Abortion

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{{Abortion}}

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 [[medicine|medical]], [[surgery|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 [[pregnancy|viability]].<ref>-''[http://www.merriam-webster.com/medical/abortion Merriam Webster’s Online Medical Dictionary]''. Retrieved [[2006-06-26]]. See also ''[http://medical-dictionary.thefreedictionary.com/abortion The Free Dictionary]'' which includes definitions from ''Dorland's Medical Dictionary'' and from ''The American Heritage Stedman's Medical Dictionary''. Retrieved [[2006-06-26]].</ref> Throughout [[History of abortion|history]], abortion has been induced by various methods and the [[Ethical aspects of abortion|moral]] and [[Abortion law|legal]] aspects of abortion are subject to intense [[Abortion debate|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 [[Death by natural causes|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...
*** to save the life of the pregnant woman;<ref name="roche1">Roche, Natalie E. (2004). [http://www.emedicine.com/med/topic3311.htm Therapeutic Abortion]. Retrieved [[2006-03-08]].</ref>
*** to preserve the woman's physical or mental health;<ref name="roche1" />
*** to terminate pregnancy that would result in a child born with a [[congenital disorder]] that would be [[death|fatal]] or associated with significant [[morbidity]];<ref name="roche1" /> or
*** to [[selective reduction|selectively reduce]] the number of [[fetus]]es to lessen health risks associated with [[multiple birth|multiple pregnancy]].<ref name="roche1" />
** ''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 [[abortion law|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.<ref>Henshaw, Stanley K., Singh, Susheela, & Haas, Taylor. (1999). [http://www.guttmacher.org/pubs/journals/25s3099.html The Incidence of Abortion Worldwide]. ''International Family Planning Perspectives, 25 (Supplement)'', 30 – 8. Retrieved [[2006-01-18]].</ref>

===By gestational age and method===
[[Image:UK abortion by gestational age 2004 histogram.svg|thumb|[[Histogram]] of abortions by [[gestational age]] in [[England and Wales]] during 2004. Average is 9.5 weeks.]]

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 abortion|suction-aspiration]], [[Dilation and curettage]], [[Dilation and evacuation]]), 7.7% by "[[medical abortion|medical]]" means ([[mifepristone]]), 0.4% by "[[instillation abortion|intrauterine instillation]]" ([[saline (medicine)|saline]] or [[prostaglandin]]), and 1.0% by "other" (including [[hysterotomy abortion|hysterotomy]] and [[hysterectomy]]).<ref name="cdc2003">Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., & Hamdan, S. (November 24, 2006). [http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm Abortion Surveillance - United States, 2003]. ''Morbidity and Mortality Weekly Report, 55 (11),'' 1-32. Retrieved May 10, 2007.</ref> 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.<ref>Finer, Lawrence B. & Henshaw, Stanley K. (2003). [http://www.guttmacher.org/pubs/journals/3500603.html Abortion Incidence and Services in the United States in 2000]. ''Perspectives on Sexual and Reproductive Health, 35 (1).'' Retrieved [[2006-05-10]].</ref> 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.<ref>{{cite web |author=Department of Health |year=2007 |title=Abortion statistics, England and Wales: 2006 |url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |accessdate=2007-10-12}}</ref>

===By personal and social factors===
[[Image:AGIAbortionReasonsBarChart.png|thumb|left|320px|A [[bar chart]] depicting selected data from the 1998 [[Alan Guttmacher Institute|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 [[childbirth|childbearing]], concern over the interruption of [[employment|work]] or [[education]], issues of financial or relationship stability, and perceived immaturity.<ref name="bankole98">Bankole, Akinrinola, Singh, Susheela, & Haas, Taylor. (1998). [http://www.guttmacher.org/pubs/journals/2411798.html Reasons Why Women Have Induced Abortions: Evidence from 27 Countries]. ''International Family Planning Perspectives, 24 (3)'', 117-127 & 152. Retrieved [[2006-01-18]].</ref> A 2004 study in which [[United States|American]] women at [[abortion clinic|clinics]] answered a [[questionnaire]] yielded similar results.<ref name="finer2005">Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Shusheela, & Moore, Ann M. (2005). [http://www.guttmacher.org/pubs/journals/3711005.pdf Reasons U.S. women have abortions: quantative and qualitative perspectives]. ''Perspectives on Sexual and Reproductive Health, 37 (3),'' 110-8. Retrieved [[2006-01-18]].</ref> 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.<ref name="bankole98" /> 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]].<ref name="finer2005"/> Another American study in 2002 concluded that 54% of women who had an abortion were using a form of [[birth control|contraception]] at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using [[condom]]s and 76% of those using the [[combined oral contraceptive pill]]; 42% of those using condoms reported failure through slipping or breakage.<ref>Jones, Rachel K., Darroch, Jacqueline E., Henshaw, Stanley K. (2002). [http://www.guttmacher.org/pubs/journals/3429402.pdf Contraceptive Use Among U.S. Women Having Abortions in 2000-2001]. ''Perspectives on Sexual and Reproductive Health, 34 (6).'' Retrieved [[June 15]], [[2006]].</ref> 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.<ref>Wellings, K., ''et al.'' (1994). ''Sexual Behaviour in Britain: The National Survey of Sexual Attitudes and Lifestyles.'' London, UK: Penguin Books.</ref>

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 parent|single motherhood]], insufficient economic support for [[family|families]], lack of access to or rejection of contraceptive methods, or efforts toward [[population control]] (such as [[People's Republic of China|China's]] [[one-child policy]]). These factors can sometimes result in compulsory abortion or [[sex-selective abortion]].

