Wiki Essays On Abortion

This essay is an original work by Earthland.
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It is not popular to read my essay before raising questions about it on the talk page. I know the essay is long, but I beg you, before you want to ask or refute something, make sure that this specific issue is not already discussed in the essay itself. I have covered some less important sections with special template so that you only see it if you click on it.
See also: Essay:Rationalwiki's abortion article and Essay:Abortion debate and open mind

"An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus/embryo, resulting in or caused by its death. In many parts of the world there is prominent and divisive public controversy over the ethical and legal issues of abortion." (Wikipedia)

Why?[edit]

“”... because life is all there is and all that matters, and abortion destroys the life of an innocent human being.

—godlessprolifers.org

“”The purpose of abortion is not merely pregnancy termination;
its purpose is to kill, to take the life of prenatal human offspring.
Under justice, however, there is no such thing as a right to
kill innocent people

—Doris Gordon

Biological arguments[edit]

Beginning of human life[edit]


The beginning of human life is the heart of the abortion debate. Why we never see pro-choice advocates, such like Planned Parenthood or NARAL, explaining where they believe life begins? Their most usual tactics is to shift the debate from whether abortion takes a human life to how "comprehensive sex education" and contraception can lower abortion rates. We are not debating the merits of different strategies to lower abortion rates, we are debating whether or not abortion takes human life, and one side almost never seriously addresses it. Maybe it's because people have a much easier time defending abortion when we don't talk about when life begins.

According to general scientific consensus, human life (in the sense at what point does an individual physical being comes into existence) starts at conception. This consensus is, for example, reflected in the Encyclopedia Britannica article:

“”Although organisms are often thought of only as adults,
and reproduction is considered to be the formation of a
new adult resembling the adult of the previous generation,
a living organism, in reality, is an organism for its entire
life cycle, from fertilized egg to adult, not for just one
short part of that cycle.

—Encyclopedia Britannica 1998, v 26, p 611

Why is it this way? Concerning when life begins, a particular aggregate of hereditary tendencies (genes and chromosomes) is first assembled at the moment of fertilization when an ovum (egg) is invaded by a sperm cell. This restores the normal number of required chromosomes, 46, for survival, growth, and reproduction of a new composite individual. And we say that it is a human being, because...

  • This being is alive. The fertilized egg has the characteristics of life. He can reproduce his own cells and develop them into a specific pattern of maturity and function.
  • This being is human. He is a functioning individual organisms that genetically belong to the species Homo sapiens. An early embryo, though not looking like a newborn, does look exactly like a human ought to look at this stage of his or her development. He is a unique being, distinguishable totally from any other living organism, completely human in all of his or her characteristics, including the 46 human chromosomes, and can develop only into a fully mature human.
  • This being is complete. Nothing new will be added from the time of union of sperm and egg until the death of the old man or woman except growth and development of what is already there at the beginning. All he needs is time to develop and mature. (For the argument of "potentially human", see below)

To survive, this individual simply needs a very specialized environment for nine months, just as it requires sustained care for an indefinite period after birth. But from the moment of union of the germ cells, there is under normal development a living, definite, going concern. To interrupt a pregnancy at any stage is like cutting the link of a chain; the chain is broken no matter where the link is cut. It is not a religious belief. It is not a philosophic theory. It is not debatable, not questioned. It is a universally accepted scientific fact.

“”The question as to when the physical material dimension
of a human being begins via sexual reproduction is strictly
a scientific question, and fundamentally should be answered
by human embryologists - not by philosophers, bioethicists,
theologians, politicians, x-ray technicians, movie stars, or
obstetricians and gynecologists.

—Dianne N. Irving,
M.A., Ph.D.

In her 1999 article When do human beings (normally) begin? "scientific" myths and scientific facts, Dianne gives a scientific view on the beginning of life. She begins with some basic facts about embryos:

"To begin with, scientifically something very radical occurs between the processes of gametogenesis and fertilization--the change from a simple part of one human being (i.e., a sperm) and a simple part of another human being (i.e., an oocyte--usually referred to as an "ovum" or "egg"), which simply possess "human life", to a new, genetically unique, newly existing, individual, whole living human being (a single-cell embryonic human zygote). That is, upon fertilization, parts of human beings have actually been transformed into something very different from what they were before; they have been changed into a single, whole humanbeing. During the process of fertilization, the sperm and the oocyte cease to exist as such, and a new human being is produced."

She then looks at the early stages of the development of babies, pointing out that they have traits particular to themselves and to human beings:

"This new single-cell human being immediately produces specifically human proteins and enzymes (not carrot or frog enzymes and proteins), and genetically directs his/her own growth and development. (In fact, this genetic growth and development has been proven not to be directed by the mother.) Finally, this new human being--the single-cell human zygote--is biologically an individual, a living organism--an individual member of the human species."

Dianne is not alone in her observation. Actually, it is difficult - probably impossible to find any human embryologist who would state that life does not begin at conception. To quote just some of them

”This fertilized ovum, known as a zygote, is a large diploid cell that is the beginning, or primordium, of a human being. /.../ Human development begins at fertilization, the process during which a male gamete or sperm ... unites with a female gamete or oocyte ... to form a single cell called a zygote. This highly specialized, totipotent cell marks the beginning of each of us as a unique individual."
Keith L. Moore (1988. Essentials of Human Embryology. p. 2. B.C. Decker Co., Toronto.)
”… gametes, which will unite at fertilization to initiate the embryonic development of a new individual.”
William J. Larsen 1993. Human Embryology. p. 1. Churchill-Livingston, New York.)
”Fertilization is an important landmark because, under ordinary circumstances, a new genetically distinct human organism is thereby formed.”
Ronan R. O’Rahilly and Fabiola Müller (1992. Human Embryology and Teratology. p. 5. Wiley-Liss, New York.)
”Human development is a continuous process that begins when an oocyte (ovum) from a female is fertilized by a sperm (spermatozoan) from a male.”
Keith L. Moore and T.V.N. Persaud (1993. The Developing Human, 5th Ed. p. 1. W.B. Saunders Co., Philadelphia.)


This sentence is important – human development is a continuous process that begins at conception. It doesn't "end" at birth, it doesn't end before death. But to develop, one must already be alive and individual. To develop as human being, one must already be a human being. The entity created by fertilization doesn't develop into human being, it develops as human being.

“”Virtually every human embryologist and
every major textbook of human
embryology states that fertilization marks
the beginning of the life of
the new individual human being.

—Dr. C. Ward Kischer ,Professor
Emeritus of Human Embryology
of the University of
Arizona School of Medicine,
American College of Pediatricians

Scott Gilbert sums it up this way (in his book Developmental Biology): "Traditional ways of classifying catalog animals according to their adult structure. But, as J. T. Bonner (1965) pointed out, this is a very artificial method, because what we consider an individual is usually just a brief slice of its life cycle. When we consider a dog, for instance, we usually picture an adult. But the dog is a “dog” from the moment of fertilization of a dog egg by a dog sperm. It remains a dog even as a senescent dying hound. Therefore, the dog is actually the entire life cycle of the animal, from fertilization through death."

