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    * Abortion *

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    (Wikipedia) - Abortion For other uses, see Abortion (disambiguation). Induced abortion ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine Patient UK
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    Abortion

    Abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo before viability. An abortion can occur spontaneously, in which case it is often called a miscarriage, or it can be purposely induced. The term abortion most commonly refers to the induced abortion of a human pregnancy. After viability, the relevant procedure is referred to as a "late termination of pregnancy". Modern medicine utilizes medications and surgical procedures for induced abortion.

    Abortion, when induced in the developed world in accordance with local law, is among the safest procedures in medicine. Uncomplicated abortions do not cause either long term psychological or physical problems. Unsafe abortions, however, result in approximately 47,000 maternal deaths and 5 million hospital admissions per year globally.

    An estimated 44 million abortions are performed globally each year, with slightly under half of those performed unsafely. The number of abortions has stabilized in recent years, having previously spent decades declining as access to family planning education and contraceptive services increased. Forty percent of the world''s women have access to legal induced abortions "without restriction as to reason, within gestational limits."

    Induced abortion has a long history and has been performed by various methods, including herbal abortifacients, the use of sharpened tools, physical trauma, and other traditional methods. The legality, prevalence, cultural and religious status of abortion vary substantially around the world. Its legality can depend on specific conditions, such as incest, rape, fetal defects, a high risk of disability, socioeconomic factors or the mother''s health being at risk. In many parts of the world there is prominent and divisive public controversy over the moral, ethical, and legal issues of abortion. Those who are against abortion generally posit that an embryo or fetus is a human with the right to life and may equate abortion to murder, while proponents of abortion rights emphasize a woman''s right to decide about matters concerning her own body.

    Contents

    Types Induced

    Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion. Most abortions result from unintended pregnancies. In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus. A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses. Specific procedures may also be selected due to legality, regional availability, and doctor or patient 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. 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. Confusion sometimes arises over the term "elective" because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.

    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. 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". When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

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

    The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus. Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.

    Methods  Practice of Induced Abortion MethodsMVAD&EEVAHysterotomyD&CIntact D&XMifepr.Induced Miscarr.0–12 weeks12–28 weeks28–40 weeks] Gestational age may determine which abortion methods are practiced.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 prostaglandin analogs in the 1970s and the antiprogestogen mifepristone in the 1980s.[28][29][30]

    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.[28] 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.[29] This regime is effective in the second trimester.[31]

    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.[32] 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.[33] If medical abortion fails, surgical abortion must be used to complete the procedure.[34]

    Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,[35][36] France,[37] Switzerland,[38] and the Nordic countries.[39] In the United States, the percentage of early medical abortions is far lower.[40][41]

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

    SurgicalA 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

    Up to 15 weeks'' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.[43] 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.[44]

    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. Premature labor and delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with hypertonic solutions containing saline or urea. 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, abortion may be performed by IDX as described above, induction of labor, 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.[45]

    First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.[41]

    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 (see history of abortion).[46] 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.[47]

    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.[48] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[49] 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.[49]

    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.[50]

    Safety

    The health risks of abortion depend on 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.[51] Legal abortions performed in the developed world are among the safest procedures in medicine.[2][52] In the US, the risk of maternal death from abortion is 0.6 per 100,000 procedures, making abortion about 14 times safer than childbirth (8.8 maternal deaths per 100,000 live births).[53][54] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth through at least 21 weeks'' gestation.[55][56][57]

    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.[58] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before elective abortion,[59] as they are believed to substantially reduce the risk of postoperative uterine infection.[41][60] Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen.

    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.[32] 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.[61][62]

    Some purported risks of abortion are promoted primarily by anti-abortion groups, but lack scientific support.[63] 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, the US National Cancer Institute, the American Cancer Society, the Royal College of Obstetricians and Gynaecologists and the American Congress of Obstetricians and Gynecologists) have concluded that abortion does not cause breast cancer,[64] although such a link continues to be promoted by anti-abortion groups.[63]

    Similarly, evidence indicates that induced abortion does not cause mental-health problems.[3][65] The American Psychological Association has concluded that a single abortion is not a threat to women''s mental health, and that women are no more likely to have mental-health problems after a first-trimester abortion than after carrying an unwanted pregnancy to term.[66][67] Abortions performed after the first trimester because of fetal abnormalities are not thought to cause mental-health problems.[68] 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 any medical or psychological organization.[69]

    Unsafe abortionSoviet 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."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.[70]

