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Dilation And Evacuation

Dilation and evacuation

Dilation and evacuation is the most common form of second trimester abortion. It is commonly referred to as a D&E. =Description= Approximately 11% of abortions are performed in the second trimester. In 2002, there were an estimated 142,000 second-trimester abortions1. The first step in a D&E is to dilate the cervix. This is often begun about a day before the surgical procedure. Enlarging the opening of the cervix enables surgical instruments such as a currette or forceps to be inserted into the uterus. The second step is to remove the fetus. Either a local anesthetic or general aneasthesia is given to the woman. If the pregnancy is less than 16 weeks, the fetus may be removed with a currette (a scraping instrument). Later-term pregnancies generally require that forceps be used to separate the fetus into components, which are removed one at a time. The head of the fetus might need to be crushed in order to fit through the cervix. Lastly, vacuum aspiration is used to ensure no fetal tissue remains in the uterus (such tissue can cause serious infections in the woman). The components are also examined to check that the entire fetus was removed. If the fetus is removed intact, the procedure is referred to as intact dilation and extraction or partial-birth abortion. =References=
- [http://www.agi-usa.org/pubs/fb_induced_abortion.html Alan Guttmacher Institute: "Induced Abortion in the United States"] Category:Abortion

Abortion

An abortion is the termination of a pregnancy associated with the death of an embryo or a fetus. In medicine, the following terms are used to define an abortion:
- Spontaneous abortion: An abortion due to accidental trauma or natural causes, this is commonly termed a miscarriage.
- Induced abortion: Induced abortions are further subcategorized into therapeutic abortions and elective abortions.
  - Therapeutic abortion: An abortion performed because the pregnancy poses physical or mental health risk to the pregnant woman.
  - Elective abortion: An abortion performed for any other reason. In common parlance, the term "abortion" is synonymous with induced abortion. A pregnancy that terminates early, but where the fetus survives to become a live infant, is instead termed a premature birth. A pregnancy that ends with an infant dead upon birth, due to causes such as spontaneous abortion or complications during delivery, is termed a stillbirth. Certain forms of birth control are used to prevent implantation before the pregnancy occurs. These acts of emergency contraception are not classified as abortion by medicine. The ethics and morality of induced abortion have become the subject of an intense debate in the past 50 years in various areas of the world, particularly in the United States of America, but also to a lesser extent in Canada and a number of countries in Europe. Any female mammal can experience abortion, however this article focuses exclusively on abortion in women.

Spontaneous abortion

Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes. A miscarriage is spontaneous loss of the embryo or fetus before the 20th week of development. Spontaneous abortions after the 20th week are generally considered preterm deliveries. Up to 78% of all conceptions may fail, in most cases even before pregnancy is confirmed. 15% of all confirmed pregnancies end in a miscarriage. Most miscarriages occur very early in a pregnancy. Early embryonic development is an error prone process, and the body may spontaneously abort if a fetus is not viable (i.e., due to genetic deformities, such as most cases of trisomy), or when the womb is unable to support the development of the fetus. Other causes can be infection (of either the mother or the fetus), immune responses, or serious systemic diseases of the mother. The risk for spontaneous abortion is greater in women over age 35, those with a history of more than three previous (known) spontaneous abortions, and those with systemic diseases. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered an induced abortion. Some states have laws increasing the criminal liability of a person who causes a miscarriage during an assault or other violent crime.

Induced abortions

The term "abortion" is usually used by lay people to refer to induced abortion. Women from 27 nations reported the following reasons for seeking an induced abortion:
- 25.5% – Want to postpone childbearing
- 21.3% – Cannot afford a baby
- 14.1% – Has relationship problem or partner does not want pregnancy
- 12.2% – Too young; parent(s) or other(s) object to pregnancy
- 10.8% – Having a child will disrupt education or job
-   7.9% – Want no (more) children
-   3.3% – Risk to fetal health
-   2.8% – Risk to mother's health
-   2.1% – Rape, incest, other In many areas of the world, especially the developing nations or where induced abortions are illegal, many women choose or are pushed to perform abortions on themselves. These self-induced abortions are commonly unsafe abortions as described by the World Health Organization. Furthermore, some abortions are induced because of societal pressures, such as stigma of disabled persons and similar eugenic ideals, societal and religious disapproval of single motherhood, insufficient economic support for families, or laws such as under China's one-child policy. These policies and societal pressures can lead to sex-selective abortion and infanticide, which is illegal in most countries, but difficult to stop.

Methods of inducing abortion

Depending on the gestational age of the embryo or fetus, different methods of abortion can be performed to remove the embryo or fetus from the womb.

