Abortion is the termination of a
pregnancy
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
by removal or expulsion of an
embryo
An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male spe ...
or
fetus
A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...
. An abortion that occurs without intervention is known as a
miscarriage
Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...
or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnancies.
When deliberate steps are taken to end a pregnancy, it is called an
induced abortion, or less frequently "induced miscarriage". The unmodified word ''abortion'' generally refers to an induced abortion. The reasons why women have abortions are diverse and vary across the world.
Reasons include
maternal health
Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ens ...
,
an inability to afford a child,
domestic violence
Domestic violence (also known as domestic abuse or family violence) is violence or other abuse that occurs in a domestic setting, such as in a marriage or cohabitation. ''Domestic violence'' is often used as a synonym for ''intimate partner ...
, lack of support, feeling they are too young, wishing to complete education or advance a career,
and not being able or willing to raise a child conceived as a result of
rape
Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or ag ...
or
incest
Incest ( ) is human sexual activity between family members or close relatives. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by affinity (marriage or stepfamily), adoption ...
.
When properly done, induced abortion is
one of the safest procedures in medicine. In the United States, the risk of maternal mortality is 14 times lower after induced abortion than after childbirth.
Unsafe abortion
An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, ...
s—those performed by people lacking the necessary skills, or in inadequately resourced settings—are a major cause of
maternal death, especially in the
developing world
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
,
though self-managed medication abortions are highly effective and safe. Public health data shows that making safe abortion legal and accessible reduces maternal deaths.
Modern methods use
medication
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
or
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
for abortions.
The drug
mifepristone
Mifepristone, also known as RU-486, is a medication typically used in combination with misoprostol to bring about a medical abortion during pregnancy and manage early miscarriage. This combination is 97% effective during the first 63 days of p ...
in combination with
prostaglandin
The prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids having diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derive ...
appears to be as safe and effective as surgery during the
first
First or 1st is the ordinal form of the number one (#1).
First or 1st may also refer to:
*World record, specifically the first instance of a particular achievement
Arts and media Music
* 1$T, American rapper, singer-songwriter, DJ, and rec ...
and
second trimester
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
s of pregnancy.
The most common surgical technique involves
dilating the
cervix and using a
suction device.
Birth control
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
, such as
the pill
The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. The pill contains two important hormones: proges ...
or
intrauterine device
An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD or ICD) or coil, is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. IUDs are one form of long-acting rever ...
s, can be used immediately following abortion.
When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term
mental or physical problems.
In contrast,
unsafe abortion
An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, ...
s performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities cause 47,000 deaths and 5 million hospital admissions each year.
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
states that "access to legal, safe and comprehensive abortion care, including
post-abortion care, is essential for the attainment of the highest possible level of sexual and reproductive health".
Around 73 million abortions are performed each year in the world, with about 45% done unsafely. Abortion rates changed little between 2003 and 2008,
before which they decreased for at least two decades as access to
family planning
Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...
and birth control increased.
, 37% of the world's women had access to legal abortions without limits as to reason.
Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.
Abortion rates are similar between countries that ban abortion and countries that allow it.
Historically
History (derived ) is the systematic study and the documentation of the human activity. The time period of event before the invention of writing systems is considered prehistory. "History" is an umbrella term comprising past events as well ...
, abortions have been attempted using
herbal medicines
Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remedies ...
, sharp tools,
forceful massage, or through other
traditional methods.
Abortion law
Abortion laws vary widely among countries and territories, and have changed over time. Such laws range from abortion being freely available on request, to regulation or restrictions of various kinds, to outright prohibition in all circumstances ...
s and cultural or religious views of abortions are different around the world. In some areas, abortion is legal only in specific cases such as rape,
fetal defects, poverty, risk to a woman's health, or incest.
There is
debate
Debate is a process that involves formal discourse on a particular topic, often including a moderator and audience. In a debate, arguments are put forward for often opposing viewpoints. Debates have historically occurred in public meetings, a ...
over the moral, ethical, and legal issues of abortion. Those who
oppose abortion often argue that an embryo or fetus is a person with a
right to life, and thus equate abortion with
murder
Murder is the unlawful killing of another human without justification (jurisprudence), justification or valid excuse (legal), excuse, especially the unlawful killing of another human with malice aforethought. ("The killing of another person wit ...
. Those who
support the legality of abortion often argue that it is part of a
woman's right to make decisions about her own body. Others favor legal and accessible abortion as a public health measure.
Types
Induced
Approximately 205 million pregnancies occur each year worldwide. Over a third are
unintended and about a fifth end in induced abortion.
Most abortions result from unintended pregnancies. In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.
[ A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the ]gestational age
In obstetrics, gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Su ...
of the embryo or fetus, which increases in size as the pregnancy progresses.
Specific procedures may also be selected due to legality, regional availability, and doctor or a woman's personal preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman; to prevent harm to the woman's physical
Physical may refer to:
*Physical examination
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally co ...
or mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
; to terminate a pregnancy where indications are that the child will have a significantly increased chance of mortality or morbidity; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy
A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
. An abortion is referred to as an elective or voluntary abortion when it is performed at the request of the woman for non-medical reasons. Confusion sometimes arises over the term ''elective'' because "elective surgery
Elective surgery or elective procedure (from the la, eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patien ...
" generally refers to all scheduled surgery, whether medically necessary or not.
Spontaneous
Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation. A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...
" or a "preterm birth". When a fetus dies in utero
''In Utero'' is the third and final studio album by American rock band Nirvana. It was released on September 21, 1993, by DGC Records. After breaking into the mainstream with their second album, ''Nevermind'' (1991), Nirvana hired Steve Albin ...
after viability, or during delivery, it is usually termed "stillborn
Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The ter ...
". Premature births
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...
and stillbirth
Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term ...
s are generally not considered to be miscarriages, although usage of these terms can sometimes overlap.
Studies of pregnant women in the US and China have shown that between 40% and 60% of embryos do not progress to birth. The vast majority of miscarriages occur before the woman is aware that she is pregnant, and many pregnancies spontaneously abort before medical practitioners can detect an embryo. Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman. 80% of these spontaneous abortions happen in the first trimester.
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities
A chromosomal abnormality, chromosomal anomaly, chromosomal aberration, chromosomal mutation, or chromosomal disorder, is a missing, extra, or irregular portion of chromosomal DNA. These can occur in the form of numerical abnormalities, where the ...
of the embryo or fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease
Vascular disease is a class of diseases of the blood vessels – the arteries and veins of the circulatory system of the body. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood vessels can cause ...
(such as lupus
Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...
), diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
, other hormonal problems, infection, and abnormalities of the uterus. Advancing maternal age and a woman's 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 trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide
Foeticide (British English), or feticide (American and Canadian English), is the act of killing a fetus, or causing a miscarriage.
Etymology
Foeticide derives from two constituent Latin roots. ''Foetus'', meaning child, is an alternate form of ...
.
Methods
Medical
Medical abortions are those induced by abortifacient
An abortifacient ("that which will cause a miscarriage" from Latin: ''abortus'' "miscarriage" and '' faciens'' "making") is a substance that induces abortion. This is a nonspecific term which may refer to any number of substances or medications, ...
pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin
The prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids having diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derive ...
analogs in the 1970s and the antiprogestogen
Antiprogestogens, or antiprogestins, also known as progesterone antagonists or progesterone blockers, are a class of drugs which prevent progestogens like progesterone from mediating their biological effects in the body. They act by receptor antag ...
mifepristone
Mifepristone, also known as RU-486, is a medication typically used in combination with misoprostol to bring about a medical abortion during pregnancy and manage early miscarriage. This combination is 97% effective during the first 63 days of p ...
