Scitech  Abortion, scientifically speaking

A look at the medical misconceptions within a moral issue

Abortion. We’re no strangers to the arguments on all sides of the discussion, nor are we ignorant of the controversy surrounding the issue. Debates, demonstrations, and protests bring the subject to our doorsteps, right here on our own campus.

But with everyone wanting to weigh in, a lot of facts and myths can be thrown around freely with little regard to their truth or relevance. How much of what we “know” is misinformation, or based on skewed or selective data? What do we really know about the science of abortion?

Procedures explained
A conversation with any MD or scientist will reveal that medical professionals divide abortion into two categories – medical and surgical. Medical abortion involves taking certain drugs to terminate a pregnancy while surgical abortion involves emptying the uterus with special instruments. A common misconception is that medical abortion can only be performed in the early stages of pregnancy, and that anyone further along has to opt for a surgical procedure.

In reality, prostaglandin drugs can be used to induce labour in pregnancies that are up to 20 weeks along, and surgical methods, such as vacuum aspirations, can be used as early as five weeks. Although certain methods are more common at certain points in time, medical professionals often use their own discretion to accommodate each client based on situation and preference.

One of the most common methods of medical abortion includes a combination of the drugs methotrexate (MTX) and misoprostol; the first stops the growth of cells in the uterus while the second causes uterine contractions, which expel the tissue. This method is used in the first eight weeks of pregnancy.

You may have heard of the drug formerly known as RU-486 – infamously protested and campaigned against internationally after its initial release in France. Although not legally available in Canada, it is now called mifepristone, and is a common substitute for MTX.

The emergency contraception drug Plan B, or the morning-after pill, is commonly known. Taken in the first three days after suspected conception, Plan B is, strictly speaking, not an abortion pill, but rather a pregnancy preventative.

Surgical options involve using suction to remove the tissue (as with vacuum aspirations and Ipas syringes). In pregnancies that are further along, dilation and evacuation (D&E) can be employed. This method takes longer than other medical or surgical options because dilators are applied overnight to open the cervix and uterus entrance, and the next day, instruments are used to evacuate the tissue.

Complications – Risky business?
Both types of procedures carry some degree of risk. Some of the after-effects include pain, nausea, cramping, and bleeding, but physical recovery usually occurs within a few hours. With surgical abortion, the risk of damaging internal organs increases and an additional set of risk factors accompanies any procedure that uses anaesthesia.

Even though there is a vast array of information available about abortion, especially on the Internet, there is almost as much misconception and speculation.

Jacqueline Coté, the head nurse at Clinique médicale Fémina, attests that eight out of 10 patients know what procedures they want performed before they even enter the clinic, thanks to their own independent research, but that most women are also misinformed about the procedure’s side effects, both long- and short-term.

“Everyone is surprised; the risks are over-exaggerated,” said Coté. “There is more danger [associated] with pregnancy and with childbirth than abortion.”

One of the most widespread and false accusations against abortion is that it increases a woman’s risk of developing breast cancer. A lot of research was carried out to determine the validity of this claim and while many older studies did seem to verify a tentative link between the two, review by the scientific community found these studies to be flawed and inconsistent.

A World Health Organization (WHO) fact sheet entitled “Induced abortion does not increase breast cancer risk” refers to a sampling bias in many case-control studies that attempt to relate abortion history and breast cancer prevalence later in life. These studies gathered results from an unrepresentative sample population and relied on the honesty of self-reports, limiting the reliability of the data.

The WHO fact sheet states: “Women with breast cancer (cases) tend to truthfully report induced abortion while controls, who often are healthy women, have no ‘incentive’ to provide information about personal and sensitive matters such as induced abortion.”

There are also countless arguments linking abortion to future health risks such as decreased fertility or riskier future pregnancies. Newer studies, for the most part, show no direct link between abortion and these medical issues. Coté dispelled the notion that any long-term medical effects are related to having an abortion.

“There are no problems with the uterus, no birth issues, no cancer, no nothing,” she said.

In the U.S., federal constitutional law gives adolescents the right to abortion, but certain states have tacked on additional barriers, such as requiring parental permission, that can lead to delays in obtaining timely abortions and even push some teens to opt for alternate solutions outside the official system.

Anne Davis, an MD at Columbia University, acknowledges some of the common obstacles faced by teens when obtaining abortions in the U.S.

“[Risks arise with] later abortions for this group, which are less safe, less accessible, more time consuming, and more expensive,” said Davis.

Health risks associated with unsound practices and means of termination, in later stages of pregnancy for teens, can be overgeneralized when applied to abortion and then communicated to the population at large.

In Montreal, there are a number of pregnancy support and crisis hotlines available for free, as well as confidential information services. Charlotte, a medical professional who volunteers for the pregnancy crisis line Grossesse-Secours (last name and position withheld for confidentiality purposes), urged that women should have access to accurate information.

“Everyone should talk to a health professional. There is a lot of false information out there on the net,” she said.

Presenting the information – Aggregation, Manipulation
Statistics can be easily manipulated to support either side of the argument – even something as simple as an accurate provincial or national abortion rate is difficult to determine. In developing countries, there are high numbers of under-the-radar abortion clinics and unsafe abortion practices, making it difficult to get an exact idea of each regional situation.

However, around 70 per cent of abortions take place in developing countries, and there is still a large amount of confusion surrounding abortion rates and practices. Even government health departments are not considered a very reliable source of data on abortion. Their reach only includes certain registered abortion providers in the area, since they must operate within restricted geographical boundaries. Even within their jurisdiction, their ability to acquire reliable and accurate responses is limited.

Each health department and each abortion centre also has its own reporting requirements, thus making it difficult to compare much of the data. Results are then weighted differently, depending on population and region, causing variation when compiling statistics.

Academics tend to turn to private agencies and institutes to compile information straight from abortion providers. These, however, can also be unreliable if they are rallying for funding, or pushing their own agenda.

In a political and moral debate, knowing the scientific accuracies of “facts” and statistics is crucial. There are countless groups, institutions, and individuals that knowingly or unknowingly abuse flawed or skewed information to support their arguments. With the air around science and research becoming increasingly foggy, and false accusations and wrongly interpreted data appearing at every corner, hopefully we can remember to search for the medical realities in our arguments and not take others’ interpretations as the final word.