abortion

An induced abortion is a medical procedure to end a pregnancy.{{cite web |vauthors=Cheng L |date=1 November 2008 |title=Surgical versus medical methods for second-trimester induced abortion |url=http://apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html |work=The WHO Reproductive Health Library |publisher=World Health Organization |access-date=17 June 2011 |archive-url=https://web.archive.org/web/20100801023058/http://apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html |archive-date=1 August 2010 |url-status=dead}} In present-day English, the term abortion, when used without further qualification, generally refers to induced abortion.

A pregnancy can be intentionally aborted in several ways. The abortion method depends upon the gestational age of the embryo or fetus, which gains mass as the pregnancy progresses.{{cite book| vauthors = Stubblefield PG |chapter=10. Family Planning |title=Novak's Gynecology| veditors=Berek JS |editor1-link=Jonathan Berek| publisher=Lippincott Williams & Wilkins| year=2002| edition=13| isbn=978-0-7817-3262-8}}{{cite journal| title=Risk factors for legal induced abortion-related mortality in the United States |pmid=15051566| journal=Obstetrics & Gynecology |year=2004 | vauthors = Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK |volume=103 |issue=4 |pages=729–737 |doi=10.1097/01.AOG.0000116260.81570.60| s2cid=42597014| doi-access=free }} Abortion laws, regional availability, and the personal preference of the women and her doctor may inform the women's choice of a specific abortion procedure.

Abortions can be characterized as either therapeutic or elective. When an abortion is performed for medical reasons, the procedure is referred to as a therapeutic abortion. Medical reasons for therapeutic abortion include saving the life of the pregnant woman, preventing harm to the woman's physical or mental health, preventing the birth of a child who will have a significantly increased chance of mortality or morbidity, and reducing the number of fetuses to lessen health risks associated with multiple pregnancy.{{cite web| vauthors = Roche NE |date=28 September 2004 |title=Therapeutic Abortion |publisher=eMedicine |archive-url=https://web.archive.org/web/20041214092044/http://www.emedicine.com/MED/topic3311.htm |url=http://emedicine.medscape.com/article/252560-overview |archive-date=14 December 2004 |access-date=19 June 2011}} An abortion is referred to as elective or voluntary when it is performed at the request of the woman for non-medical reasons. Confusion sometimes arises over the term elective because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.{{cite journal |last1=Janiak |first1=Elizabeth |last2=Goldberg |first2=Alisa B. |date=2016-02-01 |title=Eliminating the phrase 'elective abortion': why language matters |url=https://www.contraceptionjournal.org/article/S0010-7824(15)00624-1/abstract |journal=Contraception |language=English |volume=93 |issue=2 |pages=89–92 |doi=10.1016/j.contraception.2015.10.008 |pmid=26480889 |issn=0010-7824 |access-date=27 November 2022 |archive-date=24 January 2023 |archive-url=https://web.archive.org/web/20230124173416/https://www.contraceptionjournal.org/article/S0010-7824%2815%2900624-1/fulltext |url-status=live |url-access=subscription }}

About one in five pregnancies worldwide ends with an induced abortion. Most abortions result from unintended pregnancies.{{cite journal |vauthors=Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM |title=Reasons U.S. women have abortions: quantitative and qualitative perspectives |journal=Perspectives on Sexual and Reproductive Health |volume=37 |issue=3 |pages=110–118 |date=September 2005 |pmid=16150658 |doi=10.1111/j.1931-2393.2005.tb00045.x |url=http://www.guttmacher.org/pubs/journals/3711005.pdf |url-status=live |archive-url=https://web.archive.org/web/20060117143856/https://www.guttmacher.org/pubs/journals/3711005.pdf |archive-date=17 January 2006}} In the United Kingdom, 1 to 2% of abortions are done because of genetic problems in the fetus.

{{Main|Miscarriage}}

Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.{{cite book | title = Churchill Livingstone medical dictionary | publisher = Churchill Livingstone Elsevier | location = Edinburgh New York | year = 2008 | isbn = 978-0-443-10412-1 | quote = The preferred term for unintentional loss of the product of conception prior to 24 weeks' gestation is miscarriage.}} A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth" or a "preterm birth".{{cite book|quote=A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight.|page=669| veditors = Gabbe SG, Niebyl JR, Simpson JL |editor1-link=Steven Gabbe|year=2007|title=Obstetrics: Normal and Problem Pregnancies|edition=5th |publisher=Churchill Livingstone|chapter=51. Legal and Ethical Issues in Obstetric Practice|isbn=978-0-443-06930-7|vauthors = AnnasGJ, Elias S |author-link1=George Annas }} When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".{{cite encyclopedia|quote=birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception|title=Stillbirth|series=Concise Medical Dictionary|publisher=Oxford University Press|year=2010|url=https://books.google.com/books?id=Zs8ZM4OUurcC&pg=PA698|url-status=live|archive-url=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=Zs8ZM4OUurcC&pg=PA698|archive-date=15 October 2015|isbn=978-0-19-955714-1}} Premature births and stillbirths are generally not considered to be miscarriages, although usage of these terms can sometimes overlap.{{cite web|url=https://fam.state.gov/FAM/07FAM/07FAM1470.html|title=7 FAM 1470 Documenting Stillbirth (Fetal Death)|publisher=United States Department of State|date=18 February 2011|access-date=12 January 2016|archive-url=https://web.archive.org/web/20160205060246/https://fam.state.gov/FAM/07FAM/07FAM1470.html|archive-date=5 February 2016|url-status=live}}

Studies of pregnant women in the US and China have shown that between 40% and 60% of embryos do not progress to birth.{{cite book | veditors = Gabbe SG, Niebyl JR, Simpson JL |editor1-link=Steven Gabbe |year=2007|title=Obstetrics: Normal and Problem Pregnancies|edition=5th |publisher=Churchill Livingstone |chapter=24. Pregnancy loss|isbn=978-0-443-06930-7| vauthors = Annas GJ, Elias S |author-link1=George Annas }}{{cite journal |title=Early embryo mortality in natural human reproduction: What the data say [version 2; peer review: 2 approved, 1 approved with reservations] |journal=F1000Research |date=7 June 2017 | vauthors = Jarvis GE |volume=5 |page=2765 |doi=10.12688/f1000research.8937.2 |doi-access=free |pmid=28580126 |pmc=5443340 }}{{cite journal |title=Estimating limits for natural human embryo mortality [version 1; peer review: 2 approved] |journal=F1000Research |date=26 August 2016 |vauthors=Jarvis GE |volume=5 |page=2083 |doi=10.12688/f1000research.9479.1 |doi-access=free |pmid=28003878 |pmc=5142718 }} The vast majority of miscarriages occur before the woman is aware that she is pregnant, and many pregnancies spontaneously abort before medical practitioners can detect an embryo.{{cite book| vauthors = Katz VL |publisher=Mosby|year=2007|edition=5 th|title=Katz: Comprehensive Gynecology| veditors = Katz VL, Lentz GM, Lobo RA, Gershenson DM |chapter=16. Spontaneous and Recurrent Abortion – Etiology, Diagnosis, Treatment|isbn=978-0-323-02951-3}} Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.{{cite book| vauthors = Stovall TG |chapter=17. Early Pregnancy Loss and Ectopic Pregnancy|title=Novak's Gynecology| veditors = Berek JS |editor1-link=Jonathan Berek|publisher=Lippincott Williams & Wilkins|year=2002|edition=13|isbn=978-0-7817-3262-8}} 80% of these spontaneous abortions happen in the first trimester.{{cite book | veditors = Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS |editor-link4=Catherine Y. Spong |title = Williams Obstetrics |edition = 24th |year = 2014 |publisher = McGraw Hill Education |isbn = 978-0-07-179893-8}}

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,{{cite book| veditors = Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG |year=2008|title=Williams Gynecology|edition=1|publisher=McGraw-Hill Medical|isbn=978-0-07-147257-9|chapter=6. First-Trimester Abortion}}{{cite web|url=http://www.medicinenet.com/miscarriage/page1.htm |title=Miscarriage (Spontaneous Abortion) |access-date=7 April 2009 | vauthors = Stöppler MS | veditors = Shiel Jr WC |work=MedicineNet.com |publisher=WebMD |url-status=dead |archive-url=https://web.archive.org/web/20040829013142/http://www.medicinenet.com/Miscarriage/page1.htm |archive-date=29 August 2004 }} accounting for at least 50% of sampled early pregnancy losses.{{cite book |vauthors=Jauniaux E, Kaminopetros P, El-Rafaey H |chapter=Early pregnancy loss |veditors=Whittle MJ, Rodeck CH |title=Fetal medicine: basic science and clinical practice |publisher=Churchill Livingstone |location=Edinburgh |year=1999 |chapter-url=https://archive.org/details/fetalmedicinebas0000unse/page/836/mode/2up |isbn=978-0-443-05357-3 |oclc=42792567 |page=837 }} Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus. 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. A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.{{cite web |url=http://www.ncsl.org/programs/health/fethom.htm |title=Fetal Homicide Laws |access-date=7 April 2009 |publisher=National Conference of State Legislatures |archive-url=https://archive.today/20120911171355/http://www.ncsl.org/issues-research/health/fetal-homicide-state-laws.aspx |archive-date=11 September 2012}}{{cbignore|bot=medic}}

{{Main|Medical abortion}}

{{Distinguish|text= emergency contraception}}

{{Image frame|width=300|innerstyle=font-size:88%;|link=:File:Abortionmethods.png|caption=Gestational age may determine which abortion methods are practiced.|content={{#invoke:Block diagram|main|width=300|height=190|  Practice of Induced Abortion MethodsMVAD&EEVAHyst.D&CIntact D&XMifepr.Induced Miscarr.0–12 wks12–28 weeks28–40 wks}}}}

Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s.{{cite book|vauthors=Creinin MD, Gemzell-Danielsson K |year=2009| chapter=Medical abortion in early pregnancy|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care| location=Oxford|publisher=Wiley-Blackwell|pages=111–134| isbn=978-1-4051-7696-5}}{{cite book| vauthors=Kapp N, von Hertzen H |year=2009| chapter=Medical methods to induce abortion in the second trimester| veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care| location=Oxford|publisher=Wiley-Blackwell| pages=178–192| isbn=978-1-4051-7696-5}}

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,{{cite web |author=Center for Drug Evaluation and Research |title=Mifeprex (mifepristone) Information |url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information |website=FDA |access-date=2 July 2019 |date=8 February 2019 |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423032409/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm |url-status=live }} methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. 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, particularly in the second trimester.{{cite journal | vauthors = Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N | title = Medical methods for mid-trimester termination of pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 1 | pages = CD005216 | date = January 2011 | pmid = 21249669 | pmc = 8557267 | doi = 10.1002/14651858.CD005216.pub2 }} Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.{{cite journal | vauthors = Chen MJ, Creinin MD | title = Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review | journal = Obstetrics and Gynecology | volume = 126 | issue = 1 | pages = 12–21 | date = July 2015 | pmid = 26241251 | doi = 10.1097/AOG.0000000000000897 | url = http://www.escholarship.org/uc/item/2pw521h5 | access-date = 30 July 2019 | url-status = live | s2cid = 20800109 | archive-url = https://web.archive.org/web/20200726105924/https://escholarship.org/uc/item/2pw521h5 | archive-date = 26 July 2020 }}

File:Abortion pill.jpg and 800 μg misoprostol).]]

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.{{cite book |author=WHO Department of Reproductive Health and Research |url=http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf |title=Frequently asked clinical questions about medical abortion |publisher=World Health Organization |year=2006 |isbn=92-4-159484-5 |location=Geneva |access-date=22 November 2011 |url-access=subscription |archive-url=https://web.archive.org/web/20111226115043/http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf |archive-date=26 December 2011 |url-status=dead}} 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%.{{cite journal | vauthors = Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V | title = Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days | journal = Contraception | volume = 80 | issue = 3 | pages = 282–286 | date = September 2009 | pmid = 19698822 | pmc = 3766037 | doi = 10.1016/j.contraception.2009.03.010 }} 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. If medical abortion fails, surgical abortion must be used to complete the procedure.{{cite book| vauthors=Holmquist S, Gilliam M |year=2008| chapter=Induced abortion| veditors=Gibbs RS, Karlan BY, Haney AF, Nygaard I |title=Danforth's obstetrics and gynecology| edition=10th| location=Philadelphia|publisher=Lippincott Williams & Wilkins| pages=586–603| isbn=978-0-7817-6937-2}}

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,{{Cite report |title=Abortion statistics, England and Wales: 2022 |url=https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2022 |publisher= Office for Health Improvement and Disparities |date=2023| access-date=2024-07-23 |language=en|section = Table 5: Legal abortions: gestation weeks by purchaser and method of abortion, residents of England and Wales, numbers, percentages, 2022 |section-url = https://assets.publishing.service.gov.uk/media/664dcb9d4f29e1d07fadcc7b/Abortion-statistics-2022-data-tables.ods}} France,{{cite web| vauthors=Vilain A, Mouquet MC |date=22 June 2011 |title=Voluntary terminations of pregnancies in 2008 and 2009 |location=Paris |publisher=DREES, Ministry of Health, France |url=http://www.sante.gouv.fr/IMG/pdf/er765.pdf |access-date=22 November 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110926235733/http://www.sante.gouv.fr/IMG/pdf/er765.pdf |archive-date=26 September 2011 }} Switzerland,{{cite web| date=5 July 2011|title=Abortions in Switzerland 2010| location=Neuchâtel| publisher=Office of Federal Statistics, Switzerland| url=http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|access-date=22 November 2011| url-status=dead| archive-url=https://web.archive.org/web/20111003203103/http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|archive-date=3 October 2011}} United States,{{cite report | vauthors = Jones RK, Witwer E, Jerman J |title=Abortion Incidence and Service Availability in the United States, 2017 |year=2019 |publisher=Guttmacher Institute |doi=10.1363/2019.30760 |doi-access=free |pmc=5487028 }} and the Nordic countries.{{cite web| vauthors=Gissler M, Heino A|date=21 February 2011| title=Induced abortions in the Nordic countries 2009| location=Helsinki| publisher=National Institute for Health and Welfare, Finland| url=http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf| access-date=22 November 2011| url-status=dead|archive-url=https://web.archive.org/web/20120118094034/http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf|archive-date=18 January 2012}}

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, in contrast to the United States where 96% of second trimester abortions are performed surgically by dilation and evacuation.{{cite book|title=Management of unintended and abnormal pregnancy: comprehensive abortion care| vauthors=Meckstroth K, Paul M|publisher=Wiley-Blackwell| year=2009|isbn=978-1-4051-7696-5|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD| location=Oxford|pages=135–156|chapter=First-trimester aspiration abortion}}

A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion.{{cite journal | vauthors = Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD | title = Self-administered versus provider-administered medical abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD013181 | date = March 2020 | issue = 3 | pmid = 32150279 | pmc = 7062143 | doi = 10.1002/14651858.CD013181.pub2 }} Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion. Safely permitting women to self-administer abortion medication has the potential to improve access to abortion. The review also noted a research gap concerning methods to support women who take medication at home for a self-administered abortion.

File:Vacuum-aspiration (single).svg
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.{{cite web| author=Healthwise |url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 |title=Manual and vacuum aspiration for abortion |year=2004 |website=WebMD |access-date=5 December 2008| archive-url= https://web.archive.org/web/20070211155626/http://www.webmd.com/hw/womens_conditions/tw1078.asp| archive-date=11 February 2007| url-status= live}} 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. Both techniques can 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.

