Abortion
From Wikipedia, the free encyclopedia
Abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.[note 1]
An abortion can occur spontaneously, in which case it is usually called a miscarriage,
or it can be purposely induced. The term
abortion most commonly refers to the induced abortion of a human
pregnancy.
Abortion, when induced in the developed world
in accordance with local law, is among the safest procedures in medicine.[1]
However, unsafe abortions result in approximately 70,000 maternal deaths
and 5 million hospital admissions per year globally.[2]
An estimated 44 million abortions are performed globally each year, with
slightly under half of those performed unsafely.[3]
The incidence of abortion has stabilized in recent years,[3]
having previously spent decades declining as access to family planning
education and contraceptive services increased.[4]
Forty percent of the world's women have access to induced abortions (within
gestational limits).[5]
Induced abortion has a long history and has been facilitated 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, cultural and religious status of abortion vary substantially around
the world. Its legality can depend on specific conditions such as incest, rape, fetal defects, socioeconomic factors or the mother's health being at
risk. In many parts of the world there is prominent and divisive public controversy
over the ethical and legal issues of abortion.
Types
Induced
Approximately 205 million
pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[3][6]
Most abortions result from unintended pregnancies.[7][8]
A pregnancy can be intentionally aborted in several ways. The manner selected
often depends upon the gestational age
of the embryo or fetus, which increases in size as the pregnancy progresses.[9][10]
Specific procedures may also be selected due to legality, regional
availability, and doctor or patient preference.
Reasons for procuring induced
abortions are typically characterized as either therapeutic or elective. An
abortion is medically referred to as a therapeutic abortion when it is
performed to save the life of the pregnant woman; prevent harm to the woman's
physical or mental health; terminate a pregnancy where indications are that the
child will have a significantly increased chance of premature morbidity or
mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated
with multiple pregnancy.[11][12]
An abortion is referred to as an elective or voluntary abortion when it is
performed at the request of the woman for non-medical reasons.[12]
Confusion sometimes arises over the term "elective" because "elective surgery"
generally refers to all scheduled surgery, whether medically necessary or not.[13]
Spontaneous
Spontaneous abortion, also known as
miscarriage, is the unintentional expulsion of an embryo or fetus before the
24th week of gestation.[14]
A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth"
or a "preterm birth".[15]
When a fetus dies in utero after viability, or during delivery, it is
usually termed "stillborn".[16]
Premature births and stillbirths are generally not considered to be
miscarriages although usage of these terms can sometimes overlap.[17]
Only 30 to 50% of conceptions
progress past the first trimester.[18]
The vast majority of those that do not progress are lost before the woman is aware of the conception,[12]
and many pregnancies are lost before medical practitioners can detect an
embryo.[19]
Between 15% and 30% of known pregnancies end in clinically apparent
miscarriage, depending upon the age and health of the pregnant woman.[20]
The most common cause of spontaneous
abortion during the first trimester is chromosomal abnormalities of the embryo
or fetus,[12][21]
accounting for at least 50% of sampled early pregnancy losses.[22]
Other causes include vascular disease
(such as lupus), diabetes, other hormonal problems, infection, and abnormalities of
the uterus.[21]
Advancing maternal age and a patient history of previous spontaneous abortions
are the two leading factors associated with a greater risk of spontaneous
abortion.[22]
A spontaneous abortion can also be caused by accidental trauma;
intentional trauma or stress to cause miscarriage is considered induced
abortion or feticide.[23]
Methods
Medical
Medical abortions are those induced
by abortifacient pharmaceuticals. Medical abortion became an alternative
method of abortion with the availability of prostaglandin
analogs in the early 1970s and the antiprogestogen
mifepristone
in the 1980s.[24][25][26]
The most common early
first-trimester medical abortion regimens use mifepristone in combination with
a prostaglandin analog (misoprostol or gemeprost)
up to 9 weeks gestational age, methotrexate
in combination with a prostaglandin analog up to 7 weeks gestation, or a
