Abortion
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{{Abortion}}
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An '''abortion''' is the removal or expulsion of an [[embryo]] or [[fetus]] from the [[uterus]], resulting in or caused by its death. The spontaneous expulsion of a fetus or embryo before the 20th week of [[gestational age]]<ref>The 20th week of gestational age is equivalent to the 18th week after [[fertilization]] (also known as "conception"). The embryonic stage lasts approximately until the end of the 8th week after fertilization, at which point the fetal stage begins.</ref> is commonly known as a [[miscarriage]].<ref>-{{MedlinePlus|001488|Miscarriage}}. Retrieved [[2008-01-30]]. "A miscarriage is the spontaneous loss of a fetus before the [[gestational age|20th week of pregnancy]]. (Pregnancy losses after the 20th week are called preterm deliveries.) A miscarriage may also be called a "spontaneous abortion." This refers to naturally occurring events, not elective or therapeutic abortion procedures, which a woman may choose to have done.</ref> Induced abortion is the removal or expulsion of an embryo or fetus by [[medicine|medical]], [[surgery|surgical]], or other means at any point during human [[pregnancy]] for therapeutic or elective reasons.<ref>-''[http://www.merriam-webster.com/medical/abortion Merriam Webster’s Online Medical Dictionary]''. Retrieved [[2006-06-26]]. See also ''[http://medical-dictionary.thefreedictionary.com/abortion The Free Dictionary]'' which includes definitions from ''Dorland's Medical Dictionary'' and from ''The American Heritage Stedman's Medical Dictionary''. Retrieved [[2006-06-26]].</ref> The approximate number of induced abortions performed worldwide in 2003 was 42 million.<ref name="Worldwide">{{cite web |url=http://www.guttmacher.org/pubs/fb_IAW.html |title=Facts on Induced Abortion Worldwide |accessdate=2008-01-29 |format= |work=guttmacher.org}}</ref>
Throughout [[History of abortion|recorded history]], abortion has been induced by various [[traditional medicine]] methods, including botanical [[abortifacient]]s, the use of sharpened tools, and abdominal pressure.
The [[Ethical aspects of abortion|moral]] and [[Abortion law|legal]] aspects of abortion are subject to intense [[Abortion debate|social debate]] in many parts of the world. Aspects of this debate can include the public health impact of unsafe or illegal abortion as well as legal abortion's effect upon crime rates, and the ramifications of [[Abortion#Antenatal gender determination|sex-selective]] practices. Other debates include the [[abortion-breast cancer hypothesis]], [[post-abortion syndrome]], and [[fetal pain]]. Moral arguments often equate abortion to murder, or denial of abortion to oppression of women.
The history of modern Western abortion laws can be traced back to [[English common law]], which allowed abortion before the "[[quickening]]" of the fetus. Currently, abortion laws vary from country to country, with regard to religious, moral, and cultural sensibilities.<!--Note to editors: This article has a long and intense history of terminology debates. Please review the talk page before making changes to lines to see if there is a previous established consensus or compromise. Thank you.-->
==Forms of abortion==
In medical terminology, the term ''abortion'' refers to two basic phenomena: [[miscarriage]] (spontaneous abortion) and induced abortion. 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).
===Spontaneous abortion===
{{main|Miscarriage}}
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Spontaneous abortion is the expulsion of an [[embryo]] or [[fetus]] due to accidental trauma or [[Death by natural causes|natural causes]]. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. Spontaneous abortions, generally referred to as miscarriages, occur when an [[embryo]] or [[fetus]] is lost due to natural causes before the 20th [[gestational age|week of gestation]]. A pregnancy that ends between 20 and 37 weeks of gestation, if it results in a [[Live birth|live-born]] [[infant]], is known as a "[[premature birth]]". When a fetus dies [[in utero]] after about 20 weeks, or during [[childbirth|delivery]], it is termed a "[[stillbirth]]". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.
Most miscarriages occur very early in pregnancy. Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.<ref>"[http://wuphysicians.wustl.edu/dept.asp?pageID=8&ID=35 Reproductive Endocrinology and Infertility: Recurrent Pregnancy Loss (Recurrent Miscarriage)]." (n.d.) Retrieved [[2006-01-18]] from Washington University School of Medicine, Department of Obstetrics and Gynecology web site.</ref> In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy showed a rate of pregnancy in exposed ovulatory cycles of 59.6%; with 61.9% of conceptuses lost prior to 12 weeks of which 91.7% occuried subclinically, without the knowledge of the mother.<ref name="pmid7117572">{{cite journal |author=Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ |title=Early embryonic mortality in women |journal=Fertil. Steril. |volume=38 |issue=4 |pages=447–53 |year=1982 |pmid=7117572 |doi=}}</ref>
The risk of spontaneous abortion decreases sharply after the 10th week [[gestational age|LMP]],<ref> -[http://news.bbc.co.uk/2/hi/health/2176898.stm Q&A: Miscarriage]. (August 6 , 2002). ''BBC News.'' Retrieved January 10, 2007. <br />- [[Lennart Nilsson]]. (1990) ''A Child is Born.'' </ref> with a loss rate between 8.5 weeks LMP and birth of about two percent; pregnancy loss is “virtually complete by the end of the embryonic period."<ref>Rodeck, Charles; Whittle, Martin. ''[http://books.google.com/books?id=0BY0hx2l5uoC&pg=PA835&lpg=PA835&dq=%22early+pregnancy+loss%22+and+weeks&source=web&ots=RZSIYEWK6N&sig=3v2skknEA6qVVaoMnx03AAN_JpU&hl=en#PPA836,M1 Fetal Medicine: Basic Science and Clinical Practice]'' (Elsevier Health Sciences 1999), page 835.</ref>
This risk of spontaneous abortion is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental [[Physical trauma|trauma]]; intentional trauma to cause miscarriage is considered induced abortion or [[feticide]].<ref name="Fetal Homicide Laws">{{cite web |url=http://www.ncsl.org/programs/health/fethom.htm |title=Fetal Homicide Laws |accessdate=2008-03-20 |format= |work=ncsl.org}}</ref>
===Induced abortion===
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the [[gestational age]] of the [[embryo]] or [[fetus]], in addition to the legality, regional availability, and doctor-patient preference for specific procedures. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is considered to be therapeutic when it is performed to:
* to save the life of the pregnant woman;<ref name="roche1">Roche, Natalie E. (2004). [http://www.emedicine.com/med/topic3311.htm Therapeutic Abortion]. Retrieved [[2006-03-08]].</ref>
* to preserve the woman's physical or mental health;<ref name="roche1" />
* to terminate pregnancy that would result in a child born with a [[congenital disorder]] that would be [[death|fatal]] or associated with significant [[morbidity]];<ref name="roche1" /> or
* to [[selective reduction|selectively reduce]] the number of fetuses to lessen health risks associated with [[multiple birth|multiple pregnancy]].<ref name="roche1" />
An abortion is considered to be elective if it is performed for any other reason.
==== Methods ====
=====Surgical=====
[[Image:Abortionmethods.png|thumb|380px|right|[[Gestational age]] may determine which abortion methods are practiced.]]
In the first 12 weeks, [[suction-aspiration abortion|suction-aspiration]] or vacuum abortion is the most common method.<ref>Healthwise. [http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 Manual and vacuum aspiration for abortion]. (2004). ''WebMD.'' Retrieved [[2006-08-19]].</ref> ''Manual [[Vacuum aspiration]]'' (MVA) abortion, consists of removing the [[fetus]] or [[embryo]] by suction using a manual [[syringe]], while ''electric [[vacuum aspiration]]'' (EVA) abortion uses an electric [[pump]]. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "[[menstrual extraction]]", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, [[dilation and evacuation]] (D&E) is used. D&E consists of opening the [[cervix]] of the [[uterus]] and emptying it using surgical instruments and suction.
''[[Dilation and curettage]]'' (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. ''[[Curettage]]'' refers to cleaning the walls of the [[uterus]] with a [[curette]]. The [[World Health Organization]] recommends this procedure, also called ''sharp curettage,'' only when MVA is unavailable.<ref>World Health Organization. (2003). [http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html Managing complications in pregnancy and childbirth: a guide for midwives and doctors]. Retrieved [[2006-08-19]].</ref> The term ''D and C'', or sometimes ''suction curette'', is used as a [[euphemism]] for the first trimester abortion procedure, whichever the method used.