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.{{cite book|title=Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors| author=World Health Organization| publisher=World Health Organization| year=2017| isbn=978-92-4-154587-7| location=Geneva| chapter=Dilatation and curettage| oclc=181845530| access-date=30 July 2019|chapter-url=https://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html|archive-date=19 May 2009|archive-url=https://web.archive.org/web/20090519162903/http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html| url-status=live}}

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.{{cite book| title=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.| vauthors = Hammond C, Chasen S |publisher=Oxford: Wiley-Blackwell|year=2009|isbn=978-1-4051-7696-5|pages=178–192}}

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.{{cite journal | vauthors = | title = ACOG Practice Bulletin No. 135: Second-trimester abortion | journal = Obstetrics and Gynecology | volume = 121 | issue = 6 | pages = 1394–1406 | date = June 2013 | pmid = 23812485 | doi = 10.1097/01.AOG.0000431056.79334.cc | s2cid = 205384119 }}

First trimester procedures can generally be performed using local anesthesia, while second trimester methods may require deep sedation or general anesthesia.{{cite journal | vauthors = Templeton A, Grimes DA | title = Clinical practice. A request for abortion | journal = The New England Journal of Medicine | volume = 365 | issue = 23 | pages = 2198–2204 | date = December 2011 | pmid = 22150038 | doi = 10.1056/NEJMcp1103639 | doi-access = }}{{cite journal | vauthors = Allen RH, Singh R | title = Society of Family Planning clinical guidelines pain control in surgical abortion part 1 - local anesthesia and minimal sedation | language = English | journal = Contraception | volume = 97 | issue = 6 | pages = 471–477 | date = June 2018 | pmid = 29407363 | doi = 10.1016/j.contraception.2018.01.014 | url = https://www.contraceptionjournal.org/article/S0010-7824(18)30036-2/abstract | access-date = 20 January 2022 | url-status = live | s2cid = 3777869 | archive-url = https://web.archive.org/web/20220303075142/https://www.contraceptionjournal.org/article/S0010-7824%2818%2930036-2/fulltext | archive-date = 3 March 2022 | doi-access = free }}{{cite journal | vauthors = Cansino C, Denny C, Carlisle AS, Stubblefield P | title = Society of Family Planning clinical recommendations: Pain control in surgical abortion part 2 - Moderate sedation, deep sedation, and general anesthesia | language = English | journal = Contraception | volume = 104 | issue = 6 | pages = 583–592 | date = December 2021 | pmid = 34425082 | doi = 10.1016/j.contraception.2021.08.007 | url = https://www.contraceptionjournal.org/article/S0010-7824(21)00351-6/abstract | access-date = 20 January 2022 | url-status = live | s2cid = 237279946 | archive-url = https://web.archive.org/web/20220303075141/https://www.contraceptionjournal.org/article/S0010-7824%2821%2900351-6/fulltext | archive-date = 3 March 2022 | doi-access = free }}

In places lacking the necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.{{cite journal| last = Borgatta | first= Lynn |journal=Global Library of Women's Medicine| date=December 2014 |volume=GLOWM.10444| doi=10.3843/GLOWM.10444| url=http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443| access-date=25 September 2015| title=Labor Induction Termination of Pregnancy| url-status=live| archive-url=https://web.archive.org/web/20150924082507/http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443| archive-date=24 September 2015| url-access=subscription}} 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.{{cite journal | last1 = Borgatta | first1= Lynn |first2 =Nathalie |last2 =Kapp| title = Clinical guidelines. Labor induction abortion in the second trimester | journal = Contraception | volume = 84 | issue = 1 | pages = 4–18 | date = July 2011 | pmid = 21664506 | doi = 10.1016/j.contraception.2011.02.005 | url = http://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf | access-date = 25 September 2015 | url-status = live | quote = 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. | archive-url = https://web.archive.org/web/20200606205318/https://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf | archive-date = 6 June 2020 | doi-access = free }}

Only limited data are available comparing labor-induced abortion with the dilation and extraction method. 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.{{cite book| title=2015 Clinical Policy Guidelines| publisher=National Abortion Federation| date=2015| url=http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf| access-date=30 October 2015| quote=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.| url-status=live| archive-url=https://web.archive.org/web/20150812220053/http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf| archive-date=12 August 2015}}

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Such herbs include tansy, pennyroyal, black cohosh, and the now-extinct silphium.{{cite book |last=Riddle |first=John M |url=https://archive.org/details/evesherbshistory0000ridd |title=Eve's herbs: a history of contraception and abortion in the West |publisher=Harvard University Press |year=1997 |isbn=978-0-674-27024-4 |location=Cambridge, MA |oclc=36126503 |author-link=John M. Riddle |url-access=registration}}{{rp|44–47, 62–63, 154–155, 230–231}}

In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil.{{cite journal | vauthors = Sullivan JB, Rumack BH, Thomas H, Peterson RG, Bryson P | title = Pennyroyal oil poisoning and hepatotoxicity | journal = JAMA | volume = 242 | issue = 26 | pages = 2873–2874 | date = December 1979 | pmid = 513258 | doi = 10.1001/jama.1979.03300260043027 | s2cid = 26198529 }}

Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure,{{cite journal | vauthors = Ciganda C, Laborde A | title = Herbal infusions used for induced abortion | journal = Journal of Toxicology. Clinical Toxicology | volume = 41 | issue = 3 | pages = 235–239 | year = 2003 | pmid = 12807304 | doi = 10.1081/CLT-120021104 | s2cid = 44851492 }} 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.{{cite journal | vauthors = Smith JP | title = Risky choices: the dangers of teens using self-induced abortion attempts | journal = Journal of Pediatric Health Care | volume = 12 | issue = 3 | pages = 147–151 | year = 1998 | pmid = 9652283 | doi = 10.1016/S0891-5245(98)90245-0 }} In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.{{cite journal | vauthors = Potts M, Graff M, Taing J | title = Thousand-year-old depictions of massage abortion | journal = The Journal of Family Planning and Reproductive Health Care | volume = 33 | issue = 4 | pages = 233–234 | date = October 2007 | pmid = 17925100 | doi = 10.1783/147118907782101904 | doi-access = free | author-link1 = Malcolm Potts }} One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.

Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These 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.{{cite journal | vauthors = Thapa SR, Rimal D, Preston J | title = Self induction of abortion with instrumentation | journal = Australian Family Physician | volume = 35 | issue = 9 | pages = 697–698 | date = September 2006 | pmid = 16969439 | url = http://www.racgp.org.au/afp/200609/11015 | url-status = live | archive-url = https://web.archive.org/web/20090108181951/http://www.racgp.org.au/afp/200609/11015 | archive-date = 8 January 2009 }}

{{clear}}

File:Abortion Quick & Pain Free sign, Joe Slovo Park, Cape Town, South Africa-3869.jpg

The health risks of abortion depend principally on how, and under what conditions, the procedure is performed. The World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.{{cite web| publisher=World Health Organization |title=The Prevention and Management of Unsafe Abortion |date=April 1992| access-date=18 October 2017 |url=http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf | archive-url= https://web.archive.org/web/20100530072310/http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf| archive-date= 30 May 2010 | url-status= live}} Legal abortions performed in the developed world are among the safest procedures in medicine.{{cite journal | vauthors = Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH | title = Unsafe abortion: the preventable pandemic | journal = Lancet | volume = 368 | issue = 9550 | pages = 1908–1919 | date = November 25, 2006 | pmid = 17126724 | doi = 10.1016/S0140-6736(06)69481-6 | url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69481-6/fulltext | s2cid = 6188636 | url-access = subscription | access-date = 8 June 2023 | archive-date = 3 April 2023 | archive-url = https://web.archive.org/web/20230403232414/https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69481-6/fulltext | url-status = live }}{{cite journal | vauthors = Grimes DA, Creinin MD | title = Induced abortion: an overview for internists | journal = Annals of Internal Medicine | volume = 140 | issue = 8 | pages = 620–626 | date = April 2004 | pmid = 15096333 | doi = 10.7326/0003-4819-140-8-200404200-00009 | doi-access = free | citeseerx = 10.1.1.694.3531 }} According to a 2012 study in Obstetrics & Gynecology, in the United States the risk of maternal mortality is 14 times lower after induced abortion than after childbirth.{{cite journal | first1 = Elizabeth G| last1 = Raymond| last2= Grimes |first2= David A | author-link2=David Grimes (physician)| title = The comparative safety of legal induced abortion and childbirth in the United States | journal = Obstetrics & Gynecology | volume = 119 | issue = 2 Pt 1 | pages = 215–219 | date = February 2012 | pmid = 22270271 | doi = 10.1097/AOG.0b013e31823fe923 | quote = Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion. | s2cid = 25534071 }} The CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,{{cite journal | vauthors = Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM, Barfield W | display-authors = 6 | title = Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013-2017 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 18 | pages = 423–429 | date = May 2019 | pmid = 31071074 | pmc = 6542194 | doi = 10.15585/mmwr.mm6818e1 }} while the US abortion mortality rate was 0.43 maternal deaths per 100,000 procedures.{{cite journal | vauthors = Raymond EG, Grossman D, Weaver MA, Toti S, Winikoff B | title = Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States | journal = Contraception | volume = 90 | issue = 5 | pages = 476–479 | date = November 2014 | pmid = 25152259 | doi = 10.1016/j.contraception.2014.07.012 | quote = Results: The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7 deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. }}{{cite book|url=https://www.nap.edu/read/24950/chapter/4|title=Read "The Safety and Quality of Abortion Care in the United States" at NAP.edu|doi=10.17226/24950|pmid=29897702|year=2018|isbn=978-0-309-46818-3 | author2 = Health Medicine Division| author1 = National Academies of Sciences Engineering |author3=Board on Health Care Services|author4=Board on Population Health Public Health Practice|author5=Committee on Reproductive Health Services: Assessing the Safety Quality of Abortion Care in the U.S|access-date=26 May 2019|archive-date=24 July 2020|archive-url=https://web.archive.org/web/20200724204509/https://www.nap.edu/read/24950/chapter/4|url-status=live}}{{cite journal |last=Kortsmit |first=Katherine |date=2022 |title=Abortion Surveillance — United States, 2020 |url=https://www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm |journal=MMWR. Surveillance Summaries |language=en-us |volume=71 |issue=10 |pages=1–27 |doi=10.15585/mmwr.ss7110a1 |issn=1546-0738 |pmc=9707346 |pmid=36417304 |quote=The national case-fatality rate for legal induced abortion for 2013–2019 was 0.43 deaths related to legal induced abortions per 100,000 reported legal abortions. This case-fatality rate was lower than the rates for the previous 5-year periods. |access-date=14 November 2023 |archive-date=15 November 2023 |archive-url=https://web.archive.org/web/20231115033902/https://www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm |url-status=live }} 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."{{cite journal| vauthors = Donnelly L |title=Abortion is Safer than Having a Baby, Doctors Say|journal=The Telegraph|date=26 February 2011}} 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."{{cite journal | vauthors = Dixon-Mueller R, Germain A | title = Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator | journal = American Journal of Public Health | volume = 97 | issue = 1 | pages = 45–51 | date = January 2007 | pmid = 16571693 | pmc = 1716248 | doi = 10.2105/AJPH.2005.068056 }} 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.{{cite web |url=https://www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf |title=Abortion in Indonesia |publisher=Guttmacher Institute |year=2008 |access-date=13 October 2019 |archive-date=7 June 2020 |archive-url=https://web.archive.org/web/20200607212421/https://www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf |url-status=live }}

In the US from 2000 to 2009, abortion had a mortality rate lower than plastic surgery, lower or similar to running a marathon, and about equivalent to traveling {{convert|760|miles}} in a passenger car.{{ r | Ray2014 }} 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.{{cite journal | vauthors = Ralph LJ, Schwarz EB, Grossman D, Foster DG | title = Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study | journal = Annals of Internal Medicine | volume = 171 | issue = 4 | pages = 238–247 | date = August 2019 | pmid = 31181576 | doi = 10.7326/M18-1666 | s2cid = 184482546 }} The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.{{cite journal | vauthors = Raymond EG, Grimes DA | title = The comparative safety of legal induced abortion and childbirth in the United States | journal = Obstetrics and Gynecology | volume = 119 | issue = 2 Pt 1 | pages = 215–219 | date = February 2012 | pmid = 22270271 | doi = 10.1097/AOG.0b013e31823fe923 | s2cid = 25534071 }} Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.{{cite journal | vauthors = Abbas D, Chong E, Raymond EG | title = Outpatient medical abortion is safe and effective through 70 days gestation | journal = Contraception | volume = 92 | issue = 3 | pages = 197–199 | date = September 2015 | pmid = 26118638 | doi = 10.1016/j.contraception.2015.06.018 }}

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. 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.{{cite web| vauthors = Grossman D|date=3 September 2004|title=Medical methods for first trimester abortion: RHL commentary|work=Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://apps.who.int/rhl/fertility/abortion/dgcom/en/index.html|access-date=22 November 2011|url-status=dead|archive-url=https://web.archive.org/web/20111028054620/http://apps.who.int/rhl/fertility/abortion/dgcom/en/index.html|archive-date=28 October 2011}}{{cite web|vauthors=Chien P, Thomson M |date=15 December 2006|title=Medical versus surgical methods for first trimester termination of pregnancy: RHL commentary|work=Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html |access-date=1 June 2010| archive-url= https://web.archive.org/web/20100517201143/http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html| archive-date= 17 May 2010 | url-status= dead}}

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.{{cite journal | vauthors = Westfall JM, Sophocles A, Burggraf H, Ellis S | title = Manual vacuum aspiration for first-trimester abortion | journal = Archives of Family Medicine | volume = 7 | issue = 6 | pages = 559–562 | year = 1998 | pmid = 9821831 | doi = 10.1001/archfami.7.6.559 | url = http://archfami.ama-assn.org/cgi/content/full/7/6/559 | url-status = dead | archive-url = https://web.archive.org/web/20050405202853/http://archfami.ama-assn.org/cgi/content/full/7/6/559 | archive-date = 5 April 2005 | url-access = subscription }} Infections account for one-third of abortion-related deaths in the United States.{{cite journal | vauthors = Dempsey A | title = Serious infection associated with induced abortion in the United States | journal = Clinical Obstetrics and Gynecology | volume = 55 | issue = 4 | pages = 888–892 | date = December 2012 | pmid = 23090457 | doi = 10.1097/GRF.0b013e31826fd8f8 }} 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.{{cite journal | vauthors = White K, Carroll E, Grossman D | title = Complications from first-trimester aspiration abortion: a systematic review of the literature | journal = Contraception | volume = 92 | issue = 5 | pages = 422–438 | date = November 2015 | pmid = 26238336 | doi = 10.1016/j.contraception.2015.07.013 }} Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures,{{cite journal | vauthors = | title = ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures | journal = Obstetrics and Gynecology | volume = 113 | issue = 5 | pages = 1180–1189 | date = May 2009 | pmid = 19384149 | doi = 10.1097/AOG.0b013e3181a6d011 | doi-access = }} as they are believed to substantially reduce the risk of postoperative uterine infection;{{cite journal | vauthors = Sawaya GF, Grady D, Kerlikowske K, Grimes DA | title = Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis | journal = Obstetrics and Gynecology | volume = 87 | issue = 5 Pt 2 | pages = 884–890 | date = May 1996 | pmid = 8677129 }} however, antibiotics are not routinely given with abortion pills.{{cite journal | vauthors = Achilles SL, Reeves MF | title = Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102 | journal = Contraception | volume = 83 | issue = 4 | pages = 295–309 | date = April 2011 | pmid = 21397086 | doi = 10.1016/j.contraception.2010.11.006 | doi-access = free }} 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.{{cite journal | vauthors = Barnard S, Kim C, Park MH, Ngo TD | title = Doctors or mid-level providers for abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD011242 | date = July 2015 | pmid = 26214844 | doi = 10.1002/14651858.CD011242.pub2 | pmc = 9188302 | url = https://researchonline.lshtm.ac.uk/2274695/1/Doctors%20or%20mid-level%20providers%20for%20abortion_GREEN%20VoR.pdf | access-date = 24 November 2019 | archive-date = 27 August 2021 | archive-url = https://web.archive.org/web/20210827202229/https://researchonline.lshtm.ac.uk/id/eprint/2274695/1/Doctors | url-status = live }}

Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen.{{cite journal | vauthors = Lerma K, Shaw KA | title = Update on second trimester medical abortion | journal = Current Opinion in Obstetrics & Gynecology | volume = 29 | issue = 6 | pages = 413–418 | date = December 2017 | pmid = 28922193 | doi = 10.1097/GCO.0000000000000409 | quote = Second trimester surgical abortion is well tolerated and increasingly expeditious | s2cid = 12459747 }} The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period).{{cite journal | collaboration = Committee on Practice Bulletins-Gynecology | vauthors = Steinauer J, Jackson A, Grossman D |title=Second-trimester abortion. Practice Bulletin No. 135. |journal=American College of Obstetrics & Gynecology - Practice Bulletins |date=June 2013 |url=https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion |access-date=4 December 2019 |quote=The mortality rate associated with abortion is low (0.6 per 100,000 legal, induced abortions), and the risk of death associated with childbirth is approximately 14 times higher than that with abortion. Abortion-related mortality increases with each week of gestation, with a rate of 0.1 per 100,000 procedures at 8 weeks of gestation or less, and 8.9 per 100,000 procedures at 21 weeks of gestation or greater. |archive-date=24 December 2019 |archive-url=https://web.archive.org/web/20191224111109/https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion |url-status=live }}{{cite journal | vauthors = Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK | title = Risk factors for legal induced abortion-related mortality in the United States | journal = Obstetrics and Gynecology | volume = 103 | issue = 4 | pages = 729–737 | date = April 2004 | pmid = 15051566 | doi = 10.1097/01.AOG.0000116260.81570.60 | quote = The risk factor that continues to be most strongly associated with mortality from legal abortion is gestational age at the time of the abortion | s2cid = 42597014 | doi-access = free }} It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.{{cite journal | vauthors = Saccone G, Perriera L, Berghella V | title = Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 214 | issue = 5 | pages = 572–591 | date = May 2016 | pmid = 26743506 | doi = 10.1016/j.ajog.2015.12.044 | url = https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf | access-date = 27 June 2020 | url-status = live | quote = Prior surgical uterine evacuation for either I-TOP[induced termination of pregnancy] or SAB[spontaneous abortion, - also known as miscarriage] is an independent risk factor for PTB[pre-term birth]. These data warrant caution in the use of surgical uterine evacuation and should encourage safer surgical techniques as well as medical methods. | archive-url = https://web.archive.org/web/20210827202228/https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf | archive-date = 27 August 2021 }}{{cite journal | vauthors = Averbach SH, Seidman D, Steinauer J, Darney P | title = Re: Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 216 | issue = 1 | page = 87 | date = January 2017 | pmid = 27596618 | doi = 10.1016/j.ajog.2016.08.038 | url = https://www.ajog.org/article/S0002-9378(16)30650-0/fulltext | access-date = 28 June 2020 | url-status = live | archive-url = https://web.archive.org/web/20210827202230/https://www.ajog.org/article/S0002-9378%2816%2930650-0/fulltext | archive-date = 27 August 2021 | doi-access = | url-access = subscription }}

{{Main|Abortion and mental health}}

Current evidence finds no relationship between most induced abortions and mental health problems{{cite journal | vauthors = Horvath S, Schreiber CA | title = Unintended Pregnancy, Induced Abortion, and Mental Health | journal = Current Psychiatry Reports | volume = 19 | issue = 11 | page = 77 | date = September 2017 | pmid = 28905259 | doi = 10.1007/s11920-017-0832-4 | s2cid = 4769393 }} other than those expected for any unwanted pregnancy. 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.{{cite press release |publisher=American Psychological Association |title=APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health |date=12 August 2008 |access-date=7 September 2011 |url=http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx |url-status=live |archive-url=https://web.archive.org/web/20110906022824/http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx |archive-date=6 September 2011 }}{{cite web |url=http://www.apa.org/pi/women/programs/abortion/mental-health.pdf |title=Report of the APA Task Force on Mental Health and Abortion |publisher=American Psychological Association|location=Washington, DC |date=13 August 2008 |url-status=live |archive-url=https://web.archive.org/web/20100615020211/http://apa.org/pi/women/programs/abortion/mental-health.pdf |archive-date=15 June 2010 }} Some older reviews concluded that abortion was associated with an increased risk of psychological problems;{{cite journal | vauthors = Coleman PK | title = Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009 | journal = The British Journal of Psychiatry | volume = 199 | issue = 3 | pages = 180–186 | date = September 2011 | pmid = 21881096 | doi = 10.1192/bjp.bp.110.077230 | doi-access = free }} however, later reviews of the medical literature found that previous reviews did not use an appropriate control group. When a control group is utilized, receiving abortion is not associated with adverse psychological outcomes. However, women seeking abortion who are denied access to abortion have an increase in anxiety after the denial.

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,{{cite web |title=Mental Health and Abortion |url=http://www.apa.org/pi/women/programs/abortion/index.aspx |publisher=American Psychological Association |year=2008 |access-date=18 April 2012 |url-status=live |archive-url=https://web.archive.org/web/20120419174044/http://www.apa.org/pi/women/programs/abortion/index.aspx |archive-date=19 April 2012}} more rigorous research would be needed to show this conclusively.{{cite journal |vauthors=Steinberg JR |title=Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research | journal = Women's Health Issues |volume=21 |issue=3 Suppl |pages=S44–S48 |year=2011 |pmid=21530839 |doi=10.1016/j.whi.2011.02.002}} 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.{{cite journal |vauthors=Kelly K |title=The spread of 'Post Abortion Syndrome' as social diagnosis |journal=Social Science & Medicine |volume=102 |pages=18–25 |date=February 2014 |pmid=24565137 |doi=10.1016/j.socscimed.2013.11.030}}

A 2020 long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later. The researchers also stated: "These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself."{{cite journal | vauthors = Rocca CH, Samari G, Foster DG, Gould H, Kimport K | title = Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma | journal = Social Science & Medicine | volume = 248 | page = 112704 | date = March 2020 | pmid = 31941577 | doi = 10.1016/j.socscimed.2019.112704 | doi-access = free | quote=We found no evidence of emerging negative emotions or abortion decision regret; both positive and negative emotions declined over the first two years and plateaued thereafter, and decision rightness remained high and steady (predicted percent: 97.5% at baseline, 99.0% at five years). At five years postabortion, relief remained the most commonly felt emotion among all women (predicted mean on 0-4 scale: 1.0; 0.6 for sadness and guilt; 0.4 for regret, anger and happiness). Despite converging levels of emotions by decision difficulty and stigma level over time, these two factors remained most important for predicting negative emotions and decision non-rightness years later. }}

Some purported risks of abortion are promoted primarily by anti-abortion groups,{{cite journal | vauthors = Schneider AP, Zainer CM, Kubat CK, Mullen NK, Windisch AK | title = The breast cancer epidemic: 10 facts | journal = The Linacre Quarterly | volume = 81 | issue = 3 | pages = 244–277 | date = August 2014 | pmid = 25249706 | pmc = 4135458 | doi = 10.1179/2050854914Y.0000000027 | publisher = Catholic Medical Association | quote = 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. | doi-access = free }}

but lack scientific support.{{cite journal | vauthors = Jasen P | title = Breast cancer and the politics of abortion in the United States | journal = Medical History | volume = 49 | issue = 4 | pages = 423–444 | date = October 2005 | pmid = 16562329 | pmc = 1251638 | doi = 10.1017/S0025727300009145 }} For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.Position statements of major medical bodies on abortion and breast cancer include:

• World Health Organization: {{cite web|url=https://www.who.int/mediacentre/factsheets/fs240/en/ |title=Induced abortion does not increase breast cancer risk (Fact sheet N°240) |publisher=World Health Organization |access-date=6 January 2011 |archive-url=https://web.archive.org/web/20110213141046/http://www.who.int/mediacentre/factsheets/fs240/en/ |archive-date=13 February 2011 }}
• National Cancer Institute: {{cite web|url=http://www.cancer.gov/cancertopics/factsheet/risk/abortion-miscarriage |title=Abortion, Miscarriage, and Breast Cancer Risk |publisher=National Cancer Institute |access-date=11 January 2011 |archive-url=https://web.archive.org/web/20101221084337/http://www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage |archive-date=21 December 2010 |url-status=live |date=20 February 2003 }}
• American Cancer Society: {{cite web|url=http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer |publisher=American Cancer Society|date=23 September 2010 |access-date=20 June 2011 |title=Is Abortion Linked to Breast Cancer? |quote=At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer. |archive-url=https://web.archive.org/web/20110605204701/http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer |archive-date=5 June 2011 |url-status=live }}
• Royal College of Obstetricians and Gynaecologists: {{cite web|url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf |title=The Care of Women Requesting Induced Abortion |page=9 |publisher=Royal College of Obstetricians and Gynaecologists |access-date=29 June 2008 |quote=Induced abortion is not associated with an increase in breast cancer risk. |url-status=dead |archive-url=https://web.archive.org/web/20130727105037/http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf |archive-date=27 July 2013 }}
• American Congress of Obstetricians and Gynecologists: {{cite web|url=http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm |title=ACOG Finds No Link Between Abortion and Breast Cancer Risk |date=31 July 2003 |publisher=American Congress of Obstetricians and Gynecologists |access-date=11 January 2011 |archive-url=https://web.archive.org/web/20110102030744/http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm |archive-date=2 January 2011 |url-status=dead }}

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."{{cite book | vauthors = Gordon L | title = The Moral Property of Women | publisher = University of Illinois Press | year = 2002 | isbn = 0-252-02764-7 }}{{rp|25|}}

According to Rickie Solinger,

{{Blockquote|

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.{{cite book | vauthors = Solinger R | chapter = Introduction | veditors = Solinger R | title = Abortion Wars: A Half Century of Struggle, 1950–2000 | pages = [https://archive.org/details/abortionwarshalf0000soli/page/1 1–9] | publisher = University of California Press | year = 1998 | isbn = 978-0-520-20952-7 | url = https://archive.org/details/abortionwarshalf0000soli/page/1 }}{{rp|4}}

}}

A 1940s American physician spoke of his pride in having performed 13,844 illegal abortions without any fatalities.{{cite book | last1 = Bates | first1 = Jerome E | last2 = Zawadzki | first2 = Edward S | title = Criminal Abortion: A Study in Medical Sociology | publisher = Charles C. Thomas | year = 1964 | isbn = 978-0-398-00109-4 |oclc =299149| page = 59| quote = In my practice I average three operations a day. By working a six day week, I complete approximately eighteen operations in this time. This amounts to seventy-two operations a month. In my sixteen years of specializing, I have successfully performed about 13,844 abortions.
This was without the loss of the life of a single one of my patients. I feel those figures are something of which to be proud. I feel—I’m sure—that the work I have been engaged in these past years has been a contribution to Society and has helped to straighten out the messed up lives of many people.}}

In 1870s New York City, the abortionist/midwife Madame Restell (Anna Trow Lohman) is said to have lost very few women among her more than 100,000 patients{{cite book | vauthors = Keller A | title = Scandalous Lady: The Life and Times of Madame Restell | publisher = Atheneum | year = 1981 | isbn = 978-0-689-11213-3 }}—a lower mortality rate than the childbirth mortality rate at the time. In 1936, obstetrics and gynecology professor Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that

{{Blockquote|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.{{cite book | last = Taussig | first= Frederick J. | author-link = Frederick J. Taussig | title = Abortion Spontaneous and Induced: Medical and Social Aspects | publisher = C.V. Mosby | year = 1936 |location = St. Louis | page = 223 |url = https://archive.org/details/b29818394/page/223/mode/1up | oclc = 1041029321 }}

}}

{{Main|Unsafe abortion}}

File:RussianAbortionPoster.jpg

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.{{cite journal | vauthors = Okonofua F | title = Abortion and maternal mortality in the developing world | journal = Journal of Obstetrics and Gynaecology Canada | volume = 28 | issue = 11 | pages = 974–979 | date = November 2006 | pmid = 17169222 | doi = 10.1016/S1701-2163(16)32307-6 | url = http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf | url-status = dead | archive-url = https://web.archive.org/web/20120111121431/http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf | archive-date = 11 January 2012 }}

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. Unsafe abortions are believed to result in millions of injuries.{{cite journal | vauthors = Haddad LB, Nour NM | title = Unsafe abortion: unnecessary maternal mortality | journal = Reviews in Obstetrics & Gynecology | volume = 2 | issue = 2 | pages = 122–126 | year = 2009 | pmid = 19609407 | pmc = 2709326 }} Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;{{cite journal |vauthors=Shah I, Ahman E |date=December 2009 |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |url=http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |url-status=dead |journal=Journal of Obstetrics and Gynaecology Canada |volume=31 |issue=12 |pages=1149–1158 |doi=10.1016/s1701-2163(16)34376-6 |pmid=20085681 |s2cid=35742951 |archive-url=https://web.archive.org/web/20110716212405/http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |archive-date=16 July 2011}}{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | display-authors = 6 | title = 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 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–2128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | url = https://zenodo.org/record/2557786 | access-date = 14 March 2020 | url-status = live | hdl-access = free | s2cid = 1541253 | archive-date = 19 May 2020 | archive-url = https://web.archive.org/web/20200519152712/https://zenodo.org/record/2557786 | hdl = 10536/DRO/DU:30050819 }} deaths from unsafe abortion account for around 13% of all maternal deaths.{{cite book| vauthors = Speroff L, Darney PD |title=A clinical guide for contraception|year=2010|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-1-60831-610-6|page=406|edition=5th }} The World Health Organization believes that mortality has fallen since the 1990s.{{cite book |last=World Health Organisation |title=Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 |publisher=World Health Organisation |year=2011 |edition=6th |page=27 |isbn=978-92-4-150111-8 |url=http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20140328093307/http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf |archive-date=28 March 2014}} 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.{{cite journal |vauthors=Berer M | title=Making abortions safe: a matter of good public health policy and practice |journal=Bulletin of the World Health Organization |volume=78 |issue=5 |pages=580–592 |year=2000 |pmid=10859852 |pmc=2560758}}

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 countries where abortion is legal and available. For example, the 1996 legalization of abortion in South Africa led to an immediate reduction in abortion-related complications,{{cite journal |vauthors=Jewkes R, Rees H, Dickson K, Brown H, Levin J |title=The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change |journal=BJOG |volume=112 |issue=3 |pages=355–359 |date=March 2005 |pmid=15713153 |doi=10.1111/j.1471-0528.2004.00422.x |s2cid=41663939 |doi-access=}} with abortion-related deaths dropping by more than 90%.{{cite journal |vauthors=Bateman C |title=Maternal mortalities 90% down as legal TOPs more than triple |journal=South African Medical Journal = Suid-Afrikaanse Tydskrif vir Geneeskunde |volume=97 |issue=12 |pages=1238–1242 |date=December 2007 |pmid=18264602 |url=http://samj.org.za/index.php/samj/article/view/642 |url-status=live |archive-url=https://web.archive.org/web/20170830200316/http://samj.org.za/index.php/samj/article/view/642 |archive-date=30 August 2017}} Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.{{cite journal |vauthors=Conti JA, Brant AR, Shumaker HD, Reeves MF |title=Update on abortion policy |journal=Current Opinion in Obstetrics & Gynecology |volume=28 |issue=6 |pages=517–521 |date=December 2016 |pmid=27805969 |doi=10.1097/GCO.0000000000000324 |s2cid=26052790}} 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.{{cite journal| vauthors=New MJ |s2cid=53314166|title=Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era |journal=State Politics & Policy Quarterly|date=15 February 2011|volume=11|issue=1|pages=28–47|doi=10.1177/1532440010387397}} The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.{{cite journal| vauthors = Medoff MH, Dennis C |title=Another Critical Review of New's Reanalysis of the Impact of Antiabortion Legislation|journal=State Politics & Policy Quarterly|date=21 July 2014 |volume=14|issue=3|pages=269–76|doi=10.1177/1532440014535476|s2cid=155464018}} 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.{{cite web |url=http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |title=Facts on Investing in Family Planning and Maternal and Newborn Health |publisher=Guttmacher Institute|year=2010 |access-date=24 May 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120324101905/http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |archive-date=24 March 2012 }} 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".{{cite journal |vauthors=Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM |title=Women's hidden transcripts about abortion in Brazil |journal=Social Science & Medicine |volume=44 |issue=12 |pages=1833–1845 |date=June 1997 |pmid=9194245 |doi=10.1016/s0277-9536(96)00293-6}}

