abortion[]
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n.##Induced termination of a pregnancy with destruction of the embryo or fetus.
- Any of various procedures resulting in the termination of a pregnancy. Also called induced abortion.
- See miscarriage (sense 1).
- Cessation of normal growth, especially of an organ or other body part, prior to full development or maturation.
- The premature ending or abandonment of an undertaking.
- Something that is regarded as poorly made or done.
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Britannica Concise Encyclopedia:
abortion[] |
TopHome > Library > Miscellaneous > Britannica Concise Encyclopedia.content{clear:both;} Expulsion of a fetus from the uterus before it can survive on its own. Spontaneous abortion at earlier stages of pregnancy is calledmiscarriage. Induced abortions often occur through intentional medical intervention and are performed to preserve the womans life or health, to prevent the completion of a pregnancy resulting from rape or incest, to prevent the birth of a child with serious medical problems, or because the woman does not believe she is in a position to rear a child properly. The drugRU-486, if taken within a few weeks of conception, will trigger a miscarriage. Up to about 19 weeks of pregnancy, injections of saline solutions or hormones may be used to stimulate uterine contractions that will expel the fetus. Surgical removal of the contents of the uterus may be performed in the second trimester or later. Intact dilation and extraction procedures may occur in the third trimester; sometimes critically referred to as "partial-birth abortions," they have been very controversial. Other abortion procedures include manual vacuum aspiration (extraction by manual syringe) and dilation and suction curettage (extraction by machine-operated suction), both of which can be performed in early pregnancy. The social acceptability of abortion as a means of population control has varied from time to time and place to place throughout history. It was apparently a common method of family limitation in the Greco-Roman world, but Christian theologians early and vehemently condemned it. It became widely accepted in Europe in the Middle Ages. Severe criminal sanctions to deter abortion became common in the 19th century, but in the 20th century those sanctions were gradually modified in many countries. In the U.S. the 1973Roe v. Wade decision had the effect of legalizing abortion during the first three months of pregnancy; states were able to implement restrictions on access to abortion after the first trimester, though within constraints set by the courts. Since that decision, there has been a fierce debate between supporters and opponents of a liberalized abortion policy.For more information on abortion, visit Britannica.com.
World of the Body:
abortion[] |
TopHome > Library > Health > World of the BodyAbortion means the end of a pregnancy before the fetus can survive. It may be either spontaneous — when it is also known as miscarriage — or induced, when it is a deliberate termination of pregnancy.
Spontaneous abortion
Spontaneous abortion is defined in the UK as a pregnancy loss occurring before 24 completed weeks of pregnancy. Approximately 50-70% of pregnancies end in spontaneous abortion. Most of these losses are unrecognized because they occur before or at the time of the next expected menstrual period. About 15-20% of clinically diagnosed pregnancies are lost by 16 weeks. Recurrent abortion, defined as the loss of three or more consecutive pregnancies, occurs in 0.5-1% of pregnant women. Causes of spontaneous abortion may relate to the fetus, the placenta, or the uterus. Genetic factors, developmental problems, placental problems, and infection are known causes, but in a quarter of all spontaneous abortions the cause is unknown. This may be due to lack of ability to investigate these cases.
It is generally accepted that 50% of all recognized pregnancy losses in the first 3 months are due to a genetic abnormality. Abnormalities of the placenta have probably greater importance than is realized, but information on this aspect is scanty. A number of organisms have been associated with spontaneous abortion, such as listeria, brucella infection from animals, and the rubella virus. In isolated instances fetal or placental infection with various organisms may result in spontaneous abortion, but there is no evidence of their involvement in a recurrent problem. Some cases of recurrent abortion are due to congenital abnormalities of the uterus and these may be corrected surgically; 70-80% of women with the most frequent abnormalities have successful pregnancies following surgery.
Spontaneous abortion may become evident clinically either as ‘threatened’ or ‘inevitable’. A threatened abortion is said to occur when a woman bleeds from the uterus before 24 weeks of pregnancy. There are three possible outcomes: the bleeding may settle and the pregnancy continue; the fetus may die but be retained in the uterus (confirmed by an ultrasound examination) and this is known as a ‘missed’ abortion; a missed abortion may proceed to an inevitable abortion, with continued or intensified bleeding and expulsion of the products of conception. Bleeding may be severe, causing shock; in some cases this is life-threatening and blood transfusion may be required. Death occurs in a few cases where medical care is poor or absent. In the UK the death rate is of the order of 12.5 per million pregnancies.
If the pregnancy is expelled intact the abortion is said to be ‘complete’, but this is rare in the first 3 months of pregnancy. More commonly some material is left behind and only when it is removed surgically will bleeding cease. If this is not done, bleeding may continue and the uterus become infected, with serious consequences for the woman. Rarely in developed countries, but commonly in underdeveloped regions and where abortion laws are restrictive, infection occurs and abortion is a well-recognized cause of maternal death.
The emotional effects of an abortion vary greatly. A majority of women have feelings of depression, and there is usually associated fear and anxiety caused by the pain and bleeding and the uncertainty as to the cause. Reaction to abortion as a bereavement means that women require to grieve after the event. Often the intensity of the emotional reaction is not appreciated by the carers or by friends or relatives. Health workers should help the woman to express her grief. Women who have experienced such loss require considerable reassurance and support in a subsequent pregnancy.
Recurrent spontaneous abortion
Recurrent spontaneous abortion is a particularly distressing condition and there is very limited understanding of its causes. Genetic factors such as parental chromosome abnormalities are a major known cause which should be looked for. Anatomical factors such as uterine abnormalities account for perhaps 10-15% of recurrent loss. Hormonal factors, such as deficient production of progesterone, which is important for the maintenance of early pregnancy, are also cited — but evidence for such causes is scanty.
In some cases an immune response is mounted by the mother against the pregnancy, causing its demise. Chronic maternal disease such as diabetes and kidney disease may also be associated. Smoking and alcohol consumption have been linked to recurrent abortion but there is no hard evidence for this.
In the case of genetic abnormalities, genetic counselling is advisable and if, for example, the abnormality is traced to the male partner, insemination of the woman with sperm from a donor (donor insemination, DI) may be a possible solution. An abnormally shaped uterus can be corrected by surgery. Hormonal therapy has not proved successful. In the case of an immunological cause, immunotherapy has been helpful, and in some women with no ascertainable cause psychotherapy has been of value. In the event intervention may not be the best answer and it may be just as successful to wait and see.
Induced abortion: termination of pregnancy
The study of induced abortion, especially where abortion is illegal, is a major challenge in the contexts of reproductive health and women's rights.
At the International Conference on Population and Development in Cairo in 1994 the following statement was made: ‘Since unsafe abortion is a major threat to the health and lives of women, research to understand and better address the determinants and consequences should be promoted’. The conference also recognized that unsafe abortion was a world-wide public health problem and agreed that each country should legislate to solve the problem. In developed countries like the UK where abortion is readily available the related mortality is extremely low — less than 1 per 100 000 procedures. In less optimal settings where women are only able to find unsafe abortion, mortality is high. World-wide, estimates vary from a minimum of 50 000 up to 150 000 abortion-related deaths per annum.
Experience from many countries confirms that permissive legislation on abortion does not increase the abortion rate: it only determines whether it is performed under safe or unsafe conditions. The restrictive legislation which some countries have, for cultural or religious reasons, prevents a reduction in the death rate and health hazards of abortion.
In the UK restrictive legislation was still in place in 1938 — the year when Mr Alec Bourne, an eminent London gynaecologist, terminated a woman's pregnancy which had resulted from rape. He was reported for this criminal offence and was prosecuted. The judge allowed the mental health of the woman to be taken into account and Bourne was acquitted, marking a changing attitude to abortion in the UK. In 1967 the Abortion Act legalized abortion under certain circumstances, and amendments were made in 1990. Currently the Act permits termination of pregnancy if two doctors: are of the opinion in good faith a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
It is essential that a woman who seeks abortion receive proper counselling. If she wishes her partner to be involved he may be, but this is not mandatory. This involves giving the woman as much information as possible after a medical, social, and family history has been obtained: information regarding the methods of termination, their risks, and their benefits, and alternative courses of action such as adoption, and also advice which may help to determine her real wishes. All is designed to help her to reach a decision. Certain high risk groups require special counselling: teenagers; those with genetic factor risks; cases of sexual abuse; and those seeking late terminations or repeated terminations.
Most terminations are done in the first 3 months of pregnancy. At this stage it is done surgically under an anaesthetic, by dilating the cervix and removing the pregnancy by suction or by forceps. Alternatively, up to 8 weeks or so, termination using drugs is possible, and is now common. A choice may therefore be offered. In 85% of early cases no further treatment is required as the abortion is complete. Where it is not complete surgery is required.
After 3 months it is usual to use a method of termination by administration of prostaglandins. These drugs cause contractions of the uterus and the fetus and placenta are expelled.
Complications which may occur are bleeding, perforation of the uterus, tearing of the cervix, and sepsis — but these are rare when the procedure is properly performed. Where abortion is performed in unsafe circumstances these complications are common and have serious consequences.
Abortion has been regarded in some countries as a method of birth control. This should not be so. Abortion services should include advice on contraception and the better this advice the less often will abortion be resorted to. See also antenatal development; contraception; pregnancy.— Malcolm Macnaughton
Abortion: historical and social aspects
For many centuries women finding themselves pregnant have endeavoured to implement retroactive birth control by means of abortion. This practice was often occluded from legal and medical eyes, information being passed on within a female oral subculture. However manuscripts survive from a range of historical periods which record numerous substances reputed to be abortifacients, though some are also highly toxic to the woman; and various practices have also been believed to induce miscarriage. For many centuries the law only concerned itself with pregnancy subsequent to ‘quickening’. This traditional distinction and the persistent conceptualization by women of the problem as ‘bringing on’ menstruation, suggest that women did not experience pregnancy as an absolute, either/or, state.
The law, however, at least in Europe and North America, increasingly formulated the ending of all pregnancy as abortion, possibly reflecting developing medical ability in accurate, early recognition of conception. In England and Wales abortion initially became a statutory offence in 1803 under Lord Ellenborough's Act, at a time when the medical profession was increasingly concerning itself with previously woman-controlled areas such as obstetrics, and desirous of differentiating the medical man from the irregular practitioner. The concept of ‘unlawful’ abortion enabled medical practitioners to claim a right to use their clinical judgement over ‘lawful’ therapeutic abortion. Induced abortion, pre-antibiotics, was a significant cause of female mortality and morbidity, although many ‘back street’ operators were not lacking in skill. It was largely married women who patronized these, since they could more readily pass off miscarriages without need of concealment. The ‘Female Pills’ widely purveyed in the later nineteenth and early twentieth centuries were a successful commercial racket, with little in the way of effective ingredients.
Laws on the availability of surgical abortion have varied widely from nation to nation: medical expertise may be privileged over unlicensed operators, or operations even by regular practitioners regarded as a crime. Though legally condemned, abortion has frequently been available to those with the right contacts and able to pay. While certain religious groups, especially Roman Catholics, have strongly condemned abortion, such condemnation has not universally prevented women from seeking it. The role of popular feeling and debate has been influential in altering the law: in Britain the important legal case of Rex v. Bourne, 1938, establishing a common-law precedent for abortion on the grounds of a woman's mental, not merely physical, health, took place in the context of widespread debate and agitation for reform of the law. In the US, however, there was no such climate of opinion, and similarly idealistic and concerned abortionists paid the full legal penalty.
Abortion became legalized in many countries during the late 1960s and early 1970s. Unfortunately the overt inscription of the right to abortion in law (as opposed to something performed, if at all, within the privileged secrecy of the doctor/patient encounter) has provoked a vigorous ‘backlash’, particularly violent in the US. There is little evidence that abortions would be fewer if illegal; only more dangerous, and the availability of the operation more erratic and inequitable.
— Lesley A. Hall
Antonyms:
abortion[] |
TopHome > Library > Literature & Language > Antonyms nDefinition: failure Antonyms: continuation, success
Encyclopedia of Public Health:
Abortion[] |
TopHome > Library > Health > Public Health EncyclopediaAbortion is a generic term for pregnancies that do not end in a livebirth or a stillbirth. It is the premature expulsion from the uterus of the products of conception, which include the placenta, bag of waters, and fetus, if present.
Types of Abortion
There are two types of abortions. Spontaneous abortion refers to a natural biological process by which some pregnancies end. Induced abortion refers to pregnancies terminated through human intervention.
Spontaneous Abortions. A large percentage of the products of the union of an egg and a sperm never become infants. If there is something seriously wrong with the fetus, the uterus often expels it. This may occur very early in the pregnancy, with the woman only experiencing a larger than usual blood flow around the time of her expected menstrual period, or it may occur later in the pregnancy. This latter event is commonly called a miscarriage, but technically it is a spontaneous abortion if it occurs before twenty weeks of pregnancy. Spontaneous abortions are often the body's way of preventing the birth of a defective child, although sometimes they are due to maternal health problems.
Induced Abortions. In contrast, induced abortions result from the planned interruption of a pregnancy. Throughout recorded history, humans have taken a variety of steps to control family size: before conception by delaying marriage or through abstinence or contraception; or after the birth by infanticide. Induced abortion falls temporally between these two extremes by preventing a conception from becoming a live birth. In the United States in the last few decades of the twentieth century, most abortions were performed surgically using a procedure called suction curettage. The year 2000 approval in the United States of a drug, mifepristine (RU486), which in combination with another drug causes an abortion in almost all cases, may increase the percentage of abortions induced by the administration of pharmaceutical agents.
Therapeutic Abortions. This term refers to abortions thought necessary because of fetal anomalies, rape, or to protect the health of the mother when a birth might be life threatening or physically or psychologically damaging.
Elective or Voluntary Abortions. Interruption of a pregnancy before viability at the woman's request for reasons other than fetal anomalies or maternal risk is often referred to as elective or voluntary abortion. Such abortions often result from social problems, such as teenage pregnancy or non-marital births; economic difficulties, such as insufficient income to support a child; or inappropriate timing.
Legal and Illegal Abortions. Induced abortions may be legal or illegal. According to the United States Centers for Disease Control and Prevention (CDC), the federal agency that collects data on abortions, a legal abortion is "a procedure, performed by a licensed physician or someone acting under the supervision of a licensed physician, that was intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age." An illegal abortion may be self-induced, induced by someone who is not a physician or not acting under her or his supervision, or induced by a physician under conditions that violate state laws governing abortions.
