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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=[,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= |title=Miscarriage (Spontaneous Abortion) |accessdate=2009-04-07|last=Stöppler |first=Melissa Conrad |coauthors=William C. Shiel, Jr., ed. | }} 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=[,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= |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. [ 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). [ 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=}} 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= |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= |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= |accessdate=2008-12-05 |publisher=[[Microsoft]]|archiveurl=|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=||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= |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= |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= |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). 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 Watmarker in Cambodiamarker 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 Vietnammarker (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 Bangladeshmarker, India, and Kenyamarker 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'smarker 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 Unionmarker (1919), Icelandmarker (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, Taiwanmarker, 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 Guangdongmarker and 135:100 in Hainanmarker. 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 Canadiansmarker 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 Argentinesmarker 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 Braziliansmarker 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 Colombiamarker 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 Franciscomarker 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 Kingdommarker 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 Unionmarker, with legislation in 1920, and Icelandmarker, 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 Courtmarker 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 Canadamarker, 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 Irishmarker 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


External links

The following information resources may be created by those with a non-neutral position in the abortion debate:

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