Medical Abortion

Effective in the first trimester of pregnancy, medical, or non-surgical abortions comprise 10% of all abortions in the United States and Europe. The process begins with the administration of either methotrexate or mifepristone, followed by misoprostol. While misoprostol may also be used alone to induce abortion, the need for surgical intervention is slightly elevated to about 10%, compared to the 8% when medications are combined. When surgical intervention is necessary, primarily vacuum uterine aspiration is used.

Surgical abortion

In the first fifteen weeks, suction-aspiration or vacuum abortion are the most common methods, replacing the more risky dilation and curettage (D & C). Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses suction produced by an electric pump to remove the fetus or embryo. From the fifteenth week up until around the eighteenth week, a surgical dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. Dilation and suction curettage consists of emptying the uterus by suction using a different apparatus. Curettage refers to the cleaning of the walls of the uterus with a curette. Dilation and curettage (D & C) is a standard gynaecological procedure performed for a variety of reasons, such as examination. As the fetus grows, other techniques must be used to induce abortion in the third trimester. Premature delivery of the human fetus can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late abortions can be brought about by the controversial intact dilation and extraction (intact D & X) which requires the surgical decompression of the fetus's head before evacuation and is controversially termed "partial-birth abortion". A hysterotomy abortion, similar to a caesarian section but resulting in a terminated fetus, can also be used at late stages of pregnancy. Hysterotomy abortion can be performed vaginally, with an incision just above the cervix, in the late mid-trimester. An attempted abortion which results in the expulsion of a live infant (known medically as a neonate) is termed a failed abortion. A failed abortion is more likely to occur later in pregnancy. Some doctors who have induced a failed abortion have faced the prospect of having to kill the neonate, but are voicing concerns that doing so may be unethical and possibly subject them to criminal sanctions. As a result, recent investigations have been launched in England by the Confidential Enquiry into Maternal and Child Health (CEMACH) and the Royal College of Obstetricians and Gynaecologists in order to determine how widespread the problem is and an ethical response on how to treat the neonate.

Other means of abortion

A number of herbs are effective abortifacients. Using herbs in this way can cause serious side effects, including multiple organ failure and other serious injury, and are not recommended by physicians. Physical trauma to a pregnant woman's womb can cause an abortion. The severity of the impact required to cause an abortion carries high risk of injury, without necessarily inducing a miscarriage. Both accidental and deliberate abortions of this kind carry criminal liability in many countries.

Health effects

As with most surgical procedures, the most common surgical abortion methods carry the risk of potentially serious complications. These risks include: a perforated uterus, perforated bowel or bladder, septic shock, sterility, and death. It is difficult to accurately assess the risks of induced abortion due to a number of factors. These factors include wide variation in the quality of abortion services in different societies and among different socio-economic groups, a lack of uniform definitions of terms, and difficulties in patient follow-up and after-care. Use of other methods (e.g., overdose of various drugs, insertion of various objects into uterus) for abortion is very dangerous, carrying a significantly elevated risk for permanent injury or death compared to abortions done by physicians.

Physical health

Each phase of the abortion carries separate risks, and practitioners are not in agreement as to the best methods of mitigating those risks. The degree of risk depends upon the skill and experience of the practitioner; maternal age, health, and parity; gestational age; pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care. A highly-skilled practitioner, operating under ideal conditions, will tend to have a very low rate of complications; an inexperienced practitioner in an ill-equipped and ill-staffed facility, on the other hand, will often have a higher incidence of complications. Some practitioners advocate using the minimal possible anesthesia, so that patient pain can alert the practitioner to possible complications. Others recommend general anesthesia in order to prevent patient movement which might cause a perforation. General anesthesia carries its own risks and most public health officials recommend against its routine use in abortion due to an increased risk of death. Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester of pregnancy. Instruments are placed within the uterus to remove the fetus. These can, on rare occassions, cause perforation or laceration of the uterus, and damage to structures surrounding the uterus. Laceration or perforation of the uterus or cervix can, again on rare occassions, lead to even more serious complications. Incomplete emptying of the uterus can cause hemorrhage, and infection. Use of ultrasound verification of the location and duration of the pregnancy prior to abortion, with immediate follow-up of patients reporting continuing pregnancy symptoms after the procedure, will virtually eliminate this risk. In rare cases, the abortion will be unsuccessful and the pregnancy will continue. Most practitioners recommend a second procedure to terminate the pregnancy due to the possibility that the abortion attempt had caused injury to the fetus. The sooner a complication is noted and properly treated, the lower the risk of permanent injury or death. A specific and undisputed complication that can arise, especially with repeated abortions by a dilatation and curettage, is the development of Asherman syndrome.