Virtually all encyclopedias agree:

”A new individual is created when the elements of a potent sperm merge with those of a fertile ovum, or egg.”
Encyclopedia Britannica 1998, v 26, p 664:
”For the first eight weeks following egg fertilization, the developing human being is called an embryo.”
The Gale Encyclopedia of Science 1996, v 3, p 1327
”Life cycle – in biology, the sequence of developmental stages through which members of a given species pass. Most vertebrates have a simple life cycle consisting of fertilization of sex cells or gametes, a period of development as an embryo, a period of juvenile growth after hatching or birth, and adulthood including sexual reproduction, and finally death.”
The Hutchinson Dictionary of Science 1994, p 340:
”Embryo. The developing individual between the time of the union of the germ cells and the completion of the organs which characterize its body when it becomes a separate organism. [...] At the moment the sperm cell of the human male meets the ovum of the female and the union results in a fertilized ovum (zygote), a new life has begun.
Van Nostrand’s Scientific Encyclopedia 2002, v 1, p 1290
”The period of pregnancy begins with the union of the sperm and egg. At the moment of fertilization of the egg (conception), a new life begins.”
Van Nostrand’s Scientific Encyclopedia 2002, v 1, p 1291
”The new individual is established at the time of fertilization, and embryonic development simply prepares this individual for the vicissitudes of adult life, and the development of future embryos.”
Collier’s Encyclopedia 1987, v 9, p 117
”The fused sperm and egg, called zygote, is a new individual with full capacities for development in a normal environment.”
Collier’s Encyclopedia 1987, v 9, p 121

“”To accept the fact that, after fertilization has taken place,
a new human has come into being is no longer a matter
of taste or opinion. The human nature of the human being
from conception to old age is not a metaphysical conception.
It is plain experimental evidence.

—Dr. Jerome Lejeune, known as
"The Father of Modern Genetics"
Some usual arguments presented in opposition to "human life begins at conception" include:
Both egg and sperm are also "alive". And every cell from some part of a person’s body can be kept alive even if separated from the person's living body, and every cell has full human DNA, but it doesn't make every cell a unique human being.

Those cells were a part of a complete human body, and they can only reproduce as a specific type of cell. The zygote, however, is not a part of another body, but is a whole body him or herself. Any one of these cells in a human’s body can die and we do not say that human has died, but when a fertilized egg dies, the entire new human being dies. In short, there is a radical difference between parts of a human being that only possess "human life" and a human embryo that is an actual "human being."

The other important difference is that the fertilized egg multiplies into many cells in a purposeful pattern, growing distinct structures. A human sperm or egg cell, or a single cell from the skin, even if given an appropriate environment and supplied with all necessary nutrients, may survive for a time but do not multiply, or multiply but form only shapeless masses, reproducing only their own kind and cannot go on to develop specialized parts.

The embryo may be alive, but it's just a part of woman's body

Well, what does a "part of a body" actually mean? To be "part of someone's body" means being a component of an organism, an organ. Is a fetus "organ" of woman's body? Of course it's not. It doesn't serve some common function of the woman's body. Being inside something is not being part of something. The unborn gets its food and oxygen from mother, but that doesn't make it part of her body. To say that the unborn entity is part of its mother is to claim that the mother possesses four legs, two heads, two noses, and so on (and in the case of a male conceptus, two testicles.) A body part is defined by the genetic code it shares with the rest of the body, the unborn has its own DNA code. Moreover, later on the unborn has its own fingerprints and can have its own blood type that differs from the mother. Scientists have been able to achieve conception in a petri dish (the "test-tube" babies), and this conceptus, if it has white parents, can be transferred to the body of a black woman and be born white, we know conclusively that the unborn is not part of the pregnant woman's body and is a separate human being.

It's just potential human life, not a real human being. Nothing can be a certain kind of thing until it possesses the form of that kind of thing.

The fertilized eff is not a potential human being; it is a human being with vast potential. Yes, it has only potential skin, potential bones, potential legs and potential head, in other words, it is potential human adult, but it looks exactly like a human being should look at this stage of his or hers development. The unborn is simply less developed than an adult, but it doesn't make it any less human being.

Some of the quotes above make it quit clear: "Although organisms are often thought of only as adults, and reproduction is considered to be the formation of a new adult resembling the adult of the previous generation, a living organism, in reality, is an organism for its entire life cycle, from fertilized egg to adult, not for just one short part of that cycle." (Encyclopedia Britannica) and "Traditional ways of classifying catalog animals according to their adult structure. But, as J. T. Bonner (1965) pointed out, this is a very artificial method, because what we consider an individual is usually just a brief slice of its life cycle. When we consider a dog, for instance, we usually picture an adult. But the dog is a “dog” from the moment of fertilization of a dog egg by a dog sperm. Therefore, the dog is actually the entire life cycle of the animal, from fertilization through death." (Scott Gilbert).

This is best summed up in the following quote:

“”Just think of something being constructed (fabricated, assembled, composed, sculpted – in short, made), such as a house, or a scholarly article – or take a car on an assembly line. When is a car first there? At what point in the assembly line would we first say, “There’s a car”? Some of us would no doubt go with appearance, saying that there is a car as soon as the body is fairly complete (in analogy to the fetus at 10 weeks or so). I suppose that most of us would look for something functional. We would say that there is a car only after a motor is in place (in analogy to quickening). Others might wait for the wheels (in analogy to viability) or even the windshield wipers (so that it’s viable even in the rain). And a few might say, “It’s not a car until it rolls out onto the street” (in analogy to birth). There would be many differing opinions.

However, one thing upon which we’ll probably all agree is this: Nobody is going to say that the car is there at the very beginning of the assembly line, when the first screw or rivet is put in or when two pieces of metal are first welded together. Two pieces of metal fastened together don’t match up to anybody’s idea of a car.

I think that this is exactly the way that many people see the embryo, like the car-to-be at the very beginning of the construction process. In the first stages of construction you don’t have a house, you don’t have a car, you don’t have a human individual yet. You don’t ever have what you’re making when you’ve just started making it.

It is in fact not true that the bodies of living creatures are constructed, by God or by anyone else. There is no outside builder or maker. Life is not made. Life develops.

In construction, the form defining the entity being built arrives only slowly, as it is added from the outside. In development, the form defining the growing life (that which a major Christian tradition calls its “soul”) is within it from the beginning. If Corvette production is cancelled, the initial two pieces of metal stuck together can become the starting point for something else, perhaps another kind of car, or maybe a washing machine. But even if you take a human embryo out of the womb, you can never get it to develop into a puppy or a guppy.

