Abortion: Difference between revisions

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{{other uses|Abortion (disambiguation)}}
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{{Infobox medical intervention
| name = Induced abortion
| synonyms = Induced miscarriage, termination of pregnancy
| image =
| caption =
| field = [[Obstetrics]] and [[gynecology]]
| ICD10 = {{ICD10|O|04||o|00}}
| ICD9 = {{ICD9|779.6}}
| DiseasesDB = 4153
| ICDO =
| OMIM =
| MedlinePlus = 007382
| eMedicineSubj = article
| eMedicineTopic = 252560
| MeshID =D000028
}}
<!-- The lead sentence has been the topic of much discussion. Please do not edit it without first reviewing the talk page and its archives. -->
<!-- Terminology -->
'''Abortion''' is the ending of [[pregnancy]] due to removing an [[embryo]] or [[fetus]] before it can [[fetal viability|survive outside the uterus]].<ref name="definition" group="note" /> An abortion that occurs spontaneously is also known as a [[miscarriage]]. When deliberate steps are taken to end a pregnancy, it is called an [[#Induced|induced abortion]], or less frequently an "induced miscarriage". The word ''abortion'' is often used to mean only induced abortions.<ref>{{cite web|url=https://en.oxforddictionaries.com/definition/abortion|title=Abortion (noun)|publisher=Oxford Living Dictionaries|accessdate=8 June 2018|quote=''[mass noun]'' The deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy}}</ref> A similar procedure after the fetus could potentially survive outside the [[womb]] is known as a "[[late termination of pregnancy]]" or less accurately as a "late term abortion".<ref name=stuart>{{cite journal|last1=Grimes|first1=DA |last2=Stuart |first2=G |title=Abortion jabberwocky: the need for better terminology |journal=Contraception |year=2010 |volume=81 |issue=2 |pages=93–96 |pmid=20103443 |doi=10.1016/j.contraception.2009.09.005}}</ref>

<!-- Methods and safety -->
When allowed by [[abortion law|law]], abortion in the [[developed world]] is [[#Safety|one of the safest procedures in medicine]].<ref name="lancet-grimes">{{Cite journal |last1=Grimes |first1=DA |last2=Benson |first2=J |last3=Singh |first3=S |last4=Romero |first4=M |last5=Ganatra |first5=B |last6=Okonofua |first6=FE |last7=Shah |first7=IH |doi=10.1016/S0140-6736(06)69481-6 |title=Unsafe abortion: The preventable pandemic |journal=The Lancet |volume=368 |issue=9550 |pages=1908–19 |year=2006 |pmid=17126724 |url=http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf |format=PDF |deadurl=no |archiveurl=https://web.archive.org/web/20110629040442/http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf |archivedate=29 June 2011 |df=dmy-all }}</ref><ref name="Ray2014">{{cite journal |last1=Raymond |first1=EG |last2=Grossman |first2=D |last3=Weaver |first3=MA |last4=Toti |first4=S |last5=Winikoff |first5=B |title=Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States |journal=Contraception |date=November 2014 |volume=90 |issue=5 |pages=476–79 |pmid=25152259 |doi=10.1016/j.contraception.2014.07.012}}</ref> Modern methods use [[medical abortion|medication]] or [[surgical abortion|surgery]] for abortions.<ref name=1st_Methods>{{cite journal |last1=Kulier |first1=R |last2=Kapp |first2=N |last3=Gülmezoglu |first3=AM |last4=Hofmeyr |first4=GJ |last5=Cheng |first5=L |last6=Campana |first6=A |title=Medical methods for first trimester abortion |journal=The Cochrane Database of Systematic Reviews |date=9 November 2011 |issue=11 |pages=CD002855 |pmid=22071804 |doi=10.1002/14651858.CD002855.pub4}}</ref> The drug [[mifepristone]] in combination with [[prostaglandin]] appears to be as safe and effective as surgery during the [[first trimester|first]] and [[second trimester]] of pregnancy.<ref name=1st_Methods/><ref name=Kapp2013/> The most common surgical technique involves dilating the cervix and using a [[vacuum aspiration|suction device]].<ref>{{cite web |title=Abortion – Women's Health Issues |url=https://www.merckmanuals.com/home/women-s-health-issues/family-planning/abortion |website=Merck Manuals Consumer Version |accessdate=12 July 2018}}</ref> [[Birth control]], such as [[combined oral contraceptive pill|the pill]] or [[intrauterine device]]s, can be used immediately following abortion.<ref name=Kapp2013>{{cite journal|last1=Kapp |first1=N |last2=Whyte |first2=P |last3=Tang |first3=J |last4=Jackson |first4=E |last5=Brahmi |first5=D |title=A review of evidence for safe abortion care |journal=Contraception |date=September 2013 |volume=88 |issue=3 |pages=350–63 |pmid=23261233 |doi=10.1016/j.contraception.2012.10.027}}</ref> When performed legally and safely, induced abortions do not increase the risk of long-term [[mental health|mental]] or physical problems.<ref name=BMJ2014/> In contrast, [[unsafe abortion]]s (those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) cause 47,000 [[maternal death|deaths]] and 5 million hospital admissions each year.<ref name=BMJ2014>{{Cite journal |last1=Lohr |first1=PA |last2=Fjerstad |first2=M |last3=Desilva |first3=U |last4=Lyus |first4=R |title=Abortion |journal = BMJ | volume = 348 | page = f7553 | year = 2014 | doi = 10.1136/bmj.f7553}}</ref><ref name="OBGY09">{{Cite journal|last1=Shah |first1=I |last2=Ahman |first2=E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=Journal of Obstetrics and Gynaecology Canada |volume=31 |issue=12 |pages=1149–58 |date=December 2009 |pmid=20085681 |url=http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |format=PDF |deadurl=yes |archiveurl=https://web.archive.org/web/20110716212405/http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |archivedate=16 July 2011 |df=dmy |doi=10.1016/s1701-2163(16)34376-6}}</ref> The [[World Health Organization]] recommends safe and legal abortions be available to all women.<ref name=WHOPolicy2012>{{cite book |author=World Health Organization |title=Safe abortion: technical and policy guidance for health systems |date=2012 |publisher=World Health Organization |location=Geneva |isbn=978-92-4-154843-4 |page=8 |edition=2nd |url=http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1 |format=PDF |deadurl=no |archiveurl=https://web.archive.org/web/20150116223512/http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1 |archivedate=16 January 2015 |df=dmy-all }}</ref>

<!-- Epidemiology -->
Around 56 million abortions are performed each year in the world,<ref>{{cite journal|last1=Sedgh|first1=Gilda|last2=Bearak|first2=Jonathan|last3=Singh|first3=Susheela|last4=Bankole|first4=Akinrinola|last5=Popinchalk|first5=Anna|last6=Ganatra|first6=Bela|last7=Rossier|first7=Clémentine|last8=Gerdts|first8=Caitlin|last9=Tunçalp|first9=Özge|last10=Johnson|first10=Brooke Ronald|last11=Johnston|first11=Heidi Bart|last12=Alkema|first12=Leontine|title=Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends|journal=The Lancet|date=May 2016|doi=10.1016/S0140-6736(16)30380-4|pmid=27179755|volume=388|pages=258–67|pmc=5498988}}</ref> with about 45% done unsafely.<ref>{{cite web|title=Worldwide, an estimated 25 million unsafe abortions occur each year|url=http://www.who.int/mediacentre/news/releases/2017/unsafe-abortions-worldwide/en/|website=World Health Organization|accessdate=29 September 2017|date=28 September 2017}}</ref> Abortion rates changed little between 2003 and 2008,<ref name="Sedgh 2012">{{Cite journal |last1=Sedgh |first1=G. |last2=Singh |first2=S. |last3=Shah |first3=I.H. |last4=Åhman |first4=E. |last5=Henshaw |first5=S.K. |last6=Bankole |first6=A. |doi=10.1016/S0140-6736(11)61786-8 |title=Induced abortion: Incidence and trends worldwide from 1995 to 2008 |journal=The Lancet |volume=379 |issue=9816 |pages=625–32 |year=2012 |pmid=22264435 |url=http://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf |format=PDF |quote=Because few of the abortion estimates were based on studies of random samples of women, and because we did not use a model-based approach to estimate abortion incidence, it was not possible to compute confidence intervals based on standard errors around the estimates. Drawing on the information available on the accuracy and precision of abortion estimates that were used to develop the subregional, regional, and worldwide rates, we computed intervals of certainty around these rates (webappendix). We computed wider intervals for unsafe abortion rates than for safe abortion rates. The basis for these intervals included published and unpublished assessments of abortion reporting in countries with liberal laws, recently published studies of national unsafe abortion, and high and low estimates of the numbers of unsafe abortion developed by WHO. |deadurl=no |archiveurl=https://web.archive.org/web/20120206043854/http://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf |archivedate=6 February 2012 |df=dmy-all }}</ref> before which they decreased for at least two decades as access to [[family planning]] and birth control increased.<ref name="worldtrends2007">{{Cite journal |vauthors=Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J |title=Legal abortion worldwide: incidence and recent trends |journal=International Family Planning Perspectives |volume=33 |issue=3 |pages=106–16 |date=September 2007 |pmid=17938093 |doi=10.1363/ifpp.33.106.07 |url=http://www.guttmacher.org/pubs/journals/3310607.html |deadurl=no |archiveurl=https://web.archive.org/web/20090819122933/http://www.guttmacher.org/pubs/journals/3310607.html |archivedate=19 August 2009 |df=dmy-all }}</ref> {{as of|2008}}, 40% of the world's women had access to legal abortions without limits as to reason.<ref name=IJGO10/> Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.<ref name=IJGO10>{{Cite journal|vauthors=Culwell KR, Vekemans M, de Silva U, Hurwitz M |title=Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion |journal=International Journal of Gynecology & Obstetrics |volume=110 |pages=S13–16 |date=July 2010 |pmid=20451196 |doi=10.1016/j.ijgo.2010.04.003}}</ref>

<!-- History, society and culture -->
[[history of abortion|Historically]], abortions have been attempted using [[abortifacient|herbal medicines]], sharp tools, [[fundal massage|forceful massage]], or through other [[traditional medicine|traditional methods]].<ref name="Management of Abortion, Chp 1">{{cite book|chapter=1. Abortion and medicine: A sociopolitical history|isbn=978-1-4443-1293-5|publisher=John Wiley & Sons|year=2009|location=Oxford|title=Management of Unintended and Abnormal Pregnancy|edition=1st|first1=M |last1=Paul |first2=ES |last2=Lichtenberg |first3=L |last3=Borgatta |first4=DA |last4=Grimes |first5=PG |last5=Stubblefield |first6=MD |last6=Creinin |first7=Carole |last7=Joffe |url=http://media.wiley.com/product_data/excerpt/62/14051769/1405176962.pdf |format=PDF |archiveurl=https://www.webcitation.org/62bppK1Iw?url=http://media.wiley.com/product_data/excerpt/62/14051769/1405176962.pdf |archivedate=21 October 2011 |deadurl=no |ol=15895486W }}</ref> [[Abortion law]]s and cultural or religious views of abortions are different around the world. In some areas abortion is legal only in specific cases such as [[rape]], [[fetal defects|problems with the fetus]], [[Socioeconomic status|poverty]], risk to a woman's health, or [[incest]].<ref name="Dev98-07">{{Cite journal |last1=Boland |first1=R. |last2=Katzive |first2=L. |doi=10.1363/ifpp.34.110.08 |title=Developments in Laws on Induced Abortion: 1998–2007 |journal=International Family Planning Perspectives |volume=34 |issue=3 |pages=110–20 |year=2008 |pmid=18957353 |url=http://www.guttmacher.org/pubs/journals/3411008.html |deadurl=no |archiveurl=https://web.archive.org/web/20111007221828/http://www.guttmacher.org/pubs/journals/3411008.html |archivedate=7 October 2011 |df=dmy-all }}</ref> There is [[Abortion debate|debate]] over the moral, ethical, and legal issues of abortion.<ref>{{cite book|editor-last=Nixon|editor-first=Frederick |first1=Adolf |last1=Paola |first2=Robert |last2=Walker |first3=Lois |last3=LaCivita|title=Medical ethics and humanities|date=2010|publisher=Jones and Bartlett Publishers|location=Sudbury, MA|isbn=978-0-7637-6063-2|page=249|url=https://books.google.com/books?id=9pM2pw-2wl4C&pg=PA249|deadurl=no|archiveurl=https://web.archive.org/web/20170906191717/https://books.google.com/books?id=9pM2pw-2wl4C&pg=PA249|archivedate=6 September 2017|df=dmy-all|ol=13764930W}}</ref><ref>{{cite book|last1=Johnstone|first1=Megan-Jane|title=Bioethics a nursing perspective|date=2009|publisher=Churchill Livingstone/Elsevier|location=Sydney, NSW|isbn=978-0-7295-7873-8|page=228|edition=5th|url=https://books.google.com/books?id=EG-Yg1xDYakC&pg=PA228|quote=Although abortion has been legal in many countries for several decades now, its moral permissibilities continues to be the subject of heated public debate.|deadurl=no|archiveurl=https://web.archive.org/web/20170906191717/https://books.google.com/books?id=EG-Yg1xDYakC&pg=PA228|archivedate=6 September 2017|df=dmy-all}}</ref> Those who [[Anti-abortion movements|oppose abortion]] often argue that an embryo or fetus is a human with a [[right to life]], and so they may compare abortion to [[murder]].<ref>{{Cite news |author=Pastor Mark Driscoll |title=What do 55 million people have in common? |publisher=Fox News |date=18 October 2013 |accessdate=2 July 2014 |url=http://www.foxnews.com/opinion/2013/10/18/what-do-55-million-people-have-in-common/ |deadurl=no |archiveurl=https://web.archive.org/web/20140831022138/http://www.foxnews.com/opinion/2013/10/18/what-do-55-million-people-have-in-common/ |archivedate=31 August 2014 |df=dmy-all }}</ref><ref>{{Cite news |first=Dale |last=Hansen |title=Abortion: Murder, or Medical Procedure? |publisher=The Huffington Post |date=18 March 2014 |accessdate=2 July 2014 |url=http://www.huffingtonpost.com/dale-hansen/abortion-murder-or-medica_b_4986637.html |deadurl=no |archiveurl=https://web.archive.org/web/20140714230359/http://www.huffingtonpost.com/dale-hansen/abortion-murder-or-medica_b_4986637.html |archivedate=14 July 2014 |df=dmy-all }}</ref> Those who [[Abortion-rights movements|favor the legality of abortion]] often hold that it is part of [[reproductive rights|a woman's right to make decisions about her own body]].<ref>{{cite book|last1=Sifris|first1=Ronli Noa|title=Reproductive freedom, torture and international human rights: challenging the masculinisation of torture|date=2013|publisher=Taylor & Francis |location=Hoboken, NJ|isbn=978-1-135-11522-7|oclc=869373168|page=3|url=https://books.google.com/books?id=9pVWAgAAQBAJ&pg=PA3|deadurl=no|archiveurl=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=9pVWAgAAQBAJ&pg=PA3|archivedate=15 October 2015|df=dmy-all}}</ref> Others favor legal and accessible abortion as a public health measure.<ref>{{cite book|last1=Swett|first1=C.|title=Unsafe abortion : global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003|date=2007|publisher=World Health Organization|isbn=978-92-4-159612-1|edition=5th|url=http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241596121/en/}}</ref>
{{TOC limit}}

==Types==

===Induced===
An induced abortion may be classified as ''therapeutic'' (done in response to a health condition of the women or fetus) or ''elective'' (chosen for other reasons).<ref name=":0">{{Cite web|url=https://medlineplus.gov/ency/article/007382.htm|title=Abortion – medical|last=|first=|date=9 July 2018|website=US National Library of Medicine (Medline Plus)|access-date=}}</ref>

Approximately 205 million pregnancies occur each year worldwide. Over a third are [[unintended pregnancy|unintended]] and about a fifth end in induced abortion.<ref name="Sedgh 2012" /><ref>{{cite web|author=Cheng L. |url=http://apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html |title=Surgical versus medical methods for second-trimester induced abortion |date=1 November 2008 |work=The WHO Reproductive Health Library |publisher=World Health Organization |accessdate=17 June 2011 |archiveurl=https://www.webcitation.org/5zVk3OSM4?url=http://apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html |archivedate=17 June 2011 |deadurl=no |df=dmy }}</ref> Most abortions result from unintended pregnancies.<ref>{{cite journal |journal=International Family Planning Perspectives |year=1998 |volume=24 |issue=3 |pages=117–27, 152 |author=Bankole |url=http://www.guttmacher.org/pubs/journals/2411798.html |title=Reasons Why Women Have Induced Abortions: Evidence from 27 Countries |doi=10.2307/3038208 |display-authors=etal |deadurl=no |archiveurl=https://web.archive.org/web/20060117191716/http://www.guttmacher.org/pubs/journals/2411798.html |archivedate=17 January 2006 |df=dmy-all }}</ref><ref>{{cite journal|first1=Lawrence B.|last1=Finer|first2=Lori F.|last2=Frohwirth|first3=Lindsay A.|last3=Dauphinee|first4=Susheela|last4=Singh|first5=Ann M.|last5=Moore|url=http://www.guttmacher.org/pubs/journals/3711005.pdf|format=PDF|title=Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives|journal=Perspectives on Sexual and Reproductive Health|volume=37|issue=3|pages=110–18|year=2005|doi=10.1111/j.1931-2393.2005.tb00045.x|pmid=16150658|deadurl=no|archiveurl=https://web.archive.org/web/20060117143856/https://www.guttmacher.org/pubs/journals/3711005.pdf|archivedate=17 January 2006|df=dmy-all}}</ref> In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.<ref name=BMJ2014/> 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.<ref>{{Cite book|last=Stubblefield|first=Phillip G. |chapter=10. Family Planning |title=Novak's Gynecology|editor1-last=Berek|editor1-first=Jonathan S.|editor1-link=Jonathan Berek|publisher=Lippincott Williams & Wilkins|year=2002|edition=13|isbn=978-0-7817-3262-8}}</ref><ref>{{citation|title=Risk factors for legal induced abortion-related mortality in the United States|pmid=15051566|journal=Obstetrics & Gynecology |year=2004 |last1=Bartlett |first1=LA |last2=Berg |first2=CJ |last3=Shulman |first3=HB |last4=Zane |first4=SB |last5=Green |first5=CA |last6=Whitehead |first6=S |last7=Atrash |first7=HK |volume=103 |issue=4 |pages=729–37 |doi=10.1097/01.AOG.0000116260.81570.60}}</ref> 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 [[Health|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 [[selective reduction|selectively reduce]] the number of fetuses to lessen health risks associated with [[multiple pregnancy]].<ref name="roche1">{{cite web|last=Roche|first=Natalie E.|date=28 September 2004 |title=Therapeutic Abortion |publisher=eMedicine |archiveurl=https://web.archive.org/web/20041214092044/http://www.emedicine.com/MED/topic3311.htm |url=http://emedicine.medscape.com/article/252560-overview |archivedate=14 December 2004 |accessdate=19 June 2011}}</ref><ref name="Williams Gyn, Chp 6" /> 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.<ref name="Williams Gyn, Chp 6" /> Confusion sometimes arises over the term "elective" because "[[elective surgery]]" generally refers to all scheduled surgery, whether medically necessary or not.<ref name=eos-elective>{{cite web |url = http://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.html#b |title = Elective surgery |publisher = Encyclopedia of Surgery |accessdate = 17 December 2012 |postscript = . |deadurl = no |archiveurl = https://web.archive.org/web/20121113215909/http://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.html#b |archivedate = 13 November 2012 |df = dmy-all}}
"An elective surgery is a planned, non-emergency surgical procedure. It may be either medically required (e.g., cataract surgery), or optional (e.g., breast augmentation or implant) surgery.
</ref>

