Misplaced Pages

Revision as of 00:51, 15 January 2008

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 or accidentally as with a miscarriage, or be induced by medicinal, surgical or other means at any point during human pregnancy for therapeutic or elective reasons. Approximately 46 million abortions are performed every year.

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

The moral and legal aspects of abortion are subject to intense social debate in many parts of the world. Aspects of this debate can include the public health impact of unsafe or illegal abortion as well as legal abortion's effect upon crime rates, and the ramifications of sex-selective practices. Other debates may include suggested but unproven effects of abortion including the Abortion-breast cancer hypothesis, Post-abortion syndrome, and fetal pain.

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

Definitions

The following medical terms are used to categorize abortion:

• Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors.
• Induced abortion: Abortion that has been caused by deliberate human action. Induced abortions are further subcategorized into therapeutic and elective:
  • Therapeutic abortion: An abortion performed either–
    • to save the life of the pregnant woman;
    • to preserve the woman's physical or mental health;
    • to terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity; or
    • to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.
  • Elective abortion: Abortion performed for any other reason.

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

Incidence

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

By gestational age and method

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

By personal and social factors

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

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

Forms of abortion

Spontaneous abortion

Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes before the 20th week of gestation. A pregnancy that ends earlier than 37 weeks of gestation, if it results in a live-born infant, is known as a "premature birth". When a fetus dies in the uterus at some point late in gestation, beginning at about 20 weeks, or during delivery, it is termed a "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Most miscarriages occur very early in pregnancy. Between 10% and 50% of pregnancies end in miscarriage, depending upon the age and health of the pregnant woman. In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant.

The risk of spontaneous abortion decreases sharply after the 8th week. This risk is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.

Induced abortion

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

Surgical abortion

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

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

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

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

Medical abortion

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

Other means of abortion

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

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

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

Health considerations

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

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

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

History of abortion

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

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

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

Social issues

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

Effect upon crime rate

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

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

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

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

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

Sex-selective abortion

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

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

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

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

Unsafe abortion

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

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

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

Abortion debate

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

Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. In the United States, most often those in favor of 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 continue a pregnancy?"

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

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

Public opinion

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

A May 2005 survey examined attitudes toward abortion in 10 European countries, asking polltakers whether they agreed with the statement, "If a woman doesn't want children, she should be allowed to have an abortion". The highest level of approval was 81% in the Czech Republic and the highest level of disapproval was 48% in Poland.

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

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

Arguments within the debate

Suggested effects of abortion

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

Breast cancer hypothesis

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

A large epidemiological study by Mads Melbye et al. in 1997, with data from two national registries in Denmark, reported the correlation to be negligible to non-existent after statistical adjustment. The National Cancer Institute conducted a workshop with over 100 experts on the issue in February 2003, which determined from selected evidence that it was well-established that there was no correlative relationship between abortion and breast cancer, effectively refuting the causality hypothesis. In 2004, Beral et al. published a collaborative reanalysis of 53 epidemiological studies and concluded that abortion does "not increase a woman's risk of developing breast cancer."

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

Mental health

Post-abortion syndrome (PAS), post-traumatic abortion syndrome and abortion trauma syndrome, are terms used to describe a set of adverse psychopathological characteristics which are proposed to occur in women following an induced abortion. Primarily a term used by pro-life advocates, PAS is not a medically recognized syndrome, and neither the American Psychological Association nor American Psychiatric Association recognize it. Some physicians and pro-choice advocates have argued that PAS is a myth created by opponents of abortion for political purposes.

A number of studies have concluded that abortion has positive or neutral effects on women. Others have found a correlation between clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions and abortion. Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortions, may increase the likelihood of experiencing such feelings. No studies have established a causal relationship between abortion and negative psychological symptoms experienced by women.

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

Fetal pain debate

This article may contain citations that do not verify the text. Please check for citation inaccuracies. (December 2007) (Learn how and when to remove this message)

The existence or absence of fetal sensation during abortion is a matter of medical, ethical and public policy interest. Evidence conflicts, with several physicians holding that the fetus is capable of feeling pain sometime in the first trimester, and medical researchers, notably from the American Medical Association, maintaining that the neuro-anatomical requirements for such experience do not exist until the 29th week of gestation.

