Abortion as Social Policy

  • Adrieme S. WalkerEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-31816-5_2646-1

Keywords

American Medical Association Plan Parenthood Medical Abortion Legal Abortion Supreme Court Ruling 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Synonyms

Definition

Abortion is the termination of the process of gestation after the time when the zygote attaches itself to the uterine wall – normally 14 days after conception, but before the fetus is possibly capable of surviving on its own – normally 23–28 weeks from conception (Robinson 2015). A zygote is a fertilized ovum. An ovum is the mature sex cell generated by females in an ovary. Induced abortions are the intentional termination of a pregnancy before the fetus can live independently. An abortion may be elective, which is based on a woman’s personal choice, or therapeutic. Therapeutic abortions are abortions performed to save the life of the pregnant woman, prevent harm to the pregnant woman’s physical or mental health, terminate a pregnancy where indications are that the child will have a significant increased chance of premature morbidity or otherwise disabled, or reduce the number of fetuses to lessen health risks associated with multiple pregnancies (James and Roche 2004).

There are two types of common abortions – medical abortion and surgical abortion. A medical abortion is one that is brought about by taking medications that will end a pregnancy. The alternative is surgical abortion, which ends a pregnancy by emptying the uterus (or womb) with special instruments (Dudley and Mueller 2000). Dilation and curettage are the standard pregnancy practice performed for reasons such as examination of the uterine lining for probable malignant cells, examination of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. Mifepristone is an antiprogestogenic steroid, used in the medical termination of pregnancy. Methotrexate is an antimetabolite drug that works by separating fetal cells, consequently blocking the fetus from progressing any further.

An embryo is the stage of prenatal development which extends from 2 to 8 weeks after fertilization for human beings. A fetus is a Latin word meaning offspring, bringing forth, or the hatching of young. Fertilization is the process that starts when a sperm connects with an ovum. It ends with the combining of chromosomes from both the sperm and ovum to produce a full set of chromosomes, which are 46 in most humans. A trimester is a period lasting 3 months. A human pregnancy is often divided into three trimesters (9 months), between fertilization to birth. Viability is the ability for the developing fetus to live on its own if it were delivered by cesarean section or by normal delivery, and given expert medical care. This typically occurs sometime after the 21st week of gestation or the 19th week following fertilization. By about the 23rd week gestational age or the 21st week following fertilization, on the order of 60% of fetus can survive outside the womb. The US Supreme Court defines viability as “potentially able to live outside the mother’s womb, albeit with artificial aid.” Pro-choice is a belief that women should be given access to abortions if she wishes to terminate a pregnancy. Pro-life is a belief that human life becomes a human person during the conception process when a unique DNA is produced. Thus the lives of all pre-embryos, embryos, and fetuses should be protected under law until birth.

Introduction

Abortion has been used as a social policy since the late eighteenth century in the United States. Abortion is an issue that women all around the world have encountered. Since 2011, nearly half of pregnancies among American women were unintended, and about one in ten of these were terminated by abortion. Since the 1970s, there have been over 60 million unborn humans disposed through the policy of abortion. Women choose to have abortions for numerous reasons. Some feel they are too young for the duties of parenthood. Some are not in a stable relationship or worry about being a single parent. Financially, some cannot afford a child; some do not want their life’s or career goals disturbed. Some pregnancies involve health reasons such as unhealthy fetus. The US Supreme Court struggles with the issue of abortion and, at present, is more concerned with the process of abortion than whether or not abortion is an appropriate social policy.

History

The theoretical background of abortion requires members of the American political community to embrace the role of citizen-nachahmer, in the pursuit of truth about public action and the intimate consequences from those actions (Slack 2011). The core value of morality is an intimate social gospel, which citizen-nachahmer is charged with seeking through civic costly grace and through outward justice as holders of government positions. Dietrich Bonhoeffer rationalized that when the word of God and the “real” – the world created by God and given to us – are not in sync, it is the responsibility of the citizen-nachahmer and the government to modify the real so that it is in unity with the morality found in sacred document (Slack 2011). The Roman Catholics and other evangelical Christians form a major section within the pro-life society, which could also be viewed as citizen-nachahmer. These groups generally disagree with abortions and approve of executions related to convicted murderers. Pro-life supporters would allow abortions under the following circumstances:
  • Some would allow abortions only if needed to save the woman’s life.