prostaglandin analog alone.[24]
Mifepristone–misoprostol combination regimens work faster and are more
effective at later gestational ages than methotrexate–misoprostol combination
regimens, and combination regimens are more effective than misoprostol alone.[25]
This regime is effective in the second trimester.[27]
In very early abortions, up to 7
weeks gestation, medical abortion using a mifepristone–misoprostol combination
regimen is considered to be more effective than surgical abortion (vacuum
aspiration), especially when clinical practice does not include detailed
inspection of aspirated tissue.[28]
Early medical abortion regimens using mifepristone, followed 24–48 hours later
by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational
age.[29]
If medical abortion fails, surgical abortion must be used to complete the
procedure.[30]
Early medical abortions account for
the majority of abortions before 9 weeks gestation in Britain,[31][32]
France,[33]
Switzerland,[34]
and the Nordic countries.[35]
In the United States, the percentage of early medical abortions is far lower.[36][37]
Medical abortion regimens using
mifepristone in combination with a prostaglandin analog are the most common
methods used for second-trimester abortions in Canada, most of Europe, China
and India,[26]
in contrast to the United States where 96% of second-trimester abortions are
performed surgically by dilation and evacuation.[38]
Surgical
Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration
are the most common surgical methods of induced abortion.[39]
Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric
vacuum aspiration (EVA) uses an electric pump. These techniques differ in
the mechanism used to apply suction, in how early in pregnancy they can be
used, and in 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. Dilation and curettage (D&C), the second most common method of surgical
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.[40]
From the 15th week of gestation
until approximately the 26th, other techniques must be used. Dilation and evacuation (D&E) consists of opening the cervix of the uterus and emptying it using surgical instruments
and suction. Premature labor and delivery can be induced with prostaglandin;
this can be coupled with injecting the amniotic fluid
with hypertonic solutions containing saline or urea. After the 16th week of gestation, abortions can also 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.
In the third trimester of pregnancy,
abortion may be performed by IDX as described above, induction of labor, or by
hysterotomy. Hysterotomy abortion is a procedure similar to a caesarean section
and is performed under general anesthesia. It requires a smaller incision than a caesarean section
and is used during later stages of pregnancy.[41]
First-trimester procedures can
generally be performed using local anesthesia,
while second-trimester methods may require deep sedation
or general anesthesia.[37]
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).[42]
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.[43]
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.[44]
In Southeast Asia, there is an ancient tradition of attempting abortion through
forceful abdominal massage.[45]
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.[45]
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.[46]
Safety
The health risks of abortion depend
on whether the procedure is performed safely or unsafely. The World
Health Organization defines unsafe abortions
as those performed by unskilled individuals, with hazardous equipment, or in
unsanitary facilities.[47]
Legal abortions performed in the developed world
are among the safest procedures in medicine.[1][48]
In the US, the risk of maternal death
from abortion is 0.6 per 100,000 procedures, making abortion about 14 times
safer than childbirth (8.8 maternal deaths per 100,000 live births).[49][50]
The risk of abortion-related mortality increases with gestational age, but
remains lower than that of childbirth through at least 21 weeks' gestation.[51][52][53]
Vacuum aspiration in the first trimester is the safest method of surgical
abortion, and can be performed in a primary care office,
abortion clinic, or hospital. Complications are rare and can include uterine perforation, pelvic infection, and retained products of conception requiring a second
procedure to evacuate.[54]
Preventive antibiotics (such as doxycycline
or metronidazole) are typically given before elective abortion,[55]
as they are believed to substantially reduce the risk of postoperative uterine
infection.[37][56]
Complications after second-trimester abortion are similar to those after
first-trimester abortion, and depend somewhat on the method chosen.