Pain receptors begin to appear in the seventh week of gestation. 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 nociceptive process are not present until much later in gestation. Links between the thalamus and cerebral cortex form around the 23rd week. There has been suggestion that a fetus cannot feel pain at all, under the premise that it requires mental development that only occurs outside the uterus.

Abortion law

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

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

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

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

See also

References

1. -Merriam Webster’s Online Medical Dictionary. Retrieved 2006-06-26. See also The Free Dictionary which includes definitions from Dorland's Medical Dictionary and from The American Heritage Stedman's Medical Dictionary. Retrieved 2006-06-26.
2. ^ Roche, Natalie E. (2004). Therapeutic Abortion. Retrieved 2006-03-08.
3. Henshaw, Stanley K., Singh, Susheela, & Haas, Taylor. (1999). The Incidence of Abortion Worldwide. International Family Planning Perspectives, 25 (Supplement), 30 – 8. Retrieved 2006-01-18.
4. Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., & Hamdan, S. (November 24, 2006). Abortion Surveillance - United States, 2003. Morbidity and Mortality Weekly Report, 55 (11), 1-32. Retrieved May 10, 2007.
5. 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.
6. Department of Health (2007). "Abortion statistics, England and Wales: 2006". Retrieved 2007-10-12.
7. ^ 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.
8. ^ 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.
9. 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.
10. "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.
11. -Q&A: Miscarriage. (August 6 , 2002). BBC News. Retrieved January 10, 2007.
    - Lennart Nilsson. (1990) A Child is Born.
12. Healthwise. Manual and vacuum aspiration for abortion. (2004). WebMD. Retrieved 2006-08-19.
13. World Health Organization. (2003). Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Retrieved 2006-08-19.
14. Abortion. (2007). MSN Encarta. Retrieved July 1, 2007.
15. -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.
    - 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.
16. Spitz, I.M.; et al. (1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". New England Journal of Medicine. 338 (18). PMID 9562577. {{cite journal}}: Explicit use of et al. in: |author= (help)
17. Riddle, John M. (1997). Eve's Herbs: A History of Contraception and Abortion in the West. Cambridge, MA: Harvard University Press.
18. Ciganda, C., & Laborde, A. (2003). Herbal infusions used for induced abortion. J Toxicol Clin Toxicol, 41(3), 235-9. Retrieved 2006-01-25.
19. Education for Choice. (2005-05-06). Unsafe abortion. Retrieved 2006-01-11.
20. Potts, Malcolm, & Campbell, Martha. (2002). History of contraception. Gynecology and Obstetrics, vol. 6, chp. 8. Retrieved 2005-01-25.
21. Thapa, S.R., Rimal, D., & Preston, J. (2006). Self induction of abortion with instrumentation. Aust Fam Physician 35(9), pp 697-698.
22. Henshaw, Stanley K. "Induced Abortion: A World Review, 1990" International Family Planning Perspectives 23:246-252, 1991.
23. Grimes, D.A. (1994). The morbidity and mortality of pregnancy: still risky business. American Journal of Obstetrics and Gynecology, 170 (5 Pt 2), 1489-94. Retrieved December 21, 2006.
24. WHO Health Organization. Medical Methods for termination of pregnancy. WHO Technical Report Series 871, 1997
25. "Abortion, Complications". eMedicine. Retrieved 2007-06-30.
26. Pauli, E., Haller, U., Zimmermann, R. (2005). Morbidity of dilatation and evacuation in the second trimester: an analysis. Gynakol Geburtshilfliche Rundsch, 45 (2), 107-15. Retrieved December 26, 2006.
27. Bartley, J., Tong, S., Everington, D.,& Baird, D.T. (2000). Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases.... Contraception, 62(6), 297-303. Retrieved December 26, 2006.
28. Phillip G. Stubblefield, M.D., et al, "Pain of first-trimester abortion: Its quantification and relations with other variables," American Journal of Obstetrics and Gynecology, Vol. 133, No. 5 (March 1, 1979)
