Health Risks of Abortion
Abortion is one of the safest medical procedures available. The most important factor in decreasing health risks related to abortion is the legalization of abortion services. Most risks of early abortion are minor, including incomplete abortion, continuing pregnancy, excessive bleeding, or mild infections, and can be treated in a doctor’s office. However, many women are concerned with reports of serious health risks of abortion. A summary of these abortion risks is provided.
Risk of Infertility and Abortion
Asherman’s syndrome is a cause of fertility problems related to scar tissue adhesions. Scar tissue forms in the cavity of the uterus, and this prevents the pregnancy from adhering to the uterine wall. Most women with Asherman’s syndrome experience decreased or absent flow in their periods after getting a procedure. Asherman’s syndrome can be treated with an outpatient procedure that removes scar tissue.
Asherman’s syndrome is most commonly caused by D&C procedures. D&C stands for “Dilation and Curettage.” Curettage refers to scraping with a sharp instrument, a curette, to remove tissue from the cavity of the uterus. Asherman’s syndrome is most commonly caused by D&C procedures for excessive bleeding after delivery, or for treatment of miscarriage. In addition, scar tissue can form after D&C’s for abortions. Some estimates show that scar tissue forms 16% of the time after a D&C for an abortion, and this can increase to 32% if there are 3 or more abortions.
D&C’s should not be used for early termination of pregnancy. Curettage (or scraping of the uterus) is unnecessary and risky for future pregnancies. The World Health Organization endorses Manual Vacuum Aspiration (MVA) and the Abortion Pill as the safest early abortion methods. Surgical abortion can also be completed without scraping. Surgical abortion without scraping is called “suction curettage.”
Unfortunately, there is inadequate research on the relationship between Asherman’s syndrome and medical abortion, electric suction abortion without scraping (suction curettage) or Manual Vacuum Aspiration.
There is no current research that demonstrates that the Abortion Pill causes any problems with scar tissue or infertility.
Theoretically, MVA should not cause scarring of the uterus because no sharp instruments are used. MVA provides a gentle suction that detaches the pregnancy lining from the uterine wall. However, there have been 3 case reports of “adhesions” (scarring) after Manual Vacuum Aspiration for treatment of miscarriage. At this time there have not been any large studies to confirm these findings or to implicate MVA with Asherman’s syndrome.
Risk of Breast Cancer and Abortion
Abortion does not cause breast cancer. The myth that abortion causes breast cancer is propagated by the anti-choice movement, and is unsubstantiated by research.
The National Cancer Institute (NCI) declared in March 2003 that “newer studies consistently showed no association between induced and spontaneous abortions and breast cancer risk.” NCI convened a symposium of over 100 of the world’s leading experts to review existing studies on the relationship between pregnancy, abortion, miscarriage and breast cancer risk and concluded that having an abortion does not increase a woman’s subsequent risk of developing breast cancer.
Risk of Death and Abortion
The legalization of abortion has been one of the most significant factors in reducing deaths from abortion. In the past 25 years, since Roe v. Wade, the risk of death declined 85%, from 4.1/100,000 to 0.6/100,000. Causes of death from Dilation and Curettage, and second trimester procedures are from hemorrhage, infection, embolism, and anesthesia complications. The rate of death from childbirth is ten times greater than the death rate from abortion.
There are no statistics available on the risk of death related to MVA. However, the most important risk factor in abortion related deaths is the gestational age of the pregnancy. It is estimated that 87% of abortion related deaths could be prevented if abortions were completed under 8 weeks gestational age. Early pregnancy termination significantly reduces the risk of hemorrhage. It also decreases or eliminates the risk of embolism.
In addition, Manual Vacuum Aspiration is significantly less painful than surgical abortion, so the use of local anesthesia is recommended. This avoids the risk from general anesthesia. Serious infection is preventable with good counseling, follow up, and on-call services.
There may be some risk of death with the Abortion Pill. Over the last five years, six women in North America have died as a result of toxic shock secondary to a rare bacterial infection of the uterus following medical abortion with mifepristone and misoprostol. This type of fatal infection has also been observed to occur following miscarriage, childbirth and surgical abortion, as well as other contexts unrelated to pregnancy. In North America, the rate of death from the Abortion Pill is similar to surgical abortion. The Centers for Disease Control and Prevention’s (CDC) continuing investigations have found no causal link between the medications and these incidents of infection. However, there was some concern that the infection may have been related to contamination resulting from a protocol where women inserted misoprostol into the vagina. Most doctor’s offices and abortion clinics that provide the Abortion Pill now recommend that misoprostol be taken orally or buccally (in the cheek), rather than vaginally, to avoid this possibility.
Source: Bartlett LA, Berg CJ, Shulman, HB, Zane, SB, Green, CA, Whitehead, S, and Atrash HK. Risk Factors for Legal Induced Abortion-Related Mortality in the United States. Obstet Gynecol 2004; 103:729-737.