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abortion
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{{other uses|Abortion (disambiguation)}}{{pp-semi-indef}}{{pp-move-indef}}{{short description|Intentionally ending pregnancy}}{{Use dmy dates|date=May 2014}}{{EngvarA|date=September 2016}}







factoids
779.6}}| DiseasesDB = 4153| ICDO =| OMIM =| MedlinePlus = 007382| eMedicineSubj = article| eMedicineTopic = 252560| MeshID =D000028}}Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus. An abortion that occurs without intervention is known as a miscarriage or spontaneous abortion. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion.WEB, Home : Oxford English Dictionary,weblink www.oed.com, WEB,weblink Abortion (noun), Oxford Living Dictionaries, 8 June 2018, [mass noun] The deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy,weblink 28 May 2018, live, A similar procedure after the fetus has potential to survive outside the womb is known as a "late termination of pregnancy" or less accurately as a "late term abortion".JOURNAL, Grimes, DA, Stuart, G, Abortion jabberwocky: the need for better terminology, Contraception, 2010, 81, 2, 93–96, 20103443, 10.1016/j.contraception.2009.09.005, When properly done, abortion is one of the safest procedures in medicine,JOURNAL, Grimes, DA, Benson, J, Singh, S, Romero, M, Ganatra, B, Okonofua, FE, Shah, IH, 10.1016/S0140-6736(06)69481-6, Unsafe abortion: The preventable pandemic, The Lancet, 368, 9550, 1908–19, 2006, 17126724,weblink live,weblink" title="web.archive.org/web/20110629040442weblink">weblink 29 June 2011, dmy-all, JOURNAL, Raymond, EG, Grossman, D, Weaver, MA, Toti, S, Winikoff, B, Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States, Contraception, November 2014, 90, 5, 476–79, 25152259, 10.1016/j.contraception.2014.07.012, but unsafe abortion is a major cause of maternal death, especially in the developing world.WEB,weblink Preventing unsafe abortion, www.who.int, 2019-08-06, Making safe abortion legal and accessible reduces maternal deaths.JOURNAL, Faúndes, Anibal, Shah, Iqbal H., 2015-10-01, Evidence supporting broader access to safe legal abortion,weblink International Journal of Gynecology & Obstetrics, World Report on Women’s Health 2015: The unfinished agenda of women’s reproductive health, 131, S56–S59, 10.1016/j.ijgo.2015.03.018, 26433508, 0020-7292, JOURNAL, Latt, Su Mon, Milner, Allison, Kavanagh, Anne, 2019-01-05, Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries, BMC Women's Health, 19, 1, 1, 10.1186/s12905-018-0705-y, 1472-6874, 6321671, 30611257, It is safer than childbirth, which has a 14 times higher risk of death in the United States.JOURNAL, Raymond, E.G., Grimes, D.A., 2012, The Comparative Safety of Legal Induced Abortion and Childbirth in the United States, Obstetrics & Gynecology, 119, 2, Part 1, 215–19, 10.1097/AOG.0b013e31823fe923, 22270271, Modern methods use medication or surgery for abortions.JOURNAL, Kulier, R, Kapp, N, Gülmezoglu, AM, Hofmeyr, GJ, Cheng, L, Campana, A, Medical methods for first trimester abortion, The Cochrane Database of Systematic Reviews, 9 November 2011, 11, CD002855, 22071804, 10.1002/14651858.CD002855.pub4, The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy. The most common surgical technique involves dilating the cervix and using a suction device.WEB, Abortion – Women's Health Issues,weblink Merck Manuals Consumer Version, 12 July 2018,weblink 13 July 2018, live, Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.JOURNAL, Kapp, N, Whyte, P, Tang, J, Jackson, E, Brahmi, D, A review of evidence for safe abortion care, Contraception, September 2013, 88, 3, 350–63, 23261233, 10.1016/j.contraception.2012.10.027, When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term mental or physical problems. In contrast, unsafe abortions (those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) cause 47,000 deaths and 5 million hospital admissions each year.JOURNAL, Lohr, PA, Fjerstad, M, Desilva, U, Lyus, R, Abortion, BMJ, 348, f7553, 2014, 10.1136/bmj.f7553, JOURNAL, Shah, I, Ahman, E, Unsafe abortion: global and regional incidence, trends, consequences, and challenges, Journal of Obstetrics and Gynaecology Canada, 31, 12, 1149–58, December 2009, 20085681,weblink dead,weblink" title="web.archive.org/web/20110716212405weblink">weblink 16 July 2011, dmy, 10.1016/s1701-2163(16)34376-6, The World Health Organization recommends safe and legal abortions be available to all women.BOOK, World Health Organization, Safe abortion: technical and policy guidance for health systems, 2012, World Health Organization, Geneva, 978-92-4-154843-4, 8, 2nd,weblink PDF, live,weblink" title="web.archive.org/web/20150116223512weblink">weblink 16 January 2015, dmy-all, Around 56 million abortions are performed each year in the world,JOURNAL, Sedgh, Gilda, Bearak, Jonathan, Singh, Susheela, Bankole, Akinrinola, Popinchalk, Anna, Ganatra, Bela, Rossier, Clémentine, Gerdts, Caitlin, Tunçalp, Özge, Johnson, Brooke Ronald, Johnston, Heidi Bart, Alkema, Leontine, Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends, The Lancet, May 2016, 10.1016/S0140-6736(16)30380-4, 27179755, 388, 10041, 258–67, 5498988, with about 45% done unsafely.WEB, Worldwide, an estimated 25 million unsafe abortions occur each year,weblink World Health Organization, 29 September 2017, 28 September 2017,weblink" title="web.archive.org/web/20170929131145weblink">weblink 29 September 2017, live, Abortion rates changed little between 2003 and 2008,JOURNAL, Sedgh, G., Singh, S., Shah, I.H., Åhman, E., Henshaw, S.K., Bankole, A., 10.1016/S0140-6736(11)61786-8, Induced abortion: Incidence and trends worldwide from 1995 to 2008, The Lancet, 379, 9816, 625–32, 2012, 22264435,weblink Because few of the abortion estimates were based on studies of random samples of women, and because we did not use a model-based approach to estimate abortion incidence, it was not possible to compute confidence intervals based on standard errors around the estimates. Drawing on the information available on the accuracy and precision of abortion estimates that were used to develop the subregional, regional, and worldwide rates, we computed intervals of certainty around these rates (webappendix). We computed wider intervals for unsafe abortion rates than for safe abortion rates. The basis for these intervals included published and unpublished assessments of abortion reporting in countries with liberal laws, recently published studies of national unsafe abortion, and high and low estimates of the numbers of unsafe abortion developed by WHO., live,weblink" title="web.archive.org/web/20120206043854weblink">weblink 6 February 2012, dmy-all, before which they decreased for at least two decades as access to family planning and birth control increased.JOURNAL, Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J, Legal abortion worldwide: incidence and recent trends, International Family Planning Perspectives, 33, 3, 106–16, September 2007, 17938093, 10.1363/ifpp.33.106.07,weblink live,weblink" title="web.archive.org/web/20090819122933weblink">weblink 19 August 2009, dmy-all, {{as of|2008}}, 40% of the world's women had access to legal abortions without limits as to reason. Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.JOURNAL, Culwell KR, Vekemans M, de Silva U, Hurwitz M, Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion, International Journal of Gynecology & Obstetrics, 110, S13–16, July 2010, 20451196, 10.1016/j.ijgo.2010.04.003, Historically, abortions have been attempted using herbal medicines, sharp tools, forceful massage, or through other traditional methods.BOOK, 1. Abortion and medicine: A sociopolitical history, 978-1-4443-1293-5, John Wiley & Sons, 2009, Oxford, Management of Unintended and Abnormal Pregnancy, 1st, M, Paul, ES, Lichtenberg, L, Borgatta, DA, Grimes, PG, Stubblefield, MD, Creinin, Carole, Joffe,weblinkweblink" title="web.archive.org/web/20120119025652weblink">weblink 19 January 2012, live, 15895486W, Abortion laws and cultural or religious views of abortions are different around the world. In some areas abortion is legal only in specific cases such as rape, problems with the fetus, poverty, risk to a woman's health, or incest.JOURNAL, Boland, R., Katzive, L., 10.1363/ifpp.34.110.08, Developments in Laws on Induced Abortion: 1998–2007, International Family Planning Perspectives, 34, 3, 110–20, 2008, 18957353,weblink live,weblink" title="web.archive.org/web/20111007221828weblink">weblink 7 October 2011, dmy-all, There is debate over the moral, ethical, and legal issues of abortion.BOOK, Nixon, Frederick, Adolf, Paola, Robert, Walker, Lois, LaCivita, Medical ethics and humanities, 2010, Jones and Bartlett Publishers, Sudbury, MA, 978-0-7637-6063-2, 249,weblink live,weblink 6 September 2017, dmy-all, 13764930W, BOOK, Johnstone, Megan-Jane, Bioethics a nursing perspective, 2009, Churchill Livingstone/Elsevier, Sydney, NSW, 978-0-7295-7873-8, 228, 5th,weblink Although abortion has been legal in many countries for several decades now, its moral permissibilities continues to be the subject of heated public debate., live,weblink 6 September 2017, dmy-all, Those who oppose abortion often argue that an embryo or fetus is a human with a right to life, and they may compare abortion to murder.NEWS, Pastor Mark Driscoll, What do 55 million people have in common?, Fox News, 18 October 2013, 2 July 2014,weblink live,weblink" title="web.archive.org/web/20140831022138weblink">weblink 31 August 2014, dmy-all, NEWS, Dale, Hansen, Abortion: Murder, or Medical Procedure?, The Huffington Post, 18 March 2014, 2 July 2014,weblink live,weblink" title="web.archive.org/web/20140714230359weblink">weblink 14 July 2014, dmy-all, Those who support the legality of abortion often hold that it is part of a woman's right to make decisions about her own body.BOOK, Sifris, Ronli Noa, Reproductive freedom, torture and international human rights: challenging the masculinisation of torture, 2013, Taylor & Francis, Hoboken, NJ, 978-1-135-11522-7, 869373168, 3,weblink live,weblink 15 October 2015, dmy-all, Others favor legal and accessible abortion as a public health measure.BOOK, Swett, C., Unsafe abortion : global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003, 2007, World Health Organization, 978-92-4-159612-1, 5th,weblink 24 March 2018,weblink" title="web.archive.org/web/20180407131435weblink">weblink 7 April 2018, live, {{TOC limit}}

