Abortion
Un article de Vev.
Modèle:Pp-semiprotected Modèle:Abortion An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously or accidentally as with a miscarriage, or be artificially induced by 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.<ref>-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.</ref> 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.
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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;<ref name="roche1">Roche, Natalie E. (2004). 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 fatal or associated with significant morbidity;<ref name="roche1" /> or
- to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.<ref name="roche1" />
- Elective abortion: Abortion performed for any other reason.
- Therapeutic abortion: An abortion performed either...
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.<ref>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.</ref>
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).<ref name="cdc2003">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.</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). 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> Department of Health
(2007)
. Abortion statistics, England and Wales: 2006
. Retrieved on 2007-10-12. </ref>
By personal and social factors
A 1998 aggregated study, from 27 countries, on the reasons women seek to terminate their pregnancies concluded that common factors cited to have influenced the abortion decision were: desire to delay or end childbearing, concern over the interruption of work or education, issues of financial or relationship stability, and perceived immaturity.<ref name="bankole98">Bankole, Akinrinola, Singh, Susheela, & Haas, Taylor. (199Image:Cool.gif. 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 American women at 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). 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 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.<ref>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.</ref> In the United Kingdom, a 1994 survey of sexual behavior found that women who reported having an abortion were more likely to be of a higher social class, as well as either cohabitating or divorced. It also found that women who stated they have had 10 or more sexual partners in their lifetime were five times more likely to have had an abortion than those who stated they have had only one sexual partner.<ref>Wellings, K., et al. (1994). Sexual Behaviour in Britain: The National Survey of Sexual Attitudes and Lifestyles. London, UK: Penguin Books.</ref>
Some abortions are undergone as the result of societal pressures. These might include the stigmatization of disabled persons, preference for children of a specific sex, disapproval of single motherhood, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion.
Unsafe abortion (legal)
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.<ref name="whounsafe">World Health Organization. (2004). Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000. Retrieved 2006-01-12.</ref> 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.<ref>"Reproductive Endocrinology and Infertility: Recurrent Pregnancy Loss (Recurrent Miscarriage)." (n.d.) Retrieved 2006-01-18 from Washington University School of Medicine, Department of Obstetrics and Gynecology web site.</ref> In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant.
The risk of spontaneous abortion decreases sharply after the 8th week.<ref> -Q&A: Miscarriage. (August 6 , 2002). BBC News. Retrieved January 10, 2007.
- Lennart Nilsson. (1990) A Child is Born. </ref> This risk is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.
Induced abortion
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the embryo or fetus, in addition to the legality, regional availability, and doctor-patient preference for specific procedures.
Surgical abortion
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.<ref>Healthwise. Manual and vacuum aspiration for abortion. (2004). WebMD. Retrieved 2006-08-19.</ref> Manual Vacuum aspiration (MVA) abortion, consists of removing the fetus or embryo by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.
Dilation and curettage (D&C) is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.<ref>World Health Organization. (2003). Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Retrieved 2006-08-19.</ref> The term D and C, or sometimes suction curette, is used as a euphemism for the first trimester abortion procedure, whichever the method used.
Other techniques must be used to induce abortion in the third trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic 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 called "partial-birth abortion," which has been 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">Abortion. (2007). MSN Encarta. Retrieved July 1, 2007.</ref>
From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure.<ref>-Vause S, Sands J, Johnston TA, Russell S, Rimmer S. (2002). PMID 12521492 Could some fetocides be avoided by more prompt referral after diagnosis of fetal abnormality? J Obstet Gynaecol. 2002 May;22(3):243-5. Retrieved 2006-03-17.
-Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y. (2003). PMID 12576743 Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals. Fetal Diagn Ther. 2003 Mar-Apr;18(2):91-7. Retrieved 2006-03-17.
-Bhide A, Sairam S, Hollis B, Thilaganathan B. (2002). PMID 12230443 Comparison of feticide carried out by cordocentesis versus cardiac puncture. Ultrasound Obstet Gynecol. 2002 Sep;20(3):230-2. Retrieved 2006-03-17.