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,{{cite book| vauthors=Maclean G |chapter-url=https://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299|chapter=XI. Dimension, Dynamics and Diversity: A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives |pages=299–300|title=Trends in Midwifery Research| veditors=Balin RE |publisher=Nova Publishers|year=2005|isbn=978-1-59454-477-4|url-status=live|archive-date=15 March 2015|archive-url=https://web.archive.org/web/20150315113348/http://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299}} though this varies by region.{{cite journal| vauthors=Salter C, Johnson HB, Hengen N |year=1997 |url=http://info.k4health.org/pr/l10edsum.shtml |title=Care for Postabortion Complications: Saving Women's Lives |journal=Population Reports |volume=25 |issue=1 |publisher=Johns Hopkins School of Public Health |url-status=dead |archive-url=https://web.archive.org/web/20091207070103/http://info.k4health.org/pr/l10edsum.shtml |archive-date=7 December 2009}} Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.{{cite web |year=2007 |title=Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 |url=http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20110216141018/http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf |archive-date=16 February 2011 |access-date=7 March 2011 |publisher=World Health Organization}} The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion.{{cite web|title=Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health|author1=UNICEF |author2=UNFPA |author3=WHO |author4=World Bank|year=2010|access-date=31 December 2010|url-status=dead|url= https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html |archive-url=https://web.archive.org/web/20101109224916/http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html|archive-date=9 November 2010}}

There are two commonly used methods of measuring the incidence of abortion:

• Abortion rate – number of abortions annually per 1,000 women between 15 and 44 years of age;{{cite web| title = Facts on Induced Abortion Worldwide| date = January 2012| publisher = World Health Organization| url = https://www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf| access-date = 9 May 2021| archive-url = https://web.archive.org/web/20210309200507/http://www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf| archive-date = 9 March 2021| url-status = live}} some sources use a range of 15–49.
• 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.{{cite journal |vauthors=Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH |date=October 2007 |title=Induced abortion: estimated rates and trends worldwide |journal=Lancet |volume=370 |issue=9595 |pages=1338–1345 |citeseerx=10.1.1.454.4197 |doi=10.1016/S0140-6736(07)61575-X |pmid=17933648 |s2cid=28458527}} For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error. The number of abortions performed worldwide was characterized as stable in the early 2000s, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008. The abortion rate worldwide was 28 per 1000 women per year, though it was 24 per 1000 women per year for developed countries and 29 per 1000 women per year for developing countries. 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.

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. Restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely.{{cite journal | vauthors = Shah I, Ahman E | title = Unsafe abortion: global and regional incidence, trends, consequences, and challenges | journal = Journal of Obstetrics and Gynaecology Canada | volume = 31 | issue = 12 | pages = 1149–1158 | date = December 2009 | pmid = 20085681 | doi = 10.1016/s1701-2163(16)34376-6 | s2cid = 35742951 | quote = 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 1,000 women aged 15 to 44 in developed areas and 29 per 1,000 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. }}{{cite news| vauthors = Rosenthal E |url= https://www.nytimes.com/2007/10/12/world/12abortion.html |title=Legal or Not, Abortion Rates Compare|newspaper=The New York Times|date=12 October 2007|access-date=18 July 2011|url-status=live|archive-url=https://web.archive.org/web/20110828173628/http://www.nytimes.com/2007/10/12/world/12abortion.html|archive-date=28 August 2011}} 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.{{cite web|url=http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |title=Facts on Investing in Family Planning and Maternal and Newborn Health |publisher=Guttmacher Institute |date=November 2010 |access-date=24 October 2011 |url-status=dead |archive-url=https://web.archive.org/web/20111020135329/http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |archive-date=20 October 2011 }}

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 per year (Germany and Switzerland) to 30 per 1000 women per year (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.{{cite journal | vauthors = Sedgh G, Singh S, Henshaw SK, Bankole A | title = Legal abortion worldwide in 2008: levels and recent trends | journal = Perspectives on Sexual and Reproductive Health | volume = 43 | issue = 3 | pages = 188–198 | date = September 2011 | pmid = 21884387 | doi = 10.1363/4318811 | url = http://www.guttmacher.org/pubs/journals/3708411.html | url-status = live | archive-url = https://web.archive.org/web/20120107111306/http://www.guttmacher.org/pubs/journals/3708411.html | archive-date = 7 January 2012 }}{{cite book|date=2011-05-15|chapter=Populație|url=http://www.insse.ro/cms/files/Anuar%2520statistic/02/02%2520Populatie_ro.pdf|access-date=2023-02-16|archive-url=https://web.archive.org/web/20110515195102/http://www.insse.ro/cms/files/Anuar%2520statistic/02/02%2520Populatie_ro.pdf |archive-date=15 May 2011 |title=Romanian Statistical Yearbook |page=62 |publisher=National Institute of Statistics}}

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.{{cite journal | vauthors = Jones RK, Darroch JE, Henshaw SK | title = Contraceptive use among U.S. women having abortions in 2000-2001 | journal = Perspectives on Sexual and Reproductive Health | volume = 34 | issue = 6 | pages = 294–303 | year = 2002 | pmid = 12558092 | doi = 10.2307/3097748 | url = http://www.guttmacher.org/pubs/journals/3429402.pdf | url-status = live | archive-url = https://web.archive.org/web/20060615011127/http://www.guttmacher.org/pubs/journals/3429402.pdf | archive-date = 15 June 2006 | jstor = 3097748 }} Of the other half of women, who were not using contraception at the time of becoming pregnant, the vast majority had used contraception at some point in the past, indicating some level of dissatisfaction with the contraceptive options available to them. Indeed, 32% of these contraceptive nonusers cited concerns about contraceptive methods as their reason for nonuse, and a more recent study found similar results.{{Cite journal |last1=Mosher |first1=William |last2=Jones |first2=Jo |last3=Abma |first3=Joyce |date=2015 |title=Nonuse of contraception among women at risk of unintended pregnancy in the United States |journal=Contraception |volume=92 |issue=2 |pages=170–176 |doi=10.1016/j.contraception.2015.05.004 |issn=0010-7824 |pmc=6413311 |pmid=25998937}} Taken together, these statistics suggest that new contraceptive methods, such as non-hormonal contraceptives or male contraceptives, could reduce unintended pregnancy and abortion rates.{{Cite journal |last1=Dorman |first1=Emily |last2=Perry |first2=Brian |last3=Polis |first3=Chelsea B. |last4=Campo-Engelstein |first4=Lisa |last5=Shattuck |first5=Dominick |last6=Hamlin |first6=Aaron |last7=Aiken |first7=Abigail |last8=Trussell |first8=James |last9=Sokal |first9=David |date=2018 |title=Modeling the impact of novel male contraceptive methods on reductions in unintended pregnancies in Nigeria, South Africa, and the United States |url=|journal=Contraception |volume=97 |issue=1 |pages=62–69 |doi=10.1016/j.contraception.2017.08.015 |issn=0010-7824 |pmc=5732079 |pmid=28887053}}

The Guttmacher Institute has found that "most abortions in the United States are obtained by minority women" because minority women "have much higher rates of unintended pregnancy".{{cite journal | vauthors = Cohen SA |url= http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html |title=Abortion and Women of Color: The Bigger Picture |journal=Guttmacher Policy Review |year=2008 |volume=11 |issue=3 |url-status=live |archive-url=https://web.archive.org/web/20080915094346/http://www.guttmacher.org/pubs/gpr/11/3/gpr110302.html |archive-date=15 September 2008 }} In a 2022 analysis by the Kaiser Family Foundation, while people of color comprise 44% of the population in Mississippi, 59% of the population in Texas, 42% of the population in Louisiana, and 35% of the population in Alabama, they comprise 80%, 74%, 72%, and 70%, respectively, of those receiving abortions.{{cite news | vauthors = Pettus EW, Willingham L |title=Minority women most affected if abortion is banned, limited |url=https://apnews.com/article/abortion-us-supreme-court-business-health-race-and-ethnicity-3fff455cce7ef0d8694f5371f805ea18 |access-date=1 February 2022 |work=Associated Press |date=1 February 2022 |archive-date=1 February 2022 |archive-url=https://web.archive.org/web/20220201144918/https://apnews.com/article/abortion-us-supreme-court-business-health-race-and-ethnicity-3fff455cce7ef0d8694f5371f805ea18 |url-status=live }}

{{multiple image

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| image1 = UK abortion by gestational age 2019 histogram.svg

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| image2 = US abortion by gestational age 2016 histogram.svg

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| footer = Histogram of abortions by gestational age in England and Wales during 2019 (left). Abortion in the United States by gestational age, 2016 (right).

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Abortion rates 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 the end of 6 weeks of gestation or less, 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).{{cite journal | vauthors = Strauss LT, Gamble SB, Parker WY, Cook DA, Zane SB, Hamdan S | title = Abortion surveillance--United States, 2003 | journal = Morbidity and Mortality Weekly Report. Surveillance Summaries | volume = 55 | issue = 11 | pages = 1–32 | date = November 2006 | pmid = 17119534 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm | url-status = live | author7 = Centers for Disease Control Prevention | archive-url = https://web.archive.org/web/20170602171423/https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5511a1.htm | archive-date = 2 June 2017 }} 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.{{cite web |publisher=The Guttmacher Institute |title=The limitations of U.S. statistics on abortion |work=Issues in Brief |location=New York |year=1997 |url=http://www.guttmacher.org/pubs/ib14.html |archive-url=https://web.archive.org/web/20120404080239/http://www.guttmacher.org/pubs/ib14.html |archive-date=4 April 2012 |url-status=dead}}

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.{{cite journal | vauthors = Finer LB, Henshaw SK | title = Abortion incidence and services in the United States in 2000 | journal = Perspectives on Sexual and Reproductive Health | volume = 35 | issue = 1 | pages = 6–15 | year = 2003 | pmid = 12602752 | doi = 10.1363/3500603 | url = http://www.guttmacher.org/pubs/journals/3500603.html | url-status = live | archive-url = https://web.archive.org/web/20160122204324/http://www.guttmacher.org/pubs/journals/3500603.html | archive-date = 22 January 2016 | url-access = subscription }} 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.{{cite web|author=Department of Health |year=2007 |title=Abortion statistics, England and Wales: 2006 |access-date=12 October 2007 |url=http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |url-status=dead |archive-url=https://web.archive.org/web/20101206002417/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_075697 |archive-date=6 December 2010 }} There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.{{cite web| vauthors = Cheng L |date=1 November 2008|title=Surgical versus medical methods for second-trimester induced abortion: RHL commentary|work=The WHO Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=https://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html|access-date=10 February 2009|url-status=dead|archive-url= https://web.archive.org/web/20090215134007/http://www.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html|archive-date=15 February 2009}} commentary on:
{{cite journal | vauthors = Lohr PA, Hayes JL, Gemzell-Danielsson K | title = Surgical versus medical methods for second trimester induced abortion | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD006714 | date = January 2008 | pmid = 18254113 | doi = 10.1002/14651858.CD006714.pub2 | s2cid = 205184764 }}

There are both medical and non-medical reasons to have an abortion later in pregnancy (after 20 weeks). A study was conducted from 2008 to 2010 at the University of California San Francisco where more than 440 women were asked about why they experienced delays in obtaining abortion care, if there were any. This study found that almost half of individuals who obtained an abortion after 20 weeks did not suspect that they were pregnant until later in their pregnancy.{{cite web |date=December 5, 2019 |title=Abortions Later in Pregnancy |url=https://www.kff.org/womens-health-policy/fact-sheet/abortions-later-in-pregnancy/ |website=KFF (Kaiser Family Foundation) |access-date=10 November 2023 |archive-date=10 November 2023 |archive-url=https://web.archive.org/web/20231110191733/https://www.kff.org/womens-health-policy/fact-sheet/abortions-later-in-pregnancy/ |url-status=live }} Other barriers to abortion care found in the study included lack of information about where to access an abortion, difficulties with transportation, lack of insurance coverage, and inability to pay for the abortion procedure.

Medical reasons for seeking an abortion later in pregnancy include fetal anomalies and health risk to the pregnant person.{{cite book |last=Vaughn |first=Lewis |title=Bioethics: Principles, Issues, and Cases |publisher=Oxford University Press |year=2023 |isbn=978-0-19-760902-6 |edition=5th |pages=328}} There are prenatal tests that can diagnose Down Syndrome or cystic fibrosis as early as 10 weeks into gestation, but structural fetal anomalies are often detected much later in pregnancy. A proportion of structural fetal anomalies are lethal, which means that the fetus will almost certainly die before or shortly after birth. Life-threatening conditions may also develop later in pregnancy, such as early severe preeclampsia, newly diagnosed cancer in need of urgent treatment, and intrauterine infection (chorioamnionitis), which often occurs along with premature rupture of the amniotic sac (PPROM). If serious medical conditions such as these arise before the fetus is viable, the person carrying the pregnancy may pursue an abortion to preserve their own health.

File:AGIAbortionReasonsBarChart.png meta-study on the reasons women stated for having an abortion]]

The reasons why women have abortions are diverse and vary across the world.{{ cite journal | last1=Chae | first1=Sophia | last2=Desai | first2=Sheila | last3=Crowell | first3=Marjorie | last4=Sedgh | first4=Gilda | date=2017-10-01 | title=Reasons why women have induced abortions: a synthesis of findings from 14 countries | journal=Contraception | volume=96 | issue=4 | pages=233–241 | doi=10.1016/j.contraception.2017.06.014 | pmid=28694165 | pmc=5957082 | quote=In most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women's sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. | doi-access=free }} 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.{{cite journal | last = Stotland | first = Nada L |author-link = Nada Stotland| title = Update on Reproductive Rights and Women's Mental Health | journal = The Medical Clinics of North America | volume = 103 | issue = 4 | pages = 751–766 | date = July 2019 | pmid = 31078205 | doi = 10.1016/j.mcna.2019.02.006 | s2cid = 153307516 }} Additional reasons include not being able or willing to raise a child conceived as a result of rape or incest.{{cite journal | vauthors = Bankole A, Singh S, Haas T |date = September 1998 |url=http://www.guttmacher.org/pubs/journals/2411798.html |title=Reasons Why Women Have Induced Abortions: Evidence from 27 Countries |journal=International Family Planning Perspectives |volume=24 |issue=3 |pages=117–127, 152 |doi=10.2307/3038208 |url-status=live |archive-url=https://web.archive.org/web/20060117191716/http://www.guttmacher.org/pubs/journals/2411798.html |archive-date=17 January 2006 |jstor=3038208 | quote= Worldwide, the most commonly reported reason women cite for having an abortion is to postpone or stop childbearing. The second most common reason—socioeconomic concerns—includes disruption of education or employment; lack of support from the father; desire to provide schooling for existing children; and poverty, unemployment or inability to afford additional children. In addition, relationship problems with a husband or partner and a woman's perception that she is too young constitute other important categories of reasons. Women's characteristics are associated with their reasons for having an abortion: With few exceptions, older women and married women are the most likely to identify limiting childbearing as their main reason for abortion. - Conclusions - Reasons women give for why they seek abortion are often far more complex than simply not intending to become pregnant; the decision to have an abortion is usually motivated by more than one factor. }}{{cite journal |vauthors=Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM |title=Reasons U.S. women have abortions: quantitative and qualitative perspectives |journal=Perspectives on Sexual and Reproductive Health |volume=37 |issue=3 |pages=110–118 |date=September 2005 |pmid=16150658 |doi=10.1111/j.1931-2393.2005.tb00045.x |url=http://www.guttmacher.org/pubs/journals/3711005.html |url-status=live |archive-url=https://web.archive.org/web/20120107092446/http://www.guttmacher.org/pubs/journals/3711005.html |archive-date=7 January 2012|url-access=subscription }}

Some abortions are undergone as the result of societal pressures.{{cite encyclopedia | veditors = Fried MG |title=From Privacy to Autonomy: The Conditions for Reproductive and Sexual Freedom | vauthors = Copelon R |author-link=Rhonda Copelon |encyclopedia=From Abortion to Reproductive Freedom: Transforming a Movement |date=1990 |publisher=South End Press |isbn=978-0-89608-387-5 |url=https://books.google.com/books?id=keE5EmSKYr0C&q=abortion%20poverty%20autonomy&pg=PA38 |pages=27–43 |quote=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. |access-date=29 October 2020 |archive-date=26 January 2021 |archive-url=https://web.archive.org/web/20210126082936/https://books.google.com/books?id=keE5EmSKYr0C&q=abortion%20poverty%20autonomy&pg=PA38 |url-status=live }} 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.{{cite journal | vauthors = Oster E |author-link=Emily Oster |title=Explaining Asia's "Missing Women": A New Look at the Data |journal=Population and Development Review |date=September 2005 |volume=31 |issue=3 |pages=529–535 |url=https://www.researchgate.net/publication/4994961 |access-date=5 February 2019 |doi=10.1111/j.1728-4457.2005.00082.x |quote=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. |archive-url=https://web.archive.org/web/20190207131815/https://www.researchgate.net/publication/4994961_Explaining_Asia%27s_Missing_Women_A_New_Look_at_the_Data |archive-date=7 February 2019 |url-status=live }} In cultures where there is a preference for male children, some women have sex selective abortions, which have partially replaced the earlier practice of female infanticide.