===Unsafe abortion (legal)===
In many areas, especially in [[developing country|developing nations]] or where abortion is illegal, women sometimes resort to "back-alley" or [[self-induced abortion|self-induced]] procedures. The [[World Health Organization]] suggests that there are 19 million terminations annually which fit its criteria for an [[Abortion#Unsafe abortion|unsafe abortion]].<ref name="whounsafe">World Health Organization. (2004). [http://www.who.int/reproductive-health/publications/unsafe_abortion_estimates_04/estimates.pdf Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000]. Retrieved [[2006-01-12]].</ref> See [[Abortion#Social issues|social issues]] for more information on these subjects.

==Forms of abortion==
===Spontaneous abortion===
{{main|Miscarriage}}


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 birth|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 [[childbirth|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.<ref>"[http://wuphysicians.wustl.edu/dept.asp?pageID=8&ID=35 Reproductive Endocrinology and Infertility: Recurrent Pregnancy Loss (Recurrent Miscarriage)]." (n.d.) Retrieved [[2006-01-18]] from Washington University School of Medicine, Department of Obstetrics and Gynecology web site.</ref> 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.<ref> -[http://news.bbc.co.uk/2/hi/health/2176898.stm Q&A: Miscarriage]. (August 6 , 2002). ''BBC News.'' Retrieved January 10, 2007. - [[Lennart Nilsson]]. (1990) ''A Child is Born.'' </ref> 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 [[Physical trauma|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 [[embryo]] or [[fetus]], in addition to the legality, regional availability, and doctor-patient preference for specific procedures.

==== Surgical abortion ====
[[Image:Abortionmethods.png|thumb|380px|right|[[Gestational age]] may determine which abortion methods are practiced.]]
In the first 12 weeks, [[suction-aspiration abortion|suction-aspiration]] or vacuum abortion is the most common method.<ref>Healthwise. [http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 Manual and vacuum aspiration for abortion]. (2004). ''WebMD.'' Retrieved [[2006-08-19]].</ref> ''Manual [[Vacuum aspiration]]'' (MVA) abortion, consists of removing the [[fetus]] or [[embryo]] 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) 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.<ref>World Health Organization. (2003). [http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html Managing complications in pregnancy and childbirth: a guide for midwives and doctors]. Retrieved [[2006-08-19]].</ref> 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 sac|amniotic fluid]] with caustic solutions containing [[saline (medicine)|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 [[Partial-Birth Abortion Ban Act|federally banned]] in the United States. A [[hysterotomy abortion]] is a procedure similar to a [[caesarean section]], and is performed under [[general anesthesia]] because it is considered major abdominal surgery. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.<ref name="encarta">[http://encarta.msn.com/encyclopedia_761553899/Abortion.html#s3 Abortion]. (2007). ''MSN Encarta.'' Retrieved July 1, 2007.</ref>

From the 20th to 23rd week of gestation, an [[medical injection|injection]] to stop the fetal [[heart]] can be used as the first phase of the surgical abortion procedure.<ref>-Vause S, Sands J, Johnston TA, Russell S, Rimmer S. (2002). PMID 12521492 Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? J Obstet Gynaecol. 2002 May;22(3):243-5. Retrieved [[2006-03-17]]. -Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y. (2003). PMID 12576743 Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals. Fetal Diagn Ther. 2003 Mar-Apr;18(2):91-7. Retrieved [[2006-03-17]]. -Bhide A, Sairam S, Hollis B, Thilaganathan B. (2002). PMID 12230443 Comparison of feticide carried out by cordocentesis versus cardiac puncture. Ultrasound Obstet Gynecol. 2002 Sep;20(3):230-2. Retrieved [[2006-03-17]]. -Senat MV, Fischer C, Bernard JP, Ville Y. (2003). PMID 12628271 The use of lidocaine for fetocide in late termination of pregnancy. BJOG. 2003 Mar;110(3):296-300. Retrieved [[2006-03-17]]. - MV, Fischer C, Ville Y. (2002). PMID 12001185 Funipuncture for fetocide in late termination of pregnancy. Prenat Diagn. 2002 May;22(5):354-6. Retrieved [[2006-03-17]].</ref>

====Medical abortion====
{{main|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.<ref>{{cite journal|author=Spitz, I.M. et al|title=Early pregnancy termination with mifepristone and misoprostol in the United States|journal=New England Journal of Medicine|year=1998|volume=338|issue=18|id=PMID 9562577}}</ref> 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====
[[Image:Angkordemon.jpg|thumb|left|240px|[[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 [[herb]]s reputed to possess [[abortifacient]] properties have been used in [[folk medicine]]: [[tansy]], [[pennyroyal]], [[black cohosh]], and the now-extinct [[silphium]] (see [[Abortion#History of abortion|history of abortion]]).<ref name="riddle2">Riddle, John M. (1997). ''Eve's Herbs: A History of Contraception and Abortion in the West.'' Cambridge, MA: Harvard University Press.</ref> The use of herbs in such a manner can cause serious — even lethal — side effects, such as [[multiple organ dysfunction syndrome|multiple organ failure]], and is not recommended by [[physician]]s.<ref>Ciganda, C., & Laborde, A. (2003). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12807304&query_hl=9 Herbal infusions used for induced abortion]. ''J Toxicol Clin Toxicol, 41(3),'' 235-9. Retrieved [[2006-01-25]].</ref>

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]].<ref>Education for Choice. ([[2005-05-06]]). [http://www.efc.org.uk/Foryoungpeople/Factsaboutabortion/Unsafeabortion Unsafe abortion]. Retrieved [[2006-01-11]].</ref> Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In [[Myanmar|Burma]], [[Indonesia]], [[Malaysia]], the [[Philippines]], and [[Thailand]], there is an ancient tradition of attempting abortion through forceful abdominal [[massage]].<ref name="potts">Potts, Malcolm, & Campbell, Martha. (2002). [http://big.berkeley.edu/ifplp.history.pdf History of contraception]. ''Gynecology and Obstetrics'', vol. 6, chp. 8. Retrieved [[2005-01-25]].</ref>