-Senat MV, Fischer C, Bernard JP, Ville Y. (2003). PMID 12628271 The use of lidocaine for fetocide in late termination of pregnancy. BJOG. 2003 Mar;110(3):296-300. Retrieved 2006-03-17.
- MV, Fischer C, Ville Y. (2002). PMID 12001185 Funipuncture for fetocide in late termination of pregnancy. Prenat Diagn. 2002 May;22(5):354-6. Retrieved 2006-03-17.</ref>
Medical abortion
Effective in the first trimester of pregnancy, medical (non-surgical) abortions comprise 10% of all abortions in the United States and Europe. Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention.<ref>Modèle:Cite journal</ref> Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.
Other means of abortion
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). 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 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). 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 needles and clothes hangers 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>
Health considerations
Early-term surgical abortion is a simple procedure which is safer than childbirth when performed before the 16th week.<ref>Henshaw, Stanley K. "Induced Abortion: A World Review, 1990" International Family Planning Perspectives 23:246-252, 1991.</ref><ref name="grimes">Grimes, D.A. (1994). The morbidity and mortality of pregnancy: still risky business. American Journal of Obstetrics and Gynecology, 170 (5 Pt 2), 1489-94. Retrieved December 21, 2006.</ref> Abortion methods, like most minimally invasive procedures, 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> Abortion, Complications
. eMedicine
. Retrieved on 2007-06-30. </ref> The risk of complications can increase depending on how far pregnancy has progressed.<ref name="pauli">Pauli, E., Haller, U., Zimmermann, R. (2005). Morbidity of dilatation and evacuation in the second trimester: an analysis. Gynakol Geburtshilfliche Rundsch, 45 (2), 107-15. Retrieved December 26, 2006.</ref><ref name="bartley">Bartley, J., Tong, S., Everington, D.,& Baird, D.T. (2000). Parity is a major determinant of success rate in medical abortion: a retrospective analysis of 3161 consecutive cases.... Contraception, 62(6), 297-303. Retrieved December 26, 2006.</ref>
Assessing the risks of induced abortion depends on a number of factors. First, there are relative health risks of induced abortion and pregnancy, which are both affected by wide variation in the quality of health services in different 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;<ref name="bartley" /> gestational age;<ref name="bartley" /><ref name="pauli" /> 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.<ref>Department of Health. (199Image:Cool.gif. Why Mothers Die: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994 – 1996. London: The Stationery Office. Retrieved 2006-01-11.</ref> In the United States, during the year 1999, there were 4 deaths due to legal abortion, 10 due to miscarriage, and 525 due to pregnancy-related reasons.<ref>Elam-Evans, Laurie. D., Strauss, Lilo T., Herndon, Joy, Parker, Wilda Y., Bowens, Sonya V., Zane, Suzanne, et al. Centers for Disease Control and Prevention. (2003-11-23). Abortion Surveillance - United States, 2000. Morbidity and Mortality Weekly Report. Retrieved 2006-01-11.</ref><ref>Centers for Disease Control and Prevention. (2003-02-20). Fact Sheet: Pregnancy-Related Mortality Surveillance - United States, 1991-1999. Retrieved 2006-04-02.</ref>
Pain management
Women experience pain, usually minor, during first-trimester abortion procedures. In a 1979 study of 2,299 patients, 97% reported experiencing some degree of pain. Patients rated the pain as being less than earache or toothache, but more than headache or backache. Youngest patients experienced the most pain; oldest, the least.<ref>Phillip G. Stubblefield, M.D., et al, "Pain of first-trimester abortion: Its quantification and relations with other variables," American Journal of Obstetrics and Gynecology, Vol. 133, No. 5 (March 1, 1979)</ref> In a 1991 study of 35 women aged 18 to 40, 70% reported cramping, 45.7% reported fatigue (“tiring”), and 40% reported cutting. 34.3% of the women chose the following descriptions: tugging, pulling, aching, and intense. Women who had a previous abortion had more pain on the affective McGill Pain Questionnaire and Philadelphia Pain Intensity scale than did those who did not have a previous abortion.<ref>Wells N. “Pain and distress during abortion,” Health Care for Women International. 1991 Jul-Sep;12(3):293-302.</ref>
Some practitioners advocate using minimal anaesthesia so the patient can alert them to possible complications. Others recommend general anaesthesia, to prevent patient movement, which might cause a perforation. General anaesthesia carries its own risks, including death, which is why public health officials recommend against its routine use.
