abortion: Definition and Much More from Answers.com

Abortion is a generic term for pregnancies that do not end in a livebirth or a stillbirth. It is the premature expulsion from the uterus of the products of conception, which include the placenta, bag of waters, and fetus, if present.

Types of Abortion

There are two types of abortions. Spontaneous abortion refers to a natural biological process by which some pregnancies end. Induced abortion refers to pregnancies terminated through human intervention.

Spontaneous Abortions. A large percentage of the products of the union of an egg and a sperm never become infants. If there is something seriously wrong with the fetus, the uterus often expels it. This may occur very early in the pregnancy, with the woman only experiencing a larger than usual blood flow around the time of her expected menstrual period, or it may occur later in the pregnancy. This latter event is commonly called a miscarriage, but technically it is a spontaneous abortion if it occurs before twenty weeks of pregnancy. Spontaneous abortions are often the body's way of preventing the birth of a defective child, although sometimes they are due to maternal health problems.

Induced Abortions. In contrast, induced abortions result from the planned interruption of a pregnancy. Throughout recorded history, humans have taken a variety of steps to control family size: before conception by delaying marriage or through abstinence or contraception; or after the birth by infanticide. Induced abortion falls temporally between these two extremes by preventing a conception from becoming a live birth. In the United States in the last few decades of the twentieth century, most abortions were performed surgically using a procedure called suction curettage. The year 2000 approval in the United States of a drug, mifepristine (RU486), which in combination with another drug causes an abortion in almost all cases, may increase the percentage of abortions induced by the administration of pharmaceutical agents.

Therapeutic Abortions. This term refers to abortions thought necessary because of fetal anomalies, rape, or to protect the health of the mother when a birth might be life threatening or physically or psychologically damaging.

Elective or Voluntary Abortions. Interruption of a pregnancy before viability at the woman's request for reasons other than fetal anomalies or maternal risk is often referred to as elective or voluntary abortion. Such abortions often result from social problems, such as teenage pregnancy or non-marital births; economic difficulties, such as insufficient income to support a child; or inappropriate timing.

Legal and Illegal Abortions. Induced abortions may be legal or illegal. According to the United States Centers for Disease Control and Prevention (CDC), the federal agency that collects data on abortions, a legal abortion is "a procedure, performed by a licensed physician or someone acting under the supervision of a licensed physician, that was intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age." An illegal abortion may be self-induced, induced by someone who is not a physician or not acting under her or his supervision, or induced by a physician under conditions that violate state laws governing abortions.

A Historical Perspective

Almost all human societies place a high value on human life. Thus, the further along the continuum from heterosexual intercourse to a live child, the less likely is the method of fertility control to be allowed. In the modern period, most societies allow contraception, but there is more variability around abortion. The leading institutional opposition comes from the Roman Catholic Church, but other institutions also take active positions against abortion. Survey research suggests that many Americans are ambivalent about whether abortion should be legal and, if so, under what circumstances.

Induced abortion was almost universally illegal at the beginning of the twentieth century. This changed first in the early years of the Soviet Union, which made abortion legal, widely available, and encouraged as the primary method of fertility control. In the period after World War II, abortion was legalized first in the Scandinavian countries and later in most of Western and Eastern Europe. With the broaching of the Iron Curtain in the early 1990s, abortion was legalized in more of Eastern Europe, while the more restrictive policy in West Germany was extended to the former East Germany. At the beginning of the twenty-first century, abortion was legal in most of England and Asia, but illegal in most of Africa and South America.

In the United States, abortion was universally illegal from at least the late nineteenth century until the mid-1960s, when an abortion reform movement led to legalization of abortion in some states. (The regulation of abortion, like most medical issues, is a state function.) Then, in its 1973 Roev. Wade decision, the United States Supreme Court found a constitutional right to abortion before viability, at that time about twenty-eight weeks. (By the beginning of the twenty-first century, advances in the techniques of caring for very premature infants had reduced the age of viability to around twenty-three weeks.) The Court stated, however, that after viability is reached, the state's important and legitimate interest in potential life becomes compelling and it may regulate and even prohibit abortions, with the exception of those necessary to preserve the life or health of the mother.

Access to Abortions

Access to legal abortions is limited by laws and regulations, financial considerations, and the availability of providers.

Laws and Regulations. Since the 1973 decision, many states have enacted measures to limit abortion, which have led to considerable litigation.

Some laws have been disallowed as inconsistent with Roe, while others have been allowed. For example, in the late 1990s, about thirty states restricted the access of minors to abortions by requiring the notification or the consent of one or both parents before an abortion could be performed, and more are considering such legislation. The Supreme Court requires that states with parental notification or consent laws must provide for a judicial bypass; that is, the minor must be allowed to obtain permission from a court for the abortion if she is unwilling or unable to seek permission from her parent(s). States may also require a waiting period between the request for an abortion and its actual performance. Or they may require the physician who is to conduct the abortion to inform the mother about the fetus's stage of development and about alternative ways of managing an unwanted pregnancy, such as putting the baby up for adoption.

Financial Considerations. Abortion is not among the medical procedures covered by Medicaid, the federal-state program that provides health care to many poor women. Federal law, the socalled Hyde Amendment, passed in 1977 and amended in 1993, prohibits the use of federal Medicaid funds for abortion except in cases of rape, incest, or when the life of the pregnant woman is in danger. Some states use their own Medicaid funds to pay for abortions that physicians consider "medically necessary," and a few fund them in cases of fetal anomaly or grave physical health danger. Some private organizations, such as Planned Parenthood agencies, assist low-income women in states with restrictive funding policies by performing abortions for reduced fees. In 1999, less than two-fifths of women with employer-based health insurance were covered for abortion services.

Provider Availability. On the basis of a survey of abortion providers, the Alan Guttmacher Institute estimated that in 1996 there were slightly over two thousand abortion providers in the United States, a drop of 14 percent from 1992, perhaps as a result of anti-abortion publicity and disturbances. Eighty-nine of the country's 320 metropolitan areas had no known abortion providers and an additional twelve had providers who together reported fewer than fifty abortions. Abortion providers were even less available in non-metropolitan areas.

According to the Guttmacher survey, 452 abortion clinics (defined as nonhospital facilities in which half or more of patient visits were for abortion services) performed 70 percent of the abortions in 1996. Four hundred and seventeen other clinics performed 21 percent of the abortions; 703 hospitals performed 7 percent (only 9% of those on an in-patient basis); and 470 physicians' offices performed 3 percent.

Number and Rates of Abortions

There is no definitive information about the number and rate of spontaneous abortions, although worldwide it is estimated that approximately 15 percent of women who have been pregnant for five or more weeks spontaneously abort or experience stillbirths.

The CDC has been conducting surveillance of legal induced abortions in the United States since 1969. It reported 1,186,039 legal abortions in 1997, but noted that this was probably an underestimate. The number of abortions per 1,000 women between 15 and 44 years of age (the abortion rate) was 20 and the number of abortions per 1,000 live births (the abortion ratio) was 306. Most legal abortions were performed in California, New York City, Texas, and Florida. The number of legal abortions increased from 1970 until 1990 and, with the exception of 1996, has fallen ever since.

Both the abortion rate and the abortion ratio began to decline earlier.

Information on the characteristics of the women who obtain abortions and the timing of abortions is available from most, but not all, areas. Based on the information available in 1997, women between the ages of 20 and 24 obtained almost a third (31.5%) of all abortions. Abortion rates were highest for women between the ages of 20 and 24 and lowest for the youngest and oldest women. Abortion ratios, however, were highest for women under 20 and for women 40 and over, at least partially because there are fewer births in these age groups. Slightly over half(56.3%) of women who obtained abortions were white, but the abortion rate and the abortion ratio for African Americans was slightly more than two and a half times the rate for white women. For Hispanic women in the District of Columbia, New York City, and the twenty-six states reporting ethnicity, the abortion ratio was similar to the one for non-Hispanics in the same areas, but the rate was higher. Seventy-nine percent of women who obtained abortions were unmarried, 41 percent had no previous live births, and half were obtaining abortions for the first time. Eighty-six percent of women obtaining abortions had the procedure during the first twelve weeks of pregnancy.

Abortions and Public Health

There is no evidence that abortions are detrimental to the health of women. The CDC reported that in 1992, the last year for which data on abortionrelated deaths were available, only twenty-seven women died of abortion-related causes, ten due to induced abortions, seventeen to spontaneous abortions, and none to illegal abortions. This is a case-fatality rate for legal induced abortions of 0.7 per 100,000 legal induced abortions, a lower fatality rate than for pregnancies. (In 1992, the maternal mortality rate was 7.8 per 100,000 live births.) Injuries and illness, both physical and emotional, are also rare. Deaths and other adverse consequences are more likely to occur when women are unable to obtain abortions legally and attempt to induce abortions themselves or turn to providers outside the conventional medical care system. There were thirty-nine deaths due to illegal abortions in 1972 before the Roe v. Wade decision and nineteen in 1973. Since then, the number of such deaths has declined markedly: There were only two between 1988 and 1992. Studies in Czechoslovakia have shown that women who are denied abortions suffer psychological difficulties.

Most induced abortions today are the result of unwanted pregnancies. The best way to prevent this safe—but uncomfortable and usually undesirable—procedure is to make family planning counseling and methods easily available to all women.

(SEE ALSO: Ethics of Public Health; Pregnancy; Reproduction)

Bibliography

Alan Guttmacher Institute (1999). Sharing Responsibility: Women, Society and Abortion Worldwide. New York: Author.

Henry J. Kaiser Family Foundation (1999). Issue Update: Abortion Fact Sheet. Menlo Park, CA: Author.

Henry J. Kaiser Family Foundation and Health Research and Educational Trust (1999). Employer Health Benefits: 1999 Annual Survey. Menlo Park, CA: Author.

Henshaw, S. K. (1998). "Abortion Incidence and Services in the United States, 1995–1996." Family Planning Perspectives 30(6):263–270, 287.

Joffe, C. (2000). "Medical Abortion in Social Context." American Journal of Obstetrics and Gynecology 183(2):S10– S15.

Klerman, J. A. (1999). "U.S. Abortion Policy and Fertility." American Economic Review Papers and Proceedings 89(2):261–264.

Koonin, L. M.; Strauss, L. T.; Chrisman, C. E.; Montalbano, M. A.; Bartlett, L. A.; and Smith, J. C. (July 30, 1999). "Abortion Surveillance—United States, 1996." Morbidity and Mortality Weekly Report 48(SS-4):1–42.

Koonin, L. M.; Strauss, L. T.; Chrisman, C. E.; and Parker, W. Y. (December 8, 2000). "Abortion Surveillance—United States, 1997." Morbidity and Mortality Weekly Report 49(SS-11):1–43.

Levine, P. B.; Staiger, D.; Kane, T. J.; and Zimmerman, D. J. (1999). "Roe v. Wade and American Fertility." American Journal of Public Health 89(2):199–203.

Matthews, S.; Ribar, D.; and Wilhelm, M. (1997). "The Effects of Economic Conditions and Access to Reproductive Health Services on State Abortion Rates and Birthrates." Family Planning Perspectives 29(2):52–60.

— LORRAINE V. KLERMAN; JACOB A. KLERMAN

To 1800

Records of abortions exist from throughout the American colonies in the seventeenth and eighteenth centuries. A variety of herbs and other plant products, including tansy, savin, pennyroyal, seneca snakeroot, and rue were used as abortifacients, some available from physicians but many attainable through herb gardens. Historians have had difficulty determining which were effective, which were not, and which were fatal to the mother, but they conclude that many of the concoctions taken were poisonous. Some have been determined so toxic it seems unlikely that women ingested them voluntarily, unless attempting suicide. It is possible that another person—often the man who impregnated her—would persuade the woman to ingest it. However, intense reactions to medication were viewed as proof of effectiveness, so vomiting and blistering were considered necessary side effects.

Because abortions were often performed at home and detailed records were rare, it is difficult to make precise estimations of abortion rates. However, it appears that rates in the colonial era were relatively low. Surgical abortions were rare. Lack of medical knowledge, particularly regarding infection, almost guaranteed the death of the mother if surgery were performed. Cases of infanticide were more common than surgical abortions, as pregnancies might be hidden until term under loose clothing and infanticide would at least protect the life of the mother.

The tendency toward abortion depended largely on community attitudes toward nonmarital pregnancy and childbearing in general, but it was also closely tied to economics. In a developing colonial society with a land-based economy, children were generally welcomed. Economic desperation was comparatively rare, resulting in relatively low rates of abortion and infanticide. In the case of non-marital pregnancy, social pressure to name the father and demands on him to pay support eased the burden on women of even the lowest means. Paternity suits were common, the vast majority of which ended in financial support or marriage or both. The rates of premarital pregnancy in the colonies increased dramatically in the late eighteenth century, with up to 30 percent of births occurring before nine months of marriage. There was generally much more pressure on men to take responsibility for pregnancy than chastisement of women for becoming pregnant.

