|Complications Women Face Seeking Abortions: Influences of Economics, Society, and Education
by: Jeanette Sutkowi
Abortion has been controversial ever since the ability to terminate a pregnancy was feasible. While some people feel abortion should be the choice of the mother (and sometimes the father should be involved), others believe abortions are wrong regardless of the situation. These positions are often referred to as ‘pro-choice’ and ‘pro-life’ respectively, and some factions of these groups have continually been in heated rivalry. They have expressed their opinions through picketing; (for example the Genocide Awareness Project in November 2001 at MSU), as well as in literature and in appearances on television. All of these efforts have been undertaken to try and convince others to choose a side. In this essay the terms ‘clinical’ and ‘non-clinical’ will be used to describe abortion, clinical refers to surgical and medical abortion where as non-clinical refers to self-induced abortion. These will be discussed as I address whether or not factual information is being provided to expecting mothers.
Many times, in an effort to persuade an audience, those groups providing the public with information deliberately misinform or selectively inform the public with “knowledge” to support their opinions or beliefs. This is a serious problem for individuals trying to seek factual information on abortion methods. This tumultuous environment is a global phenomenon because are many divergent laws, regulations and social stigmas regarding abortion throughout the world. As a result of abortion being unacceptable or illegal in other countries, women often attempt to secretly abort their own pregnancies through a myriad of methods, many of which can be dangerous. This essay will analyze the lack of factual information and available healthcare in driving a woman’s motivations to attempt self-abortion.
Around the world, there is a history of abortions being conducted regardless of legality or safety of it. As long as women continue to have unwanted pregnancies, they will continue to attempt abortion. In an attempt to reduce the number of non-clinical abortions, the causes of unwanted pregnancies need to be considered.
Reasons for Unwanted Pregnancies
Many women have unexpected pregnancies due to lack of family planning resources, (3). “A substantial number of Americans--41 million people--do not have health insurance; this represents a 16 percent increase in the uninsured since 1990. Further, many studies show that the uninsured have significantly more difficulty than the insured in getting needed care,” (2). Women without health insurance do not have clinics, physicians or counselors available to them for consultations. In addition, women in poverty cannot afford contraceptives to prevent pregnancies. In some cultures, contraceptives are socially unacceptable or unavailable. Also, inferior contraceptive methods fail, which can lead to an unplanned or unwanted pregnancy.
Another contribution to unwanted pregnancies is sexual assault, (1). As new drugs become available ‘on the streets’ and are harder to detect in one’s drink, there may be an increase in rape, potentially leading to an increase in unwanted pregnancies and possibly more abortions. In the U.S. a woman is raped every 45 seconds and that is considering that only one out of every ten rapes are reported. So rape happens more often than statistically stated, (3).
An additional cause for abortion is due to social and economic reasons. This consists of the following factors; 1) unmarried mother who feels religiously or socially that having a child would be unacceptable; 2) a mother abandoned by her partner who feels she cannot raise a child by herself; 3) adolescents who are not mature enough to raise a child; 4) parents who are financially unable to support a child; 5) some families have too many children already; 6) women in abusive situations or environments unsuitable to rearing a child. Fifty percent of women who have abortions are under the age of 25, sixty-four percent are single, and forty-five percent have other children, (4).
Non-Clinical Abortion Methods
Women may feel compelled to perform a self-induced non-clinical abortion because the apparent ramifications of a non-clinical abortion are far less than those of an unwanted pregnancy. Although non-clinical abortions are rare in the U.S., they do occur often in other countries where abortions are illegal, (1). Many women who want to have an abortion do not have access to the appropriate healthcare for a clinical abortion. Reasons for this vary; from women feeling forced to have non-clinical abortion because it is illegal to other women feeling clinical abortion information is not available to them. All of the reasons women feel a non-clinical abortion is necessary consist of socioeconomic, legal, and cultural factors, (5). Each year, globally it is estimated that 20 million non-clinical abortions are performed by the expecting mother, (1). Non-clinical abortion procedures are usually performed by untrained individuals (usually the expecting mother herself) in unsanitary conditions which jeopardize the health of not only the fetus but also the mother. Some of the non-clinical abortion procedures performed in the past consist of; inserting objects into uterus (sticks, wires, knitting needles), drinking poisonous or harmful substances (herbs, bleach, hair dye), taking dangerous doses of over-the-counter medicine, douching with poisonous and caustic substances (bleach), inflicting physical abuse (falling down stairs, blow to the abdomen, jumping from heights), (1). All of these non-clinical abortion methods can result in serious repercussions to the mother and may even result in death. In Africa 13% of maternal deaths are due to non-clinical abortions; in Asia 12%; in Latin America 21%, and in Europe 17%. Ninety-five percent of all non-clinical abortions take place in developing countries, (1). The overall death rate in America from abortion (regardless of safety), is 119 per 100,000 abortions, (6).
