Please note that this chapter is available online in the Latvian language
A sound approach to the ethics of abortion must be grounded
in the scientific and medical facts. The facts of prenatal development are
indispensable for determining when human life begins. When those facts are
known, it remains for the ethicist, the physician, the legislator, and society
at large to interpret their moral and legal implications. Many of the questions
that arise from the abortion controversy are directly related to medical
practice: under what conditions, if any, is abortion necessary to save the
life of the mother: Under what conditions, if any, would abortion be indicated
on the grounds of mental health? What methods of abortion are used in America
today, and what medical hazards are associated with these methods? These
and other related questions are central to the contemporary abortion
debate.
The Facts of Prenatal Development [1]
Any discussion of abortion that ignores the facts of prenatal
development in incomplete. The unborn child, after all, is a
End of Page 21 - Begin Page 22
central figure in the abortion controversy. His or her moral and legal
status depends on a careful examination of the process of prenatal
development.
It is most unfortunate that scientific facts known for decades
or longer have been quietly ignored by many proponents of abortion. Arguments
that the unborn child is simply "part of the woman's body," or that human
life does not begin at conception do not accord with the well-established
scientific facts. Even medical authorities personally sympathetic to abortion
acknowledge that. An editorial in California Medicine, the official
journal of the California Medical Association, makes this clear:
The process of eroding the old ethic and substituting the new has already begun. It may be seen most clearly in changing attitudes toward human abortion. In defiance of the long held Western ethic of intrinsic and equal value for every human life regardless of its stage, condition, or status, abortion is becoming acceptable by society as moral, right, and even necessary. . . . since the old ethic has not been fully displaced it has been necessary to separate the idea of abortion from the idea of killing, which continues to be socially abhorrent. The result has been a curious avoidance of the scientific fact, which everyone really knows, that human life begins at conception and is continuous whether intra- or extra-uterine until death. The very considerable semantic gymnastics which are required to rationalize abortion as anything but taking a human life would be ludicrous if they were not often put forth under socially impeccable auspices. It is suggested that this schizophrenic sort of subterfuge is necessary because while a new ethic is being accepted the old one has not yet been rejected. [2]
The inevitable distortions caused by passion and prejudice make it all
the more imperative to keep the scientific facts clearly in focus.
It is a well-established fact that a genetically distinct human
being is brought into existence at conception. During intercourse, some
300,000,000 sperm are deposited in the vagina and begin a journey upwards
through the uterus and into the Fallopian tube leading from the uterus toward
the ovary. If an ovum has been released from the ovary, it passes from the
ovary down the Fallopian tube towards the uterus. The survival time of the
unfertilized egg is
Page 23
thought to be approximately 24 hours. Both sperm and egg will die if
fertilization does not occur within that time period. The newly fertilized
egg, called a zygote, contains the hereditary characteristics of both mother
and father, one half from each, derived from the DNA material, the genetic
thread of life.
The newly fertilized egg contains a staggering amount of genetic
information, sufficient to control the individual's growth and development
for an entire lifetime. A single thread of DNA from a human cell contains
information equivalent to a library of one thousand volumes, or six hundred
thousand printed pages with five hundred words on a page. The genetic information
stored in the new individual at conception is the equivalent of fifty times
the amount of information contained in the Encyclopedia Britannica.
[3]
There is an important qualitative difference between the fertilized
and unfertilized human ovum. Neither sperm nor egg has any capacity for
independent life, and both will die unless they participate in the fertilization
process. Once fertilization has taken place, the zygote is its own entity,
genetically distinct from both mother and father. The newly conceived individual
possesses all the necessary information for a self-directed development and
will proceed to grow in the usual human fashion, given time and nourishment.
It is simply untrue that the unborn child is merely "part of the mother's
body." In addition to being genetically distinct from the time of conception,
the unborn possesses separate circulatory, nervous, and endocrine systems.
Likewise, it is misleading to speak about the newly conceived as "potential"
human life. Prior to conception the sperm and egg represent only the potentiality
of a new human life, but once fertilization has taken place, an actual human
life has begun. More accurately, the newly conceived individual is an actual
life with great potential.
After fertilization the zygote divides first into two cells,
then four, then eight, and so on, at a rate of almost one division per day.
