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 as a miscarriage, or be artificially induced by chemical, surgical or other means. "Abortion" can refer to an induced procedure at any point during human pregnancy; it is sometimes medically defined as either miscarriage or induced termination before the point of viability. Throughout history, abortion has been induced by various methods and the moral and legal aspects of abortion are subject to intense debate in many parts of the world.

Definitions

The following medical terms are used to categorize abortion:

• Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors.
• Induced abortion: Abortion that has been caused by deliberate human action. Induced abortions are further subcategorized into therapeutic and elective:
  • Therapeutic abortion: An abortion performed either...
    • to save the life of the pregnant woman;
    • to preserve the woman's physical or mental health;
    • to terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity; or
    • to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.
  • Elective abortion: Abortion performed for any other reason.

In common parlance, the term "abortion" is synonymous with induced abortion. However, in medical texts, the word 'abortion' might exclusively refer to, or may also refer to, spontaneous abortion (miscarriage).

Incidence

The incidence and reasons for induced abortion vary regionally. It has been estimated that approximately 46 million abortions are performed worldwide every year. Of these, 26 million are said to occur in places where abortion is legal; the other 20 million happen where the procedure is illegal. Some countries, such as Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100), have a low rate of induced abortion, while others like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. The world ratio is 26 induced abortions per 100 known pregnancies.

By gestational age and method

Histogram of abortions by gestational age in England and Wales during 2004. Click image for details. 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, D&C, D&E), 7.7% by "medical" means (mifepristone), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy). 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. Similarly, in England and Wales in 2005, 90% of terminations occurred at or under 12 weeks, 9% between 13 to 19 weeks, and 1% at or over 20 weeks. 71% of those reported were by vacuum aspiration, 5% by D&E, and 24% were medical.

By personal and social factors

A bar chart depicting selected data from the 1998 AGI meta-study on the reasons women stated for having an abortion.

A 1998 aggregated study, from 27 countries, on the reasons women seek to terminate their pregnancies concluded that common factors cited to have influenced the abortion decision were; desire to delay or end childbearing, concern over the interruption of work or education, issues of financial or relationship stability, and perceived immaturity. A 2004 study in which American women at clinics answered a questionnaire yielded similar results. 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. 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. Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using condoms and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled persons, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion. In many areas, especially in developing nations or where abortion is illegal, women sometimes resort to "back-alley" or self-induced procedures. The World Health Organization suggests that there are 19 million terminations annually which fit its criteria for an unsafe abortion. See social issues for more information on these subjects.

Forms of abortion

Spontaneous abortion

Main article: 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-born infant, is known as a "premature birth". When a fetus dies in the uterus at some point late in gestation, beginning at about 20 weeks, or during delivery, it is termed a "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Most miscarriages occur very early in pregnancy. Between 10% and 50% of pregnancies end in miscarriage, depending upon the age and health of the pregnant woman. 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. This risk is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.

Induced abortion

A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the fetus, in addition to the legality, regional availability, and doctor-patient preference for specific procedures.

Surgical abortion

Gestational age may determine which abortion methods are practiced.

In the first twelve weeks, suction-aspiration or vacuum abortion is the most common method. Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses an electric pump. These techniques are comparable, differing in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and menstrual extraction, can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as STOP: 'Suction (or surgical) Termination Of Pregnancy'. From the fifteenth week until approximately the twenty-sixth week, a dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Dilation and curettage (D & C) is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called Sharp Curettage, only when MVA is unavailable. The term "D and C", or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.

Other techniques must be used to induce abortion in the third trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes termed "partial-birth abortion". A hysterotomy abortion is an abortion procedure similar to a caesarean section, and is performed under general anesthesia because it is considered major abdominal surgery. The procedure requires a smaller incision than a caesarean section and is used during later stages of pregnancy.

From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure.

Medical abortion

Main article: Medical abortion

Effective in the first trimester of pregnancy, medical (sometimes called chemical abortion), or 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. 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

File:Angkordemon.jpg

Bas-relief at Angkor Wat, dated circa 1150, depicting a demon performing an abortion by pounding a mallet into a woman's belly.

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion). The use of herbs in such a manner can cause serious — even lethal — side effects, such as multiple organ failure, and is not recommended by physicians.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Burma, Indonesia, Malaysia, the Philippines, and Thailand, there is an ancient tradition of attempting abortion through forceful abdominal massage.

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.

Health effects

Early-term surgical abortion is a simple procedure. When performed before the 16th week by competent doctors — or, in some states, nurse practitioners, nurse midwives, and physician assistants — it is safer for women than childbirth.