Suggested effects

There is controversy over a number of proposed risks and effects of abortion. Evidence, whether in support of or against such claims, might in part be influenced by the political and religious affiliations of the parties behind it.

Breast cancer

The controversial abortion-breast cancer (ABC) hypothesis posits an association between having an abortion and a higher risk of developing breast cancer. The proposed mechanism is based on the increased estrogen levels found during early pregnancy, which initiate cellular differentiation (growth) in the breast in preparation for lactation. The ABC hypothesis states that if the pregnancy is aborted before full differentiation in the third trimester, then more "vulnerable" undifferentiated cells would be left than prior to the pregnancy, resulting in an elevated risk of breast cancer. The majority of interview-based studies have indicated a link, and some have been demonstrated to be statistically significant, but there remains debate as to their reliability because of possible response bias. According to the National Cancer Institute (NCI), it is "well established" that "induced abortion is not associated with an increase in breast cancer risk." Those findings have been disputed by Dr. Joel Brind, a leading scientific advocate of the ABC hypothesis. Nevertheless, gaps and inconsistencies remain in the research as the "ABC link" continues to be a politicized issue.

Fetal pain

The experience of the fetus during abortion is a matter of consideration among scientists and political activists. Evidence is conflicting, with some authorities claiming that the fetus is capable of feeling pain from the first trimester, while others hold that the neuro-anatomical requirements for such experience do not exist until the second or third trimester. Pain receptors begin to appear in the seventh week of pregnancy. The thalamus, the part of the brain which receives signals from the nervous system and then relays them to the cerebral cortex, starts to form in the fifth week. However, other anatomical structures involved in the nociceptic process are not present until much later in gestation. Links between the thalamus and cerebral cortex aren't forged until around the 23rd week. [http://www.parliament.uk/post/pn094.pdf]. Myelin, an insulation on nerve fibres whichs aids in the conduction of electrical impulses, does not begin to develop until the sixth month. [http://www.pediatrics.emory.edu/neonatology/dpc/brain.htm] Researchers have observed changes in the heart rates and hormonal levels of neonates after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anaesthesia. [http://www.cirp.org/library/pain/anand/#n99] Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.

Mental health

It is indisputable that some women will experience negative feelings as a result of elective abortion. However, whether this phenomenon is significant enough to warrant a general diagnosis, or even classification as an independent syndrome (see abortion trauma syndrome), is a subject that is debated among members of the medical community. Data on the incidence of clinical depression, mental illness, post-traumatic stress disorder, and suicide in association with abortion remain inconclusive. [http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38623.532384.55v1] A comparative analysis of the suicide rates among postpartum and post-abortive women in Finland found a raw statistical correlation between abortion and suicide. [http://bmj.bmjjournals.com/cgi/content/full/313/7070/1431] Other studies have suggested a link between the elective termination of an unwanted pregnancy and an improvement in reported mental well-being. The majority of evidence would seem to indicate that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors. [http://www.apa.org/ppo/issues/womenabortfacts.html] Elective abortion may reduce the occurrence of depression in cases of unwanted pregnancy, as compared to cases in which the pregnancy has been carried to completion, but it is also sometimes reported as an additional stressor. Spontaneous abortion, or miscarriage, presents an increased risk of depression in women. [http://www.medicinenet.com/script/main/art.asp?articlekey=619]

History of abortion

depression The practice of induced abortion, according to some anthropologists, can be traced to ancient times. There is evidence to suggest that, historically, pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. Soranus, a 2nd century Greek physician, suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in violent exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal bathes, pessaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation. [http://www.stoa.org/diotima/anthology/wlgr/wlgr-medicine355.shtml] It is also known that the ancient Greeks relied upon the herb silphium as both a contraceptive and an abortifacient. The plant, as the chief export of Cyrene, was driven to extinction, but it is suggested that it might have possessed the same abortive properties as some of its closest extant relatives in the Apiaceae family. Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy. 19th-century medicine saw advances in the fields of surgery, anaesthesia, and sanitation, in the same era that doctors with the American Medical Association lobbied for bans on abortion in The United States and the British Parliament passed the Offences Against the Person Act. Demand for the procedure continued, however, as the disguised, but nonetheless open, advertisement of abortion services in Victorian times would seem to suggest. [http://users.telerama.com/~jdehullu/abortion/abhist.htm]

The abortion debate

Throughout the history of abortion, induced abortions have been a source of considerable debate and controversy regarding the morality and legality of this practice. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues have a strong relationship with that individual's value system. A person's position on abortion may be best described as a combination of their personal beliefs on the morality of induced abortion, and that person's beliefs on the ethical scope and responsibility of legitimate governmental and legal authority. Another factor for many individuals is religious doctrine. See religion and abortion for more. Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. Most often those in favor of legal prohibition of abortion describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to life?" for pro-life advocates, and, for those who are pro-choice, "Should the state or the individual have choice on the matter of abortion?" In both public and private debate, arguments presented in favour of or against abortion focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.