Other techniques must be used to induce abortion in the second [[trimester]]. Premature delivery can be induced with [[prostaglandin]]; this can be coupled with injecting the [[amniotic sac|amniotic fluid]] with caustic solutions containing [[saline (medicine)|saline]] or [[urea]]. After the 16th week of gestation, abortions can be induced by [[intact dilation and extraction]] (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "[[partial-birth abortion]]," which has been [[Partial-Birth Abortion Ban Act|federally banned]] in the United States. A [[hysterotomy abortion]] is a procedure similar to a [[caesarean section]], and is performed under [[general anesthesia]] because it is considered major abdominal surgery. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.<ref name="encarta">[http://encarta.msn.com/encyclopedia_761553899/Abortion.html#s3 Abortion]. (2007). ''MSN Encarta.'' Retrieved July 1, 2007.</ref>
From the 20th to 23rd week of gestation, an [[medical injection|injection]] to stop the fetal [[heart]] can be used as the first phase of the surgical abortion procedure<ref>-Vause S, Sands J, Johnston TA, Russell S, Rimmer S. (2002). PMID 12521492 Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? J Obstet Gynaecol. 2002 May;22(3):243-5. Retrieved [[2006-03-17]].<br /> -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]].<br /> -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]].<br /> -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]].<br />- MV, Fischer C, Ville Y. (2002). PMID 12001185 Funipuncture for fetocide in late termination of pregnancy. Prenat Diagn. 2002 May;22(5):354-6. Retrieved [[2006-03-17]].</ref> to ensure that the fetus is not born alive.<ref>[http://www.nuffieldbioethics.org/go/browseablepublications/criticalCareDecisionFetalNeonatalMedicine/report_542.html Critical care decisions in fetal and neonatal medicine: ethical issues] Nuffield Council on Bioethics, 2004</ref>
=====Medical=====
{{main|Medical abortion}}
Effective in the first trimester of pregnancy, non-surgical abortions (referred to as 'medical abortions') comprise 10% of all abortions in the [[United States]] and Europe. Combined regimens include [[methotrexate]] or [[mifepristone]], followed by a [[prostaglandin]] (either [[misoprostol]] or [[gemeprost]]: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention.<ref>{{cite journal|author=Spitz, I.M. et al|title=Early pregnancy termination with mifepristone and misoprostol in the United States|journal=New England Journal of Medicine|year=1998|volume=338|issue=18|pmid=9562577|doi=10.1056/NEJM199804303381801|pages=1241}}</ref> Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.
=====Other means=====
[[Image:Angkordemon.jpg|thumb|left|240px|[[Bas-relief]] at [[Angkor Wat]], dated circa 1150, depicting a [[demon]] performing an abortion by pounding a mallet into a woman's belly.]] Historically, a number of [[herb]]s reputed to possess [[abortifacient]] properties have been used in [[folk medicine]]: [[tansy]], [[pennyroyal]], [[black cohosh]], and the now-extinct [[silphium]] (see [[Abortion#History of abortion|history of abortion]]).<ref name="riddle2">Riddle, John M. (1997). ''Eve's Herbs: A History of Contraception and Abortion in the West.'' Cambridge, MA: Harvard University Press.</ref> The use of herbs in such a manner can cause serious — even lethal — side effects, such as [[multiple organ dysfunction syndrome|multiple organ failure]], and is not recommended by [[physician]]s.<ref>Ciganda, C., & Laborde, A. (2003). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12807304&query_hl=9 Herbal infusions used for induced abortion]. ''J Toxicol Clin Toxicol, 41(3),'' 235-9. Retrieved [[2006-01-25]].</ref>
Abortion is sometimes attempted by causing trauma to the [[abdomen]]. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing [[miscarriage]].<ref>Education for Choice. ([[2005-05-06]]). [http://www.efc.org.uk/Foryoungpeople/Factsaboutabortion/Unsafeabortion Unsafe abortion]. Retrieved [[2006-01-11]].</ref> Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In [[Myanmar|Burma]], [[Indonesia]], [[Malaysia]], the [[Philippines]], and [[Thailand]], there is an ancient tradition of attempting abortion through forceful abdominal [[massage]].<ref name="potts">Potts, Malcolm, & Campbell, Martha. (2002). [http://big.berkeley.edu/ifplp.history.pdf History of contraception]. ''Gynecology and Obstetrics'', vol. 6, chp. 8. Retrieved [[2005-01-25]].</ref>
Reported methods of unsafe, [[self-induced abortion]] include misuse of [[misoprostol]], and insertion of non-surgical implements such as [[knitting needle]]s and [[clothes hanger]]s into the [[uterus]]. These methods are rarely seen in developed countries where surgical abortion is legal and available.<ref>Thapa, S.R., Rimal, D., & Preston, J. (2006). Self induction of abortion with instrumentation. ''Aust Fam Physician'' 35(9), pp 697-698.</ref>
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==Incidence of induced abortion==
The incidence and reasons for induced abortion vary regionally. It has been estimated that approximately 46 million abortions are performed worldwide every year. Of these, 26 million are said to occur in [[abortion law|places where abortion is legal]]; the other 20 million happen where the procedure is illegal. Some countries, such as [[Belgium]] (11.2 per 100 known pregnancies) and the [[Netherlands]] (10.6 per 100), have a low rate of induced abortion, while others like [[Russia]] (62.6 per 100) and [[Vietnam]] (43.7 per 100) have a comparatively high rate. The world ratio is 26 induced abortions per 100 known pregnancies.<ref>Henshaw, Stanley K., Singh, Susheela, & Haas, Taylor. (1999). [http://www.guttmacher.org/pubs/journals/25s3099.html The Incidence of Abortion Worldwide]. ''International Family Planning Perspectives, 25 (Supplement)'', 30 – 8. Retrieved [[2006-01-18]].</ref>
===By gestational age and method===
[[Image:UK abortion by gestational age 2004 histogram.svg|thumb|[[Histogram]] of abortions by [[gestational age]] in [[England and Wales]] during 2004. Average is 9.5 weeks.]]
Abortion rates also vary depending on the stage of [[pregnancy]] and the method practiced. In 2003, from data collected in those areas of the [[United States]] that sufficiently reported [[gestational age]], it was found that 88.2% of abortions were conducted at or prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at or after 21 weeks. 90.9% of these were classified as having been done by "[[curettage]]" ([[Suction-aspiration abortion|suction-aspiration]], [[Dilation and curettage]], [[Dilation and evacuation]]), 7.7% by "[[medical abortion|medical]]" means ([[mifepristone]]), 0.4% by "[[instillation abortion|intrauterine instillation]]" ([[saline (medicine)|saline]] or [[prostaglandin]]), and 1.0% by "other" (including [[hysterotomy abortion|hysterotomy]] and [[hysterectomy]]).<ref name="cdc2003">Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., & Hamdan, S. (November 24, 2006). [http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm Abortion Surveillance - United States, 2003]. ''Morbidity and Mortality Weekly Report, 55 (11),'' 1-32. Retrieved May 10, 2007.</ref> The [[Guttmacher Institute]] estimated there were 2,200 [[intact dilation and extraction]] procedures in the U.S. during 2000; this accounts for 0.17% of the total number of abortions performed that year.<ref>Finer, Lawrence B. & Henshaw, Stanley K. (2003). [http://www.guttmacher.org/pubs/journals/3500603.html Abortion Incidence and Services in the United States in 2000]. ''Perspectives on Sexual and Reproductive Health, 35 (1).'' Retrieved [[2006-05-10]].</ref> Similarly, in [[England]] and [[Wales]] in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 to 19 weeks, and 1.5% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.<ref>{{cite web |author=Department of Health |year=2007 |title=Abortion statistics, England and Wales: 2006 |url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |accessdate=2007-10-12}}</ref>
===By personal and social factors===
[[Image:AGIAbortionReasonsBarChart.png|thumb|left|320px|A [[bar chart]] depicting selected data from the 1998 [[Alan Guttmacher Institute|AGI]] [[meta-study]] on the reasons women stated for having an abortion.]]
