سقط جنین (به انگلیسی: Abortion) به معنی از دست رفتن محصول حاملگی (جنین یا رویان) قبل از هفته ۲۰ بارداری است ولی پزشکان بیشتر از این اصطلاحات برای توصیف هر نوع ختم حاملگی در سه‌ماهه اول بارداری استفاده می‌کنند.
سقط جنین، به معنای پایان یافتن بارداری در هر مرحله‌ای است که زندگی نوزاد در جریان است، اگرچه غالباً به لحاظ فنی و تخصصی، خاتمه یافتن بارداری به واسطهٔ جراحی یا خارج کردن جنین یا رویان از رحم (پیش از آنکه قادر به ادامه حیات باشد) را سقط جنین می‌گویند. مرگ جنین اگر به صورت خود به خود رخ می‌دهد به آن سقط خودبه‌خودی (ناخواسته) (به انگلیسی: Miscarriage) گفته می‌شود.
در کشورهای توسعه یافته، مدت مدیدی است که سقط جنین خود خواسته و قانونی به لحاظ پزشکی از امن‌ترین فرایندها محسوب می‌شود.[۱] با این حال سقط جنین ناسالم (که توسط فرد، بدون آموزش مناسب یا خارج از محیط‌های پزشکی انجام می‌شود) سالانه حدود ۷۰ هزار مرگ مادر و ۵ میلیون معلول، در سطح جهان به جا می‌گذارد.[۲] سالانه حدود ۴۲ میلیون سقط جنین انجام می‌شود که تخمین زده شده‌است که ۲۰ میلیون از آن‌ها به شکلی ناسالم انجام شده‌است.[۲] چهل درصد زنان حاملهٔ جهان از داشتن امکانات درمانی و حق انتخاب برای سقط جنین محروم هستند.[۳] سقط جنین عمدی (خواسته) دارای سابقهٔ تاریخی طولانی است و توسط روش‌های مختلفی چون سقط‌کننده‌های گیاهی، استفاده از ابزار تیز، آسیب جسمانی، و دیگر روش‌های سنتی انجام می‌شده‌است. علم پزشکی معاصر با بهره‌گیری از داروها و روش‌های جراحی، سقط جنین را راحت کرده‌است. قانونی بودن، همه‌گیر بودن، وضعیت فرهنگی، و وضعیت مذهبی در نوع نگاه به سقط جنین، تفاوت قابل ملاحظه‌ای ایجاد می‌کند. در بسیاری از نقاط جهان، بحث‌های جنجالی بر سرِ قانونی و اخلاقی بودن، سقط جنین وجود دارد. از آنجایی که دسترسی به آموزش و خدمات تنظیم خانواده برای پیشگیری از بارداری در سراسر جهان، در حال افزایش است، سقط جنین به‌طور گسترده‌ای در حال کاهش است.[۴]
سقط جنین خود خواسته دارای سابقهٔ طولانی‌ای می‌باشد و می‌توان رده‌هایی از آن را در تمدن‌های مختلفی چون چین در زمان شننونگ (۲۷۰۰ قبل از میلادی)، مصر باستان در زمان ابری‌های پاپیروس (۱۵۵۰ قبل از میلاد) و امپراطوری روم در زمان جوونال (۲۰۰ قبل از میلاد) یافت.[۵] شواهد نشان می‌دهد که سقط جنین از طریق روش‌هایی چون گیاهان، ادوات تیز، استفاده از فشارهای شکمی و روش‌های دیگر انجام می‌شده‌است.
برخی از محققان پزشکی و مخالفان سقط جنین خاطر نشان می‌کنند که سوگند دانشجویان پزشکی در یونان باستان، آن‌ها را از انجام سقط جنین منع می‌کرده‌است.[۵] با این حال دسته‌ای دیگر از پژوهشگران با این تفسیر مخالفند[۵] متون پزشکی مربوط به طب بقراط، حاوی شرح روش‌های نافرجام و یادداشت‌هایی مربوط به خطرات ناشی از سقط جنینِ ناامن است.[۶] در مسیحیت، پاپ (۹۰–۱۵۸۵) به عنوان اولین پاپ اشاره کرد که سقط جنین بدون در نظر گرفتن اینکه در چه مرحله‌ای از حاملگی باشد، قتل محسوب می‌شود.[۷] کلیسا قبلاً بر سر اینکه آیا سقط جنین قتل محسوب می‌شود یا نه، مجزا شده بود و مخالفت با سقط جنین تا قرن ۱۹، به‌طور سرسختانه‌ای ادامه داشت.[۸] سقط جنین در اسلام تا زمانی مجاز است که به اعتقاد مسلمانان روح در جنین دمیده نشده باشد.[۹] در زمانِ دمیده شدن روح در جنین، بین متکلمان اختلاف وجود دارد، عده‌ای معتقدند این زمان ۴۰ روز بعد از لقاح است و عده‌ای دیگر این زمان را ۱۲۰ روز بعد از لقاح در نظر گرفته‌اند.[۹] با این حال سقط جنین عمدتاً در مناطق اسلامی با اعتقاد بالا همچون محدودهٔ خاورمیانه و شمال آفریقا، به‌شدت محدود می‌شود یا اینکه ممنوع است.
پیشرفت تکنیک‌های سقط جنین در اروپا و آمریکا، از قرن ۱۷میلادی آغاز شد. با این وجود، محافظه‌کاری اغلب پزشکان در رابطه با مسایل جنسی، از گسترش وسیع تکنیک‌های امن سقط جنین جلوگیری به عمل آورد.[۸] برخی پزشکان به تبلیغ خدمات خود دست زدند و فعالیت‌های آنان تا قرن ۱۹ یعنی زمانی که سقط جنین هم در آمریکا و هم در بریتانیا ممنوع شد، تحت کنترل و نظارت گسترده قرار نداشت.[۱۰] گروه‌های مرتبط با کلیسا و نیز پزشکان در جنبش‌های ضدِ سقطِ جنین شدیداً تأثیرگذار بوده‌اند.[۸] در آمریکا، تا حدود ۱۹۳۰سقط جنین از زایمان به مراتب خطرناک‌تر بود، در این زمان بهبود فزاینده شیوه‌های سقط جنین نسبت به زایمان، موجب امن‌تر شدن سقط جنین می‌شد[یادداشت۴]. اتحاد جماهیر شوروی (۱۹۱۹)، ایسلند (۱۹۳۵) و سوئد (۱۹۳۸) از اولین کشورهایی بودند که برخی یا همه اشکال سقط جنین را قانونی کردند.[۱۱] در آلمانِ نازیِ ۱۹۳۵، قانونی تصویب شد که به موجب آن سقط جنین برای کسانی که «به‌طور ارثی بیمار» تلقی می‌شدند، مجاز شمرده می‌شد، در حالیکه زنانی که به نژاد آلمان تعلق داشتند، به ویژه، از سقط جنین منع می‌شدند.[۱۲]
هرسال در جهان حدود ۲۰۵ میلیون بارداری اتفاق می‌افتد. بیش از یک سوم آن‌ها ناخواسته هستند و در حدود یک پنجم به سقط جنین عمدی ختم می‌شوند.[۱۳] بیشتر سقط‌ها ناشی از بارداری‌های ناخواسته می‌باشند.[۱۴] یک بارداری می‌تواند به‌طور خودخواسته به شیوه‌های گوناگون به سقط جنین بینجامد. شیوهٔ انتخاب شده معمولاً به سن رویان یا جنین وابسته‌است،[۱۵] که اندازه‌اش در جریان بارداری رشد می‌کند.[۱۶] همچنین ممکن است روش‌های ویژه‌ای با توجه به قانون، دسترس پذیری در منطقه، و ترجیح پزشک یا بیمار انتخاب گردد.
دلایل انجام سقط‌های عمدی:
درمانی سقط در پزشکی هنگامی درمانی گفته می‌شود که برای حفظ جان زن باردار، پیشگیری از آسیب به سلامت جسمی یا روحیِ زن، دلالت نشانه‌ها بر بالا بودن احتمال ابتلای جنین به بیماری یا مرگ پیش‌رس یا معلولیت، یا کاهش انتخابی تعداد جنین‌ها به منظور پایین آوردن احتمال خطر برای سلامت جنین در بارداری‌های چندگانه انجام شود.[۱۶]
انتخابی سقط انتخابی یا داوطلبانه سقطی است که بنا به خواستِ زن به دلایل غیرپزشکی به دست خود یا دیگری انجام شده باشد.[۱۷]
سقط جنین ناخواسته یا غیرعمدی، خروج ناخواسته رویان یا جنین پیش از هفتهٔ بیستم تا بیست و دوم بارداری است∗. چنانچه بارداری پیش از سی و هفت هفته خاتمه یابد و منجر به تولد نوزادی زنده گردد، «تولد زودرس»∗ یا «پیش از موعد»∗ تلقی می‌شود.[۱۸] جنینی که پس از حیات یافتن، در رحم یا در زمان وضع حمل بمیرد، عموماً با اصطلاح «جنین مرده به دنیا آمد»∗ شناخته می‌شود.[۱۹] تولد پیش از موعد و زایمانِ جنین مرده، عموماً سقط جنین تلقی نمی‌شوند، اگرچه استفاده از این اصطلاحات گاهی با یک‌دیگر هم‌پوشانی پیدا می‌کند.
تنها۳۰ تا ۵۰ ٪ از لقاح‌ها، سه‌ماهه اول را با موفقیت پشت سر می‌گذارند،[۲۰] حجم قابل توجهی از آن دسته از لقاح‌ها که به ثمر نمی‌رسند، پیش از آنکه زن از عمل لقاح مطلع شده باشد، از بین می‌روند[۲۱] و بسیاری از بارداری‌ها پیش از آنکه پزشکان توانایی تشخیص رویان را داشته باشند خاتمه می‌یابند.[۲۲] در بررسی از حداقل ۵۰ ٪ از بارداری‌های زود خاتمه یافته، شایع‌ترین دلیل سقط جنینِ غیرعمدی در طول سه‌ماهه اول بارداری، اختلالات کروموزومی است[۱۰][۱۶]، از جمله سایر دلایل می‌توان به بیماری‌های عروقی (همچون لوپوس)، دیابت، سایر مشکلات هورمونی، عفونت و اختلالات رحمی اشاره کرد.[۲۳] بالا رفتن سن مادری و سابقه بیمار در سقط غیرعمدی جنین، به عنوان دو عامل اساسی مرتبط با افزایشِ ریسکِ سقطِ غیرعمدی شناخته می‌شوند.[۲۴] سقط جنین غیرعمدی، همچنین ممکن است در نتیجه تروما یا ضربه اتفاقی نیز رخ دهد.[۲۵]
خطرات بهداشتی سقط جنین بستگی به این دارد که آیا روش انجام، بدون خطر یا غیربهداشتی است. سازمان جهانی بهداشت سقط جنین ناامن را روشی تعریف می‌کند که افراد غیر ماهر، با وسایل خطرناک یا در مراکز غیر بهداشتی انجام می‌دهند.[۲۶] سقط جنینی که در کشورهای توسعه یافته مطابق با قوانین انجام می‌شود، جزو کم خطرترین عمل‌های پزشکی است.[۲۷] در ایالات متحده، خطر مرگ مادران از سقط جنین ۰٫۵۶ در هر صدهزار سقط جنین است و حدود ۱۲٫۵ بار امن تر از زایمان (۷٫۰۶ مرگ و میر مادران در هر صدهزار تولد زنده) می‌باشد.[۲۸] خطر مرگ و میر مرتبط با سقط جنین با افزایش سن حاملگی افزایش می‌یابد، اما هنوز پایین‌تر از زایمان در ۲۱ هفتگی حاملگی است.[۲۹][۳۰]
آسپیراسیون خلاء∗ در سه‌ماهه اول امن‌ترین روش سقط جراحی است و می‌تواند در یک مطب مراقبت‌های اولیه، کلینیک سقط جنین، یا بیمارستان انجام شود. عوارض نادر هستند و می‌تواند سوراخ شدگی رحم، عفونت لگن خاصره، ماندن جفت و نیاز به تخلیه مجدد باشد.[۳۱]آنتی‌بیوتیک پیشگیرانه (مانند داکسی سیکلین یا مترونیدازول) به‌طور معمول قبل از سقط جنین انتخابی داده می‌شود،[۳۲] چون اعتقاد بر این است که به‌طور قابل ملاحظه‌ای خطر عفونت پس از عمل رحم را کاهش می‌دهد.[۳۳] عوارض پس از سقط سه‌ماهه دوم شبیه به عوارض افرادی است که بعد از سه‌ماهه اول سقط می‌کنند و تا حدودی به روش انتخاب شده بستگی دارد.
