Abortion: Difference between revisions
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'''Abortion''' is the termination of a [[pregnancy (mammals)|pregnancy]] by the removal or expulsion of a [[fetus]] or [[embryo]] from the [[uterus]], resulting in or caused by its death.<ref>{{Cite book|url=http://books.google.com/?id=KiRHpRl7TjsC&pg=PA173 |title=Gynaecology for Lawyers |author=Dutt T, Matthews MP |volume=14 |series-title=Medico-legal practitioner series |publisher=Routledge |year=1998 |isbn=978-1-85941-215-2}} </ref> An abortion can occur spontaneously due to [[complication (medicine)|complications]] during pregnancy or can be induced in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the [[gravidity|gravida]] (pregnant female) is termed a ''therapeutic abortion'', while an abortion induced for any other reason is termed an ''elective abortion''. The term ''abortion'' most commonly refers to the induced abortion of a [[pregnancy|human pregnancy]], while spontaneous abortions are usually termed [[miscarriage]]s. <!--Annotation: This paragraph serves to disambiguate abortion terminology and and types--> |
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'''Abortion''' refers to the termination of [[pregnancy (mammals)|pregnancy]] at any stage that does not end with live birth, though it is often technically defined as the termination of pregnancy by the removal or expulsion from the uterus of a [[fetus]] or [[embryo]] before [[fetal viability]].<ref name="definition" group="note" /> An abortion can occur spontaneously, in which case it is usually called a [[miscarriage]], or it can be purposely [[:Wikt:induce|induced]]. The term ''abortion'' most commonly refers to the induced abortion of a human rather than [[pregnancy (mammals)|non-human pregnancy]]. |
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Abortion |
Abortion, when induced in the [[developed countries|developed world]] in accordance with [[abortion law|local law]], is [[#Safety|among the safest procedures in medicine]].<ref name="lancet-grimes"/> However, [[unsafe abortion]]s (those performed by persons without proper training or outside of a medical environment) result in approximately 70 thousand [[maternal death]]s and 5 million disabilities per year globally.<ref name=OBGY09/> An estimated 42 million abortions are performed globally each year, with 20 million of those performed unsafely.<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 |year=2009 |month=December |pmid=20085681 |doi= |url=http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf|format=PDF}}</ref> Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.<ref name=IJGO10>{{Cite journal|author=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 |year=2010 |month=July |pmid=20451196 |doi=10.1016/j.ijgo.2010.04.003 }}</ref><!--Annotation: This paragraph discusses epidemiology and health risk related to the procedure.--> |
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Induced abortion has a long [[history of abortion|history]] and has been facilitated by various methods including herbal [[abortifacient]]s, the use of sharpened tools, [[physical trauma]], and other [[traditional medicine|traditional methods]]. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The [[abortion law|legality]], prevalence, cultural status, and religious status of abortion vary substantially around the world. In many parts of the world there is prominent and divisive [[Abortion debate|public controversy]] over the [[ethical aspects of abortion|ethical]] and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing [[pro-life]] and [[pro-choice]] worldwide social movements ([[Abortion-rights_movement#Term_controversy|both self-named]]). The incidence of abortion has declined worldwide as access to [[family planning]] education and [[birth control|contraceptive]] services has increased.<ref name="worldtrends">{{Cite journal|author=Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J |title=Legal abortion worldwide: incidence and recent trends |journal=Int Fam Plan Perspect |volume=33 |issue=3 |pages=106–16 |year=2007 |month=September |pmid=17938093 |doi=10.1363/ifpp.33.106.07 |url=http://www.guttmacher.org/pubs/journals/3310607.html }}</ref> <!--Annotation: This paragraph covers related issues and current events.--> |
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==Types== |
==Types== |
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===Induced=== |
===Induced=== |
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Approximately 205 million pregnancies occur each year worldwide. Over a third are [[unintended pregnancy|unintended]] and about a fifth end in induced abortion.<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=http://www.webcitation.org/5zVk3OSM4|archivedate=17 June 2011|deadurl=no}}</ref> Most abortions result from unintended pregnancies.<ref>Bankole et al., [http://www.guttmacher.org/pubs/journals/2411798.html "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries"], International Family Planning Perspectives (1998). Also see Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore, [http://www.guttmacher.org/pubs/journals/3711005.pdf "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives"], Perspectives on Sexual and Reproductive Health, 37(3):110-118 (September 2005).</ref> |
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A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the [[gestational age]] of the embryo or fetus,<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=978-0781732628}}</ref> which increases in size as the pregnancy progresses.<ref>{{cite book|last=Menikoff|first=Jerry|url=http://books.google.com/books?id=2jXOYv3X8zsC&pg=PA78|title=Law and Bioethics|page=78|publisher=Georgetown University Press|year=2001|quote=As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use.|isbn=9780878408399}}</ref> Specific procedures may also be selected due to legality, regional availability, and doctor or patient preference. |
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Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a [[Therapeutic Abortion|therapeutic abortion]] when it is performed to save the life of the pregnant woman; prevent harm to the woman's physical or mental health; terminate a pregnancy where indications are that the child will have a significantly increased chance of premature morbidity or mortality or be otherwise disabled; or to [[selective reduction|selectively reduce]] the number of fetuses to lessen health risks associated with [[multiple birth|multiple pregnancy]].<ref name="roche1">{{cite web|last=Roche|first=Natalie E.|date=28 September 2004|archiveurl=http://web.archive.org/web/20041214092044/http://www.emedicine.com/MED/topic3311.htm|title=Therapeutic Abortion|publisher=[[eMedicine]]|url=http://emedicine.medscape.com/article/252560-overview|archivedate=December 14, 2004|accessdate=June 19, 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" /> |
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More than one third of the approximately 205 million pregnancies that occur each year worldwide are unintended and about 20% of them end in induced abortion.<ref>http://apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html</ref> |
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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>Menikoff, Jerry. [http://books.google.com/books?id=2jXOYv3X8zsC&pg=PA78&dq=size+fetus+abortion+technique&lr=&as_brr=3&ei=MymmSayEFJaQyATt6JiUDg Law and Bioethics], p. 78 (Georgetown University Press 2001): "As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use." </ref> Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a [[Therapeutic Abortion|therapeutic abortion]] when it is performed to: |
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* save the life of the pregnant woman;<ref name="roche1">Roche, Natalie E. (2004). [http://www.emedicine.com/med/topic3311.htm Therapeutic Abortion]. Retrieved 2006-03-08.</ref> |
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* preserve the woman's physical or mental health;<ref name="roche1"/> |
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* terminate pregnancy that would result in a child born with a [[congenital disorder]] that would be fatal or associated with significant [[morbidity]];<ref name="roche1"/> or |
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* [[selective reduction|selectively reduce]] the number of fetuses to lessen health risks associated with [[multiple birth|multiple pregnancy]].<ref name="roche1"/> |
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An abortion is referred to as ''elective'' when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."<ref>''Encyclopedia Britannica'', (2007), Vol 26, p. 674.</ref> |
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===Spontaneous=== |
===Spontaneous=== |
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{{Main|Miscarriage}} |
{{Main|Miscarriage}} |
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Spontaneous abortion |
Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 20th to 22nd [[gestational age|week of gestation]].<ref group="note">Note that the defining line between miscarriage and premature birth or stillbirth varies among jurisdictions. {{cite web|url=http://www.state.gov/documents/organization/89168.pdf|title=Documenting Stillbirth (Fetal Death)|publisher=United States Department of State|date=February 18, 2011|accessdate=June 27, 2011|format=PDF|archiveurl=http://www.webcitation.org/5zlfxU61B|archivedate=June 27, 2011}}</ref> A pregnancy that ends before 37 weeks of gestation resulting in a [[live birth|live-born]] infant is known as 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 viability, or during [[childbirth|delivery]], it is usually termed "[[stillbirth|stillborn]]".<ref>{{cite web|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}}</ref> Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.{{Citation needed|date=June 2011}} |
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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 have the ability to detect the presence of an embryo.<ref>{{cite book|last=Katz|first=Vern L.|publisher=[[Mosby (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 - Etiology, Diagnosis, Treatment|isbn=9780323029513}}</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=978-0781732628}}</ref> |
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Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.<ref name=BBCmiscarriage>{{Cite news|url=http://news.bbc.co.uk/2/hi/health/2176898.stm |title=Q&A: Miscarriage |date=2002-08-06 |publisher=BBC |accessdate=2009-04-07}}</ref> Most miscarriages occur very early in pregnancy, in most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for [[ovulation]] and pregnancy found that 61.9% of [[conceptus]]es were lost prior to 12 weeks, and 91.7% of these losses occurred subclinically, without the knowledge of the once pregnant woman.<ref name="pmid7117572">{{Cite journal|author=Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ |title=Early embryonic mortality in women |journal=Fertil. Steril. |volume=38 |issue=4 |pages=447–453 |year=1982 |pmid=7117572 |doi=}}</ref> |
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The |
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/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=2009-04-07 |last=Stöppler |author=Conrad M |editor=Shiel WC Jr |work=MedicineNet.com|publisher=[[WebMD]]}}</ref> accounting for at least 50% of sampled early pregnancy losses.<ref name="fetal med 837">{{Cite book|author=Jauniaux E, Kaminopetros P, El-Rafaey H |chapter=Early pregnancy loss |editor=Whittle MJ,Rodeck CH |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=http://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]], other hormonal problems, infection, and abnormalities of the uterus.<ref name="mednet" /> Advancing maternal age and a patient 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=2009-04-07 |publisher=[[National Conference of State Legislatures]]}}</ref> |
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==Induction methods== |
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The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,<ref name="mednet">{{cite web|url=http://www.medicinenet.com/miscarriage/page1.htm |title=Miscarriage (Spontaneous Abortion) |accessdate=2009-04-07 |last=Stöppler |author=Conrad M |editor=Shiel WC Jr |work=MedicineNet.com }}</ref> accounting for at least 50% of sampled early pregnancy losses.<ref name="fetal med 837">{{Cite book|author=Jauniaux E, Kaminopetros P, El-Rafaey H |chapter=Early pregnancy loss |editor=Whittle MJ,Rodeck CH |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=http://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]], other hormonal problems, infection, and abnormalities of the uterus.<ref name="mednet" /> Advancing maternal age and a patient 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=2009-04-07 |publisher=[[National Conference of State Legislatures]]}}</ref> |
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==Methods== |
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[[File:Abortionmethods.png|thumb|350px|right|[[Gestational age]] may determine which abortion methods are practiced.]] |
[[File:Abortionmethods.png|thumb|350px|right|[[Gestational age]] may determine which abortion methods are practiced.]] |
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{{Main|Medical abortion}} |
{{Main|Medical abortion}} |
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"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, categorically called [[abortifacient]]s. In 2005, medical abortions constituted 13% of all abortions in the United States;<ref>{{Cite journal|author=Jones R. K |
"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, categorically called [[abortifacient]]s. In 2005, medical abortions constituted 13% of all abortions in the United States;<ref>{{Cite journal|author=Jones R. K.|title=Abortion in the United States: incidence and access to services, 2005|journal=Perspectives on Sexual and Reproductive Health|volume=40|issue=1 |pages=6–16|year=2008|url=http://www.guttmacher.org/pubs/journals/4000608.pdf|doi=10.1363/4000608|pmid=18318867|author-separator=,|display-authors=1|last2=Zolna|first2=Mia R. S.|last3=Henshaw|first3=Stanley K.|last4=Finer|first4=Lawrence B.}}</ref> in 2010 the figure increased to 17%.<ref>{{cite news| url=http://www.washingtonpost.com/wp-dyn/content/article/2011/01/11/AR2011011107331.html | work=The Washington Post | first=Rob | last=Stein | title=Decline in U.S. abortion rate stalls | date=2011-01-11}}</ref> 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.<ref>{{Cite journal|author=Spitz, I.M|title=Early pregnancy termination with mifepristone and misoprostol in the United States|journal=New England Journal of Medicine|year=1998|volume=338|issue=18|pmid=9562577 |doi=10.1056/NEJM199804303381801|page=1241 |last2=Bardin|first2=CW|last3=Benton |first3=L|last4=Robbins|first4=A|pages=1241–7}}</ref> Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, surgical abortion must be used to complete the procedure.<ref>{{Cite book|chapter=31. Induced Abortion|last=Trupin|first=Suzanne R.|title=Danforth's Obstetrics and Gynecology|edition=9|year=2003|editor1-last=Scott|editor1-first=James R.|editor2-last=Gibbs|editor2-first=Ronald S.|editor3-last=Karlan|editor3-first=Beth y.|editor4-last=Haney|editor4-first=Arthur F.|publisher=Lippincott Williams & Wilkins|isbn=978-0781737302}}</ref> |
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===Surgical=== |
===Surgical=== |
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===Other methods=== |
===Other methods=== |
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[[File:AngkorWatAbortionAD1150.JPG|thumb|left|[[Bas-relief]] at [[Angkor Wat]], [[Cambodia]], c. 1150, depicting a [[demon]] inducing an abortion by pounding the abdomen of a pregnant woman with a [[pestle]].<ref>{{Cite book|author=Potts M |
[[File:AngkorWatAbortionAD1150.JPG|thumb|left|[[Bas-relief]] at [[Angkor Wat]], [[Cambodia]], c. 1150, depicting a [[demon]] inducing an abortion by pounding the abdomen of a pregnant woman with a [[pestle]].<ref>{{Cite book|author=Potts M |title=Thousand-year-old depictions of massage abortion |journal=Journal of Family Planning and Reproductive Health Care |volume=33 |page=234 |year=2007 |quote=at Angkor, the operator is a demon.|author-separator=,|display-authors=1}} Also see {{Cite book|author=Mould R |title=Mould's Medical Anecdotes |page=406 |publisher=CRC Press |year=1996|isbn=978-0-85274-119-1}}</ref>]] |
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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 [[Abortion#History|history of abortion]]).<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, Massachusetts]] |year=1997 |pages= |isbn=978-0-674-27024-4 |oclc=36126503}}{{Page needed|date=August 2010}}</ref> The use of herbs in such a manner can cause serious—even lethal—side effects, such as [[multiple organ dysfunction syndrome|multiple organ failure]], and is not recommended by [[physician]]s.<ref>{{Cite journal|author=Ciganda C, Laborde A |title=Herbal infusions used for induced abortion |journal=J. Toxicol. Clin. Toxicol. |volume=41 |issue=3 |pages=235–239 |year=2003 |pmid=12807304 |doi=10.1081/CLT-120021104 |url= |
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 [[Abortion#History|history of abortion]]).<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, Massachusetts]] |year=1997 |pages= |isbn=978-0-674-27024-4 |oclc=36126503}}{{Page needed|date=August 2010}}</ref> The use of herbs in such a manner can cause serious—even lethal—side effects, such as [[multiple organ dysfunction syndrome|multiple organ failure]], and is not recommended by [[physician]]s.<ref>{{Cite journal|author=Ciganda C, Laborde A |title=Herbal infusions used for induced abortion |journal=J. Toxicol. Clin. Toxicol. |volume=41 |issue=3 |pages=235–239 |year=2003 |pmid=12807304 |doi=10.1081/CLT-120021104 |url=}}</ref> |
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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> |
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 doi|10.1016/S0891-5245(98)90245-0}}</ref> Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries.{{Citation needed|date=June 2011}} 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 = 233–234 | 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" /> |
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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.<ref>{{Cite journal| |
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.<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 = 697–698 | year = 2006 | pmid = 16969439| url = http://www.racgp.org.au/afp/200609/11015}}</ref> |
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==Safety== |
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The health risks of abortion depend on 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.<ref name="who-unsafe-1995">{{cite web| publisher = [[World Health Organization]] | title = The Prevention and Management of Unsafe Abortion | date = April 1995 | accessdate = June 1, 2010 | url = http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf |format = [[Portable Document Format|PDF]]}}</ref> Abortion, when performed in the [[developed country|developed world]] in accordance with local law, is among the safest procedures in medicine.<ref name="lancet-grimes">{{cite journal |author=Grimes DA |title=Unsafe abortion: the preventable pandemic |journal=Lancet |volume=368 |issue=9550 |pages=1908–19 |year=2006 |pmid=17126724 |doi=10.1016/S0140-6736(06)69481-6 |url=http://www.thelancetglobalhealthnetwork.com/wp-content/uploads/2008/04/sexual_reproductive_health4.pdf |format=PDF |author-separator=, |author2=Benson J |author3=Singh S |display-authors=3 |last4=Romero |first4=Mariana |last5=Ganatra |first5=Bela |last6=Okonofua |first6=Friday E |last7=Shah |first7=Iqbal H}}</ref><ref name="grimes-overview">{{cite journal |last1=Grimes|first1=DA|last2=Creinin|first2=MD |title=Induced abortion: an overview for internists |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=620–6 |year=2004 |pmid=15096333 |doi= 10.1001/archinte.140.5.620|url=http://www.annals.org/content/140/8/620.full}}</ref> In the US, the [[mortality rate|risk of maternal death]] from abortion is 0.567 per 100,000 procedures, making abortion approximately 12.5 times safer than childbirth (7.06 maternal deaths per 100,000 live births).<ref name="grimes-mortality">{{cite journal |author=Grimes DA |title=Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999 |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=1 |pages=92–4 |year=2006 |month=January |pmid=16389015 |doi=10.1016/j.ajog.2005.06.070 |url=}}</ref> The risk of abortion-related mortality increases with increasing 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=Obstet Gynecol |volume=103 |issue=4 |pages=729–37 |year=2004 |month=April |pmid=15051566 |doi=10.1097/01.AOG.0000116260.81570.60 |url= |author-separator=, |author2=Berg CJ |author3=Shulman HB |display-authors=3 |last4=Zane |first4=Suzanne B. |last5=Green |first5=Clarice A. |last6=Whitehead |first6=Sara |last7=Atrash |first7=Hani K.}}</ref><ref name="emedicine">{{cite web | publisher = [[eMedicine]] | title = Elective Abortion | date = May 27, 2010 | accessdate = June 1, 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}}</ref> |
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{{See also|Unsafe abortion#Health risks|l1=Health risks of unsafe abortion}} |
