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.
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: [Roche, Natalie E. (2004). Therapeutic Abortion. Retrieved 2006-03-08.]*** 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 completed 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.
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 and the
Netherlands, have a low rate of induced abortion, while others like
Russia and
Vietnam have a comparatively high rate.
[Henshaw, Stanley K., Singh, Susheela, & Haas, Taylor. (1999). The Incidence of Abortion Worldwide. International Family Planning Perspectives, 25 (Supplement), 30â€"8. Retrieved 2006-01-18.]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).
[Strauss, Lilo T., Herndon, Joy, Chang, Jeani, Parker, Wilda Y., Bowens, Sonya V., Berg, Cynthia J. Centers for Disease Control and Prevention. (2005-11-15). Abortion Surveillance - United States, 2002. Morbidity and Mortality Weekly Report. Retrieved 2006-02-20.] 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.
[Finer, Lawrence B. & Henshaw, Stanley K. (2003). Abortion Incidence and Services in the United States in 2000. Perspectives on Sexual and Reproductive Health, 35 (1). Retrieved 2006-05-10.] 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.
[Government Statistical Service for the Department of Health. (2005-07-27). Abortion statistics, England and Wales: 2004. Retrieved 2006-05-10.] |
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.
[Bankole, Akinrinola, Singh, Susheela, & Haas, Taylor. (1998). Reasons Why Women Have Induced Abortions: Evidence from 27 Countries. International Family Planning Perspectives, 24 (3), 117-127 & 152. Retrieved 2006-01-18.] A 2004 study in which
American women at
clinics answered a
questionnaire yielded similar results.
[Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Shusheela, & Moore, Ann M. (2005). Reasons U.S. women have abortions: quantative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37 (3), 110-8. Retrieved 2006-01-18.] 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.
[Jones, Rachel K., Darroch, Jacqueline E., Henshaw, Stanley K. (2002). Contraceptive Use Among U.S. Women Having Abortions in 2000-2001. Perspectives on Sexual and Reproductive Health, 34 (6). Retrieved June 15, 2006.]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.
[World Health Organization. (2004). Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000. Retrieved 2006-01-12.] See
social issues for more information on these subjects.
Spontaneous abortion
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.
["Reproductive Endocrinology and Infertility: Recurrent Pregnancy Loss (Recurrent Miscarriage)." (n.d.) Retrieved 2006-01-18 from Washington University School of Medicine, Department of Obstetrics and Gynecology web site.]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
In the first fifteen 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 equivalent, differing only in the mechanism use to apply suction. They 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.
[World Health Organization. (2003). Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Retrieved 2006-02-24.] 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.
[Vause S, Sands J, Johnston TA, Russell S, Rimmer S. (2002). PMID 12521492 Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? J Obstet Gynaecol. 2002 May;22(3):243-5. Retrieved 2006-03-17.][Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y. (2003). PMID 12576743 Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals. Fetal Diagn Ther. 2003 Mar-Apr;18(2):91-7. Retrieved 2006-03-17.][Bhide A, Sairam S, Hollis B, Thilaganathan B. (2002). PMID 12230443 Comparison of feticide carried out by cordocentesis versus cardiac puncture. Ultrasound Obstet Gynecol. 2002 Sep;20(3):230-2. Retrieved 2006-03-17.][Senat MV, Fischer C, Bernard JP, Ville Y. (2003). PMID 12628271 The use of lidocaine for fetocide in late termination of pregnancy. BJOG. 2003 Mar;110(3):296-300. Retrieved 2006-03-17.][Senat MV, Fischer C, Ville Y. (2002). PMID 12001185 Funipuncture for fetocide in late termination of pregnancy. Prenat Diagn. 2002 May;22(5):354-6. Retrieved 2006-03-17.]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. The process begins with the administration of either
methotrexate or
mifepristone, followed by
misoprostol. When appropriately used, 98% of women undergoing medical termination of pregnancy will experience completed abortion without surgical intervention. The
Food and Drug Administration currently approves the use of mifepristone up to 49 days gestation (7 weeks), though evidence based regimens exist for its use up to 61 days gestation with similar success rates. Misoprostol alone can also be used, though it is not FDA approved for this purpose. Misoprostol (Cytotec) alone has the advantage of costing less than one dollar for an effective dose, as opposed to several hundred dollars for an effective dose of mifepristone. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.