A 1998 aggregated study, from 27 countries, on the reasons women seek to terminate their pregnancies concluded that common factors cited to have influenced the abortion decision were: desire to delay or end [[childbirth|childbearing]], concern over the interruption of [[employment|work]] or [[education]], issues of financial or relationship stability, and perceived immaturity.<ref name="bankole98">Bankole, Akinrinola, Singh, Susheela, & Haas, Taylor. (1998). [http://www.guttmacher.org/pubs/journals/2411798.html Reasons Why Women Have Induced Abortions: Evidence from 27 Countries]. ''International Family Planning Perspectives, 24 (3)'', 117-127 & 152. Retrieved [[2006-01-18]].</ref> A 2004 study in which [[United States|American]] women at [[abortion clinic|clinics]] answered a [[questionnaire]] yielded similar results.<ref name="finer2005">Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Shusheela, & Moore, Ann M. (2005). [http://www.guttmacher.org/pubs/journals/3711005.pdf Reasons U.S. women have abortions: quantative and qualitative perspectives]. ''Perspectives on Sexual and Reproductive Health, 37 (3),'' 110-8. Retrieved [[2006-01-18]].</ref> In [[Finland]] and the [[United States]], concern for the health risks posed by pregnancy in individual cases was not a factor commonly given; however, in [[Bangladesh]], [[India]], and [[Kenya]] health concerns were cited by women more frequently as reasons for having an abortion.<ref name="bankole98" /> 1% of women in the 2004 survey-based U.S. study became pregnant as a result of [[rape]] and 0.5% as a result of [[incest]].<ref name="finer2005"/> Another American study in 2002 concluded that 54% of women who had an abortion were using a form of [[birth control|contraception]] at the time of becoming pregnant while 46% were not. Inconsistent use was reported by 49% of those using [[condom]]s and 76% of those using the [[combined oral contraceptive pill]]; 42% of those using condoms reported failure through slipping or breakage.<ref>Jones, Rachel K., Darroch, Jacqueline E., Henshaw, Stanley K. (2002). [http://www.guttmacher.org/pubs/journals/3429402.pdf Contraceptive Use Among U.S. Women Having Abortions in 2000-2001]. ''Perspectives on Sexual and Reproductive Health, 34 (6).'' Retrieved [[June 15]], [[2006]].</ref>
Some abortions are undergone as the result of societal pressures. These might include the stigmatization of [[disabled]] persons, preference for children of a specific [[sex]], disapproval of [[single parent|single motherhood]], insufficient economic support for [[family|families]], lack of access to or rejection of contraceptive methods, or efforts toward [[population control]] (such as [[People's Republic of China|China's]] [[one-child policy]]). These factors can sometimes result in compulsory abortion or [[sex-selective abortion]].
==Health considerations==
Early-term surgical abortion is a simple procedure which is safer than [[childbirth]] when performed before the 16th week.<ref>Henshaw, Stanley K. "Induced Abortion: A World Review, 1990" ''International Family Planning Perspectives'' 23:246-252, 1991.</ref><ref name="grimes">{{cite journal |author=Grimes DA |title=The morbidity and mortality of pregnancy: still risky business |journal=Am. J. Obstet. Gynecol. |volume=170 |issue=5 Pt 2 |pages=1489–94 |year=1994 |pmid=8178896 |doi= |url=}}</ref> Abortion methods, like most [[minimally invasive procedure]]s, carry a small potential for serious complications.<ref>WHO Health Organization. Medical Methods for termination of pregnancy. WHO Technical Report Series 871, 1997</ref><ref>{{cite web | publisher=eMedicine |title=Abortion, Complications | url=http://www.emedicine.com/emerg/topic4.htm | accessdate=2007-06-30}}</ref> The risk of complications can increase depending on how far [[pregnancy]] has progressed.<ref name="pauli">{{cite journal |author=Pauli E, Haller U, Zimmermann R |title=[Morbidity of dilatation and evacuation in the second trimester: an analysis] |language=German |journal=Gynakol Geburtshilfliche Rundsch |volume=45 |issue=2 |pages=107–15 |year=2005 |pmid=15818053 |doi=10.1159/000083785 |url=}}</ref><ref name="bartley">{{cite journal |author=Bartley J, Tong S, Everington D, Baird DT |title=Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases of early medical abortion treated with reduced doses of mifepristone and vaginal gemeprost |journal=Contraception |volume=62 |issue=6 |pages=297–303 |year=2000 |pmid=11239616 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0010-7824(00)00187-6}}</ref>
Women typically experience minor pain during first-trimester abortion procedures. In a 1979 study of 2,299 patients, 97% reported experiencing some degree of pain. Patients rated the pain as being less than earache or toothache, but more than headache or backache.<ref name="pmid443287">{{cite journal |author=Smith GM, Stubblefield PG, Chirchirillo L, McCarthy MJ |title=Pain of first-trimester abortion: its quantification and relations with other variables |journal=Am. J. Obstet. Gynecol. |volume=133 |issue=5 |pages=489–98 |year=1979 |pmid=443287 |doi= |url=}}</ref>
Some practitioners advocate using minimal [[anaesthesia]] so the patient can alert them to possible complications. Others recommend [[general anaesthesia]], to prevent patient movement, which might cause a perforation. General anaesthesia carries its own risks, including death, which is why public health officials recommend against its routine use.{{Fact|date=April 2008}}<!-- to verify official "public health officials" viewpoint -->
==History of abortion==
[[Image:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg|thumb|right|140px|"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the ''Boston Daily Times''.]]
{{main|History of abortion}}
Induced abortion can be traced to ancient times.<ref name="devereux">Devereux, G. (1967). [http://db.jhuccp.org/ics-wpd/exec/icswppro.dll?AC=GET_RECORD&XC=/ics-wpd/exec/icswppro.dll&BU=http%3A%2F%2Fdb.jhuccp.org%2Fics-wpd%2Fpopweb%2F&TN=popline&SN=AUTO32204&SE=1493&RN=24&MR=50&TR=0&TX=0&ES=0&CS=1&XP=&RF=ShortRecordDisplay&EF=&DF=LongRecordDisplay&RL=1&EL=0&DL=1&NP=0&ID=&MF=&MQ=&TI=0&DT=&ST=0&IR=77430&NR=0&NB=0&SV=0&BG=&FG=&QS=&OEX=ISO-8859-1&OEH=ISO-8859-1 A typological study of abortion in 350 primitive, ancient, and pre-industrial societies]. Retrieved [[April 22]], [[2006]]. In ''Abortion in America: medical, psychiatric, legal, anthropological, and religious considerations.'' Boston: Beacon Press. Retrieved [[April 22]], [[2006]].</ref> There is evidence to suggest that, historically, pregnancies were terminated through a number of methods, including the administration of [[abortifacient]] herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques.
The [[Hippocratic Oath]], the chief statement of [[medical ethics]] for Hippocratic physicians in [[Ancient Greece]], forbade doctors from helping to procure an abortion by [[pessary]]. [[Soranus (Greek Physician)|Soranus]], a second-century Greek [[physician]], suggested in his work ''[[Gynaecology]]'' that women wishing to abort their pregnancies should engage in energetic exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal baths, pessaries, and [[bloodletting]], but advised against the use of sharp instruments to induce miscarriage due to the risk of organ [[perforation]].<ref>Lefkowitz, Mary R. & Fant, Maureen R. (1992). ''[http://www.stoa.org/diotima/anthology/wlgr/ Women's life in Greece & Rome: a source book in translation].'' Baltimore, MD: Johns Hopkins University Press. Retrieved [[2006-01-11]].</ref> It is also believed that, in addition to using it as a [[contraceptive]], the Ancient Greeks relied upon [[silphium]] as an [[abortifacient]]. Such folk remedies, however, varied in effectiveness and were not without risk. [[Tansy]] and [[pennyroyal]], for example, are two [[poison]]ous [[herbs]] with serious [[Adverse effect (medicine)|side effects]] that have at times been used to terminate pregnancy.