Conception and "quickening"

New scientific notions of pregnancy and fetal development arose during the Age of Enlightenment as scientists and religious leaders debated the origins of life. Calvinists and Anglicans argued against abortion, citing numerous biblical passages stating that human life begins at conception. But the battle lines were not drawn simply between religion and science, as scientists disagreed among themselves about the origins of human life. Anton van Leewenhoek, famous for his development of the microscope, argued in the late seventeenth century that an entire human was contained in each male sperm, and was simply implanted in a woman. Other scientists, concerned about the waste of human lives if that held true, argued that an entire human life existed in a woman's egg, and was simply "activated" by male sperm.

Some historians have argued that until the mid-nineteenth century, human life was widely understood to begin at "quickening," the moment when a pregnant woman could first feel the fetus move—generally in the late fourth or early fifth month of pregnancy. Colonial common law instituted punishment for abortion only after quickening. Evidence shows that the scientific community, the religious community, and the community at large all believed that human life in some form began before quickening, but under common law, abortions before quickening were legal. After quickening, however, the fetus—although by no means "viable" (able to survive outside the uterus)—was considered a separate being. Until quickening, the best evidence of pregnancy was the absence of menses, which could have been a symptom of various other conditions. Until the mid-nineteenth century, women were often provided with abortifacients to remove a "blockage," and once menses resumed, she was considered treated. The cause of the blockage was not an issue of legal concern.

Women often had access to abortifacient plant products and the knowledge necessary to use them to "resume menses." Once experiencing quickening, however, she was more or less obligated to carry the fetus to term. Quickening offered better proof of pregnancy, and usually marked a pivotal point after which terminating a pregnancy was unquestionably more dangerous. Until the early nineteenth century, the power of deciding to terminate an early pregnancy essentially lay with the woman. However, by the late colonial period, others were becoming increasingly involved in the practice, as physicians and apothecaries were marketing and selling abortifacients. Even under the regulation of "experts," they were often deadly.

Restrictions on Abortion

The first legal restrictions on abortion in the United States were aimed at the sale of abortifacients. State laws of the 1820s and 1830s listed abortifacients as poisons and made their sale illegal. In some states, laws also regulated practitioners who performed surgical abortions. All of these laws were intended to protect the life of the mother, and domestic use of abortifacients before quickening was not a crime. By 1840, ten of the nation's twenty-six states had passed abortion regulations.

Widespread attempts at criminalization of abortion began in the 1850s. The American Medical Association (AMA), founded in 1847, played a major role here. For a number of reasons, its members promoted legislation to restrict abortion in various states. The AMA reflected a trend in the field of medicine that valued accreditation and expertise. Members of the AMA attacked physicians of an older generation, as well as homeopaths and midwives, as ill-trained and incompetent, and in its attempt to improve medicine it took control of the practice of abortion. Many of the new generation of physicians also viewed themselves as moral leaders, and in their crusades aimed at preserving and protecting human life, they attacked abortion on moral grounds. One element of this crusade lessened the significance of quickening, considering it simply one stage in fetal development. This laid the groundwork for prohibiting abortion at any stage.

To some extent, abortion regulation through the mid-nineteenth century might be considered in the larger context of social reform movements in America. However, in later decades the anti-abortion crusades reflected the increasing influence of the Victorian Era. Then, pregnancy—or at least illicit pregnancy—was considered a woman's punishment for immoral behavior. Abortion would allow a woman to go unpunished. Even access to methods to prevent such a pregnancy would facilitate such immoral behavior. A result was the passage of legislation to prohibit the practice of abortion and the sale and distribution of contraceptives and contraceptive information. The Comstock Law of 1873—named for the purity crusader Anthony Comstock—categorized abortion and birth control as obscenity, prohibiting them under federal anti-obscenity legislation.

Various states also criminalized abortion, except for cases in which the mother's life was endangered by pregnancy or childbirth. This gave physicians the authority to determine when an abortion could be permitted. In addition, state regulations prohibiting the sale or distribution of abortifacients were reworked to allow physicians to prescribe them.

In many cases, middle-and upper-class women who had personal physicians maintained comparatively easy access to abortion. However, abortion rates increased among the poor and ethnic minorities. By midcentury, national concerns over shifting demographics drew attention to birth rates among the "proper stock" as opposed to those among the "lesser stock." The growing trend among white middle-and upper-class women to seek abortions was an influential factor in criminalizing the procedure. Mass immigration resulted in a growing working class that was perceived as a threat to the dominant Anglo-Protestant culture. Many physicians commonly conducted abortions among the poor and minorities, some publicly declaring that white Protestant women should have more children.

Abortion and Women's Roles

The development of anti-abortion legislation not only reflected ideas of race and class, but also affected gender roles. Before the mid-nineteenth century, women held a stronger position in realm of pregnancy, childbearing, and abortion than afterward. Childbirth took place at home, often with the assistance of a midwife; pregnant women were looked after by other women; and individuals had access to natural herbs that were known abortifacients. In addition, only a pregnant woman knew when quickening took place. The devaluation of quickening by the medical community had already weakened a woman's authority in her own pregnancy. Criminalizing abortion, except under a doctor's recommendation, and abortifacients without a doctor's prescription, further weakened her authority.

Anti-abortion movements generally grew when women demanded more rights. From the mid-to the late nineteenth century, public condemnation of abortion paralleled the women's movement for political rights. Fears that women would forsake their proper social roles and the responsibility of motherhood if they had the right to abortion helped to shape the debate, and ultimately the success, of anti-abortion legislation. Equal opportunity in politics and in higher education appeared to reduce family size and some hoped that the prohibition of abortion and birth control might offset this trend. At the turn of the twentieth century, the women's movement included new demands for sexual freedom, and anti-abortion activists worked to limit abortions. Although widely criminalized, physicians still performed some abortions and illegal abortions were common. The separation of sexuality and procreation allowed greater sexual freedom for women, spurring new attacks on abortion.

Abortion and Contraception

In the 1910s, a powerful birth control movement took hold in America. Leaders of the movement, particularly Margaret Sanger, did not equate birth control with abortion. Rather, they argued that legalizing contraceptives would reduce abortion rates. Public opinion still accepted early-term abortions, and abortion was often the preferred method of birth control. With little access to contraceptives because of the Comstock Law, couples had few choices. Proponents of legal contraceptives reported graphic details of numerous self-induced abortions performed by desperate women, who often died as a result.

Clinics were established to provide contraceptives and contraceptive information. Medical professionals who opened clinics bypassed Comstock laws that barred contraceptives and contraceptive information from importation and from the U.S. mails. Critics feared that such information encouraged "free sex" among single women, when in fact it was primarily intended for married working-class couples who had no access to personal physicians. Critics of abortion similarly feared that single women were having abortions to facilitate an uninhibited sexual lifestyle. In fact, most women having abortions were married. Working-class women generally had children early, ending later pregnancies through abortion. Upper-class women generally delayed childbearing and often ended early pregnancies through abortion. In either case, they saw it as a form of birth control, although birth control advocates drew clear distinctions between contraception and abortion.

At first glance, the criminalization of abortion appeared to have a significant effect on abortion rates. In the mid-nineteenth century, some records show that as many as one out of five or six pregnancies ended in abortion, while some report that in 1900 only one in twenty did. However, the fact that abortions were a crime made it less likely that women would report them. Drawing from case reports of hospital personnel who treated women bleeding as the result of apparent abortion, scholars estimate as many as 2 million abortions per year at the end of the nineteenth century. One doctor estimated between six to ten thousand abortions were performed (many by the women themselves) in 1904 in Chicago alone. Because of criminalization, and because the abortion issue has been so politicized, it is difficult to determine accurate abortion rates. However, it is clear that criminalization did not prevent it.

The birth control movement's eventual success was linked to its alliance with the American Medical Association, which—as the movement gained strength—began to support the legalization of contraceptives. Sanger and the AMA worked hand in hand into the 1930s in efforts to condone birth control and to secure legislation to protect doctors from prosecution for prescribing contraceptives. Again, physicians gave themselves control of the distribution of contraceptives, with the support of the courts and legislative bodies. In 1936, the AMA officially abandoned its official opposition to birth control.

Black Market Abortions

The Great Depression of the 1930s created an environment in which birth control became an acceptable response to social ills because more families were economically desperate and unable to care for additional children. At the same time, however, the number of abortions performed was on the rise—so quickly that many considered it an epidemic. Scholars generally estimate that more than 500,000 took place each year in the United States during the depression. The cost of a "black market" abortion was usually under seventy-five dollars, far below the cost of feeding another child. In addition, women often lost their jobs to men during the depression, and a pregnant woman was almost certain to lose her job.

A few doctors began to support publicly the repeal of anti-abortion laws during the 1930s. However, the opposition was strong. First, Pope Pius XI's 1930 encyclical, Casti Connubii, pronounced that a developing fetus had a soul. Although America was not a Catholic nation, its largest denomination by then was Roman Catholicism, and the issue of abortion had taken on a new character in the international religious-political realm. The Soviet Union had legalized abortion in the 1920s and the procedure was viewed as tightly tied to a brand of socialist feminism in western Europe. Any connection between feminism and socialism that was tied to abortion would force legalization to confront considerable obstacles in the United States.

The demands on physicians to perform abortions were great and many received additional training in the procedure. The procedure most often used was dilation and curettage, but the injection of potassium soap solution was common by the 1930s. Physicians were legally protected as they were granted the right to conduct therapeutic abortions. Physician-abortionists were considered specialists in the medical community and general practitioners referred their patients to them. The profession officially condemned abortion, but doctors were widely involved, if not directly, then through making referrals. In essence, they could ensure their patients had access to abortion without actually performing them.

To perform an abortion except with the intent to save the life of the mother meant possible arrest. Physician-abortionists who devoted their practice exclusively to abortion risked police raids and prosecution. Raids were especially common in the 1940s and 1950s and served to expose publicly abortionists and their patients. Patients were commonly interrogated in police stations and courtrooms. Police and prosecutors went after patients rather than the referring physicians, who possessed more incriminating evidence than the women did. Because of the raids, many hospitals stopped conducting therapeutic abortions. Advances in medicine, particularly in the development of antibiotics and antiseptics, made hospitals the safest and cleanest places to have an abortion. However, hospital administrators were unwilling to face the publicity resulting from continual raids on clinics and arrests of physicians.

Medical advances also affected the ways in which the fetus was perceived. Imaging techniques allowed physicians to focus on the fetus as a developing human and they increasingly considered the uterus as the space in which the fetus developed. In the 1950s, a culture of family and children encouraged women to embrace motherhood and they were chastised for considering abortion. Other medical advances made pregnancy-related illnesses, complications, and deaths comparatively rare. Therefore, hospitals became less likely to offer therapeutic abortions.

In addition, improvements were made in sterilization procedures. In the 1950s, approximately half of the nation's hospitals offered women abortions if they agreed to simultaneous sterilization. Hospitals established therapeutic abortion committees not only to develop such regulations, but to decide in individual cases when an abortion would be permitted.

Calls for Reform and Repeal

In the mid-1950s, a small group of physicians and public health workers began a movement to reform abortion laws. They had seen the disastrous effects of criminalization on women and the medical profession that had developed in recent decades. In 1955, Planned Parenthood organized a small conference of health care professionals to organize against the existing laws. But they did not gain the momentum necessary to overturn legislation until the birth of the women's movement in the 1960s. An integral part of that movement was the demand for reproductive rights. The demand began at the grassroots level with one of the most influential organizations, Citizens for Humane Abortion Laws, founded in 1962 in California. That same year, Sherri Finkbine, a television celebrity, attracted the nation's attention when she traveled to Sweden to have an abortion after finding out that she had taken a drug containing thalidomide early in her pregnancy. In 1961, researchers discovered that thalidomide—which was commonly prescribed to pregnant women to combat sleeplessness and morning sickness—caused severe birth defects, primarily the stunting of fetal limb development.

In Griswoldv. Connecticut (1965), the U.S. Supreme Court ruled in favor of Planned Parenthood staffers who had violated Connecticut state law in dispensing a contraceptive device to a married woman. The Court ruled on the grounds that their 1961 convictions were violations of the right to privacy. The case brought national attention to birth control laws that were considered repressive, and the right-to-privacy decision paved the way for privacy considerations in the issue of abortion. The public chastisement of women caught during clinic raids in the 1950s was often claimed to violate the right to privacy, but there was no strong legal precedent to turn to in those cases. The year 1966 marked the founding of the National Organization for Women (NOW), which would strengthen the attack on abortion laws. By the 1960s, the focus of abortion rights activists was shifting from a call for reform to a call for repeal of anti-abortion laws, and various women's groups addressed abortion at the national level. In 1969, abortion rights leaders held the first National Conference on Abortion Laws and formed the National Association for Repeal of Abortion Laws (NARAL). However, grassroots organizations remained instrumental as abortion was prohibited at the state level, and although banned in every state, it was regulated on different terms.

The landmark case in abortion history was Roe v. Wade (1973). In that case (which was supported by other cases), a twenty-three-year-old pregnant woman challenged Texas's abortion law, which the Supreme Court ultimately found unconstitutional. The decision, written by Justice Harry Blackmun and based on the residual right to privacy, overturned numerous statutes that had been in place for more than one hundred years. Restrictions on abortions during the first trimester of pregnancy were lifted and abortions in the second trimester were allowed with few restrictions. States were given the right to intervene during the second and third trimesters to protect the life of the woman and the potential life of the fetus.