(also known as RU-486) in the 1980s.
The most common early first trimester medical abortion regimens use mifepristone in combination with misoprostol
Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. Misoprostol is taken by mouth w ...
(or sometimes another prostaglandin analog, gemeprost
Gemeprost (16, 16-dimethyl-trans-delta2 PGE1 methyl ester) is an analogue of prostaglandin E1.
Clinical use
It is used as a treatment for obstetric bleeding.
It is used with mifepristone to terminate pregnancy up to 24 weeks gestation.
Side ...
) up to 10 weeks (70 days) gestational age, methotrexate
Methotrexate (MTX), formerly known as amethopterin, is a chemotherapy agent and immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. Types of cancers it is used for include breast cancer, leuke ...
in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone. This regimen is effective in the second trimester. Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.
In very early abortions, up to 7 weeks gestation
Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...
, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration
Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion (otherwise commonly known as ...
), especially when clinical practice does not include detailed inspection of aspirated tissue. Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%.[ The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of ''vaginal'' misoprostol) ''previously'' used by ]Planned Parenthood
The Planned Parenthood Federation of America, Inc. (PPFA), or simply Planned Parenthood, is a nonprofit organization that provides reproductive health care in the United States and globally. It is a tax-exempt corporation under Internal Reve ...
clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman's request. The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of '' buccal'' misoprostol) ''currently'' used by Planned Parenthood clinics in the United States since April 2006 is 98% effective through 59 days gestation. If medical abortion fails, surgical abortion must be used to complete the procedure.
Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain
Britain most often refers to:
* The United Kingdom, a sovereign state in Europe comprising the island of Great Britain, the north-eastern part of the island of Ireland and many smaller islands
* Great Britain, the largest island in the United King ...
, France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
, Switzerland
). Swiss law does not designate a ''capital'' as such, but the federal parliament and government are installed in Bern, while other federal institutions, such as the federal courts, are in other cities (Bellinzona, Lausanne, Luzern, Neuchâtel ...
, United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
, and the Nordic countries
The Nordic countries (also known as the Nordics or ''Norden''; literal translation, lit. 'the North') are a geographical and cultural region in Northern Europe and the Atlantic Ocean, North Atlantic. It includes the sovereign states of Denmar ...
.
Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
, most of Europe, China
China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
and India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
, in contrast to the United States where 96% of second trimester abortions are performed surgically by dilation and evacuation
Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus (potentially including the fetus, placenta and other tissue) after the first trimester of pregnancy. It is a method of abortion as well as a common ...
.
A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion. Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion. Safely permitting women to self-administer abortion medication has the potential to improve access to abortion. Other research gaps that were identified include how to best support women who choose to take the medication home for a self-administered abortion.
Surgical
Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion. ''Manual vacuum aspiration'' (MVA) consists of removing the fetus
A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...
or embryo
An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male spe ...
, placenta
The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mater ...
, and membranes by suction using a manual syringe, while ''electric vacuum aspiration'' (EVA) uses an electric pump. These techniques can both be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.
MVA, also known as "mini-suction" and " menstrual extraction", or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage
Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecolog ...
(D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C 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. The World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
recommends ''sharp curettage'' only when suction aspiration is unavailable.
Dilation and evacuation
Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus (potentially including the fetus, placenta and other tissue) after the first trimester of pregnancy. It is a method of abortion as well as a common ...
(D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction
Intact dilation and extraction (D&X, IDX, or intact D&E) is a surgical procedure that removes an intact fetus from the uterus. The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy.
In ...
(D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.
Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion
Hysterotomy abortion is a surgical procedure that removes an intact fetus from the uterus in a process similar to a cesarean section. The procedure is generally used after another method of termination has failed, or when such a procedure would b ...
is a procedure similar to a caesarean section
Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...
and is performed under general anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.
First trimester procedures can generally be performed using local anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
, while second trimester methods may require deep sedation or general anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
.
Labor induction abortion
In places lacking the necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary. This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.
Only limited data are available comparing this method with dilation and extraction.[ Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.]
Other methods
Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine
Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
. Among these are: tansy
Tansy (''Tanacetum vulgare'') is a perennial, herbaceous flowering plant in the genus ''Tanacetum'' in the aster family, native to temperate Europe and Asia. It has been introduced to other parts of the world, including North America, and in ...
, pennyroyal, black cohosh
''Actaea racemosa'', the black cohosh, black bugbane, black snakeroot, rattle-top, or fairy candle ( syn. ''Cimicifuga racemosa''), is a species of flowering plant of the family Ranunculaceae. It is native to eastern North America from the extrem ...
, and the now-extinct silphium
Silphium (also known as ''silphion'', ''laserwort'', or ''laser'') is an unidentified plant that was used in classical antiquity as a seasoning, perfume, aphrodisiac, and medicine. It also was used as a contraceptive by ancient Greeks and Romans ...
.
In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil.
Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure
Multiple organ dysfunction syndrome (MODS) is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis.
Although Irwin and Rippe cautioned in 2005 that the use of "multiple organ failure" or "multisy ...
, such use is not recommended by physicians.
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
Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...
. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the bas relief
Relief is a sculptural method in which the sculpted pieces are bonded to a solid background of the same material. The term ''relief'' is from the Latin verb ''relevo'', to raise. To create a sculpture in relief is to give the impression that the ...
s 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
The underworld, also known as the netherworld or hell, is the supernatural world of the dead in various religious traditions and myths, located below the world of the living. Chthonic is the technical adjective for things of the underwor ...
.
Reported methods of unsafe, self-induced abortion
A self-induced abortion (also called a self-managed abortion, or sometimes a self-induced miscarriage) is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortion ...
include misuse of misoprostol
Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. Misoprostol is taken by mouth w ...
and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion is legal and available.
Safety
The health risks of abortion depend principally upon whether the procedure is performed safely or unsafely. The World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) defines unsafe abortion
An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, ...
s as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Legal abortions performed in the developed world
A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...
are among the safest procedures in medicine. In the United States as of 2012, abortion was estimated to be about 14 times safer for women than childbirth.[ CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births, while the US abortion mortality rate is 0.7 maternal deaths per 100,000 procedures.] In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term." Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed bortionprocedures constitute 13% of maternal mortality globally." In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14-16 percent of maternal deaths resulted from abortion.
In the US from 2000 to 2009, abortion had a mortality rate lower than plastic surgery
Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...
, lower or similar to running a marathon, and about equivalent to traveling in a passenger car. Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions. The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth. Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.
There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation. Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.
Vacuum aspiration
Vacuum or suction aspiration is a procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion (otherwise commonly known as ...
in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic
Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnan ...
, or hospital. Complications, which are rare, can include uterine perforation
Uterine perforation is a potential complication of any intrauterine procedure. It may be associated with injury to surrounding blood vessels or viscera such as the bladder or intestine. If not diagnosed at the time of the procedure it can occasion ...
, pelvic infection, and retained products of conception requiring a second procedure to evacuate. Infections account for one-third of abortion-related deaths in the United States. The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office. Preventive antibiotics (such as doxycycline
Doxycycline is a broad-spectrum tetracycline class antibiotic used in the treatment of infections caused by bacteria and certain parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, Lyme disease, cholera, typhus, an ...
or metronidazole
Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It i ...
) are typically given before abortion procedures, as they are believed to substantially reduce the risk of postoperative uterine infection; however, antibiotics are not routinely given with abortion pills. The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner
Mid-level practitioners, also called non-physician practitioners or advanced practice providers, are health care providers who have a defined scope of practice. The term ''mid-level'' refers to the complexity of healthcare situations they handle, ...
.
Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen. The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period). It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.