Abortion in the 19th century continued, despite bans in both the [[United Kingdom]] and the [[United States]], as the disguised, but nonetheless open, advertisement of services in the [[Victorian era]] suggests.<ref>''[http://users.telerama.com/~jdehullu/abortion/abhist.htm Histories of Abortion].'' (n.d.) Retrieved [[2006-01-11]].</ref>
In the 20th century the [[Soviet Union]] (1919), [[Iceland]] (1935) and [[Sweden]] (1938) were among the first countries to legalize certain or all forms of abortion.<ref name="cbctrust">{{cite web |url=http://www.cbctrust.com/history_law_religion.php |title=Abortion Law, History & Religion |accessdate=2008-03-23 |format= |work=Childbirth By Choice Trust}}</ref> In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of "German stock" were specifically prohibited from having abortions.<ref>Friedlander, Henry. ''[http://books.google.com/books?id=gqLDEKVk2nMC&pg=PR22&dq=Friedlander+and+abortion+nazi&ei=WOT3R4zxPIOOywSH6JW0DQ&sig=nt0z_vPg8PMvE2yKUYaoWHYTx_o#PPA30,M1 The Origins of Nazi Genocide: From Euthanasia to the Final Solution]'' (Chapel Hill, N.C.: University of Northern Carolina Press, 1995), page 30. Via Google Books.</ref><ref>Proctor, Robert. ''[http://books.google.com/books?id=hogbxS2Gp1QC&dq=abortion+and+%22Gerhard+Wagner%22&lr=&num=100&source=gbs_summary_s&cad=0 Racial Hygiene: Medicine Under the Nazis]'' (Harvard University Press 1988), pages 122-123 and 366.</ref><ref>Arnot, Margaret; Usborne, Cornelie. ''[http://books.google.com/books?id=q1BFiRa3KHkC&pg=PA241&vq=racial+hygienic&dq=abortion+and+1939+and+%22Jewish+women%22&source=gbs_search_r&cad=1_1&sig=OF64BVhtNisYdEUajsHV8iAWLAk Gender and Crime in Modern Europe]'', page 231 (1999).</ref><ref>''[http://books.google.com/books?id=gQLqRd7hJq0C&pg=PA589&dq=%22Jewish+women%22+and+nazi+and+forced+and+abortion&ei=QGT2R_GnJY_6zQSXmNTFAw&sig=AC8-4nzcT43Cu3yucTFqcZhg-5U Woman’s Studies Encyclopedia]'' (Greenwood Publishing 1999), Edited by Helen Tierney, page 589.</ref>
==Social issues==
A number of complex issues exist in the debate over abortion. These, like the suggested effects upon health listed above, are a focus of research and a fixture of discussion among members on all sides of the controversy.
===Effect upon crime rate===
{{Main|Legalized abortion and crime effect}}
A theory attempts to draw a [[correlation]] between the United States' unprecedented nationwide decline of the overall [[crime rate]] during the 1990s and the decriminalization of abortion 20 years prior.
The suggestion was brought to widespread attention by a 1999 [[academic paper]], ''[[The Impact of Legalized Abortion on Crime]]'', authored by the [[economist]]s [[Steven Levitt|Steven D. Levitt]] and John Donohue. They attributed the drop in crime to a reduction in individuals said to have a higher statistical probability of committing crimes: unwanted children, especially those born to mothers who are [[African-American]], [[poverty|impoverished]], [[teenage pregnancy|adolescent]], [[education|uneducated]], and [[single parent|single]]. The change coincided with what would have been the adolescence, or peak years of potential criminality, of those who had not been born as a result of ''[[Roe v. Wade]]'' and similar cases. Donohue and Levitt's study also noted that states which legalized abortion before the rest of the nation experienced the lowering crime rate pattern earlier, and those with higher abortion rates had more pronounced reductions.<ref>Donohue, John J. and Levitt, Steven D. (2001). [http://ssrn.com/abstract=174508 The impact of legalized abortion on crime].''Quarterly Journal of Economics'' Retrieved [[2006-02-11]]. </ref>
Fellow economists Christopher Foote and Christopher Goetz criticized the [[methodology]] in the Donohue-Levitt study, noting a lack of accommodation for statewide yearly variations such as [[cocaine]] use, and recalculating based on incidence of crime [[per capita]]; they found no [[statistically significant]] results.<ref>Foote, Christopher L. and Goetz, Christopher F. (2005). [http://www.bos.frb.org/economic/wp/wp2005/wp0515.pdf Testing economic hypotheses with state-level data: a comment on Donohue and Levitt (2001)]. ''Working Papers, 05-15''. Retrieved [[2006-02-11]].</ref> Levitt and Donohue responded to this by presenting an adjusted [[data set]] which took into account these concerns and reported that the data maintained the statistical significance of their initial paper.<ref>Donohue, John J. and Levitt, Steven D. (2006). Measurement error, legalized abortion, and the decline in crime: a response to Foote and Goetz (2005). Retrieved [[2006-02-17]], from University of Chicago, Initiative on Chicago Price Theory web site: [http://pricetheory.uchicago.edu/levitt/Papers/ResponseToFooteGoetz2006.pdf ResponseToFooteGoetz2006.pdf].</ref>
Such research has been criticized by some as being [[utilitarian]], [[discrimination|discriminatory]] as to [[Race (classification of human beings)|race]] and [[social class|socioeconomic class]], and as promoting [[eugenic]]s as a solution to [[crime]].<ref>"Crime-Abortion Study Continues to Draw Pro-life Backlash." ([[1999-08-11]]). ''The Pro-Life Infonet.'' Retrieved [[2006-02-17]] from [http://ohioroundtable.org/library/articles/life/crimeabortion.html Ohio Roundtable Online Library].</ref><ref>"[http://www.americancatholic.org/Messenger/Jan2000/Editorial.asp Abortion and the Lower Crime Rate]." (2000, January). ''St. Anthony Messenger.'' Retrieved [[2006-02-17]].</ref> Levitt states in his book ''[[Freakonomics]]'' that they are neither promoting nor negating any course of action—merely reporting data as economists.
===Sex-selective abortion===
{{Main|Sex-selective abortion and infanticide}}
The advent of both [[Medical ultrasonography|sonography]] and [[amniocentesis]] has allowed parents to determine [[sex]] before [[childbirth|birth]]. This has led to the occurrence of [[sex-selective abortion and infanticide|sex-selective abortion]] or the targeted termination of a [[fetus]] based upon its sex.
It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the [[birth rate]]s of male and female children in some places. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in [[Mainland China]], [[Republic of China|Taiwan]], [[South Korea]], and [[India]].<ref>Banister, Judith. ([[1999-03-16]]). [http://www.census.gov/ipc/www/ebspr96a.html Son Preference in Asia - Report of a Symposium]. Retrieved [[2006-01-12]].</ref>
In [[India]], the [[economic]] role of men, the costs associated with [[dowry|dowries]], and a [[Hindu]] tradition which dictates that [[funeral|funeral rites]] must be performed by a male relative have led to a [[culture|cultural]] preference for [[son]]s.<ref>Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, & Roy, T.K. (1997). [http://www2.eastwestcenter.org/pop/misc/subj-3.pdf Son Preferences and Its Effect on Fertility in India]. ''National Family Health Survey Subject Reports, Number 3.'' Retrieved [[2006-01-12]].</ref> The widespread availability of diagnostic testing, during the 1970s and '80s, led to advertisements for services which read, "Invest 500 [[rupee]]s [for a sex test] now, save 50,000 rupees [for a dowry] later."<ref>Patel, Rita. (1996). The practice of sex selective abortion in India: may you be the mother of a hundred sons. Retrieved [[2006-01-11]], from University of North Carolina, University Center for International Studies web site: [http://www.ucis.unc.edu/resources/pubs/carolina/abortion.pdf abortion.pdf].</ref> In 1991, the male-to-female [[human sex ratio|sex ratio]] in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.<ref>Sudha, S., & Irudaya Rajan, S. (1999). [http://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html Female Demographic Disadvantage in India 1981-1991: Sex Selective Abortion, Female Infanticide and Excess Female Child Mortality]. Retrieved [[2006-01-12]] </ref> Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.<ref>Reaney, Patricia. ([[2006-01-09]]). "[http://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm Selective abortion blamed for India's missing girls]." ''Reuters AlertNet.'' Retrieved [[2006-01-09]].</ref> The Indian government passed an official ban of pre-natal sex screening in 1994 and moved to pass a complete ban of sex-selective abortion in 2002.<ref>Mudur, Ganapati. (2002). "[http://bmj.bmjjournals.com/cgi/content/abridged/324/7334/385/b India plans new legislation to prevent sex selection]." ''British Medical Journal: News Roundup.'' Retrieved [[2006-01-12]].</ref>
In the [[People's Republic of China]], there is also a historic son preference. The implementation of the [[one-child policy]] in 1979, in response to population concerns, led to an increased disparity in the sex ratio as parents attempted to circumvent the law through sex-selective abortion or the abandonment of unwanted daughters.<ref>Graham, Maureen J., Larsen, Ulla, & Xu, Xiping. (1998). [http://www.agi-usa.org/pubs/journals/2407298.html Son Preference in Anhui Province, China]. ''International Family Planning Perspectives, 24 (2).'' Retrieved [[2006-01-12]].</ref> Sex-selective abortion might be an influence on the shift from the baseline male-to-female birth rate to an elevated national rate of 117:100 reported in 2002. The trend was more pronounced in rural regions: as high as 130:100 in [[Guangdong]] and 135:100 in [[Hainan]].<ref>Plafker, Ted. ([[2002-05-25]]). [http://bmj.bmjjournals.com/cgi/content/full/324/7348/1233/a?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext Sex selection in China sees 117 boys born for every 100 girls]. ''British Medical Journal: News Roundup.'' Retrieved [[2006-01-12]].</ref> A ban upon the practice of sex-selective abortion was enacted in 2003.<ref>"[http://www.china.org.cn/english/2003/Mar/59194.htm China Bans Sex-selection Abortion]." ([[2002-03-22]]). ''Xinhua News Agency.'' Retrieved [[2006-01-12]].</ref>
===Unsafe abortion===
[[Image:RussianAbortionPoster.jpg|thumb|240px|left|[[Soviet Union|Soviet]] [[Propaganda|poster]] circa 1925, promoting hospital abortions. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death."]]
{{main|Unsafe abortion}}
Where and when access to safe abortion has been barred, due to explicit sanctions or general unavailability, women seeking to terminate their pregnancies have sometimes resorted to unsafe methods.
"Back-alley abortion" is a slang term for any abortion not practiced under generally accepted standards of sanitation and professionalism. The [[World Health Organization]] (WHO) defines an unsafe abortion as being, "a procedure...carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both."<ref name="whounsafe" /> This can include a person without medical training, a professional health provider operating in sub-standard conditions, or [[self-induced abortion|the woman herself]].
Unsafe abortion remains a [[public health]] concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, [[sepsis]], [[hemorrhage]], and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the woman's death.<ref name="whounsafe">World Health Organization. (2004). [http://www.who.int/reproductive-health/publications/unsafe_abortion_estimates_04/estimates.pdf Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000]. Retrieved [[2006-01-12]].</ref> Complications of unsafe abortion are said to account, globally, for approximately 13% of all [[maternal death|maternal mortalities]], with regional estimates including 12% in Asia, 25% in [[Latin America]], and 13% in [[sub-Saharan Africa]].<ref>Salter, C., Johnson, H.B., and Hengen, N. (1997). [http://www.infoforhealth.org/pr/l10edsum.shtml Care for postabortion complications: saving women's lives]. ''Population Reports, 25 (1).'' Retrieved [[2006-02-22]].</ref> A 2007 study published in the ''[[The Lancet]]'' found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003.<ref>Sedgh, G., Henshaw, S., Singh, S., Åhman, E., & Shah, I.H. (2007). [http://www.thelancet.com/journals/lancet/article/PIIS014067360761575X/fulltext Induced abortion: estimated rates and trends worldwide]. ''The Lancet, 370 (9595)'', 1338-1345. Retrieved October 31, 2007.</ref> [[Health education]], access to [[family planning]], and improvements in [[health care]] during and after abortion have been proposed to address this phenomenon.<ref>World Health Organization. (1998). [http://www.who.int/docstore/world-health-day/en/pages1998/whd98_10.html Address Unsafe Abortion]. Retrieved [[2006-03-01]].</ref>
==Abortion debate==
[[Image:March for Women's Lives detail.jpg|thumb|right|240px||Pro-choice activists near the [[Washington Monument]] at the [[March for Women's Lives]].]]
[[Image:March for life 2007.JPG|thumb|right|240px|Pro-life activists at the [[March for Life]] in 2007. The rally is held annually in [[Washington, DC]].]]
<!-- Deleted image removed: [[Image:P1020321.JPG|thumb|right|240px||Pro-life activists at the [[March for Life]] in 2008. The rally is held annually in [[Washington, DC]].]] -->
{{main|Abortion debate|Pro-choice|Pro-life}}
In the [[history of abortion]], induced abortion has been the source of considerable [[debate]], [[controversy]], and [[activism]]. An [[opinion|individual's position]] on the complex [[ethical]], [[moral]], [[philosophical]], [[Biology|biological]], and [[legal]] issues is often related to his or her [[value system]]. Opinions of abortion may be best described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of [[government]]al [[authority|authorities]] in [[public policy]]. [[religion|Religious ethics]] also has an influence upon both personal opinion and the greater debate over abortion (see [[religion and abortion]]).
Abortion debates, especially pertaining to [[abortion law]]s, are often spearheaded by [[advocacy|advocacy groups]] belonging to one of two camps. In the [[United States]], most often those in favor of greater legal restrictions on, or even complete prohibition of abortion, describe themselves as [[pro-life]] while those against legal restrictions on abortion describe themselves as [[pro-choice]]. Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to ''life''?" for pro-life advocates, and, for those who are pro-choice, "Does a woman have the right to ''choose'' whether or not to continue a pregnancy?"
In both public and private debate, arguments presented in favor of or against abortion focus on either the moral permissibility of an induced abortion, or justification of [[laws]] permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.
Debate also focuses on whether the [[pregnancy|pregnant]] woman should have to notify and/or have the [[consent]] of others in distinct cases: a [[minor (law)|minor]], her parents; a [[marriage|legally-married]] or [[common-law marriage|common-law]] wife, her husband; or a pregnant woman, the biological father. In a 2003 Gallup poll in the United States, 79% of male and 67% of female respondents were in favor of spousal notification; overall support was 72% with 26% opposed.<ref>The Pew Research Center for the People and the Press. ([[2005-11-02]]). "[http://people-press.org/commentary/display.php3?AnalysisID=122 Public Opinion Supports Alito on Spousal Notification Even as It Favors Roe v. Wade]." ''Pew Research Center Pollwatch.'' Retrieved [[2006-03-01]].</ref>
===Public opinion===
{{Main|Societal attitudes towards abortion}}
A number of [[opinion poll]]s around the world have explored [[public opinion]] regarding the issue of abortion. Results have varied from poll to poll, country to country, and region to region, while varying with regard to different aspects of the issue.
