Birth Control Safe and effective options.

n.

1. 1. Termination of pregnancy and expulsion of an embryo or of a fetus that is incapable of survival.
   2. Any of various procedures that result in such termination and expulsion. Also called induced abortion.
2. The premature expulsion of a nonviable fetus from the uterus; a miscarriage.
3. Cessation of normal growth, especially of an organ or other body part, prior to full development or maturation.
4. An aborted organism.
5. Something malformed or incompletely developed; a monstrosity.

Abortion means the end of a pregnancy before the fetus can survive. It may be either spontaneous — when it is also known as miscarriage — or induced, when it is a deliberate termination of pregnancy.

Spontaneous abortion

Spontaneous abortion is defined in the UK as a pregnancy loss occurring before 24 completed weeks of pregnancy. Approximately 50-70% of pregnancies end in spontaneous abortion. Most of these losses are unrecognized because they occur before or at the time of the next expected menstrual period. About 15-20% of clinically diagnosed pregnancies are lost by 16 weeks. Recurrent abortion, defined as the loss of three or more consecutive pregnancies, occurs in 0.5-1% of pregnant women. Causes of spontaneous abortion may relate to the fetus, the placenta, or the uterus. Genetic factors, developmental problems, placental problems, and infection are known causes, but in a quarter of all spontaneous abortions the cause is unknown. This may be due to lack of ability to investigate these cases.

It is generally accepted that 50% of all recognized pregnancy losses in the first 3 months are due to a genetic abnormality. Abnormalities of the placenta have probably greater importance than is realized, but information on this aspect is scanty. A number of organisms have been associated with spontaneous abortion, such as listeria, brucella infection from animals, and the rubella virus. In isolated instances fetal or placental infection with various organisms may result in spontaneous abortion, but there is no evidence of their involvement in a recurrent problem. Some cases of recurrent abortion are due to congenital abnormalities of the uterus and these may be corrected surgically; 70-80% of women with the most frequent abnormalities have successful pregnancies following surgery.

Spontaneous abortion may become evident clinically either as ‘threatened’ or ‘inevitable’. A threatened abortion is said to occur when a woman bleeds from the uterus before 24 weeks of pregnancy. There are three possible outcomes: the bleeding may settle and the pregnancy continue; the fetus may die but be retained in the uterus (confirmed by an ultrasound examination) and this is known as a ‘missed’ abortion; a missed abortion may proceed to an inevitable abortion, with continued or intensified bleeding and expulsion of the products of conception. Bleeding may be severe, causing shock; in some cases this is life-threatening and blood transfusion may be required. Death occurs in a few cases where medical care is poor or absent. In the UK the death rate is of the order of 12.5 per million pregnancies.

If the pregnancy is expelled intact the abortion is said to be ‘complete’, but this is rare in the first 3 months of pregnancy. More commonly some material is left behind and only when it is removed surgically will bleeding cease. If this is not done, bleeding may continue and the uterus become infected, with serious consequences for the woman. Rarely in developed countries, but commonly in underdeveloped regions and where abortion laws are restrictive, infection occurs and abortion is a well-recognized cause of maternal death.

The emotional effects of an abortion vary greatly. A majority of women have feelings of depression, and there is usually associated fear and anxiety caused by the pain and bleeding and the uncertainty as to the cause. Reaction to abortion as a bereavement means that women require to grieve after the event. Often the intensity of the emotional reaction is not appreciated by the carers or by friends or relatives. Health workers should help the woman to express her grief. Women who have experienced such loss require considerable reassurance and support in a subsequent pregnancy.

Recurrent spontaneous abortion

Recurrent spontaneous abortion is a particularly distressing condition and there is very limited understanding of its causes. Genetic factors such as parental chromosome abnormalities are a major known cause which should be looked for. Anatomical factors such as uterine abnormalities account for perhaps 10-15% of recurrent loss. Hormonal factors, such as deficient production of progesterone, which is important for the maintenance of early pregnancy, are also cited — but evidence for such causes is scanty.

In some cases an immune response is mounted by the mother against the pregnancy, causing its demise. Chronic maternal disease such as diabetes and kidney disease may also be associated. Smoking and alcohol consumption have been linked to recurrent abortion but there is no hard evidence for this.