===Spontaneous===
{{Main|Miscarriage}}
Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th [[gestational age|week of gestation]].<ref>{{cite book | title = Churchill Livingstone medical dictionary | publisher = Churchill Livingstone Elsevier | location = Edinburgh New York | year = 2008 | isbn = 978-0-443-10412-1 | quote = The preferred term for unintentional loss of the product of conception prior to 24 weeks' gestation is miscarriage.}}</ref> A pregnancy that ends before 37 weeks of gestation resulting in a [[live birth (human)|live-born]] infant is a "[[premature birth]]" or a "preterm birth".<ref>{{cite book|quote=A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight.|page=669|editor1-last=Gabbe|editor1-first=Steven G.|editor1-link=Steven Gabbe|editor2-last=Niebyl|editor2-first=Jennifer R.|editor3-last=Simpson|editor3-first=Joe Leigh|year=2007|title=Obstetrics: Normal and Problem Pregnancies|edition=5|publisher=Churchill Livingstone|chapter=51. Legal and Ethical Issues in Obstetric Practice|isbn=978-0-443-06930-7|last1=Annas|first1=George J.|authorlink1=George Annas|last2=Elias|first2=Sherman}}</ref> When a fetus dies [[in utero]] after [[Fetal viability|viability]], or during [[childbirth|delivery]], it is usually termed "[[stillbirth|stillborn]]".<ref>{{cite encyclopedia|quote=birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception|title=Stillbirth|work=Concise Medical Dictionary|publisher=Oxford University Press|year=2010|url=https://books.google.com/books?id=Zs8ZM4OUurcC&pg=PA698&lpg=PA698|deadurl=no|archiveurl=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=Zs8ZM4OUurcC&pg=PA698&lpg=PA698|archivedate=15 October 2015|df=dmy-all}}</ref> [[Premature births]] and [[stillbirth]]s are generally not considered to be miscarriages although usage of these terms can sometimes overlap.<ref>{{cite web|url=https://fam.state.gov/FAM/07FAM/07FAM1470.html|title=7 FAM 1470 Documenting Stillbirth (Fetal Death)|publisher=United States Department of State|date=18 February 2011|accessdate=12 January 2016}}</ref>

Only 30% to 50% of conceptions progress past the [[first trimester]].<ref name="Gabbe, Chp 24">{{cite book|editor1-last=Gabbe|editor1-first=Steven G.|editor1-link=Steven Gabbe|editor2-last=Niebyl|editor2-first=Jennifer R.|editor3-last=Simpson|editor3-first=Joe Leigh|year=2007|title=Obstetrics: Normal and Problem Pregnancies|edition=5|publisher=Churchill Livingstone|chapter=24. Pregnancy loss|isbn=978-0-443-06930-7|last1=Annas|first1=George J.|authorlink1=George Annas|last2=Elias|first2=Sherman}}</ref> The vast majority of those that do not progress are lost before the woman is [[clinically silent|aware of the conception]],<ref name="Williams Gyn, Chp 6" /> and many pregnancies are lost before medical practitioners can detect an embryo.<ref>{{cite book|last=Katz|first=Vern L.|publisher=Mosby|year=2007|edition=5|title=Katz: Comprehensive Gynecology|editor1-last=Katz|editor1-first=Vern L.|editor2-last=Lentz|editor2-first=Gretchen M.|editor3-last=Lobo|editor3-first=Rogerio A.|editor4-last=Gershenson|editor4-first=David M.|chapter=16. Spontaneous and Recurrent Abortion&nbsp;– Etiology, Diagnosis, Treatment|isbn=978-0-323-02951-3}}</ref> Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.<ref>{{cite book|last=Stovall|first=Thomas G.|chapter=17. Early Pregnancy Loss and Ectopic Pregnancy|title=Novak's Gynecology|editor1-last=Berek|editor1-first=Jonathan S.|editor1-link=Jonathan Berek|publisher=Lippincott Williams & Wilkins|year=2002|edition=13|isbn=978-0-7817-3262-8}}</ref> 80% of these spontaneous abortions happen in the first trimester.<ref name=Williams18>{{cite book |editor1-last= Cunningham |editor1-first = F. Gary |editor2-last= Leveno |editor2-first = Kenneth J. |editor3-last= Bloom |editor3-first = Steven L. |editor4-last= Spong |editor4-first = Catherine Y. |editor5-last= Dashe |editor5-first = Jodi S. |editor6-last= Hoffman |editor6-first = Barbara L. |editor7-last= Casey |editor7-first = Brian M. |editor8-last= Sheffield |editor8-first = Jeanne S. |title = Williams Obstetrics |edition = 24th |year = 2014 |publisher = McGraw Hill Education |isbn = 978-0-07-179893-8}}</ref>

The most common cause of spontaneous abortion during the first trimester is [[chromosomal abnormalities]] of the embryo or fetus,<ref name="Williams Gyn, Chp 6">{{cite book|editor1-last=Schorge|editor1-first=John O.|editor2-first=Joseph I.|editor2-last=Schaffer|editor3-first=Lisa M.|editor3-last=Halvorson|editor4-first=Barbara L.|editor4-last=Hoffman|editor5-first=Karen D.|editor5-last=Bradshaw|editor6-first=F. Gary|editor6-last=Cunningham|year=2008|title=Williams Gynecology|edition=1|publisher=McGraw-Hill Medical|isbn=978-0-07-147257-9|chapter=6. First-Trimester Abortion}}</ref><ref name="mednet">{{cite web|url=http://www.medicinenet.com/miscarriage/page1.htm |title=Miscarriage (Spontaneous Abortion) |accessdate=7 April 2009 |last=Stöppler |first=Melissa Conrad |editor1-first=William C., Jr. |editor1-last=Shiel |work=MedicineNet.com |publisher=WebMD |deadurl=yes |archiveurl=https://web.archive.org/web/20040829013142/http://www.medicinenet.com/Miscarriage/page1.htm |archivedate=29 August 2004 }}</ref> accounting for at least 50% of sampled early pregnancy losses.<ref name="fetal med 837">{{Cite book|vauthors=Jauniaux E, Kaminopetros P, El-Rafaey H |chapter=Early pregnancy loss |veditors=Whittle MJ, Rodeck CH |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=https://books.google.com/?id=0BY0hx2l5uoC |isbn=978-0-443-05357-3 |oclc=42792567 |page=837}}</ref> Other causes include [[vascular disease]] (such as [[Systemic lupus erythematosus|lupus]]), [[diabetes mellitus|diabetes]], other [[Endocrine disease|hormonal problems]], infection, and abnormalities of the uterus.<ref name="mednet" /> 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.<ref name="fetal med 837" /> A spontaneous abortion can also be caused by accidental [[Physical trauma|trauma]]; intentional trauma or stress to cause miscarriage is considered induced abortion or [[feticide]].<ref name="Fetal Homicide Laws">{{cite web |url=http://www.ncsl.org/programs/health/fethom.htm |title=Fetal Homicide Laws |accessdate=7 April 2009 |publisher=National Conference of State Legislatures |archiveurl=https://archive.is/20120911171355/http://www.ncsl.org/issues-research/health/fetal-homicide-state-laws.aspx |archivedate=September 11, 2012}}{{cbignore|bot=medic}}</ref>

==Methods==
{{Abortion methods}}

===Medical===
{{Main|Medical abortion}}

Medical abortions are those induced by [[abortifacient]] pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of [[prostaglandin]] [[prostaglandin analogue|analogs]] in the 1970s and the [[antiprogestin|antiprogestogen]] [[mifepristone]] (also known as RU-486) in the 1980s.<ref name=1st_Methods/><ref name=Kapp2013/><ref name="Kulier 2011">{{cite journal|vauthors=Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A |title=Medical methods for first trimester abortion|journal=The Cochrane Database of Systematic Reviews |year=2011 |issue=11 |page=CD002855 |doi=10.1002/14651858.CD002855.pub4 |pmid=22071804 |volume=11}}</ref><ref name="Creinin 2009">{{cite book|vauthors=Creinin MD, Gemzell-Danielsson K |year=2009|chapter=Medical abortion in early pregnancy|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care|location=Oxford|publisher=Wiley-Blackwell|pages=111–34|isbn=1-4051-7696-2}}</ref><ref name="Kapp 2009">{{cite book|vauthors=Kapp N, von Hertzen H |year=2009|chapter=Medical methods to induce abortion in the second trimester|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care|location=Oxford|publisher=Wiley-Blackwell|pages=178–92|isbn=1-4051-7696-2}}</ref>

The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog ([[misoprostol]] or [[gemeprost]]) up to 9 weeks gestational age, [[methotrexate]] in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.<ref name="Kulier 2011"/> 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.<ref name="Creinin 2009"/> This regime is effective in the second trimester.<ref>{{cite journal|last=Wildschut|first=H|author2=Both, MI|author3= Medema, S|author4= Thomee, E|author5= Wildhagen, MF|author6= Kapp, N|title=Medical methods for mid-trimester termination of pregnancy|journal=The Cochrane Database of Systematic Reviews|date=19 January 2011|issue=1|pages=CD005216|pmid=21249669|doi=10.1002/14651858.CD005216.pub2}}</ref> Medical abortion regiments involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 63 days' gestation.<ref>{{cite journal|last1=Chen|first1=MJ|last2=Creinin|first2=MD|title=Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review|journal=Obstetrics and Gynecology|date=July 2015|volume=126|issue=1|pages=12–21|doi=10.1097/AOG.0000000000000897|pmid=26241251}}</ref>

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.<ref name="WHO FAQs 2006">{{cite book|author=WHO Department of Reproductive Health and Research|year=2006|title=Frequently asked clinical questions about medical abortion|location=Geneva|publisher=World Health Organization|isbn=92-4-159484-5|url=http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf|accessdate=22 November 2011|deadurl=no|archiveurl=https://web.archive.org/web/20111226115043/http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf|archivedate=26 December 2011|df=dmy-all}}{{subscription required}}</ref> 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.<ref name="Fjerstad 2009b">{{cite journal|vauthors=Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V |date=September 2009|title=Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days |journal=Contraception |volume=80 |issue=3 |pages=282–86 |doi=10.1016/j.contraception.2009.03.010 |pmid=19698822 |pmc=3766037}} The regimen (200&nbsp;mg of mifepristone, followed 24–48 hours later by 800 mcg of ''vaginal'' misoprostol) ''previously'' used by [[Planned Parenthood]] clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman's request. The regimen (200&nbsp;mg of mifepristone, followed 24–48 hours later by 800 mcg of ''[[wikt:buccal|buccal]]'' misoprostol) ''currently'' used by Planned Parenthood clinics in the United States since April 2006 is 98% effective through 59 days gestation.</ref> If medical abortion fails, surgical abortion must be used to complete the procedure.<ref>{{cite book|vauthors=Holmquist S, Gilliam M |year=2008|chapter=Induced abortion|veditors=Gibbs RS, Karlan BY, Haney AF, Nygaard I |title=Danforth's obstetrics and gynecology|edition=10th|location=Philadelphia|publisher=Lippincott Williams & Wilkins|pages=586–603|isbn=978-0-7817-6937-2}}</ref>

Early medical abortions account for the majority of abortions before 9 weeks gestation in [[Abortion in Great Britain|Britain]],<ref>{{cite web|date=24 May 2011|title=Abortion statistics, England and Wales: 2010|location=London|publisher=Department of Health, United Kingdom|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215584/dh_127202.pdf |accessdate=22 November 2011}}</ref><ref>{{cite web|date=31 May 2011|title=Abortion statistics, year ending 31 December 2010|location=Edinburgh|publisher=ISD, NHS Scotland|url=http://www.isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2011-05-31/2011-05-31-Abortions-Report.pdf?68450564147|accessdate=22 November 2011|deadurl=no|archiveurl=https://web.archive.org/web/20110726193951/http://www.isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2011-05-31/2011-05-31-Abortions-Report.pdf?68450564147|archivedate=26 July 2011|df=dmy-all}}</ref> [[Abortion in France|France]],<ref>{{cite web|vauthors=Vilain A, Mouquet MC |date=22 June 2011 |title=Voluntary terminations of pregnancies in 2008 and 2009 |location=Paris |publisher=DREES, Ministry of Health, France |url=http://www.sante.gouv.fr/IMG/pdf/er765.pdf |accessdate=22 November 2011 |deadurl=yes |archiveurl=https://web.archive.org/web/20110926235733/http://www.sante.gouv.fr/IMG/pdf/er765.pdf |archivedate=26 September 2011 }}</ref> [[Abortion in Switzerland|Switzerland]],<ref>{{cite web|author=|date=5 July 2011|title=Abortions in Switzerland 2010|location=Neuchâtel|publisher=Office of Federal Statistics, Switzerland|url=http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|accessdate=22 November 2011|deadurl=yes|archiveurl=https://web.archive.org/web/20111003203103/http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|archivedate=3 October 2011|df=dmy-all}}</ref> and the [[Nordic countries]].<ref>{{cite web|vauthors=Gissler M, Heino A|date=21 February 2011|title=Induced abortions in the Nordic countries 2009|location=Helsinki|publisher=National Institute for Health and Welfare, Finland|url=http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf|accessdate=22 November 2011|deadurl=yes|archiveurl=https://web.archive.org/web/20120118094034/http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf|archivedate=18 January 2012|df=dmy-all}}</ref> In the [[Abortion in the United States|United States]], the percentage of early medical abortions is around 30% {{as of|2014|lc=y}}.<ref name="Jones 2017">{{cite journal|last1=Jones|first1=Rachel K.|last2=Jerman|first2=Jenna|date=January 17, 2017|title=Abortion incidence and service availability in the United States, 2014|journal=Perspectives on Sexual and Reproductive Health|doi=10.1363/psrh.12015|pmid=28094905|pmc=5487028|url= http://onlinelibrary.wiley.com/doi/10.1363/psrh.12015/epdf|volume=49|issue=1|pages=17–27}}<br />96% of all abortions performed in nonhospital facilities × 31% early medical abortions of all nonhospital abortions = 30% early medical abortions of all abortions; 97% of nonhospital medical abortions used mifepristone and misoprostol—3% used methotrexate and misoprostol, or misoprostol alone—in the United States in 2014.</ref>

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second-trimester abortions in [[Abortion in Canada|Canada]], most of Europe, [[Abortion in China|China]] and [[Abortion in India|India]],<ref name="Kapp 2009"/> in contrast to the United States where 96% of second-trimester abortions are performed surgically by [[dilation and evacuation]].<ref>{{cite book|vauthors=Hammond C, Chasen ST |year=2009|chapter=Dilation and evacuation|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care |location=Oxford |publisher=Wiley-Blackwell|pages=178–92|isbn=1-4051-7696-2}}</ref>

===Surgical===
[[File:Vacuum-aspiration (single).svg|thumb|A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).<br />'''1:''' Amniotic sac<br />'''2:''' Embryo<br />'''3:''' Uterine lining<br />'''4:''' Speculum<br />'''5:''' Vacurette<br />'''6:''' Attached to a suction pump]]

Up to 15 weeks' gestation, [[suction-aspiration abortion|suction-aspiration]] or [[vacuum aspiration]] are the most common surgical methods of induced abortion.<ref>{{cite web|author=Healthwise |url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 |title=Manual and vacuum aspiration for abortion |year=2004 |publisher=WebMD |accessdate=5 December 2008| archiveurl= https://web.archive.org/web/20070211155626/http://www.webmd.com/hw/womens_conditions/tw1078.asp| archivedate=11 February 2007| deadurl= no}}</ref> ''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 differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether [[cervical dilation]] is necessary.

MVA, also known as "mini-suction" and "[[menstrual extraction]]", can be used in very early pregnancy, and does not require cervical dilation. [[Dilation and curettage]] (D&C), the second most common method of surgical abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. [[Curettage]] refers to cleaning the walls of the [[uterus]] with a [[curette]]. The [[World Health Organization]] recommends this procedure, also called ''sharp curettage,'' only when MVA is unavailable.<ref>{{Cite book|author=World Health Organization |chapter=Dilatation and curettage |chapterurl=http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html |title=Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors |publisher=World Health Organization |location=Geneva |year=2003 |pages= |isbn=978-92-4-154587-7 |oclc=181845530 |accessdate=5 December 2008}}</ref>

From the 15th week of gestation until approximately the 26th, other techniques must be used. [[Dilation and evacuation]] (D&E) consists of opening the [[cervix]] of the uterus and emptying it using surgical instruments and suction. After the 16th week of gestation, abortions can also be induced by [[intact dilation and extraction]] (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "[[partial-birth abortion]]", which has been [[Partial-Birth Abortion Ban Act|federally banned]] in the United States.

