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Take Time to Get the Facts
 
Informed Choice
 
Defining "abortion"
 
Abortion Techniques
First Trimester
Suction Aspiration
Dilatation and Curettage
RU 486
Methotrexate
Second & Third Trimesters
Dilatation and Evacuation
Instillation Methods
Salt Poisoning
Urea
Prostaglandins
Partial-Birth Abortion
          Hysterotomy
 
Is Abortion Safe?
Physical Complications
Psychological Consequences
 
Alternatives to Abortion
 
References

 

Take Time to Get the Facts

Before you decide to have an abortion or advise someone else to have one, get the facts straight. There are alternatives that may be safer and healthier -- both physically and emotionally -- for both you and your child.

No doubt an unwanted pregnancy can cause intense stress and hardship in a variety of ways, but, as you'll read in this booklet, the medical evidence is clear -- the physical and psychological consequences of abortion can be far worse. Nine short months of pregnancy is a relatively small cost to pay in light of a lifetime of potential physical and mental health problems.

Think about it.

Informed Choice

Are you thinking about having an abortion or do you know someone who is? Perhaps that's why you picked up this booklet or maybe you're simply curious. Whatever the reason, you'll find the information that follows straightforward and factual regarding the medical aspects of induced abortion.

When people talk about abortion, one is likely to hear a great deal about the social, moral, and even religious reasons for having or not having an abortion, but little about the basic medical details. In fact, many women make the decision to have an abortion without ever discussing either the medical procedures or the health considerations with anyone. Perhaps no other procedure is performed with this degree of patient ignorance.

It doesn't have to be that way.

American citizens have a right to be informed about things that might affect their health. There is no reason why any woman should go through surgery of any kind, especially induced abortion, or take powerful drugs that induce abortion, and not even be informed about potentially serious side effects.

Inside this booklet, you'll find factual, yet easy to understand information about induced abortion taken from the latest medical texts and journals. That should help you have a better idea of the risks involved. Before making a decision that could change your life forever, it only makes sense to get all the information you can on the procedure and its potential effects on you and the child you carry.

"As American citizens, we have a right to be informed about things that might affect our health..."

Defining "Abortion"

The term "abortion" actually refers to any premature expulsion of a human fetus, whether naturally spontaneous, as in a miscarriage, or artificially induced, as in a surgical or chemical abortion. Today, the most common usage of the term "abortion" applies to artificially induced abortion, which is the subject of this pamphlet.

In 1973, the Supreme Court handed down its Roe v. Wade and Doe v. Bolton decisions legalizing abortion in all 50 states during all nine months of pregnancy, for any reason, medical, social, or otherwise.[1]

The vast majority of all abortions performed today are done for social, not medical reasons -- because a woman doesn't feel ready for a baby at the time, because her partner wants her to have an abortion, etc. Approximately 93% of all induced abortions are done for elective, non-medical reasons such as these.[2]

Abortion ends a pregnancy by destroying and removing the developing child. That baby's heart has already begun to beat by the time the mother misses her period and begins to wonder if she might be pregnant (about 31 days after the mother's last menstrual period or LMP). [3] Surgical abortions are usually not performed before seven weeks, or 49 days LMP. [4] By that time, the baby has identifiable arms and legs (day 45)[5] and displays measurable brain waves (about 40 days).[6] During the seventh through the tenth weeks, when the majority of abortions are performed,[7] fingers and genitals appear and the child's face is recognizably human. [8]

Abortion Techniques: First Trimester

Suction Aspiration

Suction aspiration, or "vacuum curettage," is the abortion technique used in most first trimester abortions.[9] A powerful suction tube with a sharp cutting edge is inserted into the womb through the dilated cervix. The suction dismembers the body of the developing baby and tears the placenta from the wall of the uterus, sucking blood, amniotic fluid, placental tissue, and fetal parts[10] into a collection bottle.[11]

Great care must be taken to prevent the uterus from being punctured during this procedure, which may cause hemorrhage and necessitate further surgery.[12] Also, infection can easily develop if any fetal or placental tissue is left behind in the uterus. This is the most frequent post-abortion complication. [13]

Dilatation (Dilation) and Curettage (D&C)

In this technique, the cervix is dilated or stretched to permit the insertion of a loop shaped steel knife. The body of the baby is cut into pieces and removed and the placenta is scraped off the uterine wall. [14] Blood loss from D & C, or "mechanical" curettage is greater than for suction aspiration, as is the likelihood of uterine perforation and infection. [15]

This method should not be confused with routine D&C's done for reasons other than undesired pregnancy (to treat abnormal uterine bleeding, dysmenorrhea, etc.). [16]

RU 486

While many people focus solely on RU 486, the so-called " French abortion pill," the RU 486 technique actually uses two powerful synthetic hormones with the generic names of mifepristone and misoprostol [17] to chemically induce abortions in women five-to-nine weeks pregnant.[18]

The RU 486 procedure requires at least three trips to the abortion facility.[19] In the first visit, the woman is given a physical exam, and if she has no obvious contra-indications ("red flags" such as smoking, asthma, high blood pressure, obesity, etc., that could make the drug deadly to her[20] ), she swallows the RU 486 pills. RU 486 blocks the action of progesterone, the natural hormone vital to maintaining the rich nutrient lining of the uterus. The developing baby starves as the nutrient lining disintegrates.[21]

At a second visit 36 to 48 hours later, the woman is given a dose of artificial prostaglandins, usually misoprostol, which initiates uterine contractions and usually causes the embryonic baby to be expelled from the uterus. [22] Most women abort during the 4-hour waiting period at the clinic, but about 30% abort later at home, work, etc., [23] as many as 5 days later.[24] A third visit about 2 weeks later determines whether the abortion has occurred or a surgical abortion is necessary to complete the procedure (5 to 10% of all cases).[25]

There are several serious well documented side effects associated with RU 486/prostaglandin abortions, including prolonged (up to 44 days) [26] and severe bleeding,[27] nausea, vomiting, [28] pain, [29] and even death. At least one woman in France died while others there suffered life-threatening heart attacks from the technique. [30] In U.S. trials conducted in 1995, one woman is known to have nearly died after losing half her blood and requiring emergency surgery. [31]