In the case of genetic abnormalities, genetic counselling is advisable and if, for example, the abnormality is traced to the male partner, insemination of the woman with sperm from a donor (donor insemination, DI) may be a possible solution. An abnormally shaped uterus can be corrected by surgery. Hormonal therapy has not proved successful. In the case of an immunological cause, immunotherapy has been helpful, and in some women with no ascertainable cause psychotherapy has been of value. In the event intervention may not be the best answer and it may be just as successful to wait and see.

Induced abortion: termination of pregnancy

The study of induced abortion, especially where abortion is illegal, is a major challenge in the contexts of reproductive health and women's rights.

At the International Conference on Population and Development in Cairo in 1994 the following statement was made: ‘Since unsafe abortion is a major threat to the health and lives of women, research to understand and better address the determinants and consequences should be promoted’. The conference also recognized that unsafe abortion was a world-wide public health problem and agreed that each country should legislate to solve the problem. In developed countries like the UK where abortion is readily available the related mortality is extremely low — less than 1 per 100 000 procedures. In less optimal settings where women are only able to find unsafe abortion, mortality is high. World-wide, estimates vary from a minimum of 50 000 up to 150 000 abortion-related deaths per annum.

Experience from many countries confirms that permissive legislation on abortion does not increase the abortion rate: it only determines whether it is performed under safe or unsafe conditions. The restrictive legislation which some countries have, for cultural or religious reasons, prevents a reduction in the death rate and health hazards of abortion.

In the UK restrictive legislation was still in place in 1938 — the year when Mr Alec Bourne, an eminent London gynaecologist, terminated a woman's pregnancy which had resulted from rape. He was reported for this criminal offence and was prosecuted. The judge allowed the mental health of the woman to be taken into account and Bourne was acquitted, marking a changing attitude to abortion in the UK. In 1967 the Abortion Act legalized abortion under certain circumstances, and amendments were made in 1990. Currently the Act permits termination of pregnancy if two doctors:

are of the opinion in good faith a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

It is essential that a woman who seeks abortion receive proper counselling. If she wishes her partner to be involved he may be, but this is not mandatory. This involves giving the woman as much information as possible after a medical, social, and family history has been obtained: information regarding the methods of termination, their risks, and their benefits, and alternative courses of action such as adoption, and also advice which may help to determine her real wishes. All is designed to help her to reach a decision. Certain high risk groups require special counselling: teenagers; those with genetic factor risks; cases of sexual abuse; and those seeking late terminations or repeated terminations.

Most terminations are done in the first 3 months of pregnancy. At this stage it is done surgically under an anaesthetic, by dilating the cervix and removing the pregnancy by suction or by forceps. Alternatively, up to 8 weeks or so, termination using drugs is possible, and is now common. A choice may therefore be offered. In 85% of early cases no further treatment is required as the abortion is complete. Where it is not complete surgery is required.

After 3 months it is usual to use a method of termination by administration of prostaglandins. These drugs cause contractions of the uterus and the fetus and placenta are expelled.

Complications which may occur are bleeding, perforation of the uterus, tearing of the cervix, and sepsis — but these are rare when the procedure is properly performed. Where abortion is performed in unsafe circumstances these complications are common and have serious consequences.

Abortion has been regarded in some countries as a method of birth control. This should not be so. Abortion services should include advice on contraception and the better this advice the less often will abortion be resorted to. See also antenatal development; contraception; pregnancy.

— Malcolm Macnaughton

Abortion: historical and social aspects

For many centuries women finding themselves pregnant have endeavoured to implement retroactive birth control by means of abortion. This practice was often occluded from legal and medical eyes, information being passed on within a female oral subculture. However manuscripts survive from a range of historical periods which record numerous substances reputed to be abortifacients, though some are also highly toxic to the woman; and various practices have also been believed to induce miscarriage. For many centuries the law only concerned itself with pregnancy subsequent to ‘quickening’. This traditional distinction and the persistent conceptualization by women of the problem as ‘bringing on’ menstruation, suggest that women did not experience pregnancy as an absolute, either/or, state.

