Introduction

Abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced. The term abortion usually designates termination of gestation before the end of the 28th week of pregnancy. It implies the expulsion of all or any part of the placenta or membranes, with or without an identifiable fetus or with a live-born or stillborn infant weighing less than 1000g. If abortion occurs before 12 weeks it is referred to as early abortion, and thereafter the term is late abortion. The term abortion most commonly refers to the induced abortion of a human pregnancy. An estimated 44 million abortions are performed globally each year, with slightly under half of those performed unsafely. The incidence of abortion has stabilized in recent years, having previously spent decades declining as access to family planning education and contraceptive services increased. Forty percent of the world’s women have access to induced abortions (most often, within gestational limits). Induced abortion has long history, and can be traced back to civilizations as varied as China under Shennong (ca. 2700 BCE), Ancient Egypt with its Ebers Papyrus (ca. 1550 BCE), and the Roman Empire in the time of Juvenal (ca. 200 CE). There is evidence to suggest that pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions; other scholars disagree with this interpretation, and note the medical texts of Hippocratic Corpus contain descriptions of abortive techniques. In Christianity, Pope Sixtus V (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy; the Catholic Church had previously been divided on whether if believed that abortion was murder, and did not begin vigorously opposing abortion until the 19th century. Islamic tradition has traditionally permitted abortion 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. However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.

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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. 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. The word “abortion” comes from the Latin root aboriri (ab = “off the mark,” oriri = “to be born or rise”). Until the 19th century, both miscarriages and intentional terminations of pregnancies were referred to as abortions. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, 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 over the ethical and legal issues of abortion.

Types of Abortion
Induced Abortion
Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended 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 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 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
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mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy. 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 Abortion
Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation. A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a “premature birth” or a “preterm birth”. When a fetus dies in utero after viability, 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. 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 or fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease (such as lupus), 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; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.

Abortion Methods
Drug [or Medication] Based Abortion Methods
Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the early 1970s and the antiprogestogen mifepristone in the 1980s.
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The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog (misoprostol or gemeprost) up to 9 weeks gestational age, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. 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. In the United States, the percentage of early medical abortions is far lower. 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. In another method, a pregnant woman first takes the drug mifepristone, also known as RU-486, which blocks progesterone, a hormone needed to maintain the pregnancy. About 48 hours later, she takes another drug called misoprostol. Misoprostol is a prostaglandin (a hormone-like chemical produced by the body) that causes contractions of the uterus, the organ in which the fetus develops. These uterine contractions expel the fetus. Another type of drug combination that induces abortion is the use of misoprostol with methotrexate, an anticancer drug that interferes with cell division. A physician first injects a pregnant woman with methotrexate. About a week later, the woman takes a pill containing misoprostol to induce uterine contractions and expel the fetus. These drug-based abortion methods effectively end pregnancy in women who take them and are most effective when performed very early in a pregnancy. These methods require no anaesthesia. However, the use of drugs to induce abortion has not been widely adopted by women in the United States for a number of reasons.
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These drugs can cause unpleasant side effects—some women experience nausea, cramping, and bleeding. More serious complications, such as arrhythmia, edema, and pneumonia, affect the heart and lungs and may cause death. Perhaps the primary deterrent is that these drug-based abortion methods require at least two visits to a physician over a period of several days, and these methods are no cheaper than a surgical abortion.