In the third trimester of pregnancy, induced abortion may be performed surgically by [[intact dilation and extraction]] or by hysterotomy. [[Hysterotomy abortion]] is a procedure similar to a [[caesarean section]] and is performed under [[general anesthesia]]. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.<ref name="encarta">{{cite encyclopedia|last=McGee |first=Glenn |authorlink=Glenn McGee |author2=Jon F. Mer] |encyclopedia=Encarta |title=Abortion |url=http://encarta.msn.com/encyclopedia_761553899/Abortion.html |accessdate=5 December 2008 |publisher=Microsoft|archiveurl=https://www.webcitation.org/5kvWYG63q?url=http://encarta.msn.com/encyclopedia_761553899/Abortion.html |archivedate=31 October 2009 |deadurl=yes |df=dmy }}</ref>

First-trimester procedures can generally be performed using [[local anesthesia]], while second-trimester methods may require [[Sedation#Levels of sedation|deep sedation]] or [[general anesthesia]].<ref name="NEJMDec2011">{{Cite journal |last1=Templeton |first1=A. |last2=Grimes |first2=D.A. |doi=10.1056/NEJMcp1103639 |title=A Request for Abortion |journal=New England Journal of Medicine |volume=365 |issue=23 |pages=2198–2204 |year=2011 |url=http://www.nejm.org/doi/full/10.1056/NEJMcp1103639 |doi-access=free |deadurl=no |archiveurl=https://web.archive.org/web/20120108100041/http://www.nejm.org/doi/full/10.1056/NEJMcp1103639 |archivedate=8 January 2012 |df=dmy-all }}</ref>

===Labor induction abortion===

In places lacking the necessary medical skill for dilation and extraction, or where preferred by practitioners, an abortion can be induced by first [[Labor induction|inducing labor]] and then [[Late termination of pregnancy#Methods|inducing fetal demise]] if necessary.<ref name=GLOWM_Late>{{cite journal|last1=Borgatta|first1=L|journal=Global Library of Women's Medicine|date=December 2014|volume=GLOWM.10444|doi=10.3843/GLOWM.10444|url=http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443|accessdate=25 September 2015|title=Labor Induction Termination of Pregnancy|deadurl=no|archiveurl=https://web.archive.org/web/20150924082507/http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443|archivedate=24 September 2015|df=dmy-all}}</ref> 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.<ref name=Labor_Induced_Abortion>{{cite journal|last1=Society of Family Planning|title=Clinical Guidelines, Labor induction abortion in the second trimester|journal=Contraception|date=February 2011|volume=84|issue=1|pages=4–18|doi=10.1016/j.contraception.2011.02.005|url=http://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf|quote="10. What is the effect of feticide on labor induction abortion outcome? Deliberately causing demise of the fetus before labor induction abortion is performed primarily to avoid transient fetal survival after expulsion; this approach may be for the comfort of both the woman and the staff, to avoid futile resuscitation efforts. Some providers allege that feticide also facilitates delivery, although little data support this claim. Transient fetal survival is very unlikely after intraamniotic installation of saline or urea, which are directly feticidal. Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin. Factors associated with a higher likelihood of transient fetal survival with labor induction abortion include increasing gestational age, decreasing abortion interval and the use of nonfeticidal inductive agents such as the PGE1 analogues."|accessdate=25 September 2015}}</ref>

Only limited data are available comparing this method with dilation and extraction.<ref name=Labor_Induced_Abortion/> 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.<ref name=Labor_Induced_Abortion/><ref name=NAF_2015_Policy>{{cite journal|title=2015 Clinical Policy Guidelines|publisher=National Abortion Federation|date=2015|url=http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf|accessdate=30 October 2015|quote=Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise.|deadurl=no|archiveurl=https://web.archive.org/web/20150812220053/http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf|archivedate=12 August 2015|df=dmy-all}}</ref>

===Other methods===
Historically, a number of herbs reputed to possess abortifacient properties have been used in [[folk medicine]]. Among these are: [[tansy]], [[Mentha pulegium|pennyroyal]], [[black cohosh]], and the now-extinct [[silphium]].<ref name="riddle2">{{Cite book|first=John M. |last=Riddle |title=Eve's herbs: a history of contraception and abortion in the West |publisher=Harvard University Press |location=Cambridge, MA |year=1997|isbn=978-0-674-27024-4 |oclc=36126503}}</ref>{{rp|44–47, 62–63, 154–55, 230–31}}

In 1978 one woman in Colorado died and another was seriously injured when they attempted to procure an abortion by taking pennyroyal oil.<ref>{{citation | title=Pennyroyal oil poisoning and hepatoxicity | journal=Journal of the American Medical Association | year=1979|volume=242|issue=26|pages=2873–24|doi=10.1001/jama.1979.03300260043027| last1=Sullivan | first1=John B. |first2=Barry H. |last2=Rumack |first3=Harold Jr|last3=Thomas|display-authors=etal}}</ref>
Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as [[multiple organ dysfunction syndrome|multiple organ failure]],<ref>{{Cite journal|vauthors=Ciganda C, Laborde A |title=Herbal infusions used for induced abortion |journal=Journal of Toxicology: Clinical Toxicology |volume=41 |issue=3 |pages=235–39 |year=2003 |pmid=12807304 |doi=10.1081/CLT-120021104 |url=}}</ref> 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]].<ref>{{cite journal | author = Smith JP | title = Risky choices: The dangers of teens using self-induced abortion attempts | journal = Journal of Pediatric Health Care | volume = 12 | issue = 3 | pages = 147–51 | year = 1998 | pmid = 9652283 | doi = 10.1016/S0891-5245(98)90245-0 }}</ref> In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.<ref name="potts">{{Cite journal |last1=Potts |first1=M.| authorlink1=Malcolm Potts| last2=Graff |first2=M. |last3=Taing |first3=J. |doi=10.1783/147118907782101904 |title=Thousand-year-old depictions of massage abortion |journal=Journal of Family Planning and Reproductive Health Care |volume=33 |issue=4| pages=233–34 |year=2007 |pmid=17925100}}</ref> One of the [[bas relief]]s decorating the temple of [[Angkor Wat]] in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the [[underworld]].<ref name="potts" />

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.<ref>{{Cite journal |last1=Thapa |first1=S.R. |last2=Rimal |first2=D. |last3=Preston |first3=J. |title=Self induction of abortion with instrumentation |journal=Australian Family Physician |volume=35 |issue=9 |pages=697–98 |year=2006 |pmid=16969439 |url=http://www.racgp.org.au/afp/200609/11015 |deadurl=no |archiveurl=https://web.archive.org/web/20090108181951/http://www.racgp.org.au/afp/200609/11015 |archivedate=8 January 2009 |df=dmy-all }}</ref>
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==Safety==
[[File:Abortion Quick & Pain Free sign, Joe Slovo Park, Cape Town, South Africa-3869.jpg|thumb|right|An 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]] defines [[unsafe abortion]]s as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.<ref name="who-unsafe-1992">{{cite web| publisher=World Health Organization |title=The Prevention and Management of Unsafe Abortion |date=April 1992| accessdate=18 October 2017 |url=http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf |format=PDF| archiveurl= https://web.archive.org/web/20100530072310/http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf| archivedate= 30 May 2010 | deadurl= no}}</ref> Legal abortions performed in the [[developed country|developed world]] are among the safest procedures in medicine.<ref name="lancet-grimes" /><ref name="grimes-overview">{{cite journal |last1=Grimes |first1=DA |last2=Creinin |first2=MD |title=Induced abortion: an overview for internists |journal=Annals of Internal Medicine |volume=140 |issue=8 |pages=620–26 |year=2004 |pmid=15096333 |doi=10.7326/0003-4819-140-8-200404200-00009 |url=http://www.annals.org/content/140/8/620.full |deadurl=no |archiveurl=https://web.archive.org/web/20100507081029/http://www.annals.org/content/140/8/620.full |archivedate=7 May 2010 |df=dmy-all }}</ref> In the US, the risk of [[mortality rate|maternal death]] from abortion is 0.7 per 100,000 procedures,<ref name="Ray2014" /> making abortion about 13 times safer for women than childbirth (8.8 maternal deaths per 100,000 live births).<ref name="grimes-mortality-2012">{{Cite journal| last1=Raymond |first1=E.G. |last2=Grimes |first2=D.A. |doi=10.1097/AOG.0b013e31823fe923 |title=The Comparative Safety of Legal Induced Abortion and Childbirth in the United States |journal=Obstetrics & Gynecology |volume=119 |issue=2, Part 1 |pages=215–19 |year=2012 |pmid=22270271 |pmc=}}</ref><ref name="grimes-mortality-2006">{{cite journal |author=Grimes DA |title=Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999 |journal=American Journal of Obstetrics & Gynecology |volume=194 |issue=1 |pages=92–94 |date=January 2006 |pmid=16389015 |doi=10.1016/j.ajog.2005.06.070 |url=}}</ref> In the United States from 2000 to 2009, abortion had a lower mortality rate than [[plastic surgery]].<ref>{{cite journal|last1=Raymond|first1=EG|last2=Grossman|first2=D|last3=Weaver|first3=MA|last4=Toti|first4=S|last5=Winikoff|first5=B|title=Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States|journal=Contraception|date=November 2014|volume=90|issue=5|pages=476–79|doi=10.1016/j.contraception.2014.07.012|pmid=25152259}}</ref> The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.<ref name="bartlett">{{cite journal |author=Bartlett LA |title=Risk factors for legal induced abortion-related mortality in the United States |journal=Obstetrics & Gynecology |volume=103 |issue=4 |pages=729–37 |date=April 2004 |pmid=15051566 |doi=10.1097/01.AOG.0000116260.81570.60 |url= |author2=Berg CJ |author3=Shulman HB |last4=Zane |first4=Suzanne B. |last5=Green |first5=Clarice A. |last6=Whitehead |first6=Sara |last7=Atrash |first7=Hani K.|display-authors=3 }}</ref><ref name="emedicine">{{cite web |publisher=eMedicine |title=Elective Abortion |date=27 May 2010 |accessdate=1 June 2010 |first=Suzanne |last=Trupin |quote=At every gestational age, elective abortion is safer for the mother than carrying a pregnancy to term. |url=http://emedicine.medscape.com/article/252560-overview |deadurl=no |archiveurl=https://web.archive.org/web/20041214092044/http://www.emedicine.com/MED/topic3311.htm |archivedate=14 December 2004 |df=dmy-all }}</ref><ref name="Genevra-2012">{{cite news|url=https://www.reuters.com/article/2012/01/23/us-abortion-idUSTRE80M2BS20120123|title=Abortion safer than giving birth: study|last=Pittman|first=Genevra|date=23 January 2012|publisher=Reuters|accessdate=4 February 2012|deadurl=no|archiveurl=https://web.archive.org/web/20120206195457/http://www.reuters.com/article/2012/01/23/us-abortion-idUSTRE80M2BS20120123|archivedate=6 February 2012|df=dmy-all}}</ref> Outpatient abortion is as safe and effective from 64 to 70 days' gestation as it is from 57 to 63 days.<ref>{{cite journal|last1=Abbas|first1=D|last2=Chong|first2=E|last3=Raymond|first3=EG|title=Outpatient medical abortion is safe and effective through 70 days gestation|journal=Contraception|date=September 2015|volume=92|issue=3|pages=197–99|pmid=26118638|doi=10.1016/j.contraception.2015.06.018}}</ref> Medical abortion is safe and effective for pregnancies earlier than 6 weeks' gestation.<ref>{{Cite journal|last=Kapp|first=Nathalie|last2=Baldwin|first2=Maureen K.|last3=Rodriguez|first3=Maria Isabel|date=2017-09-18|title=Efficacy of medical abortion prior to 6 gestational weeks: a systematic review|journal=Contraception|doi=10.1016/j.contraception.2017.09.006|issn=1879-0518|pmid=28935220|volume=97|pages=90–99}}</ref>

[[Vacuum aspiration]] in the first trimester is the safest method of surgical abortion, and can be performed in a [[primary care|primary care office]], [[abortion clinic]], or hospital. Complications, which are rare, can include [[uterine perforation]], [[endometritis|pelvic infection]], and retained products of conception requiring a second procedure to evacuate.<ref name="arch-fam-practice">{{cite journal|vauthors=Westfall JM, Sophocles A, Burggraf H, Ellis S |title=Manual vacuum aspiration for first-trimester abortion |journal=Arch Fam Med |volume=7 |issue=6 |pages=559–62 |year=1998 |pmid=9821831 |doi=10.1001/archfami.7.6.559 |url=http://archfami.ama-assn.org/cgi/content/full/7/6/559 |deadurl=yes |archiveurl=https://web.archive.org/web/20050405202853/http://archfami.ama-assn.org/cgi/content/full/7/6/559 |archivedate=5 April 2005 }}</ref> Infections account for one-third of abortion-related deaths in the United States.<ref>{{cite journal|last1=Dempsey|first1=A|title=Serious infection associated with induced abortion in the United States|journal=Clinical Obstetrics and Gynecology|date=December 2012|volume=55|issue=4|pages=888–92|doi=10.1097/GRF.0b013e31826fd8f8|pmid=23090457}}</ref> 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.<ref>{{cite journal|last1=White|first1=Kari|last2=Carroll|first2=Erin|last3=Grossman|first3=Daniel|title=Complications from first-trimester aspiration abortion: a systematic review of the literature|journal=Contraception|date=November 2015|volume=92|issue=5|pages=422–38|doi=10.1016/j.contraception.2015.07.013|pmid=26238336}}</ref> Preventive antibiotics (such as [[doxycycline]] or [[metronidazole]]) are typically given before elective abortion,<ref>{{cite journal |title=ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures |journal=Obstetrics & Gynecology |volume=113 |issue=5 |pages=1180–89 |date=May 2009 |pmid=19384149 |doi=10.1097/AOG.0b013e3181a6d011 |url= |author1= ACOG Committee on Practice Bulletins – Gynecology}}</ref> as they are believed to substantially reduce the risk of postoperative uterine infection.<ref name="NEJMDec2011" /><ref>{{cite journal |vauthors=Sawaya GF, Grady D, Kerlikowske K, Grimes DA |title=Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis |journal=Obstetrics & Gynecology |volume=87 |issue=5 Pt 2 |pages=884–90 |date=May 1996 |pmid=8677129 |doi= |url=}}</ref> 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]].<ref>{{cite journal|last1=Barnard|first1=S|last2=Kim|first2=C|last3=Park|first3=MH|last4=Ngo|first4=TD|title=Doctors or mid-level providers for abortion|journal=The Cochrane Database of Systematic Reviews|date=27 July 2015|issue=7|pages=CD011242|doi=10.1002/14651858.CD011242.pub2|pmid=26214844}}</ref> Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. Second-trimester abortions are generally well-tolerated.<ref>{{Cite journal|last=Lerma|first=Klaira|last2=Shaw|first2=Kate A.|date=2017-09-15|title=Update on second trimester medical abortion|journal=Current Opinion in Obstetrics and Gynecology|doi=10.1097/GCO.0000000000000409|issn=1473-656X|pmid=28922193|volume=29|pages=413–18}}</ref>

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 9 weeks gestation.<ref name="WHO FAQs 2006"/> 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.<ref>{{cite web|author=Grossman D|date=3 September 2004|title=Medical methods for first trimester abortion: RHL commentary|work=Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://apps.who.int/rhl/fertility/abortion/dgcom/en/index.html|accessdate=22 November 2011|deadurl=no|archiveurl=https://web.archive.org/web/20111028054620/http://apps.who.int/rhl/fertility/abortion/dgcom/en/index.html|archivedate=28 October 2011|df=dmy-all}}</ref><ref>{{cite web|vauthors=Chien P, Thomson M |date=15 December 2006|title=Medical versus surgical methods for first trimester termination of pregnancy: RHL commentary|work=Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html |accessdate=1 June 2010| archiveurl= https://web.archive.org/web/20100517201143/http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html| archivedate= 17 May 2010 | deadurl= no}}</ref>

Some purported risks of abortion are promoted primarily by anti-abortion groups,<ref name="JASEN"/><ref name=Cancer_Linacre>{{cite journal|author1=Schneider, A. Patrick II|author2=Zainer, Christine|title=The breast cancer epidemic: 10 facts|journal=The Linacre Quarterly|date=August 2014|volume=81|issue=3|pages=244–77|doi=10.1179/2050854914Y.0000000027|url=http://www.maneyonline.com/doi/full/10.1179/2050854914Y.0000000027|accessdate=11 November 2015|publisher=Catholic Medical Association|quote=an association between [induced abortion] and breast cancer has been found by numerous Western and non-Western researchers from around the world. This is especially true in more recent reports that allow for a sufficient breast cancer latency period since an adoption of a Western life style in sexual and reproductive behavior.|display-authors=etal|doi-access=free|pmc=4135458}}</ref>
but lack scientific support.<ref name="JASEN">{{cite journal |author=Jasen P |title=Breast cancer and the politics of abortion in the United States |journal=Medical History |volume=49 |issue=4 |pages=423–44 |date=October 2005 |pmid=16562329 |pmc=1251638 |doi= 10.1017/S0025727300009145}}</ref> For example, the question of a link between [[abortion-breast cancer hypothesis|induced abortion and breast cancer]] has been investigated extensively. Major medical and scientific bodies (including the [[World Health Organization]], [[National Cancer Institute]], [[American Cancer Society]], [[Royal College of Obstetricians and Gynaecologists|Royal College of OBGYN]] and [[American Congress of Obstetricians and Gynecologists|American Congress of OBGYN]]) have concluded that abortion does not cause breast cancer.<ref>Position statements of major medical bodies on abortion and breast cancer include:
* World Health Organization: {{cite web|url=http://www.who.int/mediacentre/factsheets/fs240/en/ |title=Induced abortion does not increase breast cancer risk (Fact sheet N°240) |publisher=World Health Organization |accessdate=6 January 2011 |archiveurl=https://web.archive.org/web/20110213141046/http://www.who.int/mediacentre/factsheets/fs240/en/ |archivedate=13 February 2011 }}
* National Cancer Institute: {{cite web|url=http://www.cancer.gov/cancertopics/factsheet/risk/abortion-miscarriage |title=Abortion, Miscarriage, and Breast Cancer Risk |publisher=National Cancer Institute |accessdate=11 January 2011 |archiveurl=https://web.archive.org/web/20101221084337/http://www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage |archivedate=21 December 2010 |deadurl=no }}
* American Cancer Society: {{cite web|url=http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer |publisher=American Cancer Society|date=23 September 2010 |accessdate=20 June 2011 |title=Is Abortion Linked to Breast Cancer? |quote=At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer. |archiveurl=https://web.archive.org/web/20110605204701/http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer |archivedate=5 June 2011 |deadurl=no }}
* Royal College of Obstetricians and Gynaecologists: {{cite web|url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf |title=The Care of Women Requesting Induced Abortion |page=9 |format=PDF |publisher=Royal College of Obstetricians and Gynaecologists |accessdate=29 June 2008 |quote=Induced abortion is not associated with an increase in breast cancer risk. |deadurl=yes |archiveurl=https://web.archive.org/web/20130727105037/http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf |archivedate=27 July 2013 }}
* American Congress of Obstetricians and Gynecologists: {{cite web|url=http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm |title=ACOG Finds No Link Between Abortion and Breast Cancer Risk |date=31 July 2003 |publisher=American Congress of Obstetricians and Gynecologists |accessdate=11 January 2011 |archiveurl=https://web.archive.org/web/20110102030744/http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm |archivedate=2 January 2011 |deadurl=yes }}</ref>