  • Some would allow abortions to women who have become pregnant through rape or incest.

  • Some would allow abortions for women who would suffer serious or permanent disability if the pregnancy were allowed to continue.

Social and Medical Acceptance of Abortion in the United States

In 1795, Marquis de Sade published his La Philosophie dans le boudoir, in which he proposed the use of induced abortion for social reasons and as a means of population control and in the social acceptance of abortion in the United States. Prior to Marquis de Sade, induced abortion had not been discussed in public; de Sade’s writings about induced abortion received the vocal point which begin to spread in Western society. For medical justifications, abortion was also viewed as an acceptable alternative to the cesarean section procedure. The first such modern reference was by William Cooper, a Doctor of Medicine in London who in 1769 suggested the possibility of inducing abortion as an alternative to the cesarean operation, in order to resolve undeliverable pregnancies in cases of pelvic disproportion (Farr 1980). This medial justification was accepted by many obstetricians in Europe, and during the latter half of the nineteenth century, “the indications, especially in Germany, were extended to include tuberculosis, heart disease, nephritis, and certain forms of psychosis” (Page 1972). By 1880, all states had regulated abortion, but many states continued to permit abortions when there was a threat to the life of the mother or a serious threat to her health as determined by a physician (Mohr 1978).

Abortion and the American Medical Association

The American Medical Association (AMA) was formed in 1847; this association quickly made the criminalization of abortion one of its highest priorities, a move based not on moral objections to abortion but rather because the issue served so well as the center of the new organization’s professionalizing project (Starr 1982). The objective of the AMA society was not to forbid all abortions; the AMA suggested that physicians should regulate the terms under which any abortions took place. The AMA would change its opinion from the nineteenth century to the post-World War II era. In 1970, the AMA voted in favor of legal abortion, thereby reversing its campaign of some 100 years earlier to criminalize the procedure (Joffe et al. 2004). The AMA resolution that was passed by its House of Delegates contained the statement that doctors should not provide abortions “in mere acquiescence to the patient’s demand” (Halfmann 2003).

Abortion as a Tool for Population Control

During the nineteenth-century struggles of a fast-growing population, abortion was encouraged as a form of limiting the “consequences” of immigration. During the beginning of the late nineteenth century, immigrants were mainly from Eastern and Southern Europe and Russia, many of the Jewish faith. After World War I, the mood in America continued to favor restricting immigration. Abortion found effectiveness in the nineteenth century as the country became more industrial, and hence, larger families (needed on the farm) were not needed in factory life – in fact larger families became a liability of cost in the emerging urban life.

The Comstock Law of 1873 declared birth control and abortion information obscene and banned it from the US mail. Many states passed laws against contraception because there was a fear that immigrant groups tended to have larger numbers of children than white Americans born in the United States. White Americans feared that immigrants had come to dominate society if white, Protestant women did not have more babies. In 1920, Margaret Sanger, advocate of planned parenting (now known as Planned Parenthood) and founder of the American Birth Control League, wrote “Racial Quotas in Immigration” for her Birth Control Review, advocating controlled immigration of slaves, Hebrews, and Latinos because of their “lesser intelligence abilities.” Sanger’s Planned Parenthood guided the battle to have the Comstock Law reversed. In 1932, Sanger’s article, “A Plan for Peace,” in Birth Control Review suggested a Congressional Department to keep the doors of immigration closed to certain aliens, such as the feeble minded, epileptic, prostitutes, and criminals. The Comstock Law was declared unconstitutional in 1938, although state laws against birth control remained.

Types of Abortion

Medical Abortions

Medical abortions became available in the United States in the early 1970s. The procedure is noninvasive and involves no surgical instruments. During this procedure, anesthesia is not involved, and with this particular abortion, drugs are given orally or via injection. Medical abortions demand multiple visits to the doctor. With the medical abortions, women may see the insides of the womb as it is forced out, and it is common that the bleeding occurs more after medical abortions than after a surgical abortion.

