Termination of pregnancy (TOP)

Termination of pregnancy (TOP), also known as induced abortion, is the removal of the products of conception in order to stop the progression of pregnancy (1).

TOP has only recently been made legal in the UK, and remains illegal in many parts of the world, especially in countries where Catholicism is the dominant religion.

Less than half of the pregnancies worldwide are unintended and half of these end in abortion (1). Abortion can be:

• therapeutic
  • performed for serious maternal medical conditions or fetal indications
  • in England & Wales, 1–2% of termination of pregnancy are due to fetal anomaly, and 0.1% of which occur after 24 weeks’ gestation (1)
• elective (voluntary) abortion
  • done at the request of the mother due to various complex reasons (e.g. financial constraints, lack of partner support etc.)
  • second trimester abortions occur more likely in teenagers, economically disadvantaged women, and those who did not suspect they were pregnant or those who face barriers to services (2)

The present abortion law came into power in 1967. It was modified in an attempt to resolve the dilemma presented by technical advances in keeping earlier preterm babies alive.

Unsafe abortion
WHO defines unsafe abortion as "a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both" (2).

In 2015–2019, a global rate of 39 abortions per 1000 women between 15 to 49 years old was recorded (3).

• Majority of unsafe abortions take place in developing countries.
• Higher rates of abortion are seen in countries where abortion is illegal.
• Deaths due to unsafe abortion are largely due to severe infections, organ damage, or bleeding from unsafe abortion (2).

References

1. Lohr PA et al. Abortion.  BMJ 2014;348:f7553
2. World Health Organization (WHO) 2012. Unsafe abortion incidence and mortality - Global and regional levels in 2008 and trends. (accessed 14 January 2022)
3. Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: Estimates from a comprehensive model for 1990–2019. The Lancet Global Health. 2020;8(9).