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."<ref>{{cite book | last = Gordon | first = Linda | title = The Moral Property of Women | publisher = University of Illinois Press | year = 2002 | isbn = 0-252-02764-7 }}</ref>{{rp|25|}} According to [[Rickie Solinger]],
{{Quote|
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.<ref>{{citation | last = Solinger | first = Rickie | contribution = Introduction | editor-last = Solinger | editor-first = Rickie | title = Abortion Wars: A Half Century of Struggle, 1950–2000 | pages = 1–9 | publisher = University of California Press | year = 1998 | isbn = 978-0-520-20952-7}}</ref>{{rp|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.<ref>{{cite book | last1 = Bates | first1 = Jerome E. | last2 = Zawadzki | first2 = Edward S. | title = Criminal Abortion: A Study in Medical Sociology | publisher = Charles C. Thomas | year = 1964 | isbn = 978-0-398-00109-4 }}</ref>{{rp|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<ref>{{cite book | last = Keller | first = Allan | title = Scandalous Lady: The Life and Times of Madame Restell | publisher = Atheneum | year = 1981 | isbn = 978-0-689-11213-3 }}</ref>—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
{{Quote|
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.
<ref>{{cite book | last = Taussig | first = Frederick J. | title = Abortion Spontaneous and Induced: Medical and Social Aspects | publisher = C.V. Mosby | year = 1936 }}</ref>{{rp|223}}
}}

===Mental health===
{{Main|Abortion and mental health}}

Current evidence finds no relationship between most induced abortions and [[abortion and mental health|mental-health problems]]<ref name=BMJ2014/><ref name=Hor2017>{{cite journal|last1=Horvath|first1=S|last2=Schreiber|first2=CA|title=Unintended Pregnancy, Induced Abortion, and Mental Health|journal=Current Psychiatry Reports|date=14 September 2017|volume=19|issue=11|pages=77|doi=10.1007/s11920-017-0832-4|pmid=28905259}}</ref> other than those expected for any unwanted pregnancy.<ref name="apa-press"/> 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.<ref name="apa-press">{{cite press release |publisher=American Psychological Association |title=APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health |date=12 August 2008 |accessdate=7 September 2011 |url=http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx |deadurl=no |archiveurl=https://web.archive.org/web/20110906022824/http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx |archivedate=6 September 2011 |df=dmy-all }}</ref><ref>{{cite web |url=http://www.apa.org/pi/women/programs/abortion/mental-health.pdf |title=Report of the APA Task Force on Mental Health and Abortion |publisher=American Psychological Association|location=Washington, DC |date=13 August 2008 |deadurl=no |archiveurl=https://web.archive.org/web/20100615020211/http://apa.org/pi/women/programs/abortion/mental-health.pdf |archivedate=15 June 2010 |df=dmy-all }}</ref> Some older reviews concluded that abortion was associated with an increased risk of psychological problems;<ref>{{cite journal|last1=Coleman|first1=PK|title=Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009|journal=The British Journal of Psychiatry|date=September 2011|volume=199|issue=3|pages=180–86|doi=10.1192/bjp.bp.110.077230|pmid=21881096}}</ref> however, they did not use an appropriate control group.<ref name=Hor2017/>

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,<ref name="apa-2008">{{cite web | url = http://www.apa.org/pi/women/programs/abortion/index.aspx | title = Mental Health and Abortion | publisher = [[American Psychological Association]] | year = 2008 | accessdate = 18 April 2012 | deadurl = no | archiveurl = https://web.archive.org/web/20120419174044/http://www.apa.org/pi/women/programs/abortion/index.aspx | archivedate = 19 April 2012 | df = dmy-all }}</ref> more rigorous research would be needed to show this conclusively.<ref name="Steinberg2011">{{Cite journal |last1=Steinberg |first1=J.R. |title=Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions – A Critical Review of Research |doi=10.1016/j.whi.2011.02.002 |journal=Women's Health Issues |volume=21 |issue=3 |pages=S44–S48 |year=2011 |pmid=21530839}}</ref> 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.<ref>{{cite journal|last1=Kelly|first1=Kimberly|title=The spread of 'Post Abortion Syndrome' as social diagnosis|journal=Social Science & Medicine|date=February 2014|volume=102|pages=18–25|doi=10.1016/j.socscimed.2013.11.030}}</ref>

===Unsafe abortion===
{{Main|Unsafe abortion}}

[[File:RussianAbortionPoster.jpg|thumb|Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Abortions performed by either trained 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 abortion 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.<ref>{{Cite journal|last1=Okonofua |first1=F. |title=Abortion and maternal mortality in the developing world |journal=Journal of Obstetrics and Gynaecology Canada |volume=28 |issue=11 |pages=974–79 |year=2006 |pmid=17169222 |url=http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf |format=PDF |deadurl=yes |archiveurl=https://web.archive.org/web/20120111121431/http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf |archivedate=11 January 2012 |df=dmy }}</ref>

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 country|developing countries]].<ref name="lancet-grimes"/> Unsafe abortions are believed to result in millions of injuries.<ref name="lancet-grimes"/><ref name="Haddad-2009">{{Cite journal|last1=Haddad |first1=LB |last2=Nour |first2=NM |title=Unsafe abortion: unnecessary maternal mortality |journal=Reviews in Obstetrics & Gynecology |volume=2 |issue=2 |pages=122–26|year=2009 |doi=|pmid=19609407 |pmc=2709326}}</ref> Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;<ref name="lancet-grimes"/><ref name=OBGY09/><ref name=Loz2012>{{cite journal|last=Lozano|first=R|title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010|journal=Lancet|date=15 December 2012|volume=380|issue=9859|pages=2095–128|pmid=23245604|doi=10.1016/S0140-6736(12)61728-0|hdl=10536/DRO/DU:30050819|hdl-access=free}}</ref> deaths from unsafe abortion account for around 13% of all [[maternal deaths]].<ref>{{cite book|last=Darney|first=Leon Speroff, Philip D.|title=A clinical guide for contraception|year=2010|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=1-60831-610-6|page=406|edition=5th }}</ref> The [[World Health Organization]] believes that mortality has fallen since the 1990s.<ref name="WHO2011">{{cite book |last=World Health Organisation |title=Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 |publisher=World Health Organisation |year=2011 |edition=6th |page=27 |isbn=978-92-4-150111-8 |url=http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf |format=PDF |deadurl=no |archiveurl=https://web.archive.org/web/20140328093307/http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf |archivedate=28 March 2014 |df=dmy-all }}</ref> 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.<ref name="berer-who">{{cite journal |author=Berer M |title=Making abortions safe: a matter of good public health policy and practice |journal=Bulletin of the World Health Organization |volume=78 |issue=5 |pages=580–92 |year=2000 |pmid=10859852 |pmc=2560758}}</ref> In response, opponents of abortion point out that abortion bans in no way affect prenatal care for women who choose to carry their fetus to term. The Dublin Declaration on Maternal Health, signed in 2012, notes, "the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women."<ref>{{cite web| url =http://www.dublindeclaration.com/translations/| title =Translations| publisher =Dublin Declaration| accessdate =28 October 2015| deadurl =no| archiveurl =https://web.archive.org/web/20151028135616/http://www.dublindeclaration.com/translations/| archivedate =28 October 2015| df =dmy-all}}</ref>

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.<ref name="OBGY09"/><ref name="Sedgh 2012"/><ref name="berer-who"/><ref name="Sedgh 2007">{{cite journal |vauthors=Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH |title =Induced abortion: estimated rates and trends worldwide |year=2007 |journal=Lancet |volume=370 |issue=9595 |pages=1338–45 |doi=10.1016/S0140-6736(07)61575-X |pmid=17933648|citeseerx=10.1.1.454.4197 }}</ref><ref name="WHO-unsafe-2007">{{cite web |publisher=World Health Organization|year=2007 |accessdate=7 March 2011 |format=PDF |url=http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf |title=Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 |archiveurl= https://web.archive.org/web/20110216141018/http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf| archivedate= 16 February 2011 |deadurl= no}}</ref><ref>{{cite journal |author=Berer M |title=National laws and unsafe abortion: the parameters of change |journal=Reproductive Health Matters |volume=12 |issue=24 Suppl |pages=1–8 |date=November 2004 |pmid=15938152 |doi= 10.1016/S0968-8080(04)24024-1|url=}}</ref><ref>{{cite journal|last1=Culwell|first1=Kelly R.|last2=Hurwitz|first2=Manuelle|title=Addressing barriers to safe abortion|journal=International Journal of Gynecology & Obstetrics|date=May 2013|volume=121|pages=S16–S19|doi=10.1016/j.ijgo.2013.02.003}}</ref> For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,<ref name="jewkes">{{cite journal |vauthors=Jewkes R, Rees H, Dickson K, Brown H, Levin J |title=The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change |journal=BJOG: An International Journal of Obstetrics & Gynaecology |volume=112 |issue=3 |pages=355–59 |date=March 2005 |pmid=15713153 |doi=10.1111/j.1471-0528.2004.00422.x |url=}}</ref> with abortion-related deaths dropping by more than 90%.<ref name="bateman-samj">{{cite journal |author=Bateman C |title=Maternal mortalities 90% down as legal TOPs more than triple |journal=South African Medical Journal |volume=97 |issue=12 |pages=1238–42 |date=December 2007 |pmid=18264602 |url=http://samj.org.za/index.php/samj/article/view/642 |deadurl=no |archiveurl=https://web.archive.org/web/20170830200316/http://samj.org.za/index.php/samj/article/view/642 |archivedate=30 August 2017 |df=dmy-all }}</ref> Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as [[Romania]] and [[Nepal]].<ref>{{cite journal|last1=Conti|first1=Jennifer A.|last2=Brant|first2=Ashley R.|last3=Shumaker|first3=Heather D.|last4=Reeves|first4=Matthew F.|title=Update on abortion policy|journal=Current Opinion in Obstetrics and Gynecology|date=November 2016|pages=1|doi=10.1097/GCO.0000000000000324}}</ref> 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.<ref>{{cite journal|last1=New|first1=M.J.|title=Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era|journal=State Politics & Policy Quarterly|date=15 February 2011|volume=11|issue=1|pages=28–47|doi=10.1177/1532440010387397}}</ref> The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.<ref>{{cite journal|last1=Medoff|first1=M.H.|last2=Dennis|first2=C.|title=Another Critical Review of New's Reanalysis of the Impact of Antiabortion Legislation|journal=State Politics & Policy Quarterly|date=21 July 2014|volume=14|issue=3|pages=269–76|doi=10.1177/1532440014535476}}</ref> 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.<ref name="Singh">{{cite web|url=http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |title=Facts on Investing in Family Planning and Maternal and Newborn Health |format=PDF |publisher=Guttmacher Institute|year=2010 |accessdate=24 May 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20120324101905/http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |archivedate=24 March 2012 }}</ref> 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".<ref name=Pandemic>{{cite web |url = http://www.who.int/reproductivehealth/publications/unsafe_abortion/lancet_paper/en/ |title = Unsafe Abortion – The Preventable Pandemic|accessdate = 2010-01-16 |last = Grimes |first = David A. |deadurl = no |archiveurl = https://web.archive.org/web/20140305122947/http://www.who.int/reproductivehealth/publications/unsafe_abortion/lancet_paper/en/ |archivedate = 5 March 2014 |df = dmy-all}}</ref><ref name=Brazil_Unsafe>{{cite journal|last1=Nations|first1=MK|title=Women's hidden transcripts about abortion in Brazil|journal=Social Science & Medicine |date=1997|volume=44|pages=1833–45|doi=10.1016/s0277-9536(96)00293-6|pmid=9194245}}</ref>

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,<ref name="IJGO10"/> while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.<ref name="Dev98-07"/> While [[maternal death|maternal mortality]] seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.<ref name=OBGY09/> Complications of unsafe abortion account for approximately an eighth of [[maternal death|maternal mortalities]] worldwide,<ref name="Maclean">{{cite book|last=Maclean|first=Gaynor|url=https://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299|chapter=XI. Dimension, Dynamics and Diversity: A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives|pages=299–300|title=Trends in Midwifery Research|editor1-first=Randell E.|editor1-last=Balin|publisher=Nova Publishers|year=2005|isbn=978-1-59454-477-4|deadurl=no|archiveurl=https://web.archive.org/web/20150315113348/http://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299|archivedate=15 March 2015|df=dmy-all}}</ref> though this varies by region.<ref>{{cite journal|author=Salter, C. |author2=Johnson, H.B. |author3=Hengen, N. |year=1997 |url=http://info.k4health.org/pr/l10edsum.shtml |title=Care for Postabortion Complications: Saving Women's Lives |journal=Population Reports |volume=25 |issue=1 |publisher=Johns Hopkins School of Public Health |archiveurl=https://web.archive.org/web/20091207070103/http://info.k4health.org/pr/l10edsum.shtml |dead-url=yes |archivedate=7 December 2009 |df= }}</ref> Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.<ref name="WHO-unsafe-2007"/> The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.<ref name="Sedgh 2012" /> Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.<ref>{{cite web|title=Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health|authors=UNICEF, UNFPA, WHO, World Bank|year=2010|accessdate=31 December 2010 |url=http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html |deadurl=no |archiveurl=https://web.archive.org/web/20101109224916/http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html|archivedate=9 November 2010|df=dmy-all}}</ref>

===Live birth===

Although it is very uncommon, women undergoing surgical abortion after 18 weeks gestation sometimes give birth to a fetus that may survive briefly.<ref name=RCOG_2nd-trimester>{{cite journal|title=The Care of Women Requesting Induced Abortion. Evidence-Based Clinical Guideline no. 7|journal=Royal College of Obstetricians and Gynaecologists|date=November 2011|url=https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf|accessdate=31 October 2015|quote=Recommendation 6.21 Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation to ensure that there is no risk of a live birth.|deadurl=no|archiveurl=https://web.archive.org/web/20151114063300/https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf|archivedate=14 November 2015|df=dmy-all}}</ref><ref name=Labor_Induced_Abortionb>{{cite journal|last1=Society of Family Planning|title=Clinical Guidelines, Labor induction abortion in the second trimester|journal=Contraception|date=February 2011|volume=84|issue=1|pages=4–18|doi=10.1016/j.contraception.2011.02.005|url=http://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf|quote="Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin."}}</ref><ref name=Fletcher_Ethics>{{cite journal|author1=Fletcher|author2=Isada|author3=Johnson|author4=Evans|title=Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues|journal=Obstetrics and Gynecology|date=August 1992|volume=80|issue=2|pages=310–13|pmid=1635751|quote=" following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management."}}</ref> [[Fetal viability|Longer term survival]] is possible after 22 weeks.<ref name=RCOG_Term>{{cite journal|title=Termination of Pregnancy for Fetal Abnormality|journal=Royal College of Obstetricians and Gynaecologists|date=May 2010|pages=29–31|url=https://www.rcog.org.uk/globalassets/documents/guidelines/terminationpregnancyreport18may2010.pdf|accessdate=26 October 2015|deadurl=no|archiveurl=https://web.archive.org/web/20151222135512/https://www.rcog.org.uk/globalassets/documents/guidelines/terminationpregnancyreport18may2010.pdf|archivedate=22 December 2015|df=dmy-all}}</ref>

If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not.<ref name=Nuffield_Bioethics>{{cite journal|last1=Nuffield Council on Bioethics|title=Critical care decisions in fetal and neonatal medicine: a guide to the report|date=2007|url=http://nuffieldbioethics.org/wp-content/uploads/2014/07/CCD-Short-Version-FINAL.pdf|accessdate=29 October 2015|quote=Under English law, fetuses have no independent legal status. Once born, babies have the same rights to life as other people.|deadurl=no|archiveurl=https://web.archive.org/web/20160304040916/http://nuffieldbioethics.org/wp-content/uploads/2014/07/CCD-Short-Version-FINAL.pdf|archivedate=4 March 2016|df=dmy-all}}</ref><ref name=US_Ethics>{{cite journal|author1=Gerri R. Baer|author2=Robert M. Nelson|title=Preterm Birth: Causes, Consequences, and Prevention. C: A Review of Ethical Issues Involved in Premature Birth|journal=Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes|date=2007|url=https://www.ncbi.nlm.nih.gov/books/NBK11389/|quote=In 2002, the 107th U.S. Congress passed the Born-Alive Infants Protection Act of 2001. This law established personhood for all infants who are born "at any stage of development" who breathe, have a heartbeat, or "definite movement of voluntary muscles", regardless of whether the birth was due to labor or induced abortion.|deadurl=no|archiveurl=https://web.archive.org/web/20151231190458/http://www.ncbi.nlm.nih.gov/books/NBK11389/|archivedate=31 December 2015|df=dmy-all}}</ref><ref name=BAIPA>{{cite web|last1=Chabot|first1=Steve|title=H.R. 2175 (107th): Born-Alive Infants Protection Act of 2002|url=https://www.govtrack.us/congress/bills/107/hr2175|website=govtrack.us|accessdate=30 October 2015|ref=Pub.L. 107-207|date=5 August 2002|quote=The term "born alive" is defined as the complete expulsion or extraction from its mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of the voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.|deadurl=no|archiveurl=https://web.archive.org/web/20151114063301/https://www.govtrack.us/congress/bills/107/hr2175|archivedate=14 November 2015|df=dmy-all}}</ref> [[feticide#Use during legal abortion|Induced fetal demise]] before termination of pregnancy after 20–21 weeks gestation is recommended to avoid this.<ref name=ACOG_2nd>{{cite journal|title=Practice Bulletin: Second-Trimester Abortion|journal=Obstetrics & Gynecology|date=June 2013|volume=121|issue=6|pages=1394–1406|doi=10.1097/01.AOG.0000431056.79334.cc|pmid=23812485|url=http://blog.utp.edu.co/maternoinfantil/files/2012/04/135-Aborto-2-trimestre.pdf|accessdate=30 October 2015|quote=With medical abortion after 20 weeks of gestation, induced fetal demise may be preferable to the woman or provider in order to avoid transient fetal survival after expulsion.|deadurl=no|archiveurl=https://web.archive.org/web/20151114063257/http://blog.utp.edu.co/maternoinfantil/files/2012/04/135-Aborto-2-trimestre.pdf|archivedate=14 November 2015|df=dmy-all}}</ref><ref name=SFP_Demise>{{cite journal|title=Clinical Guidelines: Induction of fetal demise before abortion|journal=Contraception: a publication of Society of Family Planning|date=January 2010|page=8|doi=10.1016/j.contraception.2010.01.018|url=http://www.societyfp.org/_documents/resources/InductionofFetalDemise.pdf|quote="Inducing fetal demise before induction termination avoids signs of live birth that may have beneficial emotional, ethical and legal consequences."|accessdate=26 October 2015|volume=81|deadurl=no|archiveurl=https://web.archive.org/web/20151123065302/http://www.societyfp.org/_documents/resources/InductionofFetalDemise.pdf|archivedate=23 November 2015|df=dmy-all|author=Higginbotham Susan}}</ref><ref name=ACOG_demise>{{cite journal|last1=Committee on Health Care for Underserved Women|title=Committee Opinion 613: Increasing Access to Abortion|journal=Obstetrics & Gynecology|date=November 2014|volume=124|pages=1060–65|url=http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Increasing-Access-to-Abortion?IsMobileSet=false|accessdate=28 October 2015|quote="Partial-birth" abortion bans – The federal Partial-Birth Abortion Ban Act of 2003 (upheld by the Supreme Court in 2007) makes it a federal crime to perform procedures that fall within the definition of so-called "partial-birth abortion" contained in the statute, with no exception for procedures necessary to preserve the health of the woman...physicians and lawyers have interpreted the banned procedures as including intact dilation and evacuation unless fetal demise occurs before surgery.|doi=10.1097/01.aog.0000456326.88857.31|deadurl=no|archiveurl=https://web.archive.org/web/20151028182952/http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Increasing-Access-to-Abortion?IsMobileSet=false|archivedate=28 October 2015|df=dmy-all}}</ref><ref name=NAF_2015>{{cite journal|title=2015 Clinical Policy Guidelines|journal=National Abortion Federation|date=2015|url=http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf|accessdate=30 October 2015|quote=Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise.|deadurl=no|archiveurl=https://web.archive.org/web/20150812220053/http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf|archivedate=12 August 2015|df=dmy-all}}</ref><ref name=FIGO_Ethical>{{cite journal|title=FIGO Committee Report: Ethical aspects concerning termination of pregnancy following prenatal diagnosis|journal=International Journal of Gynecology and Obstetrics|quote=Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide.|date=2008|issue=1|pages=97–98|doi=10.1016/j.ijgo.2008.03.002|pmid=18423641|volume=102|author=Milliez Jacques}}</ref>