In 2003, methotrexate and mifepristone were the drugs that became available in the United States in order to induce abortion. Methotrexate works by separating fetal cells, consequently blocking the fetus from progressing any further. Methotrexate is used in union with misoprostol, which is a prostaglandin (fatty acid) that arouses contractions of the uterus. Methotrexate may be taken within 49 h after the first day of the last menstrual cycle. An injection of methotrexate is injected on the first visit to the doctor. On the second visit, which is normally within a span of 1 week from the first visit, the woman is vaginally given misoprostol to stimulate the contractions of the uterus. Within 2 weeks after the second visit, the woman will flush out the insides of the uterus; this in turn ends the pregnancy. To ensure that the abortion is effectively complete, a follow-up visit is highly recommended. Mifepristone works by hindering the achievement of progesterone, which is a hormone necessary for pregnancy to carry on. In 2000, mifepristone was approved by the Food and Drug Administration (FDA) as an alternative to surgical abortion. Mifepristone may be taken within 49 h after the first day of the last menstrual cycle; the woman is given a single mifepristone pill. After 2 days of taking the mifepristone pill, the woman returns to the doctor to determine if the pregnancy has been aborted; if the pregnancy has not been aborted, the doctor then gives the woman two misoprostol pills, which in turn will cause the uterus to contract. During the third visit, the doctor will observe via ultrasound that the abortion is carried out fully. If the pregnancy has not been aborted by the third visit, a surgical abortion is then carried out; surgical abortions are utilized due to the fact that the fetus may be impaired.

Surgical Abortions

Surgical abortions are one of the most common utilized abortions. During the first 12 weeks, suction aspiration or vacuum abortion is the most common method. This particular type of abortion is known as the manual vacuum aspiration (MVA) abortion, and it involves the removal of the fetus or embryo, placenta, and membranes by suction using a manual pump. The electric vacuum aspiration (EVA) method uses an electric pump. Manual vacuum aspiration is known as “mini-suction” and menstrual withdrawal. The manual vacuum aspiration can be used in early pregnancy and does not involve cervical dilation.

Dilation and curettage (D&C) is the second most used method of surgical abortion. Dilation and curettage is the standard pregnancy practice performed for reasons such as examination of the uterine lining for probable malignant cells, examination of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. Dilation and curettage involves gentle stretching of the cervix with a series of dilators or specific medications The inside of the uterus is at that time removed with a tube attached to a suction machine, and the walls of the uterus are cleaned using a slender loop called a curette. During the 15th week of gestation up until the 26th week, there are other techniques that are required to be used. Dilation and evacuation (D&E) consists of opening the cervix of the uterus and evacuating it using surgical utensils and suction.

Some of the advantages of the surgical abortion are that it is usually done as a 1 day outpatient procedure; the procedure takes roughly around 10–15 min, bleeding after the abortion lasts for duration of 5 days or less, and the woman does not visually witness the products of her womb being removed. The disadvantages are that this practice is invasive, and infections may occur.

Abortion and the Law

Abortion has been a legal procedure in the United States since 1973. In 1973, Roe vs. Wade, 410 US 113 overturned abortion laws in the United States by making it legal for all women to receive an abortion during the first trimester of pregnancy. The Roe vs. Wade court cases have advanced toward a more legal right to decide who gets the privilege of deciding when abortions are deemed legal. Legally, with the Roe vs. Wade, 410 US 113 rulings, within the third trimester of a woman’s pregnancy, the unborn child reaches a point of viability which grants it the right not to be aborted. There are certain exemptions to this ruling, such as heinous events such as rape, incest, or if the birth shall bring harm to the well-being of the mother. The legalization in 1973 advanced abortion to the forefront of both the political and legal debates where it remains in today’s societal debates, with advocates and challengers mixed up in encounters over what type of problem it is and what can and should be done about it. Politically and legally, Roe vs. Wade, 410 US 113 is the not the only Supreme Court ruling related to abortion. Other cases that followed the Roe vs. Wade, 410 US 113 case were the Akron vs. Akron Center for Reproductive Health, 462 US 416, 431–39 (1983), Webster v. Reproduction Health Services, 492 US 490, 507–11 (1989), and Planned Parenthood vs. Casey, 505 US 833, 846–53 (1992).

The Planned Parenthood vs. Casey, 505 US 833, 846–53 Supreme Court ruling placed more restrictions and limitations on abortion. Planned Parenthood vs. Casey, 505 US 833, 846–53 ruling sanctioned that there be a 24 h waiting period and a minor needing to have parental consent, and the abortion provider has to be responsible and required to retain records as being legitimate. The Planned Parenthood vs. Casey, 505 US 833, 846–53 ruling also provided the fairness and equivalence of both men and women by declaring a spousal consent clause unconstitutional under the 14th amendment; this means the husbands should not have an unconstitutional rejection over a female’s decision to have an abortion.