Types

Induced

An induced abortion may be classified as therapeutic (done in response to a health condition of the women or fetus) or elective (chosen for other reasons).WEB,weblink Abortion – medical, 9 July 2018, US National Library of Medicine (Medline Plus),weblink 12 July 2018, live, Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.WEB, Cheng L.,weblink Surgical versus medical methods for second-trimester induced abortion, 1 November 2008, The WHO Reproductive Health Library, World Health Organization, 17 June 2011,weblink" title="web.archive.org/web/20100801023058weblink">weblink 1 August 2010, live, dmy, Most abortions result from unintended pregnancies.JOURNAL, International Family Planning Perspectives, 1998, 24, 3, 117–27, 152, Bankole,weblink Reasons Why Women Have Induced Abortions: Evidence from 27 Countries, 10.2307/3038208, etal, live,weblink" title="web.archive.org/web/20060117191716weblink">weblink 17 January 2006, dmy-all, 3038208, JOURNAL, Lawrence B., Finer, Lori F., Frohwirth, Lindsay A., Dauphinee, Susheela, Singh, Ann M., Moore,weblink Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives, Perspectives on Sexual and Reproductive Health, 37, 3, 110–18, 2005, 10.1111/j.1931-2393.2005.tb00045.x, 16150658, live,weblink 17 January 2006, dmy-all, In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus. A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses.BOOK, Stubblefield, Phillip G., 10. Family Planning, Novak's Gynecology, Berek, Jonathan S., Jonathan Berek, Lippincott Williams & Wilkins, 2002, 13, 978-0-7817-3262-8, {{citation|title=Risk factors for legal induced abortion-related mortality in the United States|pmid=15051566|journal=Obstetrics & Gynecology |year=2004 |last1=Bartlett |first1=LA |last2=Berg |first2=CJ |last3=Shulman |first3=HB |last4=Zane |first4=SB |last5=Green |first5=CA |last6=Whitehead |first6=S |last7=Atrash |first7=HK |volume=103 |issue=4 |pages=729–37 |doi=10.1097/01.AOG.0000116260.81570.60}} Specific procedures may also be selected due to legality, regional availability, and doctor or a woman's personal preference.Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman; to prevent harm to the woman's physical or mental health; to terminate a pregnancy where indications are that the child will have a significantly increased chance of mortality or morbidity; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.WEB, Roche, Natalie E., 28 September 2004, Therapeutic Abortion, eMedicine,weblink" title="web.archive.org/web/20041214092044weblink">weblinkweblink 14 December 2004, 19 June 2011, An abortion is referred to as an elective or voluntary abortion when it is performed at the request of the woman for non-medical reasons. Confusion sometimes arises over the term "elective" because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.WEB,weblink Elective surgery, Encyclopedia of Surgery, 17 December 2012, live,weblink" title="web.archive.org/web/20121113215909weblink">weblink 13 November 2012, dmy-all, "An elective surgery is a planned, non-emergency surgical procedure. It may be either medically required (e.g., cataract surgery), or optional (e.g., breast augmentation or implant) surgery.

