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abortion
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{{short description|Termination of a pregnancy}}{{cs1 config|name-list-style=vanc}}{{other uses}}{{pp-semi-indef}}{{pp-move}}{{use dmy dates|date=November 2019}}{{use American English|date=September 2016}}- the content below is remote from Wikipedia
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Types
Induced
Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.WEB, Cheng L, 1 November 2008, Surgical versus medical methods for second-trimester induced abortion,apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html, The WHO Reproductive Health Library, World Health Organization, 17 June 2011,apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html," title="web.archive.org/web/20100801023058apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html,">web.archive.org/web/20100801023058apps.who.int/rhl/fertility/abortion/CD006714_chengl_com/en/index.html, 1 August 2010, dead, Most abortions result from unintended pregnancies.JOURNAL, International Family Planning Perspectives, 1998, 24, 3, 117–27, 152, Bankole A, Singh S, Haas T,www.guttmacher.org/pubs/journals/2411798.html, Reasons Why Women Have Induced Abortions: Evidence from 27 Countries, 10.2307/3038208, live,www.guttmacher.org/pubs/journals/2411798.html," title="web.archive.org/web/20060117191716www.guttmacher.org/pubs/journals/2411798.html,">web.archive.org/web/20060117191716www.guttmacher.org/pubs/journals/2411798.html, 17 January 2006, 3038208, subscription, JOURNAL, Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM, Reasons U.S. women have abortions: quantitative and qualitative perspectives, Perspectives on Sexual and Reproductive Health, 37, 3, 110–118, September 2005, 16150658, 10.1111/j.1931-2393.2005.tb00045.x,www.guttmacher.org/pubs/journals/3711005.pdf, live,web.archive.org/web/20060117143856/https://www.guttmacher.org/pubs/journals/3711005.pdf, 17 January 2006, In the United Kingdom, 1 to 2% of abortions are done because of 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 PG, 10. Family Planning, Novak’s Gynecology, Berek JS, Jonathan Berek, Lippincott Williams & Wilkins, 2002, 13, 978-0-7817-3262-8, JOURNAL, Risk factors for legal induced abortion-related mortality in the United States, 15051566, Obstetrics & Gynecology, 2004, Bartlett LA, Berg CJ, Holly Shulman, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK, 103, 4, 729–737, 10.1097/01.AOG.0000116260.81570.60, 42597014, free, Legality, regional availability, and a woman’s or her doctor’s personal preference may inform her choice of a specific procedure. 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 NE, 28 September 2004, Therapeutic Abortion, eMedicine,www.emedicine.com/MED/topic3311.htm," title="web.archive.org/web/20041214092044www.emedicine.com/MED/topic3311.htm,">web.archive.org/web/20041214092044www.emedicine.com/MED/topic3311.htm,emedicine.medscape.com/article/252560-overview, 14 December 2004, 19 June 2011, An abortion is referred to as elective or voluntary when it is performed at the request of the woman for non-medical reasons. Confusion sometimes arises over the term elective because “elective surgery” generally refers to all scheduled surgery, whether medically necessary or not.JOURNAL, Janiak, Elizabeth, Goldberg, Alisa B., 2016-02-01, Eliminating the phrase ‘elective abortion’: why language matters,www.contraceptionjournal.org/article/S0010-7824(15)00624-1/abstract, Contraception, English, 93, 2, 89–92, 10.1016/j.contraception.2015.10.008, 26480889, 0010-7824, 27 November 2022, 24 January 2023,web.archive.org/web/20230124173416/https://www.contraceptionjournal.org/article/S0010-7824%2815%2900624-1/fulltext, live, subscription,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 SG, Niebyl JR, Simpson JL, Steven Gabbe, 2007, Obstetrics: Normal and Problem Pregnancies, 5th, Churchill Livingstone, 51. Legal and Ethical Issues in Obstetric Practice, 978-0-443-06930-7, AnnasGJ, Elias S, George Annas, 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,books.google.com/books?id=Zs8ZM4OUurcC&pg=PA698, live,web.archive.org/web/20151015195038/https://books.google.com/books?id=Zs8ZM4OUurcC&pg=PA698, 15 October 2015, 978-0-19-955714-1, Premature births and stillbirths are generally not considered to be miscarriages, although usage of these terms can sometimes overlap.WEB,fam.state.gov/FAM/07FAM/07FAM1470.html, 7 FAM 1470 Documenting Stillbirth (Fetal Death), United States Department of State, 18 February 2011, 12 January 2016,web.archive.org/web/20160205060246/https://fam.state.gov/FAM/07FAM/07FAM1470.html, 5 February 2016, live, Studies of pregnant women in the US and China have shown that between 40% and 60% of embryos do not progress to birth.BOOK, Gabbe SG, Niebyl JR, Simpson JL, Steven Gabbe, 2007, Obstetrics: Normal and Problem Pregnancies, 5th, Churchill Livingstone, 24. Pregnancy loss, 978-0-443-06930-7, Annas GJ, Elias S, George Annas, JOURNAL, Early embryo mortality in natural human reproduction: What the data say [version 2; peer review: 2 approved, 1 approved with reservations],f1000research.com/articles/5-2765#ref-27, f1000research.com, 7 June 2017, 13 May 2022, Jarvis GE, 19 January 2022,web.archive.org/web/20220119134105/https://f1000research.com/articles/5-2765#ref-27, live, JOURNAL, Estimating limits for natural human embryo mortality [version 1; peer review: 2 approved],f1000research.com/articles/5-2083/v1, f1000research.com, 26 August 2016, 14 May 2022, Jarvis GE, 24 January 2023,web.archive.org/web/20230124173420/https://f1000research.com/articles/5-2083/v1, live, The vast majority of miscarriages occur before the woman is