Other means of abortion
|
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 â€" even lethal â€" side effects, such as
multiple organ failure, and is not recommended by
physicians.
[Ciganda, C., & Laborde, A. (2003). Herbal infusions used for induced abortion. J Toxicol Clin Toxicol, 41(3), 235-9. Retrieved 2006-01-25.]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.
[Education for Choice. (2005-05-06). Unsafe abortion. Retrieved 2006-01-11.] 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.
[Potts, Malcolm, & Campbell, Martha. (2002). History of contraception. Gynecology and Obstetrics, vol. 6, chp. 8. Retrieved 2005-01-25.]Reported methods of unsafe,
self-induced abortion include the misuse of
misoprostol for
ulcers, and the insertion of non-surgical implements such as
knitting needles and
clothes hangers into the
uterus.
Early-term surgical abortion is a simple procedure. When performed before the 16th week by competent
doctors â€" or, in some states,
nurse practitioners,
nurse midwives, and
physician assistants â€" it is safer than
childbirth.
[Cates W., Jr, & Tietze C. (1978). Standardized mortality rates associated with legal abortion: United States, 1972-1975 Electronic version. Family Planning Perspectives, 10 (2), 109-12. Retrieved 2006-01-28.] 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.
[Department of Health. (1998). Why Mothers Die: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994â€"1996. London: The Stationery Office. Retrieved 2006-01-11.] 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.
[Elam-Evans, Laurie. D., Strauss, Lilo T., Herndon, Joy, Parker, Wilda Y., Bowens, Sonya V., Zane, Suzanne, et al. Centers for Disease Control and Prevention. (2003-11-23). Abortion Surveillance - United States, 2000. Morbidity and Mortality Weekly Report. Retrieved 2006-01-11.] [Centers for Disease Control and Prevention. (2003-02-20). Fact Sheet: Pregnancy-Related Mortality Surveillance - United States, 1991-1999. Retrieved 2006-04-02.]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.
[Rogers, Lois. (2005-11-27). "Fifty babies a year are alive after abortion." The Sunday Times. Retrieved 2006-01-11.]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
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 increase and initiates
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 verified and abortion is not considered an actual breast cancer risk by any major cancer organization.
A large
epidemiological study done 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.
[Melbye M., Wohlfahrt, J., Olsen, J.H., Frisch, M., Westergaard, T., Helweg-Larsen, K., et al. (1997). Induced abortion and the risk of breast cancer. (abstract) New England Journal of Medicine, 336, 81-5. Retrieved 2006-01-11 from PubMed.] 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."
[National Cancer Institute. (2003-03-04). Summary Report: Early Reproductive Events and Breast Cancer Workshop. Retrieved 2006-01-11.] Then in 2004, Dr. 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."
[Beral V., Bull D., Doll R., Peto R., Reeves G. (2004). Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. (abstract) The Lancet, 363, 1007-16. Retrieved 2006-04-12 from PubMed.]Of over 100 experts at the National Cancer Institute workshop,
Dr. Joel Brind, abortion-breast cancer's primary advocate and an invitee to the workshop, filed the only dissenting opinion which criticized the NCI and Melbye conclusions.
[Brind, Joel. (2003-03-10). Early Reproductive Events and Breast Cancer: A Minority Report. Retrieved 2006-03-24.] Brind points out the majority of interview-based studies have indicated a link, and some have been demonstrated to be
statistically significant,
[American abortion-breast cancer studies] but there remains debate as to their reliability because of possible
response bias. Most medical professionals agree with the recent research that concludes no abortion-breast cancer association,
[American Cancer Society. (2006-10-03). What Are the Risk Factors for Breast Cancer? Retrieved 2006-03-30.] and the abortion-breast cancer issue is seen by some as merely a part of the current
pro-life "women-centered" strategy against abortion.
[Pro-Choice Action Network. (2002). Abortion and Breast Cancer â€" A Forged Link. Retrieved 2006-03-22.] Nevertheless, gaps and inconsistencies remain in the research, and the subject continues to be one of mostly political but some scientific contention.
