Abortion is the termination of
pregnancy by the removal or expulsion from the
uterus of a
fetus or
embryo prior to
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 pregnancy.
Abortion, when induced in the
developed world in accordance with
local law, is
among the safest procedures in medicine.
[1] However,
unsafe abortions result in approximately 70 thousand
maternal deaths and 5 million disabilities per year globally.
[2] An estimated 44 million abortions are performed globally each year, with slightly under half of those performed unsafely.
[3] The incidence of abortion has stabilized in recent years,
[3] having previously spent decades declining as access to
family planning education and
contraceptive services increased.
[4] Forty percent of the world's women have access to induced abortions (within gestational limits).
[5]
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 and religious status of abortion vary substantially around the world. Its legality can depend on specific conditions such as
incest, rape, severe
fetal defects or the mothers health being at risk. In many parts of the world there is prominent and divisive
public controversy over the
ethical and legal issues of abortion.
Induced
Approximately 205 million pregnancies occur each year worldwide. Over a third are
unintended and about a fifth end in induced abortion.
[3][6] Most abortions result from unintended pregnancies.
[7][8] A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the
gestational age of the embryo or fetus, which increases in size as the pregnancy progresses.
[9][10] 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.
[11][12] 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.
[12]
Spontaneous
Main article:
MiscarriageSpontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 24th
week of gestation.
[13] 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".
[14] When a fetus dies
in utero after viability, or during
delivery, it is usually termed "
stillborn".
[15] Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.
[16]
Only 30 to 50% of conceptions progress past the first trimester.
[17] The vast majority of those that do not progress are lost before the woman is
aware of the conception,
[12] and many pregnancies are lost before medical practitioners have the ability to detect the presence of an embryo.
[18] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.
[19]
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,
[12][20] accounting for at least 50% of sampled early pregnancy losses.
[21] Other causes include
vascular disease (such as
lupus),
diabetes, other hormonal problems, infection, and abnormalities of the uterus.
[20] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.
[21] A spontaneous abortion can also be caused by accidental
trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or
feticide.
[22]
Induction methods
Medical
Medical abortions are those induced by
abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of
prostaglandin analogs in the early 1970s and the
antiprogestogen mifepristone in the 1980s.
[23][24][25]
The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog (
misoprostol or
gemeprost) up to 9 weeks gestational age,
methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.
[23] Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone.
[24]
In very early abortions, up to 7 weeks gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue.
[26] Early medical abortion regimens using 200 mg of mifepristone, followed 24–48 hours later by 800 mcg of buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age.
[27] In cases of failure of medical abortion, surgical abortion must be used to complete the procedure.
[28]
Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,
[29][30] France,
[31] Switzerland,
[32] and the Nordic countries.
[33] In the United States, the percentage of early medical abortions is far lower.
[34][35]
Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second-trimester abortions in Canada, most of Europe, China and India,
[25] in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.
[36]
Surgical
A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).
1: Amniotic sac
2: Embryo
3: Uterine lining
4: Speculum
5: Vacurette
6: Attached to a suction pump
Up to 15 weeks' gestation,
suction-aspiration or
vacuum aspiration are the most common surgical methods of induced abortion.
[37] Manual vacuum aspiration (MVA) consists of removing the
fetus or
embryo,
placenta, and membranes by suction using a manual syringe, while
electric vacuum aspiration (EVA) uses an electric pump. These techniques differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether cervical dilation is necessary.
MVA, also known as "mini-suction" and "
menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation.
Dilation and curettage (D&C), the second most common method of surgical abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion.
Curettage refers to cleaning the walls of the
uterus with a
curette. The
World Health Organization recommends this procedure, also called
sharp curettage, only when MVA is unavailable.
[38]
From the 15th week of gestation until approximately the 26th, other techniques must be used.
Dilation and evacuation (D&E) consists of opening the
cervix of the uterus and emptying it using surgical instruments and suction. Premature labor and 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 also be induced by
intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "
partial-birth abortion," which has been
federally banned in the United States.
In the third trimester of pregnancy, abortion may be performed by IDX as described above, induction of labor, or by hysterotomy.
Hysterotomy abortion is a procedure similar to a
caesarean section and is performed under
general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.
[39]
First-trimester procedures can generally be performed using
local anesthesia, while second-trimester methods may require
deep sedation or
general anesthesia.
