Abortion is the termination of a
pregnancy by the removal or expulsion
from the
uterus of a
fetus or
embryo, resulting in or
caused by its death. An abortion can occur spontaneously due to
complications during
pregnancy or can be induced, in humans and other species. In the
context of human pregnancies, an abortion induced to preserve the
health of the
gravida (pregnant female) is
termed a
therapeutic abortion, while an abortion induced
for any other reason is termed an
elective abortion. The
term
abortion most commonly refers to the induced abortion
of a
human pregnancy, while spontaneous
abortions are usually termed
miscarriages.
Abortion has a long
history and
has been induced by various methods including herbal
abortifacients, the use of sharpened tools,
physical trauma and other
traditional methods. Contemporary
medicine utilizes
medications and
surgical procedures to induce abortion. The
legality, prevalence, and cultural
views on abortion vary substantially around the world. In many
parts of the world there is prominent and divisive
public controversy over the
ethical and legal issues of
abortion. Abortion and abortion-related issues feature prominently
in the national politics in many nations often involving the
opposing
pro-life and
pro-choice worldwide social movements. Incidence
of abortion has declined worldwide, as access to family planning
education and contraceptive services has increased. Abortion
incidence in the United States declined 8% from 1996 to 2003.
Types of abortion
Spontaneous abortion
Spontaneous abortion (also known as miscarriage) is the expulsion
of an embryo or fetus due to accidental trauma or
natural causes before approximately
the 22nd
week of gestation; the
definition by gestational age varies by country. Most miscarriages
are due to incorrect replication of chromosomes; they can also be
caused by environmental factors. A pregnancy that ends before 37
weeks of gestation resulting in a
live-born infant is known as a "
premature birth". When a fetus dies
in utero after about 22 weeks, or during
delivery, it is usually termed "
stillborn". Premature births and stillbirths are
generally not considered to be miscarriages although usage of these
terms can sometimes overlap.
Between 10% and 50% of pregnancies end in clinically apparent
miscarriage, depending upon the age and health of the pregnant
woman. Most miscarriages occur very early in pregnancy, in most
cases, they occur so early in the pregnancy that the woman is not
even aware that she was pregnant. One study testing hormones for
ovulation and pregnancy found that 61.9% of conceptuses were lost
prior to 12 weeks, and 91.7% of these losses occurred
subclinically, without the knowledge of the once pregnant
woman.
The risk of spontaneous abortion decreases sharply after the 10th
week from the
last menstrual period
(LMP). One study of 232 pregnant women showed "virtually complete
[pregnancy loss] by the end of the embryonic period" (10 weeks LMP)
with a pregnancy loss rate of only 2 percent after 8.5 weeks
LMP.{{cite book |first=E. |last=Jauniaux |coauthors=P. Kaminopetros
and H. El-Rafaey |chapter=Early pregnancy loss |editor=Martin J.
Whittle and C. H. Rodeck |title=Fetal medicine: basic science and
clinical practice |publisher=Churchill Livingstone
|location=Edinburgh |year=1999
|page=[http://books.google.com/books?id=0BY0hx2l5uoC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA836,M1
836]|isbn=0-443-05357-X |oclc=42792567}} The most common cause of
spontaneous abortion during the first trimester is chromosomal
abnormalities of the embryo/fetus,{{cite
web|url=http://www.medicinenet.com/miscarriage/page1.htm
|title=Miscarriage (Spontaneous Abortion)
|accessdate=2009-04-07|last=Stöppler |first=Melissa Conrad
|coauthors=William C. Shiel, Jr., ed. |work=MedicineNet.com }}
accounting for at least 50% of sampled early pregnancy
losses.{{cite book |first=E. |last=Jauniaux |coauthors=P.
Kaminopetros and H. El-Rafaey |chapter=Early pregnancy loss
|editor=Martin J. Whittle and C. H. Rodeck |title=Fetal medicine:
basic science and clinical practice |publisher=Churchill
Livingstone |location=Edinburgh |year=1999
|page=[http://books.google.com/books?id=0BY0hx2l5uoC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA836,M1
837] |isbn=0-443-05357-X |oclc=42792567}} Other causes include
[[vascular disease]] (such as [[Systemic lupus
erythematosus|lupus]]), [[diabetes]], other hormonal problems,
infection, and abnormalities of the uterus. Advancing maternal age
and a patient history of previous spontaneous abortions are the two
leading factors associated with a greater risk of spontaneous
abortion. A spontaneous abortion can also be caused by accidental
[[Physical trauma|trauma]]; intentional trauma or stress to cause
miscarriage is considered induced abortion or [[feticide]].{{cite
web |url=http://www.ncsl.org/programs/health/fethom.htm
|title=Fetal Homicide Laws
|accessdate=2009-04-07|publisher=[[National Conference of State
Legislatures]]}} ===Induced abortion=== A pregnancy can be
intentionally aborted in many ways. The manner selected depends
chiefly upon the [[gestational age]] of the embryo or fetus, which
increases in size as it ages.Menikoff, Jerry.
