Abortion

For other uses, see Abortion (disambiguation).

Abortion
Other namesInduced miscarriage, termination of pregnancy
SpecialtyObstetrics and gynecology
ICD-10-PCS10A0
ICD-9-CM779.6
MeSHD000028
MedlinePlus007382
eMedicine252560

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus.[nb 1][2] An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies.[3][4] 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.[5][6] The most common reasons given for having an abortion are for birth-timing and limiting family size.[7][8][9] Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.[7][9][10]

When done legally in industrialized societies, induced abortion is one of the safest procedures in medicine.[11]: 1 [12] Unsafe abortions—those performed by people lacking the necessary skills, or in inadequately resourced settings—are responsible for between 5–13% of maternal deaths, especially in the developing world.[13] However, medication abortions that are self-managed are highly effective and safe throughout the first trimester.[14][15][16] Public health data show that making safe abortion legal and accessible reduces maternal deaths.[17][18]

Modern methods use medication or surgery for abortions.[19] The drug mifepristone (aka RU-486) in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimesters of pregnancy.[19][20] The most common surgical technique involves dilating the cervix and using a suction device.[21] Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.[20] 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.[22] In contrast, unsafe abortions performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities cause between 22,000 and 44,000 deaths and 6.9 million hospital admissions each year.[23] The World Health Organization states that "access to legal, safe and comprehensive abortion care, including post-abortion care, is essential for the attainment of the highest possible level of sexual and reproductive health".[24] Historically, abortions have been attempted using herbal medicines, sharp tools, forceful massage, or other traditional methods.[25]

Around 73 million abortions are performed each year in the world,[26] with about 45% done unsafely.[27] Abortion rates changed little between 2003 and 2008,[28] before which they decreased for at least two decades as access to family planning and birth control increased.[29] As of 2018, 37% of the world's women had access to legal abortions without limits as to reason.[30] Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.[31] Abortion rates are similar between countries that restrict abortion and countries that broadly allow it, though this is partly because countries which restrict abortion tend to have higher unintended pregnancy rates.[32]

Globally, there has been a widespread trend towards greater legal access to abortion since 1973,[33] but there remains debate with regard to moral, religious, ethical, and legal issues.[34][35] Those who oppose abortion often argue that an embryo or fetus is a person with a right to life, and thus equate abortion with murder.[36][37] Those who support abortion's legality often argue that it is a woman's reproductive right.[38] Others favor legal and accessible abortion as a public health measure.[39] Abortion laws and views of the procedure are different around the world. In some countries abortion is legal and women have the right to make the choice about abortion.[40] In some areas, abortion is legal only in specific cases such as rape, incest, fetal defects, poverty, and risk to a woman's health.[41]

