The overarching issues and long term solutions
I feel deep empathy for the patients described by Dr. Gihan Abeywardena, in his article published in MediScene of June 2014. These are deeply moving real life stories that need our wise counsel and empathetic action. There are many examples that I would like to share but time and space would not permit me to do so.
There are a few overarching issues, however, that I like to highlight for the general public before I go into the specifics of abortion as a solution to the three sad scenarios of patients mentioned in the article.
1. The problems highlighted in the article of June 15 illustrate the result of the grave social evils perpetrated by humanity (sometimes close relatives) against humanity. Rape by the brother or incest by the father is a crime against humanity. The end result is pregnancy and a degraded human being for whom abortion is ostensibly mooted as a compassionate “cure”.
These case scenarios are symptoms of a decadent social fabric and fragmentation of the family unit that is unfortunately increasing in our beloved land.
These social evils are the bigger issues that need to be studied and solutions found to value human life, inculcate respect for women and young girls, preserve the sanctity of marriage and fortify the family unit. These social and philosophical issues are extremely pragmatic ones that impact the very core of us, human beings, who are relational people with a history and a culture. But these issues go beyond the remit of the medical profession and medical professionals, even though abortion which is presented as a solution to the pregnancy in the above case scenarios is viewed by medical personnel as a strictly medical issue and the “core” issue.
It is for this reason that social scientists, philosophers, religious leaders, theologians, politicians, ethicists and others enter the fray. Their purpose is not merely to discuss the issue of abortion in isolation but to study the genesis of the social problems and find solutions that teach and propagate sound ethical behaviour founded on a robust and true worldview that reinforces the sanctity of life and marriage, the importance of the family unit which is the basic building block of wider society, respect for women and girls, human rights, concern and care of differently abled people and acceptance of all human beings, however deformed they may be. The degree of civilization of a society and culture is indeed measured by the acceptance and care of the humans the “world” deems deformed, disabled and dysfunctional. We as medical professionals may abort a life and comfort a teenager temporarily but do nothing to prevent a hundred further cases. The second wrong, abortion, neither cures the victim nor deters the perpetrator. Abortion does not address the societal malady. Perhaps, abortion as an instant solution emanates from the “instant, mechanised culture” we inhabit.
2. Having presented the “big” picture, here are a few points relating to abortion. Abortion is clearly termination of a life of a baby. Medical jargon may call the baby a foetus or an embryo. But it is a fact that the baby in the womb is a human being with potential to grow into an adult. The baby is NOT a potential human BUT a human with potential. Doing an abortion is not a simplistic procedure like a tooth extraction or even an appendectomy. A mother carries a baby as part of her body/anatomy but not belonging solely to her. The baby though unborn has inbuilt rights to be nurtured in-utero and be born healthy.
The article summarised two groups of patients. The first group had two teenagers who have been raped and suffer immense mental, emotional, physical trauma not to mention spiritual agony. Therefore, in order to alleviate this pitiful state, we should legalize abortion for this group of people. Let us leave aside the issue of legalization for the moment. Let us try to understand the victims. They have suffered may be several episodes of sexual harassment and now they are pregnant. They may not be able to comprehend what it means to be pregnant and the full responsibilities inherent therein.
Now in this situation, besides all the holistic therapy, abortion is performed. What do medical studies show regarding teenagers and women who have undergone abortion? As I mentioned earlier on, abortion is NOT a simple procedure. It is the termination of a life. May be it was to save a mother from deliberate self- harm. But as the public of this country, who pay for the medical facilities of its citizens, you ought to know the possible consequences to the patients who have undergone abortion.
Short term complications of abortion:
1. Haemorrhage- the RCOG (Royal College of Obstetricians and Gynaecologists) calls this ‘low’ risk because it complicates 1 in 1000 abortions
2. Uterine perforation at the time of surgical abortion- moderate 1-4 cases per 1000
3. Uterine rupture in association with mid-trimester medical abortion-very low
4. Cervical trauma during surgical abortion-moderate, no greater than 1 in 100
5. Failed abortion and continuing pregnancy- necessitating a further procedure
6. Post-abortion infection-up to 10% of cases
Long term complications of abortion:
1. Subsequent preterm delivery- Recent, methodically robust studies have found a positive association between abortion and subsequent preterm delivery. Thorp et al (1) published a detailed review, analysing 24 studies. 12 found the association and 7 found a “dose-response” effect- the more abortions the more the risk.
2. Rooney and Calhoun’s review (2) showed 49 studies had demonstrated a statistically significant increased risk of preterm birth or low birth weight following an induced abortion. This association is further supported by two more recent European studies- EPIPAGE and EUROPOP
3. Increased psychiatric hospitalisation-Reardon DC et al- Canadian Medical Association journal
4. Increased psychiatric outpatient attendance- Coleman PK et al (3)
5. Increased death rates from injury, suicide, homicide – shown in a long term controlled study in Finland conducted between 1987 and 2000. Gissler M et al (4)
6. Higher rates of major depression, suicidal ideation, illicit drug dependence and overall mental health problems-this careful study design confirmed that these increased rates were not due to prior vulnerability and became a landmark 2006 controlled population study from New Zealand. Fergusson D et al (5)
There may be anecdotal evidence that abortion seems to resolve the pressing social problems as enunciated in the article last month. But anecdotal evidence to the contrary could also be adduced for perusal. What is needed is a quantitative evidence base and that which is present for anyone who does a literature survey shows that abortion causes significant rates of serious mental health problems and the evidence is so overwhelming that the American Psychological Association had removed its guidance from its web site in 2007 and has revised it.
In England, the Commission of Inquiry into the Operation and Consequences of the Abortion Act heard as long ago as 1994 from witnesses who were members of the Royal College of Psychiatrists that “although the majority of abortions are carried out on the grounds of danger to the mother’s mental health, there is no psychiatric justification for abortion”. The commission concluded that to perform abortions on this ground was not only questionable in terms of compliance with the law but also put women at risk of suffering a psychiatric disturbance after abortion without alleviating any psychiatric problems that already existed. The Rawlinson Report (6)
There are other psycho-social consequences of abortion:
1. Feeling the need to’ replace’ the baby
2. Inability to maintain normal routine
3. Sleeping problems
4. Flashbacks
5. Tearfulness
6. Relational problems
7. Avoidance behaviour
8. Eating disorders
9. Psychosexual problems
10.Preoccupation with becoming pregnant again-atonement babies
11. Sudden uncontrollable crying
12. Possible link with breast cancer (Gardner G (7) , Brind J. et al (8) , Davidson T(9) )
Effect on attitudes and ethics
When considering abortion and the liberalization of the laws, a ‘permissive attitude’ to abortion devalues our appreciation of fellow human beings. Euthanasia and physician assisted suicide will then have to be considered. If doctors can perform abortion for deformed babies, then why not end the life of an adult who requests it? Or more down the slippery slope why not end the life of a person who is a burden to society?? And then, why not……………….
Hence these issues have to be known and faced before amending laws.
In conclusion, may I suggest that victims of rape, incest be cared for by a multi-disciplinary team of medical professionals and other stakeholders like religious leaders, teachers, social workers, where the child/adolescent will have a home away from home for recovery, treatment, counselling and consideration regarding the ability of the patient to go ahead with the pregnancy. This is a long term, arduous process but that which considers the sanctity of life and the wellbeing of the patient of paramount interest. This certainly does not pander to the ‘instant culture’ of our day and age but takes seriously the traumatised adolescent, the unborn child and the societal issues. This approach is costly but will pay dividends in the long term.
The writer is Consultant Paediatrician, Base (Teaching) Hospital, Gampola