[http://books.google.com/books?id=2jXOYv3X8zsC&pg=PA78&dq=size+fetus+abortion+technique&lr=&as_brr=3&ei=MymmSayEFJaQyATt6JiUDg
Law and Bioethics], p. 78 (Georgetown University Press 2001): "As
the fetus grows in size, however, the vacuum aspiration method
becomes increasingly difficult to use." Specific procedures may
also be selected due to legality, regional availability, and
doctor-patient preference. Reasons for procuring induced abortions
are typically characterized as either therapeutic or elective. An
abortion is medically referred to as therapeutic when it is
performed to: *save the life of the pregnant woman;Roche, Natalie
E. (2004). [http://www.emedicine.com/med/topic3311.htm Therapeutic
Abortion]. Retrieved 2006-03-08. *preserve the woman's physical or
mental health; *terminate pregnancy that would result in a child
born with a [[congenital disorder]] that would be [[death|fatal]]
or associated with significant [[morbidity]]; or *[[selective
reduction|selectively reduce]] the number of fetuses to lessen
health risks associated with [[multiple birth|multiple pregnancy]].
An abortion is referred to as elective when it is performed at the
request of the woman "for reasons other than maternal health or
fetal disease."''Encyclopedia Britannica'', (2007), Vol 26, p. 674.
==Abortion methods==
[[Image:Abortionmethods.png|thumb|350px|right|[[Gestational age]]
may determine which abortion methods are practiced.]] ===Medical===
{{main|Medical abortion}} "Medical abortions" are non-surgical
abortions that use [[pharmaceutical drug]]s, and are only effective
in the first trimester of pregnancy. {{Fact|date=February 2009}}
Medical abortions comprise 10% of all abortions in the United
States{{cite journal |author=Strauss LT, Gamble SB, Parker WY, Cook
DA, Zane SB, Hamdan S |title=Abortion surveillance—United States,
2004 |journal=MMWR Surveill Summ |volume=56 |issue=9 |pages=1–33
|year=2007 |month=November |pmid=18030283 |doi=
|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5609a1.htm}} and
Europe.{{Fact|date=February 2009}} Combined regimens include
[[methotrexate]] or [[mifepristone]], followed by a
[[prostaglandin]] (either [[misoprostol]] or [[gemeprost]]:
misoprostol is used in the U.S.; gemeprost is used in the UK and
Sweden.) When used within 49 days gestation, approximately 92% of
women undergoing medical abortion with a combined regimen completed
it without surgical intervention.{{cite journal|author=Spitz,
I.M|title=Early pregnancy termination with mifepristone and
misoprostol in the United States|journal=New England Journal of
Medicine|year=1998|volume=338|issue=18|pmid=9562577|doi=10.1056/NEJM199804303381801|page=1241|last2=Bardin|first2=CW|last3=Benton|first3=L|last4=Robbins|first4=A}}
Misoprostol can be used alone, but has a lower efficacy rate than
combined regimens. In cases of failure of medical abortion, vacuum
or manual aspiration is used to complete the abortion surgically.
===Surgical=== [[File:Vacuum-aspiration (single).svg|thumb|A vacuum
aspiration abortion at eight weeks gestational age (six weeks after
fertilization).
'''1:''' Amniotic sac
'''2:''' Embryo
'''3:''' Uterine lining
'''4:''' Speculum
'''5:''' Vacurette
'''6:''' Attached to a suction pump]] In the first 12 weeks,
[[suction-aspiration abortion|suction-aspiration]] or vacuum
abortion is the most common method.{{cite web |author=Healthwise
|url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112
|title=Manual and vacuum aspiration for abortion |year=2004
|publisher=[[WebMD]] |accessdate=2008-12-05}} ''Manual [[Vacuum
aspiration]]'' (MVA) abortion consists of removing the [[fetus]] or
[[embryo]], [[placenta]] and membranes by suction using a manual
[[syringe]], while ''electric [[vacuum aspiration]]'' (EVA)
abortion uses an electric [[pump]]. These techniques are
comparable, and differ in the mechanism used to apply suction, how
early in pregnancy they can be used, and whether cervical dilation
is necessary. MVA, also known as "mini-suction" and "[[menstrual
extraction]]", can be used in very early pregnancy, and does not
require cervical dilation. Surgical techniques are sometimes
referred to as 'Suction (or surgical) Termination Of Pregnancy'
(STOP). From the 15th week until approximately the 26th, [[dilation
and evacuation]] (D&E) is used. D&E consists of opening the
[[cervix]] of the [[uterus]] and emptying it using surgical
instruments and suction. ''[[Dilation and curettage]]'' (D&C),
the second most common method of abortion, is a standard
gynecological procedure performed for a variety of reasons,
including examination of the uterine lining for possible
malignancy, investigation of abnormal bleeding, and abortion.