Long term effects of the drug have not yet been sufficiently studied, but there are reasons to believe that RU 486 could affect not only a woman's current pregnancy, but her future pregnancies as well, potentially inducing miscarriages or causing severe malformations in later children. [32]

Methotrexate

The procedure with methotrexate is similar to the one using RU 486, though administered by an intramuscular injection instead of a pill. [33]

Originally designed to attack fast growing cells such as cancers by neutralizing the B vitamin folic acid necessary for cell division, methotrexate apparently attacks the fast growing cells of the trophoblast as well,[34] the tissue surronding the embryo that eventually gives rise to the placenta. The trophoblast not only functions as the "life support system" for the developing child, [35] drawing oxygen and nutrients from the mother's blood supply and disposing of carbon dioxide and waste products, [36] but also produces the hCG (human chorionic gonadotropin) hormone which signals the corpus luteum to continue the production of progesterone necessary to prevent breakdown of the uterine lining and loss of the pregnancy. [37] Methotrexate initiaties the disintengration of that sustaining, protective, and nourishing environment. Deprived of the food, oxygen, and fluids he or she needs to survive, the baby dies.

Three to seven days later (depending on the protocol used), a suppository of misoprostol (the same prostaglandin used with RU 486) is inserted into a woman's vagina to trigger expulsion of the tiny body of the child from the woman's uterus. Sometimes this occurs within the next few hours, but often a second dose of the prostaglandin is required, making the time lapse between the initial administration of methotrexate and the actual completion of the abortion as long as several weeks. [38] A woman may bleed for weeks (42 days in one study[39] ), even heavily, [40] and may abort anywhere -- at home, on the bus, at work, etc. [41] Those found to be still pregnant in later visits (at least 1 in 25) are given surgical abortions. [42]

Even doctors who support abortion are reluctant to prescribe methotrexate for abortion because of its high toxicity and unpredictable side effects. [43] Those side effects commonly include nausea, pain, diarrhea, [44] as well as less visible but more serious effects such as bone marrow depression, severe anemia, liver damage and methotrexate-induced lung disease. [45]

The manufacturer warns in the package insert that while methotrexate has shown itself useful in treating certain types of cancer and severe cases of arthritis and psoriasis, "deaths have been reported with the use of methotrexate," and recommends that its use be limited to "physicians whose knowledge and experience includes the use of antimetabolite therapy." [46] Though researchers performing methotrexate abortions have dismissed such concerns because of the low dosage used, [47] other doctors in the abortion trade have disagreed, [48] and the package insert clearly warns that "toxic effects may be related in frequency and severity to dose or frequency of administration but have been seen at all doses" (emphasis added). [49]

Dilatation (Dilation) and Evacuation (D&E)

Used to abort unborn children as old as 24 weeks, this method is similar to the D&C. The difference is that forceps with sharp metal jaws are used to grasp parts of the developing baby, which are then twisted and torn away. This continues until the child's entire body is removed from the womb. Because the baby's skull has often hardened to bone by this time, the skull must sometimes be compressed or crushed to facilitate removal. If not carefully removed, sharp edges of the bones may cause cervical laceration. Bleeding from the procedure may be profuse. [50]

Dr. Warren Hern, a Boulder, Colorado abortionist who has performed a number of D&E abortions, says they can be particularly troubling to a clinic staff and worries that this may have an effect on the quality of care a woman receives.  Hern also finds them traumatic for doctors too, saying "there is no possibility of denial of an act of destruction by the operator.  It is before one's eyes.  The sensation of dismemberment flow through the forceps like an electric current." [51]

To see an illustration of this abortion method, produced a professional medical illustration firm, click HERE.

Abortion Techniques: Second and Third Trimesters

Instillation Methods

  • Chemical
  • 2nd and 3rd Trimesters

These methods involve the injection of drugs or chemicals through the abdomen or cervix into the amniotic sac to cause the death of the child and his or her expulsion from the uterus. Several drugs have been tried, [52] but the most commonly used are hypertonic saline, urea, and prostaglandins.

Salt Poisoning

Otherwise known as "saline amniocentesis," "salting out," or a "hypertonic saline" abortion, this technique is used after 16 weeks of pregnancy, when enough fluid has accumulated in the amniotic fluid sac surrounding the baby.

A needle is inserted through the mother's abdomen and 50-250 ml (as much as a cup) of amniotic fluid is withdrawn and replaced with a solution of concentrated salt. [53] The baby breathes in, swallowing the salt, and is poisoned.[54]  The chemical solution also causes painful burning and deterioration of the baby's skin. [55] Usually, after about an hour, the child dies. The mother goes into labor about 33 to 35 hours after instillation and delivers a dead, burned, and shriveled baby. [56] About 97% of mothers deliver their dead babies within 72 hours.[57]

Hypertonic saline may initiate a condition in the mother called "consumption coagulopathy" (uncontrolled blood clotting throughout the body) with severe hemorrhage as well as other serious side effects on the central nervous system. [58] Seizures, coma, or death may also result from saline inadvertently injected into the woman's vascular system.[59]

Urea

Because of the dangers associated with saline methods, other instillation methods such as hypersomolar urea are sometimes employed, [60] though these are less effective and usually must be supplemented by oxytocin or a prostaglandin in order to achieve the desired result. [61] Incomplete or failed abortion remains a problem with urea methods, often precipitating the additional risk of surgery.