Public opinion

Political sides have largely been divided into absolutes. The abortion debate, as such, tends to centre around individuals who hold strong positions. However, public opinion varies from poll to poll, country to country, and region to region:
- Australia: In a February 2005 AC Nielsen poll, as reported in the The Age, 56% thought the current abortion laws were "about right," 16% want changes in law to make abortion "more accessible," and 17% want changes to make it "less accessible." [http://www.theage.com.au/news/National/Poll-backs-abortion-laws/2005/02/15/1108230007300.html] A 1998 poll, conducted by Roy Morgan Research, asked, "Do you approve of the termination of unwanted pregnancies through surgical abortion?" 65% of the Australians polled stated that they approved of surgical abortion and 25% stated that they disapproved of it. [http://oldwww.roymorgan.com/polls/1998/3058]
- Ireland: A 1997 Irish Times/MRBI poll of the Republic of Ireland's electorate found that 18% believe that abortion should never be permitted, 35% that one should be allowed in the event that the mother's life is threatened, 18% if her health is at risk, 28% that "an abortion should be provided to those who need it," and 5% were undecided. [http://www.ireland.com/newspaper/front/1997/1211/archive.97121100003.html]
- Canada: A recent poll of Canadians, conducted in April 2005 by Gallup, found that 52% of those polled want abortion laws to "remain the same," 20% want the laws to be "less strict," and 24% would prefer that the laws become "more strict." An earlier Gallup poll, from December 2001, asked, "Do you think abortions should be legal under any circumstances, legal only under certain circumstances or illegal in all circumstances and in what circumstances?" 32% of Canadians responded that they believe abortion should be legal in all circumstance, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. See Abortion in Canada.
- The United Kingdom: An online YouGov/Daily Telegraph poll in August 2005 found that 30% of Britons would back a measure to reduce the legal limit for abortion to 20 weeks, 19% support a limit of 12 weeks, 9% support a limit of less than 12 weeks, and 25% support maintaining the current limit of 24 weeks. 6% responded that abortion should never be allowed while 2% said it should be permitted throughout the entirety of pregnancy. [http://www.yougov.com/archives/pdf/TEL050101042_1.pdf]
- The United States: A CNN/USA Today/Gallup poll conducted in November 2005 revealed that 39% believe that abortion should be legal only in "a few circumstances" and another 16% think that it should be legal under "no circumstances", whereas 26% believe it should remain legal in "all circumstances" (the current law under Roe v. Wade) and 16% said it should be legal under "most circumstances". [http://www.cnn.com/2005/US/11/27/abortion.poll] Additional recent U.S. polling data can be found [http://www.pollingreport.com/abortion.htm here.] [http://www.pollingreport.com/abortion.htm]

Abortion law

Roe v. Wade The Soviet Union (1920) and Iceland (1935) were some of the first countries to generally allow abortion. The second half of the twentieth century saw the liberalization of abortion laws in many other countries. In 1973, the U.S. Supreme Court struck down state laws banning abortion, controversially ruling that such laws violated an inferred right to privacy in the U.S. Constitution. The Supreme Court of Canada, similarly, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under in the Canadian Charter of Rights and Freedoms. Ireland, on the other hand, added an amendment to its Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn." (see Abortion in Ireland). Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, and the right to security of person are major issues of human rights that are sometimes used as justification for the existence or the absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window in which abortion is still legal to perform:
- In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
- In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessitated before it can be performed. Other countries, in which abortion is illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A handful of nations ban abortion entirely, such as Chile, El Salvador, and Malta.

Related topics


- Abortion in Canada
- Abortion in the Republic of Ireland
- Abortion in the United Kingdom
- Abortion in the United States
- Adoption
- Nuremberg Files
- Partial-birth abortion
- Pregnancy
- Religion and abortion
- Selective reduction
- Self-induced abortion
- Sex-selective abortion and infanticide
- Wrongful abortion

Sources

# Bankole, Akinrinola; Singh, Susheela; Haas, Taylor. "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries." International Family Planning Perspectives, 1998 # Moreau, C. et al, [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15777440&query_hl=8 "Previous induced abortions and the risk of very preterm delivery"], BJOG. 2005; 112(4):430-7 #[http://www.timesonline.co.uk/article/0,,2087-1892696,00.html The Sunday Times (Britain)] November 27, 2005 # [http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/05/15/nabort15.xml http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/05/15/nabort15.xml] # Beral V, Bull D, Doll R, Peto R, Reeves G; Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries. Lancet. 2004 Mar 27;363(9414):1007-16. PMID 15051280 # Ciganda C, Laborde A., [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12807304&query_hl=9 "Herbal infusions used for induced abortion"], J Toxicol Clin Toxicol. 2003; 41(3):235-9 # [http://www.efc.org.uk/Foryoungpeople/Factsaboutabortion/Unsafeabortion Education For Choice] – Unsafe abortion

