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PubMed1978

Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940 through 1976).

Both non-abortion-related maternal and abortion-related mortality declined prior to the Supreme Court decisions of 1973. In order to determine the effect of legalized abortion on maternal mortality, we have analyzed the secular trends in national abortion mortality ratios for 1940 through 1976, compared the trends to those maternal mortality ratios, and hypothesized reasons for differences between these trends. Between 1940 and 1950 and after 1965, deaths from abortion declined more rapidly than deaths from other causes associated with childbirth. However, between 1951 and 1965, maternal mortality related to pregnancy of childbirth declined more rapidly than abortion-related mortality. Five possible explanations exist for the more rapid decline in abortion deaths since 1965--selected underreporting, changes in coding practices, improved safety of illegal abortion, introduction of more effective contraception, and increased availability of legal abortion. We consider the last two explanations as the most likely reasons for the accelerated decline in abortion-related deaths.

Abortion, Legal↗
PubMed2000

Early medical abortion in India: three studies and their implications for abortion services.

Although legal in India, abortion is frequently performed under unsafe or undesirable conditions. Moreover, the advancements required to make surgical abortion safe in India appear insurmountable in the near future. Because it requires a less extensive infrastructure than surgical abortion, medical abortion offers great potential for improving abortion access and safety now. To examine the feasibility of introducing medical abortion and to assess its potential as an alternative to surgical abortion, we conducted three separate studies on the use of 600 mg mifepristone and 400 micrograms oral misoprostol for medical abortion. Study 1 focused on the safety, efficacy, and feasibility of the standard French, three-visit protocol and was conducted in urban research centers in China, Cuba, and India. Study 2 liberalized the protocol to collect information from women using the method under more "real life" conditions in urban family planning clinics in India. Lastly, study 3 extended the trial to rural Indian villages to examine feasibility in settings typical of where the majority of the population resides. In all three settings in India mifepristone-misoprostol proved to be not only feasible, but safe and acceptable as well. With some changes to current protocols, medical abortion could now be safely phased into the existing health care infrastructure in India. Yet, medical abortion will bring its own set of service delivery challenges to address.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

Medical abortion as an alternative to vacuum aspiration: first experiences with the 'abortion pill' in The Netherlands.

OBJECTIVE: To establish to what extent medical abortion is desired as a supplement to existing care provision in The Netherlands and to establish the (dis)advantages of medical abortion versus surgical vacuum aspiration. METHODS: The research project began in November 1999 and ended in September 2000. In two abortion clinics, the clients were asked to answer some questions about their expectations (before treatment) and their experiences with the treatment (at the post-treatment check-up). At the post-treatment check-up, the clients were also asked to fill out the Hopkin's Symptom Checklist (HSCL) which is an objective measure for the psychological and physical well-being of the clients during the previous week. RESULTS: One hundred and thirty-one clients who chose medical abortion and 131 clients who chose surgical vacuum aspiration participated in the study. The failure rate was 3.3% for medical abortion and 1.5% for surgical vacuum aspiration. Of the medical abortion clients, 80.2% reported they were satisfied with this treatment and 68.1% said they would choose the same treatment procedure in the future. For vacuum aspiration, these figures were 92.9% and 83.2%, respectively. The most reported advantage of medical abortion was the fact that it was a pill, and no surgical procedures were necessary. The most reported disadvantages of medical abortion were the amount of blood loss and insecurity concerning the time of abortion. CONCLUSIONS: Medical abortion seems to be a good supplement to the existing care provision in The Netherlands and should be offered in other clinics.

Abortifacient Agents↗
PubMed1998

Partial-birth abortion: the final frontier of abortion jurisprudence.

Partial-birth abortion bans patterned after the federal bill passed by both houses of Congress are constitutional. The clear legislative definition can be easily distinguished from other abortion procedures. Abortion precedents do not apply to such bans because the abortion right pertains to unborn human beings, not to those partially delivered. Such bans are also rationally-related to legitimate state interests. Even if abortion jurisprudence is deemed to apply in the partial-birth abortion context, a ban is still constitutional under Casey because a ban on partial-birth abortions does not impose an undue burden on the abortion right.