اتساع و تخلیه∗ بررسی کتابخانه‌ای کوکران در سال ۲۰۰۸ نشان داد که اتساع و تخلیه از روش‌های دیگر سقط در سه‌ماهه دوم امن‌تر بود.[۳۴]
سقط دارویی سقط دارویی با میفه پریستون و میزوپروستول پس از ۴۹ روز از سن حاملگی مؤثر است.[۳۵] در زنان تا ۶۳ روز پس از سن حاملگی استفاده شده‌است، البته با افزایش خطر عدم موفقیت (با نیاز به سقط جنین جراحی)[۳۶] سقط جنین دارویی به اندازه سقط جنین جراحی در سه‌ماهه اول، امن است، اما همراه با درد بیشتر و موفقیت کمتر است.[۳۷] به به‌طور کلی، خطر عفونت رحم، به روش دارویی از سقط جراحی کمتر است،[۳۸] هر چند در سال ۲۰۰۵ چهار مورد مرگ و میر پس از سقط‌های دارویی، ناشی از عفونت با کلستریدیوم سوردلی گزارش شده‌است.[۳۹] پس از این، برخی از ارائه دهندگان سقط جنین استفاده از آنتی‌بیوتیک پیشگیرانه را همراه با سقط دارویی شروع کرده‌اند.[۴۰]
سقط جنین ناامن علت عمده‌ای از آسیب و مرگ در میان زنان در سراسر جهان است. اگر چه داده‌ها مبهم هستند، تخمین زده می‌شود که سالانه حدود ۲۰ میلیون سقط جنین نا امن انجام می‌شوند، که ۹۷ ٪ آن در کشورهای در حال توسعه رخ می‌دهد.[۱] نتیجه سقط جنین غیربهداشتی، سالانه حدود ۶۸۰۰۰ مرگ و میر[۴۱] و میلیون‌ها آسیب است.[۴۲] اعتقاد بر این است که شرایط قانونی سقط جنین نقش عمده‌ای در میزان سقط جنین ناامن دارد.[۴۳][۴۴] به عنوان مثال، در سال ۱۹۹۶ قانونی کردن سقط جنین در آفریقای جنوبی تأثیر مثبت و فوری، حدود ۹۰ درصد کاهش، در میزان عوارض مرتبط با سقط جنین،[۴۵] و مرگ و میر ناشی از سقط جنین داشت.[۴۶] سازمان بهداشت جهانی با تأکید بر قانونی کردن سقط جنین، آموزش پرسنل پزشکی، و حصول اطمینان از دسترسی به خدمات بهداشت باروری از رویکرد سلامت عمومی حمایت می‌کند.[۴۴]
برخی مطالعات ارتباط بین سقط و سرطان پستان را نشان داده‌اند.[۴۷] طرفداران ارتباط علیتی بین این دو معتقدند که وقفه در رشد طبیعی پستان در دوران بارداری سلول‌های نابالغی را ایجاد می‌کند که بیشتر مستعد سرطان در سینه‌است. با این حال، جامعه علمی پس از بررسی شواهد و تحقیقات دقیق نتیجه گرفته‌است که چنین ارتباطی وجود ندارد. نهادهای مهم پزشکی، از جمله سازمان بهداشت جهانی، مؤسسه ملی سرطان ایالات متحده، انجمن سرطان و… همه به این نتیجه رسیدند که سقط جنین، سرطان پستان ایجاد نمی‌کند.[۴۸] مفهوم یک ارتباط علیتی بین سقط جنین عمدی و سرطان پستان در حال حاضر عمدتاً توسط گروه‌های طرفدار زندگی ترویج می‌شود.[۴۷]
توافق کنونی علمی بر آن است که هیچ رابطه علت و معلولی بین سقط جنین و مشکلات سلامت روانی وجود ندارد. انجمن روانشناسی آمریکا بر اساس شواهد علمی موجود، به این نتیجه رسیده‌است که یک مرتبه سقط جنین تهدیدی برای بهداشت روانی زنان نیست، و مشکلات سلامت روانی در این زنان بعد از سقط در سه‌ماهه اول بیشتر از مشکلات پس از حاملگی ناخواسته نیست.[۴۹][۵۰]
برخی مطالعات با نتیجه‌گیری فوق مخالف است، و معتقد است که افزایش قابل توجهی در مشکلات روحی و روانی پس از سقط وجود دارد. با این حال، این مطالعات به دلیل نادیده گرفتن سابقه اختلالات روانی، شدت یا عدم هرگونه از این اختلالات، یا انتخاب نادرست گروه‌های شاهد به دلیل نادیده گرفتن متغیرهای مداخله گر در آن‌ها از سوی پژوهشگران و سازمان‌های حرفه‌ای مورد انتقاد قرارگرفته‌اند.
تعداد سقط جنین انجام شده در سراسر جهان بین سال‌های ۱۹۹۵ و ۲۰۰۳ از ۴۵ میلیون به ۴۱ میلیون نفر کاهش یافته‌است، که به معنی کاهش در میزان سقط جنین از ۳۵ به ۲۹ در هر ۱۰۰۰ زن است. بیشترین کاهش در کشورهای توسعه یافته با کاهشی از ۳۹ به ۲۶ در هر ۱۰۰۰ زن در مقایسه با کشورهای در حال توسعه، که کاهشی از ۳۴ به ۲۹ در هر ۱۰۰۰ زن رخ داده‌است. از مجموع حدود ۴۲ میلیون سقط جنین، ۲۲ میلیون ایمن رخ داده‌است و ۲۰ میلیون مخفیانه و غیربهداشتی است.[۲]
به‌طور میانگین، فراوانی سقط جنین در کشورهای در حال توسعه (که در آن سقط جنین به‌طور کلی محدود است) به فراوانی در کشورهای توسعه یافته (که در آن سقط جنین به‌طور کلی بسیار کمتر محدود است) شباهت دارد.[۵۱][۵۲]اندازه‌گیری میزان سقط جنین در مکان‌هایی که سقط جنین در آن‌ها غیرقانونی هستند، بسیار دشوار است به عقیده مؤسسه گات ماچر و صندوق جمعیت سازمان ملل متحد، میزان سقط جنین در کشورهای در حال توسعه تا حد زیادی به علت عدم دسترسی به روش‌های ضدبارداری مدرن می‌باشد؛ با فرض هیچ تغییری در قوانین سقط جنین، با دسترسی به روش‌های ضدبارداری سالانه حدود ۲۵ میلیون سقط جنین کمتر رخ می‌دهد، از جمله تقریباً ۱۵ میلیون کمتر سقط جنین ناامن.[۵۳]
بروز سقط جنین عمدی به صورت منطقه‌ای متفاوت است. برخی از کشورها، از جمله بلژیک (۱۱٫۲ از ۱۰۰ حاملگی شناخته شده) و هلند (۱۰٫۶ در ۱۰۰)، نسبت پایینی از سقط جنین عمدی داشته‌اند. برخی دیگر مانند روسیه (۶۲٫۶ از ۱۰۰) رومانی (۶۳ از ۱۰۰)[۵۴] و ویتنام (۴۳٫۷ از ۱۰۰) نسبتی بالا داشته‌اند (داده‌های سه کشور اخیر کاملاً مجهول است). نسبت جهانی تخمین زده شده ۲۶ درصد بود، میزان جهانی—۳۵ در هر ۱۰۰۰ زن.[۵۵]
به تازگی یک پژوهش نشان داده‌است که میزان انجامِ سقط‌جنین در کشورهای مختلف، صرف‌نظر از اینکه در آن‌ها سقط‌جنین امری قانونی است یا نه یکسان است. تفاوت عمده بین کشورهایی که سقط در آن‌ها قانونی است و کشورهایی که سقط در آن‌ها به شدت ممنوع است در این است که در کشورهای دستهٔ اول، سقط‌جنین در شرایطی از نظر پزشکی ایمن و بی‌خطر صورت می‌گیرد در حالیکه در کشورهای دستهٔ دوم که سقط امری غیرقانونی است معمولاً این عمل در شرایطی از نظر پزشکی ناایمن صورت می‌گیرد. این در حالی‌ست که سالانه ده‌ها هزار زن، به دلیلِ دشواری‌ها و مشکلاتِ ناشی از سقط‌های انجام‌شده به روشِ ناایمن و غیربهداشتی جان خود را از دست می‌دهند.[۵۶]
میزان انجام سقط‌جنین با میزان دسترسی به روش‌های کنترلِ بارداریِ کارآمد «همبستگی» دارد، به شکلی که هرچه در کشوری ابزارهای کنترل بارداری کمتر در دسترس باشد، میزانِ انجام سقط‌جنین بالاتر است. همان‌طور که در یک مقاله عنوان شده‌است، «سریع‌ترین راه برای کاهشِ میزانِ سقط‌جنین، فراهم‌کردنِ ابزارهای پیشگیری از بارداریِ قابل اعتماد است.»[۵۶]
براساس آمار جهانی میزان شیوع سقط مکرر جنین ۳ تا ۴ درصد کل بارداری‌ها است. سقط مکرر علل مختلفی دارد که از جمله آن‌ها می‌توان به عوامل ژنتیکی اشاره کرد که عامل بروز ۵ تا ۱۰ درصد سقط‌های مکرر و ۶۰ تا ۷۰ درصد کل سقط‌ها در جهان محسوب می‌شود.[۵۷]
میزان سقط جنین به مرحله بارداری و روش انجام آن بستگی دارد. در سال ۲۰۰۳، مراکز کنترل و پیشگیری بیماری (CDC) گزارش کرد که ۲۶ ٪ از سقط جنین‌ها در حاملگی کمتر از ۶ هفته، ۱۸ درصد در ۷ هفته، ۱۵ درصد در ۸ هفته، ۴٫۱ درصد در ۱۶ … تا۲۰ هفته و ۱٫۴ ٪ در بیش از ۲۱ هفته رخ داده‌است. ۹۰٫۹ ٪ از سقط‌ها از طریق «کورتاژ» (مکش- آسپیراسیون، اتساع و کورتاژ، اتساع و تخلیه)، ۷٫۷ ٪ به وسیلهٔ دارو (میفه پریستون)، ۰٫۴ ٪ با «تزریق داخل رحمی» (محلول نمکی یا پروستاگلندین)، و ۱٫۰ ٪ از طریق «روش‌های دیگر» (از جمله سزارین و هیسترکتومی) انجام شده‌است.[۵۸] طبق نظر CDC، با توجه به مشکلات جمع‌آوری اطلاعات، داده‌ها باید به صورت تجربی مشاهده گردند و برخی از مرگ و میرهای جنین در بیش از ۲۰ هفتگی ممکن است مرگ و میر طبیعی باشند که به خاطر خارج نمودن جنین با همان روش سقط جنین عمدی[۵۹] به اشتباه تحت عنوان سقط جنین گزارش شده‌اند.
