On Abortion and Women’s Health
The main presidential candidates are really pushing the issue of abortion rights this year. I don’t believe it’s much of a priority for either Romney or Obama, but I expect Obama’s healthcare policies will have an effect on the way abortion is handled in this country.
Full-disclosure: I define myself as neither republican nor democrat. I would call myself generally anti-abortion, but I realize that it’s an incredibly complex issue and I don’t believe there are blanket right-and-wrong answers to be found here.
I’ve heard dozens of commercials along the same theme: republicans want to take “critical” healthcare away from women. Republicans aside, as a birth professional, I’d like to speak to the notion of abortion being “critical” for women’s health.
Today, I’m not addressing the issue of abortion from a religious or political standpoint, but from a healthcare standpoint. No, really! I’m not going to bring up Jesus. I’m not going to endorse a political party. I’m just going to share some research-based evidence.
First, it’s important to explain how abortion is performed and how it affects the body.
Abortion and miscarriage affect the body in some similar ways. A woman’s body has the amazing ability to detect genetic abnormalities and deformities in a developing baby, and 95% of the time, will spontaneously abort a baby that is developing with serious problems. This is what causes most, but not all, miscarriages. Even in a natural miscarriage, the body undergoes a massive hormonal shift that seriously jacks you up (ask any woman who has experienced miscarriage). Most women report that the emotional healing takes much longer than the physical recovery.
Abortion is different because it’s not a spontaneous, natural function of the body. Instead, it’s the removal of a (usually) normal, healthy baby, which confuses the body. There are two types of abortion practiced commonly in the US:
This is a pill, usually Mifepristone, that blocks progesterone, an important hormone in pregnancy. It is used alone or in conjunction with Misoprostol. Among other things, this causes the uterine lining to break down and be sloughed off, along with the baby, just like in a miscarriage. The FDA has approved Mifepristone for use up to 49 days past your missed period (7 weeks) but on their website, Planned Parenthood says it administers it for up to 9 weeks (I suspect in conjunction with another drug).
The packaging notes risks including vaginal bleeding or spotting, cramps, pelvic pain, vaginal burning, itching, or discharge, headache, tiredness, difficulty falling asleep or staying asleep, anxiety, back or leg pain. The chief among these is very heavy bleeding, but thorough studies haven’t been performed on this particular risk yet. The sudden hormonal shift triggered by a pregnancy loss is often stronger for women who undergo abortion because the loss was caused chemically, instead of by the body’s own hormones.
In my opinion, the biggest risk of this method is that it isn’t always completely effective. In about 5% of women, tissue may be left in the uterus which can cause infection (a very serious risk with a host of other potential side effects), thus necessitating a surgical abortion. Of course, miscarriages can also be incomplete, but I couldn’t find any definitive numbers from sound studies that indicated what percentage of miscarriages end this way.
The most common surgical abortion procedure performed in the US is called Aspiration Abortion. Basically, the cervix is dilated manually (sometimes with the assistance of drugs) and a vacuum device is used to remove the baby, placenta, and other tissue. The farther along you are in pregnancy, the riskier this procedure is, with success rates slipping lower past 6-8 weeks of pregnancy.
Risks include post-partum depression, cramping, severe bleeding, blood clots, infection, cervical tearing, uterine tearing, scarring, incomplete abortion, repeated abortion, undetected ectopic pregnancy, and rarely, death.
Another type of surgical abortion, somewhat common but less often used than aspiration abortion, is D&C, or Dilation and Curettage. The cervix is dilated and a sharp, spoon shaped blade (a Curette) is inserted and used to scrape out the inside of the uterus. Typically, this procedure is performed after an incomplete miscarriage or abortion, but some less-modern doctors still perform D&C abortions routinely.
Risks of Dilation & Curettage include postpartum depression, cramping, hemorrhage, uterine perforation and/or tearing, cervical damage and/or tearing, infection, scarring, incomplete abortion, and rarely, death.
Abortion is presented as a safe way to terminate a pregnancy. However, even apart from the possible risks and complications listed above, a host of statistics show that abortion, particularly surgical procedures, can have a long-term impact on fertility and general health.
1. Abortion can leave you sterile.
Approximately 3-5% of women who have induced abortions are rendered sterile, and the percentage is higher if you had an active venereal disease or infection at the time.
