Abortion

An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. The spontaneous expulsion of a fetus or embryo before the 20th week of gestational age is commonly known as a miscarriage. Induced abortion is the removal or expulsion of an embryo or fetus by medical, surgical, or other means at any point during human pregnancy for therapeutic or elective reasons. The approximate number of induced abortions performed worldwide in 2003 was 42 million.

Throughout recorded history, abortion has been induced by various traditional medicine methods, including botanical abortifacients, the use of sharpened tools, and abdominal pressure.

The moral and legal aspects of abortion are subject to intense social debate in many parts of the world. Aspects of this debate can include the public health impact of unsafe or illegal abortion as well as legal abortion's effect upon crime rates, and the ramifications of sex-selective practices. Other debates include the abortion-breast cancer hypothesis, post-abortion syndrome, and fetal pain. Moral arguments often equate abortion to murder, or denial of abortion to oppression of women.

The history of modern Western abortion laws can be traced back to English common law, which allowed abortion before the "quickening" of the fetus. Currently, abortion law varies from country to country, with regard to religious, moral, and cultural sensibilities.

Forms of abortion

In medical terminology, the term abortion refers to two basic phenomena: miscarriage (spontaneous abortion) and induced abortion. In common parlance, the term "abortion" is synonymous with induced abortion. However, in medical texts, the word 'abortion' might exclusively refer to, or may also refer to, spontaneous abortion (miscarriage).

Spontaneous abortion

Main article: Miscarriage

Spontaneous abortion is the expulsion of an embryo or fetus due to accidental trauma or natural causes. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes before the 20th week of gestation. A pregnancy that ends between 20 and 37 weeks of gestation, if it results in a live-born infant, is known as a "premature birth". When a fetus dies in utero after about 20 weeks, or during delivery, it is termed a "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Most miscarriages occur very early in pregnancy. Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman. In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy showed a rate of pregnancy in exposed ovulatory cycles of 59.6%; with 61.9% of conceptuses lost prior to 12 weeks of which 91.7% occuried subclinically, without the knowledge of the mother.

The risk of spontaneous abortion decreases sharply after the 10th week LMP, with a loss rate between 8.5 weeks LMP and birth of about two percent; pregnancy loss is “virtually complete by the end of the embryonic period."

This risk of spontaneous abortion is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.

Induced abortion

A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the embryo or fetus, in addition to the legality, regional availability, and doctor-patient preference for specific procedures. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is considered to be therapeutic when it is performed to:

• to save the life of the pregnant woman;
• to preserve the woman's physical or mental health;
• to terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity; or
• to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.

An abortion is considered to be elective if it is performed for any other reason.

Methods

Surgical

Gestational age may determine which abortion methods are practiced.

In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method. Manual Vacuum aspiration (MVA) abortion, consists of removing the fetus or embryo by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Dilation and curettage (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable. The term D and C, or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.

Other techniques must be used to induce abortion in the second trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "partial-birth abortion," which has been federally banned in the United States. A hysterotomy abortion is a procedure similar to a caesarean section, and is performed under general anesthesia because it is considered major abdominal surgery. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.

From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure to ensure that the fetus is not born alive.

Medical

Main article: Medical abortion

Effective in the first trimester of pregnancy, non-surgical abortions (referred to as 'medical abortions') comprise 10% of all abortions in the United States and Europe. Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention. Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.

Other means

File:Angkordemon.jpg

Bas-relief at Angkor Wat, dated circa 1150, depicting a demon performing an abortion by pounding a mallet into a woman's belly.

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion). The use of herbs in such a manner can cause serious — even lethal — side effects, such as multiple organ failure, and 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. Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Burma, Indonesia, Malaysia, the Philippines, and Thailand, there is an ancient tradition of attempting abortion through forceful abdominal massage.

Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.

Incidence of induced abortion

The incidence and reasons for induced abortion vary regionally. It has been estimated that approximately 46 million abortions are performed worldwide every year. Of these, 26 million are said to occur in places where abortion is legal; the other 20 million happen where the procedure is illegal. Some countries, such as Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100), have a low rate of induced abortion, while others like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. The world ratio is 26 induced abortions per 100 known pregnancies.

