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Abortion

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Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus.[nb 1] An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnancies.[2][3] 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.[4][5] The reasons why women have abortions are diverse and vary across the world.[6][7] Reasons include maternal health,[6][7] an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career,[8] and not being able or willing to raise a child conceived as a result of rape or incest.[7]

When properly done, induced abortion is one of the safest procedures in medicine.[9]: 1[10] In the United States, the risk of maternal mortality is 14 times lower after induced abortion than after childbirth.[11] Unsafe abortions—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,[12] though self-managed medication abortions are highly effective and safe.[13][14] Public health data shows that making safe abortion legal and accessible reduces maternal deaths.[15][16]

Modern methods use medication or surgery for abortions.[17] The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimesters of pregnancy.[17][18] The most common surgical technique involves dilating the cervix and using a suction device.[19] Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.[18] 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.[20] In contrast, unsafe abortions performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities cause 47,000 deaths and 5 million hospital admissions each year.[20][21] The World Health Organization 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".[22]

Around 73 million abortions are performed each year in the world,[23] with about 45% done unsafely.[24] Abortion rates changed little between 2003 and 2008,[25] before which they decreased for at least two decades as access to family planning and birth control increased.[26] As of 2018, 37% of the world's women had access to legal abortions without limits as to reason.[27] Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.[28] Abortion rates are similar between countries that ban abortion and countries that allow it.[29]

Historically, abortions have been attempted using herbal medicines, sharp tools, forceful massage, or through other traditional methods.[30] Abortion laws 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.[31] There is debate over the moral, ethical, and legal issues of abortion.[32][33] 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.[34][35] 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.[36] Others favor legal and accessible abortion as a public health measure.[37]

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Embryo

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 sperm cell. The resulting fusion of these two cells produces a single-celled zygote that undergoes many cell divisions that produce cells known as blastomeres. The blastomeres are arranged as a solid ball that when reaching a certain size, called a morula, takes in fluid to create a cavity called a blastocoel. The structure is then termed a blastula, or a blastocyst in mammals.

Domestic violence

Domestic violence

Domestic 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 violence, which is committed by one of the people in an intimate relationship against the other person, and can take place in relationships or between former spouses or partners. In its broadest sense, domestic violence also involves violence against children, parents, or the elderly. It can assume multiple forms, including physical, verbal, emotional, economic, religious, reproductive, or sexual abuse. It can range from subtle, coercive forms to marital rape and other violent physical abuse, such as choking, beating, female genital mutilation, and acid throwing that may result in disfigurement or death, and includes the use of technology to harass, control, monitor, stalk or hack. Domestic murder includes stoning, bride burning, honor killing, and dowry death, which sometimes involves non-cohabitating family members. In 2015, the United Kingdom's Home Office widened the definition of domestic violence to include coercive control.

Dilation and evacuation

Dilation and evacuation

Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

Cervix

Cervix

The cervix or cervix uteri is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long and roughly cylindrical in shape, which changes during pregnancy. The narrow, central cervical canal runs along its entire length, connecting the uterine cavity and the lumen of the vagina. The opening into the uterus is called the internal os, and the opening into the vagina is called the external os. The lower part of the cervix, known as the vaginal portion of the cervix, bulges into the top of the vagina. The cervix has been documented anatomically since at least the time of Hippocrates, over 2,000 years ago.

Birth control

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 control only became available in the 20th century. Planning, making available, and using birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.

Combined oral contraceptive pill

Combined oral contraceptive pill

The combined oral contraceptive pill (COCP), often referred to as the birth control pill, or simply as the pill, is a type of birth control that is designed to be taken orally by women. The pill contains two important hormones: a progestin and estrogen. When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

Family planning

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 marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

Abortifacient

Abortifacient

An abortifacient is a substance that induces abortion. This is a nonspecific term which may refer to any number of substances or medications, ranging from herbs to prescription medications.

Abortion law

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. Many countries and territories that allow abortion have gestational limits for the procedure depending on the reason; with the majority being up to 12 weeks for abortion on request, up to 24 weeks for rape, incest, or socioeconomic reasons, and more for fetal impairment or risk to the woman's health or life. As of 2022, countries that legally allow abortion on request or for socioeconomic reasons comprise about 60% of the world's population.

Abortion debate

Abortion debate

The abortion debate is a longstanding, ongoing controversy that touches on the moral, legal, medical, and religious aspects of induced abortion. In English-speaking countries, the debate most visibly polarizes around adherents of the self-described "pro-choice" and "pro-life" movements. Pro-choice emphasizes a woman's right to bodily autonomy, while the pro-life position argues that a fetus is a human deserving of legal protection, separate from the will of the mother. Both terms are considered loaded in mainstream media, where terms such as "abortion rights" or "anti-abortion" are generally preferred.

Anti-abortion movements

Anti-abortion movements

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 response to the legalization of elective abortions.

Abortion-rights movements

Abortion-rights movements

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 pregnancy without fear of legal or social backlash. These movements are in direct opposition to anti-abortion movements.

Types

Induced

Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[25][38] Most abortions result from unintended pregnancies.[39][40] In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.[20] A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses.[41][42]

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 or 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.[43][44] 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.[44] Confusion sometimes arises over the term elective because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.[45]

Spontaneous

Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.[46] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth" or a "preterm birth".[47] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[48] Premature births and stillbirths are generally not considered to be miscarriages, although usage of these terms can sometimes overlap.[49]

Studies of pregnant women in the US and China have shown that between 40% and 60% of embryos do not progress to birth.[50][51][52] The vast majority of miscarriages occur before the woman is aware that she is pregnant,[44] and many pregnancies spontaneously abort before medical practitioners can detect an embryo.[53] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[54] 80% of these spontaneous abortions happen in the first trimester.[55]

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,[44][56] accounting for at least 50% of sampled early pregnancy losses.[57] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[56] 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.[57] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[58]

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Unintended pregnancy

Unintended pregnancy

Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception.