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Abortion, when legally performed in developed countries, is among the safest procedures in medicine.<ref name="lancet-grimes">{{Cite journal|author=Grimes DA, Benson J, Singh S, ''et al.'' |title=Unsafe abortion: the preventable pandemic |journal=Lancet |volume=368 |issue=9550 |pages=1908–19 |year=2006 |month=November |pmid=17126724 |doi=10.1016/S0140-6736(06)69481-6 |url=http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf}}</ref><ref name="grimes-overview">{{Cite journal|author=Grimes DA, Creinin MD |title=Induced abortion: an overview for internists |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=620–6 |year=2004 |month=April |pmid=15096333 |doi= 10.1001/archinte.140.5.620|url=http://www.annals.org/content/140/8/620.full}}</ref> In such settings, risk of [[maternal death]] is between 0.2–1.2 per 100,000 procedures.<ref name=IOB2003>{{Cite journal|author=Yanda K. et al |title=Reproductive health and human rights |journal=International journal of gynecology and obstetrics |volume=82 |issue=3 |pages=275–283 |year=2003 |month=Sept |pmid= 14499974|doi= 10.1016/S0020-7292(03)00226-1|url=http://www.ijgo.org/article/PIIS0020729203002261/fulltext}}</ref><ref>{{Cite journal|author=Vekemans M |title=Making induced abortion safe and legal, worldwide |journal=Eur J Contracept Reprod Health Care |volume=14 |issue=3 |pages=165–8 |year=2009 |month=June |pmid=19565413 |doi=10.1080/13625180902886371 |url=}}</ref><ref name="grimes-mortality">{{Cite journal|author=Grimes DA |title=Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999 |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=1 |pages=92–4 |year=2006 |month=January |pmid=16389015 |doi=10.1016/j.ajog.2005.06.070 |url=}}</ref><ref>{{Cite book|author=Douglas W. Laube; Barzansky, Barbara M.; Beckmann, Charles R. B.; Herbert, William G. |title=Obstetrics and Gynecology |publisher=Lippincott Williams & Wilkins |location=Hagerstown, Maryland |year=2009 |page=150 |isbn=978-0-7817-8807-6 |oclc= |doi= |accessdate=}}</ref> In comparison, by 1996, mortality from childbirth in developed countries was 11 times greater.<ref name="IOB2003"/><ref>{{Cite journal|author=Kulczycki A, Potts M, Rosenfield A |title=Abortion and fertility regulation |journal=Lancet |volume=347 |issue=9016 |pages=1663–8 |year=1996 |month=June |pmid=8642962 |doi= 10.1016/S0140-6736(96)91491-9|url=}}</ref><ref>{{Cite book|author=Danielle Mazza |title=Women's health in general practice |publisher=Butterworth-Heinemann |location=Oxford |year=2004 |page=93 |isbn=978-0-7506-8773-7 |oclc= |doi= |accessdate=}}</ref><ref>{{Cite book|author=Eric Sokol; Andrew Sokol |title=General gynecology |publisher=Mosby |location=St. Louis |year=2007 |page=238 |isbn=978-0-323-03247-6 |oclc= |doi= |accessdate=}}</ref><ref>{{Cite book|author=Lloyd, Cynthia B. |title=Growing up global: the changing transitions to adulthood in developing countries |publisher=National Academies Press |location=Washington, D.C |year=2005 |page=215 |isbn=978-0-309-09528-0 |oclc= |doi= |accessdate=}}</ref><ref>{{Cite book|author=Douglas W. Laube; Barzansky, Barbara M.; Beckmann, Charles R. B.; Herbert, William G. |title=Obstetrics and Gynecology |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2009 |page=150 |isbn=978-0-7817-8807-6 |oclc= |doi= |accessdate=}}</ref> [[Unsafe abortion]]s (defined by the [[World Health Organization]] as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) carry a high risk of maternal death and other complications.<ref name="who-unsafe-1995">{{cite web| publisher = [[World Health Organization]] | title = The Prevention and Management of Unsafe Abortion |date = April 1995| accessdate = June 1, 2010 | url = http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf |format = PDF}}</ref> For unsafe procedures, the mortality rate has been estimated at 367 per 100,000 (70,000 women per year worldwide).<ref name=OBGY09/><ref>{{Cite journal|author=Fawcus SR |title=Maternal mortality and unsafe abortion |journal=Best Pract Res Clin Obstet Gynaecol |volume=22 |issue=3 |pages=533–48 |year=2008 |month=June |pmid=18249585 |doi=10.1016/j.bpobgyn.2007.10.006 |url=}}</ref> |
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[[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 are rare and 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 |author=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}}</ref> Preventive antibiotics (such as [[doxycycline]] or [[metronidazole]]) are typically given before elective abortion,<ref>{{cite journal |author= |title=ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures |journal=Obstet Gynecol |volume=113 |issue=5 |pages=1180–9 |year=2009 |month=May |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>{{cite journal |author=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=Obstet Gynecol |volume=87 |issue=5 Pt 2 |pages=884–90 |year=1996 |month=May |pmid=8677129 |doi= |url=}}</ref> Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. A 2008 [[Cochrane Library]] review found that [[dilation and evacuation]] was safer than other means of second-trimester abortion.<ref name="cochrane-2nd-tri">{{cite journal |author=Lohr PA, Hayes JL, Gemzell-Danielsson K |title=Surgical versus medical methods for second trimester induced abortion |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD006714 |year=2008 |pmid=18254113 |doi=10.1002/14651858.CD006714.pub2 |url=http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006714/frame.html |editor1-last=Lohr |editor1-first=Patricia A.}}</ref> |
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===Physical health=== |
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Surgical abortion methods, like most [[minimally invasive procedure]]s, carry a small potential for serious complications.<ref>{{Cite book|author=[[World Health Organization]] |title=Medical Methods for Termination of Pregnancy: Report of a Who Scientific Group |series=Who Technical Report Series No. 871 |publisher=[[World Health Organization]] |location=[[Geneva]] |year=1997 |pages= |isbn=978-92-4-120871-0 |oclc=38276325}}{{Page needed|date=August 2010}}</ref> |
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Medical abortion with [[mifepristone]] and [[misoprostol]] is effective through 49 days of gestational age.<ref name="nejm-mifepristone">{{cite journal |author=Spitz IM, Bardin CW, Benton L, Robbins A |title=Early pregnancy termination with mifepristone and misoprostol in the United States |journal=N. Engl. J. Med. |volume=338 |issue=18 |pages=1241–7 |year=1998 |month=April |pmid=9562577 |doi= 10.1056/NEJM199804303381801|url=}}</ref> It has been used in women up to 63 days of gestational age, albeit with an increased risk of failure (requiring surgical abortion).<ref>{{cite journal |author=Aubény E |title=Termination of early pregnancy (up to 63 days of amenorrhea) with mifepristone and increasing doses of misoprostol [corrected] |journal=Int J Fertil Menopausal Stud |volume=40 Suppl 2 |issue= |pages=85–91 |year=1995 |pmid=8574255 |doi= |url= |author-separator=, |author2=Peyron R |author3=Turpin CL |display-authors=3 |last4=Renault |first4=M |last5=Targosz |first5=V |last6=Silvestre |first6=L |last7=Ulmann |first7=A |last8=Baulieu |first8=EE}}</ref> Medical abortion is generally considered as safe as surgical abortion in the first trimester, but is associated with more pain and a lower success rate (requiring surgical abortion).<ref name="who-medical-abortion">{{cite web | publisher = [[World Health Organization]] | title = Medical versus surgical methods for first trimester termination of pregnancy | url = http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html | date = December 15, 2006 | accessdate = June 1, 2010}}</ref> Overall, the risk of [[endometritis|uterine infection]] is lower with medical than with surgical abortion,<ref name="nejm-mifepristone"/> although in 2005 four deaths after medical abortion were reported due to infection with ''[[Clostridium sordellii]]''.<ref name="c-sordellii">{{cite journal |author=Fischer M |title=Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion |journal=N. Engl. J. Med. |volume=353 |issue=22 |pages=2352–60 |year=2005 |month=December |pmid=16319384 |doi=10.1056/NEJMoa051620 |url= |author-separator=, |author2=Bhatnagar J |author3=Guarner J |display-authors=3 |last4=Reagan |first4=Sarah |last5=Hacker |first5=Jill K. |last6=Van Meter |first6=Sharon H. |last7=Poukens |first7=Vadims |last8=Whiteman |first8=David B. |last9=Iton |first9=Anthony}}</ref> As a result, some abortion providers have begun using preventive antibiotics with medical abortion.<ref name="nejm-pp">{{cite journal |author=Fjerstad M, Trussell J, Sivin I, Lichtenberg ES, Cullins V |title=Rates of serious infection after changes in regimens for medical abortion |journal=N. Engl. J. Med. |volume=361 |issue=2 |pages=145–51 |year=2009 |month=July |pmid=19587339 |doi=10.1056/NEJMoa0809146 |url=}}</ref> |
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Surgical abortion is generally safe and the rate of major complications is low<ref>{{Cite book|last1=Botha|first1=Rosanne L.|last2=Bednarek|first2=Paula H.|last3=Kaunitz|first3=Andrew M.|coauthors=Alison B. Edelman|editor=Guy I Benrubi |title=Handbook of Obstetric and Gynecologic Emergencies |edition=4|year=2010|publisher=Lippincott Williams & Wilkins|isbn=978-1-60547-666-7|page=256|chapter=Complications of Medical and Surgical Abortion|quote=Although first trimester medical and surgical abortion are safe with low rates of major complications, these are common procedures, and therefore it is not unusual for women with abortion complications to present for emergent care.}}</ref> but varies depending on how far pregnancy has progressed and the surgical method used.<ref name="Pregler"/> Concerning gestational age, incidence of major complications is highest after 20 weeks of gestation and lowest before the 8th week.<ref name="Pregler"/> With more advanced gestation there is a higher risk of [[uterine perforation]] and retained products of conception,<ref name="Rello">{{Cite book|editor=Jordi Rello|title=Infectious diseases in critical care|edition=2|publisher=Springer|isbn=978-3-540-34405-6|page=490}}</ref> and specific procedures like [[dilation and evacuation]] may be required.<ref name="cochrane-2nd-tri">{{Cite journal|author=Lohr PA, Hayes JL, Gemzell-Danielsson K |title=Surgical versus medical methods for second trimester induced abortion |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD006714 |year=2008 |pmid=18254113 |doi=10.1002/14651858.CD006714.pub2 }}</ref> |
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In contrast, [[unsafe abortion]] is 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 abortion is believed to result in approximately 68,000 deaths<ref name="Haddad-2009">{{Cite journal|last1 = Haddad |first1 = LB. |last2 = Nour |first2 = NM. |title = Unsafe abortion: unnecessary maternal mortality |journal = Rev Obstet Gynecol |volume = 2 |issue = 2 |pages = 122–6|year = 2009 |doi = |pmid = 19609407 |pmc = 2709326}}</ref> and millions of injuries annually.<ref name="lancet-grimes"/> The legal status of abortion is believed to play a major role in the frequency of unsafe abortion.<ref>{{cite journal |author=Berer M |title=National laws and unsafe abortion: the parameters of change |journal=Reprod Health Matters |volume=12 |issue=24 Suppl |pages=1–8 |year=2004 |month=November |pmid=15938152 |doi= 10.1016/S0968-8080(04)24024-1|url=}}</ref><ref name="berer-who"/> 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 |author=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 |volume=112 |issue=3 |pages=355–9 |year=2005 |month=March |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=S. Afr. Med. J. |volume=97 |issue=12 |pages=1238–42 |year=2007 |month=December |pmid=18264602 |doi= |url=}}</ref> Groups such as the [[World Health Organization]] have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the 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=Bull. World Health Organ. |volume=78 |issue=5 |pages=580–92 |year=2000 |pmid=10859852 |pmc=2560758 |doi= }}</ref> |
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Concerning the methods used, general incidence of major complications for surgical abortion varies from lower for suction curettage, to higher for saline instillation.<ref name="Pregler">{{Cite book|last1=Pregler|first1=Janet P. |last2=DeCherney|first2=Alan H. |title=Women's health: principles and clinical practice |year=2002 |publisher=pmph usa |isbn=978-1-55009-170-0 |page=232}}</ref> Possible complications include [[hemorrhage]], incomplete abortion, uterine or pelvic infection, ongoing intrauterine pregnancy, misdiagnosed/unrecognized [[ectopic pregnancy]], [[hematometra]] (in the uterus), [[uterine perforation]] and cervical laceration.<ref>{{Cite book|last1=Botha|first1=Rosanne L. |last2=Bednarek|first2=Paula H. |last3=Kaunitz|first3=Andrew M. |coauthors=Alison B. Edelman |editor=Guy I Benrubi |title=Handbook of Obstetric and Gynecologic Emergencies |edition=4 |year=2010 |publisher=Lippincott Williams & Wilkins |isbn=978-1-60547-666-7 |page=258 |chapter=Complications of Medical and Surgical Abortion}}</ref> Use of [[general anesthesia]] increases the risk of complications because it relaxes uterine musculature making it easier to perforate.<ref>{{Cite book|last1=Morgan|first1=Mark |last2=Siddighi|first2=Sam |title=NMS Obstetrics and Gynecology |edition=5 |series=National Medical Series for Independent Study |year=2004 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-2679-5 |page=140}}</ref> |
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=== Breast cancer hypothesis=== |
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Women who have uterine anomalies, [[leiomyomas]] or had previous difficult first-trimester abortion are contraindicated to undertake surgical abortion unless [[Medical ultrasonography|ultrasonography]] is immediately available and the surgeon is experienced in its intraoperative use.<ref>{{Cite book|last1=Speroff|first1=Leon|last2=Fritz|first2=Marc A.|title=Clinical gynecologic endocrinology and infertility|edition=7|year=2004|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-4795-0|page=851|chapter=Family Planning, Sterilization, and Abortion}}</ref> Abortion does not impair subsequent pregnancies, nor does it increase the risk of future [[premature birth]]s, infertility, [[ectopic pregnancy]], or miscarriage.<ref name="grimes-overview"/> |
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{{main|Abortion-breast cancer hypothesis}} |
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Although some studies have postulated an [[abortion – breast cancer hypothesis|association between abortion and breast cancer]], the current [[scientific consensus]] says no causal relationship exists. Major medical bodies, including the [[World Health Organization]],<ref>{{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=2011-01-06}}</ref> the U.S. [[National Cancer Institute]],<ref>{{cite web| url=http://www.cancer.gov/cancertopics/factsheet/risk/abortion-miscarriage| title=Abortion, Miscarriage, and Breast Cancer Risk| publisher=National Cancer Institute| accessdate=2011-01-11}}</ref> the [[American Cancer Society]],<ref name="acs-abortion-breast-cancer">{{cite web | url = http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer | publisher = [[American Cancer Society]] | date = September 23, 2010 | accessdate = June 20, 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.}}</ref> and the [[Royal College of Obstetricians and Gynaecologists]],<ref name="rcog_2000">{{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 |work=Royal College of Obstetricians and Gynaecologists |accessdate=2008-06-29|quote=Induced abortion is not associated with an increase in breast cancer risk.}}</ref> have concluded on the basis of existing evidence that abortion does not cause breast cancer.<ref name="JASEN">{{cite journal |author=Jasen P |title=Breast cancer and the politics of abortion in the United States |journal=Med Hist |volume=49 |issue=4 |pages=423–44 |year=2005 |pmid=16562329 |pmc=1251638}}</ref><ref>{{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=July 31, 2003| publisher= American Congress of Obstetricians and Gynecologists| accessdate=2011-01-11}}</ref> The concept of a link between induced abortion and breast cancer is promoted primarily by pro-life groups.<ref name="JASEN"/> |
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<!-- pain should be better defined to avoid ignoring a possible complication |
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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.<ref name="pmid443287">{{cite journal |author=Smith GM, Stubblefield PG, Chirchirillo L, McCarthy MJ |title=Pain of first-trimester abortion: its quantification and relations with other variables |journal=[[Am J Obstet Gynecol]] |volume=133 |issue=5 |pages=489–498 |year=1979 |pmid=443287 |doi= |url=}}</ref>{{Better source|date=December 2010}}--> |
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In the first trimester, [[Medical abortion#Health risks|health risks associated with medical abortion]] are generally considered no greater than for surgical abortion.<ref name="who-medical-abortion">{{cite web| publisher = [[World Health Organization]] | title = Medical versus surgical methods for first trimester termination of pregnancy | url = http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html | date = December 15, 2006 | accessdate = June 1, 2010}}</ref> |
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Although some epidemiological studies suggest an [[abortion – breast cancer hypothesis|association between abortion and breast cancer]], the [[World Health Organization]] has concluded from large cohort studies that there is "no consistent effect of first trimester induced abortion upon a woman's risk of breast cancer later in life".<ref>{{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=2011-01-06}}</ref><ref name=autogenerated1>{{cite journal |author=McCredie M et al. |title= |journal=[[International Journal of Cancer]] |volume=76 |issue= |pages=182–88 |year=1998 |pmid= |doi= |url=}}</ref> The [[National Cancer Institute]],<ref>{{cite web| url=http://www.cancer.gov/cancertopics/factsheet/risk/abortion-miscarriage| title=Abortion, Miscarriage, and Breast Cancer Risk| publisher=National Cancer Institute| accessdate=2011-01-11}}</ref> the [[Royal College of Obstetricians and Gynaecologists]],<ref name="rcog_2000">{{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 |work=Royal College of Obstetricians and Gynaecologists |accessdate=2008-06-29|quote=Induced abortion is not associated with an increase in breast cancer risk.}}</ref> and other major medical bodies have concluded that abortion does not cause breast cancer.<ref name="JASEN">{{cite journal |author=Jasen P |title=Breast cancer and the politics of abortion in the United States |journal=Med Hist |volume=49 |issue=4 |pages=423–44 |year=2005 |pmid=16562329 |pmc=1251638}}</ref><ref>{{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=July 31, 2003| publisher= American Congress of Obstetricians and Gynecologists| accessdate=2011-01-11}}</ref> |
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===Mental health=== |
===Mental health=== |
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{{Main|Abortion and mental health}} |
{{Main|Abortion and mental health}} |
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The current [[scientific consensus]] holds that there is no causal relationship between abortion and mental-health problems. There are groups of women who may be at higher risk of coping with problems and distress following abortion.<ref name="Cockburn">{{Cite book|last1=Cockburn|first1=Jayne |last2=Pawson|first2=Michael E. |title=Psychological Challenges to Obstetrics and Gynecology: The Clinical Management |year=2007 |publisher=Springer |isbn=978-1-84628-807-4 |page=243}}</ref> Some 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.<ref name="APA89">{{Cite journal|author=Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE |title=Psychological responses after abortion |journal=[[Science (journal)|Science]] |volume=248 |issue=4951 |pages=41–4 |year=1990 |pmid=2181664 |doi=10.1126/science.2181664}}</ref> The American Psychological Association has concluded, based on available scientific evidence, that a single abortion is not a threat to women's mental health, and that women are no more likely to have mental-health problems after a first-trimester abortion than after carrying an unwanted pregnancy to term.<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 = August 12, 2008 | accessdate = September 7, 2011 | url = http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx}}</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=August 13, 2008}}</ref> Similarly, abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems, though researchers have not examined the effect of second-trimester abortions performed for reasons besides fetal abnormalities.<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> |
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Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome |
Some studies{{specify}} have disagreed with above conclusions, stating that there is a significant increase in mental health problems after abortion. However, such studies have been criticized by other researchers and professional organizations for failing to fully account for pre-existing mental health complications, the severity or lack thereof of any such complications, or improper selection of control groups to account for confounding variables.<ref>{{cite web|url=http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-bjpsych-paper-mental-health-risks-and-a|title=RCOG statement on BJPsych paper on mental health risks and abortion|publisher=Royal College of Obstetricians and Gynaecologists|date=1 September 2011|accessdate=6 September 2011|deadurl=no}}</ref><ref>{{cite doi|10.1056/NEJMoa0905882}}</ref><ref>{{Cite pmid|19014789}}</ref> Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called [[Abortion_and_mental_health#Post-Abortion_Syndrome|"post-abortion syndrome"]]. However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization.<ref name="Grimes">{{Cite journal|last1=Grimes|first1=DA|last2=Creinin|first2=MD |title=Induced abortion: an overview for internists |journal=[[Ann Intern Med]] |volume=140 |issue=8 |pages=620–6 |year=2004 |pmid=15096333 |doi=10.1001/archinte.140.5.620 |quote=Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae. ... The alleged 'postabortion trauma syndrome' does not exist.}}</ref><ref name="stotlandreview">{{Cite journal|author=Stotland NL |title=Abortion and psychiatric practice |journal=[[J Psychiatr Pract]] |volume=9 |issue=2 |pages=139–149 |year=2003 |pmid=15985924 |doi=10.1097/00131746-200303000-00005 |quote=Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae.}}</ref><ref name="stotland_1404747">{{Cite journal|author=Stotland NL |title=The myth of the abortion trauma syndrome |journal=[[J Am Med Assoc]] |volume=268 |issue=15 |pages=2078–9 |year=1992 |month=October |pmid=1404747 |doi=10.1001/jama.268.15.2078}}</ref> |
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==Incidence== |
==Incidence== |
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There are two commonly used methods of measuring incidence of abortion: |
There are two commonly used methods of measuring the incidence of abortion: |
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* Abortion rate |
* Abortion rate – number of abortions per 1000 women between 15 and 44 years of age |
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* Abortion ratio |
* Abortion ratio – number of abortions out of 100 known pregnancies (excluding miscarriages and stillbirths) |
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The number of abortions performed worldwide has decreased between 1995 and 2003 from 45.6 million to 41.6 million, which means a decrease in abortion rate from 35 to 29 per 1000 women. The greatest decrease has occurred in the developed world with a drop from 39 to 26 per 1000 women in comparison to the developing world, which had a decrease from 34 to 29 per 1000 women. Out of a total of about 42 million abortions 22 million occurred safely and 20 million unsafely.<ref name=OBGY09/> |
