Medical and ethical considerations in abortion decision-making

Abortion Pros and Cons

Abortion: Pros and Cons

Abortion from a purely moral or ethical perspective can never be endorsed. However, in some medical conditions where the life of the mother is at stake abortion as a life saving intervention is certainly approved. Irrespective of the methods used abortion leaves a great psychological stigma and guilt feeling. A more prudent method would be to use the available contraceptive methods. For women who choose abortion as a method to end their unintended pregnancies the provision of post abortion-healing care is very important.

Abortion continues to be one of the much debated medical, social and ethical issue worldover. In the U.S. ever since the 1973 landmark decision by the Supreme Court ( Roe vs. Wade case) that legalized abortion the issue has become a political vendetta. Since 1973, every year around 1.3 to 1.4 million abortions are performed in the U.S. And it has become one of the most common medical procedures in this country. Statistics indicate that every year between 20 and 30 million legal abortions are performed worldwide. [Suzanne Trupin] Statistics also indicate that around 20 million abortions are performed illegally every year making it one of the leading causes of maternal mortality (13%) with such illegal abortions accounting for around 68,000 deaths. [Lisa et.al] Illegal and unsafe abortion is a very serious issue in countries with restrictive abortion laws. Even in the U.S., abortion continues to be one of the most contentious issues pertaining to women's health policies. While the prohibitionist view abortion as ethically and morally repugnant, pro-abortion activists continue to strongly proclaim that the woman is totally entitled to her reproductive rights. Leaving asides the ethical and moral perspectives researchers are also studying the mental health impact of abortion. A brief overview of abortion involving a discussion of its pros and cons will provide better insight into this controversial social issue.

Pregnancy Termination Indications

While there is much controversy surrounding elective abortion sometimes it is necessary that pregnancy should be terminated by abortion in order to save the life of the mother. Medical emergencies include prolonged illness of the mother not permitting continued pregnancy, the early identification of fetal anomalies in which case the outcome of pregnancy is most likely to be a child born with physical and/or mental anomalies, or when there is a high probability of intrauterine or neonatal death. In these cases aborting the pregnancy is medically recommended. Studies indicate that almost 3 to 5% of all pregnancies have fetal anomalies either due to genetic aberrations or due to fetal infections, maternal disease, drugs or medications, or of some unknown cause. In such cases, it is in the health interest of the mother that the pregnancy be aborted. Further the use of abortion to terminate pregnancy that was the result of a rape is fairly justified from the women's perspective, as she might not want to continue the pregnancy and give birth only to live with a trauma throughout her life. So in the cases mentioned above, the ethical or moral dilemma pertaining to abortion sinks to the background and abortion stands clearly justified. [Suzanne Trupin]

Abortion Impact on Mental Health

Several studies have focused on the impact of abortion on the long-term mental health of the woman. One recent Norwegian study focused on this aspect of abortion by including 40 women who had miscarriages and 80 women who had induced abortion at a maternity clinic in Buskerud county, Norway and followed them for over five years. The study required the subjects answer to questionnaires related to Quality of Life, Impact of event Scale (IES) and Hospital Anxiety and Depression Scale (HADS). These questionnaires were given at 10 days (T1), six months (T2), two years (T3) and five years (T4) after the termination of pregnancy. The results were analyzed using statistical ANCOVA test to infer the differential changes in the scores over the study period. The results of the study indicated that compared to women who had induced abortion, women who had miscarriage had more distress at 10 days and 6 months period. The results also showed that women who had miscarriage were quick to recover on the IES score showing significant improvement for grief, guilt, anger, loss etc. over time. However, it was evident that women who had induced abortion had much higher scores on the IES at 2 years (3.2 vs. 9.3 at T3, respectively, p < 0.001;) and 5 years 1.5 vs. 8.3 at T4 after termination of pregnancy. Women in the induced abortion group also had very high scores in the HADS compared to both miscarriage group and the general public. This study clearly indicates that abortion has serious long-term mental health impact stressing the need for effective counseling services for women who go through with the process. [Anne Broen]

Abortion and Breast Cancer Risk

There has been a lot of research devoted to the potential link between abortion and breast cancer. Karen Malec, president of the Abortion/Breast Cancer coalition says "It's time for scientists to admit publicly what they already acknowledge privately among themselves that abortion raises breast cancer risk - and to stop conducting flawed research to protect the medical establishment from massive medical practice lawsuits," [PhysiciansforLife] A recent study published by the American physicians and surgeons journal has clearly implicated abortion as the "best predictor of breast cancer," among the seven well-known risk factors. This study by Patrick S. Carroll compared the breast cancer rates and abortion incidence rates in eight European countries including England and Wales, Scotland, Northern Ireland, Irish republic, Czech Republic, Sweden, Denmark and Finland. Using a linear regression model, the researchers projected the future Breast cancer rates based on the well-known risk factors of which abortion was the most important. The study also compared the previously predicted breast cancer incidence rates (1997 projections) with the current data and found that the projections were more or less accurate with 100.5% accuracy for 2003 and 97.5% accuracy for 2004. The study projected higher breast cancer rates in England due to its high abortion rates while the forecast was on the lower side for Irish republic as well as Northern Ireland where abortion rates are very low. The research concluded that nulliparous abortions and lower fertility pose the greatest risk factors for developing breast cancer. [Patrick Carroll]

Long Island Relevance

This discussion is particularly relevant for the Long island population as LI has one of the highest rates of teenage pregnancies and abortions. Through extensive intervention programs such as the 'Suffolk Network on Adolescent Pregnancy', the county that had around 4000 adolescent pregnancies (between 10 and 29 years) has now reduced the number to only 1,800. 'Organizations such as the Suffolk Network on Adolescent Pregnancy-Long Island also mitigate the effects of teen pregnancy - but the problem is still with us, on a societal level.' [Ken Cerini] Increasing awareness about Abortion and its downsides is important as teen pregnancies continue to be a big social issue for Long island. Post abortion healing care is more important as we have discussed above that abortion has long-term psychological effects in women.

Conclusion

Abortion from a purely moral or ethical perspective can never be endorsed. However, in some medical conditions where the life of the mother is at stake abortion as a life saving intervention is certainly approved. Also in cases where the pregnancy is due to sexual victimization the woman has the right to decide about abortion. Irrespective of the methods used abortion leaves a great psychological stigma and guilt feeling.

The more horrific partial birth abortions are a cause for concern and leave deep psychological distress and depression. It is more thoughtful and appropriate to use the available contraceptive methods instead of going for abortion. However, for those women who choose abortion as a method to end their unintended pregnancies the provision of post abortion-healing care is very important.