Some abortions are performed due to concerns over maternal health. In 1990s, women cited maternal health as their main motivating factor in about a third of abortions in three of 27 countries analyzed. In seven additional countries, about 7% of abortions were maternal health related.

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."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. {{ISBN|978-1-4377-1935-2}}{{rp|1200–1201}}

{{Update section|date=September 2022}}

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.{{cite journal | vauthors = Weisz B, Schiff E, Lishner M | title = Cancer in pregnancy: maternal and fetal implications | journal = Human Reproduction Update | volume = 7 | issue = 4 | pages = 384–393 | year = 2001 | pmid = 11476351 | doi = 10.1093/humupd/7.4.384 | doi-access = free }}

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. 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.{{cite journal | vauthors = Mayr NA, Wen BC, Saw CB | title = Radiation therapy during pregnancy | journal = Obstetrics and Gynecology Clinics of North America | volume = 25 | issue = 2 | pages = 301–321 | date = June 1998 | pmid = 9629572 | doi = 10.1016/s0889-8545(05)70006-1 }}{{cite journal | vauthors = Fenig E, Mishaeli M, Kalish Y, Lishner M | title = Pregnancy and radiation | journal = Cancer Treatment Reviews | volume = 27 | issue = 1 | pages = 1–7 | date = February 2001 | pmid = 11237773 | doi = 10.1053/ctrv.2000.0193 }}

The process of birth itself may also put the mother at risk. According to Li et al., "[v]aginal 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."{{cite journal | vauthors = Li WW, Yau TN, Leung CW, Pong WM, Chan MY | title = Large-cell neuroendocrine carcinoma of the uterine cervix complicating pregnancy | journal = Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi | volume = 15 | issue = 1 | pages = 69–72 | date = February 2009 | pmid = 19197101 }}

Congenital disorders, revealed by prenatal screening, motivate some women to seek abortions. Health outcomes of preterm births include a significant probability of long-term neurodevelopmental impairment before gestational age of 29 weeks, with a higher probability with decreasing gestational age.{{cite journal | last1=Sarda | first1=Sujata P. | last2=Sarri | first2=Grammati | last3=Siffel | first3=Csaba | title=Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review | journal=Journal of International Medical Research | volume=49 | issue=7 | date=2021 | issn=0300-0605 | pmid=34284680 | pmc=8299900 | doi=10.1177/03000605211028026 | page=030006052110280}}

In the United States, public opinion shifted after television personality Sherri Finkbine's was exposed to thalidomide, a teratogen, in her fifth month of pregnancy. Unable to obtain a legal abortion in the United States, Finkbine 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.{{sfn|Doan|2007|p=57}}

{{Main|History of abortion|Religion and abortion}}

File:AngkorWatAbortionAD1150.JPG at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle{{cite book |vauthors=Mould RF |title=Mould's Medical Anecdotes |page=406 |publisher=CRC Press |year=1996 |isbn=978-0-85274-119-1| url=https://archive.org/details/moreofmouldsmedi00moulrich/page/406}}]]

Since ancient times, abortions have been done using a number of methods, including herbal medicines acting as abortifacients, sharp tools through the use of force, or through other traditional medicine methods. Induced abortion has a long history and can be traced back to civilizations as varied as ancient China (abortifacient knowledge is often attributed to the mythological ruler Shennong),{{cite book| title=Medical History of Contraception| vauthors = Himes NE |publisher=Gamut Press|year=1963|pages=109–110}} ancient India since its Vedic age,{{cite book| vauthors = Misra P |title=Domestic Violence Against Women: Legal Control and Judicial Response|url=https://books.google.com/books?id=dp6-_NMfsIsC&pg=PA79| year=2006| publisher=Deep & Deep Publications|isbn=978-81-7629-896-4|pages=79–80|quote=References in Atharva Veda show that abortion was known in the Vedic age.|access-date=5 July 2021|archive-date=9 July 2021|archive-url=https://web.archive.org/web/20210709185150/https://books.google.com/books?id=dp6-_NMfsIsC&pg=PA79|url-status=live}} ancient Egypt with its Ebers Papyrus ({{circa|1550 BCE}}), and the Roman Empire in the time of Juvenal ({{circa|200 CE}}). One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat ({{circa|1150}}). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.

In Judaism, the fetus is not considered to have a human soul until it is safely outside of the woman, is viable, and has taken its first breath.{{cite journal | vauthors=Schenker JG |title=The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law) |journal=Journal of Assisted Reproduction and Genetics |volume=25 |issue=6 |pages=271–276 |date=June 2008 |pmid=18551364 |pmc=2582082 |doi=10.1007/s10815-008-9221-6}}{{cite book|vauthors=Rosner F|year=2001|url=https://books.google.com/books?id=T7w2oAmohpEC|title=Biomedical Ethics and Jewish Law|publisher=KTAV Publishing House|isbn=978-0-88125-701-4|access-date=27 July 2022| via=Google Books|archive-date=24 January 2023|archive-url=https://web.archive.org/web/20230124173418/https://books.google.com/books?id=T7w2oAmohpEC|url-status=live}} Reprinted as {{cite web|vauthors=Rosner F|date=7 June 2015|url=https://www.myjewishlearning.com/article/the-beginning-of-life-in-judaism/|url-status=live|title=The Beginning of Life in Judaism|website=My Jewish Learning|archive-url=https://web.archive.org/web/20150607041405/https://www.myjewishlearning.com/article/the-beginning-of-life-in-judaism/| archive-date=7 June 2015| access-date=27 July 2022}}{{cite web|vauthors=Milgram G| url=http://www.reclaimingjudaism.org/teachings/when-does-life-begin-jewish-view|title=When Does Life Begin? A Jewish View| website=Reclaiming Judaism|date=23 January 2022|access-date=30 June 2022|archive-date=3 August 2022|archive-url=https://web.archive.org/web/20220803233439/http://www.reclaimingjudaism.org/teachings/when-does-life-begin-jewish-view| url-status=live}} The fetus is considered valuable property of the woman and not a human life while in the womb (Exodus 21:22-23). While Judaism encourages people to be fruitful and multiply by having children, abortion is allowed and is deemed necessary when a pregnant woman's life is in danger.{{cite web| url=https://www.ncjw.org/wp-content/uploads/2019/05/Judaism-and-Abortion-FINAL.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.ncjw.org/wp-content/uploads/2019/05/Judaism-and-Abortion-FINAL.pdf |archive-date=2022-10-09 |url-status=live|title=Judaism and Abortion|publisher=National Council of Jewish Women| date=May 2019|access-date=27 July 2022}}{{cite news|vauthors=Kestler-D'Amours J|date=17 June 2022| url=https://www.aljazeera.com/news/2022/6/17/religious-freedom-the-next-battleground-for-us-abortion-rights| title=Religious freedom: The next battleground for US abortion rights?|publisher=Al Jazeera|access-date=27 July 2022| archive-date=1 August 2022|archive-url=https://web.archive.org/web/20220801020805/https://www.aljazeera.com/news/2022/6/17/religious-freedom-the-next-battleground-for-us-abortion-rights|url-status=live}} Several religions, including Judaism, which disagree that human life begins at conception, support the legality of abortion on religious freedom grounds.{{cite web|vauthors=Georgian E|date=1 July 2022|url=https://clioandthecontemporary.com/2022/07/01/the-end-of-roe-in-historical-perspective/|title=The End of Roe in Historical Perspective|website=Clio and the Contemporary|access-date=27 July 2022| archive-date=27 July 2022|archive-url=https://web.archive.org/web/20220727180424/https://clioandthecontemporary.com/2022/07/01/the-end-of-roe-in-historical-perspective/|url-status=live}} In Islam, abortion is traditionally permitted until a point in time when Muslims believe the soul enters the fetus, considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or at quickening.{{cite news|date=9 July 2009| url=http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml|title=Religions – Islam: Abortion| publisher=BBC| access-date=10 December 2011|url-status=live|archive-url=https://web.archive.org/web/20111009065222/http://www.bbc.co.uk/religion/religions/islam/islamethics/abortion_1.shtml|archive-date=9 October 2011}} Abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.{{cite web|title=Abortion in the Middle East and North Africa| url=http://www.prb.org/pdf08/MENAabortion.pdf|url-status=live| vauthors = Dabash R, Farzaneh RF |publisher=Population Research Bureau|archive-url= https://web.archive.org/web/20111006171600/http://www.prb.org/pdf08/MENAabortion.pdf |archive-date=6 October 2011|year=2008}}

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade physicians in Ancient Greece from performing abortions; other scholars disagree with this interpretation, and state that the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath.{{cite book| vauthors = Miles SH |title=The Hippocratic Oath and the Ethics of Medicine|year=2005|publisher=Oxford University Press|isbn=978-0-19-518820-2}} The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus of Ephesus, although apparently not all doctors strictly adhered to the oath 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 only for the sake of the mother's health.{{cite book |author=Soranus|translator=Temkin O |translator2=Eastman NJ |translator3=Edelstein L |translator4=Guttmacher AF |title=Soranus' Gynecology| year=1991|publisher=Johns Hopkins University Press|page=I, 19, 60 |url=https://books.google.com/books?id=YsKWfh31gxwC| access-date=6 October 2015|url-status=live|archive-url=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=YsKWfh31gxwC|archive-date=15 October 2015 |isbn=978-0-8018-4320-4}}{{cite encyclopedia |url=http://penelope.uchicago.edu/~grout/encyclopaedia_romana/aconite/largus.html|title=Scribonius Largus and the Oath of Hippocrates |encyclopedia=Encyclopaedia Romana|publisher=University of Chicago|access-date=27 July 2022}} In Politics (350 BCE), Aristotle condemned infanticide as a means of population control. He preferred abortion in such cases,{{cite book| vauthors=Carrick P |title=Medical Ethics in the Ancient World| year=2001 |publisher=Georgetown University Press|isbn=978-0-87840-849-8}}{{cite journal| vauthors=Meyer HS |date=17 April 2002|title=Ancient Ethics: Medical Ethics in the Ancient World|journal=JAMA |publisher=American Medical Association|volume=287|issue=15|pages=2005–2006|doi=10.1001/jama.287.15.2005-JBK0417-3-1 |s2cid=240484236 }} with the restriction 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."{{cite book| author=Aristotele| title=Aristotle, Politics|translator=Rackham H|year=1944|url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0058%3Abook%3D7%3Asection%3D1335b |publisher=Harvard University Press |access-date=21 June 2011| via=Perseus|url-status=live|archive-url=https://web.archive.org/web/20110622094459/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0058%3Abook%3D7%3Asection%3D1335b|archive-date=22 June 2011}}

In the Catholic Church, opinion was divided on how serious abortion was in comparison with such acts as contraception and oral or anal sex.{{rp|155–167}} The Catholic Church did not begin vigorously opposing abortion until the 19th century. As early as ~100 CE, the Didache taught that abortion was sinful.{{cite web|date=9 September 2016|title=Didache|website=Legacy Icons| url=https://legacyicons.com/content/didache.pdf|access-date=16 May 2022|url-status=live|archive-date=8 November 2020 |archive-url=https://web.archive.org/web/20201108201133/https://legacyicons.com/content/didache.pdf}} Several historians argue that prior to the 19th century most Catholic authors did not regard termination of pregnancy before quickening or ensoulment as an abortion.Joan Cadden, "Western medicine and natural philosophy", in Vern L. Bullough and James A. Brundage, eds., Handbook of Medieval Sexuality, Garland, 1996, pp. 51–80.Cyril C. Means Jr., "A historian's view", in Robert E. Hall, ed., Abortion in a Changing World, vol. 1, Columbia University Press, 1970, pp. 16–24.John M. Riddle, "Contraception and early abortion in the Middle Ages", in Vern L. Bullough and James A. Brundage, eds., Handbook of Medieval Sexuality, Garland, 1996, pp. 261–277, {{ISBN|978-0-8153-1287-1}}. Among these authors were the Doctors of the Church, such as St. Augustine, St. Thomas Aquinas, and St. Alphonsus Liguori. In 1588, Pope Sixtus V ({{reign}} 1585–1590) was the only Pope before Pope Pius IX (in his 1869 bull, Apostolicae Sedis) to institute a Church policy labeling all abortion as homicide and condemning abortion regardless of the stage of pregnancy.{{cite web|author=Pope Sixtus V| year=1588| title=Effraenatam| via=The Embryo Project Encyclopedia|url=https://embryo.asu.edu/pages/effraenatam-1588-pope-sixtus-v| url-status=live| archive-url=https://web.archive.org/web/20210526144925/https://embryo.asu.edu/pages/effraenatam-1588-pope-sixtus-v|archive-date=26 May 2021|access-date=26 May 2021}}{{cite book| vauthors = Noonan JT |title=Contraception: A History of Its Treatment by the Catholic Theologians and Canonists |edition=2nd |publisher= Harvard University Press|year=1986}}{{rp|362–364}}{{rp|157–158}} Sixtus V's pronouncement was reversed in 1591 by Pope Gregory XIV.{{cite web| vauthors = Gershon L |date=13 February 2018|title=What a 16th-Century Abortion Ban Revealed|url=https://daily.jstor.org/what-a-16th-century-abortion-ban-revealed/|url-status=live| archive-url= https://web.archive.org/web/20210526144922/https://daily.jstor.org/what-a-16th-century-abortion-ban-revealed/| archive-date=26 May 2021|access-date=26 May 2021|website=JSTOR Daily}} In the recodification of 1917 Code of Canon Law, Apostolicae Sedis was strengthened, in part to remove a possible reading that excluded excommunication of the mother.{{cite web|title=Apostolicae Sedis Moderationi|website=New Advent |url=https://www.newadvent.org/cathen/01645a.htm|access-date=16 May 2022|url-status=live|archive-date=16 May 2022|archive-url=https://web.archive.org/web/20220516174009/https://www.newadvent.org/cathen/01645a.htm}} Statements made in the Catechism of the Catholic Church, the codified summary of the Church's teachings, considers abortion from the moment of conception as homicide and called for the end of legal abortion.{{cite web|date=1992|title=Catechism of the Catholic Church, chapter 2, article 5 |url=https://www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a5.htm| website=Vatican| access-date=4 December 2019| archive-date=14 May 2011|archive-url=https://web.archive.org/web/20110514012545/https://www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a5.htm|url-status=live }}