Some purported risks of abortion are promoted primarily by anti-abortion groups,
but lack scientific support. For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute
The National Cancer Institute (NCI) coordinates the United States National Cancer Program and is part of the National Institutes of Health (NIH), which is one of eleven agencies that are part of the U.S. Department of Health and Human Services. ...
, American Cancer Society
The American Cancer Society (ACS) is a nationwide voluntary health organization dedicated to eliminating cancer. Established in 1913, the society is organized into six geographical regions of both medical and lay volunteers operating in more than ...
, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.
In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon
Linda Gordon is an American feminist and historian. She lives in New York City and in Madison, Wisconsin. She won the Marfield Prize for ''Dorothea Lange: A Life Beyond Limits'', and the Antonovych Prize for ''Cossack Rebellions: Social Turmoil ...
states: "In fact, illegal abortions in this country have an impressive safety record." According to Rickie Solinger Rickie Solinger (born 1947) is an independent historian, curator, and lecturer whose work focuses on reproductive politics, welfare politics, politics of incarceration, race and class, and motherhood. She is the author of ''Wake Up Little Susie: S ...
,
Authors Jerome Bates and Edward Zawadzki describe the case of an illegal abortionist in the eastern U.S. in the early 20th century who was proud of having successfully completed 13,844 abortions without any fatality.
In 1870s New York City the famous abortionist/midwife Madame Restell
Ann Trow Lohman (May 6, 1812 – April 1, 1878), better known as Madame Restell, was a British-born American abortion provider who practiced in New York City.
Early life
Ann Trow was born in Painswick, Gloucestershire, England in 1812 to John a ...
(Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patients—a lower mortality rate than the childbirth mortality rate at the time. In 1936, the prominent professor of obstetrics and gynecology Frederick J. Taussig
Frederick J. Taussig (1872–1943) was an American gynecologist and professor of clinical obstetrics at Washington University School of Medicine. In the 1930s he was an influential advocate of legalization of abortion.
Life and work
Frederick Ta ...
wrote that a cause of increasing mortality during the years of illegality in the U.S. was that
Mental health
Current evidence finds no relationship between most induced abortions and mental health problems
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
other than those expected for any unwanted pregnancy. A report by the American Psychological Association
The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain. Some older reviews concluded that abortion was associated with an increased risk of psychological problems; however, they did not use an appropriate control group.[
Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,] more rigorous research would be needed to show this conclusively. Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome
Scientific and medical expert bodies have repeatedly concluded that abortion poses no greater mental health risks than carrying an unintended pregnancy to term. Nevertheless, the relationship between induced abortion and mental health is an area o ...
", but this is not recognized by medical or psychological professionals in the United States.
A 2020 long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later.
Unsafe abortion
Women seeking an abortion may use unsafe methods, especially when it is legally restricted. They may attempt self-induced abortion
A self-induced abortion (also called a self-managed abortion, or sometimes a self-induced miscarriage) is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortion ...
or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
, hemorrhage, and damage to internal organs.
Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
. Unsafe abortions are believed to result in millions of injuries. Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade; deaths from unsafe abortion account for around 13% of all maternal deaths
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...
. The World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
believes that mortality has fallen since the 1990s. To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.
A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to those where abortion is legal and available. For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications, with abortion-related deaths dropping by more than 90%. Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania
Romania ( ; ro, România ) is a country located at the crossroads of Central Europe, Central, Eastern Europe, Eastern, and Southeast Europe, Southeastern Europe. It borders Bulgaria to the south, Ukraine to the north, Hungary to the west, S ...
and Nepal
Nepal (; ne, नेपाल ), formerly the Federal Democratic Republic of Nepal ( ne,
सङ्घीय लोकतान्त्रिक गणतन्त्र नेपाल ), is a landlocked country in South Asia. It is mai ...
. A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state. The analysis, however, did not take into account travel to other states without such laws to obtain an abortion. In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally. Rates of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".
Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...
seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[ Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,] though this varies by region. Secondary infertility caused by an unsafe abortion affects an estimated 24 million women. The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion.
Incidence
There are two commonly used methods of measuring the incidence of abortion:
* Abortion rate – number of abortions annually per 1,000 women between 15 and 44 years of age; some sources use a range of 15–49.
* Abortion percentage – number of abortions out of 100 known pregnancies; pregnancies include live births, abortions, and miscarriages.
In many places, where abortion is illegal or carries a heavy social stigma, medical reporting of abortion is not reliable. For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error. The number of abortions performed worldwide seems to have remained stable in the early 2000s, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008. The abortion rate worldwide was 28 per 1000 women per year, though it was 24 per 1000 women per year for developed countries and 29 per 1000 women per year for developing countries. The same 2012 study indicated that in 2008, the estimated abortion percentage of known pregnancies was at 21% worldwide, with 26% in developed countries and 20% in developing countries.
On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. Restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely. The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute
The Guttmacher Institute is a research and policy NGO that aims to improve sexual and reproductive health and rights worldwide. This research organization was started in 1968 and works to study, educate, and advance sexual and reproductive health ...
, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.
The rate of legal, induced abortion varies extensively worldwide. According to the report of employees of Guttmacher Institute it ranged from 7 per 1000 women per year (Germany and Switzerland) to 30 per 1000 women per year (Estonia) in countries with complete statistics in 2008. The proportion of pregnancies that ended in induced abortion ranged from about 10% (Israel, the Netherlands and Switzerland) to 30% (Estonia) in the same group, though it might be as high as 36% in Hungary and Romania, whose statistics were deemed incomplete.
An American study in 2002 concluded that about half of women having abortions were using a form of contraception
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
at the time of becoming pregnant. Inconsistent use was reported by half of those using condom
A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of in ...
s and three-quarters of those using the birth control pill
The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. The pill contains two important hormones: progesti ...
; 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". In a 2022 analysis by the Kaiser Family Foundation
KFF (Kaiser Family Foundation), also known as The Henry J. Kaiser Family Foundation, is an American non-profit organization, headquartered in San Francisco, California. It prefers KFF since its legal name can cause confusion as it is no longer a ...
, while people of color comprise 44% of the population in Mississippi, 59% of the population in Texas, 42% of the population in Louisiana (by the state Health Department), and 35% of the population in Alabama, they comprise 80%, 74%, 72%, and 70% of those receiving abortions.
The abortion rate may also be expressed as the average number of abortions a woman has during her reproductive years; this is referred to as ''total abortion rate'' (TAR).
Gestational age and method
Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) reported that 26% of reported legal induced abortions in the United States were known to have been obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 18% at 9 through 10 weeks, 10% at 11 through 12 weeks, 6% at 13 through 15 weeks, 4% at 16 through 20 weeks and 1% at more than 21 weeks. 91% of these were classified as having been done by "curettage
Curettage ( or ), in medical procedures, is the use of a curette (French, meaning scoop Mosby's Medical, Nursing & Allied Health Dictionary, Fourth Edition, Mosby-Year Book 1994, p. 422) to remove tissue by scraping or scooping.
Curettages are ...
" ( suction-aspiration, dilation and curettage
Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecolog ...
, dilation and evacuation
Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus (potentially including the fetus, placenta and other tissue) after the first trimester of pregnancy. It is a method of abortion as well as a common ...
), 8% by "medical
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practic ...
" means (mifepristone
Mifepristone, also known as RU-486, is a medication typically used in combination with misoprostol to bring about a medical abortion during pregnancy and manage early miscarriage. This combination is 97% effective during the first 63 days of p ...
), >1% by " intrauterine instillation" (saline or prostaglandin
The prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids having diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derive ...