Death following live birth caused by abortion is given the [[ICD-10 Chapter XVI: Certain conditions originating in the perinatal period#(P90–P96) Other disorders originating in the perinatal period|ICD-10 underlying cause description code of P96.4]]; data are identified as either fetus or newborn. Between 1999 and 2013, in the U.S., the [[Centers for Disease Control and Prevention|CDC]] recorded 531 such deaths for newborns,<ref name=CDC_ICD-10_P96.4_Newborn>{{cite journal|title=Underlying Cause of Death 1999–2013 on CDC WONDER Online Database, released 2015|journal=Centers for Disease Control and Prevention, National Center for Health Statistics|url=http://wonder.cdc.gov/ucd-icd10.html|accessdate=12 November 2015|location=Data are from the Multiple Cause of Death Files, 1999–2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program|deadurl=no|archiveurl=https://web.archive.org/web/20151114063257/http://wonder.cdc.gov/ucd-icd10.html|archivedate=14 November 2015|df=dmy-all}}</ref> approximately 4 per 100,000 abortions.<ref name=CDC_Surveillance_2006>{{cite journal|last1=Pazol|first1=Karen|title=Abortion Surveillance – United States, 2006|journal=Morbidity and Mortality Weekly Report Surveillance Summaries|date=27 November 2009|volume=58|issue=SS08|pages=1–35|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5808a1.htm?s_cid=ss5808a1_e|accessdate=12 November 2015|display-authors=etal|deadurl=no|archiveurl=https://web.archive.org/web/20151128021337/http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5808a1.htm?s_cid=ss5808a1_e|archivedate=28 November 2015|df=dmy-all}}</ref>

==Incidence==
There are two commonly used methods of measuring the incidence of abortion:
* Abortion rate&nbsp;– number of abortions per 1000 women between 15 and 44 years of age
* Abortion percentage&nbsp;– 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.<ref name="Sedgh 2007"/> For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.<ref name="Sedgh 2012" />

The number of abortions performed worldwide seems to have remained stable in recent years, with 41.6&nbsp;million having been performed in 2003 and 43.8&nbsp;million having been performed in 2008.<ref name="Sedgh 2012" /> The abortion rate worldwide was 28 per 1000 women, though it was 24 per 1000 women for developed countries and 29 per 1000 women for developing countries.<ref name="Sedgh 2012" /> 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.<ref name="Sedgh 2012" />

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. However, restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely.<ref name=IJGO10/><ref>{{Cite journal|vauthors=Shah I, Ahman E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=Journal of Obstetrics and Gynaecology Canada |volume=31 |issue=12 |pages=1149–58 |date=December 2009 |pmid=20085681 |doi= 10.1016/s1701-2163(16)34376-6|quote=However, a woman's chance of having an abortion is similar whether she lives in a developed or a developing region: in 2003 the rates were 26 abortions per 1000 women aged 15 to 44 in developed areas and 29 per 1000 in developing areas. The main difference is in safety, with abortion being safe and easily accessible in developed countries and generally restricted and unsafe in most developing countries}}</ref><ref name="nytimes-abortion-rates">{{cite news|last=Rosenthal|first=Elizabeth|url=https://www.nytimes.com/2007/10/12/world/12abortion.html|title=Legal or Not, Abortion Rates Compare|newspaper=The New York Times|date=12 October 2007|accessdate=18 July 2011|deadurl=no|archiveurl=https://web.archive.org/web/20110828173628/http://www.nytimes.com/2007/10/12/world/12abortion.html|archivedate=28 August 2011|df=dmy-all}}</ref> 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.<ref>{{cite web|url=http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |format=PDF |title=Facts on Investing in Family Planning and Maternal and Newborn Health |publisher=Guttmacher Institute |date=November 2010 |accessdate=24 October 2011 |deadurl=yes |archiveurl=https://web.archive.org/web/20111020135329/http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |archivedate=20 October 2011 }}</ref>

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 (Germany and Switzerland) to 30 per 1000 women (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.<ref>{{Cite journal |last1=Sedgh |first1=G. |last2=Singh |first2=S. |last3=Henshaw |first3=S.K. |last4=Bankole |first4=A.|title=Legal Abortion Worldwide in 2008: Levels and Recent Trends |doi=10.1363/4318811 |journal=Perspectives on Sexual and Reproductive Health |volume=43 |issue=3 |pages=188–98 |year=2011 |pmid=21884387 |url=http://www.guttmacher.org/pubs/journals/3708411.html |deadurl=no |archiveurl=https://web.archive.org/web/20120107111306/http://www.guttmacher.org/pubs/journals/3708411.html |archivedate=7 January 2012 |df=dmy-all }}</ref><ref>[[National Institute of Statistics (Romania)|National Institute of Statistics]], [https://web.archive.org/web/20110515195102/http://www.insse.ro/cms/files/Anuar%20statistic/02/02%20Populatie_ro.pdf Romanian Statistical Yearbook, chapter 2, page 62], 2011</ref>

An American study in 2002 concluded that about half of women having abortions were using a form of [[birth control|contraception]] at the time of becoming pregnant. Inconsistent use was reported by half of those using [[condom]]s and three-quarters of those using the [[combined oral contraceptive pill|birth control pill]]; 42% of those using condoms reported failure through slipping or breakage.<ref>{{Cite journal |doi=10.2307/3097748 |last1=Jones |first1=R.K. |last2=Darroch |first2=J.E. |last3=Henshaw |first3=S.K. |title=Contraceptive Use Among U.S. Women Having Abortions in 2000–2001 |journal=Perspectives on Sexual and Reproductive Health |volume=34 |issue=6 |pages=294–303 |year=2002 |pmid=12558092 |url=http://www.guttmacher.org/pubs/journals/3429402.pdf |format=PDF |deadurl=no |archiveurl=https://web.archive.org/web/20060615011127/http://www.guttmacher.org/pubs/journals/3429402.pdf |archivedate=15 June 2006 |df=dmy-all }}</ref> 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".<ref>{{cite journal |first=SA |last=Cohen |url=http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html |title=Abortion and Women of Color: The Bigger Picture |journal=Guttmacher Policy Review |year=2008 |volume=11 |issue=3 |deadurl=no |archiveurl=https://web.archive.org/web/20080915094346/http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html |archivedate=15 September 2008 |df=dmy-all }}</ref>

The abortion rate may also be expressed as the average number of abortions a woman has during her reproductive years; this is referred to as ''total abortion rate'' (TAR).

===Gestational age and method===
{{Double image|right|UK abortion by gestational age 2004 histogram.svg|200|US abortion by gestational age 2004 histogram.svg|200|[[Histogram]] of abortions by [[gestational age]] in England and Wales during 2004. (left) Abortion in the United States by gestational age, 2004. (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 abortion|suction-aspiration]], [[dilation and curettage]], [[dilation and evacuation]]), 8% by "[[medical abortion|medical]]" means ([[mifepristone]]), >1% by "[[instillation abortion|intrauterine instillation]]" (saline or [[prostaglandin]]), and 1% by "other" (including [[hysterotomy abortion|hysterotomy]] and [[hysterectomy]]).<ref name="cdc2003">{{Cite journal |last1=Strauss |first1=L.T. |last2=Gamble |first2=S.B. |last3=Parker |first3=W.Y. |last4=Cook |first4=D.A. |last5=Zane |first5=S.B. |last6=Hamdan |first6=S. |title=Abortion surveillance – United States, 2003 |journal=Morbidity and Mortality Weekly Report Surveillance Summaries |volume=55 |issue=SS11 |pages=1–32 |year=2006 |pmid=17119534 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm |author7=Centers for Disease Control Prevention |deadurl=no |archiveurl=https://web.archive.org/web/20170602171423/https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm |archivedate=2 June 2017 |df=dmy-all }}</ref> 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.<ref name="guttmacher">{{cite web |publisher=The Guttmacher Institute |title=The limitations of U.S. statistics on abortion |work=Issues in Brief |location=New York |year=1997 |url=http://www.guttmacher.org/pubs/ib14.html |archiveurl=https://web.archive.org/web/20120404080239/http://www.guttmacher.org/pubs/ib14.html |archivedate=4 April 2012 |deadurl=yes}}</ref>

The Guttmacher Institute estimated there were 2,200 [[intact dilation and extraction]] procedures in the US during 2000; this accounts for <0.2% of the total number of abortions performed that year.<ref>{{Cite journal |last1=Finer |first1=L.B. |last2=Henshaw |first2=S.K. |title=Abortion Incidence and Services in the United States in 2000 |journal=Perspectives on Sexual and Reproductive Health |volume=35 |issue=1 |pages=6–15 |year=2003 |pmid=12602752 |url=http://www.guttmacher.org/pubs/journals/3500603.html |doi=10.1363/3500603 |deadurl=no |archiveurl=https://web.archive.org/web/20160122204324/http://www.guttmacher.org/pubs/journals/3500603.html |archivedate=22 January 2016 |df=dmy-all }}</ref> 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.<ref>{{cite web|author=Department of Health |year=2007 |title=Abortion statistics, England and Wales: 2006 |accessdate=12 October 2007 |url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |deadurl=yes |archiveurl=https://web.archive.org/web/20101206002417/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |archivedate=6 December 2010 }}</ref> There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.<ref>{{cite web|last=Cheng|first=Linan|date=1 November 2008|title=Surgical versus medical methods for second-trimester induced abortion: RHL commentary|work=The WHO Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html|accessdate=10 February 2009|deadurl=no|archiveurl=https://web.archive.org/web/20090215134007/http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html|archivedate=15 February 2009|df=dmy-all}} commentary on:<br />{{cite journal|last1=Lohr|first1=Patricia A.|last2=Hayes|first2=Jennifer L.|last3=Gemzell-Danielsson|first3=Kristina|date=23 January 2008|title=Surgical versus medical methods for second trimester abortion|journal=The Cochrane Database of Systematic Reviews|issue=1|page=CD006714|doi=10.1002/14651858.CD006714.pub2|pmid=18254113}}</ref>

==Motivation==

===Personal===
[[File:AGIAbortionReasonsBarChart.png|thumb|upright=1.5|A bar chart depicting selected data from a 1998 [[Alan Guttmacher Institute|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.<ref name="guttmacher" /><ref name="bankole98"/>

Some of the most common reasons are to postpone childbearing to a more suitable time or to focus energies and resources on existing children. Others include being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of one's own education, relationship problems with their partner, a perception of being too young to have a child, unemployment, and not being willing to raise a child conceived as a result of rape or [[incest]], among others.<ref name="bankole98">{{Cite journal |last1=Bankole |first1=Akinrinola |last2=Singh |first2=Susheela |last3=Haas |first3=Taylor |year=1998 |url=http://www.guttmacher.org/pubs/journals/2411798.html |title=Reasons Why Women Have Induced Abortions: Evidence from 27 Countries |journal=International Family Planning Perspectives |volume=24 |issue=3 |pages=117–27, 152 |doi=10.2307/3038208 |deadurl=no |archiveurl=https://web.archive.org/web/20060117191716/http://www.guttmacher.org/pubs/journals/2411798.html |archivedate=17 January 2006 |df=dmy-all }}</ref><ref name="finer2005">{{Cite journal |last1=Finer |first1=L.B. |last2=Frohwirth |first2=L.F. |last3=Dauphinee |first3=L.A. |last4=Singh |first4=S. |last5=Moore |first5=A. M. |title=Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives |journal=Perspectives on Sexual and Reproductive Health |volume=37 |issue=3 |pages=110–18 |doi=10.1111/j.1931-2393.2005.tb00045.x |year=2005 |pmid=16150658 |url=http://www.guttmacher.org/pubs/journals/3711005.html |deadurl=no |archiveurl=https://web.archive.org/web/20120107092446/http://www.guttmacher.org/pubs/journals/3711005.html |archivedate=7 January 2012 |df=dmy-all }}</ref>

===Societal===
Some abortions are undergone as the result of societal pressures.<ref>{{cite encyclopedia |editor-last1=Fried |editor-first1=Marlene Gerber |title=From Privacy to Autonomy: The Conditions for Reproductive and Sexual Freedom|last=Copelon|first=Rhonda|encyclopedia=From Abortion to Reproductive Freedom: Transforming a Movement |date=1990 |publisher=South End Press |isbn=9780896083875 |url=https://books.google.com/books?id=keE5EmSKYr0C&lpg=PA38&dq=abortion%20poverty%20autonomy&pg=PA38#v=onepage&q=abortion%20poverty%20autonomy&f=false |pages=27–43|language=en|quote=The prevalence of economically influenced abortions and the sterilization campaigns against poor, minority, and disabled women show us that autonomy is impossible without eradication of discrimination and poverty. Racism, sexism, and poverty can make the difference between abortions that reflect choice and those reflecting bitter necessity.}}</ref> 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]].<ref name="MissingWomen">{{cite journal|last=Oster |first=Emily |authorlink=Emily Oster |title=Explaining Asia's "Missing Women": A New Look at the Data|journal=Population and Development Review |date=September 2005 |volume=31 |issue=3 |pages=529–535 |url=https://www.researchgate.net/publication/4994961_Explaining_Asia's_Missing_Women_A_New_Look_at_the_Data |accessdate=5 February 2019 |doi=10.1111/j.1728-4457.2005.00082.x |quote= Households have variously resorted to female infanticide and postnatal withholding of health care; and since the mid-1980s, when technology permitting fairly low-cost determination of the sex of fetuses became available, there has been a shift toward prenatal sex selection by means of induced abortion.}}</ref>

===Maternal and fetal health===
An additional factor is risk to maternal or fetal health, which was cited as the primary reason for abortion in over a third of cases in some countries and as a significant factor in only a single-digit percentage of abortions in other countries.<ref name="guttmacher" /><ref name="bankole98"/>

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."<ref>George J. Annas and Sherman Elias. "Legal and Ethical Issues in Obstetrical Practice". Chapter 54 in ''Obstetrics: Normal and Problem Pregnancies'', 6th edition. Eds. Steven G. Gabbe, et al. 2012 Saunders, an imprint of Elsevier. {{ISBN|978-1-4377-1935-2}}</ref>{{rp|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 [[Rubella|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.{{sfn|Doan|2007|p=57}}

====Cancer====
<!-- Sources here are >10 years old, and should be updated with new ones -->
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.<ref name=Weisz>{{cite journal |url=http://humupd.oxfordjournals.org/content/7/4/384.full.pdf |format=PDF |title=Cancer in pregnancy: maternal and fetal implications |pmid=11476351 |last1=Weisz |first1=B |last2=Schiff |first2=E |last3=Lishner |first3=M |year=2001 |volume=7 |pages=384–393 |issue=4 |journal=Human Reproduction Update |doi=10.1093/humupd/7.4.384 |deadurl=no |archiveurl=https://web.archive.org/web/20151015195038/http://humupd.oxfordjournals.org/content/7/4/384.full.pdf |archivedate=15 October 2015 |df=dmy-all }}</ref>

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 [[gray (unit)|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]].<ref name=Weisz /> 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.<ref>{{cite journal |last1=Mayr |first1=NA |last2=Wen |first2=BC |last3=Saw |first3=CB|title=Radiation therapy during pregnancy |journal=Obstetrics & Gynecology Clinics of North America |year=1998 |volume=25 |issue=2 |pages=301–21 |pmid=9629572 |doi=10.1016/s0889-8545(05)70006-1}}</ref><ref name="pmid11237773">{{cite journal|vauthors=Fenig E, Mishaeli M, Kalish Y, Lishner M | title=Pregnancy and radiation. |journal=Cancer Treatment Reviews |year=2001 |volume=27 |issue=1 |pages=1–7 |pmid=11237773 |doi=10.1053/ctrv.2000.0193}}</ref>

The process of birth itself may also put the mother at risk. "Vaginal 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."<ref name="pmid19197101">{{cite journal|vauthors=Li WW, Yau TN, Leung CW, Pong WM, Chan MY |title=Large-cell neuroendocrine carcinoma of the uterine cervix complicating pregnancy |journal=Hong Kong Medical Journal |year=2009 |volume=15 |issue=1 |pages=69–72 |pmid=19197101}}</ref>

==History and religion==
{{Main|History of abortion|Religion and abortion}}
[[File:AngkorWatAbortionAD1150.JPG|thumb|[[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]].<ref name="potts" /><ref>{{Cite book|author=Mould R |title=Mould's Medical Anecdotes |page=406 |publisher=CRC Press |year=1996|isbn=978-0-85274-119-1}}</ref>]] [[File:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|"French Periodical Pills". An example of a clandestine advertisement published in a January 1845 edition of the ''[[Boston Daily Times]]''.]]
Since [[history of abortion|ancient times]] abortions have been done using [[abortifacient|herbal medicines]], sharp tools, with [[physical trauma|force]], or through other [[traditional medicine|traditional methods]].<ref name="Management of Abortion, Chp 1"/> Induced abortion has long history and can be traced back to civilizations as varied as China under [[Shennong]] (c. 2700 BCE), [[Ancient Egypt]] with its [[Ebers Papyrus]] (c. 1550 BCE), and the Roman Empire in the time of [[Juvenal]] (c. 200 CE).<ref name="Management of Abortion, Chp 1"/> There is evidence to suggest that pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. One of the [[History of abortion#5th century to 18th century|earliest]] known artistic representations of abortion is in a [[bas relief]] at Angkor Wat (c. 1150). Found in a series of [[frieze]]s that represent judgment after death in [[Hinduism|Hindu]] and [[Buddhism|Buddhist]] culture, it depicts the technique of abdominal abortion.<ref name="potts" />