The number of abortions performed worldwide has decreased between 1995 and 2003 from 45.6 million to 41.6 million, which means a decrease in abortion rate from 35 to 29 per 1000 women. The greatest decrease has occurred in the developed world with a drop from 39 to 26 per 1000 women in comparison to the developing world, which had a decrease from 34 to 29 per 1000 women. Out of a total of about 42 million abortions 22 million occurred safely and 20 million unsafely.<ref name=OBGY09/> |
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On average, the frequency of abortions is similar in developing countries (where abortion is generally restricted) to the frequency in developed countries (where abortion is generally much less restricted).<ref name=IJGO10/><ref>{{Cite journal|author=Shah I, Ahman E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=[[J Obstet Gynaecol Can]] |volume=31 |issue=12 |pages=1149–58 |year=2009 |month=December |pmid=20085681 |doi= |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><!--This sentence is currently the subject of discussion at the talk page, with an eye to improving it--> |
On average, the frequency of abortions is similar in developing countries (where abortion is generally restricted) to the frequency in developed countries (where abortion is generally much less restricted).<ref name=IJGO10/><ref>{{Cite journal|author=Shah I, Ahman E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=[[J Obstet Gynaecol Can]] |volume=31 |issue=12 |pages=1149–58 |year=2009 |month=December |pmid=20085681 |doi= |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><!--This sentence is currently the subject of discussion at the talk page, with an eye to improving it--> Abortion rates are very difficult to measure in locations where those abortions are illegal,<ref>Sedgh, Gilda and Henshaw, Stanley. "Measuring the Incidence of Abortion in Countries With Liberal Laws" in ''Methodologies for Estimating Abortion Incidence and Abortion-Related Morbidity: A Review'', (Guttmacher Institute 2010): "In countries with highly restrictive abortion laws, it is extremely difficult to obtain reliable counts of the numbers of procedures performed."</ref> and pro-life groups have criticized researchers for allegedly jumping to conclusions about those numbers.<ref>{{cite news|last=Rosenthal|first=Elizabeth|url=http://www.nytimes.com/2007/10/12/world/12abortion.html?|title=Legal or Not, Abortion Rates Compare|newspaper=The New York Times|date=October 12, 2007|quote=Anti-abortion groups criticized the research, saying that the scientists had jumped to conclusions from imperfect tallies, often estimates of abortion rates in countries where the procedure was illegal.|accessdate=July 18, 2011}}</ref> According to the [[Guttmacher Institute]] and the [[United Nations Population Fund]], the abortion rate in developing countries is largely attributable to lack of access to modern contraceptives; assuming no change in abortion laws, providing that access to contraceptives would result in about 25 million fewer abortions annually, including almost 15 million fewer unsafe abortions.<ref>Singh, Susheela et al. ''[http://www.guttmacher.org/pubs/AddingItUp2009.pdf Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health]'', pages 17, 19, and 27 (New York: Guttmacher Institute and United Nations Population Fund 2009): "Some 215 million women in the developing world as a whole have an unmet need for modern contraceptives…. If the 215 million women with unmet need used modern family planning methods....[that] would result in about 22 million fewer unplanned births; 25 million fewer abortions; and seven million fewer miscarriages....If women’s contraceptive needs were addressed (and assuming no changes in abortion laws)...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "[http://www.guttmacher.org/pubs/FB-AIU-summary.pdf Facts on Investing in Family Planning and Maternal and Newborn Health]" (Guttmacher Institute 2010).</ref> |
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The incidence of induced abortion varies regionally. |
The incidence of induced abortion varies regionally. Some countries, such as Belgium (11.2 out of 100 known pregnancies) and the Netherlands (10.6 per 100), had a comparatively low ratio of induced abortion. Others like Russia (62.6 out of 100), Romania (63 out of 100)<ref>[[National Institute of Statistics (Romania)|National Institute of Statistics]], [http://www.insse.ro/cms/files/pdf/ro/cap2.pdf Romanian Statistical Yearbook, page 29], 2008</ref> and Vietnam (43.7 out of 100) had a high ratio (data for last three countries of unknown completeness). The estimated world ratio was 26%, the world rate - 35 per 1000 women.<ref>Henshaw, Stanley K., Singh, Susheela, and Haas, Taylor. (1999). [http://www.guttmacher.org/pubs/journals/25s3099.html The Incidence of Abortion Worldwide]. ''International Family Planning Perspectives, 25 (Supplement)'', 30–38. Retrieved 2006-01-18.</ref> |
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===By gestational age and method=== |
===By gestational age and method=== |
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{{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. Average is 9.5 weeks. ( |
{{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. Average is 9.5 weeks. (Data source: [[Department of Health (United Kingdom)|United Kingdom Department of Health]]) (left)<p>Abortion in the United States by gestational age, 2004. (Data source: Centers for Disease Control and Prevention) (right) ||}} |
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Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, |
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 abortions were known to have been obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 4.1% at 16 through 20 weeks and 1.4% at more than 21 weeks. 90.9% of these were classified as having been done by "[[curettage]]" ([[Suction-aspiration abortion|suction-aspiration]], [[Dilation and curettage]], [[Dilation and evacuation]]), 7.7% by "[[medical abortion|medical]]" means ([[mifepristone]]), 0.4% by "[[instillation abortion|intrauterine instillation]]" (saline or [[prostaglandin]]), and 1.0% by "other" (including [[hysterotomy abortion|hysterotomy]] and [[hysterectomy]]).<ref name="cdc2003">Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., and Hamdan, S. (November 24, 2006). [http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm Abortion Surveillance – United States, 2003]. ''Morbidity and Mortality Weekly Report, 55 (11),'' 1–32. Retrieved May 10, 2007.</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 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}}</ref> |
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Later abortions are more common in China, India, and other developing countries than in developed countries.<ref>Cheng L. [http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html “Surgical versus medical methods for second-trimester induced abortion : RHL commentary”] (last revised: 1 November 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.</ref> |
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.<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 }}</ref> 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.<ref>{{cite web|author=Department of Health |year=2007 |title=Abortion statistics, England and Wales: 2006 |url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |accessdate=2007-10-12}}</ref> Later abortions are more common in China, India, and other developing countries than in developed countries.<ref>Cheng L. [http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html “Surgical versus medical methods for second-trimester induced abortion : RHL commentary”] (last revised: 1 November 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.</ref> |
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===Personal and social factors=== |
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[[File:AGIAbortionReasonsBarChart.png|thumb|A bar chart depicting selected data from the 1998 [[Alan Guttmacher Institute|AGI]] [[meta-study]] on the reasons women stated for having an abortion.]] |
[[File:AGIAbortionReasonsBarChart.png|thumb|A bar chart depicting selected data from the 1998 [[Alan Guttmacher Institute|AGI]] [[meta-study]] on the reasons women stated for having an abortion.]] |
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A 1998 study from 27 countries on the reasons women seek to terminate their pregnancies concluded that the most common reason women cited for having an abortion was to postpone childbearing to a more suitable time or to focus energies and resources on existing children. |
A 1998 study from 27 countries on the reasons women seek to terminate their pregnancies concluded that the most common reason women cited for having an abortion was to postpone childbearing to a more suitable time or to focus energies and resources on existing children. The most commonly reported reasons were socioeconomic factors such as being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while she is caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of education, relationship problems with a husband or partner, the perception that she is too young, and unemployment.<ref name="bankole98">Bankole, Akinrinola, Singh, Susheela, and Haas, Taylor. (1998). [http://www.guttmacher.org/pubs/journals/2411798.html Reasons Why Women Have Induced Abortions: Evidence from 27 Countries]. ''International Family Planning Perspectives, 24 (3)'', 117–127 and 152. Retrieved 2006-01-18.</ref> A 2004 study in which American women at [[abortion clinic|clinics]] answered a questionnaire yielded similar results.<ref name="finer2005">Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Shusheela, and Moore, Ann M. (2005). [http://www.guttmacher.org/pubs/journals/3711005.pdf Reasons U.S. women have abortions: quantative and qualitative perspectives]. ''Perspectives on Sexual and Reproductive Health, 37 (3),'' 110–118. Retrieved 2006-01-18.</ref> A 1998 survey found risk to maternal health cited as the main reason by 5-10% in seven countries and by 20-38% in three (Kenya, Bangladesh and India).<ref name="bankole98"/> A 1997 U.S. report cited maternal health the "most important reason" for their decision by 3% of women and another 3% cited concern that the fetus had a health problem.<ref name="guttmacher" /> In a 2004 survey-based U.S. study, 1% of women having abortions became pregnant as a result of [[rape]] and 0.5% as a result of [[incest]].<ref name="finer2005"/> Another American study in 2002 concluded that 54% of women who had an abortion were using a form of [[birth control|contraception]] at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using [[condom]]s and 76% of those using the [[combined oral contraceptive 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}}</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>Susan A. Cohen: [http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html ''Abortion and Women of Color: The Bigger Picture''], Guttmacher Policy Review, Summer 2008, Volume 11, Number 3.</ref> |
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Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled people, 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]]. |
Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled people, 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]]. |
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[[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."]] |
[[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."]] |
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{{Main|Unsafe abortion}} |
{{Main|Unsafe abortion}} |
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Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. |
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. About one in eight pregnancy-related deaths worldwide are associated with unsafe abortion.<ref>Maclean, Gaynor. [http://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA300&dq=%22Unsafe+abortion%22&hl=en&ei=oQZ8TbnsGovVgAeRntzlBw&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFsQ6AEwBzge#v=onepage&q=%22Unsafe%20abortion%22&f=false "Dimension, Dynamics and Diversity; A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives"], pages 299-300 in Trends in Midwifery Research by Randell Balin (Nova Publishers, 2005).</ref> |
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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."<ref name="whounsafe">World Health Organization. (2004). [http://www.who.int/reproductive-health/publications/unsafeabortion_2000/estimates.pdf "Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000"]. Retrieved 2009-03-22.</ref> They may be performed by [[self-induced abortion|the woman herself]], by another person without medical training, or by a healthcare professional operating in sub-standard conditions. Unsafe abortion remains a public health concern due to the higher incidence and severity of its associated complications, such as incomplete abortion, [[sepsis]], hemorrhage, and damage to internal organs. |
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."<ref name="whounsafe">World Health Organization. (2004). [http://www.who.int/reproductive-health/publications/unsafeabortion_2000/estimates.pdf "Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000"]. Retrieved 2009-03-22.</ref> They may be performed by [[self-induced abortion|the woman herself]], by another person without medical training, or by a healthcare professional operating in sub-standard conditions. Unsafe abortion remains a public health concern due to the higher incidence and severity of its associated complications, such as incomplete abortion, [[sepsis]], hemorrhage, and damage to internal organs. |
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The legality of abortion is one of the main determinants of its safety. Restrictive abortion laws are associated with a high rate of unsafe abortions.<ref name="OBGY09"/><ref name="Worldwide"/><ref name="WHO-unsafe-2007">{{cite web | publisher = [[World Health Organization]] | year = 2007 | accessdate = March 7, 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}}</ref> In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.<ref name=Singh>Singh, Susheela et al. |
The legality of abortion is one of the main determinants of its safety. Restrictive abortion laws are associated with a high rate of unsafe abortions.<ref name="OBGY09"/><ref name="Worldwide"/><ref name="WHO-unsafe-2007">{{cite web | publisher = [[World Health Organization]] | year = 2007 | accessdate = March 7, 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}}</ref> In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.<ref name=Singh>Singh, Susheela et al. ''[http://www.guttmacher.org/pubs/AddingItUp2009.pdf Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health]'' (New York: Guttmacher Institute and United Nations Population Fund 2009): "If women’s contraceptive needs were addressed (and assuming no changes in abortion laws)...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "[http://www.guttmacher.org/pubs/FB-AIU-summary.pdf Facts on Investing in Family Planning and Maternal and Newborn Health]" (Guttmacher Institute 2010).</ref> |
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Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.<ref name="IJGO10"/> 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 |
Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.<ref name="IJGO10"/> 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 12% of [[maternal death|maternal mortalities]] in Asia, 25% in Latin America, and 13% in [[sub-Saharan Africa]].<ref>{{cite journal|author=Salter, C., Johnson, H.B., and 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=http://www.webcitation.org/61MhmDwmL|archivedate=September 1, 2011}}</ref> Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.<ref name="WHO-unsafe-2007"/> 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.<ref name="Worldwide">{{cite journal | author = 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}}</ref> 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|author=[[UNICEF]], [[United Nations Population Fund]], WHO, World Bank|year=2010|url=http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html|accessdate=December 31, 2010}}</ref> |
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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|author=[[UNICEF]], [[United Nations Population Fund]], WHO, World Bank|year=2010|url=http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html|accessdate=December 31, 2010}}</ref> |
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[[File:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|right|"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the ''Boston Daily Times''.]] |
[[File:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|right|"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the ''Boston Daily Times''.]] |
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{{Main|History of abortion}} |
{{Main|History of abortion}} |
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Induced abortion can be traced to |
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, page 2" /> 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. |
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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, page 2">{{cite book|chapter=1. Abortion and medicine: A sociopolitical history|isbn=9781444312935|page=2|publisher=[[John Wiley & Sons, Ltd.]]|year=2009|location=[[Oxford, United Kingdom]]|title=Management of Unintended and Abnormal Pregnancy|edition=1st|editors=MPaul, ES Lichtenberg, L Borgatta, DA Grimes, PG Stubblefield, MD Creinin|first=Carole|last=Joffe}}</ref> However, other modern scholars disagree with this interpretation,<ref name="Management of Abortion, page 2" /> and the medical texts of [[Hippocratic Corpus]] contain descriptions of abortive techniques and notes on the risks they posed to a woman's health.<ref>{{Cite book| first = Steven | last = Miles | title =The Hippocratic Oath and the Ethics of Medicine| year = 2005| publisher = Oxford University Press| isbn = 978-0195188202}}</ref> In Christianity, [[Pope Sixtus V]] (1585–90) is noted as the first Pope 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://hdl.handle.net/2286/embryo:124802|publisher=Arizona State University}}</ref> the Church had previously been divided on whether if believed that abortion was murder, and did not begin vigorously opposing abortion until the 19th century.<ref name="Management of Abortion, page 2" /> [[Islam and abortion|Islamic tradition]] has traditionally permitted abortion up until a point in time when Muslims believe the soul enters the fetus,<ref name="Management of Abortion, page 2" /> considered by various theologians to be at conception, at 40 days after conception, at 120 days after conception, or at [[quickening]].<ref name="BBC and Islam / Abortion">http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml</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=http://www.prb.org/pdf08/MENAabortion.pdf|archivedate=July 8, 2011|year=2008|format=PDF}}</ref> |
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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 (Greek Physician)|Soranus]], a 2nd-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.<ref>{{Cite book|first=Mary R. |last=Lefkowitz |authorlink=Mary Lefkowitz |coauthors=Maureen B. Fant |title=Women's life in Greece & Rome: a source book in translation |publisher=[[Johns Hopkins University Press]] |location=[[Baltimore]] |year=1992 |pages= |isbn=978-0-8018-4474-4 |oclc=25373320 |url=http://www.stoa.org/diotima/anthology/wlgr/ |accessdate=2008-12-02}}</ref> 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 [[Adverse effect (medicine)|side effects]] that have at times been used to terminate pregnancy. |
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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, page 2" /> Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice was banned in both the United States and the United Kingdom.<ref name="Management of Abortion, page 2" /> Church groups as well as physicians were highly influential in anti-abortion movements.<ref name="Management of Abortion, page 2" /> In the U.S., abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.<ref>By 1930, medical procedures in the U.S. 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 vs. Wade'' acknowledged that abortion in the first trimester was safer than childbirth.<br />{{•}}{{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.}}<br />{{•}}{{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=0029344352}}<br />{{•}}{{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=January 28, 2001 |accessdate=May 1, 2011}}<br />{{•}}{{cite book |url=http://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=0816043299}}<br />{{•}}{{cite journal |title=Pregnancy termination |work=Population reports |publisher=Population Information Program, The Johns Hopkins University |year=1980 |author=George Washington University. Population Information Program, George Washington University. Dept. of Medical and Public Affairs, Johns Hopkins University. Population Information Program |issue=7}}<br />{{•}}{{cite web |title=Birthing a Nation: Fertility Control Access and the 19th Century Demographic Transition |last=Lahey |first=Joanna N. |publisher=Pomona College |date=September 24, 2009 |url=http://economics.pomona.edu/colloquium/ |work=Colloquium}}</ref> The Soviet Union (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 |archiveurl=http://web.archive.org/web/20080208053146/http://www.cbctrust.com/history_law_religion.php |archivedate=2008-02-08 |title=Abortion Law, History & Religion |accessdate=2008-03-23 |publisher=Childbirth By Choice Trust}}</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>{{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 |page=[http://books.google.com/books?id=gqLDEKVk2nMC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA30,M1 30] |isbn=978-0-8078-4675-9 |oclc=60191622}}</ref><ref>{{Cite book|first=Robert |last=Proctor |authorlink=Robert N. Proctor |title=Racial Hygiene: Medicine Under the Nazis |publisher=Harvard University Press |location=[[Cambridge, Massachusetts]] |year=1988 |pages=122, 123 and 366 |isbn=978-0-674-74578-0 |oclc=20760638}}</ref><ref>{{Cite book|first=Margaret L. |last=Arnot |authorlink= |coauthors=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}}</ref><ref>{{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, Connecticut]] |isbn=978-0-313-31072-0 |oclc=38504469 |pages=[http://books.google.com/books?id=gQLqRd7hJq0C&printsec=frontcover&source=gbs_summary_r&cad=0#PPA589,M1 589]}}</ref> |