Health

Health

Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity". A variety of definitions have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.

Mental health

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 includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health problems are sleep irritation, lack of energy, lack of appetite and thinking of harming yourself or others.

Selective reduction

Selective reduction

Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. The procedure is also called multifetal pregnancy reduction. The procedure is most commonly done to reduce the number of fetuses in a multiple pregnancy to a safe number, when the multiple pregnancy is the result of use of assisted reproductive technology; outcomes for both the mother and the babies are generally worse the higher the number of fetuses. The procedure is also used in multiple pregnancies when one of the fetuses has a serious and incurable disease, or in the case where one of the fetuses is outside the uterus, in which case it is called selective termination.

Elective surgery

Elective surgery

Elective surgery or elective procedure 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 patient's life, but does not need to be performed immediately.

Miscarriage

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 loss. Once ultrasound or histological evidence shows that a pregnancy has existed, the used term is clinical miscarriage, which can be early before 12 weeks and late between 12-21 weeks. Fetal death after 20 weeks of gestation is also known as a stillbirth. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety, and guilt may occur afterwards. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Recurrent miscarriage may also be considered a form of infertility.

Live birth (human)

Live birth (human)

In human reproduction, a live birth occurs when a fetus exits the mother showing any definite sign of life such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or placenta are intact. After the fetus is expelled from the maternal body it is called a neonate. Whether the birth is vaginal or by Caesarean section, and whether the neonate is ultimately viable, is irrelevant.

Uterus

Uterus

The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

Fetal viability

Fetal viability

Fetal viability is the ability of a human fetus to survive outside the uterus. Medical viability is generally considered to be between 23 and 24 weeks gestational age. Viability depends upon factors such as birth weight, gestational age, and the availability of advanced medical care. In low-income countries, half of newborns born at or below 32 weeks gestational age died due to a lack of medical access; in high-income countries, the vast majority of newborns born above 24 weeks gestational age survive.

Childbirth

Childbirth

Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

Stillbirth

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 is in contrast to miscarriage, which is an early pregnancy loss, and Sudden Infant Death Syndrome, where the baby dies a short time after being born alive.

Vascular disease

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 a range of health problems that can sometimes become severe.

Methods

Medical

 
 
Practice of Induced Abortion Methods
Induced Miscarr.
Gestational age may determine which abortion methods are practiced.

Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s.[18][17][59][60]

The most common early first trimester medical abortion regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost) up to 10 weeks (70 days) gestational age,[61][62] methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.[17] 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.[59] This regimen is effective in the second trimester.[63] 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.[62][61]

In very early abortions, up to 7 weeks gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue.[64] 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%.[61][65] If medical abortion fails, surgical abortion must be used to complete the procedure.[66]

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,[67][68] France,[69] Switzerland,[70] United States,[71] and the Nordic countries.[72]

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in Canada, most of Europe, China and India,[60] in contrast to the United States where 96% of second trimester abortions are performed surgically by dilation and evacuation.[73]

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.[74] 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.[74] Safely permitting women to self-administer abortion medication has the potential to improve access to abortion.[74] Other research gaps that were identified include how to best support women who choose to take the medication home for a self-administered abortion.[74]

Surgical

A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).1: Amniotic sac2: Embryo3: Uterine lining4: Speculum5: Vacurette6: Attached to a suction pump
A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).
1: Amniotic sac
2: Embryo
3: Uterine lining
4: Speculum
5: Vacurette
6: Attached to a suction pump

Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.[75] Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, 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.[73]

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 (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 recommends sharp curettage only when suction aspiration is unavailable.[76]

Dilation and evacuation (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 (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.[77]

Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and 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.[78]

First trimester procedures can generally be performed using local anesthesia, while second trimester methods may require deep sedation or general anesthesia.[79][80][81]

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.[82] 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.[83]

Only limited data are available comparing this method with dilation and extraction.[83] 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.[83][84]

Other methods

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[85]: 44–47, 62–63, 154–55, 230–31 

In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil.[86] Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure,[87] 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.[88] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[89] One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.[89]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These 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.[90]

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Medical abortion

Medical abortion

A medical abortion, also known as medication abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage. Medical abortions are more common than surgical abortions in most places, including Europe, India, China, and the United States.

Dilation and evacuation

Dilation and evacuation

Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

Hysterotomy abortion

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 be medically inadvisable, such as in the case of placenta accreta.

Dilation and curettage

Dilation and curettage

Dilation 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 gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion.

Intact dilation and extraction

Intact dilation and extraction

Intact dilation and extraction 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.

Mifepristone

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 pregnancy. It is also effective in the second trimester of pregnancy. Effectiveness should be verified two weeks after use. It is taken by mouth.

Abortifacient

Abortifacient

An abortifacient is a substance that induces abortion. This is a nonspecific term which may refer to any number of substances or medications, ranging from herbs to prescription medications.

Prostaglandin

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 derived enzymatically from the fatty acid arachidonic acid. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring. They are a subclass of eicosanoids and of the prostanoid class of fatty acid derivatives.

Prostaglandin analogue

Prostaglandin analogue

Prostaglandin analogues are a class of drugs that bind to a prostaglandin receptor.

Misoprostol

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 when used to prevent gastric ulcers in persons taking NSAIDs. For abortions it is used by itself and with mifepristone or methotrexate. By itself, effectiveness for abortion is between 66% and 90%. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally.

Gemeprost

Gemeprost

Gemeprost (16, 16-dimethyl-trans-delta2 PGE1 methyl ester) is an analogue of prostaglandin E1.

Methotrexate

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, leukemia, lung cancer, lymphoma, gestational trophoblastic disease, and osteosarcoma. Types of autoimmune diseases it is used for include psoriasis, rheumatoid arthritis, and Crohn's disease. It can be given by mouth or by injection.