Reported methods of unsafe, [[self-induced abortion]] include misuse of [[misoprostol]], and insertion of non-surgical implements such as [[knitting needle]]s and [[clothes hanger]]s into the [[uterus]]. These methods are rarely seen in developed countries where surgical abortion is legal and available.<ref>Thapa, S.R., Rimal, D., & Preston, J. (2006). Self induction of abortion with instrumentation. ''Aust Fam Physician'' 35(9), pp 697-698.</ref>
{{clr}}

==Health considerations==

Early-term surgical abortion is a simple procedure which is safer than [[childbirth]] when performed before the 16th week.<ref>Henshaw, Stanley K. "Induced Abortion: A World Review, 1990" ''International Family Planning Perspectives'' 23:246-252, 1991.</ref><ref name="grimes">Grimes, D.A. (1994). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8178896&dopt=Abstract The morbidity and mortality of pregnancy: still risky business]. ''American Journal of Obstetrics and Gynecology, 170 (5 Pt 2)'', 1489-94. Retrieved [[December 21]], [[2006]].</ref> Abortion methods, like most [[minimally invasive procedure]]s, carry a small potential for serious complications.<ref>WHO Health Organization. Medical Methods for termination of pregnancy. WHO Technical Report Series 871, 1997</ref><ref>{{cite web | publisher=eMedicine | title = Abortion, Complications | url=http://www.emedicine.com/emerg/topic4.htm | accessdate=2007-06-30}}</ref> The risk of complications can increase depending on how far [[pregnancy]] has progressed.<ref name="pauli">Pauli, E., Haller, U., Zimmermann, R. (2005).
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15818053&query_hl=102&itool=pubmed_docsum Morbidity of dilatation and evacuation in the second trimester: an analysis]. ''Gynakol Geburtshilfliche Rundsch, 45 (2)'', 107-15. Retrieved [[December 26]], [[2006]].</ref><ref name="bartley">Bartley, J., Tong, S., Everington, D.,& Baird, D.T. (2000). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11239616&query_hl=86&itool=pubmed_DocSum Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases...]. ''Contraception, 62(6)'', 297-303. Retrieved [[December 26]], [[2006]].</ref>

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 [[Society|societies]] and among different [[socio-economic]] groups, a lack of uniform [[definition]]s 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 (medicine)|parity]];<ref name="bartley" /> [[gestational age]];<ref name="bartley" /><ref name="pauli" /> pre-existing conditions; methods and instruments used; [[medication]]s 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.<ref>Department of Health. (1998). ''[http://www.archive.official-documents.co.uk/document/doh/wmd/wmd-hm.htm Why Mothers Die: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994 – 1996].'' London: The Stationery Office. Retrieved [[2006-01-11]].</ref> 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.<ref>Elam-Evans, Laurie. D., Strauss, Lilo T., Herndon, Joy, Parker, Wilda Y., Bowens, Sonya V., Zane, Suzanne, ''et al.'' Centers for Disease Control and Prevention. ([[2003-11-23]]). ''[http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5212a1.htm Abortion Surveillance - United States, 2000].'' Morbidity and Mortality Weekly Report. Retrieved [[2006-01-11]].</ref><ref>Centers for Disease Control and Prevention. ([[2003-02-20]]). [http://www.cdc.gov/od/oc/media/pressrel/fs030220.htm Fact Sheet: Pregnancy-Related Mortality Surveillance - United States, 1991-1999]. Retrieved [[2006-04-02]].</ref>

===Pain management===
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.<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=443287&dopt=AbstractPlus Phillip G. Stubblefield, M.D., et al, "Pain of first-trimester abortion: Its quantification and relations with other variables," American Journal of Obstetrics and Gynecology, Vol. 133, No. 5 (March 1, 1979)]</ref> In a 1991 study of 35 women aged 18 to 40, 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.<ref>[http://pubhealth.info/abortion/ab1/rPage4116.html Wells N. “Pain and distress during abortion,” Health Care for Women International. 1991 Jul-Sep;12(3):293-302.]</ref>

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.

===Failed abortion===
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.<ref name=Rogers>Rogers, Lois. ([[2005-11-27]]). "[http://www.timesonline.co.uk/article/0,,2087-1892696,00.html Fifty babies a year are alive after abortion]." ''The Sunday Times.'' Retrieved [[2006-01-11]].</ref>

===Unsafe abortion (health)===
[[#unsafe abortion|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 [[physician]]s.

===Suggested effects===
There is controversy over a number of proposed risks and effects of abortion. Arguments, whether in support of or against such claims, may be influenced by the political and ideological beliefs of the parties behind it.

