The Electronic Encyclopedia (TM)
     (C) 1988 Grolier Electronic Publishing, Inc.

          abortion
     
          An abortion is the termination of a pregnancy before the fetus is
     viable, or capable of living outside the womb. An abortion may be
     spontaneous or induced. The term miscarriage is sometimes used as a
     synonym for spontaneous abortion. Voluntary pregnancy termination is an
     act with ethical and legal ramifications.
     
               Medical Aspects.
     
          Spontaneous abortion occurs when the embryo fails to develop, when
     there is complete or incomplete expulsion of the products of
     conception--the embryo or fetus, and placenta--or when the fetus dies
     prior to 20 weeks from the woman's last menstrual period (LMP). If fetal
     death occurs at 20 weeks or more after the LMP, it is termed a late fetal
     death or a stillbirth.
     
          Perhaps as many as three-fourths of conceptions are spontaneously
     aborted, but most of those abortions occur before the woman's pregnancy
     can be confirmed, prior to 6 weeks after her LMP. Spontaneous abortions
     constitute about one-fifth of confirmed pregnancies and about one-tenth of
     all hospitalizations for pregnancy in the United States.
     
          A woman whose pregnancy is spontaneously aborted may experience
     cramping and blood loss similar to that of a normal menstrual period,
     heavier cramping or blood loss, or pains closely resembling those of
     childbirth, depending on the gestational age of the fetus and other
     factors.
     
          Induced abortion is a procedure intended to terminate a suspected or
     known pregnancy and to produce a nonviable fetus at any gestational age.
     Most induced abortions in the United States are performed in the first
     trimester--within 12 weeks of the LMP. The technique for virtually all
     first-trimester pregnancy terminations utilizes a procedure called vacuum
     aspiration or vacuum curettage. The cervix is dilated with a series of
     graduated, usually tapered dilators or a type of dried seaweed, called
     laminaria, which expands as it absorbs moisture. After dilation, 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. For sharp curettage, a procedure seldom used today, a hollow,
     spoon-shaped knife, or curette, is used instead of the vacuum tube to
     scrape the uterine walls.
     
          Second-trimester induced abortion involves a more complicated
     procedure. If the pregnancy has progressed to no more than 16 weeks since
     the last menstrual period, the most common technique is dilation and
     evacuation, a method that is similar to vacuum aspiration. The next most
     common procedure is injection of fluid into the amniotic sac; usually,
     however, this procedure is postponed until after the 16th week to reduce
     the risk of injection outside the amniotic cavity. Fluid injected into the
     cavity may be either a saline solution or the hormone PROSTAGLANDINS.
     Comparative studies of abortion techniques have determined that surgical
     evacuation techniques, especially up to 17 weeks' gestation, are safer
     than instillation techniques. Rarely used techniques for second-trimester
     abortion include hysterotomy (surgical incision of the uterus) and
     HYSTERECTOMY, used when medically indicated.
     
               Legal Aspects.
     The Electronic Encyclopedia (TM)
     (C) 1988 Grolier Electronic Publishing, Inc.

     
          Although discouraged by most major religions, induced abortion has
     been practiced in every culture since ancient times. During the 19th
     century several countries passed laws prohibiting abortion to protect
     women from the dangerous methods then in use. The USSR legalized abortion
     in 1920, but in response to a rapid drop in the birthrate, the USSR
     reinstituted restrictions in 1936. So many complications from illegal
     abortions occurred, however, that restrictions were withdrawn in 1955.
     Most Eastern European countries legalized abortion during the next 10
     years. Japan liberalized its abortion law in 1948 to decrease its
     population growth. Scandinavian countries began to liberalize their laws
     in the 1930s, although most still restrict reasons allowed for the
     abortion. Great Britain liberalized its abortion statute in 1967. Today
     most of the world's population live where abortion is either legal or
     conducted openly.
     
          In the United States legal induced abortion was generally unavailable
     until 1970, when a few states liberalized their abortion laws. Early in
     1973 the U.S. Supreme Court declared most restrictive abortion laws
     unconstitutional because they violated the woman's right of privacy. Since
     then abortion has been generally available throughout the United States.
     The 1973 Supreme Court cases ROE V. WADE AND DOE V. BOLTON left the
     decision to have a first-trimester abortion to the woman and her
     physician. States could pass regulations to insure the safety of
     second-trimester abortions, and they could prohibit third-trimester
     abortions altogether.
     
          Congress passed the Hyde Amendment in 1976, which severely restricted
     federal funds for abortions, although many states continue to fund
     abortions for indigent women. Since 1973 the U.S. Supreme Court has ruled
     on several local and state regulations, upholding those requiring parental
     notification for a minor's abortion and parental or judicial consent for
     an abortion for someone under age 15.
     
               Impact of Legalization.
     
          During the 1960s an estimated 200,000 to 1,200,000 illegal abortions
     were performed each year in the United States. Deaths from illegal
     abortions amounted to one-fifth of all deaths and hospitalizations related
     to pregnancy and childbirth. Morbidity and mortality from illegal
     abortions began to decline in the 1960s, but after 1973, mortality and
     hospitalizations dropped dramatically, in part due to improved training
     for abortion providers, increased familiarity with treatment of
     complications, and safer techniques. Legalization stimulated development
     of more convenient and lower-cost health service. More than 60 percent of
     abortions were in hospitals in 1973, but more than 70 percent were in
     freestanding clinics in 1980, about one-half of which were outpatient
     procedures.
     
          Legalization raised concerns about long-term health consequences of
     abortion. Studies to date have found that risks of spontaneous abortion,
     preterm delivery, and low birth weight for a second pregnancy following
     vacuum aspiration are no greater than risks for a first pregnancy. Other
     health risks, including a suggested association between abortion of the
     first pregnancy and breast cancer in later life, have not been adequately
     studied.
     
               Ethical Aspects.
     The Electronic Encyclopedia (TM)
     (C) 1988 Grolier Electronic Publishing, Inc.

     
          Opponents of legalized induced abortion believe that human life
     begins at conception and that abortion is the intentional killing of a
     human being and is thus morally wrong. Members of the "right to life"
     movement have lobbied for a constitutional amendment on the rights of the
     unborn. The counterpart to this position is the "pro-choice" stance. Its
     proponents generally believe that human life begins when the fetus can
     survive outside the womb. Before then, since the fetus is not a separate
     human, it is considered morally acceptable to terminate the pregnancy.
     Supporters of liberalized abortion laws also argue that legal abortion is
     safer to the woman than illegal abortion and relieves the psychological
     and social problems associated with bearing an unwanted child.
     
          Carol Hogue
     
     Bibliography:
          Centers for Disease Control, Abortion Surveillance: Annual Summary
     1979-1980 (1983); Hogue, C., et al. "The Effects of Induced Abortion on
     Subsequent Reproduction," Epidemiologic Reviews (1982); Nathanson, B. N.,
     Aborting America (1979); Tietze, C., Induced Abortion: A World Review,
     1983, 5th ed. (1983).
     

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