By gestational age and method

Histogram of abortions by gestational age in England and Wales during 2004. Average is 9.5 weeks.

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, from data collected in those areas of the United States that sufficiently reported gestational age, it was found that 88.2% of abortions were conducted at or prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 90.9% of these were classified as having been done by "curettage" (suction-aspiration, Dilation and curettage, Dilation and evacuation), 7.7% by "medical" means (mifepristone), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy). The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the U.S. during 2000; this accounts for 0.17% of the total number of abortions performed that year. Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 to 19 weeks, and 1.5% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.

By personal and social factors

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

A 1998 aggregated study, from 27 countries, on the reasons women seek to terminate their pregnancies concluded that common factors cited to have influenced the abortion decision were: desire to delay or end childbearing, concern over the interruption of work or education, issues of financial or relationship stability, and perceived immaturity. A 2004 study in which American women at clinics answered a questionnaire yielded similar results. In Finland and the United States, concern for the health risks posed by pregnancy in individual cases was not a factor commonly given; however, in Bangladesh, India, and Kenya health concerns were cited by women more frequently as reasons for having an abortion. 1% of women in the 2004 survey-based U.S. study became pregnant as a result of rape and 0.5% as a result of incest. Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using condoms and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled persons, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion.

Health considerations

Early-term surgical abortion is a simple procedure which is safer than childbirth when performed before the 16th week. Abortion methods, like most minimally invasive procedures, carry a small potential for serious complications. The risk of complications can increase depending on how far pregnancy has progressed.

Women typically experience minor pain during first-trimester abortion procedures. In a 1979 study of 2,299 patients, 97% reported experiencing some degree of pain. Patients rated the pain as being less than earache or toothache, but more than headache or backache.

Some practitioners advocate using minimal anaesthesia so the patient can alert them to possible complications. Others recommend general anaesthesia, to prevent patient movement, which might cause a perforation. General anaesthesia carries its own risks, including death, which is why public health officials recommend against its routine use.

History of abortion

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

Main article: History of abortion

Induced abortion can be traced to ancient times. There is evidence to suggest that, historically, pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques.

The Hippocratic Oath, the chief statement of medical ethics for Hippocratic physicians in Ancient Greece, forbade doctors from helping to procure an abortion by pessary. Soranus, a second-century Greek physician, suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in energetic exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal baths, pessaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation. It is also believed that, in addition to using it as a contraceptive, the ancient Greeks relied upon silphium as an abortifacient. Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy.

Abortion in the 19th century continued, despite bans in both the United Kingdom and the United States, as the disguised, but nonetheless open, advertisement of services in the Victorian era suggests.

In the 20th century the Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion. In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of "German stock" were specifically prohibited from having abortions.

Social issues

A number of complex issues exist in the debate over abortion. These, like the suggested effects upon health listed above, are a focus of research and a fixture of discussion among members on all sides of the controversy.

Effect upon crime rate

Main article: Legalized abortion and crime effect

A theory attempts to draw a correlation between the United States' unprecedented nationwide decline of the overall crime rate during the 1990s and the decriminalization of abortion 20 years prior.

The suggestion was brought to widespread attention by a 1999 academic paper, The Impact of Legalized Abortion on Crime, authored by the economists Steven D. Levitt and John Donohue. They attributed the drop in crime to a reduction in individuals said to have a higher statistical probability of committing crimes: unwanted children, especially those born to mothers who are African-American, impoverished, adolescent, uneducated, and single. The change coincided with what would have been the adolescence, or peak years of potential criminality, of those who had not been born as a result of Roe v. Wade and similar cases. Donohue and Levitt's study also noted that states which legalized abortion before the rest of the nation experienced the lowering crime rate pattern earlier, and those with higher abortion rates had more pronounced reductions.