Health Problems Due to Non-Clinical Abortions
As a result of non-clinical abortions being performed, women are at risk for permanent disabilities and health problems. It has been estimated by the World Health Organization that between 10-50% of women experience complications as a result of non-clinical abortions, (7). Some of the most frequently reported complications consist of partial abortion, infection, hemorrhage and damage to internal organs, such as puncturing or tearing of the uterus. Where as, the long term complications include chronic pain, pelvic inflammatory disease and infertility, (1). Approximately 80,000 women die annually due to complications arising from non-clinical abortions, (7). Women who experience complications from non-clinical abortions need to seek healthcare; however, many women do not receive this healthcare due to social, cultural, legal, and economic barriers.
In order to eliminate non-clinical abortions, a combined approach to target health workers, lawmakers, and advocates is needed. Societies must 1) Need to provide adequate treatment for non-clinical abortion complications both emotionally and physically; 2) Provide global post-abortion family planning; 3) Reform laws that hinder the accessibility of safe health services and trained providers, (5).
Treatment for Complications from Non-Clinical Abortions
The treatment for complications from non-clinical abortions can be quite expensive if not covered by health insurance or if the woman has no health insurance. Treatment of abortion complications can result in administration of drugs and possible blood transfusions from extensive hemorrhaging requiring hospitalization. In fact, many women perform non-clinical abortions because of financial restrictions, however, if complications are severe enough, recovery services could end up costing more than a clinical abortion. In third world countries, hospitalization for non-clinical abortion complications can consume up to 50% of the hospitals total budget, (1).
On the other hand, clinical abortions are offered in certain areas where it is legal and under the care of a physician. Regarding clinical abortions, it was reported that 97% of women who had a first trimester abortion experienced no complications and in rare instances complications were minor and simple to treat. With properly trained medical providers and a suitable environment, abortion is a very safe procedure, (4). If it is religiously, financially, and morally acceptable, clinical abortion offers much better success rates than non-clinical abortion in regards to complications and maternal mortality rate. Some of the different clinical abortion procedures consist of a RU-486, vacuum aspiration technique and dilation and evacuation technique.
RU-486 is a medical abortion method using a combination of two drugs; Mifepristone and Misoprostol. Mifepristone was approved by the Federal Drug Administration late September 2001 to abort a pregnancy up to seven weeks in gestational stage. Mifepristone is an anti-progesterone drug; progesterone is a hormone essential to the body to maintain a pregnancy. RU-486 is a progesterone antagonist, meaning that it blocks the effects of progesterone, (8). Misoprostol is a drug used to treat peptic ulcers but as an ‘off label use’ it was found to stimulate uterine contractions and promote expulsion of uterine contents (when in conjunction with Mifepristone), (9). Women who have used RU-486 do have side effects as in most medical treatments although however, usually they are minor without further complications. Women who do experience serious complications are under the care of the physician who administered the drug and can seek emergency attention. In a study conducted, The New England Journal of Medicine reported side effects consisting of headache, dizziness, back pain, fatigue, fever, vaginitis, dyspepsia, insomnia, anemia and sinusitis, (10). These side effects are comparable to side effects experienced from a surgical abortion. About 1% of women who take the drug combination experience heavy bleeding which required surgery to cease, (11). Clinical studies have shown when using RU 486, incomplete abortion resulted in 2-3% of cases and pregnancy continued in 1%, which further required a surgical abortion to terminate the pregnancy, (8). When taken correctly and soon enough, RU-486 is almost as effective as surgical abortion. “RU 486, in conjunction with a prostaglandin, is 95.5% effective in inducing abortion during the first 7 weeks of pregnancy. Studies have shown RU 486/prostaglandin abortions to be safe, with a low number of complications,” (8). Although many are still skeptical of RU-486, it has been used clinically studied and the complications along with maternal mortality rate are insignificant compared to that of a non-clinical abortion.