The reaction to Roe v. Wade was swift and far-reaching. As a result of the case, NARAL changed its name to the National Abortion Rights Action League, preparing for opposition. The Catholic Church quickly professed its opposition and fundamentalist Protestants hastened their efforts to support a pro-life movement. In 1977, Congress prohibited the use of Medicaid funds for abortion except for therapeutic reasons, and in a few other cases. The religious right gained political momentum with the election of conservatives to Congress and Ronald Reagan and George Bush Sr. to the presidency during the 1980s. This resulted in the creation of an abortion "litmus test" for Supreme Court nominees, who were considered on the basis of their stand on abortion, regardless of their experience or positions on other issues. In Webster v. Reproductive Health Services (1989) the Supreme Court limited the scope of Roe v. Wade, and in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) it reaffirmed abortion rights while permitting further restrictions.

The 1990s saw a rise in extreme measures on the pro-life side, including the harassment of women entering clinics, the bombing of clinics, and attacks on physicians known to perform abortions. In the second half of the decade, Congress repeatedly passed a bill that would ban "partial-birth abortion," but President William Jefferson Clinton vetoed it.

Partial-birth abortions are conducted in the third trimester of pregnancy when a fetus is viable, and involve the dilation of the cervix and extraction of the fetus while puncturing the skull. Although very rare, accounting for 0.04 percent of all abortions, the procedure was used extensively in the public debate by anti-abortion activists. At the end of the decade, extremists continued to attract attention to the issue and the litmus test was predicted to be a factor under George W. Bush's administration. But the nation saw groups such as right-to-life feminists calling for better options for pregnant women and rising to provide alternative solutions such as better wages for women, pregnancy and child-care employment leave, and better support for young, unwed mothers. Recent studies have shown a decrease in abortion rates and an increase in births out of marriage, demonstrating a significant shift in social mores.

Bibliography

Baird-Windle, Patricia, and Eleanor J. Bader. Targets of Hatred: Anti-Abortion Terrorism. New York: St. Martin's Press, 2001.

Blanchard, Dallas A. The Anti-Abortion Movement and the Rise of the Religious Right: From Polite to Fiery Protest. New York: Twayne, 1994.

Craig, Barbara Hinkson, and David M. O'Brien. Abortion and American Politics. Chatham, N.J.: Chatham House, 1993.

Hull, N. E. H., and Peter Charles Hoffer. Roe v. Wade: The Abortion Rights Controversy in American History. Lawrence: University Press of Kansas, 2001.

Jacoby, Kerry N. Souls, Bodies, Spirits: The Drive to Abolish Abortion since 1973. Westport, Conn.: Praeger, 1998.

Jaffe, Frederick S., Barbara L. Lindheim, and Philip R. Lee. Abortion Politics: Private Morality and Public Policy. New York: McGraw-Hill, 1981.

Mohr, James C. Abortion in America: The Origins and Evolutions of National Policy, 1800–1900. New York: Oxford University Press, 1978.

Olansky, Marvin. Abortion Rites: A Social History of Abortion in America. Wheaton, Ill.: Crossways Books, 1992.

Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973. Berkeley: University of California Press, 1997.

Solinger, Rickie, ed. Abortion Wars: A Half Century of Struggle, 1950–2000. Berkeley: University of California Press, 1998.

—Kathleen A. Tobin

This entry contains information applicable to United States law only.

The spontaneous or artificially induced expulsion of an embryo or fetus. As used in legal context, usually refers to induced abortion.

History

English common law generally allowed abortion before the "quickening" of the fetus (i.e., the first recognizable movement of the fetus in the uterus), which occurred between the sixteenth and eighteenth weeks of pregnancy. After quickening, however, common law was less clear as to whether abortion was considered a crime. In the United States, state legislatures did not pass abortion statutes until the nineteenth century. After 1880, abortion was criminalized by statute in every state of the union, owing in large measure to strong anti-abortion positions taken by the American Medical Association. Despite the illegality, many thousands of women every year sought abortions. Under a heavy cloak of shame and secrecy, women often had abortions performed in unsafe conditions, and many died or suffered complications from the procedures.

The abortion laws developed in the late nineteenth century existed largely unchanged until the 1960s and 1970s, when a number of different circumstances combined to bring about a movement for their reform. Women's rights groups, doctors, and lawyers began an organized abortion reform movement to press for changes, in part because many of them had witnessed the sometimes deadly complications resulting from illegal abortions. Women's organizations also began to see abortion reform as a crucial step toward the goal of equality between the sexes. They argued that women must be able to control their pregnancies in order to secure an equal status in American life. In addition, new concerns regarding explosive population growth and its effect on the environment increased public awareness of the need for birth control. At the same time, other countries developed far more permissive laws regarding abortion. In Japan and Eastern Europe, abortion was available on demand, and in much of Western Europe, abortion was permitted to protect the mother's health.

Public awareness of the abortion issue also increased through two incidents in the early 1960s that caused a greater number of children to be born with physical defects. In 1961, the drug thalidomide, used to treat nausea during pregnancy, was found to cause serious birth defects. And a 1962-65 German measles epidemic caused an estimated fifteen thousand children to be born with defects. Pregnant women who were affected by these incidents could not seek abortions because of the strict laws then in existence.

Reacting to these and other developments, and inspired by the successes of the civil rights movement of the 1950s and 1960s, women's rights organizations — including the National Organization for Women (NOW), formed in 1966 — sought to reform abortion laws through legislation and lawsuits. They hoped to educate a largely male dominated legal and judicial profession about this important issue for women. Their work, supported by such groups as the American Civil Liberties Union (ACLU), quickly began to have an effect. Between 1967 and 1970, twelve states adopted abortion reform legislation. However, the abortion activist groups began to see the abortion issue as a question of social justice and began to press for more than reform. Under the rallying cry of reproductive freedom, they began to demand an outright repeal of existing state laws and unobstructed access for women to abortion.

The increase in abortion-related cases before the courts eventually resulted in the need for clarification of the law by the Supreme Court. After considering many abortion-related appeals and petitions, on May 31, 1971, the Court accepted two cases, Roe v. Wade, 410 U.S. 113, 93 S. Ct. 705, 35 L. Ed. 2d 147 (1973), and Doe v. Bolton, 410 U.S. 179, 93 S. Ct. 739, 35 L. Ed. 2d 201 (1973), for hearing.

Roe v. Wade and Doe v. Bolton

Although the two cases before the Court appeared by their titles to involve the fates of two individuals, Roe and Doe, in reality both suits were brought by many people representing many different interests. Roe v. Wade was argued on behalf of all women of the state of Texas — in legal terminology, it was a class action suit. Thirty-six abortion reform groups filed briefs, or reports, with the court on Roe's behalf. These included women's, medical, university, public health, legal, welfare, church, population control, and other groups. The anti-abortion side of the case included representatives from seven different anti-abortion groups and the attorneys general of five states.

Roe involved a person using the pseudonym Jane Roe — actually Norma McCorvey, who revealed her identity in 1984. Roe, an unmarried, pregnant woman from Texas, wanted to have an abortion, but an existing abortion statute prevented her from doing so. The Texas statute, originally passed in 1857, outlawed abortion except to save the mother's life. Roe filed a lawsuit in federal district court on behalf of herself and all other pregnant women. She sought to have the abortion statute declared unconstitutional as an invasion of her right to privacy as guaranteed by the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. She also sought to have an injunction, or court order, issued against the statute's enforcement so that she might go forward with the abortion. The abortion reform movement attached two other cases to Roe's in an attempt to represent a wider range of the interests involved in the issue. A physician, James Hallford, who was being prosecuted under the statute for two abortions he had performed, also filed suit against the Texas law, as did a childless couple, the Does.

The three-judge district court combined Roe's case with the cases of Hallford and the Does, but later dismissed the suit brought by the Does on the grounds that neither had violated the law and the woman was not pregnant. The district court agreed with Roe that the law was unconstitutionally vague and violated her right to privacy under the Ninth Amendment — which allows for the existence of rights, like that of privacy, not explicitly named in the Constitution's Bill of Rights — and the Fourteenth Amendment. It refused, however, to grant the injunction allowing her to go ahead with the abortion. Roe then appealed the denial of the injunction to the U.S. Supreme Court.

Doe v. Bolton involved a 1968 Georgia statute that allowed abortion if necessary to save the mother's life, in the case of pregnancy resulting from rape or incest, or if the baby was likely to be born with serious birth defects (Ga. Crim. Code § 26-1202 a,b). However, the statute also created procedural requirements that effectively would have allowed few abortions. Those requirements included hospital accreditation, committee approval, two-doctor agreement, and state residency. The case concerned Mary Doe, who had sought an abortion at Grady Memorial Hospital, in Atlanta. She claimed that she had been advised that pregnancy would endanger her health, but the hospital's Abortion Rights Committee denied her the abortion. She sought a declaratory judgment holding that the Georgia law unconstitutionally violated her right to privacy as well as her Fourteenth Amendment guarantees of due process and equal protection. She also sought an injunction against the law's enforcement.

Roe and Doe were filed in March and April of 1970, and the women's pregnancies would not have lasted through December 1970. The Court heard the cases in December 1971 and October 1972, and they were not resolved until January 1973, when the Court announced its decisions.

In Roe, the Court, on a 7-2 vote, found the Texas abortion statute unconstitutional. In its opinion, written by Justice Harry A. Blackmun, the Court held that the law violated a right to privacy guaranteed by the Due Process Clause of the Fourteenth Amendment. However, the Court further held that such a right is a "qualified" one and subject to regulation by the state. The state has "legitimate interests in protecting both the pregnant woman's health and the potentiality of human life" (i.e., the life of the fetus). To specify when the state's interests emerge, the Court divided pregnancy into twelve-week trimesters. In the first trimester, the state cannot regulate abortion or prevent a woman's access to it. It can only require that abortions be performed by a licensed physician and under medically safe conditions. During the second trimester, the state can regulate abortion procedures as long as the regulations are reasonably related to the promotion of the mother's health. In the third trimester, the state has a dominant interest in protecting the "potentiality" of the fetus's life. A state may prohibit abortions during this time except in cases where they are essential to preserve the life or health of the mother. The Court also cited judicial precedent in holding that the fetus is not a "person" as defined by the Fourteenth Amendment.

In Doe, the Court found the Georgia statute to be unconstitutional as well, holding that it infringed on privacy and personal liberty by permitting abortion only in restricted cases. The Court ruled further that the statute's four procedural requirements — hospital accreditation, hospital committee approval, two-doctor agreement, and state residency — violated the Constitution. The state could not, for example, require that abortions be performed only at certain hospitals, because it had not shown that such restrictions advanced its interest in promoting the health of the pregnant woman. Such a requirement interfered with a woman's right to have an abortion in the first trimester of pregnancy, which the Court in Roe had declared was outside the scope of state regulation.

After Roe v. Wade

After the Supreme Court decisions in Roe v. Wade and Doe v. Bolton, states began to liberalize their abortion laws. However, abortion quickly became a divisive political issue for Americans. Grassroots opposition to abortion — supported by such influential institutions as the Catholic Church— was strong from the start. By the early 1980s, the anti-abortion movement had become a powerful political force. President Ronald Reagan, who came to office in 1981 and served through 1989, strongly opposed abortion and used his administration to try to change abortion rulings. He appointed a surgeon general, Dr. C. Everett Koop, who opposed abortion, and he made it a top priority of his Justice Department to effect a reversal of Roe. Reagan even published a book on the subject in 1984, Abortion and the Conscience of a Nation, which contains many of the essential positions of the anti-abortion movement. Reagan argued that the fetus has rights equal to those of people who are already born. He also cited figures indicating that 15 million abortions had been performed since 1973, and he stated his belief that the fetus experienced great pain as a result of the abortion procedure. He quoted a statement by Mother Teresa, the famed nun who helped the poor of Calcutta: "[T]he greatest misery of our time is the generalized abortion of children." While abortion rights, or pro-choice, adovcates argued that there were public health advantages of the new abortion laws, opponents of abortion, such as Reagan, referred to abortion as a "silent holocaust."

The anti-abortion, or pro-life, movement has challenged abortion in a number of different ways. It has sponsored constitutional amend- ments that would effectively reverse Roe, as well as legislation that would limit and regulate access to abortion, including government financing of abortion procedures. Some anti-abortion groups have practiced civil disobedience, attempting to disrupt and block abortion clinic activities. The most extreme opponents have resorted to violence and even murder in an attempt to eliminate abortion.

All these methods have resulted in a great deal of litigation and added to the complexity of the abortion issue. Many of the subsequent cases have come before the Supreme Court. Observers have often expected the Court to overturn its Roe decision, particularly after the Reagan administration appointed three justices to the Court. However, while the Court has allowed increasingly strict state regulation of abortion since Roe, it has stuck to the essential finding in Roe, that women have a limited right to terminate their pregnancies. This right is incorporated in a right of privacy guaranteed by the Fourteenth Amendment.

