Elsevier

Contraception

Volume 81, Issue 2, February 2010, Pages 93-96
Contraception

Commentary
Abortion jabberwocky: the need for better terminology

https://doi.org/10.1016/j.contraception.2009.09.005Get rights and content

Section snippets

What is an abortion?

Abortion is defined as removal of a fetus or embryo from the uterus prior to the stage of viability [5], [6], [7]. Some medical dictionaries mention 20 weeks' gestation or 500 g as the limit [5], but such limits are arbitrary and not evidence based. Few would argue that a 20-week fetus would be viable if delivered. Other dictionaries omit the threshold of viability [6], [7]. The US Supreme Court in its 1973 rulings on Roe v. Wade and Doe v. Bolton sidestepped the issue. A more pragmatic

“Abortion” after viability?

According to the accepted definition of abortion [5], [6], [7], removing a fetus from the uterus after 23 or 24 weeks' gestation is not an abortion. Hence, other terms should be used for these interventions. Examples include feticide [9], labor induction, dilation and evacuation (D&E), hysterotomy, termination of pregnancy [10], [11] or combinations of these. However, “abortion” should not be used for these procedures, since the word is not applicable after viability. Some clinics advertise

“Late-term” abortion: an oxymoron

Dr. Tiller was widely reported as having provided “late-term” abortions [3]. This phrase presents another contradiction in terms. In obstetrics, “term” modifies “infant” and indicates 260 to 294 completed days of pregnancy [13]. Hence, the phrase “late-term” abortion would suggest a pregnancy late in this interval. By definition, abortions are not performed after viability [5], [6], [7] and certainly not at term (37 to 42 weeks' gestation). “Late” is a vague but acceptable adjective for

Partial-birth abortion: a cunning conflation

“Partial-birth abortion” is an evocative neologism for intact D&E abortion. Its public-relations success stems from the juxtaposition of two diametrically opposed words in the same phrase: birth and abortion [14]. This intentional disinformation should not be endorsed or perpetuated by the medical profession. Instead, approved medical terms should be used. These include “intact D&E” or the various components of the procedure, e.g., internal podalic version, total breech extraction and

The trouble with trimesters

The trimester concept stems from obstetrical mythology [16]; dividing a pregnancy into three equal segments has no basis in embryology or science [13]. Justice Blackmun, the principal author of Roe v. Wade, adopted the unscientific obstetrical terminology of the early 1970s in the Supreme Court's decision. Debate continues as to the definitions of the trimesters. Does one divide 40 weeks by three, divide 38 weeks by 3 or divide 38 weeks by 3 and add 2 weeks to start counting from last menses?

Ordinal vs. cardinal numbers

Interchangeable use of ordinal and cardinal weeks of gestation further muddles gestational age limits [17]. Many clinicians are unaware of the difference between these two types of numbers. A cardinal number indicates quantity; examples are one, two, three, etc. An ordinal number depicts rank in a series: first, second, third, etc. Ordinal numbers are one higher than the corresponding cardinal numbers. A child 13 months old illustrates the difference: having passed her birthday, she is one

Used-up euphemisms

A third of a century after Roe v. Wade, euphemisms for induced abortion are no longer needed. A tired cliché is “therapeutic abortion” or “TA.” This is a holdover from the illegal abortion era in the US. Back then, “therapeutic” distinguished abortions performed by physicians (for medical reasons or because of rape) [5] from those done by illegal abortionists.

Abortion, like other medical and surgical procedures, is by nature therapeutic. If one views unwanted pregnancy as a disease, then the

Inarticulate disarticulation

In recent years, the term “disarticulation” has occasionally been used to describe traditional or standard D&E abortion [20]. The origin of this term is unclear, although we suspect that lawyers (unfamiliar with medical terms) played a role.

Disarticulation should not be used to describe D&E for two reasons. First, it is medically inaccurate. Disarticulation specifies “amputation of a limb through a joint without cutting of bone” [5]. Second, the term has no precedent in the abortion literature.

The preborn

Some abortion opponents twist terminology for political advantage. A common ploy is to designate the occupant of the uterus as a “baby” or a “child” [21]. However, according to the dictionary, a baby is an infant or newborn child [5] or an extremely young child [19].