[Jasen, Patricia. (2005). Breast Cancer and the Politics of Abortion in the United States. Retrieved 2006-03-26.]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.
[ BBC News Article (2005). "Foetuses 'no pain up to 29 weeks'." Retrieved 2006-07-18.] 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.
[Parliamentary Office of Science and Technology. (1997). Fetal Awareness. Retrieved 2006-01-11.] There has been some suggestion that a fetus cannot feel pain at all, as it requires mental development that only occurs outside the womb.
[ BBC News Article (2006). "Foetuses 'cannot experience pain'." Retrieved 2006-07-18.]Researchers have observed changes in the heart rates and
hormonal levels of newborn
infants after
circumcision,
blood tests, and surgery â€" effects which were alleviated with the administration of
anesthesia.
[Anand, K., Phil, D., & Hickey, P.R. (1987). Pain and its effects on the human neonate and fetus. New England Journal of Medicine, 316 (21), 1321-9. Retrieved 2006-01-11 from The Circumcision Reference Library.] Others suggest that the human experience of pain, being more than just
physiological, cannot be measured in such
reflexive responses.
Mental health
Some women will experience negative feelings as a result of their reproductive choices. In the case of abortion, however, whether this phenomenon warrants a general diagnosis, or even classification as an independent
syndrome, is debated.
Post-abortion syndrome is listed in neither the
DSM-IV-TR nor the .
Studies have suggested a link between the elective termination of an unwanted
pregnancy and an improvement in reported mental well-being.
[American Psychological Association. (2005). APA Briefing Paper on The Impact of Abortion on Women. Retrieved 2006-01-15 from The Internet Archive.] Elective abortion may reduce the occurrence of depression in cases of unwanted pregnancy, as compared to cases in which the pregnancy has been carried to completion, but it is also sometimes reported as an additional
stressor.
The majority of evidence would seem to indicate that adverse emotional reactions to the procedure are most strongly influenced by pre-existing
psychological conditions and other negative factors.
In cases in which abortion has been denied, it can have a negative, long-lasting outcome for both women and their families.
[Royal College of Obstetricians and Gynaecologists. (2000). The Care of Women Requesting Induced Abortion. Retrieved 2006-03-26 from the National Electronic Library For Health website.]Data on the incidence of
clinical depression,
mental illness,
post-traumatic stress disorder, and
suicide in association with abortion remain inconclusive.
[Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version . British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.] A comparative analysis of the suicide rates among
postpartum and post-abortive women in
Finland found a
statistical correlation between abortion and suicide.
[Gissler, M., Hemminki, E., & Lonnqvist, J. (1996). Suicides after pregnancy in Finland, 1987-94: register linkage study Electronic version. British Medical Journal, 313, 1431-4. Retrieved 2006-01-11.] Another study, 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.
[Fergusson D.M., Horwood L.J., & Ridder E.M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology & Psychiatry, 47(1), 16-24. Retrieved 2006-05-09.]Miscarriage, or spontaneous abortion, is known to present an increased risk of
depression in women.
[Depression Risk Increased After Miscarriage. (2002-04-01). Retrieved 2006-01-11.] Childbirth can also sometimes result in
maternity blues or
postpartum depression.
|
"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the Boston Daily Times. |
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.
[Lefkowitz, Mary R. & Fant, Maureen R. (1992). Women's life in Greece & Rome: a source book in translation. Baltimore, MD: John Hopkins University Press. Retrieved 2006-01-11.] 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.
[Histories of Abortion. (n.d.) Retrieved 2006-01-11.]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
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.
[Donohue, John J. and Levitt, Steven D. (2001). The impact of legalized abortion on crime.Quarterly Journal of Economics Retrieved 2006-02-11. ] 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.
[Foote, Christopher L. and Goetz, Christopher F. (2005). Testing economic hypotheses with state-level data: a comment on Donohue and Levitt (2001). Working Papers, 05-15. Retrieved 2006-02-11.] 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.
[Donohue, John J. and Levitt, Steven D. (2006). Measurement error, legalized abortion, and the decline in crime: a response to Foote and Goetz (2005). Retrieved 2006-02-17, from University of Chicago, Initiative on Chicago Price Theory web site: http://pricetheory.uchicago.edu/levitt/Papers/ResponseToFooteGoetz2006.pdf.]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.