Constitutional Amendments

Although amending the Constitution is the most direct way to reverse Roe v. Wade, neither Congress nor the states have passed a constitutional amendment related to the issue of abortion. The anti-abortion forces have found it extremely difficult to achieve a public consensus on this divisive issue. However, at least nineteen state legislatures have passed applications to convene a constitutional convention to propose an amendment that would outlaw abortions. Congressional representatives have also worked to bring such an amendment about. The many dozens of amendments that have been proposed can be grouped into two main categories: states' rights, and the right to life. The former would restore to the states the same control over abortion that they exercised prior to Roe. The latter would designate the fetus as a person, entitled to all the privileges and rights guaranteed under the Fourteenth Amendment.

One unsuccessful attempt at changing the Constitution was the Hatch amendment of 1983, sponsored by Senator Orrin G. Hatch (R-Utah), which stated, "A right to abortion is not secured by this Constitution." It did not receive the two-thirds majority necessary in Congress to be submitted to the states for ratification.

Congress has also sponsored legislation that would effectively reverse Roe. For example, the Human Life Bill (S. 158), introduced by Senator Jesse Helms (R-N.C.) in 1981, would have established that the fetus is a person, entitled to the full rights and privileges guaranteed by the Fourteenth Amendment. The bill did not pass.

Federal Financing

In 1976, Representative Henry J. Hyde (R-Ill.) sponsored an amendment to the federal budget appropriations bill for the Department of Health and Human Services (HHS). His amendment denied Medicaid funding for abortion unless the woman's life is in danger or she is pregnant as a result of rape or incest, but only if the woman reports the incident at the time of its occurrence. Despite opposition from pro-abortion groups, Hyde attached this amendment every year to the same appropriations bill. The Supreme Court has upheld the constitutionality of the Hyde amendment (Harris v. McRae, 448 U.S. 297, 100 S. Ct. 2671, 65 L. Ed. 2d 784 [1980]; McGowan v. Maryland, 366 U.S. 420, 81 S. Ct. 1101, 6 L. Ed. 2d 393 [1961]). Evidence suggests that these federal actions have caused fewer women to have abortions.

In the late 1980s, with its composition having been changed by three Reagan appointees (Justices Sandra Day O'Connor, Antonin Scalia, and Anthony M. Kennedy), the Court issued a ruling related to federal financing of abortion that many perceived as a dramatic shift against abortion rights. In Webster v. Reproductive Health Services, 492 U.S. 490, 109 S. Ct. 3040, 106 L. Ed. 2d 410 (1989), the Supreme Court upheld a Missouri law prohibiting the use of public funds and buildings for abortion procedures and counseling, including a provision that required fetal testing for viability for abortions performed after the twentieth week of pregnancy (Mo. Rev. Stat. §§ 1.205.1, 1.205.2, 188.205, 188.210, 188.215). Scalia, appointed in 1986, argued in his concurring opinion that Roe v. Wade should be overruled and that the Court had missed an opportunity in not doing so in this case.

The Webster decision resulted in a flood of new state legislation related to abortion. Many states sought to reactivate old abortion laws that had never been taken off the books subsequent to Roe. Louisiana, for example, sought to reinstate an 1855 law making all abortions illegal and imposing a ten-year sentence on doctors and women violating it. However, in January 1990, a federal district court ruled that the 1855 law could not be reinstated and that subsequent laws allowing abortions in certain circumstances took precedence (Weeks v. Connick, 733 F. Supp. 1036 [E.D. La. 1990]). By mid-1991, Pennsylvania, Guam, Utah, and Louisiana had all enacted laws banning abortions except in limited circumstances. Pennsylvania became the first to approve new abortion restrictions when it amended its Abortion Control Act (Pa. Cons. Stat. Ann. § 3201) to create strict new regulations on abortion procedures (see the discussion of Planned Parenthood of Southeastern Pennsylvania v. Casey under "Other Major Abortion Regulations," later in this entry). In other states such as South and North Dakota, legislation that would have sharply restricted abortion was only narrowly defeated. However, some states, such as Connecticut and Maryland, reacted to the Webster decision by passing legislation protecting women's rights to abortion.

Before the Court ruled on Pennsylvania's Abortion Control Act, it decided a major case relating to federal funding and regulation of family planning clinics. In Rust v. Sullivan, 500 U.S. 173, 111 S. Ct. 1759, 114 L. Ed. 2d 233 (1991), the Court upheld a series of regulations issued in 1988 by the Reagan administration's Justice Department affecting family planning clinics that receive funds through title X of the Public Health Service Act of 1970, 42 U.S.C.A. §§ 300-300a-6. The regulations prohibited clinic personnel from providing any information about abortion, including counseling or referral. The regulations also required that the only permissible response to a request for an abortion or referral was to state that the agency "does not consider abortion an appropriate method of planning and therefore does not counsel or refer for abortion." This regulation became known to its detractors as the gag rule. The regulations also prohibited title X-funded family planning clinics from lobbying for legislation that advocated or increased access to abortion, and they required that such clinics be "physically and financially separate" from abortion activities. Although a family planning agency could still conduct abortion-related activities, it could not use federal money to fund such activities. Chief Justice William H. Rehnquist, who wrote the Court's opinion, disagreed with the contentions of the plaintiffs — several family planning agencies — that the federal regulations violated a woman's due process right to choose whether to terminate her pregnancy. He pointed out that the Due Process Clause generally confers no affirmative right to government aid. The government has no constitutional duty to subsidize abortion and may validly choose to fund "childbirth over abortion." Rehnquist noted that a woman's right to seek medical advice outside a title X-funded agency remained "unfettered."

Justice Blackmun, author of the Roe majority opinion, dissented, arguing that the regulations, because they restricted speech as a condition for accepting public funds, violated the First Amendment's free speech provision. The regulations, he wrote, suppressed "truthful information regarding constitutionally protected conduct of vital importance to the listener." Black- mun saw the regulations as improper government interference in a woman's decision to continue or end a pregnancy, and he claimed that they rendered the landmark Roe ruling "technically" intact but of little substance.

On January 22, 1993, shortly after taking office, President Bill Clinton signed a memorandum that revoked the gag rule, maintaining that it "endangers women's lives by preventing them from receiving complete and accurate medical information." On February 5, 1993, the secretary of HHS complied with the president's decision and declared that the department would return to title X regulations that were in effect before February 1988. Title X-funded clinics would again be able to provide nondirective counseling on all options to a patient and to refer her for abortion services if she chose. However, such clinics would still be prohibited from engaging in pro-choice lobbying or litigation.

Other Major Abortion Regulations

Among the first abortion regulations to be enacted after Roe v. Wade were requirements for the informed consent of the woman seeking an abortion. Although informed consent varies according to different laws, it can generally be given only after a woman receives certain information from a doctor, medical professional, or counselor. This information can include the nature and risks of the abortion procedure, the risk of carrying the pregnancy to term, the alternatives to abortion, the probable age of the fetus, and specific government aid available for care of a child. Related to this issue are other types of consent — including parental and spousal consent — that states have sought to require before an abortion can be performed.

In 1976, the Court reviewed a Missouri statute requiring that the following provisions be met for an abortion to be performed: that a woman in the first twelve weeks of her pregnancy give written consent; that a wife obtain her husband's consent; and that a minor obtain her parents' consent, unless a medical necessity exists (Mo. Ann. Stat. § 188.010 et seq.). The statute also required that physicians and clinics performing abortions keep careful records of their procedures and that criminal and civil liability be imposed upon a physician who failed to observe standards of professional care in performing abortions. Planned Parenthood, a family planning organization, initiated a lawsuit to declare the law unconstitutional. The Supreme Court, in Planned Parenthood v. Danforth, 428 U.S. 52, 96 S. Ct. 2831, 49 L. Ed. 2d 788 (1976), upheld the requirement that the woman give written consent in the first trimester, as well as the requirement that records of abortion procedures be kept. However, the Court ruled that a woman need not inform her husband of an abortion performed in the first trimester, because the state may not interfere in the woman's private decision concerning her pregnancy during that period. For the same reason, the Court struck down the law requiring a minor to obtain parental consent in the first trimester.

The Court clarified its position on parental consent in later rulings. In Bellotti v. Baird, 443 U.S. 622, 99 S. Ct. 3035, 61 L. Ed. 2d 797 (1979), it struck down a state law that required the consent of both parents or judicial approval — commonly called judicial bypass— before an unmarried minor could obtain an abortion. The Court found the law unconstitutional because it gave third parties — the child's parents or the court — absolute veto power over the minor's ability to choose abortion, regardless of her best interests, maturity, or ability to make informed decisions. In H.L. v. Matheson, 450 U.S. 398, 101 S. Ct. 1164, 67 L. Ed. 2d 388 (1981), the Court upheld a Utah statute requiring that a physician notify the parents of a minor before performing an abortion on her (Utah Code Ann. § 76-7-304). Since the law required only notification rather than consent, the Court reasoned that it did not give any party veto power over the minor's decision. In Hodgson v. Minnesota, 497 U.S. 417, 110 S. Ct. 2926, 11 L. Ed. 2d 344 (1990), the Court upheld a parental notification statute because the statute's provision for judicial bypass took into account the best interests of the minor, her maturity, and her ability to make an informed decision.

In 1982, Pennsylvania passed the Abortion Control Act, which required that the woman give "voluntary and informed" consent after hearing a number of statements, including declarations of the following: the "fact that there may be detrimental physical and psychological effects" to the abortion; the particular medical risks associated with the abortion method to be employed; the probable gestational age of the fetus; the "fact that medical assistance benefits may be available" for prenatal care and childbirth; and the "fact that the father is liable to assist" in child support. The law also required a physician to report the woman's age, race, marital status, and number of previous pregnancies; the probable gestational age of the fetus; the method of payment for the abortion; and the basis of determination that "a child is not viable."

When the Pennsylvania law came before the Court in the 1986 case Thornburgh v. American College of Obstetricians & Gynecologists, 476 U.S. 747, 106 S. Ct. 2169, 90 L. Ed. 2d 779, the Reagan administration's Justice Department specifically asked the Court to overturn Roe. In its brief, the department argued that the Court should "abandon" Roe because its textual and historical basis was "so far flawed" as to be a source of instability in the law. Instead, the brief urged, the Court should leave the state legislatures free to permit or prohibit abortion as they wish. However, by a narrow (5-4) vote the Court found all the provisions of Pennsylvania's Abortion Control Act to be unconstitutional, thereby reaffirming its previous decisions upholding a woman's constitutional right to abortion. "The states," wrote Justice Blackmun in the Court's opinion, "are not free, under the guise of protecting maternal health or potential life, to intimidate women into continuing pregnancies." Pennsylvania had defended itself by claiming that its procedures gave the pregnant woman information that would better inform her decision regarding abortion. Blackmun, although he agreed in principle with the idea of informed consent, found that the Pennsylvania procedures were designed not so much to inform as to encourage a woman to withhold her consent to an abortion.

The narrow margin of the Court's decision encouraged the anti-abortion movement. By the time the Court reached its next major abortion decision, in 1992 — Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833, 112 S. Ct. 2791, 120 L. Ed. 2d 674 — many expected it to finally reverse Roe. Again, it did not. Casey, the most important abortion decision since Roe, concerned amendments to the same Pennsylvania Abortion Control Act of 1982. The amendments prohibited abortions after twenty-four weeks except to save the woman's life or to prevent substantial and irreversible impairment of her bodily functions; required a woman to wait twenty-four hours after giving her informed consent before receiving an abortion; allowed only a physician to give informed-consent information; required a woman to notify her spouse; and mandated that minors obtain informed consent from at least one parent or a court before receiving an abortion. The plaintiffs in the case, five family planning clinics and a physician provider of abortion services, asked the Court to declare the statutes invalid.

In a close (5-4) decision, the Court again supported the basic provisions of Roe and upheld a woman's right to decide to obtain an abortion. The Court did, however, uphold all the Pennsylvania statutes except for the spousal notification provision, arguing that they did not present an "undue burden" to the woman's reproductive rights. Justices O'Connor, Kennedy, and David H. Souter wrote the majority opinion, and Justices John Paul Stevens and Blackmun wrote concurring opinions. Chief Justice Rehnquist and Justices Scalia, Byron R. White, and Clarence Thomas all dissented.

Noting that the case marked the fifth time the Justice Department under the Reagan and Bush administrations had filed a report with the Court making known its desire to overturn Roe, the Court's opinion defended the reasoning of the Roe decision. The Court characterized the Roe ruling as having three major provisions:

First is a recognition of the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the state… . Second is a confirmation of the State's power to restrict abortions after fetal viability, if the law contains exceptions for pregnancies which endanger a woman's life or health. And third is the principle that the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child.

The Court in Casey, as in Roe, found the constitutional basis of a woman's right to terminate her pregnancy in the Due Process Clause of the Fourteenth Amendment. As the Court stated, "It is a promise of the Constitution that there is a realm of personal liberty which the government may not enter." The Court also invoked the legal doctrine of stare decisis, the policy of a court to follow previously decided cases rather than overrule them.

However, the Court emphasized, more than it had in Roe, "the State's ‘important and legitimate interest in potential life' [quoting Roe]." The justices also sought to better define the "undue burden" standard, originally developed by Justice O'Connor, that the Court had used to assess the validity of any possible regulations of a woman's reproductive rights. The Court more precisely defined an undue burden as one whose "purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability."