29. Devereux, G. (1967). A typological study of abortion in 350 primitive, ancient, and pre-industrial societies. Retrieved April 22, 2006. In Abortion in America: medical, psychiatric, legal, anthropological, and religious considerations. Boston: Beacon Press. Retrieved April 22, 2006.
30. Lefkowitz, Mary R. & Fant, Maureen R. (1992). Women's life in Greece & Rome: a source book in translation. Baltimore, MD: Johns Hopkins University Press. Retrieved 2006-01-11.
31. Histories of Abortion. (n.d.) Retrieved 2006-01-11.
32. Donohue, John J. and Levitt, Steven D. (2001). The impact of legalized abortion on crime.Quarterly Journal of Economics Retrieved 2006-02-11.
33. 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.
34. 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: ResponseToFooteGoetz2006.pdf.
35. "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.
36. "Abortion and the Lower Crime Rate." (2000, January). St. Anthony Messenger. Retrieved 2006-02-17.
37. 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.
38. Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. Journal of the American Medical Association, 294 (8), 947-954. Retrieved November 10, 2006.
39. Banister, Judith. (1999-03-16). Son Preference in Asia - Report of a Symposium. Retrieved 2006-01-12.
40. 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.
41. 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: abortion.pdf.
42. 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
43. Reaney, Patricia. (2006-01-09). "Selective abortion blamed for India's missing girls." Reuters AlertNet. Retrieved 2006-01-09.
44. Mudur, Ganapati. (2002). "India plans new legislation to prevent sex selection." British Medical Journal: News Roundup. Retrieved 2006-01-12.
45. Graham, Maureen J., Larsen, Ulla, & Xu, Xiping. (1998). Son Preference in Anhui Province, China. International Family Planning Perspectives, 24 (2). Retrieved 2006-01-12.
46. 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.
47. "China Bans Sex-selection Abortion." (2002-03-22). Xinhua News Agency. Retrieved 2006-01-12.
48. ^ World Health Organization. (2004). Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000. Retrieved 2006-01-12.
49. 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.
50. Sedgh, G., Henshaw, S., Singh, S., Åhman, E., & Shah, I.H. (2007). Induced abortion: estimated rates and trends worldwide. The Lancet, 370 (9595), 1338-1345. Retrieved October 31, 2007.
51. World Health Organization. (1998). Address Unsafe Abortion. Retrieved 2006-03-01.
52. 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.
53. TNS Sofres. (May 2005). European Values. Retrieved January 11, 2007.
54. The Polling Report. (2006). Retrieved 2006-01-11.
55. "Mexicans Support Status Quo on Social Issues." (December 1, 2005). Angus Reid Global Monitor. Retrieved January 10, 2006.
56. "Argentines Assess Abortion Changes." (Mar. 4, 2004). Angus Reid Global Monitor. Retrieved January 10, 2006.
57. "Brazilians Want to Keep Abortion as Crime." (April 12, 2007). Angus Reid Global Monitor. Retrieved June 20, 2007.
58. "Colombians Reject Legalizing Abortion. (August 2, 2005). Angus Reid Global Monitor. Retrieved January 10, 2006.
59. Simon, Stephanie. (2002, March 24). "Abortion Foes Seize on Reports of Cancer Link in Ad Campaign." Los Angeles Times
60. Tang, Mei-Tzu, et al. (2000). "Induced Abortion in Relation to Breast Cancer among Parous Women: A Birth Certificate Registry Study." Epidemiology, 11, 177-80.
61. Westhoff, Carolyn. (1997). "Abortion and Breast Cancer: Good Data at Last." IPPF Medical Bulletin. 31(2), 1-2.
62. Willett, W.C., et al. (1987). "Moderate Alcohol Consumption and the Risk of Breast Cancer." New England Journal of Medicine, 316(19), 1174-80.
63. Wingo, Phyllis A., et al. (1997). "The Risk of Breast Cancer Following Spontaneous or Induced Abortion." Cancer Causes and Control, 8, 93-108.
64. WHO — World Health Organization. (2000, June, accessed 2002, May 21). Induced Abortion Does Not Increase the Risk of Breast Cancer. . http://www.who.int/inf-fs/en/fact240.html
65. Russo J, Russo I (1980). "Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence". Am J Pathol. 100 (2): 497–512. PMID 6773421.
66. Russo J, Tay L, Russo I (1982). "Differentiation of the mammary gland and susceptibility to carcinogenesis". Breast Cancer Res Treat. 2 (1): 5–73. PMID 6216933.{{cite journal}}: CS1 maint: multiple names: authors list (link)
