Abortion

Abortion

Overview
Abortion is defined as the termination of pregnancy
Pregnancy (mammals)
In mammals, pregnancy is the period of reproduction during which a female carries one or more live offspring from implantation in the uterus through gestation. It begins when a fertilized zygote implants in the female's uterus; and ends once it leaves the uterus.-Fertilization and implantation:A...

 by the removal or expulsion from the uterus of a fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

 or embryo
Embryo
An embryo is a multicellular diploid eukaryote in its earliest stage of development, from the time of first cell division until birth, hatching, or germination...

 prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...

, 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
Developed country
A developed country is a country that has a high level of development according to some criteria. Which criteria, and which countries are classified as being developed, is a contentious issue...

 in accordance with local law
Abortion law
Abortion law is legislation and common law which pertains to the provision of abortion. Abortion has been a controversial subject in many societies through history because of the moral, ethical, practical, and political power issues that surround it. It has been banned frequently and otherwise...

, is among the safest procedures in medicine.
Discussion
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Quotations

Abolition of a woman's right to abortion, when and if she wants it, amounts to compulsory maternity: a form of rape by the State.

Edward Abbey, One Life at a Time, Please (1988)

The poor InfanticideInfanticide_in_history|expose their children, the rich kill the fruit of their own bodies in the womb, lest their property be divided up, and they destroy their own children in the womb with murderous poisons, and before life has been passed on, it is annihilated.

St. Ambrose|St. Ambrose, circa 370

Every person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception. No one shall be arbitrarily deprived of his life.

wikipedia:American Convention on Human Rights|American Convention on Human Rights, Article 4, 1969, ratified by 25 member-states of the Organization of American States

Concerning women who commit fornication, and destroy that which they have conceived, or who are employed in making drugs for abortion, a former decree excluded them until the hour of death, and to this some have assented. Nevertheless, being desirous to use somewhat greater lenity, we have ordained that they fulfill ten years [of penance], according to the prescribed degrees.

Synod_of_Ancyra|Synod of Ancyra canon XXI, circa 314

Supporters of [the Human Life Amendment] are often eloquent in their defense of the fertilized egg but are seldom willing to aid the woman whose body nourishes it.

Carole Anderson and Lee Campbell with Mary Anne Cohen, reprinted in Our Bodies, Ourselves|The New Our Bodies, Ourselves, Boston Women's Health Book Collective (1984)
Encyclopedia
Abortion is defined as the termination of pregnancy
Pregnancy (mammals)
In mammals, pregnancy is the period of reproduction during which a female carries one or more live offspring from implantation in the uterus through gestation. It begins when a fertilized zygote implants in the female's uterus; and ends once it leaves the uterus.-Fertilization and implantation:A...

 by the removal or expulsion from the uterus of a fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

 or embryo
Embryo
An embryo is a multicellular diploid eukaryote in its earliest stage of development, from the time of first cell division until birth, hatching, or germination...

 prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...

, 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
Developed country
A developed country is a country that has a high level of development according to some criteria. Which criteria, and which countries are classified as being developed, is a contentious issue...

 in accordance with local law
Abortion law
Abortion law is legislation and common law which pertains to the provision of abortion. Abortion has been a controversial subject in many societies through history because of the moral, ethical, practical, and political power issues that surround it. It has been banned frequently and otherwise...

, is among the safest procedures in medicine. However, unsafe abortion
Unsafe abortion
An unsafe abortion is the termination of an unwanted pregnancy by persons lacking the necessary skills, or in an environment lacking minimal medical standards, or both...

s (those performed by persons without proper training or outside of a medical environment) result in approximately 70 thousand maternal death
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...

s and 5 million disabilities per year globally. An estimated 42 million abortions are performed globally each year, with 20 million of those performed unsafely. The incidence of abortion has declined worldwide as access to family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...

 education and contraceptive
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

 services has increased. Forty percent of the world's women have access to induced abortions (within gestational limits).

Induced abortion has a long history
History of abortion
The practice of abortion, the termination of a pregnancy so that it does not result in birth, dates back to ancient times. Pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal...

 and has been facilitated by various methods including herbal abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....

s, the use of sharpened tools, physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

, and other traditional methods
Traditional medicine
Traditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern medicine...

. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality
Abortion law
Abortion law is legislation and common law which pertains to the provision of abortion. Abortion has been a controversial subject in many societies through history because of the moral, ethical, practical, and political power issues that surround it. It has been banned frequently and otherwise...

, prevalence, cultural and religious status of abortion vary substantially around the world. In many parts of the world there is prominent and divisive public controversy
Abortion debate
The abortion debate refers to discussion and controversy surrounding the moral and legal status of abortion. The two main groups involved in the abortion debate are the self-described "pro-choice" movement and the "pro-life" movement...

 over the ethical and legal issues of abortion.

Induced


Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended
Unintended pregnancy
Unintended pregnancies are those in which conception was not intended by the female sexual partner. Worldwide, 38% of pregnancies were unintended in 1999 . Unintended pregnancies are the primary cause of induced abortion, resulting in about 42 million induced abortions per year...

 and about a fifth end in induced abortion. Most abortions result from unintended pregnancies.
A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....

 of the embryo or fetus, which increases in size as the pregnancy progresses. 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
Therapeutic abortion
Therapeutic abortion is abortion induced following a medical diagnosis. Many therapeutic abortions are performed today, with some degree of controversy regarding the quality of life, if there is a genetic condition in the embryo or fetus which is incompatible with life Therapeutic abortion is...