The law, however, at least in Europe and North America, increasingly formulated the ending of all pregnancy as abortion, possibly reflecting developing medical ability in accurate, early recognition of conception. In England and Wales abortion initially became a statutory offence in 1803 under Lord Ellenborough's Act, at a time when the medical profession was increasingly concerning itself with previously woman-controlled areas such as obstetrics, and desirous of differentiating the medical man from the irregular practitioner. The concept of ‘unlawful’ abortion enabled medical practitioners to claim a right to use their clinical judgement over ‘lawful’ therapeutic abortion. Induced abortion, pre-antibiotics, was a significant cause of female mortality and morbidity, although many ‘back street’ operators were not lacking in skill. It was largely married women who patronized these, since they could more readily pass off miscarriages without need of concealment. The ‘Female Pills’ widely purveyed in the later nineteenth and early twentieth centuries were a successful commercial racket, with little in the way of effective ingredients.

Laws on the availability of surgical abortion have varied widely from nation to nation: medical expertise may be privileged over unlicensed operators, or operations even by regular practitioners regarded as a crime. Though legally condemned, abortion has frequently been available to those with the right contacts and able to pay. While certain religious groups, especially Roman Catholics, have strongly condemned abortion, such condemnation has not universally prevented women from seeking it. The role of popular feeling and debate has been influential in altering the law: in Britain the important legal case of Rex v. Bourne, 1938, establishing a common-law precedent for abortion on the grounds of a woman's mental, not merely physical, health, took place in the context of widespread debate and agitation for reform of the law. In the US, however, there was no such climate of opinion, and similarly idealistic and concerned abortionists paid the full legal penalty.

Abortion became legalized in many countries during the late 1960s and early 1970s. Unfortunately the overt inscription of the right to abortion in law (as opposed to something performed, if at all, within the privileged secrecy of the doctor/patient encounter) has provoked a vigorous ‘backlash’, particularly violent in the US. There is little evidence that abortions would be fewer if illegal; only more dangerous, and the availability of the operation more erratic and inequitable.

— Lesley A. Hall

n

Definition: failure
Antonyms: continuation, success

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Abortion is a generic term for pregnancies that do not end in a livebirth or a stillbirth. It is the premature expulsion from the uterus of the products of conception, which include the placenta, bag of waters, and fetus, if present.

Types of Abortion

There are two types of abortions. Spontaneous abortion refers to a natural biological process by which some pregnancies end. Induced abortion refers to pregnancies terminated through human intervention.

Spontaneous Abortions. A large percentage of the products of the union of an egg and a sperm never become infants. If there is something seriously wrong with the fetus, the uterus often expels it. This may occur very early in the pregnancy, with the woman only experiencing a larger than usual blood flow around the time of her expected menstrual period, or it may occur later in the pregnancy. This latter event is commonly called a miscarriage, but technically it is a spontaneous abortion if it occurs before twenty weeks of pregnancy. Spontaneous abortions are often the body's way of preventing the birth of a defective child, although sometimes they are due to maternal health problems.

Induced Abortions. In contrast, induced abortions result from the planned interruption of a pregnancy. Throughout recorded history, humans have taken a variety of steps to control family size: before conception by delaying marriage or through abstinence or contraception; or after the birth by infanticide. Induced abortion falls temporally between these two extremes by preventing a conception from becoming a live birth. In the United States in the last few decades of the twentieth century, most abortions were performed surgically using a procedure called suction curettage. The year 2000 approval in the United States of a drug, mifepristine (RU486), which in combination with another drug causes an abortion in almost all cases, may increase the percentage of abortions induced by the administration of pharmaceutical agents.

Therapeutic Abortions. This term refers to abortions thought necessary because of fetal anomalies, rape, or to protect the health of the mother when a birth might be life threatening or physically or psychologically damaging.

Elective or Voluntary Abortions. Interruption of a pregnancy before viability at the woman's request for reasons other than fetal anomalies or maternal risk is often referred to as elective or voluntary abortion. Such abortions often result from social problems, such as teenage pregnancy or non-marital births; economic difficulties, such as insufficient income to support a child; or inappropriate timing.

Legal and Illegal Abortions. Induced abortions may be legal or illegal. According to the United States Centers for Disease Control and Prevention (CDC), the federal agency that collects data on abortions, a legal abortion is "a procedure, performed by a licensed physician or someone acting under the supervision of a licensed physician, that was intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age." An illegal abortion may be self-induced, induced by someone who is not a physician or not acting under her or his supervision, or induced by a physician under conditions that violate state laws governing abortions.