Surgical Abortion Methods
Legal surgical abortion, when done by a trained provider, is essentially 100% effective. A number of surgical methods can be used to induce abortions. To end a pregnancy before it reaches eight weeks, a doctor typically performs any of the following procedure on the patient. Pre-emptive abortion or an early uterine evacuation; in both procedures a narrow tube called a cannula is inserted through the cervix (the opening to the uterus) into the uterus. The cannula is attached to a suction device, such as a syringe, and the contents of the uterus, including the fetus, are extracted. Pre-emptive abortion uses a smaller cannula and is performed in the first four to six weeks of pregnancy. Early uterine evacuation, which uses a slightly larger cannula, is performed in the first six to eight weeks of pregnancy. Both types of abortions typically require no anaesthesia and can be performed in a clinic or physician’s office. The entire procedure lasts for only several minutes. In pre-emptive abortions the most common complication is infection. Women who undergo early uterine evacuation may experience heavy bleeding for the first few days after the procedure. Vacuum aspiration is a procedure used for abortions in the 6th to 14th week of pregnancy. It requires that the cervix be dilated, or enlarged, so that a cannula can be inserted into the uterus. Progressively larger, tapered instruments called dilators may be used to dilate the cervix. During the procedure, the cannula is attached to an electrically powered pump that removes the contents of the uterus. In some cases, the lining of the uterus must also be scraped with a spoon-like tool called a curette to loosen and remove tissue. This procedure is referred to as curettage. Vacuum aspiration may require local anaesthesia and can be performed in a clinic or physician’s office. Minor bruising or injuries to the cervix may occur when the cannula is inserted. The Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. These techniques differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether cervical dilation is necessary.
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Dilation and curettage (D&C), performed during the 6th to 16th week of pregnancy, involves dilating the cervix and then scraping the uterine lining with a curette to remove the contents. A D&C often requires general anaesthesia and must be performed in a clinic or hospital. Possible complications include a reaction to the anaesthesia and cervical injuries. Since the development of vacuum aspiration, the use of D&C has declined. After the first 16 weeks of pregnancy, abortion becomes more difficult. One method that can be used during this period is dilation and evacuation (D&E), which requires greater dilation of the cervix than other methods. It also requires the use of suction, a large curette, and a grasping tool called a forceps to remove the fetus. D&E is a complicated procedure because of the larger size of the fetus and the thinner walls of the uterus, which stretch to accommodate a growing fetus. Bleeding in the uterus often occurs. D&E is often performed under general anaesthesia in a clinic or hospital. It is typically used in the first weeks of the second trimester but can be performed up to the 24th week of pregnancy. Induction abortion can also be performed in the second trimester, usually between the 16th and 24th week of pregnancy. In this type of abortion a small amount of amniotic fluid, the fluid that surrounds the fetus, is withdrawn and replaced with another fluid. About 24 to 48 hours later, the uterus begins to contract and the fetus is expelled. When this method was first developed, physicians used a strong saline (salt) solution to abort the fetus; today they may also use solutions containing prostaglandins or pitocin, a synthetic form of a chemical produced by the pituitary gland that induces labour. Heavy bleeding, infection, and injuries to the cervix can occur. This procedure is performed in the hospital and requires a stay of one or more days. Abortions performed at the end of the second trimester and during the third trimester require major surgery. Two such late-term procedures include hysterotomy and intact dilation and extraction. In hysterotomy, the uterus is cut open and the fetus is removed surgically in an operation similar to a caesarean section, but a hysterotomy requires a smaller incision. Hysterotomy is major abdominal surgery performed under general anaesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy. Intact dilation and extraction (IDX), also referred to as a partial birth abortion, consists of partially removing the fetus from the uterus through the vaginal canal,
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feet first, and using suction to remove the brain and spinal fluid from the skull. The skull is then collapsed to allow complete removal of the fetus from the uterus. The intact dilation and extraction (also called intrauterine cranial decompression) method often requires surgical decompression of the fetus’s head before evacuation. IDX is sometimes called “partial-birth abortion,” which has been federally banned in the United States.

Other Abortion Methods
Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium. The use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ failure, and is not recommended by physicians. Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the bas reliefs [wall art] 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. 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.

Sex-selective abortion
Sonography and amniocentesis allow parents to determine sex before childbirth. The development of this technology has led to sex-selective abortion, or the termination of a fetus based on sex. The selective termination of a female fetus is most common. Sex-selective abortion is partially responsible for the noticeable disparities between the birth rates of male and female children in some countries. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Taiwan, South Korea, India, and China. 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 sexscreening. In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.
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Many countries have taken legislative steps to reduce the incidence of sex-selective abortion. At the International Conference on Population and Development in 1994 over 180 states agreed to eliminate “all forms of discrimination against the girl child and the root causes of son preference”, which was also condemned by a PACE resolution in 2011. The World Health Organization and UNICEF, along with other United Nations agencies, have found that measures to reduce access to abortion are much less effective at reducing sex-selective abortions than measures to reduce gender inequality.

How safe is an Abortion?
Safe Abortion
The health risks of abortion depend on whether the procedure is performed safely or unsafely. The World Health Organization defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Legal abortions performed in the developed world are among the safest procedures in medicine. In the US, the risk of maternal death from abortion is 0.6 per 100,000 procedures, making abortion about 14 times safer than childbirth (8.8 maternal deaths per 100,000 live births). The risk of abortion-related mortality increases with 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, abortion clinic, or hospital. Complications are rare and can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate. Preventive antibiotics (such as doxycycline or metronidazole) 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 firsttrimester abortion, and depend somewhat on the method chosen. There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 9 weeks gestation. 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.