A May 2005 survey examined attitudes toward abortion in 10 [[Europe]]an countries, asking polltakers whether they agreed with the statement, "If a woman doesn't want children, she should be allowed to have an abortion". The highest level of approval was 81% (in the [[Czech Republic]]); the lowest was 47% (in [[Poland]]).<ref>TNS Sofres. (May 2005). [http://www.thebrusselsconnection.be/tbc/upload/attachments/European%20Values%20Overall%20EN.pdf European Values]. Retrieved January 11, 2007.</ref>
In [[North America]], a December 2001 poll surveyed [[Abortion in Canada#Opinion polls|Canadian opinion on abortion]], asking [[Canada|Canadians]] in what circumstances they believe abortion should be permitted; 32% responded that they believe abortion should be legal in all circumstances, 52% that it should be legal in certain circumstances, and 14% that it should be legal in no circumstances. A similar poll in January 2006 surveyed people in the [[United States]] about [[Abortion in the United States#Public Opinion|U.S. opinion on abortion]]; 33% said that abortion should be "permitted only in cases such as rape, incest or to save the woman's life", 27% said that abortion should be "permitted in all cases", 15% that it should be "permitted, but subject to greater restrictions than it is now", 17% said that it should "only be permitted to save the woman's life", and 5% said that it should "never" be permitted.<ref>''[http://www.pollingreport.com/abortion.htm The Polling Report].'' (2006). Retrieved [[2006-01-11]].</ref> A November 2005 poll in [[Mexico]] found that 73.4% think abortion should not be legalized while 11.2% think it should.<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/10042 Mexicans Support Status Quo on Social Issues]." (December 1, 2005). ''Angus Reid Global Monitor.'' Retrieved January 10, 2006.</ref>
Of attitudes in [[South America|South]] and [[Central America]], a December 2003 survey found that 30% of [[Argentina|Argentines]] thought that [[abortion in Argentina]] should be allowed "regardless of situation", 47% that it should be allowed "under some circumstances", and 23% that it should not be allowed "regardless of situation".<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/2029 Argentines Assess Abortion Changes]." (Mar. 4, 2004). ''Angus Reid Global Monitor''. Retrieved January 10, 2006.</ref> A March 2007 poll regarding the [[Abortion in Brazil|abortion law in Brazil]] found that 65% of [[Brazil]]ians believe that it "should not be modified", 16% that it should be expanded "to allow abortion in other cases", 10% that abortion should be "decriminalized", and 5% were "not sure".<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/15370 Brazilians Want to Keep Abortion as Crime]." (April 12, 2007). ''Angus Reid Global Monitor''. Retrieved June 20, 2007.</ref> A July 2005 poll in [[Colombia]] found that 65.6% said they thought that abortion should remain illegal, 26.9% that it should be made legal, and 7.5% that they were unsure.<ref>"[http://www.angus-reid.com/polls/index.cfm/fuseaction/viewItem/itemID/8333 Colombians Reject Legalizing Abortion]. (August 2, 2005). ''Angus Reid Global Monitor''. Retrieved January 10, 2006.</ref>
===Arguments within the debate===
====Breast cancer hypothesis====
{{main|Abortion-breast cancer hypothesis}}
The "abortion-breast cancer (ABC) hypothesis" (supporters call it the abortion-breast cancer link) posits that induced abortion increases the risk of developing breast cancer;<ref name="RUSSO_505">{{cite journal |author=Russo J, Russo I |title=Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence |journal=Am J Pathol |volume=100 |issue=2 |pages=505–506 |year=1980 |pmid=6773421}} "In contrast, abortion is associated with increased risk of carcinomas of the breast. The explanation for these epidemiologic findings is not known, but the parallelism between the DMBA-induced rat mammary carcinoma model and the human situation is striking. [...] Abortion would interrupt this process, leaving in the gland undifferentiated structures like those observed in the rat mammary gland, which could render the gland again susceptible to carcinogenesis."</ref> it is a controversial subject and the current [[scientific consensus]] has concluded there is no significant association between first-trimester abortion and breast cancer risk.<ref name="WHO">{{cite web |url=http://www.who.int/mediacentre/factsheets/fs240/en/index.html |title=WHO | Induced abortion does not increase breast cancer risk |accessdate=2007-12-24 |format= |work=who.int}}</ref><ref name="oversight">{{cite web |url=http://oversight.house.gov/features/politics_and_science/example_breast_cancer.htm |title=Politics & Science - Investigating the State of Science Under the Bush Administration |accessdate=2008-04-14 |format=HTML |work=oversight.house.gov}}</ref><ref name="JASEN"/>
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{{ndash}} before full maturity in the third [[trimester]]{{ndash}} then more relatively vulnerable immature cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. The hypothesis mechanism was first proposed and explored in [[rat]] studies conducted in the 1980s.<ref name="RUSSO">{{cite journal |author=Russo J, Russo I |title=Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence |journal=Am J Pathol |volume=100 |issue=2 |pages=497–512 |year=1980 |pmid=6773421}}</ref><ref name="RUSSO2">{{cite journal |author=Russo J, Tay L, Russo I |title=Differentiation of the mammary gland and susceptibility to carcinogenesis |journal=Breast Cancer Res Treat |volume=2 |issue=1 |pages=5–73 |year=1982 |pmid=6216933 |doi=10.1007/BF01805718}}</ref><ref name="RUSSO3">{{cite journal |author=Russo J, Russo I |title=Biological and molecular bases of mammary carcinogenesis |journal=Lab Invest |volume=57 |issue=2 |pages=112–37 |year=1987 |pmid=3302534}}</ref>
The [[American Cancer Society]] concludes that presently the evidence does not support a causal abortion-breast cancer association,<ref name="ACS_ABC">{{cite web |url=http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Can_Having_an_Abortion_Cause_or_Contribute_to_Breast_Cancer.asp |title=ACS :: Can Having an Abortion Cause or Contribute to Breast Cancer? |accessdate=2008-03-31 |format= |work=cancer.org}}</ref> yet a causal link continues to be championed by pro-life activists like Dr. [[Joel Brind]], Dr. Angela Lanfranchi and Karen Malec.<ref name="JASEN"/> In the past, pro-life advocates have sought legal action regarding disclosure of the abortion-breast cancer issue. This brought short-term legal and political intervention culminating with the Bush Administration changing the [[National Cancer Institute]] (NCI) fact sheet from concluding no link to a more ambiguous assessment.<ref name="HOUSE">{{cite web |url=http://democrats.reform.house.gov/features/politics_and_science/example_breast_cancer.htm |title=Politics & Science - Investigating the State of Science Under the Bush Administration |accessdate=2007-11-04 |format= |work=democrats.reform.house.gov}}</ref> In February 2003, the NCI responded by conducting a workshop with over 100 experts on the issue, which determined from selected evidence that it was well-established "abortion is not associated with an increase in breast cancer risk."<ref name="NCI">{{cite web |url=http://www.cancer.gov/cancerinfo/ere-workshop-report |title=Summary Report: Early Reproductive Events Workshop - National Cancer Institute |accessdate=2007-11-04 |format= |work=cancer.gov}}</ref>
Though the scientific community is largely skeptical of the hypothesis and has been rejected by some;<ref name="HOUSE"/><ref name="NCI"/> the ongoing promotion of an abortion-breast cancer "link" by [[pro-life]] advocates and medical associations is seen by others as merely a part of the current pro-life "woman-centered" strategy against abortion.<ref name="ABC_medical">{{cite web |url=http://www.abortionbreastcancer.com/medicalgroups/index.htm |title=Medical Groups Recognizing Link |accessdate=2008-04-14 |format= |work=abortionbreastcancer.com}}</ref><ref name="ARTHUR">{{cite web |url=http://www.prochoiceactionnetwork-canada.org/articles/abclink.shtml |title=THE PRO-CHOICE ACTION NETWORK |accessdate=2007-11-04 |format= |work=prochoiceactionnetwork-canada.org}}</ref><ref name="Mooney">{{cite web |url=http://www.washingtonmonthly.com/features/2004/0410.mooney.html |title=Research and Destroy |accessdate=2008-04-14 |format= |work=washingtonmonthly.com |author=Chris Mooney |year=2004}}</ref> Pro-life groups maintain they are providing legally necessary [[informed consent]];<ref name="deveber">{{cite web |url=http://www.deveber.org/text/whealth.html#eighteen |title=Women's Health after Abortion |accessdate=2008-04-14 |format= |work=deveber.org}}</ref> a concern shared by conservative Congressman Dr. [[Dave Weldon]].<ref name="Weldon">{{cite web |url=http://www.abortionbreastcancer.com/weldon_letter.htm |title=Weldon Letter |accessdate=2007-11-04 |format= |work=abortionbreastcancer.com}}</ref> While early research indicated a correlation between breast cancer and abortion;<ref name="DALING2">{{cite journal |author=Daling JR, Brinton LA, Voigt LF, ''et al'' |title=Risk of breast cancer among white women following induced abortion |journal=Am. J. Epidemiol. |volume=144 |issue=4 |pages=373–80 |year=1996 |pmid=8712194 |doi=}}</ref><ref name="HOWE">{{cite journal |author=Howe H, Senie R, Bzduch H, Herzfeld P |title=Early abortion and breast cancer risk among women under age 40. | journal = Int J Epidemiol | volume = 18 | issue = 2 |pages=300–4 |year=1989 | pmid = 2767842 | doi = 10.1093/ije/18.2.300}}</ref> the current scientific consensus has solidified with the publication of large [[prospective study|prospective]] [[cohort study|cohort studies]] which find no clear association between abortion and breast cancer.<ref name="MELBYE">{{cite journal |author=Melbye M, Wohlfahrt J, Olsen J, Frisch M, Westergaard T, Helweg-Larsen K, Andersen P |title=Induced abortion and the risk of breast cancer |journal=N Engl J Med |volume=336 |issue=2 |pages=81–5 |year=1997 |pmid=8988884 |doi=10.1056/NEJM199701093360201}}</ref><ref name="Michels">{{cite journal |author=Michels KB, Xue F, Colditz GA, Willett WC |title=Induced and spontaneous abortion and incidence of breast cancer among young women: a prospective cohort study |journal=Arch. Intern. Med. |volume=167 |issue=8 |pages=814–20 |year=2007 |pmid=17452545 |doi=10.1001/archinte.167.8.814}}</ref> These studies along with all relevant research strive to remove from their results the many [[Abortion-breast cancer hypothesis#Confounding factors|confounding factors]], such as delayed child bearing (parity), which affect breast cancer risk apart from abortion. The abortion-breast cancer hypothesis continues to incite mostly political and some scientific debate.<ref name="JASEN">{{cite journal |author=Jasen P |title=[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1251638 Breast cancer and the politics of abortion in the United States] |journal=Med Hist |volume=49 |issue=4 |pages=423–44 |year=2005 |pmid=16562329}}</ref>
