An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously or accidentally as with a miscarriage, or be artificially induced by medical, surgical or other means. "Abortion" can refer to an induced procedure at any point during human pregnancy; it is sometimes medically defined as either miscarriage or induced termination before the point of viability.[1] Throughout history, abortion has been induced by various methods and the moral and legal aspects of abortion are subject to intense debate in many parts of the world.
Definitions
The following medical terms are used to categorize abortion:
- Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors.
- Induced abortion: Abortion that has been caused by
deliberate human action. Induced abortions are further subcategorized
into therapeutic and elective:
- Therapeutic abortion: An abortion performed either...
- Elective abortion: Abortion performed for any other reason.
In common parlance, the term "abortion" is synonymous with induced
abortion. However, in medical texts, the word 'abortion' might
exclusively refer to, or may also refer to, spontaneous abortion (miscarriage).
Incidence
The incidence and reasons for induced abortion vary regionally. It
has been estimated that approximately 46 million abortions are
performed worldwide every year. Of these, 26 million are said to occur
in places where abortion is legal; the other 20 million happen where the procedure is illegal. Some countries, such as Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100), have a low rate of induced abortion, while others like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. The world ratio is 26 induced abortions per 100 known pregnancies.[3]
By gestational age and method
Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, from data collected in those areas of the United States that sufficiently reported gestational age,
it was found that 88.2% of abortions were conducted at or prior to 12
weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 90.9%
of these were classified as having been done by "curettage" (suction-aspiration, Dilation and curettage, Dilation and evacuation), 7.7% by "medical" means (mifepristone), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy).[4] 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.[5] 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.[6]
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.[7] A 2004 study in which American women at clinics answered a questionnaire yielded similar results.[8] 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.[7] 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.[8] 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.[9]
In the United Kingdom, a 1994 survey of sexual behavior found that
women who reported having an abortion were more likely to be of a
higher social class, as well as either cohabitating or divorced. It
also found that women who stated they have had 10 or more sexual
partners in their lifetime were five times more likely to have had an
abortion than those who stated they have had only one sexual partner.[10]
Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled persons, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion. In many areas, especially in developing nations or where abortion is illegal, women sometimes resort to "back-alley" or self-induced procedures. The World Health Organization suggests that there are 19 million terminations annually which fit its criteria for an unsafe abortion.[11] See social issues for more information on these subjects.
Forms of abortion
Spontaneous abortion
-
Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes before the 20th week of gestation. A pregnancy that ends earlier than 37 weeks of gestation, if it results in a live-born infant, is known as a "premature birth". When a fetus dies in the uterus at some point late in gestation, beginning at about 20 weeks, or during delivery, it is termed a "stillbirth".
Premature births and stillbirths are generally not considered to be
miscarriages although usage of these terms can sometimes overlap.
Most miscarriages occur very early in pregnancy. Between 10% and 50%
of pregnancies end in miscarriage, depending upon the age and health of
the pregnant woman.[12] In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant.
The risk of spontaneous abortion decreases sharply after the 8th week.[13]
This risk is greater in those with a known history of several
spontaneous abortions or an induced abortion, those with systemic
diseases, and those over age 35. Other causes can be infection (of
either the woman or fetus), immune response, or serious systemic
disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.
Induced abortion
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the fetus, in addition to the legality, regional availability, and doctor-patient preference for specific procedures.
Surgical abortion
In the first twelve weeks, suction-aspiration or vacuum abortion is the most common method.[14] Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses an electric pump.
These techniques are comparable, differing 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 STOP: 'Suction (or surgical) Termination Of Pregnancy'. From the fifteenth week until approximately the twenty-sixth week, a dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.
Dilation and curettage
(D & C) is a standard gynecological procedure performed for a
variety of reasons, including examination of the uterine lining for
possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.[15] The term "D and C", or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.
Other techniques must be used to induce abortion in the third trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction
(IDX) (also called intrauterine cranial decompression), which requires
surgical decompression of the fetus's head before evacuation. IDX is
sometimes termed "partial-birth abortion," which has been federally banned in the United States. A hysterotomy abortion is an abortion procedure similar to a caesarean section, and is performed under general anesthesia
because it is considered major abdominal surgery. The procedure
requires a smaller incision than a caesarean section and is used during
later stages of pregnancy.[16]
From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure.[17]
Medical abortion
-
Effective in the first trimester of pregnancy, medical (non-surgical) abortions comprise 10% of all abortions in the United States and Europe. Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost:
misoprostol is used in the U.S.; gemeprost is used in the UK and
Sweden.) When used within 49 days gestation, approximately 92% of women
undergoing medical abortion with a combined regimen completed it
without surgical intervention.[18]
Misoprostol can be used alone, but has a lower efficacy rate than
combined regimens. In cases of failure of medical abortion, vacuum or
manual aspiration is used to complete the abortion surgically.
