The Reasons for Having an Abortion
The term abortion is self illustrating and has always been a very debatable topic. People are often quite biased in their opinions about this delicate issue, but rarely do they realize the multitude of reasons behind making such a difficult and life altering decision.
The following are some of more commonly observed reasons why women choose to terminate a pregnancy.
Many times, abortion is the result of a horrendous event like rape or incest. Apart from these, women also opt for abortion due to a multitude of reasons.
Personal problems ranging from emotional and psychological hindrances, to financial and health reasons are often reasons for abortion. Some women feel they have not yet reached the appropriate level of maturity or are not yet emotionally prepared enough to raise a child. Some feel they are too young to become a mother and some think they lack a reliable partner with whom they could raise a child.
Some women have a weak economical background which is another main reason for abortion. Many women are still in high school or college and the option of having a baby means discontinuing their education to support the child. Couples facing extreme financial limitations are often compelled to choose abortion. They are of the view that at a later time they will be in a better position to give their child better care and a more promising future.
Many times couples end up having casual sexual relations without the slightest pretext of getting married. In such situations abortion becomes a much needed option. There are times when the sexual relationship is something more than casual but the woman may feel her partner would not make a good father or be able to provide financial support. Some women are of the view that contraceptives are quite harmful and thus they prefer abortion to precaution. Contraceptive methods are not always 100% and can fail, leading to yet another reason for abortion.
Sometimes, there are very painful and heart wrenching reasons for abortion. For instance, some women who choose to have a baby in their late reproductive years often end up developing an abnormal or defective fetus without any assurance that it might develop into a normal child. In such circumstances, the woman feels she is left with no other option but abortion. Also, some women develop life threatening diseases and conditions during pregnancy and having an abortion may be their only chance of survival. A very commonly observed condition is hyperemesis gravidarum in diabetic woman, where pregnancy is associated with uncontrollable vomiting, which might lead to complete malnutrition and dehydration of the woman. There are also chances of heart failure in such situations. Hence, abortion is the only way to save her life.
It should never be assumed that the fact that a woman may choose to have abortion is easy. In most cases it may be the most difficult decision she may have to make in her lifetime.
Abortion: The Emotional After Affects
While most people are familiar with the term abortion and possibly even the different types of abortion procedures, far less are aware of the after affects women may endure when they have chosen to terminate a pregnancy. There is always concern for a woman’s physical state during and immediately after she has an abortion; however, less importance is usually placed on her emotional and psychological well being.
Thousands of women throughout the world obtain abortions every year. The decision to have an abortion is life altering and can have an enormous impact on a woman’s future health and well being. The reasons for having an abortion vary from woman to woman. The fact that a woman has even had to consider having an abortion can be in and of itself very disturbing emotionally.
Some women experience a tremendous sense of relief, while others may have feelings of guilt, anger or profound sadness. For most women these feelings gradually improve and cease to be after a short period of time; however, for a small percentage, they may become much more pronounced or serious and for a far longer period of time. The more certain a woman is about her decision to terminate her pregnancy, the less her chances will be of developing emotional or psychological problems. The same holds true for women who have friends and/or family to provide support before, during and after this emotionally trying time.
Emotional problems following an abortion tend to be more prevalent among women who have been previously diagnosed with depression, anxiety disorders or other mental health issues. Also noted at higher risk of developing depression are teenagers, separated or divorced women, and women with a history of more than one abortion. It is not unusual for a woman to experience a range of often contradictory emotions after having an abortion, just as it would not be unusual for a woman who carried her unintended pregnancy to term. There is no “right” way to feel after an abortion. Feelings of happiness, sadness, anxiety grief or relief are common. Providing women with an outlet for discussing their feelings is the first step toward the process of achieving emotional well being following an abortion.
Most experts agree that the negative feelings a woman may have after an abortion may be due to a negative reaction by her partner, friends or family members, who might judge her negatively for having an abortion or for even becoming pregnant in the first place. Research studies indicate that emotional responses to legally induced abortion are largely positive. They also indicate that emotional problems resulting from abortion are rare and less frequent than those following childbirth. Most studies in the last 25 years have found abortion to be a relatively benign procedure in terms of emotional effect except when pre-abortion emotional problems exist or when a wanted pregnancy is terminated, such as after diagnostic genetic testing.