Spontaneous

Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.BOOK, Churchill Livingstone medical dictionary, Churchill Livingstone Elsevier, Edinburgh New York, 2008, 978-0-443-10412-1, The preferred term for unintentional loss of the product of conception prior to 24 weeks' gestation is miscarriage., A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth" or a "preterm birth".BOOK, A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight., 669, Gabbe, Steven G., Steven Gabbe, Niebyl, Jennifer R., Simpson, Joe Leigh, 2007, Obstetrics: Normal and Problem Pregnancies, 5, Churchill Livingstone, 51. Legal and Ethical Issues in Obstetric Practice, 978-0-443-06930-7, Annas, George J., George Annas, Elias, Sherman, When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".ENCYCLOPEDIA, birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception, Stillbirth, Concise Medical Dictionary, Oxford University Press, 2010,weblink live,weblink 15 October 2015, dmy-all, 978-0199557141, Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.WEB,weblink 7 FAM 1470 Documenting Stillbirth (Fetal Death), United States Department of State, 18 February 2011, 12 January 2016,weblink 5 February 2016, live, Only 30% to 50% of conceptions progress past the first trimester.BOOK, Gabbe, Steven G., Steven Gabbe, Niebyl, Jennifer R., Simpson, Joe Leigh, 2007, Obstetrics: Normal and Problem Pregnancies, 5, Churchill Livingstone, 24. Pregnancy loss, 978-0-443-06930-7, Annas, George J., George Annas, Elias, Sherman, The vast majority of those that do not progress are lost before the woman is aware of the conception, and many pregnancies are lost before medical practitioners can detect an embryo.BOOK, Katz, Vern L., Mosby, 2007, 5, Katz: Comprehensive Gynecology, Katz, Vern L., Lentz, Gretchen M., Lobo, Rogerio A., Gershenson, David M., 16. Spontaneous and Recurrent Abortion â€“ Etiology, Diagnosis, Treatment, 978-0-323-02951-3, Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.BOOK, Stovall, Thomas G., 17. Early Pregnancy Loss and Ectopic Pregnancy, Novak's Gynecology, Berek, Jonathan S., Jonathan Berek, Lippincott Williams & Wilkins, 2002, 13, 978-0-7817-3262-8, 80% of these spontaneous abortions happen in the first trimester.BOOK, Cunningham, F. Gary, Leveno, Kenneth J., Bloom, Steven L., Spong, Catherine Y., Catherine Y. Spong, Dashe, Jodi S., Hoffman, Barbara L., Casey, Brian M., Sheffield, Jeanne S., Williams Obstetrics, 24th, 2014, McGraw Hill Education, 978-0-07-179893-8, The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,BOOK, Schorge, John O., Joseph I., Schaffer, Lisa M., Halvorson, Barbara L., Hoffman, Karen D., Bradshaw, F. Gary, Cunningham, 2008, Williams Gynecology, 1, McGraw-Hill Medical, 978-0-07-147257-9, 6. First-Trimester Abortion, WEB,weblink Miscarriage (Spontaneous Abortion), 7 April 2009, Stöppler, Melissa Conrad, William C., Jr., Shiel, MedicineNet.com, WebMD, dead,weblink" title="web.archive.org/web/20040829013142weblink">weblink 29 August 2004, accounting for at least 50% of sampled early pregnancy losses.BOOK, Jauniaux E, Kaminopetros P, El-Rafaey H, Early pregnancy loss, Whittle MJ, Rodeck CH, Fetal medicine: basic science and clinical practice, Churchill Livingstone, Edinburgh, 1999,weblink 978-0-443-05357-3, 42792567, 837, Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus. Advancing maternal age and a woman's history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.WEB,weblink Fetal Homicide Laws, 7 April 2009, National Conference of State Legislatures,weblink" title="archive.today/20120911171355weblink">weblink September 11, 2012, {{cbignore|bot=medic}}

Methods

{{Pseudo image|thumb|right|300px|link=:File:Abortionmethods.png|Gestational age may determine which abortion methods are practiced.|image={{#invoke:Block diagram|main|width=300|height=190|  Practice of Induced Abortion MethodsMVAD&EEVAHyst.D&CIntact D&XMifepr.Induced Miscarr.0–12 wks12–28 weeks28–40 wks}}}}

Medical

Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s.JOURNAL, Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A, Medical methods for first trimester abortion, The Cochrane Database of Systematic Reviews, 2011, 11, CD002855, 10.1002/14651858.CD002855.pub4, 22071804, 11, BOOK, Creinin MD, Gemzell-Danielsson K, 2009, Medical abortion in early pregnancy, Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Management of unintended and abnormal pregnancy: comprehensive abortion care, Oxford, Wiley-Blackwell, 111–34, 978-1-4051-7696-5, BOOK, Kapp N, von Hertzen H, 2009, Medical methods to induce abortion in the second trimester, Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Management of unintended and abnormal pregnancy: comprehensive abortion care, Oxford, Wiley-Blackwell, 178–92, 978-1-4051-7696-5, The most common early first-trimester medical abortion regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost) up to 10 weeks (70 days) gestational age,JOURNAL, Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review, Chen MJ, Creinin MD, Obstet Gynecol, July 2015, 126, 1, 12–21, 10.1097/AOG.0000000000000897, 26241251,weblink WEB, Research, Center for Drug Evaluation and, Mifeprex (mifepristone) Information,weblink FDA, 2 July 2019, 8 February 2019, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone. This regime is effective in the second trimester.JOURNAL, Wildschut, H, Both, MI, Medema, S, Thomee, E, Wildhagen, MF, Kapp, N, Medical methods for mid-trimester termination of pregnancy, The Cochrane Database of Systematic Reviews, 19 January 2011, 1, CD005216, 21249669, 10.1002/14651858.CD005216.pub2, Medical abortion regiments involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.JOURNAL, Chen, MJ, Creinin, MD, Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review, Obstetrics and Gynecology, July 2015, 126, 1, 12–21, 10.1097/AOG.0000000000000897, 26241251,weblink In very early abortions, up to 7 weeks gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue.BOOK, WHO Department of Reproductive Health and Research, 2006, Frequently asked clinical questions about medical abortion, Geneva, World Health Organization, 92-4-159484-5,weblink 22 November 2011, live,weblink" title="web.archive.org/web/20111226115043weblink">weblink 26 December 2011, dmy-all, {{subscription required}} Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%.JOURNAL, Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V, September 2009, Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days, Contraception, 80, 3, 282–86, 10.1016/j.contraception.2009.03.010, 19698822, 3766037, The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of vaginal misoprostol) previously used by Planned Parenthood clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman's request. The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of (wikt:buccal|buccal) misoprostol) currently used by Planned Parenthood clinics in the United States since April 2006 is 98% effective through 59 days gestation. If medical abortion fails, surgical abortion must be used to complete the procedure.BOOK, Holmquist S, Gilliam M, 2008, Induced abortion, Gibbs RS, Karlan BY, Haney AF, Nygaard I, Danforth's obstetrics and gynecology, 10th, Philadelphia, Lippincott Williams & Wilkins, 586–603, 978-0-7817-6937-2, Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,WEB, 24 May 2011, Abortion statistics, England and Wales: 2010, London, Department of Health, United Kingdom,weblink 22 November 2011,weblink 1 October 2015, live, WEB, 31 May 2011, Abortion statistics, year ending 31 December 2010, Edinburgh, ISD, NHS Scotland,weblink 22 November 2011, live,weblink" title="web.archive.org/web/20110726193951weblink">weblink 26 July 2011, dmy-all, France,WEB, Vilain A, Mouquet MC, 22 June 2011, Voluntary terminations of pregnancies in 2008 and 2009, Paris, DREES, Ministry of Health, France,weblink 22 November 2011, dead,weblink" title="web.archive.org/web/20110926235733weblink">weblink 26 September 2011, Switzerland,WEB, 5 July 2011, Abortions in Switzerland 2010, Neuchâtel, Office of Federal Statistics, Switzerland,weblink 22 November 2011, dead,weblink" title="web.archive.org/web/20111003203103weblink">weblink 3 October 2011, dmy-all, and the Nordic countries.WEB, Gissler M, Heino A, 21 February 2011, Induced abortions in the Nordic countries 2009, Helsinki, National Institute for Health and Welfare, Finland,weblink 22 November 2011, dead,weblink" title="web.archive.org/web/20120118094034weblink">weblink 18 January 2012, dmy-all, In the United States, the percentage of early medical abortions performed in non-hospital facilities is 31% {{as of|2014|lc=y}}.JOURNAL, Jones, Rachel K., Jerman, Jenna, January 17, 2017, Abortion incidence and service availability in the United States, 2014, Perspectives on Sexual and Reproductive Health, 10.1363/psrh.12015, 28094905, 5487028, 49, 1, 17–27, 96% of all abortions performed in nonhospital facilities × 31% early medical abortions of all nonhospital abortions = 30% early medical abortions of all abortions; 97% of nonhospital medical abortions used mifepristone and misoprostol—3% used methotrexate and misoprostol, or misoprostol alone—in the United States in 2014.Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second-trimester abortions in Canada, most of Europe, China and India, in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.BOOK, Management of unintended and abnormal pregnancy: comprehensive abortion care, Meckstroth K, Paul M, Wiley-Blackwell, 2009, 978-1-4051-7696-5, Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Oxford, 135–156, First-trimester aspiration abortion,