It is now known that during this earliest stage of development the mass of
cells may divide into identical parts forming identical twins. Such "twinning"
may occur until the fourteenth day, though it is relatively uncommon, occurring
in only one out of about 300 births. During these first several days it is
also possible for twins or triplets
Page 24
to be recombined into a single individual. It thus appears that during
the earliest stages of prenatal development, for at least a small fraction
of zygotes, irreversible individuality may not be present. The moral implications
of this eventuality will be considered later.
After the first six or seven days of cell division, which takes
place in the Fallopian tube, the new human life enters the uterus and implants
itself in the uterine lining. This is often called the "blastocyst" stage.
One pole of the growing sphere of cells, called the trophoblast, penetrates
the uterine lining and develops into the placenta. The other pole develops
as the embryonic human being. It is worth noting here that the placenta is
an extension of the child's body, not the mother's. The part of the developing
blastocyst that becomes the placenta produces hormones, which enter the mother's
bloodstream and prevent the onset of menstruation. This hormonal signal sent
to the mother's body from the newly conceived life is essential for its survival,
since otherwise the new life would be sloughed away by the menstrual flow.
Even at this early stage it is the newly conceived individual, rather than
the mother, that takes the initiative in effecting crucial physiological
changes. The newly conceived human being is far from passive in the development
process. The mother provides an environment for the unborn child, but the
child's hormonal system has an active influence on changes in that environment.
[4]
After two weeks of development the name of the new human life
is changed from zygote to embryo. Blood cells are formed by 17 days, and
a rudimentary heart as early as 18 days. The embryonic heart, beginning as
a simple tube, shows irregular pulsations at 24 days and approximately one
week later exhibits rhythmic contraction and expansion.
The development of the nervous system also begins at approximately
the eighteenth day. By the twenty-first day the foundations of the child's
brain, spinal cord, nerves, and sense organs are completely formed. Six weeks
after conception the nervous system is so well developed that it controls
the movements of the child's muscles, though the woman may not yet even be
aware that she is pregnant.
Page 25
By the end of the sixth week, all the internal signs of
the unborn child are present, though yet in a rudimentary form. The brain
is sending out impulses, which coordinate the functions of the other bodily
organs. Reflex responses are present at 42 days, and brain waves have been
noted at 43 days. The blood vessels leading from the heart are fully deployed
and continue to grow in size. The stomach is producing digestive juices,
and the kidneys are beginning to function by extracting uric acid from the
child's blood.
By the end of the seventh week, the child will flex his neck
if the mouth and nose are tickled with a hair. By this time the ears are
also formed and may show the specific features of a family pattern. At about
this time the name is changed from embryo to fetus (Latin, "young one or
offspring").[5] By now the fingers and toes are fully
recognizable. Lines in the hands and fingerprints begin to appear at eight
weeks and remain a distinctive characteristic of the individual. Between
the ninth and tenth weeks local reflexes such as swallowing, squinting, and
tongue retraction begin to appear. If the child's forehead is touched, he
may turn his head away and pucker up and frown. By now the child can bend
the wrist and elbow independently and has the full use of his arms. By this
time the entire body is sensitive to touch and is also capable of spontaneous
movement. Thumb sucking has been observed by the eleventh week, and x-rays
will disclose clear details of the skeleton.
By the twelfth week, the child is swallowing regularly and can
move his thumb in opposition to his fingers. The child, three and one half
inches long by the end of the twelfth week, will have a complete brain structure,
which will of course continue to grow. At this time, as Arnold Gesell has
stated, the unborn child "is a sentient moving being. We need not pause to
speculate as to the nature of his psychic attributes, but we may assert that
the organization of his psychosomatic self is now well under way."
