Abortion methods: European issues

C. Fiala

Department of Obstetrics & Gynecology, Hospital Korneuburg, Vienna, Austria

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.