Method

RUNNING HEAD: HOW ABORTION AFFECTS WOMEN’S HEALTH

HOW ABORTION AFFECTS WOMEN’S HEALTH 5

Title of Paper: How abortion affects women’s health

Student Name: Leonel Lubin

University

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Module/Week x, Assignment x

Instructor Name

Date

How abortion affects women’s health

Abstract

Background on the problem:

Abortion is a practice that is carried out around the globe and statistics state that every year, there are more than fifty million abortions that are done in different parts of the world. Out of this number, 45% are being done unsafely (Erdman, 2011). Unsafe abortions are influenced by several issues such as cultural and religious beliefs as well as abortion laws which differ in states around the world. Unsafe abortions are in many cases done in unclean facilities, using unauthorized equipment and by unskilled people.

Purpose / Objective:

About 47,000 deaths and 5 million hospital admissions occur every year as a result of unsafe abortion. These unfortunate cases happen despite having modern methods of abortion that involve the use of medication or surgery. The objective of this study is to analyze how abortion affects the lives of women in many parts of the world.

Method:

Through the use of meta-analysis as the study method, this study analyzes several past studies on abortion.

Results:

Further, the study recommends legal abortions that are safe be made available to every relevant user as a way of reducing the dire consequences be it instant, short term or long term on women that result from most abortion procedures.

Conclusion:

Diversity in abortion is vital and beneficial to a woman who is thinking about abortion because through a thorough analysis of the consequences of abortion, a person can make more sound decisions that they will not regret later.

Recommendation:

This study recommends that future studies should center their work on highlighting the ways that can make abortion safe for the health of women. It is clear from this study that abortion is a practice that is done in almost every part of the world. It is, however, not healthy for studies to concentrate on revealing the negative side of abortion but not expressing on how to facilitate a safer abortion. This study, therefore, recommend more studies be done on ways to promote safe abortion practices and how to sensitize people about safe abortions.

Keywords: Abortion, Unsafe abortions, meta-analysis, legal abortions, unskilled individuals.

Introduction

Abortion is the expulsion of a fetus or embryo before it is fully developed to survive outside the uterus. It can occur in two different ways, which are, loss of the fetus naturally as a spontaneous abortion (miscarriage) or deliberately as an induced abortion (therapeutic abortion) (Culwell & Hurwitz, 2013). The latter is a surgical or medicinal procedure that terminated a pregnancy. Abortion as a topic is extremely diverse and most controversial and not everyone agrees that it is morally right. However, regardless of abortion being a touchy topic, we have to accept that its reality is not going away anytime soon and if anything, it is only going to get broad as years and age advances. Therefore, recognizing all the aspects of abortion, even without necessarily agreeing with them can make it easy to educate the world on abortion.

Abortion, whether safely or unsafely performed can endanger a woman’s physical, reproductive and even mental health (Erdman, 2011). Besides, it can lead to serious life-threatening complications. On the brighter side, safely done procedures reduce the risk of complicated effects on women after the performance of an abortion. Women are advised to have their pregnancies terminated in hospitals or licensed clinics. However, in most African countries, abortion is still unauthorized and unsafe (Stillman, Frost, Singh, Moore, & Kalyanwala, 2014). Women, including adolescents having unwanted pregnancies, turn to unsafe abortion when they cannot access safe abortion as most times it is illegal.

 Historically abortion practices mainly included unsafe means such as attempts using herbal medicines, using sharp tools and even forceful massages. Some cultures took the procedure to extreme levels by attempting to induce abortion through physical means such as battery, high-intensity exercise as well as tightening the girdle (Culwell & Hurwitz, 2013). A few of these ancient methods of abortion and more are still used in the modern world especially in developing nations. The extremes measures taken back then and now are an obvious cause of severe risks and complications of abortion with death being the main and almost immediate consequence (McGinn & Casey, 2016).

Most abortions are done during the first 12weeks of pregnancy (first trimester). In some states where abortion is legal, abortion is allowed until the 24th week (end of the second trimester), but others prohibit it after week 20 (Culwell & Hurwitz, 2013). Third-trimester abortions are not encouraged unless in a necessary situation such as when the mother’s or the baby’s life is in danger. McGinn and Casey, (2016) further reveals that procedures after the first trimester are referred to as late-term abortion since at this duration the fetus has the potential to survive outside the womb. 

Research questions

This study was undertaken to answer the following four questions. 

· Who are the people most affected by abortion in society? 

·  How does abortion affect the health of women in different parts of the world?

· What are the benefits of safe abortion as compared to unsafe abortions?  

· What are the ways to ensure a safer abortion for a woman who intends to undertake it?