), and 1% by "other" (including hysterotomy
A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester (or abortion) and delivering the fetus during caesarean section. It i ...
and hysterectomy). According to the CDC, due to data collection difficulties the data must be viewed as tentative and some fetal deaths reported beyond 20 weeks may be natural deaths erroneously classified as abortions if the removal of the dead fetus is accomplished by the same procedure as an induced abortion.
The Guttmacher Institute estimated there were 2,200 intact dilation and extraction
Intact dilation and extraction (D&X, IDX, or intact D&E) is a surgical procedure that removes an intact fetus from the uterus. The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy.
In ...
procedures in the US during 2000; this accounts for <0.2% 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 and 19 weeks, and 2% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical. There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.
Motivation
Personal
The reasons why women have abortions are diverse and vary across the world. Some of the reasons may include an inability to afford a child, domestic violence, lack of support, feeling they are too young, and the wish to complete education or advance a career. Additional reasons include not being able or willing to raise a child conceived as a result of rape or incest.
Societal
Some abortions are undergone as the result of societal pressures. These might include the preference for children of a specific sex or race, disapproval of single or early motherhood, stigmatization of people with disabilities, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control
Population control is the practice of artificially maintaining the size of any population. It simply refers to the act of limiting the size of an animal population so that it remains manageable, as opposed to the act of protecting a species from ...
(such as China's one-child policy
The term one-child policy () refers to a population planning initiative in China implemented between 1980 and 2015 to curb the country's population growth by restricting many families to a single child. That initiative was part of a much br ...
). These factors can sometimes result in compulsory abortion or sex-selective abortion
Sex-selective abortion is the practice of terminating a pregnancy based upon the predicted sex of the infant. The selective abortion of female fetuses is most common where male children are valued over female children, especially in parts of Eas ...
.
Maternal and fetal health
An additional factor is maternal health which was listed as the main reason by about a third of women in 3 of 27 countries and about 7% of women in a further 7 of these 27 countries.
In the U.S., the Supreme Court decisions in ''Roe v. Wade
''Roe v. Wade'', 410 U.S. 113 (1973),. was a landmark decision of the U.S. Supreme Court in which the Court ruled that the Constitution of the United States conferred the right to have an abortion. The decision struck down many federal and s ...
'' and '' Doe v. Bolton'': "ruled that the state's interest in the life of the fetus became compelling only at the point of viability, defined as the point at which the fetus can survive independently of its mother. Even after the point of viability, the state cannot favor the life of the fetus over the life or health of the pregnant woman. Under the right of privacy, physicians must be free to use their "medical judgment for the preservation of the life or health of the mother." On the same day that the Court decided Roe, it also decided Doe v. Bolton, in which the Court defined health very broadly: "The medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient. All these factors may relate to health. This allows the attending physician the room he needs to make his best medical judgment."
Public opinion shifted in America following television personality Sherri Finkbine
Sherri Chessen (born 1932), also known as Sherri Finkbine, is an American former children's television host. She is known also as ''Miss Sherri'', her role on the Phoenix version of the franchised children's show '' Romper Room''. In 1962, Chessen ...
's discovery during her fifth month of pregnancy that she had been exposed to thalidomide
Thalidomide, sold under the brand names Contergan and Thalomid among others, is a medication used to treat a number of cancers (including multiple myeloma), graft-versus-host disease, and a number of skin conditions including complications o ...
. Unable to obtain a legal abortion in the United States, she traveled to Sweden. From 1962 to 1965, an outbreak of German measles
Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...
left 15,000 babies with severe birth defects. In 1967, the American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's state ...
publicly supported liberalization of abortion laws. A National Opinion Research Center
NORC at the University of Chicago is one of the largest independent social research organizations in the United States. Established in 1941 as the National Opinion Research Center, its corporate headquarters is located in downtown Chicago, with o ...
poll in 1965 showed 73% supported abortion when the mother's life was at risk, 57% when birth defects were present and 59% for pregnancies resulting from rape or incest.
Cancer
The rate of cancer during pregnancy is 0.02–1%, and in many cases, cancer of the mother leads to consideration of abortion to protect the life of the mother, or in response to the potential damage that may occur to the fetus during treatment. This is particularly true for cervical cancer
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...
, the most common type of which occurs in 1 of every 2,000–13,000 pregnancies, for which initiation of treatment "cannot co-exist with preservation of fetal life (unless neoadjuvant chemotherapy is chosen)". Very early stage cervical cancers (I and IIa) may be treated by radical hysterectomy
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures.
Usually performed by a gynecologist, a hysterectomy may ...
and pelvic lymph node
A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...
dissection, radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...
, or both, while later stages are treated by radiotherapy. Chemotherapy may be used simultaneously. Treatment of breast cancer during pregnancy also involves fetal considerations, because lumpectomy
Lumpectomy (sometimes known as a tylectomy, partial mastectomy, breast segmental resection or breast wide local excision) is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or brea ...
is discouraged in favor of modified radical mastectomy
Radical mastectomy is a surgical procedure involving the removal of breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla as a treatment for breast cancer. Breast cancer is the most com ...
unless late-term pregnancy allows follow-up radiation therapy to be administered after the birth.
Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic
Teratology is the study of abnormalities of physiological development in organisms during their life span. It is a sub-discipline in medical genetics which focuses on the classification of congenital abnormalities in dysmorphology. The related t ...
effects on the fetus, with higher risks for multiple drug treatments. Treatment with more than 40 Gy of radiation usually causes spontaneous abortion. Exposure to much lower doses during the first trimester, especially 8 to 15 weeks of development, can cause intellectual disability
Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation,Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by signifi ...
or microcephaly
Microcephaly (from New Latin ''microcephalia'', from Ancient Greek μικρός ''mikrós'' "small" and κεφαλή ''kephalé'' "head") is a medical condition involving a smaller-than-normal head. Microcephaly may be present at birth or it ...
, and exposure at this or subsequent stages can cause reduced intrauterine growth and birth weight. Exposures above 0.005–0.025 Gy cause a dose-dependent reduction in IQ. It is possible to greatly reduce exposure to radiation with abdominal shielding, depending on how far the area to be irradiated is from the fetus.
The process of birth itself may also put the mother at risk. According to Li ''et al.'', " ginal delivery may result in dissemination of neoplastic cells into lymphovascular channels, haemorrhage, cervical laceration and implantation of malignant cells in the episiotomy site, while abdominal delivery may delay the initiation of non-surgical treatment."
History and religion
Since ancient times
Ancient history is a time period from the beginning of writing and recorded human history to as far as late antiquity. The span of recorded history is roughly 5,000 years, beginning with the Sumerian cuneiform script. Ancient history cov ...
, abortions have been done using a number of methods, including herbal medicine
Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remed ...
s acting as abortifacient
An abortifacient ("that which will cause a miscarriage" from Latin: ''abortus'' "miscarriage" and '' faciens'' "making") is a substance that induces abortion. This is a nonspecific term which may refer to any number of substances or medications, ...
s, sharp tools through the use of force
In physics, a force is an influence that can change the motion of an object. A force can cause an object with mass to change its velocity (e.g. moving from a state of rest), i.e., to accelerate. Force can also be described intuitively as a p ...
, or through other traditional medicine
Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
methods. Induced abortion has a long history and can be traced back to civilizations as varied as ancient China (abortifacient knowledge is often attributed to the mythological ruler Shennong
Shennong (), variously translated as "Divine Farmer" or "Divine Husbandman", born Jiang Shinian (), was a mythological Chinese ruler known as the first Yan Emperor who has become a deity in Chinese and Vietnamese folk religion. He is venerat ...