A Historical Perspective

Almost all human societies place a high value on human life. Thus, the further along the continuum from heterosexual intercourse to a live child, the less likely is the method of fertility control to be allowed. In the modern period, most societies allow contraception, but there is more variability around abortion. The leading institutional opposition comes from the Roman Catholic Church, but other institutions also take active positions against abortion. Survey research suggests that many Americans are ambivalent about whether abortion should be legal and, if so, under what circumstances.

Induced abortion was almost universally illegal at the beginning of the twentieth century. This changed first in the early years of the Soviet Union, which made abortion legal, widely available, and encouraged as the primary method of fertility control. In the period after World War II, abortion was legalized first in the Scandinavian countries and later in most of Western and Eastern Europe. With the broaching of the Iron Curtain in the early 1990s, abortion was legalized in more of Eastern Europe, while the more restrictive policy in West Germany was extended to the former East Germany. At the beginning of the twenty-first century, abortion was legal in most of England and Asia, but illegal in most of Africa and South America.

In the United States, abortion was universally illegal from at least the late nineteenth century until the mid-1960s, when an abortion reform movement led to legalization of abortion in some states. (The regulation of abortion, like most medical issues, is a state function.) Then, in its 1973 Roev. Wade decision, the United States Supreme Court found a constitutional right to abortion before viability, at that time about twenty-eight weeks. (By the beginning of the twenty-first century, advances in the techniques of caring for very premature infants had reduced the age of viability to around twenty-three weeks.) The Court stated, however, that after viability is reached, the state's important and legitimate interest in potential life becomes compelling and it may regulate and even prohibit abortions, with the exception of those necessary to preserve the life or health of the mother.

Access to Abortions

Access to legal abortions is limited by laws and regulations, financial considerations, and the availability of providers.

Laws and Regulations. Since the 1973 decision, many states have enacted measures to limit abortion, which have led to considerable litigation.

Some laws have been disallowed as inconsistent with Roe, while others have been allowed. For example, in the late 1990s, about thirty states restricted the access of minors to abortions by requiring the notification or the consent of one or both parents before an abortion could be performed, and more are considering such legislation. The Supreme Court requires that states with parental notification or consent laws must provide for a judicial bypass; that is, the minor must be allowed to obtain permission from a court for the abortion if she is unwilling or unable to seek permission from her parent(s). States may also require a waiting period between the request for an abortion and its actual performance. Or they may require the physician who is to conduct the abortion to inform the mother about the fetus's stage of development and about alternative ways of managing an unwanted pregnancy, such as putting the baby up for adoption.

Financial Considerations. Abortion is not among the medical procedures covered by Medicaid, the federal-state program that provides health care to many poor women. Federal law, the socalled Hyde Amendment, passed in 1977 and amended in 1993, prohibits the use of federal Medicaid funds for abortion except in cases of rape, incest, or when the life of the pregnant woman is in danger. Some states use their own Medicaid funds to pay for abortions that physicians consider "medically necessary," and a few fund them in cases of fetal anomaly or grave physical health danger. Some private organizations, such as Planned Parenthood agencies, assist low-income women in states with restrictive funding policies by performing abortions for reduced fees. In 1999, less than two-fifths of women with employer-based health insurance were covered for abortion services.

Provider Availability. On the basis of a survey of abortion providers, the Alan Guttmacher Institute estimated that in 1996 there were slightly over two thousand abortion providers in the United States, a drop of 14 percent from 1992, perhaps as a result of anti-abortion publicity and disturbances. Eighty-nine of the country's 320 metropolitan areas had no known abortion providers and an additional twelve had providers who together reported fewer than fifty abortions. Abortion providers were even less available in non-metropolitan areas.

According to the Guttmacher survey, 452 abortion clinics (defined as nonhospital facilities in which half or more of patient visits were for abortion services) performed 70 percent of the abortions in 1996. Four hundred and seventeen other clinics performed 21 percent of the abortions; 703 hospitals performed 7 percent (only 9% of those on an in-patient basis); and 470 physicians' offices performed 3 percent.