The dissenting justices in the case restated their opinion that Roe was decided wrongly because no fundamental right for a woman to choose to terminate her pregnancy was written into the U.S. Constitution and because U.S. society, in the past, permitted laws that prohibited abortion. They also gave different arguments for upholding the Pennsylvania statute's restrictions. Such provisions had only to show a "rational basis," and using that test, they would have upheld all the challenged portions of the Pennsylvania law. Chief Justice Rehnquist and Justice Scalia both argued that the Court had misused the notion of stare decisis in the case, because the Court did not uphold all aspects of Roe. Scalia also maintained that although the liberty to terminate a pregnancy may be of great importance to many women, it is not "a liberty protected by the Constitution."

The Court's decision in Casey was used to strike down other state laws that sharply restricted women's access to abortion. Citing the Casey decision, in Sojourner v. Edwards, 974 F.2d 27, the U.S. Court of Appeals for the Fifth Circuit in September 1992 struck down a Louisiana law that would have imposed stiff sentences on doctors performing abortions for reasons other than saving the life of the mother or in cases of rape or incest if the victim reported the crime (La. Rev. Stat. Ann. 14:87). The appeals court found the statute unconstitutional because it imposed an undue burden on women seeking an abortion before fetal viability. The Supreme Court later upheld this ruling without comment (Sojourner, 507 U.S. 972, 113 S. Ct. 1414, 122 L. Ed. 2d 785 [1993]).

After Planned Parenthood v. Casey

As a result of the Court's decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the battle over abortion moved beyond the question of whether Roe v. Wade would be overturned, to focus on what conditions truly constitute an American woman's right to safe, legal abortion. After a number of incidents of violence at abortion clinics, the abortion rights movement has focused on lobbying for legislation and winning court cases guaranteeing access to abortion clinics. The anti-abortion movement, on the other hand, has continued to vigorously oppose abortion but has become increasingly split between militant and moderate factions. Behind the split are the increasingly violent actions of militant anti-abortion protesters. Between 1993 and 1994, five abortion providers were killed by anti-abortion militants. Although such killings have undermined public support for the anti-abortion movement, they have also damaged the morale of those who staff family planning clinics; some clinics have even shut down. As a result, family planning services, including abortion, remain difficult to obtain for women in many parts of the country, particularly in rural areas.

The Supreme Court has decided a number of different cases surrounding the issue of anti-abortion protests, many of which have made it more difficult for anti-abortion groups to disrupt the operations of family planning clinics. In Madsen v. Women's Health Center, 512 U.S. 753, 114 S. Ct. 2516, 129 L. Ed. 2d 593 (1994), the Court upheld a regulation barring abortion protesters within thirty-six feet of a Melbourne, Florida, clinic. In another 1994 decision, National Organization for Women v. Scheidler, 510 U.S. 249, 114 S. Ct. 798, 127 L. Ed. 2d 99, the Court upheld the use of the Racketeer Influenced and Corrupt Organizations (RICO) chapter of the Organized Crime Control Act of 1970 (18 U.S.C.A. §§ 1961-1968) against militant anti-abortion groups. RICO, which was originally designed to combat Mafia crime, gives the government a potent tool to convict those involved in violence against abortion providers and their clinics.

In May 1994, President Clinton signed into law another tool to be used against anti-abortion militants, the Freedom of Access to Clinic Entrances Act (FACE), which allows for federal criminal prosecution of anyone who, "by force or threat of force or by physical obstruction, intentionally injures, intimidates, or interferes … with any person … obtaining or providing reproductive health services" (18 U.S.C.A. § 248). The law also makes it a federal crime to intentionally damage or destroy the property of any reproductive health facility, and it permits persons harmed by those engaging in prohibited conduct to bring private suits against the wrongdoers. The law imposes stiff penalties as well for those found guilty of violating its provisions.

Ultimately, medical technology may have as much to do with the outcome of the abortion debate as politics. New drugs have been developed that induce abortion without a surgical procedure. The most well known of these is RU-486, developed by the French pharmaceutical company Roussel Uclaf. The drug blocks the action of the female hormone progesterone, preventing the implantation of a fertilized egg in the wall of the uterus. It is used with a second drug in pill form, prostaglandin, taken forty-eight hours later, which causes uterine contractions. The uterine lining is then sloughed off, along with any fertilized eggs. Widely used in Europe, RU-486 is said to be 95 percent effective. The drug is also being tested as a morning-after pill and as a possible treatment for breast cancer, endometriosis, and brain tumors. The Food and Drug Administration (FDA), under the Reagan and Bush administrations, banned the importation of RU-486 into the United States. However, in April 1993, the Clinton administration pressured Roussel Uclaf to license the drug for sale to the U.S. Population Council, a New York-based nonprofit organization, which said it would conduct clinical tests in the United States. Seeking to avoid the ire of anti-abortion groups, Roussel Uclaf was planning to set up a nonprofit foundation that would manufacture and distribute RU-486.

The Pro-Life Movement and the Courts

Even before the Supreme Court's landmark 1973 abortion ruling in Roe v. Wade, 410 U.S. 113, 93 S. Ct. 705, 35 L. Ed. 2d 147, pro-life groups had begun to picket and protest at family planning clinics that perform abortions. Such groups had formed in response to an abortion reform movement that by 1970 had succeeded in liberalizing abortion laws in many states. From the start, most anti-abortion demonstrators modeled their protests on those of the civil rights movement of the 1950s and 1960s. The anti-abortion movement was led by such people as Joan Andrews, a pacifist and human rights advocate who became a hero for the movement after she spent two-and-a-half years in a Florida jail for attempting to disengage a suction machine used in abortions. The movement advocated the nonviolent approach to civil disobedience pioneered by Mohandas K. Gandhi and Martin Luther King, Jr. By 1975, two years after Roe, Catholic groups had begun to conduct sit-ins at family planning clinics where abortions were performed. With time, evangelical Protestant groups joined the movement, and in the mid-1990s, they accounted for a majority of anti-abortion activists.

Pro-life groups have come to call their activities direct actions or rescues, believing that they are saving unborn children from murder, and their tactics have grown increasingly complex. Typical stratagems include bringing in dozens or hundreds of volunteers and blocking clinic entrances with their bodies, often chaining themselves to doors; shouting slogans, sometimes with bullhorns; attempting to intercept women leaving or entering the building and plying them with anti-abortion literature; displaying graphic pictures of fetuses; and trailing clinic employees to and from work while shouting such things as "Baby killer!" Besides demonstrating, anti-abortion groups have sponsored "pregnancy crisis centers," where they counsel pregnant women, with the intention of persuading them to carry their pregnancies to term. By the mid-1980s, activists had created national organizations and networks that promoted civil disobedience to stop the practice of abortion. The most well known of these is Operation Rescue, which was started in the 1980s by Randall Terry, an evangelical Christian.

The aggressive strategies of the anti-abortion movement have prompted legal responses from women's and abortion rights organizations, resulting in a number of cases that have reached the Supreme Court. In several different rulings, the Court has attempted to clarify what is and is not allowed in anti-abortion demonstrations. In making these decisions, the Court has attempted to balance the rights of the demonstrators — particularly their right to free speech — with the rights of women seeking to use family planning clinic services. In 1988, for example, in Frisby v. Schultz, 487 U.S. 474, 108 S. Ct. 2495, 101 L. Ed. 2d 420, the Court upheld a Brookfield, Wisconsin, city ordinance prohibiting pickets "focused on, and taking place in front of, a particular residence." The ordinance had been created in response to anti-abortion demonstrations targeting the private home of an obstetrician who performed abortions, a tactic assumed by the protesters after picketing at the physician's clinic had not stopped its operation. Justice Sandra Day O'Connor wrote in the Court's opinion, "There is simply no right to force speech into the home of an unwilling listener."

A later Supreme Court decision gave abortion clinics further protection: it supported the constitutionality of a court injunction prohibiting protesters from going within thirty-six feet of a clinic that had been a regular target of protests. In July 1994, in Madsen v. Women's Health Center, ___U.S.___, 114 S. Ct. 2516, 129 L. Ed. 2d 593, the High Court ruled 6-3 to let stand the thirty-six-foot exclusion zone for the Melbourne, Florida, abortion clinic. However, the Court did strike down other provisions of the injunction, such as a three-hundred-foot exclusion zone and restrictions on carrying banners and pictures. The ruling was considered a major defeat for the anti-abortion movement. Justice Antonin Scalia wrote a sharp dissent in which he claimed that the Supreme Court's position on abortion had claimed "its latest, greatest and most surprising victim: the First Amendment."

Increased Violence Changes the Debate

Violence has been a part of the heated debate surrounding abortion ever since the 1973 Roe v. Wade decision that guaranteed a woman's limited right to an abortion. Bombings, arson, and even murder have been committed by anti-abortion activists in the name of their cause. The National Abortion Federation counted more than three thousand violent or threatening incidents against abortion clinics between 1976 and 1994. In the 1990s, the extremist wing of the anti-abortion movement turned even more violent, including murder as part of its tactics. Some extremists now view killing health care professionals who perform abortions as justifiable homicide.

Between March 1993 and the end of 1994, five staff workers at abortion clinics were murdered by anti-abortion zealots. Dr. David Gunn was fatally shot on March 10, 1993, outside an abortion clinic in Pensacola, Florida, by Michael Griffin. In August 1994, Dr. John Bayard Britton, age sixty-nine, who had replaced Gunn as circuit-riding doctor in northern Florida, and his escort, James Barrett, age seventy-four, were shot repeatedly in the face with a shotgun as their car pulled into the parking lot of the Ladies Clinic of Pensacola. Minutes later, police arrested Paul Hill, an anti-abortion extremist. President Bill Clinton called Britton's and Barrett's killings a case of domestic terrorism. In December 1994, in perhaps the most gruesome incident of all, John Salvi killed two people and wounded five more when he opened fire in two Boston-area family planning clinics.

According to the Alan Guttmacher Institute, in 1988 — well before the 1993-94 wave of violence — 17 percent of counties in the United States had abortion providers. The federal government cannot guarantee protection for clinics; whereas there are some fifteen hundred abortion clinics nationwide, in 1995 there were only 2,100 federal marshals.

The government and abortion rights groups have responded to the increased violence in two ways: reviewing existing laws to find those that can be used to investigate and prosecute violent groups and individuals, and creating new laws that specifically address access to abortion clinics. In the late 1980s, the National Organization for Women (NOW) filed a lawsuit against long-time pro-life activist Joseph Scheidler and his Pro-Life Action Network (PLAN). Initially, NOW attempted to use the Sherman Anti-Trust Act of 1890 (15 U.S.C.A. § 1 et seq.) against PLAN, but without success. At the prompting of Chicago lawyer Fay Clayton, NOW turned to a different law, the Racketeer Influenced and Corrupt Organizations (RICO) chapter of the Organized Crime Control Act of 1970 (18 U.S.C.A. §§ 1961-1968), and broadened its attack to include Randall Terry, founder of Operation Rescue. RICO was originally drafted as a potent means to convict all members of a criminal enterprise — including those who had routinely escaped police dragnets, the Mafia bosses. The law imposes harsh penalties on those convicted under it: up to twenty years in jail for each criminal count, and triple damages in civil judgments. In early 1994, the Supreme Court, in National Organization for Women v. Scheidler, 510 U.S. 249, 114 S. Ct. 798, 127 L. Ed. 2d 99, upheld the use of RICO against anti-abortion groups, many of which could now be attacked as criminal enterprises. Chief Justice William H. Rehnquist, writing the Court's opinion, reasoned that to be designated a criminal enterprise under RICO, an organization need not be devoted to economic gain. Justice David H. Souter wrote a concurring opinion in which he warned that RICO could conflict with First Amendment rights regarding speech. "I think it prudent to notice," he wrote, "that RICO actions could deter protected advocacy and to caution courts applying RICO to bear in mind the First Amendment interests that could be at stake."

Women's rights groups were less successful in Bray v. Alexandria Women's Health Clinic, 506 U.S. 263, 113 S. Ct. 753, 122 L. Ed. 2d 34 (1993). In this case, the Supreme Court ruled that a nineteenth-century federal civil rights law (42 U.S.C.A. § 1985[3]) aimed at protecting African Americans from the Ku Klux Klan could not be used to prevent anti-abortion protesters from blockading abortion clinics. Originally enacted as part of the Ku Klux Klan Act of 1871, a law that had first been used against mob violence and vigilantism, the relevant statute had in the 1980s been applied by courts to actions of anti-abortion groups, most notably Operation Rescue. A lower-court ruling, for example, found that Operation Rescue had violated trespassing and public nuisance laws and had conspired to violate the right to interstate travel of women seeking abortions at clinics. The court banned Operation Rescue from trespassing on or obstructing access to abortion clinics (NOW v. Operation Rescue, 726 F. Supp. 1483 [E.D. Va. 1989]). This decision was reversed by the Supreme Court in Bray, in a 6-3 ruling, when it held that women did not qualify as a class under discrimination by the provisions of the Ku Klux Klan Act.