Living organisms are not formed or defined from the outside. They define and form themselves. The form or nature of a living being is already there from the beginning, in its activated genes, and that form begins to manifest itself from the very first moment of its existence, in self-directed epigenetic interaction with its environment. Embryos don’t need to be molded into a type of being. They already are a definite kind of being.
—Richard Stith

Twinning is still possible after fertilization, when an embryo divides into two entities. Therefore, the zygote is not "individual"

Some people argue indeed that since twinning (the division of a single conceptus) may occur in the first 14 days after conception, individual human life does not begin until that time. But twinning, by its nature, is a form of asexual reproduction. The one embryo splits into two pieces, which are now identical twins. Think about cell division: a cell divides into two or more "daughter cells" (this kind of reproduction is the primary method of reproduction for most cells), but does it mean that there is no such thing like an individual cell at all? Of course not. The cell is an individual before the division. And a human embryo is an individual human being before the division. Just because something may later become two individuals doesn’t mean it is not an individual before that. How does it follow that because an entity may split that it was not a whole living organism prior to the split? This is clear analogue to cell division: not only these cells that have lost the ability to split are "individual cells", we regard every cell as an individual unit of life both before and after cell split.

Twinning is an extremely rare event - only 997 out of 1000 embryos divide into two separate individuals. Philosopher Robert Wennberg provides the following story:

“”Imagine that we lived in a world in which a certain small percentage of teenagers replicated themselves by some mysterious natural means, splitting in two upon reaching their sixteenth birthday. We would not in the least be inclined to conclude that no human being could therefore be considered a person prior to becoming sixteen years of age; nor would we conclude that life could be taken with greater impunity prior to replication than afterward. The real oddity—to press the parallel—would be two teenagers becoming one. However, in all of this we still would not judge the individual's claim to life to be undermined in any way. We might puzzle over questions of personal identity... but we would not allow these strange replications and fusions to influence our thinking about an individual's right to life. Nor therefore does it seem that such considerations are relevant in determining the point at which an individual might assume a right to life in utero.

—Robert Wennberg, Life in the Balance: Exploring the Abortion Controversy

Life begins gradually.

The simple answer is: no it doesn't. Neither does "humanness" begin gradually. We have all been zygotes - at no point is the non-living non-human entity taken out of the womb to be replaced by a living human being. The unborn entity does not "turn into" human being. You did not come from a zygote, because you once were a zygote. You did not come from an adolescent, you once were an adolescent. Between being and non-being there is no middle state.

Since there is no decisive moment that can be shown to eradicate the full humanness of the unborn entity at any stage of her development, it follows that there are no philosophical, scientific, or moral grounds by which to say that the unborn gradually becomes fully human. For it would still need to achieve full humanness at some decisive moment.

Beginning of pregnancy[edit]

Depending on where pregnancy is considered to begin, some methods of birth control or infertility treatment might be considered abortifacient.

At its 2004 Annual Meeting, The American Medical Association passed a resolution in favor of making "Plan B" emergency contraception available over-the-counter, and one of the claims in the resolution was that hormonal contraception that may affect implantation "cannot terminate an established pregnancy." Similarly, the British Medical Association has defined an "established pregnancy" as beginning at implantation.

There are, however, more reliable definitions. The American Heritage Stedman's Medical Dictionary defines "pregnancy" as "from conception until birth." Encylopedia Britannica says that "It [pregnancy] begins when a viable sperm from the male and egg from the ovary merge in the fallopian tube (see fertility; fertilization)". Also, Van Nostrand’s Scientific Encyclopedia states that "The period of pregnancy begins with the union of the sperm and egg."

Where is the evidence to support the claim that implantation marks the beginning of pregnancy? As early as 24 to 48 hours after fertilization begins, pregnancy can be confirmed by detecting a hormone called "early pregnancy factor" in the mother's blood. But implantation begins 6 days and ends 10 to 12 days after fertilization.

"Pregnant" is defined as "having a child or other offspring developing in the body" [1]. After fertilization, the women is pregnant because the child is already developing in her body (By the time of implantation, the embryo is not simply a fertilized egg but blastocyst that comprises 70-100 cells). If pregnancy begins at implantation, the absurd conclusion should be that women can carry an offspring inside her but is not pregnant.

The most important thing to remember is, however, that even if pregnancy begins at implantation, some forms of contraception still result in the killing of an already conceived individual.

Viability[edit]

Viability means in general "capacity for survival" and is more specifically used to mean a capacity for living, developing, or germinating under favorable conditions. None of us could survive outside our natural environment. Unborn baby is in his natural environment with full capacities for development.

Is viability not just an extrinsic criterion imposed upon the fetus by some members of society who simply declare that the fetus will be accepted at that moment as a human being? In other words, the viability criterion seems to be arbitrary and not applicable to the question of whether the unborn is fully human, since it relates more to the location and dependency of the unborn than to any essential change in its state of being. This criterion only tells us when certain members of our society want to accept the humanity of the unborn.

Don't forget that viability depends on technology, not the unborn herself - fetal viability is largely a function of our abilities, not the fetus's. 50 years ago viability was at 30 weeks. 25 years ago it had dropped to 25 weeks. Today we have a survivor at 20 weeks and several at 21 weeks. But babies are still the same - fetal development has not changed in the last 40 years, only our understanding and ability to support a fetus outside of the womb has changed. In other words, humanity remains the same, but viability changes. So why should we use viability as a benchmark as to when we can kill the fetus?

Nobody can claim that "life" begins with viability. It would mean that a baby in the 18oo's and a baby in this century and probably a baby from the next century all had their lives began in different time. If viability is determined by the point at which it can survive outside the womb, that means that it is the point where the fetus has a good chance of not dying. Of course, if something is going to die, it has to be alive first; this is kind of hard to get around. But if someone is alive, we should have no business judging the value of their lives. We know that viability is not the beginning of life of new human individual, so why should it have any impact on whether or not an abortion can be performed? Often viability is not even the case, the more serious abortion advocates support abortion on demand throughout all the pregnancy. In USA, the Supreme Court made abortion legal throughout all nine months of pregnancy and, today, abortion clinics across America routinely advertise elective abortions past the point where it is known that babies can survive on their own.

