A. DEFINITION: Abortion refers to the premature expulsion of the products of conception from the uterus, usually before the 20th week of pregnancy. An abortion may be spontaneous (naturally occurring), sometimes called a miscarriage, or induced (intentionally performed). Induced abortion is performed when contraceptive methods are not used or fail to prevent unwanted pregnancy. Medical termination of pregnancy refers to both the surgical methods and drug induced methods verified by the Government of India. An abortion may be elective (based on a woman's personal choice) or therapeutic (to preserve the health or save the life of a pregnant woman).
B. EPIDEMIOLOGY OF INDUCED ABORTION:
The incidence and reasons for inducing abortion vary regionally. It has been estimated that approximately 46 million abortions are performed worldwide every year. Of these, 26 million are said to occur in places where abortion is legal; the other 20 million happen where the procedure is illegal, with more than 78,000 deaths. It is estimated that globally out of every 100 pregnancies 26 are aborted manually. Belgium and Netherlands are found to perform the least amount of abortion per 100 know pregnancies. The ratio of induced abortion for these countries is 11.2 and 10.6 per 100 pregnancies respectively. Russia scores highest for induced abortion per 100 pregnancies with 62.6 rates, and is followed by Vietnam with 43.7 induced abortions out of 100 pregnancies. Annually, 10-12 million abortions are performed in India and 15-20 thousand maternal deaths are reported due to illegal procedures for abortion.
C. PURPOSE OF INDUCED ABORTION:
An abortion is practiced whenever there is some undeniable cause to discontinue the pregnancy. The word "induced" is added to the abortion so that it can be differentiated from a natural abortion or miscarriage. Bankole and associates collected data from 27 countries regarding the reasons presented by women to terminate their pregnancies. The study concluded the following reasons for decision of abortion:
1) To delay child birth.
2) To avoid interruption of job or education.
3) Financial instability.
4) Insecurity in the relationship.
5) Lack of confidence in child upbringing.
A questionnaire filled by 1000 American women in 2004 compiling reasons for induced abortion yielded similar results. For both American and Finland woman's concern for health risks was not a reason for abortion, while it was one of the biggest reasons for women in India, Bangladesh, and Kenya. 1% of women in the 2004 survey-based U.S. study became pregnant as a result of rape and 0.5% as a result of incest. Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using condoms and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.
The study by Bankole, Singh, and Sushila in 1998 also identified the social and personal factors leading to compulsory abortion. These factors include ignorance and disapproval towards disabled women, preference for male child, lack of support and approval for single mother, economic instability, lack of knowledge about contraceptive methods or suspension of use of contraceptive methods due to religious reasons, or laws by state to control the population of the country (such as China's one-child policy). The World Health Organization reported that 19 million terminations annually come under the criteria of unsafe abortion (WHO 2004). Unsafe abortions are mainly performed in the developing nations or the countries where abortion is termed illegal by the law.
The definition of elective abortion according to the MTP Act of India, 1971 is, “An abortion is considered to be elective if a woman chooses to end her pregnancy, and it is not for maternal or fetal health reasons”. Some reasons a woman might choose to have an elective abortion are: (MTP Act of India, 1971)
A health care provider performs a therapeutic abortion to maintain the well-being of the pregnant woman and to save her life. Also, if the fetus is identified with abnormalities and inability to survive or is dead in utero, a therapeutic abortion may be performed. All the conditions for therapeutic abortion are enlisted by the MTP Act of India, 1971 as below:
D. METHODS OF MEDICAL TERMINATION OF PREGNANCY:
There are three methods of induced abortion:
I. Salt poisoning method for termination of pregnancy.
II. Surgical termination of pregnancy.
III. Drug induced termination of pregnancy.