''[[Curettage]]'' refers to cleaning the walls of the [[uterus]]
with a [[curette]]. The [[World Health Organization]] recommends
this procedure, also called ''sharp curettage,'' only when MVA is
unavailable.{{cite book |author=[[World Health Organization]]
|chapter=Dilatation and curettage
|chapterurl=http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html
|title=Managing Complications in Pregnancy and Childbirth: A Guide
for Midwives and Doctors |publisher=[[World Health Organization]]
|location=[[Geneva]] |year=2003 |pages= |isbn=92-4-154587-9
|oclc=181845530 |accessdate=2008-12-05}} The term ''D and C'', or
sometimes ''suction curette'', is used as a [[euphemism]] for the
first trimester abortion procedure, whichever the method used.
Other techniques must be used to induce abortion in the second
[[trimester]]. Premature delivery can be induced with
[[prostaglandin]]; this can be coupled with injecting the
[[amniotic sac|amniotic fluid]] with hypertonic solutions
containing [[saline (medicine)|saline]] or [[urea]]. After the 16th
week of gestation, abortions can be induced by [[intact dilation
and extraction]] (IDX) (also called intrauterine cranial
decompression), which requires surgical decompression of the fetus'
head before evacuation. IDX is sometimes called "partial-birth
abortion," which has been [[Partial-Birth Abortion Ban
Act|federally banned]] in the United States. A [[hysterotomy
abortion]] is a procedure similar to a [[caesarean section]] and is
performed under [[general anesthesia]]. It requires a smaller
incision than a caesarean section and is used during later stages
of pregnancy.{{cite encyclopedia |last=McGee |first=Glenn
|authorlink=Glenn McGee |coauthors=[[Jon F. Merz]]
|encyclopedia=[[Encarta]] |title=Abortion
|url=http://encarta.msn.com/encyclopedia_761553899/Abortion.html
|accessdate=2008-12-05
|publisher=[[Microsoft]]|archiveurl=http://www.webcitation.org/5kvWYG63q|archivedate=2009-10-31|deadurl=yes}}
From the 20th to 23rd week of gestation, an [[medical
injection|injection]] to stop the fetal [[heart]] can be used as
the first phase of the surgical abortion procedure{{cite journal
|author=Vause S, Sands J, Johnston TA, Russell S, Rimmer S
|title=Could some fetocides be avoided by more prompt referral
after diagnosis of fetal abnormality? |journal=J Obstet Gynaecol
|volume=22 |issue=3 |pages=243–245 |year=2002 |month=May
|pmid=12521492 |doi=10.1080/01443610220130490
|url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/01443610220130490&magic=pubmed||1B69BA326FFE69C3F0A8F227DF8201D0
|accessdate=2008-12-03}}{{cite journal |author=Dommergues M, Cahen
F, Garel M, Mahieu-Caputo D, Dumez Y |title=Feticide during second-
and third-trimester termination of pregnancy: opinions of health
care professionals |journal=Fetal. Diagn. Ther. |volume=18 |issue=2
|pages=91–97 |year=2003 |pmid=12576743 |doi=10.1159/000068068
|url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=fdt18091
|accessdate=2008-12-03}}{{cite journal |author=Bhide A, Sairam S,
Hollis B, Thilaganathan B |title=Comparison of feticide carried out
by cordocentesis versus cardiac puncture |journal=Ultrasound Obstet
Gynecol |volume=20 |issue=3 |pages=230–232 |year=2002
|month=September |pmid=12230443
|doi=10.1046/j.1469-0705.2002.00797.x
|accessdate=2008-12-03}}{{cite journal |author=Senat MV, Fischer C,
Bernard JP, Ville Y |title=The use of lidocaine for fetocide in
late termination of pregnancy |journal=BJOG |volume=110 |issue=3
|pages=296–300 |year=2003 |month=March |pmid=12628271 |doi=
10.1046/j.1471-0528.2003.02217.x|url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1470-0328&date=2003&volume=110&issue=3&spage=296
|accessdate=2008-12-03}}{{cite journal |author=Senat MV, Fischer C,
Ville Y |title=Funipuncture for fetocide in late termination of
pregnancy |journal=Prenat. Diagn. |volume=22 |issue=5
|pages=354–356 |year=2002 |month=May |pmid=12001185
|doi=10.1002/pd.290 |accessdate=2008-12-03}} to ensure that the
fetus is not born alive.{{cite book |author=Nuffield Council on
Bioethics |chapter=Clinical perspectives (Continued)
|chapterurl=http://www.nuffieldbioethics.org/go/browseablepublications/criticalCareDecisionFetalNeonatalMedicine/report_542.html
|accessdate=2008-12-03 |title=Critical Case Decisions in Fetal and
Neonatal Medicine: Ethical Issues |publisher=Nuffield Council on
Bioethics |location= |year=2006 |isbn=1-904384-14-5
|oclc=85782378}} ===Other methods===
[[Image:AngkorWatAbortionAD1150.JPG|thumb|left|[[Bas-relief]] at
[[Angkor Wat]], [[Cambodia]], c. 1150, depicting a [[demon]]
inducing an abortion by pounding the abdomen of a pregnant woman
with a [[pestle]].Potts, M. et al. "Thousand-year-old depictions of
massage abortion," ''Journal of Family Planning and Reproductive
Health Care'', volume 33, p. 234 (2007): “at Angkor, the operator
is a demon.” Also see Mould, R. ''Mould's Medical Anecdotes'', p.