Other means of abortion
Bas-relief at Angkor Wat, dated circa 1150, depicting a demon performing an abortion by pounding a mallet into a woman's belly.
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).[19] 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.[20]
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.[21] Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Burma, Indonesia, Malaysia, the Philippines, and Thailand, there is an ancient tradition of attempting abortion through forceful abdominal massage.[22]
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.[23]
Health considerations
Early-term surgical abortion is a simple procedure, which is considered safer than childbirth when performed before the 16th week under modern medical conditions.[24][25] Abortion methods, like most minimally invasive procedures, carry a small potential for serious complications, including perforated uterus,[26][27] perforated bowel[28] or bladder,[29] septic shock,[30] sterility,[31] and death.[32] The risk of complications can increase depending on how far pregnancy has progressed.[33][34]
Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester.
Instruments that are placed within the uterus can, on rare occasions, cause perforation[33] or laceration
of the uterus, and damage structures surrounding the uterus. Laceration
or perforation of the uterus or cervix can, again on rare occasions,
lead to more serious complications.
Incomplete emptying of the uterus can cause hemorrhage and infection. Use of ultrasound
verification of the location and duration of the pregnancy prior to
abortion, with immediate follow-up of patients reporting continuing
pregnancy symptoms after the procedure, will virtually eliminate this
risk. The sooner a complication is noted and properly treated, the
lower the risk of permanent injury or death.
Assessing the risks of induced abortion depends on a number of
factors. First, there are relative health risks of induced abortion and
pregnancy, which are both affected by wide variation in the quality of
health services in different societies and among different socio-economic groups, a lack of uniform definitions
of terms, and difficulties in patient follow-up and after-care. The
degree of risk is also dependent upon the skill and experience of the
practitioner; maternal age, health, and parity;[34] gestational age;[34][33] pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care.
In the United Kingdom,
the number of deaths directly due to legal abortion between the years
of 1991 and 1993 was 5, compared to 3 deaths following spontaneous
miscarriage and 8 deaths caused by ectopic pregnancy during the same time frame.[35] In the United States, during the year 1999, there were 4 deaths due to legal abortion, 10 due to miscarriage, and 525 due to pregnancy-related reasons.[36][37]
Women experience pain, usually minor, during first-trimester
abortion procedures. In a 1979 study of 2,299 patients, 97% reported
experiencing some degree of pain. Patients rated the pain as being less
than earache or toothache, but more than headache or backache. Youngest
patients experienced the most pain; oldest, the least.[38]
In a 1991 study of 35 18 – 40 year olds, 70% reported cramping, 45.7%
reported fatigue (“tiring”), and 40% reported cutting. 34.3% of the
women chose the following descriptions: tugging, pulling, aching, and
intense. Women who had a previous abortion had more pain on the
affective McGill Pain Questionnaire and Philadelphia Pain Intensity scale than did those who did not have a previous abortion.[39]
Some practitioners advocate using minimal anaesthesia so the patient can alert them to possible complications. Others recommend general anaesthesia,
to prevent patient movement, which might cause a perforation. General
anaesthesia carries its own risks, including death, which is why public
health officials recommend against its routine use.
In rare cases, abortion will be unsuccessful and pregnancy will
continue. An unsuccessful abortion can result in delivery of a live infant.
This, termed a failed abortion, can occur only late in pregnancy. Some
doctors have voiced concerns about the ethical and legal ramifications
of letting the infant die. As a result, recent investigations have been
launched in the United Kingdom by the Confidential Enquiry into Maternal and Child Health (CEMACH) and the Royal College of Obstetricians and Gynaecologists, in order to determine how widespread the problem is and what an ethical
response in the treatment of the infant might be. A preliminary report
from this investigation indicated that at least 50 babies a year are
born in the UK following failed abortions after 18 weeks of gestation.[40]
Unsafe abortion methods (e.g. use of certain drugs, herbs, or insertion of non-surgical objects into the uterus)
are potentially dangerous, carrying a significantly elevated risk for
permanent injury or death, as compared to abortions done by physicians.
