Abortion

An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously as a miscarriage, or be artificially induced by chemical, surgical or other means. Commonly, "abortion" refers to an induced procedure at any point during human pregnancy; medically, it is defined as miscarriage or induced termination before twenty weeks' gestation, which is considered nonviable.

Throughout history, abortion has been induced by various methods. The moral and legal aspects of abortion are subject to intense debate in many parts of the world.

Definitions

The following medical terms are used to categorize abortion:

• Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes. Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors.
• Induced abortion: Abortion that has been caused by deliberate human action. Induced abortions are further sub-categorized into therapeutic and elective:
  • Therapeutic abortion is performed for one of the following reasons:
    • To save the life of the pregnant woman.
    • To preserve the woman's physical or mental health.
    • To terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity.
    • To selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.
  • Elective abortion: Abortion performed for any other reason.

During the 1950s in the United States, guidelines were set that allowed therapeutic abortion if

1. pregnancy would "gravely impair the physical and mental health of the mother,"
2. the child born was likely to have "grave physical and mental defects," or
3. the pregnancy was the result of rape or incest

The United States Supreme Court 1973 ruling in Roe v. Wade upheld the fundamental right of a woman to determine whether to continue her pregnancy, deeming legislation that overly restricted abortion as unconstitutional.

Spontaneous abortion

Spontaneous abortions, generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes before the twentieth week of gestation. A pregnancy that ends earlier than 37 weeks of gestation, if it results in a live-born infant, is known as a "premature birth." When a fetus dies in the uterus at some point late in gestation, beginning at about 20 weeks, or during delivery, it is termed a "stillbirth." Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

Most miscarriages occur very early in pregnancy. The risk of spontaneous abortion decreases sharply after the eighth week. Between 10 percent and 50 percent of pregnancies end in miscarriage, depending upon the age and health of the pregnant woman. In most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant.

The risk or miscarriage is greater in those with a known history of several spontaneous abortions or an induced abortion, those with systemic diseases, and those over age 35. Other causes can be infection (of either the woman or fetus), immune response, or serious systemic disease. A spontaneous abortion can also be caused by accidental trauma; intentional trauma to cause miscarriage is considered induced abortion or feticide.

Induced abortion

A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the fetus, in addition to the legality, regional availability, and doctor-patient preference for specific procedures.

Surgical abortion

Gestational age may determine which abortion methods are practiced.

In the first twelve weeks, suction-aspiration or vacuum abortion is the most common method. Manual vacuum aspiration, or MVA abortion, consists of removing the fetus or embryo by suction using a manual syringe, while the Electric vacuum aspiration or EVA abortion method uses an electric pump. These techniques are comparable, differing 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 STOP: 'Suction (or surgical) Termination Of Pregnancy'. From the fifteenth week until approximately the twenty-sixth week, a 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 and C) is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. 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.

Other techniques must be used to induce abortion in the third trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with caustic solutions containing saline or urea. Very late 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 termed as "partial-birth abortion." A hysterotomy abortion, similar to a caesarian section but resulting in a terminated fetus, can also be used at late stages of pregnancy.

From the twentieth to twenty-third week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure.

Medical abortion

Effective in the first trimester of pregnancy, medical (sometimes called "chemical abortion"), or non-surgical abortions comprise ten percent of all abortions in the United States and Europe. Combined regimens include methotrexate or mifepristone (also known as RU-486), 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 percent of women undergoing medical abortion with a combined regimen completed it without surgical intervention. 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.

Other means of abortion

File:Angkordemon.jpg

A visual representation of an abortion caused by pounding a woman with a mallet at Angkor Wat.

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. 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.

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. Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Burma, Indonesia, Malaysia, the Philippines, and Thailand, there is an ancient tradition of attempting abortion through forceful abdominal massage.

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.