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A medieval female physician, [[Trotula]] of Salerno,<ref>"[[s:1911 Encyclopædia Britannica/Medicine|1911 Encyclopædia Britannica/Medicine]]"</ref> administered a number of remedies for the “retention of menstrua,” which was sometimes a code for early abortifacients.<ref>{{Cite book|author=Riddle, John M. |year=1992 |title=Contraception and Abortion from the Ancient World to the Renaissance |location=London |publisher=Harvard University Press|isbn=978-0-674-16876-3}}</ref> [[Pope Sixtus V]] (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy.<ref>{{cite web|url=http://civilliberty.about.com/od/gendersexuality/tp/History-of-Prostitution.htm |title=History of Prostitution |publisher=About.com |work=Civil Liberties| archiveurl = http://www.webcitation.org/5m5jEFrP0 | archivedate = 2009-12-17| deadurl=no}}</ref> 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.<ref>{{cite web|first=James |last=DeHullu |url=http://mysite.verizon.net/jdehullu/abortion/abhist.htm |accessdate=2008-12-02 |title=Histories of Abortion}}</ref> {{Better source|date=August 2010}} |
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In the late 1960s and early 1970s, due to a confluence of factors, the number of reported abortions increased worldwide. In West Germany, the number of reported abortions increased from 2,800 in 1968 to 87,702 in 1980.{{Citation needed|date=August 2011}} [[Abortion in the United States|In the United States]], legalization of abortion in multiple states in 1967-70 was followed by a landmark decision in ''[[Roe v. Wade]]'' (1973), which legalized the procedure nationwide. This led to explosive growth in the number of reported abortions: In 1966, only 1028 abortions were reported to the [[Centers for Disease Control and Prevention]] (CDC). In 1980, 1.3 million were reported to the CDC, giving a ratio of 359 abortions per 1,000 live births.<ref>{{cite web|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00001243.htm|title=Surveillance Summary Abortion Surveillance: Preliminary Analysis, 1979-1980 -- United States|publisher=Center for Disease Control and Prevention}}</ref> The Guttmacher Institute estimates the total number of abortions in 1980 (including those unreported to CDC) to be 1.55 million.<ref>{{cite web|url=http://www.guttmacher.org/presentations/trends.pdf|title=Trends in Abortion in the United States, 1973-2008|date=January 2011|format=PDF|accessdate=August 24, 2011|publisher=The Guttmacher Institute}}</ref> |
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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.<ref name="cbctrust">{{cite web|url=http://www.cbctrust.com/history_law_religion.php |archiveurl=http://web.archive.org/web/20080208053146/http://www.cbctrust.com/history_law_religion.php |archivedate=2008-02-08 |title=Abortion Law, History & Religion |accessdate=2008-03-23 |publisher=Childbirth By Choice Trust}}</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>{{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 |page=[http://books.google.com/books?id=gqLDEKVk2nMC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA30,M1 30] |isbn=978-0-8078-4675-9 |oclc=60191622}} </ref><ref>{{Cite book|first=Robert |last=Proctor |authorlink=Robert N. Proctor |title=Racial Hygiene: Medicine Under the Nazis |publisher=Harvard University Press |location=[[Cambridge, Massachusetts]] |year=1988 |pages=122, 123 and 366 |isbn=978-0-674-74578-0 |oclc=20760638}}</ref><ref>{{Cite book|first=Margaret L. |last=Arnot |authorlink= |coauthors=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}}</ref><ref>{{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, Connecticut]] |isbn=978-0-313-31072-0 |oclc=38504469 |pages=[http://books.google.com/books?id=gQLqRd7hJq0C&printsec=frontcover&source=gbs_summary_r&cad=0#PPA589,M1 589]}} </ref> |
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However, the procedure remained relatively rare until the late 1960s. In late 1960s and early 1970s, due to a confluence of factors, the number of abortions exploded worldwide. In West Germany, the number of reported abortions spiked from 2,800 in 1968 to 87,702 in 1980.<ref>{{cite web|url=http://www.johnstonsarchive.net/policy/abortion/ab-frgermany.html|title=Historical abortion statistics, FR Germany}}</ref> In the United States, some sources show an even greater increase, from 4,600 in 1968 to 1.5 million in 1980. However, the fact that abortion remained illegal in many states prior to the landmark 1973 decision of [[Roe v. Wade]] may have affected the number of reported abortions prior to 1973. |
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==Society and culture== |
==Society and culture== |
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===Abortion debate=== |
===Abortion debate=== |
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{{Main|Abortion debate}} |
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{{Ref improve section|date=November 2008}} |
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{{Double image|right|March for Women's Lives detail.jpg|200|March for life 2009.JPG|200|Pro-choice activists near the [[Washington Monument]] at the [[March for Women's Lives]] in 2004. (left) Pro-life activists near the Washington Monument at the annual 2009 [[March for Life]] in [[Washington, DC]]. (right) ||}} |
{{Double image|right|March for Women's Lives detail.jpg|200|March for life 2009.JPG|200|Pro-choice activists near the [[Washington Monument]] at the [[March for Women's Lives]] in 2004. (left) Pro-life activists near the Washington Monument at the annual 2009 [[March for Life]] in [[Washington, DC]]. (right) ||}} |
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Induced abortion has long 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 described as being a combination of beliefs on its morality; beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy; and on the rights and responsibilities of the woman seeking to have an abortion. [[Ethics in religion|Religious ethics]] also has an [[religion and abortion|influence]] upon both personal opinion and the greater debate over abortion. |
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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. Abortion debates, especially pertaining to [[abortion law]]s, are often spearheaded by groups advocating one of these two positions. Those in favor of greater legal restrictions on, or even complete prohibition of abortion, most often describe themselves as [[pro-life]] while those against legal restrictions on abortion describe themselves as [[pro-choice]]. Generally, the former position argues that a human fetus is a human being with a [[right to life|right to live]], making abortion tantamount to murder. The latter position argues that a woman has certain [[reproductive rights]], especially the choice whether or not to carry a pregnancy to term. |
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{{Main|Abortion debate}} |
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{{See also|Religion and abortion}} |
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In the [[history of abortion]], induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her [[value system]]. The main positions are one that argues in favor of access to abortion and one argues against access to abortion. Opinions of abortion may be described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy. [[religion|Religious ethics]] also has an influence upon both personal opinion and the greater debate over abortion (see [[religion and abortion]]). |
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===Modern abortion law=== |
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Abortion debates, especially pertaining to [[abortion law]]s, are often spearheaded by groups advocating one of these two positions. In the United States, those in favor of greater legal restrictions on, or even complete prohibition of abortion, most often describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Generally, the former position argues that a human fetus is a human being with a [[right to life|right to live]] making abortion tantamount to murder. The latter position argues that a woman has certain [[reproductive rights]], especially the choice whether or not to carry a pregnancy to term. |
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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. |
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Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a [[minor (law)|minor]], her parents; a legally married or [[common-law marriage|common-law]] wife, her husband; or, for any case, [[Paternal rights and abortion|the biological father]]. In a 2003 Gallup poll in the United States, 79% of male and 67% of female respondents were in favor of legalized mandatory spousal notification; overall support was 72% with 26% opposed.<ref>The Pew Research Center for the People and the Press. (2005-11-02). "[http://people-press.org/commentary/display.php3?AnalysisID=122 Public Opinion Supports Alito on Spousal Notification Even as It Favors Roe v. Wade]." ''Pew Research Center Pollwatch.'.' Retrieved 2006-03-01.</ref> |
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===Abortion law=== |
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{{Disputed-section|date=May 2011}} |
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{{Globalize|date=December 2010}} |
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{{Main|Abortion law}} |
{{Main|Abortion law}} |
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{{See also| |
{{See also|History of abortion law debate}} |
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{{AbortionLawsMap}} |
{{AbortionLawsMap}} |
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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 rights|reproductive health]] are major issues of human rights that are sometimes used as justification for the existence or absence of laws controlling abortion. |
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The earliest secular laws regulating abortion reflect a concern with class and caste purity and preservation of male prerogatives. Abortion as such was not outlawed, but wives who procured abortions without their husband's knowledge could be severely punished, as could slaves who induced abortions in highborn women. Generally, abortions prior to [[quickening]] were treated as minor crimes, if at all. |
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The new philosophies of the [[Axial Age]], which began discussing the nature and value of human life in abstract terms, had little impact on existing abortion laws. Even the Christian [[ecclesiastical courts]] of the Middle Ages imposed penance and no corporal punishment for abortion, and retained the pre- and post-quickening distinction from the ancient philosophies. |
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With the sole exception of [[Bracton]],<ref>{{Cite book|author=[[Henry de Bracton]] |chapter=The crime of homicide and the divisions into which it falls |editor=George E. Woodbine ed.; Samuel Edmund Thorne trans. |title=On the Laws and Customs of England |origyear={{circa|1250}} |year=1968 |accessdate=2008-12-11 |volume=2 |page=341 |url=http://hlsl5.law.harvard.edu/bracton/Unframed/English/v2/341.htm |oclc=1872|isbn=978-0-19-626613-8}}</ref> commentators on the [[English common law]] formulated the [[born alive rule]], excluding feticide from homicide law, using language dating back to the [[Leges Henrici Primi]].<ref>{{cite web|author=|url=http://law.jrank.org/pages/445/Abortion-Abortion-in-English-law.html |title=Abortion – Abortion In English Law |publisher=Law.jrank.org |date= |accessdate=2011-01-30}}</ref> |
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In the late 18th century, it was claimed that scientific knowledge of human development beginning at [[human fertilization|fertilization]],<ref>{{Cite book|author=Garrison, Fielding |url=http://books.google.com/?id=JvoIAAAAIAAJ&pg=PA567&dq=fetilization+was+discovered+hertwig |title=An Introduction to the History of Medicine |pages=566–7 |publisher=Saunders |year=1921 |oclc=|isbn=978-0-7216-4030-3}} </ref> justified stricter abortion laws. This was part of a larger struggle on the part of the medical profession to distinguish modern, theory based medicine from traditional, empirically based medicine, including midwifery and herbalism.<ref>''The History of New York State'' Book 12, Chapter 13, Part 3, Editor, Dr. James Sullivan available at [http://www.usgennet.org/usa/ny/state/historyofnewyorkstate/bk12/ch13/pt3.html The History of New York State]</ref> |
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Both pre- and post-quickening abortions were criminalized by ''[[Lord Ellenborough's Act]]'' in 1803.<ref>{{cite web|url=http://members.aol.com/abtrbng/lea.htm |title=Lord Ellenborough’s Act |year=1998 |work=The Abortion Law Homepage |accessdate=2007-02-20 |archiveurl = http://web.archive.org/web/20070918233015/http://members.aol.com/abtrbng/lea.htm |archivedate = 2007-09-18}} (via Archive.org)</ref> In 1861, the [[Parliament of the United Kingdom]] passed the ''[[Offences against the Person Act 1861]]'', which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.<ref>{{cite web|author=United Nations Population Division |year=2002 |url=http://www.un.org/esa/population/publications/abortion |title=Abortion Policies: A Global Review |accessdate=February 22, 2007}}</ref> |
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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 as well. The ''[[Abortion Act 1967]]'' allowed abortion for limited reasons in the United Kingdom (except Northern Ireland). In the 1973 case, ''[[Roe v. Wade]]'', the [[Supreme Court of the United States|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]]''.<ref>{{cite pmid|18821017}}</ref> Canada later struck down provincial regulations of abortion in the case of ''[[R. v. Morgentaler (1993)]].'' By contrast, [[Abortion in the Republic of Ireland|abortion in Ireland]] was affected by the addition of an [[Eighth Amendment of the Constitution of Ireland|amendment]] to the Irish [[Constitution of Ireland|Constitution]] in 1983 by popular referendum, recognizing "the right to life of the unborn". |
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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 rights|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: |
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* In the United States, some states impose a 24-hour 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]]|author=Theodore J. Joyce, Stanley K. Henshaw, Amanda Dennis, Lawrence B. Finer and Kelly Blanchard|date=April 2009|accessdate=December 31, 2010|archiveurl = http://www.webcitation.org/5vj6Mlykp |archivedate = 2011-01-14|deadurl=yes}}</ref> |
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* 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.{{Citation needed|date=December 2010}} |
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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. |
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* A few nations ban abortion entirely: [[Abortion in Chile|Chile]], [[Abortion in El Salvador|El Salvador]], [[Abortion in Malta|Malta]], and [[Abortion in Nicaragua|Nicaragua]]. In Nicaragua, rises in maternal death directly and indirectly due to pregnancy have been noted.<ref>{{cite web|title=European delegation visits Nicaragua to examine effects of abortion ban |date=November 26, 2007 |publisher=Ipas |accessdate=2009-06-15| url=http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx| archiveurl=http://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=2008-04-17 }} "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 |place=Montevideo |agency=IPS |publisher=Inside Costa Rica}}</ref> However, in 2006, the [[Politics of Chile|Chilean government]] began the free distribution of [[emergency contraception]].<ref>{{Cite news|author=Ross, Jen |date=September 12, 2006 |url=http://www.csmonitor.com/2006/0912/p01s04-woam.html |title=In Chile, free morning-after pills to teens |work=The Christian Science Monitor |accessdate=2006-12-07}}</ref><ref>{{Cite news|author=Gallardoi, Eduardo |date=September 26, 2006 |url=http://www.washingtonpost.com/wp-dyn/content/article/2006/09/26/AR2006092600770.html |title=Morning-After Pill Causes Furor in Chile |work=[[The Washington Post]] |accessdate=2006-12-07}}</ref> |
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* 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.<ref>{{cite web|title=Surgical Abortion: History and Overview |publisher=National Abortion Federation |accessdate=2006-09-04 |url=http://www.prochoice.org/education/resources/surg_history_overview.html }}</ref> |
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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. Women without the means to travel can resort to providers of illegal abortions or try to do it themselves. |
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<ref>{{cite web|title=Need Abortion, Will Travel |author=Marcy Bloom |date=February 25, 2008 |publisher=RH Reality Check |accessdate=2009-06-15| url=http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel}}</ref> |
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In jurisdictions where abortion is legal, certain requirements must often be met before an abortion may be obtained. These requirements are usually dependent on the age of the fetus, often using a [[Pregnancy#Terminology|trimester]]-based system to regulate the window of legality. Many restrictions are waived in emergency situations. 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]]|author=Theodore J. Joyce, Stanley K. Henshaw, Amanda Dennis, Lawrence B. Finer and Kelly Blanchard|date=April 2009|accessdate=December 31, 2010|archiveurl = http://www.webcitation.org/5vj6Mlykp |archivedate = 2011-01-14|deadurl=yes}}</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 patients of the supposed health risks of the procedure, and that multiple medical authorities certify that the abortion is either medically or socially necessary. |
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In the US, about 8% of abortions are performed on women who travel from another state.<ref>{{cite web|title=United States: Percentage of Legal Abortions Obtained by Out-of-State Residents, 2005 |publisher=The Kaiser Family Foundation |accessdate=2009-06-14| url=http://www.statehealthfacts.kff.org/profileind.jsp?rgn=1&cat=10&ind=467}}</ref> However, that is driven at least partly by differing limits on abortion according to gestational age or the scarcity of doctors trained and willing to do later abortions.{{Citation needed|date=December 2010}} Thousands of women every year travel from Northern Ireland, the Republic of Ireland, Poland, and other countries where elective abortion is illegal, to Britain or other countries with less restrictive laws, in order to obtain abortions.<ref>{{Cite news |url=http://www.eturbonews.com/6052/thousands-women-n-ireland-travel-england-abortions |publisher=eTurboNews |date=November 5, 2008 |first=Shawn |last=Pogatchnik |title=Thousands of women in N. Ireland travel to England for abortions}}</ref><ref>{{Cite news |publisher=Reuters |url=http://www.reuters.com/article/idUSTRE67P46Z20100826 |title=More Polish women seen seeking abortions abroad |date=August 26, 2010 |first=Gabriela |last=Baczynska}}</ref> |
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Other jurisdictions ban abortion almost entirely. However, many, but not all, of these will allow them to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. In countries where abortion is banned entirely, such as [[Abortion in Nicaragua|Nicaragua]], rises in maternal death directly and indirectly due to pregnancy have been noted.<ref>{{cite web|title=European delegation visits Nicaragua to examine effects of abortion ban |date=November 26, 2007 |publisher=Ipas |accessdate=2009-06-15| url=http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx| archiveurl=http://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=2008-04-17 |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}}</ref> Some countries, such as Bangledesh, 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=2006-09-04 |url=http://www.prochoice.org/education/resources/surg_history_overview.html}}</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 jstor|2135775}}</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 |author=Marcy Bloom |date=February 25, 2008 |publisher=RH Reality Check |accessdate=2009-06-15| url=http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel}}</ref> |
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In the United States and some Canadian localities, [[Legal protection of access to abortion|it is a legal offense to obstruct access to a clinic or doctor's office where abortions are performed]]. "Buffer zones," regulating how close protesters can come to the clinic or to the patients, may exist. |
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[[Emergency contraception]] is generally available in countries that have not restricted abortion, and is also sometimes available in countries that have otherwise banned abortion, such as [[Abortion in Chile|Chile]].<ref>{{Cite news|author=Ross, Jen |date=September 12, 2006 |url=http://www.csmonitor.com/2006/0912/p01s04-woam.html |title=In Chile, free morning-after pills to teens |work=The Christian Science Monitor |accessdate=2006-12-07}}</ref><ref>{{Cite news|author=Gallardoi, Eduardo |date=September 26, 2006 |url=http://www.washingtonpost.com/wp-dyn/content/article/2006/09/26/AR2006092600770.html |title=Morning-After Pill Causes Furor in Chile |newspaper=[[The Washington Post]] |accessdate=2006-12-07}}</ref> This has caused controversy, as some [[pro-life]] groups have advocated that certain forms of emergency contraception are not [[contraceptive]]s but [[abortifacient]]s. |
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Other issues in abortion law may include the [[Minors and abortion|requirement that a minor obtain the consent of one or both parents to the abortion or that she notify one or both parents]], the [[Paternal rights and abortion|requirement that a woman obtain the consent of her husband to the abortion and the question of whether the fetus's father can prohibit an abortion]], the requirement that abortion providers inform patients of the supposed health risks of the procedure, and [[wrongful birth]] laws. |
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===Sex-selective=== |
===Sex-selective=== |
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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 China, Taiwan, South Korea, and India.<ref>Banister, Judith. (1999-03-16). [http://www.census.gov/ipc/www/ebspr96a.html Son Preference in Asia – Report of a Symposium]. Retrieved 2006-01-12.</ref> |