There is little difference in terms
of safety and efficacy between medical abortion using a combined regimen of
mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early
first trimester abortions up to 9 weeks gestation.[28]
Medical abortion using the prostaglandin analog misoprostol alone is less
effective and more painful than medical abortion using a combined regimen of
mifepristone and misoprostol or surgical abortion.[57][58]
Some purported risks of abortion are
promoted primarily by anti-abortion groups, but lack scientific support.[59]
For example, the question of a link
between induced abortion and breast cancer
has been investigated extensively. Major medical and scientific bodies
(including the World
Health Organization, the US National
Cancer Institute, the American Cancer Society, the Royal College of Obstetricians and Gynaecologists and the American Congress of Obstetricians and Gynecologists) have concluded that abortion does not cause breast cancer,[60]
although such a link continues to be promoted by anti-abortion groups.[59]
Similarly, current scientific
evidence indicates that induced abortion does not
cause mental-health problems.[61][62]
The American
Psychological Association has
concluded that a single abortion is not a threat to women's mental health, and
that women are no more likely to have mental-health problems after a
first-trimester abortion than after carrying an unwanted pregnancy to term.[63][64]
Abortions performed after the first trimester because of fetal abnormalities
are not thought to cause mental-health problems.[65]
Some proposed negative psychological effects of abortion have been referred to
by anti-abortion advocates as a separate condition called "post-abortion syndrome", which is not recognized by any medical or
psychological organization.[66]
Unsafe
abortion
Women seeking to terminate their
pregnancies sometimes resort to unsafe methods, particularly when access to
legal abortion is restricted. They may attempt to self-abort or rely on another person who does not have proper medical
training or access to proper facilities. This has a tendency to lead to severe
complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.[67]
Unsafe abortions are a major cause
of injury and death among women worldwide. Although data are imprecise, it is
estimated that approximately 20 million unsafe abortions are performed
annually, with 97% taking place in developing countries.[1]
Unsafe abortion is believed to result in millions of injuries and approximately
68,000 deaths annually,[1][68]
accounting for 13% of all maternal deaths.[69]
Groups such as the World
Health Organization have advocated a public-health
approach to addressing unsafe abortion, emphasizing the legalization of
abortion, the training of medical personnel, and ensuring access to
reproductive-health services.[70]
The legality of abortion is one of
the main determinants of its safety. Countries with restrictive abortion laws
have significantly higher rates of unsafe abortion (and similar overall
abortion rates) compared to those where abortion is legal and available.[2][3][70][71][72][73]
For example, the 1996 legalization of abortion in South Africa
had an immediate positive impact on the frequency of abortion-related
complications,[74]
with abortion-related deaths dropping by more than 90%.[75]
In addition, a lack of access to effective contraception contributes to unsafe
abortion. It has been estimated that the incidence of unsafe abortion could be
reduced by up to 75% (from 20 million to 5 million annually) if modern family
planning and maternal health services were readily available globally.[76]
Forty percent of the world's women
are able to access therapeutic and elective abortions within gestational
limits,[5]
while an additional 35 percent have access to legal abortion if they meet
certain physical, mental, or socioeconomic criteria.[77]
While maternal mortality seldom results from safe abortions, unsafe abortions result
in 70,000 deaths and 5 million disabilities per year.[2]
Complications of unsafe abortion account for approximately an eighth of maternal mortalities
worldwide,[78]
though this varies by region.[79]
Secondary infertility caused by an unsafe abortion affects an estimated 24
million women.[72]
The rate of unsafe abortions has increased from 44% to 49% between 1995 and
2008.[3]
Health education, access to family planning, and improvements in health care
during and after abortion have been proposed to address this phenomenon.[80]
Incidence
There are two commonly used methods
of measuring the incidence of abortion:
- Abortion rate – number of abortions per 1000 women
between 15 and 44 years of age
