ortion 

is the termination of a pregnancy by the removal or expulsion of a fetus or embryo from the uterus,

resulting in or caused by its death.[1] An abortion can occur spontaneously due to complications during
pregnancy or can be induced in humans and other species. In the context of human pregnancies, an
abortion induced to preserve the health of the gravida (pregnant female) is termed a therapeutic abortion,
while an abortion induced for any other reason is termed an elective abortion. The term abortion most
commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually
termed miscarriages.

Abortion has a low risk of maternal mortality except for abortions performed unsafely, which result in
70,000 deaths and 5 million disabilities per year globally.[2]Abortions are unsafe when performed by
persons without the proper skills or outside of a medically safe environment. An estimated 42 million
abortions are performed annually with 20 million of those abortions done unsafely around the world.
[2]
 Forty percent of the world's women are able to access therapeutic and elective abortions within
gestational limits.[3]

Abortion has a long history and has been induced by various methods including herbal abortifacients, the
use of sharpened tools, physical trauma, and other traditional methods. Contemporary medicine utilizes
medications and surgical procedures to induce abortion. The legality, prevalence, cultural, and religious
views on abortion vary substantially around the world. In many parts of the world there is prominent and
divisive public controversy over the ethical and legal issues of abortion. Abortion and abortion-related
issues feature prominently in the national politics in many nations, often involving the opposing pro-
life and pro-choice worldwide social movements (both self-named). Incidence of abortion has declined
worldwide as access to family planning education and contraceptive services has increased.[4]

Types
Induced

A 10-week-old fetus removed via a therapeutic abortion from a 44-year-old woman diagnosed with early-stage uterine
cancer. The uterus (womb), included the fetus.
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon
the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses.
[5]
 Specific procedures may also be selected due to legality, regional availability, and doctor-patient
preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or
elective. An abortion is medically referred to as a therapeutic abortion when it is performed to:

 save the life of the pregnant woman;[6]

 preserve the woman's physical or mental health;[6]
 terminate pregnancy that would result in a child born with a congenital disorder that would be fatal
or associated with significant morbidity;[6] or
 selectively reduce the number of fetuses to lessen health risks associated with multiple
pregnancy.[6]

An abortion is referred to as elective when it is performed at the request of the woman "for reasons other
than maternal health or fetal disease."[7]

Spontaneous
Main article:  Miscarriage

Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due to
accidental trauma or natural causes before approximately the 22nd week of gestation; the definition by
gestational age varies by country.[8] Most miscarriages are due to incorrect replication of chromosomes;
they can also be caused by environmental factors. A pregnancy that ends before 37 weeks of gestation
resulting in a live-born infant is known as a "premature birth". When a fetus dies in utero after about 22
weeks, or during delivery, it is usually termed "stillborn". Premature births and stillbirths are generally not
considered to be miscarriages although usage of these terms can sometimes overlap.

Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age
and health of the pregnant woman.[9] Most miscarriages occur very early in pregnancy, in most cases,
they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study
testing hormones for ovulation and pregnancy found that 61.9% of conceptuses were lost prior to 12
weeks, and 91.7% of these losses occurred subclinically, without the knowledge of the once pregnant
woman.[10]

The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual
period (LMP).[9][11] One study of 232 pregnant women showed "virtually complete [pregnancy loss] by the
end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5
weeks LMP.[12]
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities
of the embryo/fetus,[13] accounting for at least 50% of sampled early pregnancy losses.[14] Other causes
include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities
of the uterus.[13] Advancing maternal age and a patient history of previous spontaneous abortions are the
two leading factors associated with a greater risk of spontaneous abortion.[14] A spontaneous abortion can
also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered
induced abortion or feticide.[15]

Methods

Gestational age may determine which abortion methods are practiced.

Medical
Main article:  Medical abortion

"Medical abortions" are non-surgical abortions that use pharmaceutical drugs. As of 2005, medical
abortions constitute 13% of all abortions in the United States.[16] Combined regimens
include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost:
misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days
gestation, approximately 92% of women undergoing medical abortion with a combined regimen
completed it without surgical intervention.[17] Misoprostol can be used alone, but has a lower efficacy rate
than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to
complete the abortion surgically.