Suggested effects
There is controversy over a number of proposed risks and effects of
abortion. Evidence, whether in support of or against such claims, might
be influenced by the political and religious beliefs of the parties
behind it.
Breast cancer
-
The abortion-breast cancer (ABC) hypothesis (also referred to by supporters as the abortion-breast cancer link) posits a causal relationship between induced abortion and an increased risk of developing breast cancer. In early pregnancy, levels of estrogen increase, leading to breast growth in preparation for lactation. The hypothesis proposes that if this process is interrupted by an abortion – before full differentiation in the third trimester
– then more relatively vulnerable undifferentiated cells could be left
than there were prior to the pregnancy, resulting in a greater
potential risk of breast cancer. The hypothesis garnered renewed
interest from rat studies conducted in the 1980s;[41][42][43] however, it has not been scientifically verified in humans, and abortion is not considered a breast cancer risk by any major cancer organization.[44]
A large epidemiological study by Mads Melbye et al. in 1997, with data from two national registries in Denmark, reported the correlation to be negligible to non-existent after statistical adjustment.[45] The National Cancer Institute
conducted an official workshop with over 100 experts on the issue in
February 2003, which concluded with its highest strength rating for the
selected evidence that "induced abortion is not associated with an
increase in breast cancer risk."[46] In 2004, Beral et al. published a collaborative reanalysis of 53 epidemiological studies and concluded that abortion does "not increase a woman's risk of developing breast cancer."[47]
Critics of these studies argue they are subject to selection bias,[48] that the majority of interview-based studies have indicated a link, and that some are statistically significant.[49] Debate remains as to the reliability of these retrospective studies because of possible response bias. The current scientific consensus that abortion does not increase the risk of breast cancer has solidified with the publication of large prospective cohort studies which find no significant association between abortion and breast cancer.[50][51]
The ongoing prominence of the abortion-breast cancer hypothesis,
despite the lack of clear scientific evidence, is seen by some as a
part of the current pro-life "women-centered" strategy against abortion.[52][53] Nevertheless, the subject continues to be one of mostly political but some scientific contention.[54][55]
Fetal pain
-
The existence or absence of fetal sensation during abortion is a
matter of medical, ethical and public policy interest. Evidence
conflicts, with several physicians holding that the fetus is capable of
feeling pain sometime in the first trimester,[56][57] and medical researchers, notably from the American Medical Association, maintaining that the neuro-anatomical requirements for such experience do not exist until the 29th week of gestation.[58]
Pain receptors begin to appear in the seventh week of gestation.[57][59] The thalamus, the part of the brain which receives signals from the nervous system and then relays them to the cerebral cortex, starts to form in the fifth week.[60] However, other anatomical structures involved in the nociceptive process are not present until much later in gestation. Links between the thalamus and cerebral cortex form around the 23rd week.[60]
There has been suggestion that a fetus cannot feel pain at all, as it
requires mental development that only occurs outside the womb.[61]
Researchers have observed changes in heart rates and hormonal levels of newborn infants after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anesthesia.[62] Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.[63]
Mental health
-
Post-abortion syndrome (PAS) is a term used to describe a set of mental health characteristics which some researchers claim to have observed in women following an abortion.[64] The psychopathological symptoms attributed to PAS are similar to those of post-traumatic stress disorder, but have also included, "repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the 'need to repair'".[64] Whether this would warrant classification as an independent syndrome is disputed by other researchers.[65] PAS is listed in neither the DSM-IV-TR nor the ICD-10.
Some studies have shown abortion to have neutral or positive effects on the mental well-being of some patients. A 1989 study of teenagers who sought pregnancy tests found that, counting from the beginning of pregnancy until two years later, the level of stress and anxiety
of those who had an abortion did not differ from that of those who had
not been pregnant or who had carried their pregnancy to term.[66] Another study in 1992 suggested a link between elective abortion and later reports of positive self-esteem; it also noted that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors.[67] Abortion, as compared to completion, of an undesired first pregnancy was not found to directly pose the risk of significant depression in a 2005 study.[68]
Other studies have shown a correlation between abortion and negative
psychological impact. A 1996 study found that suicide is more common
after miscarriage and especially after induced abortion, than in the
general population.[69] Additional research in 2002 by David Reardon
reported that the risk of clinical depression was higher for women who
chose to have an abortion compared to those who opted to carry to term
— even if the pregnancy was unwanted.[70] Another study in 2006, which used data gathered over a 25-year period, found an increased occurrence of clinical depression, anxiety, suicidal behavior, and substance abuse among women who had previously had an abortion.[71]
Miscarriage, or spontaneous abortion, is known to present an increased risk of depression.[72] Childbirth can also sometimes result in maternity blues or postpartum depression.
