Backgrounder on Abortion

Backgrounder on Abortion

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Baby jpg

Flickr, 2012


Although the federal government of Canada permits abortion, members of the Canadian public should become knowledgeable enough about abortion to make a decision for themselves on whether or not abortion should be permissible. The following report will examine abortion's political history, fetuses' developmental stages, and current abortion methods.

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History

In 1969, the Supreme Court of Canada legalized abortions under certain conditions: if continuing the pregnancy was deemed by a committee of three doctors to potentially endanger a woman's physical or mental health, abortion was now legal (AbortionInCanada).

These conditions for permitting abortions were removed in 1988, when the Supreme Court of Canada decided that the laws making abortion illegal under any circumstances were unconstitutional. This ruling meant that a child could be aborted at any point during pregnancy for any reason (Boland).

However, the question still remained as to whether the mother was the only person to have the power to decide if her fetus was aborted or not. In 1989, two cases set precedents for the rights of fathers in this matter: Barbara Dodd and Chantal Daigle's boyfriends were refused the legal ability to prevent their girlfriends from having abortions (AbortionInCanada). These decisions prevent fathers from vetoing their partner's choice to abort.

In 1991, another legal precedent was set. This time concerning at what point a fetus gains the legal standing of a person. In this case, Gloria Lemay and Mary Sullivan, two midwives, were not held legally accountable for the death of a fetus who was partially born: the Supreme Court stated that a fetus is not legally a "person" while in the process of birth. This status of a fetus remains to date, meaning there are no legal ramifications in Canada for aborting a fetus at any stage prior to or during birth (AbortionInCanada).

For the most part, this is the stance held throughout North America: in the US, there are only nine states that have made partial-birth abortion illegal. Some state legislatures are discussing making fetal anesthesia mandatory; however, Canada has not followed suit with any regulatory laws of its own that have succeeded in being passed (Woodard).


Fetal Development

Gaining a basic understanding of the start of a human life and the developmental stages is helpful before delving into the perspectives on when an unborn child should be considered a person and debates on what stage of pregnancy, if any, an stillborn should be permitted to be legally aborted.

According to AbortionInCanada, the American Pregnancy Association, and womenshealth.gov a human fetus develops as follows:

Conception: A Zygote forms when sperm and ovum unite. The zygote begins to rapidly grow and within four days it has already developed into about thirty-two cells. Within two weeks, the zygote has reached the uterine wall and implanted itself, entering the embryonic stage.

Week 3: The gastrointestinal tract, arm and leg buds, and spinal cord begin to form. About, 21-25 days after fertilization the heart begins to beat.

Week 4-5: In addition to the continued growth of what has already become visible, the brain, heart, and circulatory system see a rapid increase in development in the fifth week. As well, the preliminary formation of the eyes and ears begins.

Week 6: The palate, jaw, and external ears start to take shape. The central nervous system and the beginnings of a skeleton develop. A vaginal ultrasound may pick up a heartbeat.

Week 7-8: Although only "one inch long and the size of a bean" each component that is "in an adult human is now present in the small embryo" (American Pregnancy Association). The fingers and toes are visible, the muscles can contract, and the cartilage that will later turn to bone is forming.


week 7.png

Week 9-12: Now referred to as a fetus. External components of sexual organs have formed adequately to identify the gender, but not yet by ultrasound. The vocal cords have begun forming and the digestive system is now functioning. By twelve weeks the fetus can make a fist.


week 9-10.png

Figure 2. Fetus: 9-10 weeks old, lunar caustic,
Fetus week 9-10, Flickr, 20 Dec. 2007. Web. 27, Sept. 2011.

Week 13-16: The second trimester begins. The fingernails have formed, and the bones continue to harden. The fetus can now make sucking motions and feel pressure and touch. By the sixteenth week, the fetus can swallow, and his mother may feel movement.

Week 17-20: The fetus' heart may be heard with a stethoscope. Eyebrows and hair are forming. By the end of this period, the fetus may scratch herself and will have developed a sleep pattern, which will continue to guide her sleep pattern after birth.

Week 21-24: The fetus has begun gaining weight and by the end of this period has reached viability, although she would still need the help of medical technology once outside of the womb. In addition, the fetus has a startle reflex and eyes that are fully developed, with pupils that can respond to changes in light.

fetus skeleton.png

Figure 3. Fetal skeleton made visible, Curious Expeditions,
6 Month Old Dyed Fetus, Flickr, 26 Jan. 2009. Web. 27 Sept. 2011.

Week 25-28: Blood is now formed entirely in the bone marrow, instead of the liver. Fingerprints are present, and the eyelids can open and close.

Week 29-32: The fetus does breathing motions and rapidly gains weight.

Week 33-term: The organs are ready to function on their own. Most fetuses will turn head downwards in preparation for birth.

Although medicine has advanced to a point where these developmental stages are understood, they have not led to any federal regulations for fetuses' treatment.


Types of Abortions

Abortions may be performed in a variety of ways depending on a mother's preference and the gestational stage, but all of the methods fall under two main categories: surgical and medical.


Surgical Abortions

Suction Aspiration: Also known as dilation and curettage (D&C). With 90% of reported abortions in Canada useing this method, it is the most extensively used. It involves dilating the cervix during the first trimester or early in the second. The fetus is then suctioned out of the uterus. Often the fetus does not stay intact during this process. As a result, special care must be taken to ensure that no pieces remain inside the mother, or they may cause infection (AbortionInCanada).

Menstrual Aspiration: This a very rare procedure in Canada with only 1% of reported abortions using this method. Usually performed in the first three to ten weeks, it involves a tube that is attached to a large syringe being inserted into a slightly dilated cervix and used to suction out an embryo (AbortionInCanada).