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 China, Taiwan, South Korea, and India.<ref>Banister, Judith. (1999-03-16). [http://www.census.gov/ipc/www/ebspr96a.html Son Preference in Asia – Report of a Symposium]. Retrieved 2006-01-12.</ref> |
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In India, the economic role of men, the costs associated with [[dowry|dowries]], and a common Indian tradition which dictates that [[funeral|funeral rites]] must be performed by a male relative have led to a cultural preference for sons.<ref>Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, and Roy, T.K. (1997). [http://www2.eastwestcenter.org/pop/misc/subj-3.pdf Son Preferences and Its Effect on Fertility in India]. ''National Family Health Survey Subject Reports, Number 3.'.' Retrieved 2006-01-12.</ref> The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 [[rupee]]s [for a sex test] now, save 50,000 rupees [for a dowry] later."<ref>{{Cite journal|first=Rita |last=Patel |year=1996 |month=Fall |title=The practice of sex selective abortion in India: May you be the mother of a hundred sons |journal=Carolina Papers in International Health and Development |volume=7 |url=http://cgi.unc.edu/research/pdf/abortion.pdf |archiveurl=http://www.webcitation.org/5qWhqeiZq |archivedate=2010-06-16 |format=PDF|accessdate=2008-12-03}}</ref> In 1991, the male-to-female [[human sex ratio|sex ratio]] in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.<ref>{{Cite journal|last=Sudha |first=S. |year=1999 |month=July |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=http://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archivedate=2003-01-01 |accessdate=2008-12-03 |last2=Rajan |first2=S. Irudaya |pmid=20162850}}</ref> Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.<ref>{{Cite news|first=Patricia |last=Reaney |publisher=Reuters |url=http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archiveurl=http://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archivedate=2006-02-20 |title=Selective abortion blamed for India's missing girls |accessdate=2008-12-03}}</ref> The Indian government passed an official ban of pre-natal sex screening in 1994 and |
In India, the economic role of men, the costs associated with [[dowry|dowries]], and a common Indian tradition which dictates that [[funeral|funeral rites]] must be performed by a male relative have led to a cultural preference for sons.<ref>Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, and Roy, T.K. (1997). [http://www2.eastwestcenter.org/pop/misc/subj-3.pdf Son Preferences and Its Effect on Fertility in India]. ''National Family Health Survey Subject Reports, Number 3.'.' Retrieved 2006-01-12.</ref> The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 [[rupee]]s [for a sex test] now, save 50,000 rupees [for a dowry] later."<ref>{{Cite journal|first=Rita |last=Patel |year=1996 |month=Fall |title=The practice of sex selective abortion in India: May you be the mother of a hundred sons |journal=Carolina Papers in International Health and Development |volume=7 |url=http://cgi.unc.edu/research/pdf/abortion.pdf |archiveurl=http://www.webcitation.org/5qWhqeiZq |archivedate=2010-06-16 |format=PDF|accessdate=2008-12-03}}</ref> In 1991, the male-to-female [[human sex ratio|sex ratio]] in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.<ref>{{Cite journal|last=Sudha |first=S. |year=1999 |month=July |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=http://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archivedate=2003-01-01 |accessdate=2008-12-03 |last2=Rajan |first2=S. Irudaya |pmid=20162850}}</ref> Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.<ref>{{Cite news|first=Patricia |last=Reaney |publisher=Reuters |url=http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archiveurl=http://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archivedate=2006-02-20 |title=Selective abortion blamed for India's missing girls |accessdate=2008-12-03}}</ref> The Indian government passed an official ban of pre-natal sex screening in 1994 and banned sex-selective abortion in 2002,<ref name="LOC India">{{cite web|url=http://www.loc.gov/law/help/sex-selection/india.php|publisher=[[Library of Congress]]|title=Sex Selection & Abortion: India|date=April 4, 2011|accessdate=July 18, 2011}}</ref> although it had already previously outlawed abortion except to save the life of the mother.<ref name="LOC India" /> |
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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.<ref>{{Cite journal|first=Maureen J. |last=Graham |year=1998 |month=June |title=Son Preference in Anhui Province, China |journal=International Family Planning Perspectives |volume=24 |issue=2 |url=http://www.agi-usa.org/pubs/journals/2407298.html |accessdate=2008-12-03 |doi=10.2307/2991929 |page=72 |author2=Larsen |author3=Xu|archiveurl = http://web.archive.org/web/20080620084622/http%3A//www.agi-usa.org/pubs/journals/2407298.html |archivedate = June 20, 2008|deadurl=yes}}</ref> 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]].<ref>{{Cite journal|last=Plafker |first=Ted |year=2002 |month=May |title=Sex selection in China sees 117 boys born for every 100 girls |journal=[[BMJ]] |volume=324 |issue=7348 |page=1233a |doi=10.1136/bmj.324.7348.1233/a |pmid=12028966 |pmc=1123206}}</ref> A ban upon the practice of sex-selective abortion was enacted in 2003.<ref>"[http://www.china.org.cn/english/2003/Mar/59194.htm China Bans Sex-selection Abortion]." (2002-03-22). ''Xinhua News Agency.'.' Retrieved 2006-01-12.</ref> |
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.<ref>{{Cite journal|first=Maureen J. |last=Graham |year=1998 |month=June |title=Son Preference in Anhui Province, China |journal=International Family Planning Perspectives |volume=24 |issue=2 |url=http://www.agi-usa.org/pubs/journals/2407298.html |accessdate=2008-12-03 |doi=10.2307/2991929 |page=72 |author2=Larsen |author3=Xu|archiveurl = http://web.archive.org/web/20080620084622/http%3A//www.agi-usa.org/pubs/journals/2407298.html |archivedate = June 20, 2008|deadurl=yes|pages=72–77}}</ref> 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]].<ref>{{Cite journal|last=Plafker |first=Ted |year=2002 |month=May |title=Sex selection in China sees 117 boys born for every 100 girls |journal=[[BMJ]] |volume=324 |issue=7348 |page=1233a |doi=10.1136/bmj.324.7348.1233/a |pmid=12028966 |pmc=1123206}}</ref> A ban upon the practice of sex-selective abortion was enacted in 2003.<ref>"[http://www.china.org.cn/english/2003/Mar/59194.htm China Bans Sex-selection Abortion]." (2002-03-22). ''Xinhua News Agency.'.' Retrieved 2006-01-12.</ref> |
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===Anti-abortion violence=== |
===Anti-abortion violence=== |
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{{Main|Anti-abortion violence}} |
{{Main|Anti-abortion violence}} |
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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 has been classified by governmental and scholarly sources as [[terrorism]].<ref name="csis">{{cite web |author=Smith, G. Davidson (Tim) |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= September 1, 2011|archiveurl = http://web.archive.org/web/20071015065711/http://csis-scrs.gc.ca/en/publications/commentary/com74.asp|archivedate=October 15, 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 = 263–273| year = 1988}}</ref> Only a small fraction of those opposed to abortion commit violence, often rationalizing their actions as [[justifiable homicide]] or [[Right of self-defense|defense of others]], committed in order to protect the lives of fetuses. |
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In the United States, four abortion providers—Drs. [[David Gunn (doctor)|David Gunn]], [[John Britton (doctor)|John Britton]], [[Barnett Slepian]], and [[George Tiller]]—have been assassinated. Attempted assassinations have also taken place in the United States and Canada, and other personnel at abortion clinics, including receptionists and security guards, have been killed in the United States and Australia. Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have also occurred.<ref>{{cite news |title=The Death of Dr. Gunn | |
In the United States, four abortion providers—Drs. [[David Gunn (doctor)|David Gunn]], [[John Britton (doctor)|John Britton]], [[Barnett Slepian]], and [[George Tiller]]—have been assassinated. Attempted assassinations have also taken place in the United States and Canada, and other personnel at abortion clinics, including receptionists and security guards, have been killed in the United States and Australia. Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have also occurred.<ref>{{cite news |title=The Death of Dr. Gunn |newspaper=New York Times |date=12 March 1993 |url=http://www.nytimes.com/1993/03/12/opinion/the-death-of-dr-gunn.html}}</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 = February 9, 2010}}</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=http://www.guardian.co.uk/theguardian/1999/feb/03/features11.g26 |newspaper=The Guardian |date=February 3, 1999 |title=The bomber under siege |first=Julian |last=Borger |location=London}}</ref> |
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===Art, literature and film=== |
===Art, literature and film=== |
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Art serves to humanize the abortion issue and illustrates the myriad of decisions and consequences it has. One of the [[History of abortion#5th century to 18th century|earliest]] known representations of abortion is in a [[bas relief]] at [[Angkor Wat]] (c. 1150). Pro-life activist [[Børre Knudsen]] was linked to a 1994 art theft as part of a pro-life drive in [[Norway]] surrounding the [[1994 Winter Olympics]].<ref name="Art theft">{{cite news |
Art serves to humanize the abortion issue and illustrates the myriad of decisions and consequences it has. One of the [[History of abortion#5th century to 18th century|earliest]] known representations of abortion is in a [[bas relief]] at [[Angkor Wat]] (c. 1150). Pro-life activist [[Børre Knudsen]] was linked to a 1994 art theft as part of a pro-life drive in [[Norway]] surrounding the [[1994 Winter Olympics]].<ref name="Art theft">{{cite news|url=http://pqasb.pqarchiver.com/thestar/access/517847961.html?dids=517847961:517847961&FMT=ABS&FMTS=ABS:FT&type=current&date=Feb+18%2C+1994&author=%28AP%29&pub=Toronto+Star&desc=Art+theft+linked+to+pro-life+drive+Abortion+foe+hints+painting%27s+return+hinges+on+TV+film&pqatl=google |
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|title=Art theft linked to pro-life drive Abortion foe hints painting's return hinges on TV film|work=thestar.com|accessdate=2010-09-25|date=1994-02-18}}</ref> A [[Swiss]] gallery removed a piece from a Chinese art collection in 2005, that had the head of a fetus attached to the body of a bird.<ref name="Xiao Yu">{{cite web|url=http://www.othershore-arts.net/xiaoyuESSAYS10.html|title=Principally relating to Xiao Yu's work Ruan|work=Other Shore Artfile|accessdate=2010-06-27}}</ref> In 2008, a [[Yale student abortion art controversy|Yale student]] proposed using aborted excretions and the induced abortion itself as a performance art project.<ref>{{cite web|url=http://network.nationalpost.com/np/blogs/fullcomment/archive/2008/04/17/marni-soupcoff-s-zeitgeist-photofiddle-rentbetter-org-mandie-brady-and-aliza-shvarts.aspx |title= Marni Soupcoff's Zeitgeist: Photofiddle, Rentbetter.org, Mandie Brady and Aliza Shvarts|accessdate=2008-04-30 |last=Soupcoff |first=Marni |date=2008-04-17 |work=Full Comment |publisher=[[National Post]]}}</ref> |
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|url=http://pqasb.pqarchiver.com/thestar/access/517847961.html?dids=517847961:517847961&FMT=ABS&FMTS=ABS:FT&type=current&date=Feb+18%2C+1994&author=%28AP%29&pub=Toronto+Star&desc=Art+theft+linked+to+pro-life+drive+Abortion+foe+hints+painting%27s+return+hinges+on+TV+film&pqatl=google |
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|title=Art theft linked to pro-life drive Abortion foe hints painting's return hinges on TV film |
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|work=thestar.com |
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|accessdate=2010-09-25 |
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| date=1994-02-18 |
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}}</ref> A [[Swiss]] gallery removed a piece from a Chinese art collection in 2005, that had the head of a fetus attached to the body of a bird.<ref name="Xiao Yu">{{cite web |
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|url=http://www.othershore-arts.net/xiaoyuESSAYS10.html |
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|title=Principally relating to Xiao Yu's work Ruan |
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|work=Other Shore Artfile |
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|accessdate=2010-06-27 |
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}}</ref> In 2008, a [[Yale student abortion art controversy|Yale student]] proposed using aborted excretions and the induced abortion itself as a performance art project.<ref>{{cite web|url=http://network.nationalpost.com/np/blogs/fullcomment/archive/2008/04/17/marni-soupcoff-s-zeitgeist-photofiddle-rentbetter-org-mandie-brady-and-aliza-shvarts.aspx |title= Marni Soupcoff's Zeitgeist: Photofiddle, Rentbetter.org, Mandie Brady and Aliza Shvarts|accessdate=2008-04-30 |last=Soupcoff |first=Marni |date=2008-04-17 |work=Full Comment |publisher=[[National Post]]}}</ref> |
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''[[The Cider House Rules]]'' (novel 1985, film 1999) follows the story of Dr. Larch an orphanage director who is a reluctant abortionist after seeing the consequences of back-alley abortions, and his orphan medical assistant Homer who is against abortion.<ref name="CiderHouse">{{Cite book |
''[[The Cider House Rules]]'' (novel 1985, film 1999) follows the story of Dr. Larch an orphanage director who is a reluctant abortionist after seeing the consequences of back-alley abortions, and his orphan medical assistant Homer who is against abortion.<ref name="CiderHouse">{{Cite book |
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|author=John Irving|title=The Cider House Rules|publisher=William Morrow|location=New York|year=1985|isbn=978-0-688-03036-0}}</ref> Feminist novels such as ''Braided Lives'' (1997) by Marge Piercy emphasize the struggles women had in dealing with unsafe abortion in various circumstances prior to legalization.<ref name="BraidedLives">{{Cite book|author=Marge Piercy|title=Braided Lives|publisher=Ballantine Books |
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|author=John Irving |
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|location=New York|year=1997|pages=|isbn=978-0-449-00091-5}}</ref> Physician [[Susan Wicklund]] wrote ''This Common Secret'' (2007) about how a personal traumatic abortion experience hardened her resolve to provide compassionate care to women who decide to have an abortion. As Wicklund crisscrosses the West to provide abortion services to remote clinics, she tells the stories of women she's treated and the sacrifices she and her loved ones made.<ref name="CommonSecret">{{Cite book|author=Susan Wicklund|title=This Common Secret: My Journey as an Abortion Doctor|publisher=PublicAffairs|location=New York|year=2007|isbn=978-1-58648-480-4}}</ref> In 2009, Irene Vilar revealed her past abuse and addiction to abortion in ''[[Impossible Motherhood]]'', where she aborted 15 pregnancies in 17 years. According to Vilar it was the result of a dark psychological cycle of power, rebellion and societal expectations.<ref name="ImpossibleMotherhood">{{Cite book|author=Irene Vilar|title=Impossible Motherhood: Testimony of an Abortion Addict|publisher=Other Press|year=2009|isbn=978-1-59051-320-0}}</ref> In [[Annie Finch]]'s mythic epic poem and opera libretto '' Among the Goddesses'' (2010), the heroine's abortion is contextualized spiritually by the goddesses [[Demeter]], [[Kali]], and [[Inanna]].<ref name="AmongtheGoddesses">{{Cite book|author=Annie Finch|title=Among the Goddesses|publisher=Red Hen Press|location=California|year=2010|isbn=978-1-59709-161-9}}</ref> |
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|title=The Cider House Rules |
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|publisher=William Morrow |
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|location=New York |
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|year=1985 |
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|pages= |
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|isbn=978-0-688-03036-0 |
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}}</ref> Feminist novels such as ''Braided Lives'' (1997) by Marge Piercy emphasize the struggles women had in dealing with unsafe abortion in various circumstances prior to legalization.<ref name="BraidedLives">{{Cite book |
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|author=Marge Piercy |
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|title=Braided Lives |
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|publisher=Ballantine Books |
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|location=New York |
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|year=1997 |
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|pages= |
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|isbn=978-0-449-00091-5 |
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}}</ref> Doctor [[Susan Wicklund]] wrote ''This Common Secret'' (2007) about how a personal traumatic abortion experience hardened her resolve to provide compassionate care to women who decide to have an abortion. As Wicklund crisscrosses the West to provide abortion services to remote clinics, she tells the stories of women she's treated and the sacrifices she and her loved ones made.<ref name="CommonSecret">{{Cite book |
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|author=Sue Wicklund; Susan Wicklund |
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|title=This Common Secret: My Journey as an Abortion Doctor |
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|publisher=PublicAffairs |
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|location=New York |
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|year=2007 |
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|pages= |
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|isbn=978-1-58648-480-4 |
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}}</ref> In 2009, Irene Vilar revealed her past abuse and addiction to abortion in ''[[Impossible Motherhood]]'', where she aborted 15 pregnancies in 17 years. According to Vilar it was the result of a dark psychological cycle of power, rebellion and societal expectations.<ref name="ImpossibleMotherhood">{{Cite book |
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|author=Irene Vilar |
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|title=Impossible Motherhood: Testimony of an Abortion Addict |
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|publisher=Other Press |
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|location= |
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|year=2009 |
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|pages= |
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|isbn=978-1-59051-320-0 |
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}}</ref> In [[Annie Finch]]'s mythic epic poem and opera libretto '' Among the Goddesses'' (2010), the heroine's abortion is contextualized spiritually by the goddesses [[Demeter]], [[Kali]], and [[Inanna]]. <ref name="AmongtheGoddesses">{{Cite book |
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|author=Annie Finch |
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|title=Among the Goddesses |
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|publisher=Red Hen Press |
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|location=California |
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|year=2010 |
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|pages= |
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|isbn=978-1-59709-161-9 |
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}}</ref> |
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Various options and realities of abortion have been dramatized in film. In ''[[Riding in Cars with Boys]]'' (2001) an underage woman carries her pregnancy to term as abortion is not an affordable option, moves in with the father and finds herself involved with drugs, has no opportunities, and questioning if she loves her child. While in ''[[Juno (film)|Juno]]'' (2007) a 16-year-old initially goes to have an abortion but decides to bear the child and allow a wealthy couple to adopt it. Other films ''[[Dirty Dancing]]'' (1987) and ''[[If These Walls Could Talk]]'' (1996) explore the availability, affordability and dangers of illegal abortions. The emotional impact of dealing with an unwanted pregnancy alone is the focus of ''Things You Can Tell Just By Looking At Her'' (2000) and ''[[Circle of Friends (1995 film)|Circle of Friends]]'' (1995). As a marriage was in trouble in the ''[[The Godfather Part II]]'' (1974) [[Kay Adams-Corleone|Kay]] knew the relationship was over when she aborted "a son" in secret.<ref name="TheGodfather">{{cite web |
Various options and realities of abortion have been dramatized in film. In ''[[Riding in Cars with Boys]]'' (2001) an underage woman carries her pregnancy to term as abortion is not an affordable option, moves in with the father and finds herself involved with drugs, has no opportunities, and questioning if she loves her child. While in ''[[Juno (film)|Juno]]'' (2007) a 16-year-old initially goes to have an abortion but decides to bear the child and allow a wealthy couple to adopt it. Other films ''[[Dirty Dancing]]'' (1987) and ''[[If These Walls Could Talk]]'' (1996) explore the availability, affordability and dangers of illegal abortions. The emotional impact of dealing with an unwanted pregnancy alone is the focus of ''Things You Can Tell Just By Looking At Her'' (2000) and ''[[Circle of Friends (1995 film)|Circle of Friends]]'' (1995). As a marriage was in trouble in the ''[[The Godfather Part II]]'' (1974) [[Kay Adams-Corleone|Kay]] knew the relationship was over when she aborted "a son" in secret.<ref name="TheGodfather">{{cite web|url=http://www.imdb.com/title/tt0071562/quotes|title=The Godfather: Part II (1974) – Memorable quotes |
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|work=imdb.com|accessdate=2010-07-01}}</ref> On the abortion debate, an irresponsible drug addict is used as a pawn in a power struggle between pro-choice and pro-life groups in ''[[Citizen Ruth]]'' (1996).<ref name="movietrain">{{cite web|url=http://www.movietrain.net/films-that-discuss-abortion-a-movie-list/|title=films that discuss Abortion . . . a movie list|work=movietrain.net|accessdate=2010-06-13}}</ref> The ''[[Law & Order]]'' television episode "[[Dignity (Law & Order)|Dignity]]" deals with the trial of a man who killed a late-term abortion doctor; the storyline was inspired by the [[Assassination of George Tiller|assassination of abortion provider George Tiller]].<ref>{{cite news|url=http://www.nytimes.com/2009/10/23/arts/television/23abort.html?|last=Wyatt|first=Edward|title=NBC's 'Law & Order' to Take on Abortion Issue|date=October 22, 2009|accessdate=July 26, 2011|newspaper=New York Times|archiveurl=http://www.webcitation.org/60ToZr2FX|archivedate=July 26, 2011|deadlink=no}}</ref> |
