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Abortion: Methods, Legal Framework and Counselling

Abortion refers to the deliberate termination of a pregnancy before the fetus is viable, performed either medically or surgically.

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Things worth knowing about "Abortion"

Abortion refers to the deliberate termination of a pregnancy before the fetus is viable, performed either medically or surgically.

What Is an Abortion?

An abortion (medically termed induced abortion or termination of pregnancy) is the deliberate ending of a pregnancy before the fetus can survive outside the womb. It is distinct from a miscarriage (spontaneous abortion), which occurs naturally without medical intervention. Abortions can be performed using medications or surgical procedures, depending on the gestational age and the patient's medical situation and preferences.

Legal Context

The legal framework governing abortion varies significantly by country. In Germany, abortion is regulated under § 218 of the Criminal Code (StGB) but is exempt from prosecution under specific conditions:

Counselling rule (Fristlösung): Abortion is legal within the first 12 weeks of pregnancy (calculated from the last menstrual period), provided the woman has attended a state-recognised counselling session at least three days before the procedure.
Medical indication: Abortion is permitted at any stage of pregnancy if there is a serious risk to the physical or mental health of the woman.
Criminological indication: Abortion is permitted up to 12 weeks in cases of pregnancy resulting from sexual assault.

Methods of Abortion

Medical (Medication) Abortion

Medical abortion is approved up to 9 weeks of pregnancy (63 days from the last menstrual period). It involves a two-step medication regimen:

Mifepristone: Blocks the hormone progesterone, which is essential for maintaining the pregnancy, causing the uterine lining to break down.
Misoprostol: A prostaglandin analogue taken 24 to 48 hours after mifepristone, which causes uterine contractions to expel the pregnancy.

This method is effective in more than 95% of cases. Common side effects include cramping, bleeding, nausea, and vomiting.

Surgical Abortion

Surgical methods are selected based on gestational age:

Vacuum aspiration (suction curettage): The most common surgical method used up to 12 weeks. The contents of the uterus are removed using gentle suction through a thin tube. The procedure typically takes only a few minutes and can be performed under local or general anaesthesia.
Dilation and evacuation (D&E): Used after 12 weeks. The cervix is gently dilated and the uterine contents are removed. General anaesthesia is usually required.

Risks and Complications

Abortion is generally a very safe medical procedure when performed by trained healthcare professionals. Potential complications include:

Infection of the uterus or fallopian tubes
Incomplete abortion requiring additional treatment
Heavy bleeding
Rare: uterine perforation (injury to the womb wall)
Emotional or psychological responses in some individuals

The risk of serious complications is very low and is comparable to or lower than the risks associated with childbirth when the procedure is performed correctly.

Counselling and Support

In many countries, counselling services are available before and after an abortion. In Germany, attendance at a state-recognised counselling session is a legal requirement before a first-trimester abortion under the counselling rule. These services are confidential, free of charge, and non-directive -- meaning they aim to support the individual in making their own decision rather than influencing it.

Psychological Aspects

Emotional responses to abortion vary greatly from person to person. Many individuals report relief as the predominant feeling, while others may experience sadness, grief, or mixed emotions. According to the scientific evidence, long-term mental health disorders directly caused by abortion are uncommon. However, psychological support should be sought if needed, particularly if the decision was made under pressure or in difficult circumstances.

References

World Health Organization (WHO): Abortion care guideline. Geneva: WHO, 2022. Available at: https://www.who.int/publications/i/item/9789240039483
National Academies of Sciences, Engineering, and Medicine: The Safety and Quality of Abortion Care in the United States. Washington, DC: The National Academies Press, 2018.
Sedgh G, et al.: Induced abortion: incidence and trends worldwide from 1995 to 2008. The Lancet. 2012; 379(9816): 625-632.

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