External links


- [http://www.johnstonsarchive.net/policy/abortion Abortion Statistics and Other Data]
- [http://annualreview.law.harvard.edu/population/abortion/abortionlaws.htm Abortion Laws of the World]
- [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review] The following links may be biased:
- [http://www.abortion.com/ Abortion.com]
- [http://agi-usa.org/ The Alan Guttmacher Institute]
- [http://www.all.org/ American Life League]
- [http://www.care-net.org/ CareNet]
- [http://justfacts.com/abortion.htm Just Facts: Abortion]
- [http://www.plannedparenthood.com Planned Parenthood] Category:Abortion Category:Abortion by country Category:Obstetrics Category:Issue in the Culture Wars ja:妊娠中絶 simple:Abortion

Partial-birth abortion

Partial birth abortion (PBA) refers to most intact dilation and extraction (IDX) procedures where the fetus is alive at the time of the procedure — thus resulting in an abortion of the fetus. IDX procedures are also called dilation and extraction (D&X), intact dilation & evacuation (Intact D&E, or IDE), and Intrauterine Cranial Decompression (for the purposes of this article, IDX will be the term of choice). While the term "Partial Birth Abortion" largely refers to IDX procedures, in broader contexts the term is sometimes applied to dilation and evacuation (D&E) procedures. Though often performed during the same developmental stage wherein most D&X procedures are done, D&E is a separate and distinct procedure from IDX. A D&E procedure differs in that the fetus is killed during the process of dismemberment before leaving the womb, rather than being extracted intact. The IDX procedure can also be used in late-term miscarriage cases. Two of the most well-known abortion practitioners who perform the IDX procedure, Dr. Martin Haskell and Dr. Leroy Carhart, have confirmed that in most cases the fetus is alive when the abortion procedure begins. Although accurate statistics detailing the number of partial birth abortions performed annually in the United States are not available, the number is usually estimated in the low thousands, comprising a small fraction of annual abortion procedures in the United States. Although not a proper medical term, partial-birth abortion is commonly used in public discussion of the procedure. Partial-birth abortion has been a central issue in the greater abortion debate.

Etymology

The procedure was first described as "Dilation and Extraction" by Cincinnati physician W. Martin Haskell, MD in a monograph that was distributed by the National Abortion Federation in September of 1992. [http://www.vanderbilt.edu/SFL/partial-birth_abortion.htm]. The term partial-birth abortion did not appear until several years later, when the Partial-Birth Abortion Ban Act of 1995 was introduced in the House of Representative on 14 June 1995. The law defined partial-birth abortion as "an abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery." That same year; however, Ohio enacted a law which referred to the procedure as dilation and extraction. In 2000, Ohio amended the law [http://onlinedocs.andersonpublishing.com/oh/lpExt.dll/PORC/13316/13a49/13a6f/13a9a?fn=document-frame.htm&f=templates&2.0#] to use the term partial birth feticide, as well as to overcome the unconstitutionality of the prior statute. There are limited other examples of the use of the term partial birth feticide. Another alternative term is brain suction abortion, the use of which has been mostly limited. Specifically, pro-life activist Janet Folger has used the term to describe the procedure.