The Supreme Court sets standards concerning significant social policy issues, and their former rulings act as a key character in determining the correct and fair-minded choice on the issue. The verdicts of the Supreme Court rest very profoundly on the judges who hold positions as Supreme Court justices. A more liberal-minded Supreme Court would passionately sponsor the woman’s right to decide what she does with her own body. On the other hand, a Supreme Court that consists of more conservative judges would be more persuaded to compete with making pronouncements that would intensify the precedent established in Roe vs. Wade, 410 US 113.

In 1992, the Supreme Court in Planned Parenthood of Southeastern Pennsylvania vs. Casey, 505 US 833 overruled Roe’s strict trimester pregnancy policy of state abortion regulation and replaced it with the “undue burden” standard. The obscurity of the undue burden standard permitted several states to endorse an assortment of restrictive abortion laws. Restrictive state abortion regulations may persuade the possibility of women aborting an undesirable pregnancy in two ways. First, these restrictive abortion laws may cost financial costs such as out-of-pocket cost of the abortion, expenses on travel and accommodations, lost work time, and/or childcare expenses to increase. Additionally, the emotional burdens such as guilt, remorse, regret, humiliation, and psychological trauma experienced by women getting an abortion may arise. Second, restrictive abortion laws may lessen the access of abortion amenities by condensing the quantity of abortion providers resulting in an increase in women’s search locating an abortion provider and time costs associated with obtaining an abortion. The more restrictive the abortion law, the costlier the abortion. If abortions become too overpriced, women may have less of them. The method in which restrictive state abortion laws modify women’s pregnancy resolution decision-making calculus can be fairly answered.

In 2003, Congress and President Bush approved the Partial-Birth Abortion Ban Act of 2003 (Public Law 108–105, 117 Stat. 1201, 18 U.S.C. § 1531, PBA Ban), which rules out the dilation and extraction (D&X). The D&X procedure can be performed both after late-term miscarriages and in late-term abortions. In 2004, another legal decision that modified the lawfulness of abortion is the Unborn Victims of Violence Act of 2004 (Public Law 108–212). The Unborn Victims of Violence Act of 2004 (Public Law 108–212) proposed that any violent crime against a pregnant woman counts as two separate crimes: one against the woman herself and the other against the unborn child. This, in turn, has heightened the debated discussions regarding abortion for the reason that it appears as an oxymoron to permit the fetus to be measured as a person in illegitimate proceedings, nevertheless, still allowing abortion to be regarded to as permissible. This further adds to abortion being viewed as a social policy due to the fact that it is conflicting to provide a fetus rights as a human while still granting a woman the legal right to decide on abortion as an option.

Conclusion

Abortion is viewed as a social problem in the United States. Some abortions are turned to as the outcome of societal pressures such as the disapproval of single motherhood, people with disabilities, scarce monetary funding for families, or lack of access to or rejection of contraceptive methods. For almost two centuries, women’s reproductive procedures, including abortion, have drawn the awareness of a wide range of social players such as medical professionals, politicians, religious groups, legal professionals, scientists, women’s rights organizations, and several other groups and individuals taking a keen interest in the issue. Abortion has continuously held a significant place in the sociopolitical debates, uneasily placed in the crossing of medicine, women’s rights, and morality. The right to life, the right to liberty, the right to security of person, and the right to reproductive health are all major issues of human rights that are sometimes used as explanation for the presence or absence of laws influencing abortion.

In places where abortion is legal, detailed conditions have to be met before a woman may obtain a safe, legal abortion. In the United States, these prerequisites usually are determined by the age of the fetus, often using a trimester-based system to regulate the view of legality, or as in the or on a doctor’s appraisal of the fetus’ viability. Also, some authorities require a waiting period before the abortion procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion. One of the most problematic things to debate when it comes to abortion is how to make a broad policy that satisfies the needs of majority of individuals in a given society minus concentrating exclusively on the extreme conservative outlook, the extreme liberal outlook, or the numerous moderate outlooks on the issues of abortion. Policymakers must remember that a decent policy does not rest on life-threatening views but tries to cover as many points of views while being conscious of the fact that one is not able to please every person in society.

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Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Jackson State UniversityJacksonUSA