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Some purported risks of abortion are promoted primarily by anti-abortion groups, but lack scientific support. For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the World Health Organization, the US National Cancer Institute, the American Cancer Society, the Royal College of Obstetricians and Gynaecologists and the American Congress of Obstetricians and Gynaecologists) have concluded that abortion does not cause breast cancer, although such a link continues to be promoted by anti-abortion groups. Similarly, current scientific evidence indicates that induced abortion does not cause mental-health problems. 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. Abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems. However, in contemporary psychological and mental health studies today proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called “post-abortion syndrome” or “post-abortion stress syndrome” (PAS or PASS).

Unsafe Abortion
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. They may attempt to selfabort 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, haemorrhage, damage to internal organs and sometimes, death. 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. Unsafe abortion is believed to result in approximately 68,000 deaths and millions of injuries annually. Groups such as the World Health Organization have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductivehealth services.

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The legality of abortion is one of the main determinants of its safety. Countries with restrictive abortion laws have significantly higher rates of unsafe abortion (and similar overall abortion rates) compared to those where abortion is legal and available. For example, the 1996 legalization of abortion in South Africa 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 up to 75% (from 20 million to 5 million annually) 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 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 worldwide, though this varies by region. Secondary infertility caused by an unsafe abortion affects an estimated 24 million women. The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning and improvements in health care during and after abortion has been proposed to address this phenomenon.

Abortion Law
Since the landmark US Supreme Court decision which legalized abortion in the wellknown Roe v Wade decision in 1973 that made abortion legal, hundreds of federal and state laws have been proposed or passed; currently, there are about 1.2 million abortions are performed each year in the United States. Abortion is one of the most visible, controversial, and legally active areas in the field of medicine. Current laws pertaining to abortion are diverse from country to country. 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.

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In jurisdictions where abortion is legal, certain requirements must often be met before a woman may obtain an abortion (an abortion performed without the woman’s consent is considered feticide). These requirements are usually dependent on the age of the fetus, often using a trimester-based system to regulate the window of legality. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion. Other jurisdictions may require that a woman obtain the consent of the fetus’ father before aborting the fetus, that abortion providers inform patients of health risks of the procedure—sometimes including those not supported by the medical literature— and that multiple medical authorities certify that the abortion is either medically or socially necessary. Many restrictions are waived in emergency situations. Other jurisdictions ban abortion almost entirely. Many, but not all, of these will allow them to be performed in a variety of circumstances. These circumstances vary based on jurisdiction, but may include whether the pregnancy is a result of rape or incest, whether the fetus’ development is impaired, whether the mother’s physical or mental well-being is endangered, or whether there are socioeconomic considerations that could be taken into consideration. In countries where abortion is banned entirely, such as Nicaragua, rises in maternal death directly and indirectly due to pregnancy have been noted. Some countries, such as Bangladesh, 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 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 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. This has caused controversy, as some anti-abortion groups have advocated that certain forms of emergency contraception are not contraceptives but abortifacients.