After Bray, congressional supporters of abortion rights, Representative Charles E. Schumer (D-N.Y.) and Senator Edward M. Kennedy (D-Mass.), introduced the Freedom of Access to Clinic Entrances Act (FACE), which would give federal courts the authority to issue restraining orders against protesters blockading abortion clinics (18 U.S.C.A. § 248). It was signed into law by President Clinton on May 26, 1994. The law allows for federal criminal prosecution of anyone who, "by force or threat of force or by physical obstruction, intentionally injures, intimidates, or interferes … with any person … obtaining or providing reproductive health services." The law also makes it a federal crime to intentionally damage or destroy the property of any reproductive health facility, and it permits persons harmed by those engaging in prohibited conduct to bring private suits against the wrongdoers. The penalties for violation of the act include imprisonment for up to one year and a fine of $10,000 for a first offense; for each subsequent offense, penalties can be up to three years' imprisonment and $25,000. FACE is patterned after existing civil rights laws, including 18 U.S.C.A. § 245(b), which prohibits force or threat of force to willfully injure, intimidate, or interfere with any person who is voting, engaging in activities related to voting, or enjoying the benefits of federal programs. Nevertheless, FACE is not identical to previous federal civil rights laws, particularly where it prohibits acts of physical obstruction.

FACE brought on immediate challenges by anti-abortion groups who claimed that it abridged their First Amendment right to freedom of speech. Courts were unwilling to invalidate the law on this ground, reasoning that the law proscribes only conduct — as in "force," "threat of force," and "physical obstruction" — rather than speech (see Council for Life Coalition v. Reno, 856 F. Supp. 1422, No. 94-0843-1EG[CM], 1994 WL 363132 [S.D. Cal. 1994]).

The violence against clinics and the murder of abortion providers have given new momentum to the pro-choice, or abortion rights, side of the abortion issue. Family planning clinics that perform abortions are receiving increased protection from local, state, and federal statutes, with FACE the most prominent of these laws. However, the debate and litigation surrounding the issue of anti-abortion protests show little sign of abating, and anti-abortion protest groups are preparing to challenge the laws regulating their activities, on the grounds that such laws abridge freedom of speech.

See: American Civil Liberties Union; Constitutional Amendment; Due Process of Law; Fetal Rights; First Amendment; Fourteenth Amendment; Freedom of Speech; Husband and Wife; Ninth Amendment; Parent and Child; Privacy; Reproduction; Roe v. Wade; Women's Rights.

A series of articles on
Main topics
Abortion Abortion by country Abortion debate Pro-choice Pro-life Abortion law History of abortion Methods of abortion

An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously as a miscarriage or be artificially induced by medical, surgical or other means. "Abortion" can refer to an induced procedure at any point during human pregnancy; it is sometimes medically defined as either miscarriage or induced termination before the point of viability.^[1] Throughout history, abortion has been induced by various methods and the moral and legal aspects of abortion are subject to intense debate in many parts of the world.

Definitions

The following medical terms are used to categorize abortion:

• Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors.
• Induced abortion: Abortion that has been caused by deliberate human action. Induced abortions are further subcategorized into therapeutic and elective:
  • Therapeutic abortion: An abortion performed either...
    • to save the life of the pregnant woman;^[2]
    • to preserve the woman's physical or mental health;^[2]
    • to terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity;^[2] or
    • to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.^[2]
  • Elective abortion: Abortion performed for any other reason.

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

Incidence

The incidence and reasons for induced abortion vary regionally. It has been estimated that approximately 46 million abortions are performed worldwide every year. Of these, 26 million are said to occur in places where abortion is legal; the other 20 million happen where the procedure is illegal. Some countries, such as Belgium (11.2 per 100 known pregnancies) and the Netherlands (10.6 per 100), have a low rate of induced abortion, while others like Russia (62.6 per 100) and Vietnam (43.7 per 100) have a comparatively high rate. The world ratio is 26 induced abortions per 100 known pregnancies.^[3]

By gestational age and method

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, from data collected in those areas of the United States that sufficiently reported gestational age, it was found that 88.2% of abortions were conducted at or prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 90.9% of these were classified as having been done by "curettage" (suction-aspiration, Dilation and curettage, Dilation and evacuation), 7.7% by "medical" means (mifepristone), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy).^[4] The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the U.S. during 2000; this accounts for 0.17% of the total number of abortions performed that year.^[5] Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 to 19 weeks, and 1.5% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.^[6]

By personal and social factors

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

A 1998 aggregated study, from 27 countries, on the reasons women seek to terminate their pregnancies concluded that common factors cited to have influenced the abortion decision were: desire to delay or end childbearing, concern over the interruption of work or education, issues of financial or relationship stability, and perceived immaturity.^[7] A 2004 study in which American women at clinics answered a questionnaire yielded similar results.^[8] In Finland and the United States, concern for the health risks posed by pregnancy in individual cases was not a factor commonly given; however, in Bangladesh, India, and Kenya health concerns were cited by women more frequently as reasons for having an abortion.^[7] 1% of women in the 2004 survey-based U.S. study became pregnant as a result of rape and 0.5% as a result of incest.^[8] Another American study in 2002 concluded that 54% of women who had an abortion were using a form of contraception at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using condoms and 76% of those using the combined oral contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.^[9] In the United Kingdom, a 1994 survey of sexual behavior found that women who reported having an abortion were more likely to be of a higher social class, as well as either cohabitating or divorced. It also found that women who stated they have had 10 or more sexual partners in their lifetime were five times more likely to have had an abortion than those who stated they have had only one sexual partner.^[10]

Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled persons, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion. In many areas, especially in developing nations or where abortion is illegal, women sometimes resort to "back-alley" or self-induced procedures. The World Health Organization suggests that there are 19 million terminations annually which fit its criteria for an unsafe abortion.^[11] See social issues for more information on these subjects.

Forms of abortion

Spontaneous abortion

Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes before the 20th week of gestation. A pregnancy that ends earlier than 37 weeks of gestation, if it results in a live-born infant, is known as a "premature birth". When a fetus dies in the uterus at some point late in gestation, beginning at about 20 weeks, or during delivery, it is termed a "stillbirth". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Most miscarriages occur very early in pregnancy. Between 10% and 50% of pregnancies end in miscarriage, depending upon the age and health of the pregnant woman.^[12] In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant.

The risk of spontaneous abortion decreases sharply after the 8th week.^[13] This risk is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.

Induced abortion

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

Surgical abortion

In the first twelve weeks, suction-aspiration or vacuum abortion is the most common method.^[14] Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses an electric pump. These techniques are comparable, differing in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and menstrual extraction, can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as STOP: 'Suction (or surgical) Termination Of Pregnancy'. From the fifteenth week until approximately the twenty-sixth week, a dilation and evacuation (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Dilation and curettage (D & C) is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.^[15] The term "D and C", or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.

Other techniques must be used to induce abortion in the third trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes termed "partial-birth abortion," which has been federally banned in the United States. A hysterotomy abortion is an abortion procedure similar to a caesarean section, and is performed under general anesthesia because it is considered major abdominal surgery. The procedure requires a smaller incision than a caesarean section and is used during later stages of pregnancy.^[16]

From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure.^[17]

Medical abortion

Effective in the first trimester of pregnancy, medical (non-surgical) abortions comprise 10% of all abortions in the United States and Europe. Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention.^[18] Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.

Other means of abortion

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

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion).^[19] The use of herbs in such a manner can cause serious — even lethal — side effects, such as multiple organ failure, and is not recommended by physicians.^[20]

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage.^[21] Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Burma, Indonesia, Malaysia, the Philippines, and Thailand, there is an ancient tradition of attempting abortion through forceful abdominal massage.^[22]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.^[23]

Health considerations

Early-term surgical abortion is a simple procedure, which is considered safer than childbirth when performed before the 16th week under modern medical conditions.^[24][25] Abortion methods, like most surgical procedures, carry a small potential for serious complications, including perforated uterus,^[26][27] perforated bowel^[28] or bladder,^[29] septic shock,^[30] sterility,^[31] and death.^[32] The risk of complications can increase depending on how far pregnancy has progressed.^[33][34]

Assessing the risks of induced abortion depends on a number of factors. First, there are relative health risks of induced abortion and pregnancy, which are both affected by wide variation in the quality of health services in different societies and among different socio-economic groups, a lack of uniform definitions of terms, and difficulties in patient follow-up and after-care. The degree of risk is also dependent upon the skill and experience of the practitioner; maternal age, health, and parity;^[34] gestational age;^[34][33] pre-existing conditions; methods and instruments used; medications used; the skill and experience of those assisting the practitioner; and the quality of recovery and follow-up care.

In the United Kingdom, the number of deaths directly due to legal abortion between the years of 1991 and 1993 was 5, compared to 3 deaths following spontaneous miscarriage and 8 deaths caused by ectopic pregnancy during the same time frame.^[35] In the United States, during the year 1999, there were 4 deaths due to legal abortion, 10 due to miscarriage, and 525 due to pregnancy-related reasons.^[36][37]

Some practitioners advocate using minimal anaesthesia so the patient can alert them to possible complications. Others recommend general anaesthesia, to prevent patient movement, which might cause a perforation. General anaesthesia carries its own risks, including death, which is why public health officials recommend against its routine use.

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

Instruments that are placed within the uterus can, on rare occasions, cause perforation^[33] or laceration of the uterus, and damage structures surrounding the uterus. Laceration or perforation of the uterus or cervix can, again on rare occasions, lead to more serious complications.

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

In rare cases, abortion will be unsuccessful and pregnancy will continue. An unsuccessful abortion can result in delivery of a live infant. This, termed a failed abortion, can occur only late in pregnancy. Some doctors have voiced concerns about the ethical and legal ramifications of letting the infant die. As a result, recent investigations have been launched in the United Kingdom by the Confidential Enquiry into Maternal and Child Health (CEMACH) and the Royal College of Obstetricians and Gynaecologists, in order to determine how widespread the problem is and what an ethical response in the treatment of the infant might be. A preliminary report from this investigation indicated that at least 50 babies a year are born in the UK following failed abortions after 18 weeks of gestation.^[38]

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

Suggested effects

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

Breast cancer

The abortion-breast cancer (ABC) hypothesis (also referred to by supporters as the abortion-breast cancer link) posits a causal relationship between induced abortion and an increased risk of developing breast cancer. In early pregnancy, levels of estrogen increase, leading to breast growth in preparation for lactation. The hypothesis proposes that if this process is interrupted by an abortion – before full differentiation in the third trimester – then more relatively vulnerable undifferentiated cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. The hypothesis garnered renewed interest from rat studies conducted in the 1980s;^[39][40][41] however, it has not been scientifically verified in humans, and abortion is not considered a breast cancer risk by any major cancer organization.^[42]

A large epidemiological study by Mads Melbye et al. in 1997, with data from two national registries in Denmark, reported the correlation to be negligible to non-existent after statistical adjustment.^[43] The National Cancer Institute conducted an official workshop with over 100 experts on the issue in February 2003, which concluded with its highest strength rating for the selected evidence that "induced abortion is not associated with an increase in breast cancer risk."^[44] In 2004, Beral et al. published a collaborative reanalysis of 53 epidemiological studies and concluded that abortion does "not increase a woman's risk of developing breast cancer."^[45]

Critics of these studies argue they are subject to selection bias,^[46] that the majority of interview-based studies have indicated a link, and that some are statistically significant.^[47] Debate remains as to the reliability of these retrospective studies because of possible response bias. The current scientific consensus that abortion does not increase the risk of breast cancer has solidified with the publication of large prospective cohort studies which find no significant association between abortion and breast cancer.^[48][49] The ongoing prominence of the abortion-breast cancer hypothesis, despite the lack of clear scientific evidence, is seen by some as a part of the current pro-life "women-centered" strategy against abortion.^[50][51] Nevertheless, the subject continues to be one of mostly political but some scientific contention.^[52][53]

Fetal pain

The existence or absence of fetal sensation during abortion is a matter of medical, ethical and public policy interest. Evidence conflicts, with several physicians holding that the fetus is capable of feeling pain sometime in the first trimester,^[54][55] and medical researchers, notably from the American Medical Association, maintaining that the neuro-anatomical requirements for such experience do not exist until the 29th week of gestation.^[56]

Pain receptors begin to appear in the seventh week of gestation.^[55][57] The thalamus, the part of the brain which receives signals from the nervous system and then relays them to the cerebral cortex, starts to form in the fifth week.^[58] However, other anatomical structures involved in the nociceptive process are not present until much later in gestation. Links between the thalamus and cerebral cortex form around the 23rd week.^[58] There has been suggestion that a fetus cannot feel pain at all, as it requires mental development that only occurs outside the womb.^[59]

Researchers have observed changes in heart rates and hormonal levels of newborn infants after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anesthesia.^[60] Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.^[61]

Mental health

Post-abortion syndrome (PAS) is a term used to describe a set of mental health characteristics which some researchers claim to have observed in women following an abortion.^[62] The psychopathological symptoms attributed to PAS are similar to those of post-traumatic stress disorder, but have also included, "repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the 'need to repair'".^[62] Whether this would warrant classification as an independent syndrome is disputed by other researchers.^[63] PAS is listed in neither the DSM-IV-TR nor the ICD-10.

