22 November 2012

What is an abortion?

Seems a simple question, doesn’t it? Everyone knows — or thinks they know — what an abortion is. Just ask the man in the street or the man on the Clapham omnibus. Today, though, it would be the person in the street or on the bus.

Well, it’s not quite as simple as you might think. The Offences against the Person Act 1861 doesn’t actually use the word abortion, it refers to “miscarriage”, but does not define what a “miscarriage” might be — and certainly not in terms of weeks of gestation. It also refers to procuring a miscarriage in a woman who isn’t pregnant; either a “catch all” clause, or just possibly a failure of understanding. (And, would you believe it, there was a successful prosecution against a medic for attempting to procure an abortion in a woman who wasn’t pregnant.)

Abortion and miscarriage are exactly synonymous in medical jargon, though miscarriage usually has the nuance or implication of “natural” and abortion is often taken to be “artificial”. It’s difficult to be certain, but it’s generally accepted that many pregnancies end in a “spontaneous miscarriage”, often without the woman realising that she was pregnant.

A dictionary definition of abortion is the premature termination of a pregnancy, but there is no mention of the period of gestation.

When the 1861 Act was formulated, the idea of “induction of labour” was unknown. Many women today have their labour induced, for whatever reason, by “ARM” — artificial rupture of the membranes — and through the use of pharmacological agents. Would the Victorians have considered this as an “abortion”?

The dictionary doesn’t include “destruction of the foetus” in its definition, even if this is what is commonly accepted today. And many would hold that a termination before 24 weeks is an abortion — after 24 weeks, the foetus is usually “viable”. Viable in the sense that it can survive, albeit with significant support.

If in practical terms we can say an abortion is the termination of pregnancy before 24 weeks, and destruction of the foetus; it’s quite possible that the law hasn’t caught up with this.

And we can also say that a full-term neonate is premature; not as paradoxical as it seems. The human baby can do nothing for itself for several years after birth. The offspring of “lower” animals can stand and search out the teat for themselves within a very short time. Human babies are born “prematurely”, it’s said, because of the size of the brain. The adult female pelvis simply won’t allow anything larger to pass; human prematurity is an evoutionary necessity. And the potential for disproportion between the foetal head and the pelvis explains a lot of the problem of labour, and, sadly, worldwide maternal mortality.

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