Abortion

• Abortion Overview
• Types of Abortion
• Abortion Preparation
• Abortion Counseling
• Explanation of the Procedures
• After the Procedure
• Follow-up
• Abortion Rights in the United States
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• Synonyms and Keywords
• Authors and Editors
• Read more on Abortion from Healthwise

Abortion Overview

Abortion is one of the most common medical procedures performed in the United States each year.More than 40% of all women will end a pregnancy by abortion at some time in their reproductive lives.

While women of every social class seek terminations, the typical woman who ends her pregnancy is either young, white, unmarried, poor, or over the age of 40.

In the United States and worldwide, abortion (known also as elective termination of pregnancy) remains common.

• The US Supreme Court legalized abortion in the well-known Roe v Wade decision in 1973; currently, there areabout 1.2 million abortions are performed each year in the United States.
  
  
• Worldwide, some 20-30 million legal abortions are performed each year, with another 10-20 million abortions performed illegally. Illegal abortions are unsafe and account for 13% of all deaths of women because of serious complications. Death from abortion is almost unknown in the United States or in other countries where abortion is legally available.

In spite of the introduction of newer, more effective, and more widely available birth control methods, more than half of the 6 million pregnancies occurring each year in the United States are considered unplanned by the women who are pregnant. Of these unplanned pregnancies, about half end in abortion.

Making abortion legal

Since the landmark 1973 US Supreme Court decision that made abortion legal, hundreds of federal and state laws have been proposed or passed. Abortion is one of the most visible, controversial, and legally active areas in the field of medicine. These laws address a variety of controversial questions including:

• The issue of parental notification. A number of state laws do require that some minors notify parents before obtaining an abortion, but what provisions are necessary to protect young women who feel they cannot notify their parents?
  
  
• Should spouses be notified before a woman has an abortion?
  
  
• Has the pregnancy progressed far enough that the fetus could live on its own before termination (termed viability)?
  
  
• Should there be mandatory waiting periods before an abortion can take place?
  
  
• What might be mandatory wording for counseling sessions or consent forms?
  
  
• Should public funds be used for abortions?
  
  
• What regulations if any should apply to abortion providers?
  
  
• What provisions might be made against specific abortion techniques?
  
  
• Should emergency contraception be allowed?
  
  
• Should the rules be different in cases of sexual assault and rape?

Before abortion was legal

Before the 19th century, most US states had no specific abortion laws. Women were able to end a pregnancy prior to viability with the assistance of medical personnel.

• Beginning with a Connecticut statute and followed by an 1829 New York law, the next 20 years saw the enactment of a series of laws restricting abortion, punishing providers, and, in some cases, punishing the woman who was seeking the abortion.
  
  
• The first US federal law on the subject was the Comstock Law of 1873, which permitted a special agent of the postal service to open mail dealing with abortion or contraception in order to suppress the circulation of "obscene" materials.
  
  
• From 1900 until the 1960s, abortions were prohibited by law. However, the Kinsey report noted that premarital pregnancies were electively aborted, and public and physician opinion began to be shaped by the alarming reports of increased numbers of unsafe illegal abortions.
  
  

In 1965, 265 deaths occurred due to illegal abortions. Of all pregnancy-related complications in New York and California, 20% were due to abortions. A series of US Supreme Court decisions granted increased rights to women and ensured their right to choice in this process. No decision was more important than Griswold v Connecticut, which, in 1965, recognized a constitutional right to privacy and ruled that a married couple had a constitutional right to obtain birth control from their health care provider.

The Supreme Court decision: Roe v Wade

The Supreme Court case of Roe v Wade was the result of the work of a wide group of people who worked to repeal the abortion laws. In 1969, abortion rights supporters held a conference to formalize their goals and formed the National Association for the Repeal of Abortion Laws (NARAL).

• Lawyers Linda Coffee and Sarah Weddington met the Texas waitress, Norma McCorvey, who wished to have an abortion but was prohibited by law. She would become plaintiff "Jane Roe." Although the ruling came too late for McCorvey's abortion, her case was successfully argued before the US Supreme Court in a decision that instantly granted the right of a woman to seek an abortion.

• In 1973, the Roe v Wade law, in the opinion written by US Supreme Court justice Harry Blackmun, the court ruled that a woman had a right to an abortion during the first 2 trimesters (6 months) of pregnancy. He cited the safety of the procedures and the basic right of women to make their own decisions.

• Since this ruling, the states have regained much control. Serious restrictions have been placed on abortion services.Debate continues by federal and state lawmakers. The US Senate approved the first federal ban on a specific abortion procedure (called partial-birth abortion, defined later in this topic) in October 2003. The bill was signed byPresident George W. Bush.
  