Some studies have shown abortion to have neutral or positive effects on the mental well-being of some patients. A 1989 study of teenagers who sought pregnancy tests found that, counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term.^[64] Another study in 1992 suggested a link between elective abortion and later reports of positive self-esteem; it also noted that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors.^[65] Abortion, as compared to completion, of an undesired first pregnancy was not found to directly pose the risk of significant depression in a 2005 study.^[66]

Other studies have shown a correlation between abortion and negative psychological impact. A 1996 study found that suicide is more common after miscarriage and especially after induced abortion, than in the general population.^[67] Additional research in 2002 by David Reardon reported that the risk of clinical depression was higher for women who chose to have an abortion compared to those who opted to carry to term — even if the pregnancy was unwanted.^[68] Another study in 2006, which used data gathered over a 25-year period, found an increased occurrence of clinical depression, anxiety, suicidal behavior, and substance abuse among women who had previously had an abortion.^[69]

Miscarriage, or spontaneous abortion, is known to present an increased risk of depression.^[70] Childbirth can also sometimes result in maternity blues or postpartum depression.

History of abortion

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

Induced abortion, according to some anthropologists, can be traced to ancient times.^[71] There is evidence to suggest that, historically, pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques.

The Hippocratic Oath, the chief statement of medical ethics in Ancient Greece, forbade all doctors from helping to procure an abortion by pessary. Nonetheless, Soranus, a second-century Greek physician, suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in violent exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal baths, pessaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation.^[72] It is also believed that, in addition to using it as a contraceptive, the ancient Greeks relied upon silphium as an abortifacient. Such folk remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example, are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy.

Abortion in the 19th century continued, despite bans in both the United Kingdom and the United States, as the disguised, but nonetheless open, advertisement of services in the Victorian era suggests.^[73]

Social issues

A number of complex issues exist in the debate over abortion. These, like the suggested effects upon health listed above, are a focus of research and a fixture of discussion among members on all sides of the controversy.

Effect upon crime rate

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

The suggestion was brought to widespread attention by a 1999 academic paper, The Impact of Legalized Abortion on Crime, authored by the economists Steven D. Levitt and John Donohue. They attributed the drop in crime to a reduction in individuals said to have a higher statistical probability of committing crimes: unwanted children, especially those born to mothers who are African-American, impoverished, adolescent, uneducated, and single. The change coincided with what would have been the adolescence, or peak years of potential criminality, of those who had not been born as a result of Roe v. Wade and similar cases. Donohue and Levitt's study also noted that states which legalized abortion before the rest of the nation experienced the lowering crime rate pattern earlier, and those with higher abortion rates had more pronounced reductions.^[74]

Fellow economists Christopher Foote and Christopher Goetz criticized the methodology in the Donohue-Levitt study, noting a lack of accommodation for statewide yearly variations such as cocaine use, and recalculating based on incidence of crime per capita; they found no statistically significant results.^[75] Levitt and Donohue responded to this by presenting an adjusted data set which took into account these concerns and reported that the data maintained the statistical significance of their initial paper.^[76]

Such research has been criticized by some as being utilitarian, discriminatory as to race and socioeconomic class, and as promoting eugenics as a solution to crime.^[77][78] Levitt states in his book, Freakonomics, that they are neither promoting nor negating any course of action — merely reporting data as economists.

Sex-selective abortion

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

It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Mainland China, Taiwan, South Korea, and India.^[79]

In India, the economic role of men, the costs associated with dowries, and a Hindu tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons.^[80] The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 rupees [for a sex test] now, save 50,000 rupees [for a dowry] later."^[81] In 1991, the male-to-female sex ratio in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.^[82] Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.^[83] 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.^[84]

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.^[85] 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.^[86] A ban upon the practice of sex-selective abortion was enacted in 2003.^[87]

Unsafe abortion

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

Where and when access to safe abortion has been barred, due to explicit sanctions or general unavailability, women seeking to terminate their pregnancies have sometimes resorted to unsafe methods.

"Back-alley abortion" is a slang term for any abortion not practiced under generally accepted standards of sanitation and professionalism. The World Health Organization defines an unsafe abortion as being, "a procedure...carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both."^[11] This can include a person without medical training, a professional health provider operating in sub-standard conditions, or the woman herself.

Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the woman's death.^[11] Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal mortalities, with regional estimates including 12% in Asia, 25% in Latin America, and 13% in sub-Saharan Africa.^[88] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.^[89]

Abortion debate

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

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

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

Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a minor, her parents; a legally-married or common-law wife, her husband; or a pregnant woman, the biological father. In a 2003 Gallup poll in the United States, 79% of male and 67% of female respondents were in favor of spousal notification; overall support was 72% with 26% opposed.^[90]

Public opinion

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

A May 2005 survey examined attitudes toward abortion in 10 European countries, asking polltakers whether they agreed with the statement, "If a woman doesn't want children, she should be allowed to have an abortion". The highest level of approval was 81% in the Czech Republic and the highest level of disapproval was 48% in Poland.^[91]

In North America, a December 2001 poll surveyed Canadian opinion on abortion, asking Canadians in what circumstances they believe abortion should be permitted; 32% responded that they believe abortion should be legal in all circumstances, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. A similar poll in January 2006 surveyed people in the United States about U.S. opinion on abortion; 33% said that abortion should be "permitted only in cases such as rape, incest or to save the woman's life", 27% said that abortion should be "permitted in all cases", 15% that it should be "permitted, but subject to greater restrictions than it is now", 17% said that it should "only be permitted to save the woman's life", and 5% said that it should "never" be permitted.^[92] A November 2005 poll in Mexico found that 73.4% think abortion should not be legalized while 11.2% think it should.^[93]

Of attitudes in South and Central America, a December 2003 survey found that 30% of Argentines thought that abortion in Argentina should be allowed "regardless of situation", 47% that it should be allowed "under some circumstances", and 23% that it should not be allowed "regardless of situation".^[94] A March 2007 poll regarding the abortion law in Brazil found that 65% of Brazilians believe that it "should not be modified", 16% that it should be expanded "to allow abortion in other cases", 10% that abortion should be "decriminalized", and 5% were "not sure".^[95] A July 2005 poll in Colombia found that 65.6% said they thought that abortion should remain illegal, 26.9% that it should be made legal, and 7.5% that they were unsure.^[96]

Abortion law

International status of abortion law (detail).

Before the scientific discovery that human development begins at fertilization, English common law allowed abortions to be performed before "quickening", the earliest perception of fetal movement by a woman during pregnancy, until both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803.^[97] In 1861, the British Parliament passed the Offences Against the Person Act, which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.^[98] The Soviet Union, with legislation in 1920, and Iceland, with legislation in 1935, were two of the first countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom. In the 1973 case, Roe v. Wade, the United States Supreme Court struck down state laws banning abortion, ruling that such laws violated an implied right to privacy in the United States Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under the Canadian Charter of Rights and Freedoms. Canada later struck down provincial regulations of abortion in the case of R. v. Morgentaler (1993). By contrast, abortion in Ireland was affected by the addition of an amendment to the Irish Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn".

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

• In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.
• In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessary before it can be performed.

Other countries, in which abortion is normally illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A few nations ban abortion entirely: Chile, El Salvador, Malta, and Nicaragua, although in 2006 the Chilean government began the free distribution of emergency contraception.^[99][100] 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.^[101]

See also

Abortion by country Abortion fund Abortion-related violence Contraception Fetal rights Ethical aspects of abortion Fertilisation Gynaecology Late-term abortion Legal protection of access to abortion