Number and Rates of Abortions

There is no definitive information about the number and rate of spontaneous abortions, although worldwide it is estimated that approximately 15 percent of women who have been pregnant for five or more weeks spontaneously abort or experience stillbirths.

The CDC has been conducting surveillance of legal induced abortions in the United States since 1969. It reported 1,186,039 legal abortions in 1997, but noted that this was probably an underestimate. The number of abortions per 1,000 women between 15 and 44 years of age (the abortion rate) was 20 and the number of abortions per 1,000 live births (the abortion ratio) was 306. Most legal abortions were performed in California, New York City, Texas, and Florida. The number of legal abortions increased from 1970 until 1990 and, with the exception of 1996, has fallen ever since.

Both the abortion rate and the abortion ratio began to decline earlier.

Information on the characteristics of the women who obtain abortions and the timing of abortions is available from most, but not all, areas. Based on the information available in 1997, women between the ages of 20 and 24 obtained almost a third (31.5%) of all abortions. Abortion rates were highest for women between the ages of 20 and 24 and lowest for the youngest and oldest women. Abortion ratios, however, were highest for women under 20 and for women 40 and over, at least partially because there are fewer births in these age groups. Slightly over half(56.3%) of women who obtained abortions were white, but the abortion rate and the abortion ratio for African Americans was slightly more than two and a half times the rate for white women. For Hispanic women in the District of Columbia, New York City, and the twenty-six states reporting ethnicity, the abortion ratio was similar to the one for non-Hispanics in the same areas, but the rate was higher. Seventy-nine percent of women who obtained abortions were unmarried, 41 percent had no previous live births, and half were obtaining abortions for the first time. Eighty-six percent of women obtaining abortions had the procedure during the first twelve weeks of pregnancy.

Abortions and Public Health

There is no evidence that abortions are detrimental to the health of women. The CDC reported that in 1992, the last year for which data on abortionrelated deaths were available, only twenty-seven women died of abortion-related causes, ten due to induced abortions, seventeen to spontaneous abortions, and none to illegal abortions. This is a case-fatality rate for legal induced abortions of 0.7 per 100,000 legal induced abortions, a lower fatality rate than for pregnancies. (In 1992, the maternal mortality rate was 7.8 per 100,000 live births.) Injuries and illness, both physical and emotional, are also rare. Deaths and other adverse consequences are more likely to occur when women are unable to obtain abortions legally and attempt to induce abortions themselves or turn to providers outside the conventional medical care system. There were thirty-nine deaths due to illegal abortions in 1972 before the Roe v. Wade decision and nineteen in 1973. Since then, the number of such deaths has declined markedly: There were only two between 1988 and 1992. Studies in Czechoslovakia have shown that women who are denied abortions suffer psychological difficulties.

Most induced abortions today are the result of unwanted pregnancies. The best way to prevent this safe—but uncomfortable and usually undesirable—procedure is to make family planning counseling and methods easily available to all women.

(SEE ALSO: Ethics of Public Health; Pregnancy; Reproduction)

Bibliography

Alan Guttmacher Institute (1999). Sharing Responsibility: Women, Society and Abortion Worldwide. New York: Author.

Henry J. Kaiser Family Foundation (1999). Issue Update: Abortion Fact Sheet. Menlo Park, CA: Author.

Henry J. Kaiser Family Foundation and Health Research and Educational Trust (1999). Employer Health Benefits: 1999 Annual Survey. Menlo Park, CA: Author.

Henshaw, S. K. (1998). "Abortion Incidence and Services in the United States, 1995–1996." Family Planning Perspectives 30(6):263–270, 287.

Joffe, C. (2000). "Medical Abortion in Social Context." American Journal of Obstetrics and Gynecology 183(2):S10– S15.

Klerman, J. A. (1999). "U.S. Abortion Policy and Fertility." American Economic Review Papers and Proceedings 89(2):261–264.

Koonin, L. M.; Strauss, L. T.; Chrisman, C. E.; Montalbano, M. A.; Bartlett, L. A.; and Smith, J. C. (July 30, 1999). "Abortion Surveillance—United States, 1996." Morbidity and Mortality Weekly Report 48(SS-4):1–42.

