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Abstract
Between August 1969, when the amendment to the Criminal Code went into effect, and December 1978 about 397 000 legal abortions were performed in hospitals with therapeutic abortion committees in Canada. During the 5-year period 1974-78 abortions in females under 20 years of age accounted for 30.9% of all the legal abortions performed in Canada on Canadian residents, and the abortion rate per 1000 women aged 15 to 19 years increased from 13.6 to 16.3. During 1974-77 the proportion of women in whom the gestation period was more than 12 weeks at the time of abortion was 25.3% for teenagers (females under 20 years of age) but only 14.6% for women aged 20 years or over. In 1976 the teenage abortion rate was lower in Canada (14.5) than in the United States (36.2%), Sweden (28.5), Hungary (26.4), Denmark (26.0), Norway (22.7), Finland (20.3), and England and Wales (15.4).
The consequences of childbearing for adolescent parents, their children, and society are severe. We have focused exclusively on one consequence of adolescent sexual activity, namely, pregnancy. In so doing we are not denying the presence of other serious consequences of sexual activity, including sexually transmitted diseases, particularly the acquired immunodeficiency syndrome. For almost all young people, pregnancy should be prevented or at least delayed. Prevention is difficult, however, because it involves understanding the complexities of adolescence as a stage in the development of the individual. It also requires increased understanding of the behavioral and cultural origins of adolescent sexual activity and pregnancy. Physicians are among those with a reasonable understanding of the individual and societal factors that influence the sexual activity of adolescents. Because of their contacts with patients and families, including adolescents, they are in a pivotal position to recognize early sexual activity, to counsel young people about ways to prevent pregnancy, and to prescribe contraceptives when appropriate. Physicians should consider taking leadership positions in the community in both educational efforts and preventive services. In some communities, physicians work closely with educators in developing and teaching family life programs in the schools. They also are in influential positions to improve the availability of preventive contraceptive services through development of community-based services. The Robert Wood Johnson High-Risk Youth Programs are an excellent example of the types of community-based services that should be provided for adolescents. Physicians can serve as an educational resource about a wide spectrum of health issues for young persons and their families and communities.(ABSTRACT TRUNCATED AT 250 WORDS)
the risks of morbidity and mortality affect a teenager's choice between termination of a pregnancy through induced abortion and continuation of the pregnancy. To identify these risks, we analyzed information from two separate sets of data collected by the Centers for Disease Control: that of the Joint Program for the Study of Abortion, a multicenter prospective study of nearly 165,000 legally induced abortions; and that of a national surveillance of abortion-related mortality. The rates of major complications associated with abortions in teenagers were 1 to 3 per 1000 suction-curettage procedures and approximately 13 per 1000 saline-administration procedures. The death-to-case rate for teenage women was 1.3 per 100,000 procedures. When the data on procedures were adjusted according to gestational age, teenagers generally had lower rates of morbidity and mortality from induced abortion than older women.
A search of the literature on the psychiatric aspects of abortion revealed poor study design, a lack of clear criteria for decisions for or against abortion, poor definition of psychologic symptoms experienced by patients, absence of control groups in clinical studies, and indecisiveness and uncritical attitudes in writers from various disciplines. A review of the sequelae of therapeutic abortion revealed that although the data are vague, symptoms of depression were reported most frequently, whereas those of psychosis were rare. Positive emotional responses and a favourable attitude toward therapeutic abortion were often reported, although again the statistical bases for these reports were inadequate. There was a lack of evidence that the reported effects were due to having an abortion rather than to other variables.Other areas dealt with inadequately in most of the articles reviewed included analyses of symptoms and of the evidence on the duration of sequelae, descriptions of the criteria for approving abortions, investigation of the psychiatric histories of the patients, presentation of data on the effects of refusing abortion requests, systematic study of a number of epidemiologic factors, and analyses of the circumstances leading to pregnancy in patients having abortions. The evidence was found to be sparse on the effects of supportive relationships, different abortion techniques and the length of gestation on the psychologic status of patients. Little attention was paid to the consequences of psychiatric labelling of patients, or to the effect of having an abortion on factors that may influence future pregnancies.The potential roles of health care professionals appear to deserve more study, and little research seems to have been done to compare the psychologic factors associated with abortion and those associated with live birth. As well, there is little evidence that differences in abortion legislation account for significant differences in the psychologic reactions of patients to abortion.
The issue of pregnancy among adolescent women has received considerable attention from the media. Contrary to common belief, both the numbers and the rates of such pregnancies, even when data on abortion are included, have been declining. Patterns of contraception may account for some of the decrease; however, more study is required. In the past, unmarried teenagers who became pregnant either got married or put the baby up for adoption. Now they can either have an abortion or keep the baby. Solutions to the problems of pregnancy among teenagers must therefore be addressed to these altered social consequences rather than to misleading comments about "epidemics", with their suggestion of increased rates of pregnancy.
This report presents an overview of current international data on induced abortion, primarily from the demographic and public health points of view. Statistical tabulations make up the major part of the report, with the text providing background information. Opening sections review definitions, sources of data, and concepts of statistical analysis. Major topics for which data are presented include the legal status of abortion (Table 1); incidence of abortion (Tables 2-20); incidence of repeat abortions (Tables 21-23); period of gestation and abortion procedures (Tables 24-27); incidence of abortion with concurrent sterilization (Table 28); complications (Tables 29-31); and mortality (Table 32). The relationships between abortion and contraception (Tables 33-35) and the effects of changes in abortion policies on trends in the numbers of legal abortions, illegal abortions, total induced abortions, and births are evaluated in the final sections (Table 36). Two technical questions are discussed in the appendix (Tables 37-38).
Spontaneous and induced abortion Report of a WHO scientific group
Spontaneous and induced abortion. Report of a WHO
scientific group. WHO Tech Rep Ser 461: 1970