406 (CRC Press 1996).]] Historically, a number of [[herb]]s reputed
to possess [[abortifacient]] properties have been used in [[folk
medicine]]: [[tansy]], [[pennyroyal]], [[black cohosh]], and the
now-extinct [[silphium]] (see [[Abortion#History of
abortion|history of abortion]]).{{cite book |first=John M.
|last=Riddle |title=Eve's herbs: a history of contraception and
abortion in the West |publisher=[[Harvard University Press]]
|location=[[Cambridge, Massachusetts]] |year=1997 |pages=
|isbn=0-674-27024-X |oclc=36126503}}{{pn}} The use of herbs in such
a manner can cause serious—even lethal—side effects, such as
[[multiple organ dysfunction syndrome|multiple organ failure]], and
is not recommended by [[physician]]s.{{cite journal |author=Ciganda
C, Laborde A |title=Herbal infusions used for induced abortion
|journal=J. Toxicol. Clin. Toxicol. |volume=41 |issue=3
|pages=235–239 |year=2003 |pmid=12807304 |doi=10.1081/CLT-120021104
|url= |accessdate=2008-12-04}} Abortion is sometimes attempted by
causing trauma to the [[abdomen]]. The degree of force, if severe,
can cause serious internal injuries without necessarily succeeding
in inducing [[miscarriage]].Education for Choice. (2005-05-06).
http://www.efc.org.uk/Foryoungpeople/Factsaboutabortion/Unsafeabortion
Unsafe abortion. Retrieved 2006-01-11. Both accidental and
deliberate abortions of this kind can be subject to criminal
liability in many countries. In
Southeast
Asia, there is an ancient tradition of attempting abortion
through forceful abdominal
massage.
One of the
bas reliefs decorating the temple of
Angkor
Wat
in Cambodia
depicts a
demon performing such an abortion upon a woman
who has been sent to the underworld.
Reported methods of unsafe,
self-induced abortion include misuse
of
misoprostol, and insertion of
non-surgical implements such as
knitting
needles and
clothes hangers into
the
uterus. These methods are rarely seen in
developed countries where surgical abortion is legal and
available.
Health considerations
Early-term surgical abortion is a simple procedure which is safer
than
childbirth when performed before the
21th week. Abortion methods, like most
minimally invasive procedures,
carry a small potential for serious complications. The risk of
complications can increase depending on how far
pregnancy has progressed.
Women typically experience minor pain during first-trimester
abortion procedures. In a 1979 study of 2,299 patients, 97%
reported experiencing some degree of pain. Patients rated the pain
as being less than earache or toothache, but more than headache or
backache. Local and general anesthetics are used during surgical
procedures.
Mental health
The relationship between induced abortion and
mental health is an area of controversy. No
scientific research has demonstrated a direct
causal relationship between abortion and poor
mental health, though some studies have noted that there may be a
statistical correlation.
Pre-existing factors in a woman's life, such as emotional
attachment to the pregnancy, lack of social support, pre-existing
psychiatric illness, and conservative views on abortion increase
the likelihood of experiencing negative feelings after an
abortion.
In a 1990 review, the
American Psychological
Association (APA) found that "severe negative reactions [after
abortion] are rare and are in line with those following other
normal life stresses." The APA revised and updated its findings in
August 2008 to account for the accumulation of new evidence, and
again concluded that induced abortion did not lead to increased
mental health problems. A 2008 review by a group from the
Johns Hopkins
Bloomberg School of Public Health concluded that the highest
quality studies found few, if any, mental health differences
between women who had abortions and their comparison groups,
whereas studies with the most flaws reported negative mental health
consequences of abortion. As of August 2008, the United Kingdom
Royal College of
Psychiatrists is also performing a
systematic review of the medical
literature to update their position statement on the subject.
Some proposed negative
psychological
effects of abortion have been referred to by
pro-life advocates as a separate condition called
"post-abortion syndrome." However, the existence of "post-abortion
syndrome" is not recognized by any medical or psychological
organization, and some
physicians and
pro-choice advocates have argued that the
effort to popularize the idea of a "post-abortion syndrome" is a
tactic used by pro-life advocates for political purposes.
Incidence of induced abortion
The incidence and reasons for induced abortion vary regionally. It
has been estimated that approximately 46 million abortions are
performed worldwide every year. Of these, 26 million are said to
occur in
places where abortion is
legal; the other 20 million happen where the procedure is
illegal.