), ancient India
According to consensus in modern genetics, anatomically modern humans first arrived on the Indian subcontinent from Africa between 73,000 and 55,000 years ago. Quote: "Y-Chromosome and Mt-DNA data support the colonization of South Asia by m ...
since its Vedic age
The Vedic period, or the Vedic age (), is the period in the late Bronze Age and early Iron Age of the history of India when the Vedic literature, including the Vedas (ca. 1300–900 BCE), was composed in the northern Indian subcontinent, betw ...
, ancient Egypt with its Ebers Papyrus (), and the Roman Empire in the time of Juvenal
Decimus Junius Juvenalis (), known in English as Juvenal ( ), was a Roman poet active in the late first and early second century CE. He is the author of the collection of satirical poems known as the ''Satires''. The details of Juvenal's life ...
(). One of the earliest known artistic representations of abortion is in a bas relief
Relief is a sculptural method in which the sculpted pieces are bonded to a solid background of the same material. The term ''relief'' is from the Latin verb ''relevo'', to raise. To create a sculpture in relief is to give the impression that the ...
at Angkor Wat (). Found in a series of frieze
In architecture, the frieze is the wide central section part of an entablature and may be plain in the Ionic or Doric order, or decorated with bas-reliefs. Paterae are also usually used to decorate friezes. Even when neither columns nor ...
s that represent judgment after death in Hindu
Hindus (; ) are people who religiously adhere to Hinduism.Jeffery D. Long (2007), A Vision for Hinduism, IB Tauris, , pages 35–37 Historically, the term has also been used as a geographical, cultural, and later religious identifier for ...
and Buddhist
Buddhism ( , ), also known as Buddha Dharma and Dharmavinaya (), is an Indian religion or philosophical tradition based on teachings attributed to the Buddha. It originated in northern India as a -movement in the 5th century BCE, and ...
culture, it depicts the technique of abdominal abortion.
In Judaism (), the fetus is not considered to have a human soul until it is safely outside of the woman, is viable, and has taken its first breath. The fetus is considered valuable property of the woman and not a human life while in the womb (). While Judaism
Judaism ( he, ''Yahăḏūṯ'') is an Abrahamic, monotheistic, and ethnic religion comprising the collective religious, cultural, and legal tradition and civilization of the Jewish people. It has its roots as an organized religion in the ...
encourages people to be fruitful and multiply
In Judaism, Christianity, and some other Abrahamic religions, the cultural mandate is the divine injunction found in Genesis 1:28, in which God, after having created the world and all in it, ascribes to humankind the tasks of filling, subduing, ...
by having children, abortion is allowed and is deemed necessary when a pregnant woman's life is in danger. Several religions, including Judaism, which disagree that human life begins at conception
The beginning of human personhood is the moment when a human is first recognized as a person. There are differences of opinion as to the precise time when human personhood begins and the nature of that status. The issue arises in a number of fi ...
, support the legality of abortion on religious freedom
Freedom of religion or religious liberty is a principle that supports the freedom of an individual or community, in public or private, to manifest religion or belief in teaching, practice, worship, and observance. It also includes the freedom ...
grounds. In Islam
IN, In or in may refer to:
Places
* India (country code IN)
* Indiana, United States (postal code IN)
* Ingolstadt, Germany (license plate code IN)
* In, Russia, a town in the Jewish Autonomous Oblast
Businesses and organizations
* Indepe ...
, abortion is traditionally permitted until a point in time when Muslims believe the soul enters the fetus, considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening. Abortion is largely heavily restricted or forbidden in areas of high Islam
Islam (; ar, ۘالِإسلَام, , ) is an Abrahamic religions, Abrahamic Monotheism#Islam, monotheistic religion centred primarily around the Quran, a religious text considered by Muslims to be the direct word of God in Islam, God (or ...
ic faith such as the Middle East and North Africa
MENA, an acronym in the English language, refers to a grouping of countries situated in and around the Middle East and North Africa. It is also known as WANA, SWANA, or NAWA, which alternatively refers to the Middle East as Western Asia (or a ...
.
Some medical scholars and abortion opponents have suggested that the Hippocratic Oath
The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific e ...
forbade physicians in Ancient Greece
Ancient Greece ( el, Ἑλλάς, Hellás) was a northeastern Mediterranean civilization, existing from the Greek Dark Ages of the 12th–9th centuries BC to the end of classical antiquity ( AD 600), that comprised a loose collection of cult ...
from performing abortions; other scholars disagree with this interpretation, and state that the medical texts of Hippocratic Corpus
The Hippocratic Corpus (Latin: ''Corpus Hippocraticum''), or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Corpus cove ...
contain descriptions of abortive techniques right alongside the Oath. The physician Scribonius Largus
Scribonius Largus (c. 1-c. 50) was the court physician to the Roman emperor Claudius.
About 47 AD, at the request of Gaius Julius Callistus, the emperor's freedman, he drew up a list of 271 prescriptions (''Compositiones''), most of them his own, ...
wrote in 43 CE that the Hippocratic Oath prohibits abortion
Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
, as did Soranus of Ephesus
Soranus of Ephesus ( grc-gre, Σωρανός ὁ Ἑφέσιος; 1st/2nd century AD) was a Greek physician. He was born in Ephesus but practiced in Alexandria and subsequently in Rome, and was one of the chief representatives of the Methodic ...
, although apparently not all doctors adhered to it strictly at the time. According to Soranus' 1st or 2nd century CE work ''Gynaecology'', one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party to which he belonged was willing to prescribe abortions only for the sake of the mother's health. In ''Politics
Politics (from , ) is the set of activities that are associated with making decisions in groups, or other forms of power relations among individuals, such as the distribution of resources or status. The branch of social science that studies ...
'' (350 BCE), Aristotle
Aristotle (; grc-gre, Ἀριστοτέλης ''Aristotélēs'', ; 384–322 BC) was a Greek philosopher and polymath during the Classical period in Ancient Greece. Taught by Plato, he was the founder of the Peripatetic school of phil ...
condemned infanticide as a means of population control. He preferred abortion in such cases, with the restriction that it "must be practised on it before it has developed sensation and life; for the line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive."
In the Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
, opinion was divided on how serious abortion was in comparison with such acts as contraception, oral sex, and sex in marriage for pleasure rather than procreation. The Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
did not begin vigorously opposing abortion until the 19th century. As early as ~100 A.D., the ''Didache
The ''Didache'' (; ), also known as The Lord's Teaching Through the Twelve Apostles to the Nations (Διδαχὴ Κυρίου διὰ τῶν δώδεκα ἀποστόλων τοῖς ἔθνεσιν), is a brief anonymous early Christian tr ...
'' taught that abortion was sinful. Several historians argue that prior to the 19th century most Catholic authors did not regard termination of pregnancy before quickening
In pregnancy terms, quickening is the moment in pregnancy when the pregnant woman starts to feel the fetus' movement in the uterus.
Medical facts
The first natural sensation of quickening may feel like a light tapping or fluttering. These sensat ...
or ensoulment
In religion and philosophy, ensoulment is the moment at which a human or other being gains a soul. Some belief systems maintain that a soul is newly created within a developing child and others, especially in religions that believe in reincarnation ...
as an abortion. Among these authors were the Doctors of the Church
Doctor of the Church (Latin: ''doctor'' "teacher"), also referred to as Doctor of the Universal Church (Latin: ''Doctor Ecclesiae Universalis''), is a title given by the Catholic Church to saints recognized as having made a significant contribu ...
, such as St. Augustine, St. Thomas Aquinas
Thomas Aquinas, OP (; it, Tommaso d'Aquino, lit=Thomas of Aquino; 1225 – 7 March 1274) was an Italian Dominican friar and priest who was an influential philosopher, theologian and jurist in the tradition of scholasticism; he is known ...