History

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

Induced abortion, according to anthropologists, can be traced to ancient times. 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 in Ancient Greece, forbade all doctors from helping to procure an abortion by pessary. Nonetheless, Soranus, a second-century Greek physician, suggested in his work Gynaecology that women wishing to abort their pregnancies should engage in violent exercise, energetic jumping, carrying heavy objects, and riding animals. He also prescribed a number of recipes for herbal baths, peccaries, and bloodletting, but advised against the use of sharp instruments to induce miscarriage due to the risk of organ perforation. 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.

Abortion laws and their enforcement have fluctuated through the various eras. Many early laws and church doctrine focused on "quickening," when a fetus began to move on its own, as a way to differentiate when an abortion became impermissible. In the eighteenth and nineteenth centuries various doctors, clerics, and social reformers successfully pushed for an all-out ban on abortion. During the twentieth century abortion became legal in many Western countries, but it is regularly subjected to legal challenges and restrictions by pro-life groups.

Prehistory to fifth century

Cyrenian coin with an image of silphium.

The first recorded evidence of induced abortion is from a Chinese document which records abortions performed upon royal concubines in China between the years 500 and 515 B.C.E. According to Chinese folklore, the legendary Emperor Shennong prescribed the use of mercury to induce abortions nearly 5000 years ago.

Abortion, along with infanticide, was well known in the ancient Greco-Roman world. Numerous methods of abortion were used, the more effective of which were exceedingly dangerous. Several common methods involved either dosing the pregnant woman with a near-fatal amount of poison, in order to induce a miscarriage, introducing poison directly into the uterus, or prodding the uterus with one of a variety of "long needles, hooks, and knives". Unsurprisingly, these methods often led to the death of the woman as well as the fetus.

There have been archaeological discoveries which would seem to indicate early surgical attempts at the extraction of a fetus; however, such methods are not believed to have been common, given the infrequency with which they are mentioned in ancient medical texts. Many of the methods employed in early and primitive cultures were non-surgical. Physical activities like strenuous labor, climbing, paddling, weightlifting, or diving were a common technique. Others included the use of irritant leaves, fasting, bloodletting, pouring hot water onto the abdomen, and lying on a heated coconut shell. In primitive cultures, techniques developed through observation, adaptation of obstetrical methods, and transculturation.

Fifth to sixteenth centuries

Art from a thirteenth-century illuminated manuscript features a herbalist preparing a concoction containing pennyroyal for a woman.

An eighth-century Sanskrit text instructs women wishing to induce an abortion to sit over a pot of steam or stewed onions.

The technique of massage abortion, involving the application of pressure to the pregnant abdomen, has been practiced in Southeast Asia for centuries. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia, dated circa 1150, depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is believed to be the oldest known visual representation of abortion.

Japanese documents show records of induced abortion from as early as the twelfth-century. It became much more prevalent during the Edo period, especially among the peasant class, who were hit hardest by the recurrent famines and high taxation of the age. Statues of the Boddhisattva Jizo, erected in memory of an abortion, miscarriage, stillbirth, or young childhood death, began appearing at least as early as 1710 at a temple in Yokohama.

Physical means of inducing abortion, such as battery, exercise, and tightening the girdle — special bands were sometimes worn in pregnancy to support the belly — were reported among English women during the early modern period.

Seventeenth to nineteenth centuries

"Admonition against abortion." Late nineteenth-century Japanese Ukiyo-e woodblock print.

Nineteenth century medicine saw advances in the fields of surgery, anaesthesia, and sanitation, in the same era that doctors with the American Medical Association lobbied for bans on abortion in the United States and the British Parliament passed the Offences Against the Person Act.

Various methods of abortion were documented regionally in the nineteenth and early twentieth centuries. After a rash of unexplained miscarriages in Sheffield, England, were attributed to lead poisoning caused by the metal pipes which fed the city's water supply, a woman confessed to having used diachylon — a lead-containing plaster — as an abortifacient in 1898.

"The Female Abortionist." Madame Restell is portrayed as a villainess in an 1847 copy of the National Police Gazette.

A well-known example of a Victorian-era abortionist was Madame Restell, or Ann Lohman, who over a forty year period illicitly provided both surgical abortion and abortifacient pills in the northern United States. She began her business in New York during the 1830s, and, by the 1840s, had expanded to include franchises in Boston and Philadelphia.