====Breast cancer hypothesis====
{{main|Abortion-breast cancer hypothesis}}
The abortion-breast cancer (ABC) hypothesis (also referred to by supporters as the "abortion-breast cancer link") is a rejected hypothesis that posits a [[causality|causal relationship]] between induced abortion and an increased risk of developing [[breast cancer]].<ref>Simon, Stephanie. (2002, March 24). "Abortion Foes Seize on Reports of Cancer Link in Ad Campaign." Los Angeles Times</ref><ref>Tang, Mei-Tzu, et al. (2000). "Induced Abortion in Relation to Breast Cancer among Parous Women: A Birth Certificate Registry Study." Epidemiology, 11, 177-80.</ref><ref>Westhoff, Carolyn. (1997). "Abortion and Breast Cancer: Good Data at Last." IPPF Medical Bulletin. 31(2), 1-2.</ref><ref>Willett, W.C., et al. (1987). "Moderate Alcohol Consumption and the Risk of Breast Cancer." New England Journal of Medicine, 316(19), 1174-80.</ref><ref>Wingo, Phyllis A., et al. (1997). "The Risk of Breast Cancer Following Spontaneous or Induced Abortion." Cancer Causes and Control, 8, 93-108.</ref><ref>WHO — World Health Organization. (2000, June, accessed 2002, May 21). Induced Abortion Does Not Increase the Risk of Breast Cancer. [Online]. http://www.who.int/inf-fs/en/fact240.html</ref> In early [[pregnancy]], levels of [[estrogen]] increase, leading to [[breast]] growth in preparation for [[lactation]]. The hypothesis proposed that if this process is interrupted by an abortion – before full maturity in the third [[trimester]] – then more relatively vulnerable immature cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. While early research suggested the possibility of a correlative relationship between breast cancer and abortion, the causal hypothesis was proposed based on a reinterpretation of [[rat]] studies conducted in the 1980s.<ref name="RUSSO">{{cite journal |author=Russo J, Russo I |title=Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence |journal=Am J Pathol |volume=100 |issue=2 |pages=497-512 |year=1980 |pmid=6773421}}</ref><ref name="RUSSO2">{{cite journal |author=Russo J, Tay L, Russo I |title=Differentiation of the mammary gland and susceptibility to carcinogenesis |journal=Breast Cancer Res Treat |volume=2 |issue=1 |pages=5-73 |year=1982 |pmid=6216933}}</ref><ref name="RUSSO3">{{cite journal |author=Russo J, Russo I |title=Biological and molecular bases of mammary carcinogenesis |journal=Lab Invest |volume=57 |issue=2 |pages=112-37 |year=1987 |pmid=3302534}}</ref> Though the link has been rejected by the scientific community and abortion is not considered a breast cancer risk by any major cancer organization,<ref name="PP">{{cite web |url=http://www.plannedparenthood.org/news-articles-press/politics-policy-issues/abortion-access/breast-cancer-5095.htm |title=Planned Parenthood - Anti-Choice Claims About Abortion and Breast Cancer |accessdate=2007-11-04 |format= |work=plannedparenthood.org}}</ref> it continues to be championed by pro-life activists like Dr. Joel Brind, Dr. Angela Lanfranchi and Dr. Karen Malec.

A large [[Epidemiology|epidemiological]] study by Mads Melbye ''et al.'' in 1997, with data from two national [[civil registry|registries]] in [[Denmark]], reported the correlation to be negligible to non-existent after [[statistical hypothesis testing|statistical adjustment]].<ref name="MELBYE">{{cite journal |author=Melbye M, Wohlfahrt J, Olsen J, Frisch M, Westergaard T, Helweg-Larsen K, Andersen P |title=Induced abortion and the risk of breast cancer |journal=N Engl J Med |volume=336 |issue=2 |pages=81-5 |year=1997 |pmid=8988884}}</ref> The [[National Cancer Institute]] conducted a workshop with over 100 experts on the issue in February 2003, which determined from selected evidence that it was well-established that there was no correlative relationship between abortion and breast cancer, effectively refuting the causality hypothesis.<ref name="NCI">{{cite web |url=http://www.cancer.gov/cancerinfo/ere-workshop-report |title=Summary Report: Early Reproductive Events Workshop - National Cancer Institute |accessdate=2007-11-04 |format= |work=cancer.gov}}</ref> In 2004, Beral ''et al.'' published a [[meta-analysis|collaborative reanalysis]] of 53 epidemiological studies and concluded that abortion does "not increase a woman's risk of developing breast cancer."<ref name="BERAL">{{cite journal |author=Beral V, Bull D, Doll R, Peto R, Reeves G |title=Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries |journal=Lancet |volume=363 |issue=9414 |pages=1007-16 |year=2004 |pmid=15051280}}</ref>

Though the hypothesis has been largely rejected, the ongoing promotion of the abortion-breast cancer hypothesis by [[pro-life]] advocates is seen by some as a part of the current pro-life "women-centered" strategy against abortion.<ref name="ARTHUR">{{cite web |url=http://www.prochoiceactionnetwork-canada.org/articles/abclink.shtml |title=THE PRO-CHOICE ACTION NETWORK |accessdate=2007-11-04 |format= |work=prochoiceactionnetwork-canada.org}}</ref><ref name="MOONEY">{{cite web |url=http://www.washingtonmonthly.com/features/2004/0410.mooney.html |title="Research and Destroy" by Chris Mooney |accessdate=2007-10-01 |format= |work=}}</ref> In the past, pro-life advocates have sought legal action regarding disclosure of the abortion-breast cancer issue. While suits brought short-term legal intervention, the scientific community responded in the form of the 2003 NCI consensus workshop. The current [[scientific consensus]] that abortion does not increase the risk of breast cancer has solidified with the publication of large [[prospective study|prospective]] [[cohort study|cohort studies]] which find no significant association between abortion and breast cancer.<ref name="ACS">{{cite web |url=http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp |title=ACS :: What Are the Risk Factors for Breast Cancer? |accessdate=2007-11-04 |format= |work=cancer.org}}</ref><ref name="Michels">{{cite journal |author=Michels KB, Xue F, Colditz GA, Willett WC |title=Induced and spontaneous abortion and incidence of breast cancer among young women: a prospective cohort study |journal=Arch. Intern. Med. |volume=167 |issue=8 |pages=814–20 |year=2007 |pmid=17452545 |doi=10.1001/archinte.167.8.814}}</ref> Nevertheless, the subject continues to be one of mostly [[Abortion-breast_cancer_hypothesis#Politicization|political]] but some scientific debate.<ref name="JASEN">{{cite journal |author=Jasen P |title=Breast cancer and the politics of abortion in the United States |journal=Med Hist |volume=49 |issue=4 |pages=423-44 |year=2005 |pmid=16562329}}</ref><ref name="HOWE">{{cite journal | author = Howe H, Senie R, Bzduch H, Herzfeld P | title = Early abortion and breast cancer risk among women under age 40. | journal = Int J Epidemiol | volume = 18 | issue = 2 | pages = 300-4 | year = 1989 | id = PMID 2767842}}</ref>