====Mental health====
{{Main|Abortion and mental health}}
The relationship between induced abortion and [[mental health]] is an area of political and scientific controversy.<ref name="Bazelon"/><ref name="now">[http://www.pbs.org/now/shows/329/index.html "Post-Abortion Politics"] NOW with David Brancaccio on PBS</ref><ref name="Position Statement on Women’s Mental Health in Relation to Induced Abortion"/> A number of studies have concluded that abortion is associated with no more psychological risk than carrying an unwanted pregnancy to term. Other studies have reported a [[association (statistics)|statistical correlation]] between abortion and negative psychological effects, though no studies have demonstrated a direct [[causality|causal relationship]].<ref name="newscientist">[http://www.newscientist.com/article/mg12416951.000-reagans-officials-suppressed-research-on-abortion-.html Reagan's officials 'suppressed' research on abortion], by Christopher Joyce. Published in the ''[[New Scientist]]'' on [[December 16]] [[1989]]. Accessed [[February 18]] [[2008]].</ref><ref name="Mooney"/><ref name = "kklpzz">[http://links.jstor.org/sici?sici=0014-7354(199001%2F02)22%3A1%3C36%3AD%3E2.0.CO%3B2-N Family Planning and Perspectives] by Nancy Adler</ref> Pre-existing factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.<ref name="APA89">{{cite journal |author=Adler NE, David HP, Major BN, Roth SH, Russo NF, Wyatt GE |title=Psychological responses after abortion |journal=Science |volume=248 |issue=4951 |pages=41–4 |year=1990 |pmid=2181664 |doi=}} An [http://www.sciencemag.org/cgi/content/abstract/248/4951/41 abstract] of this article is available for free, and the full text is available for a fee.</ref><ref name="APArelease">American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.</ref><ref>[http://findarticles.com/p/articles/mi_qa3634/is_199707/ai_n8772240 Abortion study finds no long-term ill effects on emotional well-being]</ref>
In a 1990 review, the [[American Psychological Association]] has found that "severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses."<ref name = "kklpzz"/> In light of additional studies undertaken since that time, both the APA and the [[United Kingdom]] [[Royal College of Psychiatrists]] are performing [[systematic review]]s of the medical literature in order to update their position statements.
Some proposed negative [[psychological]] effects of abortion have been referred to by [[pro-life]] advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-abortion syndrome" is not recognized by any medical or psychological organization,<ref name="Grimes">{{cite journal |author=Grimes DA, Creinin MD |title=Induced abortion: an overview for internists |journal=Ann. Intern. Med. |volume=140 |issue=8 |pages=620–6 |year=2004 |pmid=15096333 }} Key summary points: ''"Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae."'' On p. 624, the authors state: ''"The alleged 'postabortion trauma syndrome' does not exist."''</ref> and some [[physician]]s and [[pro-choice]] advocates have argued that the effort to popularize the idea of a "post-abortion syndrome" is a tactic used by pro-life advocates for political purposes.<ref name="Bazelon">[http://www.nytimes.com/2007/01/21/magazine/21abortion.t.html?pagewanted=1&ei=5088&en=5092fc3344065aec&ex=1327035600&partner=rssnyt&emc=rss&adxnnlx=1190370959-M3NVF8bZOGTDu468IEZo8g Is There a Post-Abortion Syndrome?] By [[Emily Bazelon]]. Published in the ''[[New York Times Magazine]]'', [[January 21]] [[2007]]. Accessed [[January 11]] [[2008]].</ref><ref name="Mooney">[http://www.washingtonmonthly.com/features/2004/0410.mooney.html Research and Destroy], by Chris Mooney. Published in ''[[Washington Monthly]]'', October 2004.</ref><ref name="stotlandreview">{{cite journal |author=Stotland NL |title=Abortion and psychiatric practice |journal=J Psychiatr Pract |volume=9 |issue=2 |pages=139–49 |year=2003 |pmid=15985924 |doi=}} ''"Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae."''</ref><ref name=stotland_1404747>Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.</ref>
On March 14, 2008, the [[Royal College of Psychiatrists]] released a statement saying "The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base is inconclusive – some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion."<ref name="Position Statement on Women’s Mental Health in Relation to Induced Abortion">[http://extras.timesonline.co.uk/abortion.pdf Research and Destroy], by The Royal College of Psychiatrists. Accessed March 16, 2008.</ref>
====Fetal pain debate====
{{Main | Fetal pain}}
The existence and implications of [[fetal pain]] are scientifically and politically disputed. A controversial<ref>{{cite web |url=http://www.nytimes.com/2005/08/26/health/26pain.html?_r=1&oref=slogin |title=Study Authors Didn't Report Abortion Ties |accessdate=2008-04-03 |format= |work=New York Times }}</ref> review by researchers from the [[University of California, San Francisco]] in ''[[Journal of the American Medical Association|JAMA]]'' concluded that data from dozens of medical reports and studies indicate that fetuses are unlikely to feel pain until the [[third trimester]] of pregnancy.<ref>{{cite journal |author=Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA |title=Fetal pain: a systematic multidisciplinary review of the evidence |journal=JAMA |volume=294 |issue=8 |pages=947–54 |year=2005 |pmid=16118385 |doi=10.1001/jama.294.8.947}}</ref><ref>[http://www.msnbc.msn.com/id/9053416/ "Study: Fetus feels no pain until third trimester"] MSNBC</ref> There is an emerging consensus among developmental [[neurobiology|neurobiologists]] that the establishment of [[Human thalamus|thalamocortical]] connections (at about 26 weeks) is a critical event with regard to fetal perception of pain.<ref>Johnson, Martin and Everitt, Barry. ''[http://books.google.com/books?vid=ISBN0632042877&id=MzZRuSQ5UeEC&pg=PA215&lpg=PA215&ots=cx0KcmuOYk&dq=%22emerging+consensus+among+developmental+neurobiologists+that+the+establishment+%22&num=100&sig=8I9DY9KPpuSPNYvGI3sEV2bmKsA Essential reproduction]'' (Blackwell 2000), p. 215. Retrieved [[2007-02-21]].</ref> Nevertheless, because pain can involve sensory, emotional and cognitive factors, it may be "impossible to know" when painful experiences are perceived, even if it is known when thalamocortical connections are established.<ref>Johnson, Martin and Everitt, Barry. ''[http://books.google.com/books?vid=ISBN0632042877&id=MzZRuSQ5UeEC&pg=PA215&lpg=PA215&ots=cx0KcmuOYk&dq=%22emerging+consensus+among+developmental+neurobiologists+that+the+establishment+%22&num=100&sig=8I9DY9KPpuSPNYvGI3sEV2bmKsA Essential reproduction]'' (Blackwell 2000): ''"The multidimensionality of pain perception, involving sensory, emotional, and cognitive factors may in itself be the basis of conscious, painful experience, but it will remain difficult to attribute this to a fetus at any particular developmental age."'' Retrieved [[2007-02-21]].</ref>
Whether a [[fetus]] has the ability to feel [[pain]] and to [[suffering|suffer]] is part of the abortion debate.<ref>White, R. Frank. "[http://www.asahq.org/Newsletters/2001/10_01/white.htm Are We Overlooking Fetal Pain and Suffering During Abortion?]", ''American Society of Anesthesiologists Newsletter'' (October 2001). Retrieved [[2007-03-10]].</ref><ref>David, Barry & and Goldberg, Barth. "[http://www.illinoisbar.org/IBJ/dec02lj/dectoc.htm Recovering Damages for Fetal Pain and Suffering]", ''Illinois Bar Journal'' (December 2002). Retrieved [[2007-03-10]].</ref> For example, legislation has been proposed by [[pro-life]] advocates requiring abortion providers to tell a woman that the fetus may feel pain during the abortion procedure, and that require her to accept or decline anesthesia for the fetus.<ref>Weisman, Jonathan. "[http://www.washingtonpost.com/wp-dyn/content/article/2006/12/04/AR2006120401089.html House to Consider Abortion Anesthesia Bill]", ''Washington Post'' [[2006-12-05]]. Retrieved [[2007-02-06]].</ref>
==Abortion law==
{{main|Abortion law|History of abortion law}}
{{seealso|Reproductive rights}}
[[Image:AbortionLawsMap.png|thumb|300px|right|International status of abortion law ([[:Image:AbortionLawsMap.png|detail]]). ]]
Before the scientific discovery that human development begins at fertilization, [[English common law]] allowed abortions to be performed before "[[quickening]]", the earliest perception of fetal movement by a woman during pregnancy, until both pre- and post-quickening abortions were criminalized by ''[[Lord Ellenborough's Act]]'' in 1803.<ref>[http://members.aol.com/abtrbng/lea.htm Lord Ellenborough’s Act]." (1998). ''The Abortion Law Homepage.'' Retrieved February 20, 2007.</ref> In 1861, the [[British Parliament]] passed the ''[[Offences Against The Person Act 1861|Offences Against the Person Act]]'', which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.<ref>United Nations Population Division. (2002). [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review]. Retrieved February 22, 2007.</ref> The [[Soviet Union]], with legislation in 1920, and [[Iceland]], with legislation in 1935, were two of the first countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion laws in other countries. The ''[[Abortion Act 1967]]'' allowed abortion for limited reasons in the [[United Kingdom]]. In the 1973 case, ''[[Roe v. Wade]]'', the [[Supreme Court of the United States|United States Supreme Court]] struck down state laws banning abortion, ruling that such laws violated an implied [[right to privacy]] in the [[United States Constitution]]. The [[Supreme Court of Canada]], similarly, in the case of ''[[R. v. Morgentaler]]'', discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under the ''[[Canadian Charter of Rights and Freedoms]]''. [[Canada]] later struck down provincial regulations of abortion in the case of ''[[R. v. Morgentaler (1993)]].'' By contrast, [[abortion in Ireland]] was affected by the addition of an [[Eighth Amendment of the Constitution of Ireland|amendment]] to the [[Republic of Ireland|Irish]] [[Constitution of Ireland|Constitution]] in 1983 by popular [[referendum]], recognizing "the right to life of the unborn".
Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The [[right to life]], the right to [[liberty]], the right to [[security of person]], and the right to [[Reproductive rights|reproductive health]] are major issues of [[human rights]] that are sometimes used as justification for the existence or absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a [[trimester]]-based system to regulate the window of legality:
* In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on [[prenatal development|fetal development]], or require that [[minors and abortion|parents be contacted]] if their [[Minor (law)|minor]] daughter requests an abortion.
* In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessary before it can be performed.
Other countries, in which abortion is normally illegal, will allow one to be performed in the case of [[rape]], [[incest]], or danger to the pregnant woman's life or health. A few nations ban abortion entirely: [[Abortion in Chile|Chile]], [[El Salvador]], [[Malta]], [[Ireland]] and [[Abortion in Nicaragua|Nicaragua]], although in 2006 the [[Politics of Chile|Chilean government]] began the free distribution of [[emergency contraception]].<ref>Ross, Jen. ([[September 12]], [[2006]]). "[http://www.csmonitor.com/2006/0912/p01s04-woam.html In Chile, free morning-after pills to teens]." ''The Christian Science Monitor.'' Retrieved 2006-12-07.</ref><ref>Gallardoi, Eduardo. ([[September 26]], [[2006]]). "[http://www.washingtonpost.com/wp-dyn/content/article/2006/09/26/AR2006092600770.html Morning-After Pill Causes Furor in Chile]." ''The Washington Post.'' Retrieved 2006-12-07. </ref> In [[Bangladesh]], abortion is illegal, but the government has long supported a network of "menstrual regulation clinics", where [[menstrual extraction]] ([[manual vacuum aspiration]]) can be performed as menstrual hygiene.<ref>{{cite web|title=Surgical Abortion: History and Overview|publisher=National Abortion Federation|accessdate=2006-09-04|url=http://www.prochoice.org/education/resources/surg_history_overview.html}}</ref>
In places where abortion is illegal or is socially such a stigma that it would not be possible to continue to live there if it became known that a woman had undergone one, pregnant women may engage in [[medical tourism]] and travel overseas to countries where they can undergo a termination of their pregnancy. In the USA, it is not unusual for women to travel from one state to another for reasons of termination of pregnancy.
==See also==
{|width=100%
|-valign=top
|width=33%|
* [[List of articles about abortion by country|Abortion by country]]
* [[Abortion fund]]
* [[Abortion-related violence]]
* [[Contraception]]
* [[Ethical aspects of abortion]]
* [[Eugenics]]
* [[Fertilisation]]
* [[Fetal rights]]
|width=33%|
* [[Gynaecology]]
* [[Late-term abortion]]
* [[Legal protection of access to abortion]]
* [[Libertarian perspectives on abortion]]
* [[Medical tourism]]
* [[Mexico City Policy]]
* [[Minors and abortion]]
* [[Obstetrics]]
|width=33%|
* [[Paternal rights and abortion]]
* [[Pregnancy]]
* [[Population control]]
* [[Religion and abortion]]
* [[Reproduction]]
* [[Selective reduction]]
* [[Self-induced abortion]]
* [[Stem cell research]]
* [[Teenage pregnancy]]
|}
==References==
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{{Reflist|2}}
==External links==
{{sisterlinks|abortion}}
* {{dmoz|Society/Issues/Abortion/|Abortion}}
* [http://annualreview.law.harvard.edu/population/abortion/abortionlaws.htm Abortion Laws of the World]
* [http://www.un.org/esa/population/publications/abortion Abortion Policies: A Global Review]
* "[http://www.pbs.org/wgbh/pages/frontline/twenty/watch/abortion.html Abortion Clinic]:" a 1983 PBS ''Frontline'' episode.
* [http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm#Definition U.S. National Library of Medicine and National Institutes of Health MedlinePlus encyclopedia]
* [http://www.religioustolerance.org/abortion.htm Abortion: All sides to the issue] from the [[Ontario Consultants on Religious Tolerance]]
* [http://www.publicagenda.org/issues/frontdoor.cfm?issue_type=abortion Issue Guide on Abortion] from Public Agenda Online
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'''The following information resources may be created by those with a non-neutral position in the abortion debate:'''
* [http://www.guttmacher.org/ The Guttmacher Institute] (pro-choice)
* [http://www.johnstonsarchive.net/policy/abortion Johnston's Archive: Abortion Statistics and Other Data] (pro-life)
* [http://justfacts.com/abortion.htm Just Facts: Abortion] (pro-life)
* [http://www.abortion.com/ Abortion.com: Abortion Clinics and Medical Providers] (pro-choice)
'''The following links are to groups which advocate a specific position:'''
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* [http://www.childrenbychoice.org.au Children by Choice] (Australia, pro-choice)
* [http://www.rtlaust.com Right to Life Australia] (pro-life)
* [http://www.caral.ca Canadians for Choice] (pro-choice)
* [http://www.lifecanada.org LifeCanada] (pro-life)
* [http://www.alranz.org Abortion Law Reform Association of New Zealand] (pro-choice)
* [http://www.voiceforlife.org.nz Voice for Life] (New Zealand, pro-life)
* [http://www.abortionrights.org.uk Abortion Rights] (United Kingdom, pro-choice)
* [http://www.lifeuk.org LifeUK] (United Kingdom, pro-life)
* [http://www.naral.org NARAL Pro-choice America] (pro-choice)
* [http://www.all.org American Life League] (pro-life)
* [http://www.plannedparenthood.com Planned Parenthood] (international, pro-choice)
* [http://www.care-net.org CareNet] (international, pro-life)
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[[Category:Abortion| ]]
[[Category:Reproduction]]
[[Category:Core issues in ethics]]
[[Category:Gynecology]]
[[Category:Pregnancy]]
[[Category:Obstetrics]]
[[Category:Gender studies]]
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[[cs:Interrupce]]
[[da:Provokeret abort]]
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[[es:Aborto inducido]]
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[[zh:堕胎]]