A Historical Perspective
Almost all human societies place a high value on human life. Thus, the further along the continuum from heterosexual intercourse to a live child, the less likely is the method of fertility control to be allowed. In the modern period, most societies allow contraception, but there is more variability around abortion. The leading institutional opposition comes from the Roman Catholic Church, but other institutions also take active positions against abortion. Survey research suggests that many Americans are ambivalent about whether abortion should be legal and, if so, under what circumstances.
Induced abortion was almost universally illegal at the beginning of the twentieth century. This changed first in the early years of the Soviet Union, which made abortion legal, widely available, and encouraged as the primary method of fertility control. In the period after World War II, abortion was legalized first in the Scandinavian countries and later in most of Western and Eastern Europe. With the broaching of the Iron Curtain in the early 1990s, abortion was legalized in more of Eastern Europe, while the more restrictive policy in West Germany was extended to the former East Germany. At the beginning of the twenty-first century, abortion was legal in most of England and Asia, but illegal in most of Africa and South America.
In the United States, abortion was universally illegal from at least the late nineteenth century until the mid-1960s, when an abortion reform movement led to legalization of abortion in some states. (The regulation of abortion, like most medical issues, is a state function.) Then, in its 1973 Roev. Wade decision, the United States Supreme Court found a constitutional right to abortion before viability, at that time about twenty-eight weeks. (By the beginning of the twenty-first century, advances in the techniques of caring for very premature infants had reduced the age of viability to around twenty-three weeks.) The Court stated, however, that after viability is reached, the state's important and legitimate interest in potential life becomes compelling and it may regulate and even prohibit abortions, with the exception of those necessary to preserve the life or health of the mother.
Access to Abortions
Access to legal abortions is limited by laws and regulations, financial considerations, and the availability of providers.
Laws and Regulations. Since the 1973 decision, many states have enacted measures to limit abortion, which have led to considerable litigation.
Some laws have been disallowed as inconsistent with Roe, while others have been allowed. For example, in the late 1990s, about thirty states restricted the access of minors to abortions by requiring the notification or the consent of one or both parents before an abortion could be performed, and more are considering such legislation. The Supreme Court requires that states with parental notification or consent laws must provide for a judicial bypass; that is, the minor must be allowed to obtain permission from a court for the abortion if she is unwilling or unable to seek permission from her parent(s). States may also require a waiting period between the request for an abortion and its actual performance. Or they may require the physician who is to conduct the abortion to inform the mother about the fetus's stage of development and about alternative ways of managing an unwanted pregnancy, such as putting the baby up for adoption.
Financial Considerations. Abortion is not among the medical procedures covered by Medicaid, the federal-state program that provides health care to many poor women. Federal law, the socalled Hyde Amendment, passed in 1977 and amended in 1993, prohibits the use of federal Medicaid funds for abortion except in cases of rape, incest, or when the life of the pregnant woman is in danger. Some states use their own Medicaid funds to pay for abortions that physicians consider "medically necessary," and a few fund them in cases of fetal anomaly or grave physical health danger. Some private organizations, such as Planned Parenthood agencies, assist low-income women in states with restrictive funding policies by performing abortions for reduced fees. In 1999, less than two-fifths of women with employer-based health insurance were covered for abortion services.
Provider Availability. On the basis of a survey of abortion providers, the Alan Guttmacher Institute estimated that in 1996 there were slightly over two thousand abortion providers in the United States, a drop of 14 percent from 1992, perhaps as a result of anti-abortion publicity and disturbances. Eighty-nine of the country's 320 metropolitan areas had no known abortion providers and an additional twelve had providers who together reported fewer than fifty abortions. Abortion providers were even less available in non-metropolitan areas.
According to the Guttmacher survey, 452 abortion clinics (defined as nonhospital facilities in which half or more of patient visits were for abortion services) performed 70 percent of the abortions in 1996. Four hundred and seventeen other clinics performed 21 percent of the abortions; 703 hospitals performed 7 percent (only 9% of those on an in-patient basis); and 470 physicians' offices performed 3 percent.
Number and Rates of Abortions
There is no definitive information about the number and rate of spontaneous abortions, although worldwide it is estimated that approximately 15 percent of women who have been pregnant for five or more weeks spontaneously abort or experience stillbirths.
The CDC has been conducting surveillance of legal induced abortions in the United States since 1969. It reported 1,186,039 legal abortions in 1997, but noted that this was probably an underestimate. The number of abortions per 1,000 women between 15 and 44 years of age (the abortion rate) was 20 and the number of abortions per 1,000 live births (the abortion ratio) was 306. Most legal abortions were performed in California, New York City, Texas, and Florida. The number of legal abortions increased from 1970 until 1990 and, with the exception of 1996, has fallen ever since.
Both the abortion rate and the abortion ratio began to decline earlier.
Information on the characteristics of the women who obtain abortions and the timing of abortions is available from most, but not all, areas. Based on the information available in 1997, women between the ages of 20 and 24 obtained almost a third (31.5%) of all abortions. Abortion rates were highest for women between the ages of 20 and 24 and lowest for the youngest and oldest women. Abortion ratios, however, were highest for women under 20 and for women 40 and over, at least partially because there are fewer births in these age groups. Slightly over half(56.3%) of women who obtained abortions were white, but the abortion rate and the abortion ratio for African Americans was slightly more than two and a half times the rate for white women. For Hispanic women in the District of Columbia, New York City, and the twenty-six states reporting ethnicity, the abortion ratio was similar to the one for non-Hispanics in the same areas, but the rate was higher. Seventy-nine percent of women who obtained abortions were unmarried, 41 percent had no previous live births, and half were obtaining abortions for the first time. Eighty-six percent of women obtaining abortions had the procedure during the first twelve weeks of pregnancy.
Abortions and Public Health
There is no evidence that abortions are detrimental to the health of women. The CDC reported that in 1992, the last year for which data on abortionrelated deaths were available, only twenty-seven women died of abortion-related causes, ten due to induced abortions, seventeen to spontaneous abortions, and none to illegal abortions. This is a case-fatality rate for legal induced abortions of 0.7 per 100,000 legal induced abortions, a lower fatality rate than for pregnancies. (In 1992, the maternal mortality rate was 7.8 per 100,000 live births.) Injuries and illness, both physical and emotional, are also rare. Deaths and other adverse consequences are more likely to occur when women are unable to obtain abortions legally and attempt to induce abortions themselves or turn to providers outside the conventional medical care system. There were thirty-nine deaths due to illegal abortions in 1972 before the Roe v. Wade decision and nineteen in 1973. Since then, the number of such deaths has declined markedly: There were only two between 1988 and 1992. Studies in Czechoslovakia have shown that women who are denied abortions suffer psychological difficulties.
Most induced abortions today are the result of unwanted pregnancies. The best way to prevent this safe—but uncomfortable and usually undesirable—procedure is to make family planning counseling and methods easily available to all women.
(SEE ALSO: Ethics of Public Health; Pregnancy; Reproduction)
Bibliography
Alan Guttmacher Institute (1999). Sharing Responsibility: Women, Society and Abortion Worldwide. New York: Author.
Henry J. Kaiser Family Foundation (1999). Issue Update: Abortion Fact Sheet. Menlo Park, CA: Author.
Henry J. Kaiser Family Foundation and Health Research and Educational Trust (1999). Employer Health Benefits: 1999 Annual Survey. Menlo Park, CA: Author.
Henshaw, S. K. (1998). "Abortion Incidence and Services in the United States, 1995–1996." Family Planning Perspectives 30(6):263–270, 287.
Joffe, C. (2000). "Medical Abortion in Social Context." American Journal of Obstetrics and Gynecology 183(2):S10– S15.
Klerman, J. A. (1999). "U.S. Abortion Policy and Fertility." American Economic Review Papers and Proceedings 89(2):261–264.
Koonin, L. M.; Strauss, L. T.; Chrisman, C. E.; Montalbano, M. A.; Bartlett, L. A.; and Smith, J. C. (July 30, 1999). "Abortion Surveillance—United States, 1996." Morbidity and Mortality Weekly Report 48(SS-4):1–42.
Koonin, L. M.; Strauss, L. T.; Chrisman, C. E.; and Parker, W. Y. (December 8, 2000). "Abortion Surveillance—United States, 1997." Morbidity and Mortality Weekly Report 49(SS-11):1–43.
Levine, P. B.; Staiger, D.; Kane, T. J.; and Zimmerman, D. J. (1999). "Roe v. Wade and American Fertility." American Journal of Public Health 89(2):199–203.
Matthews, S.; Ribar, D.; and Wilhelm, M. (1997). "The Effects of Economic Conditions and Access to Reproductive Health Services on State Abortion Rates and Birthrates." Family Planning Perspectives 29(2):52–60.
— LORRAINE V. KLERMAN; JACOB A. KLERMAN
US Supreme Court:
Abortion[] |
TopHome > Library > Law & Legal Issues > US Supreme CourtAlexis de Tocqueville observed in Democracy in America that “there is hardly a political question in the United States which does not sooner or later turn into a judicial one” (Meyer, ed., 1969, p. 270). It was not until the latter half of the nineteenth century that criminal sanctions against abortion became widespread, and not until the latter half of the twentieth century that the notion of a constitutional right to sexual autonomy took hold in the public mind. That development guaranteed that abortion would turn into a judicial question.
As part of the police power over health and morals, abortion laws have traditionally been the province of state governments. In early American history, abortion was more dangerous than childbirth, which was life‐threatening itself. Lawmakers who regulated sexual activity in minute detail saw no need to make abortion a crime. When medical advances made abortion safer in the nineteenth century, some states forbade abortion primarily to protect pregnant women. Other early anti‐abortion laws were essentially elements of state obscenity statutes, often called “little Comstock laws.” These laws, similar to the 1873 federal Comstock Act, included contraceptives and abortifacients among the forbidden “obscene” materials. Early in the twentieth century, reformers like Margaret Sanger began to promote birth control as a means of limiting family size, especially for the poor. By 1960, forty‐eight states had legalized birth control.
The decriminalization of birth control enhanced individual freedom by increasing women's control over their fertility, but contraception did not ensure reproductive self‐determination for women. Sexual intercourse could occur without a woman's consent—not only through rape, but also because of the legal obligation to satisfy a husband's sexual demands. Existing methods of female contraception were unreliable even when a woman was free to use them.
Since women still found themselves confronted with unwanted pregnancies, access to abortion was necessary for reliable fertility control. But abortion has always been a more controversial issue than contraception. For many who consider fetuses persons, abortion is the equivalent of homicide. Even people who are not convinced that fetuses are full human beings may have difficulty accepting the idea of legal abortion. While both men and women use contraception, only women get pregnant and can abort. The idea that women have equal rights with men is a relatively new notion. Moreover, society's cultural idea of womanhood has traditionally been bound up with motherhood. The choice of abortion is made by a woman who, at least at that specific point in time, does not want a child—and this possibility challenges widely accepted notions of the role of women.
As late as the 1960s, abortion was still illegal everywhere in the United States, except to save the mother's life. The revitalization of feminism in the late 1960s gave impetus to the abortion rights movement. A portent of changing opinions was the 1962 Model Penal Code, in which the American Law Institute (ALI) recommended that abortion be legal when the pregnancy resulted from rape or when the baby was likely to be seriously disabled. Fourteen states adopted some or all of the ALI recommendations between 1965 and 1970. New York, Alaska, and Hawaii repealed their abortion laws outright.
Abortion and Privacy
Griswold v. Connecticut (1965) disposed of the last surviving laws against birth control and established a constitutional right to a realm of privacy. The Supreme Court ruled that the right to use contraceptives lay within a protected “zone of privacy” created by “penumbras” emanating from several provisions of the Bill of Rights. Many legal scholars found this argument a less than convincing justification for the judicial creation of a right nowhere mentioned in the Constitution, but the ruling established a right whose content would be defined and explained by later decisions.
In 1973, the Court extended the right of privacy to the choice of abortion. In Roe v. Wade, a majority of seven justices ruled that the “right of privacy … is broad enough to encompass a woman's decision whether or not to terminate her pregnancy” (p. 153). Justice Harry Blackmun's majority opinion emphasized “the detriment that the state would impose on the pregnant woman” and “the distress, for all concerned, associated with an unwanted child” (p. 159.) But many critics on both sides of the abortion issue consider this opinion unpersuasive and poorly grounded. It fails to build a logical bridge between Roe and Griswold. Roe contains no argument that abortion is sufficiently similar to birth control to justify its inclusion within the protected zone of privacy. Blackmun observed that no social consensus existed that fetuses are human beings and that American law did not recognize the unborn as persons. But the state did have a compelling interest in “potential human life.” The state could also restrict abortion when necessary to protect the health of the mother. Each of these interests became strong enough to justify restrictions at different stages of pregnancy: maternal health at the end of the third month; potential life at the end of the sixth (when, according to medical authorities at the time, the fetus was viable outside the womb). Therefore, the constitutional right to choose abortion was a limited one. In the first trimester, the state had no power to restrict abortion; beginning with the second trimester, the state might regulate, but not prohibit, abortion; and in the third trimester, the state might prohibit abortion except when necessary for the mother's life or health.
More than thirty years after Roe was decided, it remains one of the most controversial decisions in Supreme Court history. Supporters of reproductive freedom welcomed the ruling enthusiastically. But Roe also led to the formation of the “right‐to‐life” movement. Even among Americans who opposed restrictions on abortion, many thought that the Court had usurped power belonging to the elected branches of government. Critics pointed to the absence of textual authority in the Constitution and demanded that the people's elected representatives decide what abortion laws they wanted and what the word “person” meant to them.
Efforts to counter Roe v. Wade have continued in full strength into the twenty‐first century. A constitutional amendment that defined “person” to include the unborn has been introduced in Congress several times. But neither this “human life amendment” nor a bill that attempted the same result through a federal law emerged from Congress. However, Congress and many state legislatures have repeatedly passed laws negating, or at least narrowing, the decision. These statutes attempt to make it harder for women seeking abortions to get them. The statutes are inevitably challenged in court. From 1973 to 1986, when William Rehnquist replaced Warren Burger as chief justice, the Supreme Court generally distinguished between obstacles to the choice of abortion and refusals to facilitate the choice, invalidating most of the former while upholding the latter. But in recent years the courts have expanded the government's power to restrict abortion.