Some countries, such as Belgium (11.2 per 100
known pregnancies) and the Netherlands (10.6 per 100), have a low
rate of induced abortion, while others like Russia (62.6 per 100)
and Vietnam
(43.7 per
100) have a comparatively high rate. The world ratio is 26
induced abortions per 100 known pregnancies.
By gestational age and method
Abortion in the United States by
gestational age, 2004.
(Data source: Centers for Disease Control and
Prevention)
Abortion rates also vary depending on the stage of
pregnancy and the method practiced. In 2003, from
data collected in those areas of the United States that
sufficiently reported
gestational
age, it was found that 88.2% of abortions were conducted at or
prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after
21 weeks. 90.9% of these were classified as having been done by
"
curettage" (
suction-aspiration,
Dilation and curettage,
Dilation and evacuation), 7.7% by
"
medical" means (
mifepristone), 0.4% by "
intrauterine instillation" (
saline or
prostaglandin), and 1.0% by "other" (including
hysterotomy and
hysterectomy). The
Guttmacher Institute estimated there
were 2,200
intact
dilation and extraction procedures in the U.S. during 2000;
this accounts for 0.17% of the total number of abortions performed
that year. Similarly, in England and Wales in 2006, 89% of
terminations occurred at or under 12 weeks, 9% between 13 to 19
weeks, and 1.5% at or over 20 weeks. 64% of those reported were by
vacuum aspiration, 6% by D&E, and 30% were medical. Later
abortions are more common in China, India, and other developing
countries than in developed countries.
By personal and social factors
A 1998 aggregated study, from 27 countries, on the reasons women
seek to terminate their pregnancies concluded that common factors
cited to have influenced the abortion decision were: desire to
delay or end
childbearing, concern over
the interruption of
work or
education, issues of financial or relationship
stability, and perceived immaturity. A 2004 study in which American
women at
clinics answered a
questionnaire yielded similar results.
In Finland
and the United States, concern for the health risks posed by
pregnancy in individual cases was not a factor commonly given;
however, in Bangladesh
, India, and Kenya
health
concerns were cited by women more frequently as reasons for having
an abortion. 1% of women in the 2004 survey-based U.S. study
became pregnant as a result of
rape and 0.5% as
a result of
incest. Another American study in
2002 concluded that 54% of women who had an abortion were using a
form of
contraception at the time of
becoming pregnant while 46% were not. Inconsistent use was reported
by 49% of those using
condoms and 76% of
those using the
combined oral contraceptive
pill; 42% of those using condoms reported failure through
slipping or breakage. The Guttmacher Institute estimated that "most
abortions in the United States are obtained by minority women"
because minority women "have much higher rates of unintended
pregnancy."
Some abortions are undergone as the result of societal pressures.
These
might include the stigmatization of disabled persons, preference for children of a
specific sex, disapproval of single motherhood, insufficient economic
support for families, lack of access to or
rejection of contraceptive methods, or efforts toward population control (such as China's
one-child
policy). These factors can sometimes result in
compulsory abortion or
sex-selective abortion.
History of abortion
"French Periodical Pills."
An example of a clandestine advertisement published in an 1845
edition of the Boston Daily Times.
Induced abortion can be traced to ancient times. There is evidence
to suggest that, historically, pregnancies were terminated through
a number of methods, including the administration of
abortifacient herbs, the use of sharpened
implements, the application of abdominal pressure, and other
techniques.
The
Hippocratic Oath, the chief
statement of
medical ethics for
Hippocratic physicians in
Ancient
Greece, forbade doctors from helping to procure an abortion by
pessary.
Soranus, a second-century Greek
physician, suggested in his work
Gynaecology that women wishing
to abort their pregnancies should engage in energetic exercise,
energetic jumping, carrying heavy objects, and riding animals. He
also prescribed a number of recipes for herbal baths, pessaries,
and
bloodletting, but advised against
the use of sharp instruments to induce miscarriage due to the risk
of organ
perforation. It is also
believed that, in addition to using it as a
contraceptive, the ancient Greeks relied upon
silphium as an
abortifacient. Such folk remedies, however,
varied in effectiveness and were not without risk.
Tansy and
pennyroyal, for
example, are two
poisonous herbs with serious
side effects that have at times
been used to terminate pregnancy.
During the
medieval period,
physicians in the Islamic
world documented detailed and extensive lists of
birth control practices, including the use of
abortifacients, commenting on their
effectiveness and prevalence. They listed many different birth
control substances in their medical encyclopedias, such as
Avicenna listing 20 in
The Canon of Medicine (1025) and
Muhammad ibn Zakariya
ar-Razi listing 176 in his
Hawi (10th century). This
was unparalleled in European medicine until the 19th century.
Abortion in the 19th century continued, despite bans in both the
United Kingdom and the United States, as the disguised, but
nonetheless open, advertisement of services in the
Victorian era suggests.