[6]
By this time, the child is active and the reflexes are more
pronounced. Muscular response is no longer mechanical and irregular, but
now graceful and fluid. This motion is present prior to "quickening," when
the mother first notices the child's movements, which generally occurs between
weeks 12 and 16, although some women feel very little movement as late as
20 weeks. It should be clearly
Page 26
understood that the time of "quickening," long considered important in the law, represents a mother's subjective perception, and not an objective point at which "animation" occurs or the first "signs of life" appear. As Dr. Albert W. Liley, a widely recognized authority in fetal medicine, has stated:
Historically, "quickening" was supposed to delineate the time when the fetus became an independent human being possessed of a soul. Now, however, we know that while he may have been too small to make his motions felt, the unborn baby is active and independent long before his mother feels him. Quickening is a maternal sensitivity and depends on the mother's own fat, the position of the placenta and the size and strength of the unborn child. Quickening is hardly an objective basis for making a decision about the existence or the value of the life of the unborn child. [7]
The child grows very rapidly between the twelfth and sixteenth
weeks. He has grown to eight or ten inches in height, and his weight increases
sixfold. At some point between the sixteenth and twentieth week it becomes
possible to hear the child's heartbeat with a simple stethoscope, as well
as by the refined EKG apparatus. By the end of the fifth month, the child
weighs approximately one pound and will be about 12 inches long. Fine baby
hair has begun to grow on his head and a fringe of eyelashes is beginning
to appear. The skeleton is hardening, and the mother can feel the child's
head, arms, and legs. After the twentieth week it is customary to speak of
a premature delivery rather than of a spontaneous abortion.
By the twenty-eighth week, the child weighs slightly over two
pounds, and some definitions of "viability" are fixed at this point. This,
however, is only an approximation. According to Dr. Andre Hellegers of Georgetown
University, 10 percent of children born between 20 and 24 weeks gestation
will survive.[8] The development of an artificial placenta
would push the date of viability back into the earliest stages of gestation.
Modern techniques of intensive therapy are able to save premature babies
that would have been considered non-viable only a few years ago.
The progress of prenatal medicine has made it increasingly clear
that the unborn child possesses a distinct individuality. As Dr.
Page 27
Arnold Gesell has noted:
Our own repeated observation of a large group of fetal infants. . . left us with no doubt that psychologically they were individuals. Just as no two looked alike, so no two behaved precisely alike. . . . These were genuine individual differences, already prophetic of the diversity which distinguishes the human family. [9]
The unborn child is no mere "mass of tissue," but a distinctly individualized human being with a characteristic pattern of behavior. Medical advances have also eliminated the artificial distinction between prenatal and postnatal human life. Dr. H.M. Liley explains:
In assessing fetal health, the doctor now watches changes in maternal function very carefully, for he has learned that it is actually the mother who is a passive carrier, while the fetus is very largely in charge of the pregnancy. [10]
Pregnancy involves the medical care of two patients, not one. The unborn child is not a passive partner, but rather in many ways controls the dynamics of the pregnancy. This new perception of the unborn child has led to the development of a whole new medical specialty called perinatology, which cares for its patients from conception to about one year of postnatal existence. For the modern physician, human life begins at conception, and medical care and observation must start at the earliest period of life.
Techniques of Abortion
There are four common methods of abortion:[11]
dilation and curettage ("D&C"); intrauterine injection of hypertonic
saline solution ("salting out"); hysterotomy; and prostaglandin infusion.
None of these techniques is without risk to the mother.
Dilation and curettage is the technique most commonly used in
first trimester abortions. The cervical muscle ring is first paralyzed and
then stretched open. A curette, a loop-shaped steel knife, is then inserted
into the uterus. The surgeon then scrapes the uterine wall, dismembering
the developing child and scraping the placenta
Page 28
from its attachment on the wall of the uterus. Bleeding is usually profuse.
A common first-trimester alternative is a vacuum aspiration or suction abortion.
The principle is the same as the D & C. After the cervix has been stretched,
a powerful suction tube is inserted into the uterus. The body of the developing
child and the placenta are sucked into a jar, where smaller parts of the
child's body are often still recognizable.
Even these early, first trimester abortions are not without significant
hazards to the woman's health. In a study of 1182 legal abortions at an English
teaching hospital, nearly 17 percent of the patients lost more than 500
milliliters of blood and 9.5 percent required transfusions. There were also
cases of cervical laceration and perforated uteruses.[12]
Another study concluded that perforation of the uterus is an almost inevitable
complication of induced abortion by vacuum aspiration or during any other
form of dilation and curettage.[13] Even so-called "menstrual
extractions" or "lunch hour" abortions performed by vacuum aspiration within
one to three weeks after failure to menstruate have been attended with
complications: the woman's not being pregnant, the implanted ovum's being
missed by the suction curette, and uterine perforation.
[14]
Second trimester abortions are often by salt poisoning. A long
needle is inserted through the abdomen and a solution of concentrated salt
is injected directly into the amniotic sac. The child breathes in the salt
solution and is poisoned by it. The concentrated saline solution burns off
the outer layer of the baby's skin and brain hemorrhages are frequent. It
takes about one hour for the child to slowly die by this method. Approximately
one day later the woman goes into labor and delivers a dead baby.