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|url=http://www.imdb.com/title/tt0071562/quotes |
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|title=The Godfather: Part II (1974) – Memorable quotes |
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|work=imdb.com |
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|accessdate=2010-07-01 |
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}}</ref> On the abortion debate, an irresponsible drug addict is used as a pawn in a power struggle between pro-choice and pro-life groups in ''[[Citizen Ruth]]'' (1996).<ref name="movietrain">{{cite web |
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|url=http://www.movietrain.net/films-that-discuss-abortion-a-movie-list/ |
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|title=films that discuss Abortion . . . a movie list |
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|work=movietrain.net |
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|accessdate=2010-06-13 |
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}}</ref> |
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==In other animals== |
==In other animals== |
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{{See|Miscarriage#In other animals}} |
{{See|Miscarriage#In other animals}} |
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Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.<ref>Spencer, James. ''[http://books.google.com/books?id=RXMuAAAAYAAJ&pg=PA124&lpg=PA124&dq=abortion+and+husbandry&source=bl&ots=WjmvGj-fB2&sig=8qH_WrPR08YEwPKr_c6PHDUOMmQ&hl=en&ei=erDbSeSVBoz4MY-F7M4I&sa=X&oi=book_result&ct=result&resnum=2#PPA124,M1 Sheep Husbandry in Canada]'', p. 124 (1911). |
Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.<ref>Spencer, James. ''[http://books.google.com/books?id=RXMuAAAAYAAJ&pg=PA124&lpg=PA124&dq=abortion+and+husbandry&source=bl&ots=WjmvGj-fB2&sig=8qH_WrPR08YEwPKr_c6PHDUOMmQ&hl=en&ei=erDbSeSVBoz4MY-F7M4I&sa=X&oi=book_result&ct=result&resnum=2#PPA124,M1 Sheep Husbandry in Canada]'', p. 124 (1911).</ref> In cows, abortion may be caused by contagious disease, such as [[Brucellosis]] or [[Campylobacter]], but can often be controlled by vaccination.<ref>[http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en "Beef cattle and Beef production: Management and Husbandry of Beef Cattle”], ''Encyclopaedia of New Zealand'' (1966).</ref> |
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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>McKinnon, Angus et al. ''[http://books.google.com/books?id=jlZAT-9VwUIC&pg=PA563&lpg=PA563&dq=%22induce+abortion%22+and+husbandry&source=bl&ots=6T9w3LtpsI&sig=aEYDFpnMIbLaKlstxK1MGK2rxwQ&hl=en&ei=eLTbSY7EO5muMrXUkMkI&sa=X&oi=book_result&ct=result&resnum=7 Equine Reproduction]'', p. 563 (Wiley-Blackwell 1993). |
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>McKinnon, Angus et al. ''[http://books.google.com/books?id=jlZAT-9VwUIC&pg=PA563&lpg=PA563&dq=%22induce+abortion%22+and+husbandry&source=bl&ots=6T9w3LtpsI&sig=aEYDFpnMIbLaKlstxK1MGK2rxwQ&hl=en&ei=eLTbSY7EO5muMrXUkMkI&sa=X&oi=book_result&ct=result&resnum=7 Equine Reproduction]'', p. 563 (Wiley-Blackwell 1993).</ref> |
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[[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|location=London|volume=303|pages=59–61|url=http://www.nature.com/nature/journal/v303/n5912/abs/303059a0.html|doi=10.1038/303059a0|pmid=6682487|issue=5912}}</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=689–694|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}}</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 Zool.|volume=54|issue=3|pages= 258–262|url=http://www.ivb.cz/folia/54/3/258-262.pdf}}</ref> although the frequency in the wild has been questioned.<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|location=London|volume=303|pages=59–61|url=http://www.nature.com/nature/journal/v303/n5912/abs/303059a0.html|doi=10.1038/303059a0|pmid=6682487|issue=5912}}</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=689–694|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}}</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 Zool.|volume=54|issue=3|pages= 258–262|url=http://www.ivb.cz/folia/54/3/258-262.pdf}}</ref> although the frequency in the wild has been questioned.<ref>{{cite jstor|4600608}}</ref> Male [[gray langur]] monkeys may attack females following male takeover, causing miscarriage.<ref>{{cite doi|10.1007/BF02435859}}</ref> |
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== Notes == |
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{{reflist|group="note"| |
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refs= |
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<ref name="definition" group="note">The definition of abortion, as with many words, varies from source to source. The following is a partial list of definitions as stated by [[obstetrics and gynecology]] (OB/GYN) textbooks, dictionaries, and other [[encyclopedias]]: |
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;Major OB/GYN textbooks |
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*The [[National Center for Health Statistics]] defines an "abortus" as "[a] fetus or embryo removed or expelled from the uterus during the first half of gestation—20 weeks or less, or in the absence of accurate dating criteria, born weighing < 500 g." They also define "birth" as "[t]he complete expulsion or extraction from the mother of a fetus after 20 weeks' gestation. [...] in the absence of accurate dating criteria, fetuses weighing <500 g are usually not considered as births, but rather are termed abortuses for purposes of vital statistics." {{cite book|editor1-last=Cunningham|editor1-first=FG|editor2-last=Leveno|editor2-first=KJ|editor3-last=Bloom|editor3-first=SL|editor4-last=Hauth|editor4-first=JC|editor5-last=Rouse|editor5-first=DJ|editor6-last=Spong |editor6-first=CY|chapter=1. Overview of Obstetrics|title=Williams Obstetrics|edition=23|publisher=[[McGraw-Hill Medical]]|year=2010|isbn=978-0-07-149701-5}} |
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*"[T]he standard medical definition of abortion [is] termination of a pregnancy when the fetus is not viable". {{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=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}} |
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*"Termination of a pregnancy, whether spontaneous or induced." {{cite book|first1=Melissa J.|last1=Kottke|first2=Mimi|last2=Zieman|chapter=33. Management of Abortion|editor1-first=John A.|editor1-last=Rock|editor2-first=Howard W.|editor2-last=Jones III|year=2008|edition=10|publisher=[[Lippincott Williams & Wilkins]]|isbn=978-0-7817-7234-1|title=TeLinde's Operative Gynecology}} |
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;Other OB/GYN textbooks |
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*"Termination of pregnancy before 20 weeks' gestation calculated from date of onset of last [[menses]]. An alternative definition is delivery of a fetus with a weight of less than 500 g. If abortion occurs before 12 weeks' gestation, it is called early; from 12 to 20 weeks it is called late." {{cite book|last=Katz|first=Vern L.|publisher=[[Mosby (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 - Etiology, Diagnosis, Treatment|isbn=9780323029513}} |
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*"Abortion is the spontaneous or induced termination of pregnancy before fetal viability. Because popular use of the word abortion implies a deliberate pregnancy termination, some prefer the word miscarriage to refer to spontaneous fetal loss before viability [...] The National Center for Health Statistics, the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) define abortion as pregnancy termination prior to 20 weeks' gestation or a fetus born weighing less than 500 g. Despite this, definitions vary widely according to state laws." {{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}} |
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;Major [[medical dictionaries]] |
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*"The spontaneous or induced termination of pregnancy before the fetus reaches a viable age." {{cite web|url=http://www.tabers.com/tabersonline/ub/view/Tabers/143003/37/abortion|title=Taber's Medical Dictionary: abortion|publisher=[[F. A. Davis Company|F.A. Davis]]|work=[[Taber's Cyclopedic Medical Dictionary]]|accessdate=June 14, 2011|archiveurl=http://www.webcitation.org/5zRoq1nVk|archivedate=June 14, 2011|deadurl=no}} |
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*"Expulsion from the uterus an embryo or fetus prior to the stage of viability (20 weeks' gestation or fetal weight <500g). A distinction made between [abortion] and premature birth: premature infants are those born after the stage of viability but prior to 37 weeks." {{cite book|title=[[Stedman's Medical Dictionary]]|publisher=[[Lippincott Williams & Wilkins]]|edition=27|isbn=0683400088}} |
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*"[P]remature expulsion from the uterus of the products of conception, either the embryo or a nonviable fetus." {{cite book|title=[[Dorland's Illustrated Medical Dictionary]]|publisher=[[Saunders (publisher)|Saunders]]|year=2007|isbn=9781416023647|edition=31}} |
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;Other medical dictionaries |
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*"[T]he termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus". {{cite web|url=http://www.merriam-webster.com/medlineplus/abortion|title=Medical Dictionary|publisher=[[Merriam-Webster]]|work=[[Merriam-Webster's Medical Dictionary]]|accessdate=June 15, 2011|archiveurl=http://www.webcitation.org/5zTA1aALZ|archivedate=June 15, 2011|deadurl=no}} |
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*"Induced termination of pregnancy, involving destruction of the embryo or fetus." "abortion." ''The American Heritage Science Dictionary''. Boston: Houghton Mifflin, 2005. |
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*"Interruption of pregnancy before the fetus has attained a stage of viability, usually before the 24th gestational week." "abortion." ''Cambridge Dictionary of Human Biology and Evolution''. Cambridge: Cambridge University Press, 2005. |
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*"[A] spontaneous or deliberate ending of pregnancy before the fetus can be expected to survive." "abortion." ''Mosby's Emergency Dictionary''. Philadelphia: Elsevier Health Sciences, 1998. |
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*"[A] situation where a fetus leaves the uterus before it is fully developed, especially during the first 28 weeks of pregnancy, or a procedure which causes this to happen...[T]o have an abortion to have an operation to make a fetus leave the uterus during the first period of pregnancy." "abortion." Dictionary of Medical Terms. London: A&C Black, 2008. |
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;Other dictionaries |
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*"The act of giving untimely birth to offspring, premature delivery, miscarriage; the procuring of premature delivery so as to destroy offspring. (In ''Med.'' abortion is limited to a delivery so premature that the offspring cannot live, i.e. in the case of the human fœtus before the sixth month.)" {{cite book|url=http://www.oed.com/oed2/00000606|edition=2|year=1989|title=Oxford English Dictionary|publisher=Oxford University Press}} |
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*"The deliberate termination of a pregnancy, usually before the embryo or fetus is capable of independent life." {{cite book|title=The American Heritage New Dictionary of Cultural Literacy, Third Edition|publisher=[[Houghton Mifflin Company]]|year=2005|accessdate=June 27, 2011|url=http://dictionary.reference.com/browse/abortion}} |
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*"[T]he removal of an embryo or fetus from the uterus before it is sufficiently developed to survive independently, deliberately induced by the use of drugs or by surgical procedures. Also called termination or induced abortion" or "[T]he spontaneous expulsion of an embryo or fetus from the uterus before it is sufficiently developed to survive independently. Also called miscarriage, spontaneous abortion." "abortion." ''Chambers 21st Century Dictionary''. London: Chambers Harrap, 2001. |
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*"[A]n operation or other procedure to terminate pregnancy before the fetus is viable" or "[T]he premature termination of pregnancy by spontaneous or induced expulsion of a nonviable fetus from the uterus". {{cite web|title=abortion|publisher=[[HarperCollins Publishers]]|work=Collins English Dictionary - Complete & Unabridged 10th Edition|accessdate=June 27, 2011|url=http://dictionary.reference.com/browse/abortion}} |
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*"A term that, in philosophy, theology, and social debates, often means the deliberate termination of pregnancy before the fetus is able to survive outside the uterus. However, participants in these debates sometimes use the term abortion simply to mean the termination of pregnancy before birth, regardless of whether the fetus is viable or not." "abortion." ''Dictionary of World Philosophy''. London: Routledge, 2001. |
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*"[T]he removal of an embryo or fetus from the uterus in order to end a pregnancy" or "[A]ny of various surgical methods for terminating a pregnancy, especially during the first six months." {{cite web|title=abortion|work=[[Dictionary.com]] Unabridged|publisher=[[Random House, Inc.]]|date=June 27, 2011|url=http://dictionary.reference.com/browse/abortion}} |
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;Encyclopedias |
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*"[T]he expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation)." {{cite web|title=Abortion (pregnancy)|publisher=[[Encyclopædia Britannica]]|work=Encyclopædia Britannica Online|year=2011|url=http://www.britannica.com/EBchecked/topic/1498/abortion|deadurl=no|archiveurl=http://www.webcitation.org/5zjwaLKR7|archivedate=June 26, 2011|accessdate=June 26, 2011}} |
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*"Expulsion of the products of conception before the embryo or fetus is viable. Any interruption of human pregnancy prior to the 28th week is known as abortion." {{cite encyclopedia|encyclopedia=The Columbia Encyclopedia|location=New York|publisher=Columbia University Press|year=2008|title=abortion|author1=<Please add first missing authors to populate metadata.>}} |
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*"The expulsion or removal of a fetus from the womb before it is capable of independent survival." {{cite encyclopedia|title=abortion|encyclopedia=World Encyclopedia|publisher=Oxford University Press|work=Oxford Reference Online|year=2008|author1=<Please add first missing authors to populate metadata.>}} |
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*"[Abortion] is commonly misunderstood outside medical circles. In general terms, the word 'abortion' simply means the failure of something to reach fulfilment or maturity. Medically, abortion means loss of the fetus, for any reason, before it is able to survive outside the womb. The term covers accidental or spontaneous ending, or miscarriage, of pregnancy as well as deliberate termination. The terms 'spontaneous abortion' and 'miscarriage' are synonymous and are defined as loss of the fetus before the twenty-eighth week of pregnancy. This definition implies a legal perception of the age at which a fetus can survive out of the womb. With great advances in recent years in the ability to keep very premature babies alive, this definition is in need of revision." {{cite encyclopedia|title=abortion and miscarriage|encyclopedia=The Royal Society of Medicine Health Encyclopedia|location=London|publisher=Bloomsbury Publishing Ltd|year=2000|author1=<Please add first missing authors to populate metadata.>}} |
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*"Abortion is the intentional removal of a fetus or an embryo from a mother's womb for purposes other than that of either producing a live birth or disposing of a dead embryo." {{cite encyclopedia|title=Abortion|encyclopedia=Encyclopedia of Human Rights Issues since 1945|location=[[Santa Barbara, California]]|year=1999|publisher=Routledge|edition=1|isbn=978-1579581664|author1=<Please add first missing authors to populate metadata.>}} |
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</ref> |
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}} |
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==References== |
==References== |
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==External links== |
==External links== |
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{{Sister project links|abortion}} |
{{Sister project links|abortion}} |
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*{{LibGuides|abortion|Abortion}} |
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* {{dmoz|Health/Reproductive_Health/Abortion}} |
* {{dmoz|Health/Reproductive_Health/Abortion}} |
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* [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review] |
* [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review] |
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* [http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm#Definition MedlinePlus Medical Encyclopedia: Abortion] |
* [http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm#Definition MedlinePlus Medical Encyclopedia: Abortion] |
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'''The following information resources may be created by those with a non-neutral position in the abortion debate:''' |
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* [http://www.guttmacher.org/ The Guttmacher Institute] |
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[[Category:Core issues in ethics]] |
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[[Category: |
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Revision as of 02:20, 9 September 2011
Abortion | |
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Specialty | Obstetrics ![]() |
Abortion refers to the termination of pregnancy at any stage that does not end with live birth, though it is often technically defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo before fetal viability.[note 1] An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced. The term abortion most commonly refers to the induced abortion of a human rather than non-human pregnancy.
Abortion, when induced in the developed world in accordance with local law, is among the safest procedures in medicine.[1] However, unsafe abortions (those performed by persons without proper training or outside of a medical environment) result in approximately 70 thousand maternal deaths and 5 million disabilities per year globally.[2] An estimated 42 million abortions are performed globally each year, with 20 million of those performed unsafely.[2] Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.[3]
Induced abortion has a long history and has been facilitated by various methods including herbal abortifacients, the use of sharpened tools, physical trauma, and other traditional methods. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, prevalence, cultural status, and religious status of abortion vary substantially around the world. In many parts of the world there is prominent and divisive public controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing pro-life and pro-choice worldwide social movements (both self-named). The incidence of abortion has declined worldwide as access to family planning education and contraceptive services has increased.[4]
Types
Induced
Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[5] Most abortions result from unintended pregnancies.[6] A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus,[7] which increases in size as the pregnancy progresses.[8] Specific procedures may also be selected due to legality, regional availability, and doctor or patient 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; prevent harm to the woman's physical or mental health; terminate a pregnancy where indications are that the child will have a significantly increased chance of premature morbidity or mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[9][10] 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.[10]
Spontaneous
Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 20th to 22nd week of gestation.[note 2] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth" or a "preterm birth".[11] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[12] Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.[citation needed]
Only 30 to 50% of conceptions progress past the first trimester.[13] The vast majority of those that do not progress are lost before the woman is aware of the conception,[10] and many pregnancies are lost before medical practitioners have the ability to detect the presence of an embryo.[14] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[15]
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,[10][16] accounting for at least 50% of sampled early pregnancy losses.[17] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[16] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[17] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[18]
Induction methods
![](http://upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Abortionmethods.png/350px-Abortionmethods.png)
Medical
"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, categorically called abortifacients. In 2005, medical abortions constituted 13% of all abortions in the United States;[19] in 2010 the figure increased to 17%.[20] 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.[21] Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, surgical abortion must be used to complete the procedure.[22]
Surgical
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/25/Vacuum-aspiration_%28single%29.svg/220px-Vacuum-aspiration_%28single%29.svg.png)
1: Amniotic sac
2: Embryo
3: Uterine lining
4: Speculum
5: Vacurette
6: Attached to a suction pump
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.[23] Manual vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.