====Mental health====
{{Main|Post-abortion syndrome|Mental health}}
'''Post-abortion syndrome''' (PAS), '''post-traumatic abortion syndrome''' and '''abortion trauma syndrome''', are terms used to describe a set of adverse [[Psychopathology|psychopathological]] characteristics which are proposed to occur in women following an induced abortion.<ref name=Gomez>Gomez, Lavin C & Zapata, Garcia R.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15999304&dopt=Abstract "Diagnostic categorization of post-abortion syndrome"], ''Actas Esp Psiquiatr''. 2005 Jul-Aug;33(4):267-72.</ref> Primarily a term used by [[pro-life]] advocates,<ref>Chris Mooney[http://www.washingtonmonthly.com/features/2004/0410.mooney.html "Research and Destroy"] Washington Monthly, October 2004</ref><ref>Bazelon, Emily. ''The New York Times Magazine''. [http://www.nytimes.com/2007/01/21/magazine/21abortion.t.html?pagewanted=2&ei=5088&en=5092fc3344065aec&ex=1327035600&adxnnl=0&partner=rssnyt&emc=rss&adxnnlx=1190370959-M3NVF8bZOGTDu468IEZo8g Is There a Post-Abortion Syndrome?]</ref><ref name="BostonG">[http://www.boston.com/news/nation/washington/articles/2005/07/31/science_in_support_of_a_cause_the_new_research/?rss_id=Boston+Globe+--+National+News Science in support of a cause: the new research], by Michael Kranish. Published in the ''[[Boston Globe]]'' on [[July 31]] [[2005]]; accessed [[November 27]] [[2007]].</ref> PAS is not a medically recognized syndrome,<ref>{{cite journal |author=Grimes DA, Creinin MD |title=Induced abortion: an overview for internists |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=620–6 |year=2004 |pmid=15096333 |doi=}} Key summary points of article state that ''"Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae."'' On p. 624, the authors state: ''"The alleged 'postabortion trauma syndrome' does not exist."''</ref> and neither the [[American Psychological Association]] nor [[American Psychiatric Association]] recognize it. Some physicians and [[pro-choice]] advocates have argued that PAS is a myth created by [[pro-life|opponents of abortion]] for political purposes.<ref name=stotland_1404747>Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.</ref><ref>Cooper, Cynthia L. [http://www.msmagazine.com/aug01/pas.html Abortion Under Attack]</ref>

A number of studies have concluded that abortion has positive or neutral effects on women. Others have found a correlation between clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions and abortion. Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortions, may increase the likelihood of experiencing such feelings. No studies have established a [[association (statistics)|causal relationship]] between abortion and negative psychological symptoms experienced by women.<ref>American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.</ref>

[[Miscarriage]], or spontaneous abortion, is known to present an increased risk of depression.<ref>''[http://www.chmeds.ac.nz/research/chds/view1.pdf Depression Risk Increased After Miscarriage].'' ([[2002-04-01]]). Retrieved [[2006-01-11]].</ref> [[Childbirth]] can also sometimes result in [[maternity blues]] or [[postpartum depression]].

==History of abortion==
[[Image:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|right|140px|"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the ''Boston Daily Times''.]]
{{main|History of abortion}}
Induced abortion can be traced to ancient times.<ref name="devereux">Devereux, G. (1967). [http://db.jhuccp.org/ics-wpd/exec/icswppro.dll?AC=GET_RECORD&XC=/ics-wpd/exec/icswppro.dll&BU=http%3A%2F%2Fdb.jhuccp.org%2Fics-wpd%2Fpopweb%2F&TN=popline&SN=AUTO32204&SE=1493&RN=24&MR=50&TR=0&TX=0&ES=0&CS=1&XP=&RF=ShortRecordDisplay&EF=&DF=LongRecordDisplay&RL=1&EL=0&DL=1&NP=0&ID=&MF=&MQ=&TI=0&DT=&ST=0&IR=77430&NR=0&NB=0&SV=0&BG=&FG=&QS=&OEX=ISO-8859-1&OEH=ISO-8859-1 A typological study of abortion in 350 primitive, ancient, and pre-industrial societies]. Retrieved [[April 22]], [[2006]]. In ''Abortion in America: medical, psychiatric, legal, anthropological, and religious considerations.'' Boston: Beacon Press. Retrieved [[April 22]], [[2006]].</ref> 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 (Greek Physician)|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]].<ref>Lefkowitz, Mary R. & Fant, Maureen R. (1992). ''[http://www.stoa.org/diotima/anthology/wlgr/ Women's life in Greece & Rome: a source book in translation].'' Baltimore, MD: Johns Hopkins University Press. Retrieved [[2006-01-11]].</ref> 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 [[poison]]ous [[herbs]] with serious [[Adverse effect (medicine)|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.<ref>''[http://users.telerama.com/~jdehullu/abortion/abhist.htm Histories of Abortion].'' (n.d.) Retrieved [[2006-01-11]].</ref>

==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===
{{Main|Legalized abortion and crime effect}}

A theory attempts to draw a [[correlation]] between the United States' unprecedented nationwide decline of the overall [[crime rate]] during the 1990s and the decriminalization of abortion 20 years prior.

