Abortion

Induced abortion
Classification and external resources
ICD-10 O04
ICD-9 779.6
DiseasesDB 4153
MedlinePlus 002912
eMedicine article/252560

Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.[note 1] An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced. The term abortion most commonly refers to the induced abortion of a human pregnancy.

Abortion, when induced in the developed world in accordance with local law, is among the safest procedures in medicine.[1] However, unsafe abortions (those performed by persons without proper training or outside of a medical environment) result in approximately 70 thousand maternal deaths and 5 million disabilities per year globally.[2] An estimated 42 million abortions are performed globally each year, with 20 million of those performed unsafely.[2] The incidence of abortion has declined worldwide as access to family planning education and contraceptive services has increased.[3] Forty percent of the world's women have access to induced abortions (within gestational limits).[4]

Induced abortion has a long history and has been facilitated 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 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.

Contents

Types

Induced

Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[5] Most abortions result from unintended pregnancies.[6] 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.[7][8] 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 mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[9][10] 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.[10]

Spontaneous

Main article: Miscarriage

Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 20th to 22nd week of gestation.[note 2] 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".[11] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[12] Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.[13]

Only 30 to 50% of conceptions progress past the first trimester.[14] The vast majority of those that do not progress are lost before the woman is aware of the conception,[10] and many pregnancies are lost before medical practitioners have the ability to detect the presence of an embryo.[15] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[16]

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,[10][17] accounting for at least 50% of sampled early pregnancy losses.[18] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[17] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[18] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[19]

Induction methods

Medical

Main article: Medical abortion

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.[20][21][22]

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.[20] 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.[21]

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.[23] 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.[24] In cases of failure of medical abortion, surgical abortion must be used to complete the procedure.[25]

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,[26][27] France,[28] Switzerland,[29] and the Nordic countries.[30] In the United States, the percentage of early medical abortions is far lower.[31][32]

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,[22] in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.[33]

Surgical

In the first 15 weeks, suction-aspiration or vacuum abortion is the most common surgical method.[34] 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. 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.[35]

From the 15th week until approximately the 26th, other techniques must be used. Dilation and evacuation (D&E) consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. Premature labor and 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 also 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.

In the third trimester of pregnancy, abortion may be performed by IDX as described above, induction of labor, or by hysterotomy. 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.[36]

First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.[32]

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).[37] 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.[38]

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.[39] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[40] 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.[40]

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.[41]

Safety

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.[42] Abortion, when performed in the developed world in accordance with local law, is among the safest procedures in medicine.[1][43] In the US, the risk of maternal death from abortion in 1999 was 0.567 per 100,000 procedures, making abortion approximately 12.5 times safer than childbirth (7.06 maternal deaths per 100,000 live births).[44] The risk of abortion-related mortality increases with increasing gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.[45][46]

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.[47] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before elective abortion,[48] as they are believed to substantially reduce the risk of postoperative uterine infection.[49][32] Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen.

There is little, if any, difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 9 weeks gestation.[23] 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.[50][51]

Unsafe abortion

Main article: Unsafe abortion

Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries.[1] Unsafe abortion is believed to result in approximately 68,000 deaths[52] and millions of injuries annually.[1] 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 reproductive-health services.[53]

Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. They may attempt to self-abort 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, hemorrhage, and damage to internal organs.[54]

The legality of abortion is one of the main determinants of its safety. Restrictive abortion laws are associated with a high rate of unsafe abortions.[2][55][56][57][53] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[58] with abortion-related deaths dropping by more than 90%.[59] In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.[60]

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,[4] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[61] 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 account for approximately an eighth of maternal mortalities worldwide,[62] though this varies by region.[63] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[56] 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.[55] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[64]

Breast cancer hypothesis

Main article: Abortion–breast cancer hypothesis

Some studies have suggested an association between abortion and breast cancer.[65] Proponents of a causal link between the two suggest that the interruption of normal breast development during pregnancy leaves immature cells that are more cancer-prone in the breasts. However, major medical bodies, including the World Health Organization, the US National Cancer Institute, the American Cancer Society, the Royal College of Obstetricians and Gynaecologists, and the American Congress of Obstetricians and Gynecologists, have all concluded on the basis of existing evidence that abortion does not cause breast cancer.[66] The concept of a causal link between induced abortion and breast cancer is promoted primarily by pro-life groups.[65]