Surgical
A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).
1: Amniotic sac
2: Embryo
3: Uterine lining
4: Speculum
5: Vacurette
6: Attached to a suction pump

In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.

[18]
 Manual vacuum aspiration (MVA) abortion consists of removing the fetus orembryo, placenta and
membranes by suction using a manual syringe, while electric  vacuum aspiration (EVA) abortion uses an
electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how
early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as
"mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require
cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of
Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is
used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and
suction.

Dilation and curettage (D&C), the second most common method of surgical abortion, is a standard
gynecological procedure performed for a variety of reasons, including examination of the uterine lining for
possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the
walls of the uterus with acurette. The World Health Organization recommends this procedure, also
called sharp curettage, only when MVA is unavailable.[19]

Other techniques must be used to induce abortion in the second trimester. Premature delivery can be
induced with prostaglandin; this can be coupled with injecting theamniotic fluid with hypertonic solutions
containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and
extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression
of the fetus's head before evacuation. IDX is sometimes called "partial-birth abortion," which has
been federally banned in the United States. A hysterotomy abortion is a procedure similar to a caesarean
section and is performed under general anesthesia. It requires a smaller incision than a caesarean
section and is used during later stages of pregnancy.[20]

The Royal College of Obstetricians and Gynaecologists has recommended that an injection be used to

stop the fetal heart during the first phase of the surgical abortion procedure to ensure that the fetus is not
born alive.[21]
Other methods

Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a

pregnant woman with a pestle.[22]

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk

medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium(see history of abortion).[23] The
use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ
failure, and is not recommended byphysicians.[24]

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.[25] Both accidental
and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast
Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[26] 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.[26]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-

surgical implements such as knitting needles and clothes hangers into the uterus. These methods are
rarely seen in developed countries where surgical abortion is legal and available.[27]

Health risks
See also:  Health risks of unsafe abortion

Abortion, when legally performed in developed countries, is among the safest procedures in medicine.[28]
[29]
 In such settings, risk of maternal death is between 0.2–1.2 per 100,000 procedures.[30][31][32][33] In
comparison, by 1996, mortality from childbirth in developed countries was 11 times greater.[30][34][35][36][37]
[38]
 Unsafe abortions (defined by the World Health Organization as those performed by unskilled
individuals, with hazardous equipment, or in unsanitary facilities) carry a high risk of maternal death and
other complications.[39] For unsafe procedures, the mortality rate has been estimated at 367 per 100,000
(70,000 women per year worldwide).[2][40]
Physical health

Surgical abortion methods, like most minimally invasive procedures, carry a small potential for serious
complications.[41]

Surgical abortion is generally safe and the rate of major complications is low[42] but varies depending on
how far pregnancy has progressed and the surgical method used.[43] Concerning gestational age,
incidence of major complications is highest after 20 weeks of gestation and lowest before the 8th week.
[43]
 With more advanced gestation there is a higher risk of uterine perforation and retained products of
conception,[44]and specific procedures like dilation and evacuation may be required.[45]

Concerning the methods used, general incidence of major complications for surgical abortion varies from
lower for suction curettage, to higher for saline instillation.[43] Possible complications include hemorrhage,
incomplete abortion, uterine or pelvic infection, ongoing intrauterine pregnancy,
misdiagnosed/unrecognized ectopic pregnancy, hematometra (in the uterus), uterine perforation and
cervical laceration.[46] Use ofgeneral anesthesia increases the risk of complications because it relaxes
uterine musculature making it easier to perforate.[47]

Women who have uterine anomalies, leiomyomas or had previous difficult first-trimester abortion are
contraindicated to undertake surgical abortion unless ultrasonography is immediately available and the
surgeon is experienced in its intraoperative use.[48] Abortion does not impair subsequent pregnancies, nor
does it increase the risk of future premature births, infertility, ectopic pregnancy, or miscarriage.[29]

In the first trimester, health risks associated with medical abortion are generally considered no greater
than for surgical abortion.[49]