  

Determining life

When does "life" begin?That is one of the issues surrounding the controversy about abortion. The legal issues are these:

• Loosely defined, the term viability is the ability of the fetus to survive outside the mother's womb without life support. A number of landmark US Supreme Court decisions dealt with this question. In Webster v Reproductive Health Services (1989), the court upheld the state of Missouri's requirement for preabortion viability testing after 20 weeks' gestation (gestation is the period of time a fetus develops in the mother's uterus, usually 40 weeks). However, there are no reliable or medically acceptable tests for viability prior to 28 weeks' gestation.

• The preamble to this law states that life begins at conception, and the unborn are entitled to the same constitutional rights as all others. By 1992, in a ruling controversial for its inclusion of mandatory waiting periods, elaborate consent processes, and record-keeping regulations, Planned Parenthood v Casey tried to address the issue of viability by inserting language recognizing that some fetuses never attain viability (for example, a developing fetus with certain brain disorders will never live on its own). In Colautti v Franklin, the court overturned a Pennsylvania law requiring doctors to follow specific directives in certain medical cases and recognized the judgment of the doctor in these matters.
  
  

Parental consent

Various federal and state decisions have tried to require parental notification, waiting periods, informed consent, and abortion counseling.

People against abortion argue that parents need to be informed about and approve an abortion for a daughter younger than 18 years.Those supporting the rights of a woman to choose abortion say parental consent is not required for a woman to carry a pregnancy to term (the birth of a baby), nor do parents need to give permission for a woman seeking birth control such as pills or an intrauterine device (IUD). Parents are also not consulted when a woman seeks treatment for a sexually transmitted disease.

Research shows that many young women younger than 18 yearsdo involve their parents in their decision to abort (45%). Laws requiring parental consent are forcing minors to obtain abortions much later in their pregnancies. Some minors must travel great distances to states with no such law.

Intact dilation and extraction

The recently crafted political term partial-birth abortion loosely means "partially vaginally delivering a living fetus before killing the fetus and completing the delivery." This definition broadly includes all methods of second-trimester abortion (done after the first three months of pregnancy. A 2007 Partial Birth Abortion ban was passed by the Supreme Court, and although its wording is open to interpretation, it essentially states that the act of termination of fetal life cannot occur in a partially extracted fetus.

Providers

Providers of abortions are generally specialists in women's health such as obstetricians and gynecologists. However, many studies have shown the safety of allowing a variety of other health care providers (physicians, physician assistants, midwives, and nurse practitioners) to perform these procedures.

Various factors over the years have influenced the number of medical professionals available and trained to perform abortions:

• Medical student training in this procedure is limited or absent from many programs. Some students may opt not to be trained in the procedure. Pharmacists may decide not to dispense medical abortion medications.
  
  
• Increasing violence against providers and clinics has further decreased their willingness to provide abortion services.
  
  
• The US Food and Drug Administration (FDA) has approved Mifeprex (mifepristone, RU-486), a drug for medical abortions. The lack of abortion providers to perform surgical terminations has led to the popular belief that individuals not willing or not skilled enough (through training or licensure) to perform surgical terminations will be willing to prescribe medications for medical termination.
  
  
• A variety of medical, social, ethical, and philosophical issues affect the availability of and restrictions on abortion services in the United States.

Abortion statistics

In the United States: In 2003, about 16 women for every 1,000 women aged 15-44 years had an abortion, and for every 1,000 live births, about 241 abortions were performed, according to the Centers for Disease Control and Prevention. In the past 20 years, considerable progress has been made in the technology used for second-trimester abortion. This and the social issues surrounding abortion have led to more women seeking terminations later in pregnancy.

• Safety: Legal abortion is a safe procedure. Infection rates are less than one percent, and fewer than 1 in 100,000 deaths occurs from first-trimester abortions. Abortion is safer for the mother than carrying a pregnancy to term. Medical and surgical abortions are both safe and effective when performed by trained practitioners.
  
  
• Race: Most women seeking abortion are white (53%); 36% are black, 8% are of another race, and 3% are of unknown race.
  
  
• Age: Abortion rates are highest among 20- to 24-year-old women. Rates are lowest among women younger than 20 or older than 40 years but these women are far more likely to have an abortion if they become pregnant.
  

In the world: Abortion causes at least 13% of all deaths among pregnant women. New estimates are that 50 million abortions are performed world wide each year, with 30 million of them in developing countries. Approximately 20 million of these are performed unsafely because of conditions or lack of provider training.