Surgical

(File:Vacuum-aspiration (single).svg|thumb|A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).1: Amniotic sac2: Embryo3: Uterine lining4: Speculum5: Vacurette6: Attached to a suction pump)Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.WEB, Healthwise,weblink Manual and vacuum aspiration for abortion, 2004, WebMD, 5 December 2008,weblink" title="web.archive.org/web/20070211155626weblink">weblink 11 February 2007, live, Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. These techniques can both be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.MVA, also known as "mini-suction" and "menstrual extraction" or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The World Health Organization recommends sharp curettage only when suction aspiration is unavailable.BOOK, Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors, World Health Organization, World Health Organization, 2017, 978-92-4-154587-7, Geneva, Dilatation and curettage, 181845530, 30 July 2019,weblink Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction(D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.BOOK, Dilation and evacuation. In Paul M, Lichtenberg ES Borgatta L Grimes DA Stubblefield P Creinin (eds)Management of unintended and abnormal pregnancy: comprehensive abortion care., Hammond, C, Chasen, S, Oxford: Wiley-Blackwell, 2009, 978-1-4051-7696-5, 178–92, Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.JOURNAL, June 2013, Practice Bulletin No. 135: Second-Trimester Abortion, Obstetrics & Gynecology, en, 121, 6, 1394–1406, 10.1097/01.AOG.0000431056.79334.cc, 23812485, 0029-7844, First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.JOURNAL, Templeton, A., Grimes, D.A., 10.1056/NEJMcp1103639, 22150038, A Request for Abortion, New England Journal of Medicine, 365, 23, 2198–2204, 2011, free, dmy-all,

Labor induction abortion

In places lacking the necessary medical skill for dilation and extraction, or where preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.JOURNAL, Borgatta, L, Global Library of Women's Medicine, December 2014, GLOWM.10444, 10.3843/GLOWM.10444,weblink 25 September 2015, Labor Induction Termination of Pregnancy, live,weblink" title="web.archive.org/web/20150924082507weblink">weblink 24 September 2015, dmy-all, This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.JOURNAL, Society of Family Planning, Clinical Guidelines, Labor induction abortion in the second trimester, Contraception, February 2011, 84, 1, 4–18, 10.1016/j.contraception.2011.02.005, 21664506,weblink 10. What is the effect of feticide on labor induction abortion outcome? Deliberately causing demise of the fetus before labor induction abortion is performed primarily to avoid transient fetal survival after expulsion; this approach may be for the comfort of both the woman and the staff, to avoid futile resuscitation efforts. Some providers allege that feticide also facilitates delivery, although little data support this claim. Transient fetal survival is very unlikely after intraamniotic installation of saline or urea, which are directly feticidal. Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin. Factors associated with a higher likelihood of transient fetal survival with labor induction abortion include increasing gestational age, decreasing abortion interval and the use of nonfeticidal inductive agents such as the PGE1 analogues., 25 September 2015, Only limited data are available comparing this method with dilation and extraction. Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.JOURNAL, 2015 Clinical Policy Guidelines, National Abortion Federation, 2015,weblink 30 October 2015, Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise., live,weblink" title="web.archive.org/web/20150812220053weblink">weblink 12 August 2015, dmy-all,

Other methods

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.BOOK, John M., Riddle, Eve's herbs: a history of contraception and abortion in the West, Harvard University Press, Cambridge, MA, 1997, 978-0-674-27024-4, 36126503, {{rp|44–47, 62–63, 154–55, 230–31}}In 1978 one woman in Colorado died and another was seriously injured when they attempted to procure an abortion by taking pennyroyal oil.{{citation | title=Pennyroyal oil poisoning and hepatoxicity | journal=Journal of the American Medical Association | year=1979|volume=242|issue=26|pages=2873–24|doi=10.1001/jama.1979.03300260043027| last1=Sullivan | first1=John B. |first2=Barry H. |last2=Rumack |first3=Harold Jr|last3=Thomas|display-authors=etal}}Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure,JOURNAL, Ciganda C, Laborde A, Herbal infusions used for induced abortion, Journal of Toxicology: Clinical Toxicology, 41, 3, 235–39, 2003, 12807304, 10.1081/CLT-120021104, such use is not recommended by physicians.Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage.JOURNAL, Smith JP, Risky choices: The dangers of teens using self-induced abortion attempts, Journal of Pediatric Health Care, 12, 3, 147–51, 1998, 9652283, 10.1016/S0891-5245(98)90245-0, In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.JOURNAL, Potts, M., Malcolm Potts, Graff, M., Taing, J., 10.1783/147118907782101904, Thousand-year-old depictions of massage abortion, Journal of Family Planning and Reproductive Health Care, 33, 4, 233–34, 2007, 17925100, One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion is legal and available.JOURNAL, Thapa, S.R., Rimal, D., Preston, J., Self induction of abortion with instrumentation, Australian Family Physician, 35, 9, 697–98, 2006, 16969439,weblink live,weblink" title="web.archive.org/web/20090108181951weblink">weblink 8 January 2009, dmy-all, {{clear}}