Dilation and curettage (D&C), the second most common method of 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.[24]
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 hypertonic 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. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.[25]
The Royal College of Obstetricians and Gynaecologists has recommended that an injection be used to stop the fetal heart during the first phase of the surgical abortion procedure to ensure that the fetus is not born alive.[26]
Other methods
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).[28] 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.[29]
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.[30] Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries.[citation needed] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[31] 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.[31]
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.[32]
Safety
The health risks of abortion depend on 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.[33] Abortion, when performed in the developed world in accordance with local law, is among the safest procedures in medicine.[1][34] In the US, the risk of maternal death from abortion is 0.567 per 100,000 procedures, making abortion approximately 12.5 times safer than childbirth (7.06 maternal deaths per 100,000 live births).[35] The risk of abortion-related mortality increases with increasing gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.[36][37]
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 are rare and can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.[38] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before elective abortion,[39] as they are believed to substantially reduce the risk of postoperative uterine infection.[40] Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. A 2008 Cochrane Library review found that dilation and evacuation was safer than other means of second-trimester abortion.[41]
Medical abortion with mifepristone and misoprostol is effective through 49 days of gestational age.[42] It has been used in women up to 63 days of gestational age, albeit with an increased risk of failure (requiring surgical abortion).[43] Medical abortion is generally considered as safe as surgical abortion in the first trimester, but is associated with more pain and a lower success rate (requiring surgical abortion).[44] Overall, the risk of uterine infection is lower with medical than with surgical abortion,[42] although in 2005 four deaths after medical abortion were reported due to infection with Clostridium sordellii.[45] As a result, some abortion providers have begun using preventive antibiotics with medical abortion.[46]
In contrast, unsafe abortion is 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.[1] Unsafe abortion is believed to result in approximately 68,000 deaths[47] and millions of injuries annually.[1] The legal status of abortion is believed to play a major role in the frequency of unsafe abortion.[48][49] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[50] with abortion-related deaths dropping by more than 90%.[51] Groups such as the World Health Organization have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductive-health services.[49]
Breast cancer hypothesis
Although some studies have postulated an association between abortion and breast cancer, the current scientific consensus says no causal relationship exists. Major medical bodies, including the World Health Organization,[52] the U.S. National Cancer Institute,[53] the American Cancer Society,[54] and the Royal College of Obstetricians and Gynaecologists,[55] have concluded on the basis of existing evidence that abortion does not cause breast cancer.[56][57] The concept of a link between induced abortion and breast cancer is promoted primarily by pro-life groups.[56]
Mental health
The current scientific consensus holds that there is no causal relationship between abortion and mental-health problems. There are groups of women who may be at higher risk of coping with problems and distress following abortion.[58] Some 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.[59] The American Psychological Association has concluded, based on available scientific evidence, that a single abortion is not a threat to women's mental health, and that women are no more likely to have mental-health problems after a first-trimester abortion than after carrying an unwanted pregnancy to term.[60][61] Similarly, abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems, though researchers have not examined the effect of second-trimester abortions performed for reasons besides fetal abnormalities.[62]
Some studies[specify] have disagreed with above conclusions, stating that there is a significant increase in mental health problems after abortion. However, such studies have been criticized by other researchers and professional organizations for failing to fully account for pre-existing mental health complications, the severity or lack thereof of any such complications, or improper selection of control groups to account for confounding variables.[63][64][65] 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.[66][67][68]
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 ratio – number of abortions out of 100 known pregnancies (excluding miscarriages and stillbirths)
The number of abortions performed worldwide has decreased between 1995 and 2003 from 45.6 million to 41.6 million, which means a decrease in abortion rate from 35 to 29 per 1000 women. The greatest decrease has occurred in the developed world with a drop from 39 to 26 per 1000 women in comparison to the developing world, which had a decrease from 34 to 29 per 1000 women. Out of a total of about 42 million abortions 22 million occurred safely and 20 million unsafely.[2]
On average, the frequency of abortions is similar in developing countries (where abortion is generally restricted) to the frequency in developed countries (where abortion is generally much less restricted).[3][69] Abortion rates are very difficult to measure in locations where those abortions are illegal,[70] and pro-life groups have criticized researchers for allegedly jumping to conclusions about those numbers.[71] According to the Guttmacher Institute and the United Nations Population Fund, the abortion rate in developing countries is largely attributable to lack of access to modern contraceptives; assuming no change in abortion laws, providing that access to contraceptives would result in about 25 million fewer abortions annually, including almost 15 million fewer unsafe abortions.[72]
The incidence of induced abortion varies regionally. Some countries, such as Belgium (11.2 out of 100 known pregnancies) and the Netherlands (10.6 per 100), had a comparatively low ratio of induced abortion. Others like Russia (62.6 out of 100), Romania (63 out of 100)[73] and Vietnam (43.7 out of 100) had a high ratio (data for last three countries of unknown completeness). The estimated world ratio was 26%, the world rate - 35 per 1000 women.[74]
By 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 abortions were known to have been obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 4.1% at 16 through 20 weeks and 1.4% at more than 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).[75] 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 fetus is accomplished by the same procedure as an induced abortion.[76]
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.[77] 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.[78] Later abortions are more common in China, India, and other developing countries than in developed countries.[79]
Personal and social factors
![](http://upload.wikimedia.org/wikipedia/commons/thumb/d/dd/AGIAbortionReasonsBarChart.png/220px-AGIAbortionReasonsBarChart.png)
A 1998 study from 27 countries on the reasons women seek to terminate their pregnancies concluded that the most common reason women cited for having an abortion was to postpone childbearing to a more suitable time or to focus energies and resources on existing children. The most commonly reported reasons were socioeconomic factors such as being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while she is caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of education, relationship problems with a husband or partner, the perception that she is too young, and unemployment.[80] A 2004 study in which American women at clinics answered a questionnaire yielded similar results.[81] A 1998 survey found risk to maternal health cited as the main reason by 5-10% in seven countries and by 20-38% in three (Kenya, Bangladesh and India).[80] A 1997 U.S. report cited maternal health the "most important reason" for their decision by 3% of women and another 3% cited concern that the fetus had a health problem.[76] In a 2004 survey-based U.S. study, 1% of women having abortions became pregnant as a result of rape and 0.5% as a result of incest.[81] 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.[82] 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."[83]
Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled people, 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.
Unsafe abortion
![](http://upload.wikimedia.org/wikipedia/commons/thumb/5/5e/RussianAbortionPoster.jpg/220px-RussianAbortionPoster.jpg)
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. About one in eight pregnancy-related deaths worldwide are associated with unsafe abortion.[84]
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."[85] They may be performed by the woman herself, by another person without medical training, or by a healthcare professional operating in sub-standard conditions. Unsafe abortion remains a public health concern due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.
The legality of abortion is one of the main determinants of its safety. Restrictive abortion laws are associated with a high rate of unsafe abortions.[2][86][87] In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.[88]
Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.[3] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[2] Complications of unsafe abortion account for approximately 12% of maternal mortalities in Asia, 25% in Latin America, and 13% in sub-Saharan Africa.[89] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[87] 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.[86] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[90]
History
![](http://upload.wikimedia.org/wikipedia/commons/thumb/3/3e/FrenchPeriodicalPills-January61845%2CBostonDailyTimes.jpg/220px-FrenchPeriodicalPills-January61845%2CBostonDailyTimes.jpg)
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).[91] 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.
Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions.[91] However, other modern scholars disagree with this interpretation,[91] and the medical texts of Hippocratic Corpus contain descriptions of abortive techniques and notes on the risks they posed to a woman's health.[92] In Christianity, Pope Sixtus V (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy;[93] the Church had previously been divided on whether if believed that abortion was murder, and did not begin vigorously opposing abortion until the 19th century.[91] Islamic tradition has traditionally permitted abortion up until a point in time when Muslims believe the soul enters the fetus,[91] considered by various theologians to be at conception, at 40 days after conception, at 120 days after conception, or at quickening.[94] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[95]
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.[91] Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice was banned in both the United States and the United Kingdom.[91] Church groups as well as physicians were highly influential in anti-abortion movements.[91] In the U.S., abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.[96] The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[97] 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.[98][99][100][101]
In the late 1960s and early 1970s, due to a confluence of factors, the number of reported abortions increased worldwide. In West Germany, the number of reported abortions increased from 2,800 in 1968 to 87,702 in 1980.[citation needed] In the United States, legalization of abortion in multiple states in 1967-70 was followed by a landmark decision in Roe v. Wade (1973), which legalized the procedure nationwide. This led to explosive growth in the number of reported abortions: In 1966, only 1028 abortions were reported to the Centers for Disease Control and Prevention (CDC). In 1980, 1.3 million were reported to the CDC, giving a ratio of 359 abortions per 1,000 live births.[102] The Guttmacher Institute estimates the total number of abortions in 1980 (including those unreported to CDC) to be 1.55 million.[103]
Society and culture
Abortion debate
Induced abortion has long 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 described as being a combination of beliefs on its morality; beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy; and on the rights and responsibilities of the woman seeking to have an abortion. Religious ethics also has an influence upon both personal opinion and the greater debate over abortion.
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. Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Those in favor of greater legal restrictions on, or even complete prohibition of abortion, most often describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Generally, the former position argues that a human fetus is a human being with a right to live, making abortion tantamount to murder. The latter position argues that a woman has certain reproductive rights, especially the choice whether or not to carry a pregnancy to term.
Modern abortion law
![](http://upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Abortion_Laws.svg/400px-Abortion_Laws.svg.png)
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 |
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.
In jurisdictions where abortion is legal, certain requirements must often be met before an abortion may be obtained. These requirements are usually dependent on the age of the fetus, often using a trimester-based system to regulate the window of legality. Many restrictions are waived in emergency situations. 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.[104] Other jurisdictions may require that a woman obtain the consent of the fetus' father before aborting the fetus, that abortion providers inform patients of the supposed health risks of the procedure, and that multiple medical authorities certify that the abortion is either medically or socially necessary.
Other jurisdictions ban abortion almost entirely. However, many, but not all, of these will allow them to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. In countries where abortion is banned entirely, such as Nicaragua, rises in maternal death directly and indirectly due to pregnancy have been noted.[105][106] Some countries, such as Bangledesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.[107] 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.[108] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.[109]
Emergency contraception is generally available in countries that have not restricted abortion, and is also sometimes available in countries that have otherwise banned abortion, such as Chile.[110][111] This has caused controversy, as some pro-life groups have advocated that certain forms of emergency contraception are not contraceptives but abortifacients.
Sex-selective
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.
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 China, Taiwan, South Korea, and India.[112]
In India, the economic role of men, the costs associated with dowries, and a common Indian tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons.[113] 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."[114] 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.[115] Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.[116] The Indian government passed an official ban of pre-natal sex screening in 1994 and banned sex-selective abortion in 2002,[117] although it had already previously outlawed abortion except to save the life of the mother.[117]
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.[118] 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.[119] A ban upon the practice of sex-selective abortion was enacted in 2003.[120]
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 has been classified by governmental and scholarly sources as terrorism.[121][122] Only a small fraction of those opposed to abortion commit violence, often rationalizing their actions as justifiable homicide or defense of others, committed in order to protect the lives of fetuses.
In the United States, four abortion providers—Drs. David Gunn, John Britton, Barnett Slepian, and George Tiller—have been assassinated. Attempted assassinations have also taken place in the United States and Canada, and other personnel at abortion clinics, including receptionists and security guards, have been killed in the United States and Australia. Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have also occurred.[123][124] 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.[125]
Art, literature and film
Art serves to humanize the abortion issue and illustrates the myriad of decisions and consequences it has. One of the earliest known representations of abortion is in a bas relief at Angkor Wat (c. 1150). Pro-life activist Børre Knudsen was linked to a 1994 art theft as part of a pro-life drive in Norway surrounding the 1994 Winter Olympics.[126] A Swiss gallery removed a piece from a Chinese art collection in 2005, that had the head of a fetus attached to the body of a bird.[127] In 2008, a Yale student proposed using aborted excretions and the induced abortion itself as a performance art project.[128]
The Cider House Rules (novel 1985, film 1999) follows the story of Dr. Larch an orphanage director who is a reluctant abortionist after seeing the consequences of back-alley abortions, and his orphan medical assistant Homer who is against abortion.[129] Feminist novels such as Braided Lives (1997) by Marge Piercy emphasize the struggles women had in dealing with unsafe abortion in various circumstances prior to legalization.[130] Physician Susan Wicklund wrote This Common Secret (2007) about how a personal traumatic abortion experience hardened her resolve to provide compassionate care to women who decide to have an abortion. As Wicklund crisscrosses the West to provide abortion services to remote clinics, she tells the stories of women she's treated and the sacrifices she and her loved ones made.[131] In 2009, Irene Vilar revealed her past abuse and addiction to abortion in Impossible Motherhood, where she aborted 15 pregnancies in 17 years. According to Vilar it was the result of a dark psychological cycle of power, rebellion and societal expectations.[132] In Annie Finch's mythic epic poem and opera libretto Among the Goddesses (2010), the heroine's abortion is contextualized spiritually by the goddesses Demeter, Kali, and Inanna.[133]
Various options and realities of abortion have been dramatized in film. In Riding in Cars with Boys (2001) an underage woman carries her pregnancy to term as abortion is not an affordable option, moves in with the father and finds herself involved with drugs, has no opportunities, and questioning if she loves her child. While in Juno (2007) a 16-year-old initially goes to have an abortion but decides to bear the child and allow a wealthy couple to adopt it. Other films Dirty Dancing (1987) and If These Walls Could Talk (1996) explore the availability, affordability and dangers of illegal abortions. The emotional impact of dealing with an unwanted pregnancy alone is the focus of Things You Can Tell Just By Looking At Her (2000) and Circle of Friends (1995). As a marriage was in trouble in the The Godfather Part II (1974) Kay knew the relationship was over when she aborted "a son" in secret.[134] On the abortion debate, an irresponsible drug addict is used as a pawn in a power struggle between pro-choice and pro-life groups in Citizen Ruth (1996).[135] The Law & Order television episode "Dignity" deals with the trial of a man who killed a late-term abortion doctor; the storyline was inspired by the assassination of abortion provider George Tiller.[136]
In other animals
Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.[137] In cows, abortion may be caused by contagious disease, such as Brucellosis or Campylobacter, but can often be controlled by vaccination.[138]
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.[139]
Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[140][141][142] although the frequency in the wild has been questioned.[143] Male gray langur monkeys may attack females following male takeover, causing miscarriage.[144]
Notes
- ^ The definition of abortion, as with many words, varies from source to source. The following is a partial list of definitions as stated by obstetrics and gynecology (OB/GYN) textbooks, dictionaries, and other encyclopedias:
- Major OB/GYN textbooks
- The National Center for Health Statistics defines an "abortus" as "[a] fetus or embryo removed or expelled from the uterus during the first half of gestation—20 weeks or less, or in the absence of accurate dating criteria, born weighing < 500 g." They also define "birth" as "[t]he complete expulsion or extraction from the mother of a fetus after 20 weeks' gestation. [...] in the absence of accurate dating criteria, fetuses weighing <500 g are usually not considered as births, but rather are termed abortuses for purposes of vital statistics." Cunningham, FG; Leveno, KJ; Bloom, SL; Hauth, JC; Rouse, DJ; Spong, CY, eds. (2010). "1. Overview of Obstetrics". Williams Obstetrics (23 ed.). McGraw-Hill Medical. ISBN 978-0-07-149701-5.
- "[T]he standard medical definition of abortion [is] termination of a pregnancy when the fetus is not viable". Annas, George J.; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. ISBN 978-0-443-06930-7.
- "Termination of a pregnancy, whether spontaneous or induced." Kottke, Melissa J.; Zieman, Mimi (2008). "33. Management of Abortion". In Rock, John A.; Jones III, Howard W. (eds.). TeLinde's Operative Gynecology (10 ed.). Lippincott Williams & Wilkins. ISBN 978-0-7817-7234-1.
- Other OB/GYN textbooks
- "Termination of pregnancy before 20 weeks' gestation calculated from date of onset of last menses. An alternative definition is delivery of a fetus with a weight of less than 500 g. If abortion occurs before 12 weeks' gestation, it is called early; from 12 to 20 weeks it is called late." Katz, Vern L. (2007). "16. Spontaneous and Recurrent Abortion - Etiology, Diagnosis, Treatment". In Katz, Vern L.; Lentz, Gretchen M.; Lobo, Rogerio A.; Gershenson, David M. (eds.). Katz: Comprehensive Gynecology (5 ed.). Mosby. ISBN 9780323029513.
- "Abortion is the spontaneous or induced termination of pregnancy before fetal viability. Because popular use of the word abortion implies a deliberate pregnancy termination, some prefer the word miscarriage to refer to spontaneous fetal loss before viability [...] The National Center for Health Statistics, the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) define abortion as pregnancy termination prior to 20 weeks' gestation or a fetus born weighing less than 500 g. Despite this, definitions vary widely according to state laws." Schorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M.; Hoffman, Barbara L.; Bradshaw, Karen D.; Cunningham, F. Gary, eds. (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN 978-0-07-147257-9.
- Major medical dictionaries
- "The spontaneous or induced termination of pregnancy before the fetus reaches a viable age." "Taber's Medical Dictionary: abortion". Taber's Cyclopedic Medical Dictionary. F.A. Davis. Archived from the original on June 14, 2011. Retrieved June 14, 2011.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - "Expulsion from the uterus an embryo or fetus prior to the stage of viability (20 weeks' gestation or fetal weight <500g). A distinction made between [abortion] and premature birth: premature infants are those born after the stage of viability but prior to 37 weeks." Stedman's Medical Dictionary (27 ed.). Lippincott Williams & Wilkins. ISBN 0683400088.
- "[P]remature expulsion from the uterus of the products of conception, either the embryo or a nonviable fetus." Dorland's Illustrated Medical Dictionary (31 ed.). Saunders. 2007. ISBN 9781416023647.
- Other medical dictionaries
- "[T]he termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus". "Medical Dictionary". Merriam-Webster's Medical Dictionary. Merriam-Webster. Archived from the original on June 15, 2011. Retrieved June 15, 2011.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - "Induced termination of pregnancy, involving destruction of the embryo or fetus." "abortion." The American Heritage Science Dictionary. Boston: Houghton Mifflin, 2005.
- "Interruption of pregnancy before the fetus has attained a stage of viability, usually before the 24th gestational week." "abortion." Cambridge Dictionary of Human Biology and Evolution. Cambridge: Cambridge University Press, 2005.
- "[A] spontaneous or deliberate ending of pregnancy before the fetus can be expected to survive." "abortion." Mosby's Emergency Dictionary. Philadelphia: Elsevier Health Sciences, 1998.
- "[A] situation where a fetus leaves the uterus before it is fully developed, especially during the first 28 weeks of pregnancy, or a procedure which causes this to happen...[T]o have an abortion to have an operation to make a fetus leave the uterus during the first period of pregnancy." "abortion." Dictionary of Medical Terms. London: A&C Black, 2008.
- Other dictionaries
- "The act of giving untimely birth to offspring, premature delivery, miscarriage; the procuring of premature delivery so as to destroy offspring. (In Med. abortion is limited to a delivery so premature that the offspring cannot live, i.e. in the case of the human fœtus before the sixth month.)" Oxford English Dictionary (2 ed.). Oxford University Press. 1989.
- "The deliberate termination of a pregnancy, usually before the embryo or fetus is capable of independent life." The American Heritage New Dictionary of Cultural Literacy, Third Edition. Houghton Mifflin Company. 2005. Retrieved June 27, 2011.
- "[T]he removal of an embryo or fetus from the uterus before it is sufficiently developed to survive independently, deliberately induced by the use of drugs or by surgical procedures. Also called termination or induced abortion" or "[T]he spontaneous expulsion of an embryo or fetus from the uterus before it is sufficiently developed to survive independently. Also called miscarriage, spontaneous abortion." "abortion." Chambers 21st Century Dictionary. London: Chambers Harrap, 2001.
