Abortion

Termination of pregnancy from natural causes prior to the 20th week of pregnancy is referred to as spontaneous abortion or miscarriage; after twenty weeks, it is referred to as a preterm birth. However, spontaneous abortions are clearly distinguished from our everyday understanding of the meaning of abortion, which is the voluntary termination of a pregnancy; also called an induced abortion or an elective abortion. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman that would otherwise be inevitable if the pregnancy is continued. However, induced abortions are often unrelated to physical health problems of the embryo or the mother. 

The two types of procedures for terminating a pregnancy are:

  • surgical abortions and
  • medical abortions.


The manner selected often depends upon the gestational age of the embryo or foetus, which increases in size as the pregnancy progresses. Until the late 1990s, virtually all abortions performed used surgical procedures, and nearly all of those used a technique called vacuum aspiration. Most early abortions today (usually defined as within the first 12 weeks of pregnancy) use a process called Manual Vacuum Aspiration (MVA), also known as ‘mini-suction’. This technique incorporates a syringe device that is operated by hand or a small hand-held electrical vacuum device. Vacuum aspiration, as the name implies, incorporates a small tube that is inserted through the cervix of the woman to which suction is applied, creating a slight vacuum that draws out the contents of the uterus, including the endometrium lining and the embedded embryo. The procedure takes up to 15 minutes, and where abortion is legal, is typically performed in a doctor’s office or medical clinic under local anaesthetic. Side effects of the procedure include abdominal cramping and usually some bleeding. More serious complications may include perforation of the uterine wall or infection.

The second most common method of surgical abortion is by Dilatation and Curettage (D&C) which is a standard gynaecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy and investigation of abnormal bleeding. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organisation recommends this procedure only when manual vacuum aspiration is unavailable.

If pregnancy has progressed beyond the first trimester, the usual termination procedure is Dilation and Evacuation, or D&E. This is a more invasive and extensive procedure, largely because by the second trimester (13 to 26 weeks) the pregnancy is more firmly established and the developing foetus in the uterus is larger, thus requiring greater dilation of the cervix. A vacuum tube is inserted to remove the foetus and most of the remaining contents of the uterus. Next, a curved surgical instrument, or the curette is inserted to scrape the linings of the uterus to free any additional tissue. This procedure is typically performed as a ‘day surgery’ in a hospital setting, and usually conducted under general sedation or general anaesthetic. Side effects include cramping for several hours and bleeding for about two weeks following the procedure. Rare but serious complications may include damage to or perforation of the uterine wall, severe bleeding and infection.

More recently there has been a clear trend away from surgical abortions for early pregnancies towards medical methods of terminating a pregnancy. A medical abortion relies on specifically targeted drugs, also known as abortifacient pharmaceuticals, to terminate a pregnancy. In cases of failure of medical abortion, a surgical abortion will complete the procedure. Early medical abortions account for the majority of abortions before 9 weeks gestation in most European countries.

The mentioned procedures for terminating a pregnancy are generally considered safe and effective. Studies have shown that the long-term effects on the mother’s fertility from a single abortion performed during the first trimester of pregnancy has little effect on the woman’s future ability to become pregnant and give birth. However, the effects of later-term abortions or of multiple abortions on future fertility and pregnancy have yet to be established by scientific studies.

However, when conducted illegally and by persons without the necessary skills and proper training, and in below standard conditions that do not conform to minimal medical standards, or outside a medical environment, may lead to permanent disabilities including infertility or maternal death. Women in developing countries,  have the least access to family planning services and the fewest resources to pay for safe abortion procedures; they are also the most likely to experience complications related to unsafe abortion.

Complications from unsafe abortion lead to morbidity and are a major cause of maternal deaths. The World Health Organisation estimated that globally some 68,000 women die each year as a consequence of unsafe abortion. Besides death, possible complications include infection, haemorrhage, and injury to internal organs, and can lead to long-term health problems such as chronic pain, pelvic inflammatory disease, and infertility. It has also been estimated that 5.3 million suffer temporary or permanent disability.

 

In addition to its immediate negative impact on women’s health, unsafe abortion also carries significant financial burden on both the individual and the public health care system. For example, complications from unsafe abortion may cause maternal deaths that leave children motherless; reduce women’s productivity, both inside and outside the home, increasing the economic burden on poor families and an inability to care for children; as well as have an adverse effect on sexual relations. Costs for women and their families include fees for medical services, medicine, and supplies; and lost income from missing work. Unsafe abortion also places a substantial burden on health and social care systems, resulting in considerable costs to already struggling public health systems. In many countries, women with incomplete abortion account for a large segment of gynaecological admissions to hospitals, and treatment may require several days of hospital stay, significant staff time, blood transfusion, and general anaesthesia.

Many people mistakenly believe that a woman’s decision to terminate her pregnancy is a relatively easy, uncaring or detached decision. The primary emotion reported by most women after having an abortion is relief. Yet most women rarely describe the experience in such terms. Research has shown that most are conflicted about the decision and may experience complex, painful, and confusing emotional reactions about the unwanted pregnancy and their decision to terminate it.

 

Undergoing abortion is not something many women choose to discuss with many others in their lives. They recognise the variety of opinions people hold on the subject and that they risk being judged for becoming pregnant, for not taking proper precautions, or for choosing to abort. As a result, many women are not given the opportunity to process the experience emotionally with the help of others. As a result, a delayed negative reaction may occur. Some may experience feelings of guilt, shame, sadness, depression, anger, anxiety, concern over judgement from others, isolation, and relationship breakdown. When such emotions are denied or buried, they can resurface having been magnified over time.