2. Abortion significantly raises your chances of developing future ectopic pregnancy.
Women who experience some kind of post-abortion infection (25-30% of abortion patients) are 5-8 times more likely to develop ectopic pregnancy. Ectopic pregnancy, when a fertilized egg becomes implanted outside the uterus (for example, in a fallopian tube) is almost always fatal to the baby and is an enormous risk to the mother’s life. The number of ectopic pregnancies in the US has more than quadrupled since abortion was legalized, and over a tenth of maternal deaths in the US are due to ectopic pregnancy, a trend that is visible in other countries with legalized abortion.
3. Each abortion significantly increases your risk of future pregnancy complications.
Dilating the cervix manually is a difficult task even with pharmaceutical help, because the cervix is meant to stay hard and closed until labor begins naturally. Minor to severe tears in the cervix and uterine wall often result. One hospital study I found reported that 12.5% of abortions required cervical sutures, while another study reported up to 22% of women needing suturing. Suturing is a service that outpatient abortion clinics usually don’t provide. Alarmingly, the risk of cervical and uterine tearing nearly doubles for women under 17, since their cervix is still maturing.
Incompetent Cervix, or a cervix too weak to hold the weight of a developing baby, is found in 75% of women who have undergone dilation for an abortion. The risk of miscarriage, premature birth, and labor complications goes up by 300-500% in women with this kind of cervical damage.
Risk of placenta previa, where the placenta develops over the birth canal, increases 7-15 times after induced abortion. This condition increases the risk of fetal malformation, perinatal death, and hemorrhage during labor.
4. Each abortion makes it increasingly unlikely you’ll be able to deliver a baby vaginally in the future.
1 in 3 American women have had at least one abortion by the time they are 45 years old. This may help to explain our unbelievable cesarean section rates, since women who have undergone surgical abortion almost always have some degree of tearing (and suturing), and thus, scar tissue. Scar tissue in the uterus can impede its ability to contract during labor, and scar tissue in and around the cervix can make it difficult or even impossible for it to dilate.
5. Abortion increases risk of handicaps in future babies.
The side effects of induced abortion increase chances of premature delivery, complications of labor, and abnormal development of the placenta in later pregnancies. These reproductive complications are the leading causes of handicaps among newborns.
6. Abortion significantly increases your chance of developing breast cancer and other cancers.
A recent study on Chinese women showed that women who had undergone one abortion were 82% more likely to develop breast cancer than women who had not had an abortion, and that number rises with each procedure. “Induced abortion prevents breast tissue from growing from immature type 1 and 2 lobules into mature type 3 and 4 lobules, which makes pregnant women more susceptible to carcinogenesis at extremely high levels of cancer-promoting estrogen during pregnancy,” Doctors Angela Lanfranchi and Joel Brind note in the study. Estrogen levels increase by 2000% during the first trimester, but those lobules don’t mature until the third trimester, so abortion during the 1st and 2nd trimester puts women at a high risk for breast cancer.
Induced abortion also raises a woman’s risk of cervical cancer 2.3 times, and up to 5 times with multiple abortions. Risk of ovarian and liver cancer are supposedly also raised, though I couldn’t find specific numbers.
7. Women who have had abortions report a multitude of emotional and psychological effects.
There is only one positive emotion that researches have consistently found present among women who have had an abortion: relief. 8 weeks after an abortion, one study reports that 60% of women report negative reactions. 55% expressed guilt, 44% complained of nervous disorders, 36% had experienced sleep disturbances, 31% had regrets about their decision, and 11% were on some form of psychotropic medicine.
A study of the medical records of 56,741 California medicaid patients revealed that women who had abortions were 160% more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery, and rates of psychiatric treatment remained significantly higher for at least four years.
Women report over 100 psychological and emotional reactions to abortion including a variety of sexual dysfunctions, depression, post-traumatic stress disorder, self-destructive behavior, personality changes, anxiety attacks, chronic sleeplessness, difficulty concentrating, self-hatred, addiction and/or substance abuse, difficulty bonding with future children, thoughts of suicide, attempted suicide… the list goes on. The risks are exponentially higher for women under 17.
Abortion has a dramatic impact on women’s health. I absolutely believe it is a critical part of healthcare, namely, educating women on the potential cost, long-term effects, and risk of irreversible damage to their bodies. I don’t share this information to condemn women who have had abortions or those who feel it is their only choice. Certainly, I believe there are cases where an abortion is an acceptable option and the risks are warranted.
I share this information because I care deeply about women’s wellbeing and about their reproductive and general health. I care deeply about our right to make informed choices about our healthcare, and these risks are not being presented clearly and consistently to women considering abortion.
If you’d like references to any of the studies I mentioned, please ask in the comments, I’m happy to email them to you. I just chose not to include them because this was already such a long post.