Abortion (redirected from Roe v. Wade and Doe v. Bolton)

abortion, expulsion of the products of conception before the embryo or fetus is viable. Any interruption of human pregnancy prior to the 28th week is known as abortion. The term spontaneous abortion, or miscarriage, is used to signify delivery of a nonviable embryo or fetus due to fetal or maternal factors, as opposed to purposely induced abortion. Therapeutic abortion is an induced abortion performed to preserve the health or life of the mother.

Spontaneous Abortion (Miscarriage)

Early spontaneous abortion (the most prevalent) is usually due to fetal malformations or chromosomal abnormalities. Spontaneous abortion during the last two thirds of pregnancy is more likely to be due to maternal factors, for example abnormalities of the cervix or uterus, insufficient progesterone, sexually transmitted diseases that affect the genital tract, endocrine dysfunction (as in hypothyroidism and diabetes mellitus), or severe emotional trauma. Immunological reactions, in which maternal antibodies mistake the fetus for foreign tissue, have been implicated in recurrent, or habitual spontaneous abortions. It is estimated that at least 20% of all pregnancies end in miscarriage (estimates range from 15% to 75%). Most occur in the first two weeks after conception, and in many cases the mother is not aware of the pregnancy.

Induced Abortion

Abortion can be induced for medical reasons or because of an elective decision to end the pregnancy. Procedures for inducing abortion include vacuum suction (the most common, used in the early stages of pregnancy), dilatation and evacuation (D and E), induction (injection of abortifacients such as prostaglandins into the uterus), and hysterotomy (a surgical procedure similar to a cesarean section, used later in pregnancy, especially when the woman's life is in danger). The "abortion pill," the drug RU-486 (mifepristone), was approved by the Food and Drug Administration in the United States in 2000. It is used within the first seven weeks of pregnancy. A second drug is taken two days later to start uterine contractions and complete the abortion. The drugs methotrexate and misoprostol have also been used experimentally to end early pregnancies.

History of Abortion

Abortion induced by herbs or manipulation was used as a form of birth control in ancient Egypt, Greece, and Rome and probably earlier. In the Middle Ages in Western Europe it was generally accepted in the early months of pregnancy. However, in the 19th cent. opinion about abortion changed. In 1869 the Roman Catholic Church prohibited abortion under any circumstances. In England and in the United States in the 19th cent. stringent antiabortion laws were passed.

Attitudes toward abortion became more liberal in the 20th cent. By the 1970s, abortion had been legalized in most European countries and Japan; in the United States, under a 1973 Supreme Court ruling (see Roe v. Wade), abortions are permitted during the first six months of pregnancy. Abortion remains a controversial issue in the United States, however, and in 1977 Congress barred the use of Medicaid funds for abortion except for therapeutic reasons and in certain other specified instances. Several state legislatures passed restrictive abortion laws in hope that the Supreme Court would overturn Roe v. Wade, but in 1992 the court reaffirmed the basic principles of the 1973 decision.

From 1995 to 2000 the U.S. Congress repeatedly passed, but President Bill Clinton vetoed, a bill that would ban a rare late-term method of abortion called by its critics "partial-birth abortion." Subsequent attempts by many U.S. states to ban this method were contested in the courts, and in 2000 the Supreme Court voided such laws that do not include an exception when the health of the mother is endangered. A federal bill banning banning the procedure was passed again in 2003 and signed into law by President George W. Bush. The law was quickly challenged in the courts, and a federal judge declared it unconstitutional in 2004 in part because of its lack of a health exception, but the Supreme Court, with two new conservative members appointed by President Bush, upheld the law in 2007. U.S. opponents of abortion have used more militant tactics at times in attempts to disrupt the operations of facilities that perform abortions, and some extremists have resorted to bombings and assassination. In India, the abortion of female fetuses by couples desiring a male child led (1994) to criminal penalties for prenatal testing when done solely to determine the sex of the fetus; such tests have been banned in parts of China for the same reason.

Bibliography

See M. Muldoon, The Abortion Debate in the United States and Canada: A Source Book (1991); J. M. Riddle, Contraception and Abortion from the Ancient World to the Renaissance (1994); Boston Women's Health Book Collective, Our Bodies, Ourselves for the New Century (1998); J. Risen and J. L. Thomas, Wrath of Angels (1998).