Fellow economists Christopher Foote and Christopher Goetz criticized the methodology in the Donohue-Levitt study, noting a lack of accommodation for statewide yearly variations such as cocaine use, and recalculating based on incidence of crime per capita; they found no statistically significant results. Levitt and Donohue responded to this by presenting an adjusted data set which took into account these concerns and reported that the data maintained the statistical significance of their initial paper.

Such research has been criticized by some as being utilitarian, discriminatory as to race and socioeconomic class, and as promoting eugenics as a solution to crime. Levitt states in his book Freakonomics that they are neither promoting nor negating any course of action — merely reporting data as economists.

Sex-selective abortion

Main article: Sex-selective abortion and infanticide

The advent of both sonography and amniocentesis has allowed parents to determine sex before birth. This has led to the occurrence of sex-selective abortion or the targeted termination of a fetus based upon its sex.

It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Mainland China, Taiwan, South Korea, and India.

In India, the economic role of men, the costs associated with dowries, and a Hindu tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons. The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 rupees [for a sex test] now, save 50,000 rupees [for a dowry] later." In 1991, the male-to-female sex ratio in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100. Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted. The Indian government passed an official ban of pre-natal sex screening in 1994 and moved to pass a complete ban of sex-selective abortion in 2002.

In the People's Republic of China, there is also a historic son preference. The implementation of the one-child policy in 1979, in response to population concerns, led to an increased disparity in the sex ratio as parents attempted to circumvent the law through sex-selective abortion or the abandonment of unwanted daughters. Sex-selective abortion might be an influence on the shift from the baseline male-to-female birth rate to an elevated national rate of 117:100 reported in 2002. The trend was more pronounced in rural regions: as high as 130:100 in Guangdong and 135:100 in Hainan. A ban upon the practice of sex-selective abortion was enacted in 2003.

Unsafe abortion

Soviet poster circa 1925, promoting hospital abortions. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death."

Main article: Unsafe abortion

Where and when access to safe abortion has been barred, due to explicit sanctions or general unavailability, women seeking to terminate their pregnancies have sometimes resorted to unsafe methods.

"Back-alley abortion" is a slang term for any abortion not practiced under generally accepted standards of sanitation and professionalism. The World Health Organization (WHO) defines an unsafe abortion as being, "a procedure...carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both." This can include a person without medical training, a professional health provider operating in sub-standard conditions, or the woman herself.

Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the woman's death. Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal mortalities, with regional estimates including 12% in Asia, 25% in Latin America, and 13% in sub-Saharan Africa. A 2007 study published in the The Lancet found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.

Abortion debate

Pro-choice activists near the Washington Monument at the March for Women's Lives.

File:P1020321.JPG

Pro-life activists at the March for Life in 2008. The rally is held annually in Washington, DC.

Main articles: Abortion debate, Pro-choice, and Pro-life

In the history of abortion, induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her value system. Opinions of abortion may be best described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy. Religious ethics also has an influence upon both personal opinion and the greater debate over abortion (see religion and abortion).

Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. In the United States, most often those in favor of greater legal restrictions on, or even complete prohibition of abortion, describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to life?" for pro-life advocates, and, for those who are pro-choice, "Does a woman have the right to choose whether or not to continue a pregnancy?"

In both public and private debate, arguments presented in favor of or against abortion focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.

Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a minor, her parents; a legally-married or common-law wife, her husband; or a pregnant woman, the biological father. In a 2003 Gallup poll in the United States, 79% of male and 67% of female respondents were in favor of spousal notification; overall support was 72% with 26% opposed.

Public opinion

Main article: Societal attitudes towards abortion

A number of opinion polls around the world have explored public opinion regarding the issue of abortion. Results have varied from poll to poll, country to country, and region to region, while varying with regard to different aspects of the issue.

A May 2005 survey examined attitudes toward abortion in 10 European countries, asking polltakers whether they agreed with the statement, "If a woman doesn't want children, she should be allowed to have an abortion". The highest level of approval was 81% (in the Czech Republic); the lowest was 47% (in Poland).