“”An abortion law truly based on "viability" would
require constant redefination. What was not
considered protectable human life last year might
be this year. If we were to take the Court at its
word, we would find ourselves with a law
that makes last year's "abortions" this year's homicides
in some cases

—A renowned fertility specialist Dr. Landrum Shettles

We should come back to what I said in the first paragraph - viability means capacity for survival - for living, developing, or germinating under favorable conditions. Unborn baby is in his natural environment, in the only place it can be. And it is perfectly viable if you leave it where it is supposed to be in the first place. The most common reason to have abortion is because the life inside the womb is perfectly viable if left as it is, and will most likely result in the birth of the child if we don't dismember it first. The fetus/embryo has every chance of living a full life if left to its own, and no difference if it 8 weeks or 8 months old. Fetal viability has nothing to do with the beginning of life, and therefore it can have no impact on whether an abortion should or should not be done. Many premature babies are not viable outside of their incubators, many are not viable without a respirator, and absolutely zero babies are viable without someone to feed and care for them every hour of the day. There are also people who are severely handicapped or suffering from some debilitating illness, or are senile or unconscious. Indeed, many born people are not viable, because they are incapable of surviving without depending on others. However, it does not make them more or less human. And if the ability to survive without others is what creates the right to life, these people have no more right to live than the unborn.

What is birth?[edit]

Although vast majority of pro-choicers don't believe it, there are still some people who truly believe that life begins at birth.

There is nothing about birth that makes a baby essentially different than he was before birth - it just changes the location of baby: inside or outside of the uterus. Although we say that "this baby is three weeks old" after three weeks have passed from the birth of the baby in question, our recognition of birthdays is cultural, not scientific. After all, we can not possibly know the exact date of conception. Although we sometimes use "birth" as synonym for "the beginning of life", it is simply an oversimplification and biologically not true.

Should all human life be given equal protection?[edit]

Absolutely yes. Every government has the right and duty to protect the lives of all living humans in that nation regardless of degree of dependency, degree of perfection, age, sex, or place of residence. Human rights is a universalist concept of the basic rights and freedoms to which all humans are entitled. They are defined as "universal minimal standard of justice, tolerance and human dignity that is owed to individuals by the mere virtue of their humanity." Human rights are universal, in that they are possessed by all by virtue of the fact that they are human, and independent in that their existence as moral standards of justification and criticism is independent whether or not they are recognized by a particular national or international legal system or government. Abortion is not a right, but a wrong under justice. The best that a government can do in order to justify abortion is to claim that an early human being is not really a human being - and that is to lie.

Some pro-abortion activists try to draw a a distinction between human being and human person, arguing that there is criteria of personhood that a being needs to exhibit to qualify as a person. I am willing to discuss this criteria below, but at first I need to show that this "personhood" argument is against the basic principle of human rights.

To begin with, personhood is a philosophical issue. After all, we can't scientifically prove that anyone is a person, but we do manage to advocate for the human rights of women, minorities, and the severely disabled - all of whom have been considered non-persons at various times in history. Pro-life people argue that personhood is properly defined only by membership in the human species, not by stage of development within that species - otherwise personhood would be a matter of size, skill, or degree of intelligence and those who adopt such definition do not value human life, but instead select arbitrary characteristics (such as particular levels of physical or psychological development). Throughout history, many societies have adopted that kind of definition of personhood, denying the personhood of certain human groups. (e.g., African slaves, Chinese etc). And who determines the criteria? Those in power, of course. Whenever personhood is defined according to one's functionality, the "line" between persons and non-persons will be a decision of will by those in power. And it will be based on self-interest. If there's an interest in killing persons, those persons will be defined as non-persons.

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And here's a simple answer why pro-lifers find that there are no such creatures like human non-persons. Because there is no equality, if one person's convenience takes precedence over another's life, provided only that the first person has more power. The protection of human rights must be based on a scientifically observable standard, because there is no other way how we could guarantee equal protection of human rights for every individual member of our species. So long as human rights are based on subjective criteria, there will be no protection for those human individuals who are viewed as being in some sense inferior or inadequate in the opinions of the majority. It is dangerous when people in power are free to determine whether other, less powerful lives are meaningful.

But coming to this "personhood criteria" itself. At first it should be mentioned that by common usage of words, "human being" and "human person" are interchangeable terms.[1][2] There are two ways how to deny that all human beings are persons with right to life.

It is argued that only these persons who have achieved some certain stage of development are real persons. But there are many problems. For example, if this certain stage of development is the point at which the fetus can survive outside the womb, then is a viable horse fetus also a person? Or if we say that born human beings are persons, then why not born puppies? Newborn humans are physically and mentally less capable than virtually all other mammals. If you argue that all born human beings are persons or that 26-weeks old fetuses should have right to life, you are actually arguing that there is something inherent in a human being which differentiates her from other creatures. Because there are many animals who are more developed, more mature, even mentally more capable than newborn human beings, but they are not "persons".

How to explain all that? Pro-life people hold that to be a person is a matter of what "kind" of being we are; we refer to "capacity" and "power". Does one definitely have to demonstrate personhood to be a person? Personhood can emerge only trough the body. The preborn has no such body, but it still has the capacity for free choice, and given time and sustenance, (s)he will eventually manifest it. (If we don't dismember it first). We insist that the zygote is the same kind of being as the adult, differing only in degree. And "being a person" is a matter of kind, not of degree. It is in the nature of the zygote to develop into a being which can reason and make moral choices - barring catastrophe, of course. The ability to perform personal acts is not added, by some outside force, to the developing human being. In the process of her growth, she naturally builds the mental structures necessary to function as a person. Personhood itself is inherent in the zygote, embryo, fetus and infant. It may be difficult to understand, because the prenate, especially at the earliest stages, seems so foreign, so other; and yet every one of us once was a prenate. You can't take adults as the norm, and then say, "It's obvious that they can't be persons! Look how unlike us, how subhuman, they are!" They're not. It's just that our model of the "normal" human is biased towards ourselves - the adults. Despite any changes in such characteristics as independence, place of residence, physical development, or demonstration of mental ability, what the being is in later life is what the being is from the beginning of its life. When I was a zygote, it was my body and nobody else's.

But there is another way how people argue in support of "personhood". What does it mean to us that someone is a person? Pro-choice people aren't interested in the power of being a person, they insists one must demonstrate his or hers personhood. It is a matter of an act in which we engage that makes us persons - it's how we demonstrate our personhood.

Some examples of this...

“There is little evidence that termination of an infant’s life in the first few months following extraction from the womb could be looked upon as murder... It would seem to be more ‘inhumane’ to kill an adult chimpanzee than a newborn baby, since the chimpanzee has greater mental awareness. Murder cannot logically apply to a life form with less mental awareness than a primate.”

Winston L. Duke
Article: The New Biology
Reason magazine, August 1972

“No newborn infant should be declared human until it has passed certain tests regarding its genetic endowment and if it fails these tests, it forfeits the right to life.”

Dr. Francis Crick
Nobel Prize winner
Pacific News Service, January, 1978

“In our book, Should the Baby Live, my colleague Helga Kuhse and I suggested that a period of 28 days after birth might be allowed before an infant is accepted as having the same right to life as others.”

Peter Singer
Professor of Bio-Ethics
Princeton University

“It is reasonable to describe infanticide as post-natal abortion... Infanticide is actually a very humane thing when you are dealing with misbegotten infants. We might have to encourage it under certain conditionalities of excess population especially when you’re dealing with defective children.”