Hypothesis

Unsafe abortion hugely impacts the health of women in many parts of the world. 

Safe abortion practices that are done in hospitals with qualified doctors can benefit women who go through it.

Thesis statement

Abortion negatively impacts the lives of women through contracting infections, heavy loss of blood and death. Unsafe abortions, which are the main cause of the negative impacts should be discouraged and safe abortion that is done by the specialized medical doctor be encouraged for the safety of women. 

Literature Review

           Surgical abortion. This is one of the two main methods of abortion. In this mode, there is a mode of pain management in which a woman is advised at the clinic on the types of anesthetic offered (Awoyemi & Novignon, 2018). They include general anesthetic where one is completely unconscious. This model comes with the danger of chocking if fasting is not properly undertaken beforehand. Nitrous oxide gas (similar gas) that puts one in a state of ‘twilight sleep’ in that you relaxed but sedated and awake. Local anesthetic in which the cervix area is injected with anesthetic to numb it so that you don’t feel anything during the procedure and local anesthetic with intravenous sedation where sedative medication is put into your vein using an intravenous line and local anesthetic injected directly into the cervix (Erdman, 2011). The procedure is then done using ‘suction (vacuum) aspiration and is only done on women in their first trimester (Berer, 2017). It involves the widening of the cervix opening using rods of increasing size followed by a slim tube inserted into the uterus. The fetus and placenta are then withdrawn with gentle suction. A curette is finally used to check if the uterus is empty. The procedure can take less than 15 minutes.

           Dilation and Evacuation (D&E) is the surgical procedure done for pregnancies after week 12. Forceps, In this case, a pair of forceps is used (Erdman, 2011). The cervix is dilated for several hours or up to a day then conscious sedation or general anesthetic is introduced before the procedure (Berer, 2017). In both cases, there are immediate side effects which include stomach cramps and vaginal bleeding of about 1 to 2 weeks. However, light bleeding can be experienced up to a month after the procedure.

           It is correct to say that on most occasions the effects of abortion on the health of a woman are dire. Infection in the womb is one of the major health complications that may occur 24hours after an abortion procedure. In the case that the infection isn’t treated promptly, it could spread to the fallopian tubes and ovaries a condition known as a pelvic inflammatory disease (PID), which can increase the risk of infertility or ectopic pregnancy (the egg implants itself outside the womb). Several abortions done on a woman has an increased risk of giving birth prematurely, especially in future pregnancies ("Reproduction: Abortion," 2017).

           Asherman’s syndrome is a condition in which a scar tissue grows in the uterus as a result of a surgical abortion. This condition can lead to abnormal, absent or painful menstrual cycles, future miscarriages and also infertility. Cases of puncture of the wall of the uterus have been reported (Awoyemi & Novignon, 2018). This happens when a medical instrument cuts through the walls of the uterus during suction abortion procedures and in the worst-case scenario, surgical removal of the uterus (hysterectomy) has to be done as repair. Severe hemorrhaging is unlike some bleeding which is typical after an abortion and can lead to a quick death. Other possible side effects on a woman after an abortion include cervical laceration (cut or torn cervix) which leads to incompetent cervix in a subsequent pregnancy, placenta problems like retained placenta, low birth weight in the future pregnancies and even injury to the bowel or the bladder. Complications from anesthesia like nausea, vomiting, headaches and respiratory problems may occur (Berer, 2017). Studies also confirm that breast cancer is a possible effect in the future after an abortion.

           Pro-choice researches concluded that a lot of women have difficulty coping in life after abortion. This is mainly as a result of the effects that abortion is said to have on a woman’s mental/psychological health (Berer, 2017). For instance, severe psychological trauma can and does happen. Feelings of guilt may lead to uncertainty on their initial decision to terminate the pregnancy may lead to depression or more serious grief responses. In some cases, post-traumatic stress disorder (PTSD) and researchers have previously confirmed that post-abortion syndrome results in PTSD (Sedgh, Singh, Shah, Åhman, Henshaw & Bankole, 2012). Symptoms in a victim may include depression, guilt, anger, social and sexual dysfunction, and even shame.

                                                                       Method

This study used quantitative data collection and analysis techniques. Meta-analysis as a form of quantitative data collection method was adopted. The need to review a huge quantity of data relating to abortion pushed for the research to used meta-analysis. Berer, (2017) defines Meta-analysis as a scientific research method that follows a systematic assessment of studies that have already been done to come up with relevant conclusions about the subject of study. 