Controversy

Often the debate over partial-birth abortion is over the name for this type of abortion, as well as the procedure itself. Those who support using the term say it describes a specific type of abortion in a phrasing that better represents what happens during the procedure. Those who oppose using the term say that the term is a deceptive political term invented to frame the argument in a way favorable to those in opposition to the procedure. The procedure is highly controversial. Supporters of the procedure argue that its use should be left to the discretion of the woman and her doctor — even in third-trimester cases. The inventor of the procedure called it "a quick, surgical outpatient method" [http://www.vanderbilt.edu/SFL/partial-birth_abortion.htm] for late second-trimester and early third-trimester abortions. Pro-life critics of the procedure consider it tantamount to infanticide or murder, and the Partial-Birth Abortion Ban Act of 2003 describes it as "a gruesome and inhumane procedure that is never medically necessary" [http://news.findlaw.com/usatoday/docs/abortion/2003s3.html] - at the same time as pro-choice groups argue that it is more humane than D&E, the most common second-trimester abortion method. Congress also made the declaration in this act that the procedure was "never medically necessary". Having made this claim without performing independent peer-reviewed scientific research, this has caused a dispute about the proper behavior of Congress in and of itself, and many doctors and pro-choice groups disagree with the claim. Many pro-choice and pro-life advocates see the issue as a central battleground in the wider abortion debate. A major part of the legal battle over banning the procedure relates to health exceptions, which would permit the procedure in special circumstances. In theory, the 1973 Supreme Court decision Roe v. Wade, which declared many state-level abortion restrictions unconsitutional, allowed states to impose some restrictions on second- and third-trimester abortions. The companion ruling, Doe v. Bolton, required that states' restrictions on abortions must provide an exception for the health of the mother, and defined health to include mental as well as physical health, though in his concurring opinion Chief Justice Burger wrote, "plainly, the Court today rejects any claim that the Constitution requires abortions on demand". In practice, the Supreme Court has found virtually every legislative restriction on abortion to be in violation of the "right" to an abortion created by Roe v. Wade. See below for exceptions. The New York Times has quoted Ron Fitzsimmons, Executive Director of the National Coalition of Abortion Providers, as saying that "in the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along." Pro-life advocates feel that this allowance for the procedure is an example of an excessive leeway in the interpretation of standards set in Roe v. Wade. Likewise, well-known abortionist George Tiller, while addressing the National Abortion Federation, stated that during the course of five years his practice performed abortions for "about 10,000 patients between 24 and 36 weeks" with only about "800 fetal anomalies between 26 and 36 weeks." [http://en.wikiquote.org/wiki/Abortion] Supporters of late-term abortion procedures argue that they prevent the pregnant woman from having to undergo childbirth or abdominal and uterine incisions of a caesarian section (c-section) when the child would not survive. However, the inventor of the procedure has stated that most partial-birth abortions are elective [http://www.nrlc.org/abortion/pba/pbafact10.html]. Supporters of a ban on such abortions also claim that partial-birth abortion subjects mothers to unnecessary risks [http://www.ppl.org/PJune_PostViability_2001.html] for the convenience of the physician [http://www.nrlc.org/abortion/pba/pbafact10.html]. Critics of the ban, in contrast, claim that the risks are less than the risks of childbirth or of a C-section. Partial-birth abortion is particularly a target of pro-life advocates because they believe the procedure most clearly illustrates why abortions, and especially late-term abortions, are immoral. Opponents of a ban on the procedure have also argued that the definition of such a ban is so vague that the law would have a chilling effect on physicians performing any abortion or other gynecological procedures such as D&C (dilation and curettage), used for various conditions of the uterus. Some who want the procedure to remain legal in the United States claim that the ban is based on religious views about when life begins. They consider the Bible as the basis for any efforts to restrict abortion in the US, and from there they argue that to rely on a religious text to determine when the life of a child begins is misguided because different cultures and religions have differing views on the subject. However it is undisputed that many laws in the United States are based on religious values, and that many world religions condemn abortion on demand and consider abortion acceptable only in very limited circumstances (Judaism: [http://www.bbc.co.uk/religion/ethics/abortion/relig_judaism1.shtml][http://www.jewsforlife.org/Jewish-leaders.cfm]; Islam: [http://www.bbc.co.uk/religion/ethics/abortion/relig_islam1.shtml]; Hinduism:[http://www.bbc.co.uk/religion/ethics/abortion/relig_hinduism1.shtml]; Buddhism: [http://www.bbc.co.uk/religion/ethics/abortion/relig_buddhism1.shtml]; Sikhism:[http://www.bbc.co.uk/religion/ethics/abortion/relig_sikhism.shtml]; Catholicism:[http://www.bbc.co.uk/religion/ethics/abortion/relig_catholicism1.shtml]; Anglicanism: [http://www.bbc.co.uk/religion/ethics/abortion/relig_anglican1.shtml]). Likewise, some atheists are also opposed to abortion.[http://www.godlessprolifers.org/members.html][http://swissnet.ai.mit.edu/~rauch/nvp/hentoff.html] Not all religions that oppose most abortions support legislative bans. Conservative, Reform, and Reconstructionist branches of Judaism, for example, are formally opposed to government regulation of abortion. They feel the procedure should be available to those women who, in consultation with their clergyperson, choose it http://www.religioustolerance.org/jud_abor.htm.

Surgical procedure

See Intact dilation and extraction for a complete description of the procedure.