- Abortion percentage – number of abortions out of 100
known pregnancies (pregnancies include live births, abortions and
miscarriages)
The number of abortions performed
worldwide has remained stable in recent years, with 41.6 million having
been performed in 2003 and 43.8 million having been performed in 2008.[3]
The abortion rate worldwide was 28 per 1000 women, though it was 24 per 1000
women for developed countries and 29 per 1000 women for developing countries.[3]
The same 2012 study indicated that in 2008, the estimated abortion percentage
of known pregnancies was at 21% worldwide, with 26% in developed countries and
20% in developing countries.[3]
On average, the incidence of
abortion is similar in countries with restrictive abortion laws and those with
more liberal access to abortion. However, restrictive abortion laws are
associated with increases in the percentage of abortions which are performed
unsafely.[5][81][82]
The unsafe abortion rate in developing countries is partly attributable to lack
of access to modern contraceptives; according to the Guttmacher Institute, providing access to contraceptives would result in about
14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe
abortion annually worldwide.[83]
The incidence of induced abortion
varies extensively worldwide. The ratio of induced abortion ranges from ten to
thirty percent; figures in the developing world vary widely and are often
incomplete.[84]
By
gestational age and method
Abortion rates also vary depending
on the stage of pregnancy and the method practiced. In 2003, the Centers
for Disease Control and Prevention
(CDC) reported that 26% of abortions in the United States were known to have been
obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 4.1%
at 16 through 20 weeks and 1.4% at more than 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).[85]
According to the CDC, due to data collection difficulties the data must be
viewed as tentative and some fetal deaths reported beyond 20 weeks may be
natural deaths erroneously classified as abortions if the removal of the fetus
is accomplished by the same procedure as an induced abortion.[86]
The Guttmacher Institute estimated there were 2,200 intact
dilation and extraction
procedures in the US during 2000; this accounts for 0.17% of the total number
of abortions performed that year.[87]
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.[88]
Later
abortions are more common in China, India,
and other developing countries than in developed countries.[89]
Personal
and social factors
The reasons why women have abortions
are diverse and vary dramatically across the world. Some of the most common
reasons are to postpone childbearing to a more suitable time or to focus
energies and resources on existing children. Others include being unable to
afford a child either in terms of the direct costs of raising a child or the
loss of income while she is caring for the child, lack of support from the
father, inability to afford additional children, desire to provide schooling
for existing children, disruption of one's own education, relationship problems
with their partner, a perception of being too young to have a child,
unemployment, and not being willing to raise a child conceived as a result of rape or incest, among others.[90][91]
An additional factor is risk to maternal or fetal health, which was cited as
the primary reason for abortion in over a third of cases in some countries and
as a significant factor in only a single-digit percentage of abortions in other
countries.[86][90]
An American study in 2002 concluded
that about half of women having abortions were using a form of contraception
at the time of becoming pregnant. Inconsistent use was reported by half of
those using condoms and
three-quarters of those using the birth-control
pill; 42% of those using condoms
reported failure through slipping or breakage.[92]
The Guttmacher Institute estimated that "most abortions in the United
States are obtained by minority women" because minority women "have
much higher rates of unintended pregnancy."[93]
Some abortions are undergone as the
result of societal pressures. These might include the preference for children
of a specific sex, disapproval of single or early motherhood, stigmatization of
people with disabilities, 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.
History
Induced abortion has long history,
and can be traced back to civilizations as varied as China under Shennong (c. 2700
BCE), Ancient Egypt with its Ebers Papyrus
(c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200
CE).[94]
There is evidence to suggest that 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.