As with other instillation techniques, gastrointestinal side effects such as nausea or vomiting are frequent, but the most common problem with second trimester techniques is cervical injuries, which range from small lacerations to complete detachments of the anterior or posterior cervix. Between 1% and 2% of patients using urea must be hospitalized for treatment of endometritis, an infection of the lining oft he uterus.[62]

Prostaglandins

Prostaglandins are naturally produced chemical compounds which normally assist in the birthing process. The injection of concentrations of artificial prostaglandins prematurely into the amniotic sac induces violent labor and the birth of a child usually too young to survive. Often salt or another toxin is first injected to ensure that the baby will be delivered dead, [63] since some babies have survived the trauma of a prostaglandin birth and been born alive. [64] This method is used during the second trimester. [65]

In addition to risks of retained placenta, cervical trauma, infection, hemorrhage, [66] hyperthermia, bronchoconstriction, tachycardia, [67] more serious side effects and complications from the use of artificial prostaglandins, including cardiac arrest and rupture of the uterus, can be unpredictable and very severe. Death is not unheard of. [68]

Partial-Birth Abortion

Abortionists sometimes refer to these or similar types of abortions using obscure, clinical-sounding euphemisms such as "Dilation and Extraction" (D&X), or "intact D&E" (IDE) which mask the realities of how the abortions are actually performed. [69]

This procedure is used to abort women who are 20 to 32 weeks pregnant -- or even later into pregnancy.* Guided by ultrasound, the abortionist reaches into the uterus, grabs the unborn baby's leg with forceps, and pulls the baby into the birth canal, except for the head, which is deliberately kept just inside the womb. (At this point in a partial-birth abortion, the baby is alive.) Then the abortionist jams scissors into the back of the baby's skull and spreads the tips of the scissors apart to enlarge the wound. After removing the scissors, a suction catheter is inserted into the skull and the baby's brains are sucked out. The collapsed head is then removed from the uterus.[71]

(More information on Partial-Birth Abortion can be found here.)

Hysterotomy

Similar to the Caesarean Section, this method is generally used if chemical methods such as salt poisoning or prostaglandins fail (see pp. 12-14). Incisions are made in the abdomen and uterus and the baby, placenta, and amniotic sac are removed. [72] Babies are sometimes born alive during this procedure, raising questions as to how and when these infants are killed and by whom.

This method offers the highest risk to the health of the mother, because the potential for rupture during subsequent pregnancies is appreciable. [73] In the first two years of legal abortion in New York State, the death rate from hysterotomy was 271.2 deaths per 100,000 cases. [74]

Is Abortion Safe?

The argument used by many advocates of abortion -- that abortion is safer than childbirth -- is difficult to defend in light of medical evidence to the contrary. The Abortion Surveillance Branch of the Centers for Disease Control (CDC) maintains that induced abortion is safer than childbirth [75] and that the serious complication rate is less than one percent. [76] Yet there is no agreement among investigators as to what constitutes a major complication and no real national system for the reporting these kind of statistics, [77] making the accuracy of such assertions questionable. Furthermore, the experiences of private physicians and gynecologists do not seem to support the validity of the CDC's claim. [78]

Daniel J. Martin, M.D., Ltd., clinical instructor at St. Louis University Medical School, St. Louis, Missouri, has said, "The impact of abortion on the body of a woman who chooses abortion is great and always negative. I can think of no beneficial effect of a social abortion on a body." [79]

Why is this so? Because induced abortion is the premature, willful, and violent penetration of a closed and safeguarded system -- a system in which nearly every cell, tissue and organ of a woman's reproductive system has been specially transformed and activated to carry out the function of sustaining and nourishing the developing child. Not surprisingly, any violation of the integrity of that system can lead to serious complications. Physical problems range from hemorrhage and infection to sterility and even death. Psychological effects range from depression and mental trauma to divorce and even suicide.

NancyJo Mann is one of many who has experienced both kinds of complications. Infection and bleeding followed her abortion which eventually led to a hysterectomy. Recalling her experience, she said, "Beforehand, I liked myself. I had never entertained the idea of abortion. But the minute that needle went through my abdomen, I hated it, because I knew it could not be reversed. I wanted to scream, 'Don't do this to me!'" [80]

Physical Complications*

Despite the use of local anesthesia, a full 97% of women having abortions reported experiencing pain during the procedure, [81] which more than a third described as "intense," [82] "severe" or "very severe." [83] Compared to other pains, researchers have rated the pain from abortion as more painful than a bone fracture, about the same as cancer pain, though not as painful as an amputation. [84]

Studies also reveal that younger women tend to find abortion more painful than do older adults, [85] and that patients typically found abortion more painful than their doctors or counselors expected. [86] The use of more powerful general anesthetics can reduce the pain, but significantly increases the risk of cervical injury or uterine perforation. [87]

Complications such as these are common, as are bleeding, hemorrhage,[88] laceration of the cervix, [89] menstrual disturbance, [90] inflammation of the reproductive organs, [91] bladder or bowel perforation, [92] and serious infection. [93]

Even more harmful long term physical complications from abortion may surface later. For example, overzealous currettage can damage the lining of the uterus and lead to permanent infertility. [94] Overall, women who have abortions face an increased risk of ectopic (tubal) pregnancy [95] and a more than doubled risk of future sterility. [96] Perhaps most important of all, the risk of these sorts of complications, along with risks of future miscarriage, increase with each subsequent abortion. [97]

The particular type and severity of complications depend a great deal on the experience of the abortionist and the particular abortion method used. Given that most abortions are performed at abortion clinics rather than by a woman's regular ob-gyn, [98] the doctor performing the abortion is likely to be a stranger of whose skill and experience a woman knows very little. [99] Such things as an inadequate gynecologic examination prior to the operation, the carelessness of the abortionist, or the retention of fetal and placental tissue can all bring on complications. These kinds of complications can usually be treated and generally subside (though not always), [100] but few women ever return to the clinics for crucial post-operative examinations. [101]

There is strong evidence that abortion increases the risk of breast cancer. A study of more than 1,800 women appearing in the Journal of the National Cancer Institute in 1994 found that overall, women having abortions increased their risk of getting breast cancer before age 45 by 50%. For women under 18 with no previous pregnancies, having an abortion after the 8th week increased the risk of breast cancer 800%. Women with a family history of breast cancer fared even worse. All 12 women participating in the study who had abortions before 18 and had a family history of breast cancer themselves got cancer before age 45. [102]

Of course, death of the mother is the most serious of all complications. Over 200 women have died from legal abortions since 1973. [103] The risk of death increases according to the duration of pregnancy [104] and the complexity of the abortion technique employed. [105]

* In most of the discussions above, the abortions referred to are surgical abortions. Chemical methods being relatively new and rare, most studies over the past twenty or so years usually tracked only complications for surgical methods. Complication rates for chemical techniques may be somewhat different; for example, while there is little risk of perforation and laceration with a chemical method, pain and bleeding will probably exceed that of surgical methods. Chemical methods also bring unique risks of their own.

