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ABORTION

Abortion is the termination of a pregnancy by the removal or


expulsion of a fetus or embryo from the uterus, 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 low risk of maternal mortality except for abortions


performed unsafely, which result in 70,000 deaths and 5 million
disabilities per year.[2] Abortions are unsafe when performed by
persons without the proper skills or outside of a medically safe
environment. An estimated 42 million abortions are performed
annually with 20 million of those abortions done unsafely.[2] Forty
percent of the world's women are able to access therapeutic and
elective abortions within gestational limits.[3]

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, cultural, and religious 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 (both self-named). Incidence of abortion has declined
worldwide, as access to family planning education and
contraceptive services has increased.[4

TYPES

Spontaneous

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.[5] 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.[6] 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.[7]

The risk of spontaneous abortion decreases sharply after the 10th


week from the last menstrual period (LMP).[6][8] 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.[9]

The most common cause of spontaneous abortion during the first


trimester is chromosomal abnormalities of the embryo/fetus,[10]
accounting for at least 50% of sampled early pregnancy losses.[11]
Other causes include vascular disease (such as lupus), diabetes,
other hormonal problems, infection, and abnormalities of the uterus.
[10]
Advancing maternal age and a patient history of previous
spontaneous abortions are the two leading factors associated with a
greater risk of spontaneous abortion.[11] A spontaneous abortion can
also be caused by accidental trauma; intentional trauma or stress to
cause miscarriage is considered induced abortion or feticide.[12]

Induced

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 the pregnancy
progresses.[13] 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 a therapeutic abortion when it is performed to:

• save the life of the pregnant woman;[14]


• preserve the woman's physical or mental health;[14]
• terminate pregnancy that would result in a child born with a congenital
disorder that would be fatal or associated with significant morbidity;[14] or
• selectively reduce the number of fetuses to lessen health risks associated with
multiple pregnancy.[14]

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."[15]

Methods
Medical

Medical abortions" are non-surgical abortions that use


pharmaceutical drugs. As of 2005, medical abortions constitute 13%
of all abortions in the United States.[16] 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.[17] 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.

Surgical

In the first 12 weeks, suction-aspiration or vacuum abortion is the


most common method.[18] 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


surgical abortion, is a standard gynecological procedure performed
for a variety of reasons, including examination of the uterine lining
for possible malignancy, investigation of abnormal bleeding, and
abortion. Curettage refers to cleaning the walls of the uterus with a
curette. The World Health Organization recommends this procedure,
also called sharp curettage, only when MVA is unavailable.[19]
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's head before evacuation. IDX is
sometimes called "partial-birth abortion," which has been federally
banned in the United States. A hysterotomy abortion is a procedure
similar to a caesarean section and is performed under general
anesthesia. It requires a smaller incision than a caesarean section
and is used during later stages of pregnancy.[20]

The Royal College of Obstetricians and Gynaecologists has


recommended that an injection be used to stop the fetal heart
during the first phase of the surgical abortion procedure to ensure
that the fetus is not born alive.[21]

Other methods

Historically, a number of herbs reputed to possess abortifacient


properties have been used in folk medicine: tansy, pennyroyal,
black cohosh, and the now-extinct silphium (see history of abortion).
[23]
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.[24]

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.[25]
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.[26] 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.[26]

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.[27]

Health risks
See also: Health risks of unsafe abortion
Abortion, when legally performed in developed countries, is among
the safest procedures in medicine.[28][29] In such settings, risk of
maternal death is between 0.2–1.2 per 100,000 procedures.[30][31][32]
[33]
In comparison, by 1996, mortality from childbirth in developed
countries was 11 times greater.[30][34][35][36][37][38] Unsafe abortions
(defined by the World Health Organization as those performed by
unskilled individuals, with hazardous equipment, or in unsanitary
facilities) carry a high risk of maternal death and other
complications.[39] For unsafe procedures, the mortality rate has been
estimated at 367 per 100,000 (70,000 women per year worldwide).
[2][40]