 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
Selective reduction
Selective reduction is the practice of aborting one or more fetuses in a multifetal pregnancy. Such an abortion procedure is often performed after a congenital defect has been identified...

 the number of fetuses to lessen health risks associated with multiple pregnancy
Multiple birth
A multiple birth occurs when more than one fetus is carried to term in a single pregnancy. Different names for multiple births are used, depending on the number of offspring. Common multiples are two and three, known as twins and triplets...

. 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.

Spontaneous



Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 20th to 22nd week of gestation
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....

.Note that the defining line between miscarriage and premature birth or stillbirth varies among jurisdictions. A pregnancy that ends before 37 weeks of gestation resulting in a live-born
Live birth
In human reproduction, a live birth occurs when a fetus, whatever its gestational age, exits the maternal body and subsequently shows any sign of life, such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or...

 infant is known as a "premature birth
Premature birth
In humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...

" or a "preterm birth". When a fetus dies in utero
In utero
In utero is a Latin term literally meaning "in the womb". In biology, the phrase describes the state of an embryo or fetus. In legal contexts, the phrase is used to refer to unborn children. Under common law, unborn children are still considered to exist for property transfer purposes.-See also:*...

 after viability, or during delivery
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

, it is usually termed "stillborn
Stillbirth
A stillbirth occurs when a fetus has died in the uterus. The Australian definition specifies that fetal death is termed a stillbirth after 20 weeks gestation or the fetus weighs more than . Once the fetus has died the mother still has contractions and remains undelivered. The term is often used in...

". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Only 30 to 50% of conceptions progress past the first trimester. The vast majority of those that do not progress are lost before the woman is aware of the conception, and many pregnancies are lost before medical practitioners have the ability to detect the presence of an embryo. Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease
Vascular disease
Vascular disease is a form of cardiovascular disease primarily affecting the blood vessels.Some conditions, such as angina and myocardial ischemia, can be considered both vascular diseases and heart diseases .Cigarette smoking is the major risk factor....

 (such as lupus
Systemic lupus erythematosus
Systemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...

), diabetes, other hormonal problems, infection, and abnormalities of the uterus. Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidental trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide
Feticide
Feticide is an act that causes the death of a fetus. In a legal context, "fetal homicide" or "child destruction" refers to the deliberate or incidental killing of a fetus due to a criminal human act, such as a blow to the abdomen of a pregnant woman...

.

Induction methods



Medical


Medical abortions are those induced by abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....

 pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....

 analog
Prostaglandin analogue
Synthetic prostaglandin analogues are molecules which are manufactured to bind to a prostaglandin receptor.Wider use of prostaglandin analogues is limited by unwanted side effects and their abortive potential.-Uses:...

s in the early 1970s and the antiprogestogen
Antiprogestin
An antiprogestin is a substance that prevents cells from making or using progesterone . Antiprogestins may stop some cancer cells from growing and they are being studied in the treatment of breast cancer...

 mifepristone
Mifepristone
Mifepristone is a synthetic steroid compound used as a pharmaceutical. It is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive. During early trials, it was known as RU-38486 or simply RU-486, its...

 in the 1980s.

The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog (misoprostol
Misoprostol
Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D...

 or gemeprost
Gemeprost
Gemeprost is an analogue of prostaglandin E1.-Clinical use:It is used as a treatment for obstetric bleeding.It is used with RU486 to terminate pregnancy up to 24 weeks gestation...

) up to 9 weeks gestational age, methotrexate
Methotrexate
Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...

 in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. 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.

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. 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. In cases of failure of medical abortion, surgical abortion must be used to complete the procedure.

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain, France, Switzerland, and the Nordic countries. Early medical abortions accounted for slightly over 25% of abortions before 9 weeks gestation in the United States in 2008, and accounted for 32% of first trimester abortions at Planned Parenthood
Planned Parenthood
Planned Parenthood Federation of America , commonly shortened to Planned Parenthood, is the U.S. affiliate of the International Planned Parenthood Federation and one of its larger members. PPFA is a non-profit organization providing reproductive health and maternal and child health services. The...

 clinics in the United States in 2008.

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, in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.

Surgical


In the first 15 weeks, suction-aspiration
Suction-aspiration abortion
Vacuum or suction aspiration uses aspiration to remove uterine contents through the cervix. It may be used as a method of induced abortion, a therapeutic procedure used after miscarriage, or a procedure to obtain a sample for endometrial biopsy. The rate of infection is lower than any other...

 or vacuum abortion is the most common surgical method. Manual vacuum aspiration (MVA) abortion consists of removing the fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

 or embryo
Embryo
An embryo is a multicellular diploid eukaryote in its earliest stage of development, from the time of first cell division until birth, hatching, or germination...

, placenta
Placenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...

 and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction
Menstrual extraction
Menstrual extraction was developed as a technique to help women gain and maintain control over their menstrual cycles and reproductive lives. It can be used as a method of very early termination of pregnancy and/or as a simple way to remove menstrual blood.-Early development:In 1971, a member of...

", can be used in very early pregnancy, and does not require cervical dilation. Dilation and curettage
Dilation and curettage
Dilation and curettage refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping . It is a diagnostic gynecological procedure.D&C normally is referred to a procedure involving a curette, also called sharp...

