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The Grievance of Loss: A Comparative Essay on Miscarriage and Abortion
Prior to the twentieth century, medical professionals used the term “abortion” to refer to both spontaneous and induced ejection of a fetus from the uterus. Moscorp explains that at the time in Britain, the words “abortion” and “miscarriage” were used interchangeably. However, women demanded that the terms be separated (2013). The interchangeability of the terms is rather understandable since, ultimately, both refer to the loss of a child within a mother’s womb. Even today, when the use of both terminologies is established, “miscarriage” and “abortion” are often conflated. However, these two are distinct from each other, with one being accepted by society while the other is criminalized. This compare and contrast essay attempts to demonstrate the differences between miscarriage and abortion. Such a delineation is relevant today in the context of the overturning of Roe v. Wade and the re-emerging criminalization and tighter controls on abortion rights, which may inevitably affect miscarriage as well.
Miscarriage: A Traumatic Experience
Miscarriage (sometimes referred to as spontaneous abortion) is the “spontaneous loss of a nonviable, intrauterine pregnancy” (Weigel, Sobel, & Salganicoff, 2019). Pregnancy loss may occur at different stages of the pregnancy. Weigel, Sobel, and Salganicoff (2019) use the term “pregnancy loss” to refer to spontaneous loss regardless of the stage of pregnancy. Clinical pregnancy loss or miscarriage refers to pregnancy loss that occurs after ultrasound detection of the intrauterine gestational sac (Abdelazim, AbuFaza, Purohit, & Farag, 2017). This is categorized into two: pre-clinical and clinical pregnancy loss. Pre-clinical pregnancy loss is further divided into two: early clinical and late clinical miscarriage. Early clinical miscarriage occurs before implantation (less than 12 weeks) while late clinical miscarriage occurs post-implantation (12 to 21 weeks). Meanwhile, any miscarriage that happens after 21 weeks is categorized as clinical pregnancy loss.
Miscarriage is a common occurrence, as only 30% of conceptions reach live birth (Abdelazim, AbuFaza, Purohit, & Farag, 2017). Maternal age and previous pregnancy loss are the two main risk factors for future miscarriage. The risk of pregnancy loss increases as the woman’s age progresses. Women aged 40 and older have 51% risk of experiencing pregnancy loss, compared with women aged 21 to 25% who have a 10 to 15% risk (Abdelazim, AbuFaza, Purohit, & Farag, 2017). Meanwhile, those who have experienced two consecutive pregnancy losses have a 17 to 25% risk, and those who have had three have a risk of 25 to 46%. Other factors also cause miscarriage, such as chromosomal abnormalities, hormonal imbalances, TORCH diseases or infections (toxoplasmosis; other infections like HIV, syphilis, chickenpox, parvovirus B19, and Zika; congenital heart disease; uterine abnormalities; severe kidney disease; thyroid disease; uncontrolled diabetes; severe malnutrition; womb or cervical dysfunction; use of certain medicines; as well as lifestyle factors (i.e., smoking, alcohol consumption, use of recreational drugs) (Abdelazim, AbuFaza, Purohit, & Farag, 2017; Ada’s Medical Knowledge Team, 2021).
Given the current legal climate concerning pregnancy loss, in particular the criminalization of abortion, it is important to note that regardless of the stage at which the pregnancy loss, or its causes, a miscarriage happens sporadically, sometimes even without the knowledge of the pregnant individual. Thus, miscarriage often involves pain, grief, and trauma from the sudden and unexpected loss of an unborn child.
Abortion: A Personal Choice
Due to legal, technical, professional, and societal developments, a distinction between spontaneous and induced pregnancy loss became significant. Abortion is the deliberate termination of a fetus from the uterus before it is viable (Oxford Learner’s Dictionaries, n.d.). The primary characteristic of abortion is that it is induced or intentional. Abortion may involve medicine to induce an abortion or a surgical process.
Abortion can be performed in the early stages of pregnancy up to the third trimester. There are different procedures for each gestational stage. Medication abortion is used for an early pregnancy. The two medicines used for this process are mifepristone and misoprostol (“The Abortion Pill,” n.d.). Surgical abortion has two methods: vacuum or suction aspiration and dilation and evacuation. Vacuum or suction aspiration, which can be used to terminate pregnancies of up to 14 weeks, is performed by suctioning the fetus or embryo and placenta from the uterus using a syringe or an electric vacuum aspiration (Burgess, 2022). Dilation and evacuation, used for pregnancies between 12 to 16 weeks, is performed by opening the cervix and removing the fetus or embryo and placenta through surgical instruments or suction. A variation of D&E, called an intact dilation and extraction, which involves surgically removing the fetus intact, can be performed on pregnancies between 18 to 20 weeks (Burgess, 2022). These procedures are easy and can be performed in less than an hour.