In the
20th century the Soviet
Union
(1919), Iceland
(1935) and
Sweden (1938) were among the first countries to legalize certain or
all forms of abortion. In 1935 Nazi Germany, a law was
passed permitting abortions for those deemed "hereditarily ill,"
while women considered of German stock were specifically prohibited
from having abortions.
Social issues
Sex-selective abortion and female infanticide
Sonography and
amniocentesis allow parents to determine
sex before
birth. The
development of this technology has led to
sex-selective
abortion, or the targeted termination of female
fetuses.
It is suggested that sex-selective abortion might be partially
responsible for the noticeable disparities between the
birth rates of male and female children in some
places.
The preference for male children is reported
in many areas of Asia, and abortion used to limit female births has
been reported in Mainland China,
Taiwan
, South
Korea, and India.
In India, the
economic role of men, the
costs associated with
dowries, and a
Hindu tradition which dictates that
funeral rites must be performed by a male relative
have led to a
cultural preference for
sons. The widespread availability of diagnostic
testing, during the 1970s and '80s, led to advertisements for
services which read, "Invest 500
rupees [for a
sex test] now, save 50,000 rupees [for a dowry] later." In 1991,
the male-to-female
sex ratio in
India was skewed from its biological norm of 105 to 100, to an
average of 108 to 100. Researchers have asserted that between 1985
and 2005 as many as 10 million female fetuses may have been
selectively aborted. The Indian government passed an official ban
of pre-natal sex screening in 1994 and moved to pass a complete ban
of sex-selective abortion in 2002.
In the People's Republic of China, there is also a historic son
preference. The implementation of the
one-child policy in 1979, in response to
population concerns, led to an increased disparity in the sex ratio
as parents attempted to circumvent the law through sex-selective
abortion or the abandonment of unwanted daughters. Sex-selective
abortion might be an influence on the shift from the baseline
male-to-female birth rate to an elevated national rate of 117:100
reported in 2002.
The trend was more pronounced in rural
regions: as high as 130:100 in Guangdong
and 135:100 in Hainan
. A
ban upon the practice of sex-selective abortion was enacted in
2003.
Unsafe abortion
Women seeking to terminate their pregnancies sometimes resort to
unsafe methods, particularly where and when access to legal
abortion is being barred.
The
World Health
Organization (WHO) defines an unsafe abortion as being "a
procedure ... carried out by persons lacking the necessary skills
or in an environment that does not conform to minimal medical
standards, or both." Unsafe abortions are sometimes known
colloquially as "back-alley" abortions. This can include a person
without medical training, a professional health provider operating
in sub-standard conditions, or
the
woman herself.
Unsafe abortion remains a
public
health concern today due to the higher incidence and severity
of its associated complications, such as incomplete abortion,
sepsis,
hemorrhage,
and damage to internal organs. WHO estimates that 19 million unsafe
abortions occur around the world annually and that 68,000 of these
result in the woman's death. Complications of unsafe abortion are
said to account, globally, for approximately 13% of all
maternal mortalities, with regional estimates
including 12% in Asia, 25% in
Latin
America, and 13% in
sub-Saharan
Africa. A 2007 study published in the
The Lancet found that, although the global
rate of abortion declined from 45.6 million in 1995 to 41.6 million
in 2003, unsafe procedures still accounted for 48% of all abortions
performed in 2003.
Health education,
access to
family planning, and
improvements in
health care during and
after abortion have been proposed to address this phenomenon.
Abortion debate
In the
history of abortion,
induced abortion has been the source of considerable
debate,
controversy, and
activism. An
individual's position on the complex
ethical,
moral,
philosophical,
biological, and
legal issues is
often related to his or her
value
system. The main positions are the
pro-choice position, which argues in favor of
access to abortion, and the
pro-life
position, which argues against access to abortion. Opinions of
abortion may be described as being a combination of beliefs on its
morality, and beliefs on the responsibility, ethical scope, and
proper extent of
governmental authorities in
public
policy.
Religious ethics also has an
influence upon both personal opinion and the greater debate over
abortion (see
religion and
abortion).
Abortion debates, especially pertaining to
abortion laws, are often spearheaded by
groups advocating one of these two
positions. In the United States, those in favor of greater legal
restrictions on, or even complete prohibition of abortion, most
often describe themselves as
pro-life while
those against legal restrictions on abortion describe themselves as
pro-choice. Generally, the pro-life
position argues that a human fetus is a
human being with the
right to live making abortion tantamount to
murder. The pro-choice position argues that a
woman has certain
reproductive
rights, especially the choice whether or not to carry a
pregnancy to term.
In both public and private debate, arguments presented in favor of
or against abortion focus on either the moral permissibility of an
induced abortion, or justification of
laws
permitting or restricting abortion.