[35]
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).
[40] 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.
[41]
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.
[42] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.
[43] 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.
[43]
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.
[44]
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.
[45] Legal abortions performed in the
developed world are among the safest procedures in medicine.
[1][46] In the US, the risk of
maternal death from abortion is 0.6 per 100,000 procedures, making abortion about 14 times safer than childbirth (8.8 maternal deaths per 100,000 live births).
[47][48] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.
[49][50][51]
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.
[52] Preventive antibiotics (such as
doxycycline or
metronidazole) are typically given before elective abortion,
[53] as they are believed to substantially reduce the risk of postoperative uterine infection.
[35][54] Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen.
There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 9 weeks gestation.
[26] Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.
[55][56]
Some purported risks of abortion are promoted primarily by anti-abortion groups, but lack scientific support.
[57] For example, the question of a
link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the
World Health Organization, the US
National Cancer Institute, the
American Cancer Society, the
Royal College of Obstetricians and Gynaecologists and the
American Congress of Obstetricians and Gynecologists) have concluded that abortion does not cause breast cancer,
[58] although such a link continues to be promoted by anti-abortion groups.
[57]
Similarly, current scientific evidence indicates that induced abortion
does not cause mental-health problems.
[59][60] The
American Psychological Association has concluded 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.
[61][62] Abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems.
[63] Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "
post-abortion syndrome", which is not recognized by any medical or psychological organization.
[64]
Unsafe abortion
Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death."
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. They may attempt to
self-abort or rely on another person who does not have proper medical training or access to proper facilities. This has a tendency to lead to severe complications, such as incomplete abortion,
sepsis, hemorrhage, and damage to internal organs.
[65]
Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in
developing countries.
[1] Unsafe abortion is believed to result in approximately 68,000 deaths and millions of injuries annually.
[1][66] 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.
[67]
The legality of abortion is one of the main determinants of its safety. Countries with restrictive abortion laws have significantly higher rates of unsafe abortion (and similar overall abortion rates) compared to those where abortion is legal and available.
[2][3][67][68][69][70] For example, the 1996 legalization of abortion in
South Africa had an immediate positive impact on the frequency of abortion-related complications,
[71] with abortion-related deaths dropping by more than 90%.
[72] In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally.
[73]
Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,
[5] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.
[74] 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 an eighth of
maternal mortalities worldwide,
[75] though this varies by region.
[76] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.
[69] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.
[3] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.
[77]
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 remained stable in recent years, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008.
[3] The abortion ratio worldwide was 28 per 1000 women, though it was 24 per 1000 women for developed countries and 29 per 1000 women for developing countries.
[3]
On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. However, restrictive abortion laws are associated with increases in the percentage of abortions which are performed unsafely.
[5][78][79] The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the
Guttmacher Institute, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.
[80]
The incidence of induced abortion varies extensively worldwide. The ratio of induced abortion ranges from ten to thirty percent; figures in the developing world vary widely and are often incomplete.
[81]
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 in the United States 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).
[82] 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.
[83]
The
Guttmacher Institute estimated there were 2,200
intact dilation and extraction procedures in the US during 2000; this accounts for 0.17% of the total number of abortions performed that year.
[84] 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.
[85] Later abortions are more common in China, India, and other developing countries than in developed countries.
[86]
Personal and social factors
A bar chart depicting selected data from a 1998
AGI meta-study on the reasons women stated for having an abortion.
The reasons why women have abortions are diverse and vary dramatically across the world. Some of the most common reasons are to postpone childbearing to a more suitable time or to focus energies and resources on existing children. Others include being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while 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 one's own education, relationship problems with their partner, a perception of being too young to have a child, unemployment, and not being willing to raise a child conceived as a result of
rape or
incest, among others.
[87][88] An additional factor is risk to maternal or fetal health, which was cited as the primary reason for abortion in over a third of cases in some countries and as a significant factor in only a single-digit percentage of abortions in other countries.
[83][87]
An American study in 2002 concluded that about half of women having abortions were using a form of
contraception at the time of becoming pregnant. Inconsistent use was reported by half of those using
condoms and three-quarters of those using the
birth-control pill; 42% of those using condoms reported failure through slipping or breakage.
[89] 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."