Abortion methods, like most surgical procedures, carry a small potential for serious complications, including perforated uterus, perforated bowel or bladder, septic shock, sterility, and death. The risk of complications can increase depending on how far pregnancy has progressed, but remains less than complications that may occur from carrying pregnancy to term.

Assessing the risks of induced abortion depends on a number of factors. First, there are relative health risks of induced abortion and pregnancy, which are both affected by wide variation in the quality of health services in different societies and among different socio-economic groups, a lack of uniform definitions of terms, and difficulties in patient follow-up and after-care. The degree of risk is also dependent upon the skill and experience of the practitioner; maternal age, health, and parity; gestational age; pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care.

In the United Kingdom, the number of deaths directly due to legal abortion between the years of 1991 and 1993 was 5, compared to 3 deaths following spontaneous miscarriage and 8 deaths caused by ectopic pregnancy during the same time frame. 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.

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.

Dilation of the cervix carries the risk of cervical tears or perforations, including small tears that might not be apparent and might cause cervical incompetence in future pregnancies. Most practitioners recommend using the smallest possible dilators, and using osmotic rather than mechanical dilators after the first trimester.

Instruments that are placed within the uterus can, on rare occasions, cause perforation or laceration of the uterus, and damage structures surrounding the uterus. Laceration or perforation of the uterus or cervix can, again on rare occasions, lead to more serious complications.

Incomplete emptying of the uterus can cause hemorrhage and infection. Use of ultrasound verification of the location and duration of the pregnancy prior to abortion, with immediate follow-up of patients reporting continuing pregnancy symptoms after the procedure, will virtually eliminate this risk. The sooner a complication is noted and properly treated, the lower the risk of permanent injury or death.

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.

Unsafe abortion methods (e.g. use of certain drugs, herbs, or insertion of non-surgical objects into the uterus) are potentially dangerous, carrying a significantly elevated risk for permanent injury or death, as compared to abortions done by physicians.

Suggested effects

There is controversy over a number of proposed risks and effects of abortion. Evidence, whether in support of or against such claims, might be influenced by the political and religious beliefs of the parties behind it.

Breast cancer

Main articles: Abortion-breast cancer hypothesis and Breast cancer

The abortion-breast cancer (ABC) hypothesis (also referred to by supporters as the ABC link) posits a causal relationship between induced abortion and an increased risk of developing breast cancer. In early pregnancy the level of estrogens increases, leading to breast growth in preparation for lactation. The abortion-breast cancer hypothesis proposes that if this process is interrupted with an abortion – before full differentiation in the third trimester – then more relatively vulnerable undifferentiated cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. The hypothesis garnered renewed interest from rat studies conducted in the 1980s, however, it has not been scientifically verified in humans, and abortion is not considered a breast cancer risk by any major cancer organization.

A large epidemiological study by Mads Melbye et al. in 1997, with data from two national registries in Denmark, reported the correlation to be negligible to non-existent after statistical adjustment. The National Cancer Institute conducted an official workshop with over 100 experts on the issue in February 2003, which concluded with its highest strength rating for the selected evidence that "induced abortion is not associated with an increase in breast cancer risk." In 2004, Beral et al. published a collaborative reanalysis of 53 epidemiological studies and concluded that abortion does "not increase a woman's risk of developing breast cancer."

Critics of these studies argue they are subject to selection bias, that the majority of interview-based studies have indicated a link, and that some are statistically significant. Debate remains as to the reliability of these retrospective studies because of possible response bias. The current scientific consensus has solidified with large prospective cohort studies which find no abortion-breast cancer association, and the ABC issue is seen by some as a part of the current pro-life "women-centered" strategy against abortion. Nevertheless, the subject continues to be one of mostly political but some scientific contention.

Fetal pain

Main article: Fetal pain

The existence or absence of fetal sensation during abortion is a matter of medical, ethical and public policy interest. Evidence conflicts, with some authorities holding that the fetus is capable of feeling pain from the first trimester, and others maintaining that the neuro-anatomical requirements for such experience do not exist until the second or third trimester.

Pain receptors begin to appear in the seventh week of gestation. 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. However, other anatomical structures involved in the nociceptive process are not present until much later in gestation. Links between the thalamus and cerebral cortex form around the 23rd week. There has been suggestion that a fetus cannot feel pain at all, as it requires mental development that only occurs outside the womb.

Researchers have observed changes in heart rates and hormonal levels of newborn infants after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anesthesia. Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.