 

The term Post-Abortion Syndrome (PAS), or Post Abortion Stress Syndrome has been coined to describe the emotional and psychological consequences of abortion, similar to Post-Partum Depression or Post Traumatic Stress Disorder. That said, few women who choose to have an abortion are believed to suffer from such severe short or long-term negative psychological outcomes afterwards. Some social scientists argue that no such syndrome exists, and that the best predictor of post abortion emotional adjustment is the level of the women’s adjustment in life before the pregnancy occurred.

 

Most mental health professionals today agree that when a woman is considering her options for dealing with an unplanned pregnancy, doctors, clinicians and counsellors should either attempt to provide non-judgemental and empathic support, or refer the woman for psychological or religious counselling services if they suspect she is having difficulty with the emotional effects of her decision to abort a pregnancy. She should be given as much information about all her pregnancy options as she personally needs and wants, including keeping the baby and giving the baby up for adoption. She should be encouraged to discuss her feelings about the pregnancy, the potential of becoming a parent or bringing a new child into the family, her ability and desire to provide for a child, and her attitudes about abortion and adoption.  The medical or counselling setting should also be open to discussing issues relating to the father of the baby, and when possible, to include the father in the decision making process.

 

In Malta, a crisis pregnancy support group called HOPE, which is one of the branches of the pro-life movement Gift of Life, seeks to help pregnant women who are considering a termination. This group adopts a non-judgemental approach and speaks to mothers-to-be in strict confidentiality to help them make informed decisions by providing them with support and information about pregnancy and foetal development, as well as available support and options. HOPE provides free pregnancy testing and non-diagnostic ultrasound scanning, referrals (obstetric, gynaecological, social, as well as referrals for professional support to women who have experienced pregnancy loss through abortion), emotional support, practical assistance and support, and psychotherapy. The support group also offers maternity and baby items.

 

Perhaps the single area of agreement between the pro-choice and pro-life factions of the abortion debate is the desire to reduce the number of abortions performed each year. Many argue that making abortion illegal does not prevent abortion, but rather drives it underground or to other countries, where the procedures are often conducted illegally and in an unsafe manner, leading to maternal deaths. An alternate route argued is to reduce abortions by decreasing the number of unplanned pregnancies through holistic sexuality and relationships education; education about substance abuse related to alcohol and drugs; empowering people make healthier and safe choices about their sexual lifestyle and behaviours, including postponement of sexual activity among adolescents; adopting alternate sexual expressions that are safe from unplanned pregnancies and the transmission of Sexually Acquired Infections; and encourage the effective and consistent use of birth control among those who despite knowledge and awareness of the risks, opt for risky penetrative sexual practices.

 

Abortion in Malta

 

Under the Criminal Code of Malta (Chapter 9 of the Laws of Malta), abortion is prohibited in all circumstances. The person performing the abortion is subject to 18 months’ to three years’ imprisonment, as is a woman who performs an abortion on herself or consents to its performance. A physician, surgeon, obstetrician, or apothecary who performs an abortion is subject to 18 months’ to four years’ imprisonment and lifelong prohibition from exercising his or her profession.

It has been commonly reported on Maltese newspapers that it is a well known fact that Maltese women seeking to terminate their pregnancy travel to the UK and Sicily to have an abortion. Malta’s only records on the number of women who terminate their pregnancies are those conducted in the UK and documented in the National Statistics Office, Malta publication - Children 2010 (shown below). No records on the number of Maltese women who have abortions in other countries are available. An article published on the Malta Independent on Sunday of 26th January 2012 (Borg and Vella, 2012) stated that procedures terminating pregnancies have been carried out in unauthorised clinics in Malta in the past. However there seems to be no evidence supporting these claims to date.

The past 20 years saw an average of 56 abortions per year being carried out on Maltese nationals in England and Wales. The lowest number of abortions was registered in 2008, with 38 abortions; while the highest number registered was 78 in 2009.

 

 

Sources of Help

 

HOPE – Crisis Pregnancy Support

In Malta, a crisis pregnancy support group called HOPE, which is one of the branches of the pro-life movement Gift of Life, seeks to help pregnant women who are considering a termination. This group adopts a non-judgemental approach and speak to mothers-to-be in strict confidentiality to help them make informed decisions by providing them with support and information about pregnancy and foetal development, as well as available support and options. Hope provides free pregnancy testing and non-diagnostic ultrasound scanning, referrals (obstetric, gynaecological and social), as well as referrals for professional support to women who have experienced pregnancy loss through abortion, emotional support, practical assistance and support, and psychotherapy. The support group also offers maternity and baby items.

For further information contact or visit:+356 21418055 hope@lifemalta.org This email address is being protected from spam bots, you need Javascript enabled to view it.

Rachel’s Vineyard

Rachel's Vineyard offer a healing service after abortion.  The program is an opportunity for people who had undergone an abortion to examine their abortion experience, identify the ways that the loss has impacted on them in the past and present, and helps to acknowledge any unresolved feelings that many individuals struggle with after abortion. Because of the emotional numbness and secrecy that often surrounds an abortion experience, conflicting emotions both during and after the event may remain unresolved. These buried feelings can surface later and may be symptoms of post abortion trauma.

Married couples, mothers, fathers, grandparents and siblings of aborted children, as well as persons who have been involved in the abortion industry have come to Rachel's Vineyard in search of peace and inner healing. To learn more, please call:

Nina or Chris Sansone on 79 248 842 

Email: chrissansone@onvol.net