Law in the United States

Intact dilation and extraction

Federal Law

On November 5, 2003, President George W. Bush signed the Partial-Birth Abortion Ban Act (HR 760, S 3), which defined partial-birth abortions as: :an abortion in which -- ::(A) the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and ::(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus Opponents of the ban claim that this definition could include even the first-trimester vacuum aspiration of embryos through the vaginal canal. Supporters of the PBA Ban deny this, and point to the "Findings" section, which describes the procedure as "an abortion in which a physician delivers an unborn child's body until only the head remains inside the womb, punctures the back of the child's skull with a sharp instrument, and sucks the child's brains out before completing delivery of the dead infant." The Partial-Birth Abortion Ban Act (PBA Ban) included an exception for the life of the mother, but not for non-life-threatening health issues. The authors believed that they adequately addressed this in the findings section of the legislation because they included a large amount of supporting documentation -- including a statement by the American Medical Association (AMA) -- which the bill's authors and supporters argue demonstrate that there is no medical situation where this procedure is necessary to preserve the physical health of the mother. Supporters of the right to partial-birth abortion dispute these conclusions. During his time in office, President Bill Clinton twice vetoed legislation that would have banned partial-birth abortion stating that it did not include sufficient protections for the health of the mother. Opponents of the current bill say that its failure to include these protections make it incompatible with retiring Justice Sandra Day O'Connor's concurring opinion in the 5-4 Stenberg v. Carhart decision (2000), in which the Supreme Court struck down a Nebraska law banning the procedure. O'Connor stated that any ban would have to include an exception for the health of the mother. Broadly worded health exceptions in abortion legislation, of the form which are allowed by the Supreme Court under the Roe v. Wade standard, have previously been interpreted by many American courts to include psychological health, which opponents of the procedure contend is so vague that it renders any attempt at prohibiting abortions toothless. Federal judges in San Francisco, New York and Lincoln, Nebraska have ruled that the current ban is unconstitutional because, among other things, the Supreme Court's Stenberg decision requires a stricter exemption for the health of the mother. While the San Francisco and New York decisions await appeals, the Nebraska decision has been upheld by the Eighth U.S. Circuit Court of Appeals. The San Francisco decision states that the government is "permanently enjoined from enforcing the [Act] against plaintiffs Planned Parenthood" or any doctors working with Planned Parenthood in any way. This affects at least the 900 Planned Parenthood clinics located nationwide. The New York ruling applies to doctors affiliated with the National Abortion Federation, accounting for more than half of the doctors across the country that perform abortions. The Eighth Circuit ruling states that the law is facially unconstitutional, meaning it is unconstitutional in all circumstances, not just those related to the doctors directly involved in the suit. The law has not been successfully enforced anywhere.

State Law

While some state laws allow late-term abortions in only the most dire of cases under state laws — for example, where the fetus is severely malformed and dying — many of these restrictions are claimed by abortion supporters to be constitutionally invalid. As of February, 2005, 17 states had bans on post-viability abortions that abortion supporters say do not meet Supreme Court requirements: three states allow late-term abortions only when the mother's life is in danger, four other states allow late-term abortions only when the mothers physical (but not mental) health is in jeopardy, and 13 states ban all abortions performed after a certain point in pregnancy. Nineteen (plus the District of Columbia) allow them when necessary to preserve the woman's life, physical health, or mental health. At least three states (Delaware, Minnesota, and Utah) have no current policy regarding post-viability abortions because the laws in those states are blocked by court order. Most or all of the remaining 47 states, plus the District of Columbia, impose some regulation on late-term abortion [http://www.guttmacher.org/statecenter/spibs/spib_RPA.pdf]. In 1995, Ohio enacted a law which referred to the procedure as dilation and extraction. In 1997, the United States Court of Appeals for the Sixth Circuit found the law unconstitutional on the grounds that it placed a substantial and unconstitutional obstacle in the path of women seeking previability abortions in the second trimester. Between 1995-2000, 29 states had passed Partial-Birth Abortion bans, all similar to the proposed federal bans and all lacking an exemption for the health of the mother. Many of these state laws faced legal challenges, with Nebraska's the first to reach decision in Stenberg v. Carhart. The Federal District Court held Nebraska's statute unconstitutional on two counts. One being the bill's language was too broad, potentially rendering a range of abortion procedures illegal, and thus, creating an undue burden on a woman's ability to choose. The other count was the bill failed to provide a necessary exception for the health of the mother. The decision was appealed to and affirmed by both the Eighth Circuit and the Supreme Court on June 2000, thus resolving the legal challenges to similar state bans nationwide. Since the Stenberg v Carhart decision, Virginia, Michigan, and Utah have introduced laws that remain virtually identical to the unconstitional Nebraska law. The Virginia and Michigan laws were similarly struck down due broadness and the failure to provide a health exemption, Utah's law remains pending trial, though is uneforceable due to a court-issued preliminary injunction. In 2000 Ohio introduced another partial-birth abortion ban. The law differed from previous attempts at the ban in that it specifically excluded D&E procedures, while also providing a narrow health exception. This law was upheld on appeal to the Sixth Circuit in 2003 on the grounds that "it permitted the partial birth procedure when necessary to prevent significant health risks." [http://www.legislature.state.oh.us/bills.cfm?ID=126_HB_228 2005 Ohio House Bill No. 228], introduced in the Ohio House of Representatives, would make significant changes to state law regarding abortion. It would prohibit all abortions, but exempt from punishment the unintentional termination of a pregnancy resulting from medical treatment to a pregnant woman to preserve her life.