Although some epidemiological studies suggest an abortion – breast cancer hypothesis, the World Health
Organization has concluded that there is "no consistent effect of first trimester induced abortion upon a
woman's risk of breast cancer later in life".[50][51] The National Cancer Institute,[52] The American Congress
of Obstetricians and Gynecologists,[53] the Royal College of Obstetricians and Gynaecologists,[54] and
other major medical bodies have also concluded that abortion does not cause breast cancer.[55]

Mental health
Main article:  Abortion and mental health

No scientific research has demonstrated that abortion is a cause of poor mental health in the general
population. However there are groups of women who may be at higher risk of coping with problems and
distress following abortion.[56] Some factors in a woman's life, such as emotional attachment to the
pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion
increase the likelihood of experiencing negative feelings after an abortion.[57] The American Psychological
Association (APA) concluded that abortion does not lead to increased mental health problems.[58]
Some proposed negative psychological effects of abortion have been referred to by pro-life advocates as
a separate condition called "post-abortion syndrome." However, the existence of "post-abortion
syndrome" is not recognized by any medical or psychological organization.[59][60][61]

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

 Abortion rate - number of abortions per 1000 women between 15 and 44 years of age
 Abortion ratio - number of abortions out of 100 known pregnancies (excluding miscarriages and
stillbirths)

The number of abortions performed worldwide has decreased between 1995 and 2003 from 45.6 million
to 41.6 million, which means a decrease in abortion rate from 35 to 29 per 1000 women. The greatest
decrease has occurred in the developed world with a drop from 39 to 26 per 1000 women in comparison
to the developing world, which had a decrease from 34 to 29 per 1000 women. Out of a total of about 42
million abortions 22 million occurred safely and 20 million unsafely.[2]

On average, the frequency of abortions is similar in developing countries (where abortion is generally
restricted) to the frequency in developed countries (where abortion is generally much less restricted).[3]
[62]
Abortion rates are very difficult to measure in locations where those abortions are illegal,[63] and pro-life
groups have criticized researchers for allegedly jumping to conclusions about those numbers.
[64]
 According to the Guttmacher Institute and the United Nations Population Fund, the abortion rate in
developing countries is largely attributable to lack of access to modern contraceptives; assuming no
change in abortion laws, providing that access to contraceptives would result in about 25 million fewer
abortions annually, including almost 15 million fewer unsafe abortions.[65]

The incidence of induced abortion varies regionally. Some countries, such as Belgium (11.2 out of 100
known pregnancies) and the Netherlands (10.6 per 100), had a comparatively low ratio of induced
abortion. Others like Russia (62.6 out of 100), Romania (63 out of 100) and Vietnam (43.7 out of 100) had
a high ratio (data for last three countries of unknown completeness). The estimated world ratio was 26%,
the world rate - 35 per 1000 women.[66]

By gestational age and method

 Histogram of abortions by gestational age in England and Wales during 2004. Average
is 9.5 weeks. (left) Abortion in the United States by gestational age, 2004. (Data source:
Centers for Disease Control and Prevention) (right)

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, from
data collected in those areas of the United States that sufficiently reported gestational age, it was found
that 88.2% of abortions were conducted at or prior to 12 weeks, 10.4% from 13 to 20 weeks, and 1.4% at
or after 21 weeks. 90.9% of these were classified as having been done by "curettage" (suction-
aspiration, Dilation and curettage, Dilation and evacuation), 7.7% by "medical" means (mifepristone),
0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other"
(including hysterotomy and hysterectomy).[67] The Guttmacher Institute estimated there were 2,200 intact
dilation and extraction procedures in the U.S. during 2000; this accounts for 0.17% of the total number of
abortions performed that year.[68] Similarly, in England and Wales in 2006, 89% of terminations occurred
at or under 12 weeks, 9% between 13 to 19 weeks, and 1.5% at or over 20 weeks. 64% of those reported
were by vacuum aspiration, 6% by D&E, and 30% were medical.[69] Later abortions are more common in
China, India, and other developing countries than in developed countries.[70]

By personal and social factors

A bar chart depicting selected data from the 1998 AGI meta-study on the reasons women stated for having an abortion.