aware that she is pregnant, and many pregnancies spontaneously abort before medical practitioners can detect an embryo.BOOK, Katz VL, Mosby, 2007, 5 th, Katz: Comprehensive Gynecology, Katz VL, Lentz GM, Lobo RA, Gershenson DM, 16. Spontaneous and Recurrent Abortion – 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 TG, 17. Early Pregnancy Loss and Ectopic Pregnancy, Novak’s Gynecology, Berek JS, Jonathan Berek, Lippincott Williams & Wilkins, 2002, 13, 978-0-7817-3262-8, 80% of these spontaneous abortions happen in the first trimester.BOOK, Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS, Catherine Y. Spong, 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 JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG, 2008, Williams Gynecology, 1, McGraw-Hill Medical, 978-0-07-147257-9, 6. First-Trimester Abortion, WEB,www.medicinenet.com/miscarriage/page1.htm, Miscarriage (Spontaneous Abortion), 7 April 2009, Stöppler MS, Shiel Jr WC, MedicineNet.com, WebMD, dead,www.medicinenet.com/Miscarriage/page1.htm," title="web.archive.org/web/20040829013142www.medicinenet.com/Miscarriage/page1.htm,">web.archive.org/web/20040829013142www.medicinenet.com/Miscarriage/page1.htm, 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,books.google.com/books?id=0BY0hx2l5uoC, 978-0-443-05357-3, 42792567, 837, {{Dead link|date=August 2021 |bot=InternetArchiveBot |fix-attempted=yes }} 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,www.ncsl.org/programs/health/fethom.htm, Fetal Homicide Laws, 7 April 2009, National Conference of State Legislatures,www.ncsl.org/issues-research/health/fetal-homicide-state-laws.aspx," title="archive.today/20120911171355www.ncsl.org/issues-research/health/fetal-homicide-state-laws.aspx,">archive.today/20120911171355www.ncsl.org/issues-research/health/fetal-homicide-state-laws.aspx, 11 September 2012, {{cbignore|bot=medic}}Methods
Medical
{{Image frame|width=300|innerstyle=font-size:88%;|link=:File:Abortionmethods.png|caption=Gestational age may determine which abortion methods are practiced.|content={{#invoke:Block diagram|main|width=300|height=190| Practice of Induced Abortion MethodsMVAD&EEVAHyst.D&CIntact D&XMifepr.Induced Miscarr.0–12 wks12–28 weeks28–40 wks}}}}Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s.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, 111–134, 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, 178–192, 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,WEB, Center for Drug Evaluation and Research, Mifeprex (mifepristone) Information,www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information, FDA, 2 July 2019, 8 February 2019, 23 April 2019,web.archive.org/web/20190423032409/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm, live, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone, particularly in the second trimester.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, 2011, 1, CD005216, January 2011, 21249669, 8557267, 10.1002/14651858.CD005216.pub2, Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days’ gestation.JOURNAL, Chen MJ, Creinin MD, Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review, Obstetrics and Gynecology, 126, 1, 12–21, July 2015, 26241251, 10.1097/AOG.0000000000000897,www.escholarship.org/uc/item/2pw521h5, 30 July 2019, live, 20800109,web.archive.org/web/20200726105924/https://escholarship.org/uc/item/2pw521h5, 26 July 2020, File:Abortion pill.jpg|thumb|right|Shown here is the typical regimen for early medical abortions (200 mg mifepristone and 800 μg misoprostolmisoprostolIn 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,whqlibdoc.who.int/publications/2006/9241594845_eng.pdf, Frequently asked clinical questions about medical abortion, World Health Organization, 2006, 92-4-159484-5, Geneva, 22 November 2011, subscription,whqlibdoc.who.int/publications/2006/9241594845_eng.pdf," title="web.archive.org/web/20111226115043whqlibdoc.who.int/publications/2006/9241594845_eng.pdf,">web.archive.org/web/20111226115043whqlibdoc.who.int/publications/2006/9241594845_eng.pdf, 26 December 2011, dead, Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%.JOURNAL, Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V, Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days, Contraception, 80, 3, 282–286, September 2009, 19698822, 3766037, 10.1016/j.contraception.2009.03.010, The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of vaginal misoprostol) previously used by Planned Parenthood clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman’s request. The regimen (200 mg of mifepristone, followed 24–48 hours later by 800 mcg of (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,www.gov.uk/government/uploads/system/uploads/attachment_data/file/215584/dh_127202.pdf, 22 November 2011,web.archive.org/web/20151001094437/https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215584/dh_127202.pdf, 1 October 2015, live, WEB, 31 May 2011, Abortion statistics, year ending 31 December 2010, Edinburgh, ISD, NHS Scotland,www.isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2011-05-31/2011-05-31-Abortions-Report.pdf?68450564147, 22 November 2011, live,www.isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2011-05-31/2011-05-31-Abortions-Report.pdf?68450564147," title="web.archive.org/web/20110726193951www.isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2011-05-31/2011-05-31-Abortions-Report.pdf?68450564147,">web.archive.org/web/20110726193951www.isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2011-05-31/2011-05-31-Abortions-Report.pdf?68450564147, 26 July 2011, France,WEB, Vilain A, Mouquet MC, 22 June 2011, Voluntary terminations of pregnancies in 2008 and 2009, Paris, DREES, Ministry