Mental health

Main article: Abortion and mental health

The current scientific consensus holds that there is no causal relationship between abortion and mental-health problems.[67] While women most frequently feel relieved after the procedure,[32] some factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, or pre-existing psychiatric illness increase the likelihood of experiencing negative feelings after an abortion.[68] 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.[69][70] Similarly, abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems.[71]

Some studies have disagreed with above conclusions; other researchers and professional organizations have noted that such studies typically fail to use appropriate comparison groups, do not adequately account for confounding variables, and improperly account for pre-existing mental health complications.[note 3] Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as a separate condition called "post-abortion syndrome", which is not recognized by any medical or psychological organization.[72]

Incidence

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

The number of abortions performed worldwide has decreased between 1995 and 2003 from 45.6 million to 41.6 million, which means a decrease in abortion rate per annum from 35 to 29 per 1000 women.[55] 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.[2] In 2003, the estimated global abortion ratio was 31.[55]

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. However, restrictive abortion laws are associated with increases in the percentage of abortions which are performed unsafely.[4][73][74] The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.[75]

The incidence of induced abortion varies extensively worldwide. The ratio of induced abortion ranges from ten to thirty percent; figures in the developing world vary widely and are often incomplete.[76]

By gestational age and method

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention (CDC) reported that 26% of abortions in the United States were known to have been obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 4.1% at 16 through 20 weeks and 1.4% at more than 21 weeks. 90.9% of these were classified as having been done by "curettage" (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).[77] According to the CDC, due to data collection difficulties the data must be viewed as tentative and some fetal deaths reported beyond 20 weeks may be natural deaths erroneously classified as abortions if the removal of the fetus is accomplished by the same procedure as an induced abortion.[78]

The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for 0.17% of the total number of abortions performed that year.[79] 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.[80] Later abortions are more common in China, India, and other developing countries than in developed countries.[81]

Personal and social factors

The reasons why women have abortions are diverse and vary dramatically across the world. Some of the most common reasons are to postpone childbearing to a more suitable time or to focus energies and resources on existing children. Others include being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while she is caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of one's own education, relationship problems with their partner, a perception of being too young to have a child, and unemployment, among others.[82][83]An additional factor is risk to maternal or fetal health, which was cited as the primary reason for abortion in over a third of cases in some countries and as a significant factor in only a single-digit percentage of abortions in other countries.[82][78] Pregnancies caused as a result of incest or rape comprised less than 1.5% of abortions in a 2004 U.S. study.[83]

Another American study in 2002 concluded that about half of women having abortions were using a form of contraception at the time of becoming pregnant. Inconsistent use was reported by half of those using condoms and three-quarters of those using the birth-control pill; 42% of those using condoms reported failure through slipping or breakage.[84] 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."[85]

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 or earl 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.

History

Main article: History of abortion

Induced abortion has long history, and can be traced back to civilizations as varied as China under Shennong (c. 2700 BCE), Ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE).[86] 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;[86] other scholars disagree with this interpretation,[86] and note the medical texts of Hippocratic Corpus contain descriptions of abortive techniques.[87] 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;[88] 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.[86] Islamic tradition has traditionally permitted abortion up until a point in time when Muslims believe the soul enters the fetus,[86] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[89] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[90]

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.[86] 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.[86] Church groups as well as physicians were highly influential in anti-abortion movements.[86] In the US, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.[note 4] The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[91] 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.[92] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.[86]

Society and culture

Abortion debate

Main article: Abortion debate

Induced abortion has long been the source of considerable debate, controversy, and activism. An individual's position concerning the complex ethical, moral, philosophical, biological, and legal issues which surround abortion is often related to his or her value system. Opinions of abortion may be described as being a combination of beliefs about abortion's morality, beliefs on the responsibility, ethical scope, and the proper extent of governmental authority in public policy; and on the rights and responsibilities of the woman seeking to have an abortion. Religious ethics also has an influence on both personal opinion and the greater debate over abortion.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Those in favor of greater legal restrictions on abortion, including complete prohibition, most often describe themselves as pro-life 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 morally the same as murder. The latter position argues that a woman has certain reproductive rights, especially the choice whether or not to carry a pregnancy to term.

Modern abortion law

Main article: Abortion law
See also: History of abortion law debate

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.

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. Many restrictions are waived in emergency situations. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.[93] 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.