Denominations that support abortion rights with some limits include the United Methodist Church, Episcopal Church, Evangelical Lutheran Church in America and Presbyterian Church USA.{{cite web | last=Masci | first=David | title=Where major religious groups stand on abortion | website=Pew Research Center | date=2020-05-30 | url=https://www.pewresearch.org/fact-tank/2016/06/21/where-major-religious-groups-stand-on-abortion/ | access-date=2023-01-22 | archive-date=22 January 2023 | archive-url=https://web.archive.org/web/20230122160816/https://www.pewresearch.org/fact-tank/2016/06/21/where-major-religious-groups-stand-on-abortion/ | url-status=live }} A 2014 Guttmacher survey of abortion patients in the United States found that many reported a religious affiliation: 24% were Catholic while 30% were Protestant.{{cite report| url=https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014|title=Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008| vauthors = Jerman J, Jones RK, Onda T |date=10 May 2016| publisher=Guttmacher| access-date=25 February 2021|archive-date=24 February 2021|archive-url=https://web.archive.org/web/20210224085344/https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014| url-status=live}} 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. A 2019 Pew Research Center study found that most Christian denominations were against overturning Roe v. Wade, which in the United States legalized abortion, at around 70%, except White Evangelicals at 35%.{{cite web|url=https://www.pewresearch.org/fact-tank/2020/10/20/8-key-findings-about-catholics-and-abortion/|title=8 key findings about Catholics and abortion|date=20 October 2020 | publisher=Pew Research Center|access-date=15 May 2022|archive-date=15 May 2022|archive-url=https://web.archive.org/web/20220515173202/https://www.pewresearch.org/fact-tank/2020/10/20/8-key-findings-about-catholics-and-abortion/|url-status=live}}

File:FrenchPeriodicalPills-January61845,BostonDailyTimes.jpg.{{cite book |url=https://www.worldcat.org/oclc/53993049 |title=The abortion rights controversy in America: a legal reader |date=2004 |publisher=University of North Carolina Press |editor-first=N. E. H. |editor-last=Hull |editor-first2=Williamjames |editor-last2=Hoffer |editor-first3=Peter Charles |editor-last3=Hoffer |isbn=0-8078-2873-4 |location=Chapel Hill |oclc=53993049 |page=17 |access-date=21 April 2023 |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701041348/https://search.worldcat.org/title/53993049 |url-status=live }}]]

Abortion has been a fairly common practice,{{cite book| vauthors = Reagan LJ |year=2022|orig-year=1997|title=When Abortion Was a Crime: Women, Medicine and the Law in the United States, 1867–1973|edition=1st |location=Berkeley| publisher=University of California Press|isbn=978-0-520-38741-6}}{{cite web|vauthors=Blakemore E|date=22 May 2022 |url=https://www.nationalgeographic.com/history/article/the-complex-early-history-of-abortion-in-the-united-states |title=The complex early history of abortion in the United States|website=National Geographic|access-date=26 July 2022| quote=But that view of history is the subject of great dispute. Though interpretations differ, most scholars who have investigated the history of abortion argue that terminating a pregnancy wasn't always illegal—or even controversial.| archive-date=26 July 2022|archive-url=https://web.archive.org/web/20220726201522/https://www.nationalgeographic.com/history/article/the-complex-early-history-of-abortion-in-the-united-states|url-status=dead}} and was not always illegal or controversial until the 19th century.{{cite journal| vauthors = Hardin G |date=December 1978|title=Abortion in America. The Origins and Evolution of National Policy, 1800–1900. James C. Mohr|journal=The Quarterly Review of Biology| volume=53| issue=4| page=499|doi=10.1086/410954|quote=The long silence had led us to assume that opposition to abortion had existed from time immemorial. Not so: most of the opposition to, and all of the laws against, abortion arose in the 19th century. Historian Mohr amply documents the earlier acceptance of abortion. ... In the 19th century even many of the feminists expressed horror at abortion, urging abstinence instead. Not so in the 20th century. In the 19th century the medical profession was fairly united against abortion; Mohr argues that this arose from the commercial competition between the 'regulars' (men with M.D.'s) and the irregulars (women without M.D.'s). ... A key role in generating prohibition laws was played by the press, ... . By 1900 the abortion-prohibition laws were immune to questioning, as they remained until the 1960's when feminists and a new breed of physicians combined to arouse the public to the injustice of the law. ... the Roe v. Wade decision of the Supreme Court ... essentially returned the practice of abortion to the permissive state ante 1820.}}{{cite journal| vauthors = Acevedo ZP |date=Summer 1979|title=Abortion in early America| journal=Women Health|volume=4|issue=2|pages=159–167|doi=10.1300/J013v04n02_05|pmid=10297561 |quote=This piece describes abortion practices in use from the 1600s to the 19th century among the inhabitants of North America. The abortive techniques of women from different ethnic and racial groups as found in historical literature are revealed. Thus, the point is made that abortion is not simply a 'now issue' that effects select women. Instead, it is demonstrated that it is a widespread practice as solidly rooted in our past as it is in the present.}} Under common law, including early English common law dating back to Edward Coke in 1648,{{cite journal| vauthors = Alford S |title=Is Self-Abortion a Fundamental Right?|volume=52|journal=Duke Law Journal|pages=1011–1029| issue=5| year=2003| jstor=1373127|pmid=12964572}} abortion was generally permitted before quickening (14–26 weeks after conception, or between the fourth and sixth month),{{cite web|vauthors=Dine R|date=8 August 2013| url=https://www.americanprogress.org/article/scarlet-letters-getting-the-history-of-abortion-and-contraception-right/| title=Scarlet Letters: Getting the History of Abortion and Contraception Right|publisher=Center for American Progress| access-date=26 July 2022|archive-date=28 July 2022|archive-url=https://web.archive.org/web/20220728035809/https://www.americanprogress.org/article/scarlet-letters-getting-the-history-of-abortion-and-contraception-right/|url-status=live}}{{cite web|vauthors=Reagan LJ|date=2 June 2022 |url=https://www.politico.com/news/magazine/2022/06/02/alitos-anti-roe-argument-wrong-00036174|title=What Alito Gets Wrong About the History of Abortion in America|website=Politico|access-date=26 July 2022|archive-date=23 June 2022| archive-url=https://web.archive.org/web/20220623133238/https://www.politico.com/news/magazine/2022/06/02/alitos-anti-roe-argument-wrong-00036174|url-status=live}}{{cite news|vauthors=Root D|date=23 June 2022| url=https://reason.com/2022/06/23/unenumerated-rights-and-roe-v-wade/|title=Alito's Leaked Abortion Opinion Misunderstands Unenumerated Rights| work=Reason|access-date=27 July 2022|archive-date=27 July 2022|archive-url=https://web.archive.org/web/20220727180438/https://reason.com/2022/06/23/unenumerated-rights-and-roe-v-wade/|url-status=live}} and at women's discretion; it was whether abortion was performed after quickening that determined if it was a crime. In Europe and North America, abortion techniques advanced starting in the 17th century; the conservatism of most in the medical profession with regards to sexual matters prevented the wide expansion of abortion techniques.{{cite book| title=Abortion in America: The Origins and Evolution of National Policy| vauthors = Mohr JC |year=1978|pages=[https://archive.org/details/abortioninameric00mohr/page/35 35–36]|publisher=Oxford University Press|isbn=978-0-19-502616-0| url=https://archive.org/details/abortioninameric00mohr/page/35}}{{cite book|vauthors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Joffe C|year=2009|chapter-url=http://media.wiley.com/product_data/excerpt/62/14051769/1405176962.pdf|url-status=live|chapter=Abortion and Medicine: A Sociopolitical History|title=Management of Unintended and Abnormal Pregnancy|edition=1st|location=Oxford|publisher=John Wiley & Sons| isbn=978-1-4443-1293-5|ol=15895486W|archive-url=https://web.archive.org/web/20120119025652/http://media.wiley.com/product_data/excerpt/62/14051769/1405176962.pdf|archive-date=19 January 2012}} 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,{{cite news| vauthors = Dannenfelser M |title=The Suffragettes Would Not Agree With Feminists Today on Abortion| url=https://time.com/4093214/suffragettes-abortion/|access-date=4 November 2015|magazine=Time|date=4 November 2015|url-status=live| archive-url=https://web.archive.org/web/20151106015742/http://time.com/4093214/suffragettes-abortion/| archive-date=6 November 2015}} was banned in both the United States and the United Kingdom.{{refn|In the United States, the first laws related to abortion beginning in the 1820s were made to protect women from real or perceived risks, and those more restrictive penalized only the provider. By 1859, abortion was not a crime in 21 out of 33 states, and was prohibited only post-quickening, while penalties for pre-quickening abortions were lower. This changed starting in the 1860s under the influence of anti-immigrant and anti-Catholic sentiment.|group=nb}}

Some 19th-century physicians, one of the most famous and consequential being the American Horatio Storer, argued for anti-abortion laws on racist and misogynist as well as moral grounds.{{cite book |last=Poole |first=W. Scott |url=https://archive.org/details/sataninamericade0000pool |title=Satan in America: The Devil We Know |publisher=Rowman & Littlefield |year=2009 |isbn=978-0-7425-6171-7 |page=86 |access-date=2023-03-20 |url-access=registration }}{{cite journal| vauthors = Wilson C |date=2 November 2020|title=Nostalgia, Entitlement and Victimhood: The Synergy of White Genocide and Misogyny|journal=Terrorism and Political Violence|volume=34 |issue=8 |publisher=Routledge|pages=1810–1825|doi=10.1080/09546553.2020.1839428 |s2cid=228837398 }} Storer is cited at p. 4. Church groups were also highly influential in anti-abortion movements,{{cite news |vauthors=Abdeltath R, Arablouei R, Caine J, Kaplan-Levenson L, Wu L, Yvellez V, Miner C, Sangweni Y, Steinberg A, George D |display-authors=6 |title=Before Roe: The Physicians' Crusade |url=https://www.npr.org/2022/05/18/1099795225/before-roe-the-physicians-crusade |work=Throughline |publisher=NPR |access-date=26 July 2022 |archive-date=26 July 2022 |archive-url=https://web.archive.org/web/20220726150545/https://www.npr.org/2022/05/18/1099795225/before-roe-the-physicians-crusade |url-status=live }} and religious groups more so since the 20th century.{{cite web| vauthors=Samuels A, Potts M|date=25 July 2022|url=https://fivethirtyeight.com/features/how-the-fight-to-ban-abortion-is-rooted-in-the-great-replacement-theory/|title=How The Fight To Ban Abortion Is Rooted In The 'Great Replacement' Theory| website=FiveThirtyEight|access-date=26 July 2022|archive-date=25 July 2022|archive-url=https://web.archive.org/web/20220725234312/https://fivethirtyeight.com/features/how-the-fight-to-ban-abortion-is-rooted-in-the-great-replacement-theory/|url-status=live}} Some of the early anti-abortion laws punished only the doctor or abortionist, and while women could be criminally tried for a self-induced abortion, they were rarely prosecuted in general. In the United States, some argued that abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.{{refn|By 1930, medical procedures in the United States 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. For sources, see:

• {{cite book|title=Time Communication 1940–1989: Retrospective|publisher=Time|year=1989|chapter=The 1970s|quote=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.}}
• {{cite book| vauthors = Will GF |title=Suddenly: The American Idea Abroad and at Home, 1986–1990|publisher=Free Press|year=1990|page=[https://archive.org/details/suddenlyamericangwill00will/page/312 312]|isbn=0-02-934435-2|url=https://archive.org/details/suddenlyamericangwill00will/page/312}}
• {{cite web|vauthors=Lewis J, Shimabukuro JO |url= http://www.policyalmanac.org/culture/archive/crs_abortion_overview.shtml|title=Abortion Law Development: A Brief Overview|publisher=Congressional Research Service|date=28 January 2001|access-date=1 May 2011|archive-url=https://web.archive.org/web/20110514133610/http://www.policyalmanac.org/culture/archive/crs_abortion_overview.shtml|archive-date=14 May 2011|url-status=dead}}
• {{cite book|url=https://books.google.com/books?id=EHj_0R2rbxAC&pg=PA1|page=1|title=Encyclopedia of American Law| vauthors = Schultz DA |publisher=Infobase Publishing|year=2002|isbn=0-8160-4329-9|url-status=live|archive-url=https://web.archive.org/web/20151209000856/https://books.google.com/books?id=EHj_0R2rbxAC&pg=PA1|archive-date=9 December 2015}}
• {{cite web | vauthors = Lahey JN |title=Birthing a Nation: Fertility Control Access and the 19th Century Demographic Transition|publisher=Pomona College|date=24 September 2009|url=http://economics-files.pomona.edu/colloquium/joannalahey.pdf|format=PDF; preliminary version|work=Colloquium|url-status=live|archive-url=https://web.archive.org/web/20120107162744/http://economics-files.pomona.edu/colloquium/joannalahey.pdf|archive-date=7 January 2012}}|group=nb}} Others maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe.{{cite journal| vauthors = Lee CA |year=1838|title=Report of a Trial for Murder|journal=American Journal of the Medical Sciences|volume=XXII|pages=351–353}}Benjamin Bailey, "Induction of abortion and premature labor", North American Journal of Homeopathy, vol. XI, no. 3 (1896), pp. 144–150.Keith Simpson, Forensic Medicine, Edward Arnold Publishers, 1969 [first published 1947], pp. 173–174. Several scholars argue that, despite improved medical procedures, the period from the 1930s until the 1970s saw more zealous enforcement of anti-abortion laws, alongside an increasing control of abortion providers by organized crime.{{refn|For sources, see:
• James Donner, Women in Trouble: The Truth about Abortion in America, Monarch Books, 1959.
• Ann Oakley, The Captured Womb, Basil Blackwell, 1984, p. 91.
• Rickie Solinger, The Abortionist: A Woman Against the Law, The Free Press, 1994, pp. xi, 5, 16–17, 157–175.
• Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973, University of California Press, 1997.
• Max Evans, Madam Millie: Bordellos from Silver City to Ketchikan, University of New Mexico Press, 2002, pp. 209–218, 230, 267–286, 305.|group=nb}}

In 1920, Soviet Russia became the first country to legalize abortion after Lenin insisted that no woman be forced to give birth.{{cite book | last=Bullough | first=V.L. | title=Encyclopedia of Birth Control | publisher=ABC-CLIO | series=ABC-CLIO E-Books | year=2001 | isbn=978-1-57607-181-6 | url=https://books.google.com/books?id=XuX-MGTZnJoC&pg=PA5 | access-date=2022-10-19 | page=5 | archive-date=24 January 2023 | archive-url=https://web.archive.org/web/20230124173418/https://books.google.com/books?id=XuX-MGTZnJoC&pg=PA5 | url-status=live }}{{cite book | last=Raphael | first=D. | title=Being Female: Reproduction, Power, and Change | publisher=De Gruyter | series=World Anthropology | year=2011 | isbn=978-3-11-081312-8 | url=https://books.google.com/books?id=84hyfRRHeakC&pg=PA30 | access-date=2022-10-19 | page=30 | archive-date=24 January 2023 | archive-url=https://web.archive.org/web/20230124173418/https://books.google.com/books?id=84hyfRRHeakC&pg=PA30 | url-status=live }} Iceland (1935) and Sweden (1938) would follow suit to legalize certain or all forms of abortion.{{cite web|url=http://www.cbctrust.com/history_law_religion.php|title=Abortion Law, History & Religion|access-date=23 March 2008|publisher=Childbirth By Choice Trust|archive-url=https://archive.today/20080208053146/http://www.cbctrust.com/history_law_religion.php|archive-date=8 February 2008}}{{cbignore}} In Nazi Germany (1935), a law permitted abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions.For sources describing abortion policy in Nazi Germany, see:

• {{cite book| vauthors = Friedlander H |title=The origins of Nazi genocide: from euthanasia to the final solution|publisher=University of North Carolina Press|location=Chapel Hill|year=1995|url=https://books.google.com/books?id=gqLDEKVk2nMC|page=30|isbn=978-0-8078-4675-9|oclc=60191622|url-status=live|archive-url=https://web.archive.org/web/20160729051956/https://books.google.com/books?id=gqLDEKVk2nMC|archive-date=29 July 2016}}
• {{cite book| vauthors = Proctor RN |title=Racial Hygiene: Medicine Under the Nazis|publisher=Harvard University Press|year=1988|pages=[https://archive.org/details/racialhygiene00robe/page/122 122–123, 366]|isbn=978-0-674-74578-0|oclc=20760638|url=https://archive.org/details/racialhygiene00robe/page/122}}
• {{cite book | vauthors = Arnot ML, Usborne C|title=Gender and Crime in Modern Europe|publisher=Routledge|location=New York|year=1999|page=231|isbn=978-1-85728-745-5|oclc=186748539}}
• {{cite encyclopedia|vauthors=DiMeglio PM|veditors=Tierney H|encyclopedia=Women's Studies Encyclopedia|title=Germany 1933–1945 (National Socialism)|year=1999|publisher=Greenwood Press|location=Westport, Connecticut|isbn=978-0-313-31072-0|oclc=38504469|url=https://books.google.com/books?id=gQLqRd7hJq0C|page=589|url-status=live|archive-url=https://web.archive.org/web/20151015195038/https://books.google.com/books?id=gQLqRd7hJq0C|archive-date=15 October 2015}} Beginning in the second half of the 20th century, abortion was legalized in a greater number of countries. In Japan, abortion was first legalized by the 1948 "Eugenics Protection Law" meant to prevent the births of "inferior" humans. {{As of| 2022}}, due to Japan's continuing strongly patriarchal culture and traditional views on women's societal roles, women who want an abortion must normally get written permission from their partner.{{cite news |last1=Ye Hee Lee |first1=Michelle |title=In Japan, Abortion is Legal — But Most Women Need Their Husband's Consent |url=https://www.washingtonpost.com/world/2022/06/14/japan-abortion-pill-women-reproductive-rights/ |access-date=March 16, 2023 |date=June 14, 2022}}{{cite web | last=Wingfield-Hayes | first=Rupert | title=Abortion pill: Why Japanese women will need their partner's consent to get a tablet | website=BBC News | date=August 31, 2022 | url=https://www.bbc.com/news/world-asia-62515356 | access-date=March 15, 2023 | quote=It was actually one of the first countries in the world to pass an abortion law, back in 1948. But it was part of the Eugenics Protection Law – yes, it really was called that. It had nothing to do with giving women more control over their reproductive health. Rather, it was about preventing 'inferior' births. ... So, to this day, women who want an abortion must get written permission from their husband, partner, or in some cases their boyfriend. ... Unlike the US, Japanese views on abortion are not driven by religious belief. Instead, they derive from a long history of patriarchy and deeply traditional views on the role of women and motherhood. | archive-date=5 March 2023 | archive-url=https://web.archive.org/web/20230305214443/https://www.bbc.com/news/world-asia-62515356 | url-status=live }}

{{Further|Societal attitudes towards abortion}}

{{Main|Abortion debate}}

Induced abortion has long been the source of considerable debate. Ethical, moral, philosophical, biological, religious and legal issues surrounding abortion are related to value systems. Opinions of abortion may be about fetal rights, governmental authority, and women's rights.

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 the justification of laws permitting or restricting abortion.{{cite book | vauthors = Farrell C | title =Abortion Debate| publisher =ABDO Publishing Company| year =2010| pages =6–7| isbn =978-1-61785-264-0}} 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."{{cite web|url=http://www.wma.net/en/30publications/10policies/a1/ |title=WMA Declaration on Therapeutic Abortion |publisher=World Medical Association |access-date=28 October 2015 |url-status=dead |archive-url=https://web.archive.org/web/20151028182953/http://www.wma.net/en/30publications/10policies/a1/ |archive-date=28 October 2015 }} Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while groups who are against such legal restrictions describe themselves as "pro-choice".Farrell, p. 8

{{Main|Abortion law}}

{{See also|History of abortion law debate}}

{{AbortionLawsMap|size=330px}}

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 legal abortion (an abortion performed without the woman's consent is considered feticide and is generally illegal). 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.{{cite web|url=http://internationalfamilyplanningperspectives.org/pubs/MandatoryCounseling.pdf |title=The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review |publisher=Guttmacher Institute| vauthors = Joyce TJ, Henshaw SK, Dennis A, Finer LB, Blanchard K |date=April 2009 |access-date=31 December 2010 |archive-url=https://web.archive.org/web/20120316155239/http://internationalfamilyplanningperspectives.org/pubs/MandatoryCounseling.pdf |archive-date=16 March 2012 |url-status=dead }} 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{{cite news|url=https://www.theguardian.com/world/2015/oct/29/china-abandons-one-child-policy|title=China ends one-child policy after 35 years| vauthors = Phillips T |date=29 October 2015|newspaper=The Guardian|issn=0261-3077|access-date=30 November 2016|url-status=live|archive-url=https://web.archive.org/web/20161201021629/https://www.theguardian.com/world/2015/oct/29/china-abandons-one-child-policy|archive-date=1 December 2016}} one-child policy, and now has a three-child policy,{{cite news |title=China NPC: Three-child policy formally passed into law |url=https://www.bbc.com/news/world-asia-china-58277473 |access-date=6 April 2024 |date=20 August 2021 |archive-date=29 June 2022 |archive-url=https://web.archive.org/web/20220629190816/https://www.bbc.com/news/world-asia-china-58277473 |url-status=live }} has at times incorporated mandatory abortions as part of their population control strategy.{{cite encyclopedia |title=Science, Technology, and Society: An Encyclopedia |page=2 | veditors = Restivo SP |year=2005 |publisher=Oxford University Press |isbn=978-0-19-514193-1 |url=https://books.google.com/books?id=A8C3m8rRba4C |url-status=live |archive-url=https://web.archive.org/web/20150315111926/http://books.google.com/books?id=A8C3m8rRba4C |archive-date=15 March 2015 }}

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. 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.{{cite web|title=European delegation visits Nicaragua to examine effects of abortion ban |date=26 November 2007 |publisher=Ipas |access-date=15 June 2009 |url=http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx |archive-url=https://web.archive.org/web/20080417033829/http://www.ipas.org/Library/News/News_Items/European_delegation_visits_Nicaragua_to_examine_effects_of_abortion_ban.aspx |archive-date=17 April 2008 |quote=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.}}{{cite news |url=http://insidecostarica.com/special_reports/2008-06/nicaragua_womens_movement.htm |title=Nicaragua: 'The Women's Movement Is in Opposition' |date=28 June 2008 |location=Montevideo |agency=IPS |publisher=Inside Costa Rica |url-status=live |archive-url=https://web.archive.org/web/20110606102151/http://insidecostarica.com/special_reports/2008-06/nicaragua_womens_movement.htm |archive-date=6 June 2011 }} Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.{{cite web|title=Surgical Abortion: History and Overview |publisher=National Abortion Federation |access-date=4 September 2006 |url=http://www.prochoice.org/education/resources/surg_history_overview.html |archive-url=https://web.archive.org/web/20060922152349/http://www.prochoice.org/education/resources/surg_history_overview.html |archive-date=22 September 2006 |url-status=dead }} This is also a terminology in traditional medicine.{{cite journal | vauthors = Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM | title = Women's hidden transcripts about abortion in Brazil | journal = Social Science & Medicine | volume = 44 | issue = 12 | pages = 1833–1845 | date = June 1997 | pmid = 9194245 | doi = 10.1016/s0277-9536(96)00293-6 | quote = 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 ... }} 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.{{cite journal | vauthors = Henshaw SK | title = The accessibility of abortion services in the United States | journal = Family Planning Perspectives | volume = 23 | issue = 6 | pages = 246–52, 263 | year = 1991 | pmid = 1786805 | doi = 10.2307/2135775 | url = http://www.guttmacher.org/pubs/journals/3501603.pdf | access-date = 25 October 2017 | url-status = live | citeseerx = 10.1.1.360.6115 | jstor = 2135775 | archive-date = 24 March 2016 | archive-url = https://web.archive.org/web/20160324041912/http://www.guttmacher.org/pubs/journals/3501603.pdf }} Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.{{cite web |title=Need Abortion, Will Travel | vauthors = Bloom M |date=25 February 2008 |publisher=RH Reality Check |access-date=15 June 2009 |url=http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel |url-status=live |archive-url=https://web.archive.org/web/20081130010309/http://www.rhrealitycheck.org/blog/2008/02/25/need-abortion-will-travel |archive-date=30 November 2008 }}

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.{{cite journal | vauthors = Gomperts R | title = Women on waves: where next for the abortion boat? | journal = Reproductive Health Matters | volume = 10 | issue = 19 | pages = 180–183 | date = May 2002 | pmid = 12369324 | doi = 10.1016/S0968-8080(02)00004-6 | doi-access = free }}{{cite journal| vauthors = Best A |date=2005|title=Abortion Rights along the Irish-English Border and the Liminality of Women's Experiences|journal=Dialectical Anthropology|volume=29|issue=3–4|pages=423–37|doi=10.1007/s10624-005-3863-x|s2cid=145318165|issn=0304-4092}}{{cite journal| vauthors = Lambert-Beatty C |date=2008|title=Twelve miles: Boundaries of the new art/activism|journal=Signs: Journal of Women in Culture and Society|volume=33|issue=2|pages=309–27|doi=10.1086/521179|s2cid=147307705}}

{{Main|Sex-selective abortion}}

Sonography and amniocentesis allow parents to determine sex before childbirth. The development of this technology has led to sex-selective abortion, or the termination of a fetus based on its 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.Banister, Judith. (16 March 1999). [https://www.census.gov/ipc/www/ebspr96a.html Son Preference in Asia – Report of a Symposium] {{webarchive|url=https://web.archive.org/web/20060216134324/http://www.census.gov/ipc/www/ebspr96a.html |date=16 February 2006 }}. Retrieved 12 January 2006. 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.{{cite news| vauthors = Reaney P |agency=Reuters |url=http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archive-url=https://web.archive.org/web/20060220072756/http://www.alertnet.org/thenews/newsdesk/L06779563.htm |archive-date=20 February 2006 |title=Selective abortion blamed for India's missing girls |access-date=3 December 2008}}{{cite journal | vauthors = Sudha S, Irudaya RS | title = Female demographic disadvantage in India 1981-1991: sex selective abortions and female infanticide | journal = Development and Change | volume = 30 | issue = 3 | pages = 585–618 | date = July 1999 | pmid = 20162850 | doi = 10.1111/1467-7660.00130 | s2cid = 33446683 | url = http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html | access-date = 3 December 2008 | archive-url = https://web.archive.org/web/20030101210623/http://www.hsph.harvard.edu/organizations/healthnet/gender/docs/sudha.html | archive-date = 1 January 2003 | url-access = subscription }}{{cite web|url=https://www.loc.gov/law/help/sex-selection/india.php|publisher=Library of Congress|title=Sex Selection & Abortion: India|date=4 April 2011|access-date=18 July 2011|url-status=live|archive-url=https://web.archive.org/web/20110927234151/http://www.loc.gov/law/help/sex-selection/india.php|archive-date=27 September 2011}}{{cite news|agency=Xinhua News Agency|title=China Bans Sex-selection Abortion|url=http://www.china.org.cn/english/2003/Mar/59194.htm|access-date=2023-02-16|work=www.china.org.cn|date=March 22, 2003|archive-date=12 February 2006|archive-url=https://web.archive.org/web/20060212204114/http://www.china.org.cn/english/2003/Mar/59194.htm|url-status=live}} In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.{{cite journal| vauthors = Graham MJ, Larsen U, Xu X |date=June 1998 |title=Son Preference in Anhui Province, China |journal=International Family Planning Perspectives |volume=24 |issue=2 |url=http://www.guttmacher.org/pubs/journals/2407298.html |doi=10.2307/2991929 |archive-url=https://web.archive.org/web/20120106165446/http://www.guttmacher.org/pubs/journals/2407298.html |archive-date=6 January 2012 |url-status=live |pages=72–77 |jstor=2991929 |url-access=subscription }}

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",{{cite web|url=http://www.unfpa.org/webdav/site/global/shared/documents/publications/2011/Preventing_gender-biased_sex_selection.pdf|title=Preventing gender-biased sex selection|publisher=UNFPA|access-date=1 November 2011|archive-url=https://web.archive.org/web/20111011095023/https://www.unfpa.org/webdav/site/global/shared/documents/publications/2011/Preventing_gender-biased_sex_selection.pdf|archive-date=11 October 2011|url-status=live}} conditions also condemned by a PACE resolution in 2011.{{cite web|url=http://assembly.coe.int/Documents/WorkingDocs/Doc11/EDOC12715.pdf |title=Prenatal sex selection |publisher=Parliamentary Assembly of the Council of Europe |url-status=dead |archive-url=https://web.archive.org/web/20111003133834/http://assembly.coe.int/Documents/WorkingDocs/Doc11/EDOC12715.pdf |archive-date=3 October 2011 |access-date=17 November 2015 }} The World Health Organization and UNICEF, along with other United Nations agencies, have found that measures to restrict access to abortion in an effort to reduce sex-selective abortions have unintended negative consequences, largely stemming from the fact that women may seek or be coerced into seeking unsafe, extralegal abortions. On the other hand, measures to reduce gender inequality can reduce the prevalence of such abortions without attendant negative consequences.{{cite journal |last=Das Gupta |first=Monica |date=2019 |title=Is banning sex-selection the best approach for reducing prenatal discrimination? |journal=Asian Population Studies |volume=15 |issue=3 |pages=319–336|doi=10.1080/17441730.2019.1671015 |pmid=34046078 |pmc=8153244 }}

{{Main|Anti-abortion violence}}

Abortion providers and facilities have been subjected to violence, including murder, assault, arson, and bombing. Some scholars consider anti-abortion violence to be within the definition of terrorism,{{cite journal | vauthors = Wilson M, Lynxwiler J | title = Abortion clinic violence as terrorism | journal = Terrorism | volume = 11 | issue = 4 | pages = 263–273 | year = 1988 | pmid = 11618209 | doi = 10.1080/10576108808435717 }} a view shared by some governments.{{cite web | vauthors = Smith GD |publisher=Canadian Security Intelligence Service |year=1998 |url=http://www.csis-scrs.gc.ca/en/publications/commentary/com74.asp |title=Single Issue Terrorism Commentary |access-date= 1 September 2011| archive-url=https://web.archive.org/web/20071015065711/http://csis-scrs.gc.ca/en/publications/commentary/com74.asp| archive-date=15 October 2007|url-status=dead}} 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.{{cite web| url=https://prochoice.org/wp-content/uploads/2017-NAF-Violence-and-Disruption-Statistics.pdf| title=2017 violence and disruption statistics |last=National Abortion Federation| date=2017|access-date=26 May 2019| archive-date=28 July 2020| archive-url=https://web.archive.org/web/20200728204107/https://prochoice.org/wp-content/uploads/2017-NAF-Violence-and-Disruption-Statistics.pdf| url-status=live}} Abortion clinics have also been targeted by acid attacks, invasions, and vandalism{{cite web |publisher=National Abortion Federation| year=2009 |url=http://www.prochoice.org/pubs_research/publications/downloads/about_abortion/violence_stats.pdf |title=Incidence of Violence & Disruption Against Abortion Providers in the U.S. & Canada |access-date=9 February 2010 |url-status=live |archive-url=https://web.archive.org/web/20100613042214/http://prochoice.org/pubs_research/publications/downloads/about_abortion/violence_stats.pdf |archive-date=13 June 2010 }} The majority of abortion opponents have not been involved in violent acts.

