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Abortion

2010-07-15T20:00:45Z

Kabel:

'''Abortion''' is the termination of a [[pregnancy (mammals)|pregnancy]] by the removal or expulsion from the [[uterus]] of a [[fetus]] or [[embryo]], resulting in or caused by its death.<ref>{{cite book |url=http://books.google.com/?id=KiRHpRl7TjsC&pg=PA173 |title=Gynaecology for Lawyers |author=Dutt T, Matthews MP |volume=14 |series-title=Medico-legal practitioner series |publisher=Routledge |year=1998 |isbn=9781859412152}}</ref> An abortion can occur spontaneously due to [[complication (medicine)|complications]] during pregnancy or can be induced, in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the [[gravidity|gravida]] (pregnant female) is termed a ''therapeutic abortion'', while an abortion induced for any other reason is termed an ''elective abortion''. The term ''abortion'' most commonly refers to the induced abortion of a [[pregnancy|human pregnancy]], while spontaneous abortions are usually termed [[miscarriage]]s. 

Worldwide 42 million abortions are estimated to take place annually with 22 million of these occurring safely and 20 million unsafely.<ref name=OBGY09>{{cite journal |author=Shah I, Ahman E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=[[J Obstet Gynaecol Can]] |volume=31 |issue=12 |pages=1149–58 |year=2009 |month=December |pmid=20085681 |doi= |url=}}</ref> While [[maternal death|maternal mortality]] seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.<ref name=OBGY09/> One of the main determinants of the availability of safe abortions is the legality of the procedure. Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.<ref name=IJGO10>{{cite journal |author=Culwell KR, Vekemans M, de Silva U, Hurwitz M|title=Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion |journal=[[International Journal of Gynecology & Obstetrics]] |volume=110 |pages=S13–16 |year=2010 |month=July |pmid=20451196 |doi=10.1016/j.ijgo.2010.04.003 }}</ref> The frequency of abortions is, however, similar whether or not access is restricted.<ref name=IJGO10/>

Abortion has a long [[history of abortion|history]] and has been induced by various methods including herbal [[abortifacient]]s, the use of sharpened tools, [[physical trauma]], and other [[traditional medicine|traditional methods]]. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The [[abortion law|legality]], prevalence, and cultural views on abortion vary substantially around the world. In many parts of the world there is prominent and divisive [[Abortion debate|public controversy]] over the [[ethical aspects of abortion|ethical]] and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing [[pro-life]] and [[pro-choice]] worldwide social movements ([[Pro-choice#Term_controversy|both self-named]]). Incidence of abortion has declined worldwide, as access to [[family planning]] education and contraceptive services has increased.<ref name="worldtrends">{{cite journal |author=Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J |title=Legal abortion worldwide: incidence and recent trends |journal=Int Fam Plan Perspect |volume=33 |issue=3 |pages=106–16 |year=2007 |month=September |pmid=17938093 |doi=10.1363/ifpp.33.106.07 |url=http://www.guttmacher.org/pubs/journals/3310607.html }}</ref> 

==Types==
[[File:Human fetus 10 weeks - therapeutic abortion.jpg|thumb|A 10-week-old fetus removed from a 44-year-old female diagnosed with early-stage [[uterine cancer]] via a therapeutic abortion. The uterus (womb), included the fetus.]]
===Spontaneous===
{{Main|Miscarriage}}
Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due to accidental trauma or natural causes before approximately the 22nd [[gestational age|week of gestation]]; the definition by gestational age varies by country.<ref name="WHOmiscarriage">{{cite web |url=http://www.who.int/reproductive-health/impac/Symptoms/Vaginal_bleeding_early_S7_S16.html |title=Managing Complications in Pregnancy and Childbirth – A guide for midwives and doctors |last=Department of Reproductive Health and Research |publisher=World Health Organization |year=2003 |accessdate=2009-04-07}} NB: This definition is subject to regional differences, see [[Miscarriage#Terminology|miscarriage]].</ref> Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. A pregnancy that ends before 37 weeks of gestation resulting in a [[live birth|live-born]] infant is known as a "[[premature birth]]". When a fetus dies [[in utero]] after about 22 weeks, or during [[childbirth|delivery]], it is usually termed "[[stillbirth|stillborn]]". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.<ref name=BBCmiscarriage>{{cite news |url=http://news.bbc.co.uk/2/hi/health/2176898.stm |title=Q&A: Miscarriage |date=2002-08-06 |publisher=BBC |accessdate=2009-04-07}}</ref> Most miscarriages occur very early in pregnancy, in most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy found that 61.9% of conceptuses were lost prior to 12 weeks, and 91.7% of these losses occurred subclinically, without the knowledge of the once pregnant woman.<ref name="pmid7117572">{{cite journal |author=Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ |title=Early embryonic mortality in women |journal=Fertil. Steril. |volume=38 |issue=4 |pages=447–453 |year=1982 |pmid=7117572 |doi=}}</ref>

The risk of spontaneous abortion decreases sharply after the 10th week from the [[gestational age|last menstrual period]] (LMP).<ref name=BBCmiscarriage /><ref>{{cite book |first=Lennart |last=Nilsson |authorlink=Lennart Nilsson |coauthors=Lars Hamberger | page=91 |title=[[A Child Is Born (book)|A child is born]] |publisher=[[Doubleday (publisher)|Doubleday]] |location=[[Garden City, New York]] |year=1990 |pages= |isbn=0-385-40085-3 |oclc=21412111 |origyear=1965}}</ref> One study of 232 pregnant women showed "virtually complete <nowiki>[pregnancy loss]</nowiki> by the end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5 weeks LMP.<ref name="fetal med 836">{{cite book |chapter=Early pregnancy loss |editor=Martin J. Whittle and C. H. Rodeck |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=http://books.google.com/?id=0BY0hx2l5uoC |isbn=0-443-05357-X |oclc=42792567 |page=836 |author8=Jauniaux E, Kaminopetros P, El-Rafaey H }}</ref>

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,<ref name="mednet">{{cite web |url=http://www.medicinenet.com/miscarriage/page1.htm |title=Miscarriage (Spontaneous Abortion) |accessdate=2009-04-07 |last=Stöppler |author=Conrad M |editor=Shiel WC Jr |work=MedicineNet.com }}</ref> accounting for at least 50% of sampled early pregnancy losses.<ref name="fetal med 837">{{cite book |author=Jauniaux E, Kaminopetros P, El-Rafaey H |chapter=Early pregnancy loss |editor=Whittle MJ,Rodeck CH |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=http://books.google.com/?id=0BY0hx2l5uoC |isbn=0-443-05357-X |oclc=42792567 |page=837 }}</ref> Other causes include [[vascular disease]] (such as [[Systemic lupus erythematosus|lupus]]), [[diabetes]], other hormonal problems, infection, and abnormalities of the uterus.<ref name="mednet" /> Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.<ref name="fetal med 837" /> A spontaneous abortion can also be caused by accidental [[Physical trauma|trauma]]; intentional trauma or stress to cause miscarriage is considered induced abortion or [[feticide]].<ref name="Fetal Homicide Laws">{{cite web |url=http://www.ncsl.org/programs/health/fethom.htm |title=Fetal Homicide Laws |accessdate=2009-04-07 |publisher=[[National Conference of State Legislatures]]}}</ref>

===Induced===
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the [[gestational age]] of the embryo or fetus, which increases in size as it ages.<ref>Menikoff, Jerry. [http://books.google.com/books?id=2jXOYv3X8zsC&pg=PA78&dq=size+fetus+abortion+technique&lr=&as_brr=3&ei=MymmSayEFJaQyATt6JiUDg Law and Bioethics], p. 78 (Georgetown University Press 2001): "As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use."</ref> Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as ''therapeutic'' when it is performed 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>
*preserve the woman's physical or mental health;<ref name="roche1"/>
*terminate pregnancy that would result in a child born with a [[congenital disorder]] that would be fatal or associated with significant [[morbidity]];<ref name="roche1"/> or
*[[selective reduction|selectively reduce]] the number of fetuses to lessen health risks associated with [[multiple birth|multiple pregnancy]].<ref name="roche1"/>
An abortion is referred to as ''elective'' when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."<ref>''Encyclopedia Britannica'', (2007), Vol 26, p. 674.</ref>

==Methods==
[[Image:Abortionmethods.png|thumb|350px|right|[[Gestational age]] may determine which abortion methods are practiced.]]
===Medical===
{{Main|Medical abortion}}

"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, and are only effective in the first trimester of pregnancy. {{Citation needed|date=February 2009}} Medical abortions comprise 10% of all abortions in the United States<ref>{{cite journal |author=Strauss LT, Gamble SB, Parker WY, Cook DA, Zane SB, Hamdan S |title=Abortion surveillance—United States, 2004 |journal=MMWR Surveill Summ |volume=56 |issue=9 |pages=1–33 |year=2007 |month=November |pmid=18030283 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5609a1.htm}}</ref> and Europe.{{Citation needed|date=February 2009}} 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|title=Early pregnancy termination with mifepristone and misoprostol in the United States|journal=New England Journal of Medicine|year=1998|volume=338|issue=18|pmid=9562577|doi=10.1056/NEJM199804303381801|page=1241|last2=Bardin|first2=CW|last3=Benton|first3=L|last4=Robbins|first4=A}}</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.

===Surgical===
[[File:Vacuum-aspiration (single).svg|thumb|A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization). '''1:''' Amniotic sac '''2:''' Embryo '''3:''' Uterine lining '''4:''' Speculum '''5:''' Vacurette '''6:''' Attached to a suction pump]]
In the first 12 weeks, [[suction-aspiration abortion|suction-aspiration]] or vacuum abortion is the most common method.<ref>{{cite web |author=Healthwise |url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 |title=Manual and vacuum aspiration for abortion |year=2004 |publisher=[[WebMD]] |accessdate=2008-12-05}}</ref> ''Manual [[Vacuum aspiration]]'' (MVA) abortion consists of removing the [[fetus]] or [[embryo]], [[placenta]] and membranes by suction using a manual syringe, while ''electric [[vacuum aspiration]]'' (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "[[menstrual extraction]]", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, [[dilation and evacuation]] (D&E) is used. D&E consists of opening the [[cervix]] of the uterus and emptying it using surgical instruments and suction.

''[[Dilation and curettage]]'' (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. ''[[Curettage]]'' refers to cleaning the walls of the [[uterus]] with a [[curette]]. The [[World Health Organization]] recommends this procedure, also called ''sharp curettage,'' only when MVA is unavailable.<ref>{{cite book |author=[[World Health Organization]] |chapter=Dilatation and curettage |chapterurl=http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html |title=Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors |publisher=[[World Health Organization]] |location=Geneva |year=2003 |pages= |isbn=92-4-154587-9 |oclc=181845530 |accessdate=2008-12-05}}</ref>

Other techniques must be used to induce abortion in the second [[wiktionary:trimester|trimester]]. Premature delivery can be induced with [[prostaglandin]]; this can be coupled with injecting the [[amniotic sac|amniotic fluid]] with hypertonic 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]]. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.<ref name="encarta">{{cite encyclopedia |last=McGee |first=Glenn |authorlink=Glenn McGee |coauthors=[[Jon F. Merz]] |encyclopedia=[[Encarta]] |title=Abortion |url=http://encarta.msn.com/encyclopedia_761553899/Abortion.html |accessdate=2008-12-05 |publisher=[[Microsoft]]|archiveurl=http://www.webcitation.org/5kvWYG63q|archivedate=2009-10-31|deadurl=yes}}</ref>

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<ref>{{cite journal |author=Vause S, Sands J, Johnston TA, Russell S, Rimmer S |title=Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? |journal=J Obstet Gynaecol |volume=22 |issue=3 |pages=243–245 |year=2002 |month=May |pmid=12521492 |doi=10.1080/01443610220130490 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/01443610220130490&magic=pubmed||1B69BA326FFE69C3F0A8F227DF8201D0 |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y |title=Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals |journal=Fetal. Diagn. Ther. |volume=18 |issue=2 |pages=91–97 |year=2003 |pmid=12576743 |doi=10.1159/000068068 |url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=fdt18091 |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Bhide A, Sairam S, Hollis B, Thilaganathan B |title=Comparison of feticide carried out by cordocentesis versus cardiac puncture |journal=Ultrasound Obstet Gynecol |volume=20 |issue=3 |pages=230–232 |year=2002 |month=September |pmid=12230443 |doi=10.1046/j.1469-0705.2002.00797.x |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Senat MV, Fischer C, Bernard JP, Ville Y |title=The use of lidocaine for fetocide in late termination of pregnancy |journal=BJOG |volume=110 |issue=3 |pages=296–300 |year=2003 |month=March |pmid=12628271 |doi= 10.1046/j.1471-0528.2003.02217.x|url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1470-0328&date=2003&volume=110&issue=3&spage=296 |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Senat MV, Fischer C, Ville Y |title=Funipuncture for fetocide in late termination of pregnancy |journal=Prenat. Diagn. |volume=22 |issue=5 |pages=354–356 |year=2002 |month=May |pmid=12001185 |doi=10.1002/pd.290 |accessdate=2008-12-03}}</ref> to ensure that the fetus is not born alive.<ref>{{cite book |author=Nuffield Council on Bioethics |chapter=Clinical perspectives (Continued) |chapterurl=http://www.nuffieldbioethics.org/go/browseablepublications/criticalCareDecisionFetalNeonatalMedicine/report_542.html |accessdate=2008-12-03 |title=Critical Case Decisions in Fetal and Neonatal Medicine: Ethical Issues |publisher=Nuffield Council on Bioethics |location= |year=2006 |isbn=1-904384-14-5 |oclc=85782378}}</ref>