See also


- Intact dilation and extraction
- Abortion in the United States
- Abortion Law
- Morality and legality of abortion
- Religion and abortion

External links

Legislation, Testimony, and Court Decisions


- [http://www.ama-assn.org/amednews/2004/01/19/gvsa0119.htm Appeals court upholds Ohio "partial-birth abortion" law (AMANews article)] : 19 January 2004.
- [http://pacer.ca6.uscourts.gov/cgi-bin/getopn.pl?OPINION=03a0446p.06 Appeals Court decision in Haskell v. Taft, upholding Ohio PBA Ban] : (decided 17 December 2003) Includes description of the procedure, Decision of the Court, and Dissenting opinion
- [http://news.findlaw.com/usatoday/docs/abortion/2003s3.html Partial Birth Abortion Ban Act of 2003, signed by President Bush in March, 2003]
- [http://onlinedocs.andersonpublishing.com/oh/lpExt.dll/PORC/13316/13a49/13a6f/13a9a?fn=document-frame.htm&f=templates&2.0# Ohio law banning "partial birth feticide"] : enacted 18 August 2000.
- [http://supct.law.cornell.edu/supct/html/99-830.ZS.html Stenberg v. Carhart Decision voiding Nebraska's PBA ban, circa 2000]
- [http://www.jeremiahproject.com/prophecy/clint_banact.html HR 1833, vetoed by President Clinton in 1996]
- [http://www.priestsforlife.org/testimony/brendatestimony.html Congressional Testimony of Brenda Pratt Shafer, RN, March 21, 1996]

Commentary


- [http://www.reason.com/sullum/102403.shtml Ban Wagons] - Reason Magazine article about the politically motivated naming of "partial birth abortion"
- [http://www.politicalaffairs.net/article/articleview/283/1/32 The Myth of Partial Birth Abortion, by Don Sloan, MD]
- [http://www.cwfa.org/articledisplay.asp?id=3399 Partial-Birth Abortion - A Chink In The Pro-Abortion Armor]
- [http://slate.msn.com/id/2090201/ The "Partial-Birth" Myth - No, it's not a birth]
- [http://www.vanderbilt.edu/SFL/Sprang.htm (JAMA. 1998;280:744-747) Rationale for Banning Abortions Late in Pregnancy, by M. LeRoy Sprang, MD & Mark G. Neerhof, DO]

Interest Groups


- [http://www.aclu.org/ReproductiveRights/ReproductiveRightsmain.cfm American Civil Liberties Union on Partial Birth Abortion]
- [http://www.hli.org/ Human Life International]
- [http://www.lifenews.com/ LifeNews.com (Pro-life news site)]
- [http://www.naral.com/ National Abortion Rights Action League (NARAL)]
- [http://www.nrlc.org/abortion/pba/ National Right to Life Partial Birth Abortion Resources]
- [http://www.plannedparenthood.org/ Planned Parenthood]
- [http://www.prayerforlife.com/ Prayer for Life]
- [http://www.priestsforlife.org/ Priests For Life]
- [http://www.prochoiceresource.org/issue/is_late.html The ProChoice Resource Center on Partial Birth Abortion]
- [http://www.prolifeaction.com/ Pro-Life Action]
- [http://www.ProLifeCommittee.org/ Pro-Life Campaign Committee]
- [http://www.rcrc.org/ Religious Coalition for Reproductive Choice]

Other


- [http://www.vanderbilt.edu/SFL/partial-birth_abortion.htm First known description of partial-birth abortion (Martin Haskell's 1992 monograph, which called the procedure "Dilation and Extraction")]
- [http://www.ncrtl.org/LifeLine.htm Fetal development timeline (from National Right to Life)]
- [http://www.religioustolerance.org/abo_pba.htm ReligiousTolerance.org: D&X Procedure (aka Partial Birth Abortion) - All sides]
- [http://www.ppl.org/PJune_PostViability_2001.html A Pediatrician Looks at Babies Late in Pregnancy and Late Term Abortion] Very comprehensive Category:Abortion

Category:Abortion

Category:obstetrics Category:Birth control Category:Core issues in ethics

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