Other jurisdictions ban abortion almost entirely. However, many, but not all, of these will allow them to be performed in a variety of circumstances. These circumstances vary based on jurisdiction, but may include whether the pregnancy is a result of rape or incest, whether the fetus' development is impaired, whether the mother's physical or mental well-being is endangered, or whether there are socioeconomic considerations that could be taken into consideration.[61] In countries where abortion is banned entirely, such as Nicaragua, rises in maternal death directly and indirectly due to pregnancy have been noted.[94][95] Some countries, such as Bangledesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.[96] 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.[97] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.[98]

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.[99][100] This has caused controversy, as some pro-life groups have advocated that certain forms of emergency contraception are not contraceptives but abortifacients.

Sex-selective abortion

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 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.[101] This deviation from the standard birth rates of males and females occurs despite the fact that the country in question may have officially banned sex-selective abortion or even sex-screening.[102][103][104][105] In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.[106]

Anti-abortion violence

Main article: Anti-abortion violence

In a number of cases, abortion providers and these facilities have been subjected to various forms of violence, including murder, attempted murder, kidnapping, stalking, assault, arson, and bombing. Anti-abortion violence has been classified by governmental and scholarly sources as terrorism.[107][108] 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 physicians who performed abortions—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.[109][110] 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.[111]

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.[113] 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.[114] In 2008, a Yale student proposed using aborted excretions and the induced abortion itself as a performance art project.[115]

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.[116] 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.[117] Physician 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 she and her loved ones made.[118] 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.[119] In Annie Finch's mythic epic poem and opera libretto Among the Goddesses (2010), the heroine's abortion is contextualized spiritually by the goddesses Demeter, Kali, and Inanna.[120]

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. 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. The 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). In The Godfather Part II (1974) Kay informed Michael Corleone that she had obtained an abortion without his knowledge nor consent.[121] 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).[122] The Law & Order television episode "Dignity" deals with the trial of a man who killed a late-term abortion doctor; the storyline was inspired by the assassination of abortion provider George Tiller.[123]

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.[124] In cows, abortion may be caused by contagious disease, such as Brucellosis or Campylobacter, but can often be controlled by vaccination.[125]

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.[126]

Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[127][128][129] although the frequency in the wild has been questioned.[130] Male gray langur monkeys may attack females following male takeover, causing miscarriage.[131]