Safety

(File:Abortion Quick & Pain Free sign, Joe Slovo Park, Cape Town, South Africa-3869.jpg|thumb|right|An abortion flyer in South Africa)The health risks of abortion depend principally upon whether the procedure is performed safely or unsafely. The World Health Organization defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.WEB, World Health Organization, The Prevention and Management of Unsafe Abortion, April 1992, 18 October 2017,weblinkweblink" title="web.archive.org/web/20100530072310weblink">weblink 30 May 2010, live, Legal abortions performed in the developed world are among the safest procedures in medicine.JOURNAL, Grimes, DA, Creinin, MD, Induced abortion: an overview for internists, Annals of Internal Medicine, 140, 8, 620–26, 2004, 15096333, 10.7326/0003-4819-140-8-200404200-00009, dmy-all, In the United States as of 2012, abortion was estimated to be about 14 times safer for women than childbirth. CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,JOURNAL, Petersen, Emily E., 2019, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017, MMWR. Morbidity and Mortality Weekly Report, 68, 18, 423–429, 10.15585/mmwr.mm6818e1, 31071074, 6542194, 0149-2195, while the US abortion mortality rate is 0.7 maternal deaths per 100,000 procedures.BOOK,weblink Read "The Safety and Quality of Abortion Care in the United States" at NAP.edu, In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term."JOURNAL, Donnelly L, Abortion is Safer than Having a Baby, Doctors Say, The Telegraph, 26 February 2011, Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed [abortion] procedures constitute 13% of maternal mortality globally."JOURNAL, Dixon-Mueller R, Germain A, Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator, American Journal of Public Health, 97, 1, 45–51, January 2007, 16571693, 1716248, 10.2105/AJPH.2005.068056, In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14-16 percent of maternal deaths resulted from abortion.WEB,weblink Abortion in Indonesia, Guttmacher Institute, 2008, 13 October 2019, In the US from 2000 to 2009, abortion had a lower mortality rate than plastic surgery, and a similar or lower mortality rate than running a marathon.JOURNAL, Raymond, EG, Grossman, D, Weaver, MA, Toti, S, Winikoff, B, Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States, Contraception, November 2014, 90, 5, 476–79, 10.1016/j.contraception.2014.07.012, 25152259, Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions.JOURNAL, Ralph, Lauren J., Schwarz, Eleanor Bimla, Grossman, Daniel, Foster, Diana Greene, 2019-06-11, Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study, Annals of Internal Medicine, en, 10.7326/M18-1666, 31181576, 0003-4819, The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.JOURNAL, Raymond, Elizabeth G., Grimes, David A., February 2012, The Comparative Safety of Legal Induced Abortion and Childbirth in the United States, Obstetrics & Gynecology, en, 119, 2, Part 1, 215–219, 10.1097/AOG.0b013e31823fe923, 22270271, 0029-7844, Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.JOURNAL, Abbas, D, Chong, E, Raymond, EG, Outpatient medical abortion is safe and effective through 70 days gestation, Contraception, September 2015, 92, 3, 197–99, 26118638, 10.1016/j.contraception.2015.06.018, Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.JOURNAL, Westfall JM, Sophocles A, Burggraf H, Ellis S, Manual vacuum aspiration for first-trimester abortion, Arch Fam Med, 7, 6, 559–62, 1998, 9821831, 10.1001/archfami.7.6.559,weblink dead,weblink" title="web.archive.org/web/20050405202853weblink">weblink 5 April 2005, Infections account for one-third of abortion-related deaths in the United States.JOURNAL, Dempsey, A, Serious infection associated with induced abortion in the United States, Clinical Obstetrics and Gynecology, December 2012, 55, 4, 888–92, 10.1097/GRF.0b013e31826fd8f8, 23090457, The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.JOURNAL, White, Kari, Carroll, Erin, Grossman, Daniel, Complications from first-trimester aspiration abortion: a systematic review of the literature, Contraception, November 2015, 92, 5, 422–38, 10.1016/j.contraception.2015.07.013, 26238336, Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures,JOURNAL, ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures, Obstetrics & Gynecology, 113, 5, 1180–89, May 2009, 19384149, 10.1097/AOG.0b013e3181a6d011, ACOG Committee on Practice Bulletins – Gynecology, as they are believed to substantially reduce the risk of postoperative uterine infection;JOURNAL, Sawaya GF, Grady D, Kerlikowske K, Grimes DA, Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis, Obstetrics & Gynecology, 87, 5 Pt 2, 884–90, May 1996, 8677129, however, antibiotics are not routinely given with abortion pills.JOURNAL, Achilles, Sharon L., Reeves, Matthew F., April 2011, Prevention of infection after induced abortion, Contraception, en, 83, 4, 295–309, 10.1016/j.contraception.2010.11.006, 21397086, The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner.JOURNAL, Barnard, S, Kim, C, Park, MH, Ngo, TD, Doctors or mid-level providers for abortion, The Cochrane Database of Systematic Reviews, 27 July 2015, 7, CD011242, 10.1002/14651858.CD011242.pub2, 26214844, Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen. Second-trimester abortions are generally well-tolerated.JOURNAL, Lerma, Klaira, Shaw, Kate A., 2017-09-15, Update on second trimester medical abortion, Current Opinion in Obstetrics and Gynecology, 10.1097/GCO.0000000000000409, 1473-656X, 28922193, 29, 6, 413–18, There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation. Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.WEB, Grossman D, 3 September 2004, Medical methods for first trimester abortion: RHL commentary, Reproductive Health Library, Geneva, World Health Organization,weblink 22 November 2011, live,weblink" title="web.archive.org/web/20111028054620weblink">weblink 28 October 2011, dmy-all, WEB, Chien P, Thomson M, 15 December 2006, Medical versus surgical methods for first trimester termination of pregnancy: RHL commentary, Reproductive Health Library, Geneva, World Health Organization,weblink 1 June 2010,weblink" title="web.archive.org/web/20100517201143weblink">weblink 17 May 2010, live, Some purported risks of abortion are promoted primarily by anti-abortion groups,JOURNAL, Schneider, A. Patrick II, Zainer, Christine, The breast cancer epidemic: 10 facts, The Linacre Quarterly, August 2014, 81, 3, 244–77, 10.1179/2050854914Y.0000000027, 25249706, Catholic Medical Association, an association between [induced abortion] and breast cancer has been found by numerous Western and non-Western researchers from around the world. This is especially true in more recent reports that allow for a sufficient breast cancer latency period since an adoption of a Western life style in sexual and reproductive behavior., etal, free, 4135458, but lack scientific support.JOURNAL, Jasen P, Breast cancer and the politics of abortion in the United States, Medical History, 49, 4, 423–44, October 2005, 16562329, 1251638, 10.1017/S0025727300009145, For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the World Health Organization, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.Position statements of major medical bodies on abortion and breast cancer include:
  • World Health Organization: WEB,weblink Induced abortion does not increase breast cancer risk (Fact sheet N°240), World Health Organization, 6 January 2011,weblink" title="web.archive.org/web/20110213141046weblink">weblink 13 February 2011,
  • National Cancer Institute: WEB,weblink Abortion, Miscarriage, and Breast Cancer Risk, National Cancer Institute, 11 January 2011,weblink" title="web.archive.org/web/20101221084337weblink">weblink 21 December 2010, live,
  • American Cancer Society: WEB,weblink American Cancer Society, 23 September 2010, 20 June 2011, Is Abortion Linked to Breast Cancer?, At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer.,weblink" title="web.archive.org/web/20110605204701weblink">weblink 5 June 2011, live,
  • Royal College of Obstetricians and Gynaecologists: WEB,weblink The Care of Women Requesting Induced Abortion, 9, Royal College of Obstetricians and Gynaecologists, 29 June 2008, Induced abortion is not associated with an increase in breast cancer risk., dead,weblink" title="web.archive.org/web/20130727105037weblink">weblink 27 July 2013,
  • American Congress of Obstetricians and Gynecologists: WEB,weblink ACOG Finds No Link Between Abortion and Breast Cancer Risk, 31 July 2003, American Congress of Obstetricians and Gynecologists, 11 January 2011,weblink" title="web.archive.org/web/20110102030744weblink">weblink 2 January 2011, dead,
In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record."BOOK, Gordon, Linda, The Moral Property of Women, University of Illinois Press, 2002, 0-252-02764-7, {{rp|25|}} According to Rickie Solinger,{{rp|4}}}}Authors Jerome Bates and Edward Zawadzki describe the case of an illegal abortionist in the eastern U.S. in the early 20th century who was proud of having successfully completed 13,844 abortions without any fatality.BOOK, Bates, Jerome E., Zawadzki, Edward S., Criminal Abortion: A Study in Medical Sociology, Charles C. Thomas, 1964, 978-0-398-00109-4, {{rp|59}}In 1870s New York City the famous abortionist/midwife Madame Restell (Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patientsBOOK, Keller, Allan, Scandalous Lady: The Life and Times of Madame Restell, Atheneum, 1981, 978-0-689-11213-3, —a lower mortality rate than the childbirth mortality rate at the time. In 1936 the prominent professor of obstetrics and gynecology Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that{{rp|223}}}}