مؤسسه گات ماچر ۲۲۰۰ مورد اتساع کامل و تخلیه مکشی را طی سال ۲۰۰۰ در ایالات متحده برآورد کرده‌است، این تعداد ۰٫۱۷ ٪ از تعداد کل سقط جنین انجام شده در آن سال است.[۶۰] به‌طور مشابه در انگلستان و ولز در سال ۲۰۰۶، ۸۹ درصد از سقط‌ها در ۱۲ هفتگی یا کمتر از آن، ۹ درصد بین ۱۳ تا ۱۹ هفتگی، و ۱٫۵ ٪ در بیش از ۲۰ هفتگی بارداری انجام شده‌است. ۶۴ ٪ از سقط‌های گزارش شده به روش دمیدن هوا، ۶ درصد توسط E & D، و ۳۰ ٪ دارویی بود.[۶۱]
مطالعه‌ای که در سال ۱۹۹۸ در ۲۷ کشور دربارهٔ دلایل زنان برای خاتمه بارداری انجام شد نشان داد شایع‌ترین دلیل زنان برای سقط جنین، به تعویق انداختن بچه دار شدن به زمان مناسب تر یا تمرکز قوا و منابع بر روی کودکان موجود بود. شایع‌ترین دلایل عوامل اجتماعی - اقتصادی بودند مانند ناتوانی در پرداخت هزینه کودک از جمله هزینه‌های مستقیم برای تربیت فرزند یا از دست دادن درآمد هنگام مراقبت از فرزند، عدم حمایت از سوی پدر، عدم توانایی مالی برای داشتن کودکان اضافی، تمایل به ارائه تحصیل برای کودکان موجود، اختلال در تحصیل، مشکلات رابطه با شوهر و ذکر این که او بیش از حد جوان و بیکار است.[۶۲] مطالعه‌ای در سال ۲۰۰۴ که در آن زنان آمریکایی در کلینیکی پرسشنامه‌ای را پاسخ دادند نتایج مشابهی داشت.[۶۳] بررسی سال ۱۹۹۸ خطر برای سلامت مادران را دلیل اصلی با نسبت ۵–۱۰ درصد در هفت کشور و ۲۰–۳۸ ٪ در سه کشور (کنیا، بنگلادش و هند) عنوان کرد.[۶۲] در گزارش ۱۹۹۷ ایالات متحده، سلامت مادران «مهم‌ترین دلیل» ۳٪ از زنان و نگرانی از سلامت جنین دلیل ۳٪ دیگر عنوان شد.[۶۴] در سال ۲۰۰۴ در نظر سنجی در آمریکا ۱٪ از زنانی که سقط جنین داشتند در نتیجه تجاوز باردار شده بودند و ۰٫۵ ٪ در اثر زنای با محارم.[۶۳] مطالعه‌ای در سال ۲۰۰۲ در آمریکا به این نتیجه رسید که ۵۴ ٪ از زنانی که سقط جنین داشتند هنگام باردار شدن از یکی از روش‌های ضدبارداری استفاه می‌کردند در حالیکه ۴۶ ٪ از این روش‌ها استفاده نمی‌کردند. ۴۹ ٪ از افراد از کاندوم، استفاده ناپایدار و ۷۶ ٪ از آن‌ها قرص ضد حاملگی خوراکی ترکیبی مصرف کرده بودند؛ ۴۲ ٪ از کسانی که کاندوم استفاده کرده بودند عدم موفقیت را در نتیجه لغزش یا پارگی عنوان کردند.[۶۵] مؤسسه گات ماچر تخمین زده‌است که "اکثر سقط جنین‌ها را در ایالات متحده زنان اقلیت‌ها انجام می‌دهند "چون زنان اقلیت "میزان بسیار بالاتری از بارداری ناخواسته دارند."[۶۶]
برخی از سقط جنین‌ها در نتیجه فشارهای اجتماعی است. از جمله ندادن حق به افراد معلول برای داشتن فرزند، اولویت برای کودکانی از جنس خاص، تقبیح مادران مجرد، حمایت اقتصادی ناکافی از خانواده‌ها، عدم دسترسی یا نفی روش‌های پیشگیری از بارداری یا تلاش در جهت کنترل جمعیت (مانند سیاست تک فرزندی در چین). گاهی اوقات این عوامل می‌تواند به سقط جنین اجباری یا سقط جنین جنس انتخابی منجر شود.
به دنبال قانونی‌شدن سقط‌جنین در ایالات متحده در اوایل دههٔ ۱۹۷۰، میزانِ بزهکاری در این کشور به‌طور ناگهانی و جدی کاهش یافت. این کاهش در حول‌وحوش سال ۱۹۹۰ ظاهر شد، یعنی ۱۷ سال پس از قانونی‌شدن سقط‌جنین در این کشور. البته اینکه کودکانِ ناخواسته، غالباً تبدیل به بزرگسالانی ناتوان [و در نتیجه غالباً مشکل‌دار و مشکل‌ساز] می‌شوند از مدت‌ها قبل شناخته شده بود. با اینکه وجود «همبستگی» بین دو «متغیر»، لزوماً نشان‌دهندهٔ «رابطهٔ علی» بین آن دو نیست اما برخی دانشمندان علوم اجتماعی، با تحلیل آماری حجمِ بالایی از داده‌ها به این نتیجه رسیده‌اند که در دسترس بودن امکانِ سقط‌جنین، فاکتور مهمی در کاهشِ متعاقب در میزانِ بزهکاری بوده‌است.[۵۶]
گاهی اوقات زنان برای خاتمه دادن به دورهٔ بارداری خود به شیوه‌های ناامن متوسل می‌شوند، به خصوص زمانی که عمل سقط جنین، محدودیت قانونی نیز به‌همراه داشته باشد. حدود یک مورد از هشت مرگ و میر مرتبط با حاملگی، در سراسر جهان، به سقط جنین ناامن مربوط می‌شود.[۶۷]
تعریف سازمان بهداشت جهانی(WHO) از سقط جنین ناامن "روش انجام عمل سقط جنین توسط افراد فاقد مهارت‌های لازم ویا انجام این عمل در محیط‌هایی با حداقل استانداردهای پزشکی یا دارا بودن هر دو این شرایط "است.[۶۸] سقط جنین ناامن ممکن است از طریق خود زن یا توسط فرد دیگری بدون آموزش‌های پزشکی، یا توسط عامل حرفه‌ای در محیطی با شرایطی زیر استانداردهای لازم انجام بگیرد.
قانونی بودن سقط جنین یکی از عوامل اصلی ایمنی آن است. محدودیت‌های قانونی مربوط به سقط جنین با نرخ بالایی از سقط جنین‌های ناامن همراه است.[۲][۶۹][۷۰] علاوه براین، عدم دسترسی به راه‌های امن و مؤثر پیشگیری از بارداری، منجر به سقط جنین ناامن می‌شود. برآورد شده‌است که اگر برنامه‌های مربوط به تنظیم خانواده و خدمات بهداشتی، در سطح جهانی، به راحتی قابل دسترس خانواده‌ها باشد، بروز سقط جنین ناامن می‌تواند ۷۳ درصد کاهش یابد، بدون آنکه تغییری در محدودیت‌های قانونی مربوط به سقط جنین ایجاد شود.[۷۱]
چهل درصد زنان جهان قادرند به امکانات درمانی و انتخابی سقط جنین در دوره حاملگی دسترسی پیدا کنند.[۳] در حالی که به ندرت در سقط جنین امن مرگ و میر یافت می‌شود، ۷۰۰۰۰ مرگ و میر و ۵ میلیون معلولیت در هر سال، نتیجه سقط جنین ناامن است.[۷۲] عواقب مربوط به سقط جنین در حدود ۱۲ درصد مرگ مادران در آسیا، ۲۵ درصد در آمریکای لاتین و ۱۳ درصد در کشورهای جنوب صحرای آفریقا، محاسبه شده‌است.[۷۳] تخمین زده شده‌است که حدود ۲۴ میلیون زن دچار ناباروری ثانویهٔ ناشی از سقط جنین ناامن می‌شوند.[۷۴] اگر چه نرخ جهانی سقط جنین از ۶/۴۵ میلیون نفر در سال ۱۹۹۵ به ۶/۴۱ میلیون نفر در سال ۲۰۰۳ کاهش یافته‌است، با این حال روش‌های ناامن همچنان ۴۸٪ کل روش‌های سقط جنین انجام شده در سال ۲۰۰۳ را تشکیل می‌دادند.[۷۵] دسترسی به برنامه‌های تنظیم خانواده، آموزش بهداشت، و بهبود در مراقبت‌های بهداشتی در طول و بعد از سقط جنین توصیه می‌شود تا به درستی به این پدیده رسیدگی شود.[۷۶]
در حال حاضر قوانین مربوط به سقط‌جنین متفاوت هستند. در سرتاسر جهان حساسیت‌های مذهبی، اخلاقی و فرهنگی در تلاشند تا قوانین سقط جنین را تحت تأثیر خود قرار دهند. حق زندگی، حق آزادی و حق باروری سالم موارد عمدهٔ حقوق بشری هستند که گاهی اوقات به عنوان توجیهی برای وجود یا عدم وجود قوانین سقط جنین استفاده می‌شوند. در حوزه‌های قضائی که سقط جنین قانونی است، قبل از سقط جنین می‌بایست الزاماتی رعایت شوند. این الزامات معمولاً وابسته به سن جنین می‌باشند، در این رابطه یکی از دوره‌های سه‌ماههٔ بارداری مورد بررسی قرار می‌گیرد. در مواقع ضروری محدودیت‌های بسیاری لغو می‌شوند. برخی از حوزه‌های قضائی، در مواردی این‌چنینی، قبل از اعمال قانون باید برای مدتی در انتظار بمانند: جهت تکمیل شدن اطلاعات در رابطه با رشد جنین یا تماس با پدر و مادر متقاضی جوانی که درخواست سقط جنین کرده‌است.[[۷۷] حوزه‌های قضائی دیگر ممکن است از زن، رضایت پدر جنین را مطالبه کنند. این گروه از دست‌اندرکاران، بیماران را از خطرات احتمالی‌ای که در فرایند سقط جنین محتمل است، آگاه می‌کنند، و مقامات پزشکی هم تصدیق می‌کنند که سقط جنین یا با روش طبی انجام می‌گیرد یا الزامی اجتماعی دارد.
دیگر حوزه‌های قضایی به‌طور کامل سقط جنین را ممنوع کرده‌اند. با این حال، بسیاری، اما نه همه، در مواردی همچون تجاوز جنسی، زنای با محارم، یا خطر حیات و سلامتی زن باردار، سقط جنین مجاز است. در کشورهایی که در آن‌ها سقط جنین به‌طور کامل ممنوع شده‌است، مانند نیکاراگوئه، می‌توان به افزایش مرگ مادران که به‌طور مستقیم یا غیرمستقیم ناشی از بارداری می‌باشد، اشاره کرد.[۷۸][۷۹] در برخی از کشورها مانند بنگلادش که سقط جنین به‌طور اسمی ممنوع شده‌است، همچنین ممکن است درمانگاه‌ها سقط جنین را در قالب خدمات بهداشت و درمانی مربوط به مشکلات دورهٔ قاعدگی، انجام دهند.[۸۰] در جاهایی که سقط جنین غیرقانونی است یا اینکه انگ اجتماعی سنگینی به همراه دارد، زنان باردار ممکن به گردشگری پزشکی روی آورند و به کشورهایی سفر می‌کنند تا در آنجا بتوانند به بارداری خود خاتمه دهند.[۸۱] زنانی هم که قادر به سفر نیستند به ناچار به ارائه دهندگان سقط‌های غیرقانونی متوسل می‌شوند یا اینکه خود تلاش می‌کنند تا به هر نحوی سقط جنین را انجام دهند.[۸۲]
در کشورهایی که سقط جنین به‌طور کلی ممنوع نیست، خدمات پیشگیری از بارداری قابل دسترس می‌باشد و همچنین، گاهی اوقات در کشورهایی هم که سقط جنین در آن‌ها ممنوع است، همچون شیلی، این خدمات دردسترس است.[۸۳][۸۴] این موجب شده‌است تا چالش‌هایی در رابطه با ساخت اشکال خاصی از قرص‌های ضدبارداری اضطراری که موجب سقط جنین می‌شود، را برای برخی از گروه‌های حامی زندگی به وجود آورد.
سونوگرافی و آمنیوسنتز به پدر و مادر اجازه می‌دهد تا از ماهیت جنسیت فرزند خود، قبل از زایمان آگاه شوند. پیشرفت این تکنولوژی به سقط جنین‌های انتخابی منجر شده‌است که سقط جنین با توجه به نوع جنسیت رویان انجام می‌شود، این نوع سقط انتخابی در مورد جنس ماده بسیار شایع است.