Since this study was to systematically review and analyze data, the first step for the researcher was to formulate research questions. The PICO tool was followed in formulating the research questions and dictating the direction of the study. The PICO(S) tool involved coming up with questions with references to participants, interventions, comparisons, and outcomes. Therefore, the main questions that this study intended to answer include: 

· Who are the people most affected by abortion in society? 

· How does abortion complicate the lives of women in different parts of the world?

· What are the benefits of safe abortion as compared to unsafe abortions?  

· What are the ways to ensure a safer abortion for a woman who intends to undertake it?

After the formulation of the research question, the researcher concentrated on the literature search. In this search, the researcher selected studies to be used based on quality criteria, where studies were selected based on their relevance on the topic of abortion. Also, the publication date was used as a criterion for the selection of study materials. Also, this study selected recent data that were published from the early ’90s to date. Lastly, because of the need for inclusivity, the study used both online and offline material. Figure 1, below illustrates how getting the right source for meta-analysis was done through the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA). 

15 sources identified through other offline sources

90 sources identified through database search

Identification

60 sources after removing duplicates

Screening

50 sources screened

10 sources excluded

15 sources excluded with reasons.

Eligibility

35 sources accessed for eligibility

25 sources used in the quantitative synthesis

20 sources used in the meta-analysis

Included

Results

From the thorough examination of the data, it is clear that more than 25million abortions that take place in the world every year. And most of the abortion cases, almost ninety percent take place in developing countries of Africa, Latin America, and Asia (Berer, 2017). In answering the first study question, women who are in their productive age, between 15 years to about sixty years are mostly impacted by abortion cases. Studies have further revealed that out of all the abortion cases recorded, forty-five percent are unsafe (Shah & Åhman, 2012). As the 2008 report by the American Psychological Association (APA) revealed, some women experience clinically significant disorders, including depression, anxiety, sadness and grief following the termination of a pregnancy. 

Medical abortions are the most common followed by surgical abortions. The complications are registered of all abortions were mostly for registered patients past week 12 of pregnancy, with incomplete abortion being the leading complication related to medical abortions (Faúndes & Shah, 2015). In a country like Finland for example, in more than twenty-four thousand individuals who underwent a medical abortion, more than fifteen percent were diagnosed with bleeding at some later stage. More than ten percent suffered from incomplete abortion while two percent had infection issues. (Tietze, 2017).    

Abortion related infections are often caused by ascending bacterial infection like chlamydia that moves from the lower genitals and proceeds to the uterus via the cervix and can spread to the fallopian tube causing infertility (Dzuba, Winikoff & Peña, 2013). WHO recommends the use of an antibiotic called prophylaxis to treat infectious complications resulting from abortions. Antibiotic treatment should be administered in the case that an infection is traced which could be before, during or after an abortion (World Health Organization, & World Health Organization. Reproductive Health, 2015). Although bleeding is considered a part of the normal abortion process, more bleeding that lasts for more than twelve hours is a complication and medical advice should be sought. Different women have different reasons for contemplating abortion with the main reason being the pregnancy being unplanned for.

Discussion   

This study was undertaken to investigate ways in which abortion complicates women’s health around the globe. The main finding that was statistically significant was that most complications result from complications after unsafe as well as medical abortions after the first trimester (Faúndes & Shah, 2015). Despite the complications associated with abortion decreasing over the years, the battle is far from over especially in developing countries, most of which have not legalized abortion. This study, therefore, is in line with numerous sources that agree that the legalization of abortion as the best option for reducing the number of complications related to abortions in the future.

In dealing with the issue of how women can get safer abortions, the hypothesis of this study is to let the practice be done by qualified health practitioners. The majority of the sources analyzed also concur that women interested in procuring an abortion should visit hospitals or licensed clinics and have appointments made for several days before the procedure is done (Shah & Åhman, 2012). The necessity of having appointments is to discuss the reasons for considering abortion as the way out. One needs to be sure to make a sound decision and a counselor may come in handy. It is also important to review the medical options available, their associated risks and complications. An ultrasound during this time is needed to know how many weeks pregnant a woman is to make the opted method identifiable. The clinical appointments before the abortion procedure are also necessary to test for possible STIs, blood type and low iron levels (anemia) and finally sign a consent form then have a date set for the procedure (Awoyemi & Novignon, 2018).

 The reasons that women give for contemplating abortions are broad and diverse. Pregnancies being unwanted or unplanned for is one of the main reasons (Shah & Åhman, 2012). It is not always that family planning methods work and in the case that they do not and one ends up pregnant, it is possible to consider terminating that ‘unwanted pregnancy’. Some pregnancies that arise from crimes such as incest or rape can necessitate abortion. Besides, other causes of abortion are social for instance, poverty. An expectant woman may argue that she cannot raise the expected child because of financial incapability bearing in mind that raising a child is a great and at times costly responsibility thus the need for an abortion (Faúndes, 2010). The inability to cope with a child or another child as well as the argument that one is too young to cope with parenting are more social reasons given for abortion. In some serious cases, some nations have a strict government policy about the regulation of the population in terms of size as well as given groups within a population and also improving the population status leading to abortions to fit by the law requirements.

Limitations

The main limitation faced in data collection was deciding on the best sample size for the study. Although there are numerous studies on the subject of abortion, most of the studies are outdated. The researcher concentrated on getting the best content as recent sources. The challenge is that there are few sources with extensive analysis of the impact of abortion on women. Additionally, the researcher faced the aspect of biases in the sources analyzed. Most of the sources analyzed revealed the negative aspects of abortion, with only a few of them touching on how to make the practice safe. 

Conclusion

It is correct to conclude that women have difficulty coping in life after an abortion. Women face psychological effects such as trying to cope whether they made the right decision or not. Physical effects such as contracting diseases and huge loss of blood are also common in many developing countries (Faúndes & Shah, 2015). The majority of these effects arise as a result of many people in the world addressing abortion as a crime or a bad vice. However, this study proposes that abortion be discussed more openly within educational institutions as well as through the media. This will enable women to be more aware of the potential risks they are taking. Overall effects brought about by an increase in knowledge for women might decrease the number of abortions as it will lead to informed decision making (Tietze & Lincoln, 2016). 

Also, abortion should be legalized and the laws governing it be strictly looked into such that in the necessary cause of abortion. This way, women can get proper medical attention reducing the risk of complications that result from abortions (Faúndes, 2010). Moreover, in the states where abortion is already legal, the governments in those states must provide affordable medical services so that botched procedures cannot be sought with the excuse that they cannot be afforded.

Finally, education on the use of family planning methods is vital and should be made affordable and accessible all over the world as a way to curb unwanted pregnancies that result in abortion. Medication such as antibiotics should come in handy to curd deaths or infection-related complications.

References

Awoyemi, B. O., & Novignon, J. (2018). Demand for abortion and post abortion care in Ibadan, Nigeria. Health Economics Review, 4(1). doi:10.1186/s13561-014-0003-9

Berer, M. (2017). Abortion law and policy around the world: in search of decriminalization. Health and human rights, 19(1), 13.

Culwell, K. R., & Hurwitz, M. (2013). Addressing barriers to safe abortion. International Journal of Gynecology & Obstetrics, 121, S16-S19.

Dzuba, I. G., Winikoff, B., & Peña, M. (2013). Medical abortion: a path to safe, high-quality abortion care in Latin America and the Caribbean. The European Journal of Contraception & Reproductive Health Care, 18(6), 441-450.

Erdman, J. N. (2011). Access to information on safe abortion: a harm reduction and human rights approach. Harv. JL & Gender, 34, 413.

Faúndes, A. (2010). Unsafe abortion–the current global scenario. Best practice & research Clinical obstetrics & gynaecology, 24(4), 467-477.

Faúndes, A., & Shah, I. H. (2015). Evidence supporting broader access to safe legal abortion. International Journal of Gynecology & Obstetrics, 131, S56-S59.

McGinn, T., & Casey, S. E. (2016). Why don’t humanitarian organizations provide safe abortion services? Conflict and health, 10(1), 8.

Shah, I. H., & Åhman, E. (2012). Unsafe abortion differentials in 2008 by age and developing country region: high burden among young women. Reproductive health matters, 20(39), 169-173.

Sedgh, G., Singh, S., Shah, I. H., Åhman, E., Henshaw, S. K., & Bankole, A. (2012). Induced abortion: incidence and trends worldwide from 1995 to 2008. The Lancet, 379(9816), 625-632.

Stillman, M., Frost, J. J., Singh, S., Moore, A. M., & Kalyanwala, S. (2014). Abortion in India: a literature review. New York: Guttmacher Institute, 12-14.

The effects of abortion work. (2019). Pregnancy and abortion counselling, 165-186. doi:10.4324/9780203360125_chapter_9

Tietze, C. (2017). The Public Health Effects of Legal Abortion in the United States. Family Planning Perspectives, 16(1), 26. doi:10.2307/2135120

Tietze, S. L., & Lincoln, R. (2016). The Public Health Effects of Legal Abortion in the United States. Fertility Regulation and the Public Health, 142-145. doi:10.1007/978-1-4612-4702-9_15

World Health Organization, & World Health Organization. Reproductive Health. (2015). Health Worker Role in Providing Safe Abortion Care and Post Abortion Contraception. World Health Organization.