The salt poisoning technique is common in the United States
in spite of its well-documented hazards. It was used by the Japanese after
World War II but later abandoned because of maternal morbidity and
mortality.[15] Maternal deaths have been reported from
accidental injection of the saline solution into the circulatory system,
from acute kidney failure, from seepage through uterine puncture wounds into
the abdominal cavity, and from infections.[16] Other documented
complications of saline abortions include fevers, cervical lacerations, serious
disruptions of the blood coagulation
Page 29
mechanism, and hemorrhages. [17]
If the pregnancy is too advanced for the D & C or salting
out procedures, a hysterotomy abortion may be performed. The techniques for
a hysterotomy abortion are similar to those for a caesarean section, except
that the incisions made in the abdomen and uterus are smaller. Having been
removed from the uterus, the child is laid aside to die from neglect. This
procedure is even more hazardous for the woman than the salting out procedure.
The potential for accidental rupture during subsequent pregnancies is also
appreciable, especially during labor. [18]
More recently the drugs prostaglandin E2 and
prostaglandin F2a have been widely investigated as abortifacients.
These drugs artificially induce labor and may be administered orally,
intravenously, by vaginal suppositories, or by direct injection into the
amniotic sac. Although usually too small to survive, the child is frequently
born alive. Thus far prostaglandin abortions have produced a number of
significant complications. In one study 30 percent of the women undergoing
prostaglandin abortions experienced vomiting.[19] Other
problems encountered with prostaglandin abortions include incomplete evacuation
of the uterus, hemorrhages, infections, and cervical lacerations.
[20]
The findings of the English study cited earlier accept the overall
medical risks of induced abortions:
The morbidity and fatal potential of criminal abortion is accepted widely, while at the same time the public is misled into believing that legal abortion is a trivial incident even a lunch-hour procedure, which can be used as a mere extension of contraceptive practice. There has been almost a conspiracy of silence in declaring its risks. Unfortunately, because of the emotional reactions to legal abortion, well-documented evidence from countries with a vast experience of it receives little attention in either the medical or lay press. This is medically indefensible when patients suffer as a result. [21]
The well-documented medical evidence shows that induced abortion is far from a simple and hazard-free operation. There has been a dangerous silence concerning the risks of abortion not only in England but also in America. It is high time this silence be broken.
Page 30
Indications for Abortion
Later in this volume we will discuss the problems of rape and
potential birth defects as possible indications for induced abortion. Here
the discussion will focus on psychiatric problems and specific physical
conditions during pregnancy that might be thought to constitute a threat
to the physical health of the mother.
During the last two decades there has been a marked increase
in the number of abortions performed on psychiatric grounds. Prior to the
1973 Supreme Court abortion decisions 90 percent of abortions in Oregon were
performed on such grounds. It is likely, however, that many abortions aimed
at preventing "grave impairments to mental health" were in fact subterfuges
for other social problems and personal inconveniences. Competent psychiatric
opinion is agreed that there are no known psychiatric diseases that can be
cured by abortion; further, there are none that can be predictably improved
by abortion.[22] Nor are there any clear-cut psychiatric
indications for abortion. According to the standard psychiatric textbook
of Noyes and Kolb, experience shows that pregnancy and childbirth do not
adversely influence the course of schizophrenias, manic-depressive illnesses,
or the majority of psychoneuroses.[23] With appropriate
treatment, depressive psychoses carry a good prognosis whether or not the
pregnancy is interrupted.[24]
Threats of suicide are frequently presented as psychiatric
indications for abortion. But as Sloane has pointed out,
Although the risk of suicide is perhaps the most frequently used psychiatric indication for therapeutic abortion, there is almost unanimous agreement that it is extremely rare. Hook in her follow-up study of nearly 300 women could not find a single one who had either committed or attempted suicide during the pregnancy. [25]
The suicide rate among pregnant women in fact appears to be one-sixth
the rate among non-pregnant women of the same age.