Abortion Law in Nigeria
Abortion in Nigeria is governed by two different laws. In the predominantly Muslim states of Northern Nigeria, which contain about half the population of the country, the Penal Code, Law No. 18 of 1959, is in effect. In the southern part of the country, which is largely Christian in religion, the Criminal Code of 1916 is in effect. While
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both Codes generally prohibit the performance of abortions, differences in the wording of the Codes, as well as in their interpretation, that have resulted in two slightly different treatments of the offence of abortion. Grounds on which abortion is permitted: To save the life of the woman Yes To preserve physical health Yes To preserve mental health Yes Rape or incest No Foetal impair No Economic or social reasons No Available on request No Additional requirements: Two physicians are required to certify that the pregnancy poses a serious threat to the life of the woman. Under the Penal Code, which is related to the criminal law of India and Pakistan, an abortion may be legally performed only to save the life of the pregnant woman. Except for this purpose, a person who voluntarily causes a woman with child to miscarry is subject to up to fourteen years’ imprisonment and/or payment of a fine. A woman who causes her own miscarriage is subject to the same penalty. Harsher penalties are applied if the woman dies as a result of the miscarriage. Like the Penal Code, the Criminal Code, which is modelled on the English Offences against the Person Act of 1861, permits an abortion to be legally performed only to save the life of the woman. Section 297 provides that “a person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation...upon an unborn child for the preservation of the mother’s life if the performance of the operation is reasonable, having regard to the patient’s state at the time and all the circumstances of the case”. Any person who, with intent to procure the miscarriage of a woman, unlawfully administers to her any noxious thing or uses any other means is subject to fourteen years’ imprisonment. A woman who undertakes the same act with respect to herself or consents to it is subject to seven years’ imprisonment. Any person who supplies anything knowing that it is intended to be unlawfully used to procure a miscarriage is subject to three years’ imprisonment. Unlike the Penal Code, however, the Criminal Code has been interpreted to allow abortions to be legally performed under broader circumstances. In the southern
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states of Nigeria, at least one court has followed the holding of the 1938 English Rex v. Bourne decision in determining whether an abortion performed for health reasons is lawful. In the Bourne decision, a physician was acquitted of the offence of performing an abortion in the case of a woman who had been raped. The court ruled that the abortion was lawful because it had been performed to prevent the woman from becoming “a physical and mental wreck”, thus setting a precedent for future abortion cases performed on the grounds of preserving the pregnant woman’s physical and mental health. A 1982 attempt to liberalize abortion law in Nigeria was defeated. A termination of pregnancy bill, sponsored by the Society of Gynaecologists and Obstetricians of Nigeria, was presented to the National Assembly. The bill would have permitted abortion if two physicians certified that the continuation of a pregnancy would involve risk to the life of a pregnant woman, or of injury to her physical and mental health or to any existing children in her family greater than if the pregnancy were terminated. The bill would also have allowed abortion if “there was a substantial risk that the child, if born, would suffer such physical and mental abnormalities as to be seriously handicapped”. Abortions performed on these expanded grounds could have been carried out only in the first 12 weeks of pregnancy, except to save the life of the woman. The bill also would have permitted physicians to refuse to perform an abortion on grounds of conscience. The bill was strongly opposed by religious leaders and by the Nigerian National Council of Women’s Societies of Nigeria who feared that its passage would promote sexual promiscuity. The abortion law is believed unchanged to date.

Religious Positions about Abortion
Christianity
Christianity and abortion has a long and complex history though there is no mention of abortion in the Christian Bible, and there is scholarly disagreement on how early Christians felt about abortion. Some scholars have concluded that early Christians took a nuanced stance on what is now called abortion and that at different time and in separate places, early Christians have taken different stances. Other scholars have concluded that early Christians considered abortion a sin at all stages; though there is disagreement over their thoughts on what type of sin it was and how grave a sin it was held to be, it was seen as at least as grave as sexual immorality. Some early Christians believed that the embryo did not have a soul from conception, and
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consequently opinion was divided as to whether early abortion was murder or ethically equivalent to murder. Early Christian texts nonetheless condemned abortion without distinction: Luker mentions the Didache, Clement of Alexandria, Tertullian, and Saint Basil. Early church councils punished women for abortions that were combined with other sexual crimes, as well as makers of abortifacient drugs. Christian philosophers such as Father of the Church Augustine and Doctor of the Church Aquinas. Augustine affirmed Aristotle’s concepts of ensoulment occurring some time after conception, after which point abortion was to be considered homicide, while still maintaining the condemnation of abortion at any time from conception onward. Aquinas reiterated Aristotle’s views of successive souls: vegetative, animal, and rational. This would be the Catholic Church’s position until 1869, when the limitation of automatic excommunication to abortion of a formed fetus was removed, a change that has been interpreted as an implicit declaration that conception was the moment of ensoulment. Consequently, in the Middle Ages, a less severe penance was imposed for the sin of abortion “before [the foetus] has life”. Contemporary Christian denominations have nuanced positions, thoughts and teachings about abortion, especially in extenuating circumstances. The Catholic Church, the Eastern Orthodox Church Oriental Orthodoxy, and most evangelical Protestants oppose deliberate abortion as immoral, while allowing what is sometimes called indirect abortion, namely, an action that does not seek the death of the fetus as an end or a means but that is followed by the death as a side effect. Some mainline Protestant denominations such as the Methodist Church, United Church of Christ, and the Evangelical Lutheran Church of America, among others, are more permissive of abortion. More generally, some Christian denominations can be considered pro-life while others may be considered pro-choice. Additionally, there are sizable minorities in all denominations that disagree with their denomination's stance on abortion, an example of which is the group Catholics for a Free Choice.