Physical health

Surgical abortion methods, like most minimally invasive procedures,


carry a small potential for serious complications.[41]
Surgical abortion is generally safe and the rate of major
complications is low[42] but varies depending on how far pregnancy
has progressed and the surgical method used.[43] Concerning
gestational age, incidence of major complications is highest after 20
weeks of gestation and lowest before the 8th week.[43] With more
advanced gestation there is a higher risk of uterine perforation and
retained products of conception,[44] and specific procedures like
dilation and evacuation may be required.[45]
Concerning the methods used, general incidence of major
complications for surgical abortion varies from lower for suction
curettage, to higher for saline instillation.[43] Possible complications
include hemorrhage, incomplete abortion, uterine or pelvic
infection, ongoing intrauterine pregnancy,
misdiagnosed/unrecognized ectopic pregnancy, hematometra (in
the uterus), uterine perforation and cervical laceration.[46] Use of
general anesthesia increases the risk of complications because it
relaxes uterine musculature making it easier to perforate.[47]
Women who have uterine anomalies, leiomyomas or had previous
difficult first-trimester abortion are contraindicated to undertake
surgical abortion unless ultrasonography is immediately available
and the surgeon is experienced in its intraoperative use.[48] Abortion
does not impair subsequent pregnancies, nor does it increase the
risk of future premature births, infertility, ectopic pregnancy, or
miscarriage.[29]
In the first trimester, health risks associated with medical abortion
are generally considered no greater than for surgical abortion.[49]
Although some epidemiological studies suggest an abortion–breast
cancer hypothesis, the World Health Organization has concluded
that there is "no consistent effect of first trimester induced abortion
upon a woman's risk of breast cancer later in life".[50][51] The National
Cancer Institute,[52] American Medical Association, and other major
medical bodies have also concluded that abortion does not cause
breast cancer.

Mental health
Main article: Abortion and mental health
No scientific research has demonstrated that abortion is a cause of
poor mental health in the general population. However there are
groups of women who may be at higher risk of coping with problems
and distress following abortion.[53] Some 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.[54] The American Psychological Association (APA)
concluded that abortion does not lead to increased mental health
problems.[55]
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.[56][57][58]

Incidence
There are two commonly used methods of measuring incidence of
abortion:

• Abortion rate - number of abortions per 1000 women between 15 and 44 years
of age
• Abortion ratio - number of abortions out of 100 known pregnancies (excluding
miscarriages and stillbirths)

The number of abortions performed worldwide has decreased


between 1995 and 2003 from 45.6 million to 41.6 million, which
means a decrease in abortion rate from 35 to 29 per 1000 women.
The greatest decrease has occurred in the developed world with a
drop from 39 to 26 per 1000 women in comparison to the
developing world, which had a decrease from 34 to 29 per 1000
women. Out of a total of about 42 million abortions 22 million
occurred safely and 20 million unsafely.[2]
On average, the frequency of abortions is similar in developing
countries (where abortion is generally restricted) to the frequency in
developed countries (where abortion is generally much less
restricted).[3][59] Abortion rates are very difficult to measure in
locations where those abortions are illegal,[60] and pro-life groups
have criticized researchers for allegedly jumping to conclusions
about those numbers.[61] According to the Guttmacher Institute and
the United Nations Population Fund, the abortion rate in developing
countries is largely attributable to lack of access to modern
contraceptives; assuming no change in abortion laws, providing that
access to contraceptives would result in about 25 million fewer
abortions annually, including almost 15 million fewer unsafe
abortions.[62]
The incidence of induced abortion varies regionally. Some countries,
such as Belgium (11.2 out of 100 known pregnancies) and the
Netherlands (10.6 per 100), had a comparatively low ratio of
induced abortion. Others like Russia (62.6 out of 100), Romania (63
out of 100) and Vietnam (43.7 out of 100) had a high ratio (data for
last three countries of unknown completeness). The estimated world
ratio was 26%, the world rate - 35 per 1000 women.[63]

By gestational age and method

Histogram of abortions by gestational age in England and


Wales during 2004. Average is 9.5 weeks. (left) Abortion in
the United States by gestational age, 2004. (Data source:
Centers for Disease Control and Prevention) (right)
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).[64] 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.[65] 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.[66] Later abortions are more common in
China, India, and other developing countries than in developed
countries.[67]