References

Citations

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Notes

  1. ^ The definition of abortion, as with many words, varies from source to source. The following is a partial list of definitions as stated by obstetrics and gynecology (OB/GYN) textbooks, dictionaries, and other encyclopedias:
    Major OB/GYN textbooks
    • The National Center for Health Statistics defines an "abortus" as "[a] fetus or embryo removed or expelled from the uterus during the first half of gestation—20 weeks or less, or in the absence of accurate dating criteria, born weighing < 500 g." They also define "birth" as "[t]he complete expulsion or extraction from the mother of a fetus after 20 weeks' gestation. [...] in the absence of accurate dating criteria, fetuses weighing <500 g are usually not considered as births, but rather are termed abortuses for purposes of vital statistics." Cunningham, FG; Leveno, KJ; Bloom, SL et al., eds (2010). "1. Overview of Obstetrics". Williams Obstetrics (23 ed.). McGraw-Hill Medical. ISBN 978-0-07-149701-5. 
    • "[T]he standard medical definition of abortion [is] termination of a pregnancy when the fetus is not viable". Annas, George J.; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh. Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. ISBN 978-0-443-06930-7. 
    • "Termination of a pregnancy, whether spontaneous or induced." Kottke, Melissa J.; Zieman, Mimi (2008). "33. Management of Abortion". In Rock, John A.; Jones III, Howard W.. TeLinde's Operative Gynecology (10 ed.). Lippincott Williams & Wilkins. ISBN 978-0-7817-7234-1. 
    Other OB/GYN textbooks
    • "Termination of pregnancy before 20 weeks' gestation calculated from date of onset of last menses. An alternative definition is delivery of a fetus with a weight of less than 500 g. If abortion occurs before 12 weeks' gestation, it is called early; from 12 to 20 weeks it is called late." Katz, Vern L. (2007). "16. Spontaneous and Recurrent Abortion - Etiology, Diagnosis, Treatment". In Katz, Vern L.; Lentz, Gretchen M.; Lobo, Rogerio A. et al.. Katz: Comprehensive Gynecology (5 ed.). Mosby. ISBN 9780323029513. 
    • "Abortion is the spontaneous or induced termination of pregnancy before fetal viability. Because popular use of the word abortion implies a deliberate pregnancy termination, some prefer the word miscarriage to refer to spontaneous fetal loss before viability [...] The National Center for Health Statistics, the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) define abortion as pregnancy termination prior to 20 weeks' gestation or a fetus born weighing less than 500 g. Despite this, definitions vary widely according to state laws." Schorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M. et al., eds (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN 978-0-07-147257-9. 
    Major medical dictionaries
    Other medical dictionaries
    • "[T]he termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus". "Medical Dictionary". Merriam-Webster's Medical Dictionary. Springfield, Mass.: Merriam-Webster. Archived from the original on June 15, 2011. http://www.webcitation.org/5zTA1aALZ. Retrieved June 15, 2011. 
    • "Induced termination of pregnancy, involving destruction of the embryo or fetus." "abortion." The American Heritage Science Dictionary. Boston: Houghton Mifflin. 2005. ISBN 9780618455041. 
    • "Interruption of pregnancy before the fetus has attained a stage of viability, usually before the 24th gestational week." "abortion." Cambridge Dictionary of Human Biology and Evolution. Cambridge; New York: Cambridge University Press. 2005. OCLC 54374716. 
    • "[A] spontaneous or deliberate ending of pregnancy before the fetus can be expected to survive." "abortion." Mosby's Emergency Dictionary. Philadelphia: Elsevier Health Sciences. 1998. OCLC 37553784. 
    • "[A] situation where a fetus leaves the uterus before it is fully developed, especially during the first 28 weeks of pregnancy, or a procedure which causes this to happen...[T]o have an abortion to have an operation to make a fetus leave the uterus during the first period of pregnancy." ""abortion"". Dictionary of Medical Terms. London: A & C Black. 2005. OCLC 55634250. 
    • "1. Induced termination of a pregnancy with destruction of the fetus or embryo; therapeutic abortion. 2. Spontaneous abortion." The American Heritage Medical Dictionary (reprint ed.). Houghton Mifflin. 2008. p. 2. ISBN 0618947256. OCLC 608212441. 
    • ”Although the term abortion is generic and implies a premature termination of pregnancy for any reason, the lay public better understands the word ‘miscarriage’ for involuntary fetal loss or fetal wastage.” The Dictionary of Modern Medicine. Parthenon Publishing. 1992. p. 3. ISBN 1850703213. 
    • ”The termination of pregnancy or premature expulsion of the products of conception by any means, usually before fetal viability.” Churchill’s Medical Dictionary. Churchill Livingstone. 1989. p. 3. ISBN 0443086915. 
    Major English dictionaries (general-purpose)
    • "1. a. The expulsion or removal from the womb of a developing embryo or fetus, spec. (Med.) in the period before it is capable of independent survival, occurring as a result either of natural causes (more fully spontaneous abortion) or of a deliberate act (more fully induced abortion); the early or premature termination of pregnancy with loss of the fetus; an instance of this." "abortion, n.". Oxford English Dictionary (Third ed.). Oxford University Press. September 2009; online version September 2011. http://www.oed.com/viewdictionaryentry/Entry/503. 
    • "[A]n operation or other procedure to terminate pregnancy before the fetus is viable" or "[T]he premature termination of pregnancy by spontaneous or induced expulsion of a nonviable fetus from the uterus". "abortion". Collins English Dictionary - Complete & Unabridged 10th Edition. HarperCollins Publishers. http://dictionary.reference.com/browse/abortion. Retrieved June 27, 2011. 