Joseph Fletcher
Professor of Ethics
Harvard Divinity School
Infanticide and the Value of Life,
Prometheus Books, 1978

To take this gradualist approach about "moral significance" is to say that the right to life "increases" during one's lifetime, gradually with the psychological and physical development. It is to assume that there is some kind of "morally most significant person", whose physical and psychological development is almost perfect. Probably Albert Einstein could have been one, if he only had won all the gold medals at the Olympic Games. All other people are inferior and deserve the right to life less and less. A thirteen years old boy is morally less significant than 20-years old person. Even the hypothetical sportsman Albert Einstein is "less person" when he is tired or asleep, but "more person" when he's on the stadion. Those who are asleep would be classified as non-persons, because they are not consciously performing personal acts. Those who are in a coma could be killed at any point during their coma, because they don't even have the present capacity to perform personal acts.

I oppose abortion because I seek truly equal human rights for all human beings, not just those deemed worthy by the powerful. That inclusive spirit has been at the heart of the greatest social movements in human history. Remember that whether the abortion is performed early or late, or the "fetus" killed 30 years after birth, it's the same human being who dies.

Women rights vs. right to life[edit]

This is what pro-choice activists say:

Anti-choicers insist that the key question in the abortion debate is whether a fetus is a person or not. That is not the key question at all, of course - the practice of abortion is unrelated to the status of the fetus - it hinges totally on the aspirations and needs of women.[3] Even if the unborn are human beings, they have fewer rights than the woman. No one should be expected to donate her body as a life-support system for someone else. There is no such thing as the right to live inside the body of another, i.e. there is no right to enslave. Contrary to the opinion of anti-abortion activists a woman is not a breeding pig owned by the state.[4] It would be unfair to restrict a woman’s choice by prohibiting abortion.

Here I must adress many questions:

1) If the "right to abortion" is going to be based on privacy rights, they are also based upon the assumption that their exercise does not entail injuring, much less killing, a human being. There is no such thing as a right to kill innocent people. Privacy, on the other hand, is never an absolute right, but is always governed by other rights. For example, the privacy right to walk where one pleases does not include the right to injure people by walking on their faces if they are lying on the ground. Which is a greater violation of rights - forced pregnancy and childbirth, or violent death? Clearly, the right to life underlies and sustains every other right we have.

2) To imply that the issue is not abortion, but choice, is to say that what’s being chosen is irrelevant. That is illogical, given that all choices are not equal. If we are arguing whether abortion is the deliberate killing of a living human being or not, it is illogical to argue that we couldn't ban it simply because it would restrict someone's freedom to choose it. Just think about any random crime - do we let people make their own choices to rape, rob or drive drunk? No, we don't. By definition, the goal of every law is to deny someone the legal ability to choose a particular activity. Abortion does not become acceptable simply because someone chooses to do it.

Another way how to look at it is to say that it's up to woman to decide whether abortion is moral or not. But we cannot allow individuals to create their own realities in order to justify killing other people. For example, we don't allow Ku Klux Klan to kill black people just because they claim to honestly believe that black people are not really human beings.

However, one of the strangest things is that people only very rarely say that they "support abortion", they only say that they support the "choice" - that every woman should have the right to choose abortion. They assert that they are actually "personally opposed" to abortion, but that they can't inflict their beliefs on others. But the effort to outlaw abortion is not merely personal morality. It is not merely what a person does. It is about what a person does to another person. And the one-time choice of abortion robs someone else of a lifetime of choices and prevents him or her from ever exercising his or her rights...

3) If the abortion is the deliberate killing of another human being, it is absolutely unrelated to the question whether or not it is about empowering women. Even if the abortion really is about empowering women, it still remains the deliberate killing of another human being. But that an harmful act empowers someone is not enough to make it legal or moral. Slavery wast about empowering white people, sexism is about empowering men; we don't say that these things are moral because someone made a profit out of it.

But having a clean place to kill their babies isn't really the cornerstone of women’s equality. As pro-life feminist Melissa Simmons-Tulin once said, “Women will never climb to equality over the dead bodies of their children.” If it was otherwise, then why no woman is ever admired for having an abortion and why no woman has ever bragged about her abortion? Why don't we see any woman climbing off an abortionist’s table with a higher opinion of herself than she had when she climbed onto it?

The basic premises of the abortion-rights movement are demeaning to women. Some of the abortion-rights strategies assume female incompetence and subject women to ignorance and exploitation. To say that abortion rights are essential to having equal rights with men is to say that women are essentially lower beings than men and that they need a special procedure - abortion - to become equal with men.

Experiences of uncountable number of women prove that pregnant woman usually continues with her social life and career. Pregnant women don’t become some kind of unanimous and passive life-support system for someone else. And it is reasonable for society to expect an adult to live temporarily with an inconvenience if the only alternative is killing a child.

I can hear people screaming that circumstances of many women leave them no choice but an abortion. Obviously, it is virtually impossible to name these "circumstances" that leave no other choice but to kill an innocent human being - the only circumstance is probably a clear risk to the life of the mother. But convincing someone that she has "no other choice" is clearly not "pro-choice"...

Wanted or not, we all have the right to life[edit]

“”Pro-choice, that’s a lie,
babies never choose to die!

—Anonymous quote, from
"March for Life"

Pro-choice activist say that,

"...It’s unfair to children to bring them into a world where they’re not wanted. Having a baby who is not wanted and wont be loved is amoral. Every child should be a wanted child."

One of the most incredible aspects of the abortion lobby’s approach to this issue is that they try to sell it as compassionate. That it shows "love" to kill children who are not wanted by their parents, because they won't be loved and they will have an unhappy life.

It, of course, completely misses the fact that a new human being is already brought to this world – at the moment of conception. “Unwanted” describes not a condition of the child, but an attitude of adults. And since when does anyone’s right to live depend upon someone else wanting them? The problem of unwantedness is a poor argument for eliminating children. Should we complete the slogan "Every child a wanted child" with "if not wanted, kill!"?

350px

That is exactly what that Planned Parenthood slogan means. Someone is killed just because someone else didn't want him. But human being has value simply because it is, not because it is wanted.

You may ask, doesn't the unwantedness of children lead to child abuse? That babies/children who are abused were "unwanted" children who should have been aborted?

But isn't abortion itself an ultimate abuse of children? How can we separate the violence of abortion from the family violence heard on the news? Simply because it seems kinder to kill a voiceless embryo in the womb?

In fact, abortion has done nothing to end child abuse. It has had just the opposite effect. According to the National Center of Child Abuse and Neglect (U.S. Department of Health and Human Services), child abuse has dramatically increased since abortion was legalized. In 1973 the agency reported 167,000 cases of child abuse. In 1983, it reported 929,000 cases.