Safety

A likely illegal abortion flyer in South Africa
A likely illegal abortion flyer in South Africa

The health risks of abortion depend principally upon whether the procedure is performed safely or unsafely. The World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.[91] Legal abortions performed in the developed world are among the safest procedures in medicine.[9][92] In the United States as of 2012, abortion was estimated to be about 14 times safer for women than childbirth.[11] CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,[93] while the US abortion mortality rate is 0.7 maternal deaths per 100,000 procedures.[10][94] 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."[95] 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 [abortion] procedures constitute 13% of maternal mortality globally."[96] 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.[97]

In the US from 2000 to 2009, abortion had a mortality rate lower than plastic surgery, lower or similar to running a marathon, and about equivalent to traveling 760 miles (1,220 km) in a passenger car.[10] 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.[98] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.[99] Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.[100]

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.[64] 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.[101][102]

Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.[103] Infections account for one-third of abortion-related deaths in the United States.[104] 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.[105] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures,[106] as they are believed to substantially reduce the risk of postoperative uterine infection;[79][107] however, antibiotics are not routinely given with abortion pills.[108] 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.[109]

Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen.[110] 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).[111][112] 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.[113][114]

Some purported risks of abortion are promoted primarily by anti-abortion groups,[115][116] but lack scientific support.[115] 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, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.[117]

In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record."[118]: 25  According to Rickie Solinger,

A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... [T]he historical evidence does not support such claims.[119]: 4 

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.[120]: 59  In 1870s New York City the famous abortionist/midwife Madame Restell (Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patients[121]—a lower mortality rate than the childbirth mortality rate at the time. In 1936, the prominent professor of obstetrics and gynecology Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that

With each decade of the past fifty years the actual and proportionate frequency of this accident [perforation of the uterus] has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus.[122]: 223 

Mental health

Current evidence finds no relationship between most induced abortions and mental health problems[20][123] other than those expected for any unwanted pregnancy.[124] A report by the American Psychological Association 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.[124][125] Some older reviews concluded that abortion was associated with an increased risk of psychological problems;[126] however, they did not use an appropriate control group.[123]

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,[127] more rigorous research would be needed to show this conclusively.[128] Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome", but this is not recognized by medical or psychological professionals in the United States.[129]

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.[130]

Unsafe abortion

Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Miscarriages induced by either grandma or self-taught midwives not only maim the woman, they also often lead to death."
Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Miscarriages induced by either grandma or self-taught midwives not only maim the woman, they also often lead to death."

Women seeking an abortion may use unsafe methods, especially when it is legally restricted. They may attempt self-induced 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, hemorrhage, and damage to internal organs.[131]

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.[9] Unsafe abortions are believed to result in millions of injuries.[9][132] Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;[9][21][133] deaths from unsafe abortion account for around 13% of all maternal deaths.[134] The World Health Organization believes that mortality has fallen since the 1990s.[135] 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.[136]

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.[21][25] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[137] with abortion-related deaths dropping by more than 90%.[138] Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.[139] 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.[140] The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.[141] 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.[142] 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".[143][144]

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,[28] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[31] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[21] Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,[145] though this varies by region.[146] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[147] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.[25] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion.[148]

Discover more about Safety related topics

Developed country

Developed country

A developed country is a sovereign state that has a high quality of life, developed economy and advanced technological infrastructure relative to other less industrialized nations. Most commonly, the criteria for evaluating the degree of economic development are gross domestic product (GDP), gross national product (GNP), the per capita income, level of industrialization, amount of widespread infrastructure and general standard of living. Which criteria are to be used and which countries can be classified as being developed are subjects of debate. Different definitions of developed countries are provided by the International Monetary Fund and the World Bank; moreover, HDI ranking is used to reflect the composite index of life expectancy, education, and income per capita. Another commonly used measure of a developed country is the threshold of GDP (PPP) per capita of at least USD$22,000. In 2022, 36 countries fit all four criteria, while an additional 17 countries fit three out of four.

Plastic surgery

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 craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims at improving of its the appearance of it.

Primary care

Primary care

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a physician assistant, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Abortion clinic

Abortion clinic

An abortion clinic is a medical facility that provides abortions. Such clinics may be public medical centers, private medical practices or nonprofit organizations such as Planned Parenthood.

Endometritis

Endometritis

Endometritis is inflammation of the inner lining of the uterus (endometrium). Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. It is the most common cause of infection after childbirth. It is also part of spectrum of diseases that make up pelvic inflammatory disease.

Doxycycline

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, and syphilis. It is also used to prevent malaria in combination with quinine. Doxycycline may be taken by mouth or by injection into a vein.

Metronidazole

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 is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis. It is an option for a first episode of mild-to-moderate Clostridium difficile colitis if vancomycin or fidaxomicin is unavailable. Metronidazole is available by mouth, as a cream, and by injection into a vein.

Mid-level practitioner

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, not the quality of the care provided. This means that they are trained and legally permitted to provide healthcare in fewer situations than physicians but more than other health professionals. For example, a mid-level provider may be trained for and legally permitted to perform minor surgical procedures, but not trained for or legally permitted to perform complex or experimental surgeries.

National Cancer Institute

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. The NCI conducts and supports research, training, health information dissemination, and other activities related to the causes, prevention, diagnosis, and treatment of cancer; the supportive care of cancer patients and their families; and cancer survivorship.

American Cancer Society

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 250 Regional offices throughout the United States. Its global headquarters is located in the American Cancer Society Center in Atlanta, Georgia. The ACS publishes the journals Cancer, CA: A Cancer Journal for Clinicians and Cancer Cytopathology.

Linda Gordon

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 in the Sixteenth-Century Ukraine.

Madame Restell

Madame Restell

Ann Trow Lohman , better known as Madame Restell, was a British-born American abortion provider who practiced in New York City.