Some medical scholars and abortion
opponents have suggested that the Hippocratic Oath
forbade Ancient Greek physicians from performing abortions;[94]
other scholars disagree with this interpretation,[94]
and note the medical texts of Hippocratic Corpus contain descriptions of abortive techniques.[95]
Aristotle,
in his treatise on government Politics (350 BCE), condemns infanticide as a means of population
control. He preferred abortion in such cases, with the restriction[96]
"[that it] must be practised on it before it has developed sensation and
life; for the line between lawful and unlawful abortion will be marked by the
fact of having sensation and being alive."[97]In
Christianity, Pope Sixtus V
(1585–90) is noted as the first Pope to declare that abortion is homicide
regardless of the stage of pregnancy;[98]
the Catholic Church had previously been divided on whether it believed that
abortion was murder, and did not begin vigorously opposing abortion until the
19th century.[94]
Islamic tradition has traditionally permitted abortion until a point in time
when Muslims believe the soul enters the fetus,[94]
considered by various theologians to be at conception, 40 days after
conception, 120 days after conception, or quickening.[99]
However, abortion is largely heavily restricted or forbidden in areas of high
Islamic faith such as the Middle
East and North Africa.[100]
In Europe and North America,
abortion techniques advanced starting in the 17th century. However, conservatism
by most physicians with regards to sexual matters prevented the wide expansion
of safe abortion techniques.[94]
Other medical practitioners in addition to some physicians advertised their
services, and they were not widely regulated until the 19th century, when the
practice was banned in both the United States and the United Kingdom.[94]
Church groups as well as physicians were highly influential in anti-abortion
movements.[94]
In the US, abortion was more dangerous than childbirth until about 1930 when
incremental improvements in abortion procedures relative to childbirth made
abortion safer.[note 2]
The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first
countries to legalize certain or all forms of abortion.[101]
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.[102]
Beginning in the second half of the twentieth century, abortion was legalized
in a greater number of countries.[94]
Society
and culture
Abortion
debate
Induced abortion has long been the
source of considerable debate, controversy, and activism. An individual's
position concerning the complex ethical, moral, philosophical, biological, and
legal issues which surround abortion is often related to his or her value system.
Opinions of abortion may be described as being a combination of beliefs about
abortion's morality the proper extent of governmental authority in public
policy; and on the rights and responsibilities of the woman seeking to have an
abortion. Religious ethics also has an influence on both personal opinion and the greater debate over
abortion.
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. Abortion debates, especially pertaining to abortion laws,
are often spearheaded by groups advocating one of these two positions.
Anti-abortion groups who favor greater legal restrictions on abortion,
including complete prohibition, most often describe themselves as
"pro-life" while abortion rights groups who are against such legal
restrictions 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 morally the same as murder. The latter position argues that a woman
has certain reproductive rights, especially the choice whether or not to carry a pregnancy
to term.
Modern
abortion law
Legal on request
Legal for rape, maternal life, health, mental health,
socioeconomic factors, and/or fetal defects
Illegal with exception for rape, maternal life,
health, mental health, and/or fetal defects
Illegal with exception for rape, maternal life,
health, and/or mental health
Illegal with exception for maternal life, health,
and/or mental health
Illegal with no exceptions
Varies
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 health are major issues of human rights that are sometimes used as
justification for the existence or absence of laws controlling abortion.
In jurisdictions where abortion is
legal, certain requirements must often be met before a woman may obtain a safe,
legal abortion (an abortion performed without the woman's consent is considered
feticide). These
requirements usually depend the age of the fetus, often using a trimester-based
system to regulate the window of legality. Some jurisdictions require a 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.[105]
Other jurisdictions may require that a woman obtain the consent of
the fetus' father before aborting the fetus, that
abortion providers inform patients of health risks of the procedure—sometimes
including "risks" not supported by the medical literature—and that
multiple medical authorities certify that the abortion is either medically or
socially necessary. Many restrictions are waived in emergency situations.