[90]
Some abortions are undergone as the result of societal pressures. These might include the preference for children of a specific sex, disapproval of single or early motherhood, stigmatization of people with disabilities, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward
population control (such as China's
one-child policy). These factors can sometimes result in compulsory abortion or
sex-selective abortion.
History
"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the
Boston Daily Times.
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] other scholars disagree with this interpretation,
[91] and note the medical texts of
Hippocratic Corpus contain descriptions of abortive techniques.
[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 Catholic 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 until a point in time when Muslims believe the soul enters the fetus,
[91] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or
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 US, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.
[note 2] The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.
[96] 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.
[97] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.
[91]
Society and culture
Abortion debate
Induced abortion has long been the source of considerable debate, controversy, and activism. An individual's position concerning the complex ethical, moral, philosophical, biological, and legal issues which surround abortion is often related to his or her
value system. Opinions of abortion may be described as being a combination of beliefs about abortion's morality the proper extent of governmental authority in public policy; and on the rights and responsibilities of the woman seeking to have an abortion.
Religious ethics also has an
influence on 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. Anti-abortion groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while abortion rights groups who are against such legal restrictions describe themselves as "pro-choice". Generally, the former position argues that a human fetus is a human being with a
right to live, making abortion morally the same as murder. The latter position argues that a woman has certain
reproductive rights, especially the choice whether or not to carry a pregnancy to term.
Modern abortion law
International status of
abortion law
UN 2011 report on abortion law
[98]
Legal on request
Legal for rape, maternal life, health, mental health, socioeconomic factors, and/or fetal defects
Illegal with exception for rape, maternal life, health, mental health, and/or fetal defects
Illegal with exception for rape, maternal life, health, and/or mental health
Illegal with exception for maternal life, health, and/or mental health
Illegal with no exceptions
Varies
No information
[99][dated info]Main article:
Abortion lawCurrent 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 a woman may obtain an abortion (an abortion performed without the woman's consent is considered
feticide). These requirements are usually dependent on the age of the fetus, often using a
trimester-based system to regulate the window of legality. 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.
[100] Other jurisdictions may require that a woman obtain the
consent of the fetus' father before aborting the fetus, that abortion providers inform patients of health risks of the procedure—sometimes including those not supported by the medical literature—and that multiple medical authorities certify that the abortion is either medically or socially necessary. Many restrictions are waived in emergency situations.
Other jurisdictions ban abortion almost entirely. Many, but not all, of these will allow them to be performed in a variety of circumstances. These circumstances vary based on jurisdiction, but may include whether the pregnancy is a result of rape or incest, whether the fetus' development is impaired, whether the mother's physical or mental well-being is endangered, or whether there are socioeconomic considerations that could be taken into consideration.
[74] In countries where abortion is banned entirely, such as
Nicaragua, rises in maternal death directly and indirectly due to pregnancy have been noted.
[101][102] Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.
[103] 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.
[104] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.
[105]
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.
[106][107] This has caused controversy, as some anti-abortion groups have advocated that certain forms of emergency contraception are not
contraceptives but
abortifacients.
Sex-selective abortion
Sonography and
amniocentesis allow parents to determine sex before childbirth. The development of this technology has led to
sex-selective abortion, or the termination of a fetus based on sex. The selective termination of a female fetus is most common.
Sex-selective abortion is partially responsible for the noticeable disparities between the birth rates of male and female children in some countries. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Taiwan, South Korea, India, and China.
[108] This deviation from the standard birth rates of males and females occurs despite the fact that the country in question may have officially banned sex-selective abortion or even sex-screening.
[109][110][111][112] In China, a historical preference for a male child has been exacerbated by the
one-child policy, which was enacted in 1979.
[113]
Many countries have taken legislative steps to reduce the incidence of sex-selective abortion. At the
International Conference on Population and Development in 1994 over 180 states agreed to eliminate "all forms of discrimination against the girl child and the root causes of son preference",
[114] which was also condemned by a
PACE resolution in 2011.
[115] The
World Health Organization and
UNICEF, along with other
United Nations agencies, have found that measures to reduce access to abortion are much less effective at reducing sex-selective abortions than measures to reduce gender inequality.
[114]
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.
[116][117] 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 physicians who performed abortions —
David Gunn,
John Britton,
Barnett Slepian, and
George Tiller — have been murdered. Also murdered, in the U.S. and Australia, have been other personnel at abortion clinics, including receptionists and security guards such as James Barrett, Shannon Lowney, Lee Ann Nichols, and Robert Sanderson. Attempted murders have also taken place in the United States and Canada, Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have also occurred.