["Crime-Abortion Study Continues to Draw Pro-life Backlash." (1999-08-11). The Pro-Life Infonet. Retrieved 2006-02-17 from Ohio Roundtable Online Library.] ["Abortion and the Lower Crime Rate." (2000, January). St. Anthony Messenger. Retrieved 2006-02-17.] 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
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 gender.
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.
[Banister, Judith. (1999-03-16). Son Preference in Asia - Report of a Symposium. Retrieved 2006-01-12.]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.
[Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, & Roy, T.K. (1997). Son Preferences and Its Effect on Fertility in India. National Family Health Survey Subject Reports, Number 3. Retrieved 2006-01-12.] 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."
[Patel, Rita. (1996). The practice of sex selective abortion in India: may you be the mother of a hundred sons. Retrieved 2006-01-11, from University of North Carolina, University Center for International Studies web site: http://www.ucis.unc.edu/resources/pubs/carolina/abortion.pdf.] 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.
[Sudha, S., & Irudaya Rajan, S. (1999). Female Demographic Disadvantage in India 1981-1991: Sex Selective Abortion, Female Infanticide and Excess Female Child Mortality. Retrieved 2006-01-12 ] Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.
[Reaney, Patricia. (2006-01-09). "Selective abortion blamed for India's missing girls." Reuters AlertNet. Retrieved 2006-01-09.] 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.
[Mudur, Ganapati. (2002). "India plans new legislation to prevent sex selection." British Medical Journal: News Roundup. Retrieved 2006-01-12.]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.
[Graham, Maureen J., Larsen, Ulla, & Xu, Xiping. (1998). Son Preference in Anhui Province, China. International Family Planning Perspectives, 24 (2). Retrieved 2006-01-12.] 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.
[Plafker, Ted. (2002-05-25). Sex selection in China sees 117 boys born for every 100 girls. British Medical Journal: News Roundup. Retrieved 2006-01-12.] A ban upon the practice of sex-selective abortion was enacted in 2003.
["China Bans Sex-selection Abortion." (2002-03-22). Xinhua News Agency. Retrieved 2006-01-12.]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." |
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.
[Salter, C., Johnson, H.B., and Hengen, N. (1997). Care for postabortion complications: saving women's lives. Population Reports, 25 (1). Retrieved 2006-02-22.] Health education, access to
family planning, and improvements in
health care during and after abortion have been proposed to address this phenomenon.
[World Health Organization. (1998). Address Unsafe Abortion. Retrieved 2006-03-01.]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 doctrine 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.
[The Pew Research Center for the People and the Press. (2005-11-02). "Public Opinion Supports Alito on Spousal Notification Even as It Favors Roe v. Wade." Pew Research Center Pollwatch. Retrieved 2006-03-01.]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."
[Grattan, Michelle. (2005-02-16). "Poll backs abortion laws." The Age. Retrieved 2006-01-11.] 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.
[Roy Morgan International. (1998-03-03). Almost Two-Thirds Of Australians Approve Of Abortion. Retrieved 2006-01-11.]*
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.
[Kennedy, Geraldine. (1997-12-11). "77% say limited abortion right should be provided." The Irish Times. Retrieved 2006-01-11.]*
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.
[YouGov. (2005-07-30). YouGov/Daily Telegraph Survey Results. Retrieved 2006-01-11.]*
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.
[The Polling Report. (2006). Retrieved 2006-01-11.] 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.
[ Harris Interactive. (2006-05-04). "U.S. Attitudes Toward Roe v. Wade." The Wall Street Journal. Retrieved 2006-05-05.] One U.S.
Gallup/
CNN/
USA Today poll conducted in 2003 yielded results very similar to an identical survey conducted in 1975.
[ "Views on abortion have not changed significantly since the 1970s." (2006). Public Agenda Online. Retrieved 2006-07-24.] |
International status of abortion law (Detail) |
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.
*
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 DataThe following links are to groups which advocate a specific position:*
Abortion Watch*
American Life League*
CareNet*
Planned Parenthood