By personal and social factors


A bar chart depicting selected data from the 1998 AGI meta-study on the reasons
women stated for having an abortion.
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.[68] A 2004 study in which American women at clinics
answered a questionnaire yielded similar results.[69] 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.[68] 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.[69] 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.[70] 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."[71]
Some abortions are undergone as the result of societal pressures.
These might include the stigmatization of disabled people,
preference for children of a specific sex, disapproval of single
motherhood, insufficient economic support for families, lack of
access to or rejection of contraceptive methods, or efforts toward
population control (such as China's one-child policy). These factors
can sometimes result in compulsory abortion or sex-selective
abortion.

Unsafe abortion

Soviet poster circa 1925, warning against midwives performing abortions. Title
translation: "Abortions performed by either trained or self-taught midwives not only
maim the woman, they also often lead to death."
Main article: Unsafe abortion
One of the main determinants of the availability of safe abortions is
the legality of the procedure. Forty percent of the world's women
are able to access therapeutic and elective abortions within
gestational limits.[3] Women seeking to terminate their pregnancies
sometimes resort to unsafe methods, particularly where and when
access to legal abortion is restricted. 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."[72]
Unsafe abortions are sometimes known colloquially as "back-alley"
abortions. They may be performed by the woman herself, another
person without medical training, or a professional health provider
operating in sub-standard conditions. Unsafe abortion remains a
public health concern due to the higher incidence and severity of its
associated complications, such as incomplete abortion, sepsis,
hemorrhage, and damage to internal organs. While maternal
mortality seldom results from safe abortions, unsafe abortions result
in 70,000 deaths and 5 million disabilities per year.[2] Complications
of unsafe abortion 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.
[73]
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.[74] Health education, access
to family planning, and improvements in health care during and
after abortion have been proposed to address this phenomenon.[75]

History

"French Periodical Pills." An example of a clandestine advertisement published in an


1845 edition of the Boston Daily Times.
Main article: History of abortion
Induced abortion can be traced to ancient times.[76] 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.[77] 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 Islamic Golden Age, physicians there documented
detailed and extensive lists of birth control practices commenting on
their effectiveness and prevalence.[78] They listed many different
birth control substances in their medical encyclopedias, such as
Avicenna's list of twenty in The Canon of Medicine (1025 C.E.) and
Muhammad ibn Zakariya ar-Razi's list of 176 substances in his Hawi
(10th century C.E.) This was "unparalleled in European medicine
until the 19th century".[79]
During the Middle Ages, abortion was tolerated[where?] and there were
no laws against it.[80][non-primary source needed] A medieval female physician,
Trotula of Salerno,[81] administered a number of remedies for the
“retention of menstrua,” which was sometimes a code for early
abortifacients.[82] Pope Sixtus V (1585–90) is noted as the first Pope
to declare that abortion is homicide regardless of the stage of
pregnancy.[83] 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.[84][non-primary source needed]
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.[85] 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.[86][87][88][89]
However, the procedure remained relatively rare until the late
1960s. In late 1960s and early 1970s, due to a confluence of factors,
the number of abortions exploded worldwide. In West Germany, the
number of reported abortions spiked from 2,800 in 1968 to 87,702
in 1980.[90] In the United States, some sources show an even greater
increase, from 4,600 in 1968 to 1.5 million in 1980. However, the
fact that abortion remained illegal in many states prior to the
landmark 1973 decision of Roe v. Wade may have affected the
number of reported abortions prior to 1973.