While most abortion providers offer post abortion counseling or counseling referral sources, it was not until recently that a specialized organization was formed with the purpose of providing post abortion counseling in a nonjudgmental context. Founded in 2000 in Oakland, California, Exhale operates a national telephone hotline by which trained, volunteer peer counselors help women who have had abortions, as well as their partners and families, talk through their feelings, immediately after an abortion or even years later.
Medical Abortion
Women who are eight weeks pregnant (or less) can opt for medical abortion if they don’t wish to continue with the pregnancy. Medical abortion is a type of early abortion; it is performed by the administration of a combination of medications given to the pregnant woman, under the supervision of experienced physicians.
During the initial visit to the office, patients are given the first medication to be taken orally. A second medication is given to be given 24 to 72 hours later from the privacy of the patient’s home. The second medication causes contractions of the uterus which causes a miscarriage. These medications are FDA approved, and when used in combination, are 95-97% effective, taken within two weeks.
The hormone progesterone is required to maintain a pregnancy. The initial pill that is given in the clinic blocks this hormone. As a result, the uterine lining start to shed, the cervix begins to soften and bleeding may occur at this point. When the second medication is taken sometime later, the uterus starts contracting and the pregnancy is expelled, usually within six to eight hours.
Patients may choose when they would like to take the second medication; of course this must be within the time frame of twenty four to seventy-two hours after the first one medication taken during the initial visit. This allows patients some flexibility and control over when the pregnancy is expelled and when they will begin experiencing the side effects of cramping and bleeding. For some women, Medical Abortion is preferable because of the privacy it provides. Other women find it empowering because it allows them to play an active role in the whole process.
When patients visit the clinic for the first time, an ultrasound is conducted to ensure that they are less than eight weeks pregnant. Experienced counselors are available, to explain how the medications work and to answer questions. Health history is reviewed and if determined is satisfactory, patients can be given the first medication to take orally. The second medication will be sent home with the patient, and must be taken within twenty- four to seventy-two hours after taking the first medication.
Patients may start bleeding soon after taking the first medication at the clinic. The bleeding may vary from woman to woman as women’s bodies are different. Some may experience light bleeding, similar to spotting at the end of a menstrual period. Others may experience heavier bleeding similar to that of a regular menstrual period, or it may be more like a heavy period. Some women do not bleed at all until they take the second medication.
When the second medication has been taken, bleeding, clotting and cramping may start within twenty minutes. Most women will miscarry within the next six to eight hours. The cramping may increase and decrease in intensity, and may come and go in waves. Very heavy bleeding with large clots may take place. At this time, the embryo will pass, but may not be seen because it is very small. The amount of bleeding that occurs with the Medical Abortion may be much heavier than with the aspiration abortion.
Medical vs. Surgical Abortion
From a medical point of view, abortion procedures are generally classified into two types, the medical abortion or the surgical abortion. Before explaining the differences, it is best to acquaint patients with some of the terms commonly used in the abortion process. For example, the periods of pregnancy are referred to as trimesters and there are three trimesters in a pregnancy. The first trimester includes weeks 1 through 12, the second trimester proceeds from week 13 through week 26, and the third trimester begins with week 27 until full term which is usually 40 and 44.
The abortion procedures are critically linked to these trimesters. Prior to making a decision about which procedure to chose, it is important to know the details related to the main methods of abortion including the pros and cons of both. Medical abortion involves the use of a combination of medicines that causes a shedding of the uterine lining which contains the pregnancy, while with a surgical abortion the cervix is dilated and the physician uses suction aspiration to remove the pregnancy from the uterus.
Medical abortion can be performed during the earliest weeks of pregnancy and is most effective within the first 8 weeks. The success rate of medical abortion decreases with the advancing weeks. On the other hand, the surgical abortion can be performed during the first trimester but it is not usually recommended prior to the 6th week of pregnancy. It is best performed between the 6th and the 14th week of pregnancy. Surgical procedures performed earlier than 6 weeks have an increased chance of failing.
The medical abortion is a lengthier process and requires at least two clinic visits, encompassing up to 2 weeks or more. The surgical abortion however, usually requires just a single visit to the clinic that might last 3-4 hours. The medical abortion has a 95% – 97% success rate while the surgical procedure has one of 98% – 99%.