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;[149] 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.[150] For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.[25] 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.[25] 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.[25] 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.[25]

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion.[151] Restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely.[28][152][151] The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.[153]

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.[154][155]

An American study in 2002 concluded that about half of women having abortions were using a form of contraception at the time of becoming pregnant. Inconsistent use was reported by half of those using condoms and three-quarters of those using the birth control pill; 42% of those using condoms reported failure through slipping or breakage.[156] 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".[157] In a 2022 analysis by the Kaiser Family Foundation, 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.[158]

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).[159]

Gestational age and method

Histogram of abortions by gestational age in England and Wales during 2019 (left). Abortion in the United States by gestational age, 2016 (right).
Histogram of abortions by gestational age in England and Wales during 2019 (left). Abortion in the United States by gestational age, 2016 (right).
Histogram of abortions by gestational age in England and Wales during 2019 (left). Abortion in the United States by gestational age, 2016 (right).

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention (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" (suction-aspiration, dilation and curettage, dilation and evacuation), 8% by "medical" means (mifepristone), >1% by "intrauterine instillation" (saline or prostaglandin), and 1% by "other" (including hysterotomy and hysterectomy).[160] 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.[6]

The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for [161] 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.[162] There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.[163]

Discover more about Incidence related topics

Guttmacher Institute

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 and rights. The organization works mainly in the United States but also focuses on developing countries. Founded as part of Planned Parenthood, the Guttmacher Institute became independent from Planned Parenthood in 2007.

Birth control

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 control only became available in the 20th century. Planning, making available, and using birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.

Condom

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 intercourse—women whose partners use male condoms experience a 2% per-year pregnancy rate. With typical use, the rate of pregnancy is 18% per-year. Their use greatly decreases the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV/AIDS. To a lesser extent, they also protect against genital herpes, human papillomavirus (HPV), and syphilis.

Combined oral contraceptive pill

Combined oral contraceptive pill

The combined oral contraceptive pill (COCP), often referred to as the birth control pill, or simply as the pill, is a type of birth control that is designed to be taken orally by women. The pill contains two important hormones: a progestin and estrogen. When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

Histogram

Histogram

A histogram is an approximate representation of the distribution of numerical data. The term was first introduced by Karl Pearson. To construct a histogram, the first step is to "bin" the range of values—that is, divide the entire range of values into a series of intervals—and then count how many values fall into each interval. The bins are usually specified as consecutive, non-overlapping intervals of a variable. The bins (intervals) must be adjacent and are often of equal size.

Centers for Disease Control and Prevention

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, Georgia.

Curettage

Curettage

Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.

Dilation and curettage

Dilation and curettage

Dilation 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 gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion.

Dilation and evacuation

Dilation and evacuation

Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

Instillation abortion

Instillation abortion

Instillation abortion is a rarely used method of late-term abortion, performed by injecting a solution into the uterus.

Hysterotomy abortion

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 be medically inadvisable, such as in the case of placenta accreta.

Hysterectomy

Hysterectomy

Hysterectomy is the partial or total surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Partial hysterectomies allow for hormone regulation while total hysterectomies do not.

Motivation

Personal

A bar chart depicting selected data from a 1998 AGI meta-study on the reasons women stated for having an abortion
A bar chart depicting selected data from a 1998 AGI meta-study on the reasons women stated for having an abortion

The reasons why women have abortions are diverse and vary across the world.[6][7] 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.[8] Additional reasons include not being able or willing to raise a child conceived as a result of rape or incest.[7][164]

Societal

Some abortions are undergone as the result of societal pressures.[165] 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 (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion.[166]

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.[6][7]

In the U.S., the Supreme Court decisions in Roe v. Wade 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."[167]: 1200–01 

Public opinion shifted in America following television personality Sherri Finkbine's discovery during her fifth month of pregnancy that she had been exposed to thalidomide. Unable to obtain a legal abortion in the United States, she traveled to Sweden. From 1962 to 1965, an outbreak of German measles left 15,000 babies with severe birth defects. In 1967, the American Medical Association publicly supported liberalization of abortion laws. A National Opinion Research Center 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.[168]

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, 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 and pelvic lymph node dissection, radiation therapy, 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 is discouraged in favor of modified radical mastectomy unless late-term pregnancy allows follow-up radiation therapy to be administered after the birth.[169]

Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic 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 or microcephaly, 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.[169] 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.[170][171]

The process of birth itself may also put the mother at risk. According to Li et al., "[v]aginal 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."[172]

Discover more about Motivation related topics

Population control

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 excessive rates of extinction, which is referred to as conservation biology.

One-child policy

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 broader effort to control population growth that began in 1970 and ended in 2021, a half century program that included minimum ages at marriage and childbearing, two-child limits for many couples, minimum time intervals between births, heavy surveillance, and stiff fines for non-compliance. The program had wide-ranging social, cultural, economic, and demographic effects, although the contribution of one-child restrictions to the broader program has been the subject of controversy.

Sex-selective abortion

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 East Asia and South Asia, as well as in the Caucasus, Western Balkans, and to a lesser extent North America. Based on the third National Family and Health Survey, results showed that if both partners, mother and father, or just the father, preferred male children, sex-selective abortion was more common. In cases where only the mother prefers sons, this is likely to result in sex-selective neglect in which the child is not likely to survive past infancy.

Roe v. Wade

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 choose to have an abortion. The decision struck down many federal and state abortion laws, and it caused an ongoing abortion debate in the United States about whether, or to what extent, abortion should be legal, who should decide the legality of abortion, and what the role of moral and religious views in the political sphere should be. The decision also shaped debate concerning which methods the Supreme Court should use in constitutional adjudication.

Doe v. Bolton

Doe v. Bolton

Doe v. Bolton, 410 U.S. 179 (1973), was a decision of the Supreme Court of the United States overturning the abortion law of Georgia. The Supreme Court's decision was released on January 22, 1973, the same day as the decision in the better-known case of Roe v. Wade.

Rubella

Rubella

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 last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

American Medical Association

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 271,660 in 2022.

Cervical cancer

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 vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

Lymph node

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 include B and T cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles including cancer cells, but have no detoxification function.

Radiation therapy

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. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor. Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers. The subspecialty of oncology concerned with radiotherapy is called radiation oncology. A physician who practices in this subspecialty is a radiation oncologist.

Lumpectomy

Lumpectomy

Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions.

Radical mastectomy

Radical mastectomy

Radical mastectomy is a surgical procedure involving the removal of breast, underlying chest muscle, and lymph nodes of the axilla as a treatment for breast cancer. Breast cancer is the most common cancer among women today, and is primarily treated by surgery, particularly during the early twentieth century when the mastectomy was developed with success. However, with the advancement of technology and surgical skills, the extent of mastectomies has been reduced. Less invasive mastectomies are employed today in comparison to those in the past. Nowadays, a combination of radiotherapy and breast conserving mastectomy are employed to optimize treatment.

History and religion

Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle[89][173]
Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle[89][173]

Since ancient times, abortions have been done using a number of methods, including herbal medicines acting as abortifacients, sharp tools through the use of force, or through other traditional medicine methods.[30] 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),[174] ancient India since its Vedic age,[175] ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE).[30] One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.[89]

In Judaism (Genesis 2:7), 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.[176][177][178] The fetus is considered valuable property of the woman and not a human life while in the womb (Exodus 21:22–23). While Judaism encourages people to be fruitful and multiply by having children, abortion is allowed and is deemed necessary when a pregnant woman's life is in danger.[179][180] Several religions, including Judaism, which disagree that human life begins at conception, support the legality of abortion on religious freedom grounds.[181] In Islam, abortion is traditionally permitted until a point in time when Muslims believe the soul enters the fetus,[30] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[182] Abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[183]

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade physicians in Ancient Greece from performing abortions;[30] other scholars disagree with this interpretation,[30] and state that the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath.[184] The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus of Ephesus, 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.[185][186] In Politics (350 BCE), Aristotle condemned infanticide as a means of population control. He preferred abortion in such cases,[187][188] 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."[189]

In the Catholic Church, 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.[190]: 155–167  The Catholic Church did not begin vigorously opposing abortion until the 19th century.[30][181] As early as ~100 CE, the Didache taught that abortion was sinful.[191] Several historians argue that prior to the 19th century most Catholic authors did not regard termination of pregnancy before quickening or ensoulment as an abortion.[192][193][194] Among these authors were the Doctors of the Church, such as St. Augustine, St. Thomas Aquinas, and St. Alphonsus Liguori. In 1588, Pope Sixtus V (r.  1585–90) was the only Pope before Pope Pius IX (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.[195][190]: 362–364 [85]: 157–158  Sixtus V's pronouncement was reversed in 1591 by Pope Gregory XIV.[196] In the recodification of 1917 Code of Canon Law, Apostolicae Sedis was strengthened, in part to remove a possible reading that excluded excommunication of the mother.[197] Statements made in the Catechism of the Catholic Church, 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.[198]

Denominations that support abortion rights with some limits include the United Methodist Church, Episcopal Church, Evangelical Lutheran Church in America and Presbyterian Church USA.[199] 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.[200] A 1995 survey reported that Catholic women are as likely as the general population to terminate a pregnancy, Protestants are less likely to do so, and evangelical Christians are the least likely to do so.[6][7] A 2019 Pew Research Center study found that most Christian denominations were against overturning Roe v. Wade, which in the United States legalized abortion, at around 70%, except White Evangelicals at 35%.[201]

"French Periodical Pills" was an example of a clandestine advertisement published in a January 1845 edition of the Boston Daily Times.
"French Periodical Pills" was an example of a clandestine advertisement published in a January 1845 edition of the Boston Daily Times.

Abortion has been a fairly common practice,[202][203] and was not always illegal or controversial until the 19th century.[204][205] Under common law, including early English common law dating back to Edward Coke in 1648,[206] abortion was generally permitted before quickening (14–26 weeks after conception, or between the fourth and sixth month),[207][208][209] and at women's discretion;[181] it was whether abortion was performed after quickening that determined if it was a crime.[206] In Europe and North America, abortion techniques advanced starting in the 17th century; the conservatism of most in the medical profession with regards to sexual matters prevented the wide expansion of abortion techniques.[30][210][211] 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,[212] was banned in both the United States and the United Kingdom.[30][nb 2]

Church groups, as well as physicians, were highly influential in anti-abortion movements,[30][204][213] and religious groups more so since the 20th century.[214] Some of the early anti-abortion laws punished only the doctor or abortionist,[181] and while women could be criminally tried for a self-induced abortion,[206] they were rarely prosecuted in general.[204] 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.[nb 3] Others maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe.[215][216][217] 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.[nb 4]

In 1920, Soviet Russia became the first country to legalize abortion after Lenin insisted that no woman be forced to give birth.[218][219] Iceland (1935) and Sweden (1938) would follow suit to legalize certain or all forms of abortion.[220] In Nazi Germany (1935), a law permitted abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions.[221] Preceding the Nazi German example was that of some 19th-century physicians, one of the most famous and consequential being Horatio Storer,[214] who argued for anti-abortion laws on racist and pseudoscientific grounds.[213][222][223] Beginning in the second half of the 20th century, abortion was legalized in a greater number of countries.[30]

Discover more about History and religion related topics

History of abortion

History of abortion

The practice of induced abortion—the deliberate termination of a pregnancy—has been known since ancient times. Various methods have been used to perform or attempt abortion, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. A naturally occurring abortion that ends a pregnancy sometimes is described as a "spontaneous" abortion or, with the more frequently used popular euphemism, "miscarriage", to distinguish a difference between an induced abortion and a naturally occurring one, but medically, abortion is the terminology applied to either natural or induced.

Religion and abortion

Religion and abortion

Numerous religious traditions have taken a stance on abortion but few are absolute. These stances span a broad spectrum, based on numerous teachings, deities, or religious print, and some of those views are highlighted below.

Angkor Wat

Angkor Wat

Angkor Wat is a temple complex in Cambodia and is the largest religious monument in the world, on a site measuring 162.6 hectares. Originally constructed as a Hindu temple dedicated to the god Vishnu for the Khmer Empire by King Suryavarman II during the 12th century, it was gradually transformed into a Buddhist temple towards the end of the century; as such, it is also described as a "Hindu-Buddhist" temple.

Cambodia

Cambodia

Cambodia, officially the Kingdom of Cambodia, is a country located in the southern portion of the Indochinese Peninsula in Southeast Asia, spanning an area of 181,035 square kilometres, bordered by Thailand to the northwest, Laos to the north, Vietnam to the east, and the Gulf of Thailand to the southwest. The capital and largest city is Phnom Penh.

Demon

Demon

A demon is a malevolent supernatural entity. Historically, belief in demons, or stories about demons, occurs in religion, occultism, literature, fiction, mythology, and folklore; as well as in media such as comics, video games, movies, anime, and television series.

Herbal medicine

Herbal medicine

Herbal medicine 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, such as the anti-malarial group of drugs called artemisinin isolated from Artemisia annua, a herb that was known in Chinese medicine to treat fever. There is limited scientific evidence for the safety and efficacy of plants used in 21st century herbalism, which generally does not provide standards for purity or dosage. The scope of herbal medicine commonly includes fungal and bee products, as well as minerals, shells and certain animal parts. Herbal medicine is also called phytomedicine or phytotherapy.

Abortifacient

Abortifacient

An abortifacient is a substance that induces abortion. This is a nonspecific term which may refer to any number of substances or medications, ranging from herbs to prescription medications.

Force

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, i.e., to accelerate. Force can also be described intuitively as a push or a pull. A force has both magnitude and direction, making it a vector quantity. It is measured in the SI unit of newton (N). Force is represented by the symbol F.

Ancient Egypt

Ancient Egypt

Ancient Egypt was a civilization in Northeast Africa situated in the Nile Valley. Ancient Egyptian civilization followed prehistoric Egypt and coalesced around 3100 BC with the political unification of Upper and Lower Egypt under Menes. The history of ancient Egypt occurred as a series of stable kingdoms, separated by periods of relative instability known as Intermediate Periods: the Old Kingdom of the Early Bronze Age, the Middle Kingdom of the Middle Bronze Age and the New Kingdom of the Late Bronze Age.

Ebers Papyrus

Ebers Papyrus

The Ebers Papyrus, also known as Papyrus Ebers, is an Egyptian medical papyrus of herbal knowledge dating to c. 1550 BCE. Among the oldest and most important medical papyri of Ancient Egypt, it was purchased at Luxor in the winter of 1873–1874 by the German Egyptologist Georg Ebers. It is currently kept at the Leipzig University Library in Germany.

Juvenal

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 are unclear, although references within his text to known persons of the late first and early second centuries CE fix his earliest date of composition. One recent scholar argues that his first book was published in 100 or 101. A reference to a political figure dates his fifth and final surviving book to sometime after 127.

Frieze

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 pilasters are expressed, on an astylar wall it lies upon the architrave and is capped by the moldings of the cornice. A frieze can be found on many Greek and Roman buildings, the Parthenon Frieze being the most famous, and perhaps the most elaborate. This style is typical for the Persians.

Society and culture

Abortion debate

Induced abortion has long been the source of considerable debate. Ethical, moral, philosophical, biological, religious and legal issues surrounding abortion are related to value systems. Opinions of abortion may be about fetal rights, governmental authority, and women's rights.

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.[224] The World Medical Association 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."[225] Abortion debates, especially pertaining to abortion laws, 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".[226]

Modern abortion law

Legality of abortion by country or territory   Legal on request:   .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}  No gestational limit     Gestational limit after the first 17 weeks     Gestational limit in the first 17 weeks     Unclear gestational limit   Legally restricted to cases of:     Risk to woman's life, to her health*, rape*, fetal impairment*, or socioeconomic factors     Risk to woman's life, to her health*, rape, or fetal impairment     Risk to woman's life, to her health*, or fetal impairment     Risk to woman's life*, to her health*, or rape     Risk to woman's life or to her health     Risk to woman's life     Illegal with no exceptions     No information   * Does not apply to some countries or territories in that category  Note: In some countries or territories, abortion laws are modified by other laws, regulations, legal principles or judicial decisions. This map shows their combined effect as implemented by the authorities.
Legal on request:
  No gestational limit
  Gestational limit after the first 17 weeks
  Gestational limit in the first 17 weeks
  Unclear gestational limit
Legally restricted to cases of:
  Risk to woman's life, to her health*, rape*, fetal impairment*, or socioeconomic factors
  Risk to woman's life, to her health*, rape, or fetal impairment
  Risk to woman's life, to her health*, or fetal impairment
  Risk to woman's life*, to her health*, or rape
  Risk to woman's life or to her health
  Risk to woman's life
  Illegal with no exceptions
  No information
* Does not apply to some countries or territories in that category
Note: In some countries or territories, abortion laws are modified by other laws, regulations, legal principles or judicial decisions. This map shows their combined effect as implemented by the authorities.

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, and the right to reproductive health 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). 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, or require that parents be contacted if their minor daughter requests an abortion.[227] 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[228] one-child policy, and now has a two child policy,[229][230] has at times incorporated mandatory abortions as part of their population control strategy.[231]

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.[31] In countries where abortion is banned entirely, such as Nicaragua, 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.[232][233] Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.[234] This is also a terminology in traditional medicine.[235] In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in medical tourism and travel to countries where they can terminate their pregnancies.[236] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.[237]

The organization Women on Waves 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.[238][239][240]

Sex-selective abortion

Sonography and amniocentesis allow parents to determine sex before childbirth. The development of this technology has led to sex-selective abortion, 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.[241] 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.[242][243][244][245] In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.[246]

Many countries have taken legislative steps to reduce the incidence of sex-selective abortion. At the International Conference on Population and Development in 1994 over 180 states agreed to eliminate "all forms of discrimination against the girl child and the root causes of son preference",[247] conditions also condemned by a PACE resolution in 2011.[248] The World Health Organization and UNICEF, 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.[247]

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.[249][250] 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.[251] 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 (1998), and George Tiller (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.[252][253] Notable perpetrators of anti-abortion violence include Eric Robert Rudolph, Scott Roeder, Shelley Shannon, and Paul Jennings Hill, the first person to be executed in the United States for murdering an abortion provider.[254]

Legal protection of access to abortion 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 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.[255] Some protestors record women entering clinics on camera.[255]

Discover more about Society and culture related topics

Societal attitudes towards abortion

Societal attitudes towards abortion

Societal attitudes towards abortion have varied throughout different historical periods and cultures. One manner of assessing such attitudes in the modern era has been to conduct opinion polls to measure levels of public opinion on abortion.

Abortion debate

Abortion debate

The abortion debate is a longstanding, ongoing controversy that touches on the moral, legal, medical, and religious aspects of induced abortion. In English-speaking countries, the debate most visibly polarizes around adherents of the self-described "pro-choice" and "pro-life" movements. Pro-choice emphasizes a woman's right to bodily autonomy, while the pro-life position argues that a fetus is a human deserving of legal protection, separate from the will of the mother. Both terms are considered loaded in mainstream media, where terms such as "abortion rights" or "anti-abortion" are generally preferred.

Medical ethics

Medical ethics

Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. Medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment.

Morality

Morality

Morality is the differentiation of intentions, decisions and actions between those that are distinguished as proper (right) and those that are improper (wrong). Morality can be a body of standards or principles derived from a code of conduct from a particular philosophy, religion or culture, or it can derive from a standard that a person believes should be universal. Morality may also be specifically synonymous with "goodness" or "rightness".

Philosophical aspects of the abortion debate

Philosophical aspects of the abortion debate

The philosophical aspects of the abortion debate are logical arguments that can be made either in support of or in opposition to abortion.

Ethics in religion

Ethics in religion

Ethics involves systematizing, defending, and recommending concepts of right and wrong behavior. A central aspect of ethics is "the good life", the life worth living or life that is simply satisfying, which is held by many philosophers to be more important than traditional moral conduct.

Abortion law

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. Many countries and territories that allow abortion have gestational limits for the procedure depending on the reason; with the majority being up to 12 weeks for abortion on request, up to 24 weeks for rape, incest, or socioeconomic reasons, and more for fetal impairment or risk to the woman's health or life. As of 2022, countries that legally allow abortion on request or for socioeconomic reasons comprise about 60% of the world's population.

Fetal rights

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 concept of fetal rights has evolved to include the issues of maternal substance use disorders, including alcohol use disorder and opioid use disorder. Most international human rights charters "clearly reject claims that human rights should attach from conception or any time before birth." While international human rights instruments lack a universal inclusion of the fetus as a person for the purposes of human rights, the fetus is granted various rights in the constitutions and civil codes of several countries.

Abortion-rights movements

Abortion-rights movements

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 pregnancy without fear of legal or social backlash. These movements are in direct opposition to anti-abortion movements.

History of abortion law debate

History of abortion law debate

In the earliest written sources, abortion is not considered as a general category of crime. Rather, specific kinds of abortion are prohibited, for various social and political reasons. In the earliest texts, it can be difficult to discern to what extent a particular religious injunction held force as secular law. In later texts, the rationale for abortion laws may be sought in a wide variety of fields including philosophy, religion, and jurisprudence. These rationales were not always included in the wording of the actual laws.

Maternal death

Maternal death

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 pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while they are pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

Complications of pregnancy

Complications of pregnancy

Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. Severe complications of pregnancy, childbirth, and the puerperium are present in 1.6% of mothers in the US, and in 1.5% of mothers in Canada. In the immediate postpartum period (puerperium), 87% to 94% of women report at least one health problem. Long-term health problems are reported by 31% of women.

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.[256] In cows, abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but can often be controlled by vaccination.[257] Eating pine needles can also induce abortions in cows.[258][259] Several plants, including broomweed, skunk cabbage, poison hemlock, and tree tobacco, are known to cause fetal deformities and abortion in cattle[260]: 45–46  and in sheep and goats.[260]: 77–80  In horses, a fetus may be aborted or resorbed if it has lethal white syndrome (congenital intestinal aganglionosis). Foal embryos that are homozygous for the dominant white gene (WW) are theorized to also be aborted or resorbed before birth.[261] In many species of sharks and rays, stress-induced abortions occur frequently on capture.[262]

Viral infection can cause abortion in dogs.[263] 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 programs, to prevent unwanted kittens from being born.[264][265][266] Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect.[267]

Abortion may also be induced in animals, in the context of animal husbandry. For example, abortion may be induced in mares that have been mated improperly, or that have been purchased by owners who did not realize the mares were pregnant, or that are pregnant with twin foals.[268] Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[269][270][271] although the frequency in the wild has been questioned.[272] Male gray langur monkeys may attack females following male takeover, causing miscarriage.[273]

Discover more about Non-human examples related topics

Miscarriage

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 loss. Once ultrasound or histological evidence shows that a pregnancy has existed, the used term is clinical miscarriage, which can be early before 12 weeks and late between 12-21 weeks. Fetal death after 20 weeks of gestation is also known as a stillbirth. The most common symptom of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety, and guilt may occur afterwards. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Recurrent miscarriage may also be considered a form of infertility.

Brucellosis

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.

Campylobacter

Campylobacter

Campylobacter is a genus of Gram-negative bacteria. Campylobacter typically appear comma- or s-shaped, and are motile. Some Campylobacter species can infect humans, sometimes causing campylobacteriosis, a diarrhoeal disease in humans. Campylobacteriosis is usually self-limiting and antimicrobial treatment is often not required, except in severe cases or immunocompromised patients. The most known source for Campylobacter is poultry, but due to their diverse natural reservoir, Campylobacter spp. can also be transmitted via water. Other known sources of Campylobacter infections include food products, such as unpasteurised milk and contaminated fresh produce. Sometimes the source of infection can be direct contact with infected animals, which often carry Campylobacter asymptomatically. At least a dozen species of Campylobacter have been implicated in human disease, with C. jejuni (80–90%) and C. coli (5-10%) being the most common. C. jejuni is recognized as one of the main causes of bacterial foodborne disease in many developed countries. It is the number one cause of bacterial gastroentritis in Europe, with over 246,000 cases confirmed annually. C. jejuni infection can also cause bacteremia in immunocompromised people, while C. lari is a known cause of recurrent diarrhea in children. C. fetus can cause spontaneous abortions in cattle and sheep, and is an opportunistic pathogen in humans.

Gutierrezia sarothrae

Gutierrezia sarothrae

Gutierrezia sarothrae is a species of flowering plant in the family Asteraceae known by the common names broom snakeweed, broomweed, snakeweed, and matchweed. It is a subshrub native to much of the western half of North America, from western Canada to northern Mexico, and can be found in a number of arid, grassland, and mountain habitats. It can be toxic to livestock in large quantities, due mainly to the presence of saponins.

Conium maculatum

Conium maculatum

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 a variety of environments, hemlock is widely naturalized in locations outside its native range, such as parts of Australia, West Asia, and North and South America, to which it has been introduced. It is capable of spreading and thereby becoming an invasive weed.

Nicotiana glauca

Nicotiana glauca

Nicotiana glauca is a species of flowering plant in the tobacco genus Nicotiana of the nightshade family Solanaceae. It is known by the common name tree tobacco. Its leaves are attached to the stalk by petioles, and its leaves and stems are neither pubescent nor sticky like Nicotiana tabacum. It resembles Cestrum parqui but differs in the form of leaves and fusion of the outer floral parts. It grows to heights of more than two meters.

Lethal white syndrome

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 born after the full 11-month gestation and externally appear normal, though they have all-white or nearly all-white coats and blue eyes. However, internally, these foals have a nonfunctioning colon. Within a few hours, signs of colic appear; affected foals die within a few days. Because the death is often painful, such foals are often humanely euthanized once identified. The disease is particularly devastating because foals are born seemingly healthy after being carried to full term.

Dominant white

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 to the discovery of the W alllelic series, many of these patterns were described by the term sabino, which is still used by some breed registries.

Trap–neuter–return

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, if possible, vaccinated, then releasing them back into the outdoors. If the location is deemed unsafe or otherwise inappropriate, the cats may be relocated to other appropriate areas. Ideally, friendly adults and kittens young enough to be easily socialized are retained and placed for adoption. Feral cats cannot be socialized, shun most human interaction and do not fare well in confinement, so they are not retained. Cats suffering from severe medical problems such as terminal, contagious, or untreatable illnesses or injuries are often euthanized.

Bruce effect

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 in laboratory mice. In mice, pregnancy can only be terminated prior to embryo implantation, but other species will interrupt even a late-term pregnancy.

Animal husbandry

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, starting with the Neolithic Revolution when animals were first domesticated, from around 13,000 BC onwards, predating farming of the first crops. By the time of early civilisations such as ancient Egypt, cattle, sheep, goats, and pigs were being raised on farms.

Gray langur

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 about 2001, additional species have been recognized. The taxonomy has been in flux, but currently eight species are recognized.

Source: "Abortion", Wikipedia, Wikimedia Foundation, (2023, January 31st), https://en.wikipedia.org/wiki/Abortion.

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Notes
  1. ^ For a list of definitions as stated by obstetrics and gynecology (OB/GYN) textbooks, dictionaries, and other sources, see Definitions of abortion. Definitions of abortion vary from source to source, and language used to define abortion often reflects societal and political opinions, not only scientific knowledge.[1]
  2. ^ In the United States, the first laws related to abortion beginning in the 1820s were made to protect women from real or perceived risks, and those more restrictive penalized only the provider. By 1859, abortion was not a crime in 21 out of 33 states, and was prohibited only post-quickening, while penalties for pre-quickening abortions were lower. This changed starting in the 1860s under the influence of anti-immigrant and anti-Catholic sentiment.[181]
  3. ^ By 1930, medical procedures in the United States had improved for both childbirth and abortion but not equally, and induced abortion in the first trimester had become safer than childbirth. In 1973, Roe v. Wade acknowledged that abortion in the first trimester was safer than childbirth. For sources, see:
    • "The 1970s". Time Communication 1940–1989: Retrospective. Time. 1989. Blackmun was also swayed by the fact that most abortion prohibitions were enacted in the 19th century when the procedure was more dangerous than now.
    • Will GF (1990). Suddenly: The American Idea Abroad and at Home, 1986–1990. Free Press. p. 312. ISBN 0-02-934435-2.
    • Lewis J, Shimabukuro JO (28 January 2001). "Abortion Law Development: A Brief Overview". Congressional Research Service. Archived from the original on 14 May 2011. Retrieved 1 May 2011.
    • Schultz DA (2002). Encyclopedia of American Law. Infobase Publishing. p. 1. ISBN 0-8160-4329-9. Archived from the original on 9 December 2015.
    • Lahey JN (24 September 2009). "Birthing a Nation: Fertility Control Access and the 19th Century Demographic Transition" (PDF; preliminary version). Colloquium. Pomona College. Archived (PDF) from the original on 7 January 2012.
  4. ^ For sources, see:
    • James Donner, Women in Trouble: The Truth about Abortion in America, Monarch Books, 1959.
    • Ann Oakley, The Captured Womb, Basil Blackwell, 1984, p. 91.
    • Rickie Solinger, The Abortionist: A Woman Against the Law, The Free Press, 1994, pp. xi, 5, 16–17, 157–175.
    • Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973, University of California Press, 1997.
    • Max Evans, Madam Millie: Bordellos from Silver City to Ketchikan, University of New Mexico Press, 2002, pp. 209–218, 230, 267–286, 305.
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