Abortion and Public Funding
The Supreme Court has consistently upheld laws denying governmental support for abortion. The first “Hyde amendment,” a federal limitation on the use of Medicaid funds, was enacted in 1976. It and similar state laws, all of which make exceptions for abortions to save the mother's life, continue to survive judicial scrutiny. Justice Potter Stewart's majority opinion in Harris v. McRae (1981) is typical. “Although government may not place obstacles in the path of a woman's exercise of her freedom of choice, it need not remove those not of its own creation. Indigency falls in the latter category” (p. 316). Justices William Brennan, Thurgood Marshall, and Blackmun maintained that these laws make safe abortions unavailable for poor women, thus creating a double standard of constitutional rights. But Stewart's view prevailed. A constitutional challenge to these laws is even less likely to succeed now that Chief Justice Rehnquist, a dissenter in Roe, is the only holdover from that case still on the Court and several supporters of Roe have been replaced by opponents. Rust v. Sullivan (1991) further limited poor women's access to abortion by upholding the federal “gag rule” forbidding clinics receiving federal funds from even advising clients that abortion is available. This “gag rule” was revoked in Bill Clinton's first week as president and reinstated when George W. Bush took office.
Legal Limits on Reproductive Choice
Some statutory obstacles to abortion are direct: for example, a spousal consent requirement for a married woman or parental consent for a minor. The Supreme Court invalidated mandatory spousal consent in its first post–Roe abortion case (Planned Parenthood v. Danforth, 1976) and mandatory spousal notification in Planned Parenthood v. Casey (1992.) Parental consent and notification have proved more problematic. The constitutional rights of minors are not as extensive as those of adults, and parental consent is necessary before a minor can get medical treatment. Nevertheless, Danforth rejected a parental consent requirement, and the Court has never upheld a law that gives parents an absolute veto. But laws requiring parental involvement have been sustained. The Supreme Court upheld a parental notification requirement in H.L. v. Matheson (1981) and several laws requiring consent from either a parent or a judge (Bellotti v. Baird, 1979; Planned Parenthood v. Ashcroft, 1983; Ohio v. Akron Center for Reproductive Health, 1990.) In Hodgson v. Minnesota (1991), the Court upheld a law requiring consent from both parents or a judge. These “judicial bypass” provisions require a minor seeking an abortion to convince a judge that she is mature enough to make the decision and that the abortion is in her best interests.
Some legal obstacles are designed not so much to impede the choice of abortion as to discourage it. These deterrents include prohibitions on the use of certain abortion techniques, mandatory counseling or waiting periods, or requirements that abortions take place in hospitals (the vast majority of elective abortions are performed in clinics). The Supreme Court has yet to sustain the first type of restriction. As recently as 2000, Stenberg v. Carhart struck down a Nebraska law prohibiting what the anti‐choice movement calls “partial‐birth abortion” (a technique called dilation and extraction that is used in late term procedures) on the grounds that the law was unconstitutionally vague and excessively burdened the woman's choice.
Several rulings between 1976 and 1986 overturned the second and third types of restriction, either on grounds of vagueness and unreasonableness or because, as Justice Brennan wrote in Thornburgh v. American College of Obstetricians and Gynecologists (1986), “the states are not free, under the guise of protecting maternal health or potential life, to intimidate women into continuing pregnancies” (p. 759.)
The Conservative Retreat
The anti‐choice movement showed its electoral strength in 1980, when Ronald Reagan won the presidency. Reagan promised to appoint justices who would overrule Roe. He replaced members of the Roe majority with Sandra Day O'Connor, Anthony Kennedy, and Antonin Scalia. Reagan's successor, George H. W. Bush, replaced Brennan with David Souter and Marshall with Clarence Thomas. The Roe consensus began to unravel even before Rehnquist replaced Warren Burger. For example, Justice O'Connor's dissent in Akron v. Akron Center for Reproductive Health (1983) insisted that the trimester framework was “on a collision course with itself” (p. 458.) Medical advances, she argued, had made late abortion safer and had kept alive infants born earlier.
Webster v. Reproductive Health Services (1989) eliminated the trimester framework and represented a significant retreat from abortion rights. In upholding a Missouri law that declared that life began at conception, forbade the use of any public funds and facilities for abortion, and required viability testing in abortions after twenty weeks, the Court sustained restrictions similar to those it had invalidated in Akron and Thornburgh. Webster came within one vote of overturning Roe outright. O'Connor supported the restrictions but refused to join four other justices in reversal.
Roe Reaffirmed?
The replacement of Brennan and Marshall with David Souter and Clarence Thomas was widely regarded as the death knell for Roe. The new Court had its next opportunity to reverse the decision in Planned Parenthood v. Casey (1992). To the astonishment of virtually every Court‐watcher in the country, this did not happen. Justice Souter joined O'Connor and Kennedy in a plurality opinion reaffirming the “central holding of Roe” (p. 843): the right to an abortion before viability, a state's power to impose restrictions after viability, and a state's legitimate interests in protecting maternal health and fetal life throughout pregnancy. For the first time, the Court recognized discouraging abortion as a valid state interest. From now on, abortion laws would survive judicial scrutiny unless they imposed an “undue burden” (p. 874). Casey demoted abortion from the status of a constitutional right; restrictions need no longer pass the “compelling state interest” test of Roe. The Casey majority upheld an informed consent requirement, a mandatory twenty‐four‐hour waiting period, and a parental consent/judicial bypass provision.
Casey remains binding precedent. The government may not ban abortion outright, but laws that leave poor women, rural women, and minors without access to abortion may stand. The Court has not revisited the constitutionality of abortion laws in general. The election of an anti‐choice president in 2000, and the Republican control of Congress, worried reproductive‐choice advocates, especially as they anticipated George W. Bush's appointments to the Court. The development of RU‐486, an abortion‐inducing drug, may render the abortion controversy obsolescent. Anti‐abortion forces lost their battle against RU‐486 when the Food and Drug Administration gave the drug full marketing approval in 2000. It is now widely available. Mark A. Graber, Rethinking Abortion (1996); Eileen L. McDonagh, Breaking the Abortion Deadlock (1996); Karen O'Connor, No Neutral Ground? (1996); Rosalind P. Petchesky, Abortion and Woman's Choice (1990); Lawrence H. Tribe, Abortion: The Clash of Absolutes (1991).
—Judith A. Baer
Encyclopedia of Judaism:
Abortion[] |
TopHome > Library > Religion & Spirituality > Encyclopedia of Judaism Four considerations of Jewish law are involved in induced abortion. The most severe consideration is that abortion may involve the prohibition against murder, although it is not regarded as a capital crime. This is so if the fetus is viewed by the halakhah as a living being. The talmudic sources are not conclusive; see Rashi (San. 72b) and Tos. Nid. 44a, which seem to indicate that the unborn child is not considered a living being. Additional considerations include the prohibition against inflicting bodily injury, the prohibition against the destruction of human seed, and the prohibition against causing financial or property damage. The father has a property interest in his offspring, and if someone strikes a woman and causes her to miscarry, he would be required to pay pecuniary compensation to the father (Ex. 21:22). All rabbinic authorities agree that for social or economic reasons alone, abortion is contrary to Jewish law. However, if a woman's life is endangered by the pregnancy the abortion is permitted. The Mishnah (Ohol. 7:6) explicitly states that it is permissible to sacrifice a fetus in order to save the mother's life, because the life of the mother takes precedence over the life of the unborn child. While most rabbinic authorities will consider permitting an abortion only when the mother's life is endangered, some permit an abortion if it is ascertained that the fetus suffers a severe malformation or genetic disease, such as Tay-Sachs Disease. Others permit an abortion if continuation of the pregnancy would affect the mother's mental health. Furthermore, a lenient position is taken if the fetus is less than 41 days old, since the Talmud asserts that a foetus is not formed until after that time.
Philosophy Dictionary:
abortion[] |
TopHome > Library > History, Politics & Society > Philosophy DictionaryTermination of the life of a foetus, after conception but before birth. The event may be intentionally induced or natural, although it is intentionally induced abortion that is the topic of moral philosophy. The issues divide conservatives or ‘pro-life’ supporters, who regard deliberately induced abortion as impermissible, and liberal or ‘pro-choice’ supporters, who regard the action as permissible in a variety of cases. The liberal attitude may extend to almost any case in which a mother wishes an abortion, or may involve a variety of restrictions, including the age of the foetus. Moderates restrict the permissible cases, but the debate has not been notable for moderation. Issues arising include the nature of personhood, and its beginning; the extent of the right to life; the fragile notion of the sanctity of life; the way in which conflicting rights should be treated; and the political and social issues of who has the right to decide moral and legal policy and to enforce it.
Buddhism Dictionary:
abortion[] |
TopHome > Library > Religion & Spirituality > Buddhism DictionaryAbortion as a moral problem is not discussed at length in Buddhist literature. However, there are sufficient references in the Pāli Canon and other ancient sources to indicate that the practice was regarded as gravely wrong. Buddhist disapproval of abortion is related to its belief in rebirth and its teachings on embryology. It is widely held that conception marks the moment of rebirth, and that any intentional termination of pregnancy after that time constitutes a breach of the first of the Five Precepts (see pañca-śīla). Broadly speaking, this continues to be the avowed view of most Buddhists, although this position is not always reflected in the abortion statistics in Buddhist countries. In the more conservative countries of south-east Asia abortion is generally illegal unless there is a threat to the mother's life. Illegal abortions, however, are common, with an annual figure of perhaps 300,000 per annum in Thailand. In certain east Asian countries abortions are even more numerous, and a figure of one million per annum or greater is sometimes cited for countries such as Japan and South Korea. In Japan a memorial service known as mizuko kuyō has evolved as a response to the large number of abortions carried out in recent decades.
US History Encyclopedia:
Abortion[] |
TopHome > Library > History, Politics & Society > US History EncyclopediaTo 1800
Records of abortions exist from throughout the American colonies in the seventeenth and eighteenth centuries. A variety of herbs and other plant products, including tansy, savin, pennyroyal, seneca snakeroot, and rue were used as abortifacients, some available from physicians but many attainable through herb gardens. Historians have had difficulty determining which were effective, which were not, and which were fatal to the mother, but they conclude that many of the concoctions taken were poisonous. Some have been determined so toxic it seems unlikely that women ingested them voluntarily, unless attempting suicide. It is possible that another person—often the man who impregnated her—would persuade the woman to ingest it. However, intense reactions to medication were viewed as proof of effectiveness, so vomiting and blistering were considered necessary side effects.
Because abortions were often performed at home and detailed records were rare, it is difficult to make precise estimations of abortion rates. However, it appears that rates in the colonial era were relatively low. Surgical abortions were rare. Lack of medical knowledge, particularly regarding infection, almost guaranteed the death of the mother if surgery were performed. Cases of infanticide were more common than surgical abortions, as pregnancies might be hidden until term under loose clothing and infanticide would at least protect the life of the mother.
The tendency toward abortion depended largely on community attitudes toward nonmarital pregnancy and childbearing in general, but it was also closely tied to economics. In a developing colonial society with a land-based economy, children were generally welcomed. Economic desperation was comparatively rare, resulting in relatively low rates of abortion and infanticide. In the case of non-marital pregnancy, social pressure to name the father and demands on him to pay support eased the burden on women of even the lowest means. Paternity suits were common, the vast majority of which ended in financial support or marriage or both. The rates of premarital pregnancy in the colonies increased dramatically in the late eighteenth century, with up to 30 percent of births occurring before nine months of marriage. There was generally much more pressure on men to take responsibility for pregnancy than chastisement of women for becoming pregnant.
Conception and "quickening"
New scientific notions of pregnancy and fetal development arose during the Age of Enlightenment as scientists and religious leaders debated the origins of life. Calvinists and Anglicans argued against abortion, citing numerous biblical passages stating that human life begins at conception. But the battle lines were not drawn simply between religion and science, as scientists disagreed among themselves about the origins of human life. Anton van Leewenhoek, famous for his development of the microscope, argued in the late seventeenth century that an entire human was contained in each male sperm, and was simply implanted in a woman. Other scientists, concerned about the waste of human lives if that held true, argued that an entire human life existed in a woman's egg, and was simply "activated" by male sperm.
Some historians have argued that until the mid-nineteenth century, human life was widely understood to begin at "quickening," the moment when a pregnant woman could first feel the fetus move—generally in the late fourth or early fifth month of pregnancy. Colonial common law instituted punishment for abortion only after quickening. Evidence shows that the scientific community, the religious community, and the community at large all believed that human life in some form began before quickening, but under common law, abortions before quickening were legal. After quickening, however, the fetus—although by no means "viable" (able to survive outside the uterus)—was considered a separate being. Until quickening, the best evidence of pregnancy was the absence of menses, which could have been a symptom of various other conditions. Until the mid-nineteenth century, women were often provided with abortifacients to remove a "blockage," and once menses resumed, she was considered treated. The cause of the blockage was not an issue of legal concern.
Women often had access to abortifacient plant products and the knowledge necessary to use them to "resume menses." Once experiencing quickening, however, she was more or less obligated to carry the fetus to term. Quickening offered better proof of pregnancy, and usually marked a pivotal point after which terminating a pregnancy was unquestionably more dangerous. Until the early nineteenth century, the power of deciding to terminate an early pregnancy essentially lay with the woman. However, by the late colonial period, others were becoming increasingly involved in the practice, as physicians and apothecaries were marketing and selling abortifacients. Even under the regulation of "experts," they were often deadly.
Restrictions on Abortion
The first legal restrictions on abortion in the United States were aimed at the sale of abortifacients. State laws of the 1820s and 1830s listed abortifacients as poisons and made their sale illegal. In some states, laws also regulated practitioners who performed surgical abortions. All of these laws were intended to protect the life of the mother, and domestic use of abortifacients before quickening was not a crime. By 1840, ten of the nation's twenty-six states had passed abortion regulations.
Widespread attempts at criminalization of abortion began in the 1850s. The American Medical Association (AMA), founded in 1847, played a major role here. For a number of reasons, its members promoted legislation to restrict abortion in various states. The AMA reflected a trend in the field of medicine that valued accreditation and expertise. Members of the AMA attacked physicians of an older generation, as well as homeopaths and midwives, as ill-trained and incompetent, and in its attempt to improve medicine it took control of the practice of abortion. Many of the new generation of physicians also viewed themselves as moral leaders, and in their crusades aimed at preserving and protecting human life, they attacked abortion on moral grounds. One element of this crusade lessened the significance of quickening, considering it simply one stage in fetal development. This laid the groundwork for prohibiting abortion at any stage.