Debate also focuses on whether the
pregnant woman should have to notify and/or have
the
consent of others in distinct cases: a
minor, her parents; a
legally married or
common-law wife, her husband; or a
pregnant woman, the biological father. In a 2003 Gallup poll in the
United States, 79% of male and 67% of female respondents were in
favor of legalized mandatory spousal notification; overall support
was 72% with 26% opposed.
Public opinion
A number of
opinion polls around the
world have explored
public opinion
regarding the issue of abortion. Results have varied from poll to
poll, country to country, and region to region, while varying with
regard to different aspects of the issue.
A May 2005 survey examined attitudes toward abortion in 10 European
countries, asking polltakers whether they agreed with the
statement, "If a woman doesn't want children, she should be allowed
to have an abortion". The highest level of approval was 81% (in the
Czech Republic); the lowest was 47% (in Poland).
In North
America, a December 2001 poll surveyed Canadian opinion on
abortion, asking Canadians
in what circumstances they believe abortion should
be permitted; 32% responded that they believe abortion should be
legal in all circumstances, 52% that it should be legal in certain
circumstances, and 14% that it should be legal in no
circumstances. A similar poll in April 2009 surveyed people
in the United States about
U.S. opinion on
abortion; 18% said that abortion should be "legal in all
cases", 28% said that abortion should be "legal in most cases", 28%
said abortion should be "illegal in most cases" and 16% said
abortion should be "illegal in all cases". A November 2005 poll in
Mexico found that 73.4% think abortion should not be legalized
while 11.2% think it should.
Of
attitudes in South America, a December
2003 survey found that 30% of Argentines
thought that abortion in Argentina should be
allowed "regardless of situation", 47% that it should be allowed
"under some circumstances", and 23% that it should not be allowed
"regardless of situation". A March 2007 poll regarding the abortion law in Brazil found that 65% of
Brazilians
believe that it "should not be modified", 16% that
it should be expanded "to allow abortion in other cases", 10% that
abortion should be "decriminalized", and 5% were "not sure".
A July
2005 poll in Colombia
found that 65.6% said they thought that abortion
should remain illegal, 26.9% that it should be made legal, and 7.5%
that they were unsure.
Selected issues of the abortion debate
Breast cancer hypothesis
The abortion-breast cancer hypothesis posits that induced abortion
increases the risk of developing
breast
cancer. This position contrasts with the
scientific consensus that abortion does
not cause breast cancer.
In early
pregnancy, levels of
estrogen increase, leading to
breast growth in preparation for
lactation. The hypothesis proposes that if this
process is interrupted by an abortion before full maturity in the
third
trimester then more relatively
vulnerable immature cells could be left than there were prior to
the pregnancy, resulting in a greater potential risk of breast
cancer. The hypothesis mechanism was first proposed and explored in
rat studies conducted in the 1980s.
Fetal pain debate
Fetal pain, its existence, and its implications are part of a
larger debate about abortion. Many researchers in the area of fetal
development believe that a fetus is unlikely to feel pain until
after the seventh month of pregnancy. Others disagree.
neurobiologists suspect
that the establishment of
thalamocortical connections (at about 26
weeks) may be critical to fetal perception of pain. However,
legislation has been proposed by
pro-life
advocates requiring abortion providers to tell a woman that the
fetus may feel pain during an abortion procedure.
A review
by researchers from the University of California, San
Francisco
in JAMA
concluded that data from dozens of medical reports and studies
indicate that fetuses are unlikely to feel pain until the third trimester of pregnancy. However
a number of medical critics have since disputed these conclusions.
At the end of the 20th century there was an emerging consensus
among developmental
neurobiologists
that the establishment of
thalamocortical connections (at about 26
weeks) is a critical event with regard to fetal perception of pain.
Other researchers such as Anand and Fisk have challenged this late
date, positing that pain can be felt around 20 weeks. Because pain
can involve sensory, emotional and cognitive factors, it may be
"impossible to know" when painful experiences are perceived, even
if it is known when thalamocortical connections are established. In
any case, one of the first steps in second-trimester and
third-trimester abortions is to anesthetize the fetus or stop its
heart to prevent fetal pain.
Effect upon crime rate
A theory attempts to draw a
correlation
between the United States' unprecedented nationwide decline of the
overall
crime rate during the 1990s and
the decriminalization of abortion 20 years prior.
The suggestion was brought to widespread attention by a 1999
academic paper,
The Impact of
Legalized Abortion on Crime, authored by the
economists Steven D.
Levitt and John Donohue. They
attributed the drop in crime to a reduction in individuals said to
have a higher statistical probability of committing crimes:
unwanted children, especially those born to mothers who are
African-American,
impoverished,
adolescent,
uneducated, and
single. The change coincided with what would
have been the adolescence, or peak years of potential criminality,
of those who had not been born as a result of
Roe v. Wade and similar cases. Donohue and
Levitt's study also noted that states which legalized abortion
before the rest of the nation experienced the lowering crime rate
pattern earlier, and those with higher abortion rates had more
pronounced reductions.