of Health, France,www.sante.gouv.fr/IMG/pdf/er765.pdf, 22 November 2011, dead,www.sante.gouv.fr/IMG/pdf/er765.pdf," title="web.archive.org/web/20110926235733www.sante.gouv.fr/IMG/pdf/er765.pdf,">web.archive.org/web/20110926235733www.sante.gouv.fr/IMG/pdf/er765.pdf, 26 September 2011, Switzerland,WEB, 5 July 2011, Abortions in Switzerland 2010, Neuchâtel, Office of Federal Statistics, Switzerland,www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html, 22 November 2011, dead,www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html," title="web.archive.org/web/20111003203103www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html,">web.archive.org/web/20111003203103www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html, 3 October 2011, United States,REPORT, Jones RK, Witwer E, Jerman J, Abortion Incidence and Service Availability in the United States, 2017, 2019, Guttmacher Institute, 10.1363/2019.30760, free, 5487028, 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,www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf, 22 November 2011, dead,www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf," title="web.archive.org/web/20120118094034www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf,">web.archive.org/web/20120118094034www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf, 18 January 2012, Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in Canada, most of Europe, China and India, in contrast to the United States where 96% of second trimester abortions are performed surgically by dilation and evacuation.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, A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion.JOURNAL, Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD, Self-administered versus provider-administered medical abortion, The Cochrane Database of Systematic Reviews, 2020, CD013181, March 2020, 3, 32150279, 7062143, 10.1002/14651858.CD013181.pub2, Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion. Safely permitting women to self-administer abortion medication has the potential to improve access to abortion. Other research gaps that were identified include how to best support women who choose to take the medication home for a self-administered 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,www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112, Manual and vacuum aspiration for abortion, 2004, WebMD, 5 December 2008,www.webmd.com/hw/womens_conditions/tw1078.asp," title="web.archive.org/web/20070211155626www.webmd.com/hw/womens_conditions/tw1078.asp,">web.archive.org/web/20070211155626www.webmd.com/hw/womens_conditions/tw1078.asp, 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,www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html, 19 May 2009,www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html," title="web.archive.org/web/20090519162903www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html,">web.archive.org/web/20090519162903www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html, live, Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.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, 178–192, Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.JOURNAL, ACOG Practice Bulletin No. 135: Second-trimester abortion, Obstetrics and Gynecology, 121, 6, 1394–1406, June 2013, 23812485, 10.1097/01.AOG.0000431056.79334.cc, 205384119, 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 DA, Clinical practice. A request for abortion, The New England Journal of Medicine, 365, 23, 2198–2204, December 2011, 22150038, 10.1056/NEJMcp1103639, JOURNAL, Allen RH, Singh R, Society of Family Planning clinical guidelines pain control in surgical abortion part 1 - local anesthesia and minimal sedation, English, Contraception, 97, 6, 471–477, June 2018, 29407363, 10.1016/j.contraception.2018.01.014,www.contraceptionjournal.org/article/S0010-7824(18)30036-2/abstract, 20 January 2022, live, 3777869,web.archive.org/web/20220303075142/https://www.contraceptionjournal.org/article/S0010-7824%2818%2930036-2/fulltext, 3 March 2022, free, JOURNAL, Cansino C, Denny C, Carlisle AS, Stubblefield P, Society of Family Planning clinical recommendations: Pain control in surgical abortion part 2 - Moderate sedation, deep sedation, and general anesthesia, English, Contraception, 104, 6, 583–592, December 2021, 34425082, 10.1016/j.contraception.2021.08.007,www.contraceptionjournal.org/article/S0010-7824(21)00351-6/abstract, 20 January 2022, live, 237279946,web.archive.org/web/20220303075141/https://www.contraceptionjournal.org/article/S0010-7824%2821%2900351-6/fulltext, 3 March 2022, free,Labor induction abortion
In places lacking the necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.JOURNAL, Borgatta, Lynn, Global Library of Women’s Medicine, December 2014, GLOWM.10444, 10.3843/GLOWM.10444,www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443, 25 September 2015, Labor Induction Termination of Pregnancy, live,www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443," title="web.archive.org/web/20150924082507www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443,">web.archive.org/web/20150924082507www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443, 24 September 2015, subscription, This is sometimes called “induced miscarriage”. This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.JOURNAL, Borgatta, Lynn, Nathalie, Kapp, Clinical guidelines. Labor induction abortion in the second trimester, Contraception, 84, 1, 4–18, July 2011, 21664506, 10.1016/j.contraception.2011.02.005,www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf, 25 September 2015, live, 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.,web.archive.org/web/20200606205318/https://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf, 6 June 2020, free, Only limited data are available comparing labor-induced abortion with the dilation and extraction method. Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.BOOK, 2015 Clinical Policy Guidelines, National Abortion Federation, 2015,prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf, 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,prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf," title="web.archive.org/web/20150812220053prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf,">web.archive.org/web/20150812220053prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf, 12 August 2015,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, Riddle, John M,archive.org/details/evesherbshistory0000ridd, Eve’s herbs: a history of contraception and abortion in the West, Harvard University Press, 1997, 978-0-674-27024-4, Cambridge, MA, 36126503, John M. Riddle, registration, {{rp|44–47, 62–63, 154–155, 230–231}}In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil.JOURNAL, Sullivan JB, Rumack BH, Thomas H, Peterson RG, Bryson P, Pennyroyal oil poisoning and hepatotoxicity, JAMA, 242, 26, 2873–2874, December 1979, 513258, 10.1001/jama.1979.03300260043027, 26198529, 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, 235–239, 2003, 12807304, 10.1081/CLT-120021104, 44851492, such use is not recommended by physicians.Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage.JOURNAL, Smith JP, Risky choices: the dangers of teens using self-induced abortion attempts, Journal of Pediatric Health Care, 12, 3, 147–151, 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, Graff M, Taing J, Thousand-year-old depictions of massage abortion, The Journal of Family Planning and Reproductive Health Care, 33, 4, 233–234, October 2007, 17925100, 10.1783/147118907782101904, free, Malcolm Potts, One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called “induced miscarriage”. Such methods are rarely used in countries where surgical abortion is legal and available.JOURNAL, Thapa SR, Rimal D, Preston J, Self induction of abortion with instrumentation, Australian Family Physician, 35, 9, 697–698, September 2006, 16969439,www.racgp.org.au/afp/200609/11015, live,www.racgp.org.au/afp/200609/11015," title="web.archive.org/web/20090108181951www.racgp.org.au/afp/200609/11015,">web.archive.org/web/20090108181951www.racgp.org.au/afp/200609/11015, 8 January 2009, {{clear}}Safety
(File:Abortion Quick & Pain Free sign, Joe Slovo Park, Cape Town, South Africa-3869.jpg|thumb|right|A likely illegal abortion flyer in South Africa)The health risks of abortion depend principally on how, and under what conditions, the procedure is performed. The World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.WEB, World Health Organization, The Prevention and Management of Unsafe Abortion, April 1992, 18 October 2017,whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf,whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf," title="web.archive.org/web/20100530072310whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf,">web.archive.org/web/20100530072310whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf, 30 May 2010, live, Legal abortions performed in the developed world are among the safest procedures in medicine.JOURNAL, Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH, Unsafe abortion: the preventable pandemic, Lancet, 368, 9550, 1908–1919, November 25, 2006, 17126724, 10.1016/S0140-6736(06)69481-6,www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69481-6/fulltext, 6188636, subscription, JOURNAL, Grimes DA, Creinin MD, Induced abortion: an overview for internists, Annals of Internal Medicine, 140, 8, 620–626, April 2004, 15096333, 10.7326/0003-4819-140-8-200404200-00009, free, 10.1.1.694.3531, According to a 2012 study in the journal Obstetrics & Gynecology by F. G. Raymond and D. A. Grimes, in the United States the risk of maternal mortality is 14 times lower after induced abortion than after childbirth.JOURNAL, Raymond EG, Grimes DA, The comparative safety of legal induced abortion and childbirth in the United States, Obstetrics and Gynecology, 119, 2 Pt 1, 215–219, February 2012, 22270271, 10.1097/AOG.0b013e31823fe923, Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion., 25534071, CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,JOURNAL, Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM, Barfield W, 6, 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, May 2019, 31071074, 6542194, 10.15585/mmwr.mm6818e1, while the US abortion mortality rate was 0.43 maternal deaths per 100,000 procedures.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, 90, 5, 476–479, November 2014, 25152259, 10.1016/j.contraception.2014.07.012, Results: The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7 deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities., BOOK,www.nap.edu/read/24950/chapter/4, Read “The Safety and Quality of Abortion Care in the United States” at NAP.edu, 10.17226/24950, 29897702, 2018, 978-0-309-46818-3, Health Medicine Division, National Academies of Sciences Engineering, Board on Health Care Services, Board on Population Health Public Health Practice, Committee on Reproductive Health Services: Assessing the Safety Quality of Abortion Care in the U.S, 26 May 2019, 24 July 2020,web.archive.org/web/20200724204509/https://www.nap.edu/read/24950/chapter/4, live, JOURNAL, Kortsmit, Katherine, 2022, Abortion Surveillance — United States, 2020,www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm, MMWR. Surveillance Summaries, en-us, 71, 10, 1–27, 10.15585/mmwr.ss7110a1, 1546-0738, 9707346, 36417304, The national case-fatality rate for legal induced abortion for 2013–2019 was 0.43 deaths related to legal induced abortions per 100,000 reported legal abortions. This case-fatality rate was lower than the rates for the previous 5-year periods., 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,www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf, Abortion in Indonesia, Guttmacher Institute, 2008, 13 October 2019, 7 June 2020,web.archive.org/web/20200607212421/https://www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf, live, In the US from 2000 to 2009, abortion had a mortality rate lower than plastic surgery, lower or similar to running a marathon, and about equivalent to traveling {{convert|760|miles}} in a passenger car. 