Mental health

Current evidence finds no relationship between most induced abortions and mental-health problemsJOURNAL, Horvath, S, Schreiber, CA, Unintended Pregnancy, Induced Abortion, and Mental Health, Current Psychiatry Reports, 14 September 2017, 19, 11, 77, 10.1007/s11920-017-0832-4, 28905259, other than those expected for any unwanted pregnancy. A report by the American Psychological Association concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain.PRESS RELEASE, American Psychological Association, APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health, 12 August 2008, 7 September 2011,weblink live,weblink" title="web.archive.org/web/20110906022824weblink">weblink 6 September 2011, dmy-all, WEB,weblink Report of the APA Task Force on Mental Health and Abortion, American Psychological Association, Washington, DC, 13 August 2008, live,weblink" title="web.archive.org/web/20100615020211weblink">weblink 15 June 2010, dmy-all, Some older reviews concluded that abortion was associated with an increased risk of psychological problems;JOURNAL, Coleman, PK, Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009, The British Journal of Psychiatry, September 2011, 199, 3, 180–86, 10.1192/bjp.bp.110.077230, 21881096, however, they did not use an appropriate control group.Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,WEB,weblink Mental Health and Abortion, American Psychological Association, 2008, 18 April 2012, live,weblink" title="web.archive.org/web/20120419174044weblink">weblink 19 April 2012, dmy-all, more rigorous research would be needed to show this conclusively.JOURNAL, Steinberg, J.R., Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions – A Critical Review of Research, 10.1016/j.whi.2011.02.002, Women's Health Issues, 21, 3, S44–S48, 2011, 21530839, Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome", but this is not recognized by medical or psychological professionals in the United States.JOURNAL, Kelly, Kimberly, The spread of 'Post Abortion Syndrome' as social diagnosis, Social Science & Medicine, February 2014, 102, 18–25, 10.1016/j.socscimed.2013.11.030, 24565137,

Unsafe abortion

(File:RussianAbortionPoster.jpg|thumb|Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Abortions performed by either trained or self-taught midwives not only maim the woman, they also often lead to death.")Women seeking an abortion may use unsafe methods, especially when abortion is legally restricted. They may attempt self-induced abortion or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.JOURNAL, Okonofua, F., Abortion and maternal mortality in the developing world, Journal of Obstetrics and Gynaecology Canada, 28, 11, 974–79, 2006, 17169222,weblink dead,weblink" title="web.archive.org/web/20120111121431weblink">weblink 11 January 2012, dmy, 10.1016/S1701-2163(16)32307-6, Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries. Unsafe abortions are believed to result in millions of injuries.JOURNAL, Haddad, LB, Nour, NM, Unsafe abortion: unnecessary maternal mortality, Reviews in Obstetrics & Gynecology, 2, 2, 122–26, 2009, 19609407, 2709326, Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;JOURNAL, Lozano, R, Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet, 15 December 2012, 380, 9859, 2095–128, 23245604, 10.1016/S0140-6736(12)61728-0, 10536/DRO/DU:30050819, free, deaths from unsafe abortion account for around 13% of all maternal deaths.BOOK, Darney, Leon Speroff, Philip D., A clinical guide for contraception, 2010, Lippincott Williams & Wilkins, Philadelphia, 978-1-60831-610-6, 406, 5th, The World Health Organization believes that mortality has fallen since the 1990s.BOOK, World Health Organisation, Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008, World Health Organisation, 2011, 6th, 27, 978-92-4-150111-8,weblink live,weblink" title="web.archive.org/web/20140328093307weblink">weblink 28 March 2014, dmy-all, To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.JOURNAL, Berer M, Making abortions safe: a matter of good public health policy and practice, Bulletin of the World Health Organization, 78, 5, 580–92, 2000, 10859852, 2560758, In response, opponents of abortion point out that abortion bans in no way affect prenatal care for women who choose to carry their fetus to term. The Dublin Declaration on Maternal Health, signed in 2012, notes, "the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women."WEB,weblink Translations, Dublin Declaration, 28 October 2015, live,weblink" title="web.archive.org/web/20151028135616weblink">weblink 28 October 2015, dmy-all, A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to those where abortion is legal and available.JOURNAL, Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH, Induced abortion: estimated rates and trends worldwide, 2007, Lancet, 370, 9595, 1338–45, 10.1016/S0140-6736(07)61575-X, 17933648, 10.1.1.454.4197, WEB, World Health Organization, 2007, 7 March 2011,weblink Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003,weblink" title="web.archive.org/web/20110216141018weblink">weblink 16 February 2011, live, JOURNAL, Berer M, National laws and unsafe abortion: the parameters of change, Reproductive Health Matters, 12, 24 Suppl, 1–8, November 2004, 15938152, 10.1016/S0968-8080(04)24024-1, JOURNAL, Culwell, Kelly R., Hurwitz, Manuelle, Addressing barriers to safe abortion, International Journal of Gynecology & Obstetrics, May 2013, 121, S16–S19, 10.1016/j.ijgo.2013.02.003, 23477700, For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,JOURNAL, Jewkes R, Rees H, Dickson K, Brown H, Levin J, The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change, BJOG: An International Journal of Obstetrics & Gynaecology, 112, 3, 355–59, March 2005, 15713153, 10.1111/j.1471-0528.2004.00422.x, with abortion-related deaths dropping by more than 90%.JOURNAL, Bateman C, Maternal mortalities 90% down as legal TOPs more than triple, South African Medical Journal, 97, 12, 1238–42, December 2007, 18264602,weblink live,weblink" title="web.archive.org/web/20170830200316weblink">weblink 30 August 2017, dmy-all, Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.JOURNAL, Conti, Jennifer A., Brant, Ashley R., Shumaker, Heather D., Reeves, Matthew F., Update on abortion policy, Current Opinion in Obstetrics and Gynecology, 28, 6, November 2016, 517–521, 10.1097/GCO.0000000000000324, 27805969, A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state.JOURNAL, New, M.J., Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era, State Politics & Policy Quarterly, 15 February 2011, 11, 1, 28–47, 10.1177/1532440010387397, The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.JOURNAL, Medoff, M.H., Dennis, C., Another Critical Review of New's Reanalysis of the Impact of Antiabortion Legislation, State Politics & Policy Quarterly, 21 July 2014, 14, 3, 269–76, 10.1177/1532440014535476, In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally.WEB,weblink Facts on Investing in Family Planning and Maternal and Newborn Health, Guttmacher Institute, 2010, 24 May 2012, dead,weblink" title="web.archive.org/web/20120324101905weblink">weblink 24 March 2012, Rates of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".WEB,weblink Unsafe Abortion – The Preventable Pandemic, 2010-01-16, Grimes, David A., live,weblink" title="web.archive.org/web/20140305122947weblink">weblink 5 March 2014, dmy-all, JOURNAL, Nations, MK, Women's hidden transcripts about abortion in Brazil, Social Science & Medicine, 1997, 44, 12, 1833–45, 10.1016/s0277-9536(96)00293-6, 9194245, Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,BOOK, Maclean, Gaynor,weblink XI. Dimension, Dynamics and Diversity: A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives, 299–300, Trends in Midwifery Research, Randell E., Balin, Nova Publishers, 2005, 978-1-59454-477-4, live,weblink" title="web.archive.org/web/20150315113348weblink">weblink 15 March 2015, dmy-all, though this varies by region.JOURNAL, Salter, C., Johnson, H.B., Hengen, N., 1997,weblink Care for Postabortion Complications: Saving Women's Lives, Population Reports, 25, 1, Johns Hopkins School of Public Health,weblink" title="web.archive.org/web/20091207070103weblink">weblink dead, 7 December 2009, Secondary infertility caused by an unsafe abortion affects an estimated 24 million women. The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.WEB, Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health, UNICEF, UNFPA, WHO, World Bank, 2010, 31 December 2010,weblink dead,weblink" title="web.archive.org/web/20101109224916weblink">weblink 9 November 2010, dmy-all,