Some medical scholars and abortion opponents have suggested that the [[Hippocratic Oath]] forbade [[Ancient Greece|Ancient Greek]] physicians from performing abortions;<ref name="Management of Abortion, Chp 1" /> other scholars disagree with this interpretation,<ref name="Management of Abortion, Chp 1" /> and state that the medical texts of [[Hippocratic Corpus]] contain descriptions of abortive techniques right alongside the [[Hippocratic Oath|Oath]].<ref>{{Cite book |first=Steven |last=Miles |authorlink=Steven H. Miles |title=The Hippocratic Oath and the Ethics of Medicine |year=2005| publisher=Oxford University Press| isbn=978-0-19-518820-2}}</ref> The physician [[Scribonius Largus]] wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did [[Soranus of Ephesus|Soranus]], although apparently not all doctors adhered to it strictly at the time. According to [[Soranus of Ephesus|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, but only for the sake of the mother's health.<ref name=Largus>{{cite web|url=http://penelope.uchicago.edu/~grout/encyclopaedia_romana/aconite/largus.html|title=Scribonius Largus and the Oath of Hippocrates|website=penelope.uchicago.edu}}</ref><ref name=Soranus>{{cite book|last1=Soranus, Owsei Temkin|title=Soranus' Gynecology|date=1956|publisher=JHU Press|page=I.19.60|url=https://books.google.com/books?id=YsKWfh31gxwC|accessdate=6 October 2015|deadurl=no|archiveurl=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=YsKWfh31gxwC|archivedate=15 October 2015|df=dmy-all}}</ref>

[[Aristotle]], in his treatise on government ''[[Politics (Aristotle)|Politics]]'' (350 BCE), condemns infanticide as a means of population control. He preferred abortion in such cases, with the restriction<ref>{{Cite book| first = Paul| last = Carrick | title = Medical Ethics in the Ancient World| year = 2001| publisher = Georgetown University Press| isbn = 978-0-87840-849-8}}</ref> "<nowiki>[that it]</nowiki> 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".<ref>{{cite web |url=http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0058%3Abook%3D7%3Asection%3D1335b |title=Aristotle, Politics |last1=Rackham |first1=H. |year=1944 |work= |publisher=Harvard University Press |accessdate=21 June 2011 |deadurl=no |archiveurl=https://web.archive.org/web/20110622094459/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0058%3Abook%3D7%3Asection%3D1335b |archivedate=22 June 2011 |df=dmy-all }}</ref> [[Christianity and abortion|In Christianity]], [[Pope Sixtus V]] (1585–90) was the only Pope before 1869 to declare that abortion is homicide regardless of the stage of pregnancy;<ref>{{cite encyclopedia |first=Katherine |last=Brind'Amour |title=Effraenatam |encyclopedia=Embryo Project Encyclopedia |year=2007 |url=http://embryo.asu.edu/view/embryo:123948 |archiveurl=https://www.webcitation.org/658tiVCq0?url=http://embryo.asu.edu/view/embryo:123948 |archivedate=2 February 2012 |publisher=Arizona State University |deadurl=yes |df=dmy }}</ref> and his pronouncement of 1588 was reversed three years later by his successor. Through most of its history the Catholic Church was divided on whether it believed that abortion was murder, and it did not begin vigorously opposing abortion until the 19th century.<ref name="Management of Abortion, Chp 1" /> In fact, several historians have written<ref>Joan Cadden, "Western medicine and natural philosophy," in Vern L. Bullough and James A. Brundage, eds., ''Handbook of Medieval Sexuality'', Garland, 1996, pp. 51–80.</ref><ref>Cyril C. Means, Jr., "A historian's view," in Robert E. Hall, ed., ''Abortion in a Changing World'', vol. 1, Columbia University Press, 1970, pp. 16–24.</ref><ref>John M. Riddle, "Contraception and early abortion in the Middle Ages," in Vern L. Bullough and James A. Brundage, eds., ''Handbook of Medieval Sexuality'', Garland, 1996, pp. 261–77, {{ISBN|978-0-8153-1287-1}}.</ref> that prior to the 19th century most Catholic authors did not regard termination of pregnancy before "quickening" or "ensoulment" as an abortion.

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.<ref name="guttmacher" /><ref name="bankole98"/> [[Islam and abortion|Islamic tradition]] has traditionally permitted abortion until a point in time when Muslims believe the soul enters the fetus,<ref name="Management of Abortion, Chp 1" /> considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or [[quickening]].<ref name="BBC and Islam / Abortion">{{cite web |url=http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml |title=Religions&nbsp;– Islam: Abortion |publisher=BBC |date= |accessdate=10 December 2011 |deadurl=no |archiveurl=https://web.archive.org/web/20111009065222/http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml |archivedate=9 October 2011 |df=dmy-all }}</ref> However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the [[Middle East and North Africa]].<ref>{{cite web|title=Abortion in the Middle East and North Africa|url=http://www.prb.org/pdf08/MENAabortion.pdf|deadurl=no|last1=Dabash|first1=Rasha|first2=Farzaneh|last2=Roudi-Fahimi|publisher=Population Research Bureau|archiveurl=https://web.archive.org/web/20111006171600/http://www.prb.org/pdf08/MENAabortion.pdf|archivedate=6 October 2011|year=2008|format=PDF|df=dmy-all}}</ref>

In Europe and North America, abortion techniques advanced starting in the 17th century. However, conservatism by most physicians with regards to sexual matters prevented the wide expansion of safe abortion techniques.<ref name="Management of Abortion, Chp 1" /> 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'')<ref>{{cite news|last1=Dannenfelser|first1=Marjorie|title=The Suffragettes Would Not Agree With Feminists Today on Abortion|url=http://time.com/4093214/suffragettes-abortion/|accessdate=4 November 2015|work=Time|date=4 November 2015|deadurl=no|archiveurl=https://web.archive.org/web/20151106015742/http://time.com/4093214/suffragettes-abortion/|archivedate=6 November 2015|df=dmy-all}}</ref> was banned in both the United States and the United Kingdom.<ref name="Management of Abortion, Chp 1" /> Church groups as well as physicians were highly influential in anti-abortion movements.<ref name="Management of Abortion, Chp 1" /> In the US, according to some sources, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.<ref group="note">By 1930, medical procedures in the US 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:
* {{cite book |title=Time communication 1940–1989: retrospective |publisher=Time Inc. |year=1989 |chapter=The 1970s |quote=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.}}
* {{cite book |last=Will |first=George |title=Suddenly: the American idea abroad and at home, 1986–1990 |publisher=Free Press |year=1990 |page=312 |isbn=0-02-934435-2}}
* {{cite web |url=http://www.policyalmanac.org/culture/archive/crs_abortion_overview.shtml |title=Abortion Law Development: A Brief Overview |last1=Lewis |first1=J. |last2=Shimabukuro |first2=Jon O. |publisher=Congressional Research Service |date=28 January 2001 |accessdate=1 May 2011 |archiveurl=https://web.archive.org/web/20110514133610/http://www.policyalmanac.org/culture/archive/crs_abortion_overview.shtml |archivedate=14 May 2011 |deadurl=yes |df=dmy-all }}<br /> *{{cite book |url=https://books.google.com/books?id=EHj_0R2rbxAC&pg=PA1 |page=1 |title=Encyclopedia of American law |last=Schultz |first=David Andrew |publisher=Infobase Publishing |year=2002 |isbn=0-8160-4329-9 |deadurl=no |archiveurl=https://web.archive.org/web/20151209000856/https://books.google.com/books?id=EHj_0R2rbxAC&pg=PA1 |archivedate=9 December 2015 |df=dmy-all }}
* {{cite web |title=Birthing a Nation: Fertility Control Access and the 19th Century Demographic Transition |last=Lahey |first=Joanna N. |publisher=Pomona College |date=24 September 2009 |url=http://economics-files.pomona.edu/colloquium/joannalahey.pdf |format=PDF; preliminary version |work=Colloquium |deadurl=no |archiveurl=https://web.archive.org/web/20120107162744/http://economics-files.pomona.edu/colloquium/joannalahey.pdf |archivedate=7 January 2012 |df=dmy-all }}</ref> However, other sources maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe.<ref>Charles A. Lee, "Report of a trial for murder," ''American Journal of the Medical Sciences'', vol. XXII (1838), pp. 351–53.</ref><ref>Benjamin Bailey, "Induction of abortion and premature labor," ''North American Journal of Homeopathy'', vol. XI, no. 3 (1896), pp. 144–50.</ref><ref>Keith Simpson, ''Forensic Medicine'', Edward Arnold Publishers, 1969 [first published 1947], pp. 173–74.</ref>
In addition, some commentators have written that, despite improved medical procedures, the period from the 1930s until legalization also saw more zealous enforcement of anti-abortion laws, and concomitantly an increasing control of abortion providers by organized crime.<ref>Leslie J. Reagan, ''When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973'', University of California Press, 1997.</ref><ref>Max Evans, ''Madam Millie: Bordellos from Silver City to Ketchikan'', University of New Mexico Press, 2002, pp. 209–18, 230, 267–86, 305.</ref><ref>James Donner, ''Women in Trouble: The Truth about Abortion in America'', Monarch Books, 1959.</ref><ref>Ann Oakley, ''The Captured Womb'', Basil Blackwell, 1984, p. 91.</ref><ref>Rickie Solinger, ''The Abortionist: A Woman Against the Law'', The Free Press, 1994, pp. xi, 5, 16–17, 157–75.</ref>

Soviet Russia (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.<ref name="cbctrust">{{cite web|url=http://www.cbctrust.com/history_law_religion.php |title=Abortion Law, History & Religion |accessdate=23 March 2008 |publisher=Childbirth By Choice Trust|archiveurl=https://archive.is/20080208053146/http://www.cbctrust.com/history_law_religion.php|archivedate=12 January 2013}}{{cbignore}}</ref> In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions.<ref>For sources describing abortion policy in Nazi Germany, see:
* {{Cite book |last=Friedlander |first=Henry |authorlink=Henry Friedlander |title=The origins of Nazi genocide: from euthanasia to the final solution |publisher=University of North Carolina Press |location=Chapel Hill |year=1995 |url=https://books.google.com/books?id=gqLDEKVk2nMC |page=30 |isbn=978-0-8078-4675-9 |oclc=60191622 |deadurl=no |archiveurl=https://web.archive.org/web/20160729051956/https://books.google.com/books?id=gqLDEKVk2nMC |archivedate=29 July 2016 |df=dmy-all }}
* {{Cite book|first=Robert |last=Proctor |authorlink=Robert N. Proctor |title=Racial Hygiene: Medicine Under the Nazis |publisher=Harvard University Press |location=Cambridge, MA|year=1988 |pages=122–23, 366 |isbn=978-0-674-74578-0 |oclc=20760638}}
* {{Cite book|first=Margaret L. |last=Arnot |authorlink= |author2=Cornelie Usborne |title=Gender and Crime in Modern Europe |publisher=Routledge |location=New York |year=1999 |page=231 |isbn=978-1-85728-745-5 |oclc=186748539}}
* {{cite encyclopedia |last=DiMeglio |first=Peter M. |editor=Helen Tierney |encyclopedia=Women's studies encyclopedia |title=Germany 1933–1945 (National Socialism) |year=1999 |publisher=Greenwood Press |location=Westport, CN |isbn=978-0-313-31072-0 |oclc=38504469 |url=https://books.google.com/books?id=gQLqRd7hJq0C |page=589 |deadurl=no |archiveurl=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=gQLqRd7hJq0C |archivedate=15 October 2015 |df=dmy-all }}</ref> Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.<ref name="Management of Abortion, Chp 1" />

==Society and culture==

===Abortion debate===
{{Main|Abortion debate}}
Induced abortion has long been the source of considerable debate. [[Medical ethics|Ethical]], [[Morality|moral]], [[Philosophical aspects of the abortion debate|philosophical]], [[Therapeutic abortion|biological]], [[Ethics in religion|religious]] and [[Abortion law|legal]] issues surrounding abortion are related to [[value system]]s. 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 justification of laws permitting or restricting abortion.<ref>{{cite book | first=Courtney| last=Farrell| title =Abortion Debate| publisher =ABDO Publishing Company| year =2010| pages =6–7| isbn =1-61785-264-3}}</ref> 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."<ref>{{cite web|url=http://www.wma.net/en/30publications/10policies/a1/ |title=WMA Declaration on Therapeutic Abortion |publisher=World Medical Association |accessdate=28 October 2015 |deadurl=yes |archiveurl=https://web.archive.org/web/20151028182953/http://www.wma.net/en/30publications/10policies/a1/ |archivedate=28 October 2015 }}</ref> Abortion debates, especially pertaining to [[abortion law]]s, are often spearheaded by groups advocating one of these two positions. Anti-abortion groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while abortion rights groups who are against such legal restrictions describe themselves as "pro-choice".<ref>Farrell, p. 8</ref> Generally, the former position argues that a human fetus is a [[Personhood|human person]] with a [[right to life|right to live]], making abortion morally the same as [[murder]]. The latter position argues that a woman has certain [[reproductive rights]], especially the right to decide whether or not to carry a pregnancy to term.

===Modern abortion law===
{{Main|Abortion law}}
{{See also|History of abortion law debate}}
{{AbortionLawsMap|size=330px}}

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 safe, 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 [[Pregnancy#Terminology|trimester]]-based system to regulate the window of legality, or as in the U.S., on a doctor's evaluation of the fetus' [[Fetal viability|viability]]. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on [[prenatal development|fetal development]], or require that [[minors and abortion|parents be contacted]] if their minor daughter requests an abortion.<ref>{{cite web|url=http://internationalfamilyplanningperspectives.org/pubs/MandatoryCounseling.pdf |title=The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review |format=PDF |publisher=Guttmacher Institute|author1=Theodore J. Joyce |author2=Stanley K. Henshaw |author3=Amanda Dennis |author4=Lawrence B. Finer |author5=Kelly Blanchard |date=April 2009 |accessdate=31 December 2010 |archiveurl=https://www.webcitation.org/5vj6Mlykp?url=http://internationalfamilyplanningperspectives.org/pubs/MandatoryCounseling.pdf |archivedate=14 January 2011 |deadurl=yes |df=dmy }}</ref> Other jurisdictions may require that a woman obtain the [[Paternal rights and abortion|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<ref>{{Cite news|url=https://www.theguardian.com/world/2015/oct/29/china-abandons-one-child-policy|title=China ends one-child policy after 35 years|last=Phillips|first=Tom|date=2015-10-29|newspaper=The Guardian|language=en-GB|issn=0261-3077|access-date=2016-11-30|deadurl=no|archiveurl=https://web.archive.org/web/20161201021629/https://www.theguardian.com/world/2015/oct/29/china-abandons-one-child-policy|archivedate=1 December 2016|df=dmy-all}}</ref> [[one-child policy]], and now has a two child policy,<ref>{{Cite news|url=https://www.nytimes.com/2015/10/30/world/asia/china-end-one-child-policy.html|title=China Ends One-Child Policy, Allowing Families Two Children|last=Buckley|first=Chris|date=2015-10-29|newspaper=The New York Times|issn=0362-4331|access-date=2016-11-30|deadurl=no|archiveurl=https://web.archive.org/web/20161124102045/http://www.nytimes.com/2015/10/30/world/asia/china-end-one-child-policy.html|archivedate=24 November 2016|df=dmy-all}}</ref><ref>{{Cite news|url=https://www.bbc.com/news/world-asia-34665539|title=China to end one-child policy and allow two|date=2015-10-29|newspaper=BBC News|language=en-GB|access-date=2016-11-30|deadurl=no|archiveurl=https://web.archive.org/web/20161121005729/http://www.bbc.com/news/world-asia-34665539|archivedate=21 November 2016|df=dmy-all}}</ref> has at times incorporated mandatory abortions as part of their population control strategy.<ref>{{Cite encyclopedia |title=Science, Technology, and Society: An Encyclopedia |page=2 |editor1-first=Sal P. |editor1-last=Restivo |year=2005 |publisher=Oxford University Press |isbn=978-0-19-514193-1 |url=https://books.google.com/books?id=A8C3m8rRba4C |deadurl=no |archiveurl=https://web.archive.org/web/20150315111926/http://books.google.com/books?id=A8C3m8rRba4C |archivedate=15 March 2015 |df=dmy-all }}</ref>

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.<ref name="Dev98-07" /> In countries where abortion is banned entirely, such as [[Abortion in Nicaragua|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.<ref>{{cite web|title=European delegation visits Nicaragua to examine effects of abortion ban |date=26 November 2007 |publisher=Ipas |accessdate=15 June 2009 |url=http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx |archiveurl=https://web.archive.org/web/20080417033829/http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx |archivedate=17 April 2008 |quote=More than 82 maternal deaths had been registered in Nicaragua since the change. During this same period, indirect obstetric deaths, or deaths caused by illnesses aggravated by the normal effects of pregnancy and not due to direct obstetric causes, have doubled.}}</ref><ref>{{Cite news |url=http://insidecostarica.com/special_reports/2008-06/nicaragua_womens_movement.htm |title=Nicaragua: 'The Women's Movement Is in Opposition' |date=28 June 2008 |location=Montevideo |agency=IPS |publisher=Inside Costa Rica |deadurl=no |archiveurl=https://web.archive.org/web/20110606102151/http://insidecostarica.com/special_reports/2008-06/nicaragua_womens_movement.htm |archivedate=6 June 2011 |df=dmy-all }}</ref> Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.<ref>{{cite web|title=Surgical Abortion: History and Overview |publisher=National Abortion Federation |accessdate=4 September 2006 |url=http://www.prochoice.org/education/resources/surg_history_overview.html |archiveurl=https://web.archive.org/web/20060922152349/http://www.prochoice.org/education/resources/surg_history_overview.html |archivedate=22 September 2006 |deadurl=yes |df= }}</ref> This is also a terminology in traditional medicine.<ref name= nations1977>{{cite journal | pmid = 9194245 | title = Women's hidden transcripts about abortion in Brazil |vauthors=Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM | journal = Social Science & Medicine | date = June 1997 | volume = 44 | issue = 12 | pages = 1833–45 |quote= Two folk medical conditions, "delayed" (atrasada) and "suspended" (suspendida) menstruation, are described as perceived by poor Brazilian women in Northeast Brazil. Culturally prescribed methods to "regulate" these conditions and provoke menstrual bleeding are also described&nbsp;... | doi=10.1016/s0277-9536(96)00293-6}}</ref> 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.<ref>{{Cite journal| last1=Henshaw |first1=S.K. |title=The Accessibility of Abortion Services in the United States |doi=10.2307/2135775 |year=1991 |pages=246–63 |issue=6 |journal=Family Planning Perspectives |volume=23|url=http://www.guttmacher.org/pubs/journals/3501603.pdf |jstor=2135775 |citeseerx=10.1.1.360.6115 }}</ref> Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.<ref>{{cite web |title=Need Abortion, Will Travel |first=Marcy |last=Bloom |date=25 February 2008 |publisher=RH Reality Check |accessdate=15 June 2009 |url=http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel |deadurl=no |archiveurl=https://web.archive.org/web/20081130010309/http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel |archivedate=30 November 2008 |df=dmy-all }}</ref>