Abortion, Eugenic↗
PubMed1975

The effect of legalized abortion on morbidity resulting from criminal abortion.

In order to examine the effect of legalized abortion on the complications of criminal abortion, a surveillance system was established at a large urban hospital in Atlanta, Georgia. Between 1969 and 1973, legally induced abortions at this hospital increased logarithmically from 8 to 498 per quarter year. The number of women admitting to attempts at illegal abortion decreased significantly, but the decline began only after three years of increasing numbers of legal abortions. A slight decrease in the number of septic "spontaneous" abortions also occurred. Making legal abortion services available can result in a decrease in morbidity associated with illegal abortions, but the availability of legal abortion must be sufficiently broad to obviate having to resort to criminal means.

Abortion, Illegal↗
PubMed1997

Choosing between surgical abortions and medical abortions induced with methotrexate and misoprostol.

Women phoning to request an abortion at a free-standing abortion clinic who were less than 46 days from the last menstrual period were given a choice between a surgical abortion and a medical abortion induced with methotrexate and misoprostol. Twenty-six percent (116 of 405 women) chose a medical abortion. Younger women were more likely to choose a surgical abortion. There were no other significant differences in the two groups in terms of gestational age, race, or prior pregnancies. The reasons most women listed as "very important" when making the decision to have a medical abortion were the timing (being able to have the abortion before 7 weeks), the privacy of aborting at home, and fear of surgery. The women who chose surgery gave the reasons of fear of experimental medications, the lack of emotional support at home, and wanting to avoid the extra visits and blood tests.

Abortifacient Agents↗
PubMed1996

[Early diagnosis of congenital and acquired intrauterine causes of abortion by post-abortion hysteroscopy].

A prospective study was conducted on the incidence of intrauterine pathology after abortions diagnosed by post-abortion hysteroscopy. In 80 patients outpatient hysteroscopy was performed 8-12 weeks after a dilatation and curettage for incomplete or missed abortions. Intrauterine pathological changes were found in 40 patients. There were 10 cases of uterus subseptus/ bicornis and 7 of uterus arcuatus, 2 submucous myoma and 1 corpus polyp. Intrauterine adhesions were diagnosed in 20 patients. The incidence of intrauterine adhesions was about the same after incomplete abortions and after missed abortions, but in patients with recurrent abortions the incidence was significantly higher than in patients after the first abortion (27.8% versus 14.9%). Post-abortion hysteroscopy is a simple and useful method for early diagnosis of congenital and acquired intrauterine pathology after abortions.

Abortion, Habitual↗
PubMed1975

[I. Induced abortions and spontaneous abortions. Psychopathological aspects apropos of a preliminary sample of 411 requests for pregnancy interruption].

Since 1975 (17th January), abortion is free and legal in France. The authors analyse 411 first cases of women requiring for an abortion (seen over a period of 11 weeks). Most of them are young women, single, many begin their sexual life. Unwanted pregnancy indicates absence of contraception by ignorance, refusal or ambivalence (never used = 184 cases). 105 women used archaic and inefficient contraceptive means. Modern contraceptive means was used by 154 women but ill applied, ill tolerated and/or discarded (pill = 103 cases, I.U.D. = 14, diaphragme = 2, condoms = 35). Unwanted pregnancy and abortion signify failure of contraception. We compare psychologic and psychopathologic features of women requiring repeated induced abortion with those of women suffering of repeated spontaneous abortion and infertility. These women have frequently (same) problems of feminine identity, bad maternal imago, absence of father, unhappy, and conflictive childhood, immature sexuality and personnality. Contradiction between conscious and unconscious wishes create the two opposite situations and intrapsychic conflicts (spontaneous abortion = conscious willing of pregnancy + unconscious rejection of unbearable pregnancy; induced abortion = strong but unconscious wish of pregancy + conscious and volontary rejection of maternity). Psychotherapy should improve sexual and affective life and in both cases. The authors compare infanticide and abortion behaviors, contraceptive means, and psychological problems of doctors who are asked abortion.