    • "[T]he removal of an embryo or fetus from the uterus in order to end a pregnancy" or "[A]ny of various surgical methods for terminating a pregnancy, especially during the first six months." "abortion". Dictionary.com Unabridged. Random House, Inc.. June 27, 2011. http://dictionary.reference.com/browse/abortion. 
    • "[T]he termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus: as (a) spontaneous expulsion of a human fetus during the first 12 weeks of gestation (b) induced expulsion of a human fetus (c) expulsion of a fetus by a domestic animal often due to infection at any time before completion of pregnancy." Merriam-Webster Dictionary, from Merriam-Webster, an Encyclopedia Brittanica Company.
    • "1. medicine the removal of an embryo or fetus from the uterus before it is sufficiently developed to survive independently, deliberately induced by the use of drugs or by surgical procedures. Also called termination or induced abortion. 2. medicine the spontaneous expulsion of an embryo or fetus from the uterus before it is sufficiently developed to survive independently. Also called miscarriage, spontaneous abortion." Chambers 21st Century Dictionary. London: Chambers Harrap, 2001.
    • "a medical operation to end a pregnancy so that the baby is not born alive". Longman Dictionary of Contemporary English, online edition.
    Other dictionaries
    • "The deliberate termination of a pregnancy, usually before the embryo or fetus is capable of independent life." The American Heritage New Dictionary of Cultural Literacy (3rd ed.). Houghton Mifflin Company. 2005. http://dictionary.reference.com/browse/abortion. 
    • "A term that, in philosophy, theology, and social debates, often means the deliberate termination of pregnancy before the fetus is able to survive outside the uterus. However, participants in these debates sometimes use the term abortion simply to mean the termination of pregnancy before birth, regardless of whether the fetus is viable or not." "abortion." Dictionary of World Philosophy. London: Routledge, 2001.
    • "1. An artificially induced termination of a pregnancy for the purpose of destroying an embryo or fetus. 2. The spontaneous expulsion of an embryo or fetus before viability;" Garner, Bryan A. (June 2009). Black's Law Dictionary (9th ed.). Thomson West. ISBN 9780314199492. 
    Encyclopedias
    • "[T]he expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation)." "Abortion (pregnancy)". Encyclopædia Britannica Online. Encyclopædia Britannica. 2011. Archived from the original on June 26, 2011. http://www.britannica.com/EBchecked/topic/1498/abortion. Retrieved June 26, 2011. 
    • "Expulsion of the products of conception before the embryo or fetus is viable. Any interruption of human pregnancy prior to the 28th week is known as abortion." "Abortion". The Columbia Encyclopedia. New York: Columbia University Press. 2008. 
    • "The expulsion or removal of a fetus from the womb before it is capable of independent survival." "Abortion". World Encyclopedia. Oxford University Press. 2008. 
    • "[Abortion] is commonly misunderstood outside medical circles. In general terms, the word 'abortion' simply means the failure of something to reach fulfilment or maturity. Medically, abortion means loss of the fetus, for any reason, before it is able to survive outside the womb. The term covers accidental or spontaneous ending, or miscarriage, of pregnancy as well as deliberate termination. The terms 'spontaneous abortion' and 'miscarriage' are synonymous and are defined as loss of the fetus before the twenty-eighth week of pregnancy. This definition implies a legal perception of the age at which a fetus can survive out of the womb. With great advances in recent years in the ability to keep very premature babies alive, this definition is in need of revision." "Abortion and miscarriage". The Royal Society of Medicine Health Encyclopedia. London: Bloomsbury Publishing. 2000. 
    • "Abortion is the intentional removal of a fetus or an embryo from a mother's womb for purposes other than that of either producing a live birth or disposing of a dead embryo." "Abortion". Encyclopedia of Human Rights Issues since 1945 (1 ed.). Santa Barbara, California: Routledge. 1999. ISBN 978-1579581664. 
  2. ^ Note that the defining line between miscarriage and premature birth or stillbirth varies among jurisdictions. "Documenting Stillbirth (Fetal Death)" (PDF). United States Department of State. February 18, 2011. Archived from the original on June 27, 2011. http://www.webcitation.org/5zlfxU61B. Retrieved June 27, 2011. 
  3. ^ For example of such studies and why researchers have criticized them, see:
  4. ^ By 1930, medical procedures in the US had improved for both childbirth and abortion but not equally, and induced abortion in the first trimester had become safer than childbirth. In 1973, Roe vs. Wade acknowledged that abortion in the first trimester was safer than childbirth:

External links

Comparison
Behavioral
Avoiding vaginal intercourse: Abstinence • Anal sex • Masturbation • Non-penetrative sex • Oral sex
Including vaginal intercourse: Breastfeeding infertility (LAM) • Calendar-based methods (rhythm, etc.) • Fertility awareness • Withdrawal
Barrier or
spermicidal
Hormonal
(formulations)
Anti-estrogen
Ormeloxifene (Centchroman)
Post-intercourse
Intrauterine device
Abortion
Surgical • Medical (RU-486/abortion pill)
Sterilization
Female: Tubal ligation • Essure
Male: Vasectomy

M: ♀ FRS

anat/phys/devp

noco/cong/npls, sysi/epon

proc/asst, drug (G1/G2B/G3CD)
Substantive human rights
Note: What is considered a human right is controversial and not all the topics listed are universally accepted as human rights.
Civil and political
Economic, social
and cultural
Reproductive
War and conflict
Rights
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Planning
Health
Pregnancy
Medicine
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By country
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