Live birth

In 2019, a US Senate Bill entitled the "Born-Alive Abortion Survivors Protection Act" raised the issue of live birth after abortion.WEB,weblink The Facts on the Born-Alive Debate, Robertson, Lori, 2019-03-04, FactCheck.org, 2019-08-05, NEWS,weblink 'Executing Babies': Here Are the Facts Behind Trump's Misleading Abortion Tweet, Grady, Denise, 2019-02-26, The New York Times, 2019-08-05, 0362-4331, The bill would mandate that medical providers resuscitate neonates delivered showing signs of life during an abortion process. During the debate around this issue, US Republicans falsely alleged that medical providers "execute" live-born babies. Existing US laws would punish execution as homicide. Furthermore, US abortion experts refute the claim that a "born-alive" fetus is a common event and reject laws that would mandate resuscitation against the wishes of the parents.JOURNAL, Jatlaoui, Tara C., 2018, Abortion Surveillance — United States, 2015, MMWR. Surveillance Summaries, 67, 13, 1–45, 10.15585/mmwr.ss6713a1, 30462632, 6289084, 1546-0738, Only 1.3% of abortions occur after 21 weeks of pregnancy in the US. Although it is very uncommon, women undergoing surgical abortion after this gestational age sometimes give birth to a fetus that may survive briefly.JOURNAL, November 2011, The Care of Women Requesting Induced Abortion. Evidence-Based Clinical Guideline no. 7,weblink live, Royal College of Obstetricians and Gynaecologists,weblink 14 November 2015, 31 October 2015, Recommendation 6.21 Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation to ensure that there is no risk of a live birth., dmy-all, JOURNAL, Society of Family Planning, February 2011, Clinical Guidelines, Labor induction abortion in the second trimester,weblink Contraception, 84, 1, 4–18, 10.1016/j.contraception.2011.02.005, 21664506, Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin., JOURNAL, Fletcher, Isada, Johnson, Evans, August 1992, Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues, Obstetrics and Gynecology, 80, 2, 310–13, 1635751, following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management., The periviable period is considered to be between 20 and 25 weeks gestation.WEB,weblink Periviable Birth - ACOG, www.acog.org, 2019-07-14, Long-term survival is possible after 22 weeks.JOURNAL, May 2010, Termination of Pregnancy for Fetal Abnormality,weblink live, Royal College of Obstetricians and Gynaecologists, 29–31,weblink 22 December 2015, 26 October 2015, dmy-all, However, odds of long-term survival between 22 and 23 weeks are 2-3 percent and odds of survival between 23 and 24 weeks are 20 percent.JOURNAL, Younge, Noelle, Goldstein, Ricki F., Bann, Carla M., Hintz, Susan R., Patel, Ravi M., Smith, P. Brian, Bell, Edward F., Rysavy, Matthew A., Duncan, Andrea F., 2017-02-16, Survival and Neurodevelopmental Outcomes among Periviable Infants, New England Journal of Medicine, 376, 7, 617–628, 10.1056/NEJMoa1605566, 0028-4793, 28199816, 5456289, "Intact survival", which means survival of a neonate without subsequent damage to organs such as the brain or bowel is 1% at 22 weeks and 13% at 23 weeks. Survival odds increase with increasing gestational age.If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not.JOURNAL, Nuffield Council on Bioethics, 2007, Critical care decisions in fetal and neonatal medicine: a guide to the report,weblink live,weblink" title="web.archive.org/web/20160304040916weblink">weblink 4 March 2016, 29 October 2015, Under English law, fetuses have no independent legal status. Once born, babies have the same rights to life as other people., dmy-all, JOURNAL, Gerri R. Baer, Robert M. Nelson, 2007, Preterm Birth: Causes, Consequences, and Prevention. C: A Review of Ethical Issues Involved in Premature Birth,weblink live, Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes,weblink" title="web.archive.org/web/20151231190458weblink">weblink 31 December 2015, In 2002, the 107th U.S. Congress passed the Born-Alive Infants Protection Act of 2001. This law established personhood for all infants who are born "at any stage of development" who breathe, have a heartbeat, or "definite movement of voluntary muscles", regardless of whether the birth was due to labor or induced abortion., dmy-all, WEB,weblink H.R. 2175 (107th): Born-Alive Infants Protection Act of 2002, Chabot, Steve, 5 August 2002, govtrack.us,weblink 14 November 2015, live, 30 October 2015, The term "born alive" is defined as the complete expulsion or extraction from its mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of the voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion., Pub.L. 107-207, dmy-all, Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended by some sources to avoid this and to comply with the US Partial Birth Abortion Ban.JOURNAL, June 2013, Practice Bulletin: Second-Trimester Abortion,weblink live, Obstetrics & Gynecology, 121, 6, 1394–1406, 10.1097/01.AOG.0000431056.79334.cc, 23812485,weblink" title="web.archive.org/web/20151114063257weblink">weblink 14 November 2015, 30 October 2015, With medical abortion after 20 weeks of gestation, induced fetal demise may be preferable to the woman or provider in order to avoid transient fetal survival after expulsion., dmy-all, JOURNAL, Higginbotham Susan, January 2010, Clinical Guidelines: Induction of fetal demise before abortion,weblink live, Contraception: A Publication of Society of Family Planning, 81, 6, 462–73, 10.1016/j.contraception.2010.01.018, 20472112,weblink" title="web.archive.org/web/20151123065302weblink">weblink 23 November 2015, 26 October 2015, Inducing fetal demise before induction termination avoids signs of live birth that may have beneficial emotional, ethical and legal consequences., dmy-all, JOURNAL, Committee on Health Care for Underserved Women, November 2014, Committee Opinion 613: Increasing Access to Abortion,weblink live, Obstetrics & Gynecology, 124, 5, 1060–65, 10.1097/01.aog.0000456326.88857.31, 25437742,weblink" title="web.archive.org/web/20151028182952weblink">weblink 28 October 2015, 28 October 2015, "Partial-birth" abortion bans – The federal Partial-Birth Abortion Ban Act of 2003 (upheld by the Supreme Court in 2007) makes it a federal crime to perform procedures that fall within the definition of so-called "partial-birth abortion" contained in the statute, with no exception for procedures necessary to preserve the health of the woman...physicians and lawyers have interpreted the banned procedures as including intact dilation and evacuation unless fetal demise occurs before surgery., dmy-all, JOURNAL, 2015, 2015 Clinical Policy Guidelines,weblink live, National Abortion Federation,weblink" title="web.archive.org/web/20150812220053weblink">weblink 12 August 2015, 30 October 2015, Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise., dmy-all, JOURNAL, Milliez Jacques, 2008, FIGO Committee Report: Ethical aspects concerning termination of pregnancy following prenatal diagnosis, International Journal of Gynecology and Obstetrics, 102, 1, 97–98, 10.1016/j.ijgo.2008.03.002, 18423641, Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide., Induced fetal demise does not improve the safety of an abortion procedure and may incur risks to the health of the woman having the abortion.