To some extent, abortion regulation through the mid-nineteenth century might be considered in the larger context of social reform movements in America. However, in later decades the anti-abortion crusades reflected the increasing influence of the Victorian Era. Then, pregnancy—or at least illicit pregnancy—was considered a woman's punishment for immoral behavior. Abortion would allow a woman to go unpunished. Even access to methods to prevent such a pregnancy would facilitate such immoral behavior. A result was the passage of legislation to prohibit the practice of abortion and the sale and distribution of contraceptives and contraceptive information. The Comstock Law of 1873—named for the purity crusader Anthony Comstock—categorized abortion and birth control as obscenity, prohibiting them under federal anti-obscenity legislation.
Various states also criminalized abortion, except for cases in which the mother's life was endangered by pregnancy or childbirth. This gave physicians the authority to determine when an abortion could be permitted. In addition, state regulations prohibiting the sale or distribution of abortifacients were reworked to allow physicians to prescribe them.
In many cases, middle-and upper-class women who had personal physicians maintained comparatively easy access to abortion. However, abortion rates increased among the poor and ethnic minorities. By midcentury, national concerns over shifting demographics drew attention to birth rates among the "proper stock" as opposed to those among the "lesser stock." The growing trend among white middle-and upper-class women to seek abortions was an influential factor in criminalizing the procedure. Mass immigration resulted in a growing working class that was perceived as a threat to the dominant Anglo-Protestant culture. Many physicians commonly conducted abortions among the poor and minorities, some publicly declaring that white Protestant women should have more children.
Abortion and Women's Roles
The development of anti-abortion legislation not only reflected ideas of race and class, but also affected gender roles. Before the mid-nineteenth century, women held a stronger position in realm of pregnancy, childbearing, and abortion than afterward. Childbirth took place at home, often with the assistance of a midwife; pregnant women were looked after by other women; and individuals had access to natural herbs that were known abortifacients. In addition, only a pregnant woman knew when quickening took place. The devaluation of quickening by the medical community had already weakened a woman's authority in her own pregnancy. Criminalizing abortion, except under a doctor's recommendation, and abortifacients without a doctor's prescription, further weakened her authority.
Anti-abortion movements generally grew when women demanded more rights. From the mid-to the late nineteenth century, public condemnation of abortion paralleled the women's movement for political rights. Fears that women would forsake their proper social roles and the responsibility of motherhood if they had the right to abortion helped to shape the debate, and ultimately the success, of anti-abortion legislation. Equal opportunity in politics and in higher education appeared to reduce family size and some hoped that the prohibition of abortion and birth control might offset this trend. At the turn of the twentieth century, the women's movement included new demands for sexual freedom, and anti-abortion activists worked to limit abortions. Although widely criminalized, physicians still performed some abortions and illegal abortions were common. The separation of sexuality and procreation allowed greater sexual freedom for women, spurring new attacks on abortion.
Abortion and Contraception
In the 1910s, a powerful birth control movement took hold in America. Leaders of the movement, particularly Margaret Sanger, did not equate birth control with abortion. Rather, they argued that legalizing contraceptives would reduce abortion rates. Public opinion still accepted early-term abortions, and abortion was often the preferred method of birth control. With little access to contraceptives because of the Comstock Law, couples had few choices. Proponents of legal contraceptives reported graphic details of numerous self-induced abortions performed by desperate women, who often died as a result.
Clinics were established to provide contraceptives and contraceptive information. Medical professionals who opened clinics bypassed Comstock laws that barred contraceptives and contraceptive information from importation and from the U.S. mails. Critics feared that such information encouraged "free sex" among single women, when in fact it was primarily intended for married working-class couples who had no access to personal physicians. Critics of abortion similarly feared that single women were having abortions to facilitate an uninhibited sexual lifestyle. In fact, most women having abortions were married. Working-class women generally had children early, ending later pregnancies through abortion. Upper-class women generally delayed childbearing and often ended early pregnancies through abortion. In either case, they saw it as a form of birth control, although birth control advocates drew clear distinctions between contraception and abortion.
At first glance, the criminalization of abortion appeared to have a significant effect on abortion rates. In the mid-nineteenth century, some records show that as many as one out of five or six pregnancies ended in abortion, while some report that in 1900 only one in twenty did. However, the fact that abortions were a crime made it less likely that women would report them. Drawing from case reports of hospital personnel who treated women bleeding as the result of apparent abortion, scholars estimate as many as 2 million abortions per year at the end of the nineteenth century. One doctor estimated between six to ten thousand abortions were performed (many by the women themselves) in 1904 in Chicago alone. Because of criminalization, and because the abortion issue has been so politicized, it is difficult to determine accurate abortion rates. However, it is clear that criminalization did not prevent it.
The birth control movement's eventual success was linked to its alliance with the American Medical Association, which—as the movement gained strength—began to support the legalization of contraceptives. Sanger and the AMA worked hand in hand into the 1930s in efforts to condone birth control and to secure legislation to protect doctors from prosecution for prescribing contraceptives. Again, physicians gave themselves control of the distribution of contraceptives, with the support of the courts and legislative bodies. In 1936, the AMA officially abandoned its official opposition to birth control.
Black Market Abortions
The Great Depression of the 1930s created an environment in which birth control became an acceptable response to social ills because more families were economically desperate and unable to care for additional children. At the same time, however, the number of abortions performed was on the rise—so quickly that many considered it an epidemic. Scholars generally estimate that more than 500,000 took place each year in the United States during the depression. The cost of a "black market" abortion was usually under seventy-five dollars, far below the cost of feeding another child. In addition, women often lost their jobs to men during the depression, and a pregnant woman was almost certain to lose her job.
A few doctors began to support publicly the repeal of anti-abortion laws during the 1930s. However, the opposition was strong. First, Pope Pius XI's 1930 encyclical, Casti Connubii, pronounced that a developing fetus had a soul. Although America was not a Catholic nation, its largest denomination by then was Roman Catholicism, and the issue of abortion had taken on a new character in the international religious-political realm. The Soviet Union had legalized abortion in the 1920s and the procedure was viewed as tightly tied to a brand of socialist feminism in western Europe. Any connection between feminism and socialism that was tied to abortion would force legalization to confront considerable obstacles in the United States.
The demands on physicians to perform abortions were great and many received additional training in the procedure. The procedure most often used was dilation and curettage, but the injection of potassium soap solution was common by the 1930s. Physicians were legally protected as they were granted the right to conduct therapeutic abortions. Physician-abortionists were considered specialists in the medical community and general practitioners referred their patients to them. The profession officially condemned abortion, but doctors were widely involved, if not directly, then through making referrals. In essence, they could ensure their patients had access to abortion without actually performing them.
To perform an abortion except with the intent to save the life of the mother meant possible arrest. Physician-abortionists who devoted their practice exclusively to abortion risked police raids and prosecution. Raids were especially common in the 1940s and 1950s and served to expose publicly abortionists and their patients. Patients were commonly interrogated in police stations and courtrooms. Police and prosecutors went after patients rather than the referring physicians, who possessed more incriminating evidence than the women did. Because of the raids, many hospitals stopped conducting therapeutic abortions. Advances in medicine, particularly in the development of antibiotics and antiseptics, made hospitals the safest and cleanest places to have an abortion. However, hospital administrators were unwilling to face the publicity resulting from continual raids on clinics and arrests of physicians.
Medical advances also affected the ways in which the fetus was perceived. Imaging techniques allowed physicians to focus on the fetus as a developing human and they increasingly considered the uterus as the space in which the fetus developed. In the 1950s, a culture of family and children encouraged women to embrace motherhood and they were chastised for considering abortion. Other medical advances made pregnancy-related illnesses, complications, and deaths comparatively rare. Therefore, hospitals became less likely to offer therapeutic abortions.
In addition, improvements were made in sterilization procedures. In the 1950s, approximately half of the nation's hospitals offered women abortions if they agreed to simultaneous sterilization. Hospitals established therapeutic abortion committees not only to develop such regulations, but to decide in individual cases when an abortion would be permitted.
Calls for Reform and Repeal
In the mid-1950s, a small group of physicians and public health workers began a movement to reform abortion laws. They had seen the disastrous effects of criminalization on women and the medical profession that had developed in recent decades. In 1955, Planned Parenthood organized a small conference of health care professionals to organize against the existing laws. But they did not gain the momentum necessary to overturn legislation until the birth of the women's movement in the 1960s. An integral part of that movement was the demand for reproductive rights. The demand began at the grassroots level with one of the most influential organizations, Citizens for Humane Abortion Laws, founded in 1962 in California. That same year, Sherri Finkbine, a television celebrity, attracted the nation's attention when she traveled to Sweden to have an abortion after finding out that she had taken a drug containing thalidomide early in her pregnancy. In 1961, researchers discovered that thalidomide—which was commonly prescribed to pregnant women to combat sleeplessness and morning sickness—caused severe birth defects, primarily the stunting of fetal limb development.
In Griswoldv. Connecticut (1965), the U.S. Supreme Court ruled in favor of Planned Parenthood staffers who had violated Connecticut state law in dispensing a contraceptive device to a married woman. The Court ruled on the grounds that their 1961 convictions were violations of the right to privacy. The case brought national attention to birth control laws that were considered repressive, and the right-to-privacy decision paved the way for privacy considerations in the issue of abortion. The public chastisement of women caught during clinic raids in the 1950s was often claimed to violate the right to privacy, but there was no strong legal precedent to turn to in those cases. The year 1966 marked the founding of the National Organization for Women (NOW), which would strengthen the attack on abortion laws. By the 1960s, the focus of abortion rights activists was shifting from a call for reform to a call for repeal of anti-abortion laws, and various women's groups addressed abortion at the national level. In 1969, abortion rights leaders held the first National Conference on Abortion Laws and formed the National Association for Repeal of Abortion Laws (NARAL). However, grassroots organizations remained instrumental as abortion was prohibited at the state level, and although banned in every state, it was regulated on different terms.
The landmark case in abortion history was Roe v. Wade (1973). In that case (which was supported by other cases), a twenty-three-year-old pregnant woman challenged Texas's abortion law, which the Supreme Court ultimately found unconstitutional. The decision, written by Justice Harry Blackmun and based on the residual right to privacy, overturned numerous statutes that had been in place for more than one hundred years. Restrictions on abortions during the first trimester of pregnancy were lifted and abortions in the second trimester were allowed with few restrictions. States were given the right to intervene during the second and third trimesters to protect the life of the woman and the potential life of the fetus.
The reaction to Roe v. Wade was swift and far-reaching. As a result of the case, NARAL changed its name to the National Abortion Rights Action League, preparing for opposition. The Catholic Church quickly professed its opposition and fundamentalist Protestants hastened their efforts to support a pro-life movement. In 1977, Congress prohibited the use of Medicaid funds for abortion except for therapeutic reasons, and in a few other cases. The religious right gained political momentum with the election of conservatives to Congress and Ronald Reagan and George Bush Sr. to the presidency during the 1980s. This resulted in the creation of an abortion "litmus test" for Supreme Court nominees, who were considered on the basis of their stand on abortion, regardless of their experience or positions on other issues. In Webster v. Reproductive Health Services (1989) the Supreme Court limited the scope of Roe v. Wade, and in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) it reaffirmed abortion rights while permitting further restrictions.
The 1990s saw a rise in extreme measures on the pro-life side, including the harassment of women entering clinics, the bombing of clinics, and attacks on physicians known to perform abortions. In the second half of the decade, Congress repeatedly passed a bill that would ban "partial-birth abortion," but President William Jefferson Clinton vetoed it.
Partial-birth abortions are conducted in the third trimester of pregnancy when a fetus is viable, and involve the dilation of the cervix and extraction of the fetus while puncturing the skull. Although very rare, accounting for 0.04 percent of all abortions, the procedure was used extensively in the public debate by anti-abortion activists. At the end of the decade, extremists continued to attract attention to the issue and the litmus test was predicted to be a factor under George W. Bush's administration. But the nation saw groups such as right-to-life feminists calling for better options for pregnant women and rising to provide alternative solutions such as better wages for women, pregnancy and child-care employment leave, and better support for young, unwed mothers. Recent studies have shown a decrease in abortion rates and an increase in births out of marriage, demonstrating a significant shift in social mores.
Bibliography
Baird-Windle, Patricia, and Eleanor J. Bader. Targets of Hatred: Anti-Abortion Terrorism. New York: St. Martin's Press, 2001.
Blanchard, Dallas A. The Anti-Abortion Movement and the Rise of the Religious Right: From Polite to Fiery Protest. New York: Twayne, 1994.
Craig, Barbara Hinkson, and David M. O'Brien. Abortion and American Politics. Chatham, N.J.: Chatham House, 1993.
Hull, N. E. H., and Peter Charles Hoffer. Roe v. Wade: The Abortion Rights Controversy in American History. Lawrence: University Press of Kansas, 2001.
Jacoby, Kerry N. Souls, Bodies, Spirits: The Drive to Abolish Abortion since 1973. Westport, Conn.: Praeger, 1998.
Jaffe, Frederick S., Barbara L. Lindheim, and Philip R. Lee. Abortion Politics: Private Morality and Public Policy. New York: McGraw-Hill, 1981.
Mohr, James C. Abortion in America: The Origins and Evolutions of National Policy, 1800–1900. New York: Oxford University Press, 1978.
Olansky, Marvin. Abortion Rites: A Social History of Abortion in America. Wheaton, Ill.: Crossways Books, 1992.
Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973. Berkeley: University of California Press, 1997.
Solinger, Rickie, ed. Abortion Wars: A Half Century of Struggle, 1950–2000. Berkeley: University of California Press, 1998.
