THE medical induction of abortion early in pregnancy has proved remarkably safe. There have been more than 2 million women treated in Europe in this way, and three deaths. In one of these, usual protocol was not followed.

Three or four years ago a women in the North East died from a haemorrhage. There had been one similar death in Sweden. The third woman who died after medical induction was given it well into the second trimester. She died of thrombo-embolism (a clot), such as might complicate any pregnancy. In the US there have been five cases of infection with Clostridium sordelli but this infection has not been reported in Europe.

Laws governing induced miscarriage, or abortions, vary from country to country. Early abortion is legally available to women in two thirds of the world, and where there are stricter laws they are not always enforced. Only one woman in twelve in the world now lives in a country where abortion laws are rigidly enforced. In Britain the law hasn’t changed in recent years but its interpretation is increasingly liberal.

The favoured method of inducing an abortion in early pregnancy is by medical, rather than surgical, means. In this country this has been widely available in the private sector and larger NHS units for several years. Recently smaller hospitals and centres have been adopting medical matters in preference to surgical intervention and the evacuation of the uterus. In Europe a medical induction is acceptable until the end of the seventh week, but in the UK, Norway and Sweden has been allowed until the ninth week.

Medical inductions became possible after the introduction of a medicine called Mifegyne mifepristone. On the day a patient attends a licensed clinic she is given a Mifegyne tablet, goes home and, in Britain, 36 to 48 hours later returns for the intro-vaginal insertion of prostaglandins. She may stay on the premises. She then returns for a check-up. The Abortion Act, as it licenses premises not doctors, does not allow the entire procedure to be carried out at home.

The greatest danger is from bleeding. After medical induction one woman in 200 bleeds severely enough for it to be described as a haemorrhage, and needs a transfusion.

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