A 1998 aggregated study, from 27 countries, on the reasons women seek to terminate their pregnancies
concluded that common factors cited to have influenced the abortion decision were: desire to delay or end
childbearing, concern over the interruption of work or education, issues of financial or relationship
stability, and perceived immaturity.[71] A 2004 study in which American women at clinics answered a
questionnaire yielded similar results.[72] In Finland and the United States, concern for the health risks
posed by pregnancy in individual cases was not a factor commonly given; however, in Bangladesh, India,
and Kenya health concerns were cited by women more frequently as reasons for having an abortion.
[71]
 1% of women in the 2004 survey-based U.S. study became pregnant as a result of rape and 0.5% as a
result of incest.[72] Another American study in 2002 concluded that 54% of women who had an abortion
were using a form of contraception at the time of becoming pregnant while 46% were not. Inconsistent
use was reported by 49% of those using condoms and 76% of those using the combined oral
contraceptive pill; 42% of those using condoms reported failure through slipping or breakage.[73] The
Guttmacher Institute estimated that "most abortions in the United States are obtained by minority women"
because minority women "have much higher rates of unintended pregnancy."[74]

Some abortions are undergone as the result of societal pressures. These might include the stigmatization
of disabled people, preference for children of a specific sex, disapproval of single motherhood, 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.

Unsafe abortion

Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Abortions performed by either
trained or self-taught midwives not only maim the woman, they also often lead to death."

Main article:  Unsafe abortion

One of the main determinants of the availability of safe abortions is the legality of the procedure. Forty
percent of the world's women are able to access therapeutic and elective abortions within gestational
limits.[3] Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly
where and when access to legal abortion is restricted. The World Health Organization (WHO) defines an
unsafe abortion as being "a procedure ... carried out by persons lacking the necessary skills or in an
environment that does not conform to minimal medical standards, or both."[75] Unsafe abortions are
sometimes known colloquially as "back-alley" abortions. They may be performed by the woman herself,
another person without medical training, or a professional health provider operating in sub-standard
conditions. Unsafe abortion remains a public health concern due to the higher incidence and severity of
its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal
organs. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000
deaths and 5 million disabilities per year.[2]Complications of unsafe abortion are said to account, globally,
for approximately 13% of all maternal mortalities, with regional estimates including 12% in Asia, 25% in
Latin America, and 13% in sub-Saharan Africa.[76] Although the global rate of abortion declined from 45.6
million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions
performed in 2003.[77] Health education, access to family planning, and improvements in health care
during and after abortion have been proposed to address this phenomenon.[78]

History

"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the Boston Daily Times.

Main article:  History of abortion

Induced abortion can be traced to ancient times.[79] There is evidence to suggest that, historically,
pregnancies were terminated through a number of methods, including the administration
of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other
techniques.

The Hippocratic Oath, the chief statement of medical ethics for Hippocratic physicians in Ancient Greece,
forbade doctors from helping to procure an abortion by pessary.Soranus, a 2nd-century Greek physician,
suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in
energetic exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a
number of recipes for herbal baths, pessaries, and bloodletting, but advised against the use of sharp
instruments to induce miscarriage due to the risk of organ perforation.[80] It is also believed that, in addition
to using it as a contraceptive, the ancient Greeks relied upon silphium as an abortifacient. Such folk
remedies, however, varied in effectiveness and were not without risk. Tansy and pennyroyal, for example,
are two poisonous herbs with serious side effects that have at times been used to terminate pregnancy.

During the Islamic Golden Age, physicians there documented detailed and extensive lists of birth control
practices commenting on their effectiveness and prevalence.[81]They listed many different birth control
substances in their medical encyclopedias, such as Avicenna's list of twenty in The Canon of
Medicine (1025 CE) and Muhammad ibn Zakariya ar-Razi's list of 176 substances in his Hawi (10th
century CE) This was "unparalleled in European medicine until the 19th century".[82]

During the Middle Ages, abortion was tolerated[where?] and there were no laws against it.[83][non-
primary  source  needed]
 A medieval female physician, Trotula of Salerno,[84]administered a number of remedies for
the “retention of menstrua,” which was sometimes a code for early abortifacients.[85] Pope Sixtus V (1585–
90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy.
[86]
 Abortion in the 19th century continued, despite bans in both the United Kingdom and the United
States, as the disguised, but nonetheless open, advertisement of services in the Victorian era suggests.[87]
[non-primary  source  needed]

