From Encyclopedia of Sex and Sexuality
The termination of pregnancy by loss or destruction of the fetus before it has reached viability. An abortion may be spontaneous (Miscarriage) or induced. It may further be divided into early or late abortion depending on whether it has occurred before or after the twelfth week of pregnancy (in the first or second trimester). Induced abortion is associated with many legal and ethical considerations.
 Spontaneous Abortion (miscarriage)
This occurs when the embryo ceases to develop and when there is complete or incomplete expulsion of the products of conception—the fetus and placenta—prior to twenty weeks of gestation. As many as one-third of early pregnancies are spontaneously aborted. Most occur before they can be clinically diagnosed and may only be detected by a very sensitive pregnancy test that has only recently become available. After some delay, the woman may experience bleeding and cramping similar to that of a normal menstrual period. With more advanced gestation, however, heavier cramping and blood loss occur as the fetus and placenta are expelled.
In early, first trimester abortions, chromosomal aberrations have been found in about two-thirds of aborted fetuses. Infection, hormonal and environmental factors, and maternal diseases have also been suggested as possible causes. In late, second trimester abortions, where a normally-developed fetus is usually found, anatomic changes of the uterus and uterine cervix can frequently be demonstrated (see also Miscarriage).
 Abortion Procedures
 Induced Abortion
A procedure intended to interrupt a pregnancy by evacuation of the nonviable fetus and placenta from the uterine cavity. Although discouraged by most major religions, induced abortion has been practiced in every culture since ancient times. To date, abortion is legalized and regulated in most developed countries, where it is available on request. Restrictive policies are found in Ireland, fundamentalist Islamic countries, sub-Saharan Africa, and Latin America. Illegal abortions performed in these countries are associated with high morbidity and maternal mortality rates. Although legally induced abortion has been made available in most states of the United States since the early 1970s, abortion remains a hotly debated issue on religious and ethical grounds. In the 1980s, it was estimated that about 40 to 60 million induced abortions occurred yearly around the world; about 33 million of these were legal.
Most induced abortions are performed in the first trimester—during the first twelve weeks of gestation. The technique most commonly used for first trimester pregnancy termination utilizes a procedure called vacuum aspiration, or vacuum curettage. After dilation of the uterine cervix, a hollow plastic tube with a hole near its end is inserted into the uterus. The embryo or fetus and placenta are drawn into the tube through vacuum pressure. This procedure is usually completed by cleaning the remains of conception with a curette—a metal rod with a sharp ring at its end. This instrument has been used for centuries to empty the uterine cavity following spontaneous and induced abortions.
 Second Trimester (Late) Induced Abortions
This involves several more complicated procedures, since dilation and curettage are too hazardous after twelve weeks of pregnancy. The most complicated procedure is the injection of a saline solution or hormones (prostaglandins) into the amniotic sac. To avoid an inadvertent injection of these substances outside the amniotic cavity, the procedure is usually performed after the sixteenth week of gestation. Prostaglandins, which cause efficient uterine contractions, may also be administered by inserting a catheter into the uterus, but not penetrating the amniotic sac. Regular uterine contractions develop promptly and the fetus and placenta are usually expelled after several hours in a process that is very similar to normal delivery. Following abortion, the remains of conception are removed with a sharp curette. When expulsion of the fetus fails or is delayed, a high dose of oxytocin—a hormone that causes labor contractions—may be added intravenously; when this method fails, hysterotomy—surgical incision of the uterus to remove the fetus—may be performed.
In France in the 1980s, an abortion-inducing drug called ru–486 was developed. This antiprogesterone was proved 85 percent effective in inducing abortion during the first six weeks of pregnancy, especially when used with prostaglandins. The drug is taken orally and is so far licensed only in France, China, and England.
Studies of long-term health consequences of abortion indicate that risks of future spontaneous abortion, preterm delivery, and low birth weight are not significantly increased if the procedure is performed early in the first trimester by vacuum aspiration. Late abortion and, especially, illegal termination at any pregnancy stage are associated with a significantly higher rate of morbidity, long-term aftereffects, and maternal mortality.