Fellow economists Christopher Foote and Christopher Goetz
criticized the
methodology in the
Donohue-Levitt study, noting a lack of accommodation for statewide
yearly variations such as
cocaine use, and
recalculating based on incidence of crime
per
capita; they found no
statistically significant results.
Levitt and Donohue responded to this by presenting an adjusted
data set which took into account these
concerns and reported that the data maintained the statistical
significance of their initial paper.
Such research has been criticized by some as being
utilitarian,
discriminatory as to
race and
socioeconomic class, and as promoting
eugenics as a solution to
crime. Levitt states in his book
Freakonomics that they are neither
promoting nor negating any course of action—merely reporting data
as economists.
Mexico City Policy
The Mexico City policy, also known as the "Global Gag Rule"
required any
non-governmental organization
receiving US Government funding to refrain from performing or
promoting abortion services in other countries. This had a
significant effect on the health policies of many nations across
the globe. The Mexico City Policy was instituted under
President Reagan, suspended under
President Clinton, reinstated by
President George W. Bush, and suspended again by
President Barack Obama on January 24,
2009.
Religious views
Abortion law
International status of abortion law:
Vertical stripes (various colours): Illegal but unenforced
Before the scientific discovery in the nineteenth century that
human development begins at
fertilization,
English common law forbade abortions
after "
quickening”, that is, after “an
infant is able to stir in the mother's womb.” There was also an
earlier period in England when abortion was prohibited "if the
foetus is already formed" but not yet quickened. Both pre- and
post-quickening abortions were criminalized by
Lord Ellenborough's Act in
1803.
In
1861, the Parliament of the United
Kingdom
passed the Offences against the Person
Act 1861, which continued to outlaw abortion and served as
a model for similar prohibitions in some other
nations.
The
Soviet
Union, with legislation in 1920, and Iceland, with
legislation in 1935, were two of the first countries to generally
allow abortion. The second half of the 20th century saw the
liberalization of abortion laws in other countries. The
Abortion Act 1967 allowed
abortion for limited reasons in Great Britain. In the 1973 case,
Roe v. Wade, the United
States Supreme Court
struck down state laws banning abortion, ruling
that such laws violated an implied right to privacy in the United States
Constitution. The Supreme Court of Canada
, similarly, in the case of R. v. Morgentaler, discarded its criminal
code regarding abortion in 1988, after ruling that such
restrictions violated the security of person guaranteed to women
under the
Canadian Charter of
Rights and Freedoms. Canada later struck down provincial
regulations of abortion in the case of
R. v. Morgentaler . By contrast, abortion in Ireland was
affected by the addition of an amendment to
the Irish
Constitution
in 1983 by popular referendum,
recognizing "the right to life of the unborn".
Current laws pertaining to abortion are diverse. Religious, moral,
and cultural sensibilities continue to influence abortion laws
throughout the world. The
right to
life, the right to
liberty, the right to
security of person, and the right
to
reproductive health are major
issues of
human rights that are
sometimes used as justification for the existence or absence of
laws controlling abortion. Many countries in which abortion is
legal require that certain criteria be met in order for an abortion
to be obtained, often, but not always, using a
trimester-based system to regulate the window of
legality:
- In the United States, some states impose a 24-hour waiting
period before the procedure, prescribe the distribution of
information on fetal
development, or require that parents be contacted if their minor daughter requests an abortion.
- In the United Kingdom, as in some other countries, two doctors
must first certify that an abortion is medically or socially
necessary before it can be performed.
- In Canada, a similar requirement was rejected as
unconstitutional in 1988.
Other countries, in which abortion is normally illegal, will allow
one to be performed in the case of
rape,
incest, or danger to the pregnant woman's
life or health.
In places where abortion is illegal or carries heavy social stigma,
pregnant women may engage in
medical
tourism and travel to countries where they can terminate their
pregnancy. Women without the means to travel can resort to
providers of illegal abortions or try to do it themselves.
In the USA, about 8% of abortions are performed on women who travel
from another state. However, that is driven at least partly by
differing limits on abortion according to gestational age or the
scarcity of doctors trained and willing to do later
abortions.
In other animals
Spontaneous abortion occurs in various animals. For example, in
sheep, it may be caused by crowding through doors, or being chased
by dogs. In cows, abortion may be caused by contagious disease,
such as
Brucellosis or
Campylobacter, but can often be controlled by
vaccination. Additionally, many other diseases are known to
increase the risk of miscarriage in humans and other animals.
Abortion may also be induced in animals, in the context of
animal husbandry. For example, abortion may
be induced in
mares that have been mated
improperly, or that have been purchased by owners who did not
realize the mares were pregnant, or that are pregnant with twin
foals.
Feticide can occur in
horses and
zebras due to male
harassment of pregnant mares or
forced
copulation, although the frequency in the wild has been
questioned. Male
Gray langur monkeys may
attack females following male takeover, causing miscarriage.
See also
References
External links
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with a non-neutral position in the abortion debate:
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