2nd | Top topics in sexual ethics |
Abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or embryo, resulting in or caused by its death.[1] An abortion can occur spontaneously due to complications during pregnancy or can be induced, in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the gravida (pregnant female) is termed a therapeutic abortion, while an abortion induced for any other reason is termed an elective abortion. The term abortion most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.
Abortion has a long history and has been induced by various methods including herbal abortifacients, the use of sharpened tools, physical trauma and other traditional methods. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, prevalence, and cultural views on abortion vary substantially around the world. In many parts of the world there is prominent and divisive public controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing "pro-life" and "pro-choice" worldwide social movements. Incidence of abortion has declined worldwide, as access to family planning education and contraceptive services has increased. Abortion incidence in the United States declined 8% from 1996 to 2003.[2]
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Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due to accidental trauma or natural causes before approximately the 22nd week of gestation; the definition by gestational age varies by country.[3] Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth". When a fetus dies in utero after about 22 weeks, or during delivery, it is usually termed "stillborn". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.
Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[4] Most miscarriages occur very early in pregnancy, in most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy found that 61.9% of conceptuses were lost prior to 12 weeks, and 91.7% of these losses occurred subclinically, without the knowledge of the once pregnant woman.[5]
The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual period (LMP).[4][6] One study of 232 pregnant women showed "virtually complete [pregnancy loss] by the end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5 weeks LMP.[7]
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,[8] accounting for at least 50% of sampled early pregnancy losses.[9] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[8] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[9] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[10]
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the embryo or fetus, which increases in size as it ages.[11] Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as therapeutic when it is performed to:
An abortion is referred to as elective when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."[13]
"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, and are only effective in the first trimester of pregnancy.[citation needed] Medical abortions comprise 10% of all abortions in the United States[14] and Europe.[citation needed] 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.[15] 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.
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.[16] Manual Vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta 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", 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), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.[17] The term D and C, or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.[citation needed]
Other techniques must be used to induce abortion in the second trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with hypertonic solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus' 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. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.[18]
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[19][20][21][22][23] to ensure that the fetus is not born alive.[24]
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).[26] 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.[27]
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.[28] Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[29] One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.[29]
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.[30]
Early-term surgical abortion is a simple procedure which is safer than childbirth when performed before the 21st week.[31][32][33] Abortion methods, like most minimally invasive procedures, carry a small potential for serious complications.[34][35] The risk of complications can increase depending on how far pregnancy has progressed.[36][37]
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.[38] Local and general anesthetics are used during surgical procedures.[39]
The relationship between induced abortion and mental health is an area of controversy.[40][41] No scientific research has demonstrated a direct causal relationship between abortion and poor mental health,[42][43] though some studies have noted that there may be a statistical correlation. Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.[44][45]
In a 1990 review, the American Psychological Association (APA) found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses."[43] The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that induced abortion did not lead to increased mental health problems.[46][47] A 2008 review by a group from the Johns Hopkins Bloomberg School of Public Health concluded that the highest quality studies found few, if any, mental health differences between women who had abortions and their comparison groups, whereas studies with the most flaws reported negative mental health consequences of abortion.[48] As of August 2008, the United Kingdom Royal College of Psychiatrists is also performing a systematic review of the medical literature to update their position statement on the subject.
Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization,[49] and some physicians and pro-choice advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.[40][42][50][51]
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.[52]
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).[53] 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.[54] 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.[55] Later abortions are more common in China, India, and other developing countries than in developed countries.[56]
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.[57] A 2004 study in which American women at clinics answered a questionnaire yielded similar results.[58] 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.[57] 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.[58] 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.[59] 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."[60]
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.
Induced abortion can be traced to ancient times.[61] 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.[62] 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.
During the medieval period, physicians in the Islamic world documented detailed and extensive lists of birth control practices, including the use of abortifacients, commenting on their effectiveness and prevalence.[63] They listed many different birth control substances in their medical encyclopedias, such as Avicenna listing 20 in The Canon of Medicine (1025) and Muhammad ibn Zakariya ar-Razi listing 176 in his Hawi (10th century). This was unparalleled in European medicine until the 19th century.[64]
During the Middle Ages, abortion was tolerated because there were no laws against it.[65] A medieval female physician, Trotula of Salerno,[66] administered a number of remedies for the “retention of menstrua,” which was sometimes a code for early abortifacients.[67] Pope Sixtus V (1585–1590) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy.[68] 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.[69]
In the 20th century the Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[70] 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.[71][72][73][74]
Sonography and amniocentesis allow parents to determine sex before birth. The development of this technology has led to sex-selective abortion, or the targeted termination of female fetuses.
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.[75]
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.[76] 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."[77] 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.[78] Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.[79] 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.[80]
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.[81] 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.[82] A ban upon the practice of sex-selective abortion was enacted in 2003.[83]
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly where and when access to legal abortion is being barred.
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."[84] Unsafe abortions are sometimes known colloquially as "back-alley" abortions. 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.[84] 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.[85] 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.[86] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[87]
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. The main positions are the pro-choice position, which argues in favor of access to abortion, and the pro-life position, which argues against access to abortion. Opinions of abortion may be 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 groups advocating one of these two positions. In the United States, those in favor of greater legal restrictions on, or even complete prohibition of abortion, most often describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Generally, the pro-life position argues that a human fetus is a human being with the right to live making abortion tantamount to murder. The pro-choice position argues that a woman has certain reproductive rights, especially the choice whether or not to carry a pregnancy to term.
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.
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 legalized mandatory spousal notification; overall support was 72% with 26% opposed.[88]
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); the lowest was 47% (in Poland).[89]
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 April 2009 surveyed people in the United States about U.S. opinion on abortion; 18% said that abortion should be "legal in all cases", 28% said that abortion should be "legal in most cases", 28% said abortion should be "illegal in most cases" and 16% said abortion should be "illegal in all cases".[90] A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.[91]
Of attitudes in South 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".[92] 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".[93] 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.[94]
The abortion-breast cancer hypothesis posits that induced abortion increases the risk of developing breast cancer.[95] This position contrasts with the scientific consensus that abortion does not cause breast cancer.[96][97][98][99]
In early pregnancy, levels of estrogen increase, leading to breast growth in preparation for lactation. The hypothesis proposes 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. The hypothesis mechanism was first proposed and explored in rat studies conducted in the 1980s.[100][101][102]
Fetal pain, its existence, and its implications are part of a larger debate about abortion. Many researchers in the area of fetal development believe that a fetus is unlikely to feel pain until after the seventh month of pregnancy. Others disagree.[103][104] However, legislation has been proposed by pro-life advocates requiring abortion providers to tell a woman that the fetus may feel pain during an abortion procedure.[105]
A review by researchers from the University of California, San Francisco in JAMA concluded that data from dozens of medical reports and studies indicate that fetuses are unlikely to feel pain until the third trimester of pregnancy.[106] However a number of medical critics have since disputed these conclusions.[103][107] At the end of the 20th century there was an emerging consensus among developmental neurobiologists that the establishment of thalamocortical connections (at about 26 weeks) is a critical event with regard to fetal perception of pain.[108] Other researchers such as Anand and Fisk have challenged this late date, positing that pain can be felt around 20 weeks.[109] Because pain can involve sensory, emotional and cognitive factors, it may be "impossible to know" when painful experiences are perceived, even if it is known when thalamocortical connections are established.[110] In any case, one of the first steps in second-trimester and third-trimester abortions is to anesthetize the fetus or stop its heart to prevent fetal pain.[citation needed]
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.[111]
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.[112] 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.[113]
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.[114][115] Levitt states in his book Freakonomics that they are neither promoting nor negating any course of action—merely reporting data as economists.
The Mexico City policy, also known as the "Global Gag Rule" required any non-governmental organization receiving US Government funding to refrain from performing or promoting abortion services in other countries. This had a significant effect on the health policies of many nations across the globe. The Mexico City Policy was instituted under President Reagan, suspended under President Clinton, reinstated by President George W. Bush,[116] and suspended again by President Barack Obama on January 24, 2009.[117]
Each faith has many varying views on the moral implications of abortion with each side citing their own textual proof. Often times, these views can be in direct opposition to each other.[118]
Before the scientific discovery in the nineteenth century that human development begins at fertilization,[119] English common law forbade abortions after "quickening”, that is, after “an infant is able to stir in the mother's womb.”[120] There was also an earlier period in England when abortion was prohibited "if the foetus is already formed" but not yet quickened.[121] Both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803.[122] In 1861, the Parliament of the United Kingdom passed the Offences against the Person Act 1861, which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.[123]
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 (except Northern Ireland). 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, the right to security of person, and the right to reproductive health are major issues of human rights that are sometimes used as justification for the existence or absence of laws controlling abortion. 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:
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.
In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in medical tourism and travel to countries where they can terminate their pregnancy. Women without the means to travel can resort to providers of illegal abortions or try to do it themselves. [130]
In the USA, about 8% of abortions are performed on women who travel from another state.[131] However, that is driven at least partly by differing limits on abortion according to gestational age or the scarcity of doctors trained and willing to do later abortions.
Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.[132] In cows, abortion may be caused by contagious disease, such as Brucellosis or Campylobacter, but can often be controlled by vaccination.[133] Additionally, many other diseases are known to increase the risk of miscarriage in humans and other animals.[citation needed]
Abortion may also be induced in animals, in the context of animal husbandry. 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.[134]
Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[135][136][137] although the frequency in the wild has been questioned.[138] Male Gray langur monkeys may attack females following male takeover, causing miscarriage.[139]
The following information resources may be created by those with a non-neutral position in the abortion debate:
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Quotes on Abortion are listed in alphabetical order (according to the name of the speaker).
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Those who slew the unborn children will be tortured forever, for God wills it to so.
The term abortion is used by the lay person to refer to an elective termination of pregnancy. Medical staff working in the field of obstetrics use this term to describe miscarriage before 24 weeks gestation and is also referred to as spontaneous abortion. There are different types of spontaneous abortion and the importance of diagnosis cannot be underestimated as each is managed in a different way. The physician dealing with a woman who has presented with spontaneous abortion must choose his/her words carefully when discussing the diagnosis with the patient. This is already a very stressful time for such patients and the term "abortion" used inappropriately may cause this stress and anxiety to be unduly exasperated. Therefore, the term "miscarriage" will be used in place of the word "abortion" for the rest of this article.
The risk Factors for spontaneous Abortion are:
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Threatened miscarriage is defined as vaginal bleeding before 20 weeks gestation in the presence of a viable fetus. One in five pregnancies will present in this manner and these pregnancies are 2.6 times more likely to result in complete miscarriage.
History:
Examination:
Investigation:
Unfortunately, there is no medical treatment indicated. Management involves bed rest if bleeding recurs and anti-D if indicated. Prognosis can be assessed with further ultrasound scans.
In inevitable miscarriage, the cervix has begun to open and some products of conception have passed, therefore, the pregnancy cannot be saved and miscarriage is inevitable.
History:
Examination:
Medical
Surgical
This is defined as the return to normal uterine size after the passage of all products of conception and normally occurs before 8 weeks gestation.
This is most common between 8 and 14 weeks gestation. All the products of conception have not been passed and the patient requires evacuation of the retained products of conception.
History:
Examination:
Medical
Surgical
A missed (or silent) miscarriage is the spontaneous abortion of a pregnancy in the absence of vaginal bleeding. In essence, the fetus is dead in utero.
History:
Examination
Investigations
Evacuate uterus
This is a uterine infection of the retained non-viable products of conception following an incomplete miscarriage. An attempt at an illegal termination of pregnancy (back-street abortion) should be suspected.
History
Examination
Investigations
IV antibiotics, fluids and curretage.
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Medical warning! This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead. |
ABORTION (from Lat. aboriri, to fail to be born, or perish), in obstetrics, the premature separation and expulsion of the contents of the pregnant uterus. It is a common terminology to call premature labour of an accidental type a "miscarriage," in order to distinguish "abortion" as a deliberately induced act, whether as a medical necessity by the accoucheur, or as a criminal proceeding (see Medical Jurisprudence); otherwise the term "abortion" would ordinarily be used when occurring before the eighth month of gestation, and "premature labour" subsequently. As an accident of pregnancy, it is far from uncommon, although its relative frequency, as compared with that of completed gestation, has been very differently estimated by accoucheurs. It is more liable to occur in the earlier than in the later months of pregnancy, and it would also appear to occur more readily at the periods corresponding to those of the menstrual discharge. It may be induced by numerous causes, both of a local and general nature. Malformations of the pelvis, accidental injuries and the diseases and displacements to which the uterus is liable, on the one hand; and, on the other, various morbid conditions of the ovum or placenta leading to the death of the foetus, are among the direct local causes. The general causes embrace certain states of the system which are apt to exercise a more or less direct influence upon the progress of utero-gestation. The tendency to recurrence in persons who have previously miscarried is well known, and should ever be borne in mind with the view of avoiding any cause likely to lead to a repetition of the accident. Abortion resembles ordinary labour in its general phenomena, excepting that in the former hemorrhage often to a large extent forms one of the leading symptoms. The treatment embraces the means to be used by rest, astringents and sedatives, to prevent the occurrence when it merely threatens; or when, on the contrary, it is inevitable, to accomplish as speedily as possible the complete removal of the entire contents of the uterus.
Among primitive savage races abortion is practised to a far less extent than infanticide, which offers a simpler way of getting rid of inconvenient progeny. But it is common among the American Indians, as well as in China, Cambodia and India, although throughout Asia it is generally contrary both to law and religion. How far it was considered a crime among the civilized nations of antiquity has long been debated. Those who maintain the impunity of the practice rely for their authority upon certain passages in the classical authors, which, while bitterly lamenting the frequency of this enormity, yet never allude to any laws by which it might be suppressed. For example, in one of Plato's dialogues (Theaet.), Socrates is made to speak of artificial abortion as a practice, not only common but allowable; and Plato himself authorizes it in his Republic (lib. v.). Aristotle (Pout. lib. vii. c. 17) gives it as his opinion that no child ought to be suffered to come into the world, the mother being above forty or the father above fifty-five years of age. Lysias maintained, in one of his pleadings quoted by Harpocration, that forced abortion could not be considered homicide, because a child in utero was not an animal, and had no separate existence. Among the Romans, Ovid (Amor. lib. ii.), Juvenal (Sat. vi. 594) and Seneca (Consol. ad Hel. 16) mention the frequency of the offence, but maintain silence as to any laws for punishing it. On the other hand, it is argued that the authority of Galen and Cicero (pro Cluentio) place it beyond a doubt that, so far from being allowed to pass with impunity, the offence in question was sometimes punished by death; that the authority of Lysias is of doubtful authenticity; and that the speculative reasonings of Plato and Aristotle, in matters of legislation, ought not to be confounded with the actual state of the laws. Moreover, Stobaeus (Serm. 73) has preserved a passage from Musonius, in which that philosopher expressly states that the ancient law-givers inflicted punishments on females who caused themselves to abort. After the spread of Christianity among the Romans, however, foeticide became equally criminal with the murder of an adult, and the barbarian hordes which afterwards overran the empire also treated the offence as a crime punishable with death. This severe penalty remained in force in all the countries of Europe until the Middle Ages. With the gradual disuse of the old barbarous punishments so universal in medieval times came also a reversal of opinion as to the magnitude of the crime involved in killing a child not yet born. But the exact period of transition is not clearly marked.
In England the Anglo-Saxons seem to have regarded abortion only as an ecclesiastical offence. Sir Matthew Hale (1609-1676) tells us that if anything is done to "a woman quick or great with child, to make an abortion, or whereby the child within her is killed, it is not murder or manslaughter by the law of England, because it is not yet in rerum natura." But the common law appears, nevertheless, to have treated as a mis demeanour any attempt to effect the destruction of such an infant, though unsuccessful. Blackstone (1723-1780), to be sure, a hundred years later, says that, "if a woman is quick with child, and by poison or otherwise killeth it in her womb, or if any one beat her, whereby the child dieth in her body, and she is delivered of a dead child, this, though not murder, was, by the ancient law, homicide or manslaughter." Whatever may have been the exact view taken by the common law, the offence was made statutory by an act of 1803, making the attempt to cause the miscarriage of a woman, not being, or not being proved, to be quick with child, a felony, punishable with fine, imprisonment, whipping or transportation for any term not exceeding fourteen years. Should the woman have proved to have quickened, the attempt was punishable with death. The provisions of this statute were re-enacted in 1828. The English law on the subject is now governed by the Offences against the Person Act 1861, which makes the attempting to cause miscarriage by administering poison or other noxious thing, or unlawfully using any instrument equally a felony, whether the woman be, or be not, with child. No distinction is now made as to whether the foetus is or is not alive, legislation appearing to make the offence statutory with the object of prohibiting any risk to the life of the mother. If a woman administers to herself any poison or other noxious thing, or unlawfully uses any instrument or other means to procure her own miscarriage, she is guilty of felony. The punishment for the offence is penal servitude for life or not less than three years, or imprisonment for not more than two years. If a child is born alive, but in consequence of its premature birth, or of the means employed, afterwards dies, the offence is murder; the general law as to accessories applies to the offence.
In all the countries of Europe the causing of abortion is now punishable with more or less lengthy terms of imprisonment. Indeed, the tendency in continental Europe is to regard the abortion as a crime against the unborn child, and several codes (notably that of the German Empire) expressly recognize the life of the foetus, while others make the penalty more severe if abortion has been caused in the later stages of pregnancy, or if the woman is married. According to the weight of authority in the United States abortion was not regarded as a punishable offence at common law, if the abortion was produced with the consent of the mother prior to the time when she became quick with child; but the Supreme Courts of Pennsylvania and North Carolina held it a crime at common law, which might be committed as soon as gestation had begun (Mills v. Corn. 13 Pa. St. 630; State v. Slagle, 83 N.C. 630). The attempt is a punishable offence in several states, but not in Ohio. Nor was it ever murder at common law to take the life of the child at any period of gestation, even in the very act of delivery (Mitchell v. Com. 78 Ky. 204). If the death of the woman results it is murder at common law (Corn. v. Parker, 9 Met. [Mass.] 263). It is now a statutory offence in all states of the Union, but the woman must be actually pregnant. In most states not only is the person who causes the abortion punishable, but also any one who supplies any drug or instrument for the purpose. The woman, however, is not an accomplice (except by statute as in Ohio, State v. M'Coy, 39 N.E. 316), nor is she guilty of any crime unless by statute as in New York (Penal Code, � 295) and California (Penal Code, � 275) and Connecticut (Gen. Stats. 1902, � 1156). She may be a witness, and her testimony does not need corroboration. The attempt is also a crime in New York (1905, People v. Conrad, 102 App. D. 566).
- Ploucquet, Commentarius Medicus in processus criminales super homicidio et infanticidio, eec. (1736); Burke Ryan, Infanticide, its Law, Prevalence, Prevention and History (1862); G. Greaves, Observations on the Laws referring to Child-Murder and Criminal Abortion (1864); Storer and Heard, Criminal Abortion, its Nature, Evidence and Law (Boston, 1868); J. Cave Browne, Infanticide, its Origin, Progress and Suppression (1857); T. R. Beck, Medical Jurisprudence (1842); A. S. Taylor, Principles and Practice of Medical Jurisprudence (1894); Sir J. Stephen, History of the Criminal Law of England (1883); Sir W. O. Russell, Crimes and Misdemeanours (3 vols., 1896); Archbold's Pleading and Evidence in Criminal Cases (1900); Roscoe's Evidence in Criminal Cases (1898); Treub, van Oppenraag and Vlaming, The Right to Life of the Unborn Child (New York, 1903); L. Hochheimer, Crimes and Criminal Procedure (New York, 1897); A. A. Tardieu, Etude medico-legal sur l'avortement (Paris, 1904); F. Berolzheimer, System der Rechtsand Wissenschaftsphilosophie (Munich, 1904).
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In mammals, an abortion is when a pregnancy ends early without the birth of offspring. Abortions can occur naturally, usually because something went wrong with the pregnancy. When this happens, it is called a miscarriage. Humans can also end the pregnancy on purpose before birth takes place. This is called an induced abortion.
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A developing human takes about thirty-eight weeks to grow and be born. Normally, this occurs about forty weeks after the mother's last menstrual period. This developing human is called embryo for the first eight weeks of the pregnancy, and fetus for the remaining thirty-two.
There are two kinds (or types) of abortion. Sometimes, things go wrong during a pregnancy. These things may lead to the death of the embryo or fetus. Depending on what time in pregnancy they happen in, such abortions are called miscarriage or stillbirth.
In some cases finishing the pregnancy might be very dangerous for the pregnant woman. Giving birth might also be very difficult for her, she may have many worries, or she might not want to have a baby at all. In such cases, things can be done to end the pregnancy on purpose. This is called an induced abortion.
In both types of abortion, the embryo or fetus usually comes out of the womb. This is called a complete abortion. In some cases, the embryo or fetus remains inside the womb. This is called a missed abortion. Surgery is needed to remove the embryo or fetus from the womb so the woman does not get an infection.
People speak of spontaneous abortion or miscarriage when the embryo or fetus is lost due to natural causes before the 20th week of pregnancy. A pregnancy that ends this way, but that is between 20 and 37 weeks old is known as "premature birth" if the baby is born alive. If the fetus dies in the womb after 20 weeks, or while it is born, this is known as "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages.
Spontaneous abortions (miscarriages) are common. About fifteen percent of pregnancies end in spontaneous abortion. In many cases, the woman is not even aware she was pregnant. The pregnancy is only a few days or weeks old and the woman believes the miscarriage is just her menses. About twenty-five percent of all women will have a spontaneous abortion during their lives.[1]
Most miscarriages occur very early. Between ten and fifty percent of pregnancies end with a miscarriage, where the mother or the doctors are aware of it. These figures depend on the age and health of the pregnant woman.[2] Most spontaneous abortions occur so early in the pregnancy that the woman is not even aware that she was pregnant. One particular study showed a rate of pregnancy in exposed ovulatory cycles of 59.6%; with 61.9% of conceptuses lost before twelve weeks. 91.7% of these occuried subclinically, without the knowledge of the mother.[3]
The risk of spontaneous abortion decreases sharply after the 10th week of pregnancy,[4] with a loss rate between 8.5 weeks LMP and birth of about two percent; pregnancy loss is “virtually complete by the end of the embryonic period."[5]
Those people who have already had several spontaneous or induced abortions run a greater risk of having a spontaneous one. Those with certain diseases, and those over the age 35 also run a greater risk. Other causes for abortions can be the infection of either the woman or embryo/fetus, or their immune response. Certain diseases or an accidental trauma can also cause a spontaneous abortion. Putting the woman under trauma or stress to cause miscarriage is considered induced abortion. Some countries call this feticide.[6]
Most miscarriages are due to problems with the copying of chromosomes, but some are caused by environmental factors. When a human is conceived, it gets 23 chromosomes from its mother and 23 from its father. If it does not get the right number its development happens wrong (it does not grow right.) It may have many bad birth defects.
Most embryos and fetuses with chromosome problems will not live for a long time. They die very early. There are a few chromosome problems that babies can sometimes be born with. For example, Down Syndrome happens when there are three copies of chromosome #21. (Usually people have 2 of every chromosome.) This is called trisomy 21 (tri- means 3.)
The most common symptom is bleeding from the vagina. This can be very little blood (less blood than a normal menses.) It can be very much blood (much more than a normal menses.) Some women have bad pains in their low abdomen when they have a miscarriage. This is sometimes like the pain of menses. It can be much worse. Or a woman may have no pain at all. If the pregnancy is many weeks old, the woman may see the embryo or fetus when it comes out. But if it is less than 12 weeks old a woman may not see anything but blood.
Sometimes no treatment is needed. Sometimes doctors do a surgical abortion. This is the same kind of surgery that is done for induced abortions. Sometimes doctors give women medicines to help the miscarriage finish without needing surgery.
An induced abortion is when things are done to end the pregnancy on purpose. These things should usually be done by doctors. In countries where abortion can be done legally, it is often done by specialists who know a lot about women's bodies (gynecologists). Abortions done illegally are often performed by people without this special knowledge. This makes them more dangerous. Such abortions are usually called unsafe abortions, back-alley abortions or DIY abortions, mainly because the risk to the health of the mother is much higher than with abortions carried out by skilled doctors.
There can be medical reasons, why an abortion is performed. These include:[7]
Surgical induced abortions are where the embryo or fetus is taken out by a physical act. The kind of surgical abortion done depends on how long the pregnancy has gone on. It is easier in earlier stages of the pregnancy. There are less problems that can occur. So it is best to do a surgical abortion as early as possible.
Medical abortions are where a doctor gives a woman a medicine to end the pregnancy. There are two medicines used for this. The medicines are mifepristone (RU-486) and methotrexate. These two medicines both stop the pregnancy. Then the abortion happens like a spontaneous abortion.
A pregnancy that ends without a child being born also may cause some problems to the woman this happens to. There are two broad groups of things that can happen:
Abortion is safer than childbirth, if it is done before the 16th week of pregnancy and a professional does the abortion.[8][9] Certain methods of abortion are pretty safe, and complications are rare.[10][11] Generally, stopping a pregnancy that has gone on longer is riskier.[12][13]
Women typically feel a small amount of 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.[14]
Local and general anesthesias are used during the procedure.[15]
Few studies have been done to see if an abortion affects the woman psychologically, or mentally. Those that have been done give contradictory results. One study looked at 13.000 women who had become pregnant even though they did not want to. The study found that having an induced abortion does not increase the risk of getting mental health problems; the group that was compared were women who also did not want to have a baby, but who did not have an abortion.[16] Other studies[17] showed similar results: women who had an abortion did better in school or at work after the abortion. Another study showed that women who had an abortion had a higher self-esteem and felt better than those who did not.[18][19]
Many women who had an abortion felt better afterwards, they also felt relieved. They would do it again in a similar situation.[20][21]
A study done in New Zealand in 2006[22] showed that many women who had an abortion develeoped severe depressions up to 4 years after they had the abortion. They were also more likely have problems with alcohol and illegal drugs than those women who did not have an abortion. The person who oversaw the study later told media that given these results it would be very hard to say that having an abortion has no psychological effects on the womam who has is. He called the abortion "a traumatic experience".[23]
Both spontaneous and induced abortions have some risk for the woman.
If a bad thing happens because of a surgery or medicine that a doctor gives, or because of a miscarriage, it is called a complication. Complications of abortions can be infection, bleeding, pain. There may or may not be problems getting pregnant again; this is still being researched. In places where induced abortions are legal less than 1% of induced abortions have a bad complication. If doctors do induced abortions, the risk to the woman is less than the risk of complications of childbirth (giving birth to a baby). In places where induced abortions are legal, less women have complications of induced abortion than in places where induced abortion is illegal. This is because induced abortions that are not done by doctors have much more risks. For example, after induced abortions became legal in the United Stated in 1973, less women died from having abortions. In the United States in 2000, 11 women died from the complications of legal abortion.[1] The risk of death from a legal abortion is 1/100 of the risk of an appendectomy.[2] The risk of death from an injection (shot) of penicillin (an antibiotic) is bigger than the risk of death from a legal abortion.[3]
There can be emotional problems for the woman after a spontaneous or induced abortion. She may feel sad, angry, or guilty that she had a miscarriage or asked for an abortion. She may think she has done something that made the miscarriage happen, or that having an abortion was the wrong thing to do, and because of this she may feel intense grief.[4] There are many places where women can get help dealing with these feelings.
Some women who have induced abortions may get criticism from friends or family who have different beliefs. When scientists look at this in research studies, however, they do not usually see that women have emotional problems after induced abortions. In 1987, President Ronald Reagan told the Surgeon General of the US to look at this question. Both president Reagan and the Surgeon General C. Everett Koop did not think abortion was right. Dr Koop looked at 250 papers that scientists wrote in scientific journals. Dr Koop said that the science we know does not show that induced abortions cause emotional problems for women who have them.[5]
The number of induced abortions done are different for different parts of the world. This is also true for the reasons why women decide to have an abortion. Estimates are that about 46 million induced abortions are done worldwide, every year. 26 million of them occur in places where abortion is legal, 20 million happen in countries where it is illegal to have an abortion. Some countries, like Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100) have a low rate of induced abortion. Others, like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. Overall, there are 26 induced abortions per 100 known pregnancies.[24]
Abortion rates vary. The length the pregnancy has gone on, and the method used to do the abortion influence these rates. According to data collected in the United States, 88.2% of abortions were done in the first twelve weeks of pregnancy, 10.4% between week 13 and week 20 of the pregnancy. The remaining 1.4% were done in week 21 or later.
90.9% were done by curettage, 7.7% were medical abortions (using drugs, mifepristone in most cases), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy).[25] The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the U.S. during 2000 - 0.17% of the total number of abortions performed that year.[26] Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 and 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.[27] Later abortions are more common in China, India, and other developing countries than in developed countries.[28]
[[File:|thumb|300px|right|A bar chart from a study done in 1998. In shows the reasons why women had an abortion]]
In 1998, a study was done in 27 countries. This study wanted to find the reasons, why women wanted to end their pregnancy. It found that women often gave one of the following reasons:
A different study, done in the United States in 2004 came to similar conclusions.[30]
Women who had an abortion in Finland and the United States usually did not state that the pregnancy posed a risk to their health. In Bangladesh, India and Kenya, however, more such women thought the pregnancy was a risk to their health.[29] 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.[30] 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. 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.[31] 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."[32]
Some women have an abortion because the society they live in pressures them to.
Any of these factors might force a pregnant woman to have an abortion.
[[File:|thumb|300px|Dark blue: legal. Red: illegal. Other colors are for illegal, with some exceptions (rape, threat of life to the mother)]]
Induced abortion is not legal in every place. In some countries, a doctor who does an induced abortion is committing a crime. In the United States, Canada, and many countries in Europe abortion is legal (not a crime). In some countries like Ireland and Somalia it is legal only to save the life of the woman. If a woman is raped in Ireland and becomes pregnant, she cannot get an induced abortion. In some countries like Chile and El Salvador, abortion is never legal, including in cases where the woman risks dying from continuing the pregnancy.
In countries where induced abortion is not legal many more women die from abortion. Women still get induced abortions, but they cannot get them in safe hospitals and clinics. These induced abortions have more complications than abortions done by doctors.
Women who live in places where abortion is illegal, or heavily frowned upon sometimes travel to other places where an abortion can be done legally, so they can have an abortion. This is a form of medical tourism.
Spontaneous abortion occurs in various mammals. In sheep, it may be caused by crowding through doors, or by being chased by dogs.[33] In cows, abortion may be caused by contagious diseases, such as Brucellosis or Campylobacter. This can often be controlled by vaccination, though.[34]
Abortion may also be induced in animals, in the context of animal husbandry. 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.[35]
Feticide can occur in horses and zebras. Usually this is done because males harass pregnant mares or force copulation.[36][37][38] Scientists have raised the question, how often this occurs in the wild, though.[39] Male Gray langur monkeys may attack females following male takeover, causing miscarriage.[40]
Induced abortion is a subject that is controversial. Each person has a system of moral values. Based on their system of morals, people have different opinions about it. Religion can also influence this opinion.
A number of opinion polls have been carried out around the world. They have tried to find out what people think about abortion. Results were different for different countries, but also varied with the questions that were asked.
