Myth: Having an abortion means that it will be hard to get pregnant when you want to.

Fact: When legal abortions were difficult to get, complications of botched illegal abortions did affect many women’s fertility. Since abortion became legal in the United States, no scientific studies have upheld the notion that abortion leads to infertility.

As we have seen, no contraceptive is perfectly reliable even if used correctly every single time, though in theory some are more than 99 percent safe. In real life, contraception can fail because you don’t use it, or you don’t use it correctly, or the method lets you down. Unintended pregnancies, whether they come about through carelessness or method failure, can be devastating because they will alter the course of your future. Pregnancies that come about through sexual assault or incest can be unbearably painful.

Before 1973, when Roe v. Wade made abortion legal in the United States, there were three choices for women who became pregnant and did not want or could not take care of the child: going through with the pregnancy and giving up the baby for adoption, having an illegal abortion, or going somewhere where abortion was legal.

Today the option of legal abortion does exist, and should exist for women as an adjunct to birth control. No physician likes to perform abortions: it is far better to prevent a pregnancy than to end one. Ideally, abortion should be limited to cases where contraception fails, where prenatal testing discovers some serious fetal abnormality, or where the pregnancy resulted from rape or incest. The issue of abortion can touch a woman’s deepest feelings about herself, her relation to her partner, and the values that shape her life.

Once an unwanted pregnancy begins, women have several choices, but all have consequences. Pregnancy is not something that can be undone by wishful thinking or denial.

One evening I answered a page from a patient I’ll call Doris. She had discovered she was pregnant and desperately wanted not to be. I pointed out that she had two choices, to go through with the pregnancy or to have an abortion. “No,” said Doris, “no baby, and no abortion either.” Again I stated what seemed obvious, that in that case she had only three options: have the child and keep it, have the child and give it up for adoption, or have an abortion. Doris rejected all three.

My husband, who had overheard my end of the conversation, said, “Ah, what that woman wants is an ‘unscrewing pill.'” He meant a marvelous medication to undo what Doris and her partner had done, essentially a pill that would take her back in time to before conception had occurred.

Since such a magic pill does not exist, I believe that women (and men, too) should think about their risks before they become sexually active. I strongly encourage my teenage patients in particular to realize that from the moment they have intercourse, they expose themselves to the possibilities of sexually transmitted diseases and unwanted pregnancy. Since no contraceptive short of a hysterectomy is 100 percent effective, the safest sex is abstinence from intercourse. Even having your fallopian tubes tied has a known rate of failure.

Give some serious thought to what you would do if the unforeseen happened: Would you keep the baby? Would you give up your child for adoption? Would you have an abortion? If none of these is a viable choice for you, then you should not have intercourse.

When I was a medical student, in the days before Roe v. Wade, many young women who became pregnant went through with their pregnancies and offered their babies for adoption. This does not happen often anymore, maybe once or twice among the five hundred babies my medical group delivers each year. The woman chooses abortion or she raises the child, possibly with the help of her family.

When can an abortion be performed?

Ideally, abortions should be performed during the first trimester of pregnancy — the first three months, or thirteen weeks. Most gynecologists will not recommend doing them until four to five weeks after conception, two to three weeks after you have missed your period. A few abortions are done during the second trimester, the second three months.

These guidelines have been established because of fetal viability, the age at which the fetus can survive on its own outside the mother’s body. No one can pinpoint when that moment arrives, but it is quite certain that the fetus cannot live independently before twenty-two weeks of gestation. It is very rare to save a baby born prematurely at twenty-four weeks gestational age, but it is not uncommon to save one at twenty-six weeks. So the lower limits of viability are somewhere between twenty-two and twenty-six weeks of gestation.

Unusual circumstances may cause variations of these guidelines. If, for example, ultrasound reveals that the fetus has a severe deformity that would prevent its ever living outside the mother’s body, then viability takes on a different meaning even though the fetus may be older than twenty-six weeks. I do not consider the termination of this kind of pregnancy an abortion at all, since the fetus could not survive independently.

Abortion

An abortion is the termination of a pregnancy before the fetus can live independently of the mother. Abortion can occur spontaneously, without intervention, in which case it may be called miscarriage, though physicians often use the term “abortion” to describe this event. People outside the medical profession use the word to describe the deliberate, intentional ending of a pregnancy.

Abortion Versus Adoption

When someone, particularly a teenager, comes to me with an unwanted pregnancy, we first discuss the possibility of adoption. If she chooses this route, I assure her that in this day and age she can find parents who are quite desperate to have a child and will give her baby the love and care that all children need and deserve. She may grieve that she has given up her child, and she may continue to think about that child for the rest of her life, but she will know that the child is provided for.

A second choice is to raise the child herself, with or without the help of her parents. I have seen 15-year-old girls responsible for infants; more frequently, I see mothers helping their daughters by taking on these responsibilities. Neither scenario is easy. Teenagers with a baby to care for find themselves with all the burdens of adulthood. They love their babies, but see their friends going to college, getting the education necessary to better their lives, or simply having a good time. Many of these young mothers say they love their children — but I can see that they resent them also, because they refer to them as “rugrats” or “little brats.” Children are sensitive and smart; they pick up on parental resentment.