Islam
Although there are different opinions among Islamic scholars about when life begins and when abortion is permissible, most agree that the termination of a pregnancy after 120 days – the point at which, in Islam, a fetus is thought to become a living soul – is not permissible. All schools of Muslim law accept that abortion is permitted if continuing the pregnancy would put the mother’s life in real danger. This is also the only reason accepted for abortion after 120 days of the pregnancy.
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Different schools of Muslim law hold different views on whether any other reasons for abortion are permitted, and at what stage of pregnancy if so. Some schools of Muslim law permit abortion in the first 16 weeks of pregnancy, while others only permit it in the first 7 weeks. However, even those scholars who would permit early abortion in certain cases still regard abortion as wrong, but do not regard it as a punishable wrong. The more advanced the pregnancy, the greater the wrong. The Qur'an does not explicitly refer to abortion but offers guidance on related matters. Scholars accept that this guidance can properly be applied to abortion. Sanctity of life: The Islamic view is based on the very high priority the faith gives to the sanctity of life. The Qur'an states; Whosoever has spared the life of a soul, it is as though he has spared the life of all people. Whosoever has killed a soul, it is as though he has murdered all of mankind. Qur'an 5:32 Most Muslim scholars would say that a foetus in the womb is recognised and protected by Islam as a human life. Islam allows abortion to save the life of the mother because it sees this as the ‘lesser of two evils’ and there is a general principle in Sharia (Muslim law) of choosing the lesser of two evils. Abortion is regarded as a lesser evil in this case because: 1. 2. 3. 4. 5. the mother is the ‘originator’ of the foetus the mother's life is well-established the mother has with duties and responsibilities the mother is part of a family allowing the mother to die would also kill the foetus in most cases

The Qur'an makes it clear that a foetus must not be aborted because the family fear that they will not be able to provide for it - they should trust Allah to look after things: Kill not your offspring for fear of poverty; it is We who provide for them and for you. Surely, killing them is a great sin. Qur'an 17:32 The same (and similar) texts also ban abortion on social or financial grounds relating to the mother or the rest of the family - e.g. that the pregnancy wasn’t planned and a baby will interfere with the mother’s life, education or career.
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However, if it is confirmed in the early period of pregnancy that a foetus suffers from a defect that can’t be treated and that will cause great suffering to the child, a number of scholars would say that it is permissible to abort, provided that the pregnancy is less than 120 days old. A slightly more liberal opinion is that abortion within the first 120 days would be permitted if a child would be born with such physical and mental deformity as would deprive the child of a normal life. The opinion of at least two competent medical specialists is required. Other scholars disagree and hold that abortion is not permitted in such cases. There is almost unanimous opinion that after 120 days an abortion is not permissible unless the defect in the embryo puts the mother's life in danger. In recent times in Iran, Ayatollah Ali Khameni has issued a fatwa permitting abortion for foetuses less than 10 weeks shown to have the genetic blood disorder thalassemia. Also in Iran, Grand Ayatollah Yusuf Saanei issued a fatwa which permits abortion in the first three months for various reasons. Saanei accepted that abortion was generally forbidden in Islam, but went on to say: But Islam is also a religion of compassion, and if there are serious problems, God sometimes doesn’t require his creatures to practice his law. So under some conditions--such as parents’ poverty or overpopulation--then abortion is allowed, (Grand Ayatollah Yusuf Saanei quoted in Los Angeles Times, December 29, 2000). Widely quoted is a resolution of the Islamic jurisprudence council of Mekkah Al Mukaramah (the Islamic World League) passing a Fatwa in its 12th session held in February 1990. This allowed abortion if the foetus was: grossly malformed with untreatable severe condition proved by medical investigations and decided upon by a committee formed by competent trustworthy physicians, and provided that abortion is requested by the parents and the foetus is less than 120 days computed from moment of conception.