(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
Curettage
Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....

refers to cleaning the walls of the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

 with a curette
Curette
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge...

. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 recommends this procedure, also called sharp curettage, only when MVA is unavailable.

From the 15th week until approximately the 26th, other techniques must be used. Dilation and evacuation
Dilation and evacuation
Dilation and evacuation literally refers to the dilation of the cervix and surgical evacuation of the contents of the uterus...

 (D&E) consists of opening the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...

 of the uterus and emptying it using surgical instruments and suction. Premature labor and delivery can be induced with prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....

; this can be coupled with injecting the amniotic fluid
Amniotic sac
The amniotic sac is the sac in which the fetus develops in amniotes. It is a tough but thin transparent pair of membranes, which hold a developing embryo until shortly before birth. The inner membrane, the amnion, contains the amniotic fluid and the fetus. The outer membrane, the Chorion,...

 with hypertonic solutions containing saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

 or urea
Urea
Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....

. After the 16th week of gestation, abortions can also be induced by intact dilation and extraction
Intact dilation and extraction
Intact dilation and extraction is a procedure done in late term abortion. It is also known as intact dilation and evacuation, dilation and extraction , intrauterine cranial decompression and, vernacularly in the United States, as partial birth abortion...

 (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
Partial-Birth Abortion Ban Act
The Partial-Birth Abortion Ban Act of 2003 is a United States law prohibiting a form of late-term abortion that the Act calls "partial-birth abortion", often referred to in medical literature as intact dilation and extraction...

 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
Hysterotomy abortion
Hysterotomy abortion is a form of abortion in which the uterus is opened through an abdominal incision and the fetus is removed, similar to a caesarean section, but requiring a smaller incision...

 is a procedure similar to a caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...

 and is performed under general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.

Other methods



Historically, a number of herbs reputed to possess abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....

 properties have been used in folk medicine
Folk medicine
-Description:Refers to healing practices and ideas of body physiology and health preservation known to a limited segment of the population in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience.All cultures and societies...

: tansy
Tansy
Tansy is a perennial, herbaceous flowering plant of the aster family, native to temperate Europe and Asia. It has been introduced to other parts of the world and in some areas has become invasive...

, pennyroyal
Pennyroyal
Pennyroyal refers to two plants in the mint family, Lamiaceae. For the American species, see American pennyroyal. The European pennyroyal, Mentha pulegium, , is a plant in the mint genus, within the family Lamiaceae. Crushed Pennyroyal leaves exhibit a very strong fragrance similar to spearmint...

, black cohosh, and the now-extinct silphium
Silphium
Silphium was a plant that was used in classical antiquity as a rich seasoning and as a medicine. It was the essential item of trade from the ancient North African city of Cyrene, and was so critical to the Cyrenian economy that most of their coins bore a picture of the plant...

 (see history of abortion). The use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ failure
Multiple organ dysfunction syndrome
Multiple organ dysfunction syndrome ', previously known as multiple organ failure or multisystem organ failure , is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis...

, and is not recommended by physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s.

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
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...

. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the bas reliefs decorating the temple of Angkor Wat
Angkor Wat
Angkor Wat is a temple complex at Angkor, Cambodia, built for the king Suryavarman II in the early 12th century as his state temple and capital city. As the best-preserved temple at the site, it is the only one to have remained a significant religious centre since its foundation – first Hindu,...

 in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld
Underworld
The Underworld is a region which is thought to be under the surface of the earth in some religions and in mythologies. It could be a place where the souls of the recently departed go, and in some traditions it is identified with Hell or the realm of death...

.

Reported methods of unsafe, self-induced abortion
Self-induced abortion
A self-induced abortion is an abortion performed by the pregnant woman herself outside the recognized medical system. Although the term can include abortions induced through legal, over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, often more...

 include misuse of misoprostol
Misoprostol
Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D...

, 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.

Safety


The health risks of abortion depend on whether the procedure is performed safely or unsafely. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Abortion, when performed in the developed world
Developed country
A developed country is a country that has a high level of development according to some criteria. Which criteria, and which countries are classified as being developed, is a contentious issue...

 in accordance with local law, is among the safest procedures in medicine. In the US, the risk of maternal death
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

 from abortion in 1999 was 0.567 per 100,000 procedures, making abortion approximately 12.5 times safer than childbirth (7.06 maternal deaths per 100,000 live births). The risk of abortion-related mortality increases with increasing gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.

Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...

, abortion clinic
Abortion clinic
An abortion clinic is a medical facility that primarily performs or specializes in abortions. Such clinics may be public medical centers or private medical practices.-Canada:*There were 197 abortion providers in Canada in 2001....

, or hospital. Complications are rare and can include uterine perforation
Uterine perforation
Uterine perforation is a potential complication of any intrauterine procedure. It may be associated with injury to surrounding blood vessels or viscera such as the bladder or intestine. If not diagnosed at the time of the procedure it can result in massive hemorrhage or sepsis...

, pelvic infection
Endometritis
Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. Pathologists have traditionally classified endometritis as either acute or chronic: acute endometritis is characterized by the presence of microabscesses or neutrophils within the endometrial glands, while...

, and retained products of conception requiring a second procedure to evacuate. Preventive antibiotics (such as doxycycline
Doxycycline
Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...

 or metronidazole
Metronidazole
Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....

