Abortion

is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or
embryo, resulting in or caused by its death. An abortion can occur spontaneously due to complications
during pregnancy or can be induced, in humans and other species. In the context of human pregnancies,
an abortion induced to preserve the health of the gravida (pregnant female) is termed a therapeutic
abortion, while an abortion induced for any other reason is termed an elective abortion. The term abortion
most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are
usually termed miscarriages.
Worldwide 42 million abortions are estimated to take place annually with 22 million of these occurring
safely and 20 million unsafely. While maternal mortality seldom results from safe abortions, unsafe
abortions result in 70,000 deaths and 5 million disabilities per year. One of the main determinants of the
availability of safe abortions is the legality of the procedure. Forty percent of the world's women are able
to access therapeutic and elective abortions within gestational limits. The frequency of abortions is,
however, similar whether or not access is restricted.
Abortion has a long history and has been induced by various methods including herbal abortifacients, the
use of sharpened tools, physical trauma, and other traditional methods. Contemporary medicine utilizes
medications and surgical procedures to induce abortion. The legality, prevalence, and cultural views on
abortion vary substantially around the world. In many parts of the world there is prominent and divisive
public controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues
feature prominently in the national politics in many nations, often involving the opposing pro-life and
pro-choice worldwide social movements (both self-named). Incidence of abortion has declined
worldwide, as access to family planning education and contraceptive services has increased.

Types of Abortion

Spontaneous
(also known as miscarriage) is the expulsion of an embryo or fetus due to accidental trauma or
natural causes before approximately the 22nd week of gestation; the definition by gestational age varies
by country. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused
by environmental factors.

Induced
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly
upon the gestational age of the embryo or fetus, which increases in size as it ages. Specific procedures
may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for
procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is
medically referred to as therapeutic when it is performed to:
*Save the life of the pregnant woman;
*Preserve the woman's physical or mental health;
*Terminate pregnancy that would result in a child born with a congenital disorder that would be
fatal or associated with significant morbidity; or
*Selectively reduce the number of fetuses to lessen health risks associated with multiple
pregnancy.
An abortion is referred to as elective when it is performed at the request of the woman "for reasons other
than maternal health or fetal disease."

Methods of Abortion

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

Surgical
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method. Manual
vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta and membranes by
suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump.
These techniques are comparable, and differ in the mechanism used to apply suction, how early in
pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-
suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical
dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of
Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is
used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and
suction.

Other Methods
Historically, a number of herbs reputed to possess abortifacient properties have been used in folk
medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion). The
use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ
failure, and is not recommended by physicians.
Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can
cause serious internal injuries without necessarily succeeding in inducing miscarriage. Both accidental
and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast
Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the
bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an
abortion upon a woman who has been sent to the underworld.
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.
Health Risk

Physical Health
Surgical abortion methods, like most minimally invasive procedures, carry a small potential for
serious complications.
Surgical abortion is generally safe and the rate of major complications is low but varies depending on
how far pregnancy has progressed and the surgical method used. Concerning gestational age, incidence of
major complications is highest after 20 weeks of gestation and lowest before the 8th week.[48] With more
advanced gestation there is a higher risk of uterine perforation and retained products of conception,[49]
and specific procedures like dilation and evacuation may be required.
Concerning the methods used, general incidence of major complications for surgical abortion varies from
lower for suction curettage, to higher for saline instillation. Possible complications include hemorrhage,
incomplete abortion, uterine or pelvic infection, ongoing intrauterine pregnancy,
misdiagnosed/unrecognized ectopic pregnancy, hematometra (in the uterus), uterine perforation and
cervical laceration. Use of general anesthesia increases the risk of complications because it relaxes uterine
musculature making it easier to perforate.
Women who have uterine anomalies, leiomyomas or had previous difficult first-trimester abortion are
contraindicated to undertake surgical abortion unless ultrasonography is immediately available and the
surgeon is experienced in its intraoperative use. Abortion does not impair subsequent pregnancies, nor
does it increase the risk of future premature births, infertility, ectopic pregnancy, or miscarriage.[34]
In the first trimester, health risks associated with medical abortion are generally considered no greater
than for surgical abortion.

Mental Health
No scientific research has demonstrated that abortion is a cause of poor mental health in the
general population. However there are groups of women who may be at higher risk of coping with
problems and distress following abortion. Some factors in a woman's life, such as emotional attachment to
the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion
increase the likelihood of experiencing negative feelings after an abortion. The American Psychological
Association (APA) concluded that abortion does not lead to increased mental health problems.
Some proposed negative psychological effects of abortion have been referred to by anti-abortion
advocates as a separate condition called "post-abortion syndrome." However, the existence of "post-
abortion syndrome" is not recognized by any medical or psychological organization.
History of Abortion

Induced abortion can be traced to ancient times.There is evidence to suggest that, historically,
pregnancies were terminated through a number of methods, including the administration of abortifacient
herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques.
The Hippocratic Oath, the chief statement of medical ethics 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. 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.
During the Islamic Golden Age, physicians there documented detailed and extensive lists of birth control
practices, including[citation needed] the use of abortifacients, commenting on their effectiveness and
prevalence. They listed many different birth control substances in their medical encyclopedias, such as
Avicenna's list of twenty in The Canon of Medicine (1025 C.E.) and Muhammad ibn Zakariya ar-Razi's
list of 176 substances in his Hawi (10th century C.E.) This was "unparalleled in European medicine until
the 19th century".
During the Middle Ages, abortion was tolerated[where?] and there were no laws against it. [non-primary
source needed] A medieval female physician, Trotula of Salerno, administered a number of remedies for
the “retention of menstrua,” which was sometimes a code for early abortifacients. Pope Sixtus V (1585–
90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of 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[non-
primary source needed]
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. 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.

Society and Culture

Abortion Debate
In the history of abortion, induced abortion has been the source of considerable debate,
controversy, and activism. An individual's position on the complex ethical, moral, philosophical,
biological, and legal issues is often related to his or her value system. The main positions are one that
argues in favor of access to abortion and one argues against access to abortion. Opinions of abortion may
be described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical
scope, and proper extent of governmental authorities in public policy. 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 groups advocating one
of these two positions. In the United States, those in favor of greater legal restrictions on, or even
complete prohibition of abortion, most often describe themselves as pro-life while those against legal
restrictions on abortion describe themselves as pro-choice. Generally, the former position argues that a
human fetus is a human being with a right to live making abortion tantamount to murder. The latter
position argues that a woman has certain reproductive rights, especially the choice whether or not to carry
a pregnancy to term.
In both public and private debate, arguments presented in favor of or against abortion access focus on
either the moral permissibility of an induced abortion, or justification of laws permitting or restricting
abortion.
Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of
others in distinct cases: a minor, 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 legalized mandatory spousal notification; overall support was 72%
with 26% opposed.