In the 20th century the Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first
countries to legalize certain or all forms of abortion.[88] In 1935 Nazi Germany, a law was passed
permitting abortions for those deemed "hereditarily ill," while women considered of German stock were
specifically prohibited from having abortions.[89][90][91][92]

However, the procedure remained relatively rare until the late 1960s. In late 1960s and early 1970s, due
to a confluence of factors, the number of abortions exploded worldwide. In West Germany, the number of
reported abortions spiked from 2,800 in 1968 to 87,702 in 1980.[93] In the United States, some sources
show an even greater increase, from 4,600 in 1968 to 1.5 million in 1980. However, the fact that abortion
remained illegal in many states prior to the landmark 1973 decision of Roe v. Wade may have affected
the number of reported abortions prior to 1973.

Society and culture

Abortion debate
This section needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may
be challenged and removed. (November 2008)
 Pro-choice activists near the Washington Monument at the March for Women's Lives in
2004. (left) Pro-life activists near the Washington Monument at the annual 2009 March
for Life in Washington, DC. (right)
Main article:  Abortion debate

See also:  Religion and abortion

In the history of abortion, induced abortion has been the source of considerable debate, controversy, and
activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues
is often related to his or her value system. The main positions are one that argues in favor of access to
abortion and one argues against access to abortion. Opinions of abortion may be described as being a
combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of
governmental authorities in public policy. Religious ethics also has an influence upon both personal
opinion and the greater debate over abortion (seereligion and abortion).

Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one
of these two positions. In the United States, those in favor of greater legal restrictions on, or even
complete prohibition of abortion, most often describe themselves as pro-life while those against legal
restrictions on abortion describe themselves as pro-choice. Generally, the former position argues that a
human fetus is a human being with a right to live making abortion tantamount to murder. The latter
position argues that a woman has certain reproductive rights, especially the choice whether or not to carry
a pregnancy to term.

In both public and private debate, arguments presented in favor of or against abortion access focus on
either the moral permissibility of an induced abortion, or justification of laws permitting or restricting
abortion.

Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of
others in distinct cases: a minor, her parents; a legally married or common-law wife, her husband; or, for
any case, the biological father. In a 2003 Gallup poll in the United States, 79% of male and 67% of female
respondents were in favor of legalized mandatory spousal notification; overall support was 72% with 26%
opposed.[94]

Abortion law
 The examples and perspective in this article may not represent a worldwide
view of the subject. Please improve this article and discuss the issue on the talk
page. (December 2010)
Main article:  Abortion law

See also:  Reproductive rights   and  History of Abortion Law Debate

International status of abortion law:

  Legal on request
  Illegal with exception for rape, maternal life, health, mental health, fetal defects, and/or socioeconomic factors
  Illegal with exception for rape, maternal life, health, mental health, and/or fetal defects
  Illegal with exception for rape, maternal life, health, and/or mental health
  Illegal with exception for maternal life, health, and/or mental health
  Illegal with no exceptions
  Varies by region
  No information

The earliest secular laws regulating abortion reflect a concern with class and caste purity and
preservation of male prerogatives. Abortion as such was not outlawed, but wives who procured abortions
without their husband's knowledge could be severely punished, as could slaves who induced abortions in
highborn women. Generally, abortions prior to quickening were treated as minor crimes, if at all.

The new philosophies of the Axial Age, which began discussing the nature and value of human life in
abstract terms, had little impact on existing abortion laws. Even the Christian ecclesiastical courts of the
Middle Ages imposed penance and no corporal punishment for abortion, and retained the pre- and post-
quickening distinction from the ancient philosophies.