  1. ^ Kulczycki A. "Abortion". Oxford Bibliographies. Archived from the original on 13 April 2014. Retrieved 9 April 2014.
  2. ^ Rao R (2016). "Abortion". Oxford Constitutional Law. Oxford University Press. doi:10.1093/law:mpeccol/e67.013.67. Retrieved 27 September 2024.
  3. ^ The Johns Hopkins Manual of Gynecology and Obstetrics (4 ed.). Lippincott Williams & Wilkins. 2012. pp. 438–439. ISBN 978-1-4511-4801-5. Archived from the original on 10 September 2017.
  4. ^ "How many people are affected by or at risk for pregnancy loss or miscarriage?". NICHD. 15 July 2013. Archived from the original on 2 April 2015. Retrieved 14 March 2015.
  5. ^ "abortion". Oxford English Dictionary. Archived from the original on 19 August 2020. Retrieved 5 April 2019.
  6. ^ "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
  7. ^ a b Cite error: The named reference bankole98 was invoked but never defined (see the help page).
  8. ^ Cite error: The named reference Chae_2017 was invoked but never defined (see the help page).
  9. ^ a b Cite error: The named reference guttmacher was invoked but never defined (see the help page).
  10. ^ Cite error: The named reference :5 was invoked but never defined (see the help page).
  11. ^ Cite error: The named reference lancet-grimes was invoked but never defined (see the help page).
  12. ^ Cite error: The named reference Ray2014 was invoked but never defined (see the help page).
  13. ^ "Preventing unsafe abortion". World Health Organization. Archived from the original on 23 August 2019. Retrieved 6 August 2019.
  14. ^ "Self-management Recommendation 50: Self-management of medical abortion in whole or in part at gestational ages < 12 weeks (3.6.2) - Abortion care guideline". WHO Department of Sexual and Reproductive Health and Research. 19 November 2021. Archived from the original on 29 June 2022. Retrieved 21 September 2023.
  15. ^ Moseson H, Jayaweera R, Raifman S, Keefe-Oates B, Filippa S, Motana R, et al. (October 2020). "Self-managed medication abortion outcomes: results from a prospective pilot study". Reproductive Health. 17 (1): 164. doi:10.1186/s12978-020-01016-4. ISSN 1742-4755. PMC 7588945. PMID 33109230.
  16. ^ Moseson H, Jayaweera R, Egwuatu I, Grosso B, Kristianingrum IA, Nmezi S, et al. (January 2022). "Effectiveness of self-managed medication abortion with accompaniment support in Argentina and Nigeria (SAFE): a prospective, observational cohort study and non-inferiority analysis with historical controls". The Lancet. Global Health. 10 (1): e105–e113. doi:10.1016/S2214-109X(21)00461-7. PMC 9359894. PMID 34801131.
  17. ^ Faúndes A, Shah IH (October 2015). "Evidence supporting broader access to safe legal abortion". International Journal of Gynaecology and Obstetrics. World Report on Women's Health 2015: The unfinished agenda of women's reproductive health. 131 (Suppl 1): S56–S59. doi:10.1016/j.ijgo.2015.03.018. PMID 26433508. A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. [...] [C]riminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates.
  18. ^ Latt SM, Milner A, Kavanagh A (January 2019). "Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries". BMC Women's Health. 19 (1): 1. doi:10.1186/s12905-018-0705-y. PMC 6321671. PMID 30611257.
  19. ^ a b Zhang J, Zhou K, Shan D, Luo X (May 2022). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews. 2022 (5): CD002855. doi:10.1002/14651858.CD002855.pub5. PMC 9128719. PMID 35608608.
  20. ^ a b Kapp N, Whyte P, Tang J, Jackson E, Brahmi D (September 2013). "A review of evidence for safe abortion care". Contraception. 88 (3): 350–363. doi:10.1016/j.contraception.2012.10.027. PMID 23261233.
  21. ^ "Abortion – Women's Health Issues". Merck Manuals Consumer Version. Archived from the original on 13 July 2018. Retrieved 12 July 2018.
  22. ^ Lohr PA, Fjerstad M, Desilva U, Lyus R (2014). "Abortion". BMJ. 348: f7553. doi:10.1136/bmj.f7553. S2CID 220108457.
  23. ^ "Induced Abortion Worldwide | Guttmacher Institute". Guttmacher.org. 1 March 2018. Archived from the original on 1 March 2018. Retrieved 23 June 2023.
  24. ^ "Abortion". www.who.int. Archived from the original on 6 May 2021. Retrieved 14 April 2021.
  25. ^ Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Joffe C (2009). "1. Abortion and medicine: A sociopolitical history" (PDF). Management of Unintended and Abnormal Pregnancy (1st ed.). Oxford: John Wiley & Sons. ISBN 978-1-4443-1293-5. OL 15895486W. Archived (PDF) from the original on 19 January 2012.