Society and culture


Abortion debate

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Please help improve this article by adding reliable references. Unsourced material may be
challenged and removed. (November 2008)
Pro-choice activists near the Washington Monument at the March for
Women's Lives in 2004. (left) Pro-life activists near the Washington
Monument at the annual 2009 March for Life in Washington, DC. (right)
Main article: Abortion debate
See also: Religion and abortion
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 one that argues in favor of access to abortion and one
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 former
position argues that a human fetus is a human being with a right to
live making abortion tantamount to murder. The latter 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 access 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, for any case, 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.[91]

Abortion law

The examples and perspective in this article may not represent a worldwide
view of the subject. Please improve this article and discuss the issue on the
talk page. (December 2010)
Main article: Abortion law
See also: Reproductive rights and History of Abortion Law Debate
International status of abortion law:
Legal on request
Illegal with exception for rape, maternal life, health, mental health, fetal defects,
and/or socioeconomic factors
Illegal with exception for rape, maternal life, health, mental health, and/or fetal
defects
Illegal with exception for rape, maternal life, health, and/or mental health
Illegal with exception for maternal life, health, and/or mental health
Illegal with no exceptions
Varies by region
No information
The earliest secular laws regulating abortion reflect a concern with
class and caste purity and preservation of male prerogatives.
Abortion as such was not outlawed, but wives who procured
abortions without their husband's knowledge could be severely
punished, as could slaves who induced abortions in highborn
women. Generally, abortions prior to quickening were treated as
minor crimes, if at all.
The new philosophies of the Axial Age, which began discussing the
nature and value of human life in abstract terms, had little impact
on existing abortion laws. Even the Christian ecclesiastical courts of
the Middle Ages imposed penance and no corporal punishment for
abortion, and retained the pre- and post-quickening distinction from
the ancient philosophies.
With the sole exception of Bracton,[92] commentators on the English
common law formulated the born alive rule, excluding feticide from
homicide law, using language dating back to the Leges Henrici
Primi.[93]
In the late eighteenth century, it was claimed that scientific
knowledge of human development beginning at fertilization,[94]
justified stricter abortion laws. This was part of a larger struggle on
the part of the medical profession to distinguish modern, theory
based medicine from traditional, empirically based medicine,
including midwifery and herbalism.[95]
Both pre- and post-quickening abortions were criminalized by Lord
Ellenborough's Act in 1803.[96] 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.[97]
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.[98] 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:

• In the United States, some states impose a 24-hour waiting period before the
procedure, prescribe the distribution of information on fetal development, or
require that parents be contacted if their minor daughter requests an abortion.
[99]

• In the United Kingdom, as in some other countries, two doctors must first
certify that an abortion is medically or socially necessary before it can be
performed.[citation needed]

Other countries, in which abortion is normally illegal, will allow one


to be performed in the case of rape, incest, or danger to the
pregnant woman's life or health.

• A few nations ban abortion entirely: Chile, El Salvador, Malta, and Nicaragua,
with consequent rises in maternal death directly and indirectly due to
pregnancy.[100][101] However, in 2006, the Chilean government began the free
distribution of emergency contraception.[102][103]
• In Bangladesh, abortion is illegal, but the government has long supported a
network of "menstrual regulation clinics", where menstrual extraction (manual
vacuum aspiration) can be performed as menstrual hygiene.[104]

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 try to do it themselves. [105]
In the US, about 8% of abortions are performed on women who
travel from another state.[106] 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.[citation
needed]
Thousands of women every year travel from Northern Ireland,
the Republic of Ireland, Poland, and other countries where elective
abortion is illegal, to Britain or other countries with less restrictive
laws, in order to obtain abortions.[107][108]
In the United States and some Canadian localities, it is a legal
offense to obstruct access to a clinic or doctor's office where
abortions are performed. "Buffer zones," regulating how close
protesters can come to the clinic or to the patients, may exist.
Other issues in abortion law may include the requirement that a
minor obtain the consent of one or both parents to the abortion or
that she notify one or both parents, the requirement that a woman
obtain the consent of her husband to the abortion and the question
of whether the fetus's father can prohibit an abortion, the
requirement that abortion providers inform patients of the supposed
health risks of the procedure, and wrongful birth laws.