—Kathleen A. Tobin
Columbia Encyclopedia:
abortion[] |
TopHome > Library > Miscellaneous > Columbia Encyclopediaabortion, expulsion of the products of conception before the embryo or fetus is viable. Any interruption of human pregnancy prior to the 28th week is known as abortion. The term spontaneous abortion, or miscarriage, is used to signify delivery of a nonviable embryo or fetus due to fetal or maternal factors, as opposed to purposely induced abortion. Therapeutic abortion is an induced abortion performed to preserve the health or life of the mother.Spontaneous Abortion (Miscarriage)
Early spontaneous abortion (the most prevalent) is usually due to fetal malformations or chromosomal abnormalities. Spontaneous abortion during the last two thirds of pregnancy is more likely to be due to maternal factors, for example abnormalities of the cervix or uterus, insufficient progesterone, sexually transmitted diseases that affect the genital tract, endocrine dysfunction (as in hypothyroidism and diabetes mellitus), or severe emotional trauma. Immunological reactions, in which maternal antibodies mistake the fetus for foreign tissue, have been implicated in recurrent, or habitual spontaneous abortions. It is estimated that at least 20% of all pregnancies end in miscarriage (estimates range from 15% to 75%). Most occur in the first two weeks after conception, and in many cases the mother is not aware of the pregnancy.
Induced Abortion
Abortion can be induced for medical reasons or because of an elective decision to end the pregnancy. Procedures for inducing abortion include vacuum suction (the most common, used in the early stages of pregnancy), dilatation and evacuation (D and E), induction (injection of abortifacients such as prostaglandins into the uterus), and hysterotomy (a surgical procedure similar to a cesarean section, used later in pregnancy, especially when the woman's life is in danger). The "abortion pill," the drug RU-486 (mifepristone), was approved by the Food and Drug Administration in the United States in 2000. It is used within the first seven weeks of pregnancy. A second drug is taken two days later to start uterine contractions and complete the abortion. The drugs methotrexate and misoprostol have also been used experimentally to end early pregnancies.
History of Abortion
Abortion induced by herbs or manipulation was used as a form of birth control in ancient Egypt, Greece, and Rome and probably earlier. In the Middle Ages in Western Europe it was generally accepted in the early months of pregnancy. However, in the 19th cent. opinion about abortion changed. In 1869 the Roman Catholic Church prohibited abortion under any circumstances. In England and in the United States in the 19th cent. stringent antiabortion laws were passed.
Attitudes toward abortion became more liberal in the 20th cent. By the 1970s, abortion had been legalized in most European countries and Japan; in the United States, under a 1973 Supreme Court ruling (see Roe v. Wade), abortions are permitted during the first six months of pregnancy. Abortion remains a controversial issue in the United States, however, and in 1977 Congress barred the use of Medicaid funds for abortion except for therapeutic reasons and in certain other specified instances. Several state legislatures passed restrictive abortion laws in hope that the Supreme Court would overturn Roe v. Wade, but in 1992 the court reaffirmed the basic principles of the 1973 decision.
From 1995 to 2000 the U.S. Congress repeatedly passed, but President Bill Clinton vetoed, a bill that would ban a rare late-term method of abortion called by its critics "partial-birth abortion." Subsequent attempts by many U.S. states to ban this method were contested in the courts, and in 2000 the Supreme Court voided such laws that do not include an exception when the health of the mother is endangered. A federal bill banning banning the procedure was passed again in 2003 and signed into law by President George W. Bush. The law was quickly challenged in the courts, and a federal judge declared it unconstitutional in 2004 in part because of its lack of a health exception, but the Supreme Court, with two new conservative members appointed by President Bush, upheld the law in 2007. U.S. opponents of abortion have used more militant tactics at times in attempts to disrupt the operations of facilities that perform abortions, and some extremists have resorted to bombings and assassination. In India, the abortion of female fetuses by couples desiring a male child led (1994) to criminal penalties for prenatal testing when done solely to determine the sex of the fetus; such tests have been banned in parts of China for the same reason.
Bibliography
See M. Muldoon, The Abortion Debate in the United States and Canada: A Source Book (1991); J. M. Riddle, Contraception and Abortion from the Ancient World to the Renaissance (1994); Boston Women's Health Book Collective, Our Bodies, Ourselves for the New Century (1998); J. Risen and J. L. Thomas, Wrath of Angels (1998).
Law Encyclopedia:
Abortion[] |
TopHome > Library > Law & Legal Issues > Law EncyclopediaThis entry contains information applicable to United States law only.
The spontaneous or artificially induced expulsion of an embryo or fetus. As used in legal context, usually refers to induced abortion.
History
English common law generally allowed abortion before the "quickening" of the fetus (i.e., the first recognizable movement of the fetus in the uterus), which occurred between the sixteenth and eighteenth weeks of pregnancy. After quickening, however, common law was less clear as to whether abortion was considered a crime. In the United States, state legislatures did not pass abortion statutes until the nineteenth century. After 1880, abortion was criminalized by statute in every state of the union, owing in large measure to strong anti-abortion positions taken by the American Medical Association. Despite the illegality, many thousands of women every year sought abortions. Under a heavy cloak of shame and secrecy, women often had abortions performed in unsafe conditions, and many died or suffered complications from the procedures.
The abortion laws developed in the late nineteenth century existed largely unchanged until the 1960s and 1970s, when a number of different circumstances combined to bring about a movement for their reform. Women's rights groups, doctors, and lawyers began an organized abortion reform movement to press for changes, in part because many of them had witnessed the sometimes deadly complications resulting from illegal abortions. Women's organizations also began to see abortion reform as a crucial step toward the goal of equality between the sexes. They argued that women must be able to control their pregnancies in order to secure an equal status in American life. In addition, new concerns regarding explosive population growth and its effect on the environment increased public awareness of the need for birth control. At the same time, other countries developed far more permissive laws regarding abortion. In Japan and Eastern Europe, abortion was available on demand, and in much of Western Europe, abortion was permitted to protect the mother's health.
Public awareness of the abortion issue also increased through two incidents in the early 1960s that caused a greater number of children to be born with physical defects. In 1961, the drug thalidomide, used to treat nausea during pregnancy, was found to cause serious birth defects. And a 1962-65 German measles epidemic caused an estimated fifteen thousand children to be born with defects. Pregnant women who were affected by these incidents could not seek abortions because of the strict laws then in existence.
Reacting to these and other developments, and inspired by the successes of the civil rights movement of the 1950s and 1960s, women's rights organizations — including the National Organization for Women (NOW), formed in 1966 — sought to reform abortion laws through legislation and lawsuits. They hoped to educate a largely male dominated legal and judicial profession about this important issue for women. Their work, supported by such groups as the American Civil Liberties Union (ACLU), quickly began to have an effect. Between 1967 and 1970, twelve states adopted abortion reform legislation. However, the abortion activist groups began to see the abortion issue as a question of social justice and began to press for more than reform. Under the rallying cry of reproductive freedom, they began to demand an outright repeal of existing state laws and unobstructed access for women to abortion.
The increase in abortion-related cases before the courts eventually resulted in the need for clarification of the law by the Supreme Court. After considering many abortion-related appeals and petitions, on May 31, 1971, the Court accepted two cases, Roe v. Wade, 410 U.S. 113, 93 S. Ct. 705, 35 L. Ed. 2d 147 (1973), and Doe v. Bolton, 410 U.S. 179, 93 S. Ct. 739, 35 L. Ed. 2d 201 (1973), for hearing.
Roe v. Wade and Doe v. Bolton
Although the two cases before the Court appeared by their titles to involve the fates of two individuals, Roe and Doe, in reality both suits were brought by many people representing many different interests. Roe v. Wade was argued on behalf of all women of the state of Texas — in legal terminology, it was a class action suit. Thirty-six abortion reform groups filed briefs, or reports, with the court on Roe's behalf. These included women's, medical, university, public health, legal, welfare, church, population control, and other groups. The anti-abortion side of the case included representatives from seven different anti-abortion groups and the attorneys general of five states.
Roe involved a person using the pseudonym Jane Roe — actually Norma McCorvey, who revealed her identity in 1984. Roe, an unmarried, pregnant woman from Texas, wanted to have an abortion, but an existing abortion statute prevented her from doing so. The Texas statute, originally passed in 1857, outlawed abortion except to save the mother's life. Roe filed a lawsuit in federal district court on behalf of herself and all other pregnant women. She sought to have the abortion statute declared unconstitutional as an invasion of her right to privacy as guaranteed by the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. She also sought to have an injunction, or court order, issued against the statute's enforcement so that she might go forward with the abortion. The abortion reform movement attached two other cases to Roe's in an attempt to represent a wider range of the interests involved in the issue. A physician, James Hallford, who was being prosecuted under the statute for two abortions he had performed, also filed suit against the Texas law, as did a childless couple, the Does.
The three-judge district court combined Roe's case with the cases of Hallford and the Does, but later dismissed the suit brought by the Does on the grounds that neither had violated the law and the woman was not pregnant. The district court agreed with Roe that the law was unconstitutionally vague and violated her right to privacy under the Ninth Amendment — which allows for the existence of rights, like that of privacy, not explicitly named in the Constitution's Bill of Rights — and the Fourteenth Amendment. It refused, however, to grant the injunction allowing her to go ahead with the abortion. Roe then appealed the denial of the injunction to the U.S. Supreme Court.
Doe v. Bolton involved a 1968 Georgia statute that allowed abortion if necessary to save the mother's life, in the case of pregnancy resulting from rape or incest, or if the baby was likely to be born with serious birth defects (Ga. Crim. Code § 26-1202 a,b). However, the statute also created procedural requirements that effectively would have allowed few abortions. Those requirements included hospital accreditation, committee approval, two-doctor agreement, and state residency. The case concerned Mary Doe, who had sought an abortion at Grady Memorial Hospital, in Atlanta. She claimed that she had been advised that pregnancy would endanger her health, but the hospital's Abortion Rights Committee denied her the abortion. She sought a declaratory judgment holding that the Georgia law unconstitutionally violated her right to privacy as well as her Fourteenth Amendment guarantees of due process and equal protection. She also sought an injunction against the law's enforcement.
Roe and Doe were filed in March and April of 1970, and the women's pregnancies would not have lasted through December 1970. The Court heard the cases in December 1971 and October 1972, and they were not resolved until January 1973, when the Court announced its decisions.
In Roe, the Court, on a 7-2 vote, found the Texas abortion statute unconstitutional. In its opinion, written by Justice Harry A. Blackmun, the Court held that the law violated a right to privacy guaranteed by the Due Process Clause of the Fourteenth Amendment. However, the Court further held that such a right is a "qualified" one and subject to regulation by the state. The state has "legitimate interests in protecting both the pregnant woman's health and the potentiality of human life" (i.e., the life of the fetus). To specify when the state's interests emerge, the Court divided pregnancy into twelve-week trimesters. In the first trimester, the state cannot regulate abortion or prevent a woman's access to it. It can only require that abortions be performed by a licensed physician and under medically safe conditions. During the second trimester, the state can regulate abortion procedures as long as the regulations are reasonably related to the promotion of the mother's health. In the third trimester, the state has a dominant interest in protecting the "potentiality" of the fetus's life. A state may prohibit abortions during this time except in cases where they are essential to preserve the life or health of the mother. The Court also cited judicial precedent in holding that the fetus is not a "person" as defined by the Fourteenth Amendment.
In Doe, the Court found the Georgia statute to be unconstitutional as well, holding that it infringed on privacy and personal liberty by permitting abortion only in restricted cases. The Court ruled further that the statute's four procedural requirements — hospital accreditation, hospital committee approval, two-doctor agreement, and state residency — violated the Constitution. The state could not, for example, require that abortions be performed only at certain hospitals, because it had not shown that such restrictions advanced its interest in promoting the health of the pregnant woman. Such a requirement interfered with a woman's right to have an abortion in the first trimester of pregnancy, which the Court in Roe had declared was outside the scope of state regulation.
After Roe v. Wade
After the Supreme Court decisions in Roe v. Wade and Doe v. Bolton, states began to liberalize their abortion laws. However, abortion quickly became a divisive political issue for Americans. Grassroots opposition to abortion — supported by such influential institutions as the Catholic Church— was strong from the start. By the early 1980s, the anti-abortion movement had become a powerful political force. President Ronald Reagan, who came to office in 1981 and served through 1989, strongly opposed abortion and used his administration to try to change abortion rulings. He appointed a surgeon general, Dr. C. Everett Koop, who opposed abortion, and he made it a top priority of his Justice Department to effect a reversal of Roe. Reagan even published a book on the subject in 1984, Abortion and the Conscience of a Nation, which contains many of the essential positions of the anti-abortion movement. Reagan argued that the fetus has rights equal to those of people who are already born. He also cited figures indicating that 15 million abortions had been performed since 1973, and he stated his belief that the fetus experienced great pain as a result of the abortion procedure. He quoted a statement by Mother Teresa, the famed nun who helped the poor of Calcutta: "[T]he greatest misery of our time is the generalized abortion of children." While abortion rights, or pro-choice, adovcates argued that there were public health advantages of the new abortion laws, opponents of abortion, such as Reagan, referred to abortion as a "silent holocaust."
The anti-abortion, or pro-life, movement has challenged abortion in a number of different ways. It has sponsored constitutional amend- ments that would effectively reverse Roe, as well as legislation that would limit and regulate access to abortion, including government financing of abortion procedures. Some anti-abortion groups have practiced civil disobedience, attempting to disrupt and block abortion clinic activities. The most extreme opponents have resorted to violence and even murder in an attempt to eliminate abortion.
All these methods have resulted in a great deal of litigation and added to the complexity of the abortion issue. Many of the subsequent cases have come before the Supreme Court. Observers have often expected the Court to overturn its Roe decision, particularly after the Reagan administration appointed three justices to the Court. However, while the Court has allowed increasingly strict state regulation of abortion since Roe, it has stuck to the essential finding in Roe, that women have a limited right to terminate their pregnancies. This right is incorporated in a right of privacy guaranteed by the Fourteenth Amendment.
Constitutional Amendments
Although amending the Constitution is the most direct way to reverse Roe v. Wade, neither Congress nor the states have passed a constitutional amendment related to the issue of abortion. The anti-abortion forces have found it extremely difficult to achieve a public consensus on this divisive issue. However, at least nineteen state legislatures have passed applications to convene a constitutional convention to propose an amendment that would outlaw abortions. Congressional representatives have also worked to bring such an amendment about. The many dozens of amendments that have been proposed can be grouped into two main categories: states' rights, and the right to life. The former would restore to the states the same control over abortion that they exercised prior to Roe. The latter would designate the fetus as a person, entitled to all the privileges and rights guaranteed under the Fourteenth Amendment.
One unsuccessful attempt at changing the Constitution was the Hatch amendment of 1983, sponsored by Senator Orrin G. Hatch (R-Utah), which stated, "A right to abortion is not secured by this Constitution." It did not receive the two-thirds majority necessary in Congress to be submitted to the states for ratification.