Women of Jewish descent in Lower East Side, Manhattan are said to have carried the ancient Indian practice of sitting over a pot of steam into the early twentieth century. Evelyn Fisher wrote of how women living in a mining town in Wales during the 1920s used candles intended for Roman Catholic ceremonies to dilate the cervix in an effort to self-induce abortion. Similarly, the use of candles and other objects, such as glass rods, penholders, curling irons, spoons, sticks, knives, and catheters was reported during the nineteenth-century in the United States.

A paper published in 1870 on the abortion services to be found in Syracuse, New York, concluded that the method most often practiced there during this time was to flush inside of the uterus with injected water. The article's author, Ely Van de Warkle, claimed this procedure was affordable even to a maid, as a man in town offered it for $10 on an installment plan. Other prices which 19th-century abortionists are reported to have charged were much more steep. In Great Britain, it could cost from 10 to 50 guineas, or five percent of the yearly income of a lower middle class household.

Māori who lived in New Zealand before or at the time of colonization terminated pregnancies via miscarriage-inducing drugs, ceremonial methods, and girding of the abdomen with a restrictive belt. They were afraid to practice abortion directly, for fear of Makutu, and so the results of their efforts were viewed as miscarriages or feticide.

Twentieth century

Although prototypes of the modern curette are referred to in ancient texts, the instrument which is used today was initially designed in France in 1723, but was not applied specifically to a gynecological purpose until 1842. Dilation and curettage has been practiced since the late nineteenth century.

The twentieth century saw improvements in abortion technology, increasing its safety, and reducing its side-effects. Vacuum devices, first described in medical literature in the 1800s, allowed for the development of suction-aspiration abortion. This method was practiced in the Soviet Union, Japan, and China, before being introduced to Britain and the United States in the 1960s. The invention of the Karman cannula, a flexible plastic cannula which replaced earlier metal models in the 1970s, reduced the occurrence of perforation and made suction-aspiration methods possible under local anesthesia. In 1971, Lorraine Rothman and Carol Downer, founding members of the feminist self-help movement, invented the Del-Em, a safe, cheap suction device that made it possible for people with minimal training to perform early abortions called menstrual extraction.

Intact dilation and extraction was developed by James McMahon in 1983. It resembles a procedure used in the nineteenth century to save a woman's life in cases of obstructed labor, in which the fetal skull was first punctured with a perforator, then crushed and extracted with a forceps-like instrument, known as a cranioclast. In 1980, researchers at Roussel Uclaf in France developed mifepristone, a chemical compound which works as an abortifacient by blocking hormone action. It was first marketed in France under the trade name Mifegyne in 1988.

Debate

File:March.jpg

Pro-choice activists near the Washington Monument at the March for Women's Lives.

File:Pro-life protest.jpg

Pro-life activists at the March for Life in 2002. The rally is held annually in Washington, DC.

Over the course of the history, induced abortion has been the source of considerable debate, controversy, and activism. The ethical, moral, philosophical, biological, and legal issues are complex. Opinions regarding abortion may be best described as being a combination of beliefs on its morality, and 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.

Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. In the United States, most often those in favor of legal prohibition of abortion describe themselves as "pro-life" while those against legal restrictions on abortion describe themselves as "pro-choice." Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to life?" for pro-life advocates, and, for those who are pro-choice, "Does a woman have the right to choose whether or not to continue a pregnancy?"

In both public and private debate, arguments presented in favor of or against abortion focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand.

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, seventy-two percent of respondents were in favor of spousal notification, with twenty-six percent opposed; of those polled, seventy-nine percent of males and sixty-seven percent of females responded in favor.

Ethical issues

Ethics refers to "moral philosophy," or the study of values and the analysis of right and wrong. In contrast with politics, ethics goes beyond what is or can be legal to what should be legal. Regarding abortion, the ethics debate usually surrounds the questions of whether an embryo has rights, and whether those rights should take precedence over a woman's. For many, there is a strong correlation between religion and abortion ethics.