    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][71] Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;[2][4][72] deaths from unsafe abortion account for around 13% of all maternal deaths.[73] The World Health Organization believes that mortality has fallen since the 1990s.[74] 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.[75]

    The legality of abortion is one of the main determinants of its safety. Countries with restrictive abortion laws have significantly higher rates of unsafe abortion (and similar overall abortion rates) compared to those where abortion is legal and available.[4][5][75][76][77][78] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[79] with abortion-related deaths dropping by more than 90%.[80] 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.[81]

    Forty percent of the world''s women are able to access therapeutic and elective abortions within gestational limits,[7] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[82] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[4] Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,[83] though this varies by region.[84] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[77] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.[5] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[85]

    Incidence

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

    The number of abortions performed worldwide has remained stable in recent years, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008.[5] 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.[5] 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.[5]

    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 which are performed unsafely.[7][86][87] 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.[88]

    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 Neatherlands 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.[89][90]

    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 methodHistogram of abortions by gestational age in England and Wales during 2004. (Data source: United Kingdom Department of Health) (left)Abortion in the United States by gestational age, 2004. (Data source: Centers for Disease Control and Prevention) (right)

    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 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).[91] 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 fetus is accomplished by the same procedure as an induced abortion.[92]

    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.[93] Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 to 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.[94] There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.[95]

    Motivation Personal

    The reasons why women have abortions are diverse and vary across the world.[92][96]

    A bar chart depicting selected data from a 1998 AGI meta-study on the reasons women stated for having an abortion.

    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 she is 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.[96][97]

    Societal

    Some abortions are undergone as the result of societal pressures. These might include the preference for children of a specific sex, 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).[citation needed] These factors can sometimes result in compulsory abortion or sex-selective abortion.[citation needed]

    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.[98] 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."[99]

    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.[92][96]

    In the U.S., the Supreme Court decisions in Roe vs Wade and Doe vs 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."[100]:1200–1201

    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 which occurs in 1 of every 2000-13000 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.[101]

    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.[101] 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.[102][103]

    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."[104]

    History"French Periodical Pills." An example of a clandestine advertisement published in an 1845 edition of the Boston Daily Times.Main article: History of abortion

    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).[105] 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.

    Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions;[105] other scholars disagree with this interpretation,[105] and note the medical texts of Hippocratic Corpus contain descriptions of abortive techniques.[106] 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[107] "[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."[108] In Christianity, Pope Sixtus V (1585–90) is noted as the first Pope to declare that abortion is homicide regardless of the stage of pregnancy;[109] 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.[105] Islamic tradition has traditionally permitted abortion until a point in time when Muslims believe the soul enters the fetus,[105] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[110] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[111]

    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.[105] Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice was banned in both the United States and the United Kingdom.[105] Church groups as well as physicians were highly influential in anti-abortion movements.[105] 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] The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[112] 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.[113] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.[105]

    Society and culture Abortion debate Main article: Abortion debate

    Induced abortion has long been the source of considerable debate, controversy, and activism. An individual''s position concerning the complex ethical, moral, philosophical, biological, and legal issues which surround abortion is often related to his or her value system. Opinions of abortion may be described as being a combination of beliefs about abortion''s morality, beliefs about the proper extent of governmental authority in public policy, and beliefs about the rights and responsibilities of the woman seeking to have an abortion. Religious ethics also has an influence both on personal opinion and on the greater debate over abortion.

    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. 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". Generally, the former position argues that a human fetus is a human being 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.

    Abortion-rights movementsAbortion-rights activists in Sao Paulo, Brazil.Main article: Abortion-rights movements

    Abortion-rights movements advocate for legal access to induced abortion services. The issue of induced abortion remains divisive in public life, with recurring arguments to liberalize or to restrict access to legal abortion services. Abortion-rights supporters themselves are frequently divided as to the types of abortion services that should be available and to the circumstances, for example different periods in the pregnancy such as late term abortions, in which access may be restricted.

    Modern abortion law

    International status of abortion law

    UN 2013 report on abortion law.[114]

      Legal on request   Legal for maternal life, health, mental health, rape, fetal defects, and/or socioeconomic factors   Illegal with exception for maternal life, health, mental health, rape, and/or fetal defects   Illegal with exception for maternal life, health, mental health, and/or rape   Illegal with exception for maternal life, health, and/or mental health   Illegal with no exceptions   Varies   No information[115][dated info]Main article: Abortion law

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