Rape, Incest and Adultery
Some scholars state that abortion where the mother is the victim of a rape or of incest is permissible in the first 120 days of the pregnancy. Others say abortion for such reasons is never permitted. Explaining the difficulty of such a case, one scholar says: I believe that the value of life is the same whether this embryo is the result of fornication with relatives or non-relatives or valid marriage. In Sharia life has the
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same value in all cases. (Sheikh M. A. Al-Salami, Third Symposium on Medical Jurisprudence). It is reported that Bosnian women raped by the Serbian army were issued a fatwa allowing them to abort, but were urged to complete the abortion before the 120 day mark. A similar fatwa was issued in Algeria. This demonstrates that Islamic law has the flexibility to be compassionate in appropriate circumstances. In Egypt (where abortion is illegal) in June 2004, Muhammad Sayed Tantawi, the Grand Sheikh of Al Azhar, approved a draft law allowing women to abort a pregnancy that is the result of rape. The law would also make it legal for women to undergo an abortion more than four months after conception. His decision caused controversy among other Muslim scholars: The mufti of Egypt, Ali Gomaa, said Tantawi's decision was wrong and violated the Qur'an's injunction that “forbids killing innocent souls.” He said, “It is haram [forbidden] to abort the fetus after life is breathed into it, in other words after 120 days.” However, he added that a woman could terminate a pregnancy if she was in immediate danger. Islam does not permit abortion where an unwanted pregnancy is the result of unforced adultery. Islam forbids the termination of a pregnancy after soul or ‘Ruh’ is given to the foetus. There’s disagreement within Islam as to when this happens. The three main opinions are: at 120 days, at 40 days, when there is voluntary movement of the foetus: this usually happens during the 12th week of gestation but many women don’t notice the movement until much later - sometimes as late as 20 weeks. A relevant hadith suggests that the moment of ensoulment is 120 days: Narrated Abdullah: Allah’s Apostle, the true and truly inspired said, “(as regards your creation), every one of you is collected in the womb of his mother for the first forty days, and then he becomes a clot for another forty days, and then a piece of flesh for another forty days. Then Allah sends an angel to write four words: He writes his deeds, time of his death, means of his livelihood, and whether he will be wretched or blessed (in religion). Then the soul is breathed into his body...” (Sahih Bukhari, Volume 4, Book 55, Number 549).

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However, it’s important to note that many scholars believe that life begins at conception, and that all scholars believe that an embryo deserves respect and protection at all stages of the pregnancy.

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, which would then involve the deliberate destruction of life, should be rejected. Many Buddhists also subscribe to this view. Complicating the issue is the Buddhist belief that “life is a continuum with no discernible starting point”. The Dalai Lama has said that abortion is “negative,” but there are exceptions. He said, “I think abortion should be approved or disapproved according to each circumstance.” Inducing or otherwise causing an abortion is regarded as a serious matter in the monastic rules followed by both Theravada and Vajrayana monks; monks can be expelled for assisting a woman in procuring an abortion. Traditional sources do not recognize a distinction between early- and late-term abortion, but in Sri Lanka and Thailand the “moral stigma” associated with an abortion grows with the development of the fetus. While traditional sources do not seem to be aware of the possibility of abortion as relevant to the health of the mother, modern Buddhist teachers from many traditions – and abortion laws in many Buddhist countries – recognize a threat to the life or physical health of the mother as an acceptable justification for abortion as a practical matter, though it may still be seen as a deed with negative moral or karmic consequences.

Hinduism
Classical Hindu texts strongly condemn abortion. When considering abortion, the Hindu way is to choose the action that will do least harm to all involved: the mother and father, the foetus and society. In practice, however, abortion is practiced in Hindu culture in India, because the religious ban on abortion is sometimes overruled by the cultural preference for sons. This can lead to abortion to prevent the birth of girl babies, which is called ‘female foeticide’. Hindu scholars and women’s rights advocates have supported bans on sex-selective abortions. Some Hindus support abortion in cases where the mother’s life is at imminent risk or when the fetus has a life threatening developmental anomaly.

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Some Hindu theologians and Brahma Kumaris believe personhood begins at three months and develops through to five months of gestation, possibly implying permitting abortion up to the third month and considering any abortion past the third month to be destruction of the soul’s current incarnate body.