Personhood

Some argue that abortion is wrong based on a belief that an embryo is an innocent person with a right to live. Others argue that the designation of an embryo as a person is incorrect. Personhood may be judged through a set of criteria—a being need not exhibit every criterion to qualify as a person, but failure to exhibit most is proposed as disqualification. Suggested criteria include consciousness (at least the capacity to feel pain), reasoning, self motivation, the ability to communicate on many possible topics, self-awareness, self-consciousness, rationality, and autonomy.

According to these criteria, an embryo is not a person because it satisfies only one criterion, namely consciousness (and this only after it becomes susceptible to pain).

Criticism of this line of reasoning begins with two classes of persons (after birth) in which these criteria do not confer personhood: those who are comatose, and infants. Just like embryos, comatose patients (even when the coma is reversible) do not satisfy the criteria—they are not conscious, do not communicate, and so on. Therefore, based on the criteria, these are not "persons" and lack a right to life. Likewise, infants do not begin to exhibit additional criteria—beyond embryos— until around one year old. Mary Ann Warren concedes that infants are not "persons" by these criteria, which leads to the conclusion that infanticide could be morally acceptable under some circumstances (such as if the infant is severely disabled or in order to save the lives of other infants).

An alternate definition of personhood relies on a being's natural capacity instead of its current observable capacity. It is argued that being the kind of being that can develop itself to the point of exhibiting the criteria is what is crucial. Biological humans have this natural capacity—and have it essentially. By this view, personhood begins at conception and it is not possible for an embryo to fail to have a right to life.

Pro-life demonstrators in Washington, D.C. symbolically cover their mouths with red tape.

Deprivation

Some argue that abortion is wrong because it deprives the embryo of a valuable future. By this argument, killing any human being is wrong because it deprives the victim of a valuable future: any experiences, activities, projects, and enjoyments that would have been enjoyed. Thus, if a being has a valuable future ahead of it—a "future like ours"—then killing that being would be seriously wrong. As an embryo has a valuable future, the "overwhelming majority" of deliberate abortions are placed in the "same moral category" as killing an innocent adult human being. Not all abortions are deemed to be seriously wrong. According to this formulation, abortion may be justified if the same justification can be applied to killing a postnatal human.

Criticism of this line of reasoning follows several threads. Some argue that the personal identity of the embryo is questionable, arguing that humans are not biological organisms, but rather embodied minds that come into existence when the brain gives rise to certain developed psychological capacities. By this criticism, the embryo would not itself have a future of value, but would merely have the potential to give rise to a different entity that would have a future of value. Some argue that deprivation of a valuable future is not possible if there are no psychological connections (memory, belief, desire, and so forth) between the being as it is at death and the being as it would have become.

Bodily rights

Some argue that abortion is right (or permissible) because it allows a woman her right to control her body. This formulation argues that the decision to carry an embryo to term falls within the prerogative of each woman. Forcing a woman to continue an unwanted pregnancy is made analogous to forcing one person's body to be used as a dialysis machine for another person suffering from kidney failure.

Criticism of this line of reasoning argues that the given analogy with dialysis is poor. It is argued that the analogy overlooks tacit consent and subsequent responsibility for having participated in intercourse; the embryo is the woman's child as opposed to a stranger; and that abortion kills the embryo not merely letting it die.

Related to the issue of bodily rights is the questionable quality of life for unwanted children when a woman is forced to carry a pregnancy to term. This is particularly relevant in the case of rape or incest victims, as well as women who, due to youth or disability, are incapable of caring for a child, or of having given consent to the act of intercourse that led to the pregnancy. While the issue of quality of life of the infant after delivery may be resolved through the option of adoption, the issue of whether the nature of the act and the relationship of the biological parents is significant in conception, and whether the attitude of the mother toward the fetus during pregnancy affects the quality of life in the future are still areas of concern.

Social issues

A number of complex social and health issues exist in the debate over abortion. Some of these are discussed below.