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

References

1. ^ -Merriam Webster’s Online Medical Dictionary. Retrieved 2006-06-26. See also The Free Dictionary which includes definitions from Dorland's Medical Dictionary and from The American Heritage Stedman's Medical Dictionary. Retrieved 2006-06-26.
2. ^ ^{a b c d} Roche, Natalie E. (2004). Therapeutic Abortion. Retrieved 2006-03-08.
3. ^ Henshaw, Stanley K., Singh, Susheela, & Haas, Taylor. (1999). The Incidence of Abortion Worldwide. International Family Planning Perspectives, 25 (Supplement), 30 – 8. Retrieved 2006-01-18.
4. ^ Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., & Hamdan, S. (November 24, 2006). Abortion Surveillance - United States, 2003. Morbidity and Mortality Weekly Report, 55 (11), 1-32. Retrieved May 10, 2007.
5. ^ Finer, Lawrence B. & Henshaw, Stanley K. (2003). Abortion Incidence and Services in the United States in 2000. Perspectives on Sexual and Reproductive Health, 35 (1). Retrieved 2006-05-10.
6. ^ Department of Health (2007). Abortion statistics, England and Wales: 2006. Retrieved on 2007-10-12.
7. ^ ^{a b} Bankole, Akinrinola, Singh, Susheela, & Haas, Taylor. (1998). Reasons Why Women Have Induced Abortions: Evidence from 27 Countries. International Family Planning Perspectives, 24 (3), 117-127 & 152. Retrieved 2006-01-18.
8. ^ ^{a b} Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Shusheela, & Moore, Ann M. (2005). Reasons U.S. women have abortions: quantative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37 (3), 110-8. Retrieved 2006-01-18.
9. ^ Jones, Rachel K., Darroch, Jacqueline E., Henshaw, Stanley K. (2002). Contraceptive Use Among U.S. Women Having Abortions in 2000-2001. Perspectives on Sexual and Reproductive Health, 34 (6). Retrieved June 15, 2006.
10. ^ Wellings, K., et al. (1994). Sexual Behaviour in Britain: The National Survey of Sexual Attitudes and Lifestyles. London, UK: Penguin Books.
11. ^ ^{a b c} World Health Organization. (2004). Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000. Retrieved 2006-01-12.
12. ^ "Reproductive Endocrinology and Infertility: Recurrent Pregnancy Loss (Recurrent Miscarriage)." (n.d.) Retrieved 2006-01-18 from Washington University School of Medicine, Department of Obstetrics and Gynecology web site.
13. ^ -Q&A: Miscarriage. (August 6 , 2002). BBC News. Retrieved January 10, 2007.
    - Lennart Nilsson. (1990) A Child is Born.
14. ^ Healthwise. Manual and vacuum aspiration for abortion. (2004). WebMD. Retrieved 2006-08-19.
15. ^ World Health Organization. (2003). Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Retrieved 2006-08-19.
16. ^ Abortion. (2007). MSN Encarta. Retrieved July 1, 2007.
17. ^ -Vause S, Sands J, Johnston TA, Russell S, Rimmer S. (2002). PMID 12521492 Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? J Obstet Gynaecol. 2002 May;22(3):243-5. Retrieved 2006-03-17.
    -Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y. (2003). PMID 12576743 Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals. Fetal Diagn Ther. 2003 Mar-Apr;18(2):91-7. Retrieved 2006-03-17.
    -Bhide A, Sairam S, Hollis B, Thilaganathan B. (2002). PMID 12230443 Comparison of feticide carried out by cordocentesis versus cardiac puncture. Ultrasound Obstet Gynecol. 2002 Sep;20(3):230-2. Retrieved 2006-03-17.
    -Senat MV, Fischer C, Bernard JP, Ville Y. (2003). PMID 12628271 The use of lidocaine for fetocide in late termination of pregnancy. BJOG. 2003 Mar;110(3):296-300. Retrieved 2006-03-17.
    - MV, Fischer C, Ville Y. (2002). PMID 12001185 Funipuncture for fetocide in late termination of pregnancy. Prenat Diagn. 2002 May;22(5):354-6. Retrieved 2006-03-17.
18. ^ Spitz, I.M. et al (1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". New England Journal of Medicine 338 (18). PMID 9562577. 
19. ^ Riddle, John M. (1997). Eve's Herbs: A History of Contraception and Abortion in the West. Cambridge, MA: Harvard University Press.
20. ^ Ciganda, C., & Laborde, A. (2003). Herbal infusions used for induced abortion. J Toxicol Clin Toxicol, 41(3), 235-9. Retrieved 2006-01-25.
21. ^ Education for Choice. (2005-05-06). Unsafe abortion. Retrieved 2006-01-11.
22. ^ Potts, Malcolm, & Campbell, Martha. (2002). History of contraception. Gynecology and Obstetrics, vol. 6, chp. 8. Retrieved 2005-01-25.
23. ^ Thapa, S.R., Rimal, D., & Preston, J. (2006). Self induction of abortion with instrumentation. Aust Fam Physician 35(9), pp 697-698.
24. ^ Henshaw, Stanley K. "Induced Abortion: A World Review, 1990" International Family Planning Perspectives 23:246-252, 1991.
25. ^ Grimes, D.A. (1994). The morbidity and mortality of pregnancy: still risky business. American Journal of Obstetrics and Gynecology, 170 (5 Pt 2), 1489-94. Retrieved December 21, 2006.
26. ^ Legarth, J., Peen, U.B., & Michelsen, J.W. (1991). Mifepristone or vacuum aspiration in termination of early pregnancy. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 41 (2), 91-6. Retrieved December 21, 2006.
27. ^ Mittal, S., & Misra, S.L. (1985). Uterine perforation following medical termination of pregnancy by vacuum aspiration. International Journal of Gynaecology and Obstetrics, 23 (1), 45-50. Retrieved December 21, 2006.
28. ^ WHO Health Organization. Medical Methods for termination of pregnancy. WHO Technical Report Series 871, 1997
29. ^ Abortion, Complications. eMedicine. Retrieved on 2007-06-30.
30. ^ Dzhavakhadze, M.V., & Daraselia, M.I. (2005). Mortality case analyses of obstetric-gynecologic sepsis. Georgian Medical News, 127, 26-9. Retrieved December 21, 2006.
31. ^ Tzonou, A., Hsieh, C.C., Trichopoulos, D., Aravandinos, D., Kalandidi, A., Margaris, D., Goldman, M., et al. (1993) Induced abortions, miscarriages, and tobacco smoking as risk factors for secondary infertility. Journal of Epidemiology and Community Health, 47 (1), 36-9. Retrieved December 21, 2006.
32. ^ Lanska, M.J., Lanska, D., & Rimm, A.A. (1983). Mortality from abortion and childbirth. Journal of the American Medical Association, 250(3), 361-2. Retrieved December 21, 2006.
33. ^ ^{a b c} Pauli, E., Haller, U., Zimmermann, R. (2005). Morbidity of dilatation and evacuation in the second trimester: an analysis. Gynakol Geburtshilfliche Rundsch, 45 (2), 107-15. Retrieved December 26, 2006.
34. ^ ^{a b c} Bartley, J., Tong, S., Everington, D.,& Baird, D.T. (2000). Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases.... Contraception, 62(6), 297-303. Retrieved December 26, 2006.
35. ^ Department of Health. (1998). Why Mothers Die: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994 – 1996. London: The Stationery Office. Retrieved 2006-01-11.
36. ^ Elam-Evans, Laurie. D., Strauss, Lilo T., Herndon, Joy, Parker, Wilda Y., Bowens, Sonya V., Zane, Suzanne, et al. Centers for Disease Control and Prevention. (2003-11-23). Abortion Surveillance - United States, 2000. Morbidity and Mortality Weekly Report. Retrieved 2006-01-11.
37. ^ Centers for Disease Control and Prevention. (2003-02-20). Fact Sheet: Pregnancy-Related Mortality Surveillance - United States, 1991-1999. Retrieved 2006-04-02.
38. ^ Rogers, Lois. (2005-11-27). "Fifty babies a year are alive after abortion." The Sunday Times. Retrieved 2006-01-11.
39. ^ Russo J, Russo I (1980). "Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence". Am J Pathol 100 (2): 497-512. PMID 6773421. 
40. ^ Russo J, Tay L, Russo I (1982). "Differentiation of the mammary gland and susceptibility to carcinogenesis". Breast Cancer Res Treat 2 (1): 5-73. PMID 6216933. 
41. ^ Russo J, Russo I (1987). "Biological and molecular bases of mammary carcinogenesis". Lab Invest 57 (2): 112-37. PMID 3302534. 
42. ^ PlannedParenthood.org – Anti-Choice Claims About Abortion and Breast Cancer
43. ^ Melbye M, Wohlfahrt J, Olsen J, Frisch M, Westergaard T, Helweg-Larsen K, Andersen P (1997). "Induced abortion and the risk of breast cancer". N Engl J Med 336 (2): 81-5. PMID 8988884. 
44. ^ National Cancer Institute. (2003-03-04). Summary Report: Early Reproductive Events and Breast Cancer Workshop. Retrieved 2006-01-11.
45. ^ Beral V, Bull D, Doll R, Peto R, Reeves G (2004). "Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries". Lancet 363 (9414): 1007-16. PMID 15051280. 
46. ^ bcpinstitute.org – FACT SHEET: Abortion and Breast Cancer: re: "collaborative reanalysis of data" published in Lancet 3/25/04 (1)
47. ^ Etters.net – American abortion-breast cancer studies
48. ^ American Cancer Society. (2006-10-03) Cancer.org – What Are the Risk Factors for Breast Cancer? Retrieved 2006-03-30.
49. ^ Karin B. Michels, ScD, PhD; Fei Xue, MD; Graham A. Colditz, MD, DrPH; Walter C. Willett, MD, DrPH. "Induced and Spontaneous Abortion and Incidence of Breast Cancer Among Young Women." Arch Intern Med. 2007;167:814-820. Abstract.
50. ^ Arthur, Joyce. (2002) ProChoiceActionNetwork-Canada.org – Abortion and Breast Cancer — A Forged Link
51. ^ "Research and Destroy" by Chris Mooney. Retrieved on 2007-10-01.
52. ^ Jasen P (2005). "Breast cancer and the politics of abortion in the United States". Med Hist 49 (4): 423-44. PMID 16562329. 
53. ^ Howe H, Senie R, Bzduch H, Herzfeld P (1989). "Early abortion and breast cancer risk among women under age 40.". Int J Epidemiol 18 (2): 300-4. PMID 2767842. 
54. ^ Schmidt, Dr. Richard T. F., et al. (1984-02-13). Open Letter to President Reagan. Press release. Retrieved on 2006-11-18.
55. ^ ^{a b} Robinson, B.A. (2006). Can a fetus feel pain?. Ontario Consultants for Religious Tolerance. Retrieved December 14, 2005.
56. ^ BBC News Article (2005). "Foetuses 'no pain up to 29 weeks'." Retrieved 2006-07-18.
57. ^ Myers, Laura B. (2003). Fetal Surgery: The Anathesia Perspective. Retrieved March 14, 2007.
58. ^ ^{a b} Parliamentary Office of Science and Technology. (1997). Fetal Awareness. Retrieved 2006-01-11.
59. ^ BBC News Article (2006). "Foetuses 'cannot experience pain'." Retrieved 2006-07-18.
60. ^ Anand, K., Phil, D., & Hickey, P.R. (1987). Pain and its effects on the human neonate and fetus. New England Journal of Medicine, 316 (21), 1321-9. Retrieved 2006-01-11 from The Circumcision Reference Library.
61. ^ Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. Journal of the American Medical Association, 294 (8), 947-954. Retrieved November 10, 2006.
62. ^ ^{a b} Gomez, Lavin C., & Zapata, Garcia R. (2005). - "Diagnostic categorization of post-abortion syndrome". Actas Esp Psiquiatr, 33 (4), 267-72. Retrieved Setepmber 8, 2006.
63. ^ Stotland, N.L. (1992). The myth of the abortion trauma syndrome. Journal of the American Medical Association, 268 (15), 2078-9. Retrieved December 7, 2006.
64. ^ Zabin, L.S., Hirsch, M.B., Emerson, M.R. (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives, 21 (6), 248-55. Retrieved September 8, 2006.
65. ^ Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280. Retrieved September 8, 2006.
66. ^ Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version . British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.
67. ^ Gissler, M., Hemminki, E., & Lonnqvist, J. (1996). Suicides after pregnancy in Finland, 1987-94: register linkage study Electronic version. British Medical Journal, 313, 1431-4. Retrieved 2006-01-11.
68. ^ Reardon, D.C. & Cougle, J.R. (2002): Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study. BMJ (British Medical Journal) 19.1.2002 324:151-2. Electronic version. Retrieved 2007-03-14.
69. ^ Fergusson D.M., Horwood L.J., & Ridder E.M. (2006). "Abortion in young women and subsequent mental health". Journal of Child Psychology & Psychiatry 47 (1). PMID 16405636. 
70. ^ Depression Risk Increased After Miscarriage. (2002-04-01). Retrieved 2006-01-11.
71. ^ Devereux, G. (1967). A typological study of abortion in 350 primitive, ancient, and pre-industrial societies. Retrieved April 22, 2006. In Abortion in America: medical, psychiatric, legal, anthropological, and religious considerations. Boston: Beacon Press. Retrieved April 22, 2006.
72. ^ Lefkowitz, Mary R. & Fant, Maureen R. (1992). Women's life in Greece & Rome: a source book in translation. Baltimore, MD: Johns Hopkins University Press. Retrieved 2006-01-11.
73. ^ Histories of Abortion. (n.d.) Retrieved 2006-01-11.
74. ^ Donohue, John J. and Levitt, Steven D. (2001). The impact of legalized abortion on crime.Quarterly Journal of Economics Retrieved 2006-02-11.
75. ^ Foote, Christopher L. and Goetz, Christopher F. (2005). Testing economic hypotheses with state-level data: a comment on Donohue and Levitt (2001). Working Papers, 05-15. Retrieved 2006-02-11.
76. ^ Donohue, John J. and Levitt, Steven D. (2006). Measurement error, legalized abortion, and the decline in crime: a response to Foote and Goetz (2005). Retrieved 2006-02-17, from University of Chicago, Initiative on Chicago Price Theory web site: ResponseToFooteGoetz2006.pdf.
77. ^ "Crime-Abortion Study Continues to Draw Pro-life Backlash." (1999-08-11). The Pro-Life Infonet. Retrieved 2006-02-17 from Ohio Roundtable Online Library.
78. ^ "Abortion and the Lower Crime Rate." (2000, January). St. Anthony Messenger. Retrieved 2006-02-17.
79. ^ Banister, Judith. (1999-03-16). Son Preference in Asia - Report of a Symposium. Retrieved 2006-01-12.
80. ^ Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, & Roy, T.K. (1997). Son Preferences and Its Effect on Fertility in India. National Family Health Survey Subject Reports, Number 3. Retrieved 2006-01-12.
81. ^ Patel, Rita. (1996). The practice of sex selective abortion in India: may you be the mother of a hundred sons. Retrieved 2006-01-11, from University of North Carolina, University Center for International Studies web site: abortion.pdf.
82. ^ Sudha, S., & Irudaya Rajan, S. (1999). Female Demographic Disadvantage in India 1981-1991: Sex Selective Abortion, Female Infanticide and Excess Female Child Mortality. Retrieved 2006-01-12
83. ^ Reaney, Patricia. (2006-01-09). "Selective abortion blamed for India's missing girls." Reuters AlertNet. Retrieved 2006-01-09.
84. ^ Mudur, Ganapati. (2002). "India plans new legislation to prevent sex selection." British Medical Journal: News Roundup. Retrieved 2006-01-12.
85. ^ Graham, Maureen J., Larsen, Ulla, & Xu, Xiping. (1998). Son Preference in Anhui Province, China. International Family Planning Perspectives, 24 (2). Retrieved 2006-01-12.
86. ^ Plafker, Ted. (2002-05-25). Sex selection in China sees 117 boys born for every 100 girls. British Medical Journal: News Roundup. Retrieved 2006-01-12.
87. ^ "China Bans Sex-selection Abortion." (2002-03-22). Xinhua News Agency. Retrieved 2006-01-12.
88. ^ Salter, C., Johnson, H.B., and Hengen, N. (1997). Care for postabortion complications: saving women's lives. Population Reports, 25 (1). Retrieved 2006-02-22.
89. ^ World Health Organization. (1998). Address Unsafe Abortion. Retrieved 2006-03-01.
90. ^ The Pew Research Center for the People and the Press. (2005-11-02). "Public Opinion Supports Alito on Spousal Notification Even as It Favors Roe v. Wade." Pew Research Center Pollwatch. Retrieved 2006-03-01.
91. ^ TNS Sofres. (May 2005). European Values. Retrieved January 11, 2007.
92. ^ The Polling Report. (2006). Retrieved 2006-01-11.
93. ^ "Mexicans Support Status Quo on Social Issues." (December 1, 2005). Angus Reid Global Monitor. Retrieved January 10, 2006.
94. ^ "Argentines Assess Abortion Changes." (Mar. 4, 2004). Angus Reid Global Monitor. Retrieved January 10, 2006.
95. ^ "Brazilians Want to Keep Abortion as Crime." (April 12, 2007). Angus Reid Global Monitor. Retrieved June 20, 2007.
96. ^ "Colombians Reject Legalizing Abortion. (August 2, 2005). Angus Reid Global Monitor. Retrieved January 10, 2006.
97. ^ Lord Ellenborough’s Act." (1998). The Abortion Law Homepage. Retrieved February 20, 2007.
98. ^ United Nations Population Division. (2002). Abortion Policies: A Global Review. Retrieved February 22, 2007.
99. ^ Ross, Jen. (September 12, 2006). "In Chile, free morning-after pills to teens." The Christian Science Monitor. Retrieved 2006-12-07.
100. ^ Gallardoi, Eduardo. (September 26, 2006). "Morning-After Pill Causes Furor in Chile." The Washington Post. Retrieved 2006-12-07.
101. ^ Surgical Abortion: History and Overview. National Abortion Federation. Retrieved on 2006-09-04.

External links

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

The following information resources may be created by those with a non-neutral position in the abortion debate:

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

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

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

Birth control
Behavioral:	Avoiding vaginal intercourse: Anal sex, Oral sex, Non-penetrative sex, Masturbation, Abstinence Including vaginal intercourse: Fertility awareness, Rhythm Method, Withdrawal, Breastfeeding infertility
Barrier:	Condom, Female condom, Diaphragm, Lea's shield, Cervical cap
Spermicide	Contraceptive sponge
Hormonal:	Combined: Combined oral contraceptive pill ('the Pill'), Contraceptive patch, NuvaRing Progestogen only: Progestogen only pill ('minipill'), Depo-Provera, Norplant/Jadelle, Implanon
Anti-estrogen:	Ormeloxifene (a.k.a. Centchroman)
Intra-uterine:	IUD (copper or progestogen), IUS (progestogen)
Post-intercourse:	Contraception: Emergency contraception (pills or copper IUD) Abortion: Surgical abortion, Medical abortion (RU-486/abortion pill)
Sterilization:	Male: Vasectomy Female: Tubal ligation, Essure

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)