[26]
The experience of one British medical social worker indicates
that easy accession to abortion on psychological grounds may in fact be a
grave disservice to the woman:
....the woman's feeling that she cannot tolerate bringing aPage 31
child into the world may be a symptom of a situation such as an inability to cope with married life, and by making abortion too readily available we do little but relieve the patient's immediate suffering for a short time and thus do her no real service, producing in her a sense of guilt which she can redress only by becoming pregnant again as quickly as possible. . . . When talking to the parents of these unborn children one must at all times be aware that what may at first seem to be an uncompromising attitude may swing around to a complete reversal of the original rejection. [27]
Experience shows that maternal attitudes can change, and unwanted
conceptions very often produce wanted children. Psychiatric problems,
then, rarely if ever justify abortion. On the contrary, such problems call
for the proper mental health care and emotional and spiritual support needed
by pregnant women in difficult circumstances.
But are there physical conditions that might constitute valid
indications for abortion? According to one recent authority, there are in
general "very few absolute contraindications to pregnancy and even these
are gradually disappearing with modern medical
advances."[28] As a result of these advances, it is now
extremely rare for any pregnancy to be so hazardous to a woman as to necessitate
abortion. Pregnancy, labor, and delivery, if properly managed, have no
deleterious effects upon a pregnant woman suffering from
tuberculosis.[29] Organic heart disease occurs in only
one or two percent of pregnant women, and only about one in ten of these
is serious enough even to consider an induced abortion.[30]
Pregnant women suffering from diabetes or kidney disorders can, with very
few exceptions, be brought safely to term.[31] A few diseases,
such as rheumatoid arthritis, are actually improved during
pregnancy.[32] Given this favorable outlook for pregnant
women with medical complications, it is not surprising that a study reported
to the World Health Organization found that, even in the permissive contemporary
abortion climate, patients who had abortions on medical grounds formed only
four to six percent of most reported series.[33] It is
likely that, had optimal medical care been available, the latter figures
would have been even lower.
Page 32
Admittedly, there are those tragic situations, fortunately
rare, where induced abortion may be necessary to save the life of the mother.
Two such circumstances involve an ectopic (tubal) pregnancy and a cancerous
uterus. Without intervention in such cases, both mother and child may perish.
The motive for surgical intervention is not to end the child's life but to
save the life that has some reasonable chance of survival, i.e., the mother's.
The death of the child is a secondary result of the lifesaving intervention.
Given present medical technology, the unborn in such circumstances have little
or no chance of survival. But with new medical advances, which will hasten
viability, such tragic dilemmas should be even less frequent, if not
eliminated.
Complications of Induced Abortion
The most serious complication of induced abortion is, of course,
the death of the mother. Proponents of abortion cite data from Eastern European
countries and the United States to the effect that abortion is "x-times as
safe as childbirth." The limitations of such an argument have been pointed
out by other writers.[34] For example, maternal deaths
related to abortion may simply go unreported or, if reported, may be attributed
to other causes. That would artificially deflate the actual maternal death
rate. Moreover, isolating attention on maternal mortality rates overlooks
two other very important considerations, namely, the death of the unborn
child, and nonfatal injuries to the woman. Two individuals, not one, are
at risk in an abortion, the child being subject to direct assault. And
furthermore, evidence from many countries around the world indicates that
women in America are not being fully informed about the long-term hazards
of what has become our nation's most common surgical procedure.
As we have already noted, a study of 1182 abortions performed
in an English teaching hospital showed that nearly 17 percent of the patients
lost more than 500 milliliters of blood and 9.5 percent required blood
transfusions. Other women suffered cervical lacerations, perforated uteruses,
peritonitis, and septicaemia. [35]
Studies performed in Greece indicate a clear connection
between
Page 33
induced abortion and subsequent stillbirths, premature births, and
sterility. One study was made of 13,242 women who were admitted for delivery
over a two-year period at hospitals in Athens. Of the 8,312 women whose pregnancy
was not the first, 29 percent admitted to one or more induced abortions.