- "[A]n operation or other procedure to terminate pregnancy before the fetus is viable" or "[T]he premature termination of pregnancy by spontaneous or induced expulsion of a nonviable fetus from the uterus". "abortion". Collins English Dictionary - Complete & Unabridged 10th Edition. HarperCollins Publishers. Retrieved June 27, 2011.
- "A term that, in philosophy, theology, and social debates, often means the deliberate termination of pregnancy before the fetus is able to survive outside the uterus. However, participants in these debates sometimes use the term abortion simply to mean the termination of pregnancy before birth, regardless of whether the fetus is viable or not." "abortion." Dictionary of World Philosophy. London: Routledge, 2001.
- "[T]he removal of an embryo or fetus from the uterus in order to end a pregnancy" or "[A]ny of various surgical methods for terminating a pregnancy, especially during the first six months." "abortion". Dictionary.com Unabridged. Random House, Inc. June 27, 2011.
- Encyclopedias
- "[T]he expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation)." "Abortion (pregnancy)". Encyclopædia Britannica Online. Encyclopædia Britannica. 2011. Archived from the original on June 26, 2011. Retrieved June 26, 2011.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - "Expulsion of the products of conception before the embryo or fetus is viable. Any interruption of human pregnancy prior to the 28th week is known as abortion." <Please add first missing authors to populate metadata.> (2008). "abortion". The Columbia Encyclopedia. New York: Columbia University Press.
- "The expulsion or removal of a fetus from the womb before it is capable of independent survival." <Please add first missing authors to populate metadata.> (2008). "abortion". World Encyclopedia. Oxford University Press.
{{cite encyclopedia}}
:|work=
ignored (help) - "[Abortion] is commonly misunderstood outside medical circles. In general terms, the word 'abortion' simply means the failure of something to reach fulfilment or maturity. Medically, abortion means loss of the fetus, for any reason, before it is able to survive outside the womb. The term covers accidental or spontaneous ending, or miscarriage, of pregnancy as well as deliberate termination. The terms 'spontaneous abortion' and 'miscarriage' are synonymous and are defined as loss of the fetus before the twenty-eighth week of pregnancy. This definition implies a legal perception of the age at which a fetus can survive out of the womb. With great advances in recent years in the ability to keep very premature babies alive, this definition is in need of revision." <Please add first missing authors to populate metadata.> (2000). "abortion and miscarriage". The Royal Society of Medicine Health Encyclopedia. London: Bloomsbury Publishing Ltd.
- "Abortion is the intentional removal of a fetus or an embryo from a mother's womb for purposes other than that of either producing a live birth or disposing of a dead embryo." <Please add first missing authors to populate metadata.> (1999). "Abortion". Encyclopedia of Human Rights Issues since 1945 (1 ed.). Santa Barbara, California: Routledge. ISBN 978-1579581664.
- ^ Note that the defining line between miscarriage and premature birth or stillbirth varies among jurisdictions. "Documenting Stillbirth (Fetal Death)". United States Department of State. February 18, 2011. Archived from the original (PDF) on June 27, 2011. Retrieved June 27, 2011.
References
- ^ a b c d Grimes DA; Benson J; Singh S; et al. (2006). "Unsafe abortion: the preventable pandemic" (PDF). Lancet. 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help) - ^ a b c d e Shah, I.; Ahman, E. (2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges" (PDF). Journal of Obstetrics and Gynaecology Canada. 31 (12): 1149–58. PMID 20085681.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ a b c Culwell KR, Vekemans M, de Silva U, Hurwitz M (2010). "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion". International Journal of Gynecology & Obstetrics. 110: S13–16. doi:10.1016/j.ijgo.2010.04.003. PMID 20451196.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J (2007). "Legal abortion worldwide: incidence and recent trends". Int Fam Plan Perspect. 33 (3): 106–16. doi:10.1363/ifpp.33.106.07. PMID 17938093.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Cheng L. (1 November 2008). "Surgical versus medical methods for second-trimester induced abortion". The WHO Reproductive Health Library. World Health Organization. Archived from the original on 17 June 2011. Retrieved 17 June 2011.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - ^ Bankole et al., "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries", International Family Planning Perspectives (1998). Also see Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore, "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives", Perspectives on Sexual and Reproductive Health, 37(3):110-118 (September 2005).
- ^ Stubblefield, Phillip G. (2002). "10. Family Planning". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN 978-0781732628.
- ^ Menikoff, Jerry (2001). Law and Bioethics. Georgetown University Press. p. 78. ISBN 9780878408399.
As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use.
- ^ Roche, Natalie E. (28 September 2004). "Therapeutic Abortion". eMedicine. Archived from the original on December 14, 2004. Retrieved June 19, 2011.
- ^ a b c d Schorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M.; Hoffman, Barbara L.; Bradshaw, Karen D.; Cunningham, F. Gary, eds. (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN 978-0-07-147257-9.
- ^ Annas, George J.; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. p. 669. ISBN 978-0-443-06930-7.
A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight.
- ^ "Stillbirth". Concise Medical Dictionary. Oxford University Press. 2010.
birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception
{{cite web}}
: Missing or empty|url=
(help) - ^ Annas, George J.; Elias, Sherman (2007). "24. Pregnancy loss". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. ISBN 978-0-443-06930-7.
- ^ Katz, Vern L. (2007). "16. Spontaneous and Recurrent Abortion - Etiology, Diagnosis, Treatment". In Katz, Vern L.; Lentz, Gretchen M.; Lobo, Rogerio A.; Gershenson, David M. (eds.). Katz: Comprehensive Gynecology (5 ed.). Mosby. ISBN 9780323029513.
- ^ Stovall, Thomas G. (2002). "17. Early Pregnancy Loss and Ectopic Pregnancy". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN 978-0781732628.
- ^ a b Stöppler. Shiel WC Jr (ed.). "Miscarriage (Spontaneous Abortion)". MedicineNet.com. WebMD. Retrieved 2009-04-07.
{{cite web}}
: More than one of|author=
and|last=
specified (help) - ^ a b Jauniaux E, Kaminopetros P, El-Rafaey H (1999). "Early pregnancy loss". In Whittle MJ,Rodeck CH (ed.). Fetal medicine: basic science and clinical practice. Edinburgh: Churchill Livingstone. p. 837. ISBN 978-0-443-05357-3. OCLC 42792567.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ^ "Fetal Homicide Laws". National Conference of State Legislatures. Retrieved 2009-04-07.
- ^ Jones R. K.; et al. (2008). "Abortion in the United States: incidence and access to services, 2005" (PDF). Perspectives on Sexual and Reproductive Health. 40 (1): 6–16. doi:10.1363/4000608. PMID 18318867.
{{cite journal}}
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ignored (help) - ^ Stein, Rob (2011-01-11). "Decline in U.S. abortion rate stalls". The Washington Post.
- ^ Spitz, I.M; Bardin, CW; Benton, L; Robbins, A (1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". New England Journal of Medicine. 338 (18): 1241. doi:10.1056/NEJM199804303381801. PMID 9562577.
{{cite journal}}
: More than one of|pages=
and|page=
specified (help) - ^ Trupin, Suzanne R. (2003). "31. Induced Abortion". In Scott, James R.; Gibbs, Ronald S.; Karlan, Beth y.; Haney, Arthur F. (eds.). Danforth's Obstetrics and Gynecology (9 ed.). Lippincott Williams & Wilkins. ISBN 978-0781737302.
- ^ Healthwise (2004). "Manual and vacuum aspiration for abortion". WebMD. Retrieved 2008-12-05.
- ^ World Health Organization (2003). "Dilatation and curettage". Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. Geneva: World Health Organization. ISBN 978-92-4-154587-7. OCLC 181845530.
{{cite book}}
:|access-date=
requires|url=
(help); External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) - ^ McGee, Glenn. "Abortion". Encarta. Microsoft. Archived from the original on 2009-10-31. Retrieved 2008-12-05.
{{cite encyclopedia}}
: Unknown parameter|coauthors=
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suggested) (help); Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - ^ Nuffield Council on Bioethics (June 22, 2007). "Dilemmas in Current Practice: The Fetus". Critical Case Decisions in Fetal and Neonatal Medicine: Ethical Issues. Nuffield Council on Bioethics. ISBN 978-1-904384-14-4. OCLC 85782378.
{{cite book}}
:|access-date=
requires|url=
(help); External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help) - ^ Potts M (2007). Thousand-year-old depictions of massage abortion. Vol. 33. p. 234.
at Angkor, the operator is a demon.
{{cite book}}
:|journal=
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(help); Unknown parameter|author-separator=
ignored (help) Also see Mould R (1996). Mould's Medical Anecdotes. CRC Press. p. 406. ISBN 978-0-85274-119-1. - ^ Riddle, John M. (1997). Eve's herbs: a history of contraception and abortion in the West. Cambridge, Massachusetts: Harvard University Press. ISBN 978-0-674-27024-4. OCLC 36126503.[page needed]
- ^ Ciganda C, Laborde A (2003). "Herbal infusions used for induced abortion". J. Toxicol. Clin. Toxicol. 41 (3): 235–239. doi:10.1081/CLT-120021104. PMID 12807304.
- ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1016/S0891-5245(98)90245-0, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
|doi=10.1016/S0891-5245(98)90245-0
instead. - ^ a b Potts, M.; Graff, M.; Taing, J. (2007). "Thousand-year-old depictions of massage abortion". Journal of Family Planning and Reproductive Health Care. 33 (4): 233–234. doi:10.1783/147118907782101904. PMID 17925100.
- ^ Thapa, S. R.; Rimal, D.; Preston, J. (2006). "Self induction of abortion with instrumentation". Australian Family Physician. 35 (9): 697–698. PMID 16969439.
- ^ "The Prevention and Management of Unsafe Abortion" (PDF). World Health Organization. April 1995. Retrieved June 1, 2010.
- ^ Grimes, DA; Creinin, MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. doi:10.1001/archinte.140.5.620. PMID 15096333.
- ^ Grimes DA (2006). "Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999". Am. J. Obstet. Gynecol. 194 (1): 92–4. doi:10.1016/j.ajog.2005.06.070. PMID 16389015.
{{cite journal}}
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ignored (help) - ^ Bartlett LA; Berg CJ; Shulman HB; et al. (2004). "Risk factors for legal induced abortion-related mortality in the United States". Obstet Gynecol. 103 (4): 729–37. doi:10.1097/01.AOG.0000116260.81570.60. PMID 15051566.
{{cite journal}}
: Unknown parameter|author-separator=
ignored (help); Unknown parameter|month=
ignored (help) - ^ Trupin, Suzanne (May 27, 2010). "Elective Abortion". eMedicine. Retrieved June 1, 2010.
At every gestational age, elective abortion is safer for the mother than carrying a pregnancy to term.
- ^ Westfall JM, Sophocles A, Burggraf H, Ellis S (1998). "Manual vacuum aspiration for first-trimester abortion". Arch Fam Med. 7 (6): 559–62. doi:10.1001/archfami.7.6.559. PMID 9821831.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ ACOG Committee on Practice Bulletins--Gynecology (2009). "ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures". Obstet Gynecol. 113 (5): 1180–9. doi:10.1097/AOG.0b013e3181a6d011. PMID 19384149.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Sawaya GF, Grady D, Kerlikowske K, Grimes DA (1996). "Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis". Obstet Gynecol. 87 (5 Pt 2): 884–90. PMID 8677129.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ Lohr PA, Hayes JL, Gemzell-Danielsson K (2008). Lohr, Patricia A. (ed.). "Surgical versus medical methods for second trimester induced abortion". Cochrane Database Syst Rev (1): CD006714. doi:10.1002/14651858.CD006714.pub2. PMID 18254113.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ a b Spitz IM, Bardin CW, Benton L, Robbins A (1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". N. Engl. J. Med. 338 (18): 1241–7. doi:10.1056/NEJM199804303381801. PMID 9562577.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Aubény E; Peyron R; Turpin CL; et al. (1995). "Termination of early pregnancy (up to 63 days of amenorrhea) with mifepristone and increasing doses of misoprostol [corrected]". Int J Fertil Menopausal Stud. 40 Suppl 2: 85–91. PMID 8574255.
{{cite journal}}
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ignored (help) - ^ "Medical versus surgical methods for first trimester termination of pregnancy". World Health Organization. December 15, 2006. Retrieved June 1, 2010.
- ^ Fischer M; Bhatnagar J; Guarner J; et al. (2005). "Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion". N. Engl. J. Med. 353 (22): 2352–60. doi:10.1056/NEJMoa051620. PMID 16319384.
{{cite journal}}
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ignored (help); Unknown parameter|month=
ignored (help) - ^ Fjerstad M, Trussell J, Sivin I, Lichtenberg ES, Cullins V (2009). "Rates of serious infection after changes in regimens for medical abortion". N. Engl. J. Med. 361 (2): 145–51. doi:10.1056/NEJMoa0809146. PMID 19587339.
{{cite journal}}
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ Haddad, LB.; Nour, NM. (2009). "Unsafe abortion: unnecessary maternal mortality". Rev Obstet Gynecol. 2 (2): 122–6. PMC 2709326. PMID 19609407.
- ^ Berer M (2004). "National laws and unsafe abortion: the parameters of change". Reprod Health Matters. 12 (24 Suppl): 1–8. doi:10.1016/S0968-8080(04)24024-1. PMID 15938152.
{{cite journal}}
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ignored (help) - ^ a b Berer M (2000). "Making abortions safe: a matter of good public health policy and practice". Bull. World Health Organ. 78 (5): 580–92. PMC 2560758. PMID 10859852.
- ^ Jewkes R, Rees H, Dickson K, Brown H, Levin J (2005). "The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change". BJOG. 112 (3): 355–9. doi:10.1111/j.1471-0528.2004.00422.x. PMID 15713153.
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ignored (help)CS1 maint: multiple names: authors list (link) - ^ Bateman C (2007). "Maternal mortalities 90% down as legal TOPs more than triple". S. Afr. Med. J. 97 (12): 1238–42. PMID 18264602.
{{cite journal}}
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ignored (help) - ^ "Induced abortion does not increase breast cancer risk (Fact sheet N°240)". World Health Organization. Retrieved 2011-01-06.
- ^ "Abortion, Miscarriage, and Breast Cancer Risk". National Cancer Institute. Retrieved 2011-01-11.
- ^ "Is Abortion Linked to Breast Cancer?". American Cancer Society. September 23, 2010. Retrieved June 20, 2011.
At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer.
- ^ "The Care of Women Requesting Induced Abortion" (PDF). Royal College of Obstetricians and Gynaecologists. p. 9. Retrieved 2008-06-29.
Induced abortion is not associated with an increase in breast cancer risk.
- ^ a b Jasen P (2005). "Breast cancer and the politics of abortion in the United States". Med Hist. 49 (4): 423–44. PMC 1251638. PMID 16562329.
- ^ "ACOG Finds No Link Between Abortion and Breast Cancer Risk". American Congress of Obstetricians and Gynecologists. July 31, 2003. Retrieved 2011-01-11.
- ^ Cockburn, Jayne; Pawson, Michael E. (2007). Psychological Challenges to Obstetrics and Gynecology: The Clinical Management. Springer. p. 243. ISBN 978-1-84628-807-4.
- ^ Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE (1990). "Psychological responses after abortion". Science. 248 (4951): 41–4. doi:10.1126/science.2181664. PMID 2181664.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ "APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health" (Press release). American Psychological Association. August 12, 2008. Retrieved September 7, 2011.
- ^ "Report of the APA Task Force on Mental Health and Abortion" (PDF). Washington, DC: American Psychological Association. August 13, 2008.
- ^ Steinberg, J. R. (2011). "Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions—A Critical Review of Research". Women's Health Issues. 21 (3): S44–S48. doi:10.1016/j.whi.2011.02.002. PMID 21530839.
- ^ "RCOG statement on BJPsych paper on mental health risks and abortion". Royal College of Obstetricians and Gynaecologists. 1 September 2011. Retrieved 6 September 2011.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1056/NEJMoa0905882, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
|doi=10.1056/NEJMoa0905882
instead. - ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 19014789, please use {{cite journal}} with
|pmid=19014789
instead. - ^ Grimes, DA; Creinin, MD (2004). "Induced abortion: an overview for internists". Ann Intern Med. 140 (8): 620–6. doi:10.1001/archinte.140.5.620. PMID 15096333.
Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae. ... The alleged 'postabortion trauma syndrome' does not exist.
- ^ Stotland NL (2003). "Abortion and psychiatric practice". J Psychiatr Pract. 9 (2): 139–149. doi:10.1097/00131746-200303000-00005. PMID 15985924.
Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae.
- ^ Stotland NL (1992). "The myth of the abortion trauma syndrome". J Am Med Assoc. 268 (15): 2078–9. doi:10.1001/jama.268.15.2078. PMID 1404747.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Shah I, Ahman E (2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges". J Obstet Gynaecol Can. 31 (12): 1149–58. PMID 20085681.
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
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Sedgh, Gilda and Henshaw, Stanley. "Measuring the Incidence of Abortion in Countries With Liberal Laws" in Methodologies for Estimating Abortion Incidence and Abortion-Related Morbidity: A Review, (Guttmacher Institute 2010): "In countries with highly restrictive abortion laws, it is extremely difficult to obtain reliable counts of the numbers of procedures performed."
- ^ Rosenthal, Elizabeth (October 12, 2007). "Legal or Not, Abortion Rates Compare". The New York Times. Retrieved July 18, 2011.
Anti-abortion groups criticized the research, saying that the scientists had jumped to conclusions from imperfect tallies, often estimates of abortion rates in countries where the procedure was illegal.
- ^ Singh, Susheela et al. Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health, pages 17, 19, and 27 (New York: Guttmacher Institute and United Nations Population Fund 2009): "Some 215 million women in the developing world as a whole have an unmet need for modern contraceptives…. If the 215 million women with unmet need used modern family planning methods....[that] would result in about 22 million fewer unplanned births; 25 million fewer abortions; and seven million fewer miscarriages....If women’s contraceptive needs were addressed (and assuming no changes in abortion laws)...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "Facts on Investing in Family Planning and Maternal and Newborn Health" (Guttmacher Institute 2010).
- ^ National Institute of Statistics, Romanian Statistical Yearbook, page 29, 2008
- ^ Henshaw, Stanley K., Singh, Susheela, and Haas, Taylor. (1999). The Incidence of Abortion Worldwide. International Family Planning Perspectives, 25 (Supplement), 30–38. Retrieved 2006-01-18.
- ^ Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., and Hamdan, S. (November 24, 2006). Abortion Surveillance – United States, 2003. Morbidity and Mortality Weekly Report, 55 (11), 1–32. Retrieved May 10, 2007.
- ^ a b "The Limitations of U.S. Statistics on Abortion". Issues in Brief. New York: The Guttmacher Institute. 1997.
- ^ Finer, L. B.; Henshaw, S. K. (2003). "Abortion Incidence and Services in the United States in 2000". Perspectives on Sexual and Reproductive Health. 35 (1): 6–15. doi:10.1363/3500603. PMID 12602752.
- ^ Department of Health (2007). "Abortion statistics, England and Wales: 2006". Retrieved 2007-10-12.
- ^ Cheng L. “Surgical versus medical methods for second-trimester induced abortion : RHL commentary” (last revised: 1 November 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.
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