Abortion Applicants↗
PubMed1986

Kernel abortion in maize : I. Carbohydrate concentration patterns and Acid invertase activity of maize kernels induced to abort in vitro.

Kernels cultured in vitro were induced to abort by high temperature (35 degrees C) and by culturing six kernels/cob piece. Aborting kernels failed to enter a linear phase of dry mass accumulation and had a final mass that was less than 6% of nonaborting field-grown kernels. Kernels induced to abort by high temperature failed to synthesize starch in the endosperm and had elevated sucrose concentrations and low fructose and glucose concentrations in the pedicel during early growth compared to nonaborting kernels. Kernels induced to abort by high temperature also had much lower pedicel soluble acid invertase activities than did nonaborting kernels. These results suggest that high temperature during the lag phase of kernel growth may impair the process of sucrose unloading in the pedicel by indirectly inhibiting soluble acid invertase activity and prevent starch synthesis in the endosperm. Kernels induced to abort by culturing six kernels/cob piece had reduced pedicel fructose, glucose, and sucrose concentrations compared to kernels from field-grown ears. These aborting kernels also had a lower pedicel soluble acid invertase activity compared to nonaborting kernels from the same cob piece and from field-grown ears. The low invertase activity in pedicel tissue of the aborting kernels was probably caused by a lack of substrate (sucrose) for the invertase to cleave due to the intense competition for available assimilates. In contrast to kernels cultured at 35 degrees C, aborting kernels from cob pieces containing all six kernels accumulated starch in a linear fashion. These results indicate that kernels cultured six/cob piece abort because of an inadequate supply of sugar and are similar to apical kernels from field-grown ears that often abort prior to the onset of linear growth.

Journal Article↗
PubMed1992

The abortion pill: a solution for unsafe abortions in developing countries?

The abortion pill is a new abortion technique which does not require technically skilled health personnel. Several clinical researchers have stated that the ease of administration of the abortion pill gives it the potential to save lives in countries where thousands of women die annually from complications of failed abortions due to poor health services. This article discusses medical and users' aspects of the abortion pill, with particular emphasis on its use in developing countries, and questions the usefulness of the abortion pill in areas where health care facilities are in short supply. It stresses the need to consider the social, cultural and health care context in which the abortion pill will be used before it is sold on the world market. The safety and efficacy of the abortion pill could be adversely affected by the way women perceive its effectiveness, women's beliefs about conception and pregnancy, and their health status. In the present two-phase administration form the abortion pill is not likely to be appropriate for use in developing countries with a shortage of health care facilities.

Abortion, Illegal↗
PubMed1997

Safety, efficacy, and acceptability of medical abortion in China, Cuba, and India: a comparative trial of mifepristone-misoprostol versus surgical abortion.

OBJECTIVE: We investigated safety, efficacy, and acceptability of an oral regimen of medical abortion compared with surgical abortion in three developing countries. STUDY DESIGN: Women (n = 1373) with amenorrhea < or = 56 days chose either surgical abortion (as provided routinely) or 600 mg of mifepristone followed after 48 hours by 400 micrograms of misoprostol. This is the appropriate design for studying safety, efficacy, and acceptability among women selecting medical abortion over available surgical services. RESULTS: The medical regimen had more side effects, particularly bleeding, than did surgical abortion but very few serious side effects. Failure rates for medical abortion, although low, exceeded those for surgical abortion: 8.6% versus 0.4% (China), 16.0% versus 4.0% (Cuba), and 5.2% versus 0% (India). Nearly half of failures among medical clients were not true drug failures, however, but surgical interventions not medically necessary (acceptability failures or misdiagnoses). Women were satisfied with either method, but more preferred medical abortion. CONCLUSION: Medical abortion can be safe, efficacious, and acceptable in developing countries.