Failed abortion
In rare cases, abortion will be unsuccessful and pregnancy will continue. An unsuccessful abortion can result in delivery of a live infant. This, termed a failed abortion, can occur only late in pregnancy. Some doctors have voiced concerns about the ethical and legal ramifications of letting the infant die. As a result, recent investigations have been launched in the United Kingdom by the Confidential Enquiry into Maternal and Child Health (CEMACH) and the Royal College of Obstetricians and Gynaecologists, in order to determine how widespread the problem is and what an ethical response in the treatment of the infant might be. A preliminary report from this investigation indicated that at least 50 babies a year are born in the UK following failed abortions after 18 weeks of gestation.<ref name=Rogers>Rogers, Lois. (2005-11-27). "Fifty babies a year are alive after abortion." The Sunday Times. Retrieved 2006-01-11.</ref>
Unsafe abortion (health)
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. Arguments, whether in support of or against such claims, may be influenced by the political and ideological beliefs of the parties behind it.
Breast cancer hypothesis
The abortion-breast cancer (ABC) hypothesis (also referred to by supporters as the "abortion-breast cancer link") is a rejected hypothesis that posits a causal relationship between induced abortion and an increased risk of developing breast cancer.<ref>Simon, Stephanie. (2002, March 24). "Abortion Foes Seize on Reports of Cancer Link in Ad Campaign." Los Angeles Times</ref><ref>Tang, Mei-Tzu, et al. (2000). "Induced Abortion in Relation to Breast Cancer among Parous Women: A Birth Certificate Registry Study." Epidemiology, 11, 177-80.</ref><ref>Westhoff, Carolyn. (1997). "Abortion and Breast Cancer: Good Data at Last." IPPF Medical Bulletin. 31(2), 1-2.</ref><ref>Willett, W.C., et al. (1987). "Moderate Alcohol Consumption and the Risk of Breast Cancer." New England Journal of Medicine, 316(19), 1174-80.</ref><ref>Wingo, Phyllis A., et al. (1997). "The Risk of Breast Cancer Following Spontaneous or Induced Abortion." Cancer Causes and Control, 8, 93-108.</ref><ref>WHO — World Health Organization. (2000, June, accessed 2002, May 21). Induced Abortion Does Not Increase the Risk of Breast Cancer. [Online]. http://www.who.int/inf-fs/en/fact240.html</ref> In early pregnancy, levels of estrogen increase, leading to breast growth in preparation for lactation. The hypothesis proposed that if this process is interrupted by an abortion – before full maturity in the third trimester – then more relatively vulnerable immature cells could be left than there were prior to the pregnancy, resulting in a greater potential risk of breast cancer. While early research suggested the possibility of a correlative relationship between breast cancer and abortion, the causal hypothesis was proposed based on a reinterpretation of rat studies conducted in the 1980s.<ref name="RUSSO">Modèle:Cite journal</ref><ref name="RUSSO2">Modèle:Cite journal</ref><ref name="RUSSO3">Modèle:Cite journal</ref> Though the link has been rejected by the scientific community and abortion is not considered a breast cancer risk by any major cancer organization,<ref name="PP"> Planned Parenthood - Anti-Choice Claims About Abortion and Breast Cancer
. plannedparenthood.org
. Retrieved on 2007-11-04. </ref> it continues to be championed by pro-life activists like Dr. Joel Brind, Dr. Angela Lanfranchi and Dr. Karen Malec.