Sex-selective abortion

The advent of both sonography and amniocentesis has allowed parents to determine gender before birth. This has led to the occurrence of gender-selective abortion and infanticide, or the targeted termination of a fetus based upon its gender. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Mainland China, Taiwan, South Korea, and India.

In India, the economic role of men, the costs associated with dowries, and a Hindu tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons. Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted. 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.

In the People's Republic of China, there is also a historical preference for sons. 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. A ban upon the practice of sex-selective abortion was enacted in 2003.

Unsafe abortion

Where and when access to safe abortion has been barred, due to explicit sanctions or general unavailability, women seeking to terminate their pregnancies have sometimes resorted to unsafe methods.

The World Health Organization 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." This can include a person without medical training, a professional health provider operating in sub-standard conditions, or the woman herself.

Unsafe abortion remains a public health concern today due to the severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. WHO estimates that 19 million unsafe abortions occur around the world annually and that 68,000 of these result in the woman's death. Complications of unsafe abortion are said to account, globally, for approximately thirteen percent of all maternal mortalities, with regional estimates including twelve percent in Asia, twenty-five percent in Latin America, and thirteen percent in sub-Saharan Africa. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.

Religious Views

Many major religions are opposed to abortion, although some exceptions are made if the life of the mother is endangered.

The Catholic Church argues that life begins at conception, and therefore intentional abortion is the willful taking of a life. Some Protestant sects such as the Lutherans and Calvinists share the Catholic perspective. There is, however, no direct reference to abortion in the New Testament.

Orthodox Judaism prohibits abortions: "It is a capital crime to destroy the embryo in the womb" (Talmud, Sanhedrin 57b). It is also mentioned that if a woman suffers a miscarriage due to a quarrel, the guilty person is required to pay a fine, or if the woman dies, the guilty person must pay with their life (Ex. 21:22-23). The Mishnah states that the life of the woman has priority over the that of the child:

If a woman is in hard travail, one cuts up the child in her womb and brings it forth member by member, because her life comes before the child. (Mishnah, Ohalot 7.6)

The Islamic Qur'an generally forbids abortion out of respect for God as the cause of life. There are two exceptions to this rule: when the woman's life is in danger and when the pregnancy is the result of rape without marriage.

In Hinduism, abortion is not acceptable and is considered to be murder as conception is the moment when a person's spirit is united with their matter (Kaushitake Upanishad 111.1).

Buddhism, too, condemns abortion as murder. Buddhism does, however, focus on a person's good intentions, creating leeway for those who pursue abortions in order to spare the unborn child a difficult life due to congenital deformities or other such hardships.

Traditional Chinese religions operate under the belief that life begins at birth, which led to a less restrictive view of abortion.

"No to abortion" at a 2007 meeting with Pope Benedict XVI in São Paulo, Brazil.

Church and state

The separation of church and state is an oft-debated topic in connection with abortion. Many churches have official positions on abortion, and there is a correlation between these official positions and the personal positions of adherents. Some argue that efforts to codify official church positions are an illegal breach of separation. Arguments regarding church intrusion are defended by referencing the similar ethical arguments against abortion that are made by atheists.

Abortion law

File:AbortionLawsMap.png

International status of abortion law (Detail)

Before the scientific discovery that human development begins at fertilization, English common law allowed abortions to be performed before "quickening," the earliest perception of fetal movement by a woman during pregnancy. Both pre- and post-quickening abortions were criminalized by Lord Ellenborough's Act in 1803. In 1861, the British Parliament passed the Offences Against the Person Act, which continued to outlaw abortion and served as a model for similar prohibitions in other nations.

The Soviet Union, with legislation in 1920, and Iceland, with legislation in 1935, were two of the first countries to allow abortion. The second half of the twentieth century saw the liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom. 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. 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."

United States President George W. Bush signs the Partial-Birth Abortion Ban Act of 2003

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, and the right to security of person 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.

In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially warranted before it can be performed. However, since UK law stipulates that a woman seeking an abortion should never be barred from seeking another doctor's referral, and since some doctors believe that abortion is in all cases medically or socially warranted, in practice women are never fully barred from obtaining an abortion.