In May 2005, a survey was done in ten European countries. The people were asked, if they could agree with the statement: "If a woman does not want children, she should be allowed to have an abortion". The highest level of approval was 81% in the Czech Republic; the lowest was 47% in Poland.[41]
A poll was done in November 2001. The poll asked people in Canada in what circumstances they believed an 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 never be legal. A similar poll in April 2009 surveyed people in the United States about abortion; 18% said that abortion should be "legal in all cases", 28% said that abortion should be "legal in most cases", 28% said abortion should be "illegal in most cases" and 16% said abortion should be "illegal in all cases".[42] A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.[43]
Of attitudes in South America, a December 2003 survey found that 30% of Argentines thought that abortion should be allowed in Argentina "regardless of situation", 47% that it should be allowed "under some circumstances", and 23% that it should not be allowed "regardless of situation".[44] A March 2007 poll about abortion 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".[45] 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.[46]
Some people feel very strongly about abortion. People who think that abortion is wrong and that the law should not allow it are called pro-life. People who think think the law should let women choose to have abortions are called pro-choice.
People who are pro-life believe that all humans, including embryos and fetuses, have a right to life. For this reason, they believe abortion is wrong, sometimes comparing it to murder. They think the law should make abortion a crime in order to protect embryos and fetuses. However, though pro-life people think abortion is wrong, there are special cases in which they will sometimes support allowing an abortion to happen, like if the pregnancy puts the woman's life at risk or if she got pregnant from rape. Pro-life people think women who are pregnant and do not want to raise a child should give the baby up for adoption instead of having an abortion. They have started advocacy groups, like the American Life League, to try to convince more people to think abortion is wrong and to try to get governments to make laws to restrict abortion. Sometimes, people who are against abortion have used violence to try to stop abortions from happening, like bombing the clinics that do abortions or shooting the people who work inside them. However, most people who are against abortion do not do such things and believe that they are wrong, and so they try to stop abortions from happening through peaceful activism.
People who are pro-choice believe that women should be allowed to have control over their own bodies when it comes to ending or continuing a pregnancy. They believe that, because the embryo or fetus is inside the woman's body and does not have developed enough organs to survive on its own until later in the pregnancy, it is not yet a person with rights. Pro-choice people also make the argument that abortion needs to be legal in order to protect women, because when abortion is illegal, it does not completely stop abortions from happening, but makes it so that women try to do abortions on themselves or get them done by people who are not trained doctors, which puts those women in danger of death or injury. Pro-choice people believe the way to prevent abortion is to make sure women only get pregnant when they want to. In addition to advocating the legality of abortion, pro-choice groups like Planned Parenthood often try to improve people's access to things used to prevent pregnancy (called contraception), and try to teach young people about sex to reduce the number of teen pregnancies.
Many religions have a view on abortion. These views span a broad spectrum from acceptance to rejection.[47] Most religions generally oppose abortion.[48]
Generally, when there is a debate about whether abortion laws should be changed in a country, there are advocacy groups. Some of the arguments these groups often have are outlined below.
There is a hypothesis that induced abortion raises the risk of getting breast cancer. People who support this, call it a link, rather than a hypothesis.[49] The subject has been controversial, but currently, scientists agree that there is no link between abortion in the first trimester, and increasing the risk to get breast cancer.[50][51][52][53]
In early pregnancy, levels of estrogen increase. This causes the breast to grow, and to prepare for lactation. In the 1890s, studies were done on rats, before this hypothesis was put forward.[54][55][56]
It is currently unclear from what moment the embryo or fetus can feel pain. This is also used in the debate about abortion. Many researchers think that a fetus is unlikely to feel pain until after the seventh month of pregnancy. Others disagree.[57] At about twenty-six weeks of pregnancy, certain connections are made in the thalamus of the growing fetus. Developmental neurobiologists suspect that these connections may be critical to perception of pain by the fetus.[58] However, legislation has been proposed by pro-life advocates requiring abortion providers to tell a woman that the embryo or fetus may feel pain during an abortion procedure.[59]
Researchers from the University of California, San Francisco published a study in the Journal of the American Medical Association. The study analyzed data from dozens of medical reports and other studies. The researchers concluded that fetuses are unlikely to feel pain until the third trimester of pregnancy.[60] However a number of medical critics have since disputed these conclusions.[57][61] There are certain connections in the thalamus of the fetuse. These connections develop at about twenty-six weeks of pregnancy. At the end of the 20th century there was an emerging consensus among developmental neurobiologists that these connections are very important when it comes to the perception of pain in the fetus.[62] Other researchers such as Anand and Fisk have challenged this late date, positing that pain can be felt around twenty weeks.[63] Pain can have many different aspects: It might be purely relying on sensory input, but it might also involve emotions and thought. For this reason, it is perhaps impossible to know exactly when the embryo or fetus feels pain, even if it has developed the links in the thalamus.[64]
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