Abortion methods: European issues

Abortion methods: European issues

C. Fiala

Department of Obstetrics & Gynecology, Hospital Korneuburg, Vienna,


Currently 3 methods are available for first trimester termination of

pregnancy: surgical under general anaesthesia, surgical under local anaesthesia

and medical. Interestingly, the frequency of these 3 methods varies tremendously

by country and also by region within a given country.

The medical method for example is used in 0.8% of all first trimester

abortions in the Netherlands, whereas the figure is around 50% in Scotland and

Sweden. The other countries are in between these two extremes. And the very slow

integration of medical abortion in most countries may reflect the reluctance of

adopting new developments in female reproductive health. This reluctance is in

sharp contrast to other examples in medicine, i.e. Viagra® was rapidly

integrated in the medical system. Another example is general anaesthesia, which

in most countries is the predominant method of analgesia for surgical abortion.

Not so in the Netherlands, where 60% of surgical abortions are performed under

local anaesthesia.

It is unlikely that these huge regional variations in the frequency of

different methods are the result of patient preference. Furthermore, most women

are given only a limited choice concerning the method. It is therefore safe to

assume these differences reflect regional traditions, provider preference and

administrative or legal incentives. They may also be seen as the remains of the

prevailing double standard concerning women with an unwanted pregnancy.

The predominant use of general anaesthesia for surgical abortion has

important implications in another aspect: it reinforces the woman’s

pre-existing fantasies and imaginations about an abortion. At the same time, it

prevents her from correcting these mostly wrong and overdramatic fantasies. The

majority of women have never experienced an abortion before. Their fantasies

about this procedure are therefore entirely based on second-hand information.

But most of the information available to the public is coming from religious

sources. These institutions have no professional experience in performing

abortions and dramatise this intervention by giving wrong information in an

emotional language.

It is no surprise that women coming for an abortion frequently report this

same misinformation. If the health professionals performing the intervention are

offering general anaesthesia in this situation, they do in fact confirm these

erroneous fantasies. Although they claim general anaesthesia would be in the

best interest of the women, this might not necessarily be the case. Instead, the

different methods should be explained in the pre-abortion counselling. Women

should be offered the option to correct their fantasies after professional

counselling and with empathic care during the intervention. Studies evaluating

the psychological status of women after an abortion showed most women were

satisfied with the method they had used provided they had a truly free choice.

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