) are typically given before elective abortion, as they are believed to substantially reduce the risk of postoperative uterine infection. Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen.

There is little, if any, 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. 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.

Unsafe abortion




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
Developing country
A developing country, also known as a less-developed country, is a nation with a low level of material well-being. Since no single definition of the term developing country is recognized internationally, the levels of development may vary widely within so-called developing countries...

. Unsafe abortion is believed to result in approximately 68,000 deaths and millions of injuries annually. Groups such as the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 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.

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
Self-induced abortion
A self-induced abortion is an abortion performed by the pregnant woman herself outside the recognized medical system. Although the term can include abortions induced through legal, over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, often more...

 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
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...

, hemorrhage, and damage to internal organs.

The legality of abortion is one of the main determinants of its safety. Restrictive abortion laws are associated with a high rate of unsafe abortions. For example, the 1996 legalization of abortion in South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

 had an immediate positive impact on the frequency of abortion-related complications, with abortion-related deaths dropping by more than 90%. 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 as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...

 seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. Complications of unsafe abortion account for approximately an eighth of maternal mortalities
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...

 worldwide, though this varies by region. Secondary infertility caused by an unsafe abortion affects an estimated 24 million women. 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.

Breast cancer hypothesis



Some studies have suggested an association between abortion and breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

. Proponents of a causal link between the two suggest that the interruption of normal breast development during pregnancy leaves immature cells that are more cancer-prone in the breasts. However, major medical bodies, including the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, the US National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...

, the American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...

, the Royal College of Obstetricians and Gynaecologists
Royal College of Obstetricians and Gynaecologists
The Royal College of Obstetricians and Gynaecologists is a professional association based in the UK. Its members, including people with and without medical degrees, work in the field of obstetrics and gynaecology, that is, pregnancy, childbirth, and female sexual and reproductive health...

, and the American Congress of Obstetricians and Gynecologists
American Congress of Obstetricians and Gynecologists
The American Congress of Obstetricians and Gynecologists , formerly the American College of Obstetricians and Gynecologists, is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 55,000 and represents 90 percent...

, have all concluded on the basis of existing evidence that abortion does not cause breast cancer. The concept of a causal link between induced abortion and breast cancer is currently promoted primarily by pro-life groups.

Mental health



The current scientific consensus
Scientific consensus
Scientific consensus is the collective judgment, position, and opinion of the community of scientists in a particular field of study. Consensus implies general agreement, though not necessarily unanimity. Scientific consensus is not by itself a scientific argument, and it is not part of the...

 holds that there is no causal relationship between abortion and mental-health problems. Some factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, or pre-existing psychiatric illness increase the likelihood of experiencing negative feelings after an abortion. 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. Similarly, abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems.

Some studies have disagreed with above conclusions; other researchers and professional organizations have noted that such studies typically fail to use appropriate comparison groups, do not adequately account for confounding variables, improperly account for pre-existing mental health complications or and their degree of severity.For example of such studies and why researchers have criticized them, see: Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome", which is not recognized by any medical or psychological organization.

Incidence


There are two commonly used methods of measuring the incidence of abortion:
  • Abortion rate – number of abortions per 1000 women between 15 and 44 years of age
  • Abortion ratio – number of abortions out of 100 known pregnancies (excluding miscarriages and stillbirths)


The number of abortions performed worldwide has decreased between 1995 and 2003 from 45.6 million to 41.6 million, which means a decrease in abortion rate per annum from 35 to 29 per 1000 women. The greatest decrease has occurred in the developed world with a drop from 39 to 26 per 1000 women in comparison to the developing world, which had a decrease from 34 to 29 per 1000 women. In 2003, the estimated global abortion ratio was 31.

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. The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute
Guttmacher Institute
The Guttmacher Institute is a non-profit organization which works to advance sexual and reproductive health. The institute operates in the United States and globally "through an interrelated program of social science research, policy analysis and public education." According to their mission...

, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.

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.

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
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

 (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
Curettage
Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....

" (suction-aspiration
Suction-aspiration abortion
Vacuum or suction aspiration uses aspiration to remove uterine contents through the cervix. It may be used as a method of induced abortion, a therapeutic procedure used after miscarriage, or a procedure to obtain a sample for endometrial biopsy. The rate of infection is lower than any other...

, Dilation and curettage
Dilation and curettage
Dilation and curettage refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping . It is a diagnostic gynecological procedure.D&C normally is referred to a procedure involving a curette, also called sharp...

, Dilation and evacuation
Dilation and evacuation
Dilation and evacuation literally refers to the dilation of the cervix and surgical evacuation of the contents of the uterus...

), 7.7% by "medical
Medical abortion
A medical abortion is a type of non-surgical abortion in which abortifacient pharmaceutical drugs are used to induce abortion. An oral preparation for medical abortion is commonly referred to as an abortion pill....

" means (mifepristone
Mifepristone
Mifepristone is a synthetic steroid compound used as a pharmaceutical. It is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive. During early trials, it was known as RU-38486 or simply RU-486, its...

), 0.4% by "intrauterine instillation
Instillation abortion
Instillation abortion is a rarely used method of induced abortion, performed in the second trimester, by injecting a solution into the uterus to cause uterine contractions.-Procedure:...

" (saline or prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....

), and 1.0% by "other" (including hysterotomy
Hysterotomy abortion
Hysterotomy abortion is a form of abortion in which the uterus is opened through an abdominal incision and the fetus is removed, similar to a caesarean section, but requiring a smaller incision...

 and hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...

). 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.

The Guttmacher Institute
Guttmacher Institute
The Guttmacher Institute is a non-profit organization which works to advance sexual and reproductive health. The institute operates in the United States and globally "through an interrelated program of social science research, policy analysis and public education." According to their mission...

 estimated there were 2,200 intact dilation and extraction
Intact dilation and extraction
Intact dilation and extraction is a procedure done in late term abortion. It is also known as intact dilation and evacuation, dilation and extraction , intrauterine cranial decompression and, vernacularly in the United States, as partial birth abortion...

 procedures in the US 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. Later abortions are more common in China, India, and other developing countries than in developed countries.

Personal and social factors


A 1998 study from 27 countries on the reasons women seek to terminate their pregnancies concluded that the most common reason women cited for having an abortion was to postpone childbearing to a more suitable time or to focus energies and resources on existing children. The most commonly reported reasons were socioeconomic factors such as being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while she is caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of education, relationship problems with a husband or partner, the perception that she is too young, and unemployment. A 2004 study in which American women at clinics
Abortion clinic
An abortion clinic is a medical facility that primarily performs or specializes in abortions. Such clinics may be public medical centers or private medical practices.-Canada:*There were 197 abortion providers in Canada in 2001....

 answered a questionnaire yielded similar results. A 1998 survey found risk to maternal health cited as the main reason by 5-10% in seven countries and by 20-38% in three (Kenya, Bangladesh and India). A 1997 U.S. report cited maternal health the "most important reason" for their decision by 3% of women and another 3% cited concern that the fetus had a health problem. In a 2004 survey-based U.S. study, 1% of women having abortions became pregnant as a result of rape
Rape
Rape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...

 and 0.5% as a result of incest
Incest
Incest is sexual intercourse between close relatives that is usually illegal in the jurisdiction where it takes place and/or is conventionally considered a taboo. The term may apply to sexual activities between: individuals of close "blood relationship"; members of the same household; step...

. Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

 at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using condom
Condom
A condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...

s and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage. 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."

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled people, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control
Population control
Human population control is the practice of artificially altering the rate of growth of a human population.Historically, human population control has been implemented by limiting the population's birth rate, usually by government mandate, and has been undertaken as a response to factors including...

 (such as China's one-child policy
One-child policy
The one-child policy refers to the one-child limitation applying to a minority of families in the population control policy of the People's Republic of China . The Chinese government refers to it under the official translation of family planning policy...

). These factors can sometimes result in compulsory abortion or sex-selective abortion
Sex-selective abortion
Sex-selective abortion is the practice of terminating a pregnancy based upon the predicted sex of the baby. The selective abortion of female fetuses is most common in areas where cultural norms value male children over female children, especially in parts of People's Republic of China, India,...

.

History




Induced abortion has long history, and can be traced back to civilizations as varied as China under Shennong
Shennong
Shennong , which names mean "Divine Farmer", but also known as the Emperor of the Five Grains , was a legendary ruler of China and culture hero reputed to have lived some 5,000 years ago...

 (c. 2700 BCE), Ancient Egypt
Ancient Egypt
Ancient Egypt was an ancient civilization of Northeastern Africa, concentrated along the lower reaches of the Nile River in what is now the modern country of Egypt. Egyptian civilization coalesced around 3150 BC with the political unification of Upper and Lower Egypt under the first pharaoh...

 with its Ebers Papyrus
Ebers papyrus
The Ebers Papyrus, also known as Papyrus Ebers, is an Egyptian medical papyrus dating to circa 1550 BC. Among the oldest and most important medical papyri of ancient Egypt, it was purchased at Luxor, in the winter of 1873–74 by Georg Ebers...

 (c. 1550 BCE), and the Roman Empire in the time of Juvenal
Juvenal
The Satires are a collection of satirical poems by the Latin author Juvenal written in the late 1st and early 2nd centuries AD.Juvenal is credited with sixteen known poems divided among five books; all are in the Roman genre of satire, which, at its most basic in the time of the author, comprised a...

 (c. 200 CE). There is evidence to suggest that pregnancies were terminated through a number of methods, including the administration of abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....

 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
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...

 forbade Ancient Greek
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 physicians from performing abortions; other scholars disagree with this interpretation, and note the medical texts of Hippocratic Corpus
Hippocratic Corpus
The Hippocratic Corpus , or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings...

 contain descriptions of abortive techniques and notes on the risks they posed to a woman's health. In Christianity, Pope Sixtus V
Pope Sixtus V
Pope Sixtus V , born Felice Peretti di Montalto, was Pope from 1585 to 1590.-Early life:The chronicler Andrija Zmajević states that Felice's family originated from modern-day Montenegro...

 (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy; the Church had previously been divided on whether if believed that abortion was murder, and did not begin vigorously opposing abortion until the 19th century. Islamic tradition
Islam and abortion
Muslim views on abortion are shaped by the Quran and Hadith as well as by the opinions of legal and religious scholars and commentators. In Islam, the fetus is believed to become a living soul after four months of gestation, and abortion after that point is generally viewed as impermissible...

 has traditionally permitted abortion up until a point in time when Muslims believe the soul enters the fetus, considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening
Quickening
Quickening is the earliest perception of fetal movement by a mother during pregnancy Quickening may also refer to:* Quickening , Final Fantasy XIIs incarnation of "Limit Breaks"...