With the sole exception of Bracton,[95] commentators on the English common law formulated the born

alive rule, excluding feticide from homicide law, using language dating back to the Leges Henrici Primi.[96]

In the late 18th century, it was claimed that scientific knowledge of human development beginning
at fertilization,[97] justified stricter abortion laws. This was part of a larger struggle on the part of the
medical profession to distinguish modern, theory based medicine from traditional, empirically based
medicine, including midwifery and herbalism.[98]
Both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803.[99] In 1861,
the Parliament of the United Kingdom passed theOffences against the Person Act 1861, which continued
to outlaw abortion and served as a model for similar prohibitions in some other nations.[100]

The Soviet Union, with legislation in 1920, and Iceland, with legislation in 1935, were two of the first
countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion
laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom
(except Northern Ireland). In the 1973 case, Roe v. Wade, the United States Supreme Court struck down
state laws banning abortion, ruling that such laws violated an implied right to privacy in the United States
Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler, discarded its
criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person
guaranteed to women under the Canadian Charter of Rights and Freedoms.[101] Canada later struck down
provincial regulations of abortion in the case of R. v. Morgentaler (1993). By contrast, abortion in
Ireland was affected by the addition of an amendment to the Irish Constitution in 1983 by popular
referendum, recognizing "the right to life of the unborn".

Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to
influence abortion laws throughout the world. The right to life, the right to liberty, the right to security of
person, and the right to reproductive health are major issues of human rights that are sometimes used as
justification for the existence or absence of laws controlling abortion. Many countries in which abortion is
legal require that certain criteria be met in order for an abortion to be obtained, often, but not always,
using a trimester-based system to regulate the window of legality:

 In the United States, some states impose a 24-hour 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.[102]
 In the United Kingdom, as in some other countries, two doctors must first certify that an abortion
is medically or socially necessary before it can be performed.[citation needed]

Other countries, in which abortion is normally illegal, will allow one to be performed in the case of rape,
incest, or danger to the pregnant woman's life or health.

 A few nations ban abortion entirely: Chile, El Salvador, Malta, and Nicaragua, with consequent

rises in maternal death directly and indirectly due to pregnancy.[103][104] However, in 2006, the Chilean
governmentbegan the free distribution of emergency contraception.[105][106]
 In Bangladesh, abortion is illegal, but the government has long supported a network of "menstrual
regulation clinics", where menstrual extraction (manual vacuum aspiration) can be performed as
menstrual hygiene.[107]
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. Women without the means to
travel can resort to providers of illegal abortions or try to do it themselves. [108]

In the US, about 8% of abortions are performed on women who travel from another state.[109] However,
that is driven at least partly by differing limits on abortion according to gestational age or the scarcity of
doctors trained and willing to do later abortions.[citation needed] Thousands of women every year travel from
Northern Ireland, the Republic of Ireland, Poland, and other countries where elective abortion is illegal, to
Britain or other countries with less restrictive laws, in order to obtain abortions.[110][111]

In the United States and some Canadian localities, it is a legal offense to obstruct access to a clinic or
doctor's office where abortions are performed. "Buffer zones," regulating how close protesters can come
to the clinic or to the patients, may exist.

Other issues in abortion law may include the requirement that a minor obtain the consent of one or both
parents to the abortion or that she notify one or both parents, the requirement that a woman obtain the
consent of her husband to the abortion and the question of whether the fetus's father can prohibit an
abortion, the requirement that abortion providers inform patients of the supposed health risks of the
procedure, and wrongful birth laws.

Sex-selective
Main article:  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 targeted termination of female fetuses.

It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities
between the birth rates of male and female children in some places. The preference for male children is
reported in many areas of Asia, and abortion used to limit female births has been reported in China,
Taiwan, South Korea, and India.[112]

In India, the economic role of men, the costs associated with dowries, and a common Indian tradition
which dictates that funeral rites must be performed by a male relative have led to a cultural preference for
sons.[113] The widespread availability of diagnostic testing, during the 1970s and '80s, led to
advertisements for services which read, "Invest 500 rupees [for a sex test] now, save 50,000 rupees [for a
dowry] later."[114] In 1991, the male-to-female sex ratio in India was skewed from its biological norm of 105
to 100, to an average of 108 to 100.[115] Researchers have asserted that between 1985 and 2005 as many
as 10 million female fetuses may have been selectively aborted.[116] The Indian government passed an
official ban of pre-natal sex screening in 1994 and moved to pass a complete ban of sex-selective
abortion in 2002.[117]
In the People's Republic of China, there is also a historic son preference. The implementation of the one-
child policy in 1979, in response to population concerns, led to an increased disparity in the sex ratio as
parents attempted to circumvent the law through sex-selective abortion or the abandonment of unwanted
daughters.[118] Sex-selective abortion might be an influence on the shift from the baseline male-to-female
birth rate to an elevated national rate of 117:100 reported in 2002. The trend was more pronounced in
rural regions: as high as 130:100 in Guangdong and 135:100 in Hainan.[119] A ban upon the practice of
sex-selective abortion was enacted in 2003.[120]

