Abortion jabberwocky: the need for better terminology

A lively critique of the misleading language used about abortion, published in the journal Contraception.

Grimes and Stuart note that ‘the contentious issue of abortion is riddled with jabberwocky…terminology that is contradictory, obsolete, ambiguous and misleading’.  Both the lay and professional literature uses obstetrical terms improperly, they argue, and suboptimal terminology is widespread in obstetrics - indeed, many traditional terms are ‘inaccurate, insensitive or stigmatising’. The examples they cite include ‘fetal wastage’, ‘incompetent cervix’, ‘blighted ovum’ and ‘pregnancy failure’.

Regarding abortion, some misuse of terms is ‘inadvertent’, while other misuse is ‘intentional’. The effect, argue Grimes and Stuart, is ‘confusion of the public and medical profession about the nature and scope of abortion practice’. In this commentary, they highlight a number of examples of ‘archaic or suboptimal abortion terminology’ - for example:

‘Late-term’ abortion: an oxymoron

Dr George Tiller was widely reported as having provided ‘late-term’ abortions, but this phrase presents a contradiction in terms. In obstetrics, ‘term’ modifies ‘infant’ and indicates 260 to 294 completed days of pregnancy. Hence, the phrase ‘late-term’ abortion would suggest a pregnancy late in this interval. By definition, abortions are not performed after viabilityand certainly not at term (37 to 42 weeks’ gestation). ‘Late’ is a vague but acceptable adjective for abortion, but ‘late-term’ is not.

The trouble with trimesters

The trimester concept stems from obstetrical mythology; dividing a pregnancy into three equal segments has no basis in embryology or science. 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? The trimester threshold does not help with determining the upper gestational age limit for abortion, since viability occurs before the end of the second trimester, regardless of the definition used. Clinicians should use completed days or weeks of pregnancy, not trimesters, to describe the duration of pregnancy.

Ordinal vs. cardinal numbers

Interchangeable use of ordinal and cardinal weeks of gestation further muddles gestational age limits. 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 (cardinal) year old, but she is in her second (ordinal) year of life.

This difference makes a difference. Ambiguous or contradictory use of ordinal numbers occurs in more than a third of published articles on abortion. An example is use of ordinal numbers in a title that do not correspond to the cardinal numbers in the text. This problem has practical importance when specifying upper gestational age limits for abortion. For example, the 20th week of pregnancy is not 20 weeks of pregnancy.

Other examples of confusing terminology provided by Grimes and Stuart include partial-birth abortion (’a cunning conflation’ ), termination of pregnancy (all pregnancies terminate, but not all abort’ ), and the preborn (adults are not “postborn” or “predead” persons).

Grimes and Stuart offer some 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 “elective” or “therapeutic” ... Obsolete euphemisms for induced abortion, such as “termination of pregnancy,” “medical termination of pregnancy” and “voluntary interruption of pregnancy” should be retired. “Standard” or “traditional” D&E can be used to distinguish this operation from intact D&E. Finally, the occupant of the uterus during pregnancy is an embryo or fetus.’

In conclusion, the authors offer an argument as to why ‘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. Physicians and other health care providers should take the lead in using and promoting proper medical terms. Better terminology for abortion can help the ongoing debate remain both civil and informative.’

Abortion jabberwocky: the need for better terminology. By David A. Grimes and Gretchen Stuart. Contraception Volume 81, Issue 2, Pages 93-96 (February 2010)