Other jurisdictions ban abortion
almost entirely. Many, but not all, of these allow legal abortions in a variety
of circumstances. These circumstances vary based on jurisdiction, but may
include whether the pregnancy is a result of rape or incest, the fetus'
development is impaired, the woman's physical or mental well-being is
endangered, or socioeconomic considerations make childbirth a hardship.[77]
In countries where abortion is banned entirely, such as Nicaragua, medical authorities have recorded rises in maternal death
directly and indirectly due to pregnancy as well as deaths due to doctors'
fears of prosecution if they treat other gynecological emergencies.[106][107]
Some countries, such as Bangladesh, that nominally ban abortion, may also
support clinics that perform abortions under the guise of menstrual hygiene.[108]
This is also a terminology in traditional medicine.[109]
In places where abortion is illegal or carries heavy social stigma, pregnant
women may engage in medical tourism
and travel to countries where they can terminate their pregnancies.[110]
Women without the means to travel can resort to providers of illegal abortions
or attempt to perform an abortion by themselves.[111]
Emergency contraception is generally available in countries that have not
restricted abortion and is also sometimes available in countries that have
otherwise banned abortion, such as Chile.[112][113]
This has caused controversy, as some anti-abortion groups assert that certain
forms of emergency contraception are not contraceptives
but abortifacients (See, e.g., Abortion
in the Dominican Republic.)
Sex-selective
abortion
Sonography and amniocentesis
allow parents to determine sex before childbirth. The development of this
technology has led to sex-selective
abortion, or the termination of a fetus
based on sex. The selective termination of a female fetus is most common.
Sex-selective abortion is partially
responsible for the noticeable disparities between the birth rates of male and
female children in some countries. The preference for male children is reported
in many areas of Asia, and abortion used to limit female births has been
reported in Taiwan, South Korea, India, and China.[114]
This deviation from the standard birth rates of males and females occurs
despite the fact that the country in question may have officially banned
sex-selective abortion or even sex-screening.[115][116][117][118]
In China, a historical preference for a male child has been exacerbated by the one-child policy,
which was enacted in 1979.[119]
Many countries have taken
legislative steps to reduce the incidence of sex-selective abortion. At the International Conference on Population and Development in 1994 over 180 states agreed to eliminate "all forms
of discrimination against the girl child and the root causes of son
preference",[120]
which was also condemned by a PACE resolution in 2011.[121]
The World
Health Organization and UNICEF, along with other United Nations
agencies, have found that measures to reduce access to abortion are much less
effective at reducing sex-selective abortions than measures to reduce gender
inequality.[120]
Anti-abortion
violence
In a number of cases, abortion
providers and these facilities have been subjected to various forms of
violence, including murder, attempted murder, kidnapping, stalking, assault,
arson, and bombing. Anti-abortion violence is classified by both governmental
and scholarly sources as terrorism.[122][123]
Only a small fraction of those opposed to abortion commit violence, often
rationalizing their actions as justifiable homicide or defense of others, committed in order to protect the lives of fetuses.
Invasion of privacy and stalking of doctors, clinic workers, and patients, even
by police officers, is similarly justified.[124]
In the United States, four
physicians who performed abortions have been murdered: David Gunn (1993), John Britton (1994), Barnett Slepian
(1998), and George Tiller (2009). Also murdered, in the U.S. and Australia, have been
other personnel at abortion clinics, including receptionists and security
guards such as James Barrett, Shannon Lowney, Lee Ann Nichols, and Robert
Sanderson. Woundings (e.g., Garson Romalis)
and attempted murders have also taken place in the United States and Canada,
Hundreds of bombings, arsons, acid attacks, invasions, and incidents of
vandalism against abortion providers have also occurred.[125][126]
Notable perpetrators of anti-abortion violence include Eric Robert Rudolph, Scott Roeder, Shelley Shannon,
and Paul Jennings Hill, the first person to be executed in the United States for
murdering an abortion provider.[127]
Legal
protection of access to abortion
has been brought into some countries where abortion is legal. These laws
typically seek to protect abortion clinics from obstruction, vandalism,
picketing, and other actions, or to protect patients and employees of such
facilities from threats and harassment.