In North America, a December 2001 poll surveyed Canadian opinion on abortion, asking Canadians in what circumstances they believe abortion should be permitted; 32% responded that they believe abortion should be legal in all circumstances, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. A similar poll in January 2006 surveyed people in the United States about U.S. opinion on abortion; 33% said that abortion should be "permitted only in cases such as rape, incest or to save the woman's life", 27% said that abortion should be "permitted in all cases", 15% that it should be "permitted, but subject to greater restrictions than it is now", 17% said that it should "only be permitted to save the woman's life", and 5% said that it should "never" be permitted. A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.

Of attitudes in South and Central America, a December 2003 survey found that 30% of Argentines thought that abortion in Argentina should be allowed "regardless of situation", 47% that it should be allowed "under some circumstances", and 23% that it should not be allowed "regardless of situation". A March 2007 poll regarding the abortion law in Brazil found that 65% of Brazilians believe that it "should not be modified", 16% that it should be expanded "to allow abortion in other cases", 10% that abortion should be "decriminalized", and 5% were "not sure". A July 2005 poll in Colombia found that 65.6% said they thought that abortion should remain illegal, 26.9% that it should be made legal, and 7.5% that they were unsure.

Arguments within the debate

Breast cancer hypothesis

Main article: Abortion-breast cancer hypothesis

The "abortion-breast cancer (ABC) hypothesis" (also referred to by supporters as the abortion-breast cancer link) is a hypothesis that posits a causal relationship between induced abortion and an increased risk of developing breast cancer. In early pregnancy, levels of estrogen increase, leading to breast growth in preparation for lactation. The hypothesis proposes that if this process is interrupted by an abortion – before full maturity in the third trimester – then more relatively vulnerable immature cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. While early research suggested the possibility of a correlative relationship between breast cancer and abortion, the causal hypothesis was proposed based on a reinterpretation of rat studies conducted in the 1980s. The American Cancer Society concludes that presently the evidence does not support a causal abortion-breast cancer association, yet a causal link continues to be championed by pro-life activists like Dr. Joel Brind, Dr. Angela Lanfranchi and Karen Malec.

A large epidemiological study by Mads Melbye et al. in 1997, with data from two national registries in Denmark, reported the correlation to be negligible to non-existent after statistical adjustment. The National Cancer Institute conducted a workshop with over 100 experts on the issue in February 2003, which determined from selected evidence that it was well-established that "abortion is not associated with an increase in breast cancer risk." In 2004, Beral et al. published a collaborative reanalysis of 53 epidemiological studies and concluded that abortion does "not increase a woman's risk of developing breast cancer."

Though the hypothesis has been largely rejected by the scientific community, the ongoing promotion of the abortion-breast cancer hypothesis by pro-life advocates is seen by some as a part of the current pro-life "women-centered" strategy against abortion. In the past, pro-life advocates have sought legal action regarding disclosure of the abortion-breast cancer issue. While suits brought short-term legal and political intervention, the scientific community responded in the form of the 2003 NCI consensus workshop. The current scientific consensus that abortion does not increase the risk of breast cancer has solidified with the publication of large prospective cohort studies which find no significant association between abortion and breast cancer. Nevertheless, the subject continues to be one of mostly political but some scientific debate.

Mental health

Main article: Abortion and mental health

The relationship between induced abortion and mental health is an area of political and scientific controversy. A number of studies have concluded that abortion is associated with no more psychological risk than carrying an unwanted pregnancy to term. Other studies have reported a statistical correlation between abortion and negative psychological effects, though no studies have demonstrated a direct causal relationship. Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.

In a 1990 review, the American Psychological Association has found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses." In light of additional studies undertaken since that time, both the APA and the United Kingdom Royal College of Psychiatrists are performing systematic reviews of the medical literature in order to update their position statements.

Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization, and some physicians and pro-choice advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.

On March 14, 2008, the Royal College of Psychiatrists released a statement saying "The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base is inconclusive – some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion."

