Abortion

An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in, or caused by, its death. This can occur spontaneously as a miscarriage, or be artificially induced through chemical, surgical or other means. Commonly, "abortion" refers to an induced procedure at any point in the pregnancy; medically, it is defined as a miscarriage or induced termination before twenty weeks gestation, which is considered nonviable.

There have been various methods of inducing abortion throughout history. The moral and legal aspects of abortion are the subject of intense debate in many parts of the world.

Definitions

The following medical terms are used to define an abortion:

• Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes, such as a chromosomal number discrepancy, early disease, or environmental factors.
• Induced abortion: An abortion deliberately caused. Induced abortions are further subcategorized into therapeutic abortions and elective abortions:
  • Therapeutic abortion:
    • To save the life of the pregnant woman.
    • To preserve the woman's physical or mental health.
    • To terminate a pregnancy that would result in a child born with a congenital disorder which would be fatal or associated with significant morbidity.
    • To selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.
  • Elective abortion: An abortion performed for any other reason.

A pregnancy that ends earlier than 37 complete weeks of gestation, and where an infant is born and survives, is termed a premature birth. A pregnancy that ends with an infant dead upon birth at any gestational stage, due to causes including spontaneous abortion or complications during delivery, is termed a stillbirth.

In common parlance, the term "abortion" is synonymous with induced abortion of a human fetus. However, in medical texts, the word 'abortion' can also refer to spontaneous abortion (miscarriage).

The distinctions between spontaneous abortion, therapeutic abortion and induced delivery may be blurred. For example, in cases of pre-eclampsia spontaneous abortion may occur, but if it does not, doctors may opt for immediate delivery regardless of the potential viability of the fetus.

Incidence

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

The percentage of abortions by gestational age in England and Wales during 2004.

Rates of abortion also vary depending upon the stage of pregnancy and the method practiced. In 2002, from data collected in those areas of the United States which sufficiently reported gestational age, it was found that 86.7% of abortions were conducted at or prior to 12 weeks, 9.9% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 91.3% percent of these were classified as having been done by "curettage" (suction-aspiration, D&C, D&E), 5.2% by "medical" means (mifepristone), 0.8% by "intrauterine instillation" (saline or prostaglandin), and 1.5 % by "other" (hysterotomy and hysterectomy). The Guttmacher Institute estimated that there were 2,200 intact dilation and extraction procedures in the U.S. during 2000 which would account for only 0.17% of the total number of abortions performed that year. Similarly, in England and Wales in 2004, 87.6% of terminations occurred at or under 12 weeks, 10.7% between 13 to 19 weeks, and 1.5% at or over 20 weeks. 76% of those reported were by vacuum aspiration, 4% by D&E, 19% by a chemical agent, and 1% by feticide.

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

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

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled persons, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). A combination of these factors can sometimes result in compulsory abortion or sex-selective abortion. In many areas, especially in developing nations or where abortion is illegal, women sometimes resort to "back-alley" or self-induced procedures. The World Health Organization suggests that there are 19 million terminations annually which fit its criteria for an unsafe abortion. See social issues for more information on these subjects.

Forms of abortion

Spontaneous abortion

Main article: Miscarriage

Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes. A miscarriage is spontaneous loss of the embryo or fetus before the 20th week of development. Spontaneous abortions after the 20th week are generally considered to be preterm deliveries. Most miscarriages occur very early in a pregnancy. Approximately 10-50% of pregnancies end in miscarriage, depending upon the age and health of the pregnant woman.

The risk for spontaneous abortion is greater in those with a history of more than three previous (known) spontaneous abortions, those who have had a previous induced abortion, those with systemic diseases, and in women over age 35.

Other causes can be infection (of either the woman or the fetus), immune responses, or serious systemic diseases of the woman.

A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered an induced abortion.

Induced abortion

A pregnancy can be intentionally aborted in a number of ways. The manner selected depends chiefly upon the gestational age of the fetus, in addition to the legality, regional availability, and/or doctor-patient preference for specific procedures.

Surgical abortion

Gestational age may determine which abortion methods are practiced.

In the first twelve weeks, suction-aspiration or vacuum abortion is the most common method. Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses an electric pump. These techniques are comparable, differing 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 doesn't require cervical dilation. Surgical techniques are sometimes referred to as STOP: 'Suction (or surgical) Termination of Pregnancy'. From the fifteenth week up until around the twenty-sixth week, a surgical 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) is a standard gynaecological 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 the cleaning of the walls of the uterus with a curette. The World Health Organization recommends this sort of procedure, also called Sharp Curettage, only when MVA is unavailable. Sharp curettage only accounted for 2.4% of abortion procedures in the US in 2002. The term "D and C", or perhaps suction curette, etc, is sometimes used as a euphemism to refer to the first trimester abortion procedure, irrespective of the method used to perform the procedure.