عنوان می‌شود که انتخاب جنسی در سقط جنین ممکن است تا حدی مسئول نابرابری‌های قابل توجه بین نرخ تولد فرزندان پسر و فرزندان دختر، در بعضی از نقاط جهان باشد. اولویت برای داشتن کودکان پسر و استفاده از سقط جنین برای محدود کردن تولد دختران در بسیاری از نقاط آسیا از جمله چین، تایوان، کره جنوبی و هند گزارش شده‌است.[۸۵] در هند نقش اقتصادی مردان، هزینه‌های مرتبط با تأمین جهیزیه و همچنین وجود برخی نقش‌های فرهنگی سنتی که بر عهده مردان گذاشته شده‌است چون تشییع جنازه توسط خویشاوند نزدیک مرد، منجر به اولویتِ داشتن فرزند پسر به دختر شده‌است.[۸۶] در دسترس بودن گستردهٔ انجام تست‌های تشخیصی در طول سال‌های ۱۹۷۰ تا ۱۹۸۰ منجر به تبلیغات به منظور سرمایه‌گذاری در خدماتی گردید که "سرمایه‌گذاری ۵۰۰ روپیه [برای تشخیص جنسی]، ذخیره ۵۰۰۰۰ روپیه [برای جهیزیه] در آینده "نامیده می‌شد.[۸۷]
در سال ۱۹۹۱ نسبت جنس مرد به زن در هند از هنجار بیولوژیکی خود که ۱۰۵ به ۱۰۰ بود به حدود ۱۰۸ به ۱۰۰ منحرف شد.[۸۸] محققان ادعا می‌کنند که بین سال‌های ۱۹۸۵ و ۲۰۰۵ در حدود ۱۰ میلیون جنین دختر مورد انتخاب سقط جنین قرار گرفته بودند.[۸۹] دولت هند در سال ۱۹۹۴ ممنوعیت سقط جنین انتخابی قبل از وضع حمل را به تصویب رساند و در سال ۲۰۰۲ آن را به‌طور رسمی ممنوع اعلام کرد.[۹۰] و در حال حاضر سقط جنین جز در مواردی که سلامتی مادر در خطر باشد، ممنوع است.[۹۰]
در جمهوری خلق چین نیز ترجیحِ داشتن فرزند پسر به دختر ریشه‌های تاریخی دارد. اجرای سیاست تک فرزندی در سال ۱۹۷۹ در پاسخ به نگرانی‌های افزایش جمعیت، منجر به افزایش نابرابری در نسبت جنسی شد. این نابرابری در اثر دور زدن قانون، توسط پدر و مادرهایی که از آزادی سقط جنین در جهت سقط جنین دختران ناخواسته‌شان استفاده می‌کردند، به وجود می‌آمد.[۹۱] این احتمال بسیار زیاد است که سقط جنینِ جنس انتخابی، بر روی افزایش نسبت نرخ تولد مرد به زن که ۱۱۷ به ۱۰۰ در سال ۲۰۰۲ گزارش شده، مؤثر بوده‌است. این روند به‌طور برجسته‌تری در مناطق روستایی گزارش شده: بالاترین آمار با ۱۳۰ به ۱۰۰ در گوانگدونگ و ۱۳۵ به ۱۰۰ در هاینن بوده‌است.[۹۲] ممنوعیت سقط جنین انتخابی در سال ۲۰۰۳ به تصویب رسید[۹۳]
در میان ۲۸ کشور عضو اتحادیه سقط جنین در ۲۴ کشور در هفته‌های اول بارداری و اغلب تا پیش از هفته دوازدهم به‌طور کامل قانونی است و بنا به درخواست مادر صورت می‌پذیرد. با این وجود در برخی کشورها همچون ایرلند شمالی، لهستان و فنلاند سقط جنین تنها تحت شرایط خاص صورت می‌گیرد.[۹۴]
مواردی از اعمال خشونت، علیه کسانی که اقدام به انجام سقط جنین می‌کنند و همچنین ارائه‌دهندگان امکانات مربوط به سقط جنین، مشاهده شده‌است. خشونت علیه سقط جنین توسط منابع دولتی و علمی به عنوان عملی تروریستی طبقه‌بندی شده‌است.[۹۵][۹۶]
مشاور دفتر سلامت خانواده وزارت بهداشت در روزنامه وطن امروز، در خرداد ۱۳۹۳ از وقوع روزانه هزار مورد سقط جنین در کشور خبر داد: ۱۵۰ تا ۳۵۰ هزار سقط جنین در طول سال اتفاق می‌افتد که از این میان ۱۲۰ هزار مورد اعلام کرده‌اند که فرزند نمی‌خواسته‌اند، ۱۰۰ هزار مورد بیمار بوده‌اند و ۲۰ تا ۳۶ درصد به دلیل مسائل اقتصادی رخ می‌دهد. محمد اسلامی مشاور فنی دفتر سلامت خانواده وزارت بهداشت با اشاره به سقط‌های غیرقانونی در کشور اظهار داشت: ۱۵۰ تا ۳۵۰ هزار سقط جنین در طول سال داریم به طوری که روزانه هزار مورد سقط اتفاق می‌افتد. وی به دلایل سقط جنین در ایران اشاره کرد و افزود: افزایش سن زن، افزایش سن همسر، فاصله بارداری زیاد پس از ازدواج، بارداری برنامه‌ریزی نشده و تمایل نداشتن به فرزندآوری از این دلایل است و اعتقادات مذهبی مهم‌ترین مانع برای انجام سقط گزارش شده‌اند. به گفته اسلامی، از ۲۲۰ هزار مورد در سال ۹۱، ۱۲۰ هزار مورد اعلام کرده‌اند که فرزند نمی‌خواسته‌اند، ۱۰۰ هزار مورد گفته‌اند بیمار بوده‌اند، ۲۰ تا ۳۶ درصد به دلیل مسائل اقتصادی بوده و ۵ درصد به دلیل تداخل با تحصیل گزارش شده‌است.
سقط جنین عمدی از نظر دین اسلام گناه می‌باشد و حتی در صورتی که جنین حاصل رابطه غیر مشروع باشد نیز این امر را مجاز نمی‌داند. بنا به نظر اکثر علمای ایران سقط جنین فقط در مواردی که یقین یا خوف خطر جدی وجود داشته باشد مجاز است. برخی از شرایطی که به استناد آن می‌توان به صورت قانونی در ایران سقط جنین کرد عبارتند از:
نطفه در لوله آزمایشگاه رشد یافته باشد.
در صورتی که جنین ناقص‌الخلقه شود.
جان مادر در خطر باشد.
سلامتی مادر در خطر باشد.
جنین معیوب یا ناقص‌الخلقه باشد.
عباس آمیان مدیرکل پزشک قانونی استان کرمان، با اشاره به قانون سقط درمانی مصوب مجلس شورای اسلامی به ایسنا (شهریور ۱۳۹۳) گفت، ماده واحدهٔ سقط درمانی با تشخیص قطعی سه پزشک متخصص و تأیید پزشکی قانونی مبنی بر بیماری جنین که به علت عقب‌افتادگی یا ناقص‌الخلقه بودن موجب حرج مادر است یا بیماری مادر که با تهدید جانی مادر توأم باشد پیش از چهار ماه با رضایت زن مجاز به سقط است. وی ادامه داد، در غیر این‌صورت متخلفان از اجرای مفاد این قانون به مجازات‌های مقرر در قانون مجازات اسلامی می‌شوند. مدیرکل پزشک قانونی استان کرمان یادآور شد، پارسال موارد ارجاعی سقط درمانی به اداره‌کل پزشکی قانونی ۳۶۷ مورد بوده‌است که، نزدیک به ۱۶۷ مورد، منتج به صدور مجوز شده‌اند.
شنیده می‌شود بیشتر مراجعه‌کنندگان دختران جوانی هستند که بدون اینکه خانوادهٔ آن‌ها چیزی از این ارتباط بدانند مراجعه می‌کنند.[۹۷]
^ تعریف علمی سقط جنین عبارتست از: خارج شدن یا تخلیه جنین از رحم قبل از ۵ ماهگی یا وزن جنین زیر ۵۰۰ گرم. Cunningham, FG; Leveno, KJ; Bloom, SL et al, eds. (2010). "1. Overview of Obstetrics". Williams Obstetrics (23 ed.). McGraw-Hill Medical. ISBN978-0-07-149701-5.
↑ ۲٫۰۲٫۱۲٫۲۲٫۳Shah, I. ; Ahman, E. (December 2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges" (PDF). Journal of Obstetrics and Gynaecology Canada 31 (12): 1149–58. PMID 20085681
↑ ۳٫۰۳٫۱Culwell KR, Vekemans M, de Silva U, Hurwitz M (July 2010). "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion". International Journal of Gynecology & Obstetrics 110: S13–16. doi:10.1016/j.ijgo.2010.04.003. PMID 20451196
↑Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J (September 2007). "Legal abortion worldwide: incidence and recent trends". Int Fam Plan Perspect 33 (3): 106–16. doi:10.1363/ifpp.33.106.07. PMID 17938093
↑Dabash, Rasha; Roudi-Fahimi, Farzaneh (2008). "Abortion in the Middle East and North Africa" (PDF). Population Research Bureau. Archived from the original on July 8, 2011. http://www.prb.org/pdf08/MENAabortion.pdf.
↑^ World Abortion Policies 2007, United Nations, Department of Economic and Social Affairs, Population Division.
↑^ Theodore J. Joyce, Stanley K. Henshaw, Amanda Dennis, Lawrence B. Finer and Kelly Blanchard (April 2009). "The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review" (PDF). Guttmacher Institute. Archived from the original on 2011-01-14. http://www.webcitation.org/5vj6Mlykp. Retrieved December 31, 2010.
↑Cheng L. (November 1, 2008). "Surgical versus medical methods for second-trimester induced abortion". The WHO Reproductive Health Library. World Health Organization. Archived from the original on June 17, 2011. http://apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html. Retrieved June 17, 2011.
↑Bankole et al. , "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries", International Family Planning Perspectives (1998). Also see Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore, "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives", Perspectives on Sexual and Reproductive Health, 37(3):110-118 (September 2005).
↑# Stubblefield, Phillip G. (2002). "10. Family Planning". In Berek, Jonathan S.. Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN978-0-7817-3262-8. # ^ Menikoff, Jerry (2001). Law and Bioethics. Georgetown University Press. p. 78. ISBN978-0-87840-839-9. http://books.google.com/books?id=2jXOYv3X8zsC&pg=PA78. "As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use."
↑Schorge, John O. ; Schaffer, Joseph I. ; Halvorson, Lisa M. et al. , eds (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN978-0-07-147257-9
↑Annas, George J. ; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G. ; Niebyl, Jennifer R. ; Simpson, Joe Leigh. Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. p. 669. ISBN978-0-443-06930-7. "A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight.
↑"Stillbirth". Concise Medical Dictionary. Oxford University Press. 2010. "birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception"
↑Annas, George J. ; Elias, Sherman (2007). "24. Pregnancy loss". In Gabbe, Steven G. ; Niebyl, Jennifer R. ; Simpson, Joe Leigh. Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. ISBN978-0-443-06930-7.
↑Schorge, John O. ; Schaffer, Joseph I. ; Halvorson, Lisa M. et al. , eds (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN978-0-07-147257-9.
↑Katz, Vern L. (2007). "16. Spontaneous and Recurrent Abortion - Etiology, Diagnosis, Treatment". In Katz, Vern L. ; Lentz, Gretchen M. ; Lobo, Rogerio A. et al.. Katz: Comprehensive Gynecology (5 ed.). Mosby. ISBN978-0-323-02951-3.
↑Thapa, S. R. ; Rimal, D. ; Preston, J. (2006). "Self induction of abortion with instrumentation". Australian Family Physician 35 (9): 697–698. PMID 16969439
↑Grimes, DA; Creinin, MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. doi:10.1001/archinte.140.5.620. PMID 15096333
↑Grimes DA (January 2006). "Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999". Am. J. Obstet. Gynecol. 194 (1): 92–4. doi:10.1016/j.ajog.2005.06.070. PMID 16389015
↑Bartlett LA, Berg CJ, Shulman HB et al. (April 2004). "Risk factors for legal induced abortion-related mortality in the United States". Obstet Gynecol 103 (4): 729–37. doi:10.1097/01.AOG.0000116260.81570.60. PMID 15051566
↑Trupin, Suzanne (May 27, 2010). "Elective Abortion". eMedicine. http://emedicine.medscape.com/article/252560-overview. Retrieved June 1, 2010. "At every gestational age, elective abortion is safer for the mother than carrying a pregnancy to term."