The suggestion was brought to widespread attention by a 1999 [[academic paper]], ''[[The Impact of Legalized Abortion on Crime]]'', authored by the [[economist]]s [[Steven Levitt|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]], [[poverty|impoverished]], [[teenage pregnancy|adolescent]], [[education|uneducated]], and [[single parent|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.<ref>Donohue, John J. and Levitt, Steven D. (2001). [http://ssrn.com/abstract=174508 The impact of legalized abortion on crime].''Quarterly Journal of Economics'' Retrieved [[2006-02-11]]. </ref>

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.<ref>Foote, Christopher L. and Goetz, Christopher F. (2005). [http://www.bos.frb.org/economic/wp/wp2005/wp0515.pdf Testing economic hypotheses with state-level data: a comment on Donohue and Levitt (2001)]. ''Working Papers, 05-15''. Retrieved [[2006-02-11]].</ref> 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.<ref>Donohue, John J. and Levitt, Steven D. (2006). Measurement error, legalized abortion, and the decline in crime: a response to Foote and Goetz (2005). Retrieved [[2006-02-17]], from University of Chicago, Initiative on Chicago Price Theory web site: [http://pricetheory.uchicago.edu/levitt/Papers/ResponseToFooteGoetz2006.pdf ResponseToFooteGoetz2006.pdf].</ref>

Such research has been criticized by some as being [[utilitarian]], [[discrimination|discriminatory]] as to [[race]] and [[social class|socioeconomic class]], and as promoting [[eugenic]]s as a solution to [[crime]].<ref>"Crime-Abortion Study Continues to Draw Pro-life Backlash." ([[1999-08-11]]). ''The Pro-Life Infonet.'' Retrieved [[2006-02-17]] from [http://ohioroundtable.org/library/articles/life/crimeabortion.html Ohio Roundtable Online Library].</ref><ref>"[http://www.americancatholic.org/Messenger/Jan2000/Editorial.asp Abortion and the Lower Crime Rate]." (2000, January). ''St. Anthony Messenger.'' Retrieved [[2006-02-17]].</ref> Levitt states in his book ''[[Freakonomics]]'' that they are neither promoting nor negating any course of action — merely reporting data as economists.

===Fetal pain debate===
{{Citecheck|date=December 2007}}
{{main|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 and nociception|pain]] sometime in the first [[trimester]],<ref>{{cite press release | title = Open Letter to President Reagan | publisher = Schmidt, Dr. Richard T. F., et al.|date = 1984-02-13|url = http://www.mpomerle.com/NoAbort/Reagan_Fetal_Pain.shtml| accessdate = 2006-11-18 }}</ref><ref name="AboPain">Robinson, B.A. (2006). [http://www.religioustolerance.org/abo_pain.htm Can a fetus feel pain?]. ''Ontario Consultants for Religious Tolerance.'' Retrieved December 14, 2005.</ref> and medical researchers, notably from the [[American Medical Association]], maintaining that the [[neuroanatomy|neuro-anatomical]] requirements for such experience do not exist until the 29th week of gestation.<ref>BBC News Article (2005). "[http://news.bbc.co.uk/1/hi/health/4180592.stm Foetuses 'no pain up to 29 weeks']." Retrieved [[2006-07-18]].</ref>

[[Nociceptors|Pain receptors]] begin to appear in the seventh week of gestation.<ref name="AboPain"/><ref>Myers, Laura B. (2003). [http://www.pedsanesthesia.org/meetings/2003jspa/pdfs/manuscript2.pdf Fetal Surgery: The Anathesia Perspective]. Retrieved March 14, 2007.</ref> 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.<ref name="fetalaware">Parliamentary Office of Science and Technology. (1997). ''[http://www.parliament.uk/post/pn094.pdf Fetal Awareness].'' Retrieved [[2006-01-11]].</ref> However, other anatomical structures involved in the [[Pain and nociception|nociceptive]] process are not present until much later in [[gestation]]. Links between the thalamus and cerebral cortex form around the 23rd week.<ref name="fetalaware" /> There has been suggestion that a fetus cannot feel pain at all, under the premise that it requires mental development that only occurs outside the uterus.<ref>BBC News Article (2006). "[http://news.bbc.co.uk/1/hi/health/4905892.stm Foetuses 'cannot experience pain']." Retrieved [[2006-07-18]].</ref>

Researchers have observed changes in heart rates and [[hormones|hormonal levels]] of newborn [[infants]] after [[circumcision]], [[blood tests]], and surgery — effects which were alleviated with the administration of [[anesthesia]].<ref>Anand, K., Phil, D., & Hickey, P.R. (1987). Pain and its effects on the human neonate and fetus. ''New England Journal of Medicine, 316 (21),'' 1321-9. Retrieved [[2006-01-11]] from [http://www.cirp.org/library/pain/anand/ The Circumcision Reference Library].</ref> Others suggest that the human experience of pain, being more than just [[physiology|physiological]], cannot be measured in such reflexive responses.<ref>Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). [http://jama.ama-assn.org/cgi/content/short/294/8/947 Fetal Pain: A Systematic Multidisciplinary Review of the Evidence]. ''Journal of the American Medical Association, 294 (8)'', 947-954. Retrieved [[November 10]], [[2006]]. </ref>

===Sex-selective abortion===
{{Main|Sex-selective abortion and infanticide}}

The advent of both [[Medical ultrasonography|sonography]] and [[amniocentesis]] has allowed parents to determine [[sex]] before [[childbirth|birth]]. This has led to the occurrence of [[sex-selective abortion and infanticide|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 rate]]s 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]], [[Republic of China|Taiwan]], [[South Korea]], and [[India]].<ref>Banister, Judith. ([[1999-03-16]]). [http://www.census.gov/ipc/www/ebspr96a.html Son Preference in Asia - Report of a Symposium]. Retrieved [[2006-01-12]].</ref>