Dilation and Evacuation (D&E): This method is most frequently used after thirteen weeks and removes the fetus with suction, forceps, and instruments for gently scraping the uterus wall. Once the fetus is removed, the pieces of tissue are examined to ensure that no parts of the fetus remain in the uterus because they would cause a risk of infection to the mother (Abortion; AbortioninCanada). Feticides may be administered to kill the fetus before the procedure is performed (AbortioninCanada).

Dilation and Extraction (D&X): This procedure is a variation of D&E that leaves the fetus intact. It is also dubbed "partial birth abortion" because the fetus may be partially delivered feet-first before its skull is collapsed to allow it to pass through the cervix. As with D&E, feticide may be used prior to the procedure (Hammond; AbortionInCanada). Although technically legal in Canada, it is not certain if any of these abortions are actually occurring (AbortionInCanada).

Surgical Dilation and Curettage (D&C): The cervix is dilated allowing a loop-shaped knife to be inserted into the cervix. It then is used to scrape the uterine wall, break up the fetus, and pull the fetal and placental parts out of the cervix.

Hysterotomy and Hysterectomy: Hysterotomy occurs when an incision is made in the mother's abdomen and uterus, allowing the fetus and placenta to be removed. The fetus may be born alive if pre-operative feticide is not used (AbortionInCanada).


Medical Abortion Methods

Medical abortions use medication rather than surgery (Winikoff).

Misoprostol and Methotrexate: Misoprostol may be used on its own; however, it is more effective when used in combination with methotrexate, succeeding in aborting 70-90% of the time when used in combination, rather than 22-94% when used alone (AbortionInCanada). This combination may be used until the forty-ninth day of gestation (AbortionInCanada).

Mifepristone and Misoprostol: Globally, this is the most commonly used combination medical abortion. By blocking glucocorticoid and progesterone receptors, mifepristone produces abortive effects, such as dilating the cervix, causing the uterine membrane to break down, and encouraging contractions (Winikoff; Hammond; AbortionInCanada). Because of side effects deemed too severe, the use of mifepriston for medical abortions has not been approved in Canada (AbortionInCanada).

Labor Induction Methods: These methods inject substances, such as saline, prostaglandins, and urea, into the amniotic sac to induce labor; however, since they pose a greater risk to the mother's health than some other methods outlined above, they are rarely used on their own in Canada. More frequently, they are used as feticides in combination with other methods, such as D&E (AbortionInCanada).

With these methods there have also been instances where the abortion was not successful and fetuses have been born alive: One such example is Gianna Jessen, who survived a third-trimester saline abortion. As a result of the abortion, she now has cerebral palsy; however, she has survived until adulthood and is well enough to do public speaking (giannajessen.com).


Reasons for Abortion

Federally, there are no regulations governing what reasons are acceptable grounds for an abortion; however, there are some common reasons that women give. Often women feel that they cannot handle the responsibility of a child due to their financial situation, career/life goals, maturity level, relational circumstances, or any combination of these challenges (AbortionInCanada). In addition, if a fetus is diagnosed with an undesired abnormality, some parents respond by aborting: According to Cassing Hammond, access to prenatal diagnosis has increased the rate of second-trimester abortions.

One of the least common reasons for abortion is rape or incest: the New York Times and AbortionInCanada.ca cite surveys completed by the Alan Guttmacher Institute in which the results indicate that 1% of women in the United States give rape or incest as their reason for aborting their fetus. Even among women who said their pregnancy was due to rape or incest, 95% said it was not their only reason (NewYorkTimes).

Other women feel external pressure from partners or spouses to have an abortion, overtly or through lack of support. According to Katrina Kimport et al, when a woman does not feel she was fully allowed to make her own decision to bring her child to term or not, her abortion is often accompanied by more negative emotions afterward than women who felt their decision was entirely their own.


What Now?

Although the federal government has legalized abortion, during any stage of fetal development, there continues to be debate over which methods of abortion should be allowed and if abortion should be permissible under all circumstances.


For further discussion on personhood debates please see: A Note to Old Zygotes


Bibliography

AbortionInCanada.ca. LifeCanada. Web. 15 Sept. 2011.

"Fetal Development." American Pregnancy Association. American Pregnancy
Association, 2005. Web. 15 Sept. 2011.

"Gianna Jessen's Biography." giannajessen.com. (2005). Web. 21 Sept. 2011.

Hammond, Cassing. "Recent advances in second-trimester abortion: an evidence-based review." American Journal of Obstetrics and Gynecology. 200.4. (2009): 347-356

Kimport, Katrina, Kira Foster, and Tracy A. Weitz. "Social Sources of Women's Emotional Difficulty After Abortion: Lessons from Women's Abortion Narratives." Perspectives on Sexual and Reproductive Health 43.2 (2011): 103-9. Academic Search Complete. Web. 15 Sept. 2011.

Lewin, Tamar. "Rape and Incest: Just 1% of All Abortions." TheNewYorkTimes. 13 October 1989. Web. 27 September, 2011.

Napier, Stephen. "Abortion and the Onus of Proof." National Catholic Bioethics Centre. N.P. 22 Dec. 2008. Web. 27 Sept. 2011.

"Pregnancy." womenshealth.gov. N.P. 27 Sept. 2010. Web. 28 Sept. 2011.

"Speak no evil: The lack of any debate on abortion in canada is deafening." The Ottawa Citizen. ProQuest. A.20-A20. 5 Dec. 2003. Web. 14 Sept. 2011.

"Abortion." Women's Web. 2010. Web. 5 Dec. 2011.

Woodard, J. "A generation of death: Abortion survives a quarter-century, but public repulsion is growing stronger." Report Newsmagazine. 22.9 (1998): 38. ProQuest. Web. 21 Sept. 2011.

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