AAPLOG Statement: Clarification of Abortion Restrictions

With the recent overturning of Roe and Casey, the question of the legality of elective abortion has been returned to the states. As some states seek to restrict elective abortion, there has been confusion about restricting the use of the medications and procedures used for elective abortion. Some of this confusion is a result of unclear terminology surrounding elective abortion. To clarify, elective abortion is defined as those drugs or procedures used with the primary intent to end the life of the human being in the womb. Elective abortion is not treatment of a miscarriage or an ectopic pregnancy nor is it separating the mother and the baby at any gestational age to save a mother’s life. There are no laws in any state in the United States which criminalize treatment of any of these conditions.

Medications used for elective abortion

Elective abortion can be accomplished with the use of the drugs mifepristone and misoprostol. However, these medications have other uses that have nothing to do with elective abortion. Mifepristone is approved for use in Cushing’s syndrome and is being evaluated for use in miscarriage. Misoprostol is used for ulcer prevention, labor induction, cervical ripening, control of hemorrhage, treatment of miscarriage, and pre-treatment for cervical dilation for non-abortion D&C. These lists are not exhaustive. AAPLOG’s position is that any restrictions on elective abortion should not restrict other indicated uses of these drugs.

Surgery

Surgical elective abortion in the first trimester is typically accomplished by a suction aspiration procedure. Related procedures and terminologies include uterine aspiration, dilation and evacuation and dilation and curettage. However, these procedures have other non-abortion uses, most commonly for emptying the uterus after the fetus has spontaneously died (i.e., miscarriage). AAPLOG’s position is not to ban all such procedures but rather to ban (these and any other) procedures only when they are used for the primary intent of ending the life of an embryonic or fetal human being. Additionally, there may be situations in which a patient has an abortion by one practitioner, then presents to another practitioner with retained tissue, or infection. Evacuating the uterus in this situation is providing medical care for a complication, not performing an abortion.

Terminology

The term “abortion” is commonly used in lay language to refer to the intentional killing of the unborn child. However, in medical terminology, the term” abortion” refers to any pregnancy that ends prior to 20 weeks gestation. For example, in medical terminology, a miscarriage is called a “spontaneous abortion,” a miscarriage that has not passed is a “missed abortion,” and a miscarriage that is not complete is called an “incomplete abortion.” A “threatened abortion” is a pregnancy at risk of not surviving. The terms “induced abortion” or “elective abortion” refer to the intentional killing of the unborn child. Restrictions on abortion should not find fault with a doctor using the terms above when treating a miscarriage. Thus, it is imperative that any law be explicitly clear about the meaning of the terms used. State restrictions on “abortion” are restrictions on intentional killing of the developing human and should never apply to caring for women with complications of pregnancy.

Ectopic Pregnancy

Similar confusion has arisen with ectopic pregnancy, a life-threatening condition. Treating ectopic pregnancy is not elective abortion and should never be classified as such. As AAPLOG states elsewhere, “Although treatment for ectopic pregnancy results in the unfortunate death of the embryo, this is not the intent of the treatment.  The intent is to save the life of the mother.  The sole intent of an elective abortion is to end the life of the developing human being. Therefore, legislation restricting elective abortion will not limit a physician’s ability to treat ectopic pregnancy.”[i]

Early delivery of the baby to save the mother’s life.

 There are situations where the mother and the baby must be separated to save the mother’s life. After approximately 22 weeks gestation (viability), babies can survive these separations if the separations are done in situations where both mother and baby can receive intensive care.

There are situations where separations must be accomplished (by induction or cesarean section) before viability. Although this foreseeably results in the baby’s death, failure to intervene can result in the death of both mother and baby.

However, such separations are not the same as elective abortion. There is no medical indication for an elective abortion. The purpose of an elective abortion is to end the life of the developing human being. AAPLOG provides further information in Practice Bulletins and Position Statements.[ii] [iii] [iv]

AAPLOG supports laws which protect both the mother and the human being in her womb. and provides a review of supporting medical evidence in the recent Committee Opinion on State Restrictions.[v] AAPLOG does not support the conflation of elective abortion with other appropriate medical interventions and treatments performed to save the life of the mother. Elective abortion restrictions should be designed to restrict the intentional killing of the developing human and to protect women, not to prohibit using the same medications or procedures for other purposes.