Fetal pain debate

Main article: Fetal pain

The existence and implications of fetal pain are scientifically and politically disputed. A controversial review by researchers from the University of California, San Francisco in JAMA concluded that data from dozens of medical reports and studies indicate that fetuses are unlikely to feel pain until the third trimester of pregnancy. There may be an emerging consensus among developmental neurobiologists that the establishment of thalamocortical connections (at about 26 weeks) is a critical event with regard to fetal perception of pain. Nevertheless, because pain can involve sensory, emotional and cognitive factors, it may be "impossible to know" when painful experiences are perceived, even if it is known when thalamocortical connections are established.

Whether a fetus has the ability to feel pain and to suffer is part of the abortion debate. For example, legislation has been proposed by pro-life advocates requiring abortion providers to tell a woman that the fetus may feel pain during the abortion procedure, and that require her to accept or decline anesthesia for the fetus.

Abortion law

Main articles: Abortion law and History of abortion law

See also: Reproductive rights

International status of abortion law (detail).

Before the scientific discovery that human development begins at fertilization, English common law allowed abortions to be performed before "quickening", the earliest perception of fetal movement by a woman during pregnancy, until both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803. In 1861, the British Parliament passed the Offences Against the Person Act, which continued to outlaw abortion and served as a model for similar prohibitions in some other nations. The Soviet Union, with legislation in 1920, and Iceland, with legislation in 1935, were two of the first countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom. In the 1973 case, Roe v. Wade, the United States Supreme Court struck down state laws banning abortion, ruling that such laws violated an implied right to privacy in the United States Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under the Canadian Charter of Rights and Freedoms. Canada later struck down provincial regulations of abortion in the case of R. v. Morgentaler (1993). By contrast, abortion in Ireland was affected by the addition of an amendment to the Irish Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn".

Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, the right to security of person, and the right to reproductive health are major issues of human rights that are sometimes used as justification for the existence or absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window of legality:

• In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
• In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessary before it can be performed.

Other countries, in which abortion is normally illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A few nations ban abortion entirely: Chile, El Salvador, Malta, Ireland and Nicaragua, although in 2006 the Chilean government began the free distribution of emergency contraception. In Bangladesh, abortion is illegal, but the government has long supported a network of "menstrual regulation clinics", where menstrual extraction (manual vacuum aspiration) can be performed as menstrual hygiene.

In places where abortion is illegal or is socially such a stigma that it would not be possible to continue to live there if it became known that a woman had undergone one, pregnant women may engage in medical tourism and travel overseas to countries where they can undergo a termination of their pregnancy. In the USA, it is not unusual for women to travel from one state to another for reasons of termination of pregnancy.

See also

Abortion by country Abortion fund Abortion-related violence Contraception Ethical aspects of abortion Eugenics Fertilisation Fetal rights Gynaecology Late-term abortion Legal protection of access to abortion

Libertarian perspectives on abortion Medical tourism Minors and abortion Obstetrics Paternal rights and abortion Pregnancy Population control Religion and abortion Reproduction Selective reduction Self-induced abortion Teenage pregnancy

External links

• Template:Dmoz
• Abortion Laws of the World
• Abortion Policies: A Global Review
• "Abortion Clinic:" a 1983 PBS Frontline episode.
• U.S. National Library of Medicine and National Institutes of Health MedlinePlus encyclopedia
• Abortion: All sides to the issue from the Ontario Consultants on Religious Tolerance
• Issue Guide on Abortion from Public Agenda Online

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

• The Guttmacher Institute (pro-choice)
• Johnston's Archive: Abortion Statistics and Other Data (pro-life)
• Just Facts: Abortion (pro-life)
• Abortion.com: Abortion Clinics and Medical Providers (pro-choice)

The following links are to groups which advocate a specific position:

• Children by Choice (Australia, pro-choice)
• Right to Life Australia (pro-life)
• Canadians for Choice (pro-choice)
• LifeCanada (pro-life)
• Abortion Law Reform Association of New Zealand (pro-choice)
• Voice for Life (New Zealand, pro-life)
• Abortion Rights (United Kingdom, pro-choice)
• LifeUK (United Kingdom, pro-life)
• NARAL Pro-choice America (pro-choice)
• American Life League (pro-life)
• Planned Parenthood (international, pro-choice)
• CareNet (international, pro-life)