↑Westfall JM, Sophocles A, Burggraf H, Ellis S (1998). "Manual vacuum aspiration for first-trimester abortion". Arch Fam Med 7 (6): 559–62. doi:10.1001/archfami.7.6.559. PMID 9821831
↑ACOG Committee on Practice Bulletins--Gynecology (May 2009). "ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures". Obstet Gynecol 113 (5): 1180–9. doi:10.1097/AOG.0b013e3181a6d011. PMID 19384149
↑Sawaya GF, Grady D, Kerlikowske K, Grimes DA (May 1996). "Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis". Obstet Gynecol 87 (5 Pt 2): 884–90. PMID 8677129
↑Lohr PA, Hayes JL, Gemzell-Danielsson K (2008). Lohr, Patricia A.. ed. "Surgical versus medical methods for second trimester induced abortion". Cochrane Database Syst Rev (1): CD006714.
↑Spitz IM, Bardin CW, Benton L, Robbins A (April 1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". N. Engl. J. Med. 338 (18): 1241–7. doi:10.1056/NEJM199804303381801. PMID 956257
↑Aubény E, Peyron R, Turpin CL et al. (1995). "Termination of early pregnancy (up to 63 days of amenorrhea) with mifepristone and increasing doses of misoprostol[corrected]". Int J Fertil Menopausal Stud 40 Suppl 2: 85–91. PMID 8574255
↑Spitz IM, Bardin CW, Benton L, Robbins A (April 1998). "Early pregnancy termination with mifepristone and misoprostol in the United States". N. Engl. J. Med. 338 (18): 1241–7. doi:10
↑Fischer M, Bhatnagar J, Guarner J et al. (December 2005). "Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion". N. Engl. J. Med. 353 (22): 2352–60. doi:10.1056/NEJMoa051620. PMID 16319384
↑^ Fjerstad M, Trussell J, Sivin I, Lichtenberg ES, Cullins V (July2009). "Rates of serious infection after changes in regimens for medical abortion". N. Engl. J. Med. 361 (2): 145–51. doi:10.1056/NEJMoa0809146. PMID 19587339
↑Grimes DA, Benson J, Singh S et al. (2006). "Unsafe abortion: the preventable pandemic" (PDF). Lancet 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724
↑Berer M (November 2004). "National laws and unsafe abortion: the parameters of change". Reprod Health Matters 12 (24 Suppl): 1–8. doi:10.1016/S0968-8080(04)24024-1. PMID 15938152
↑ ۴۴٫۰۴۴٫۱Berer M (2000). "Making abortions safe: a matter of good public health policy and practice". Bull. World Health Organ. 78 (5): 580–92. PMC 2560758. PMID 10859852
↑Jewkes R, Rees H, Dickson K, Brown H, Levin J (March 2005). "The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change". BJOG 112 (3): 355–9. doi:10.1111/j.1471-0528.2004.00422.x. PMID 15713153
↑Bateman C (December 2007). "Maternal mortalities 90% down as legal TOPs more than triple". S. Afr. Med. J. 97 (12): 1238–42. PMID 18264602
↑ ۴۷٫۰۴۷٫۱Jasen P (2005). "Breast cancer and the politics of abortion in the United States". Medical History 49 (4): 423–44. PMC 1251638. PMID 16562329
↑Culwell KR, Vekemans M, de Silva U, Hurwitz M (July 2010). "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion". International Journal of Gynecology & Obstetrics 110: S13–16. doi:10.1016/j.ijgo.2010.04.003. PMID 20451196.
↑Rosenthal, Elizabeth (October 12, 2007). "Legal or Not, Abortion Rates Compare". The New York Times. http://www.nytimes.com/2007/10/12/world/12abortion.html?. Retrieved July 18, 2011. "Anti-abortion groups criticized the research, saying that the scientists had jumped to conclusions from imperfect tallies, often estimates of abortion rates in countries where the procedure was illegal.
↑Henshaw, Stanley K. , Singh, Susheela, and Haas, Taylor. (1999). The Incidence of Abortion Worldwide. International Family Planning Perspectives, 25 (Supplement), 30–38. Retrieved 2006-01-18.
↑Strauss, L.T. , Gamble, S.B. , Parker, W.Y, Cook, D.A. , Zane, S.B. , and Hamdan, S. (November 24, 2006). Abortion Surveillance – United States, 2003. Morbidity and Mortality Weekly Report, 55 (11), 1–32. Retrieved May 10, 2007.
↑Finer, L. B. ; Henshaw, S. K. (2003). "Abortion Incidence and Services in the United States in 2000". Perspectives on Sexual and Reproductive Health 35 (1): 6–15. doi:10.1363/3500603. PMID 12602752
↑Cheng L. “Surgical versus medical methods for second-trimester induced abortion: RHL commentary” (last revised: November 1, 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.
↑# Bankole, Akinrinola, Singh, Susheela, and Haas, Taylor. (1998). Reasons Why Women Have Induced Abortions: Evidence from 27 Countries. International Family Planning Perspectives, 24 (3), 117–127 and 152. Retrieved 2006-01-18.
↑ ۶۲٫۰۶۲٫۱Jones, R. K. ; Darroch, J. E. ; Henshaw, S. K. (2002). "Contraceptive Use Among U.S. Women Having Abortions in 2000-2001" (PDF). Perspectives on Sexual and Reproductive Health 34 (6): 294–303. doi:10.2307/3097748. PMID 12558092. http://www.guttmacher.org/pubs/journals/3429402.pdf.
↑ ۶۳٫۰۶۳٫۱Susan A. Cohen: Abortion and Women of Color: The Bigger Picture, Guttmacher Policy Review, Summer 2008, Volume 11, Number 3.
↑Maclean, Gaynor. "Dimension, Dynamics and Diversity; A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives", pages 299-300 in Trends in Midwifery Research by Randell Balin (Nova Publishers, 2005).
↑World Health Organization. (2004). "Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000". Retrieved 2009-03-22.
↑Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH (2007). "Induced abortion: estimated rates and trends worldwide". Lancet 370 (9595): 1338–45. doi:10.1016/S0140-6736(07)61575-X. PMID 17933648
↑Singh, Susheela et al. Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health (New York: Guttmacher Institute and United Nations Population Fund 2009): "If women’s contraceptive needs were addressed (and assuming no changes in abortion laws)...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "Facts on Investing in Family Planning and Maternal and Newborn Health" (Guttmacher Institute 2010).
↑Salter, C. , Johnson, H.B. , and Hengen, N. (1997). "Care for Postabortion Complications: Saving Women's Lives". Population Reports (Johns Hopkins School of Public Health) 25 (1). Archived from the original on September 1, 2011. http://www.webcitation.org/61MhmDwmL.
↑offe, Carole (2009). "1. Abortion and medicine: A sociopolitical history". In MPaul, ES Lichtenberg, L Borgatta, DA Grimes, PG Stubblefield, MD Creinin. Management of Unintended and Abnormal Pregnancy (1st ed.). Oxford, United Kingdom: John Wiley & Sons, Ltd.. p. 2. ISBN978-1-4443-1293-5
↑alter, C. , Johnson, H.B. , and Hengen, N. (1997). "Care for Postabortion Complications: Saving Women's Lives". Population Reports (Johns Hopkins School of Public Health) 25 (1). Archived from the original on September 1, 2011. http://www.webcitation.org/61MhmDwmL.
↑Singh, Susheela et al. Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health (New York: Guttmacher Institute and United Nations# Population Fund 2009): "If women’s contraceptive needs were addressed (and assuming no changes in abortion laws)...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "Facts on Investing in Family Planning and Maternal and Newborn Health" (Guttmacher Institute 2010).
↑Miles, Steven (2005). The Hippocratic Oath and the Ethics of Medicine. Oxford University Press. ISBN978-0-19-518820-2
↑Henshaw, S. K. (1991). "The Accessibility of Abortion Services in the United States". Family Planning Perspectives 23 (6): 246–263. doi:10.2307/2135775
↑Banister, Judith. (1999-03-16). Son Preference in Asia – Report of a Symposium. Retrieved 2006-01-12
↑Mutharayappa, Rangamuthia, Kim Choe, Minja, Arnold, Fred, and 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.
↑Patel, Rita (Fall 1996). "The practice of sex selective abortion in India: May you be the mother of a hundred sons" (PDF). Carolina Papers in International Health and Development 7. Archived from the original on 2010-06-16. http://www.webcitation.org/5qWhqeiZq. Retrieved 2008-12-03.
↑Wilson, M. ; Lynxwiler, J. (1988). "Abortion clinic violence as terrorism". Studies in Conflict & Terrorism 11 (4): 263–273. doi:10.1080/10576108808435717
نکته: مواردی که بهعنوان حقوق بشر ( غیر از حقهای بنیادین حقوق بشری ) مورد مناقشه هستند و تمامی مواردی که در اینجا فهرست شده‌اند، ممکن است در همهجا حقوق بشر نباشند.
Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus.[note 1] An abortion that occurs without intervention is known as a miscarriage or spontaneous abortion. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion.[1][2] A similar procedure after the fetus has potential to survive outside the womb is known as a "late termination of pregnancy" or less accurately as a "late term abortion".[3]
When properly done, abortion is one of the safest procedures in medicine,[4][5] but unsafe abortion is a major cause of maternal death, especially in the developing world.[6] Making safe abortion legal and accessible reduces maternal deaths.[7][8] It is safer than childbirth, which has a 14 times higher risk of death in the United States.[9] Modern methods use medication or surgery for abortions.[10] The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy.[10][11] The most common surgical technique involves dilating the cervix and using a suction device.[12]Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.[11] When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term mental or physical problems.[13] In contrast, unsafe abortions (those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) cause 47,000 deaths and 5 million hospital admissions each year.[13][14] The World Health Organization recommends safe and legal abortions be available to all women.[15]
Around 56 million abortions are performed each year in the world,[16] with about 45% done unsafely.[17] Abortion rates changed little between 2003 and 2008,[18] before which they decreased for at least two decades as access to family planning and birth control increased.[19] As of 2008[update], 40% of the world's women had access to legal abortions without limits as to reason.[20] Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.[20]
An induced abortion may be classified as therapeutic (done in response to a health condition of the women or fetus) or elective (chosen for other reasons).[29]
Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[18][30] Most abortions result from unintended pregnancies.[31][32] In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.[13] 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.[33][34] Specific procedures may also be selected due to legality, regional availability, and doctor or a woman's personal 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; to prevent harm to the woman's physical or mental health; to terminate a pregnancy where indications are that the child will have a significantly increased chance of mortality or morbidity; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[35][36] 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.[36] Confusion sometimes arises over the term "elective" because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.[37]
Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.[38] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth" or a "preterm birth".[39] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[40]Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.[41]
Only 30% to 50% of conceptions progress past the first trimester.[42] The vast majority of those that do not progress are lost before the woman is aware of the conception,[36] and many pregnancies are lost before medical practitioners can detect an embryo.[43] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[44] 80% of these spontaneous abortions happen in the first trimester.[45]
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,[36][46] accounting for at least 50% of sampled early pregnancy losses.[47] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[46] Advancing maternal age and a woman's history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[47] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[48]
The most common early first-trimester medical abortion regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost) up to 10 weeks (70 days) gestational age,[52][53]methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.[49] 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.[50] This regime is effective in the second trimester.[54] Medical abortion regiments involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.[53][55]
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.[56] 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; from 9 to 10 weeks efficacy decreases modestly to 94%.[55][57] If medical abortion fails, surgical abortion must be used to complete the procedure.[58]
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,[51] in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.[65]
Surgical
A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization). 1: Amniotic sac 2: Embryo 3: Uterine lining 4: Speculum 5: Vacurette 6: Attached to a suction pump
Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.[66]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 can both be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.[65]
MVA, also known as "mini-suction" and "menstrual extraction" or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. 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. The World Health Organization recommends sharp curettage only when suction aspiration is unavailable.[67]
Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction(D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.[68]
Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. 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 can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.[69]
In places lacking the necessary medical skill for dilation and extraction, or where preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.[71] This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.[72]
Only limited data are available comparing this method with dilation and extraction.[72] Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.[72][73]
Other methods
Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[74]:44–47, 62–63, 154–55, 230–31
In 1978 one woman in Colorado died and another was seriously injured when they attempted to procure an abortion by taking pennyroyal oil.[75]
Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure,[76] such use 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.[77] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[78] 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.[78]
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 and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion is legal and available.[79]
Safety
An abortion flyer in South Africa
The health risks of abortion depend principally upon 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.[80] Legal abortions performed in the developed world are among the safest procedures in medicine.[4][81] In the United States as of 2012, abortion was estimated to be about 14 times safer for women than childbirth.[9] CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,[82] while the US abortion mortality rate is 0.7 maternal deaths per 100,000 procedures.[5][83] In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term."[84] Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed [abortion] procedures constitute 13% of maternal mortality globally."[85] In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14-16 percent of maternal deaths resulted from abortion.[86]
In the US from 2000 to 2009, abortion had a lower mortality rate than plastic surgery, and a similar or lower mortality rate than running a marathon.[87] Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions.[88] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.[89] Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.[90]
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, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.[91] Infections account for one-third of abortion-related deaths in the United States.[92] The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.[93] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures,[94] as they are believed to substantially reduce the risk of postoperative uterine infection;[70][95] however, antibiotics are not routinely given with abortion pills.[96] The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner.[97] Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. Second-trimester abortions are generally well-tolerated.[98]
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 10 weeks gestation.[56] 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.[99][100]
In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record."[104]:25 According to Rickie Solinger,
A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... [T]he historical evidence does not support such claims.[105]:4
Authors Jerome Bates and Edward Zawadzki describe the case of an illegal abortionist in the eastern U.S. in the early 20th century who was proud of having successfully completed 13,844 abortions without any fatality.[106]:59
In 1870s New York City the famous abortionist/midwife Madame Restell (Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patients[107]—a lower mortality rate than the childbirth mortality rate at the time. In 1936 the prominent professor of obstetrics and gynecology Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that
With each decade of the past fifty years the actual and proportionate frequency of this accident [perforation of the uterus] has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus.