Mental health

Main articles: Post-abortion syndrome and Mental health

Post-abortion syndrome (PAS) is a term used to describe a set of mental health characteristics which some people claim to have observed in women following an abortion. According to Spanish researcher Carmen Gomez Lavin, symptoms attributed to PAS are "dreams and nightmares related with the abortion," and "feelings of guilt". Lavin and company examined ways to categorize PAS under the assumption that it exists and is related to Post Traumatic Stress Disorder. Abortion is illegal in Spain except in cases of rape or incest.

Researchers at the Department of Psychiatry at the University of Chicago Medical Center in the United States have found that the existence of PAS to be a myth. PAS is listed in neither the DSM-IV-TR nor the ICD-10, and not considered a medical condition by the American Psychiatric Association.

Some studies have shown abortion to have neutral or positive effects on the mental well-being of some patients. A 1989 study of teenagers who sought pregnancy tests found that, counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term. Another study in 1992 suggested a link between elective abortion and later reports of positive self-esteem; it also noted that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors. Abortion, as compared to completion, of an undesired first pregnancy was not found to directly pose the risk of significant depression in a 2005 study.

Two studies, one done in Finland and the other in New Zealand, found links between abortion and depression. However, both studies were unable to establish a causal relationship between abortion and depression because it is not clear if abortion causes depression in women, or if women who are depressed are more likely to elect to have an abortion as the result of an unplanned pregnancy.

Miscarriage, or spontaneous abortion, is known to present an increased risk of depression. Childbirth can also sometimes result in maternity blues or postpartum depression.

History of abortion

"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the Boston Daily Times.

Main article: History of abortion

Induced abortion, according to some anthropologists, can be traced to ancient times. There is evidence to suggest that, historically, pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques.

The Hippocratic Oath, the chief statement of medical ethics in Ancient Greece, forbade all doctors from helping to procure an abortion by pessary. Nonetheless, Soranus, a second-century Greek physician, suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in violent exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal baths, pessaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation. It is also believed that, in addition to using it as a contraceptive, the ancient Greeks relied upon silphium as an abortifacient. Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy.

Abortion in the 19th century continued, despite bans in both the United Kingdom and the United States, as the disguised, but nonetheless open, advertisement of services in the Victorian era suggests.

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 article: Legalized abortion and crime effect

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

The suggestion was brought to widespread attention by a 1999 academic paper, The Impact of Legalized Abortion on Crime, authored by the economists Steven D. Levitt and John Donohue. They attributed the drop in crime to a reduction in individuals said to have a higher statistical probability of committing crimes: unwanted children, especially those born to mothers who are African-American, impoverished, adolescent, uneducated, and single. The change coincided with what would have been the adolescence, or peak years of potential criminality, of those who had not been born as a result of Roe v. Wade and similar cases. Donohue and Levitt's study also noted that states which legalized abortion before the rest of the nation experienced the lowering crime rate pattern earlier, and those with higher abortion rates had more pronounced reductions.

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. 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.

Such research has been criticized by some as being utilitarian, discriminatory as to race and socioeconomic class, and as promoting eugenics as a solution to crime. Levitt states in his book, Freakonomics, that they are neither promoting nor negating any course of action — merely reporting data as economists.

Sex-selective abortion

Main article: Sex-selective abortion and infanticide

The advent of both sonography and amniocentesis has allowed parents to determine sex before birth. This has led to the occurrence of sex-selective abortion or the targeted termination of a fetus based upon its sex.

It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Mainland China, Taiwan, South Korea, and India.

In India, the economic role of men, the costs associated with dowries, and a Hindu tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons. The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 rupees [for a sex test] now, save 50,000 rupees [for a dowry] later." 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. Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted. 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.

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. 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. A ban upon the practice of sex-selective abortion was enacted in 2003.

Unsafe abortion

Soviet poster circa 1925. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death."

Main article: 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 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." This can include a person without medical training, a professional health provider operating in sub-standard conditions, or the woman herself.

Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the woman's death. Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal mortalities, with regional estimates including 12% in Asia, 25% in Latin America, and 13% in sub-Saharan Africa. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.

Abortion debate

File:March.jpg

Pro-choice activists near the Washington Monument at the March for Women's Lives.

File:Pro-life protest.jpg

Pro-life activists at the March for Life in 2002. The rally is held annually in Washington, DC.

Main articles: Abortion debate, Pro-choice, and Pro-life

Over the course of the history of abortion, induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her value system. Opinions of abortion may be best described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy. Religious ethics also has an influence upon both personal opinion and the greater debate over abortion (see religion and abortion).

Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. In the United States, most often those in favor of legal prohibition of abortion describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to life?" for pro-life advocates, and, for those who are pro-choice, "Does a woman have the right to choose whether or not to continue a pregnancy?"