Other techniques must be used to induce abortion in the third trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late abortions can be brought about by intact dilation and extraction (intact D & X) (also called Intrauterine cranial decompression), which requires the surgical decompression of the fetus's head before evacuation, and is sometimes termed "partial-birth abortion." A hysterotomy abortion, similar to a caesarian section but resulting in a terminated fetus, can also be used at late stages of pregnancy. It can be performed vaginally, with an incision just above the cervix, in the late mid-trimester.

From somewhere between the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure.

Chemical abortion

Main article: Chemical abortion

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

Other means of abortion

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A visual representation of an abortion caused by pounding a woman with a mallet at Angkor Wat.

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion). The use of herbs in such a manner can cause serious — even lethal — side effects, such as multiple organ failure, and is not recommended by physicians.

Abortion is sometimes attempted through means of trauma to the abdomen. The degree of force applied, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Burma, Indonesia, Malaysia, the Philippines, and Thailand, there is an ancient tradition of attempting abortion through forceful abdominal massage.

Reported methods of unsafe, self-induced abortion include the misuse of misoprostol (a drug for ulcers), and the insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus.

Health effects

Early-term surgical abortion is a simple procedure. When performed before the 16th week by competent doctors — or, in some states, nurse practitioners, nurse midwives, and physician assistants — it is safer than childbirth.

As with most surgical procedures, the most common surgical abortion methods carry a small risk of potentially serious complications. These risks include: a perforated uterus, perforated bowel or bladder, septic shock, sterility, and death. The risk of complications occurring can increase depending on how far the pregnancy has progressed, but remains less than complications that may occur from carrying the pregnancy to term.

Assessing the risks of induced abortion depend on a number of factors. First, there are relative health risks of induced abortion and pregnancy, which are both affected by wide variation in the quality of health services in different societies and among different socio-economic groups, a lack of uniform definitions of terms, and difficulties in patient follow-up and after-care. The degree of risk is also dependent upon the skill and experience of the practitioner; maternal age, health, and parity; gestational age; pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care. A highly-skilled practitioner of birth and abortion, operating under ideal conditions, will tend to have a low rate of complications; an inexperienced practitioner in an ill-equipped and ill-staffed facility, on the other hand, will often have a higher incidence of complications that could cause death during pregnancy, birth, or abortion.

In the United Kingdom, the number of deaths due to legal abortion between the years of 1991 and 1993 was 5, as compared to the 9 deaths caused by ectopic pregnancy during the same time frame. In the United States, during the year 1999, there were 4 deaths due to legal abortion, 10 due to miscarriage, and 525 due to pregnancy-related reasons.

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

Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester of pregnancy.

Instruments are placed within the uterus to remove the fetus. These can, on rare occasions, cause perforation or laceration of the uterus, and damage to structures surrounding the uterus. Laceration or perforation of the uterus or cervix can, again on rare occasions, lead to even more serious complications.

Incomplete emptying of the uterus can cause hemorrhage and infection. Use of ultrasound verification of the location and duration of the pregnancy prior to abortion, with immediate follow-up of patients reporting continuing pregnancy symptoms after the procedure, will virtually eliminate this risk. The sooner a complication is noted and properly treated, the lower the risk of permanent injury or death.

In rare cases, the abortion will be unsuccessful and the pregnancy will continue. An unsuccessful abortion can also result in the delivery of a live neonate, or infant. This, termed a failed abortion, is very rare and can only occur late in the pregnancy. Some doctors faced with this situation have voiced concerns about the ethical and legal ramifications of then letting the neonate die. As a result, recent investigations have been launched in the United Kingdom by the Confidential Enquiry into Maternal and Child Health (CEMACH) and the Royal College of Obstetricians and Gynecologists, in order to determine how widespread the problem is and what an ethical response in the treatment of the infant might be.

Unsafe abortion methods (e.g. use of certain drugs, herbs, or insertion of non-surgical objects into the uterus) are potentially dangerous, carrying a significantly elevated risk for permanent injury or death, as compared to abortions done by physicians.

Suggested effects

There is controversy over a number of proposed risks and effects of abortion. Evidence, whether in support of or against such claims, might in part be influenced by the political and religious beliefs of the parties behind it.