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.<ref>{{Cite journal|last=Gomperts|first=Rebecca|date=2002|title=Women on Waves: Where next for the abortion boat?|journal=Reproductive Health Matters|volume=10|issue=19|pages=180–83}}</ref><ref>{{Cite journal|last=Best|first=Alyssa|date=2005|title=Abortion Rights along the Irish-English Border and the Liminality of Women's Experiences|journal=Dialectical Anthropology|language=en|volume=29|issue=3–4|pages=423–37|doi=10.1007/s10624-005-3863-x|issn=0304-4092}}</ref><ref>{{Cite journal|last=Lambert-Beatty|first=Carrie|date=2008|title=Twelve miles: Boundaries of the new art/activism|url=|journal=Signs: Journal of Women in Culture and Society|volume=33|issue=2|pages=309–27|via=}}</ref>

===Sex-selective abortion===
{{Main|Sex-selective abortion}}

[[Medical ultrasonography|Sonography]] and [[amniocentesis]] allow parents to determine sex before childbirth. The development of this technology has led to [[sex-selective abortion and female infanticide|sex-selective abortion]], or the termination of a fetus based on 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.<ref>Banister, Judith. (16 March 1999). [https://www.census.gov/ipc/www/ebspr96a.html Son Preference in Asia&nbsp;– Report of a Symposium] {{webarchive|url=https://web.archive.org/web/20060216134324/http://www.census.gov/ipc/www/ebspr96a.html |date=16 February 2006 }}. Retrieved 12 January 2006.</ref> 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.<ref>{{Cite news|first=Patricia |last=Reaney |publisher=Reuters |url=http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archiveurl=https://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archivedate=20 February 2006 |title=Selective abortion blamed for India's missing girls |accessdate=3 December 2008}}</ref><ref>{{Cite journal|last=Sudha |first=S. |date=July 1999 |title=Female Demographic Disadvantage in India 1981–1991: Sex Selective Abortions and Female Infanticide |journal=Development and Change |volume=30 |issue=3 |pages=585–618 |doi=10.1111/1467-7660.00130 |url=http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archiveurl=https://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archivedate=1 January 2003 |accessdate=3 December 2008 |last2=Rajan |first2=S. Irudaya |pmid=20162850}}</ref><ref name="LOC India">{{cite web|url=https://www.loc.gov/law/help/sex-selection/india.php|publisher=Library of Congress|title=Sex Selection & Abortion: India|date=4 April 2011|accessdate=18 July 2011|deadurl=no|archiveurl=https://web.archive.org/web/20110927234151/http://www.loc.gov/law/help/sex-selection/india.php|archivedate=27 September 2011|df=dmy-all}}</ref><ref>[http://www.china.org.cn/english/2003/Mar/59194.htm "China Bans Sex-selection Abortion"] {{webarchive|url=https://web.archive.org/web/20060212204114/http://www.china.org.cn/english/2003/Mar/59194.htm |date=12 February 2006 }} (22 March 2002). Xinhua News Agency. Retrieved 12 January 2006.</ref> In China, a historical preference for a male child has been exacerbated by the [[one-child policy]], which was enacted in 1979.<ref>{{Cite journal|first=Maureen J. |last=Graham |date=June 1998 |title=Son Preference in Anhui Province, China |journal=International Family Planning Perspectives |volume=24 |issue=2 |url=http://www.guttmacher.org/pubs/journals/2407298.html |doi=10.2307/2991929 |author2=Larsen |author3=Xu |archiveurl=https://www.webcitation.org/62bsN3Cfj?url=http://www.guttmacher.org/pubs/journals/2407298.html |archivedate=21 October 2011 |deadurl=no |pages=72–77 |df=dmy }}</ref>

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",<ref name="UNFPA">{{cite web|url=http://www.unfpa.org/webdav/site/global/shared/documents/publications/2011/Preventing_gender-biased_sex_selection.pdf|title=Preventing gender-biased sex selection|publisher=UNFPA|accessdate=1 November 2011}}</ref> conditions also condemned by a [[Parliamentary Assembly of the Council of Europe|PACE]] resolution in 2011.<ref>{{cite web|url=http://assembly.coe.int/Documents/WorkingDocs/Doc11/EDOC12715.pdf |title=Prenatal sex selection |publisher=Parliamentary Assembly of the Council of Europe |deadurl=yes |archiveurl=https://web.archive.org/web/20111003133834/http://assembly.coe.int/Documents/WorkingDocs/Doc11/EDOC12715.pdf |archivedate=3 October 2011 |accessdate=17 November 2015 }}</ref> 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.<ref name="UNFPA"/>

===Anti-abortion violence===
{{Main|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.<ref name="csis">{{cite web |author=Smith, G. Davidson |publisher=Canadian Security Intelligence Service |year=1998 |url=http://www.csis-scrs.gc.ca/en/publications/commentary/com74.asp |title=Single Issue Terrorism Commentary |accessdate= 1 September 2011|archiveurl=https://web.archive.org/web/20071015065711/http://csis-scrs.gc.ca/en/publications/commentary/com74.asp|archivedate=15 October 2007|deadurl=yes}}</ref><ref>{{Cite journal |last1=Wilson |first1=M. |last2=Lynxwiler |first2=J. |doi=10.1080/10576108808435717 |title=Abortion clinic violence as terrorism |journal=Studies in Conflict & Terrorism |volume=11 |issue=4 |pages=263–73| year=1988}}</ref> Only a small fraction of those opposed to abortion commit violence.

In the United States, four physicians who performed abortions have been murdered: [[David Gunn (doctor)|David Gunn]] (1993), [[John Britton (doctor)|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.<ref>{{cite news |title=The Death of Dr. Gunn |newspaper=New York Times |date=12 March 1993 |url=https://www.nytimes.com/1993/03/12/opinion/the-death-of-dr-gunn.html |deadurl=no |archiveurl=https://web.archive.org/web/20161110071743/http://www.nytimes.com/1993/03/12/opinion/the-death-of-dr-gunn.html |archivedate=10 November 2016 |df=dmy-all }}</ref><ref name="naf">{{cite web |publisher=National Abortion Federation|year=2009 |url=http://www.prochoice.org/pubs_research/publications/downloads/about_abortion/violence_stats.pdf |format=PDF |title=Incidence of Violence & Disruption Against Abortion Providers in the U.S. & Canada |accessdate=9 February 2010 |deadurl=no |archiveurl=https://web.archive.org/web/20100613042214/http://prochoice.org/pubs_research/publications/downloads/about_abortion/violence_stats.pdf |archivedate=13 June 2010 |df=dmy-all }}</ref> 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.<ref>{{Cite news |url=https://www.theguardian.com/theguardian/1999/feb/03/features11.g26 |newspaper=The Guardian |date=3 February 1999 |title=The bomber under siege |first=Julian |last=Borger |location=London |deadurl=no |archiveurl=https://web.archive.org/web/20170222105914/https://www.theguardian.com/theguardian/1999/feb/03/features11.g26 |archivedate=22 February 2017 |df=dmy-all }}</ref>

[[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 pro-life organizations throughout Texas to prevent the construction of a [[Planned Parenthood]] facility in Austin. The organizations [[doxing|released the personal information]] online, of those involved with construction, sending them up to 1200 phone calls a day and contacting their churches.<ref name=Doan>{{cite book|title=Opposition and Intimidation:The abortion wars and strategies of political harassment|author=Alesha E. Doan|year=2007|page=2|publisher=University of Michigan}}</ref> Some protestors record women entering clinics on camera.<ref name=Doan/>

=={{anchor|Other animals}}Other animals==
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{{further|Miscarriage}}
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.<ref>{{cite book |author=Spencer, James B. |title=Sheep Husbandry in Canada |year=1908 |page=114 |oclc=798508694 }}</ref> In cows, abortion may be caused by contagious disease, such as [[brucellosis]] or ''[[Campylobacter]]'', but can often be controlled by vaccination.<ref>{{cite web |url=http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en |title=Beef cattle and Beef production: Management and Husbandry of Beef Cattle |work=Encyclopaedia of New Zealand |year=1966 |deadurl=no |archiveurl=https://web.archive.org/web/20090101142401/http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en |archivedate=1 January 2009 |df=dmy-all }}</ref> Eating [[pine needle]]s can also induce abortions in cows.<ref>{{cite book |last1=Myers |first1=Brandon |last2=Beckett |first2=Jonathon |title=Animal Health Care and Maintenance |chapter=Pine needle abortion |url=http://ag.arizona.edu/arec/pubs/rmg/4%20animalcare&healthmaintenance/31%20pineneedleabortion01.pdf |accessdate=10 April 2013 |year=2001 |publisher=Arizona Cooperative Extension, University of Arizona |location=Tucson |pages=47–50 |deadurl=yes |archiveurl=https://web.archive.org/web/20150728003136/http://ag.arizona.edu/AREC/pubs/rmg/4%20animalcare%26healthmaintenance/31%20pineneedleabortion01.pdf |archivedate=28 July 2015 |df=dmy-all }}</ref><ref>{{cite journal |last1=Kim |first1=Ill-Hwa |last2=Choi |first2=Kyung-Chul |last3=An |first3=Beum-Soo |last4=Choi |first4=In-Gyu |last5=Kim |first5=Byung-Ki |last6=Oh |first6=Young-Kyoon |last7=Jeung |first7=Eui-Bae |year=2003 |title=Effect on abortion of feeding Korean pine needles to pregnant Korean native cows |journal=Canadian Journal of Veterinary Research |volume=67 |issue=3 |pages=194–97 |publisher=Canadian Veterinary Medical Association |pmc=227052 |pmid=12889725}}</ref>
Several plants, including [[Gutierrezia sarothrae|broomweed]], [[Veratrum californicum|skunk cabbage]], [[Conium maculatum|poison hemlock]], and [[Nicotiana glauca|tree tobacco]], are known to cause fetal deformities and abortion in cattle<ref name="Kirkbride">{{cite book|last=Njaa|first=Bradley L., editor|title=Kirkbride's Diagnosis of Abortion and Neonatal Loss in Animals|year=2011|publisher=John Wiley & Sons|isbn=978-0-470-95852-0}}</ref>{{rp|45–46}} and in sheep and goats.<ref name="Kirkbride"/>{{rp|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.<ref name=phj>{{cite web|url=http://www.painthorsejournal.com/pastissues/pdfs/byahair-mar04.pdf |title=By a Hair |last=Overton |first=Rebecca |work=Paint Horse Journal |date=March 2003 |accessdate=19 December 2012 |postscript=. |deadurl=yes |archiveurl=https://web.archive.org/web/20130218233122/http://www.painthorsejournal.com/pastissues/pdfs/byahair-mar04.pdf |archivedate=18 February 2013 }}</ref> In many species of sharks and rays, stress-induced abortions occur frequently on capture.<ref>{{cite journal|last1=Adams|first1=Kye R.|last2=Fetterplace|first2=Lachlan C.|last3=Davis|first3=Andrew R.|last4=Taylor|first4=Matthew D.|last5=Knott|first5=Nathan A.|title=Sharks, rays and abortion: The prevalence of capture-induced parturition in elasmobranchs|journal=Biological Conservation|date=January 2018|volume=217|pages=11–27|doi=10.1016/j.biocon.2017.10.010}}</ref>

Viral infection can cause abortion in dogs.<ref name=dogabort1>{{cite web |url = http://www.petmd.com/dog/conditions/infectious-parasitic/c_dg_canine_herpesvirus_infection |title = Herpesvirus in dog pups |publisher = petMD |accessdate = 18 December 2012 |postscript = . |deadurl = no |archiveurl = https://web.archive.org/web/20131109165216/http://www.petmd.com/dog/conditions/infectious-parasitic/c_dg_canine_herpesvirus_infection |archivedate = 9 November 2013 |df = dmy-all}}
</ref> 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.<ref name=spay1>{{cite web |url = http://www.carolsferals.org/spaying-pregnant-females/ |title = Spaying Pregnant Females |publisher = Carol's Ferals |accessdate = 17 December 2012 |postscript = . |deadurl = no |archiveurl = https://web.archive.org/web/20121118110647/http://www.carolsferals.org/spaying-pregnant-females/ |archivedate = 18 November 2012 |df = dmy-all}}
</ref><ref name=spay2>{{cite web |url = http://www.petmd.com/blogs/fullyvetted/2007/may/feline-abortion-often-unnerving-necessity |title = Feline abortion: often an unnerving necessity |first = Jennifer |last = Coates |date = 7 May 2007 |publisher = petMD |accessdate = 18 December 2012 |postscript = . |deadurl = no |archiveurl = https://web.archive.org/web/20120121085850/http://www.petmd.com/blogs/fullyvetted/2007/may/feline-abortion-often-unnerving-necessity |archivedate = 21 January 2012 |df = dmy-all}}
</ref><ref name=spay3>{{cite web |url = http://www.carolsferals.org/spaying-pregnant-females/ |title = Feline abortion: often an unnerving necessity (Part 2) |first = Patty |last = Khuly |date = 1 April 2011 |publisher = petMD |accessdate = 18 December 2012 |postscript = . |deadurl = no |archiveurl = https://web.archive.org/web/20121118110647/http://www.carolsferals.org/spaying-pregnant-females/ |archivedate = 18 November 2012 |df = dmy-all}}
</ref>
Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the [[Bruce effect]].<ref name=Schwagmeyer>
{{cite journal |jstor=2460564 |pages=932–38 |last1=Schwagmeyer |first1=P.L. |title=The Bruce Effect: An Evaluation of Male/Female Advantages |volume=114 |issue=6 |journal=The American Naturalist |year=1979 |doi=10.1086/283541}}
</ref>

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.<ref>{{cite book |url=https://books.google.com/books?id=jlZAT-9VwUIC |title=Equine Reproduction |page=563 |first1=Angus O. |last1=McKinnon |first2=James L. |last2=Voss |publisher=Wiley-Blackwell |isbn=0-8121-1427-2 |year=1993 |deadurl=no |archiveurl=https://web.archive.org/web/20150315091737/http://books.google.com/books?id=jlZAT-9VwUIC |archivedate=15 March 2015 |df=dmy-all }}</ref> Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,<ref>{{Cite journal|last=Berger|first=Joel W|date=5 May 1983|title=Induced abortion and social factors in wild horses |journal=Nature |volume=303 |pages=59–61 |doi=10.1038/303059a0 |pmid=6682487|issue=5912|last2=Vuletić|first2=L|last3=Boberić|first3=J|last4=Milosavljević|first4=A|last5=Dilparić|first5=S|last6=Tomin|first6=R|last7=Naumović|first7=P}}</ref><ref>{{Cite journal|last=Pluháček |first=Jan |year=2000 |title=Male infanticide in captive plains zebra, Equus burchelli |journal=Animal Behaviour |volume=59 |pages=689–94 |url=http://af.czu.cz/~bartos/publications/pdf/Pluhacek_Bartos_2000_AB.pdf |doi=10.1006/anbe.1999.1371 |pmid=10792924 |last2=Bartos |first2=L |issue=4 |deadurl=yes |archiveurl=https://web.archive.org/web/20110718170925/http://af.czu.cz/~bartos/publications/pdf/Pluhacek_Bartos_2000_AB.pdf |archivedate=18 July 2011 }}</ref><ref>{{Cite journal|last=Pluháček|first=Jan|year=2005|title=Further evidence for male infanticide and feticide in captive plains zebra, ''Equus burchelli'' |journal=Folia Zoologica |volume=54|issue=3|pages=258–62|url=http://www.ivb.cz/folia/54/3/258-262.pdf|deadurl=no|archiveurl=https://web.archive.org/web/20120222174717/http://www.ivb.cz/folia/54/3/258-262.pdf|archivedate=22 February 2012|df=dmy-all}}</ref> although the frequency in the wild has been questioned.<ref>{{Cite journal |last1=Kirkpatrick |first1=J.F.|last2=Turner |first2=J.W.|title=Changes in Herd Stallions among Feral Horse Bands and the Absence of Forced Copulation and Induced Abortion |journal=Behavioral Ecology and Sociobiology |volume=29 |issue=3 |pages=217–19 |doi=10.1007/BF00166404 |year=1991 |jstor=4600608}}</ref> Male [[gray langur]] monkeys may attack females following male takeover, causing miscarriage.<ref>{{Cite journal |last1=Agoramoorthy |first1=G.|last2=Mohnot |first2=S.M.|last3=Sommer |first3=V.|last4=Srivastava |first4=A.|title=Abortions in free ranging Hanuman langurs (''Presbytis entellus'')&nbsp;– a male induced strategy? |journal=Human Evolution |volume=3| issue=4| pages=297–308| year=1988 |doi=10.1007/BF02435859}}</ref>

== Notes ==
{{Reflist|group="note"|
refs=
<ref name="definition" group="note">[[Definitions of abortion]], as with many words, vary from source to source. Language used to define abortion often reflects societal and political opinions (not only scientific knowledge).<!-- {{cite web
|url = http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0090.xml?rskey=tygpVh&result=1
|title = Abortion
|publisher = [[Oxford Bibliographies]]
|accessdate = 9 April 2014
|author = Kulczycki, Andrzej
|deadurl = no
|archiveurl = https://web.archive.org/web/20140413132203/http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0090.xml?rskey=tygpVh&result=1
|archivedate = 13 April 2014
|df = dmy-all
}} --> For a list of definitions as stated by [[obstetrics and gynecology]] (OB/GYN) textbooks, dictionaries, and other sources, please see [[Definitions of abortion]].</ref>
}}

