Several different abortion procedures are used at different stages of pregnancy. In the United States, 62% of legal abortions occur within the first 8 weeks of pregnancy, and 92% of abortions are done in the first 12 weeks (Mugge, 2011). Early abortion is very safe. The risk of dying from a surgical abortion is 0.1 per 100,000 women, while the risk of pregnancy fatality is 11.8 per 100,000 (Zielinski, 2006). The most common procedures are medical abortion, suction curettage, D and E, and prostaglandin induction.

Medical abortion uses pills instead of surgery to end a pregnancy (Templeton & Grimes, 2011). A woman can have a medical abortion within days of a missed period and up to 9 weeks into a pregnancy. The medication mifepristone, commonly known as RU 486, became available in 2000 to women in the United States. Medical abortion has been available in European countries since 1980—20 years earlier than in the United States. Decades of anti-abortion political action against the U. S. manufacture and dis­tribution of medications for abortion caused the delay (Jones & Henshaw, 2002). Medi­cal abortions account for about 13% of all elective abortions in the United States (Ginty, 2008b). Women with 12 years or more of education are more likely than women with less than a high school education to have medical abortions (Yunzal-Butler et al., 2011).

A medical abortion is 99% effective in ending pregnancies of less than 7 weeks and 91% effective in the 8th week of pregnancy (Speroff & Fritz, 2005). It is safer than the abortion procedures done later in pregnancy and safer than childbirth itself. In addition, a woman who opts for a medical abortion can see her family doctor at an office instead of going to another facility (Quindlen, 2009b).

Medical abortion works by blocking the hormone progesterone, which causes the cervix to soften, the lining of the uterus to break down, and bleeding to begin. A few days later the woman takes a second medicine that makes the uterus contract and expel the grape-size embryonic sac. I Figure 11.1 shows how a medical abortion works. Side effects can include cramping, headaches, nausea, or vomiting, but many women experi­ence no physical side effects (Hausknecht, 2003).

Suction curettage is a surgical technique used 7 to 13 weeks past the last menstrual period. A suction curettage is performed by physicians at clinics or hospitals and takes about 10 minutes. During the procedure local anesthetic is used and a small plastic tube is inserted through the cervical os into the uterus. The tube is attached to a vacuum aspirator, which draws the placenta, built-up uterine lining, and fetal tissue out of the uterus. Rare complications include uterine infection or perforation, hemorrhage, or incomplete removal of the uterine contents. Research data indicate that a first-trimester abortion does not have a significant effect on subsequent fertility, pregnancy or health of the newborn (Guttmacher Institute, 2011a).

If a pregnancy progresses past approximately 12 weeks, the suction curettage proce­dure is no longer as safe, because the uterine walls have become thinner, making perfora­tion and bleeding more likely. For pregnancy termination between 13 and 21 weeks, a D and E, or dilation and evacuation, is the safest and most widely used technique. A combination of suction equipment, special forceps, and a curette (a metal instrument

How pregnancy occurs

Egg* is released from ovary and produces hormone progesterone

Medical abortion

Used to end pregnancy within seven weeks of a woman’s last menstrual cycle. Involves a com­bination of two drugs and three visits to the doctor. Here’s how it works:

О The dose: When tablets go into the system, they block receptors of progesterone, a hormone needed to maintain pregnancy.

О Abortion: Two days later, two tablets of a hormonelike substance cause the uterus to contract and expel any remaining fetal tissue.

I Figure 11.1 How medical abortions work.

used to scrape the walls of the uterus) is used. General anesthesia is usually required, and the procedure is riskier. About 8.9 women out of 100,000 will die from an abor­tion after 20 weeks of pregnancy—still less than the rate of 11.8 out of 100,000 who die from a full-term pregnancy (Zielinski, 2006). Women who are more likely to have abortions at 13 weeks or later have some characteristics in common. They have less education and are more likely to be African American than are women who have first – trimester abortions. They have also experienced three or more disruptive life events in the past year, such as being a victim of a crime, becoming unemployed, having a medical problem, or experiencing the death of a friend or family member (Jones & Finer, 2011). Teens are more likely than older women to delay having an abortion until after 15 weeks of pregnancy (Guttmacher Institute, 2011a).

Second-trimester pregnancies can also be terminated by using compounds such as prostaglandins, hormones that cause uterine contractions. The prostaglandin is intro­duced into the vagina as a suppository or into the amniotic sac by inserting a needle through the abdominal wall; the fetus and placenta are usually expelled from the vagina within 24 hours. Complications from procedures that induce labor contractions include nausea, vomiting, and diarrhea; tearing of the cervix; excessive bleeding; and the pos­sibility of shock and death.

Late-term abortion, or intact dilation and evacuation, is done after 20 weeks and before viability at 24 weeks’ gestation. It is reserved for situations when serious health risks to the woman, or severe fetal abnormalities, exist. In this procedure the cervix is dilated, the fetus emerges feet first out of the uterus, and the fetal skull is collapsed to

Conceiving Children: process and Choice

permit passage of the head through the cervix and vagina. Although late-term abortions after 21 weeks of pregnancy are rare, comprising 1.3% of all abortions in the United States, they continue to be the focus of intense political controversy (Mugge, 2011). Opponents of abortion rights call this procedure "partial-birth abortion," and the media have adopted this term instead of dilation and evacuation despite its imprecise meaning and absence from medical texts (Pollitt, 2006). In 2003 Congress approved a ban on late-term abortion, and President George W Bush signed the bill. In 2007 the Supreme Court upheld the legislation, creating the first-ever federal ban on a medical procedure (Guttmacher Institute, 2009b).