Psychological Consequences

Clinical research provides a growing body of scientific evidence that having an abortion can cause psychological harm to some women. "Women who report negative after-effects from abortion know exactly what their problem is," observed psychologist Wanda Franz, Ph.D., in a March 1989 congressional hearing on the impact of abortion. "They report horrible nightmares of children calling them from trash cans, of body parts, and blood," Franz told the Congressional panel. "When they are reminded of the abortion," Franz testified, "the women re-experienced it with terrible psychological pain ... They feel worthless and victimized because they failed at the most natural of human activities -- the role of being a mother."[106]

The emergence of chemical abortion methods poses a new possibly more devastating psychological threat. Unlike surgical abortions, in which women rarely see the cut up body parts, women having chemical abortions often do see the complete tiny bodies of their unborn children and are even able to distinguish the child's developing hands, eyes, etc. [107] So traumatic is this for some women that both patients and researchers involved in these studies have recommended that women unprepared for the experience of seeing their aborted children not take the drugs. [108] Long-term psychological implications of this experience have not been studied.

Researchers on the after-effects of abortion have identified a pattern of psychological problems known as Post-Abortion Syndrome (PAS). Women suffering PAS may experience drug and alcohol abuse, personal relationship disorders, sexual dysfunction, repeated abortions, communications difficulties, damaged self-esteem, and even attempt suicide. Post-Abortion Syndrome appears to be a type of pattern of denial which may last for five to ten years before emotional difficulties surface. [109]

Now that some clinicians have established that there is an identifiable patterns to PAS, they face a new challenge. What is still unknown is how widespread psychological problems are among women who have had abortions. A Los Angeles Times survey in 1989 found that 56% of women who had abortions felt guilty about it, and 26% "mostly regretted the abortion."[110] Clinicians' current goal should be to conduct extensive national research studies to obtain data on the psychological after-effects of abortion.[111]

With the growing awareness of Post Abortion Syndrome in scholarly and clinical circles, women with PAS can expect to receive a more sensitive appreciation of the suffering that they endure. Fortunately, a growing network of peer support groups of women who have had abortions offers assistance to women who are experiencing emotional difficulties.

Many post-abortive women have also been speaking out publicly about their own abortion experiences and the healing process they went through.. Women or family members seeking information about this particular outreach can contact American Victims of Abortion, 512 10th St. NW, Washington, D.C., 20004.

Alternatives to Abortion

Despite all their talk about "choice," those at abortion clinics who counsel women on their options often act as if abortion is a woman's only realistic alternative. This simply isn't so.

Throughout the United States, there are nearly 3,000 Crisis Pregnancy Centers staffed by volunteers ready to provide real help to women facing unplanned or untimely pregnancies. [112] In addition to providing pregnancy tests and counseling, these centers often offer a full range of services, helping women obtain housing, maternity and baby clothes, baby equipment, pre- and post-natal medical care, legal assistance and financial support, information about adoption, and even advice on how a woman in school can continue her education. [113] Offering real and tangible assistance, these centers have helped thousands of women to realize that they didn't have to choose between their own lives and the lives of their unborn babies.

Unlike their counterparts at the local abortion clinic, the volunteer counselors at your Crisis Pregnancy Center do not have a vested financial interest in the ultimate decision you make. Their concern and commitment are genuine, so you can count on them to stick by you through the tense and sometimes difficult months ahead.

If you picked up this pamphlet at your local Crisis Pregnancy Center, you already have some idea of the quality of people who work there. But if not, you can look in the Yellow Pages under the heading "Abortion Alternatives," or call, toll-free, 1 (800) 848-LOVE, any time, day or night, to find the nearest Crisis Pregnancy Center in your area. You'll find someone who genuinely cares about what happens to you and your unborn baby.

References

1. Roe v. Wade, 410 U.S.; 113, 163-164 (1973) and Doe v. Bolton, 410 U.S. 179, 191-192 (1973). While Roe declares that the state may proscribe late term abortions in the interest of protecting fetal life after viability, it adds the caveat "except when it is necessary to preserve the life or health of the mother," which Doe explains is to include not only physical health but mental health, to be understood to include factors such as age, familial status, emotional state, etc.

2. Aida Torres and J.D. Forrest, "Why Do Women Have Abortions?" Family Planning Perspectives, Vol. 20, No.4 (July/August 1988). P. 170.

3. Keith L. Moore, The Developing Human, 4th ed.. (Philadelphia,: W.B. Saunders Co., 1988), p. 3, 29. Moore's chart uses the actual age of the child rather than the gestational age commonly used by most doctors. His numbers are translated here into gestational age, measured from the woman's last menstrual period, or LMP.

4. According to the Morbidity and Mortality Weekly Report of the Centers for Disease Control (CDC), Vol. 43, No. 50 (December 23, 1994), p. 931, only about 13.8% of abortions are performed prior to 7 weeks of gestation.

5. Robert Rugh, Ph.D., and Landrum Shettles, M.D., Ph.D., From Conception to Birth (New York: Harper & Row, 1971), p. 46. Rugh's and Shettles' dates are also translated to gestational age here, measured by LMP.

6. Hannibal Hamlin, M.D., "Life or Death by EEG," Journal of the American Medical Association (October 12, 1964), p. 113. See also Sharon Begley, "Do you hear what I hear?" Newsweek (Special Issue, Summer 1991), p. 14.

7. The CDC says 15.2 % of abortions are performed during week 7, 20.9 % during week 8, and 24.6% in weeks 9 through 10. This totals 60.7% of all abortions. See note 4.