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.<ref name="MELBYE">Modèle:Cite journal</ref> The National Cancer Institute conducted a workshop with over 100 experts on the issue in February 2003, which determined from selected evidence that it was well-established that there was no correlative relationship between abortion and breast cancer, effectively refuting the causality hypothesis.<ref name="NCI"> Summary Report: Early Reproductive Events Workshop - National Cancer Institute
. cancer.gov
. Retrieved on 2007-11-04. </ref> 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."<ref name="BERAL">Modèle:Cite journal</ref>
Though the hypothesis has been largely rejected, the ongoing promotion of the abortion-breast cancer hypothesis by pro-life advocates is seen by some as a part of the current pro-life "women-centered" strategy against abortion.<ref name="ARTHUR"> THE PRO-CHOICE ACTION NETWORK
. prochoiceactionnetwork-canada.org
. Retrieved on 2007-11-04. </ref><ref name="MOONEY"> "Research and Destroy" by Chris Mooney
. Retrieved on 2007-10-01.
</ref> In the past, pro-life advocates have sought legal action regarding disclosure of the abortion-breast cancer issue. While suits brought short-term legal intervention, the scientific community responded in the form of the 2003 NCI consensus workshop. The current scientific consensus that abortion does not increase the risk of breast cancer has solidified with the publication of large prospective cohort studies which find no significant association between abortion and breast cancer.<ref name="ACS"> ACS :: What Are the Risk Factors for Breast Cancer?
. cancer.org
. Retrieved on 2007-11-04. </ref><ref name="Michels">Modèle:Cite journal</ref> Nevertheless, the subject continues to be one of mostly political but some scientific debate.<ref name="JASEN">Modèle:Cite journal</ref><ref name="HOWE">Modèle:Cite journal</ref>
Mental health
Post-abortion syndrome (PAS), post-traumatic abortion syndrome and abortion trauma syndrome, are terms used to describe a set of adverse psychopathological characteristics which are proposed to occur in women following an induced abortion.<ref name=Gomez>Gomez, Lavin C & Zapata, Garcia R."Diagnostic categorization of post-abortion syndrome", Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.</ref> Primarily a term used by pro-life advocates,<ref>Chris Mooney"Research and Destroy" Washington Monthly, October 2004</ref><ref>Bazelon, Emily. The New York Times Magazine. Is There a Post-Abortion Syndrome?</ref><ref name="BostonG">Science in support of a cause: the new research, by Michael Kranish. Published in the Boston Globe on July 31 2005; accessed November 27 2007.</ref> PAS is not a medically recognized syndrome,<ref>Modèle:Cite journal Key summary points of article state that "Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae." On p. 624, the authors state: "The alleged 'postabortion trauma syndrome' does not exist."</ref> and neither the American Psychological Association nor American Psychiatric Association recognize it. Some physicians and pro-choice advocates have argued that PAS is a myth created by opponents of abortion for political purposes.<ref name=stotland_1404747>Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.</ref><ref>Cooper, Cynthia L. Abortion Under Attack</ref>
A number of studies have concluded that abortion has positive or neutral effects on women. Others have found a correlation between clinical depression, anxiety, suicidal behaviors, or adverse effects on women's sexual functions and abortion. Various factors, such as emotional attachment to the pregnancy, lack of support, and conservative views on abortions, may increase the likelihood of experiencing such feelings. No studies have established a causal relationship between abortion and negative psychological symptoms experienced by women.<ref>American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.</ref>
Miscarriage, or spontaneous abortion, is known to present an increased risk of depression.<ref>Depression Risk Increased After Miscarriage. (2002-04-01). Retrieved 2006-01-11.</ref> Childbirth can also sometimes result in maternity blues or postpartum depression.
History of abortion
Induced abortion can be traced to ancient times.<ref name="devereux">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.</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, 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). 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 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.<ref>Histories of Abortion. (n.d.) Retrieved 2006-01-11.</ref>
Social issues
A number of complex issues exist in the debate over abortion. These, like the suggested effects upon health listed above, are a focus of research and a fixture of discussion among members on all sides of the controversy.
Effect upon crime rate
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 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.<ref>Donohue, John J. and Levitt, Steven D. (2001). 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). 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: ResponseToFooteGoetz2006.pdf.</ref>
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.<ref>"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.</ref><ref>"Abortion and the Lower Crime Rate." (2000, January). St. Anthony Messenger. Retrieved 2006-02-17.</ref> Levitt states in his book Freakonomics that they are neither promoting nor negating any course of action — merely reporting data as economists.