Congress has also sponsored legislation that would effectively reverse Roe. For example, the Human Life Bill (S. 158), introduced by Senator Jesse Helms (R-N.C.) in 1981, would have established that the fetus is a person, entitled to the full rights and privileges guaranteed by the Fourteenth Amendment. The bill did not pass.
Federal Financing
In 1976, Representative Henry J. Hyde (R-Ill.) sponsored an amendment to the federal budget appropriations bill for the Department of Health and Human Services (HHS). His amendment denied Medicaid funding for abortion unless the woman's life is in danger or she is pregnant as a result of rape or incest, but only if the woman reports the incident at the time of its occurrence. Despite opposition from pro-abortion groups, Hyde attached this amendment every year to the same appropriations bill. The Supreme Court has upheld the constitutionality of the Hyde amendment (Harris v. McRae, 448 U.S. 297, 100 S. Ct. 2671, 65 L. Ed. 2d 784 [1980]; McGowan v. Maryland, 366 U.S. 420, 81 S. Ct. 1101, 6 L. Ed. 2d 393 [1961]). Evidence suggests that these federal actions have caused fewer women to have abortions.
In the late 1980s, with its composition having been changed by three Reagan appointees (Justices Sandra Day O'Connor, Antonin Scalia, and Anthony M. Kennedy), the Court issued a ruling related to federal financing of abortion that many perceived as a dramatic shift against abortion rights. In Webster v. Reproductive Health Services, 492 U.S. 490, 109 S. Ct. 3040, 106 L. Ed. 2d 410 (1989), the Supreme Court upheld a Missouri law prohibiting the use of public funds and buildings for abortion procedures and counseling, including a provision that required fetal testing for viability for abortions performed after the twentieth week of pregnancy (Mo. Rev. Stat. §§ 1.205.1, 1.205.2, 188.205, 188.210, 188.215). Scalia, appointed in 1986, argued in his concurring opinion that Roe v. Wade should be overruled and that the Court had missed an opportunity in not doing so in this case.
The Webster decision resulted in a flood of new state legislation related to abortion. Many states sought to reactivate old abortion laws that had never been taken off the books subsequent to Roe. Louisiana, for example, sought to reinstate an 1855 law making all abortions illegal and imposing a ten-year sentence on doctors and women violating it. However, in January 1990, a federal district court ruled that the 1855 law could not be reinstated and that subsequent laws allowing abortions in certain circumstances took precedence (Weeks v. Connick, 733 F. Supp. 1036 [E.D. La. 1990]). By mid-1991, Pennsylvania, Guam, Utah, and Louisiana had all enacted laws banning abortions except in limited circumstances. Pennsylvania became the first to approve new abortion restrictions when it amended its Abortion Control Act (Pa. Cons. Stat. Ann. § 3201) to create strict new regulations on abortion procedures (see the discussion of Planned Parenthood of Southeastern Pennsylvania v. Casey under "Other Major Abortion Regulations," later in this entry). In other states such as South and North Dakota, legislation that would have sharply restricted abortion was only narrowly defeated. However, some states, such as Connecticut and Maryland, reacted to the Webster decision by passing legislation protecting women's rights to abortion.
Before the Court ruled on Pennsylvania's Abortion Control Act, it decided a major case relating to federal funding and regulation of family planning clinics. In Rust v. Sullivan, 500 U.S. 173, 111 S. Ct. 1759, 114 L. Ed. 2d 233 (1991), the Court upheld a series of regulations issued in 1988 by the Reagan administration's Justice Department affecting family planning clinics that receive funds through title X of the Public Health Service Act of 1970, 42 U.S.C.A. §§ 300-300a-6. The regulations prohibited clinic personnel from providing any information about abortion, including counseling or referral. The regulations also required that the only permissible response to a request for an abortion or referral was to state that the agency "does not consider abortion an appropriate method of planning and therefore does not counsel or refer for abortion." This regulation became known to its detractors as the gag rule. The regulations also prohibited title X-funded family planning clinics from lobbying for legislation that advocated or increased access to abortion, and they required that such clinics be "physically and financially separate" from abortion activities. Although a family planning agency could still conduct abortion-related activities, it could not use federal money to fund such activities. Chief Justice William H. Rehnquist, who wrote the Court's opinion, disagreed with the contentions of the plaintiffs — several family planning agencies — that the federal regulations violated a woman's due process right to choose whether to terminate her pregnancy. He pointed out that the Due Process Clause generally confers no affirmative right to government aid. The government has no constitutional duty to subsidize abortion and may validly choose to fund "childbirth over abortion." Rehnquist noted that a woman's right to seek medical advice outside a title X-funded agency remained "unfettered."
Justice Blackmun, author of the Roe majority opinion, dissented, arguing that the regulations, because they restricted speech as a condition for accepting public funds, violated the First Amendment's free speech provision. The regulations, he wrote, suppressed "truthful information regarding constitutionally protected conduct of vital importance to the listener." Black- mun saw the regulations as improper government interference in a woman's decision to continue or end a pregnancy, and he claimed that they rendered the landmark Roe ruling "technically" intact but of little substance.
On January 22, 1993, shortly after taking office, President Bill Clinton signed a memorandum that revoked the gag rule, maintaining that it "endangers women's lives by preventing them from receiving complete and accurate medical information." On February 5, 1993, the secretary of HHS complied with the president's decision and declared that the department would return to title X regulations that were in effect before February 1988. Title X-funded clinics would again be able to provide nondirective counseling on all options to a patient and to refer her for abortion services if she chose. However, such clinics would still be prohibited from engaging in pro-choice lobbying or litigation.
Other Major Abortion Regulations
Among the first abortion regulations to be enacted after Roe v. Wade were requirements for the informed consent of the woman seeking an abortion. Although informed consent varies according to different laws, it can generally be given only after a woman receives certain information from a doctor, medical professional, or counselor. This information can include the nature and risks of the abortion procedure, the risk of carrying the pregnancy to term, the alternatives to abortion, the probable age of the fetus, and specific government aid available for care of a child. Related to this issue are other types of consent — including parental and spousal consent — that states have sought to require before an abortion can be performed.
In 1976, the Court reviewed a Missouri statute requiring that the following provisions be met for an abortion to be performed: that a woman in the first twelve weeks of her pregnancy give written consent; that a wife obtain her husband's consent; and that a minor obtain her parents' consent, unless a medical necessity exists (Mo. Ann. Stat. § 188.010 et seq.). The statute also required that physicians and clinics performing abortions keep careful records of their procedures and that criminal and civil liability be imposed upon a physician who failed to observe standards of professional care in performing abortions. Planned Parenthood, a family planning organization, initiated a lawsuit to declare the law unconstitutional. The Supreme Court, in Planned Parenthood v. Danforth, 428 U.S. 52, 96 S. Ct. 2831, 49 L. Ed. 2d 788 (1976), upheld the requirement that the woman give written consent in the first trimester, as well as the requirement that records of abortion procedures be kept. However, the Court ruled that a woman need not inform her husband of an abortion performed in the first trimester, because the state may not interfere in the woman's private decision concerning her pregnancy during that period. For the same reason, the Court struck down the law requiring a minor to obtain parental consent in the first trimester.
The Court clarified its position on parental consent in later rulings. In Bellotti v. Baird, 443 U.S. 622, 99 S. Ct. 3035, 61 L. Ed. 2d 797 (1979), it struck down a state law that required the consent of both parents or judicial approval — commonly called judicial bypass— before an unmarried minor could obtain an abortion. The Court found the law unconstitutional because it gave third parties — the child's parents or the court — absolute veto power over the minor's ability to choose abortion, regardless of her best interests, maturity, or ability to make informed decisions. In H.L. v. Matheson, 450 U.S. 398, 101 S. Ct. 1164, 67 L. Ed. 2d 388 (1981), the Court upheld a Utah statute requiring that a physician notify the parents of a minor before performing an abortion on her (Utah Code Ann. § 76-7-304). Since the law required only notification rather than consent, the Court reasoned that it did not give any party veto power over the minor's decision. In Hodgson v. Minnesota, 497 U.S. 417, 110 S. Ct. 2926, 11 L. Ed. 2d 344 (1990), the Court upheld a parental notification statute because the statute's provision for judicial bypass took into account the best interests of the minor, her maturity, and her ability to make an informed decision.
In 1982, Pennsylvania passed the Abortion Control Act, which required that the woman give "voluntary and informed" consent after hearing a number of statements, including declarations of the following: the "fact that there may be detrimental physical and psychological effects" to the abortion; the particular medical risks associated with the abortion method to be employed; the probable gestational age of the fetus; the "fact that medical assistance benefits may be available" for prenatal care and childbirth; and the "fact that the father is liable to assist" in child support. The law also required a physician to report the woman's age, race, marital status, and number of previous pregnancies; the probable gestational age of the fetus; the method of payment for the abortion; and the basis of determination that "a child is not viable."
When the Pennsylvania law came before the Court in the 1986 case Thornburgh v. American College of Obstetricians & Gynecologists, 476 U.S. 747, 106 S. Ct. 2169, 90 L. Ed. 2d 779, the Reagan administration's Justice Department specifically asked the Court to overturn Roe. In its brief, the department argued that the Court should "abandon" Roe because its textual and historical basis was "so far flawed" as to be a source of instability in the law. Instead, the brief urged, the Court should leave the state legislatures free to permit or prohibit abortion as they wish. However, by a narrow (5-4) vote the Court found all the provisions of Pennsylvania's Abortion Control Act to be unconstitutional, thereby reaffirming its previous decisions upholding a woman's constitutional right to abortion. "The states," wrote Justice Blackmun in the Court's opinion, "are not free, under the guise of protecting maternal health or potential life, to intimidate women into continuing pregnancies." Pennsylvania had defended itself by claiming that its procedures gave the pregnant woman information that would better inform her decision regarding abortion. Blackmun, although he agreed in principle with the idea of informed consent, found that the Pennsylvania procedures were designed not so much to inform as to encourage a woman to withhold her consent to an abortion.
The narrow margin of the Court's decision encouraged the anti-abortion movement. By the time the Court reached its next major abortion decision, in 1992 — Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833, 112 S. Ct. 2791, 120 L. Ed. 2d 674 — many expected it to finally reverse Roe. Again, it did not. Casey, the most important abortion decision since Roe, concerned amendments to the same Pennsylvania Abortion Control Act of 1982. The amendments prohibited abortions after twenty-four weeks except to save the woman's life or to prevent substantial and irreversible impairment of her bodily functions; required a woman to wait twenty-four hours after giving her informed consent before receiving an abortion; allowed only a physician to give informed-consent information; required a woman to notify her spouse; and mandated that minors obtain informed consent from at least one parent or a court before receiving an abortion. The plaintiffs in the case, five family planning clinics and a physician provider of abortion services, asked the Court to declare the statutes invalid.
In a close (5-4) decision, the Court again supported the basic provisions of Roe and upheld a woman's right to decide to obtain an abortion. The Court did, however, uphold all the Pennsylvania statutes except for the spousal notification provision, arguing that they did not present an "undue burden" to the woman's reproductive rights. Justices O'Connor, Kennedy, and David H. Souter wrote the majority opinion, and Justices John Paul Stevens and Blackmun wrote concurring opinions. Chief Justice Rehnquist and Justices Scalia, Byron R. White, and Clarence Thomas all dissented.
Noting that the case marked the fifth time the Justice Department under the Reagan and Bush administrations had filed a report with the Court making known its desire to overturn Roe, the Court's opinion defended the reasoning of the Roe decision. The Court characterized the Roe ruling as having three major provisions: First is a recognition of the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the state… . Second is a confirmation of the State's power to restrict abortions after fetal viability, if the law contains exceptions for pregnancies which endanger a woman's life or health. And third is the principle that the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child.The Court in Casey, as in Roe, found the constitutional basis of a woman's right to terminate her pregnancy in the Due Process Clause of the Fourteenth Amendment. As the Court stated, "It is a promise of the Constitution that there is a realm of personal liberty which the government may not enter." The Court also invoked the legal doctrine of stare decisis, the policy of a court to follow previously decided cases rather than overrule them.
However, the Court emphasized, more than it had in Roe, "the State's ‘important and legitimate interest in potential life' [quoting Roe]." The justices also sought to better define the "undue burden" standard, originally developed by Justice O'Connor, that the Court had used to assess the validity of any possible regulations of a woman's reproductive rights. The Court more precisely defined an undue burden as one whose "purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability."
The dissenting justices in the case restated their opinion that Roe was decided wrongly because no fundamental right for a woman to choose to terminate her pregnancy was written into the U.S. Constitution and because U.S. society, in the past, permitted laws that prohibited abortion. They also gave different arguments for upholding the Pennsylvania statute's restrictions. Such provisions had only to show a "rational basis," and using that test, they would have upheld all the challenged portions of the Pennsylvania law. Chief Justice Rehnquist and Justice Scalia both argued that the Court had misused the notion of stare decisis in the case, because the Court did not uphold all aspects of Roe. Scalia also maintained that although the liberty to terminate a pregnancy may be of great importance to many women, it is not "a liberty protected by the Constitution."
The Court's decision in Casey was used to strike down other state laws that sharply restricted women's access to abortion. Citing the Casey decision, in Sojourner v. Edwards, 974 F.2d 27, the U.S. Court of Appeals for the Fifth Circuit in September 1992 struck down a Louisiana law that would have imposed stiff sentences on doctors performing abortions for reasons other than saving the life of the mother or in cases of rape or incest if the victim reported the crime (La. Rev. Stat. Ann. 14:87). The appeals court found the statute unconstitutional because it imposed an undue burden on women seeking an abortion before fetal viability. The Supreme Court later upheld this ruling without comment (Sojourner, 507 U.S. 972, 113 S. Ct. 1414, 122 L. Ed. 2d 785 [1993]).
After Planned Parenthood v. Casey
As a result of the Court's decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the battle over abortion moved beyond the question of whether Roe v. Wade would be overturned, to focus on what conditions truly constitute an American woman's right to safe, legal abortion. After a number of incidents of violence at abortion clinics, the abortion rights movement has focused on lobbying for legislation and winning court cases guaranteeing access to abortion clinics. The anti-abortion movement, on the other hand, has continued to vigorously oppose abortion but has become increasingly split between militant and moderate factions. Behind the split are the increasingly violent actions of militant anti-abortion protesters. Between 1993 and 1994, five abortion providers were killed by anti-abortion militants. Although such killings have undermined public support for the anti-abortion movement, they have also damaged the morale of those who staff family planning clinics; some clinics have even shut down. As a result, family planning services, including abortion, remain difficult to obtain for women in many parts of the country, particularly in rural areas.