Another clinical abortion method is vacuum aspiration which is a surgical procedure that involves the removal of the fetus. It is aborted by the following procedure:
A piece of laminaria tent is inserted into the women’s cervix to begin widening the uterus; this takes place usually one day before the abortion. The doctor begins by inserting a speculum into the vagina, while the cervix is numbed with an injection of local anesthetic or possibly she would be put to sleep briefly using a general anesthetic. The physician dilates the cervix inserting a series of narrow, tapered rods, each slightly wider in diameter than the previous. The doctor inserts a small, hollow tube attached to an aspirator machine. Once the tube is inserted the doctor turns on the suction and once the uterus is empty, the suction process is ceased. Next, the walls of the uterus are then gently scraped with a loop-shaped instrument assuring all tissue from the embryo or placenta was expelled. Dilation is often uncomfortable, and may result in women feeling menstrual –like cramps both during and after the procedure, (4).
Dilation and Evacuation
The second surgical abortion technique is dilation and evacuation (D&E technique), which can take place in both the first and second trimester. Dilation and evacuation technique is similar to vacuum aspiration method with the exception of a physician using forceps as opposed to suction to remove fetal matter, (4). It has been reported that both dilation and evacuation and vacuum aspiration provide a safe and effective method of treating incomplete abortions and often conserves hospital resources, (12).
Benefits of Clinical Abortion
All three clinical abortion methods have a significant decrease in the severity of complications as well as the number of maternal mortality rates. They are all conducted under the care of a trained physician who is capable of dealing with emergency situations unlike self-induced abortions. Clinical abortions are also performed in sanitary environments with the appropriate instruments available.
There has been a lot of controversy about the maternal mortality rate resulting from abortions. However, the difference is between clinical and non-clinical abortions. It was reported approximately one death occurs for every 160,000 clinical abortions performed. This low percentage of deaths, are a result mainly of adverse effects to anesthesia, heart attacks or uncontrolled bleeding. A women’s health is 10 times more at risk of carrying a pregnancy to term than having a clinical abortion, (13). It seems that the safety of clinical abortions cannot be questioned if it proves to be safer than caring a pregnancy to term. Even so, there are still some rare heath problems associated with clinical abortions, which need to be addressed and taken into account.
Complications from Clinical Abortion Methods
Some of the health problems associated with surgical abortions consists of 0.1 % hemorrhage; 0.1 % infection; 0.1 % laceration of cervix; 0.1 % perforation of uterus; and 0.7 % retained products of conception, (4). Some serious complications do arise, although these are rare and are usually the result of a very late terminated pregnancy.
Other health problems to consider are the emotional and psychological health of a woman who has just undergone an abortion. Women after abortions feel a mixture of feelings, although they had the abortion for a reason, many may feel very depressed and traumatized by the procedure. A woman’s feelings may be affected by adjustment in hormonal levels, the attitude her community reflects toward abortion, or possibly lack of support by family and friends, (4). Most women result feeling relief and know that they made the right choice and did so in a suitable environment; their feelings of depression are manageable and are usually overcome with feelings of happiness. Most physicians and clinics recommend that women see a counselor and have family or friends they can talk to during this negative state for support. This is another way in which clinical abortions, which are safe, help in monitoring the patient and their progress, by having counselors and support group meetings available.
In conclusion, putting the moral and ethical debate of abortions aside, and comparing statistical information, it is quite obvious that clinical abortions done by trained certified physicians is much more safe as well as effective. If complications arose in a monitored setting, the physician may be able to save the mother’s life depending on severity and response time. Abortions have been practiced all over the world; both clinically (through medical and surgical methods) and non-clinically (self-induced). Many extreme measures have been taken by women in order to terminate a pregnancy which has unfortunately often cost them there own life. With the help of organizations; women (especially in developing countries) can be informed of the risks involved with non-clinical abortions. Furthermore, women can be offered services to treat complications associated with it. Organizations would improve 1) clinical abortion services by trained staff and physicians; 2) counseling sessions and support groups; 3) policies and to increase availability of family planning. Women will continually self-induce abortions if they feel necessary as a result of lack of abortion services or because it is illegal. Women are therefore putting their own life in jeopardy as a result of desperately wanting to terminate a pregnancy and will go to almost no end to do so. Consequently, by not providing abortion information or services to these women; or by having laws that say it is illegal is actually encouraging them to take that risk even with a high maternal mortality rate. The issue at hand here is not the moral or ethical view on abortion since the mother is going to choose what she feels is best, but rather the safety issue of abortion. With all the statistics supporting the safety of clinical abortions, shouldn’t society be making this available to women in low-income areas, or women in areas where it is illegal, to help reduce the number of maternal deaths from non-clinical abortions which are inevitable if the mother feels strongly enough. So it seems by not providing this information or healthcare services, the inevitable is being delayed but with a higher maternal mortality rate. There has been extensive research conducted, which has provided statistical information on the safety of different abortion methods. With the use of RU-486 and other clinical abortion methods, women can have a sanitary and monitored abortion as a safe alternative.
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