Anti-abortion violence
Main article:  Anti-abortion violence

Doctors and facilities that provide abortion have been subjected to various forms of violence, including
murder, attempted murder, kidnapping, stalking, assault, arson, and bombing. Anti-abortion violence has
been classified by governmental and scholarly sources as terrorism.[121][122] Only a small fraction of those
opposed to abortion commit violence, often rationalizing their actions as justifiable homicide or defense of
others, committed in order to protect the lives of fetuses.

In the United States, four abortion providers—Drs. David Gunn, John Britton, Barnett Slepian,

and George Tiller—have been assassinated. Attempted assassinations have also taken place in the
United States and Canada, and other personnel at abortion clinics, including receptionists and security
guards, have been killed in the United States and Australia. Hundreds of bombings, arsons, acid attacks,
invasions, and incidents of vandalism against abortion providers have also occurred.[123][124] Notable
perpetrators of anti-abortion violence include Eric Robert Rudolph, Scott Roeder, Shelley Shannon,
and Paul Jennings Hill, the first person to be executed in the United States for murdering an abortion
provider.[125]

Art, literature and film

Art serves to humanize the abortion issue and illustrates the myriad of decisions and consequences it
has. One of the earliest known representations of abortion is in a bas relief at Angkor Wat (c. 1150). Pro-
life activist Børre Knudsen was linked to a 1994 art theft as part of a pro-life drive in Norway surrounding
the 1994 Winter Olympics.[126] A Swiss gallery removed a piece from a Chinese art collection in 2005, that
had the head of a fetus attached to the body of a bird.[127] In 2008, a Yale student proposed using aborted
excretions and the induced abortion itself as a performance art project.[128]

The Cider House Rules (novel 1985, film 1999) follows the story of Dr. Larch an orphanage director who
is a reluctant abortionist after seeing the consequences of back-alley abortions, and his orphan medical
assistant Homer who is against abortion.[129] Feminist novels such as Braided Lives (1997) by Marge
Piercy emphasize the struggles women had in dealing with unsafe abortion in various circumstances prior
to legalization.[130] Doctor Susan Wicklund wrote This Common Secret (2007) about how a personal
traumatic abortion experience hardened her resolve to provide compassionate care to women who decide
to have an abortion. As Wicklund crisscrosses the West to provide abortion services to remote clinics, she
tells the stories of women she's treated and the sacrifices she and her loved ones made.[131] In 2009, Irene
Vilar revealed her past abuse and addiction to abortion in Impossible Motherhood, where she aborted 15
pregnancies in 17 years. According to Vilar it was the result of a dark psychological cycle of power,
rebellion and societal expectations.[132]

Various options and realities of abortion have been dramatized in film. In Riding in Cars with Boys (2001)
an underage woman carries her pregnancy to term as abortion is not an affordable option, moves in with
the father and finds herself involved with drugs, has no opportunities, and questioning if she loves her
child. While in Juno (2007) a 16-year-old initially goes to have an abortion but decides to bear the child
and allow a wealthy couple to adopt it. Other films Dirty Dancing (1987) and If These Walls Could
Talk (1996) explore the availability, affordability and dangers of illegal abortions. The emotional impact of
dealing with an unwanted pregnancy alone is the focus of Things You Can Tell Just By Looking At
Her (2000) and Circle of Friends (1995). As a marriage was in trouble in the The Godfather Part
II (1974) Kay knew the relationship was over when she aborted "a son" in secret.[133] On the abortion
debate, an irresponsible drug addict is used as a pawn in a power struggle between pro-choice and pro-
life groups in Citizen Ruth(1996).[134]