 Religious, Ethical, and Moral Issues
In 1973 the United States Supreme Court ruled in the case known as Roe v. Wade that a woman’s right to privacy also gave her the right to have an abortion. Her decision could not be overruled by the state or any of its authorities, or by any other individual. With that court ruling, the legality of abortion in the United States was established. The question of abortion, however, is still steeped in intense controversy. Moral and ethical issues continue to infuse it, with emotionalism on the subject often running high.
On a personal level, women contemplating abortion often confront feelings of sadness and loss. A woman may also feel guilt or social shame. However, the overwhelming psychological response from women is relief. For most women, abortion is not approached casually. If a woman decides to terminate her pregnancy, there are usually very compelling reasons.
Perhaps the greatest controversy surrounding abortion stems from the fact that opinions differ widely on the point at which life truly begins. For those in our society who strongly believe that life begins at the instant of conception, abortion may be regarded as murder. This is the position of the Catholic Church as well as of other religious groups, both Jewish and Christian. But this position is not universally held by Christian or Jewish theologians. The Bible itself does not directly address the issue and is open to a variety of interpretations. In principle, most Christians and Jews accept a woman’s right to have an abortion; they view the end of the second trimester of pregnancy as the point at which a fetus becomes a distinct and individual human being, or life, capable of sustaining itself outside the womb.
The “pro-life” movement, which believes abortion is immoral and should not be legal, is often in collision with the “pro-choice” movement, which believes abortion must be legal because women have the absolute right to make decisions about their own bodies. The question remains: since there is no standard scientific definition of when life begins, should the religious or moral beliefs of one segment of society, however strongly held, be imposed on the society as a whole?
The moral and ethical issues surrounding abortion are very complex. For example, there is controversy about the rights of fathers; debate about parental consent in the case of pregnant minors seeking abortions; and questions, even in the minds of those who are in principle opposed to abortion, about cases of rape, incest, and the mother’s health.
While some American states have laws requiring parental consent for a minor’s abortion, the issue of parental consent remains ethically problematic. While most people agree that, ideally, a girl who is under eighteen years of age and finds herself pregnant should discuss the matter with her parents, in the real world teens who do not talk to their parents usually have very good reasons for not doing so. Most pregnant teenagers turn to one or both parents for guidance. However, many parents are not the right people to turn to for support and advice when it comes to an issue as explosive as abortion. If a teenager’s pregnancy is the result of incest, this is almost certainly the case. Some teens know they face punishment for becoming pregnant. While it is argued that minors are not legally, morally, or ethically equipped to make a decision about abortion without parental consent, others believe that every woman’s privacy in this matter is a right and needs to be respected whatever her age.
Since Roe v. Wade ruled that only a woman has the right to resolve how her pregnancy will end, a number of lovers, fiancés, and husbands have sought injunctions to delay or prevent abortion. At issue is more than the law. It is the mother’s versus the father’s moral biological right to make the decision. Most people agree that, ideally, the decision to terminate a pregnancy should be shared by both partners. But what if there is no marriage or true relationship? What if a married woman is abused and fears her husband’s response? A woman’s ethical obligation to involve her partner in her decision is clearly not a cut-and-dried matter (see also Birth Control).
 The Legal Aspects
The legal aspects of abortion in the United States changed dramatically in 1973. However, they have continued to be an issue in the courts and in legislative bodies—both in the United States Congress and the legislatures of many of the fifty states—since that time. Key issues today include government funding of abortion, restrictions on when abortions are permitted, attempts by abortion opponents to block access to abortion clinics, and the methods of abortion that are considered to be legal.
Prior to 1973, abortion was seldom legally available in the United States. Most states, like Texas, had laws which prohibited abortion except to save the life of the woman, a phrase which was not well defined as to its meaning. Sixteen or so states allowed abortion for the additional reasons of rape or incest and sometimes to protect the woman’s health, but often restrictions (such as review of the case by a hospital committee) were imposed. The legislatures in a few states (such as California and New York) had passed laws generally allowing abortion.
Before 1973 women in states in which abortion was illegal traveled to those few states where it was legal if they had the money. Other women traveled out of the country, a few to Europe and many to Mexico, where abortion was illegal but readily available. Some visited places operating illegally in the United States—places which were often ill-equipped medically and therefore dangerous. A few women attempted self-abortion. Women who had undergone abortions in such conditions were often seen in hospital emergency rooms; a few died and others suffered long-lasting medical conditions.