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 LJ, Schwarz EB, Grossman D, Foster DG, Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study, Annals of Internal Medicine, 171, 4, 238–247, August 2019, 31181576, 10.7326/M18-1666, 184482546, The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.JOURNAL, Raymond EG, Grimes DA, The comparative safety of legal induced abortion and childbirth in the United States, Obstetrics and Gynecology, 119, 2 Pt 1, 215–219, February 2012, 22270271, 10.1097/AOG.0b013e31823fe923, 25534071, 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, 92, 3, 197–199, September 2015, 26118638, 10.1016/j.contraception.2015.06.018, There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation. Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.WEB, Grossman D, 3 September 2004, Medical methods for first trimester abortion: RHL commentary, Reproductive Health Library, Geneva, World Health Organization,apps.who.int/rhl/fertility/abortion/dgcom/en/index.html, 22 November 2011, dead,apps.who.int/rhl/fertility/abortion/dgcom/en/index.html," title="web.archive.org/web/20111028054620apps.who.int/rhl/fertility/abortion/dgcom/en/index.html,">web.archive.org/web/20111028054620apps.who.int/rhl/fertility/abortion/dgcom/en/index.html, 28 October 2011, 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,apps.who.int/rhl/fertility/abortion/pccom/en/index.html, 1 June 2010,apps.who.int/rhl/fertility/abortion/pccom/en/index.html," title="web.archive.org/web/20100517201143apps.who.int/rhl/fertility/abortion/pccom/en/index.html,">web.archive.org/web/20100517201143apps.who.int/rhl/fertility/abortion/pccom/en/index.html, 17 May 2010, dead, Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.JOURNAL, Westfall JM, Sophocles A, Burggraf H, Ellis S, Manual vacuum aspiration for first-trimester abortion, Archives of Family Medicine, 7, 6, 559–562, 1998, 9821831, 10.1001/archfami.7.6.559,archfami.ama-assn.org/cgi/content/full/7/6/559, dead,archfami.ama-assn.org/cgi/content/full/7/6/559," title="web.archive.org/web/20050405202853archfami.ama-assn.org/cgi/content/full/7/6/559,">web.archive.org/web/20050405202853archfami.ama-assn.org/cgi/content/full/7/6/559, 5 April 2005, subscription, 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, 55, 4, 888–892, December 2012, 23090457, 10.1097/GRF.0b013e31826fd8f8, The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.JOURNAL, White K, Carroll E, Grossman D, Complications from first-trimester aspiration abortion: a systematic review of the literature, Contraception, 92, 5, 422–438, November 2015, 26238336, 10.1016/j.contraception.2015.07.013, 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 and Gynecology, 113, 5, 1180–1189, May 2009, 19384149, 10.1097/AOG.0b013e3181a6d011, 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 and Gynecology, 87, 5 Pt 2, 884–890, May 1996, 8677129, however, antibiotics are not routinely given with abortion pills.JOURNAL, Achilles SL, Reeves MF, Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102, Contraception, 83, 4, 295–309, April 2011, 21397086, 10.1016/j.contraception.2010.11.006, free, The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner.JOURNAL, Barnard S, Kim C, Park MH, Ngo TD, Doctors or mid-level providers for abortion, The Cochrane Database of Systematic Reviews, 2015, 7, CD011242, July 2015, 26214844, 10.1002/14651858.CD011242.pub2, 9188302,researchonline.lshtm.ac.uk/2274695/1/Doctors%20or%20mid-level%20providers%20for%20abortion_GREEN%20VoR.pdf, 24 November 2019, Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen.JOURNAL, Lerma K, Shaw KA, Update on second trimester medical abortion, Current Opinion in Obstetrics & Gynecology, 29, 6, 413–418, December 2017, 28922193, 10.1097/GCO.0000000000000409, Second trimester surgical abortion is well tolerated and increasingly expeditious, 12459747, The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period).JOURNAL, Committee on Practice Bulletins-Gynecology, Steinauer J, Jackson A, Grossman D, Second-trimester abortion. Practice Bulletin No. 135., American College of Obstetrics & Gynecology - Practice Bulletins, June 2013,www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion, 4 December 2019, The mortality rate associated with abortion is low (0.6 per 100,000 legal, induced abortions), and the risk of death associated with childbirth is approximately 14 times higher than that with abortion. Abortion-related mortality increases with each week of gestation, with a rate of 0.1 per 100,000 procedures at 8 weeks of gestation or less, and 8.9 per 100,000 procedures at 21 weeks of gestation or greater., 24 December 2019,web.archive.org/web/20191224111109/https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion, live, JOURNAL, Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK, Risk factors for legal induced abortion-related mortality in the United States, Obstetrics and