===Other methods===
Historically, a number of herbs reputed to possess [[abortifacient]] properties have been used in [[folk medicine]]: [[tansy]], [[pennyroyal]], [[black cohosh]], and the now-extinct [[silphium]] (see [[Abortion#History of abortion|history of abortion]]).<ref name="riddle2">{{cite book |first=John M. |last=Riddle |title=Eve's herbs: a history of contraception and abortion in the West |publisher=[[Harvard University Press]] |location=[[Cambridge, Massachusetts]] |year=1997 |pages= |isbn=0-674-27024-X |oclc=36126503}}{{pn}}</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>{{cite journal |author=Ciganda C, Laborde A |title=Herbal infusions used for induced abortion |journal=J. Toxicol. Clin. Toxicol. |volume=41 |issue=3 |pages=235–239 |year=2003 |pmid=12807304 |doi=10.1081/CLT-120021104 |url= |accessdate=2008-12-04}}</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 Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.<ref name="potts">{{cite journal |first=Malcolm |last=Potts |authorlink=Malcolm Potts |year=2002 |title=History of Contraception |journal=Gynecology and Obstetrics |volume=6 |issue=8 |accessdate=2008-12-04}}</ref> One of the [[bas relief]]s decorating the temple of [[Angkor Wat]] in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the [[underworld]].<ref name="potts" />

Reported methods of unsafe, [[self-induced abortion]] include misuse of [[misoprostol]], and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.<ref>{{cite journal |author=Thapa SR, Rimal D, Preston J |title=Self induction of abortion with instrumentation |journal=Aust Fam Physician |volume=35 |issue=9 |pages=697–698 |year=2006 |month=September |pmid=16969439 |doi= |url=http://www.racgp.org.au/afp/200609/11015 |accessdate=2008-12-04}}</ref>
{{clr}}

==Health risks==
{{See also|Unsafe abortion#Health risks|l1=Health risks of unsafe abortion}}
Abortion, when legally performed in developed countries, is among the safest procedures in medicine.<ref name="lancet-grimes">{{cite journal |author=Grimes DA, Benson J, Singh S, ''et al.'' |title=Unsafe abortion: the preventable pandemic |journal=Lancet |volume=368 |issue=9550 |pages=1908–19 |year=2006 |month=November |pmid=17126724 |doi=10.1016/S0140-6736(06)69481-6 |url=http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf}}</ref><ref name="grimes-overview">{{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 |month=April |pmid=15096333 |doi= |url=http://www.annals.org/content/140/8/620.full}}</ref> In such settings, risk of [[maternal death]] is between 0.2–1.2 per 100,000 procedures.<ref name=IOB2003>{{cite journal |author=Yanda K. et al |title=Reproductive health and human rights |journal=International journal of gynecology and obstetrics |volume=82 |issue=3 |pages=275–283 |year=2003 |month=Sept |pmid= 14499974|doi= 10.1016/S0020-7292(03)00226-1|url=http://www.ijgo.org/article/PIIS0020729203002261/fulltext}}</ref><ref>{{cite journal |author=Vekemans M |title=Making induced abortion safe and legal, worldwide |journal=Eur J Contracept Reprod Health Care |volume=14 |issue=3 |pages=165–8 |year=2009 |month=June |pmid=19565413 |doi=10.1080/13625180902886371 |url=}}</ref><ref name="grimes-mortality">{{cite journal |author=Grimes DA |title=Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999 |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=1 |pages=92–4 |year=2006 |month=January |pmid=16389015 |doi=10.1016/j.ajog.2005.06.070 |url=}}</ref><ref>{{cite book |author=Douglas W. Laube; Barzansky, Barbara M.; Beckmann, Charles R. B.; Herbert, William G. |title=Obstetrics and Gynecology |publisher=Lippincott Williams & Wilkins |location=Hagerstown, Maryland |year=2009 |pages=150 |isbn=0-7817-8807-2 |oclc= |doi= |accessdate=}}</ref> In comparison, by 1996, mortality from childbirth in developed countries was 11 times greater.<ref>{{cite journal |author=Kulczycki A, Potts M, Rosenfield A |title=Abortion and fertility regulation |journal=Lancet |volume=347 |issue=9016 |pages=1663–8 |year=1996 |month=June |pmid=8642962 |doi= 10.1016/S0140-6736(96)91491-9|url=}}</ref><ref>{{cite journal |author=Yanda K. et al |title=Reproductive health and human rights |journal=International journal of gynecology and obstetrics |volume=82 |issue=3 |pages=275–283 |year=2003 |month=Sept |pmid= 14499974|doi= 10.1016/S0020-7292(03)00226-1|url=http://www.ijgo.org/article/PIIS0020729203002261/fulltext}}</ref><ref>{{cite book |author=Danielle Mazza |title=Women's health in general practice |publisher=Butterworth-Heinemann |location=Oxford |year=2004 |pages=93 |isbn=0-7506-8773-8 |oclc= |doi= |accessdate=}}</ref><ref>{{cite book |author=Eric Sokol; Andrew Sokol |title=General gynecology |publisher=Mosby |location=St. Louis |year=2007 |pages=238 |isbn=0-323-03247-8 |oclc= |doi= |accessdate=}}</ref><ref>{{cite book |author=Lloyd, Cynthia B. |title=Growing up global: the changing transitions to adulthood in developing countries |publisher=National Academies Press |location=Washington, D.C |year=2005 |pages=215 |isbn=0-309-09528-X |oclc= |doi= |accessdate=}}</ref><ref>{{cite book |author=Douglas W. Laube; Barzansky, Barbara M.; Beckmann, Charles R. B.; Herbert, William G. |title=Obstetrics and Gynecology |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2009 |pages=150 |isbn=0-7817-8807-2 |oclc= |doi= |accessdate=}}</ref> [[Unsafe abortion]]s (defined by the [[World Health Organization]] as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) carry a high risk of maternal death and other complications.<ref name="who-unsafe-1995">{{cite web| publisher = [[World Health Organization]] | title = The Prevention and Management of Unsafe Abortion | date = April 1995 | accessdate = June 1, 2010 | url = http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf |format = PDF}}</ref> For unsafe procedures, the mortality rate has been estimated at 367 per 100,000.<ref>{{cite journal |author=Fawcus SR |title=Maternal mortality and unsafe abortion |journal=Best Pract Res Clin Obstet Gynaecol |volume=22 |issue=3 |pages=533–48 |year=2008 |month=June |pmid=18249585 |doi=10.1016/j.bpobgyn.2007.10.006 |url=}}</ref>

====Physical health====
Surgical abortion methods, like most [[minimally invasive procedure]]s, carry a small potential for serious complications.<ref>{{cite book |author=[[World Health Organization]] |title=Medical Methods for Termination of Pregnancy: Report of a Who Scientific Group |series=Who Technical Report Series No. 871 |publisher=[[World Health Organization]] |location=[[Geneva]] |year=1997 |pages= |isbn=92-4-120871-6 |oclc=38276325}}{{pn}}</ref>

Surgical abortion is generally safe and the rate of major complications is low<ref>{{cite book |last1=Botha|first1=Rosanne L.|last2=Bednarek|first2=Paula H.|last3=Kaunitz|first3=Andrew M.|coauthors=Alison B. Edelman|editor=Guy I Benrubi |title=Handbook of Obstetric and Gynecologic Emergencies |edition=4|year=2010|publisher=Lippincott Williams & Wilkins|isbn=978-1605476667|page=256|chapter=Complications of Medical and Surgical Abortion|quote=Although first trimester medical and surgical abortion are safe with low rates of major complications, these are common procedures, and therefore it is not unusual for women with abortion complications to present for emergent care.}}</ref> but varies depending on how far pregnancy has progressed and the surgical method used.<ref name="Pregler"/> Concerning gestational age, incidence of major complications is highest after 20 weeks of gestation and lowest before the 8th week.<ref name="Pregler"/> With more advanced gestation there is a higher risk of [[uterine perforation]] and retained products of conception,<ref name="Rello">{{cite book|editor=Jordi Rello|title=Infectious diseases in critical care|edition=2|publisher=Springer|isbn=978-3540344056|page=490}}</ref> and specific procedures like [[dilation and evacuation]] may be required.<ref name="cochrane-2nd-tri">{{cite journal |author=Lohr PA, Hayes JL, Gemzell-Danielsson K |title=Surgical versus medical methods for second trimester induced abortion |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD006714 |year=2008 |pmid=18254113 |doi=10.1002/14651858.CD006714.pub2 }}</ref>

Concerning the methods used, general incidence of major complications for surgical abortion varies from lower for suction curettage, to higher for saline instillation.<ref name="Pregler">{{cite book|last1=Pregler|first1=Janet P. |last2=DeCherney|first2=Alan H. |title=Women's health: principles and clinical practice |year=2002 |publisher=pmph usa |isbn=978-1550091700 |page=232}}</ref> Possible complications include [[hemorrhage]], incomplete abortion, uterine or pelvic infection, ongoing intrauterine pregnancy, misdiagnosed/unrecognized [[ectopic pregnancy]], [[hematometra]] (in the uterus), [[uterine perforation]] and cervical laceration.<ref>{{cite book |last1=Botha|first1=Rosanne L. |last2=Bednarek|first2=Paula H. |last3=Kaunitz|first3=Andrew M. |coauthors=Alison B. Edelman |editor=Guy I Benrubi |title=Handbook of Obstetric and Gynecologic Emergencies |edition=4 |year=2010 |publisher=Lippincott Williams & Wilkins |isbn=978-1605476667 |page=258 |chapter=Complications of Medical and Surgical Abortion}}</ref> Use of [[general anesthesia]] increases the risk of complications because it relaxes uterine musculature making it easier to perforate.<ref>{{cite book |last1=Morgan|first1=Mark |last2=Siddighi|first2=Sam |title=NMS Obstetrics and Gynecology |edition=5 |series=National Medical Series for Independent Study |year=2004 |publisher=Lippincott Williams & Wilkins |isbn=978-0781726795 |page=140}}</ref>

Women who have uterine anomalies, [[leiomyomas]] or had previous difficult first-trimester abortion are contraindicated to undertake surgical abortion unless [[Medical ultrasonography|ultrasonography]] is immediately available and the surgeon is experienced in its intraoperative use.<ref>{{cite book|last1=Speroff|first1=Leon|last2=Fritz|first2=Marc A.|title=Clinical gynecologic endocrinology and infertility|edition=7|year=2004|publisher=Lippincott Williams & Wilkins|isbn=978-0781747950|page=851|chapter=Family Planning, Sterilization, and Abortion}}</ref> Abortion does not impair subsequent pregnancies, nor does it increase the risk of future [[premature birth]]s, infertility, [[ectopic pregnancy]], or miscarriage.<ref name="grimes-overview"/>


In the first trimester, [[Medical abortion#Health risks|health risks associated with medical abortion]] are generally considered no greater than for surgical abortion.<ref name="who-medical-abortion">{{cite web | publisher = [[World Health Organization]] | title = Medical versus surgical methods for first trimester termination of pregnancy | url = http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html | date = December 15, 2006 | accessdate = June 1, 2010}}</ref>

===Mental health===
{{Main|Abortion and mental health}}
No scientific research has demonstrated that abortion is a cause of poor mental health in the general population. However there are groups of women who may be at higher risk of coping with problems and distress following abortion.<ref name="Cockburn">{{cite book |last1=Cockburn|first1=Jayne |last2=Pawson|first2=Michael E. |title=Psychological Challenges to Obstetrics and Gynecology: The Clinical Management |year=2007 |publisher=Springer |isbn=978-1846288074 |page=243}}</ref> Some factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.<ref name="APA89">{{cite journal |author=Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE |title=Psychological responses after abortion |journal=[[Science (journal)|Science]] |volume=248 |issue=4951 |pages=41–4 |year=1990 |pmid=2181664 |doi=10.1126/science.2181664}}</ref> The [[American Psychological Association]] (APA) concluded that abortion does not lead to increased mental health problems.<ref>{{cite web |url=http://www.apa.org/pi/women/programs/abortion/mental-health.pdf |title=Report of the APA Task Force on Mental Health and Abortion |publisher=[[American Psychological Association]] |location=Washington, DC |date=August 13, 2008}}</ref>

Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization.<ref name="Grimes">{{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=10.1001/archinte.140.5.620 |quote=Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae. ... The alleged 'postabortion trauma syndrome' does not exist.}}</ref><ref name="stotlandreview">{{cite journal |author=Stotland NL |title=Abortion and psychiatric practice |journal=[[J Psychiatr Pract]] |volume=9 |issue=2 |pages=139–149 |year=2003 |pmid=15985924 |doi=10.1097/00131746-200303000-00005 |quote=Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae.}}</ref><ref name="stotland_1404747">{{cite journal |author=Stotland NL |title=The myth of the abortion trauma syndrome |journal=[[J Am Med Assoc]] |volume=268 |issue=15 |pages=2078–9 |year=1992 |month=October |pmid=1404747 |doi=10.1001/jama.268.15.2078 |doi_brokendate=2009-11-14}}</ref>

==Incidence==
The number of abortions performed worldwide has deceased between 1995 and 2003 from 45.6 million to 41.6 million (a decrease from 35 to 29 per 1000 women between 15 and 44 years of age).<ref name=OBGY09/> The greatest decrease has occurred in the developed world with a decrease from 39 to 26 per 1000 women in comparison to the developing world which had a decrease from 34 to 29 per 1000 women.<ref name=OBGY09/> Of these approximately 42 million abortions 22 million occurred safely and 20 million unsafely.<ref name=OBGY09/>

The incidence and reasons for induced abortion vary regionally. Some countries, such as Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100), had a comparatively low rate of induced abortion, while others like Russia (62.6 per 100) and Vietnam (43.7 per 100) had a high rate. The world ratio was 26 induced abortions per 100 known pregnancies (excluding miscarriages and stillbirths).<ref>Henshaw, Stanley K., Singh, Susheela, and Haas, Taylor. (1999). [http://www.guttmacher.org/pubs/journals/25s3099.html The Incidence of Abortion Worldwide]. ''International Family Planning Perspectives, 25 (Supplement)'', 30–38. Retrieved 2006-01-18.</ref>

===By gestational age and method===
{{Double image|right|UK abortion by gestational age 2004 histogram.svg|200|US abortion by gestational age 2004 histogram.svg|200|[[Histogram]] of abortions by [[gestational age]] in England and Wales during 2004. Average is 9.5 weeks. (left) Abortion in the United States by gestational age, 2004. (Data source: Centers for Disease Control and Prevention) (right) ||}}

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, from data collected in those areas of the United States that sufficiently reported gestational age, it was found that 88.2% of abortions were conducted at or prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 90.9% of these were classified as having been done by "[[curettage]]" ([[Suction-aspiration 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 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., and 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. and 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> Later abortions are more common in China, India, and other developing countries than in developed countries.<ref>Cheng L. [http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html “Surgical versus medical methods for second-trimester induced abortion : RHL commentary”] (last revised: 1 November 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.</ref>

===By personal and social factors===
[[Image:AGIAbortionReasonsBarChart.png|thumb|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 childbearing, concern over the interruption of work or education, issues of financial or relationship stability, and perceived immaturity.<ref name="bankole98">Bankole, Akinrinola, Singh, Susheela, and 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 and 152. Retrieved 2006-01-18.</ref> A 2004 study in which 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, and 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),'' 110–118. 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> The Guttmacher Institute estimated that "most abortions in the United States are obtained by minority women" because minority women "have much higher rates of unintended pregnancy."<ref>Susan A. Cohen: [http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html ''Abortion and Women of Color: The Bigger Picture''], Guttmacher Policy Review, Summer 2008, Volume 11, Number 3.</ref>

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled people, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward [[population control]] (such as China's [[one-child policy]]). These factors can sometimes result in compulsory abortion or [[sex-selective abortion]].

===Unsafe abortion===
[[Image:RussianAbortionPoster.jpg|thumb|Soviet poster circa 1925, promoting hospital abortions. 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}}
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly where and when access to legal abortion is restricted. The [[World Health Organization]] (WHO) defines an unsafe abortion as being "a procedure ... carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both."<ref name="whounsafe">World Health Organization. (2004). [http://www.who.int/reproductive-health/publications/unsafeabortion_2000/estimates.pdf "Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000"]. Retrieved 2009-03-22.</ref> Unsafe abortions are sometimes known colloquially as "back-alley" abortions. They may be performed by [[self-induced abortion|the woman herself]], another person without medical training, or a professional health provider operating in sub-standard conditions. Unsafe abortion remains a public health concern due to the higher incidence and severity of its associated complications, such as incomplete abortion, [[sepsis]], hemorrhage, and damage to internal organs. It is estimated that 20 million unsafe abortions occur around the world annually and that 70,000 of these result in the woman's death.<ref name=OBGY09/> 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 post abortion complications: saving women's lives]. ''Population Reports, 25 (1).'.' Retrieved 2006-02-22.</ref> 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 name="Worldwide">{{cite journal |first=Gilda |last=Sedgh |year=2007 |month=October |title=Induced abortion: estimated rates and trends worldwide |journal=[[The Lancet]] |volume=370 |issue=9595 |pages=1338–1345 |doi=10.1016/S0140-6736(07)61575-X |pmid=17933648 |url=http://media.mcclatchydc.com/smedia/2007/10/17/13/Chang-Guttmacher_Institute_abortion_report.source.prod_affiliate.91.pdf |format=PDF|accessdate=2008-12-02 |last2=Henshaw |first2=S |last3=Singh |first3=S |last4=Ahman |first4=E |last5=Shah |first5=IH}}</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>

==History==
[[Image:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|right|"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">{{cite book |last=Devereux |first=G. |chapter=A typological study of abortion in 350 primitive, ancient, and pre-industrial societies |chapterurl=http://www.popline.org/docs/671051 |accessdate=2008-12-02 |editor=Harold Rosen |title=Abortion in America; medical, psychiatric, legal, anthropological, and religious considerations |year=1967 |location=[[Boston]] |publisher=[[Beacon Press]] |oclc=187445}}</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>{{cite book |first=Mary R. |last=Lefkowitz |authorlink=Mary Lefkowitz |coauthors=Maureen B. Fant |title=Women's life in Greece & Rome: a source book in translation |publisher=[[Johns Hopkins University Press]] |location=[[Baltimore]] |year=1992 |pages= |isbn=0-8018-4474-6 |oclc=25373320 |url=http://www.stoa.org/diotima/anthology/wlgr/ |accessdate=2008-12-02}}</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 poisonous herbs with serious [[Adverse effect (medicine)|side effects]] that have at times been used to terminate pregnancy.

During the [[Islamic Golden Age|medieval period]], [[Medicine in medieval Islam|physicians in the Islamic world]] documented detailed and extensive lists of birth control practices, including the use of abortifacients, commenting on their effectiveness and prevalence.<ref>{{Cite book|last=Sheikh|first=Sa'diyya|contribution=Family Planning, Contraception, and Abortion in Islam|editor-first=Daniel C.|editor-last=Maguire|title=Sacred Rights: The Case for Contraception and Abortion in World Religions|publisher=[[Oxford University Press]] US|year=2003|isbn=0195160010|pages=105–128 [105–106]}}</ref> They listed many different birth control substances in their medical encyclopedias, such as [[Avicenna]] listing 20 in ''[[The Canon of Medicine]]'' (1025) and [[Muhammad ibn Zakariya ar-Razi]] listing 176 in his ''Hawi'' (10th century). This was unparalleled in European medicine until the 19th century.<ref>{{Cite book|last=Sheikh|first=Sa'diyya|contribution=Family Planning, Contraception, and Abortion in Islam|editor-first=Daniel C.|editor-last=Maguire|title=Sacred Rights: The Case for Contraception and Abortion in World Religions|publisher=[[Oxford University Press]] US|year=2003|isbn=0195160010|pages=105–128 [115]}}</ref>{{Request quotation|date=January 2010}}

During the [[Middle Ages]], abortion was tolerated and there were no laws against it.<ref>"[http://facts.randomhistory.com/2008/12/14_abortion.html 50 Random Facts About ...... Abortion]". Random Facts.</ref> A medieval female physician, [[Trotula]] of Salerno,<ref>"[[s:1911 Encyclopædia Britannica/Medicine|1911 Encyclopædia Britannica/Medicine]]"</ref> administered a number of remedies for the “retention of menstrua,” which was sometimes a code for early abortifacients.<ref>Riddle, John M. 1992. Contraception and Abortion from the Ancient World to the Renaissance. London, England: Harvard University Press.</ref> [[Pope Sixtus V]] (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy.<ref>"[http://civilliberty.about.com/od/gendersexuality/tp/History-of-Prostitution.htm History of Prostitution]". About.com: Civil Liberties.</ref> 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>{{cite web |first=James |last=DeHullu |url=http://mysite.verizon.net/jdehullu/abortion/abhist.htm |accessdate=2008-12-02 |title=Histories of Abortion}}</ref>

In the 20th century the Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.<ref name="cbctrust">{{cite web |url=http://www.cbctrust.com/history_law_religion.php |archiveurl=http://web.archive.org/web/20080208053146/http://www.cbctrust.com/history_law_religion.php |archivedate=2008-02-08 |title=Abortion Law, History & Religion |accessdate=2008-03-23 |work=Childbirth By Choice Trust}}</ref> In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill," while women considered of German stock were specifically prohibited from having abortions.<ref>{{cite book |last=Friedlander |first=Henry |authorlink=Henry Friedlander |title=The origins of Nazi genocide: from euthanasia to the final solution |publisher=University of North Carolina Press |location=Chapel Hill |year=1995 |page=[http://books.google.com/books?id=gqLDEKVk2nMC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA30,M1 30] |isbn=0-8078-4675-9 |oclc=60191622}}</ref><ref>{{cite book |first=Robert |last=Proctor |authorlink=Robert N. Proctor |title=Racial Hygiene: Medicine Under the Nazis |publisher=[[Harvard University Press]] |location=[[Cambridge, Massachusetts]] |year=1988 |pages=122, 123 and 366 |isbn=0-674-74578-7 |oclc=20760638}}</ref><ref>{{cite book |first=Margaret L. |last=Arnot |authorlink= |coauthors=Cornelie Usborne |title=Gender and Crime in Modern Europe |publisher=Routledge |location=New York |year=1999 |page=231 |isbn=1-85728-745-2 |oclc=186748539}}</ref><ref>{{cite encyclopedia |last=DiMeglio |first=Peter M. |editor=Helen Tierney |encyclopedia=Women's studies encyclopedia |title=Germany 1933–1945 (National Socialism) |year=1999 |publisher=Greenwood Press |location=[[Westport, Connecticut]] |isbn=0-313-31072-6 |oclc=38504469 |pages=[http://books.google.com/books?id=gQLqRd7hJq0C&printsec=frontcover&source=gbs_summary_r&cad=0#PPA589,M1 589]}}</ref>

==Society and culture==
===Abortion debate===
{{Refimprovesect|date=November 2008}}
{{Double image|right|March for Women's Lives detail.jpg|200|March for life 2009.JPG|200|Pro-choice activists near the [[Washington Monument]] at the [[March for Women's Lives]] in 2004. (left) Pro-life activists near the Washington Monument at the annual 2009 [[March for Life]] in [[Washington, DC]]. (right) ||}}

{{Main|Abortion debate}}
In the [[history of abortion]], induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her [[value system]]. The main positions are one that argues in favor of access to abortion and one argues against access to abortion. Opinions of abortion may be described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy. [[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 groups advocating one of these two positions. In the United States, those in favor of greater legal restrictions on, or even complete prohibition of abortion, most often describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Generally, the former position argues that a human fetus is a human being with a [[right to life|right to live]] making abortion tantamount to murder. The latter position argues that a woman has certain [[reproductive rights]], especially the choice whether or not to carry a pregnancy to term.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion.

Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a [[minor (law)|minor]], her parents; a 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 legalized mandatory 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>

===Abortion law===
{{Main|Abortion law}}
{{See also|Reproductive rights}}
[[File:AbortionLawsMap-NoLegend.png|thumb|right|250px|International status of abortion law: {{legend|#3f9bbb|Legal on request}} {{legend|#d4df5a|Legal for maternal life, health, mental health, rape, fetal defects, and/or socioeconomic factors}} {{legend|#64513B|Legal for or illegal with exception for maternal life, health, mental health, rape, and/or fetal defects}} {{legend|#FA7014|Illegal with exception for maternal life, health, mental health and/or rape}} {{legend|#cc7662|Illegal with exception for maternal life, health, and/or mental health}} {{legend|#3236D3|Illegal with no exceptions}} {{legend|#B3B3B3|No information}} Vertical stripes (various colours): Illegal but unenforced]]

Before the scientific discovery in the nineteenth century that human development begins at [[human fertilization|fertilization]],<ref>{{cite book |author=Garrison, Fielding |url=http://books.google.com/?id=JvoIAAAAIAAJ&pg=PA567&dq=fetilization+was+discovered+hertwig |title=An Introduction to the History of Medicine |pages=566–7 |publisher=Saunders |year=1921 |oclc=}}</ref> [[English common law]] forbade abortions after "[[quickening]]", that is, after "an infant is able to stir in the mother's womb."<ref>{{cite book |first=William |last=Blackstone |authorlink=William Blackstone |chapter=Amendment IX, Document 1 |chapterurl=http://press-pubs.uchicago.edu/founders/documents/amendIXs1.html |title=[[Commentaries on the Laws of England]] |origyear=1765 |year=1979 |publisher=University of Chicago Press |location=Chicago |volume=5 |page=388 |isbn=3511090288}}</ref> There was also an earlier period in England when abortion was prohibited "if the foetus is already formed" but not yet quickened.<ref>{{cite book |author=[[Henry de Bracton]] |chapter=The crime of homicide and the divisions into which it falls |editor=George E. Woodbine ed.; Samuel Edmund Thorne trans. |title=On the Laws and Customs of England |origyear={{circa|1250}} |year=1968 |accessdate=2008-12-11 |volume=2 |page=341 |url=http://hlsl5.law.harvard.edu/bracton/Unframed/English/v2/341.htm |oclc=1872}}</ref> Both pre- and post-quickening abortions were criminalized by ''[[Lord Ellenborough's Act]]'' in 1803.<ref>{{cite web |url=http://web.archive.org/web/20070918233015/http://members.aol.com/abtrbng/lea.htm |title=Lord Ellenborough’s Act |year=1998 |work=The Abortion Law Homepage |accessdate=2007-02-20}} (via Archive.org)</ref> In 1861, the [[Parliament of the United Kingdom]] passed the ''[[Offences against the Person Act 1861]]'', which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.<ref>{{cite web |author=United Nations Population Division |year=2002 |url=http://www.un.org/esa/population/publications/abortion |title=Abortion Policies: A Global Review |accessdate=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 (except Northern Ireland). 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 the Republic of Ireland|abortion in Ireland]] was affected by the addition of an [[Eighth Amendment of the Constitution of Ireland|amendment]] to the 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, the right to [[security of person]], and the right to [[reproductive rights|reproductive health]] are major issues of human rights that are sometimes used as justification for the existence or absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window of legality:
*In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on [[prenatal development|fetal development]], or require that [[minors and abortion|parents be contacted]] if their minor daughter requests an abortion.<ref>[http://www.lawserver.com/abortion Interactive maps comparing U.S. abortion restrictions by state] LawServer.</ref>
*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.
*In Canada, a similar requirement was rejected as unconstitutional in 1988.

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]], [[Abortion in El Salvador|El Salvador]], [[Abortion in Malta|Malta]], and [[Abortion in Nicaragua|Nicaragua]], with consequent rises in maternal death directly and indirectly due to pregnancy.<ref>{{cite web |title=European delegation visits Nicaragua to examine effects of abortion ban |date=November 26, 2007 |publisher=Ipas |accessdate=2009-06-15| url=http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx }} "More than 82 maternal deaths had been registered in Nicaragua since the change. During this same period, indirect obstetric deaths, or deaths caused by illnesses aggravated by the normal effects of pregnancy and not due to direct obstetric causes, have doubled."</ref><ref>{{cite news|url=http://insidecostarica.com/special_reports/2008-06/nicaragua_womens_movement.htm |title=NICARAGUA: "The Women’s Movement Is in Opposition" |date=28 June 2008 |place=Montevideo |agency=IPS |publisher=Inside Costa Rica}}</ref> However, in 2006, the [[Politics of Chile|Chilean government]] began the free distribution of [[emergency contraception]].<ref>{{cite news |author=Ross, Jen |date=September 12, 2006 |url=http://www.csmonitor.com/2006/0912/p01s04-woam.html |title=In Chile, free morning-after pills to teens |work=The Christian Science Monitor |accessdate=2006-12-07}}</ref><ref>{{cite news |author=Gallardoi, Eduardo |date=September 26, 2006 |url=http://www.washingtonpost.com/wp-dyn/content/article/2006/09/26/AR2006092600770.html |title=Morning-After Pill Causes Furor in Chile |work=[[The Washington Post]] |accessdate=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>

In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in [[medical tourism]] and travel to countries where they can terminate their pregnancies. Women without the means to travel can resort to providers of illegal abortions or try to do it themselves.
<ref>{{cite web |title=Need Abortion, Will Travel |author=Marcy Bloom |date=February 25, 2008 |publisher=RH Reality Check |accessdate=2009-06-15| url=http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel}}</ref>

In the US, about 8% of abortions are performed on women who travel from another state.<ref>{{cite web |title=United States: Percentage of Legal Abortions Obtained by Out-of-State Residents, 2005 |publisher=The Kaiser Family Foundation |accessdate=2009-06-14| url=http://www.statehealthfacts.kff.org/profileind.jsp?rgn=1&cat=10&ind=467}}</ref> However, that is driven at least partly by differing limits on abortion according to gestational age or the scarcity of doctors trained and willing to do later abortions.

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

[[Medical ultrasonography|Sonography]] and [[amniocentesis]] allow parents to determine sex before childbirth. The development of this technology has led to [[sex-selective abortion and female infanticide|sex-selective abortion]], or the targeted termination of female fetuses.

It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in China, Taiwan, South Korea, and India.<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 common Indian tradition which dictates that [[funeral|funeral rites]] must be performed by a male relative have led to a cultural preference for sons.<ref>Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, and 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>{{cite journal |first=Rita |last=Patel |year=1996 |month=Fall |title=The practice of sex selective abortion in India: May you be the mother of a hundred sons |journal=Carolina Papers in International Health and Development |volume=7 |url=http://cgi.unc.edu/research/pdf/abortion.pdf |format=PDF|accessdate=2008-12-03}}</ref> In 1991, the male-to-female [[human sex ratio|sex ratio]] in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.<ref>{{cite journal |last=Sudha |first=S. |year=1999 |month=July |title=Female Demographic Disadvantage in India 1981–1991: Sex Selective Abortions and Female Infanticide |journal=Development and Change |volume=30 |issue=3 |pages=585–618 |doi=10.1111/1467-7660.00130 |url=http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archiveurl=http://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archivedate=2003-01-01 |accessdate=2008-12-03 |last2=Rajan |first2=S. Irudaya |pmid=20162850}}</ref> Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.<ref>{{cite news |first=Patricia |last=Reaney |publisher=Reuters |url=http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archiveurl=http://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archivedate=2006-02-20 |title=Selective abortion blamed for India's missing girls |accessdate=2008-12-03}}</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>{{cite journal |last=Mudur |first=Ganapati |year=2002 |title=India plans new legislation to prevent sex selection |journal=[[BMJ]] |volume=324 |issue=7334 |page=385b |doi=10.1136/bmj.324.7334.385/b}}</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>{{cite journal |first=Maureen J. |last=Graham |year=1998 |month=June |title=Son Preference in Anhui Province, China |journal=International Family Planning Perspectives |volume=24 |issue=2 |url=http://www.agi-usa.org/pubs/journals/2407298.html |accessdate=2008-12-03 |doi=10.2307/2991929 |page=72 |author2=Larsen |author3=Xu}}</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>{{cite journal |last=Plafker |first=Ted |year=2002 |month=May |title=Sex selection in China sees 117 boys born for every 100 girls |journal=[[BMJ]] |volume=324 |issue=7348 |page=1233a |doi=10.1136/bmj.324.7348.1233/a |pmid=12028966 |pmc=1123206}}</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>

==In other animals==
{{See|Miscarriage#In other animals}}
Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.<ref>Spencer, James. ''[http://books.google.com/books?id=RXMuAAAAYAAJ&pg=PA124&lpg=PA124&dq=abortion+and+husbandry&source=bl&ots=WjmvGj-fB2&sig=8qH_WrPR08YEwPKr_c6PHDUOMmQ&hl=en&ei=erDbSeSVBoz4MY-F7M4I&sa=X&oi=book_result&ct=result&resnum=2#PPA124,M1 Sheep Husbandry in Canada]'', p. 124 (1911).</ref> In cows, abortion may be caused by contagious disease, such as [[Brucellosis]] or [[Campylobacter]], but can often be controlled by vaccination.<ref>[http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en "Beef cattle and Beef production: Management and Husbandry of Beef Cattle”], ''Encyclopaedia of New Zealand'' (1966).</ref> Additionally, many other diseases are known to increase the risk of miscarriage in humans and other animals.{{Citation needed|date=April 2009}}

Abortion may also be induced in animals, in the context of [[animal husbandry]]. For example, abortion may be induced in mares that have been mated improperly, or that have been purchased by owners who did not realize the mares were pregnant, or that are pregnant with twin foals.<ref>McKinnon, Angus et al. ''[http://books.google.com/books?id=jlZAT-9VwUIC&pg=PA563&lpg=PA563&dq=%22induce+abortion%22+and+husbandry&source=bl&ots=6T9w3LtpsI&sig=aEYDFpnMIbLaKlstxK1MGK2rxwQ&hl=en&ei=eLTbSY7EO5muMrXUkMkI&sa=X&oi=book_result&ct=result&resnum=7 Equine Reproduction]'', p. 563 (Wiley-Blackwell 1993).</ref>

[[Feticide]] can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,<ref>{{cite journal|last=Berger|first=Joel W|date=5 May 1983|title=Induced abortion and social factors in wild horses|journal=Nature|location=London|volume=303|pages=59–61|url=http://www.nature.com/nature/journal/v303/n5912/abs/303059a0.html|doi=10.1038/303059a0|pmid=6682487|issue=5912}}</ref><ref>{{cite journal|last=Pluháček|first=Jan|year=2000|title=Male infanticide in captive plains zebra, Equus burchelli|journal=Animal Behaviour|volume=59|pages=689–694|url=http://af.czu.cz/~bartos/publications/pdf/Pluhacek_Bartos_2000_AB.pdf|doi=10.1006/anbe.1999.1371|pmid=10792924|last2=Bartos|first2=L|issue=4}}</ref><ref>{{cite journal|last=Pluháček|first=Jan|year=2005|title=Further evidence for male infanticide and feticide in captive plains zebra, Equus burchelli|journal=Folia Zool.|volume=54|issue=3|pages= 258–262|url=http://www.ivb.cz/folia/54/3/258-262.pdf}}</ref> although the frequency in the wild has been questioned.<ref>{{cite journal|last=JW|first=Fitzpatrick|date=October 1991|title=Changes in herd stallions among feral horse bands and the absence of forced copulation and induced abortion |journal=Behavioral Ecology and Sociobiology|publisher=Springer|location=Berlin/Heidelberg|volume=29|issue=3|pages=217–219|issn=0340-5443 (Print) 1432-0762 (Online)|url=http://www.springerlink.com/content/k1543n1548987255/}}</ref> Male [[Gray langur]] monkeys may attack females following male takeover, causing miscarriage.<ref>{{cite journal|last=Agoramoorthy |first=G.|date=August 1988|title=Abortions in free ranging Hanuman langurs (Presbytis entellus)—a male induced strategy?|journal=Human Evolution|publisher=Springer|location=Netherlands|volume=3|issue=4|pages=297–308|issn=0393-9375 (Print) 1824-310X (Online)|url=http://www.springerlink.com/content/324g107410293474/}}</ref>

==See also==
*[[Abortion fund]]
*[[Anti-abortion violence]]
*[[Connolly v. DPP]]
*[[Fetal rights]]
*[[Late-term abortion]]
*[[Minors and abortion]]
*[[Paternal rights and abortion]]
*[[Population control]]
*[[Self-induced abortion]]
*[[Stem cell controversy]]

==References==
{{Reflist|colwidth=30em}}

==External links==
{{sisterlinks|abortion}}
*{{dmoz|Health/Reproductive_Health/Abortion}}
*[http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review]
*[http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm#Definition MedlinePlus Medical Encyclopedia: Abortion]


'''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]

Abortion

2010-07-15T19:59:55Z

Kabel:

{{Infobox_Disease
| Name = Induced abortion
| Image = AngkorWatAbortionAD1150.JPG
| Caption = [[Bas-relief]] at [[Angkor Wat]], [[Cambodia]], c. 1150, depicting a [[demon]] inducing an abortion by pounding the abdomen of a pregnant woman with a [[pestle]].<ref>{{cite book |author=Potts M ''et al.'' |title=Thousand-year-old depictions of massage abortion |journal=Journal of Family Planning and Reproductive Health Care |volume=33 |pages=234 |year=2007 |quote=at Angkor, the operator is a demon.}} Also see {{cite book |author=Mould R |title=Mould's Medical Anecdotes |pages=406 |publisher=[[CRC Press]] |year=1996}}</ref>
| ICD10 = {{ICD10|O|04||o|00}}
| ICD9 = {{ICD9|779.6}}
| DiseasesDB = 4153
| ICDO =
| OMIM =
| MedlinePlus = 002912
| eMedicineSubj = article
| eMedicineTopic = 252560
| MeshID =
}}

'''Abortion''' is the termination of a [[pregnancy (mammals)|pregnancy]] by the removal or expulsion from the [[uterus]] of a [[fetus]] or [[embryo]], resulting in or caused by its death.<ref>{{cite book |url=http://books.google.com/?id=KiRHpRl7TjsC&pg=PA173 |title=Gynaecology for Lawyers |author=Dutt T, Matthews MP |volume=14 |series-title=Medico-legal practitioner series |publisher=Routledge |year=1998 |isbn=9781859412152}}</ref> An abortion can occur spontaneously due to [[complication (medicine)|complications]] during pregnancy or can be induced, in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the [[gravidity|gravida]] (pregnant female) is termed a ''therapeutic abortion'', while an abortion induced for any other reason is termed an ''elective abortion''. The term ''abortion'' most commonly refers to the induced abortion of a [[pregnancy|human pregnancy]], while spontaneous abortions are usually termed [[miscarriage]]s. 