On 22 January 1973, the Supreme Court, in the case called Roe v. Wade, declared the Texas anti-abortion law—and by implication the laws of other states—to be unconstitutional. The court’s opinion declared that women’s constitutional right of privacy applied to the decision of whether to continue or terminate a pregnancy.
The springboard for the decision was a 1965 Supreme Court case, Griswold v. Connecticut. That case struck down a Connecticut statute that prohibited the use of contraceptives, a law equally applicable to married and unmarried persons. The Court relied on the right of privacy for individuals to decide whether “to bear a child.”
The abortion case was filed by an unmarried pregnant woman, Jane Roe (not her real name), against the District Attorney of Dallas County, Henry Wade, an official responsible for enforcing the Texas law. The Supreme Court voted 7 to 2 in her favor. The opinion was written by Justice Harry A. Blackmun; the dissenting Justices were now-Chief Justice William Rehnquist and now-retired Justice Byron White.
The legal status of abortion issues must be examined in light of the makeup of the Supreme Court, the body that sets the constitutionality of laws for the nation and each of the states. That decision turned out to be the beginning of a stream of litigation on abortion issues that has continued until the present time. The zigzag pattern of abortion litigation after Roe v. Wade followed the changing membership of the Supreme Court. In fact, by 1992, forces seeking to overturn or reverse Roe v. Wade were only one Supreme Court vote away from victory.
As Justices retired during the 1980s, they were replaced by appointments made first by President Ronald Reagan and then by President George Bush. Each of those presidents opposed the Roe v. Wade decision and the legality of abortion. In late 1991, four Justices seemed to be ready to overturn Roe: Rehnquist, White, Justice Antonin Scalia, and Justice Clarence Thomas. Other Justices named to the court in the 1980s, such as Justice Sandra Day O’Connor, Justice Donald Souter and Justice Anthony Kennedy, were prepared to modify Roe by allowing states to restrict abortion. Only two Justices remained who fully supported Roe v. Wade: Justice Blackmun and Justice John Paul Stevens.
When Bill Clinton was sworn in as president in January 1993, the chances of Roe being overturned were almost extinguished. Clinton was elected on a platform of supporting the principles of Roe, and his first appointee, Justice Ruth Bader Ginsburg, who replaced Justice White, also supported those principles.
While it is now clear that abortion will continue to be legal, at least for the foreseeable future, there are many issues about accessibility to the procedure. One issue is whether the poorest American women, those eligible for medical services paid for by Medicaid, will have access to abortion. Congress, which controls federal funding for those services, in general has refused to pay for abortion services except in very narrow cases of medical necessity. It has, however, sometimes permitted payment for women who are pregnant as a result of rape or incest. Although state governments could choose to provide abortion services to those women, less than a quarter of the states have chosen to do so.
Another issue is whether the youngest women will have access to abortion. A variety of state laws have been passed requiring minors either to have the consent of both parents or of one parent, or to notify them. Supreme Court cases have basically ruled that the states may require involvement of parents, but only if there is a “judicial by-pass” in the legislation. “Judicial by-pass” refers to a speedy procedure that can be used by a minor if mature and if she has an important reason why she feels she cannot talk to her parents. In such cases she can ask a judge for permission to proceed with an abortion.
Another issue is whether the health care proposals now being debated in the United States will include abortion services. The legislation introduced in Congress in 1993 at the urging of the Clinton administration to provide payment for medical services for all Americans would allow coverage of abortion services; members of Congress opposed to abortion have vowed to prevent inclusion of those services when the bill eventually is considered.
Some abortion opponents have used tactics that include picketing clinics and the homes of abortion providers; seeking to prevent entry into abortion clinics by physical blockades; attempting to close clinics via arson or throwing acid and other substances; and in two cases, shooting doctors providing abortion services. One doctor was wounded, and another, Dr. David Gunn, was killed in 1992 by an anti-abortion assailants.