Judaism
Orthodox Jewish teachings sanction abortion as a means of safeguarding the life of the woman. While the Reform, Reconstructionist and Conservative movements openly advocate for the right to a safe and accessible abortion, the Orthodox movement is less unified on the issue. In Judaism, views on abortion draw primarily upon the legal and ethical teachings of the Hebrew Bible, the Talmud, the case-by-case decisions of responsa, and other rabbinic literature. In the modern period, moreover, Jewish thinking on abortion has responded both to liberal understandings of personal autonomy as well as Christian opposition to abortion. Generally speaking, orthodox Jews oppose abortion, with few health-related exceptions, and reform and conservative Jews tend to allow greater latitude for abortion. There are rulings that often appear conflicting on the matter. The Talmud states that a fetus is not legally a person until it is delivered. The Torah contains the law that “when men fight and one of them pushes a pregnant woman and a miscarriage results but no other misfortune, the one responsible shall be fined...but if other misfortune ensues, the penalty shall be life (nefesh) for life (nefesh).” (Ex.21:22-25); causing an abortion on an unwilling woman is thus a crime, but not because the fetus is considered a person. According to the British Broadcasting Corporation, “Judaism does not forbid abortion, but it does not permit abortion on demand. Abortion is only permitted for serious reasons. Judaism expects every case [related to abortion] to be considered on its own merits and the decision to be taken after consultation with a rabbi competent to give advice on such matters.”

Sikhism
Although the Sikh code of conduct does not deal directly with abortion (or indeed many other bioethical issues), it is generally forbidden in Sikhism because it is said to interfere with the creative work of God. Despite this theoretical viewpoint, abortion is not uncommon among the Sikh community in India, and there is growing concern that female fetuses are being aborted because of the cultural preference for sons.

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Psychological Effects of Abortion
The relationship between induced abortion and psychology [or mental health] is an area of political controversy. Expert groups have had divided opinions of the effects of an abortion on the psychological well-being of a woman who had undergone one form of abortion or the other. A group of psychologist found no scientific evidence of a causal relationship between abortion and poor mental health while another group where able to relate abortion to some mental health issues. A view is that for women with unplanned pregnancies, the risk of mental-health problems is equal whether they carry the pregnancy to term or undergo an abortion. 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. In 1990, 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.” The APA updated its findings in August 2008 to account for new evidence, and again concluded that termination of a first unplanned pregnancy did not increase the risk of mental-health problems. The data for multiple abortions were more equivocal, as the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health difficulties. A 2008 systematic review of the medical literature on abortion and mental health found that high-quality studies consistently showed few or no mental-health consequences of abortion, while poor-quality studies were more likely to report negative consequences. In December 2011, the U.K. National Collaborating Centre for Mental Health published a systematic review of available evidence, similarly concluding that abortion did not increase the risk of mental-health problems. Despite the weight of medical opinion on the subject, some pro-life advocacy groups have continued to allege a link between abortion and mental-health problems. Some pro-life groups have used the term “post-abortion stress syndrome” (PASS) or “postabortion syndrome” (PAS) to refer to negative psychological effects which they attribute to abortion. However, “post-abortion syndrome” is not recognized as an actual syndrome by any medical or psychological organization, and physicians and pro-choice advocates have argued that the effort to popularize the idea of a “postabortion syndrome” is a tactic used by pro-life advocates for political purposes.
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Some U.S. state legislatures have mandated that patients be told that abortion increases their risk of depression and suicide, despite the fact that such risks are not supported by the bulk of the scientific literature.

Post-abortion Syndrome (PAS)
The term “post-abortion syndrome” was first used in 1981 by Vincent Rue, a pro-life advocate, in testimony before Congress in which he stated that he had observed post-traumatic stress disorder which developed in response to the stress of abortion. Rue proposed the name “post-abortion syndrome” (PAS) to describe this phenomenon. The term post-abortion syndrome (PAS) has subsequently been popularized and widely used by pro-life advocates to describe a broad range of adverse emotional reactions which they attribute to abortion. “Post-abortion syndrome” has not found widespread acceptance outside the pro-life community; the American Psychological Association and the American Psychiatric Association do not recognize PAS [or PASS] as an actual diagnosis or condition, and it is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or in the ICD-10 list of psychiatric conditions. No matter your philosophical, religious, or political views on abortion, the fact of the matter is, the actual experience can affect women not only on a personal level but can potentially have psychological repercussions. Women’s reasons for having an abortion are always highly personal, but it’s important to remember that some women might choose to have an abortion after experiencing rape at the hands of a stranger or someone they know. Conversely, at times women may feel compelled not to follow through with a pregnancy under pressure from a husband, boyfriend, or family member. In any case, it is usually thought of as a solution to stressful circumstances. Nevertheless, any event that causes trauma can indeed result in Post Traumatic Stress Disorder (PTSD), and abortion is no exception. A woman can be of sound and solid mind when she makes a choice to terminate a pregnancy, but it is never an easy decision. Even when it is the right decision, there is sometimes a level of conflict that needs to be addressed so that the woman can be at peace with her choice. Believing that PASS or PAS exists does not mean that one does not believe in a woman’s right to choose; it simply means that one believes in supportive and constructive counselling around the trauma symptoms.