Professor Edward Lenoski at the University of Southern California studied over 600 cases of child abuse. He found that in over 90% of these cases, the parents said that the child they abused had been a wanted child.

And finally, if it is compassionate to execute an unborn child who might live an unpleasant life, isn't it even more compassionate to execute a five-year-old who we know is living an unpleasant life?

Is abortion a murder?[edit]

It depends on what we consider to be a murder. Usually "murder" has three components:

  • Objective component: killing an innocent human being
  • Subjective component: intention to kill innocent human being
  • Juridical component: action against law

As life of every human being starts at conception, abortion is always the killing of an innocent human being. Only half the patients who go into an abortion clinic come out alive.

However, abortion does not always include the intention to kill innocent human being. Firstly, many people simply don't know abortion results in death of innocent human being (this goes for women who want abortion, because every competent doctor knows that abortion results in someone's death). Abortions may be performed in very different situations, with very different knowledge and with very different intentions.

Secondly, there are cases when mother's life is at risk. In such case, abortion is a regrettable secondary subject not the intention itself.

Juridical component is far more simpel; abortions are legal, wheter in all, most or some circumstances.

Therefore, it is wrong to call every abortion a murder. But abortion is and always will be direct killing of the innocent human being, always regrettable and never morally justifiable.

Religiousness of pro-life people[edit]


A person does not have to be religious to say it’s wrong to murder a child, any more than they have to be religious to say it’s wrong to steal money. Just because many (but not all) pro-lifers are motivated by religious beliefs does not make abortion a religious issue. Remember, the civil rights movement was often led by pastors and headquartered in churches, but that didn’t make civil rights a religious issue.

To say that abortion should be off limits to the law because many pro-life people are religious, is as illogical as saying we should do away with laws against theft because one of the Ten Commandments is, "Thou shalt not steal." If we are going to start rejecting laws simply because they are supported by religion, then we will have to do away with all of our laws.

Of course, it is true that opposition to abortion is a religious position for many people. But many people are against abortion for reasons that are independent of religious authority or belief. Many would still be against abortion if they lost their faith; others are opposed to it after they have lost faith, or if they never had any faith. But the pro-abortion forces concentrate heavily on religious arguments against abortion and generally ignore the secular arguments - possibly because they cannot answer them.

“”In fact, one thing that both the abortion industry
and the pro-life movement agree on is that
public ignorance about fetal development, abortion
methodology and post-abortion complications is
necessary if abortion is to remain legal. Ironically,
the religious orientation of most pro-lifers may
act as the major factor preventing education from
taking place.
I would literally hold my breath whenever
abortion was the topic on television, waiting for religion
to be mentioned. The media never let me down.

—Judy Ferris,
"Why should atheist be pro-life"

It's science, not religion, that makes people pro-life. Dr Bernard Nathanson was called the "king of abortions" and what made him reconsider his views? Development of ultra-sound! Also Judy Ferris says: "Believing that the fetus was just a "blob of tissue", that pro-lifers were lying about how developed aborted fetuses are, I had no reason to avoid information from sources that were not "anti-abortion". I learned about fetal development when my other children were born. I experienced nightmares, crying spells and suicidal thoughts. I knew these were not caused by the activities or words of pro-lifers or preachers. Was I supposed to be upset with sonogram technicians or childbirth instructors for educating me?"

This is strongly supported by the evidence that about 80% of women who see an ultrasound of their unborn child decide not to abort.

Other things Judy Ferris wrote: "As an atheist, one of the most ironic discoveries I made when I became pro-life was the cultist nature of the followers of choice. To a skeptic like myself, the "pro-choice" movement started to look frighteningly fundamentalist. I started asking questions and was "answered" with slogans. Dissatisfied with slogans, I continued asking questions and was accused of being "anti-choice". To question was taboo; information from pro-lifers was "heresy", and I had become a "heretic"."

I think many people are pro-choice not because what they actually believe, but because there are very strong stereotypes about pro-life people: they are woman-hating Bible-thumping clinic bombers. This kind of stereotype draws more attention than the actual strongest arguments against abortion, which are medical, legal, and scientific facts.

In an interview, someone called "the raving atheist" said:

"In the late 1960's the pro-choice movement made a deliberate, strategic decision to trivialize the abortion debate by dismissing all pro-life arguments as mere Catholic dogma. This made it easy to gloss over the inconvenient, undeniable scientific embryological fact that human life begins at conception in favor of specious arguments regarding church/state separation and accusation that religion "is being forced down our throats." Planned Parenthood today still insists that the question of when life begins is a religious one which varies from woman to woman, apparently mind-dependent rather than reality-dependent. They do draw the line at the old Mayan practice of throwing infants into volcanos, although I don't see why, under their theory, that wouldn't be a protected exercise of religion as well. I've seen more of a reliance on science - embryology, ultrasound - on the pro-life side than on the pro-choice side. In fact, the mainstream pro-choice organizations oppose showing women who are considering abortion ultrasound pictures of the child on the grounds that they are "confusing." It should be noted that the pro-choice side isn't opposed to raising religious arguments when it suits them. Planned Parenthood has hired clergy to promote abortion from a theological standpoint. The Religious Coalition for Reproductive Choice devotes its very existence to that endeavor. Ironically, even the atheistic Freedom from Religion Foundation employs a religious argument when it comes to abortion - it argues that the practice should be permitted because it isn't expressly forbidden by the Bible."

See also[edit]

  1. ↑Merriam-Webster dictionary:Person - human, individual
  2. ↑Wiktionary: Person - A human being; an individual.
  3. ↑Joyce Arthur: The Fetus Focus Fallacy
  4. ↑Abortionisprolife: FAQ

For other uses, see Abortion (disambiguation).

Abortion is the ending of pregnancy by removing a fetus or embryo before it can survive outside the uterus.[note 1] An abortion that occurs spontaneously is also known as a miscarriage. An abortion may be caused purposely and is then called an induced abortion, or less frequently, "induced miscarriage". The word abortion is often used to mean only induced abortions. A similar procedure after the fetus could potentially survive outside the womb is known as a "late termination of pregnancy".[1]

When allowed by law, abortion in the developed world is one of the safest procedures in medicine.[2][3] Modern methods use medication or surgery for abortions.[4] The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy.[4][5]Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.[5] When performed legally and safely, induced abortions do not increase the risk of long-term mental or physical problems.[6] 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.[6][7] The World Health Organization recommends safe and legal abortions be available to all women.[8]

Around 56 million abortions are performed each year in the world,[9] with about 45% done unsafely.[10] Abortion rates changed little between 2003 and 2008,[11] before which they decreased for at least two decades as access to family planning and birth control increased.[12] As of 2008[update], 40% of the world's women had access to legal abortions without limits as to reason.[13] Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.[13]