The Supreme Court has decided a number of different cases surrounding the issue of anti-abortion protests, many of which have made it more difficult for anti-abortion groups to disrupt the operations of family planning clinics. In Madsen v. Women's Health Center, 512 U.S. 753, 114 S. Ct. 2516, 129 L. Ed. 2d 593 (1994), the Court upheld a regulation barring abortion protesters within thirty-six feet of a Melbourne, Florida, clinic. In another 1994 decision, National Organization for Women v. Scheidler, 510 U.S. 249, 114 S. Ct. 798, 127 L. Ed. 2d 99, the Court upheld the use of the Racketeer Influenced and Corrupt Organizations (RICO) chapter of the Organized Crime Control Act of 1970 (18 U.S.C.A. §§ 1961-1968) against militant anti-abortion groups. RICO, which was originally designed to combat Mafia crime, gives the government a potent tool to convict those involved in violence against abortion providers and their clinics.
In May 1994, President Clinton signed into law another tool to be used against anti-abortion militants, the Freedom of Access to Clinic Entrances Act (FACE), which allows for federal criminal prosecution of anyone who, "by force or threat of force or by physical obstruction, intentionally injures, intimidates, or interferes … with any person … obtaining or providing reproductive health services" (18 U.S.C.A. § 248). The law also makes it a federal crime to intentionally damage or destroy the property of any reproductive health facility, and it permits persons harmed by those engaging in prohibited conduct to bring private suits against the wrongdoers. The law imposes stiff penalties as well for those found guilty of violating its provisions.
Ultimately, medical technology may have as much to do with the outcome of the abortion debate as politics. New drugs have been developed that induce abortion without a surgical procedure. The most well known of these is RU-486, developed by the French pharmaceutical company Roussel Uclaf. The drug blocks the action of the female hormone progesterone, preventing the implantation of a fertilized egg in the wall of the uterus. It is used with a second drug in pill form, prostaglandin, taken forty-eight hours later, which causes uterine contractions. The uterine lining is then sloughed off, along with any fertilized eggs. Widely used in Europe, RU-486 is said to be 95 percent effective. The drug is also being tested as a morning-after pill and as a possible treatment for breast cancer, endometriosis, and brain tumors. The Food and Drug Administration (FDA), under the Reagan and Bush administrations, banned the importation of RU-486 into the United States. However, in April 1993, the Clinton administration pressured Roussel Uclaf to license the drug for sale to the U.S. Population Council, a New York-based nonprofit organization, which said it would conduct clinical tests in the United States. Seeking to avoid the ire of anti-abortion groups, Roussel Uclaf was planning to set up a nonprofit foundation that would manufacture and distribute RU-486.
The Pro-Life Movement and the Courts
Even before the Supreme Court's landmark 1973 abortion ruling in Roe v. Wade, 410 U.S. 113, 93 S. Ct. 705, 35 L. Ed. 2d 147, pro-life groups had begun to picket and protest at family planning clinics that perform abortions. Such groups had formed in response to an abortion reform movement that by 1970 had succeeded in liberalizing abortion laws in many states. From the start, most anti-abortion demonstrators modeled their protests on those of the civil rights movement of the 1950s and 1960s. The anti-abortion movement was led by such people as Joan Andrews, a pacifist and human rights advocate who became a hero for the movement after she spent two-and-a-half years in a Florida jail for attempting to disengage a suction machine used in abortions. The movement advocated the nonviolent approach to civil disobedience pioneered by Mohandas K. Gandhi and Martin Luther King, Jr. By 1975, two years after Roe, Catholic groups had begun to conduct sit-ins at family planning clinics where abortions were performed. With time, evangelical Protestant groups joined the movement, and in the mid-1990s, they accounted for a majority of anti-abortion activists.
Pro-life groups have come to call their activities direct actions or rescues, believing that they are saving unborn children from murder, and their tactics have grown increasingly complex. Typical stratagems include bringing in dozens or hundreds of volunteers and blocking clinic entrances with their bodies, often chaining themselves to doors; shouting slogans, sometimes with bullhorns; attempting to intercept women leaving or entering the building and plying them with anti-abortion literature; displaying graphic pictures of fetuses; and trailing clinic employees to and from work while shouting such things as "Baby killer!" Besides demonstrating, anti-abortion groups have sponsored "pregnancy crisis centers," where they counsel pregnant women, with the intention of persuading them to carry their pregnancies to term. By the mid-1980s, activists had created national organizations and networks that promoted civil disobedience to stop the practice of abortion. The most well known of these is Operation Rescue, which was started in the 1980s by Randall Terry, an evangelical Christian.
The aggressive strategies of the anti-abortion movement have prompted legal responses from women's and abortion rights organizations, resulting in a number of cases that have reached the Supreme Court. In several different rulings, the Court has attempted to clarify what is and is not allowed in anti-abortion demonstrations. In making these decisions, the Court has attempted to balance the rights of the demonstrators — particularly their right to free speech — with the rights of women seeking to use family planning clinic services. In 1988, for example, in Frisby v. Schultz, 487 U.S. 474, 108 S. Ct. 2495, 101 L. Ed. 2d 420, the Court upheld a Brookfield, Wisconsin, city ordinance prohibiting pickets "focused on, and taking place in front of, a particular residence." The ordinance had been created in response to anti-abortion demonstrations targeting the private home of an obstetrician who performed abortions, a tactic assumed by the protesters after picketing at the physician's clinic had not stopped its operation. Justice Sandra Day O'Connor wrote in the Court's opinion, "There is simply no right to force speech into the home of an unwilling listener."
A later Supreme Court decision gave abortion clinics further protection: it supported the constitutionality of a court injunction prohibiting protesters from going within thirty-six feet of a clinic that had been a regular target of protests. In July 1994, in Madsen v. Women's Health Center, ___U.S.___, 114 S. Ct. 2516, 129 L. Ed. 2d 593, the High Court ruled 6-3 to let stand the thirty-six-foot exclusion zone for the Melbourne, Florida, abortion clinic. However, the Court did strike down other provisions of the injunction, such as a three-hundred-foot exclusion zone and restrictions on carrying banners and pictures. The ruling was considered a major defeat for the anti-abortion movement. Justice Antonin Scalia wrote a sharp dissent in which he claimed that the Supreme Court's position on abortion had claimed "its latest, greatest and most surprising victim: the First Amendment."
Increased Violence Changes the Debate
Violence has been a part of the heated debate surrounding abortion ever since the 1973 Roe v. Wade decision that guaranteed a woman's limited right to an abortion. Bombings, arson, and even murder have been committed by anti-abortion activists in the name of their cause. The National Abortion Federation counted more than three thousand violent or threatening incidents against abortion clinics between 1976 and 1994. In the 1990s, the extremist wing of the anti-abortion movement turned even more violent, including murder as part of its tactics. Some extremists now view killing health care professionals who perform abortions as justifiable homicide.
Between March 1993 and the end of 1994, five staff workers at abortion clinics were murdered by anti-abortion zealots. Dr. David Gunn was fatally shot on March 10, 1993, outside an abortion clinic in Pensacola, Florida, by Michael Griffin. In August 1994, Dr. John Bayard Britton, age sixty-nine, who had replaced Gunn as circuit-riding doctor in northern Florida, and his escort, James Barrett, age seventy-four, were shot repeatedly in the face with a shotgun as their car pulled into the parking lot of the Ladies Clinic of Pensacola. Minutes later, police arrested Paul Hill, an anti-abortion extremist. President Bill Clinton called Britton's and Barrett's killings a case of domestic terrorism. In December 1994, in perhaps the most gruesome incident of all, John Salvi killed two people and wounded five more when he opened fire in two Boston-area family planning clinics.
According to the Alan Guttmacher Institute, in 1988 — well before the 1993-94 wave of violence — 17 percent of counties in the United States had abortion providers. The federal government cannot guarantee protection for clinics; whereas there are some fifteen hundred abortion clinics nationwide, in 1995 there were only 2,100 federal marshals.
The government and abortion rights groups have responded to the increased violence in two ways: reviewing existing laws to find those that can be used to investigate and prosecute violent groups and individuals, and creating new laws that specifically address access to abortion clinics. In the late 1980s, the National Organization for Women (NOW) filed a lawsuit against long-time pro-life activist Joseph Scheidler and his Pro-Life Action Network (PLAN). Initially, NOW attempted to use the Sherman Anti-Trust Act of 1890 (15 U.S.C.A. § 1 et seq.) against PLAN, but without success. At the prompting of Chicago lawyer Fay Clayton, NOW turned to a different law, the Racketeer Influenced and Corrupt Organizations (RICO) chapter of the Organized Crime Control Act of 1970 (18 U.S.C.A. §§ 1961-1968), and broadened its attack to include Randall Terry, founder of Operation Rescue. RICO was originally drafted as a potent means to convict all members of a criminal enterprise — including those who had routinely escaped police dragnets, the Mafia bosses. The law imposes harsh penalties on those convicted under it: up to twenty years in jail for each criminal count, and triple damages in civil judgments. In early 1994, the Supreme Court, in National Organization for Women v. Scheidler, 510 U.S. 249, 114 S. Ct. 798, 127 L. Ed. 2d 99, upheld the use of RICO against anti-abortion groups, many of which could now be attacked as criminal enterprises. Chief Justice William H. Rehnquist, writing the Court's opinion, reasoned that to be designated a criminal enterprise under RICO, an organization need not be devoted to economic gain. Justice David H. Souter wrote a concurring opinion in which he warned that RICO could conflict with First Amendment rights regarding speech. "I think it prudent to notice," he wrote, "that RICO actions could deter protected advocacy and to caution courts applying RICO to bear in mind the First Amendment interests that could be at stake."
Women's rights groups were less successful in Bray v. Alexandria Women's Health Clinic, 506 U.S. 263, 113 S. Ct. 753, 122 L. Ed. 2d 34 (1993). In this case, the Supreme Court ruled that a nineteenth-century federal civil rights law (42 U.S.C.A. § 1985[3]) aimed at protecting African Americans from the Ku Klux Klan could not be used to prevent anti-abortion protesters from blockading abortion clinics. Originally enacted as part of the Ku Klux Klan Act of 1871, a law that had first been used against mob violence and vigilantism, the relevant statute had in the 1980s been applied by courts to actions of anti-abortion groups, most notably Operation Rescue. A lower-court ruling, for example, found that Operation Rescue had violated trespassing and public nuisance laws and had conspired to violate the right to interstate travel of women seeking abortions at clinics. The court banned Operation Rescue from trespassing on or obstructing access to abortion clinics (NOW v. Operation Rescue, 726 F. Supp. 1483 [E.D. Va. 1989]). This decision was reversed by the Supreme Court in Bray, in a 6-3 ruling, when it held that women did not qualify as a class under discrimination by the provisions of the Ku Klux Klan Act.
After Bray, congressional supporters of abortion rights, Representative Charles E. Schumer (D-N.Y.) and Senator Edward M. Kennedy (D-Mass.), introduced the Freedom of Access to Clinic Entrances Act (FACE), which would give federal courts the authority to issue restraining orders against protesters blockading abortion clinics (18 U.S.C.A. § 248). It was signed into law by President Clinton on May 26, 1994. The law allows for federal criminal prosecution of anyone who, "by force or threat of force or by physical obstruction, intentionally injures, intimidates, or interferes … with any person … obtaining or providing reproductive health services." The law also makes it a federal crime to intentionally damage or destroy the property of any reproductive health facility, and it permits persons harmed by those engaging in prohibited conduct to bring private suits against the wrongdoers. The penalties for violation of the act include imprisonment for up to one year and a fine of $10,000 for a first offense; for each subsequent offense, penalties can be up to three years' imprisonment and $25,000. FACE is patterned after existing civil rights laws, including 18 U.S.C.A. § 245(b), which prohibits force or threat of force to willfully injure, intimidate, or interfere with any person who is voting, engaging in activities related to voting, or enjoying the benefits of federal programs. Nevertheless, FACE is not identical to previous federal civil rights laws, particularly where it prohibits acts of physical obstruction.
FACE brought on immediate challenges by anti-abortion groups who claimed that it abridged their First Amendment right to freedom of speech. Courts were unwilling to invalidate the law on this ground, reasoning that the law proscribes only conduct — as in "force," "threat of force," and "physical obstruction" — rather than speech (see Council for Life Coalition v. Reno, 856 F. Supp. 1422, No. 94-0843-1EG[CM], 1994 WL 363132 [S.D. Cal. 1994]).
The violence against clinics and the murder of abortion providers have given new momentum to the pro-choice, or abortion rights, side of the abortion issue. Family planning clinics that perform abortions are receiving increased protection from local, state, and federal statutes, with FACE the most prominent of these laws. However, the debate and litigation surrounding the issue of anti-abortion protests show little sign of abating, and anti-abortion protest groups are preparing to challenge the laws regulating their activities, on the grounds that such laws abridge freedom of speech.
See: American Civil Liberties Union; Constitutional Amendment; Due Process of Law; Fetal Rights; First Amendment; Fourteenth Amendment; Freedom of Speech; Husband and Wife; Ninth Amendment; Parent and Child; Privacy; Reproduction; Roe v. Wade; Women's Rights.
Health Dictionary:
abortion[] |
TopHome > Library > Health > Health Dictionary
The ending of pregnancy and expulsion of the embryo or fetus, generally before the embryo or fetus is capable of surviving on its own. Abortion may be brought on intentionally by artificial means (induced abortion) or may occur naturally (spontaneous abortion, which is commonly referred to as a miscarriage). (Compare stillbirth; see also family planning and population control.)
Veterinary Dictionary:
abortion[] |
TopHome > Library > Animal Life > Veterinary DictionaryPremature expulsion from the uterus of the products of conception; termination of pregnancy before the fetus is viable.
- complete a. — complete expulsion of all the products of conception.
- early a. — abortion within the first third of pregnancy.