Current evidence finds no relationship between most induced abortions and mental-health problems[13][109] other than those expected for any unwanted pregnancy.[110] A report by the American Psychological Association concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain.[110][111] Some older reviews concluded that abortion was associated with an increased risk of psychological problems;[112] however, they did not use an appropriate control group.[109]
Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,[113] more rigorous research would be needed to show this conclusively.[114] Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome", but this is not recognized by medical or psychological professionals in the United States.[115]
Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death."
Women seeking an abortion may use unsafe methods, especially when abortion is legally restricted. They may attempt self-induced abortion or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.[116]
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.[4] Unsafe abortions are believed to result in millions of injuries.[4][117] Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;[4][14][118] deaths from unsafe abortion account for around 13% of all maternal deaths.[119] The World Health Organization believes that mortality has fallen since the 1990s.[120] To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.[121] In response, opponents of abortion point out that abortion bans in no way affect prenatal care for women who choose to carry their fetus to term. The Dublin Declaration on Maternal Health, signed in 2012, notes, "the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women."[122]
A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to those where abortion is legal and available.[14][18][121][123][124][125][126] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[127] with abortion-related deaths dropping by more than 90%.[128] Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.[129] A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state.[130] The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.[131] 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.[132] Rates of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".[133][134]
Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,[20] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[22] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[14] Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,[135] though this varies by region.[136] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[124] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.[18] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[137]
Live birth
In 2019, a US Senate Bill entitled the "Born-Alive Abortion Survivors Protection Act" raised the issue of live birth after abortion.[138][139] The bill would mandate that medical providers resuscitate neonates delivered showing signs of life during an abortion process.[138][139] During the debate around this issue, US Republicans falsely alleged that medical providers "execute" live-born babies. Existing US laws would punish execution as homicide. Furthermore, US abortion experts refute the claim that a "born-alive" fetus is a common event and reject laws that would mandate resuscitation against the wishes of the parents.[139][140]
Only 1.3% of abortions occur after 21 weeks of pregnancy in the US. Although it is very uncommon, women undergoing surgical abortion after this gestational age sometimes give birth to a fetus that may survive briefly.[141][142][143] The periviable period is considered to be between 20 and 25 weeks gestation.[144]Long-term survival is possible after 22 weeks.[145] However, odds of long-term survival between 22 and 23 weeks are 2–3 percent and odds of survival between 23 and 24 weeks are 20 percent.[146] "Intact survival", which means survival of a neonate without subsequent damage to organs such as the brain or bowel is 1% at 22 weeks and 13% at 23 weeks.[146] Survival odds increase with increasing gestational age.[146]
If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not.[147][148][149]Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended by some sources to avoid this and to comply with the US Partial Birth Abortion Ban.[150][151][152][153][154] Induced fetal demise does not improve the safety of an abortion procedure and may incur risks to the health of the woman having the abortion.[151]
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)
In many places, where abortion is illegal or carries a heavy social stigma, medical reporting of abortion is not reliable.[123] For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.[18]
The number of abortions performed worldwide seems to have remained stable in recent years, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008.[18] 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.[18] 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.[18]
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 performed unsafely.[20][155][156] 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.[157]
The rate of legal, induced abortion varies extensively worldwide. According to the report of employees of Guttmacher Institute it ranged from 7 per 1000 women (Germany and Switzerland) to 30 per 1000 women (Estonia) in countries with complete statistics in 2008. The proportion of pregnancies that ended in induced abortion ranged from about 10% (Israel, the Netherlands and Switzerland) to 30% (Estonia) in the same group, though it might be as high as 36% in Hungary and Romania, whose statistics were deemed incomplete.[158][159]
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.[160] 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".[161]
The abortion rate may also be expressed as the average number of abortions a woman has during her reproductive years; this is referred to as total abortion rate (TAR).
Gestational age and method
Histogram of abortions by gestational age in England and Wales during 2004. (left) Abortion in the United States by gestational age, 2004. (right)
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 reported legal induced 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, 18% at 9 through 10 weeks, 10% at 11 through 12 weeks, 6% at 13 through 15 weeks, 4% at 16 through 20 weeks and 1% at more than 21 weeks. 91% of these were classified as having been done by "curettage" (suction-aspiration, dilation and curettage, dilation and evacuation), 8% by "medical" means (mifepristone), >1% by "intrauterine instillation" (saline or prostaglandin), and 1% by "other" (including hysterotomy and hysterectomy).[162] 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 dead fetus is accomplished by the same procedure as an induced abortion.[163]
The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for <0.2% of the total number of abortions performed that year.[164] Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 and 19 weeks, and 2% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.[165] There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.[166]
Motivation
Personal
A bar chart depicting selected data from a 1998 AGImeta-study on the reasons women stated for having an abortion.
The reasons why women have abortions are diverse and vary across the world.[163][167] Some of the reasons may include an inability to afford a child, domestic violence, lack of support, feeling they are too young, and the wish to complete education or advance a career.[168] Additional reasons include not being willing to raise a child conceived as a result of rape or incest.[167][169]
Societal
Some abortions are undergone as the result of societal pressures.[170] These might include the preference for children of a specific sex or race, 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.[171]
Maternal and fetal health
An additional factor is maternal health which was listed as the main reason by about a third of women in 3 of 27 countries and about 7% of women in a further 7 of these 27 countries.[163][167]
In the U.S., the Supreme Court decisions in Roe v. Wade and Doe v. Bolton: "ruled that the state's interest in the life of the fetus became compelling only at the point of viability, defined as the point at which the fetus can survive independently of its mother. Even after the point of viability, the state cannot favor the life of the fetus over the life or health of the pregnant woman. Under the right of privacy, physicians must be free to use their "medical judgment for the preservation of the life or health of the mother." On the same day that the Court decided Roe, it also decided Doe v. Bolton, in which the Court defined health very broadly: "The medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient. All these factors may relate to health. This allows the attending physician the room he needs to make his best medical judgment."[172]:1200–01
Public opinion shifted in America following television personality Sherri Finkbine's discovery during her fifth month of pregnancy that she had been exposed to thalidomide. Unable to obtain a legal abortion in the United States, she traveled to Sweden. From 1962 to 1965, an outbreak of German measles left 15,000 babies with severe birth defects. In 1967, the American Medical Association publicly supported liberalization of abortion laws. A National Opinion Research Center poll in 1965 showed 73% supported abortion when the mother's life was at risk, 57% when birth defects were present and 59% for pregnancies resulting from rape or incest.[173]
Cancer
The rate of cancer during pregnancy is 0.02–1%, and in many cases, cancer of the mother leads to consideration of abortion to protect the life of the mother, or in response to the potential damage that may occur to the fetus during treatment. This is particularly true for cervical cancer, the most common type of which occurs in 1 of every 2,000–13,000 pregnancies, for which initiation of treatment "cannot co-exist with preservation of fetal life (unless neoadjuvant chemotherapy is chosen)". Very early stage cervical cancers (I and IIa) may be treated by radical hysterectomy and pelvic lymph node dissection, radiation therapy, or both, while later stages are treated by radiotherapy. Chemotherapy may be used simultaneously. Treatment of breast cancer during pregnancy also involves fetal considerations, because lumpectomy is discouraged in favor of modified radical mastectomy unless late-term pregnancy allows follow-up radiation therapy to be administered after the birth.[174]
Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic effects on the fetus, with higher risks for multiple drug treatments. Treatment with more than 40 Gy of radiation usually causes spontaneous abortion. Exposure to much lower doses during the first trimester, especially 8 to 15 weeks of development, can cause intellectual disability or microcephaly, and exposure at this or subsequent stages can cause reduced intrauterine growth and birth weight. Exposures above 0.005–0.025 Gy cause a dose-dependent reduction in IQ.[174] It is possible to greatly reduce exposure to radiation with abdominal shielding, depending on how far the area to be irradiated is from the fetus.[175][176]
The process of birth itself may also put the mother at risk. "Vaginal delivery may result in dissemination of neoplastic cells into lymphovascular channels, haemorrhage, cervical laceration and implantation of malignant cells in the episiotomy site, while abdominal delivery may delay the initiation of non-surgical treatment."[177]
"French Periodical Pills". An example of a clandestine advertisement published in a January 1845 edition of the Boston Daily Times.
Since ancient times abortions have been done using herbal medicines, sharp tools, with force, or through other traditional methods.[21] 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).[21] 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. One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.[78]
Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions;[21] other scholars disagree with this interpretation,[21] and state that the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath.[179] The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus, although apparently not all doctors adhered to it strictly at the time. According to Soranus' 1st or 2nd century CE work Gynaecology, one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party—to which he belonged—was willing to prescribe abortions, but only for the sake of the mother's health.[180][181]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[182] "[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".[183]
In Christianity, Pope Sixtus V (1585–90) was the first Pope before 1869 to declare that abortion is homicide regardless of the stage of pregnancy;[184] and his pronouncement of 1588 was reversed three years later by his successor. Through most of its history the Catholic Church was divided on whether it believed that abortion was murder, and it did not begin vigorously opposing abortion until the 19th century.[21] In fact, several historians have written that prior to the 19th century most Catholic authors did not regard termination of pregnancy before "quickening" or "ensoulment" as an abortion.[185][186][187] Statements made in 1992 in the Catechism of the Catholic Church opposed abortion.[188]
A 1995 survey reported that Catholic women are as likely as the general population to terminate a pregnancy, Protestants are less likely to do so, and Evangelical Christians are the least likely to do so.[163][167]Islamic tradition has traditionally permitted abortion until a point in time when Muslims believe the soul enters the fetus,[21] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[189] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[190]
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.[21] Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice (sometimes called restellism)[191] was banned in both the United States and the United Kingdom.[21] Church groups as well as physicians were highly influential in anti-abortion movements.[21] In the US, according to some sources, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.[note 2] However, other sources maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe.[192][193][194]
In addition, some commentators have written that, despite improved medical procedures, the period from the 1930s until legalization also saw more zealous enforcement of anti-abortion laws, and concomitantly an increasing control of abortion providers by organized crime.[195][196][197][198][199]
Soviet Russia (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[200] 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.[201] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.[21]
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.[202] The World Medical Association Declaration on Therapeutic Abortion notes, "circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question as to whether or not the pregnancy should be deliberately terminated."[203] 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".[204] Generally, the former position argues that a human fetus is a human person 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 right to decide whether or not to carry a pregnancy to term.