, and St. Alphonsus Liguori. In 1588, Pope Sixtus V
Pope Sixtus V ( it, Sisto V; 13 December 1521 – 27 August 1590), born Felice Piergentile, was head of the Catholic Church and ruler of the Papal States from 24 April 1585 to his death in August 1590. As a youth, he joined the Franciscan order ...
( 1585–90) was the only Pope before Pope Pius IX
Pope Pius IX ( it, Pio IX, ''Pio Nono''; born Giovanni Maria Mastai Ferretti; 13 May 1792 – 7 February 1878) was head of the Catholic Church from 1846 to 1878, the longest verified papal reign. He was notable for convoking the First Vatican ...
(in his 1869 bull, ''Apostolicae Sedis'') to institute a Church policy labeling all abortion as homicide and condemning abortion regardless of the stage of pregnancy. Sixtus V's pronouncement was reversed in 1591 by Pope Gregory XIV
Pope Gregory XIV ( la, Gregorius XIV; it, Gregorio XIV; 11 February 1535 – 16 October 1591), born Niccolò Sfondrato or Sfondrati, was head of the Catholic Church and ruler of the Papal States from 5 December 1590 to his death in October ...
. In the recodification of 1917 Code of Canon Law
The 1917 ''Code of Canon Law'' (abbreviated 1917 CIC, from its Latin title ), also referred to as the Pio-Benedictine Code,Dr. Edward Peters accessed June-9-2013 was the first official comprehensive codification of Latin canon law.
Ordered ...
, ''Apostolicae Sedis'' was strengthened, in part to remove a possible reading that excluded excommunication of the mother. Statements made in the ''Catechism of the Catholic Church
The ''Catechism of the Catholic Church'' ( la, Catechismus Catholicae Ecclesiae; commonly called the ''Catechism'' or the ''CCC'') is a catechism promulgated for the Catholic Church by Pope John Paul II in 1992. It aims to summarize, in book for ...
'', the codified summary of the Church's teachings, considers abortion from the moment of conception as homicide and called for the end of legal abortion.
A 2014 Guttmacher survey of abortion patients in the United States found that many reported a religious affiliation: 24% were Catholic while 30% were Protestant. A 1995 survey reported that Catholic women are as likely as the general population to terminate a pregnancy, Protestants
Protestantism is a branch of Christianity that follows the theological tenets of the Protestant Reformation, a movement that began seeking to reform the Catholic Church from within in the 16th century against what its followers perceived to b ...
are less likely to do so, and evangelical Christians
Evangelicalism (), also called evangelical Christianity or evangelical Protestantism, is a worldwide interdenominational movement within Protestant Christianity that affirms the centrality of being " born again", in which an individual exper ...
are the least likely to do so. A 2019 Pew Research Center
The Pew Research Center is a nonpartisan American think tank (referring to itself as a "fact tank") based in Washington, D.C.
It provides information on social issues, public opinion, and demographic trends shaping the United States and the w ...
study found that most Christian denomination
A Christian denomination is a distinct religious body within Christianity that comprises all church congregations of the same kind, identifiable by traits such as a name, particular history, organization, leadership, theological doctrine, worsh ...
s were against overturning ''Roe v. Wade
''Roe v. Wade'', 410 U.S. 113 (1973),. was a landmark decision of the U.S. Supreme Court in which the Court ruled that the Constitution of the United States conferred the right to have an abortion. The decision struck down many federal and s ...
,'' which in the United States legalized abortion, at around 70%, except White Evangelicals at 35%.
Abortion has been a fairly common practice, and was not always illegal or controversial until the 19th century. Under common law
In law, common law (also known as judicial precedent, judge-made law, or case law) is the body of law created by judges and similar quasi-judicial tribunals by virtue of being stated in written opinions."The common law is not a brooding omnipresen ...
, including early English common law
English law is the common law legal system of England and Wales, comprising mainly criminal law and civil law, each branch having its own courts and procedures.
Principal elements of English law
Although the common law has, historically, bee ...
dating back to Edward Coke
Edward is an English given name. It is derived from the Anglo-Saxon name ''Ēadweard'', composed of the elements '' ēad'' "wealth, fortune; prosperous" and '' weard'' "guardian, protector”.
History
The name Edward was very popular in Anglo-Sa ...
in 1648, abortion was generally permitted before quickening (14–26 weeks after conception, or between the fourth and sixth month), and at women's discretion; it was whether abortion was performed after quickening that determined if it was a crime. In Europe and North America, abortion techniques advanced starting in the 17th century; the conservatism
Conservatism is a cultural, social, and political philosophy that seeks to promote and to preserve traditional institutions, practices, and values. The central tenets of conservatism may vary in relation to the culture and civilizati ...
of most in the medical profession with regards to sexual matters prevented the wide expansion of abortion techniques. Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century when the practice, sometimes called ''restellism
Ann Trow Lohman (May 6, 1812 – April 1, 1878), better known as Madame Restell, was a British-born American abortion provider who practiced in New York City.
Early life
Ann Trow was born in Painswick, Gloucestershire, England in 1812 to John a ...
'', was banned in both the United States and the United Kingdom.
Church groups, as well as physicians, were highly influential in anti-abortion movement
Anti-abortion movements, also self-styled as pro-life or abolitionist movements, are involved in the abortion debate advocating against the practice of abortion and its legality. Many anti-abortion movements began as countermovements in respon ...
s, and religious groups more so since the 20th century. Some of the early anti-abortion laws
Abortion laws vary widely among countries and territories, and have changed over time. Such laws range from abortion being freely available on request, to regulation or restrictions of various kinds, to outright prohibition in all circumstances ...
punished only the doctor or abortionist, and while women could be criminally tried for a self-induced abortion
A self-induced abortion (also called a self-managed abortion, or sometimes a self-induced miscarriage) is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortion ...
, they were rarely prosecuted in general. In the United States, some argued that abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer. Others maintain that in the 19th century early abortions under the hygienic conditions in which midwives
A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.
The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...
usually worked were relatively safe. Several scholars argue that, despite improved medical procedures, the period from the 1930s until the 1970s saw more zealous enforcement of anti-abortion laws, and concomitantly an increasing control of abortion providers by organized crime.
In 1920, Soviet Russia
The Russian Soviet Federative Socialist Republic, Russian SFSR or RSFSR ( rus, Российская Советская Федеративная Социалистическая Республика, Rossíyskaya Sovétskaya Federatívnaya Soci ...
became the first country to legalize abortion after Lenin
Vladimir Ilyich Ulyanov. ( 1870 – 21 January 1924), better known as Vladimir Lenin,. was a Russian revolutionary, politician, and political theorist. He served as the first and founding head of government of Soviet Russia from 1917 to 19 ...
insisted that no woman be forced to give birth. Iceland
Iceland ( is, Ísland; ) is a Nordic island country in the North Atlantic Ocean and in the Arctic Ocean. Iceland is the most sparsely populated country in Europe. Iceland's capital and largest city is Reykjavík, which (along with its s ...
(1935) and Sweden
Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic country located on ...
(1938) would follow suit to legalize certain or all forms of abortion. In Nazi Germany
Nazi Germany (lit. "National Socialist State"), ' (lit. "Nazi State") for short; also ' (lit. "National Socialist Germany") (officially known as the German Reich from 1933 until 1943, and the Greater German Reich from 1943 to 1945) was ...
(1935), a law permitted abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions. Preceding the Nazi German example was that of some 19th-century physicians, one of the most famous and consequential being Horatio Storer, who argued for anti-abortion laws on racist
Racism is the belief that groups of humans possess different behavioral traits corresponding to inherited attributes and can be divided based on the superiority of one race over another. It may also mean prejudice, discrimination, or antagonism ...
and pseudoscientific grounds. Beginning in the second half of the 20th century, abortion was legalized in a greater number of countries.