Abortifacient Agents↗
PubMed2000

Early surgical abortion: an alternative to and backup for medical abortion.

Surgical abortion by vacuum aspiration is one of the most commonly reported surgical procedures in the United States. The developments of highly sensitive urinary pregnancy tests and transvaginal ultrasonography have encouraged the application of surgical abortion methods at earlier gestational ages. Manual vacuum aspiration with a handheld syringe safely accomplishes early abortion in a variety of settings, from elective abortion in the office or clinic setting to emergency care of a patient with an incomplete abortion. As a wider range of clinicians expresses interest in offering medical abortion, the appropriate use and technique of surgical backup are crucial in safely providing medical abortion. This article reviews vacuum aspiration during the first few weeks of pregnancy, with special attention to manual vacuum aspiration, both for elective surgical abortion and when intervention is required after medical abortion.

Abortifacient Agents↗
PubMed2004

[Study on the influence of medical abortion and surgical abortion on subsequent pregnancy].

OBJECTIVE: To evaluate and compare medical abortion versus surgical abortion in respect of their influence on the safety of the mother and baby in the subsequent pregnancy and parturition. METHODS: Based on the principle of informed consent of subjects, 150 healthy pregnant women with a past history of having experienced medical abortion once were included in the study group (also called medical abortion group), and in the same period, 150 healthy pregnant women with a past history of having experienced surgical abortion once were enrolled into the comparison group (also called surgical abortion group). From then on, all the pregnant women in the two groups were followed up till a week after labor. The baseline data of the two groups were comparable (P>0.05). The rates of complications observed in these women during pregnancy and labor were evaluated. RESULTS: The incidence rates of miscarriage, placental abnormality, premature delivery and postpartum hemorrhage in the study group were significantly lower than those in the comparison group (P<0.05). No significant differences on other variables were observed between the two groups. CONCLUSION: Medical abortion is probably safer than surgical abortion in respect of their influence on subsequent pregnancy. So, provided there is less contraindication, medical abortion may be the choice for terminating unwanted pregnancy, especially for those women without a child.

Abortifacient Agents↗
PubMed1993

Comparison of ovine abortion and non-abortion isolates of Chlamydia psittaci using inclusion morphology, polyacrylamide gel electrophoresis, restriction endonuclease analysis and reactivity with monoclonal antibodies.

Twelve reference and four Northern Ireland ovine Chlamydia psittaci isolates including ovine abortion, faecal, conjunctivitis and arthritis isolates were compared. Inclusion morphology was shown to provide a useful means of differentiating the abortion and the non-abortion isolates studied. Identical SDS-PAGE polypeptide profiles were produced by the ovine abortion isolates. The polypeptide profiles of the non-abortion isolates were similar to one another and clearly distinct from the abortion isolate profiles. The restriction endonuclease profiles of the abortion isolates were remarkably similar whereas different profiles were produced by most of the non-abortion isolates. Monoclonal antibodies were prepared and characterized. A number of these reacted with all the isolates of chlamydia tested. Three mAbs reacted exclusively with the ovine abortion isolates while four mAbs reacted exclusively with a number of the faecal isolates.

Abortion, Veterinary↗
PubMed2005

Antichoice attitudes to abortion in women presenting for medical abortions.

OBJECTIVE: To examine attitudes of women presenting for elective abortions. METHOD: Women presenting for elective abortion induced with medication at an urban free-standing abortion clinic were given semistructured interviews about their attitudes to abortion. RESULTS: Of the 60 women interviewed, 26 voiced antichoice attitudes. These interviews were transcribed and analyzed for themes. The women with antichoice attitudes were similar to the women with prochoice attitudes in age, education, and religion but were less likely to be white (61.8% of prochoice women identified themselves as white, compared with 30.8% of antichoice women, P = 0.02). The antichoice women felt most strongly that other women should not be allowed to have an abortion if they gave as their reason, "want no more children," "not married," or "cannot afford." The most common themes were that one needed "enough" reasons to have an abortion and that women should take better precautions to prevent conception. CONCLUSION: It is important for abortion clinic staff to realize that many women coming to an abortion clinic have antichoice views. These views may affect a woman's ability to recover emotionally after the procedure and will therefore have implications for the kind of supportive care women need both before and after the abortion.