67. Russo J, Russo I (1987). "Biological and molecular bases of mammary carcinogenesis". Lab Invest. 57 (2): 112–37. PMID 3302534.
68. "Planned Parenthood - Anti-Choice Claims About Abortion and Breast Cancer". plannedparenthood.org. Retrieved 2007-11-04.
69. Melbye M, Wohlfahrt J, Olsen J, Frisch M, Westergaard T, Helweg-Larsen K, Andersen P (1997). "Induced abortion and the risk of breast cancer". N Engl J Med. 336 (2): 81–5. PMID 8988884.{{cite journal}}: CS1 maint: multiple names: authors list (link)
70. "Summary Report: Early Reproductive Events Workshop - National Cancer Institute". cancer.gov. Retrieved 2007-11-04.
71. 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". Lancet. 363 (9414): 1007–16. PMID 15051280.{{cite journal}}: CS1 maint: multiple names: authors list (link)
72. "THE PRO-CHOICE ACTION NETWORK". prochoiceactionnetwork-canada.org. Retrieved 2007-11-04.
73. ""Research and Destroy" by Chris Mooney". Retrieved 2007-10-01.
74. "ACS :: What Are the Risk Factors for Breast Cancer?". cancer.org. Retrieved 2007-11-04.
75. Michels KB, Xue F, Colditz GA, Willett WC (2007). "Induced and spontaneous abortion and incidence of breast cancer among young women: a prospective cohort study". Arch. Intern. Med. 167 (8): 814–20. doi:10.1001/archinte.167.8.814. PMID 17452545.{{cite journal}}: CS1 maint: multiple names: authors list (link)
76. Jasen P (2005). "Breast cancer and the politics of abortion in the United States". Med Hist. 49 (4): 423–44. PMID 16562329.
77. Howe H, Senie R, Bzduch H, Herzfeld P (1989). "Early abortion and breast cancer risk among women under age 40". Int J Epidemiol. 18 (2): 300–4. PMID 2767842.{{cite journal}}: CS1 maint: multiple names: authors list (link)
78. Gomez, Lavin C & Zapata, Garcia R."Diagnostic categorization of post-abortion syndrome", Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.
79. Chris Mooney"Research and Destroy" Washington Monthly, October 2004
80. Bazelon, Emily. The New York Times Magazine. Is There a Post-Abortion Syndrome?
81. Science in support of a cause: the new research, by Michael Kranish. Published in the Boston Globe on July 31 2005; accessed November 27 2007.
82. Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. PMID 15096333. Key summary points of article state that "Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae." On p. 624, the authors state: "The alleged 'postabortion trauma syndrome' does not exist."
83. Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
84. Cooper, Cynthia L. Abortion Under Attack
85. American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.
86. Depression Risk Increased After Miscarriage. (2002-04-01). Retrieved 2006-01-11.
87. "Open Letter to President Reagan" (Press release). Schmidt, Dr. Richard T. F., et al. 1984-02-13. Retrieved 2006-11-18.
88. ^ Robinson, B.A. (2006). Can a fetus feel pain?. Ontario Consultants for Religious Tolerance. Retrieved December 14, 2005.
89. BBC News Article (2005). "Foetuses 'no pain up to 29 weeks'." Retrieved 2006-07-18.
90. Myers, Laura B. (2003). Fetal Surgery: The Anathesia Perspective. Retrieved March 14, 2007.
91. ^ Parliamentary Office of Science and Technology. (1997). Fetal Awareness. Retrieved 2006-01-11.
92. BBC News Article (2006). "Foetuses 'cannot experience pain'." Retrieved 2006-07-18.
93. Lord Ellenborough’s Act." (1998). The Abortion Law Homepage. Retrieved February 20, 2007.
94. United Nations Population Division. (2002). Abortion Policies: A Global Review. Retrieved February 22, 2007.
95. Ross, Jen. (September 12, 2006). "In Chile, free morning-after pills to teens." The Christian Science Monitor. Retrieved 2006-12-07.
96. Gallardoi, Eduardo. (September 26, 2006). "Morning-After Pill Causes Furor in Chile." The Washington Post. Retrieved 2006-12-07.
97. "Surgical Abortion: History and Overview". National Abortion Federation. Retrieved 2006-09-04.

External links

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

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

• The Guttmacher Institute
• Johnston's Archive: Abortion Statistics and Other Data
• Just Facts: Abortion
• Abortion.com: Abortion Clinics and Medical Providers

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

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

• Abortion
• Reproduction
• Core issues in ethics
• Gynecology
• Pregnancy
• Obstetrics
• Gender studies