[118][119] 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.
[120]
Legal protection of access to abortion has been brought in to some countries where abortion is legal. These laws typically seek to protect abortion clinics from obstruction, vandalism, picketing, and other actions, or to protect patients and employees of such facilities from threats and harassment.
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). Anti-abortion activist
Børre Knudsen was linked to a 1994
art theft as part of an anti-abortion drive in
Norway surrounding the
1994 Winter Olympics.
[122] 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.
[123] In 2008, a
Yale student proposed using aborted excretions and the induced abortion itself as a performance art project.
[124]
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.
[125] 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.
[126] 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.
[127] 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.
[128] 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.
[129]
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. 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. The 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). In
The Godfather Part II (1974)
Kay informed Michael Corleone that she had obtained an abortion without his knowledge nor consent.
[130] On the abortion debate, an irresponsible drug addict is used as a pawn in a power struggle between abortion rights and anti-abortion groups in
Citizen Ruth (1996).
[131] 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.
[132]
References
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- The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of vaginal misoprostol) previously used by Planned Parenthood clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of patients having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or patient request.
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- ^ "ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures". Obstet Gynecol 113 (5): 1180–9. May 2009. doi:10.1097/AOG.0b013e3181a6d011. PMID 19384149.
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- ^ Position statements of major medical bodies on abortion and breast cancer include:
- ^ 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.
- ^ "APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health" (Press release). American Psychological Association. 12 August 2008. http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx. Retrieved 7 September 2011.
- ^ "Report of the APA Task Force on Mental Health and Abortion". Washington, DC: American Psychological Association. 13 August 2008. http://www.apa.org/pi/women/programs/abortion/mental-health.pdf.
- ^ 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.
- ^ See, for example:
- 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 (October 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.
- ^ Okonofua, F. (2006). "Abortion and maternal mortality in the developing world" (PDF). Journal of Obstetrics and Gynaecology Canada 28 (11): 974–979. PMID 17169222. http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf.
- ^ Haddad, LB.; Nour, NM. (2009). "Unsafe abortion: unnecessary maternal mortality". Rev Obstet Gynecol 2 (2): 122–6. PMC 2709326. PMID 19609407. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2709326/.
- ^ 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. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2560758/.
- ^ Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH (2007). "Induced abortion: estimated rates and trends worldwide". Lancet 370 (9595): 1338–45. doi:10.1016/S0140-6736(07)61575-X. PMID 17933648.
- ^ a b "Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003" (PDF). World Health Organization. 2007. Archived from the original on 16 February 2011. http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf. Retrieved 7 March 2011.
- ^ Berer M (November 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.
- ^ Jewkes R, Rees H, Dickson K, Brown H, Levin J (March 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.
- ^ Bateman C (December 2007). "Maternal mortalities 90% down as legal TOPs more than triple". S. Afr. Med. J. 97 (12): 1238–42. PMID 18264602.
- ^ "Facts on Investing in Family Planning and Maternal and Newborn Health" (PDF). Guttmacher Institute. 2010. http://www.guttmacher.org/pubs/FB-AIU-summary.pdf. Retrieved May 24, 2012.
- ^ a b Boland, R.; Katzive, L. (2008). "Developments in Laws on Induced Abortion: 1998–2007". International Family Planning Perspectives 34 (3): 110–120. doi:10.1363/ifpp.34.110.08. PMID 18957353. http://www.guttmacher.org/pubs/journals/3411008.html.
- ^ Maclean, Gaynor (2005). "XI. Dimension, Dynamics and Diversity: A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives". In Balin, Randell E.. Trends in Midwifery Research. Nova Publishers. pp. 299–300. ISBN 9781594544774. http://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299#v=onepage&q&f=false.
- ^ Salter, C., Johnson, H.B., and Hengen, N. (1997). "Care for Postabortion Complications: Saving Women's Lives". Population Reports (Johns Hopkins School of Public Health) 25 (1). Archived from the original on 1 September 2011. http://www.webcitation.org/61MhmDwmL.
- ^ UNICEF, United Nations Population Fund, WHO, World Bank (2010). "Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health". http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html. Retrieved 31 December 2010.