In [[India]], the [[economic]] role of men, the costs associated with [[dowry|dowries]], and a [[Hindu]] tradition which dictates that [[funeral|funeral rites]] must be performed by a male relative have led to a [[culture|cultural]] preference for [[son]]s.<ref>Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, & Roy, T.K. (1997). [http://www2.eastwestcenter.org/pop/misc/subj-3.pdf Son Preferences and Its Effect on Fertility in India]. ''National Family Health Survey Subject Reports, Number 3.'' Retrieved [[2006-01-12]].</ref> The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 [[rupee]]s [for a sex test] now, save 50,000 rupees [for a dowry] later."<ref>Patel, Rita. (1996). The practice of sex selective abortion in India: may you be the mother of a hundred sons. Retrieved [[2006-01-11]], from University of North Carolina, University Center for International Studies web site: [http://www.ucis.unc.edu/resources/pubs/carolina/abortion.pdf abortion.pdf].</ref> 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.<ref>Sudha, S., & Irudaya Rajan, S. (1999). [http://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html Female Demographic Disadvantage in India 1981-1991: Sex Selective Abortion, Female Infanticide and Excess Female Child Mortality]. Retrieved [[2006-01-12]] </ref> Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.<ref>Reaney, Patricia. ([[2006-01-09]]). "[http://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm Selective abortion blamed for India's missing girls]." ''Reuters AlertNet.'' Retrieved [[2006-01-09]].</ref> 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.<ref>Mudur, Ganapati. (2002). "[http://bmj.bmjjournals.com/cgi/content/abridged/324/7334/385/b India plans new legislation to prevent sex selection]." ''British Medical Journal: News Roundup.'' Retrieved [[2006-01-12]].</ref>

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.<ref>Graham, Maureen J., Larsen, Ulla, & Xu, Xiping. (1998). [http://www.agi-usa.org/pubs/journals/2407298.html Son Preference in Anhui Province, China]. ''International Family Planning Perspectives, 24 (2).'' Retrieved [[2006-01-12]].</ref> 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]].<ref>Plafker, Ted. ([[2002-05-25]]). [http://bmj.bmjjournals.com/cgi/content/full/324/7348/1233/a?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext Sex selection in China sees 117 boys born for every 100 girls]. ''British Medical Journal: News Roundup.'' Retrieved [[2006-01-12]].</ref> A ban upon the practice of sex-selective abortion was enacted in 2003.<ref>"[http://www.china.org.cn/english/2003/Mar/59194.htm China Bans Sex-selection Abortion]." ([[2002-03-22]]). ''Xinhua News Agency.'' Retrieved [[2006-01-12]].</ref>

===Unsafe abortion (social)===
[[Image:RussianAbortionPoster.jpg|thumb|240px|left|[[Soviet Union|Soviet]] [[Propaganda|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."]]
{{main|Unsafe abortion}}
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]] (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."<ref name="whounsafe" /> This can include a person without medical training, a professional health provider operating in sub-standard conditions, or [[self-induced abortion|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.<ref name="whounsafe" /> Complications of unsafe abortion are said to account, globally, for approximately 13% of all [[maternal death|maternal mortalities]], with regional estimates including 12% in Asia, 25% in [[Latin America]], and 13% in [[sub-Saharan Africa]].<ref>Salter, C., Johnson, H.B., and Hengen, N. (1997). [http://www.infoforhealth.org/pr/l10edsum.shtml Care for postabortion complications: saving women's lives]. ''Population Reports, 25 (1).'' Retrieved [[2006-02-22]].</ref> 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.<ref>Sedgh, G., Henshaw, S., Singh, S., Åhman, E., & Shah, I.H. (2007). [http://www.thelancet.com/journals/lancet/article/PIIS014067360761575X/fulltext Induced abortion: estimated rates and trends worldwide]. ''The Lancet, 370 (9595)'', 1338-1345. Retrieved October 31, 2007.</ref> [[Health education]], access to [[family planning]], and improvements in [[health care]] during and after abortion have been proposed to address this phenomenon.<ref>World Health Organization. (1998). [http://www.who.int/docstore/world-health-day/en/pages1998/whd98_10.html Address Unsafe Abortion]. Retrieved [[2006-03-01]].</ref>

==Abortion debate==
[[Image:March for Women's Lives detail.jpg|thumb|right|240px||Pro-choice activists near the [[Washington Monument]] at the [[March for Women's Lives]].]]
[[Image:Pro-life protest.jpg|thumb|right|240px||Pro-life activists at the [[March for Life]] in 2002. The rally is held annually in [[Washington, DC]].]]
{{main|Abortion debate|Pro-choice|Pro-life}}
Over the course of the [[history of abortion]], induced abortion has been the source of considerable [[debate]], [[controversy]], and [[activism]]. An [[opinion|individual's position]] on the complex [[ethical]], [[moral]], [[philosophical]], [[Biology|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 [[government]]al [[authority|authorities]] in [[public policy]]. [[religion|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 law]]s, are often spearheaded by [[advocacy|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 [[pregnancy|pregnant]] woman should have to notify and/or have the [[consent]] of others in distinct cases: a [[minor (law)|minor]], her parents; a [[marriage|legally-married]] or [[common-law marriage|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.<ref>The Pew Research Center for the People and the Press. ([[2005-11-02]]). "[http://people-press.org/commentary/display.php3?AnalysisID=122 Public Opinion Supports Alito on Spousal Notification Even as It Favors Roe v. Wade]." ''Pew Research Center Pollwatch.'' Retrieved [[2006-03-01]].</ref>

===Public opinion===
{{Main|Societal attitudes towards abortion}}

A number of [[opinion poll]]s 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 [[Europe]]an 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]].<ref>TNS Sofres. (May 2005). [http://www.thebrusselsconnection.be/tbc/upload/attachments/European%20Values%20Overall%20EN.pdf European Values]. Retrieved January 11, 2007.</ref>

In [[North America]], a December 2001 poll surveyed [[Abortion in Canada#Opinion polls|Canadian opinion on abortion]], asking [[Canada|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 [[Abortion in the United States#Public Opinion|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.<ref>''[http://www.pollingreport.com/abortion.htm The Polling Report].'' (2006). Retrieved [[2006-01-11]].</ref> A November 2005 poll in [[Mexico]] found that 73.4% think abortion should not be legalized while 11.2% think it should.<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/10042 Mexicans Support Status Quo on Social Issues]." (December 1, 2005). ''Angus Reid Global Monitor.'' Retrieved January 10, 2006.</ref>