Current laws pertaining to abortion are diverse. Religious, moral, and cultural factors 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 sometimes constitute the basis for the existence or absence of abortion laws.
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 on the age of the fetus, often using a trimester-based system to regulate the window of legality, or as in the U.S., on a doctor's evaluation of the fetus' viability. 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.[207] Other jurisdictions may require that a woman obtain the consent of the fetus' father before aborting the fetus, that abortion providers inform women 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. China, which has ended their[208]one-child policy, and now has a two child policy,[209][210] has at times incorporated mandatory abortions as part of their population control strategy.[211]
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.[22] 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.[212][213] Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.[214] This is also a terminology in traditional medicine.[215] 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.[216] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.[217]
The organization Women on Waves, has been providing education about medical abortions since 1999. The NGO created a mobile medical clinic inside a shipping container, which then travels on rented ships to countries with restrictive abortion laws. Because the ships are registered in the Netherlands, Dutch law prevails when the ship is in international waters. While in port, the organization provides free workshops and education; while in international waters, medical personnel are legally able to prescribe medical abortion drugs and counseling.[218][219][220]
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.[221] 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.[222][223][224][225] In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.[226]
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",[227] conditions also condemned by a PACE resolution in 2011.[228] 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.[227]
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.[229][230] In the U.S. and Canada, over 8,000 incidents of violence, trespassing, and death threats have been recorded by providers since 1977, including over 200 bombings/arsons and hundreds of assaults.[231] The majority of abortion opponents have not been involved in violent acts.
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 occurred.[232][233] 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.[234]
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 women and employees of such facilities from threats and harassment.
Far more common than physical violence is psychological pressure. In 2003, Chris Danze organized pro-life organizations throughout Texas to prevent the construction of a Planned Parenthood facility in Austin. The organizations released the personal information online, of those involved with construction, sending them up to 1200 phone calls a day and contacting their churches.[235] Some protestors record women entering clinics on camera.[235]
Spontaneous abortion occurs in various animals. For example, in sheep it may be caused by stress or physical exertion, such as crowding through doors or being chased by dogs.[236] In cows, abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but can often be controlled by vaccination.[237] Eating pine needles can also induce abortions in cows.[238][239]
Several plants, including broomweed, skunk cabbage, poison hemlock, and tree tobacco, are known to cause fetal deformities and abortion in cattle[240]:45–46 and in sheep and goats.[240]:77–80 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 theorized to also be aborted or resorbed before birth.[241] In many species of sharks and rays, stress-induced abortions occur frequently on capture.[242]
Viral infection can cause abortion in dogs.[243] 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.[244][245][246]
Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect.[247]
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.[248] Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[249][250][251] although the frequency in the wild has been questioned.[252] Male gray langur monkeys may attack females following male takeover, causing miscarriage.[253]
Notes
^Definitions of abortion, as with many words, vary from source to source. Language used to define abortion often reflects societal and political opinions (not only scientific knowledge). For a list of definitions as stated by obstetrics and gynecology (OB/GYN) textbooks, dictionaries, and other sources, please see Definitions of abortion.
^By 1930, medical procedures in the US had improved for both childbirth and abortion but not equally, and induced abortion in the first trimester had become safer than childbirth. In 1973, Roe v. Wade acknowledged that abortion in the first trimester was safer than childbirth:
"The 1970s". Time communication 1940–1989: retrospective. Time Inc. 1989. Blackmun was also swayed by the fact that most abortion prohibitions were enacted in the 19th century when the procedure was more dangerous than now.
^"Abortion (noun)". Oxford Living Dictionaries. Archived from the original on 28 May 2018. Retrieved 8 June 2018. [mass noun] The deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy
^ abRaymond, EG; Grossman, D; Weaver, MA; Toti, S; Winikoff, B (November 2014). "Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States". Contraception. 90 (5): 476–79. doi:10.1016/j.contraception.2014.07.012. PMID25152259.
^ abRaymond, E.G.; Grimes, D.A. (2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology. 119 (2, Part 1): 215–19. doi:10.1097/AOG.0b013e31823fe923. PMID22270271.
^ abcdefghSedgh, G.; Singh, S.; Shah, I.H.; Åhman, E.; Henshaw, S.K.; Bankole, A. (2012). "Induced abortion: Incidence and trends worldwide from 1995 to 2008"(PDF). The Lancet. 379 (9816): 625–32. doi:10.1016/S0140-6736(11)61786-8. PMID22264435. Archived(PDF) from the original on 6 February 2012. Because few of the abortion estimates were based on studies of random samples of women, and because we did not use a model-based approach to estimate abortion incidence, it was not possible to compute confidence intervals based on standard errors around the estimates. Drawing on the information available on the accuracy and precision of abortion estimates that were used to develop the subregional, regional, and worldwide rates, we computed intervals of certainty around these rates (webappendix). We computed wider intervals for unsafe abortion rates than for safe abortion rates. The basis for these intervals included published and unpublished assessments of abortion reporting in countries with liberal laws, recently published studies of national unsafe abortion, and high and low estimates of the numbers of unsafe abortion developed by WHO.
^ abcdCulwell KR, Vekemans M, de Silva U, Hurwitz M (July 2010). "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion". International Journal of Gynecology & Obstetrics. 110: S13–16. doi:10.1016/j.ijgo.2010.04.003. PMID20451196.
^Johnstone, Megan-Jane (2009). Bioethics a nursing perspective (5th ed.). Sydney, NSW: Churchill Livingstone/Elsevier. p. 228. ISBN978-0-7295-7873-8. Archived from the original on 6 September 2017. Although abortion has been legal in many countries for several decades now, its moral permissibilities continues to be the subject of heated public debate.
^Stubblefield, Phillip G. (2002). "10. Family Planning". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN978-0-7817-3262-8.
^Bartlett, LA; Berg, CJ; Shulman, HB; Zane, SB; Green, CA; Whitehead, S; Atrash, HK (2004), "Risk factors for legal induced abortion-related mortality in the United States", Obstetrics & Gynecology, 103 (4): 729–37, doi:10.1097/01.AOG.0000116260.81570.60, PMID15051566
^Roche, Natalie E. (28 September 2004). "Therapeutic Abortion". eMedicine. Archived from the original on 14 December 2004. Retrieved 19 June 2011.
^ abcdSchorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M.; Hoffman, Barbara L.; Bradshaw, Karen D.; Cunningham, F. Gary, eds. (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN978-0-07-147257-9.
^"Elective surgery". Encyclopedia of Surgery. Archived from the original on 13 November 2012. Retrieved 17 December 2012.
"An elective surgery is a planned, non-emergency surgical procedure. It may be either medically required (e.g., cataract surgery), or optional (e.g., breast augmentation or implant) surgery.
^Churchill Livingstone medical dictionary. Edinburgh New York: Churchill Livingstone Elsevier. 2008. ISBN978-0-443-10412-1. The preferred term for unintentional loss of the product of conception prior to 24 weeks' gestation is miscarriage.
^Annas, George J.; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. p. 669. ISBN978-0-443-06930-7. A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight.
^"Stillbirth". Concise Medical Dictionary. Oxford University Press. 2010. ISBN978-0199557141. Archived from the original on 15 October 2015. birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception
^Annas, George J.; Elias, Sherman (2007). "24. Pregnancy loss". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. ISBN978-0-443-06930-7.
^Katz, Vern L. (2007). "16. Spontaneous and Recurrent Abortion – Etiology, Diagnosis, Treatment". In Katz, Vern L.; Lentz, Gretchen M.; Lobo, Rogerio A.; Gershenson, David M. (eds.). Katz: Comprehensive Gynecology (5 ed.). Mosby. ISBN978-0-323-02951-3.
^Stovall, Thomas G. (2002). "17. Early Pregnancy Loss and Ectopic Pregnancy". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN978-0-7817-3262-8.
^Cunningham, F. Gary; Leveno, Kenneth J.; Bloom, Steven L.; Spong, Catherine Y.; Dashe, Jodi S.; Hoffman, Barbara L.; Casey, Brian M.; Sheffield, Jeanne S., eds. (2014). Williams Obstetrics (24th ed.). McGraw Hill Education. ISBN978-0-07-179893-8.
^ abCreinin MD, Gemzell-Danielsson K (2009). "Medical abortion in early pregnancy". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy: comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 111–34. ISBN978-1-4051-7696-5.
^ abKapp N, von Hertzen H (2009). "Medical methods to induce abortion in the second trimester". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy: comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 178–92. ISBN978-1-4051-7696-5.
^Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V (September 2009). "Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days". Contraception. 80 (3): 282–86. doi:10.1016/j.contraception.2009.03.010. PMC3766037. PMID19698822. The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of vaginal misoprostol) previously used by Planned Parenthood clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman's request. The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of buccal misoprostol) currently used by Planned Parenthood clinics in the United States since April 2006 is 98% effective through 59 days gestation.
^Holmquist S, Gilliam M (2008). "Induced abortion". In Gibbs RS, Karlan BY, Haney AF, Nygaard I (eds.). Danforth's obstetrics and gynecology (10th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 586–603. ISBN978-0-7817-6937-2.
^Jones, Rachel K.; Jerman, Jenna (17 January 2017). "Abortion incidence and service availability in the United States, 2014". Perspectives on Sexual and Reproductive Health. 49 (1): 17–27. doi:10.1363/psrh.12015. PMC5487028. PMID28094905. 96% of all abortions performed in nonhospital facilities × 31% early medical abortions of all nonhospital abortions = 30% early medical abortions of all abortions; 97% of nonhospital medical abortions used mifepristone and misoprostol—3% used methotrexate and misoprostol, or misoprostol alone—in the United States in 2014.
^ abMeckstroth K, Paul M (2009). "First-trimester aspiration abortion". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy: comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 135–156. ISBN978-1-4051-7696-5.
^World Health Organization (2017). "Dilatation and curettage". Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. Geneva: World Health Organization. ISBN978-92-4-154587-7. OCLC181845530. Retrieved 30 July 2019.
^Hammond, C; Chasen, S (2009). Dilation and evacuation. In Paul M, Lichtenberg ES Borgatta L Grimes DA Stubblefield P Creinin (eds)Management of unintended and abnormal pregnancy: comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 178–92. ISBN978-1-4051-7696-5.
^ abTempleton, A.; Grimes, D.A. (2011). "A Request for Abortion". New England Journal of Medicine. 365 (23): 2198–2204. doi:10.1056/NEJMcp1103639. PMID22150038.
^ abcSociety of Family Planning (February 2011). "Clinical Guidelines, Labor induction abortion in the second trimester". Contraception. 84 (1): 4–18. doi:10.1016/j.contraception.2011.02.005. PMID21664506. Retrieved 25 September 2015. 10. What is the effect of feticide on labor induction abortion outcome? Deliberately causing demise of the fetus before labor induction abortion is performed primarily to avoid transient fetal survival after expulsion; this approach may be for the comfort of both the woman and the staff, to avoid futile resuscitation efforts. Some providers allege that feticide also facilitates delivery, although little data support this claim. Transient fetal survival is very unlikely after intraamniotic installation of saline or urea, which are directly feticidal. Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin. Factors associated with a higher likelihood of transient fetal survival with labor induction abortion include increasing gestational age, decreasing abortion interval and the use of nonfeticidal inductive agents such as the PGE1 analogues.
^"2015 Clinical Policy Guidelines"(PDF). National Abortion Federation. 2015. Archived(PDF) from the original on 12 August 2015. Retrieved 30 October 2015. Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise.Cite journal requires |journal= (help)
^Riddle, John M. (1997). Eve's herbs: a history of contraception and abortion in the West. Cambridge, MA: Harvard University Press. ISBN978-0-674-27024-4. OCLC36126503.
^Smith JP (1998). "Risky choices: The dangers of teens using self-induced abortion attempts". Journal of Pediatric Health Care. 12 (3): 147–51. doi:10.1016/S0891-5245(98)90245-0. PMID9652283.
^ abcdPotts, M.; Graff, M.; Taing, J. (2007). "Thousand-year-old depictions of massage abortion". Journal of Family Planning and Reproductive Health Care. 33 (4): 233–34. doi:10.1783/147118907782101904. PMID17925100.