  26. ^ "Abortion". www.who.int. Archived from the original on 21 September 2022. Retrieved 21 September 2022.
  27. ^ "Worldwide, an estimated 25 million unsafe abortions occur each year". World Health Organization. 28 September 2017. Archived from the original on 29 September 2017. Retrieved 29 September 2017.
  28. ^ Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, Bankole A (February 2012). "Induced abortion: incidence and trends worldwide from 1995 to 2008" (PDF). Lancet. 379 (9816): 625–632. doi:10.1016/S0140-6736(11)61786-8. PMID 22264435. S2CID 27378192. 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.
  29. ^ Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J (September 2007). "Legal abortion worldwide: incidence and recent trends". International Family Planning Perspectives. 33 (3): 106–116. doi:10.1363/3310607. PMID 17938093. Archived from the original on 19 August 2009.
  30. ^ "Induced Abortion Worldwide". Guttmacher Institute. 1 March 2018. Archived from the original on 23 February 2020. Retrieved 21 February 2020. Of the world's 1.64 billion women of reproductive age, 6% live where abortion is banned outright, and 37% live where it is allowed without restriction as to reason. Most women live in countries with laws that fall between these two extremes.
  31. ^ Culwell KR, Vekemans M, de Silva U, Hurwitz M, Crane BB (July 2010). "Critical gaps in universal access to reproductive health: contraception and prevention of unsafe abortion". International Journal of Gynaecology and Obstetrics. 110 (Suppl): S13–S16. doi:10.1016/j.ijgo.2010.04.003. PMID 20451196. S2CID 40586023.
  32. ^ "Unintended Pregnancy and Abortion Worldwide". Guttmacher Institute. 28 May 2020. Archived from the original on 23 February 2020. Retrieved 9 March 2021. Abortion is sought and needed even in settings where it is restricted—that is, in countries where it is prohibited altogether or is allowed only to save the women's life or to preserve her physical or mental health. Unintended pregnancy rates are highest in countries that restrict abortion access and lowest in countries where abortion is broadly legal. As a result, abortion rates are similar in countries where abortion is restricted and those where the procedure is broadly legal (i.e., where it is available on request or on socioeconomic grounds).
  33. ^ Staff FP (24 June 2022). "Roe Abolition Makes U.S. a Global Outlier". Foreign Policy. Archived from the original on 24 June 2022. Retrieved 20 October 2023.
  34. ^ Paola A, Walker R, LaCivita L (2010). Nixon F (ed.). Medical ethics and humanities. Sudbury, MA: Jones and Bartlett Publishers. p. 249. ISBN 978-0-7637-6063-2. OL 13764930W. Archived from the original on 6 September 2017.
  35. ^ Johnstone MJ (2009). "Bioethics a nursing perspective". Confederation of Australian Critical Care Nurses Journal. 3 (4) (5th ed.). Sydney, NSW: Churchill Livingstone/Elsevier: 24–30. ISBN 978-0-7295-7873-8. PMID 2129925. 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.
  36. ^ Driscoll M (18 October 2013). "What do 55 million people have in common?". Fox News. Archived from the original on 31 August 2014. Retrieved 2 July 2014.
  37. ^ Hansen D (18 March 2014). "Abortion: Murder, or Medical Procedure?". The Huffington Post. Archived from the original on 14 July 2014. Retrieved 2 July 2014.
  38. ^ Sifris RN (2013). Reproductive freedom, torture and international human rights: challenging the masculinisation of torture. Hoboken, NJ: Taylor & Francis. p. 3. ISBN 978-1-135-11522-7. OCLC 869373168. Archived from the original on 15 October 2015.
  39. ^ Åhman E (2007). Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 (5th ed.). World Health Organization. ISBN 978-92-4-159612-1. Archived from the original on 7 April 2018. Retrieved 24 March 2018.
  40. ^ Fabiola Sanchez, Megan Janetsky, Mexico decriminalizes abortion, extending Latin American trend of widening access to procedure Archived 6 September 2023 at the Wayback Machine, Associated Press (AP), September 6, 2023
  41. ^ Boland R, Katzive L (September 2008). "Developments in laws on induced abortion: 1998-2007". International Family Planning Perspectives. 34 (3): 110–120. doi:10.1363/3411008. PMID 18957353. Archived from the original on 7 October 2011.


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