Abortion, Induced↗
PubMed2001

NK cell activity and subsets in women with a history of spontaneous abortion. Cause, number of abortions, and subsequent pregnancy outcome.

OBJECTIVE: The aim of this study was to assess the role of NK cells in nonpregnant women with a history of spontaneous abortion. STUDY DESIGN: 113 nonpregnant women with a history of spontaneous abortion were assessed for peripheral NK cell activity and percentage of NK cell subsets, in relation to the cause of abortions, the number of spontaneous abortions, and subsequent pregnancy outcome (n = 56). RESULTS: Neither NK cell activity nor subsets showed a significant difference in relation to the cause or number of spontaneous abortions. NK cell activity in nonpregnant women who later experienced subsequent abortion with normal chromosomes (n = 10) (mean +/- SD: 42.8 +/- 15.8%) was relatively higher than that in women with subsequent live birth (control, n = 39) (32.1 +/- 13.7%) (p = 0.099). NK cell activity in women who later experienced subsequent abortion with abnormal chromosomes (n = 7) (28.7 +/- 21.4%) was the same as the level in the control. CONCLUSION: Peripheral NK cell activity or subsets during nonpregnant status were not related to the cause or number of previous spontaneous abortions. A relation between preconceptional NK cell activity and later experiencing abortion with normal chromosomes should be further studied.

Abortion, Habitual↗
PubMed1994

Abortion ethics--women's post abortion assessments.

BACKGROUND: Induced abortion is often discussed in terms of ethics. The aim of the present report is to describe the abortion ethics as it was expressed by women undergoing a legal abortion. OBJECTIVE: Moral considerations expressed during semistructured interviews by 128 women two weeks after a first trimester abortion in Stockholm 1987-90 are reported. RESULT: The women had faced a choice between abortion and parenthood. At the time of the abortion many of them were living under conditions that meant they were unable to offer a child the security they regarded as a child's right. The conflict the women spontaneously described as their main moral dilemma was not a conflict between the woman and the fetus, but a conflict between several close relationships, also concerning the prospective father. The ethics that the women applied to the problems of abortion was founded on a long-term responsibility to care for persons in their relationships. CONCLUSION: The women interviewed had three levels of moral reasoning simultaneously present. 1. A theoretical level--most of all concerning other women--a liberal view of rights: abortion should be a freely obtainable option. 2. A theoretical level--above all, concerning themselves--a restrictive deontological view: the extinction of life is morally wrong and should be avoided. 3. A practical level--when the problem was a reality: a consequentialist ethics of care. According to this ethics of care it was important that the abortion could be performed as early as possible during pregnancy.

Abortion, Legal↗
PubMed2000

Medical abortion and the potential for new abortion providers: a cautionary tale.

The prochoice movement has expressed much hope that medical abortion will increase the pool of abortion providers because it does not require surgical training and does not need to be performed in specialized settings. By offering a detailed case study of the events surrounding a methotrexate abortion in a rural community health center by a family practice physician who had not previously performed surgical abortion, this article suggests that the diffusion of medical abortion to new providers and new settings may be more complex than some have suggested. The article illustrates that abortion is not only a medical procedure, but also a social process involving relations with large, often unfriendly bureaucracies as well as with the local community in which the abortion takes place. While still retaining optimism that medical abortion will ultimately increase the number of providers and hence increase access to abortion, the author believes that such a change will be considerably more gradual than commonly thought.

Abortifacient Agents, Nonsteroidal↗