^Raymond, EG; Grossman, D; Weaver, MA; Toti, S; Winikoff, B (November 2014). "Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States". Contraception. 90 (5): 476–79. doi:10.1016/j.contraception.2014.07.012. PMID25152259.
^Ralph, Lauren J.; Schwarz, Eleanor Bimla; Grossman, Daniel; Foster, Diana Greene (11 June 2019). "Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study". Annals of Internal Medicine. doi:10.7326/M18-1666. ISSN0003-4819. PMID31181576.
^Raymond, Elizabeth G.; Grimes, David A. (February 2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology. 119 (2, Part 1): 215–219. doi:10.1097/AOG.0b013e31823fe923. ISSN0029-7844. PMID22270271.
^Abbas, D; Chong, E; Raymond, EG (September 2015). "Outpatient medical abortion is safe and effective through 70 days gestation". Contraception. 92 (3): 197–99. doi:10.1016/j.contraception.2015.06.018. PMID26118638.
^Dempsey, A (December 2012). "Serious infection associated with induced abortion in the United States". Clinical Obstetrics and Gynecology. 55 (4): 888–92. doi:10.1097/GRF.0b013e31826fd8f8. PMID23090457.
^White, Kari; Carroll, Erin; Grossman, Daniel (November 2015). "Complications from first-trimester aspiration abortion: a systematic review of the literature". Contraception. 92 (5): 422–38. doi:10.1016/j.contraception.2015.07.013. PMID26238336.
^ACOG Committee on Practice Bulletins – Gynecology (May 2009). "ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures". Obstetrics & Gynecology. 113 (5): 1180–89. doi:10.1097/AOG.0b013e3181a6d011. PMID19384149.
^Sawaya GF, Grady D, Kerlikowske K, Grimes DA (May 1996). "Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis". Obstetrics & Gynecology. 87 (5 Pt 2): 884–90. PMID8677129.
^Lerma, Klaira; Shaw, Kate A. (15 September 2017). "Update on second trimester medical abortion". Current Opinion in Obstetrics and Gynecology. 29 (6): 413–18. doi:10.1097/GCO.0000000000000409. ISSN1473-656X. PMID28922193. Second trimester surgical abortion is well tolerated and increasingly expeditious
^Schneider, A. Patrick II; Zainer, Christine; et al. (August 2014). "The breast cancer epidemic: 10 facts". The Linacre Quarterly. Catholic Medical Association. 81 (3): 244–77. doi:10.1179/2050854914Y.0000000027. PMC4135458. PMID25249706. an association between [induced abortion] and breast cancer has been found by numerous Western and non-Western researchers from around the world. This is especially true in more recent reports that allow for a sufficient breast cancer latency period since an adoption of a Western life style in sexual and reproductive behavior.
^Position statements of major medical bodies on abortion and breast cancer include:
American Cancer Society: "Is Abortion Linked to Breast Cancer?". American Cancer Society. 23 September 2010. Archived from the original on 5 June 2011. Retrieved 20 June 2011. At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer.
Royal College of Obstetricians and Gynaecologists: "The Care of Women Requesting Induced Abortion"(PDF). Royal College of Obstetricians and Gynaecologists. p. 9. Archived from the original(PDF) on 27 July 2013. Retrieved 29 June 2008. Induced abortion is not associated with an increase in breast cancer risk.
^Gordon, Linda (2002). The Moral Property of Women. University of Illinois Press. ISBN0-252-02764-7.
^Solinger, Rickie (1998), "Introduction", in Solinger, Rickie (ed.), Abortion Wars: A Half Century of Struggle, 1950–2000, University of California Press, pp. 1–9, ISBN978-0-520-20952-7
^Bates, Jerome E.; Zawadzki, Edward S. (1964). Criminal Abortion: A Study in Medical Sociology. Charles C. Thomas. ISBN978-0-398-00109-4.
^Keller, Allan (1981). Scandalous Lady: The Life and Times of Madame Restell. Atheneum. ISBN978-0-689-11213-3.
^Taussig, Frederick J. (1936). Abortion Spontaneous and Induced: Medical and Social Aspects. C.V. Mosby.
^ abHorvath, S; Schreiber, CA (14 September 2017). "Unintended Pregnancy, Induced Abortion, and Mental Health". Current Psychiatry Reports. 19 (11): 77. doi:10.1007/s11920-017-0832-4. PMID28905259.
^Coleman, PK (September 2011). "Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009". The British Journal of Psychiatry. 199 (3): 180–86. doi:10.1192/bjp.bp.110.077230. PMID21881096.
^Steinberg, J.R. (2011). "Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions – A Critical Review of Research". Women's Health Issues. 21 (3): S44–S48. doi:10.1016/j.whi.2011.02.002. PMID21530839.
^Lozano, R (15 December 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. hdl:10536/DRO/DU:30050819. PMID23245604.
^Darney, Leon Speroff, Philip D. (2010). A clinical guide for contraception (5th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 406. ISBN978-1-60831-610-6.
^Berer M (November 2004). "National laws and unsafe abortion: the parameters of change". Reproductive Health Matters. 12 (24 Suppl): 1–8. doi:10.1016/S0968-8080(04)24024-1. PMID15938152.
^Culwell, Kelly R.; Hurwitz, Manuelle (May 2013). "Addressing barriers to safe abortion". International Journal of Gynecology & Obstetrics. 121: S16–S19. doi:10.1016/j.ijgo.2013.02.003. PMID23477700.
^Jewkes R, Rees H, Dickson K, Brown H, Levin J (March 2005). "The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change". BJOG: An International Journal of Obstetrics & Gynaecology. 112 (3): 355–59. doi:10.1111/j.1471-0528.2004.00422.x. PMID15713153.
^Conti, Jennifer A.; Brant, Ashley R.; Shumaker, Heather D.; Reeves, Matthew F. (November 2016). "Update on abortion policy". Current Opinion in Obstetrics and Gynecology. 28 (6): 517–521. doi:10.1097/GCO.0000000000000324. PMID27805969.
^Medoff, M.H.; Dennis, C. (21 July 2014). "Another Critical Review of New's Reanalysis of the Impact of Antiabortion Legislation". State Politics & Policy Quarterly. 14 (3): 269–76. doi:10.1177/1532440014535476.
^"The Care of Women Requesting Induced Abortion. Evidence-Based Clinical Guideline no. 7"(PDF). Royal College of Obstetricians and Gynaecologists. November 2011. Archived(PDF) from the original on 14 November 2015. Retrieved 31 October 2015. Recommendation 6.21 Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation to ensure that there is no risk of a live birth.
^Fletcher; Isada; Johnson; Evans (August 1992). "Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues". Obstetrics and Gynecology. 80 (2): 310–13. PMID1635751. following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management.
^Gerri R. Baer; Robert M. Nelson (2007). "Preterm Birth: Causes, Consequences, and Prevention. C: A Review of Ethical Issues Involved in Premature Birth". Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Archived from the original on 31 December 2015. In 2002, the 107th U.S. Congress passed the Born-Alive Infants Protection Act of 2001. This law established personhood for all infants who are born "at any stage of development" who breathe, have a heartbeat, or "definite movement of voluntary muscles", regardless of whether the birth was due to labor or induced abortion.
^Chabot, Steve (5 August 2002). "H.R. 2175 (107th): Born-Alive Infants Protection Act of 2002". govtrack.us. Archived from the original on 14 November 2015. Retrieved 30 October 2015. The term "born alive" is defined as the complete expulsion or extraction from its mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of the voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.
^"Practice Bulletin: Second-Trimester Abortion"(PDF). Obstetrics & Gynecology. 121 (6): 1394–1406. June 2013. doi:10.1097/01.AOG.0000431056.79334.cc. PMID23812485. Archived(PDF) from the original on 14 November 2015. Retrieved 30 October 2015. With medical abortion after 20 weeks of gestation, induced fetal demise may be preferable to the woman or provider in order to avoid transient fetal survival after expulsion.
^Committee on Health Care for Underserved Women (November 2014). "Committee Opinion 613: Increasing Access to Abortion". Obstetrics & Gynecology. 124 (5): 1060–65. doi:10.1097/01.aog.0000456326.88857.31. PMID25437742. Archived from the original on 28 October 2015. Retrieved 28 October 2015. "Partial-birth" abortion bans – The federal Partial-Birth Abortion Ban Act of 2003 (upheld by the Supreme Court in 2007) makes it a federal crime to perform procedures that fall within the definition of so-called "partial-birth abortion" contained in the statute, with no exception for procedures necessary to preserve the health of the woman...physicians and lawyers have interpreted the banned procedures as including intact dilation and evacuation unless fetal demise occurs before surgery.
^"2015 Clinical Policy Guidelines"(PDF). National Abortion Federation. 2015. Archived(PDF) from the original on 12 August 2015. Retrieved 30 October 2015. Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise.
^Milliez Jacques (2008). "FIGO Committee Report: Ethical aspects concerning termination of pregnancy following prenatal diagnosis". International Journal of Gynecology and Obstetrics. 102 (1): 97–98. doi:10.1016/j.ijgo.2008.03.002. PMID18423641. Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide.
^Shah I, Ahman E (December 2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges". Journal of Obstetrics and Gynaecology Canada. 31 (12): 1149–58. doi:10.1016/s1701-2163(16)34376-6. PMID20085681. However, a woman's chance of having an abortion is similar whether she lives in a developed or a developing region: in 2003 the rates were 26 abortions per 1000 women aged 15 to 44 in developed areas and 29 per 1000 in developing areas. The main difference is in safety, with abortion being safe and easily accessible in developed countries and generally restricted and unsafe in most developing countries
^Strauss, L.T.; Gamble, S.B.; Parker, W.Y.; Cook, D.A.; Zane, S.B.; Hamdan, S.; Centers for Disease Control Prevention (2006). "Abortion surveillance – United States, 2003". Morbidity and Mortality Weekly Report Surveillance Summaries. 55 (SS11): 1–32. PMID17119534. Archived from the original on 2 June 2017.
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^Copelon, Rhonda (1990). "From Privacy to Autonomy: The Conditions for Reproductive and Sexual Freedom". In Fried, Marlene Gerber (ed.). From Abortion to Reproductive Freedom: Transforming a Movement. South End Press. pp. 27–43. ISBN9780896083875. The prevalence of economically influenced abortions and the sterilization campaigns against poor, minority, and disabled women show us that autonomy is impossible without eradication of discrimination and poverty. Racism, sexism, and poverty can make the difference between abortions that reflect choice and those reflecting bitter necessity.
^Oster, Emily (September 2005). "Explaining Asia's "Missing Women": A New Look at the Data". Population and Development Review. 31 (3): 529–535. doi:10.1111/j.1728-4457.2005.00082.x. Archived from the original on 7 February 2019. Retrieved 5 February 2019. Households have variously resorted to female infanticide and postnatal withholding of health care; and since the mid-1980s, when technology permitting fairly low-cost determination of the sex of fetuses became available, there has been a shift toward prenatal sex selection by means of induced abortion.
^George J. Annas and Sherman Elias. "Legal and Ethical Issues in Obstetrical Practice". Chapter 54 in Obstetrics: Normal and Problem Pregnancies, 6th edition. Eds. Steven G. Gabbe, et al. 2012 Saunders, an imprint of Elsevier. ISBN978-1-4377-1935-2
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^"European delegation visits Nicaragua to examine effects of abortion ban". Ipas. 26 November 2007. Archived from the original on 17 April 2008. Retrieved 15 June 2009. More than 82 maternal deaths had been registered in Nicaragua since the change. During this same period, indirect obstetric deaths, or deaths caused by illnesses aggravated by the normal effects of pregnancy and not due to direct obstetric causes, have doubled.
^Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM (June 1997). "Women's hidden transcripts about abortion in Brazil". Social Science & Medicine. 44 (12): 1833–45. doi:10.1016/s0277-9536(96)00293-6. PMID9194245. Two folk medical conditions, "delayed" (atrasada) and "suspended" (suspendida) menstruation, are described as perceived by poor Brazilian women in Northeast Brazil. Culturally prescribed methods to "regulate" these conditions and provoke menstrual bleeding are also described ...
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