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abortion

Expulsion of a fetus from the uterus before it can survive on its own. Spontaneous abortion at earlier stages of pregnancy is called miscarriage. Induced abortions often occur through intentional medical intervention and are performed to preserve the woman’s life or health, to prevent the completion of a pregnancy resulting from rape or incest, to prevent the birth of a child with serious medical problems, or because the woman does not believe she is in a position to rear a child properly. The drug RU-486, if taken within a few weeks of conception, will trigger a miscarriage. Up to about 19 weeks of pregnancy, injections of saline solutions or hormones may be used to stimulate uterine contractions that will expel the fetus. Surgical removal of the contents of the uterus may be performed in the second trimester or later. Intact dilation and extraction procedures may occur in the third trimester; sometimes critically referred to as “partial-birth abortions,” they have been very controversial. Other abortion procedures include manual vacuum aspiration (extraction by manual syringe) and dilation and suction curettage (extraction by machine-operated suction), both of which can be performed in early pregnancy. The social acceptability of abortion as a means of population control has varied from time to time and place to place throughout history. It was apparently a common method of family limitation in the Greco-Roman world, but Christian theologians early and vehemently condemned it. It became widely accepted in Europe in the Middle Ages. Severe criminal sanctions to deter abortion became common in the 19th century, but in the 20th century those sanctions were gradually modified in many countries. In the U.S. the 1973 Roe v. Wade decision had the effect of legalizing abortion during the first three months of pregnancy; states were able to implement restrictions on access to abortion after the first trimester, though within constraints set by the courts. Since that decision, there has been a fierce debate between supporters and opponents of a liberalized abortion policy.

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abortion [ə′bȯr·shən]

(medicine)

The spontaneous or induced expulsion of the fetus prior to the time of viability, most often during the first 20 weeks of the human gestation period.

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Abortion 

termination of pregnancy as a result of the expulsion of the fetus before the expiration of 28 weeks, at which time the human fetus is not yet viable. According to the official medical terminology used in the Soviet Union, abortion refers to pregnancies interrupted within the first 15 weeks, before the complete formation of the placenta. Interruption of pregnancy from the 16th through the 28th week is considered premature birth, the birth of an immature fetus, if the fetus survives until the mother’s discharge from the medical facility; otherwise it is also considered abortion.

Abortion may occur spontaneously or be induced artificially.

Spontaneous abortion. Spontaneous abortion, the interruption of pregnancy without any interference by the woman herself or by any other person, is encountered in 5 to 15 percent of all pregnancies. Illnesses in the mother or the fetus may cause the abortion; however, an exact demarcation between these causes is not always possible in practice. The illnesses in the mother that most often result in abortion include severe contagious diseases (for example, typhus and typhoid, malaria, erysipelas, lobar pneumonia, and influenza); chronic diseases (for example, syphilis, tuberculosis, and toxoplasmosis); hypertension, kidney diseases, serious heart trouble, endocrine disorders, psychic trauma, and so forth; chronic poisoning (by such substances as mercury, benzine, nicotine, alcohol, and manganese); incompatibility between the blood of the mother and that of the fetus primarily as a result of the Rh factor; disorders of the female sex organs (for example, swelling or active inflammation of the sexual organs, or infantilism); and reduced vitamin content, especially of vitamins A and E, in the pregnant woman’s diet. Abortion may also be connected with chromosome damage.

Prophylaxis consists of curing the basic illness that may give rise to abortion.

An abortion begins with protracted pains in the lower abdomen and small of the back. Hospitalization is required if there is bloody emission. At this stage the proper treatment—complete physical and psychological rest, abstention from sex, hormonal preparations, or doses of vitamins A and E, as indicated—may make it possible to save the pregnancy. If bleeding becomes excessive, the pregnancy usually cannot be saved; complications may develop that threaten the mother’s life (heavy bleeding, spread of infection, and so forth), requiring surgical intervention.

Induced abortion. Induced abortion is the interruption of pregnancy as a direct result of action affecting the fetus or the organism of the pregnant woman.

The abortion operation consists either of removing the fetal embryo and scraping the uterine walls with a special obstetric spoon or scraper, or of using suction by means of devices that create a negative pressure (vacuum method).

Administering certain medicinal substances in order to induce abortion is not only unproductive but even harmful, for it may poison the woman’s body. The use of hot baths, syringes, and the like with the same aim may complicate the performance of a subsequent abortion operation.

The frequency of complications varies from 2 to 30 percent; they usually result from nonhospital abortions. During an operation, bleeding or injury to the cervix or uterine walls may occur, and in the postoperative period there may be inflammation of the uterus and the adjoining tissues and organs. The long-term consequence of abortion is basically the disturbance of the hormonal and menstrual functions (2 to 28 percent of cases), often leading to infertility; about 30 percent of female infertility cases have this cause. Chronic inflammation of the internal sex organs may also occur. Weakness during labor and asphyxiation of the fetus at time of birth are found more often among women who have had abortions. Bleeding in the postnatal period is five times more frequent and adherence of the placenta is four times more frequent. In light of the harm done by abortion to women who do not wish to have children, recourse to contraception is recommended.