Medical abortion is generally more painful as most women may experience strong cramping throughout the process which could extend up to 2 weeks. The process also involves heavy bleeding and passing of clots throughout those weeks. With the surgical procedure women generally experience pain during the surgical process only which usually lasts from 5 to 10 minutes. This is followed by mild bleeding that may last 6-8 weeks after the procedure.
Medical abortion is less expensive than surgical abortion and there are also no chances of uterine perforation or cervical injury during medical abortion as it does not involve the insertion of any instrument or suction into the vagina or uterus as in the case of the surgical procedure. Medical abortion is also more like the natural process of miscarriage while the surgical procedure, although the process takes only a few minutes, may be frightening to some as it implies surgery similar to an operation one might have to have in a hospital setting.
Both procedures have their own advantages and disadvantages, but neither of the processes interferes with a woman’s ability to become pregnant in the future should she so desire.
Early Abortion Options
The earlier a woman decides to have an abortion, the more options there will be available to her.
Two options, both non-surgical, are the Abortion Pill and the Aspiration Procedure. Both are natural and safe methods for ending pregnancy. These early options are completed within less than ten weeks of pregnancy.
It is recommended that pregnancies be terminated within the 5th to 10th weeks. Before ten weeks, the pregnancy actually consists of a thickened tissue which lines the uterus (this is similar to tissue development before menstruation) and a gestational sac, which is filled with fluid and approximately the size of a grape. The action of the Abortion Pill blocks the pregnancy hormones causing it to stop developing and induces labor. The Aspiration procedure applies pressure to the menstrual lining which releases it from the uterine wall.
Both the Abortion Pill and the Aspiration Procedure are gentle, natural and the safest methods of early abortion. They are conducted simply and can be offered in a medical office. They have fewer complications than surgical abortion and are equally as effective. The early methods are safer compared to surgical abortions because they do not involve electronic suctioning, scraping of the uterus or general anesthesia.
During the Aspiration Procedure, the physician removes the pregnancy tissue with a quiet, handheld instrument. This procedure is performed on a medical examination table in the same position as having a pap smear. Patients may resume their normal activities immediately following as it takes only three to five minutes. This procedure used to be described as a menstrual extraction.
The Aspiration Procedure has many advantages. It is much safer than surgical abortion because just as with Abortion Pill procedure there is no electronic suctioning, scraping of the uterus and no sedation.
As for a medical abortion, it is completed in the privacy of your home. The first pill is taken with the physician in the medical office. 24-72 hours later, another set of pills are taken at home. The second set of pills will induce bleeding. Cramping may be experienced for several hours. Pain medications may be administered to relieve the discomfort caused by the cramping. A subsequent visit to the doctor is required to make certain the process has been complete.
The non-surgical methods described above have been endorsed by the World Health Organization (WHO). In their Technical Guidelines on Safe Abortion, they have stated that medical abortion and aspiration are the preferred methods for first trimester abortions. Both methods are effective, safe and suitable for primary level care which should be available in private clinical settings.
Some health facilities still use the dilation and curettage or sharp curettage method. According to the WHO guidelines, this method should be used only when medication abortion or vacuum aspiration procedures are not available, because of the much higher chance of complications associated with the sharp curettage method.
Abortion: What are the costs?
The Supreme Court of the US ruled 1979 that abortions may be conducted up until the time that a baby can live outside its mother’s womb, which is estimated to be the twenty eighth week of a pregnancy.
This is the same ruling that gave “Jane Roe” the right to abortion. Since then, different states have tried to restrict abortions in various ways, but at this time, it cannot be banned.
When a woman is considering having an abortion, there are several factors and costs that she must take into consideration.
With Health Insurance
Approximately 67% of the health insurance companies include elective abortion in their plan and cover the costs, treating abortion as an outpatient surgical procedure. Every insurance plan is different. Anyone who is has decided to terminate an unwanted pregnancy and hopes to be able to use their health insurance should closely evaluate their insurance policy to determine if it is included in the plan. If it is covered, the next important step is to find out if there are any deductibles and if there would be any co-payment amounts required for an outpatient procedure. Depending on the plan, this amount can vary between the first $75 to $500.