Of attitudes in [[South America|South]] and [[Central America]], a December 2003 survey found that 30% of [[Argentina|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".<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/2029 Argentines Assess Abortion Changes]." (Mar. 4, 2004). ''Angus Reid Global Monitor''. Retrieved January 10, 2006.</ref> A March 2007 poll regarding the [[Abortion in Brazil|abortion law in Brazil]] found that 65% of [[Brazil]]ians 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".<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/15370 Brazilians Want to Keep Abortion as Crime]." (April 12, 2007). ''Angus Reid Global Monitor''. Retrieved June 20, 2007.</ref> 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.<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/8333 Colombians Reject Legalizing Abortion]. (August 2, 2005). ''Angus Reid Global Monitor''. Retrieved January 10, 2006.</ref>

==Abortion law==
{{main|Abortion law|History of abortion law}}
[[Image:AbortionLawsMap.png|thumb|300px|right|International status of abortion law ([[:Image:AbortionLawsMap.png|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.<ref>[http://members.aol.com/abtrbng/lea.htm Lord Ellenborough’s Act]." (1998). ''The Abortion Law Homepage.'' Retrieved February 20, 2007.</ref> In 1861, the [[British Parliament]] passed the ''[[Offences Against The Person Act 1861|Offences Against the Person Act]]'', which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.<ref>United Nations Population Division. (2002). [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review]. Retrieved February 22, 2007.</ref> 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 [[Supreme Court of the United States|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 [[Eighth Amendment of the Constitution of Ireland|amendment]] to the [[Republic of Ireland|Irish]] [[Constitution of Ireland|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 [[prenatal development|fetal development]], or require that [[minors and abortion|parents be contacted]] if their [[Minor (law)|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: [[Abortion in Chile|Chile]], [[El Salvador]], [[Malta]], and [[Abortion in Nicaragua|Nicaragua]], although in 2006 the [[Politics of Chile|Chilean government]] began the free distribution of [[emergency contraception]].<ref>Ross, Jen. ([[September 12]], [[2006]]). "[http://www.csmonitor.com/2006/0912/p01s04-woam.html In Chile, free morning-after pills to teens]." ''The Christian Science Monitor.'' Retrieved 2006-12-07.</ref><ref>Gallardoi, Eduardo. ([[September 26]], [[2006]]). "[http://www.washingtonpost.com/wp-dyn/content/article/2006/09/26/AR2006092600770.html Morning-After Pill Causes Furor in Chile]." ''The Washington Post.'' Retrieved 2006-12-07. </ref> 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.<ref>{{cite web|title=Surgical Abortion: History and Overview|publisher=National Abortion Federation|accessdate=2006-09-04|url=http://www.prochoice.org/education/resources/surg_history_overview.html}}</ref>

==See also==
{|width=100%
|-valign=top
|width=50%|
* [[List of articles about abortion by country|Abortion by country]]
* [[Abortion fund]]
* [[Abortion-related violence]]
* [[Contraception]]
* [[Fetal rights]]
* [[Ethical aspects of abortion]]
* [[Fertilisation]]
* [[Gynaecology]]
* [[Late-term abortion]]
* [[Legal protection of access to abortion]]
|width=50%|
* [[Libertarian perspectives on abortion]]
* [[Minors and abortion]]
* [[Obstetrics]]
* [[Paternal rights and abortion]]
* [[Pregnancy]]
* [[Religion and abortion]]
* [[Reproduction]]
* [[Selective reduction]]
* [[Self-induced abortion]]
* [[Teenage pregnancy]]
|}

==References==

{{Reflist|2}}

==External links==
{{sisterlinks|abortion}}
* {{dmoz|Society/Issues/Abortion/|Abortion}}
* [http://annualreview.law.harvard.edu/population/abortion/abortionlaws.htm Abortion Laws of the World]
* [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review]
* "[http://www.pbs.org/wgbh/pages/frontline/twenty/watch/abortion.html Abortion Clinic]:" a 1983 PBS ''Frontline'' episode.
* [http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm#Definition U.S. National Library of Medicine and National Institutes of Health MedlinePlus encyclopedia]
* [http://www.religioustolerance.org/abortion.htm Abortion: All sides to the issue] from the [[Ontario Consultants on Religious Tolerance]]
* [http://www.publicagenda.org/issues/frontdoor.cfm?issue_type=abortion Issue Guide on Abortion] from Public Agenda Online


'''The following information resources may be created by those with a non-neutral position in the abortion debate:'''
* [http://www.guttmacher.org/ The Guttmacher Institute]
* [http://www.johnstonsarchive.net/policy/abortion Johnston's Archive: Abortion Statistics and Other Data]
* [http://justfacts.com/abortion.htm Just Facts: Abortion]
* [http://www.abortion.com/ Abortion.com: Abortion Clinics and Medical Providers]

'''The following links are to groups which advocate a specific position:'''

* [http://www.childrenbychoice.org.au Children by Choice] (Australia, pro-choice)
* [http://www.rtlaust.com Right to Life Australia] (pro-life)
* [http://www.caral.ca Canadians for Choice] (pro-choice)
* [http://www.lifecanada.org LifeCanada] (pro-life)
* [http://www.alranz.org Abortion Law Reform Association of New Zealand] (pro-choice)
* [http://www.voiceforlife.org.nz Voice for Life] (New Zealand, pro-life)
* [http://www.abortionrights.org.uk Abortion Rights] (United Kingdom, pro-choice)
* [http://www.lifeuk.org LifeUK] (United Kingdom, pro-life)
* [http://www.all.org American Life League] (pro-life)
* [http://www.naral.org NARAL Pro-choice America] (pro-choice)
* [http://www.care-net.org CareNet] (international, pro-life)
* [http://www.plannedparenthood.com Planned Parenthood] (international, pro-choice)

{{BirthControl}}

[[Category:Abortion|*]]
[[Category:Reproduction]]
[[Category:Core issues in ethics]]
[[Category:Gynecology]]
[[Category:Pregnancy]]
[[Category:Obstetrics]]
[[Category:Gender_studies]]

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