Among that group, the average number of abortions was two. The percentage
of premature births and stillbirths among the women with previous abortions,
spontaneous or induced, doubled that of the control
group.[36] Another study conducted in Athens carefully
matched the women surveyed with a control group of similar age, socioeconomic
background, and previous childbearing history. The researchers found that
the relative risk of subsequent sterility among women with at least one induced
abortion and no spontaneous abortions was 3.4 times that among women without
any induced or spontaneous abortions. The study concluded that in Greece
about 45 percent of the cases of secondary infertility may be attributed
to previous induced abortions. [37]
A study conducted in the Hebrew University-Hadassah Medical
School in Jerusalem examined the effects of induced abortion on the outcome
of subsequent pregnancies. Of 11,057 pregnant women interviewed in West
Jerusalem, the 752 women who disclosed one or more induced abortions in the
past were more likely to report bleeding in each of the first three months
of their current pregnancies. They were also less likely to have a normal
delivery, and more of them needed a manual removal of the placenta or other
obstetrical intervention during the final stage of labor. Increases were
found in major and minor birth defects. There was a significant increase
in the incidence of low birthweights. [38]
Physicians from Eastern European nations such as Yugoslavia,
Czechoslovakia, and Hungary, where abortion has been legal for many years,
are now calling attention to the significant complications arising from
permissive abortion policies. According to J. Jurukovski and L. Sukarov,
in Hungary the rate of premature births is 11 to 12 percent overall, rising
to 15 percent in towns. "There seems little doubt that there is a true
relationship between the high incidence of induced abortion and prematurity,"
according to these researchers.[39] They also conclude
that the total incidence of complications
Page 34
following induced abortions is considerably higher than usually reported, probably on the order of ten percent.[40] Alfred Kotasek, a Czechoslovakian researcher studying the effects of induced abortion in his own country, found that acute inflammatory complications occurred in about five percent of the cases. Other complications, including chronic inflammation of the genital organs, sterility, and tubal pregnancies, were registered in about 20 to 30 percent of all women having induced abortions. Also observed was a high incidence of cervical incompetence, increasing the risks of miscarriage during future pregnancies.[41] These disturbing findings by Eastern European investigators are reflected in the conclusions drawn by Yugoslavian physicians after a study of over 80,000 abortions performed in that country:
In the light of our long experience . . . we must conclude that even in cases of legal abortions, despite improvements in abortion techniques, the woman suffers both physically and emotionally. This is the overriding medical and ethical consideration which for us completely resolves the choice between legal abortion and contraception." [42]
Thus far, these somber warnings have gone largely unheeded in the United States. Neither the mass media nor the American medical establishment has properly publicized the documented hazards of abortion. As a result, growing numbers of American women now having abortions, many of them unmarried teenagers, may soon awaken to the tragic discovery that they have impaired their health and their childbearing capacities in the process.
Chapter 2 ||
Chapter 4 ||
Table of Contents
1. For the information in this section I am indebted
to Andre Hellegers, "Fetal Development," Theological Studies 31 (1970):
3-9; C.R. Austin, "The Egg and Fertilization," Science Journal 6
(1970):37-42; E.C. Amoroso, "Development of the Early Embryo," Science
Journal 6 (1970): 59-64; Bart T. Heffernan, "The Early Biography of
Everyman," and Albert W. Liley, "The Foetus in Control of His Environment,"
in Hilgers and Horan, eds., Abortion and Social Justice (New York:
Sheed and Ward, 1972), pp. 3-36.
2. California Medicine 113, no.3 (1970), reprinted
in The Human Life Review 1, no.1 (1975): 103-4.
3. R. Houwink, Data: Mirrors of Science (1970), pp.
104-90, cited by Heffernan, "Early Biography of Everyman," p.4.
4. The active nature of the unborn child is detailed in Liley,
"Fetus in Control." pp. 27-36.
5. This Latin term is used in medicine to refer to the unborn
child from approximately eight weeks until birth. Since it has tended to
depersonalize the unborn in the abortion debate, many prefer to use the
terminology "unborn child," which more accurately communicates the real genetic
and physiological continuity of prenatal and postnatal human life.
6. Cited by Heffernan, "Early Biography of Everyman," p.15.
7. Ibid.
8. Ibid., p.17.
9. Arnold Gesell, The Embryology of Behavior (1945),
cited by Heffernan, "Early Biography of Everyman," pp. 17, 18.
10. H.M. Liley, Modern Motherhood (1969), cited by
Heffernan, "Early Biography of Everyman," p.18.
11. Much of the information in this section is drawn from
David N. Danforth, ed., Textbook of Obstetrics and Gynecology (New
York: Harper and Rowe, 1971); Jack Pritchard and Paul McDonald, Williams'
Obstetrics (New York: Appleton Century Crofts, 1976); C. Everett Koop,
The Right to Live: the Right to Die (Wheaton, Ill.:Tyndale House,
1976); J.C. Willke, Handbook on Abortion (Cincinnati: Hayes, 1975).