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Symptoms of PASS may include any of the following: Guilt: Experiencing guilt does not imply that you made a mistake or “violated your own moral code,” as some pro-lifers would imply. However, feelings around having an abortion may be complex and have to take into account fear of what others might think. Anxiety: General anxiety is a common symptom of PTSD—in the case of PASS, there might be a particular anxiety over fertility issues and the ability to get pregnant again. Numbness, Depression: Again, common symptoms of PTSD. Women often describe symptoms of depression when telling of their feelings about their abortion experiences. Many feel completely immobilized. They haven’t been interested in anyone or anything since their abortion. They don’t talk to anyone, they don’t go to work, and they don’t function adequately in any area of life. In short, they are alienated from those around them and feel they have no one to confide in. In their depression, many women find they have been crying since their abortions. Others have insomnia and nightmares about little boys or girls the age their children would have been. Flashbacks: Most abortion is surgical, and in most cases, it’s surgery that happens while the patient is fully conscious. This can be a distressing experience. Suicidal thoughts: In extreme cases, the PTSD that results from a controversial abortion could lead to suicidal thoughts or tendencies and would require immediate treatment. It’s important to note that this is not a common or expected symptom of PASS, but as with any form of PTSD, it is possible.

Conclusion
While abortion can induce post-traumatic stress in some, others will suffer no repercussions at all. In fact, studies have shown that women may feel relieved after experiencing an abortion. However, women who are okay with having an abortion are more likely to talk about their experience than women who are ashamed and regretful and have a better chance of working through this process faster than other women. Nevertheless, even those who argue that PASS or PAS does not exist will acknowledge that having an abortion may induce normal feelings of sadness, grief, or regret. And women with religious backgrounds can have a hard time choosing to
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abort. But admitting that abortion is a difficult choice does not equate to admitting that it is “wrong.” Feelings are complex, and sometimes a woman will need to seek out counselling to help her sort through her own emotions and reactions as well as any perceived or actual stigma she may be experiencing. Post-abortion syndrome exists and could be overcome, even if the women believe that they are not allowed to be happy again. A compassionate, unbiased, and appropriate counsellor can help a woman who has undergone an abortion come to terms with her decision and find peace again— without a political agenda.

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References
Adler, N. E. David, H.P., Major, B.N., Roth, S.H., Russo, N.F. and Wyatt, G.E. (1992) Psychological factors in abortion: A review. American Psychologist, 47, 11941204. Bankole et al. (1998). “Reasons Why Women Have Induced Abortions: Evidence from 27 Countries”. International Family Planning Perspectives 24 (3): 117–127 & 152. BBC; Religion and Ethics: “Introduction to the abortion debate”. www.bbc.co.uk/ Retrieved on September 6, 2009. Haddad, LB.; Nour, NM. (2009). “Unsafe abortion: unnecessary maternal mortality”. Rev Obstet Gynecol 2 (2): 122–6. PMC 2709326. PMID 19609407. Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C (2009). “Abortion and mental health: evaluating the evidence” (PDF). American Psychologist 64 (9): 863–890. Mall, D., and Watts, W.F., (1979). The Psychological Aspects of Abortion, University Publications of America, Washington, D.C. Mary Boyle, Prof. Reflections on abortion and psychology: the hidden issues. The Psychologist, vol 15, October 2002: 502-503. Okonofua, F. (2006). “Abortion and maternal mortality in the developing world” (PDF). Journal of Obstetrics and Gynaecology Canada 28 (11): 974–979. PMID 17169222. “Report of the APA Task Force on Mental Health and Abortion”. American Psychological Association. 2008. UNICEF, United Nations Population Fund, WHO, World Bank (2010). “Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health”. “Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003” (PDF). World Health Organization. 2007. Archived from the original on 16 February 2011. WHO Department of Reproductive Health and Research (23 November, 2006). Frequently asked clinical questions about medical abortion. Geneva: World Health Organization. ISBN 9241594845.
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