Fetal pain debate
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,<ref>Modèle:Cite press release</ref><ref name="AboPain">Robinson, B.A. (2006). Can a fetus feel pain?. Ontario Consultants for Religious Tolerance. Retrieved December 14, 2005.</ref> and medical researchers, notably from the American Medical Association, maintaining that the neuro-anatomical requirements for such experience do not exist until the 29th week of gestation.<ref>BBC News Article (2005). "Foetuses 'no pain up to 29 weeks'." Retrieved 2006-07-18.</ref>
Pain receptors begin to appear in the seventh week of gestation.<ref name="AboPain"/><ref>Myers, Laura B. (2003). Fetal Surgery: The Anathesia Perspective. Retrieved March 14, 2007.</ref> The thalamus, the part of the brain which receives signals from the nervous system and then relays them to the cerebral cortex, starts to form in the fifth week.<ref name="fetalaware">Parliamentary Office of Science and Technology. (1997). Fetal Awareness. Retrieved 2006-01-11.</ref> 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.<ref name="fetalaware" /> There has been suggestion that a fetus cannot feel pain at all, under the premise that it requires mental development that only occurs outside the womb.<ref>BBC News Article (2006). "Foetuses 'cannot experience pain'." Retrieved 2006-07-18.</ref>
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.<ref>Anand, K., Phil, D., & Hickey, P.R. (1987). Pain and its effects on the human neonate and fetus. New England Journal of Medicine, 316 (21), 1321-9. Retrieved 2006-01-11 from The Circumcision Reference Library.</ref> Others suggest that the human experience of pain, being more than just physiological, cannot be measured in such reflexive responses.<ref>Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. Journal of the American Medical Association, 294 (Image:Cool.gif, 947-954. Retrieved November 10, 2006. </ref>
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.<ref>Banister, Judith. (1999-03-16). Son Preference in Asia - Report of a Symposium. Retrieved 2006-01-12.</ref>
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.<ref>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.</ref> 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."<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: abortion.pdf.</ref> In 1991, the male-to-female sex ratio in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100.<ref>Sudha, S., & Irudaya Rajan, S. (1999). 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). "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). "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. (199Image:Cool.gif. 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). 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>"China Bans Sex-selection Abortion." (2002-03-22). Xinhua News Agency. Retrieved 2006-01-12.</ref>
Unsafe abortion (social)
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 the woman herself.
Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the woman's death.<ref name="whounsafe" /> Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal 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). 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). 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. (199Image:Cool.gif. Address Unsafe Abortion. Retrieved 2006-03-01.</ref>
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.<ref>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.</ref>
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.<ref>TNS Sofres. (May 2005). European Values. Retrieved January 11, 2007.</ref>
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.<ref>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>"Mexicans Support Status Quo on Social Issues." (December 1, 2005). Angus Reid Global Monitor. Retrieved January 10, 2006.</ref>
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".<ref>"Argentines Assess Abortion Changes." (Mar. 4, 2004). Angus Reid Global Monitor. Retrieved January 10, 2006.</ref> 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".<ref>"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>"Colombians Reject Legalizing Abortion. (August 2, 2005). Angus Reid Global Monitor. Retrieved January 10, 2006.</ref>
Abortion law
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>Lord Ellenborough’s Act." (199Image:Cool.gif. The Abortion Law Homepage. Retrieved February 20, 2007.</ref> 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.<ref>United Nations Population Division. (2002). 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 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.<ref>Ross, Jen. (September 12, 2006). "In Chile, free morning-after pills to teens." The Christian Science Monitor. Retrieved 2006-12-07.</ref><ref>Gallardoi, Eduardo. (September 26, 2006). "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> Surgical Abortion: History and Overview
. National Abortion Federation
. Retrieved on 2006-09-04. </ref>
See also
References
External links
- [Abortion Catégorie Society/Issues/Abortion/] de l’annuaire dmoz.
- 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)
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