when the pregnancy is the result of rape. In other countries, abortion is completely legal.

In the framework of a rights-based approach, feminist movements emphasize the importance of ensuring the freedom to decide over their own bodies for women and people who can become pregnant. Some movements also contend that abortion should not only be legal, safe, and free, but also based on free choice, including in selecting the methods used such as the traditional medicine of various peoples. Especially in Latin America—where legislation is more restrictive—these movements advocate for the legalization and decriminalization of abortion as a public health, social justice, and women’s rights issue.