Art,
literature and film
Art serves to humanize the abortion
issue and illustrates the myriad of decisions and consequences it has. One of
the earliest known representations of abortion is in a bas relief
at Angkor Wat
(c. 1150). Anti-abortion activist Børre Knudsen
was linked to a 1994 art theft as part of an anti-abortion drive in Norway surrounding the 1994 Winter Olympics.[129]
A Swiss gallery
removed a piece from a Chinese art collection in 2005, that had the head of a
fetus attached to the body of a bird.[130]
In 2008, a Yale
student proposed using aborted excretions
and the induced abortion itself as a performance art project.[131]
The Cider
House Rules (novel 1985, film 1999) follows the
story of Dr. Larch an orphanage director who is a reluctant abortionist after
seeing the consequences of back-alley abortions, and his orphan medical
assistant Homer who is against abortion.[132]
Feminist novels such as Braided Lives (1997) by Marge Piercy emphasize
the struggles women had in dealing with unsafe abortion in various
circumstances prior to legalization.[133]
Physician Susan Wicklund wrote This Common Secret (2007) about how a personal
traumatic abortion experience hardened her resolve to provide compassionate
care to women who decide to have an abortion. As Wicklund crisscrosses the West
to provide abortion services to remote clinics, she tells the stories of women she's
treated and the sacrifices she and her loved ones made.[134]
In 2009, Irene Vilar revealed her past abuse and addiction to abortion in Impossible
Motherhood, where she aborted 15 pregnancies
in 17 years. According to Vilar it was the result of a dark psychological cycle
of power, rebellion and societal expectations.[135]
In Annie Finch's
mythic epic poem and opera libretto Among the Goddesses (2010), the
heroine's abortion is contextualized spiritually by the goddesses Demeter, Kali, and Inanna.[136]
Various options and realities of
abortion have been dramatized in film. In Riding in
Cars with Boys (2001) an underage woman carries
her pregnancy to term as abortion is not an affordable option, moves in with
the father and finds herself involved with drugs, has no opportunities, and
questioning if she loves her child. In Juno (2007) a
16-year-old initially goes to have an abortion but decides to bear the child
and allow a wealthy couple to adopt it. The films Dirty Dancing
(1987) and If These
Walls Could Talk (1996) explore the availability,
affordability and dangers of illegal abortions. The emotional impact of dealing
with an unwanted pregnancy alone is the focus of Things You Can Tell Just By
Looking at Her (2000) and Circle
of Friends (1995). In The
Godfather Part II (1974) Kay informed Michael Corleone that she had obtained an abortion
without his knowledge nor consent.[137]
On the abortion debate, an irresponsible drug addict is used as a pawn in a
power struggle between abortion rights and anti-abortion groups in Citizen Ruth
(1996).[138]
The Law & Order television episode "Dignity" deals with the trial of a man who killed a late-term
abortion doctor; the storyline was inspired by the assassination of abortion provider George Tiller.[139]
In
other animals
Spontaneous abortion occurs in
various animals. For example, in sheep, it may be caused by crowding through
doors, or being chased by dogs.[140]
In cows, abortion may be caused by contagious disease, such as Brucellosis
or Campylobacter, but can often be controlled by vaccination.[141]
Eating pine needles can also induce abortions in cows.[142][143]
In horses, a fetus may be aborted or resorbed if it has Lethal white syndrome (congenital intestinal aganglionosis). Foal embryos that
are homozygous for the dominant white gene (WW) are often resorbed before
birth.[144]
Viral infection can cause abortion
in dogs.[145]
Cats can experience spontaneous abortion for many reasons, including hormonal
imbalance. A combined abortion and spaying is performed on pregnant cats,
especially in Trap-Neuter-Return programs, to prevent unwanted kittens from being born.[146][147][148]
Abortion may also be induced in
animals, in the context of animal husbandry.
For example, abortion may be induced in mares that have been mated improperly,
or that have been purchased by owners who did not realize the mares were
pregnant, or that are pregnant with twin foals.[149]
Feticide can occur
in horses and zebras due to male harassment of pregnant mares or forced
copulation,[150][151][152]
although the frequency in the wild has been questioned.[153]
Male gray langur monkeys may attack females following male takeover, causing
miscarriage.[154]
The entire article, with images and references, can be found
at:
http://en.wikipedia.org/wiki/Abortion
No comments:
Post a Comment