8. Sharon Begley with John Carey, "How Human Life Begins," Newsweek, January 1, 1982, p. 46.

9. Phillip G. Stubblefield, "First and Second Trimester Abortion," in Gynecologic and Obstetric Surgery, ed. David H. Nichols (Baltimore: Mosby, 1993) p. 1016. Also, the U.S. Centers for Disease Control (CDC), "Abortion Surveillance: Preliminary Data -- United States, 1991, " Morbidity and Mortality Weekly Report, Vol. 43, No. 3, 1994, p. 43, puts the percentage of suction curettage abortions relative to other techniques at 98%, though the CDC admits that their numbers include a number of D & E abortions which should be classified otherwise (personal communication with Lisa Koonin,Division of Reproductive Health, CDC, March 6, 1996).

10. U.S. Senate Report of the Committee on the Judiciary, Human Life Federalism Amendment, Senate Joint Resolution 3, 98th Congress, 1st Session, legislative day June 6, 1983, p. 36. (Hereafter referred to as Human Life Federalism Amendment).

11. A. Jefferson Penfield, M.D., Gynecologic Surgery Under Local Anesthesia, (Baltimore: Urban & Schwarzenburg, 1986), p. 79.

12. Jane E. Hodgson, M.D.,"Abortion by vacuum aspiration," Abortion and Sterilization: Medical and social aspects, Jane E. Hodgson, ed. (New York: Academic Press, Grune and Strathon, 1981), pp. 256-258.

13. Ibid, pp. 256, 260-261.

14. Human Life Federalism Amendment, cited in note 10, p. 36.

15. F. Gary Cunningham, M.D., et al, Williams Obstetrics, 19th ed. (Norwalk, CT: Appleton & Lang, 1993), p.683.

16. Penfield,cited in note 11, pp. 50-51.

17. According to Andrea Sachs, because of these generic names, the RU 486 technique is sometimes referred to as the "M & M " method. "Abortion Pills on Trial," TIME, December 5, 1994, p. 45.

18. Étienne-Émile Baulieu, M.D., Ph. D., "1993: RU 486 -- A Decade on Today and Tomorrow," in Clinical Applications of Mifepristone (RU 486) and Other Antiprogestins, Institute of Medicine, eds. Molla .S. Donaldson et al (Washington, D.C.: National Academy Press, 1993), p. 92-96. Though Baulieu, creator of the abortion pill, recommends its use up to nine weeks, American trials have found the method considerably less effective after the seventh week, according to Carol Jouzaiis, "Abortion Pill Clinic Tests Drawing to a Close in U.S.," Chicago Tribune, Wednesday, August 30, 1995, p. 1.

19. The Population Council of New York, Release, October 27, 1994, p. 3. The Population Council is the entity conducting tests on RU 486 in the United States. The regimen in France, where the drug was first developed and approved, involves a total of four visits, adding an additional week for reflection prior to the ingestion of the pills (Diane Gianelli, "RU 486 effective, not problem-free," American Medical News, April 12, 1993, p. 25.

20. See Janice G. Raymond, Renate Klein, Lynette J. Dumble, RU 486: Misconceptions, Myths, and Morals (Cambridge, MA: Institute on Women and Technology, 1991), pp. 17, 34, 35; and Beatrice Couzinet, M.D., et al, "Termination of Early Pregnancy by the Progesterone Antagonist RU 486 (Mifepristone)," New England Journal of Medicine Vol. 315 (December 18, 1986), p. 1565; Louise Silvestre, M.D., et al, "Voluntary Interruption of Pregnancy with Mifepristone (RU 486) and a Prostaglandin Analogue," New England Journal of Medicine, Vol. 322 (March 8, 1990), p. 645.

21. Raymond, Klein, and Dumble, Misconceptions, cited in note 20, pp. 57-62.

22. André Ulmann, et al, "Medical Termination of Early Pregnancy With Mifepristone (RU 486) Followed By A Prostaglandin Analogue," Acta Obst. Gyn. Scand., Vol. 71 (1992), pp. 280-281.

23. Population Council, Release, cited in note 19, p. 3

24. Gianelli, "RU 486 effective..." cited in note 19, p. 25.

25. Élisabeth Aubeny and É.É.Baulieu, "Contragestion with Ru 486 and an orally active prostaglandin," C.R. Acad. Sci. Paris (III), Vol. 312 (1991), pp. 539-545, obtained a 95% completion rate with women 49 days amenorrhea or less. Carolyn McKinley, et al, "The effect of dose of mifepristone and gestation on the efficacy of medical abortion with mifepristone and misoprostol," Hum. Reproduc., Vol. 8 (1993), pp. 1502-1503, obtained a completion rate of 89.1% for women 50-63 days amenorrhea.

26. Mary W. Rodger and David T. Baird, "Blood loss following a prostaglandin analogue (Gemeprost)" Contraception, Vol. 40 (1989), pp. 439-447.

27. UK Multicentre Trial, "The efficacy and tolerance of mifepristone and prostaglandin in first trimester termination of pregnancy, B.J. Obst. & Gyn., Vol. 97 (1990), pp. 480-486.

28. Population Council, Release, cited in note 19, p. 3.

29. McKinley, et al, "The effect of dose of mifepristone...," cited in note 25, p. 1504.

30. Alan Riding, "Frenchwoman's Death is Linked To Abortion Pill and a Hormone," New York Times, April 10, 1991, p. A-10

31. Mark Louviere, M.D., "Group lied when it said 'abortion pill' test resulted in no complications,' Waterloo Courier, September 24, 1995, p. F3. See alsoTom Carney, "'Abortion pill' test goes awry for one patient," Des Moines Register, September 21, 1995, pp. 1M, 5M.

32. Raymond, Klein, and Dumble, Misconceptions, cited in note 20 , pp. 71-79.

33. Richard U. Hausknecht, M.D., "Methotrexate and Misoprostol to Terminate Early Pregnancy," New England Journal of Medicine, Vol. 33, No. 9 (August 31, 1995), p.538, and Eric A Schaff, M.D., et al, "Combined Methtrexate and Misoprostol for Early Induced Abortion," Archives of Family Medicine, Vol. 4. 1995, p. 2.

34. Mitchell D. Creinin, M.D., "Methotrexate for abortion at £42 days gestation," Contraception, Vol. 48, No. 6 (December, 1993), p. 519.

35. Daniel R. Mishell, Jr., M.D., and Val Davajan, M.D., Infertility, Contraception, & Reproductive Endochrinology, 2nd Ed. (Oradell, NJ: Medical Economics Books, 1986), pp. 120.

36. Keith Moore, Ph.D., Essentials of Human Embryology (Philadelphia: B.C. Decker, Inc., 1988), p. 10.

37. Mishell and Davajan, cited in note 35, p. 120.

38. Schaff, et al, cited in note 33, p. 4. The precise time of abortion is hard to specify; while Schaff measured decrease in ßhCG levels as an indicator of abortion, Hausknecht (cited in note 33) looked for the "expulsion of the products of conception" or the "passage of tissue" (P. 538). Using this criteria, Hausknecht still apparently had some who took at least 18 days to abort (methotrexate on day 1, misoprostol day 7, repeat misoprostol, day 14, abortion 4 days later, pp. 538-539). Those still pregnant at that point underwent a surgical abortion.

39. Mitchell D. Creinin, M.D., and Philip D. Darney, M.D., "Methotrexate and misoprostol for early abortion," Contraception, Vol. 48 (October, 1993), p. 344.

40. See Schaff, et al, cited in note 33, p. 4., Hausknecht, cited in same note, pp. 538-539.

41. Conversation between Richard U. Hausknecht, M.D., and Phil Donahue, "An Abortion Pill by Prescription Without Surgery," The Phil Donahue Show, September 26, 1995; Journal Graphics, Transcript #4346, pp. 2-4.

42. Schaff, et al, cited in note 33, p. 2. See also Hausknecht, cited in note 33, p. 538.

43. According to an October 22,1993 article titled "Existing Drugs Induced Abortions But some warn about toxicity," appearing on p. 7 of Newsday (New York), the medical director of Planned Parenthood of New York, Dr. Hakim Elahi indicated the side effects were so unpredictable he would not use it as an abortion drug in any dose. In a letter to the editors of the New York Times (April 8, 1996, at p. A14), abortionist Don Sloan warned that methotrexate can produce severe anemias, ulcers, and bone marrow depressions that can be fatal,even at the doses used for abortion and said "many of us in the 'abortion trade,' as I am, are recoiling at the stark irresponsibility of those who are parading this medication in such cavalier fashion."

44. Schaff, et al, cited in note 33, p. 4.

45. Physicians' Desk Reference (PDR), 47th edition (Montvale, NJ: Medical Economics Data, 1993)., p. 1245.

46. PDR, cited above.

47. Richard Hausknecht, interviewed by Charlayne Hunter-Gault, MacNeil-Lehrer News Hour, PBS, August 30, 1995.

48. See Drs. Hakim Elahi and Don Sloan, cited in note 43.

49. PDR, ctied in note 45, p. 1246.

50. Warren M. Hern, M.D., Abortion Practice (Philadelphia: J.B. Lipincott Company, 1984), pp. 153-154. See also Human Life Federalism Amendment, cited in note 10, p. 36.

51. Warren M. Hern, M.D., and Billie Corrigan, R.N., "What About Us? Staff Reactions to the D & E Procedure," paper presented at the Annual Meeting of the Association of Planned Parenthood Physicians, San Diego, California, October 26, 1978.

52. Nelson B. Isada, MD., et al, mention potassium chloride and digoxin in "Fetal Intracardiac Potassium Chloride Injection to Avoid the Hopeless Resuscitation of an Abnormal Abortus: I. Clinical Issues," Obstetrics and Gynecology, Vol. 80, No. 2 (August 1992), pp.296, 298, (though they administered this directly into the baby's heart, rather than just the surrounding amniotic sac), and Marc A. Bygdeman mentions, but does not discuss in detail, the use of hypertonic glucose in "Prostaglandin Procedures," Second Trimester Abortion, ed. Gary S. Berger, et al (Boston: Martinus Nijhoff Publishers, 1981), p. 101. Oxytocin, normally used to stimulate contractions in full term pregnancies, can apparently also be used as an abortifacient in mid-trimester pregnancies, if used in high enough doses, according to Stubblefield, "First and Second Trimester Abortion...,"cited in note 9, p. 1027.

53.Thomas D. Kerenyi, "Hypertonic Saline Instillation," in Second Trimester Abortion, cited above, p. 81.

54. R.S. Galen, P. Chauhan, H. Wietzner, et al, "Fetal pathology and mechanism of fetal death in saline-induced abortion: a study of 143 gestations and critical reveiw of the literature," American Journal of Obstetrics and Gynecology, Vol. 120 (1974), p.347.

55. Jeff Lyon, 'Abortion paradox: A live baby," York Daily Record (York, Pennsylvania), August 21, 1982. See also Congressional Record, March 23, 1983, H1680.

56. Stephen L. Corson., M.D., et al, Fertility Control (Boston, MA: Little, Brown, and Company, 1985), pp. 82-83.

57. Thomas D. Kerenyi, Abortion and Sterilization, ed. Hodgson, cited in note 12, p. 362.

58. James R. Scott, M.D., et al, Danforth's Obstetrics and Gynecology, 6th ed. (Philadephia: J.B. Lippincott, 1990), p. 726.

59. Thomas D. Kerenyi, "Hypertonic Saline Instillation," in Second Trimester Abortion, cited in note 52, p.83; and R. Bolognese and S. Corson, Interruption of Pregnancy -- A Total Patient Approach (Baltimore: Wilkins and Wilkins, 1985), p. 136.