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, although in 2006 the Chilean government began the free distribution of emergency contraception. 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.

References

ISBN links support NWE through referral fees

• Critchlow, Donald T. The Politics of Abortion and Birth Control in Historical Perspective (1996)
• Critchlow, Donald T. Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America (2001). ISBN 0195145933
• Garrow, David J. Liberty and Sexuality: The Right to Privacy and the Making of Roe V. Wade (1998). ISBN 0025427555
• Hull, N.E.H. Roe V. Wade: The Abortion Rights Controversy in American History (2001). Legal history. ISBN 0700611436
• Mohr, James C. Abortion in America: The Origins and Evolution of National Policy, 1800-1900 (1979). ISBN 0195026160
• Staggenborg. Suzanne. The Pro-Choice Movement: Organization and Activism in the Abortion Conflict (1994). ISBN 0195089251
• Rubin, Eva R. ed. The Abortion Controversy: A Documentary History (1994). ISBN 0313284768
• Hull, N.E.H. The Abortion Rights Controversy in America: A Legal Reader (2004). ISBN 0807855359
• Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine, and Law in the United State, 1867-1973 (1997). ISBN 0520216571
• Boonin, David (2003). A Defense of Abortion, Cambridge Studies in Philosophy and Public Policy. Boulder: University of Colorado. ISBN 0521520355. 
• Lee, Patrick (1996). Abortion and Unborn Human Life. Catholic University of America Press. ISBN 0813208467. 
• Lee, Patrick (June 2004). The Pro-Life Argument from Substantial Identity: A Defense. Bioethics 18 (3): 249.
• Mappes, Thomas A. and David DeGrazia (2001). Biomedical Ethics. McGraw-Hill. ISBN 0072303654. 
• Marquis, Don (April 1989). Why Abortion is Immoral. The Journal of Philosophy 86 (4): 183-202.
• McMahan, Jeff (2002). The Ethics of Killing: Problems at the Margins of Life, Oxford Ethics Series. New York: Oxford University Press. ISBN 0195169824. 
• Warren, Mary Ann (1973). Thomas A. Mappes "On the Moral and Legal Status of Abortion". Biomedical Ethics, David DeGrazia, 456-461, McGraw-Hill.
• Warren, Mary Ann (1982). Thomas A. Mappes "Postscript on Infanticide". Biomedical Ethics, David DeGrazia, 461-463, McGraw-Hill.
• Schwarz, Stephen D. (1990). The Moral Question of Abortion. Chicago: Loyola University Press. ISBN 0829406239. 
• Singer, Peter (2000). Writings on an Ethical Life. Ecco (HarperCollins). ISBN 0060198389. 
• Stone, Jim (December 1987). Why Potentiality Matters. Canadian Journal of Philosophy 17 (4): 815-830.
• Stretton, Dean (June 2004). Essential Properties and the Right to Life: A Response to Lee. Bioethics 18 (3): 264-282.
• Tooley, Michael (1972). Abortion and Infanticide. Philosophy and Public Affairs 2 (1): 37-65.

External links

• Text of the Roe v Wade decision Findlaw Retrieved August 4, 2007.
• Roe v. Wade, 410 U.S. 113 (1973) (full text with links to cited material) Retrieved August 4, 2007.
• "Abortion Clinic:" a 1983 PBS Frontline episode. Retrieved August 4, 2007.
• U.S. National Library of Medicine and National Institutes of Health MedlinePlus encyclopedia Retrieved August 4, 2007.
• Abortion: All sides to the issue from the Ontario Consultants on Religious Tolerance Retrieved August 4, 2007.
• Issue Guide on Abortion from Public Agenda Online Retrieved August 4, 2007.
• Abortion in Law, History & Religion Retrieved August 4, 2007.
• Surgical Instruments from Ancient Rome Retrieved August 4, 2007.
• Collection of Obstetrical Instruments Retrieved August 4, 2007.

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