History of abortion
"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the Boston Daily Times.
-
Induced abortion, according to some anthropologists, can be traced to ancient times.[73]
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 in Ancient Greece, forbade all doctors from helping to procure an abortion by pessary. Nonetheless, Soranus, a second-century Greek physician, suggested in his work Gynaecology
that women wishing to abort their pregnancies should engage in violent
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.[74] It is also believed that, in addition to using it as a contraceptive, the ancient Greeks relied upon silphium as an abortifacient. Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy.
Abortion in the 19th century continued, despite bans in both the United Kingdom and the United States, as the disguised, but nonetheless open, advertisement of services in the Victorian era suggests.[75]
Social issues
A number of complex issues exist in the debate over abortion. These,
like the suggested effects upon health listed above, are a focus of
research and a fixture of discussion among members on all sides of the
controversy.
Effect upon crime rate
-
A controversial theory attempts to draw a correlation between the United States' unprecedented nationwide decline of the overall crime rate during the 1990s and the decriminalization of abortion 20 years prior.
The suggestion was brought to widespread attention by a 1999 academic paper, The Impact of Legalized Abortion on Crime, authored by the economists Steven D. Levitt
and John Donohue. They attributed the drop in crime to a reduction in
individuals said to have a higher statistical probability of committing
crimes: unwanted children, especially those born to mothers who are African-American, impoverished, adolescent, uneducated, and single.
The change coincided with what would have been the adolescence, or peak
years of potential criminality, of those who had not been born as a
result of Roe v. Wade
and similar cases. Donohue and Levitt's study also noted that states
which legalized abortion before the rest of the nation experienced the
lowering crime rate pattern earlier, and those with higher abortion
rates had more pronounced reductions.[76]
Fellow economists Christopher Foote and Christopher Goetz criticized the methodology in the Donohue-Levitt study, noting a lack of accommodation for statewide yearly variations such as cocaine use, and recalculating based on incidence of crime per capita; they found no statistically significant results.[77] Levitt and Donohue responded to this by presenting an adjusted data set
which took into account these concerns and reported that the data
maintained the statistical significance of their initial paper.[78]
Such research has been criticized by some as being utilitarian, discriminatory as to race and socioeconomic class, and as promoting eugenics as a solution to crime.[79][80] Levitt states in his book, Freakonomics, that they are neither promoting nor negating any course of action — merely reporting data as economists.
Sex-selective abortion
-
The advent of both sonography and amniocentesis has allowed parents to determine sex before birth. This has led to the occurrence of sex-selective abortion or the targeted termination of a fetus based upon its sex.
It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates
of male and female children in some places. The preference for male
children is reported in many areas of Asia, and abortion used to limit
female births has been reported in Mainland China, Taiwan, South Korea, and India.[81]
In India, the economic role of men, the costs associated with dowries, and a Hindu tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons.[82]
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."[83] 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.[84] Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.[85]
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.[86]
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.[87]
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.[88] A ban upon the practice of sex-selective abortion was enacted in 2003.[89]
Unsafe abortion
Soviet poster
circa 1925. Title translation: "Abortions performed by either trained
or self-taught midwives not only maim the woman, they also often lead
to death."
-
Where and when access to safe abortion has been barred, due to
explicit sanctions or general unavailability, women seeking to
terminate their pregnancies have sometimes resorted to unsafe methods.
"Back-alley abortion" is a slang term for any abortion not practiced
under generally accepted standards of sanitation and professionalism.
The World Health Organization
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."[11]
This can include a person without medical training, a professional
health provider operating in sub-standard conditions, or the woman
herself.
Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage,
and damage to internal organs. WHO estimates that 19 million unsafe
abortions occur around the world annually and that 68,000 of these
result in the woman's death.[11] 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.[90] A 2007 study published in the The Lancet
found that, although the global rate of abortion declined from 45.6
million in 1995 to 41.6 million in 2003, unsafe procedures still
accounted for 48% of all abortions performed in 2003.[91] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[92]
Abortion debate
-
Over the course of the history of abortion, induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her value system.
Opinions of abortion may be best described as being a combination of
beliefs on its morality, and beliefs on the responsibility, ethical
scope, and proper extent of governmental authorities in public policy. Religious ethics also has an influence upon both personal opinion and the greater debate over abortion (see religion and abortion).
Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. In the United States, most often those in favor of legal prohibition of abortion describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice.
Both are used to indicate the central principles in arguments for and
against abortion: "Is the fetus a human being with a fundamental right
to life?" for pro-life advocates, and, for those who are pro-choice, "Does a woman have the right to choose whether or not to continue a pregnancy?"
In both public and private debate, arguments presented in favor of
or against abortion focus on either the moral permissibility of an
induced abortion, or justification of laws
permitting or restricting abortion. Arguments on morality and legality
tend to collide and combine, complicating the issue at hand.
Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a minor, her parents; a legally-married or common-law
wife, her husband; or a pregnant woman, the biological father. In a
2003 Gallup poll in the United States, 79% of male and 67% of female
respondents were in favor of spousal notification; overall support was
72% with 26% opposed.[93]
Public opinion
-
A number of opinion polls around the world have explored public opinion
regarding the issue of abortion. Results have varied from poll to poll,
country to country, and region to region, while varying with regard to
different aspects of the issue.
A May 2005 survey examined attitudes toward abortion in 10 European
countries, asking polltakers whether they agreed with the statement,
"If a woman doesn't want children, she should be allowed to have an
abortion". The highest level of approval was 81% in the Czech Republic and the highest level of disapproval was 48% in Poland.[94]
In North America, a December 2001 poll surveyed Canadian opinion on abortion, asking Canadians
in what circumstances they believe abortion should be permitted; 32%
responded that they believe abortion should be legal in all
circumstances, 52% that it should be legal in certain circumstances,
and 14% that it should be legal in no circumstances. A similar poll in
January 2006 surveyed people in the United States about U.S. opinion on abortion;
33% said that abortion should be "permitted only in cases such as rape,
incest or to save the woman's life", 27% said that abortion should be
"permitted in all cases", 15% that it should be "permitted, but subject
to greater restrictions than it is now", 17% said that it should "only
be permitted to save the woman's life", and 5% said that it should
"never" be permitted.[95] A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.[96]
Of attitudes in South and Central America, a December 2003 survey found that 30% of Argentines thought that abortion in Argentina
should be allowed "regardless of situation", 47% that it should be
allowed "under some circumstances", and 23% that it should not be
allowed "regardless of situation".[97] A March 2007 poll regarding the abortion law in Brazil found that 65% of Brazilians
believe that it "should not be modified", 16% that it should be
expanded "to allow abortion in other cases", 10% that abortion should
be "decriminalized", and 5% were "not sure".[98] A July 2005 poll in Colombia
found that 65.6% said they thought that abortion should remain illegal,
26.9% that it should be made legal, and 7.5% that they were unsure.[99]
Abortion law
-
International status of abortion law ( detail).
Before the scientific discovery that human development begins at fertilization, English common law allowed abortions to be performed before "quickening",
the earliest perception of fetal movement by a woman during pregnancy,
until both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803.[100] In 1861, the British Parliament passed the Offences Against the Person Act, which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.[101] The Soviet Union, with legislation in 1920, and Iceland,
with legislation in 1935, were two of the first countries to generally
allow abortion. The second half of the 20th century saw the
liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom. In the 1973 case, Roe v. Wade, the United States Supreme Court struck down state laws banning abortion, ruling that such laws violated an implied right to privacy in the United States Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler,
discarded its criminal code regarding abortion in 1988, after ruling
that such restrictions violated the security of person guaranteed to
women under the Canadian Charter of Rights and Freedoms. Canada later struck down provincial regulations of abortion in the case of R. v. Morgentaler (1993). By contrast, abortion in Ireland was affected by the addition of an amendment to the Irish Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn".
Current laws pertaining to abortion are diverse. Religious, moral,
and cultural sensibilities continue to influence abortion laws
throughout the world. The right to life, the right to liberty, and the right to security of person are major issues of human rights
that are sometimes used as justification for the existence or absence
of laws controlling abortion. Many countries in which abortion is legal
require that certain criteria be met in order for an abortion to be
obtained, often, but not always, using a trimester-based system to regulate the window of legality:
- In the United States, some states impose a 24-hour waiting period
before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
- In the United Kingdom, as in some other countries, two doctors must
first certify that an abortion is medically or socially necessary
before it can be performed.
Other countries, in which abortion is normally illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A few nations ban abortion entirely: Chile, El Salvador, Malta, and Nicaragua, although in 2006 the Chilean government began the free distribution of emergency contraception.[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]
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