Worldwide 42 million abortions are estimated to take place annually with 22 million of these occurring safely and 20 million unsafely.<ref name=OBGY09>{{cite journal |author=Shah I, Ahman E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=[[J Obstet Gynaecol Can]] |volume=31 |issue=12 |pages=1149–58 |year=2009 |month=December |pmid=20085681 |doi= |url=}}</ref> While [[maternal death|maternal mortality]] seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.<ref name=OBGY09/> One of the main determinants of the availability of safe abortions is the legality of the procedure. Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.<ref name=IJGO10>{{cite journal |author=Culwell KR, Vekemans M, de Silva U, Hurwitz M|title=Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion |journal=[[International Journal of Gynecology & Obstetrics]] |volume=110 |pages=S13–16 |year=2010 |month=July |pmid=20451196 |doi=10.1016/j.ijgo.2010.04.003 }}</ref> The frequency of abortions is, however, similar whether or not access is restricted.<ref name=IJGO10/>

Abortion has a long [[history of abortion|history]] and has been induced by various methods including herbal [[abortifacient]]s, the use of sharpened tools, [[physical trauma]], and other [[traditional medicine|traditional methods]]. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The [[abortion law|legality]], prevalence, and cultural views on abortion vary substantially around the world. In many parts of the world there is prominent and divisive [[Abortion debate|public controversy]] over the [[ethical aspects of abortion|ethical]] and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing [[pro-life]] and [[pro-choice]] worldwide social movements ([[Pro-choice#Term_controversy|both self-named]]). Incidence of abortion has declined worldwide, as access to [[family planning]] education and contraceptive services has increased.<ref name="worldtrends">{{cite journal |author=Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J |title=Legal abortion worldwide: incidence and recent trends |journal=Int Fam Plan Perspect |volume=33 |issue=3 |pages=106–16 |year=2007 |month=September |pmid=17938093 |doi=10.1363/ifpp.33.106.07 |url=http://www.guttmacher.org/pubs/journals/3310607.html }}</ref> 

==Types==
[[File:Human fetus 10 weeks - therapeutic abortion.jpg|thumb|A 10-week-old fetus removed from a 44-year-old female diagnosed with early-stage [[uterine cancer]] via a therapeutic abortion. The uterus (womb), included the fetus.]]
===Spontaneous===
{{Main|Miscarriage}}
Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due to accidental trauma or natural causes before approximately the 22nd [[gestational age|week of gestation]]; the definition by gestational age varies by country.<ref name="WHOmiscarriage">{{cite web |url=http://www.who.int/reproductive-health/impac/Symptoms/Vaginal_bleeding_early_S7_S16.html |title=Managing Complications in Pregnancy and Childbirth – A guide for midwives and doctors |last=Department of Reproductive Health and Research |publisher=World Health Organization |year=2003 |accessdate=2009-04-07}} NB: This definition is subject to regional differences, see [[Miscarriage#Terminology|miscarriage]].</ref> Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. A pregnancy that ends before 37 weeks of gestation resulting in a [[live birth|live-born]] infant is known as a "[[premature birth]]". When a fetus dies [[in utero]] after about 22 weeks, or during [[childbirth|delivery]], it is usually termed "[[stillbirth|stillborn]]". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.<ref name=BBCmiscarriage>{{cite news |url=http://news.bbc.co.uk/2/hi/health/2176898.stm |title=Q&A: Miscarriage |date=2002-08-06 |publisher=BBC |accessdate=2009-04-07}}</ref> Most miscarriages occur very early in pregnancy, in most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy found that 61.9% of conceptuses were lost prior to 12 weeks, and 91.7% of these losses occurred subclinically, without the knowledge of the once pregnant woman.<ref name="pmid7117572">{{cite journal |author=Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ |title=Early embryonic mortality in women |journal=Fertil. Steril. |volume=38 |issue=4 |pages=447–453 |year=1982 |pmid=7117572 |doi=}}</ref>

The risk of spontaneous abortion decreases sharply after the 10th week from the [[gestational age|last menstrual period]] (LMP).<ref name=BBCmiscarriage /><ref>{{cite book |first=Lennart |last=Nilsson |authorlink=Lennart Nilsson |coauthors=Lars Hamberger | page=91 |title=[[A Child Is Born (book)|A child is born]] |publisher=[[Doubleday (publisher)|Doubleday]] |location=[[Garden City, New York]] |year=1990 |pages= |isbn=0-385-40085-3 |oclc=21412111 |origyear=1965}}</ref> One study of 232 pregnant women showed "virtually complete <nowiki>[pregnancy loss]</nowiki> by the end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5 weeks LMP.<ref name="fetal med 836">{{cite book |chapter=Early pregnancy loss |editor=Martin J. Whittle and C. H. Rodeck |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=http://books.google.com/?id=0BY0hx2l5uoC |isbn=0-443-05357-X |oclc=42792567 |page=836 |author8=Jauniaux E, Kaminopetros P, El-Rafaey H }}</ref>

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,<ref name="mednet">{{cite web |url=http://www.medicinenet.com/miscarriage/page1.htm |title=Miscarriage (Spontaneous Abortion) |accessdate=2009-04-07 |last=Stöppler |author=Conrad M |editor=Shiel WC Jr |work=MedicineNet.com }}</ref> accounting for at least 50% of sampled early pregnancy losses.<ref name="fetal med 837">{{cite book |author=Jauniaux E, Kaminopetros P, El-Rafaey H |chapter=Early pregnancy loss |editor=Whittle MJ,Rodeck CH |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |url=http://books.google.com/?id=0BY0hx2l5uoC |isbn=0-443-05357-X |oclc=42792567 |page=837 }}</ref> Other causes include [[vascular disease]] (such as [[Systemic lupus erythematosus|lupus]]), [[diabetes]], other hormonal problems, infection, and abnormalities of the uterus.<ref name="mednet" /> Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.<ref name="fetal med 837" /> A spontaneous abortion can also be caused by accidental [[Physical trauma|trauma]]; intentional trauma or stress to cause miscarriage is considered induced abortion or [[feticide]].<ref name="Fetal Homicide Laws">{{cite web |url=http://www.ncsl.org/programs/health/fethom.htm |title=Fetal Homicide Laws |accessdate=2009-04-07 |publisher=[[National Conference of State Legislatures]]}}</ref>

===Induced===
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the [[gestational age]] of the embryo or fetus, which increases in size as it ages.<ref>Menikoff, Jerry. [http://books.google.com/books?id=2jXOYv3X8zsC&pg=PA78&dq=size+fetus+abortion+technique&lr=&as_brr=3&ei=MymmSayEFJaQyATt6JiUDg Law and Bioethics], p. 78 (Georgetown University Press 2001): "As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use."</ref> Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as ''therapeutic'' when it is performed 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>
*preserve the woman's physical or mental health;<ref name="roche1"/>
*terminate pregnancy that would result in a child born with a [[congenital disorder]] that would be fatal or associated with significant [[morbidity]];<ref name="roche1"/> or
*[[selective reduction|selectively reduce]] the number of fetuses to lessen health risks associated with [[multiple birth|multiple pregnancy]].<ref name="roche1"/>
An abortion is referred to as ''elective'' when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."<ref>''Encyclopedia Britannica'', (2007), Vol 26, p. 674.</ref>

==Methods==
[[Image:Abortionmethods.png|thumb|350px|right|[[Gestational age]] may determine which abortion methods are practiced.]]
===Medical===
{{Main|Medical abortion}}

"Medical abortions" are non-surgical abortions that use pharmaceutical drugs, and are only effective in the first trimester of pregnancy. {{Citation needed|date=February 2009}} Medical abortions comprise 10% of all abortions in the United States<ref>{{cite journal |author=Strauss LT, Gamble SB, Parker WY, Cook DA, Zane SB, Hamdan S |title=Abortion surveillance—United States, 2004 |journal=MMWR Surveill Summ |volume=56 |issue=9 |pages=1–33 |year=2007 |month=November |pmid=18030283 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5609a1.htm}}</ref> and Europe.{{Citation needed|date=February 2009}} 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|title=Early pregnancy termination with mifepristone and misoprostol in the United States|journal=New England Journal of Medicine|year=1998|volume=338|issue=18|pmid=9562577|doi=10.1056/NEJM199804303381801|page=1241|last2=Bardin|first2=CW|last3=Benton|first3=L|last4=Robbins|first4=A}}</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.

===Surgical===
[[File:Vacuum-aspiration (single).svg|thumb|A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization). '''1:''' Amniotic sac '''2:''' Embryo '''3:''' Uterine lining '''4:''' Speculum '''5:''' Vacurette '''6:''' Attached to a suction pump]]
In the first 12 weeks, [[suction-aspiration abortion|suction-aspiration]] or vacuum abortion is the most common method.<ref>{{cite web |author=Healthwise |url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 |title=Manual and vacuum aspiration for abortion |year=2004 |publisher=[[WebMD]] |accessdate=2008-12-05}}</ref> ''Manual [[Vacuum aspiration]]'' (MVA) abortion consists of removing the [[fetus]] or [[embryo]], [[placenta]] and membranes by suction using a manual syringe, while ''electric [[vacuum aspiration]]'' (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "[[menstrual extraction]]", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, [[dilation and evacuation]] (D&E) is used. D&E consists of opening the [[cervix]] of the uterus and emptying it using surgical instruments and suction.

''[[Dilation and curettage]]'' (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. ''[[Curettage]]'' refers to cleaning the walls of the [[uterus]] with a [[curette]]. The [[World Health Organization]] recommends this procedure, also called ''sharp curettage,'' only when MVA is unavailable.<ref>{{cite book |author=[[World Health Organization]] |chapter=Dilatation and curettage |chapterurl=http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html |title=Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors |publisher=[[World Health Organization]] |location=Geneva |year=2003 |pages= |isbn=92-4-154587-9 |oclc=181845530 |accessdate=2008-12-05}}</ref>

Other techniques must be used to induce abortion in the second [[wiktionary:trimester|trimester]]. Premature delivery can be induced with [[prostaglandin]]; this can be coupled with injecting the [[amniotic sac|amniotic fluid]] with hypertonic 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]]. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.<ref name="encarta">{{cite encyclopedia |last=McGee |first=Glenn |authorlink=Glenn McGee |coauthors=[[Jon F. Merz]] |encyclopedia=[[Encarta]] |title=Abortion |url=http://encarta.msn.com/encyclopedia_761553899/Abortion.html |accessdate=2008-12-05 |publisher=[[Microsoft]]|archiveurl=http://www.webcitation.org/5kvWYG63q|archivedate=2009-10-31|deadurl=yes}}</ref>