60. Marc A. Bygdeman, "Prostaglandin Procedures," in Second Trimester Abortion, cited in note 52, p. 101.

61. Ronald T. Burkman, Theodore M. King, Milagros F. Atienza, "Hyperosmolar Urea," in Second Trimester Abortion,cited in note 52, pp. 109-110.

62. Ibid., pp. 115-116.

63 . Nancy K. Rhoden, "The New Neonatal Dilemma: Live Births from Late Abortions," The Georgetown Law Journal, Vol. 72 (1984), p. 1458.

64. Liz Jeffries and Rick Edmonds, "Abortion, The Dreaded Complication," The Philadelphia Inquirer, August 2, 1981, 4 page insert.

65. Warren M. Hern, M.D., Abortion Practice, cited in note 50, pp. 123, 125. 66. Ibid., p. 125.

66.  Ibid., p. 125.

67. James R. Scott, Danforth's Obstetrics and Gynecology, cited in note 58, p. 726.

68. Willard Cates, M.D. and H.V.F. Jordaan, "Sudden Collapse and Death of Women Obtaining Abortion Induced by Prostaglandin F2 Alpha," American Journal of Obstetrics and Gynecology, Vol. 133 (February 15, 1979), pp. 398-400. See also David Grimes, M.D., et al, "Midtrimester abortion by intra-amniotic prostaglandin F2a: Safer than saline?" Obstet Gynecol, Vol. 49 (1977), p. 612 and A.C. Wentz, et al, "Posterior cervical rupture following prostaglandin-induced midtrimester abortion," American Journal of Obstetrics and Gynecology, Vol. 115 (1973), p. 1107.

69. Some have also used the highly descriptive term "brain suction abortion" to refer to the procedure.

70.  See Maureen Hack, et.al, "Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Network," Pediatrics, Vol. 87, No. 5 (May 1991), p58.

71 . Dr. Martin Haskell described the partial-birth abortion procedure, which he called "dilation and extraction,"at a Sept. 1992 meeting of the National Abortion Federation, a trade association of abortion providers. He said he had done 700 of these "procedures." See Martin Haskell, M.D., "Dilation and Extraction for Late Second Trimester Abortion," in "Second Trimester Abortion: From Every Angle," Fall Risk Management Seminar, September 13-14, 1992, Dallas, Texas, National Abortion Federation. See also Diane Gianelli, "Shock-tactic ads target late-term abortion procedure," American Medical News (July 5, 1993), pp. 3, 15-16.

72. Human Life Federalism Amendment, cited in note 10, p. 37.

73. Cunningham, et al, cited in note 15, p. 683.

74 . P. Diggory, "Hysterotomy and hysterectomy as abortion techniques," in Abortion and Sterilization, ed. Hodgson, cited in note 12, p. 326.

75 . Willard Cates, Jr., et al, "Mortality from Abortion and Childbirth: Are the Statistics Biased?" Journal of the American Medical Association, Vol. 28, No.2 (July 9, 1982), p. 196.

76 . J.W. Buehler, K.F. Schulz, David. A. Grimes, C.J.R. Hogue, "The risk of serious complications from induced abortion: Do personal characteristics make a difference? American Journal of Obstetrics and Gynecology, Vol. 153 (1985), pp. 14-20.

77 . Christopher Tietze, "Demographic and Public Health Experience with Legal Abortion: 1973-1980," in J. Douglas Butler and David F. Walbert, eds., Abortion, Medicine, and the Law 3rd Rev. ed. (New York: Facts on File, 1986), p. 303.

78 . Matthew Bulfin, M.D., "Complications of Legal Abortion: A Perspective from Private Practice," The Zero People, ed. Jeff Lane Hensley (Ann Arbor, MI: Servant Books, 1983), pp. 97-105.

79 . Daniel J. Martin, M.D. , "The Impact of Legal Abotion on Women's Minds and Bodies," paper presented at the "Human Life and Health Care Ethics" national conference, April, 1993.

80. Christine Russell, "Don't Do This," Washington Post, January 23, 1983, p. A13.

81. Phillip G. Stubblefield, M.D., et al, "Pain of first-trimester abortion: Its quantification and relations with other variables," American Journal of Obstetrics and Gynecology, Vol. 133, No. 5 (March 1, 1979), p. 489.

82. Nancy Wells, D.N.Sc., R.N., "Pain and Distress During Abortion," Health Care for Women International, Vol 12 (1991), pp. 296-297. Actually, all 35 women participating in Wells' study (100%) reported some degree of pain during the abortion, which 34.4% described as "intense."

83. Stubblefield, et al, cited in note 80, p. 493.

84. Eliane Bélanger, Ronald Melzak, and Pierre Lauzon, "Pain of first-trimester abortion: a study of psychosocial and medical predictors," Pain, Vol. 36 (1989), pp. 343, 345.

85 . Belanger, et al, cited above, p. 345, and Stubblefield, et al, cited in note 80, p. 495.

86 . See Tables VII, VIII, IX, X, and XIII, in Stubblefield, et al, cited in note 80, pp. 493-496.

87 . Kenneth F. Schulz, David A. Grimes, Willard Cates, Jr., "Measures to Prevent Cervical Injury During Suction Curettage Abortion," The Lancet, May 28,1983, p. 1184. See also Steven G. Kaali, M.D., et al, "The frequency and management of uterine perforations duing first-trimester abortions," American Journal of Obstetrics and Gynecology, August 1989, p. 408.

88 . Schulz, et al, cited in note 87, p. 1182.

89.  Stubblefield, cited in note 9, pp. 1023-1024, and S. Kaali, cited in note 87 pp. 406-408.

90.  Stubblefied, cited in note 9, p. 1023

91.  L.H. Roht, et al, "Increased Reporting of Menstrual Symptoms Among Women Who Used Induced Abortion," American Journal of Obstetrics and Gynecology, Vol. 127 (1977), p. 356.

92. Ibid.

93 . David N. Danforth, Ph.D., M.D., ed., et al, Obstetrics and Gynecology, 5th ed. (Philadelphia: J.B. Lipincott, 1986), pp. 217, 257, 382-383. See also Jack Pritchard, et al, Williams Obstetrics, 17th ed. (Norwalk, CT: Appleton-Century-Crofts, 1985), p. 484.