. However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.

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. 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. Church groups as well as physicians were highly influential in anti-abortion movements. In the US, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.By 1930, medical procedures in the US had improved for both childbirth and abortion but not equally, and induced abortion in the first trimester had become safer than childbirth. In 1973, Roe vs. Wade acknowledged that abortion in the first trimester was safer than childbirth:
}
The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion. 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. Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.

Abortion debate


Induced abortion has long been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her value system
Value system
A value system is a set of consistent ethic values and measures used for the purpose of ethical or ideological integrity. A well defined value system is a moral code.-Personal and communal:...

. Opinions of abortion may be described as being a combination of beliefs on its morality; beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy; and on the rights and responsibilities of the woman seeking to have an abortion. Religious ethics
Ethics in religion
Most religions have an ethical component, often derived from purported supernatural revelation or guidance. "For many people, ethics is not only tied up with religion, but is completely settled by it...

 also has an influence
Religion and abortion
Many religious traditions have taken a stance on abortion, and these stances span a broad spectrum as highlighted below.-Buddhism:There is no single Buddhist view concerning abortion. Traditional sources, such as the Buddhist monastic code, hold that life begins at conception and that abortion,...

 upon both personal opinion and the greater debate over abortion.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Abortion debates, especially pertaining to abortion law
Abortion law
Abortion law is legislation and common law which pertains to the provision of abortion. Abortion has been a controversial subject in many societies through history because of the moral, ethical, practical, and political power issues that surround it. It has been banned frequently and otherwise...

s, are often spearheaded by groups advocating one of these two positions. Those in favor of greater legal restrictions on abortion, including complete prohibition, most often describe themselves as pro-life
Pro-life
Opposition to the legalization of abortion is centered around the pro-life, or anti-abortion, movement, a social and political movement opposing elective abortion on moral grounds and supporting its legal prohibition or restriction...

 while those against legal restrictions on abortion describe themselves as pro-choice
Pro-choice
Support for the legalization of abortion is centered around the pro-choice movement, a sociopolitical movement supporting the ethical view that a woman should have the legal right to elective abortion, meaning the right to terminate her pregnancy....

. Generally, the former position argues that a human fetus is a human being with a right to live
Right to life
Right to life is a phrase that describes the belief that a human being has an essential right to live, particularly that a human being has the right not to be killed by another human being...

, making abortion morally the same as murder. The latter position argues that a woman has certain reproductive rights
Reproductive rights
Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health. The World Health Organization defines reproductive rights as follows:...

, especially the choice whether or not to carry a pregnancy to term.

Modern abortion law


Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, the right to security of person
Security of person
Security of the person is a basic entitlement guaranteed by the Universal Declaration of Human Rights, adopted by the United Nations in 1948. It is also a human right explicitly mentioned and protected by the Constitution of Canada, the Constitution of South Africa and other laws around the...

, and the right to reproductive health
Reproductive rights
Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health. The World Health Organization defines reproductive rights as follows:...

 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
Feticide
Feticide is an act that causes the death of a fetus. In a legal context, "fetal homicide" or "child destruction" refers to the deliberate or incidental killing of a fetus due to a criminal human act, such as a blow to the abdomen of a pregnant woman...

). These requirements are usually dependent on the age of the fetus, often using a trimester-based system to regulate the window of legality. Many restrictions are waived in emergency situations. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion. Other jurisdictions may require that a woman obtain the consent of the fetus' father
Paternal rights and abortion
The paternal rights and abortion issue is an extension of both the abortion debate and the fathers' rights movement. Countries recognizing father's legal rights on abortion have laws requiring that the male who impregnated the pregnant female either consent or be informed before she has an...

 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.

Other jurisdictions ban abortion almost entirely. However, 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. In countries where abortion is banned entirely, such as Nicaragua
Abortion in Nicaragua
Abortion in Nicaragua is completely illegal. Prior to a change in the law, which took effect on 18 November 2006, the law allowed pregnancies to be terminated for "therapeutic" reasons, but this clause is no longer in effect.-Abortion law in Nicaragua:...

, rises in maternal death directly and indirectly due to pregnancy have been noted. Some countries, such as Bangledesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene. In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in medical tourism
Medical tourism
Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...

 and travel to countries where they can terminate their pregnancies. Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.

Emergency contraception
Emergency contraception
Emergency contraception , or emergency postcoital contraception, refers to birth control measures that, if taken after sexual intercourse, may prevent pregnancy.Forms of EC include:...

 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
Abortion in Chile
Abortion in Chile is illegal without exception. The Chilean abortion law is considered one of the most restrictive in the world.-Legal background:...

. This has caused controversy, as some pro-life
Pro-life
Opposition to the legalization of abortion is centered around the pro-life, or anti-abortion, movement, a social and political movement opposing elective abortion on moral grounds and supporting its legal prohibition or restriction...

 groups have advocated that certain forms of emergency contraception are not contraceptives but abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....

s.

Sex-selective abortion


Sonography
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

 and amniocentesis
Amniocentesis
Amniocentesis is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA is examined for...

 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. 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. In China, a historical preference for a male child has been exacerbated by the one-child policy
One-child policy
The one-child policy refers to the one-child limitation applying to a minority of families in the population control policy of the People's Republic of China . The Chinese government refers to it under the official translation of family planning policy...

, which was enacted in 1979.