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<ref>{{cite journal |author=Vause S, Sands J, Johnston TA, Russell S, Rimmer S |title=Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? |journal=J Obstet Gynaecol |volume=22 |issue=3 |pages=243–245 |year=2002 |month=May |pmid=12521492 |doi=10.1080/01443610220130490 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/01443610220130490&magic=pubmed||1B69BA326FFE69C3F0A8F227DF8201D0 |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y |title=Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals |journal=Fetal. Diagn. Ther. |volume=18 |issue=2 |pages=91–97 |year=2003 |pmid=12576743 |doi=10.1159/000068068 |url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=fdt18091 |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Bhide A, Sairam S, Hollis B, Thilaganathan B |title=Comparison of feticide carried out by cordocentesis versus cardiac puncture |journal=Ultrasound Obstet Gynecol |volume=20 |issue=3 |pages=230–232 |year=2002 |month=September |pmid=12230443 |doi=10.1046/j.1469-0705.2002.00797.x |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Senat MV, Fischer C, Bernard JP, Ville Y |title=The use of lidocaine for fetocide in late termination of pregnancy |journal=BJOG |volume=110 |issue=3 |pages=296–300 |year=2003 |month=March |pmid=12628271 |doi= 10.1046/j.1471-0528.2003.02217.x|url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1470-0328&date=2003&volume=110&issue=3&spage=296 |accessdate=2008-12-03}}</ref><ref>{{cite journal |author=Senat MV, Fischer C, Ville Y |title=Funipuncture for fetocide in late termination of pregnancy |journal=Prenat. Diagn. |volume=22 |issue=5 |pages=354–356 |year=2002 |month=May |pmid=12001185 |doi=10.1002/pd.290 |accessdate=2008-12-03}}</ref> to ensure that the fetus is not born alive.<ref>{{cite book |author=Nuffield Council on Bioethics |chapter=Clinical perspectives (Continued) |chapterurl=http://www.nuffieldbioethics.org/go/browseablepublications/criticalCareDecisionFetalNeonatalMedicine/report_542.html |accessdate=2008-12-03 |title=Critical Case Decisions in Fetal and Neonatal Medicine: Ethical Issues |publisher=Nuffield Council on Bioethics |location= |year=2006 |isbn=1-904384-14-5 |oclc=85782378}}</ref>

===Other methods===
Historically, a number of herbs reputed to possess [[abortifacient]] properties have been used in [[folk medicine]]: [[tansy]], [[pennyroyal]], [[black cohosh]], and the now-extinct [[silphium]] (see [[Abortion#History of abortion|history of abortion]]).<ref name="riddle2">{{cite book |first=John M. |last=Riddle |title=Eve's herbs: a history of contraception and abortion in the West |publisher=[[Harvard University Press]] |location=[[Cambridge, Massachusetts]] |year=1997 |pages= |isbn=0-674-27024-X |oclc=36126503}}{{pn}}</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>{{cite journal |author=Ciganda C, Laborde A |title=Herbal infusions used for induced abortion |journal=J. Toxicol. Clin. Toxicol. |volume=41 |issue=3 |pages=235–239 |year=2003 |pmid=12807304 |doi=10.1081/CLT-120021104 |url= |accessdate=2008-12-04}}</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 Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.<ref name="potts">{{cite journal |first=Malcolm |last=Potts |authorlink=Malcolm Potts |year=2002 |title=History of Contraception |journal=Gynecology and Obstetrics |volume=6 |issue=8 |accessdate=2008-12-04}}</ref> One of the [[bas relief]]s decorating the temple of [[Angkor Wat]] in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the [[underworld]].<ref name="potts" />

Reported methods of unsafe, [[self-induced abortion]] include misuse of [[misoprostol]], and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.<ref>{{cite journal |author=Thapa SR, Rimal D, Preston J |title=Self induction of abortion with instrumentation |journal=Aust Fam Physician |volume=35 |issue=9 |pages=697–698 |year=2006 |month=September |pmid=16969439 |doi= |url=http://www.racgp.org.au/afp/200609/11015 |accessdate=2008-12-04}}</ref>
{{clr}}

==Health risks==
{{See also|Unsafe abortion#Health risks|l1=Health risks of unsafe abortion}}
Abortion, when legally performed in developed countries, is among the safest procedures in medicine.<ref name="lancet-grimes">{{cite journal |author=Grimes DA, Benson J, Singh S, ''et al.'' |title=Unsafe abortion: the preventable pandemic |journal=Lancet |volume=368 |issue=9550 |pages=1908–19 |year=2006 |month=November |pmid=17126724 |doi=10.1016/S0140-6736(06)69481-6 |url=http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf}}</ref><ref name="grimes-overview">{{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 |month=April |pmid=15096333 |doi= |url=http://www.annals.org/content/140/8/620.full}}</ref> In such settings, risk of [[maternal death]] is between 0.2–1.2 per 100,000 procedures.<ref name=IOB2003>{{cite journal |author=Yanda K. et al |title=Reproductive health and human rights |journal=International journal of gynecology and obstetrics |volume=82 |issue=3 |pages=275–283 |year=2003 |month=Sept |pmid= 14499974|doi= 10.1016/S0020-7292(03)00226-1|url=http://www.ijgo.org/article/PIIS0020729203002261/fulltext}}</ref><ref>{{cite journal |author=Vekemans M |title=Making induced abortion safe and legal, worldwide |journal=Eur J Contracept Reprod Health Care |volume=14 |issue=3 |pages=165–8 |year=2009 |month=June |pmid=19565413 |doi=10.1080/13625180902886371 |url=}}</ref><ref name="grimes-mortality">{{cite journal |author=Grimes DA |title=Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999 |journal=Am. J. Obstet. Gynecol. |volume=194 |issue=1 |pages=92–4 |year=2006 |month=January |pmid=16389015 |doi=10.1016/j.ajog.2005.06.070 |url=}}</ref><ref>{{cite book |author=Douglas W. Laube; Barzansky, Barbara M.; Beckmann, Charles R. B.; Herbert, William G. |title=Obstetrics and Gynecology |publisher=Lippincott Williams & Wilkins |location=Hagerstown, Maryland |year=2009 |pages=150 |isbn=0-7817-8807-2 |oclc= |doi= |accessdate=}}</ref> In comparison, by 1996, mortality from childbirth in developed countries was 11 times greater.<ref>{{cite journal |author=Kulczycki A, Potts M, Rosenfield A |title=Abortion and fertility regulation |journal=Lancet |volume=347 |issue=9016 |pages=1663–8 |year=1996 |month=June |pmid=8642962 |doi= 10.1016/S0140-6736(96)91491-9|url=}}</ref><ref>{{cite journal |author=Yanda K. et al |title=Reproductive health and human rights |journal=International journal of gynecology and obstetrics |volume=82 |issue=3 |pages=275–283 |year=2003 |month=Sept |pmid= 14499974|doi= 10.1016/S0020-7292(03)00226-1|url=http://www.ijgo.org/article/PIIS0020729203002261/fulltext}}</ref><ref>{{cite book |author=Danielle Mazza |title=Women's health in general practice |publisher=Butterworth-Heinemann |location=Oxford |year=2004 |pages=93 |isbn=0-7506-8773-8 |oclc= |doi= |accessdate=}}</ref><ref>{{cite book |author=Eric Sokol; Andrew Sokol |title=General gynecology |publisher=Mosby |location=St. Louis |year=2007 |pages=238 |isbn=0-323-03247-8 |oclc= |doi= |accessdate=}}</ref><ref>{{cite book |author=Lloyd, Cynthia B. |title=Growing up global: the changing transitions to adulthood in developing countries |publisher=National Academies Press |location=Washington, D.C |year=2005 |pages=215 |isbn=0-309-09528-X |oclc= |doi= |accessdate=}}</ref><ref>{{cite book |author=Douglas W. Laube; Barzansky, Barbara M.; Beckmann, Charles R. B.; Herbert, William G. |title=Obstetrics and Gynecology |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2009 |pages=150 |isbn=0-7817-8807-2 |oclc= |doi= |accessdate=}}</ref> [[Unsafe abortion]]s (defined by the [[World Health Organization]] as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) carry a high risk of maternal death and other complications.<ref name="who-unsafe-1995">{{cite web| publisher = [[World Health Organization]] | title = The Prevention and Management of Unsafe Abortion | date = April 1995 | accessdate = June 1, 2010 | url = http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf |format = PDF}}</ref> For unsafe procedures, the mortality rate has been estimated at 367 per 100,000.<ref>{{cite journal |author=Fawcus SR |title=Maternal mortality and unsafe abortion |journal=Best Pract Res Clin Obstet Gynaecol |volume=22 |issue=3 |pages=533–48 |year=2008 |month=June |pmid=18249585 |doi=10.1016/j.bpobgyn.2007.10.006 |url=}}</ref>

====Physical health====
Surgical abortion methods, like most [[minimally invasive procedure]]s, carry a small potential for serious complications.<ref>{{cite book |author=[[World Health Organization]] |title=Medical Methods for Termination of Pregnancy: Report of a Who Scientific Group |series=Who Technical Report Series No. 871 |publisher=[[World Health Organization]] |location=[[Geneva]] |year=1997 |pages= |isbn=92-4-120871-6 |oclc=38276325}}{{pn}}</ref>

Surgical abortion is generally safe and the rate of major complications is low<ref>{{cite book |last1=Botha|first1=Rosanne L.|last2=Bednarek|first2=Paula H.|last3=Kaunitz|first3=Andrew M.|coauthors=Alison B. Edelman|editor=Guy I Benrubi |title=Handbook of Obstetric and Gynecologic Emergencies |edition=4|year=2010|publisher=Lippincott Williams & Wilkins|isbn=978-1605476667|page=256|chapter=Complications of Medical and Surgical Abortion|quote=Although first trimester medical and surgical abortion are safe with low rates of major complications, these are common procedures, and therefore it is not unusual for women with abortion complications to present for emergent care.}}</ref> but varies depending on how far pregnancy has progressed and the surgical method used.<ref name="Pregler"/> Concerning gestational age, incidence of major complications is highest after 20 weeks of gestation and lowest before the 8th week.<ref name="Pregler"/> With more advanced gestation there is a higher risk of [[uterine perforation]] and retained products of conception,<ref name="Rello">{{cite book|editor=Jordi Rello|title=Infectious diseases in critical care|edition=2|publisher=Springer|isbn=978-3540344056|page=490}}</ref> and specific procedures like [[dilation and evacuation]] may be required.<ref name="cochrane-2nd-tri">{{cite journal |author=Lohr PA, Hayes JL, Gemzell-Danielsson K |title=Surgical versus medical methods for second trimester induced abortion |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD006714 |year=2008 |pmid=18254113 |doi=10.1002/14651858.CD006714.pub2 }}</ref>

Concerning the methods used, general incidence of major complications for surgical abortion varies from lower for suction curettage, to higher for saline instillation.<ref name="Pregler">{{cite book|last1=Pregler|first1=Janet P. |last2=DeCherney|first2=Alan H. |title=Women's health: principles and clinical practice |year=2002 |publisher=pmph usa |isbn=978-1550091700 |page=232}}</ref> Possible complications include [[hemorrhage]], incomplete abortion, uterine or pelvic infection, ongoing intrauterine pregnancy, misdiagnosed/unrecognized [[ectopic pregnancy]], [[hematometra]] (in the uterus), [[uterine perforation]] and cervical laceration.<ref>{{cite book |last1=Botha|first1=Rosanne L. |last2=Bednarek|first2=Paula H. |last3=Kaunitz|first3=Andrew M. |coauthors=Alison B. Edelman |editor=Guy I Benrubi |title=Handbook of Obstetric and Gynecologic Emergencies |edition=4 |year=2010 |publisher=Lippincott Williams & Wilkins |isbn=978-1605476667 |page=258 |chapter=Complications of Medical and Surgical Abortion}}</ref> Use of [[general anesthesia]] increases the risk of complications because it relaxes uterine musculature making it easier to perforate.<ref>{{cite book |last1=Morgan|first1=Mark |last2=Siddighi|first2=Sam |title=NMS Obstetrics and Gynecology |edition=5 |series=National Medical Series for Independent Study |year=2004 |publisher=Lippincott Williams & Wilkins |isbn=978-0781726795 |page=140}}</ref>

Women who have uterine anomalies, [[leiomyomas]] or had previous difficult first-trimester abortion are contraindicated to undertake surgical abortion unless [[Medical ultrasonography|ultrasonography]] is immediately available and the surgeon is experienced in its intraoperative use.<ref>{{cite book|last1=Speroff|first1=Leon|last2=Fritz|first2=Marc A.|title=Clinical gynecologic endocrinology and infertility|edition=7|year=2004|publisher=Lippincott Williams & Wilkins|isbn=978-0781747950|page=851|chapter=Family Planning, Sterilization, and Abortion}}</ref> Abortion does not impair subsequent pregnancies, nor does it increase the risk of future [[premature birth]]s, infertility, [[ectopic pregnancy]], or miscarriage.<ref name="grimes-overview"/>


In the first trimester, [[Medical abortion#Health risks|health risks associated with medical abortion]] are generally considered no greater than for surgical abortion.<ref name="who-medical-abortion">{{cite web | publisher = [[World Health Organization]] | title = Medical versus surgical methods for first trimester termination of pregnancy | url = http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html | date = December 15, 2006 | accessdate = June 1, 2010}}</ref>