If you don’t have Health Insurance
Patients who don’t have health insurance, or those whose health insurance does not cover elective abortion, will find that the costs vary depending on the location, the type of procedure used, and the length of pregnancy.
Women who cannot afford the expense of terminating a pregnancy may be able to seek assistance with state agencies or through private donor funding which might help with paying a part of the fee. There is also Medicare, which covers the cost of abortion in some states. For additional information, please go to the Medicare website.
Taking time off from work
It may be necessary to take some time off from work after the abortion. Although your body will take about 6 weeks to heal completely and become fully normal, some women may wish to take some personal time away from work after the procedure, for rest and recuperation. Lost wages should be factored into the cost for the abortion.
Mental Health Counseling
Many people need someone to discuss and work out the mental and emotional health issues they experience after undergoing an abortion. Seeking the services of a mental health professional can cost between $20 to $100 per hour depending on whether or not a patient has health insurance that allows for this services. For many women this may not be necessary; however, in the event that is does, this should also be considered with financial planning.
Follow-up Visits
As with any surgery, there is always the possibility of complications arising. Depending on health insurance coverage, the costs could range between $25-35 to $200. It is also important to consider any possible procedures or tests that may be needed.
The Abortion Debate
The debate over abortion is one of the most controversial topics in the US today.
What are the issues?
In this debate, the rights of the mother are pitted against the rights of the fetus. The issue has broadly combined two conflicting stances, the “pro-choice” and the “pro-life” positions. These vastly differing viewpoints revolve round legal as well as moral considerations. There is another more pragmatist view, more blended, that says abortions should be prohibited, with exceptions made for specific cases.
The advocates of the “Pro-choice” stand emphasize the woman’s right to decide whether she will terminate her pregnancy or not and when it should be done. According to this view, a woman should be allowed to have total control over her body and by extension of this, over the continuation or not of the fetus within her body.
According to the “Pro-life” advocates, life begins at the time of conception, and termination of the pregnancy after the embryo has been formed is considered murder.
Supreme Court ruling
An underlying, significant legal debate is raging in the US. There was a landmark Supreme Court ruling over Roe v. Wade in 1973, which continues to be relevant to this day. The Court had voted 7-2 and overturned the state laws that banned abortion. The Justices had concluded that those laws violated woman’s constitutional right over privacy. After this judgment, the moral debate took on political implications.
Other viewpoints
There are other viewpoints on the issue besides the “pro life” and “pro choice” positions. For instance, there are some pro choice supporters who believe that abortions later than the second trimester are not morally permissible. In the same way, some pro-life supporters think abortions should be allowed in extreme cases such as incest or rape. Approximately, 2% of pregnancies are result of those atrocities.
But the debate over abortion brings to the forefront a much bigger question: When should the government intervene in the personal lives of citizens, and when should it avoid such intervention?
Issues within the Bigger Debate
Within the larger debate, the two other pressing questions are should ‘partial birth’ abortions become legal, and should first trimester abortions be allowed to remain legal? ‘Partial birth’ refers to the procedure in which the intact fetus is surgically removed from the uterus through the cervix, with the help of the ‘intact dilation & extraction’ process.
In the mid 1990’s, the Republicans had introduced legislations which banned ‘partial birth’ abortions. In 2003, President George Bush signed the ‘Partial Birth Abortion Ban Act’ which had been passed by the Congress.
The ‘partial birth’ abortion law had been held unconstitutional by the Supreme Court because it withheld a doctor from conducting the procedure even when it was the only method available to preserve the health (or life) of the mother.
In 2004, the US District Court Judge ruled against the federal statute, on one of the grounds that the law did not have provisions required for preserving a woman’s health. It is now expected that the case will be appealed to in the Supreme Court.
In 2007 Carhart vs. Gonzales was decided by the Supreme Court which states that performing a partial birth abortion is illegal. Due to the inhumane way that the procedure takes place was the reason for the outlawing of the procedure, in which it was declared that the Dilatation and Evacuation (D&E) procedure though it consists of removing tissue and limbs of the fetus from inside the uterus more acceptable though there was data presented that showed that the D&X was safer than the D&E procedure to the mother. Clearly the Supreme Court was concerned more of protection of the fetus than maternal safety.