In all capitalist countries except Japan, abortion is permitted only for medical reasons, although in Sweden it is also allowed for social reasons. Abortion was forbidden in prerevolutionary Russia. After the establishment of Soviet power, in view of the economic ruin of the country and the precarious material circumstances of the population, the government made abortion legal on November 18, 1920. As a result, the mortality rate from abortions fell from 4 percent to 0.28 percent. On June 27, 1936, a decree of the Central Executive Committee and the Council of People’s Commissars of the USSR was published, titled “On the prohibition of abortions, the increase of material aid to prospective mothers, the establishment of government support for large families, the expansion of maternity homes, child-care centers, and nurseries, the strengthening of criminal penalties for nonpayment of alimony, and several changes in the laws on divorce,” which allowed abortions to be performed only for medical reasons. The number of abortions in the country in 1937 as compared with 1935 fell by a factor of more than three, but in subsequent years the number of abortions began to rise again, mainly as a result of nonhospital abortions, which accounted for 80 to 90 percent of the total. Taking into account the higher cultural level of the population, the relatively high birthrate, and the natural growth of the population, the Presidium of the Supreme Soviet of the USSR published a decree on November 23, 1955, entitled “On the annulment of the prohibition against abortions” which allowed women to make their own conscious choice on the question of parenthood. The decree states that in the future the way to ensure a reduction in the number of abortions should be by the further development of explanatory, educational government measures to promote parenthood. In accordance with the decree, abortions may be performed at the wish of the woman, but only at a medical facility, unless there are contraindications regarding her health. Contraindications may be gonorrhea, inflammation of the sexual organs, suppurative processes a lapse of less than six months since the previous abortion, or a pregnancy of more than 12 weeks. If continued pregnancy threatens the health of the woman or the unborn child because of active tuberculosis or certain cardiovascular diseases, blood diseases, and nervous or mental disorders, an abortion may be performed even after 12 weeks of pregnancy. Abortion is considered illegal and criminally punishable if it is performed, even by a doctor, somewhere other than a hospital, maternity home, or other stationary medical institution; if it is performed by a person who does not have a higher education in medicine; or if the operation is performed in a pregnancy of more than 12 weeks. In cases where there are other contraindications regarding artificial termination of pregnancy, abortion is also considered illegal regardless of what actions aimed at terminating pregnancy are used.

The penalty specified for an illegal abortion performed by a doctor is loss of liberty for up to one year, corrective labor for the same period, or abrogation of the right to practice medicine (Criminal Code of the RSFSR, article 116). If the crime is committed by a person who does not have a higher education in medicine, a stricter penalty for illegal abortion is set—loss of liberty for up to two years or corrective labor for a one-year term. A higher penalty—loss of liberty for up to eight years—is fixed in the case of an abortion performed, whether by a doctor or by a person not trained medically, if the crime is committed by the guilty party more than once or if the abortion results in the death of the woman or in other serious consequences.

Legal abortion presupposes the consent of the pregnant woman to the interruption of the pregnancy. If the abortion is done without her consent, the offense is deemed premeditated grave bodily injury. The percentage of nonhospital abortions in the USSR after removal of the ban on abortions fell from 80–84 in 1955 to 15.3 in 1967, and the mortality rate from abortions was reduced by more than ten times.

After World War II a government organization for planned parenthood was created in nearly every country, including the United States, England, Canada, West Germany, and Italy. A similar organization was set up in the UN as well. The activity of these organizations may be summarized as the search for effective and convenient means of contraception and the effort to inform the population of how to use them. However, such methods in the struggle to reduce the number of abortions cannot be considered effective without government measures aimed at raising the material and cultural level of the population and promoting parenthood.

REFERENCES

Rusin, Ia. I. Abort. [Yaroslavl,] 1946.
Strumilin, S. G. “K probleme rozhdaemosti v robochei srede.” In Problemy ekonomiki truda. Moscow, 1957.
Nikonchik, O. K. “Problema kontratseptsii i organizatsiia bor’by s abortami v SSSR.” Akusherstvo i ginekologiia, 1959, no. 6.
Sadvokasova, E. A. “Nekotorye sotsial’no-gigienicheskie aspekty izucheniia aborta.” Sovetskoe zdravookhranenie, 1963, no. 3.

O. K. NIKONCHIK