Breast cancer

Main articles: Abortion-breast cancer hypothesis and Breast cancer

The abortion-breast cancer (ABC) hypothesis (also known as ABC link) posits a causal relationship between induced abortion and an increased risk of developing breast cancer. In early pregnancy the level of estrogens increases, leading to breast growth in preparation for lactation. The abortion-breast cancer hypothesis proposes that if this process is interrupted with an abortion – before full differentiation in the third trimester – then more relatively vulnerable undifferentiated cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. The hypothesis, however, has not been scientifically verified, and abortion is not considered a breast cancer risk by any major cancer organization.

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

Of over 100 experts at the National Cancer Institute workshop, Dr. Joel Brind, the primary advocate of an abortion-breast cancer link and an invitee to the workshop, filed the only dissenting opinion criticizing the NCI's and Melbye's conclusions. Brind argues that the majority of interview-based studies have indicated a link and some are statistically significant, but there remains debate as to the reliability of these retrospective studies because of possible response bias. Most medical professionals agree with the recent prospective studies that conclude no abortion-breast cancer association, and the ABC issue is seen by some as merely a part of the current pro-life "women-centered" strategy against abortion. Nevertheless, the subject continues to be one of mostly political but some scientific contention.

Fetal pain

Main article: Fetal pain

The existence or absence of fetal sensation during abortion is a matter of medical, ethical and public policy interest. Evidence is conflicting, with some authorities holding that the fetus is capable of feeling pain from the first trimester, and others maintaining that the neuro-anatomical requirements for such experience do not exist until the second or third trimester.

Pain receptors begin to appear in the seventh week of pregnancy. The thalamus, the part of the brain which receives signals from the nervous system and then relays them to the cerebral cortex, starts to form in the fifth week. However, other anatomical structures involved in the nociceptic process are not present until much later in gestation. Links between the thalamus and cerebral cortex aren't forged until around the 23rd week. There has been some suggestion that a fetus cannot feel pain at all, as it requires mental development that only occurs outside the womb.

Researchers have observed changes in the heart rates and hormonal levels of newborn infants after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anesthesia. Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.

Mental health

Some women experience stress, anxiety, depression, substance abuse disorders and suicidal behavior after an abortion. Whether this warrants a general diagnosis or classification as an independent syndrome, is currently considered a possibility by an extreme minority. [39] Post-abortion syndrome is listed in neither the DSM-IV-TR nor the ICD-10. Data on the incidence of disorders such as clinical depression, substance abuse, post-traumatic stress disorder, anxiety and suicide in association with abortion remain inconclusive--some women experience them; some do not. Women who suffer from conditions listed in the DSM-IV following an abortion--such as depression, anxiety, stress, substance abuse and suicidal behavior--do not need a diagnosis of "post abortion syndrome" to be treated for those conditions.

Some studies have shown abortion to have neutral or positive effects on the mental well-being of some patients. A 1989 study of African-American teenagers who sought pregnancy tests in Baltimore, Maryland found that the level of stress and anxiety, from the time of the test until two years later, of those who had an abortion did not differ from that of those who had not been pregnant at all or who had carried their pregnancy to term. Another study in 1992 suggested a link between the elective termination of an unwanted pregnancy and later reports of positive self-esteem; it also noted that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors.Termination, as compared to completion, of an undesired first pregnancy was not found to directly pose the risk of significant depression in a 2005 study.

Other studies have shown a correlation between abortion and negative psychological impact. A 1996 comparative analysis of the suicide rates among postpartum and post-abortive women in Finland found that suicide is more common after a miscarriage and especially after an induced abortion than in the general population. Additional research in 2002 reported that the risk of clinical depression was higher for women who chose to have an abortion in comparison to those who opted to carry to term — even if the pregnancy was unwanted. Another study in 2006, which used data gathered over a 25-year period in Christchurch, New Zealand, found an increased occurrence of depression, anxiety, suicidal behavior, and substance abuse among women who had previously had an abortion.

Miscarriage, or spontaneous abortion, is known to present an increased risk of depression in women. Childbirth can also sometimes result in maternity blues or postpartum depression.

History of abortion

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

Main article: History of abortion

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

Soranus, a 2nd century Greek physician, suggested in his work Gynecology that women wishing to abort their pregnancies should engage in violent exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal baths, pessaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation. It is also known that the ancient Greeks relied upon the herb silphium as both a contraceptive and an abortifacient. The plant, as the chief export of Cyrene, was driven to extinction, but it is suggested that it might have possessed the same abortive properties as some of its closest extant relatives in the Apiaceae family.

Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy.

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

Social issues

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

Effect upon crime rate

Main article: Legalized abortion and crime effect

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

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

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

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

Sex-selective abortion

Main article: Sex-selective abortion and infanticide

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

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

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

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

Unsafe abortion

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

Main article: Unsafe abortion

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

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

Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the death of the woman. Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal mortalities, with regional estimates including 12% in Asia, 25% in Latin America, and 13% in sub-Saharan Africa. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.