Society and culture
Abortion debate
Induced abortion has long been the source of considerable debate. Ethical
Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concerns ma ...
, moral
A moral (from Latin ''morālis'') is a message that is conveyed or a lesson to be learned from a story or event. The moral may be left to the hearer, reader, or viewer to determine for themselves, or may be explicitly encapsulated in a maxim. A ...
, philosophical
Philosophy (from , ) is the systematized study of general and fundamental questions, such as those about existence, reason, knowledge, values, mind, and language. Such questions are often posed as problems to be studied or resolved. Some ...
, biological, religious
Religion is usually defined as a social system, social-cultural system of designated religious behaviour, behaviors and practices, morality, morals, beliefs, worldviews, religious text, texts, sacred site, sanctified places, prophecy, prophecie ...
and legal
Law is a set of rules that are created and are enforceable by social or governmental institutions to regulate behavior,Robertson, ''Crimes against humanity'', 90. with its precise definition a matter of longstanding debate. It has been vario ...
issues surrounding abortion are related to value system
In ethics and social sciences, value denotes the degree of importance of something or action, with the aim of determining which actions are best to do or what way is best to live (normative ethics in ethics), or to describe the significance of dif ...
s. Opinions of abortion may be about fetal rights
Fetal rights are the moral rights or legal rights of the human fetus under natural and civil law. The term ''fetal rights'' came into wide usage after ''Roe v. Wade'', the 1973 landmark case that legalized abortion in the United States. The conce ...
, governmental authority, and women's rights
Women's rights are the rights and entitlements claimed for women and girls worldwide. They formed the basis for the women's rights movement in the 19th century and the feminist movements during the 20th and 21st centuries. In some countries, ...
.
In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or the justification of laws permitting or restricting abortion. The World Medical Association
The World Medical Association (WMA) is an international and independent confederation of free professional medical associations representing physicians worldwide. WMA was formally established on September 18, 1947 and has grown to 115 national ...
Declaration on Therapeutic Abortion notes, "circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question as to whether or not the pregnancy should be deliberately terminated." Abortion debates, especially pertaining to abortion law
Abortion laws vary widely among countries and territories, and have changed over time. Such laws range from abortion being freely available on request, to regulation or restrictions of various kinds, to outright prohibition in all circumstances ...
s, are often spearheaded by groups advocating one of these two positions. Groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while groups who are against such legal restrictions describe themselves as "pro-choice
Abortion-rights movements, also referred to as pro-choice movements, advocate for the right to have legal access to induced abortion services including elective abortion. They seek to represent and support women who wish to terminate their pre ...
".
Modern abortion law
Current laws pertaining to abortion are diverse. Religious, moral, and cultural factors continue to influence abortion laws throughout the world. The right to life, the right to liberty, the right to security of person Security of the person is a basic entitlement guaranteed by the Universal Declaration of Human Rights, adopted by the United Nations in 1948. It is also a human right explicitly defined and guaranteed by the European Convention on Human Rights, th ...
, and the right to reproductive health
Sexual and reproductive health (SRH) is a field of research, healthcare, and social activism that explores the health of an individual's reproductive system and sexual wellbeing during all stages of their life.
The term can also be further de ...
are major issues of human rights that sometimes constitute the basis for the existence or absence of abortion laws.
In jurisdictions where abortion is legal, certain requirements must often be met before a woman may obtain a legal abortion (an abortion performed without the woman's consent is considered feticide
Foeticide (British English), or feticide (American and Canadian English), is the act of killing a fetus, or causing a miscarriage.
Etymology
Foeticide derives from two constituent Latin roots. ''Foetus'', meaning child, is an alternate form of ...
). These requirements usually depend on the age of the fetus, often using a trimester-based system to regulate the window of legality, or as in the U.S., on a doctor's evaluation of the fetus' viability. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on fetal development
Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...
, or require that parents be contacted if their minor daughter requests an abortion. Other jurisdictions may require that a woman obtain the consent of the fetus' father before aborting the fetus, that abortion providers inform women of health risks of the procedure—sometimes including "risks" not supported by the medical literature—and that multiple medical authorities certify that the abortion is either medically or socially necessary. Many restrictions are waived in emergency situations. China, which has ended their one-child policy
The term one-child policy () refers to a population planning initiative in China implemented between 1980 and 2015 to curb the country's population growth by restricting many families to a single child. That initiative was part of a much br ...
, and now has a two child policy, has at times incorporated mandatory abortions as part of their population control strategy.
Other jurisdictions ban abortion almost entirely. Many, but not all, of these allow legal abortions in a variety of circumstances. These circumstances vary based on jurisdiction, but may include whether the pregnancy is a result of rape or incest, the fetus' development is impaired, the woman's physical or mental well-being is endangered, or socioeconomic considerations make childbirth a hardship. In countries where abortion is banned entirely, such as Nicaragua
Nicaragua (; ), officially the Republic of Nicaragua (), is the largest country in Central America, bordered by Honduras to the north, the Caribbean to the east, Costa Rica to the south, and the Pacific Ocean to the west. Managua is the cou ...
, medical authorities have recorded rises in maternal death directly and indirectly due to pregnancy as well as deaths due to doctors' fears of prosecution if they treat other gynecological emergencies. Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene. This is also a terminology in traditional medicine. In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in medical tourism
Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable a ...
and travel to countries where they can terminate their pregnancies. Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.
The organization Women on Waves
Women on Waves (WoW) is a Dutch nongovernmental organization (NGO) created in 1999 by Dutch physician Rebecca Gomperts, in order to bring reproductive health services, particularly non-surgical abortion services and education, to women in countr ...
has been providing education about medical abortions since 1999. The NGO created a mobile medical clinic inside a shipping container, which then travels on rented ships to countries with restrictive abortion laws. Because the ships are registered in the Netherlands, Dutch law prevails when the ship is in international waters. While in port, the organization provides free workshops and education; while in international waters, medical personnel are legally able to prescribe medical abortion drugs and counseling.
Sex-selective abortion
Sonography
Medical ultrasound includes diagnostic techniques (mainly imaging techniques) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, musc ...
and amniocentesis
Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is n ...
allow parents to determine sex before childbirth. The development of this technology has led to sex-selective abortion
Sex-selective abortion is the practice of terminating a pregnancy based upon the predicted sex of the infant. The selective abortion of female fetuses is most common where male children are valued over female children, especially in parts of Eas ...
, or the termination of a fetus based on its sex. The selective termination of a female fetus is most common.
Sex-selective abortion is partially responsible for the noticeable disparities between the birth rates of male and female children in some countries. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Taiwan, South Korea, India, and China. This deviation from the standard birth rates of males and females occurs despite the fact that the country in question may have officially banned sex-selective abortion or even sex-screening. In China, a historical preference for a male child has been exacerbated by the one-child policy
The term one-child policy () refers to a population planning initiative in China implemented between 1980 and 2015 to curb the country's population growth by restricting many families to a single child. That initiative was part of a much br ...
, which was enacted in 1979.
Many countries have taken legislative steps to reduce the incidence of sex-selective abortion. At the International Conference on Population and Development
The United Nations coordinated an International Conference on Population and Development (ICPD) in Cairo, Egypt, on 5–13 September 1994. Its resulting Programme of Action is the steering document for the United Nations Population Fund (UNFPA) ...
in 1994 over 180 states agreed to eliminate "all forms of discrimination against the girl child and the root causes of son preference", conditions also condemned by a PACE
Pace or paces may refer to:
Business
*Pace (transit), a bus operator in the suburbs of Chicago, US
* Pace Airlines, an American charter airline
*Pace Foods, a maker of a popular brand of salsa sold in North America, owned by Campbell Soup Compan ...
resolution in 2011. The World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
and UNICEF
UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
, along with other United Nations agencies, have found that measures to reduce access to abortion are much less effective at reducing sex-selective abortions than measures to reduce gender inequality.