Sex-selective

Main article: 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 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 China, Taiwan, South Korea, and
India.[109]
In India, the economic role of men, the costs associated with
dowries, and a common Indian tradition which dictates that funeral
rites must be performed by a male relative have led to a cultural
preference for sons.[110] 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."[111] 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.[112] Researchers have asserted that
between 1985 and 2005 as many as 10 million female fetuses may
have been selectively aborted.[113] 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.[114]
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.[115]
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.
[116]
A ban upon the practice of sex-selective abortion was enacted in
2003.[117]

Anti-abortion violence

Main article: Anti-abortion violence


Abortion providers have been subjected to various forms of
violence, including murder, assault, kidnapping, arson, and
bombing. Anti-abortion violence has been classified by
governmental and scholarly sources as terrorism.[118][119] Only a small
fraction of those opposed to abortion commit violence, often
rationalizing their actions as justifiable homicide or defense of
others, committed in order to protect the lives of fetuses.
In the United States, four abortion providers—Drs. David Gunn, John
Britton, Barnett Slepian, and George Tiller—have been assassinated.
Attempted assassinations have also taken place in the United States
and Canada, and other personnel at abortion clinics, including
receptionists and security guards, have been killed in the United
States and Australia. Hundreds of bombings, arsons, acid attacks,
invasions, and incidents of vandalism against abortion providers
have also occurred.[120][121] Notable perpetrators of anti-abortion
violence include Eric Robert Rudolph, Scott Roeder, Shelley
Shannon, and Paul Jennings Hill, the first person to be executed in
the United States for murdering an abortion provider.[122]

Art, literature and film

Art serves to humanize the abortion issue and illustrates the myriad
of decisions and consequences it has. One of the earliest known
representations of abortion is in a bas relief at Angkor Wat (c. 1150).
Pro-life activist Børre Knudsen was linked to a 1994 art theft as part
of a pro-life drive in Norway surrounding the 1994 Winter Olympics.
[123]
A Swiss gallery removed a piece from a Chinese art collection in
2005, that had the head of a fetus attached to the body of a bird.[124]
In 2008, a Yale student proposed using aborted excretions and the
induced abortion itself as a performance art project.[125]
The Cider House Rules (novel 1985, film 1999) follows the story of
Dr. Larch an orphanage director who is a reluctant abortionist after
seeing the consequences of back-alley abortions, and his orphan
medical assistant Homer who is against abortion.[126] Feminist novels
such as Braided Lives (1997) by Marge Piercy emphasize the
struggles women had in dealing with unsafe abortion in various
circumstances prior to legalization.[127] Doctor Susan Wicklund wrote
This Common Secret (2007) about how a personal traumatic
abortion experience hardened her resolve to provide compassionate
care to women who decide to have an abortion. As Wicklund
crisscrosses the West to provide abortion services to remote clinics,
she tells the stories of women she's treated and the sacrifices
herself and her loved ones made.[128] In 2009, Irene Vilar revealed
her past abuse and addiction to abortion in Impossible Motherhood,
where she aborted 15 pregnancies in 17 years. According to Vilar it
was the result of a dark psychological cycle of power, rebellion and
societal expectations.[129]
Various options and realities of abortion have been dramatized in
film. In Riding in Cars with Boys (2001) an underage woman carries
her pregnancy to term as abortion is not an affordable option,
moves in with the father and finds herself involved with drugs, has
no opportunities, and questioning if she loves her child. While in
Juno (2007) a 16-year-old initially goes to have an abortion but
decides to bear the child and allow a wealthy couple to adopt it.
Other films Dirty Dancing (1987) and If These Walls Could Talk
(1996) explore the availability, affordability and dangers of illegal
abortions. The emotional impact of dealing with an unwanted
pregnancy alone is the focus of Things You Can Tell Just By Looking
At Her (2000) and Circle of Friends (1995). As a marriage was in
trouble in the The Godfather Part II (1974) Kay knew the relationship
was over when she aborted "a son" in secret.[130] On the abortion
debate, an irresponsible drug addict is used as a pawn in a power
struggle between pro-choice and pro-life groups in Citizen Ruth
(1996).[131]

In other animals
Further information: Miscarriage#In other animals
Spontaneous abortion occurs in various animals. For example, in
sheep, it may be caused by crowding through doors, or being
chased by dogs.[132] In cows, abortion may be caused by contagious
disease, such as Brucellosis or Campylobacter, but can often be
controlled by vaccination.[133]
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]
Human fetus 10 weeks -
therapeutic abortion.jpg