Historically, abortions have been attempted using herbal medicines, sharp tools, with force, or through other traditional methods.[14]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.[15] In many places there is much debate over the moral, ethical, and legal issues of abortion.[16][17] Those who oppose abortion often maintain that an embryo or fetus is a human with a right to life and may compare abortion to murder.[18][19] Those who favor the legality of abortion often hold that a woman has a right to make decisions about her own body.[20]

Types

Induced

Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[11][21] Most abortions result from unintended pregnancies.[22][23] In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.[6] 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.[24][25] 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; prevent harm to the woman's physical or mental health; terminate a pregnancy where indications are that the child will have a significantly increased chance of premature morbidity or mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[26][27] 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.[27] Confusion sometimes arises over the term "elective" because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.[28]

Spontaneous

Main article: Miscarriage

Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.[29] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth" or a "preterm birth".[30] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[31] Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.[32]

Only 30% to 50% of conceptions progress past the first trimester.[33] The vast majority of those that do not progress are lost before the woman is aware of the conception,[27] and many pregnancies are lost before medical practitioners can detect an embryo.[34] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[35] 80% of these spontaneous abortions happen in the first trimester.[36]

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,[27][37] accounting for at least 50% of sampled early pregnancy losses.[38] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[37] 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.[38] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[39]

Methods

Medical

Main article: Medical abortion

Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandinanalogs in the 1970s and the antiprogestogenmifepristone (also known as RU-486) in the 1980s.[4][5][40][41][42]

The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog (misoprostol or gemeprost) up to 9 weeks gestational age, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.[40] 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.[41] This regime is effective in the second trimester.[43] Medical abortion regiments involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 63 days' gestation.[44]

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.[45] 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.[46] If medical abortion fails, surgical abortion must be used to complete the procedure.[47]

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,[48][49] France,[50] Switzerland,[51] and the Nordic countries.[52] In the United States, the percentage of early medical abortions is far lower.[53][54]

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,[42] in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.[55]

Surgical

Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.[56]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 differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether cervical dilation is necessary.

MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Dilation and curettage (D&C), the second most common method of surgical abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.[57]

From the 15th week of gestation until approximately the 26th, other techniques must be used. Dilation and evacuation (D&E) consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. After the 16th week of gestation, abortions can also be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "partial-birth abortion", which has been federally banned in the United States.

In the third trimester of pregnancy, induced abortion may be performed surgically by intact dilation and extraction or by hysterotomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.[58]

First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.[54]

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.[59] 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.[60]

Only limited data are available comparing this method with dilation and extraction.[60] 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 U.S.[60][61]

Other methods

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[62] The use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ failure, and is not recommended by physicians.[63]

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.[64] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[65] 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.[65]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.[66] All of these, and any other method to terminate pregnancy may be called "induced miscarriage".

Safety

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.[67] Legal abortions performed in the developed world are among the safest procedures in medicine.[2][68] In the US, the risk of maternal death from abortion is 0.7 per 100,000 procedures,[3] making abortion about 13 times safer for women than childbirth (8.8 maternal deaths per 100,000 live births).[69][70] In the United States from 2000 to 2009, abortion had a lower mortality rate than plastic surgery.[71] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.[72][73][74] Outpatient abortion is as safe and effective from 64 to 70 days' gestation as it is from 57 to 63 days.[75] Medical abortion is safe and effective for pregnancies earlier than 6 weeks' gestation.[76]

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 are rare and can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.[77] Infections account for one-third of abortion-related deaths in the United States.[78] 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.[79] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before elective abortion,[80] as they are believed to substantially reduce the risk of postoperative uterine infection.[54][81] 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.[82] 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.[83]

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 9 weeks gestation.[45] 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.[84][85]

Some purported risks of abortion are promoted primarily by anti-abortion groups,[86][87] but lack scientific support.[86] 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.[88]

Mental health

Main article: Abortion and mental health

Current evidence finds no relationship between most induced abortions and mental-health problems[6][89] other than those expected for any unwanted pregnancy.[90] 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.[90][91] Some older reviews concluded that abortion was associated with an increased risks of psychological problems,[92] however, they did not use an appropriate control group.[89]

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,[93] more rigorous research would be needed to show this conclusively.[94] Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome", which is not recognized by medical or psychological professionals in the United States.[95]

Unsafe abortion

Main article: Unsafe abortion

Women seeking to terminate their pregnancies sometimes resort to unsafe methods, particularly when access to legal abortion is restricted. They may attempt to self-abort or rely on another person who does not have proper medical training or access to proper facilities. This has a tendency to lead to severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.[96]

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.[2] Unsafe abortions are believed to result in millions of injuries.[2][97] Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;[2][7][98] deaths from unsafe abortion account for around 13% of all maternal deaths.[99] The World Health Organization believes that mortality has fallen since the 1990s.[100] 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.[101] However, 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."[102]

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.[7][11][101][103][104][105][106] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[107] with abortion-related deaths dropping by more than 90%.[108] Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.[109] 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.[110] The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.[111] 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.[112] 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".[113][114]

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,[13] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[15] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[7] Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,[115] though this varies by region.[116] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[104] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.[11] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[117]

Live birth

Although it is very uncommon, women undergoing surgical abortion after 18 weeks gestation sometimes give birth to a fetus that may survive briefly.[118][119][120]Longer term survival is possible after 22 weeks.[121]

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.[122][123][124]Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended to avoid this.[125][126][127][128][129]

Death following live birth caused by abortion is given the ICD-10 underlying cause description code of P96.4; data are identified as either fetus or newborn. Between 1999 and 2013, in the U.S., the CDC recorded 531 such deaths for newborns,[130] approximately 4 per 100,000 abortions.[131]

Incidence

There are two commonly used methods of measuring the incidence of abortion:

  • Abortion rate – number of abortions per 1000 women between 15 and 44 years of age
  • Abortion percentage – 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.[103] For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.[11]

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.[11] 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.[11] 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.[11]

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.[13][132][133] 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.[134]

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.[135][136]

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

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, 9.7% at 11 through 12 weeks, 6.2% at 13 through 15 weeks, 4.1% at 16 through 20 weeks and 1.4% at more than 21 weeks. 90.9% of these were classified as having been done by "curettage" (suction-aspiration, dilation and curettage, dilation and evacuation), 7.7% by "medical" means (mifepristone), 0.4% by "intrauterine instillation" (saline or prostaglandin), and 1.0% by "other" (including hysterotomy and hysterectomy).[137] 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.[138]

The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for 0.17% of the total number of abortions performed that year.[139] Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 and 19 weeks, and 1.5% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.[140] There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.[141]

Motivation

Personal

The reasons why women have abortions are diverse and vary across the world.[138][142]