===Mental health===
{{Main|Abortion and mental health}}
No scientific research has demonstrated that abortion is a cause of poor mental health in the general population. However there are groups of women who may be at higher risk of coping with problems and distress following abortion.<ref name="Cockburn">{{cite book |last1=Cockburn|first1=Jayne |last2=Pawson|first2=Michael E. |title=Psychological Challenges to Obstetrics and Gynecology: The Clinical Management |year=2007 |publisher=Springer |isbn=978-1846288074 |page=243}}</ref> Some factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.<ref name="APA89">{{cite journal |author=Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE |title=Psychological responses after abortion |journal=[[Science (journal)|Science]] |volume=248 |issue=4951 |pages=41–4 |year=1990 |pmid=2181664 |doi=10.1126/science.2181664}}</ref> The [[American Psychological Association]] (APA) concluded that abortion does not lead to increased mental health problems.<ref>{{cite web |url=http://www.apa.org/pi/women/programs/abortion/mental-health.pdf |title=Report of the APA Task Force on Mental Health and Abortion |publisher=[[American Psychological Association]] |location=Washington, DC |date=August 13, 2008}}</ref>

Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization.<ref name="Grimes">{{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=10.1001/archinte.140.5.620 |quote=Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae. ... The alleged 'postabortion trauma syndrome' does not exist.}}</ref><ref name="stotlandreview">{{cite journal |author=Stotland NL |title=Abortion and psychiatric practice |journal=[[J Psychiatr Pract]] |volume=9 |issue=2 |pages=139–149 |year=2003 |pmid=15985924 |doi=10.1097/00131746-200303000-00005 |quote=Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae.}}</ref><ref name="stotland_1404747">{{cite journal |author=Stotland NL |title=The myth of the abortion trauma syndrome |journal=[[J Am Med Assoc]] |volume=268 |issue=15 |pages=2078–9 |year=1992 |month=October |pmid=1404747 |doi=10.1001/jama.268.15.2078 |doi_brokendate=2009-11-14}}</ref>

==Incidence==
The number of abortions performed worldwide has deceased between 1995 and 2003 from 45.6 million to 41.6 million (a decrease from 35 to 29 per 1000 women between 15 and 44 years of age).<ref name=OBGY09/> The greatest decrease has occurred in the developed world with a decrease from 39 to 26 per 1000 women in comparison to the developing world which had a decrease from 34 to 29 per 1000 women.<ref name=OBGY09/> Of these approximately 42 million abortions 22 million occurred safely and 20 million unsafely.<ref name=OBGY09/>

The incidence and reasons for induced abortion vary regionally. Some countries, such as Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100), had a comparatively low rate of induced abortion, while others like Russia (62.6 per 100) and Vietnam (43.7 per 100) had a high rate. The world ratio was 26 induced abortions per 100 known pregnancies (excluding miscarriages and stillbirths).<ref>Henshaw, Stanley K., Singh, Susheela, and Haas, Taylor. (1999). [http://www.guttmacher.org/pubs/journals/25s3099.html The Incidence of Abortion Worldwide]. ''International Family Planning Perspectives, 25 (Supplement)'', 30–38. Retrieved 2006-01-18.</ref>

===By gestational age and method===
{{Double image|right|UK abortion by gestational age 2004 histogram.svg|200|US abortion by gestational age 2004 histogram.svg|200|[[Histogram]] of abortions by [[gestational age]] in England and Wales during 2004. Average is 9.5 weeks. (left) Abortion in the United States by gestational age, 2004. (Data source: Centers for Disease Control and Prevention) (right) ||}}

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, from data collected in those areas of the United States that sufficiently reported gestational age, it was found that 88.2% of abortions were conducted at or prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 90.9% of these were classified as having been done by "[[curettage]]" ([[Suction-aspiration 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 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., and 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. and 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> Later abortions are more common in China, India, and other developing countries than in developed countries.<ref>Cheng L. [http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html “Surgical versus medical methods for second-trimester induced abortion : RHL commentary”] (last revised: 1 November 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.</ref>

===By personal and social factors===
[[Image:AGIAbortionReasonsBarChart.png|thumb|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 childbearing, concern over the interruption of work or education, issues of financial or relationship stability, and perceived immaturity.<ref name="bankole98">Bankole, Akinrinola, Singh, Susheela, and 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 and 152. Retrieved 2006-01-18.</ref> A 2004 study in which 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, and 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),'' 110–118. 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> The Guttmacher Institute estimated that "most abortions in the United States are obtained by minority women" because minority women "have much higher rates of unintended pregnancy."<ref>Susan A. Cohen: [http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html ''Abortion and Women of Color: The Bigger Picture''], Guttmacher Policy Review, Summer 2008, Volume 11, Number 3.</ref>

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled people, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward [[population control]] (such as China's [[one-child policy]]). These factors can sometimes result in compulsory abortion or [[sex-selective abortion]].

===Unsafe abortion===
[[Image:RussianAbortionPoster.jpg|thumb|Soviet poster circa 1925, promoting hospital abortions. 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}}
Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly where and when access to legal abortion is restricted. The [[World Health Organization]] (WHO) defines an unsafe abortion as being "a procedure ... carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both."<ref name="whounsafe">World Health Organization. (2004). [http://www.who.int/reproductive-health/publications/unsafeabortion_2000/estimates.pdf "Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000"]. Retrieved 2009-03-22.</ref> Unsafe abortions are sometimes known colloquially as "back-alley" abortions. They may be performed by [[self-induced abortion|the woman herself]], another person without medical training, or a professional health provider operating in sub-standard conditions. Unsafe abortion remains a public health concern due to the higher incidence and severity of its associated complications, such as incomplete abortion, [[sepsis]], hemorrhage, and damage to internal organs. It is estimated that 20 million unsafe abortions occur around the world annually and that 70,000 of these result in the woman's death.<ref name=OBGY09/> 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 post abortion complications: saving women's lives]. ''Population Reports, 25 (1).'.' Retrieved 2006-02-22.</ref> 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 name="Worldwide">{{cite journal |first=Gilda |last=Sedgh |year=2007 |month=October |title=Induced abortion: estimated rates and trends worldwide |journal=[[The Lancet]] |volume=370 |issue=9595 |pages=1338–1345 |doi=10.1016/S0140-6736(07)61575-X |pmid=17933648 |url=http://media.mcclatchydc.com/smedia/2007/10/17/13/Chang-Guttmacher_Institute_abortion_report.source.prod_affiliate.91.pdf |format=PDF|accessdate=2008-12-02 |last2=Henshaw |first2=S |last3=Singh |first3=S |last4=Ahman |first4=E |last5=Shah |first5=IH}}</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>

==History==
[[Image:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|right|"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">{{cite book |last=Devereux |first=G. |chapter=A typological study of abortion in 350 primitive, ancient, and pre-industrial societies |chapterurl=http://www.popline.org/docs/671051 |accessdate=2008-12-02 |editor=Harold Rosen |title=Abortion in America; medical, psychiatric, legal, anthropological, and religious considerations |year=1967 |location=[[Boston]] |publisher=[[Beacon Press]] |oclc=187445}}</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>{{cite book |first=Mary R. |last=Lefkowitz |authorlink=Mary Lefkowitz |coauthors=Maureen B. Fant |title=Women's life in Greece & Rome: a source book in translation |publisher=[[Johns Hopkins University Press]] |location=[[Baltimore]] |year=1992 |pages= |isbn=0-8018-4474-6 |oclc=25373320 |url=http://www.stoa.org/diotima/anthology/wlgr/ |accessdate=2008-12-02}}</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 poisonous herbs with serious [[Adverse effect (medicine)|side effects]] that have at times been used to terminate pregnancy.

During the [[Islamic Golden Age|medieval period]], [[Medicine in medieval Islam|physicians in the Islamic world]] documented detailed and extensive lists of birth control practices, including the use of abortifacients, commenting on their effectiveness and prevalence.<ref>{{Cite book|last=Sheikh|first=Sa'diyya|contribution=Family Planning, Contraception, and Abortion in Islam|editor-first=Daniel C.|editor-last=Maguire|title=Sacred Rights: The Case for Contraception and Abortion in World Religions|publisher=[[Oxford University Press]] US|year=2003|isbn=0195160010|pages=105–128 [105–106]}}</ref> They listed many different birth control substances in their medical encyclopedias, such as [[Avicenna]] listing 20 in ''[[The Canon of Medicine]]'' (1025) and [[Muhammad ibn Zakariya ar-Razi]] listing 176 in his ''Hawi'' (10th century). This was unparalleled in European medicine until the 19th century.<ref>{{Cite book|last=Sheikh|first=Sa'diyya|contribution=Family Planning, Contraception, and Abortion in Islam|editor-first=Daniel C.|editor-last=Maguire|title=Sacred Rights: The Case for Contraception and Abortion in World Religions|publisher=[[Oxford University Press]] US|year=2003|isbn=0195160010|pages=105–128 [115]}}</ref>{{Request quotation|date=January 2010}}

During the [[Middle Ages]], abortion was tolerated and there were no laws against it.<ref>"[http://facts.randomhistory.com/2008/12/14_abortion.html 50 Random Facts About ...... Abortion]". Random Facts.</ref> A medieval female physician, [[Trotula]] of Salerno,<ref>"[[s:1911 Encyclopædia Britannica/Medicine|1911 Encyclopædia Britannica/Medicine]]"</ref> administered a number of remedies for the “retention of menstrua,” which was sometimes a code for early abortifacients.<ref>Riddle, John M. 1992. Contraception and Abortion from the Ancient World to the Renaissance. London, England: Harvard University Press.</ref> [[Pope Sixtus V]] (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy.<ref>"[http://civilliberty.about.com/od/gendersexuality/tp/History-of-Prostitution.htm History of Prostitution]". About.com: Civil Liberties.</ref> 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>{{cite web |first=James |last=DeHullu |url=http://mysite.verizon.net/jdehullu/abortion/abhist.htm |accessdate=2008-12-02 |title=Histories of Abortion}}</ref>

In the 20th century the Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.<ref name="cbctrust">{{cite web |url=http://www.cbctrust.com/history_law_religion.php |archiveurl=http://web.archive.org/web/20080208053146/http://www.cbctrust.com/history_law_religion.php |archivedate=2008-02-08 |title=Abortion Law, History & Religion |accessdate=2008-03-23 |work=Childbirth By Choice Trust}}</ref> In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill," while women considered of German stock were specifically prohibited from having abortions.<ref>{{cite book |last=Friedlander |first=Henry |authorlink=Henry Friedlander |title=The origins of Nazi genocide: from euthanasia to the final solution |publisher=University of North Carolina Press |location=Chapel Hill |year=1995 |page=[http://books.google.com/books?id=gqLDEKVk2nMC&printsec=frontcover&source=gbs_summary_r&cad=0#PPA30,M1 30] |isbn=0-8078-4675-9 |oclc=60191622}}</ref><ref>{{cite book |first=Robert |last=Proctor |authorlink=Robert N. Proctor |title=Racial Hygiene: Medicine Under the Nazis |publisher=[[Harvard University Press]] |location=[[Cambridge, Massachusetts]] |year=1988 |pages=122, 123 and 366 |isbn=0-674-74578-7 |oclc=20760638}}</ref><ref>{{cite book |first=Margaret L. |last=Arnot |authorlink= |coauthors=Cornelie Usborne |title=Gender and Crime in Modern Europe |publisher=Routledge |location=New York |year=1999 |page=231 |isbn=1-85728-745-2 |oclc=186748539}}</ref><ref>{{cite encyclopedia |last=DiMeglio |first=Peter M. |editor=Helen Tierney |encyclopedia=Women's studies encyclopedia |title=Germany 1933–1945 (National Socialism) |year=1999 |publisher=Greenwood Press |location=[[Westport, Connecticut]] |isbn=0-313-31072-6 |oclc=38504469 |pages=[http://books.google.com/books?id=gQLqRd7hJq0C&printsec=frontcover&source=gbs_summary_r&cad=0#PPA589,M1 589]}}</ref>

==Society and culture==
===Abortion debate===
{{Refimprovesect|date=November 2008}}
{{Double image|right|March for Women's Lives detail.jpg|200|March for life 2009.JPG|200|Pro-choice activists near the [[Washington Monument]] at the [[March for Women's Lives]] in 2004. (left) Pro-life activists near the Washington Monument at the annual 2009 [[March for Life]] in [[Washington, DC]]. (right) ||}}

{{Main|Abortion debate}}
In the [[history of abortion]], induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her [[value system]]. The main positions are one that argues in favor of access to abortion and one argues against access to abortion. Opinions of abortion may be described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy. [[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 groups advocating one of these two positions. In the United States, those in favor of greater legal restrictions on, or even complete prohibition of abortion, most often describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Generally, the former position argues that a human fetus is a human being with a [[right to life|right to live]] making abortion tantamount to murder. The latter position argues that a woman has certain [[reproductive rights]], especially the choice whether or not to carry a pregnancy to term.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion.

Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a [[minor (law)|minor]], her parents; a 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 legalized mandatory 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>

===Abortion law===
{{Main|Abortion law}}
{{See also|Reproductive rights}}
[[File:AbortionLawsMap-NoLegend.png|thumb|right|250px|International status of abortion law: {{legend|#3f9bbb|Legal on request}} {{legend|#d4df5a|Legal for maternal life, health, mental health, rape, fetal defects, and/or socioeconomic factors}} {{legend|#64513B|Legal for or illegal with exception for maternal life, health, mental health, rape, and/or fetal defects}} {{legend|#FA7014|Illegal with exception for maternal life, health, mental health and/or rape}} {{legend|#cc7662|Illegal with exception for maternal life, health, and/or mental health}} {{legend|#3236D3|Illegal with no exceptions}} {{legend|#B3B3B3|No information}} Vertical stripes (various colours): Illegal but unenforced]]

Before the scientific discovery in the nineteenth century that human development begins at [[human fertilization|fertilization]],<ref>{{cite book |author=Garrison, Fielding |url=http://books.google.com/?id=JvoIAAAAIAAJ&pg=PA567&dq=fetilization+was+discovered+hertwig |title=An Introduction to the History of Medicine |pages=566–7 |publisher=Saunders |year=1921 |oclc=}}</ref> [[English common law]] forbade abortions after "[[quickening]]", that is, after "an infant is able to stir in the mother's womb."<ref>{{cite book |first=William |last=Blackstone |authorlink=William Blackstone |chapter=Amendment IX, Document 1 |chapterurl=http://press-pubs.uchicago.edu/founders/documents/amendIXs1.html |title=[[Commentaries on the Laws of England]] |origyear=1765 |year=1979 |publisher=University of Chicago Press |location=Chicago |volume=5 |page=388 |isbn=3511090288}}</ref> There was also an earlier period in England when abortion was prohibited "if the foetus is already formed" but not yet quickened.<ref>{{cite book |author=[[Henry de Bracton]] |chapter=The crime of homicide and the divisions into which it falls |editor=George E. Woodbine ed.; Samuel Edmund Thorne trans. |title=On the Laws and Customs of England |origyear={{circa|1250}} |year=1968 |accessdate=2008-12-11 |volume=2 |page=341 |url=http://hlsl5.law.harvard.edu/bracton/Unframed/English/v2/341.htm |oclc=1872}}</ref> Both pre- and post-quickening abortions were criminalized by ''[[Lord Ellenborough's Act]]'' in 1803.<ref>{{cite web |url=http://web.archive.org/web/20070918233015/http://members.aol.com/abtrbng/lea.htm |title=Lord Ellenborough’s Act |year=1998 |work=The Abortion Law Homepage |accessdate=2007-02-20}} (via Archive.org)</ref> In 1861, the [[Parliament of the United Kingdom]] passed the ''[[Offences against the Person Act 1861]]'', which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.<ref>{{cite web |author=United Nations Population Division |year=2002 |url=http://www.un.org/esa/population/publications/abortion |title=Abortion Policies: A Global Review |accessdate=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 (except Northern Ireland). 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 the Republic of Ireland|abortion in Ireland]] was affected by the addition of an [[Eighth Amendment of the Constitution of Ireland|amendment]] to the 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, the right to [[security of person]], and the right to [[reproductive rights|reproductive health]] are major issues of human rights that are sometimes used as justification for the existence or absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window of legality:
*In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on [[prenatal development|fetal development]], or require that [[minors and abortion|parents be contacted]] if their minor daughter requests an abortion.<ref>[http://www.lawserver.com/abortion Interactive maps comparing U.S. abortion restrictions by state] LawServer.</ref>
*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.
*In Canada, a similar requirement was rejected as unconstitutional in 1988.

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]], [[Abortion in El Salvador|El Salvador]], [[Abortion in Malta|Malta]], and [[Abortion in Nicaragua|Nicaragua]], with consequent rises in maternal death directly and indirectly due to pregnancy.<ref>{{cite web |title=European delegation visits Nicaragua to examine effects of abortion ban |date=November 26, 2007 |publisher=Ipas |accessdate=2009-06-15| url=http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx }} "More than 82 maternal deaths had been registered in Nicaragua since the change. During this same period, indirect obstetric deaths, or deaths caused by illnesses aggravated by the normal effects of pregnancy and not due to direct obstetric causes, have doubled."</ref><ref>{{cite news|url=http://insidecostarica.com/special_reports/2008-06/nicaragua_womens_movement.htm |title=NICARAGUA: "The Women’s Movement Is in Opposition" |date=28 June 2008 |place=Montevideo |agency=IPS |publisher=Inside Costa Rica}}</ref> However, in 2006, the [[Politics of Chile|Chilean government]] began the free distribution of [[emergency contraception]].<ref>{{cite news |author=Ross, Jen |date=September 12, 2006 |url=http://www.csmonitor.com/2006/0912/p01s04-woam.html |title=In Chile, free morning-after pills to teens |work=The Christian Science Monitor |accessdate=2006-12-07}}</ref><ref>{{cite news |author=Gallardoi, Eduardo |date=September 26, 2006 |url=http://www.washingtonpost.com/wp-dyn/content/article/2006/09/26/AR2006092600770.html |title=Morning-After Pill Causes Furor in Chile |work=[[The Washington Post]] |accessdate=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>

In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in [[medical tourism]] and travel to countries where they can terminate their pregnancies. Women without the means to travel can resort to providers of illegal abortions or try to do it themselves.
<ref>{{cite web |title=Need Abortion, Will Travel |author=Marcy Bloom |date=February 25, 2008 |publisher=RH Reality Check |accessdate=2009-06-15| url=http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel}}</ref>

In the US, about 8% of abortions are performed on women who travel from another state.<ref>{{cite web |title=United States: Percentage of Legal Abortions Obtained by Out-of-State Residents, 2005 |publisher=The Kaiser Family Foundation |accessdate=2009-06-14| url=http://www.statehealthfacts.kff.org/profileind.jsp?rgn=1&cat=10&ind=467}}</ref> However, that is driven at least partly by differing limits on abortion according to gestational age or the scarcity of doctors trained and willing to do later abortions.

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

[[Medical ultrasonography|Sonography]] and [[amniocentesis]] allow parents to determine sex before childbirth. The development of this technology has led to [[sex-selective abortion and female infanticide|sex-selective abortion]], or the targeted termination of female fetuses.

It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in China, Taiwan, South Korea, and India.<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 common Indian tradition which dictates that [[funeral|funeral rites]] must be performed by a male relative have led to a cultural preference for sons.<ref>Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, and 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>{{cite journal |first=Rita |last=Patel |year=1996 |month=Fall |title=The practice of sex selective abortion in India: May you be the mother of a hundred sons |journal=Carolina Papers in International Health and Development |volume=7 |url=http://cgi.unc.edu/research/pdf/abortion.pdf |format=PDF|accessdate=2008-12-03}}</ref> In 1991, the male-to-female [[human sex ratio|sex ratio]] in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.<ref>{{cite journal |last=Sudha |first=S. |year=1999 |month=July |title=Female Demographic Disadvantage in India 1981–1991: Sex Selective Abortions and Female Infanticide |journal=Development and Change |volume=30 |issue=3 |pages=585–618 |doi=10.1111/1467-7660.00130 |url=http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archiveurl=http://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html |archivedate=2003-01-01 |accessdate=2008-12-03 |last2=Rajan |first2=S. Irudaya |pmid=20162850}}</ref> Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.<ref>{{cite news |first=Patricia |last=Reaney |publisher=Reuters |url=http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archiveurl=http://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archivedate=2006-02-20 |title=Selective abortion blamed for India's missing girls |accessdate=2008-12-03}}</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>{{cite journal |last=Mudur |first=Ganapati |year=2002 |title=India plans new legislation to prevent sex selection |journal=[[BMJ]] |volume=324 |issue=7334 |page=385b |doi=10.1136/bmj.324.7334.385/b}}</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>{{cite journal |first=Maureen J. |last=Graham |year=1998 |month=June |title=Son Preference in Anhui Province, China |journal=International Family Planning Perspectives |volume=24 |issue=2 |url=http://www.agi-usa.org/pubs/journals/2407298.html |accessdate=2008-12-03 |doi=10.2307/2991929 |page=72 |author2=Larsen |author3=Xu}}</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>{{cite journal |last=Plafker |first=Ted |year=2002 |month=May |title=Sex selection in China sees 117 boys born for every 100 girls |journal=[[BMJ]] |volume=324 |issue=7348 |page=1233a |doi=10.1136/bmj.324.7348.1233/a |pmid=12028966 |pmc=1123206}}</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>

==In other animals==
{{See|Miscarriage#In other animals}}
Spontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.<ref>Spencer, James. ''[http://books.google.com/books?id=RXMuAAAAYAAJ&pg=PA124&lpg=PA124&dq=abortion+and+husbandry&source=bl&ots=WjmvGj-fB2&sig=8qH_WrPR08YEwPKr_c6PHDUOMmQ&hl=en&ei=erDbSeSVBoz4MY-F7M4I&sa=X&oi=book_result&ct=result&resnum=2#PPA124,M1 Sheep Husbandry in Canada]'', p. 124 (1911).</ref> In cows, abortion may be caused by contagious disease, such as [[Brucellosis]] or [[Campylobacter]], but can often be controlled by vaccination.<ref>[http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en "Beef cattle and Beef production: Management and Husbandry of Beef Cattle”], ''Encyclopaedia of New Zealand'' (1966).</ref> Additionally, many other diseases are known to increase the risk of miscarriage in humans and other animals.{{Citation needed|date=April 2009}}

Abortion may also be induced in animals, in the context of [[animal husbandry]]. For example, abortion may be induced in mares that have been mated improperly, or that have been purchased by owners who did not realize the mares were pregnant, or that are pregnant with twin foals.<ref>McKinnon, Angus et al. ''[http://books.google.com/books?id=jlZAT-9VwUIC&pg=PA563&lpg=PA563&dq=%22induce+abortion%22+and+husbandry&source=bl&ots=6T9w3LtpsI&sig=aEYDFpnMIbLaKlstxK1MGK2rxwQ&hl=en&ei=eLTbSY7EO5muMrXUkMkI&sa=X&oi=book_result&ct=result&resnum=7 Equine Reproduction]'', p. 563 (Wiley-Blackwell 1993).</ref>

[[Feticide]] can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,<ref>{{cite journal|last=Berger|first=Joel W|date=5 May 1983|title=Induced abortion and social factors in wild horses|journal=Nature|location=London|volume=303|pages=59–61|url=http://www.nature.com/nature/journal/v303/n5912/abs/303059a0.html|doi=10.1038/303059a0|pmid=6682487|issue=5912}}</ref><ref>{{cite journal|last=Pluháček|first=Jan|year=2000|title=Male infanticide in captive plains zebra, Equus burchelli|journal=Animal Behaviour|volume=59|pages=689–694|url=http://af.czu.cz/~bartos/publications/pdf/Pluhacek_Bartos_2000_AB.pdf|doi=10.1006/anbe.1999.1371|pmid=10792924|last2=Bartos|first2=L|issue=4}}</ref><ref>{{cite journal|last=Pluháček|first=Jan|year=2005|title=Further evidence for male infanticide and feticide in captive plains zebra, Equus burchelli|journal=Folia Zool.|volume=54|issue=3|pages= 258–262|url=http://www.ivb.cz/folia/54/3/258-262.pdf}}</ref> although the frequency in the wild has been questioned.<ref>{{cite journal|last=JW|first=Fitzpatrick|date=October 1991|title=Changes in herd stallions among feral horse bands and the absence of forced copulation and induced abortion |journal=Behavioral Ecology and Sociobiology|publisher=Springer|location=Berlin/Heidelberg|volume=29|issue=3|pages=217–219|issn=0340-5443 (Print) 1432-0762 (Online)|url=http://www.springerlink.com/content/k1543n1548987255/}}</ref> Male [[Gray langur]] monkeys may attack females following male takeover, causing miscarriage.<ref>{{cite journal|last=Agoramoorthy |first=G.|date=August 1988|title=Abortions in free ranging Hanuman langurs (Presbytis entellus)—a male induced strategy?|journal=Human Evolution|publisher=Springer|location=Netherlands|volume=3|issue=4|pages=297–308|issn=0393-9375 (Print) 1824-310X (Online)|url=http://www.springerlink.com/content/324g107410293474/}}</ref>

==See also==
*[[Abortion fund]]
*[[Anti-abortion violence]]
*[[Connolly v. DPP]]
*[[Fetal rights]]
*[[Late-term abortion]]
*[[Minors and abortion]]
*[[Paternal rights and abortion]]
*[[Population control]]
*[[Self-induced abortion]]
*[[Stem cell controversy]]

==References==
{{Reflist|colwidth=30em}}

==External links==
{{sisterlinks|abortion}}
*{{dmoz|Health/Reproductive_Health/Abortion}}
*[http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review]
*[http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm#Definition MedlinePlus Medical Encyclopedia: Abortion]


'''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]