12. J.A. Stallworthy et al., "Legal Abortion: A Critical
Assessment of Its Risks," Lancet, December 4, 1976, p. 1245.
13. Peter J. Moberg, "Uterine Perforation in Connection
with Vacuum Aspiration for Legal Abortion," International Journal of
Gynaecology and Obstetrics 14 (1976):77.
14. Pritchard and McDonald, Williams' Obstetrics,
p. 500.
15. Ibid., p. 504.
16. Danforth, Obstetrics and Gynecology, p. 354.
17. Pritchard and McDonald, Williams' Obstetrics,
p. 505.
18. Ibid., p. 503.
19. M.I Ragab, D.A. Edelman, "Early Termination of Pregnancy:
A Comparative Study of Intrauterine Prostaglandin F2a and Vacuum Aspiration,"
Prostaglandins 2, no. 2 (1976): 275-83.
20. Pritchard and McDonald, Williams' Obstetrics,
p. 505.
21. Stallworthy et al., "Legal Abortion: Its Risks," p.
1245.
22. Fred E. Mecklenberg, "Indications for Induced Abortion,"
in Hilgers and Horan, Abortion and Social Justice, p.39.
23. Lawrence C. Kolb, Noyes' Modern Clinical Psychiatry
(Philadelphia: W.B. Saunders, 1968), p. 447.
24. R. Bruce Sloane, "The Unwanted Pregnancy," New England
Journal of Medicine 280, no. 22 (1969): 1207.
25. Ibid. The study cited is K. Hook, "Refused Abortion,"
Acta Psychiat.Scandinav. 39 (Supp. 168): 1-156, 1963.
26. Mecklenberg, "Indications for Induced Abortion," p.
40.
27. N.M. Cogan, "A Medical Social Worker Looks at the New
Abortion Law," British Medical Journal 2, (1968): 235.
28. E.W. Page, C.A. Villee and D.B. Villee, Human
Reproduction (Philadelphia: W.B. Saunders, 1976), p. 394.
29. Robert E. Nesbitt, Jr., "Coincidental Medical Disorders
Complicating Pregnancy," in Danforth, Obstetrics and Gynecology, p.
435.
30. Page, Villee and Villee, Human Reproduction,
p. 396.
31. Ibid., pp. 396, 399.
32. Ibid., p. 394.
33. R. Illsley and M.H. Hall, "Psychosocial Aspects of
Abortion," Bulletin of the World Health Organization 53, no. 1 (1976):
89.
34. See Thomas W. Hilgers and Dennis O'Hare in New
Perspectives on Human Abortion (Frederick, Md.: University Publications,
1981), pp. 69-91. Willard Cates, Jr. et al., "Legal Abortion Mortality in
the United States," Journal of the American Medical Association 237,
no. 5 (1977): 452-55, argues that induced abortion in the first trimester
is almost nine times safer than childbirth. While Cates and his coworkers
have attempted a comprehensive data search, he admits that "we cannot be
certain that all deaths related to legal abortion have been reported" (p.452).
This leaves open the possibility that the actual maternal death rate from
abortion is significantly higher than concluded in the study.
35. Stallworthy et al., "Legal Abortion: Its Risks,"
p.1245.
36. Stafanos N. Pantelakis et al., "Influence of Induced
and Spontaneous Abortions on the Outcome of Subsequent Pregnancies,"
American Journal of Obstetrics and Gynecology 116, no. 6 (1973):
799.
37. D. Trichopoulos et al., "Induced Abortion and Secondary
Infertility," British Journal of Obstetrics and Gynecology 83 (1976):
645.
38. S. Harlap and A.M. Davies, "Late Sequelae of Induced
Abortions: Complications and Outcome of Pregnancy and Labor," American
Journal of Epidemiology 102, no. 3 (1975): 217.
39. J. Jurukovski and L. Sukarov, "A Critical Review of
Legal Abortion," International Journal of Gynecology and Obstetrics
9, no. 3 (1971): 115.
40. Ibid.
41. Alfred Kotasek, "Artificicial Termination of Pregnancy
in Czechoslovakia," International Journal of Gynecology and Obstetrics
9, no. 3 (1971): 119.
42. B. Beric et al., "Accidents and Sequaelae of Medical
Abortions," American Journal of Obstetrics and Gynecology 116, no. 6 (1973):
813-21.