- epizootic bovine a. — characterized by serious fetal disease followed by abortion. Endemic in California's coastal range and in the foothill region of the Sierra Nevada, USA. Necropsy findings in the fetus are diagnostic; they include profuse petechiation and severe granulomatous hepatitis. Cause appears to be a novel deltaproteobacterium closely related to members of the order Myxococcales. Transmitted by the tick, Ornithodoros coriaceus. Called also foothill abortion.
- habitual a. — spontaneous abortion occurring in three or more successive pregnancies.
- incomplete a. — abortion in which parts of the products of conception are retained in the uterus.
- induced a. — abortion procured by the veterinarian to eliminate a misalliance, to reduce wastage in animals in a feedlot, to encourage commencement of lactation earlier than would otherwise occur. In cattle manipulation through the rectal wall is a possible way of destroying the viability of the fetus. Induction by the administration of prostaglandins or corticosteroids is more usual. See also pregnancy termination.
- infectious a. — the common causes in the various species are:
- missed a. — retention of a dead embryo or fetus for more than 1 to 2 weeks.
- pine needle a. — a late-term abortion with retained fetal membranes in cattle caused by ingestion of isocupressic acid in the needles of Pinus spp., commonly P. ponderosa, but also P. jeffryi, P. contorta and Juniperus scopulorum and J. communis. Nutrient deficiency and tree management practices may promote ingestion off the ground as cattle graze through while eating early growing spring grass.
- a. rate — number of abortions as a percentage of the cows in the herd which were diagnosed pregnant in early pregnancy; the target is <2% but rates commonly approach 8% in dairy cattle and 5% in beef cattle.
- septic a. — abortion associated with serious infection of the uterus leading to generalized infection.
- spontaneous a. — abortion occurring naturally. See also spontaneous abortion.
- a. storm — a cluster of abortions occurring at about the same time or in rapid sequence within a group of pregnant females. See also equine viral abortion.
- therapeutic a. — abortion induced by a veterinarian for medical or other health reasons.
- cattle — Brucella abortus (brucellosis); Campylobacter fetus subsp. venerealis (vibriosis); Campylobacter fetus subsp. fetus; Leptospira pomona, L. hardjo (leptospirosis); Listeria monocytogenes (listeriosis); Arcanobacterium pyogenes; Aspergillus, Absidia and Mucor spp. (fungal abortion); bovine virus diarrhea virus; infectious bovine rhinotracheitis herpesvirus; Chlamydophila abortus; a deltaproteobacterium (epizootic bovine abortion); Coxiella burnetii (Q fever), Neospora caninum.
- sheep and goats — Campylobacter fetus subsp. fetus (vibriosis); Campylobacter jejuni; Chlamydophila abortus (enzootic abortion of ewes); Listeria monocytogenes (listeriosis); Salmonella abortus-ovis; Brucella melitensis; Toxoplasma gondii (toxoplasmosis); Brucella ovis (limited occurrence); bluetongue virus; border disease.
- horse — Streptococcus equi subsp zooepidemicus; Actinobacillus equuli, A. equisimilis; Rhodococcus equi; leptospirosis, most commonly the pomona serogroup and less frequently serovar grippotyphosa; equine herpesvirus (EHV1); equine viral arteritis (EVA); equine arteritis; Potomac horse fever; and in the USA the mare reproductive loss syndrome associated with ingestion of the Eastern tent caterpillar Malacosoma americanum.
- pig — Leptospira pomona, L. grippotyphosa, L. canicola, L. icterohaemorrhagiae (leptospirosis); Erysipelothrix rhusiopathiae (erysipelas); porcine reproductive respiratory syndrome (PRRS) virus; parvovirus; porcine circovirus 2; Aujesky's disease; classical swine fever; and African swine fever.
- dog and cat — Brucella canis, feline leukemia virus, feline herpesvirus.
Sign Language Videos:
abortion[] |
TopHome > Library > Literature & Language > Sign Language Videossign description: The A-hand scraps down the palm of the flat hand and then throws it away. (This sign is typically used to mean to abort or discard or throw away).
Quotes About:
Abortion[] |
TopHome > Library > Literature & Language > Quotes AboutQuotes:
"The one regret I have about my own abortions is that they cost money that might otherwise have been spent on something more pleasurable, like taking the kids to movies and theme parks." - Barbara Ehrenreich
"The emphasis must be not on the right to abortion but on the right to privacy and reproductive control." - Ruth Bader Ginsberg
"The preservation of life seems to be rather a slogan than a genuine goal of the anti-abortion forces; what they want is control. Control over behavior: power over women. Women in the anti-choice movement want to share in male power over women, and do so by denying their own womanhood, their own rights and responsibilities." - Ursula K. Le Guin
"The cemetery of the victims of human cruelty in our century is extended to include yet another vast cemetery, that of the unborn." - John Paul II
"The greatest destroyer of peace is abortion because if a mother can kill her own child, what is left for me to kill you and you to kill me? There is nothing between." - Mother Teresa
"Dread not infanticide; the crime is imaginary: we are always mistress of what we carry in our womb, and we do no more harm in destroying this kind of matter than in evacuating another, by medicines, when we feel the need." - Marquis De Sade
See more famous quotes about Abortion
Science Dictionary:
abortion[] |
TopHome > Library > Science > Science Dictionary
The deliberate termination of a pregnancy, usually before the embryo or fetus is capable of independent life. In medical contexts, this procedure is called an induced abortion and is distinguished from a spontaneous abortion (miscarriage) or stillbirth.
Abortion laws are extremely controversial. Those who describe themselves as “pro-choice” believe that the decision to have an abortion should be left to the mother. In contrast, the “pro-life” faction, arguing that abortion is killing, holds that the state should prohibit abortion in most cases. Feminists (see feminism) and liberals generally support the pro-choice side; Roman Catholics and Protestant fundamentalists generally back the pro-life side. (See Roe versus Wade.)
Wikipedia:
Abortion[] |
TopHome > Library > Miscellaneous > Wikipedia
| Induced abortion | |
|---|---|
| Classification and external resources | |
| [7]
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.[1] | |
| ICD-10 | O |
| ICD-9 | 779.6 |
| DiseasesDB | 4153 |
| MedlinePlus | 002912 |
| eMedicine | article/252560 |
Abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or embryo, resulting in or caused by its death.[2] 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.
Worldwide 42 million abortions are estimated to take place annually with 22 million of these occurring safely and 20 million unsafely.[3] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[3] 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.[4] The frequency of abortions is, however, similar whether or not access is restricted.[3][4]
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, and cultural 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.[5]
| Contents [hide]*1 Types |
Types[]
[8][9]A 10-week-old fetus removed via a therapeutic abortion from a 44-year-old female diagnosed with early-stage uterine cancer. The uterus (womb), included the fetus.===Spontaneous=== Main article: MiscarriageSpontaneous 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.[6] 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.[7] 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.[8]
The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual period (LMP).[7][9] 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.[10]
The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,[11] accounting for at least 50% of sampled early pregnancy losses.[12] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[11] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[12] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[13]
Induced[]
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 it ages.[14] 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 therapeutic when it is performed to:
- save the life of the pregnant woman;[15]
- preserve the woman's physical or mental health;[15]
- terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity;[15] or
- selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[15]
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."[16]
Methods[]
[10][11]Gestational age may determine which abortion methods are practiced.===Medical=== Main article: Medical abortion"Medical abortions" are non-surgical abortions that use pharmaceutical drugs. Medical abortions comprise 10% of all abortions in the United States[17] and Europe.[citation needed] 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.[18] 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[]
[12][13]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 pumpIn the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.[19] Manual vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, 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 abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.[20]
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 the amniotic 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.[21]
From the 20th to 23rd week of gestation, an injection to stop the fetal heart may be used as the first phase of the surgical abortion procedure[22][23][24][25][26] to ensure that the fetus is not born alive.[27]
Other methods[]
Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion).[28] The use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ failure, and is not recommended by physicians.[29]
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.[30] 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.[31] 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.[31]
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.[32]
Health risks[]
See also: Health risks of unsafe abortionAbortion, when legally performed in developed countries, is among the safest procedures in medicine.[33][34] In such settings, risk of maternal death is between 0.2–1.2 per 100,000 procedures.[35][36][37][38] In comparison, by 1996, mortality from childbirth in developed countries was 11 times greater.[39][40][41][42][43][44] 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.[45] For unsafe procedures, the mortality rate has been estimated at 367 per 100,000.[46]
Physical health[]
Surgical abortion methods, like most minimally invasive procedures, carry a small potential for serious complications.[47]
Surgical abortion is generally safe and the rate of major complications is low[48] but varies depending on how far pregnancy has progressed and the surgical method used.[49] Concerning gestational age, incidence of major complications is highest after 20 weeks of gestation and lowest before the 8th week.[49] With more advanced gestation there is a higher risk of uterine perforation and retained products of conception,[50] and specific procedures like dilation and evacuation may be required.[51]
Concerning the methods used, general incidence of major complications for surgical abortion varies from lower for suction curettage, to higher for saline instillation.[49] 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.[52] Use of general anesthesia increases the risk of complications because it relaxes uterine musculature making it easier to perforate.[53]
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.[54] Abortion does not impair subsequent pregnancies, nor does it increase the risk of future premature births, infertility, ectopic pregnancy, or miscarriage.[34]
In the first trimester, health risks associated with medical abortion are generally considered no greater than for surgical abortion.[55]
Mental health[]
Main article: Abortion and mental healthNo 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 anti-abortion 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[]
The number of abortions performed worldwide has deceased between 1995 and 2003 from 45.6 million to 41.6 million (a decrease from 35 to 29 per 1000 women between 15 and 44 years of age).[3] The greatest decrease has occurred in the developed world with a decrease from 39 to 26 per 1000 women in comparison to the developing world which had a decrease from 34 to 29 per 1000 women.[3] Of these approximately 42 million abortions 22 million occurred safely and 20 million unsafely.[3]
The incidence and reasons for induced abortion vary regionally. Some countries, such as Belgium (11.2 per 1000 known pregnancies) and the Netherlands (10.6 per 1000), had a comparatively low rate of induced abortion, while others like Russia (62.6 per 1000) and Vietnam (43.7 per 1000) had a high rate. The world ratio was 26 induced abortions per 1000 known pregnancies (excluding miscarriages and stillbirths).[62]
By gestational age and method[]
| [14] | [15] | |
| 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).[63] 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.[64] 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.[65] Later abortions are more common in China, India, and other developing countries than in developed countries.[66]
By personal and social factors[]
[16][17]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.[67] A 2004 study in which American women at clinics answered a questionnaire yielded similar results.[68] 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.[67] 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.[68] 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.[69] 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."[70]
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[]
[18][19]Soviet poster circa 1925, promoting hospital 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 abortionWomen 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."[71] 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. It is estimated that 20 million unsafe abortions occur around the world annually and that 70,000 of these result in the woman's death.[3] 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.[72] 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.[73] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[74]
History[]
[20][21]"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the Boston Daily Times.Main article: History of abortionInduced abortion can be traced to ancient times.[75] 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 second-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.[76] 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 medieval period, physicians in the Islamic world documented detailed and extensive lists of birth control practices, including the use of abortifacients, commenting on their effectiveness and prevalence.[77] They listed many different birth control substances in their medical encyclopedias, such as Avicenna listing 20 in The Canon of Medicine (1025) and Muhammad ibn Zakariya ar-Razi listing 176 in his Hawi (10th century). This was unparalleled in European medicine until the 19th century.[78][Need quotation to verify]
During the Middle Ages, abortion was tolerated and there were no laws against it.[79] A medieval female physician, Trotula of Salerno,[80] administered a number of remedies for the “retention of menstrua,” which was sometimes a code for early abortifacients.[81] Pope Sixtus V (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy.[82] 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.[83]
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.[84] 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.[85][86][87][88]
Society and culture[]
Abortion debate[]
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| 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 debateIn 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 (see religion 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 a pregnant woman, 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.[89]
Abortion law[]
Main article: Abortion lawSee also: Reproductive rights[25][26]International status of abortion law: Legal on request Legal for maternal life, health, mental health, rape, fetal defects, and/or socioeconomic factors Legal for or illegal with exception for maternal life, health, mental health, rape, and/or fetal defects Illegal with exception for maternal life, health, mental health and/or rape Illegal with exception for maternal life, health, and/or mental health Illegal with no exceptions No information Vertical stripes (various colours): Illegal but unenforcedBefore the scientific discovery in the nineteenth century that human development begins at fertilization,[90] English common law forbade abortions after "quickening", that is, after "an infant is able to stir in the mother's womb."[91] There was also an earlier period in England when abortion was prohibited "if the foetus is already formed" but not yet quickened.[92] Both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803.[93] In 1861, the Parliament of the United Kingdom passed the Offences against the Person Act 1861, which continued to outlaw abortion and served as a model for similar prohibitions in some other nations.[94]
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. 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.[95]
- 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.
- In Canada, a similar requirement was rejected as unconstitutional in 1988.
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.[96][97] However, in 2006, the Chilean government began the free distribution of emergency contraception.[98][99]
- 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.[100]
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. [101]
In the US, about 8% of abortions are performed on women who travel from another state.[102] 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.
Sex-selective[]
Main article: Sex-selective abortionSonography 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.[103]
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.[104] 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."[105] 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.[106] Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted.[107] 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.[108]
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.[109] 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.[110] A ban upon the practice of sex-selective abortion was enacted in 2003.[111]
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 implicated in a 1994 art theft as part of a pro-life drive in Norway surrounding the 1994 Winter Olympics.[112] 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.[113] In 2008, a Yale student proposed using aborted excretions and the induced abortion itself as a performance art project.[114]
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.[115] 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.[116] 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 herself and her loved ones made.[117] 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.[118]
Various options and realities of abortion have been dramatized in film. In Riding in Cars with Boys (2001) an underage woman decides to keep her baby, 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 finds she would be happier having it adopted by a wealthy couple. 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) she knew the relationship was over when she aborted "a son" in secret.[119] 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).[120]
In other animals[]
Further information: Miscarriage#In other animalsSpontaneous abortion occurs in various animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs.[121] In cows, abortion may be caused by contagious disease, such as Brucellosis or Campylobacter, but can often be controlled by vaccination.[122] Additionally, many other diseases are known to increase the risk of miscarriage in humans and other animals.[citation needed]
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.[123]
Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[124][125][126] although the frequency in the wild has been questioned.[127] Male Gray langur monkeys may attack females following male takeover, causing miscarriage.[128]