==References==
{{Reflist}}

== Bibliography ==
{{refbegin|30em}}
* {{cite book|last=Devereux|first=George|title=A Study of Abortion in Primitive Societies|publisher=International Universities Press|year=1976|isbn=978-0-8236-6245-6}}
* {{cite book|last=Doan|first=Alesha E.|title=Opposition and Intimidation: The abortion wars and strategies of political harassment|year=2007|publisher=University of Michigan|ref=harv}}
* {{cite book|last=Riddle|first=John M.|title=Eve's Herbs: A History of Contraception and Abortion in the West|year=1997|publisher=Harvard University Press}}
* {{cite journal|last1=Ganatra|first1=Bela|last2=Tunçalp|first2=Özge|last3=Johnston|first3=Heidi Bart|last4=Johnson Jr|first4=Brooke R|last5=Gülmezoglu|first5=Ahmet Metin|last6=Temmerman|first6=Marleen|title=From concept to measurement: operationalizing WHO's definition of unsafe abortion|journal=Bulletin of the World Health Organization|date=1 March 2014|volume=92|issue=3|pages=155–55|doi=10.2471/BLT.14.136333|pmc=3949603|pmid=24700971}}
* {{cite book|last=Hartmann|first=Betsy|title=Reproductive Rights and Wrongs: The Global Politics of Population Control|publisher=South End Press|year=1995|isbn=978-0-89608-491-9}}
* {{cite book|last=Koblitz|first=Ann Hibner|title=Sex and Herbs and Birth Control: Women and Fertility Regulation Through the Ages|publisher=Kovalevskaia Fund|year=2014|isbn=978-0-9896655-0-6}}
* {{cite journal|last1=Sedgh|first1=Gilda|last2=Bearak|first2=Jonathan|last3=Singh|first3=Susheela|last4=Bankole|first4=Akinrinola|last5=Popinchalk|first5=Anna|last6=Ganatra|first6=Bela|last7=Rossier|first7=Clémentine|last8=Gerdts|first8=Caitlin|last9=Tunçalp|first9=Özge|last10=Johnson|first10=Brooke Ronald|last11=Johnston|first11=Heidi Bart|last12=Alkema|first12=Leontine|title=Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends|journal=The Lancet|date=July 2016|volume=388|issue=10041|pages=258–67|doi=10.1016/S0140-6736(16)30380-4|ref={{harvid|Sedgh et al|2016}}|pmid=27179755|pmc=5498988}}
* {{cite book|last=UN|authorlink=United Nations|title=Abortion Policies: A Global Review 3 vols.|date=2002|publisher=Population Division, [[Department of Economic and Social Affairs]], United Nations|url=https://www.un.org/esa/population/publications/abortion/}}
* {{cite book|last1=WHO|authorlink=World Health Organization|title=The World Health Report 2005: Make every mother and child count|url=http://www.who.int/whr/2005/en/|date=2005|publisher=World Health Organization |location=Geneva|isbn=92-4-156290-0|ref={{harvid|WHO|2005}}}}
* {{cite book|last1=WHO|authorlink=World Health Organization|title=Safe abortion: technical and policy guidance for health systems|date=2012|publisher=World Health Organization|location=Geneva|isbn=978-92-4-154843-4|edition=2nd |url=http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1|ref=harv}}
* {{cite web|last1=WHO|authorlink=World Health Organization|title=Health worker roles in providing safe abortion care and post-abortion contraception|url=http://srhr.org/safeabortion/|accessdate=8 January 2017|date=2016|ref={{harvid|WHO|2016a}}}}
{{refend}}

==External links==
* {{Portal inline|size=tiny|Abortion}}
{{Library resources box |by=no |onlinebooks=no |others=yes lcheading=Abortion}}
{{Scholia|topic}}
<!-- HELP KEEP THIS ARTICLE SHORT AND SIMPLE: ADD LINKS TO WHICHEVER SUB-ARTICLE WOULD BE APPROPRIATE INSTEAD OF HERE. ALSO, PLEASE UNDERSTAND THAT SITES CONTAINING SHOCK MATERIAL SHALL IN NO CASE BE ACCEPTED. THANKS!!-->
* [https://web.archive.org/web/20171018012623/https://www.guideline.gov/summaries/summary/47346/firsttrimester-abortion-in-women-with-medical-conditions?q=Women First-trimester abortion in women with medical conditions.] US Department of Health and Human Services
* [http://apps.who.int/iris/bitstream/10665/173586/1/WHO_RHR_15.04_eng.pdf?ua=1 Safe abortion: Technical & policy guidance for health systems], World Health Organization (2015)

{{Subject bar |portal1= Medicine |portal2= Religion |commons= y |commons-search= Abortion |n= y |wikt= y|b= y |q= y |s= y |v= n |voy= n }}

{{Abortion}}
{{Birth control methods}}
{{Particular human rights}}
{{Reproductive health}}

[[Category:Abortion| ]]
[[Category:Fertility]]
[[Category:Gender studies]]
[[Category:Human reproduction]]
[[Category:RTT]]
[[Category:RTTEM]]

Revision as of 14:08, 29 March 2019

Abortion
Other namesInduced miscarriage, termination of pregnancy
SpecialtyObstetrics and gynecology
ICD-10-PCSO04
ICD-9-CM779.6
MeSHD000028
MedlinePlus007382

Abortion is the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus.[note 1] An abortion that occurs spontaneously is also known as a miscarriage. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently an "induced miscarriage". The word abortion is often used to mean only induced abortions.[1] A similar procedure after the fetus could potentially survive outside the womb is known as a "late termination of pregnancy" or less accurately as a "late term abortion".[2]

When allowed by law, abortion in the developed world is one of the safest procedures in medicine.[3][4] Modern methods use medication or surgery for abortions.[5] The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy.[5][6] The most common surgical technique involves dilating the cervix and using a suction device.[7] Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.[6] When performed legally and safely, induced abortions do not increase the risk of long-term mental or physical problems.[8] In contrast, unsafe abortions (those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) cause 47,000 deaths and 5 million hospital admissions each year.[8][9] The World Health Organization recommends safe and legal abortions be available to all women.[10]

Around 56 million abortions are performed each year in the world,[11] with about 45% done unsafely.[12] Abortion rates changed little between 2003 and 2008,[13] before which they decreased for at least two decades as access to family planning and birth control increased.[14] As of 2008, 40% of the world's women had access to legal abortions without limits as to reason.[15] Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.[15]

Historically, abortions have been attempted using herbal medicines, sharp tools, forceful massage, or through other traditional methods.[16] 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, problems with the fetus, poverty, risk to a woman's health, or incest.[17] There is debate over the moral, ethical, and legal issues of abortion.[18][19] Those who oppose abortion often argue that an embryo or fetus is a human with a right to life, and so they may compare abortion to murder.[20][21] Those who favor the legality of abortion often hold that it is part of a woman's right to make decisions about her own body.[22] Others favor legal and accessible abortion as a public health measure.[23]

Types

Induced

An induced abortion may be classified as therapeutic (done in response to a health condition of the women or fetus) or elective (chosen for other reasons).[24]

Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[13][25] Most abortions result from unintended pregnancies.[26][27] In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.[8] 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.[28][29] 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.[30][31] 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.[31] Confusion sometimes arises over the term "elective" because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.[32]

Spontaneous

Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.[33] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth" or a "preterm birth".[34] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[35] Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.[36]

Only 30% to 50% of conceptions progress past the first trimester.[37] The vast majority of those that do not progress are lost before the woman is aware of the conception,[31] and many pregnancies are lost before medical practitioners can detect an embryo.[38] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[39] 80% of these spontaneous abortions happen in the first trimester.[40]

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,[31][41] accounting for at least 50% of sampled early pregnancy losses.[42] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[41] 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.[42] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[43]

Methods

Template:Abortion methods

Medical

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.[5][6][44][45][46]

The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog (misoprostol or gemeprost) up to 9 weeks gestational age, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.[44] 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.[45] This regime is effective in the second trimester.[47] Medical abortion regiments involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 63 days' gestation.[48]

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.[49] 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.[50] If medical abortion fails, surgical abortion must be used to complete the procedure.[51]

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,[52][53] France,[54] Switzerland,[55] and the Nordic countries.[56] In the United States, the percentage of early medical abortions is around 30% as of 2014.[57]

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,[46] in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.[58]

Surgical

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.[59] 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 differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether cervical dilation is necessary.

MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Dilation and curettage (D&C), the second most common method of surgical abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.[60]

From the 15th week of gestation until approximately the 26th, other techniques must be used. Dilation and evacuation (D&E) consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. After the 16th week of gestation, abortions can also be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "partial-birth abortion", which has been federally banned in the United States.

In the third trimester of pregnancy, induced abortion may be performed surgically by intact dilation and extraction or by hysterotomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.[61]

First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.[62]

Labor induction abortion

In places lacking the necessary medical skill for dilation and extraction, or where preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.[63] 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.[64]

Only limited data are available comparing this method with dilation and extraction.[64] 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.[64][65]

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.[66]: 44–47, 62–63, 154–55, 230–31 

In 1978 one woman in Colorado died and another was seriously injured when they attempted to procure an abortion by taking pennyroyal oil.[67] Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure,[68] 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.[69] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[70] 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.[70]

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.[71]

Safety

An 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 defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.[72] Legal abortions performed in the developed world are among the safest procedures in medicine.[3][73] In the US, the risk of maternal death from abortion is 0.7 per 100,000 procedures,[4] making abortion about 13 times safer for women than childbirth (8.8 maternal deaths per 100,000 live births).[74][75] In the United States from 2000 to 2009, abortion had a lower mortality rate than plastic surgery.[76] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.[77][78][79] Outpatient abortion is as safe and effective from 64 to 70 days' gestation as it is from 57 to 63 days.[80] Medical abortion is safe and effective for pregnancies earlier than 6 weeks' gestation.[81]

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.[82] Infections account for one-third of abortion-related deaths in the United States.[83] 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.[84] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before elective abortion,[85] as they are believed to substantially reduce the risk of postoperative uterine infection.[62][86] 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.[87] Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. Second-trimester abortions are generally well-tolerated.[88]

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 9 weeks gestation.[49] 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.[89][90]

Some purported risks of abortion are promoted primarily by anti-abortion groups,[91][92] but lack scientific support.[91] For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the World Health Organization, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.[93]

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."[94]: 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.[95]: 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.[96]: 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[97]—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. [98]: 223 

Mental health

Current evidence finds no relationship between most induced abortions and mental-health problems[8][99] other than those expected for any unwanted pregnancy.[100] 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.[100][101] Some older reviews concluded that abortion was associated with an increased risk of psychological problems;[102] however, they did not use an appropriate control group.[99]

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,[103] more rigorous research would be needed to show this conclusively.[104] 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.[105]

Unsafe abortion

Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Abortions performed by either trained 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 abortion 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.[106]

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.[3] Unsafe abortions are believed to result in millions of injuries.[3][107] Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;[3][9][108] deaths from unsafe abortion account for around 13% of all maternal deaths.[109] The World Health Organization believes that mortality has fallen since the 1990s.[110] 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.[111] In response, opponents of abortion point out that abortion bans in no way affect prenatal care for women who choose to carry their fetus to term. The Dublin Declaration on Maternal Health, signed in 2012, notes, "the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women."[112]

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.[9][13][111][113][114][115][116] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[117] with abortion-related deaths dropping by more than 90%.[118] Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.[119] 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.[120] The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.[121] 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.[122] 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".[123][124]

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,[15] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[17] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[9] Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,[125] though this varies by region.[126] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[114] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.[13] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[127]

Live birth

Although it is very uncommon, women undergoing surgical abortion after 18 weeks gestation sometimes give birth to a fetus that may survive briefly.[128][129][130] Longer term survival is possible after 22 weeks.[131]

If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not.[132][133][134] Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended to avoid this.[135][136][137][138][139]

Death following live birth caused by abortion is given the ICD-10 underlying cause description code of P96.4; data are identified as either fetus or newborn. Between 1999 and 2013, in the U.S., the CDC recorded 531 such deaths for newborns,[140] approximately 4 per 100,000 abortions.[141]

Incidence

There are two commonly used methods of measuring the incidence of abortion:

  • Abortion rate – number of abortions per 1000 women between 15 and 44 years of age
  • 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.[113] For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.[13]

The number of abortions performed worldwide seems to have remained stable in recent years, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008.[13] The abortion rate worldwide was 28 per 1000 women, though it was 24 per 1000 women for developed countries and 29 per 1000 women for developing countries.[13] 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.[13]

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. However, restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely.[15][142][143] 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.[144]

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 (Germany and Switzerland) to 30 per 1000 women (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.[145][146]

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.[147] 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".[148]

The abortion rate may also be expressed as the average number of abortions a woman has during her reproductive years; this is referred to as total abortion rate (TAR).

Gestational age and method

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention (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).[149] 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.[150]

The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for <0.2% of the total number of abortions performed that year.[151] 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.[152] There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.[153]

Motivation

Personal

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.[150][154]

Some of the most common reasons are to postpone childbearing to a more suitable time or to focus energies and resources on existing children. Others include being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of one's own education, relationship problems with their partner, a perception of being too young to have a child, unemployment, and not being willing to raise a child conceived as a result of rape or incest, among others.[154][155]

Societal

Some abortions are undergone as the result of societal pressures.[156] 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.[157]

Maternal and fetal health

An additional factor is risk to maternal or fetal health, which was cited as the primary reason for abortion in over a third of cases in some countries and as a significant factor in only a single-digit percentage of abortions in other countries.[150][154]

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."[158]: 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.[159]

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.[160]

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.[160] 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.[161][162]

The process of birth itself may also put the mother at risk. "Vaginal 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."[163]

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.[70][164]
"French Periodical Pills". An example of a clandestine advertisement published in a January 1845 edition of the Boston Daily Times.

Since ancient times abortions have been done using herbal medicines, sharp tools, with force, or through other traditional methods.[16] Induced abortion has long history and can be traced back to civilizations as varied as China under Shennong (c. 2700 BCE), Ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE).[16] There is evidence to suggest that pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. 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.[70]

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions;[16] other scholars disagree with this interpretation,[16] and state that the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath.[165] The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus, 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, but only for the sake of the mother's health.[166][167]

Aristotle, in his treatise on government Politics (350 BCE), condemns infanticide as a means of population control. He preferred abortion in such cases, with the restriction[168] "[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".[169] In Christianity, Pope Sixtus V (1585–90) was the only Pope before 1869 to declare that abortion is homicide regardless of the stage of pregnancy;[170] and his pronouncement of 1588 was reversed three years later by his successor. Through most of its history the Catholic Church was divided on whether it believed that abortion was murder, and it did not begin vigorously opposing abortion until the 19th century.[16] In fact, several historians have written[171][172][173] that prior to the 19th century most Catholic authors did not regard termination of pregnancy before "quickening" or "ensoulment" as an abortion.

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.[150][154] Islamic tradition has traditionally permitted abortion until a point in time when Muslims believe the soul enters the fetus,[16] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[174] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[175]

In Europe and North America, abortion techniques advanced starting in the 17th century. However, conservatism by most physicians with regards to sexual matters prevented the wide expansion of safe abortion techniques.[16] 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)[176] was banned in both the United States and the United Kingdom.[16] Church groups as well as physicians were highly influential in anti-abortion movements.[16] In the US, according to some sources, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.[note 2] However, other sources maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe.[177][178][179] In addition, some commentators have written that, despite improved medical procedures, the period from the 1930s until legalization also saw more zealous enforcement of anti-abortion laws, and concomitantly an increasing control of abortion providers by organized crime.[180][181][182][183][184]

Soviet Russia (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[185] In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions.[186] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.[16]

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 justification of laws permitting or restricting abortion.[187] 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."[188] Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Anti-abortion groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while abortion rights groups who are against such legal restrictions describe themselves as "pro-choice".[189] Generally, the former position argues that a human fetus is a human person with a right to live, making abortion morally the same as murder. The latter position argues that a woman has certain reproductive rights, especially the right to decide whether or not to carry a pregnancy to term.

Modern abortion law

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 safe, 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.[190] 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[191] one-child policy, and now has a two child policy,[192][193] has at times incorporated mandatory abortions as part of their population control strategy.[194]

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.[17] 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.[195][196] Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.[197] This is also a terminology in traditional medicine.[198] 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.[199] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.[200]

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.[201][202][203]

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 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.[204] 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.[205][206][207][208] In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.[209]

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",[210] conditions also condemned by a PACE resolution in 2011.[211] 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.[210]

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.[212][213] Only a small fraction of those opposed to abortion commit violence.

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.[214][215] 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.[216]

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 pro-life 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, sending them up to 1200 phone calls a day and contacting their churches.[217] Some protestors record women entering clinics on camera.[217]

Other animals

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.[218] In cows, abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but can often be controlled by vaccination.[219] Eating pine needles can also induce abortions in cows.[220][221] Several plants, including broomweed, skunk cabbage, poison hemlock, and tree tobacco, are known to cause fetal deformities and abortion in cattle[222]: 45–46  and in sheep and goats.[222]: 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.[223] In many species of sharks and rays, stress-induced abortions occur frequently on capture.[224]

Viral infection can cause abortion in dogs.[225] 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.[226][227][228] Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect.[229]

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.[230] Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[231][232][233] although the frequency in the wild has been questioned.[234] Male gray langur monkeys may attack females following male takeover, causing miscarriage.[235]

Notes

  1. ^ Definitions of abortion, as with many words, vary from source to source. Language used to define abortion often reflects societal and political opinions (not only scientific knowledge). For a list of definitions as stated by obstetrics and gynecology (OB/GYN) textbooks, dictionaries, and other sources, please see Definitions of abortion.
  2. ^ By 1930, medical procedures in the US 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:
    • "The 1970s". Time communication 1940–1989: retrospective. Time Inc. 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, George (1990). Suddenly: the American idea abroad and at home, 1986–1990. Free Press. p. 312. ISBN 0-02-934435-2.
    • Lewis, J.; Shimabukuro, Jon O. (28 January 2001). "Abortion Law Development: A Brief Overview". Congressional Research Service. Archived from the original on 14 May 2011. Retrieved 1 May 2011. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
      *Schultz, David Andrew (2002). Encyclopedia of American law. Infobase Publishing. p. 1. ISBN 0-8160-4329-9. Archived from the original on 9 December 2015. {{cite book}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
    • Lahey, Joanna N. (24 September 2009). "Birthing a Nation: Fertility Control Access and the 19th Century Demographic Transition" (PDF). Colloquium. Pomona College. Archived from the original (PDF; preliminary version) on 7 January 2012. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)

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    96% of all abortions performed in nonhospital facilities × 31% early medical abortions of all nonhospital abortions = 30% early medical abortions of all abortions; 97% of nonhospital medical abortions used mifepristone and misoprostol—3% used methotrexate and misoprostol, or misoprostol alone—in the United States in 2014.
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Bibliography

External links