Incidence

There are two commonly used methods of measuring the incidence of abortion:
  • Abortion rate â€“ number of abortions per 1000 women between 15 and 44 years of age
  • Abortion percentage â€“ number of abortions out of 100 known pregnancies (pregnancies include live births, abortions and miscarriages)
In many places, where abortion is illegal or carries a heavy social stigma, medical reporting of abortion is not reliable. For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.The number of abortions performed worldwide seems to have remained stable in recent years, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008. The abortion rate worldwide was 28 per 1000 women, though it was 24 per 1000 women for developed countries and 29 per 1000 women for developing countries. The same 2012 study indicated that in 2008, the estimated abortion percentage of known pregnancies was at 21% worldwide, with 26% in developed countries and 20% in developing countries.On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. However, restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely.JOURNAL, Shah I, Ahman E, Unsafe abortion: global and regional incidence, trends, consequences, and challenges, Journal of Obstetrics and Gynaecology Canada, 31, 12, 1149–58, December 2009, 20085681, 10.1016/s1701-2163(16)34376-6, However, a woman's chance of having an abortion is similar whether she lives in a developed or a developing region: in 2003 the rates were 26 abortions per 1000 women aged 15 to 44 in developed areas and 29 per 1000 in developing areas. The main difference is in safety, with abortion being safe and easily accessible in developed countries and generally restricted and unsafe in most developing countries, NEWS, Rosenthal, Elizabeth,weblink Legal or Not, Abortion Rates Compare, The New York Times, 12 October 2007, 18 July 2011, live,weblink" title="web.archive.org/web/20110828173628weblink">weblink 28 August 2011, dmy-all, The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.WEB,weblink Facts on Investing in Family Planning and Maternal and Newborn Health, Guttmacher Institute, November 2010, 24 October 2011, dead,weblink" title="web.archive.org/web/20111020135329weblink">weblink 20 October 2011, The rate of legal, induced abortion varies extensively worldwide. According to the report of employees of Guttmacher Institute it ranged from 7 per 1000 women (Germany and Switzerland) to 30 per 1000 women (Estonia) in countries with complete statistics in 2008. The proportion of pregnancies that ended in induced abortion ranged from about 10% (Israel, the Netherlands and Switzerland) to 30% (Estonia) in the same group, though it might be as high as 36% in Hungary and Romania, whose statistics were deemed incomplete.JOURNAL, Sedgh, G., Singh, S., Henshaw, S.K., Bankole, A., Legal Abortion Worldwide in 2008: Levels and Recent Trends, 10.1363/4318811, Perspectives on Sexual and Reproductive Health, 43, 3, 188–98, 2011, 21884387,weblink live,weblink" title="web.archive.org/web/20120107111306weblink">weblink 7 January 2012, dmy-all, National Institute of Statistics, weblink" title="web.archive.org/web/20110515195102weblink">Romanian Statistical Yearbook, chapter 2, page 62, 2011An American study in 2002 concluded that about half of women having abortions were using a form of contraception at the time of becoming pregnant. Inconsistent use was reported by half of those using condoms and three-quarters of those using the birth control pill; 42% of those using condoms reported failure through slipping or breakage.JOURNAL, 10.2307/3097748, Jones, R.K., Darroch, J.E., Henshaw, S.K., Contraceptive Use Among U.S. Women Having Abortions in 2000–2001, Perspectives on Sexual and Reproductive Health, 34, 6, 294–303, 2002, 12558092,weblink live,weblink" title="web.archive.org/web/20060615011127weblink">weblink 15 June 2006, dmy-all, 3097748, 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".JOURNAL, SA, Cohen,weblink Abortion and Women of Color: The Bigger Picture, Guttmacher Policy Review, 2008, 11, 3, live,weblink" title="web.archive.org/web/20080915094346weblink">weblink 15 September 2008, dmy-all, The abortion rate may also be expressed as the average number of abortions a woman has during her reproductive years; this is referred to as total abortion rate (TAR).

Gestational age and method

{{multiple image| align = right| image1 = UK abortion by gestational age 2004 histogram.svg| width1 = 200| alt1 = | caption1 = | image2 = US abortion by gestational age 2004 histogram.svg| width2 = 200| alt2 = | caption2 = | footer = Histogram of abortions by gestational age in England and Wales during 2004. (left) Abortion in the United States by gestational age, 2004. (right)}}Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention (CDC) reported that 26% of reported legal induced abortions in the United States were known to have been obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 18% at 9 through 10 weeks, 10% at 11 through 12 weeks, 6% at 13 through 15 weeks, 4% at 16 through 20 weeks and 1% at more than 21 weeks. 91% of these were classified as having been done by "curettage" (suction-aspiration, dilation and curettage, dilation and evacuation), 8% by "medical" means (mifepristone), >1% by "intrauterine instillation" (saline or prostaglandin), and 1% by "other" (including hysterotomy and hysterectomy).JOURNAL, Strauss, L.T., Gamble, S.B., Parker, W.Y., Cook, D.A., Zane, S.B., Hamdan, S., Abortion surveillance – United States, 2003, Morbidity and Mortality Weekly Report Surveillance Summaries, 55, SS11, 1–32, 2006, 17119534,weblink Centers for Disease Control Prevention, live,weblink 2 June 2017, dmy-all, According to the CDC, due to data collection difficulties the data must be viewed as tentative and some fetal deaths reported beyond 20 weeks may be natural deaths erroneously classified as abortions if the removal of the dead fetus is accomplished by the same procedure as an induced abortion.WEB, The Guttmacher Institute, The limitations of U.S. statistics on abortion, Issues in Brief, New York, 1997,weblinkweblink" title="web.archive.org/web/20120404080239weblink">weblink 4 April 2012, dead, The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for

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