Physicians and other abortion clinic staff have been murdered by abortion opponents. In the United States, at least four physicians have been murdered in connection with their work at abortion clinics, including David Gunn (1993), John Britton (1994), Barnett Slepian (1998), and George Tiller (2009). In Canada, gynecologist Garson Romalis survived murder attempts in both 1994 and 2000. Besides physicians, killings have targeted other clinic staff, such as John Salvi's 1994 murder of two receptionists in Massachusetts clinic and Peter Knight's 2001 murder of a security guard in a Melbourne clinic. Notable perpetrators of anti-abortion violence include Eric Rudolph, Scott Roeder, Shelley Shannon, and Paul Hill, the first person to be executed in the United States for murdering an abortion provider.{{cite news |url=https://www.theguardian.com/theguardian/1999/feb/03/features11.g26 |newspaper=The Guardian |date=3 February 1999 |title=The bomber under siege | vauthors = Borger J |location=London |url-status=live |archive-url=https://web.archive.org/web/20170222105914/https://www.theguardian.com/theguardian/1999/feb/03/features11.g26 |archive-date=22 February 2017 }}

Some countries have laws to protecting access to abortion.

Such laws prevent abortion opponents from interfering with access to legal abortion services. For example, the American Freedom of Access to Clinic Entrances Act bars the use of threats or violence to interfere with abortion access. Abortion access laws may also establish safe access zones around abortion clinics, with limits on protests and enhanced penalties for anti-abortion violence.{{Cite journal |last1=Pridemore |first1=William Alex |author1-link=William Alex Pridemore |last2=Freilich |first2=Joshua D. |date=2007-12-01 |title=The Impact of State Laws Protecting Abortion Clinics and Reproductive Rights on Crimes Against Abortion Providers: Deterrence, Backlash, or Neither? |url=https://doi.org/10.1007/s10979-006-9078-0 |journal=Law and Human Behavior |language=en |volume=31 |issue=6 |pages=611–627 |doi=10.1007/s10979-006-9078-0 |pmid=17268826 |issn=1573-661X}}

Psychological pressure may also be used to limit abortion access. In 2003, Chris Danze organized anti-abortion 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, sent them up to 1200 phone calls a day and contacted their churches.{{sfn|Doan|2007|p=2}} Some protestors record women entering clinics on camera.{{sfn|Doan|2007|p=2}}

{{Further|Miscarriage}}

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.{{cite book | vauthors = Spencer JB |title=Sheep Husbandry in Canada |year=1908 |page=114 |oclc=798508694 }} In cows, abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but can often be controlled by vaccination.{{cite encyclopedia |url=http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en |title=Beef cattle and Beef production: Management and Husbandry of Beef Cattle |encyclopedia=Encyclopaedia of New Zealand |year=1966 |url-status=live |archive-url=https://web.archive.org/web/20090101142401/http://www.teara.govt.nz/1966/B/BeefCattleAndBeefProduction/ManagementAndHusbandryOfBeefCattle/en |archive-date=1 January 2009 }} Eating pine needles can also induce abortions in cows.{{cite book | vauthors = Myers B, Beckett J |title=Animal Health Care and Maintenance |chapter=Pine needle abortion |chapter-url=http://ag.arizona.edu/arec/pubs/rmg/4%20animalcare&healthmaintenance/31%20pineneedleabortion01.pdf |access-date=10 April 2013 |year=2001 |publisher=Arizona Cooperative Extension, University of Arizona |location=Tucson |pages=47–50 |url-status=dead |archive-url=https://web.archive.org/web/20150728003136/http://ag.arizona.edu/AREC/pubs/rmg/4%20animalcare%26healthmaintenance/31%20pineneedleabortion01.pdf |archive-date=28 July 2015 }}{{cite journal | vauthors = Kim IH, Choi KC, An BS, Choi IG, Kim BK, Oh YK, Jeung EB | title = Effect on abortion of feeding Korean pine needles to pregnant Korean native cows | journal = Canadian Journal of Veterinary Research | volume = 67 | issue = 3 | pages = 194–197 | date = July 2003 | pmid = 12889725 | pmc = 227052 | publisher = Canadian Veterinary Medical Association }} Several plants, including broomweed, skunk cabbage, poison hemlock, and tree tobacco, are known to cause fetal deformities and abortion in cattle{{cite book| veditors = Njaa BL |title=Kirkbride's Diagnosis of Abortion and Neonatal Loss in Animals| year=2011| publisher=John Wiley & Sons|isbn=978-0-470-95852-0}}{{rp|45–46}} and in sheep and goats.{{rp|77–80}} In horses, a fetus may be aborted or reabsorbed if it has lethal white syndrome. Foal embryos that are homozygous for the dominant white gene (WW) are theorized to also be aborted or resorbed before birth.{{cite web| url=http://www.painthorsejournal.com/pastissues/pdfs/byahair-mar04.pdf |title=By a Hair | vauthors = Overton R | work=Paint Horse Journal |date=March 2003 |access-date=19 December 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130218233122/http://www.painthorsejournal.com/pastissues/pdfs/byahair-mar04.pdf |archive-date=18 February 2013}} In many species of sharks and rays, stress-induced abortions occur frequently on capture.{{cite journal| vauthors = Adams KR, Fetterplace LC, Davis AR, Taylor MD, Knott NA |title=Sharks, rays and abortion: The prevalence of capture-induced parturition in elasmobranchs| journal=Biological Conservation|date=January 2018|volume=217|pages=11–27| doi=10.1016/j.biocon.2017.10.010|bibcode=2018BCons.217...11A | s2cid=90834034 |url=http://marxiv.org/k2qvy/|access-date=30 July 2019| archive-date=23 February 2019|archive-url=https://web.archive.org/web/20190223020619/https://marxiv.org/k2qvy/|url-status=dead}}

Viral infection can cause abortion in dogs.{{cite web |url = http://www.petmd.com/dog/conditions/infectious-parasitic/c_dg_canine_herpesvirus_infection |title = Herpesvirus in dog pups |publisher = petMD |access-date = 18 December 2012 |url-status = live |archive-url = https://web.archive.org/web/20131109165216/http://www.petmd.com/dog/conditions/infectious-parasitic/c_dg_canine_herpesvirus_infection |archive-date = 9 November 2013}} 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.{{cite web |url = http://www.carolsferals.org/spaying-pregnant-females/ |title = Spaying Pregnant Females |publisher = Carol's Ferals |access-date = 17 December 2012 |url-status = usurped |archive-url = https://web.archive.org/web/20121118110647/http://www.carolsferals.org/spaying-pregnant-females/ |archive-date = 18 November 2012}}

{{cite web |url = http://www.petmd.com/blogs/fullyvetted/2007/may/feline-abortion-often-unnerving-necessity |title = Feline abortion: often an unnerving necessity | vauthors = Coates J |date = 7 May 2007 |publisher = petMD |access-date = 18 December 2012 |url-status = live |archive-url = https://web.archive.org/web/20120121085850/http://www.petmd.com/blogs/fullyvetted/2007/may/feline-abortion-often-unnerving-necessity |archive-date = 21 January 2012}}{{cite web |url = http://www.carolsferals.org/spaying-pregnant-females/ |title = Feline abortion: often an unnerving necessity (Part 2) | vauthors = Khuly P |date = 1 April 2011 |publisher = petMD |access-date = 18 December 2012 |url-status = usurped |archive-url = https://web.archive.org/web/20121118110647/http://www.carolsferals.org/spaying-pregnant-females/ |archive-date = 18 November 2012}}

Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect.{{cite journal |jstor=2460564 |pages=932–938 | vauthors = Schwagmeyer PL |title=The Bruce Effect: An Evaluation of Male/Female Advantages |volume=114 |issue=6 |journal=The American Naturalist |year=1979 |doi=10.1086/283541|bibcode=1979ANat..114..932S |s2cid=85097151 }}

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.{{cite book |url=https://books.google.com/books?id=jlZAT-9VwUIC |title=Equine Reproduction |page=563 | vauthors = McKinnon AO, Voss JL |publisher=Wiley-Blackwell |isbn=0-8121-1427-2 |year=1993 |url-status=live |archive-url=https://web.archive.org/web/20150315091737/http://books.google.com/books?id=jlZAT-9VwUIC |archive-date=15 March 2015 }} Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,{{cite journal | vauthors = Berger J | title = Induced abortion and social factors in wild horses | journal = Nature | volume = 303 | issue = 5912 | pages = 59–61 | date = 5 May 1983 | pmid = 6682487 | doi = 10.1038/303059a0 | s2cid = 4259800 | bibcode = 1983Natur.303...59B }}{{cite journal | vauthors = Pluhácek J, Bartos L | title = Male infanticide in captive plains zebra, Equus burchelli | journal = Animal Behaviour | volume = 59 | issue = 4 | pages = 689–694 | date = April 2000 | pmid = 10792924 | doi = 10.1006/anbe.1999.1371 | url = http://af.czu.cz/~bartos/publications/pdf/Pluhacek_Bartos_2000_AB.pdf | url-status = dead | s2cid = 10961845 | archive-url = https://web.archive.org/web/20110718170925/http://af.czu.cz/~bartos/publications/pdf/Pluhacek_Bartos_2000_AB.pdf | archive-date = 18 July 2011}}{{cite journal| first1= Jan |last1 = Pluhacek | first2 = Luděk |last2 = Bartoš |year=2005| title=Further evidence for male infanticide and feticide in captive plains zebra, Equus burchelli| journal=Folia Zoologica|volume=54| issue=3|pages=258–262| url=http://www.ivb.cz/folia/54/3/258-262.pdf| url-status=dead|archive-url=https://web.archive.org/web/20120222174717/http://www.ivb.cz/folia/54/3/258-262.pdf| archive-date=22 February 2012| access-date=12 April 2009}} although the frequency in the wild has been questioned.{{cite journal |vauthors = Kirkpatrick JF, Turner JW |title=Changes in Herd Stallions among Feral Horse Bands and the Absence of Forced Copulation and Induced Abortion |journal=Behavioral Ecology and Sociobiology |volume=29 |issue=3 |pages=217–19 |doi=10.1007/BF00166404 |year=1991 |jstor=4600608|bibcode=1991BEcoS..29..217K | s2cid=32756929}} Male gray langur monkeys may attack females following male takeover, causing miscarriage.{{cite journal |vauthors = Agoramoorthy G, Mohnot SM, Sommer V, Srivastava A |title=Abortions in free ranging Hanuman langurs (Presbytis entellus) – a male induced strategy? |journal=Human Evolution |volume=3| issue=4| pages=297–308| year=1988 |doi=10.1007/BF02435859| s2cid=84849590}}

• Abortion doula
• Forced abortion
• My body, my choice
• Indirect abortion

{{reflist|group=nb}}

{{reflist|colwidth=30em}}

{{Refbegin|30em}}

{{Further|United States anti-abortion movement#Further reading}}

• {{cite Catholic Encyclopedia |wstitle=Abortion |volume=1 | vauthors = Coppens C }}
• {{cite book |vauthors=Devereux G |author-link=George Devereux |title=A Study of Abortion in Primitive Societies |publisher=International Universities Press |year=1976 |isbn=978-0-8236-6245-6 |url=https://archive.org/details/studyofabortioni00deve}}
• {{cite book |vauthors=Doan AE |title=Opposition and Intimidation: The abortion wars and strategies of political harassment |year=2007 |publisher=University of Michigan}}
• {{cite journal |vauthors=Ganatra B, Tunçalp Ö, Johnston HB, Johnson BR, Gülmezoglu AM, Temmerman M |title=From concept to measurement: operationalizing WHO's definition of unsafe abortion |journal=Bulletin of the World Health Organization |volume=92 |issue=3 |page=155 |date=March 2014 |pmid=24700971 |pmc=3949603 |doi=10.2471/BLT.14.136333}}
• {{cite book |vauthors=Hartmann B |title=Reproductive Rights and Wrongs: The Global Politics of Population Control |publisher=South End Press |year=1995 |isbn=978-0-89608-491-9}}
• {{cite book |vauthors=Koblitz AH |author-link=Ann Hibner Koblitz |title=Sex and Herbs and Birth Control: Women and Fertility Regulation Through the Ages |publisher=Kovalevskaia Fund |year=2014 |isbn=978-0-9896655-0-6}}
• {{cite book |vauthors=Riddle JM |author-link=John M. Riddle |title=Eve's Herbs: A History of Contraception and Abortion in the West |year=1997 |publisher=Harvard University Press}}
• {{cite journal |vauthors=Sedgh G, Bearak J, Singh S, Bankole A, Popinchalk A, Ganatra B, Rossier C, Gerdts C, Tunçalp Ö, Johnson BR, Johnston HB, Alkema L |display-authors=6 |title=Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends |journal=Lancet |volume=388 |issue=10041 |pages=258–267 |date=July 2016 |pmid=27179755 |pmc=5498988 |doi=10.1016/S0140-6736(16)30380-4 |ref={{harvid|Sedgh et al|2016}}}}
• {{Cite Q|Q124418995}}
• {{cite book |last=UN |author-link=United Nations |title=Abortion Policies: A Global Review 3 vols. |date=2002 |publisher=Population Division, Department of Economic and Social Affairs, United Nations |url=https://www.un.org/esa/population/publications/abortion/ |access-date=28 June 2017 |archive-date=11 January 2005 |archive-url=https://web.archive.org/web/20050111012745/http://www.un.org/esa/population/publications/abortion/doc/macedonia.doc |url-status=live}}
• {{cite book |last1=WHO |author-link=World Health Organization |title=The World Health Report 2005: Make every mother and child count |url=https://www.who.int/whr/2005/en/ |archive-url=https://web.archive.org/web/20050413194036/http://www.who.int/whr/2005/en/ |url-status=dead |archive-date=13 April 2005 |date=2005 |publisher=World Health Organization |location=Geneva |isbn=92-4-156290-0}}
• {{cite book |last1=WHO |author-link=World Health Organization |title=Safe abortion: technical and policy guidance for health systems |date=2012 |publisher=World Health Organization |location=Geneva |isbn=978-92-4-154843-4 |edition=2nd |url=http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1 |access-date=2 November 2014 |archive-date=16 January 2015 |archive-url=https://web.archive.org/web/20150116223512/http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1 |url-status=live}}
• {{cite web |last1=WHO |author-link=World Health Organization |title=Health worker roles in providing safe abortion care and post-abortion contraception |url=http://srhr.org/safeabortion/ |access-date=8 January 2017 |date=2016 |ref={{harvid|WHO|2016a}} |archive-date=29 March 2019 |archive-url=https://web.archive.org/web/20190329150415/http://srhr.org/safeabortion/ |url-status=live}}

{{Refend}}

{{Library resources box |by=no |onlinebooks=no |others=yes lcheading=Abortion}}

{{Scholia|topic}}

• [https://www.who.int/news-room/fact-sheets/detail/abortion WHO fact sheet on abortion]
• [https://apps.who.int/iris/bitstream/handle/10665/173586/WHO_RHR_15.04_eng.pdf;jsessionid=A45A2A52E41EF59E9E71A08430BF4DA0?sequence=1 Safe abortion: Technical & policy guidance for health systems], World Health Organization (2015)
• [https://web.archive.org/web/20171018012623/https://www.guideline.gov/summaries/summary/47346/firsttrimester-abortion-in-women-with-medical-conditions?q=Women First-trimester abortion in women with medical conditions.] US Department of Health and Human Services

{{Abortion}}

{{Women's health|state=collapsed}}

{{Pregnancy}}

{{Particular human rights}}

{{Reproductive health}}

{{Birth control methods}}

{{Population}}

{{Subject bar|Medicine |Religion |auto=1|wikt=y|b=y}}

{{Authority control}}

Category:Human reproduction

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate