Every year, approximately 46 million babies die from abortion worldwide – equivalent to one baby being aborted every two seconds. Unfortunately, the numbers are increasing annually especially amongst youths.
Apart from the physical and mental trauma that a woman has to go through while dealing with unwanted pregnancy, going through an abortion is not just about getting rid of an unborn baby. The psychological harm can be taxing.
Do you know anyone who is facing the abortion pressure? Here are 10 things that you need to know about abortion from Dr Arthur Tseng, Consultant of Urogynaecology Department at KKH Hospital, Singapore.
1. What is the essential issue concerning abortion, which most people are not aware of?
In Singapore, the safest abortion procedure is a “vacuum aspiration” termination of pregnancy (TOP), between 7 to 11 weeks of pregnancy. This is usually done under general anaesthesia, but can be done under regional anaesthesia, depending on patient preference.
Certain countries offer medical termination, where medication is ingested, inserted vaginally, or injected to cause an abortion, and many patients believe this is a simple, safe and expedient method to get rid of an unwanted pregnancy.
This is relatively unsafe, as 1 in 5 women will have bleeding sufficiently alarming to warrant a vacuum aspiration TOP, with possible hospital stay and the need for possible blood transfusion; with it’s own attendant risks of Hepatitis B or HIV, no matter how small that risk may be. There is also a risk of infection of the blood and products of conception, which affects future pregnancy and may be life-threatening.
2. How safe is it to have an abortion? How many types of abortion are there?
A vacuum aspiration TOP has a complication rate between 0. 5 to 1.0%, in terms of bleeding, infection, retained products, unsuccessful termination of pregnancy, menstrual irregularity.
There are other rarer complications like blood clots developing in the legs (deep vein thrombosis), Asherman Syndrome (where the uterine cavity is wholly or partially obliterated); uterine injury from the aspirator device, injury of other pelvic organs when a uterine perforation occurs, where a diagnostic laparoscopy (a camera through the belly button) is performed and injuries are repaired then and there. In general, a vacuum aspiration TOP is considered very safe in experienced hands.
Other abortions apart from the medical abortion mentioned above, are a “Dilatation and Extraction”, done between 12 to 15 weeks, which is similar to a vacuum aspiration TOP except the fetus is removed piece-meal with certain devices that crush the developing bones.
There is also a “Mid-Trimester Pregnancy Termination” can be performed up to 24 weeks (when the fetus is considered viable and abortion is illegal), where the fetus is essentially too large and well formed for other methods, such that the patient is admitted for pre-evacuation medical treatment with pessaries that induce labour. After the fetus has been delivered, a surgical evacuation of the uterus is performed, where remnants of placenta, membranes and blood clots are removed. This method of termination usually requires a few days in hospital.
There are also abortions done not by medical specialists, but by non-medical personnel. The methods may range from taking “special herbs” or concoctions to “surgical methods” involving inserting unsterile metal instruments to rupture the amniotic membranes and induce a miscarriage. Needless to say, all abortion performed by non-medical specialists are unsafe, and it unwise to choose this option.
3. Are abortions safer when performed earlier or later in the pregnancy?
As mentioned previously, a vacuum aspiration TOP, performed between 7 to 11 weeks is deemed the safest.
4. How many abortions can a woman have?
The safest number of abortions is the least number of abortions done in an individual. With increasing number of abortions done, there is an increasing risk of injury to the endometrial cavity, causing scarring. This is called Asherman Syndrome. This may cause menstrual problems or more importantly, fertility problems, where the fetilised egg cannot implant in a damaged cavity.
There is also a risk of undiagnosed uterine injury, such as a partial perforation of a vacuum aspirator device. This may weaken the integrity of the uterine wall, and there is a risk that the uterus may rupture when the patient is in labour.
5. Should there be counseling for unintended pregnancy and abortion?
There is an inbuilt system in KK Hospital where patients asking for an abortion are sent for TOP counseling by a certified abortion counselor or to the medical social workers in certain cases. This is true for all restructured hospitals. Only after a mandatory 48 hour waiting period is the TOP allowed to proceed.
6. What are some of the psychological consequences/ after-effects of abortion?
Certain patients are still unprepared for the loss of the unborn fetus, despite having objectively decided to proceed with the TOP, or even after TOP counseling. The process of grieving and emotional acceptance may take some time to occur, before the patient comes to terms with the abortion-related loss.
7. Are there any ‘post-abortion syndromes’?
In rare instances, some patients actually suffer from Post-Traumatic Stress Disorder (PTSD), as a result of an abortion. Patience and understanding is required to handle these patients sensitively. There may be a need for psychological support from counselors, psychologists, and rarely psychiatrists who specialise in female emotional health issues.
8. Statistics have shown that the number of teenage pregnancies and abortions are increasing worldwide. Can sex education help to address these issues?
9. How will it help?
Sex education can help women at risk for unwanted pregnancies to better understand the process of getting pregnant and thereby ways they can mitigate this risk. The government is currently looking into this matter very seriously to improve sex and health education.
10. What is your advice to teenagers regarding unprotected sex?
For teenagers who do practice unprotected sex, I would strongly appeal that condoms be used, not just to reduce the chance of an unwanted pregnancy, but also to reduce the risk of sexually transmitted infections (STI’s), like Hepatitis B, HIV, and so on.
The possibility of using an oral contraceptive pill (OCP) with a condom should be encouraged also. This “double dutch” method protects against pregnancy and also against STI’s. Information is key to the public layperson understanding the risks of abortion and the risks of acquiring an STI, and utilizing means to protect themselves.