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
Terrorism
Terrorism is the systematic use of terror, especially as a means of coercion. In the international community, however, terrorism has no universally agreed, legally binding, criminal law definition...

. Only a small fraction of those opposed to abortion commit violence, often rationalizing their actions as justifiable homicide
Justifiable homicide
The United States' concept of justifiable homicide in criminal law stands on the dividing line between an excuse, justification and an exculpation. It is different from other forms of homicide in that due to certain circumstances the homicide is justified as preventing greater harm to innocents...

 or defense of others, committed in order to protect the lives of fetuses.

In the United States, four physicians who performed abortions—David Gunn
David Gunn (doctor)
David Gunn was an American physician. He received his bachelors degree from Vanderbilt University and earned his M.D. at the University of Kentucky. Gunn moved to Brewton, Alabama, after his residency, choosing to provide OB/GYN and abortion services in rural America.Gunn was murdered in...

, John Britton
John Britton (doctor)
John Bayard Britton was an American physician. He was murdered in Pensacola, Florida by anti-abortion terrorist Paul Jennings Hill...

, Barnett Slepian
Barnett Slepian
Barnett Slepian was an American physician and OB/GYN who was murdered in his home by anti-abortion militant James Charles Kopp....

, and George Tiller
George Tiller
George Richard Tiller, MD was an American physician from Wichita, Kansas. He was the medical director of a clinic in Wichita, Women's Health Care Services, one of only three nationwide which provided abortions after the 21st week of pregnancy .Pro-life group Operation Rescue kept a daily vigil...

—have been assassinated. Attempted assassinations have also taken place in the United States and Canada, and other personnel at abortion clinics, including receptionists and security guards, have been killed in the United States and Australia. Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have also occurred. Notable perpetrators of anti-abortion violence include Eric Robert Rudolph
Eric Robert Rudolph
Eric Robert Rudolph , also known as the Olympic Park Bomber, is a criminal responsible for a series of bombings across the southern United States between 1996 and 1998, which killed two people and injured at least 150 others in the name of an anti-abortion and anti-gay agenda...

, Scott Roeder, Shelley Shannon, and Paul Jennings Hill
Paul Jennings Hill
Paul Jennings Hill was the first person in the United States to be executed for murdering a doctor who performed abortions.-Early life:...

, the first person to be executed in the United States for murdering an abortion provider.

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
Angkor Wat
Angkor Wat is a temple complex at Angkor, Cambodia, built for the king Suryavarman II in the early 12th century as his state temple and capital city. As the best-preserved temple at the site, it is the only one to have remained a significant religious centre since its foundation – first Hindu,...

 (c. 1150). Pro-life activist Børre Knudsen
Børre Knudsen
Børre Knudsen is a Norwegian Lutheran minister noted for his pro-life activism.Knudsen completed his seminary education in 1966 and was ordained in the Church of Norway in 1967...

 was linked to a 1994 art theft
Art theft
Art theft is usually for the purpose of resale or for ransom . Stolen art is sometimes used by criminals to secure loans.. One must realize that only a small percentage of stolen art is recovered. Estimates range from 5 to 10%. This means that little is known about the scope and characteristics of...

 as part of a pro-life drive in Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...

 surrounding the 1994 Winter Olympics
1994 Winter Olympics
The 1994 Winter Olympics, officially known as the XVII Olympic Winter Games, was a winter multi-sport event celebrated from 12 to 27 February 1994 in and around Lillehammer, Norway. Lillehammer failed to win the bid for the 1992 event. Lillehammer was awarded the games in 1988, after having beat...

. 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. In 2008, a Yale student
Yale student abortion art controversy
Aliza Shvarts was a Yale University art student who caused major controversy in 2008 for her proposed senior performance art project. Shvarts currently attends NYU, where she is pursuing a Ph.D in Performance Studies.- Initial reports :...

 proposed using aborted excretions and the induced abortion itself as a performance art project.

The Cider House Rules
The Cider House Rules
The Cider House Rules is a 1985 novel by John Irving. It is Irving's sixth published novel, and has been adapted into a film of the same name and a stage play by Peter Parnell.-Plot:...

(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. 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. Physician Susan Wicklund
Susan Wicklund
Susan Wicklund is an American abortion provider. She is the sole provider in many areas of the midwestern United States and, as such, has been a prominent target of violence and harassment from opponents of abortion rights....

 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. In 2009, Irene Vilar revealed her past abuse and addiction to abortion in Impossible Motherhood
Impossible Motherhood
Impossible Motherhood is a memoir by Irene Vilar. It is the second memoir published by Vilar, the first being The Ladies’ Gallery.-Controversy:...

, 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. In Annie Finch
Annie Finch
Annie Finch is an American poet. She is author of numerous books of poetry as well as poetry translation, poetry anthologies and criticism, opera libretti, and poetic collaborations with visual art, music, theater, and dance. Her writings on poetry address topics including meter and prosody,...

's mythic epic poem and opera libretto Among the Goddesses (2010), the heroine's abortion is contextualized spiritually by the goddesses Demeter
Demeter
In Greek mythology, Demeter is the goddess of the harvest, who presided over grains, the fertility of the earth, and the seasons . Her common surnames are Sito as the giver of food or corn/grain and Thesmophoros as a mark of the civilized existence of agricultural society...