Gynecology, 103, 4, 729–737, April 2004, 15051566, 10.1097/01.AOG.0000116260.81570.60, The risk factor that continues to be most strongly associated with mortality from legal abortion is gestational age at the time of the abortion, 42597014, free, It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.JOURNAL, Saccone G, Perriera L, Berghella V, Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis, American Journal of Obstetrics and Gynecology, 214, 5, 572–591, May 2016, 26743506, 10.1016/j.ajog.2015.12.044,www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf, 27 June 2020, live, Prior surgical uterine evacuation for either I-TOP[induced termination of pregnancy] or SAB[spontaneous abortion, - also known as miscarriage] is an independent risk factor for PTB[pre-term birth]. These data warrant caution in the use of surgical uterine evacuation and should encourage safer surgical techniques as well as medical methods.,web.archive.org/web/20210827202228/https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf, 27 August 2021, JOURNAL, Averbach SH, Seidman D, Steinauer J, Darney P, Re: Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis, American Journal of Obstetrics and Gynecology, 216, 1, 87, January 2017, 27596618, 10.1016/j.ajog.2016.08.038,www.ajog.org/article/S0002-9378(16)30650-0/fulltext, 28 June 2020, live,web.archive.org/web/20210827202230/https://www.ajog.org/article/S0002-9378%2816%2930650-0/fulltext, 27 August 2021, subscription, Some purported risks of abortion are promoted primarily by anti-abortion groups,JOURNAL, Schneider AP, Zainer CM, Kubat CK, Mullen NK, Windisch AK, The breast cancer epidemic: 10 facts, The Linacre Quarterly, 81, 3, 244–277, August 2014, 25249706, 4135458, 10.1179/2050854914Y.0000000027, 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., free, but lack scientific support.JOURNAL, Jasen P, Breast cancer and the politics of abortion in the United States, Medical History, 49, 4, 423–444, 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 WHO, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.Position statements of major medical bodies on abortion and breast cancer include:- World Health Organization: WEB,www.who.int/mediacentre/factsheets/fs240/en/, Induced abortion does not increase breast cancer risk (Fact sheet N°240), World Health Organization, 6 January 2011,www.who.int/mediacentre/factsheets/fs240/en/," title="web.archive.org/web/20110213141046www.who.int/mediacentre/factsheets/fs240/en/,">web.archive.org/web/20110213141046www.who.int/mediacentre/factsheets/fs240/en/, 13 February 2011,
- National Cancer Institute: WEB,www.cancer.gov/cancertopics/factsheet/risk/abortion-miscarriage, Abortion, Miscarriage, and Breast Cancer Risk, National Cancer Institute, 11 January 2011,www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage," title="web.archive.org/web/20101221084337www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage,">web.archive.org/web/20101221084337www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage, 21 December 2010, live, 20 February 2003,
- American Cancer Society: WEB,www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer, 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.,www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer," title="web.archive.org/web/20110605204701www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer,">web.archive.org/web/20110605204701www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer, 5 June 2011, live,
- Royal College of Obstetricians and Gynaecologists: WEB,www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf, 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,www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf," title="web.archive.org/web/20130727105037www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf,">web.archive.org/web/20130727105037www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf, 27 July 2013,
- American Congress of Obstetricians and Gynecologists: WEB,www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm, ACOG Finds No Link Between Abortion and Breast Cancer Risk, 31 July 2003, American Congress of Obstetricians and Gynecologists, 11 January 2011,www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm," title="web.archive.org/web/20110102030744www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm,">web.archive.org/web/20110102030744www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm, 2 January 2011, dead,
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, 19, 11, 77, September 2017, 28905259, 10.1007/s11920-017-0832-4, 4769393, other than those expected for any unwanted pregnancy. A report by the American Psychological Association concluded that a woman’s first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman’s second or greater abortion is less certain.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,www.apa.org/news/press/releases/2008/08/single-abortion.aspx, live,www.apa.org/news/press/releases/2008/08/single-abortion.aspx," title="web.archive.org/web/20110906022824www.apa.org/news/press/releases/2008/08/single-abortion.aspx,">web.archive.org/web/20110906022824www.apa.org/news/press/releases/2008/08/single-abortion.aspx, 6 September 2011, WEB,www.apa.org/pi/women/programs/abortion/mental-health.pdf, Report of the APA Task Force on Mental Health and Abortion, American Psychological Association, Washington, DC, 13 August 2008, live,apa.org/pi/women/programs/abortion/mental-health.pdf," title="web.archive.org/web/20100615020211apa.org/pi/women/programs/abortion/mental-health.pdf,">web.archive.org/web/20100615020211apa.org/pi/women/programs/abortion/mental-health.pdf, 15 June 2010, 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, 199, 3, 180–186, September 2011, 21881096, 10.1192/bjp.bp.110.077230, free, however, later reviews of the medical literature found that they did not use an appropriate control group. When a control group is utilized, receiving abortion is not associated with adverse psychological outcomes. However, women seeking abortion who are denied access to abortion have an increase in anxiety after the denial.Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,WEB, Mental Health and Abortion,www.apa.org/pi/women/programs/abortion/index.aspx, American Psychological Association, 2008, 18 April 2012, live,www.apa.org/pi/women/programs/abortion/index.aspx," title="web.archive.org/web/20120419174044www.apa.org/pi/women/programs/abortion/index.aspx,">web.archive.org/web/20120419174044www.apa.org/pi/women/programs/abortion/index.aspx, 19 April 2012, more rigorous research would be needed to show this conclusively.JOURNAL, Steinberg JR, Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research, Women’s Health Issues, 21, 3 Suppl, S44–S48, 2011, 21530839, 10.1016/j.whi.2011.02.002, Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called “post-abortion syndrome”, but this is not recognized by medical or psychological professionals in the United States.JOURNAL, Kelly K, The spread of ‘Post Abortion Syndrome’ as social diagnosis, Social Science & Medicine, 102, 18–25, February 2014, 24565137, 10.1016/j.socscimed.2013.11.030, A 2020 long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later. The researchers also stated: “These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself.“JOURNAL, Rocca CH, Samari G, Foster DG, Gould H, Kimport K, Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma, Social Science & Medicine, 248, 112704, March 2020, 31941577, 10.1016/j.socscimed.2019.112704, free, We found no evidence of emerging negative emotions or abortion decision regret; both positive and negative emotions declined over the first two years and plateaued thereafter, and decision rightness remained high and steady (predicted percent: 97.5% at baseline, 99.0% at five years). At five years postabortion, relief remained the most commonly felt emotion among all women (predicted mean on 0-4 scale: 1.0; 0.6 for sadness and guilt; 0.4 for regret, anger and happiness). Despite converging levels of emotions by decision difficulty and stigma level over time, these two factors remained most important for predicting negative emotions and decision non-rightness years later.,Unsafe abortion
(File:RussianAbortionPoster.jpg|thumb|Soviet poster {{Circa|1925}}, warning against midwives performing abortions. Title translation: “Miscarriages induced by either grandma 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 it 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, 974–979, November 2006, 17169222, 10.1016/S1701-2163(16)32307-6,www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf, dead,www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf," title="web.archive.org/web/20120111121431www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf,">web.archive.org/web/20120111121431www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf, 11 January 2012, Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries. Unsafe abortions are believed to result in millions of injuries.JOURNAL, Haddad LB, Nour NM, Unsafe abortion: unnecessary maternal mortality, Reviews in Obstetrics & Gynecology, 2, 2, 122–126, 2009, 19609407, 2709326, Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;JOURNAL, Shah I, Ahman E, December 2009, Unsafe abortion: global and regional incidence, trends, consequences, and challenges,www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf, dead, Journal of Obstetrics and Gynaecology Canada, 31, 12, 1149–1158, 10.1016/s1701-2163(16)34376-6, 20085681, 35742951,www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf," title="web.archive.org/web/20110716212405www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf,">web.archive.org/web/20110716212405www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf, 16 July 2011, JOURNAL, Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O’Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA, 6, 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, 380, 9859, 2095–2128, December 2012, 23245604, 10.1016/S0140-6736(12)61728-0, 10790329,zenodo.org/record/2557786, 14 March 2020, live, free, 1541253, 19 May 2020,web.archive.org/web/20200519152712/https://zenodo.org/record/2557786, 10536/DRO/DU:30050819, deaths from unsafe abortion account for around 13% of all maternal deaths.BOOK, Speroff L, Darney PD, 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,whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf, live,whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf," title="web.archive.org/web/20140328093307whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf,">web.archive.org/web/20140328093307whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf, 28 March 2014, To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.JOURNAL, Berer M, Making abortions safe: a matter of good public health policy and practice, Bulletin of the World Health Organization, 78, 5, 580–592, 2000, 10859852, 2560758, A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to those where abortion is legal and available. 