Anti-abortion violence
In a number of cases, abortion providers and these facilities have been subjected to various forms of violence, including murder, attempted murder, kidnapping, stalking, assault, arson, and bombing. Anti-abortion violence is classified by both governmental and scholarly sources as terrorism. In the U.S. and Canada, over 8,000 incidents of violence, trespassing, and death threats have been recorded by providers since 1977, including over 200 bombings/arsons and hundreds of assaults. The majority of abortion opponents have not been involved in violent acts.
In the United States, four physicians who performed abortions have been murdered: David Gunn (1993), John Britton (1994), Barnett Slepian
Barnett Abba Slepian (April 23, 1946 – October 23, 1998) was an American physician and abortion provider who was assassinated in his home by James Charles Kopp, a militant member of the US anti-abortion movement.
Life and career
Slepian was ...
(1998), and George Tiller
George Richard Tiller (August 8, 1941 – May 31, 2009) was an American physician from Wichita, Kansas. He gained national attention as the medical director of Women's Health Care Services, which was one of only three abortion clinics nationwide ...
(2009). Also murdered, in the U.S. and Australia, have been other personnel at abortion clinics, including receptionists and security guards such as James Barrett, Shannon Lowney, Lee Ann Nichols, and Robert Sanderson. Woundings (e.g., Garson Romalis) and attempted murders have also taken place in the United States and Canada. Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have occurred. Notable perpetrators of anti-abortion violence include Eric Robert Rudolph
Eric Robert Rudolph (born September 19, 1966), also known as the Olympic Park Bomber, is an American domestic terrorist convicted for a series of bombings across the southern United States between 1996 and 1998, which killed two people and inju ...
, Scott Roeder
On May 31, 2009, George Tiller, a physician from Wichita, Kansas, who was nationally known for being one of the few doctors in the United States to perform late terminations of pregnancy (also known as "late-term abortions"), was murdered by Sc ...
, Shelley Shannon
Rachelle Ranae "Shelley" Shannon (born March 31, 1956) is an American anti-abortion extremist who was convicted in a Kansas state court for the attempted murder of George Tiller by shooting him in his car in Wichita, Kansas in 1993.Phillips, Don ...
, and Paul Jennings Hill
Paul Jennings Hill (February 6, 1954 – September 3, 2003) was an American minister and anti-abortion terrorist who murdered physician John Britton and Britton's bodyguard, retired Air Force Lieutenant Colonel James Barrett, in 1994. Hill was ...
, the first person to be executed in the United States for murdering an abortion provider.
Legal protection of access to abortion Governments sometimes take measures designed to afford legal protection of access to abortion. Such legislation often seeks to guard facilities which provide induced abortion against obstruction, vandalism, picketing, and other actions, or to prot ...
has been brought into some countries where abortion is legal. These laws typically seek to protect abortion clinics from obstruction, vandalism, picketing, and other actions, or to protect women and employees of such facilities from threats and harassment.
Far more common than physical violence is psychological pressure. In 2003, Chris Danze organized anti-abortion organizations throughout Texas to prevent the construction of a Planned Parenthood
The Planned Parenthood Federation of America, Inc. (PPFA), or simply Planned Parenthood, is a nonprofit organization that provides reproductive health care in the United States and globally. It is a tax-exempt corporation under Internal Reve ...
facility in Austin. The organizations released the personal information online of those involved with construction, sent them up to 1200 phone calls a day and contacted their churches. Some protestors record women entering clinics on camera.
Non-human examples
Spontaneous abortion occurs in various animals. For example, in sheep it may be caused by stress or physical exertion, such as crowding through doors or being chased by dogs. In cows, abortion may be caused by contagious disease, such as brucellosis
Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretions. It is also known as undulant fever, Malta fever, and Mediterranean fever.
The ...
or '' Campylobacter'', but can often be controlled by vaccination. Eating pine needle
A pine is any conifer tree or shrub in the genus ''Pinus'' () of the family Pinaceae. ''Pinus'' is the sole genus in the subfamily Pinoideae. The World Flora Online created by the Royal Botanic Gardens, Kew and Missouri Botanical Garden accep ...
s can also induce abortions in cows. Several plants, including broomweed, skunk cabbage
Skunk cabbage is a common name for several plants and may refer to:
* the genus ''Lysichiton''
** Asian skunk cabbage, ''Lysichiton camtschatcensis'', grows in eastern Asia
** Western skunk cabbage, '' Lysichiton americanus'', grows in western Nor ...
, poison hemlock
''Conium maculatum'', colloquially known as hemlock, poison hemlock or wild hemlock, is a highly poisonous biennial herbaceous flowering plant in the carrot family Apiaceae, native to Europe and North Africa. A hardy plant capable of living in ...
, and tree tobacco, are known to cause fetal deformities and abortion in cattle and in sheep and goats. In horses, a fetus may be aborted or resorbed if it has lethal white syndrome
Lethal white syndrome (LWS), also called overo lethal white syndrome (OLWS), lethal white overo (LWO), and overo lethal white foal syndrome (OLWFS), is an autosomal genetic disorder most prevalent in the American Paint Horse. Affected foals are bo ...
(congenital intestinal aganglionosis). Foal embryos that are homozygous for the dominant white
Dominant white (W) is a group of genetically related coat color alleles on the KIT gene of the horse, best known for producing an all-white coat, but also able to produce various forms of white spotting, as well as bold white markings. Prior ...
gene (WW) are theorized to also be aborted or resorbed before birth. In many species of sharks and rays, stress-induced abortions occur frequently on capture.
Viral infection can cause abortion in dogs. Cats can experience spontaneous abortion for many reasons, including hormonal imbalance. A combined abortion and spaying is performed on pregnant cats, especially in trap–neuter–return
Trap–neuter–return (TNR), also known as trap–neuter–release, is a controversial method that attempts to manage populations of feral cats. The process involves live-trapping the cats, having them neutered, ear-tipped for identification, and, ...
programs, to prevent unwanted kittens from being born.[
][
] Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect
The Bruce effect, or pregnancy block, is the tendency for female rodents to terminate their pregnancies following exposure to the scent of an unfamiliar male. The effect was first noted in 1959 by Hilda M. Bruce, and has primarily been studied i ...
.
Abortion may also be induced in animals, in the context of animal husbandry
Animal husbandry is the branch of agriculture concerned with animals that are raised for meat, fibre, milk, or other products. It includes day-to-day care, selective breeding, and the raising of livestock. Husbandry has a long history, starti ...
. 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
Gray langurs, also called Hanuman langurs and Hanuman monkeys, are Old World monkeys native to the Indian subcontinent constituting the genus ''Semnopithecus''. Traditionally only one species ''Semnopithecus entellus'' was recognized, but since a ...
monkeys may attack females following male takeover, causing miscarriage.
See also
* Abortion doula
*Forced abortion
A forced abortion may occur when the perpetrator causes abortion by force, threat or coercion, or by taking advantage of a situation where a pregnant individual is unable to give consent, or when valid consent is in question due to duress. This m ...
Notes
References
Bibliography
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External links
First-trimester abortion in women with medical conditions.
US Department of Health and Human Services
Safe abortion: Technical & policy guidance for health systems
World Health Organization (2015)
{{Authority control
Human reproduction
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