Medical Aspects of Abortion

By Dr. John O’Keeffe

In this article I would like to go over some of the facts about abortion in Colorado. I will discuss the types of abortion and their techniques as well as complications and psychosocial issues. Other articles will discuss the ethics of abortion.

In 2022 there were 14,154 abortions in Colorado with 28 % due to abortion tourism- women from states with strong anti-abortion laws. Chemical abortions accounted for 62% of this total with suction curettages occurring in 24% and dilatation and surgical evacuation another 4 %. There were 487 surgical abortions in pregnancies of 21 weeks or more. Altogether, about one out of six pregnancies end in abortion here in our state, and one-third of Colorado women have had an abortion.

First, it must be stated that birth control is not 100% effective. Women who use the “pill” have a 9/100 chance of becoming pregnant. In approximately 2.6% of pill cycles, the woman ovulates and conception can occur. The pill blocks implantation, so these fertilized eggs do not have a chance for development of pregnancy. This results in the abortion of the newly conceived life. Ovulation and failure to implant a fertilized egg also occurs in 1% of IUD users. Most barrier methods have failure rates of 10-30%.

Many women desire emergency contraception after unprotected sex. Plan B involves taking a progesterone medication that delays or prevents ovulation but does not affect a developing pregnancy. 15 million units of Plan B are sold a year at $40 per package. Emergency insertion of an IUD is also used for emergency contraception.

Once a woman knows she has an unwanted pregnancy, medical abortion is the most common method used — about 62% of abortions in Colorado. This method involves two medications — mifepristone (RU 486) which terminates the pregnancy, followed 48 hours later with misoprostol, which causes uterine contractions to expel the fetus. Medical abortions are done in the first 12 weeks of pregnancy and are 95% effective. In 5% of cases, a woman will need a surgical procedure if the fetus is not totally removed. Bleeding and cramping can be severe with this method. This treatment can be delivered by mail and costs $500-$1500.

Surgical abortions include vacuum aspiration (less than 14 weeks), dilation and evacuation (12-18 weeks) and dilation and extraction (18-22 weeks). These are all highly effective and have low complication rates but damage or rupture to the uterus leading to sterility can happen. The cost for these ranges from $800-$2500. Science has shown that, at 20 weeks, fetal response to pain is present, making late term abortions a form of cruelty to the fetus. Viability in Colorado is now at 22 weeks of pregnancy. 

Prenatal screening is another factor that influences abortion. In an obstetric practice a first trimester patient is offered blood tests and ultrasound to screen for Down’s (1 in 700 pregnancies) and other chromosomal disorders. In the second trimester a “quad screen” is used to detect Down’s, trisomy 18, neural tube defects and other genetic abnormalities. A quad screen consists of 4 blood tests: estriol, alpha feta protein, beta hcg, and inhibin A; and these can detect Down’s in 77% of cases. If these tests are positive, diagnostic procedures are done: ultrasound, chorionic villus sampling and amniocentesis. These tests are used to confirm screening abnormalities but are also not 100% accurate and may result in pregnancy loss or false positive results, with a healthy baby being falsely diagnosed as having a chromosomal abnormality. Women are often guided down the abortion pathway if suspicions of genetic abnormalities are high.

In the case of ectopic pregnancies, the first duty of a physician is to protect the life of the mother; if she dies, the baby will die as well. These ectopic pregnancies are not viable and are always treated medically or surgically. 

Abortion kills twice — the life of the baby and soul of the woman. 81% of post-abortive women have mental health concerns, and there is a 4.1:1 increase in suicides in this group. Abortion is not medical care, and the active killing of preborns cannot be justified by a constitutional right to abortion. We have three natural rights that come from God: the right to life, the right to liberty, and the right to pursue happiness. The last two do not exist without the right to life. The preborn are persons — self moving, self directing, and self perfecting. Protecting life is truth spoken to power.

(Dr. John O’Keeffe is a family practice physician and a member of St. Francis of Assisi Parish in Colorado Springs.)