Other intentionally provocative terms for the embryo or fetus include “preborn” or “unborn” person. Centuries ago, the homunculus (a fully formed miniature human) was thought to live in a germ cell and only grew during pregnancy. In

Preferred terms

Abortion can be performed up to viability; thereafter, according to standard dictionaries, other terms should be used for uterine evacuation. “Late” is an acceptable descriptor for abortion; “late-term” is not. Gestational age should be expressed in completed cardinal days, weeks or months; ordinal numbers (and trimesters) should be avoided. “Intact D&E” should be used instead of the oxymoronic “partial-birth abortion” or the mysterious “D&X.”

“Induced” is the proper adjective for abortion, not

Words matter

For decades, imprecise, misleading and obsolete abortion terminology has hindered, not helped, the ongoing debate about abortion. Medically accurate, dispassionate terminology is especially important when emotions run high, as is customary with abortion. Words should precisely convey meaning and, simultaneously, preclude possible misinterpretation [4], [25]. Physicians and other health care providers should take the lead in using and promoting proper medical terms. Better terminology for

First page preview

First page preview
Click to open first page preview

References (25)

  • British Medical Association

    Abortion time limit, May 2008

  • DommerguesM. et al.

    Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals

    Fetal Diagn Ther

    (2003)
  • Cited by (31)

    • “Without any indication”: stigma and a hidden curriculum within medical students’ discussion of elective abortion

      2018, Social Science and Medicine
      Citation Excerpt :

      The American Congress of Obstetricians and Gynecologists supports efforts to destigmatize abortion training in medical education to allow unencumbered access to legal, necessary abortion services (Committee on Health Care for Underserved Women, 2014). Biomedical and public health researchers have argued that the language of abortion care may perpetuate stigma and create barriers to optimal care (Grimes and Stuart, 2010; Janiak and Goldberg, 2016; Johnson et al., 2005; Weitz and Kimport, 2012). Language is also key to medical education reform, particularly when exploring a phenomenon now commonly called the hidden curriculum.

    • In Response

      2011, Journal of Obstetrics and Gynaecology Canada
    • Promoting or Undermining Quality Decision Making? A Qualitative Content Analysis of Patient Decision Aids Comparing Surgical and Medication Abortion

      2019, Women's Health Issues
      Citation Excerpt :

      Guidance from academic researchers about language has largely focused on using plain language (e.g., brief sentences, be specific, minimize jargon) to support quality decision making and patient satisfaction (Holmes-Rovner et al., 2005; King & Hoppe, 2013; McCaffery et al., 2013; Rudd, Kaphingst, Colton, Gregoire, & Hyde, 2004). In abortion care, calls for improved terminology have largely reflected health professionals' perspectives (Belfield, 2010; Grimes & Stuart, 2010; Weitz, Foster, Ellertson, Grossman, & Stewart, 2004), which, although important, need to be weighed alongside what women find acceptable. List et al. (1994) took this approach when developing breast and cervical cancer health education materials and made important changes after learning that women lacked understanding of or were uncomfortable with several key words, including cervix, hysterectomy, and menopause.

    • Put a Ring in It: Exploring Women's Experiences with the Contraceptive Vaginal Ring in Ontario

      2018, Women's Health Issues
      Citation Excerpt :

      Our participants highlighted that the NuvaRing could represent a viable in between option for those considering the use of LARC, such as the IUD. This is an interesting conceptualization and is linked to the fact that reproductive health is a field often plagued with confusing and unclear language, which paves the way for differing interpretations (Grimes & Stuart, 2010; Pruitt & Mullen, 2005). Anecdotal evidence suggests that the ways contraceptive and reproductive health researchers group methods together are not always the same as the way that contraceptive users do.

    • Exploring Canadian Women's Multiple Abortion Experiences: Implications for Reducing Stigma and Improving Patient-Centered Care

      2018, Women's Health Issues
      Citation Excerpt :

      In reproductive health, a field that is already stigmatized, often misunderstood, and the subject of ongoing political and legislative attacks, the stakes seem especially high. Time and again, we have seen the anti-choice movement create incorrect terminology and engage in a process of reframing to serve a political purpose and evoke an emotional response from the public (Cannold, 2002; Grimes & Stuart, 2010; McCaffrey & Keys, 2000; Weitz et al., 2004). That these terms are then adopted by the media and general public is representative of how language diffuses and consequently creates meaning (Pruitt & Mullen, 2005).

    View all citing articles on Scopus
    View full text