In both public and private debate, arguments presented in favor of or against abortion focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.

Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a minor, her parents; a legally-married or common-law wife, her husband; or a pregnant woman, the biological father. In a 2003 Gallup poll in the United States, 72% of respondents were in favor of spousal notification, with 26% opposed; of those polled, 79% of males and 67% of females responded in favor.

Public opinion

Main article: Societal attitudes towards abortion

A number of opinion polls around the world have explored public opinion regarding the issue of abortion. Results have varied from poll to poll, country to country, and region to region, while varying with regard to different aspects of the issue.

A May 2005 survey examined attitudes toward abortion in 10 European countries, asking polltakers whether they agreed with the statement, "If a woman doesn't want children, she should be allowed to have an abortion". The highest level of approval was 81% in the Czech Republic and the highest level of disapproval was 48% in Poland.

In North America, a December 2001 poll surveyed Canadian opinion on abortion, asking Canadians in what circumstances they believe abortion should be permitted; 32% responded that they believe abortion should be legal in all circumstances, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. A similar poll in January 2006 surveyed people in the United States about U.S. opinion on abortion; 33% said that abortion should be "permitted only in cases such as rape, incest or to save the woman's life", 27% said that abortion should be "permitted in all cases", 15% that it should be "permitted, but subject to greater restrictions than it is now", 17% said that it should "only be permitted to save the woman's life", and 5% said that it should "never" be permitted. A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.

Of attitudes in South and Central America, a December 2003 survey found that 30% of Argentines thought that abortion in Argentina should be allowed "regardless of situation", 47% that it should be allowed "under some circumstances", and 23% that it should not be allowed "regardless of situation". A March 2007 poll regarding the abortion law in Brazil found that 65% of Brazilians believe that it "should not be modified", 16% that it should be expanded "to allow abortion in other cases", 10% that abortion should be "decriminalized", and 5% were "not sure". 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.

Abortion law

Main articles: Abortion law and History of abortion

International status of abortion law (Detail)

File:Signing the Partial-Birth Abortion ban.jpg

United States President George W. Bush signs the Partial-Birth Abortion Ban Act of 2003

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. In 1861, the British Parliament passed the Offences Against the Person Act, which continued to outlaw abortion and served as a model for similar prohibitions in some other nations. The Soviet Union, with legislation in 1920, and Iceland, with legislation in 1935, were two of the first countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom. In the 1973 case, Roe v. Wade, the United States Supreme Court struck down state laws banning abortion, ruling that such laws violated an implied right to privacy in the United States Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under the Canadian Charter of Rights and Freedoms. Canada later struck down provincial regulations of abortion in the case of R. v. Morgentaler (1993). By contrast, abortion in Ireland was affected by the addition of an amendment to the Irish Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn".

Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, and the right to security of person are major issues of human rights that are sometimes used as justification for the existence or absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window of legality:

• In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
• In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially warranted before it can be performed. However, since UK law stipulates that a woman seeking an abortion should never be barred from seeking another doctor's referral, and since some doctors believe that abortion is in all cases medically or socially warranted, in practice women are never fully barred from obtaining an abortion.

Other countries, in which abortion is normally illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A few nations ban abortion entirely: Chile, El Salvador, Malta, and Nicaragua, although in 2006 the Chilean government began the free distribution of emergency contraception. 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.

See also

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

Libertarian perspectives on abortion Marriage gap Minors and abortion Obstetrics Paternal rights and abortion Pregnancy Religion and abortion Reproduction Selective reduction Self-induced abortion Teenage pregnancy

External links

• Abortion Laws of the World
• Abortion Policies: A Global Review
• "Abortion Clinic:" a 1983 PBS Frontline episode.
• U.S. National Library of Medicine and National Institutes of Health MedlinePlus encyclopedia
• Abortion: All sides to the issue from the Ontario Consultants on Religious Tolerance
• 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:

• The Guttmacher Institute
• Johnston's Archive: Abortion Statistics and Other Data
• Just Facts: Abortion
• Abortion.com: Abortion Clinics and Medical Providers

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

• Children by Choice (Australia, pro-choice)
• Right to Life Australia (pro-life)
• Canadians for Choice (pro-choice)
• LifeCanada (pro-life)
• Abortion Law Reform Association of New Zealand (pro-choice)
• Voice for Life (New Zealand, pro-life)
• Abortion Rights (United Kingdom, pro-choice)
• LifeUK (United Kingdom, pro-life)
• American Life League (pro-life)
• NARAL Pro-choice America (pro-choice)
• CareNet (international, pro-life)
• Planned Parenthood (international, pro-choice)