, Kali
Kali
' , also known as ' , is the Hindu goddess associated with power, shakti. The name Kali comes from kāla, which means black, time, death, lord of death, Shiva. Kali means "the black one". Since Shiva is called Kāla - the eternal time, Kālī, his consort, also means "Time" or "Death" . Hence, Kāli is...

, and Inanna
Inanna
Inanna, also spelled Inana is the Sumerian goddess of sexual love, fertility, and warfare....

.

Various options and realities of abortion have been dramatized in film. In Riding in Cars with Boys
Riding in Cars with Boys
Riding in Cars with Boys is a 2001 film based on the autobiography of the same name by Beverly Donofrio, about a woman who overcame difficulties including being a teen mother to earning a master's degree from the span of 1961 to 1986. It stars Drew Barrymore, Steve Zahn, Brittany Murphy, and James...

(2001) an underage woman carries her pregnancy to term as abortion is not an affordable option, moves in with the father and finds herself involved with drugs, has no opportunities, and questioning if she loves her child. While in Juno
Juno (film)
Juno is a 2007 comedy-drama film directed by Jason Reitman and written by Diablo Cody. Ellen Page stars as the title character, an independent-minded teenager confronting an unplanned pregnancy and the subsequent events that put pressures of adult life onto her. Michael Cera, Olivia Thirlby, J. K....

(2007) a 16-year-old initially goes to have an abortion but decides to bear the child and allow a wealthy couple to adopt it. Other films Dirty Dancing
Dirty Dancing
Dirty Dancing is a 1987 American romantic film. Written by Eleanor Bergstein and directed by Emile Ardolino, the film features Patrick Swayze and Jennifer Grey in the lead roles, as well as Cynthia Rhodes and Jerry Orbach...

(1987) and If These Walls Could Talk
If These Walls Could Talk
If These Walls Could Talk is a 1996 made for television movie, broadcast on HBO. It follows the plights of three different women and their experiences with abortion. Each of the three stories takes place in the same house, 22 years each: 1952, 1974, and 1996. All three segments were co-written by...

(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
Circle of Friends (1995 film)
Circle of Friends is a 1995 film directed by Irish filmmaker Pat O'Connor and based on the novel of the same name written by Maeve Binchy.-Plot:...

(1995). As a marriage was in trouble in the The Godfather Part II
The Godfather Part II
The Godfather Part II is a 1974 American gangster film directed by Francis Ford Coppola from a script co-written with Mario Puzo. The film is both a sequel and a prequel to The Godfather, chronicling the story of the Corleone family following the events of the first film while also depicting the...

(1974) Kay knew the relationship was over when she aborted "a son" in secret. On the abortion debate, an irresponsible drug addict is used as a pawn in a power struggle between pro-choice and pro-life groups in Citizen Ruth
Citizen Ruth
Citizen Ruth is a 1996 film that tells a story of a poor, irresponsible and pregnant woman who unexpectedly attracts attention from those involved in the debate about the morality and legality of abortion. The film stars Laura Dern, Swoosie Kurtz, Mary Kay Place, Kurtwood Smith and Kelly Preston,...

(1996). The Law & Order
Law & Order
Law & Order is an American police procedural and legal drama television series, created by Dick Wolf and part of the Law & Order franchise. It aired on NBC, and in syndication on various cable networks. Law & Order premiered on September 13, 1990, and completed its 20th and final season on May 24,...

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
Assassination of George Tiller
On May 31, 2009, George Tiller, a physician from Wichita, Kansas who was nationally known for being one of the few doctors in the United States to perform late-term abortions, was shot and killed by Scott Roeder, an anti-abortion activist. Tiller was killed during a Sunday morning service at his...

.

In other animals



Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs. In cows, abortion may be caused by contagious disease, such as Brucellosis
Brucellosis
Brucellosis, also called Bang's disease, Crimean fever, Gibraltar fever, Malta fever, Maltese fever, Mediterranean fever, rock fever, or undulant fever, is a highly contagious zoonosis caused by ingestion of unsterilized milk or meat from infected animals or close contact with their secretions...

or Campylobacter
Campylobacter
Campylobacter is a genus of bacteria that are Gram-negative, spiral, and microaerophilic. Motile, with either unipolar or bipolar flagella, the organisms have a characteristic spiral/corkscrew appearance and are oxidase-positive. Campylobacter jejuni is now recognized as one of the main causes...

, but can often be controlled by vaccination.

Abortion may also be induced in animals, in the context of animal husbandry
Animal husbandry
Animal husbandry is the agricultural practice of breeding and raising livestock.- History :Animal husbandry has been practiced for thousands of years, since the first domestication of animals....

. For example, abortion may be induced in mares that have been mated improperly, or that have been purchased by owners who did not realize the mares were pregnant, or that are pregnant with twin foals.

Feticide
Feticide
Feticide is an act that causes the death of a fetus. In a legal context, "fetal homicide" or "child destruction" refers to the deliberate or incidental killing of a fetus due to a criminal human act, such as a blow to the abdomen of a pregnant woman...

 can occur in horses and zebras due to male harassment of pregnant mares or forced copulation, although the frequency in the wild has been questioned. Male gray langur
Gray langur
Gray langurs or Hanuman langurs, the most widespread langurs of South Asia, are a group of Old World monkeys constituting the entirety of the genus Semnopithecus. All taxa have traditionally been placed in the single species Semnopithecus entellus...

monkeys may attack females following male takeover, causing miscarriage.

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