The ethics of abortion is one of the most controversial issues in the history of modern society. On the one hand, pro-life and fundamentalist Christian groups say that a fetus or an embryo is a person, which makes abortion murder. On the other, pro-choice groups argue that abortion is a necessary element of healthcare that protects both the health and freedom of women. However, this issue is made more complicated by the fact that people have different reasons for requiring an abortion. Some women seek abortion because they do not yet want to have children. They are not financially or mentally ready for the responsibilities of parenthood. Some, meanwhile, require abortion because pregnancy complications endanger the life of the mother or the fetus (American College of Obstetricians and Gynecologists [ACOG], n.d.). Thanks to the advancement in medical technology, doctors are now able to determine when a pregnancy is endangering the life of the mother as well as if the fetus will be able to survive outside the womb. With such knowledge, abortion becomes a tool or a treatment that could help save a person’s life.
As mentioned, abortion is an extremely controversial topic. Currently, only 13 countries allow abortion based on social or economic grounds, 75 permit abortion upon request (with gestational limits), 50 countries allow abortion to preserve the mother’s health, 42 others permit it to save the woman’s life, while 24 countries have strict laws against abortion (Guttmacher Institute, 2017). The World Health Organization considers access to safe abortion still a major social issue, especially in developing countries. However, the recent overturning of Roe v. Wade in the US demonstrates that this issue is not limited to developing countries. Making safe abortion illegal and, therefore, inaccessible brings about numerous health risks for all people. Women’s health and safety are first to suffer since the inaccessibility of abortion means that doctors cannot perform the procedure even if it is necessary to save their lives (ACOG, n.d.). Meanwhile, the criminalization of abortion also comes with illegal operations that are significantly unsafe. Furthermore, the inaccessibility of abortion also violates various basic human rights, such as the right to life and the right to benefit from scientific progress (Guttmacher Institute, 2017). Regardless of the reason for the individual’s need for abortion, such rights are inalienable.
Both miscarriage and abortion involve the termination of a pregnancy. The main difference between the two is that miscarriage is unplanned and spontaneous, often the result of a complication, while abortion is planned and intended either for personal preference or for the health or safety of the pregnant individual. This key difference is significant to those who experienced miscarriage because the experience is traumatic and was not desired (Moscorp, 2013). In contrast, those who have had abortions may not see their experience as traumatic. However, it is possible that some patients may have sought abortion following a traumatic experience such as rape. Understanding these distinctions is even more important in the US as laws become stricter regarding abortion wherein mislabeling an experience could lead to serious legal repercussions. In any case, both miscarriage and abortion are serious experiences in a person’s life and each individual deserves support, regardless of the circumstances.
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Ada’s Medical Knowledge Team. (2021, October 28). Causes of miscarriage. Ada.com. https://ada.com/causes-of-miscarriage/
American College of Obstetricians and Gynecologists [ACOG]. (n.d.). Facts are important: Abortion is healthcare. Retrieved September 7, 2022. https://www.acog.org/advocacy/facts-are-important/abortion-is-healthcare
Burgess, L. (2022, July 6). What are the different types of abortion? Medical News Today. Retrieved September 7, 2022. https://www.medicalnewstoday.com/articles/325582
Moscorp. A. (2013). ‘Miscarriage or abortion?’ Understanding the medical language of pregnancy loss in Britain; a historical perspective. Medical Humanities, 39(2), pp.98-104. https://doi.org/10.1136%2Fmedhum-2012-010284
Oxford Learner’s Dictionaries. Abortion. In O xfordlearnersdictionaries.com dictionary. Retrieved September 4, 2022, from https://www.oxfordlearnersdictionaries.com/us/definition/english/abortion?q=abortion
Wiegel, G., Sobel, L., & Salganicoff, A. (2019). Understanding pregnancy loss in the context of abortion restrictions and fetal harm laws. Kaiser Family Foundation. https://www.kff.org/womens-health-policy/issue-brief/understanding-pregnancy-loss-in-the-context-of-abortion-restrictions-and-fetal-harm-laws/