Legal responses have included city ordinances limiting picketing of private homes and setting parameters for picketing activities at businesses (including abortion clinics), and state laws making related offenses felonies instead of misdemeanors. In 1994 it is likely that Congress will pass the Freedom of Access to Clinical Entrances Act, which will make some of the tactics of abortion opponents federal crimes and will result in greater enforcement of those laws.
Other opponents have sought to enact laws to make it more difficult for women to have an abortion. These laws as passed by various states contain a variety of provisions. In general, however, the Supreme Court has approved state laws which: require a waiting period of twenty-four hours between the time a woman goes to or contacts an abortion clinic and the time she has a procedure; require that a woman be told prescribed information about fetal development and alternatives to abortion; and require record-keeping and state oversight of the medical aspects of abortion.
One method of abortion which has not been available in the United States is a drug called RU–486, used for non-surgical abortions in France and a few other European countries for several years. During the 1980s, the Food and Drug Administration refused to allow the drug into the United States and the Supreme Court refused to intervene when a pregnant American woman sought to bring RU–486 in from England for her own use. The Clinton administration has caused the FDA to look more favorably on the drug, and a process is now underway that could well result in RU-486 being available in the United States in the 1990s.
Another issue has been the time frame in pregnancy when states could severely restrict availability of abortion. Roe v. Wade said that the states could do so at “viability,” the point at which the fetus could live on its own. Medical science has moved back the time of viability from usually twenty-eight weeks in 1973 to usually twenty-four weeks in 1993; some say that point could be pushed back still further. Justice O’Connor commented that “Roe v. Wade is on a collision course with medical science.”
Others contend that 96 percent of all women who have abortions have them in the first twelve weeks of pregnancy and that the few who have later abortions do so for compelling reasons. Some states allow abortion after viability to save the life of the woman or for severe, irreversible fetal deformity. Medical science has also improved the medical tools for diagnosing fetal deformity at an earlier stage of pregnancy.
Also at issue is the involvement of the man who helped create a pregnancy. For example, the Supreme Court considered a Pennsylvania statute requiring that a woman notify her husband of her intent to have an abortion (except in cases where he was not the father, in cases where he could not be located, and in situations involving domestic violence). It ruled that provision unconstitutional. Boyfriends have sought to prevent abortions, but a legal right to do so has not been established.
In general, if the fertilized ovum or fetus is in a woman’s body, she is considered the person legally entitled to make the decision about it. However, in one case in which a pregnant wife was in a coma and therefore could not legally give consent to surgery, her husband was legally recognized to have the right to consent to abortion. In another case involving a fertilized ovum produced by In Vitro Fertilization, where the ovum was preserved in a frozen solution, the prior husband, whose sperm were involved, was recognized as having a right equal to that of his former wife who wanted to give the ovum to a childless couple, and the transfer was blocked.
 Abortion Laws in Other Countries
The laws governing abortion differ in other countries like a patchwork quilt. Abortion is illegal in Mexico and most Latin American countries (abortion is also the leading cause of death of women of childbearing age in many of those countries). Abortion laws are in flux in countries that have recently left the Soviet political sphere. Previously, in Eastern Europe contraception was less available and abortion laws were generally liberal. However, in 1993 Poland passed stricter abortion laws; doctors who violate the law are subject to up to two years in prison. The former East Germany had liberal abortion laws, but in 1993 unified Germany’s Constitutional Court overturned a year-old abortion law and replaced it with tougher restrictions. Conversely, in Romania abortion was illegal under the former dictator Nicolae Ceascescu, but is now permitted. As of March 1993, three pregnancies are reported aborted for each live birth. In Ireland, abortion remains illegal but voters in late 1992 overwhelmingly approved permitting women to travel abroad for abortions and obtain information about how to do so, both of which were once illegal.
Abortion is generally legal and available in Western Europe; the same is true in Asia and the Far East, particularly for countries struggling with fast-expanding populations. In Japan, there are half a million legal abortions annually. In India, abortion is legal until the twentieth week of pregnancy. China has encouraged— some believe it has coerced—couples to have only one child. The birth rate for girls has decreased and some suggest a correlation with the modern availability of ultrasound scanners and their use to identify the sex of fetuses. It is reported that many female fetuses are aborted in China solely because of their sex.