94. Danforth, cited above, p. 887, and David H. Nichols, M.D., Gynecologic and Obstetric Surgery (St. Louis: Mosby-Year Book Inc., 1993), p. 260, and Leon Speroff, Robert H. Glass, Nathan G. Kase, Clinical Gynecological Endochrinology & Infertility (Baltimore: Williams & Wilkins, 1983), pp. 156-157.

95. A. Levin, et al, "Ectopic Pregnancy and Prior Induced Abortion," American Journal of Public Health, Vol. 72, No. 3 (March 1982), pp. 253-256.

96. Anastasia Tzonou, et al, "Induced abortions, miscarriages, and tobacco smoking as risk factors for secondary infertility," Journal of Epidemiology and Community Health, Vol. 47 (1993), p. 36.

97. A. Levin, et al, "Association of induced abortion with subsequent pregnancy loss," Journal of the American Medical Association, Vol. 243, No. 24 (June 27, 1980), pp. 2495-2496, 2498-2499.

98. In 1992, out of 1,528,930 abortions, only 54,460, or 3.6% were performed in physician's offices. The vast majority were performed in abortion clinics (1,057,500 or 69.2%) or at other clinics (307,020 or 20.1%). The rest were performed in hospitals (109,950 or 7.2%). Figures from Stanley K. Henshaw and Jennifer Van Vort, "Abortion Services in the United States, 1991 and 1992, Family Planning Perspectives, Vol. 26, No. 3 (May/June 1994), p. 101.

99. Pamela Zekman and Pamela Warrick, "Women take chances with 'tryout' doctors," Chicago Sun Times, November 14, 1978, p. 1.

100. Stanislaw Z. Lienbrych, M.D., "Fertility Problems Following Aborted First Pregnancy," New Perspectives on Human Abortion, ed. Hilgers, Horan, and Mall, (Frederick, MD: University Publications of America, 1981), pp. 128, 132.

101. Diane Gianelli, "With RU-486, Will More Physicians Provide Abortions?" American Medical News, April 12, 1993, p. 3, 25, 27.

102. Janet Daling, et al, "Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion," Journal of the National Cancer Institute, Vol. 86, No. 21 (November 2, 1994), pp. 1584-1592.

103. Lawson , H. et al, "Abortion Mortality U.S., 1972-1987," American Journal of Obstetrics and Gynecology, Vol. 171, No. 5 (November 1994), pp. 1365-1352. See also, Morbidity and Mortality Weekly Report (CDC), "Abortion Surveillance - U.S., 1989, Vol. 141, No. 55-5, September 4, 1992.

104. Pritchard, cited in note 92, p. 483.

105. Hern, Abortion Practice, cited note 50, pp. 26-35. See also Centers for Disease Control, Abortion Surveillance, 1978, (November 1980) and Christopher Tieze, et al, "Maternal mortality associated with legal abortion in New York State: July 1, 1970-June 30, 1972," Obstet Gynecol, Vol. 43 (1974), p. 315.

106. Wanda Franz, Ph.D., testimony, U.S. Congress, House, Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, Hearing on Medical and Psychological Impact of Abortion, 101st Congress, 1st Session, March 16, 1989 (Hereafter referred to as Hearing on the Impact of Abortion, 1989). See also Vincent Rue, Ph.D., testimony, U.S. Congress, Senate Committee on the Judiciary, Constitutional Amendments Relating to Abortion, R.J. Res. 18, S.J. Res. 19 and S.J. Res. 110, 97th Congress, 1st Session, Vol. 1, pp. 3329-378; David C. Reardon, Aborted Women, Silent No More (Chicago: Loyola University Press and Westchester, IL: Crossway Books, 1987); Anne Speckhard, Ph.D., The Psycho-Social Stress Following Abortion (Kansas City, MO: Sheed and Ward, 1987); and David Mall and Walter F. Watts, M.D., eds., Psychological Aspects of Abortion (Frederick, MD: University Publications of America, 1979).

107 . Debra Rosenberg, Michele Ingrassia, and Sharon Begley, "Blood and Tears," Newsweek, September 18, 1995, p. 68; Louise Levanthes, "Listening to RU 486," Health, January/February 1995, p. 88. See also Mary Ann Castle, et al, "Listening and Learning from Women About Mifepristone: Implications for Counseling and Health Education," Women's Health Issues, Vol. 5, No. 3 (Fall 1995), pp. 132-133.

108. Philip J. Hilts, "Clinic Trials of French Abortion Pill Begin in U.S., " New York Times, October 28, 1994, p. A28; also Hausknecht, speaking on Donahue, cited in note 41, p. 6.

109. See note 106. See also Vincent M. Rue, Ph.D., Anne Speckhard, Ph.D., James Rogers, Ph.D., and Wanda Franz, Ph.D., "The Psychological Aftermath of Abortion: A White Paper," presented to C. Everett Koop, M.D., Surgeon General of the U.S., September 15, 1987, enclosure to testimony of Wanda Franz, Ph.D., Hearing on Impact of Abortion, 1989, cited in note 106.

110. George Skelton, "Abortion often causes guilt, poll finds," The Sacramento Bee, March 19, 1989, p. A7.

111. Letter from C. Everett Koop, M.D., Sc.D., U.S. Surgeon General to President Ronald Reagan, January 9, 1989.

112. International Life Services, Inc., 1996-1997 Pro-Life Resource Directory (Los Angeles, CA: International Life Services, Inc., scheduled for publication, 1996). The 1994-1995 Pro-Life Resource Directory listing Crisis Pregnancy Services in the U.S. and Canada is available from International Life Services, 2606 ½ West 8th St., Los Angeles, California, 90057-3810.

113. See the 1994-1995 Pro-Life Resource Directory, cited above, and also Frederica Mathewes-Green, Real Choices (Sisters, Oregon: Multnomah Books, 1994), pp. 234-235.