- ^ Shah I, Ahman E (December 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"
- ^ Rosenthal, Elizabeth (12 October 2007). "Legal or Not, Abortion Rates Compare". The New York Times. http://www.nytimes.com/2007/10/12/world/12abortion.html?. Retrieved 18 July 2011.
- ^ "Facts on Investing in Family Planning and Maternal and Newborn Health" (PDF). Guttmacher Institute. November 2010. http://www.guttmacher.org/pubs/FB-AIU-summary.pdf. Retrieved 24 October 2011.
- ^ Sedgh, G.; Singh, S.; Henshaw, S. K.; Bankole, A. (2011). "Legal Abortion Worldwide in 2008: Levels and Recent Trends". Perspectives on Sexual and Reproductive Health 43 (3): 188–198. doi:10.1363/4318811. PMID 21884387. http://www.guttmacher.org/pubs/journals/3708411.html.
- ^ Strauss, L. T.; Gamble, S. B.; Parker, W. Y.; Cook, D. A.; Zane, S. B.; Hamdan, S.; Centers for Disease Control Prevention (2006). "Abortion surveillance—United States, 2003". Morbidity and Mortality Weekly Report Surveillance Summaries 55 (SS11): 1–32. PMID 17119534. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm.
- ^ a b "The Limitations of U.S. Statistics on Abortion". Issues in Brief. New York: The Guttmacher Institute. 1997. http://www.guttmacher.org/pubs/ib14.html.
- ^ 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. http://www.guttmacher.org/pubs/journals/3500603.html.
- ^ Department of Health (2007). "Abortion statistics, England and Wales: 2006". http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697. 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.
- ^ a b 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. http://www.guttmacher.org/pubs/journals/2411798.html.
- ^ Finer, L. B.; Frohwirth, L. F.; Dauphinee, L. A.; Singh, S.; Moore, A. M. (2005). "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives". Perspectives on Sexual and Reproductive Health 37 (3): 110–118. doi:10.1111/j.1931-2393.2005.tb00045.x. PMID 16150658. http://www.guttmacher.org/pubs/journals/3711005.html.
- ^ Jones, R. K.; Darroch, J. E.; Henshaw, S. K. (2002). "Contraceptive Use Among U.S. Women Having Abortions in 2000-2001" (PDF). Perspectives on Sexual and Reproductive Health 34 (6): 294–303. doi:10.2307/3097748. PMID 12558092. http://www.guttmacher.org/pubs/journals/3429402.pdf.
- ^ Susan A. Cohen: Abortion and Women of Color: The Bigger Picture, Guttmacher Policy Review, Summer 2008, Volume 11, Number 3.
- ^ a b c d e f g h i Joffe, Carole (2009). "1. Abortion and medicine: A sociopolitical history". In MPaul, ES Lichtenberg, L Borgatta, DA Grimes, PG Stubblefield, MD Creinin (PDF). Management of Unintended and Abnormal Pregnancy (1st ed.). Oxford, United Kingdom: John Wiley & Sons, Ltd.. ISBN 9781444312935. Archived from the original on 21 October 2011. http://media.wiley.com/product_data/excerpt/62/14051769/1405176962.pdf.
- ^ Miles, Steven (2005). The Hippocratic Oath and the Ethics of Medicine. Oxford University Press. ISBN 978-0195188202.
- ^ Brind'Amour, Katherine (2007). "Effraenatam". Embryo Project Encyclopedia. Arizona State University. Archived from the original on 1 February 2012. http://www.webcitation.org/658tiVCq0.
- ^ "Religions - Islam: Abortion". BBC. http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml. Retrieved 2011-12-10.
- ^ Dabash, Rasha; Roudi-Fahimi, Farzaneh (2008). "Abortion in the Middle East and North Africa" (PDF). Population Research Bureau. Archived from the original on 8 July 2011. http://www.prb.org/pdf08/MENAabortion.pdf.
- ^ "Abortion Law, History & Religion". Childbirth By Choice Trust. Archived from the original on 2008-02-08. http://web.archive.org/web/20080208053146/http://www.cbctrust.com/history_law_religion.php. Retrieved 2008-03-23.
- ^ For sources describing abortion policy in Nazi Germany, see:
- ^ http://www.un.org/esa/population/publications/2011abortion/2011wallchart.pdf
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