Abortion debate

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

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Pro-life activists at the March for Life in 2002. The rally is held annually in Washington, DC.

Main article: Abortion debate

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

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

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

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

Public opinion

Political sides have largely been divided into absolutes. The abortion debate, as such, tends to center on individuals who hold strong positions. However, public opinion varies from poll to poll, country to country, and region to region:

• Australia: In a February 2005 ACNielsen poll, as reported in The Age, 56% thought the current abortion laws, which generally allow abortion for the sake of life or health, were "about right," 16% want changes in law to make abortion "more accessible," and 17% want changes to make it "less accessible." A 1998 poll, conducted by Roy Morgan Research, asked, "Do you approve of the termination of unwanted pregnancies through surgical abortion?" 65% of the Australians polled stated that they approved of surgical abortion and 25% stated that they disapproved of it.
• Canada: A recent poll of Canadians, conducted in April 2005 by Gallup, found that 52% of those polled want abortion laws to "remain the same," 20% want the laws to be "less strict," and 24% would prefer that the laws become "more strict." An earlier Gallup poll, from December 2001, asked, "Do you think abortions should be legal under any circumstances, legal only under certain circumstances or illegal in all circumstances and in what circumstances?" 32% of Canadians responded that they believe abortion should be legal in all circumstance, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. Canada currently has no laws restricting abortion. See Abortion in Canada.
• Ireland: A 1997 Irish Times/MRBI poll of the Republic of Ireland's electorate found that 18% believe that abortion should never be permitted, 35% that one should be allowed in the event that the woman's life is threatened, 18% if her health is at risk, 28% that "an abortion should be provided to those who need it," and 5% were undecided.
• United Kingdom: An online YouGov/Daily Telegraph poll in August 2005 found that 30% of Britons would back a measure to reduce the legal limit for abortion to 20 weeks, 19% support a limit of 12 weeks, 9% support a limit of less than 12 weeks, and 25% support maintaining the current limit of 24 weeks. 6% responded that abortion should never be allowed while 2% said it should be permitted throughout the entirety of pregnancy.
• United States: In a January 2006 CBS News poll, which asked, "What is your personal feeling about abortion?", 27% said that abortion should be "permitted in all cases," 15% that it should be "permitted, but subject to greater restrictions than it is now," 33% said that it should be "permitted only in cases such as rape, incest or to save the woman's life," 17% said that it should "only be permitted to save the woman's life," and 5% said that it should "never" be permitted. An April 2006 Harris poll on Roe v. Wade, asked, "Do you favor or oppose the part of Roe v. Wade that made abortions up to three months of pregnancy legal?", to which 49% of respondents indicated favor while 47% indicated opposition. One U.S. Gallup/CNN/USA Today poll conducted in 2003 yielded results very similar to an identical survey conducted in 1975.

Abortion law

Main article: Abortion law

International status of abortion law (Detail)

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United States President George W. Bush signs the Partial-Birth Abortion Ban Act of 2003

Before the scientific discovery that human development began at fertilization, British common law allowed abortions to be performed before quickening, the earliest perception of fetal movement by a woman during the second trimester of pregnancy. In 1861, the British Parliament passed the Offences Against the Person Act, which outlawed abortion throughout the British Empire. The Soviet Union, with legislation in 1920, and Iceland with legislation in 1935 were some of the first countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom. In the 1973 case, Roe v. Wade, the United States Supreme Court struck down state laws banning abortion in the first trimester, ruling that such laws violated an implied right to privacy in the United States Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under the Canadian Charter of Rights and Freedoms Canada later struck down provincial regulations of abortion in the case of R. v. Morgentaler (1993). Abortion in Ireland, on the other hand has been affected by the addition of an amendment to its Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn".

Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, and the right to security of person are major issues of human rights that are sometimes used as justification for the existence or the 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 in which abortion is still legal to perform:

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

Other countries, in which abortion is illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A handful of nations ban abortion entirely, such as Chile, El Salvador, and Malta, although Chilean government freely distributes the "morning-after" pill. In Bangladesh--although abortion is illegal-- the government has long supported a network of "menstrual regulation clinics," where menstrual extraction (manual vacuum aspiration) can be performed as menstrual hygiene.

See also

Abortion by country Anti-abortion violence Contraception Fetal rights Ethical aspects of abortion Fertilisation Gynaecology Late-term abortion

Obstetrics Paternal rights and abortion Pregnancy Religion and abortion Reproduction Selective reduction Self-induced abortion Teenage pregnancy

External links

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

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

• The Guttmacher Institute
• Just Facts: Abortion
• Johnston's Archive: Abortion Statistics and Other Data

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

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