Box: A Few Facts About Abortion

  • Since the landmark Supreme Court decision Roe v. Wade struck down restrictive laws in 1973, abortion has been legal in the United States.
  • According to the Centers for Disease Control, about 2.7 million unintended pregnancies occur in the United States each year. Family planning experts estimate that about half of these end in abortion.
  • There is no evidence that making abortion illegal would reduce the number of abortions performed; it would only make them more dangerous.
  • Almost half of American women have had an abortion by the time they reach the age of 45.
  • About two thirds of women who have one abortion never have another.

Some of my older patients, women in their 40s, 50s, and even 60s, help their daughters by raising the grandchildren, in part because they want to save their daughters from being trapped in a downward economic spiral. While the grandmothers do love their grandchildren, they express sorrow at losing the freedom they thought would be theirs when their own child rearing was done.

Liz, now 50, works as a nurse in the labor and delivery unit at the hospital. Her daughter, who never married, has three children between the ages of 10 and 13. After giving birth to these three, the daughter simply left town, unhappy with the responsibilities of mothering. Liz and her husband felt they had no choice but to take on the children and care for them.

One of the boys, now 12, has attention deficit disorder and is a difficult child. Liz must work hard to support her grandchildren. While she is facing the stresses of menopause, she is also trying to cope with three children on the brink of adolescence. She is discouraged but determined to succeed.

I do not believe that most women in the United States use abortion as a substitute for birth control. Rather, they choose it because something has gone wrong with contraception. This is not the case in, for example, Eastern Europe, where women formerly had an average of five abortions during their reproductive lives.

The reasons women seek to end unwanted pregnancies can be medical, financial, personal, or a combination of these factors. Among the medical reasons are genetic abnormalities or serious malformations of the fetus, which have been uncovered by prenatal testing. Fetal abnormality is one of the major motives for second-trimester abortions, and as testing becomes increasingly prevalent and sophisticated, more abortions will probably be performed for medical reasons.

Women who are the victims of incest or rape frequently seek abortion. Some women, especially the younger ones, seek abortions because they are unmarried, because they have no financial means of caring for a child, because they are still pursuing their education or furthering their careers, or because they know they are not mature enough to care for a child. Older women seek abortions because they have completed their families, or feel they are physically too old to care for a child (or another child). Still others seek abortions because they recognize that they are emotionally unable to care for a child, perhaps because of depression or instability.

Do abortions scar women emotionally?

Studies on the psychological aftermath of abortion have had conflicting results. Because abortion is so politicized in this country, people with strong opinions tend to interpret study results in ways that support their own points of view. Conservative groups, who believe that abortion should be legally banned, generally discover that the long-term emotional impact on women is harmful. Groups who uphold women’s legal right to terminate a pregnancy emphasize data suggesting that most women feel significant relief at not having to bear and raise an unwanted child, and that the emotional effects are less significant. We must also realize that the issue of abortion comes with considerable baggage in a society that is ambivalent about sex. Although it is legal, abortion still carries a stigma; so even if women feel relief at not having to go through with an unwanted pregnancy, some still feel the burden of stigmatization.

Although some women have multiple abortions, most women do not terminate a pregnancy lightly. For many the decision is painful even though the child is not wanted. However, most women do deal successfully with the emotional consequences: they feel overwhelming relief, even as they acknowledge a sense of loss.

In my practice I have met women who later in life regretted an abortion, especially if infertility problems arose. I have also met women who suffered long-term psychological consequences because they did not have an abortion and raised an unwanted child. And I have met women who endured a profound lack of self-esteem because they knew their own mothers did not want them.

Are abortions likely to cause later physical problems?

Now that abortion is legal and is performed by trained practitioners in sterile settings, usually during the first trimester, abortion is unlikely to result in complications that will reduce fertility later on. There is no evidence that having a first-trimester abortion increases risk for future ectopic pregnancies. One study raised the possibility that having an abortion increases risk for breast cancer, but subsequent work has shown no connection.

Do abortions often have complications?

While abortions are not high risk, any surgical procedure has its dangers. Even when performed by a board-certified gynecologist or obstetrician who has had special training beyond the usual medical school work, surgical abortions can occasionally have complications. Because the walls of the uterus are softer during a pregnancy, there is a greater chance of perforating the uterus during the procedure than there is during a D&C, which is essentially similar. Uterine perforation happens in about 1 or 2 of every 1,000 abortions (a rate of 0.1-0.2 percent).

The other risks of this and any surgery are infection and bleeding. The earlier the abortion is performed, the less the chance of complications. Abortions performed in the second trimester are riskier than those done in the first.

Do women die of abortions?

The death rate in the United States is 2-3 of every 100,000 legal abortions, much lower than the death rate from childbirth, which is in the range of 15 per 100,000 deliveries. Again, later abortions are riskier than those done in the first trimester.

First-Trimester Abortions

Second-Trimester Abortions

 

Selections from the book: “The Yale Guide to Women`s Reproductive Health: From Menarche to Menopause”, 2003.

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