Some of the most common reasons are to postpone childbearing to a more suitable time or to focus energies and resources on existing children. Others include being unable to afford a child either in terms of the direct costs of raising a child or the loss of income while caring for the child, lack of support from the father, inability to afford additional children, desire to provide schooling for existing children, disruption of one's own education, relationship problems with their partner, a perception of being too young to have a child, unemployment, and not being willing to raise a child conceived as a result of rape or incest, among others.[142][143]

Societal

Some abortions are undergone as the result of societal pressures. These might include the preference for children of a specific sex or race,[144] disapproval of single or early motherhood, stigmatization of people with disabilities, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion.[145]

An 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.[146] 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".[147]

Maternal and fetal health

An additional factor is risk to maternal or fetal health, which was cited as the primary reason for abortion in over a third of cases in some countries and as a significant factor in only a single-digit percentage of abortions in other countries.[138][142]

In the U.S., the Supreme Court decisions in Roe v. Wade and Doe v. Bolton: "ruled that the state's interest in the life of the fetus became compelling only at the point of viability, defined as the point at which the fetus can survive independently of its mother. Even after the point of viability, the state cannot favor the life of the fetus over the life or health of the pregnant woman. Under the right of privacy, physicians must be free to use their "medical judgment for the preservation of the life or health of the mother." On the same day that the Court decided Roe, it also decided Doe v. Bolton, in which the Court defined health very broadly: "The medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient. All these factors may relate to health. This allows the attending physician the room he needs to make his best medical judgment."[148]:1200–1201

Public opinion shifted in America following television personality Sherri Finkbine's discovery during her fifth month of pregnancy that she had been exposed to thalidomide, unable to abort in the United States she traveled to Sweden. From 1962-65 there was an outbreak of German measles that left 15,000 babies with severe birth defects. In 1967, the American Medical Association publicly supported liberalization of abortion laws. A National Opinion Research Center poll in 1965 showed 73% supported abortion when the mothers life was at risk, 57% when birth defects were present and 59% for pregnancies resulting from rape or incest.

Cancer

The rate of cancer during pregnancy is 0.02–1%, and in many cases, cancer of the mother leads to consideration of abortion to protect the life of the mother, or in response to the potential damage that may occur to the fetus during treatment. This is particularly true for cervical cancer, the most common type of which occurs in 1 of every 2,000–13,000 pregnancies, for which initiation of treatment "cannot co-exist with preservation of fetal life (unless neoadjuvant chemotherapy is chosen)". Very early stage cervical cancers (I and IIa) may be treated by radical hysterectomy and pelvic lymph node dissection, radiation therapy, or both, while later stages are treated by radiotherapy. Chemotherapy may be used simultaneously. Treatment of breast cancer during pregnancy also involves fetal considerations, because lumpectomy is discouraged in favor of modified radical mastectomy unless late-term pregnancy allows follow-up radiation therapy to be administered after the birth.[150]

Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic effects on the fetus, with higher risks for multiple drug treatments. Treatment with more than 40 Gy of radiation usually causes spontaneous abortion. Exposure to much lower doses during the first trimester, especially 8 to 15 weeks of development, can cause intellectual disability or microcephaly, and exposure at this or subsequent stages can cause reduced intrauterine growth and birth weight. Exposures above 0.005–0.025 Gy cause a dose-dependent reduction in IQ.[150] It is possible to greatly reduce exposure to radiation with abdominal shielding, depending on how far the area to be irradiated is from the fetus.[151][152]

The process of birth itself may also put the mother at risk. "Vaginal delivery may result in dissemination of neoplastic cells into lymphovascular channels, haemorrhage, cervical laceration and implantation of malignant cells in the episiotomy site, while abdominal delivery may delay the initiation of non-surgical treatment."[153]

History and religion

Main article: History of abortion

Since ancient times abortions have been done using herbal medicines, sharp tools, with force, or through other traditional methods.[14] Induced abortion has long history, and can be traced back to civilizations as varied as China under Shennong (c. 2700 BCE), Ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE).[14] There is evidence to suggest that pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.[65]

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions;[14] other scholars disagree with this interpretation,[14] and state the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath.[155] The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus, although apparently not all doctors adhered to it strictly at the time. According to Soranus' 1st or 2nd century CE work Gynaecology, one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party—to which he belonged—was willing to prescribe abortions, but only for the sake of the mother's health.[156][157]

Aristotle, in his treatise on government Politics (350 BCE), condemns infanticide as a means of population control. He preferred abortion in such cases, with the restriction[158] "[that it] must be practised on it before it has developed sensation and life; for the line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive".[159]In Christianity, Pope Sixtus V (1585–90) was the first Pope to declare that abortion is homicide regardless of the stage of pregnancy;[160] the Catholic Church had previously been divided on whether it believed that abortion was murder, and did not begin vigorously opposing abortion until the 19th century.[14] A 1995 survey reported that Catholic women are as likely as the general population to terminate a pregnancy, Protestants are less likely to do so, and Evangelical Christians are the least likely to do so.[138][142]Islamic tradition has traditionally permitted abortion until a point in time when Muslims believe the soul enters the fetus,[14] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[161] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[162]

In Europe and North America, abortion techniques advanced starting in the 17th century. However, conservatism by most physicians with regards to sexual matters prevented the wide expansion of safe abortion techniques.[14] Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice (sometimes called restellism)[163] was banned in both the United States and the United Kingdom.[14] Church groups as well as physicians were highly influential in anti-abortion movements.[14] In the US, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.[note 2] Soviet Russia (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[164] In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions.[165] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.[14]

Society and culture

Abortion debate

Main article: Abortion debate

Induced abortion has long been the source of considerable debate. Ethical, moral, philosophical, biological, religious and legal issues surrounding abortion are related to value systems. Opinions of abortion may be about fetal rights, governmental authority, and women's rights.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion.[166] The World Medical Association Declaration on Therapeutic Abortion notes, "circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question as to whether or not the pregnancy should be deliberately terminated."[167] Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Anti-abortion groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while abortion rights groups who are against such legal restrictions describe themselves as "pro-choice".[168] Generally, the former position argues that a human fetus is a human person with a right to live, making abortion morally the same as murder. The latter position argues that a woman has certain reproductive rights, especially the choice whether or not to carry a pregnancy to term.

Modern abortion law

Main article: Abortion law

See also: History of abortion law debate

A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).
1: Amniotic sac
2: Embryo
3: Uterine lining
4: Speculum
5: Vacurette
6: Attached to a suction pump
An abortion flyer in South Africa
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."

Histogram of abortions by gestational age in England and Wales during 2004. (left)

Abortion in the United States by gestational age, 2004. (right)

A bar chart depicting selected data from a 1998 AGImeta-study on the reasons women stated for having an abortion.
"French Periodical Pills". An example of a clandestine advertisement published in a January 1845 edition of the Boston Daily Times.

International status of abortion law

UN 2013 report on abortion law.[169]

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