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, 112, 3, 355–359, March 2005, 15713153, 10.1111/j.1471-0528.2004.00422.x, 41663939, 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 = Suid-Afrikaanse Tydskrif vir Geneeskunde, 97, 12, 1238–1242, December 2007, 18264602,samj.org.za/index.php/samj/article/view/642, live,samj.org.za/index.php/samj/article/view/642," title="web.archive.org/web/20170830200316samj.org.za/index.php/samj/article/view/642,">web.archive.org/web/20170830200316samj.org.za/index.php/samj/article/view/642, 30 August 2017, Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.JOURNAL, Conti JA, Brant AR, Shumaker HD, Reeves MF, Update on abortion policy, Current Opinion in Obstetrics & Gynecology, 28, 6, 517–521, December 2016, 27805969, 10.1097/GCO.0000000000000324, 26052790, A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state.JOURNAL, New MJ, 53314166, 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 MH, 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, 155464018, In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally.WEB,www.guttmacher.org/pubs/FB-AIU-summary.pdf, Facts on Investing in Family Planning and Maternal and Newborn Health, Guttmacher Institute, 2010, 24 May 2012, dead,www.guttmacher.org/pubs/FB-AIU-summary.pdf," title="web.archive.org/web/20120324101905www.guttmacher.org/pubs/FB-AIU-summary.pdf,">web.archive.org/web/20120324101905www.guttmacher.org/pubs/FB-AIU-summary.pdf, 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”.JOURNAL, Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH, Unsafe abortion: the preventable pandemic, Lancet, 368, 9550, 1908–1919, November 2006, 17126724, 10.1016/S0140-6736(06)69481-6,www.who.int/reproductivehealth/publications/unsafe_abortion/lancet_paper/en/, 16 January 2010, live, 6188636,www.who.int/reproductivehealth/publications/unsafe_abortion/lancet_paper/en/," title="web.archive.org/web/20140305122947www.who.int/reproductivehealth/publications/unsafe_abortion/lancet_paper/en/,">web.archive.org/web/20140305122947www.who.int/reproductivehealth/publications/unsafe_abortion/lancet_paper/en/, 5 March 2014, subscription, JOURNAL, Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM, Women’s hidden transcripts about abortion in Brazil, Social Science & Medicine, 44, 12, 1833–1845, June 1997, 9194245, 10.1016/s0277-9536(96)00293-6, Forty percent of the world’s women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,BOOK, Maclean G,books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299, XI. Dimension, Dynamics and Diversity: A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives, 299–300, Trends in Midwifery Research, Balin RE, Nova Publishers, 2005, 978-1-59454-477-4, live, 15 March 2015,books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299," title="web.archive.org/web/20150315113348books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299,">web.archive.org/web/20150315113348books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299, though this varies by region.JOURNAL, Salter C, Johnson HB, Hengen N, 1997,info.k4health.org/pr/l10edsum.shtml, Care for Postabortion Complications: Saving Women’s Lives, Population Reports, 25, 1, Johns Hopkins School of Public Health, dead,info.k4health.org/pr/l10edsum.shtml," title="web.archive.org/web/20091207070103info.k4health.org/pr/l10edsum.shtml,">web.archive.org/web/20091207070103info.k4health.org/pr/l10edsum.shtml, 7 December 2009, Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.WEB, 2007, Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003,whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf, live,whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf," title="web.archive.org/web/20110216141018whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf,">web.archive.org/web/20110216141018whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf, 16 February 2011, 7 March 2011, World Health Organization, The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion.WEB, Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health, UNICEF, UNFPA, WHO, World Bank, 2010, 31 December 2010, dead,www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html,www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html," title="web.archive.org/web/20101109224916www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html,">web.archive.org/web/20101109224916www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html, 9 November 2010,Incidence
There are two commonly used methods of measuring the incidence of abortion:- Abortion rate – number of abortions annually per 1,000 women between 15 and 44 years of age;WEB, Facts on Induced Abortion Worldwide, January 2012, World Health Organization,www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf, 9 May 2021,www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf," title="web.archive.org/web/20210309200507www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf,">web.archive.org/web/20210309200507www.who.int/reproductivehealth/publications/unsafe_abortion/induced_abortion_2012.pdf, 9 March 2021, live, some sources use a range of 15–49.
- Abortion percentage – number of abortions out of 100 known pregnancies; pregnancies include live births, abortions, and miscarriages.
Gestational age and method
{{multiple image| align = right| image1 = UK abortion by gestational age 2019 histogram.svg| width1 = 200| alt1 = | caption1 = | image2 = US abortion by gestational age 2016 histogram.svg| width2 = 200| alt2 = | caption2 =- WHO fact sheet on abortion
- Safe abortion: Technical & policy guidance for health systems, World Health Organization (2015)
- www.guideline.gov/summaries/summary/47346/firsttrimester-abortion-in-women-with-medical-conditions?q=Women" title="web.archive.org/web/20171018012623www.guideline.gov/summaries/summary/47346/firsttrimester-abortion-in-women-with-medical-conditions?q=Women">First-trimester abortion in women with medical conditions. US Department of Health and Human Services
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