Abortion and the Significance Towards Women\'s Health With Evidence

Abortion and the Significance Towards Women's Health With Evidence

Induced abortion represents a multifaceted ethical, moral, biological, psychological, and legal human issue. The complex issue of induced abortion has been the source of substantial debate, controversy, and activism over the course of several decades. Induced abortion is medically defined as the removal or expulsion of a fetus or embryo before the fetus is able to survive outside of the uterus (Grimes et al. 2004). Fetal viability has been explained as 20 weeks gestation or a fetal weight that is less than 500 grams; however, there is not a reported case of a fetus surviving at 20 weeks and weight alone is not the strongest predictor of viability (Grimes et al. 2004). In the United States, the U.S. Supreme Court case Roe v. Wade legalized abortion nationwide (Grimes et al. 2004). Abortion is currently one of the most common medical procedures performed on women aged 15-44 in the U.S., and the majority of women who have abortions tend to be young, unmarried, white, and undergo the procedure during early pregnancy (Jones et al. 2008; Grimes et al. 2004). The procedure can be performed medically or surgically.

Several studies have emerged which inquire into various aspects of the multidimensional, and often controversial, abortion issue and examines the ways in which abortion affects women's health. One study examined the incidence of medical abortion within a population of women from Denmark, and investigated the risk of subsequent adverse pregnancy outcomes (Virk et al. 2007). Another study performed a 30-year longitudinal study to research the psychological effects of abortion, and compare the prevalence of mental health disorders in women who had undergone induced abortion (Fergusson et al. 2008). A third study investigated the obstacles obstetric and gynecological physicians face while trying to integrate abortion procedures into their practices (Freedman et al. 2010). Each study hosts a variety of research strengths and weaknesses. Abortion has been the source of intense controversy and debate, and millions of women undergo medical abortion to terminate unwanted pregnancies. Despite the controversy and debate, these women deserve access to efficient medical care and gender-sensitive intervention methods while undergoing, and following the completion of, abortion treatment.

Researchers and medical professionals have established the long-term safety of surgical abortion in the first trimester, and understand the low risk surgical abortion has on creating adverse effects on subsequent pregnancies. Medical abortion, which is abortion by means of medication, is an alternative option to the surgical procedure. Although some form of medical abortion has been in practice since the 1950s, limited information is available regarding the effects of this treatment on a woman's subsequent pregnancies (Virk et al. 2007). The use of medical abortion has increased in recent years and there are currently three regimens available: misoprostol alone, methotrexate followed by misoprostol, and the mifepristone followed by misoprostol, which is the most commonly used method; by 2000, 3 million women worldwide used the mifepristone and misoprostol treatment (Virk et al. 2007). Considering the uncertainty of the effect of this treatment on subsequent pregnancies, Virk et al. performed a study to compare pregnancy health in woman who had previously undergone medical abortion vs. surgical abortion (2007). The study identified women living in Denmark who had undergone an induced abortion for non-medical reasons between 1999 and 2004, and then evaluated the two populations (medical and surgical abortion) for their risk of ectopic pregnancy, spontaneous abortion, preterm birth, and low both rate in the first subsequent pregnancy (Virk et al. 2007). The study concluded with no evidence suggesting previous medical abortion, in comparison with surgical abortion, increases the risk of adverse conditions in subsequent pregnancy (Virk et al. 2007).

The adequate amount of data available for the Virk et al. research adds to the strength of the study. The Danish National Induced Abortion Registry has maintained records of all induced abortion performed in the country since 1973, which allowed Virk et al. To access all information concerning medical and surgical abortion treatments within the country's population (2007). The study was strengthened as the group had access to an accurate research source which permitted them to evaluate 11,814 pregnancies in women who had previous first-trimester abortion procedures between 1999 and 2004 (Virk et al. 2007). To obtain information regarding ectopic pregnancies and spontaneous abortion the researchers utilized the Danish National Patient Registry, which contains information on all hospital stays and outpatient visits for the entirety of the study period (Virk et al. 2007). Again, the strength of the study is apparent in its ability to access complete medical information. The study also performed a population study which allowed them to survey all abortion treatments in the country, versus other studies that have suggested a risk between medical abortion and ectopic pregnancy using population-based case patients and controls (Virk et al. 2007).

The strengths of the Virk et al. study are evident in its access to medical records; however, its relatively small sample size contributes to its weaknesses. Among the 11,814 pregnancies in women who had undergone previous first-trimester abortion, 2,710 women had medical abortion and 9,104 women had surgical abortion. The study then compared the first-trimester results of the 11,814 subsequent pregnancies for birth weight, preterm birth, ectopic pregnancy, and spontaneous abortion (Virk et al. 2007). Only the results of 2,710 subsequent pregnancies were studied in women who had undergone previous medical abortion. This sample size is relatively small when considering the millions of subsequent pregnancies that have occurred in women with previous medical abortion history. The statistical information collected by Virk et al. was also adjusted for maternal age, parity, interpregnancy interval, cohabitation status, maternal residence, and gestational age at the time of the abortion, but was not adjusted for smoking, history of sexually transmitted diseases, or history of ectopic pregnancy (Virk et al. 2007). These are other variables which could affect subsequent pregnancies, yet were not examined in this study.

An additional study investigating the significance of abortion and its role on women's health examined the links between pregnancy and mental health outcomes. Over the course of the past two decades, research has been conducted to consider mental health outcomes, such as depression, substance use, anxiety, and suicidal behavior in association with induced abortion (Fergusson et al. 2008). The research performed by Fergusson et al. based their results from a longitudinal study of 534 women who had been participants in the Chirstchurch Health and Development Study (CHDS); CHDS studied individuals at birth, 4 months, 1 year, every following year to age 16, and at ages 18, 21, 25, and 30 (2008). Each woman had provided information over the 30-year period regarding pregnancies and mental health history. Based on this study group, 284 women reported a total of 686 pregnancies prior to age 30, and included a total of 153 abortions that occurred to 117 women (Fergusson et al. 2008). During every assessment from age 16 to 30 years, participants were questioned regarding mental health issues since the previous assessment using specific, structured questionnaires (Fergusson et al. 2008). After analyzing the correlations between abortion and mental health, Fergusson et al. found abortion may be associated with a small increase in risk of mental health disorders; women who had abortions showed rates of mental disorder that were approximately 30% higher than the other female participants (Fergusson et al. 2008).