Koonin, L. M.; Strauss, L. T.; Chrisman, C. E.; and Parker, W. Y. (December 8, 2000). "Abortion Surveillance—United States, 1997." Morbidity and Mortality Weekly Report 49(SS-11):1–43.

Levine, P. B.; Staiger, D.; Kane, T. J.; and Zimmerman, D. J. (1999). "Roe v. Wade and American Fertility." American Journal of Public Health 89(2):199–203.

Matthews, S.; Ribar, D.; and Wilhelm, M. (1997). "The Effects of Economic Conditions and Access to Reproductive Health Services on State Abortion Rates and Birthrates." Family Planning Perspectives 29(2):52–60.

— LORRAINE V. KLERMAN; JACOB A. KLERMAN

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Alexis de Tocqueville observed in Democracy in America that “there is hardly a political question in the United States which does not sooner or later turn into a judicial one” (Meyer, ed., 1969, p. 270). It was not until the latter half of the nineteenth century that criminal sanctions against abortion became widespread, and not until the latter half of the twentieth century that the notion of a constitutional right to sexual autonomy took hold in the public mind. That development guaranteed that abortion would turn into a judicial question.

As part of the police power over health and morals, abortion laws have traditionally been the province of state governments. In early American history, abortion was more dangerous than childbirth, which was life‐threatening itself. Lawmakers who regulated sexual activity in minute detail saw no need to make abortion a crime. When medical advances made abortion safer in the nineteenth century, some states forbade abortion primarily to protect pregnant women. Other early anti‐abortion laws were essentially elements of state obscenity statutes, often called “little Comstock laws.” These laws, similar to the 1873 federal Comstock Act, included contraceptives and abortifacients among the forbidden “obscene” materials. Early in the twentieth century, reformers like Margaret Sanger began to promote birth control as a means of limiting family size, especially for the poor. By 1960, forty‐eight states had legalized birth control.

The decriminalization of birth control enhanced individual freedom by increasing women's control over their fertility, but contraception did not ensure reproductive self‐determination for women. Sexual intercourse could occur without a woman's consent—not only through rape, but also because of the legal obligation to satisfy a husband's sexual demands. Existing methods of female contraception were unreliable even when a woman was free to use them.

Since women still found themselves confronted with unwanted pregnancies, access to abortion was necessary for reliable fertility control. But abortion has always been a more controversial issue than contraception. For many who consider fetuses persons, abortion is the equivalent of homicide. Even people who are not convinced that fetuses are full human beings may have difficulty accepting the idea of legal abortion. While both men and women use contraception, only women get pregnant and can abort. The idea that women have equal rights with men is a relatively new notion. Moreover, society's cultural idea of womanhood has traditionally been bound up with motherhood. The choice of abortion is made by a woman who, at least at that specific point in time, does not want a child—and this possibility challenges widely accepted notions of the role of women.

As late as the 1960s, abortion was still illegal everywhere in the United States, except to save the mother's life. The revitalization of feminism in the late 1960s gave impetus to the abortion rights movement. A portent of changing opinions was the 1962 Model Penal Code, in which the American Law Institute (ALI) recommended that abortion be legal when the pregnancy resulted from rape or when the baby was likely to be seriously disabled. Fourteen states adopted some or all of the ALI recommendations between 1965 and 1970. New York, Alaska, and Hawaii repealed their abortion laws outright.

Abortion and Privacy

Griswold v. Connecticut (1965) disposed of the last surviving laws against birth control and established a constitutional right to a realm of privacy. The Supreme Court ruled that the right to use contraceptives lay within a protected “zone of privacy” created by “penumbras” emanating from several provisions of the Bill of Rights. Many legal scholars found this argument a less than convincing justification for the judicial creation of a right nowhere mentioned in the Constitution, but the ruling established a right whose content would be defined and explained by later decisions.

In 1973, the Court extended the right of privacy to the choice of abortion. In Roe v. Wade, a majority of seven justices ruled that the “right of privacy … is broad enough to encompass a woman's decision whether or not to terminate her pregnancy” (p. 153). Justice Harry Blackmun's majority opinion emphasized “the detriment that the state would impose on the pregnant woman” and “the distress, for all concerned, associated with an unwanted child” (p. 159.) But many critics on both sides of the abortion issue consider this opinion unpersuasive and poorly grounded. It fails to build a logical bridge between Roe and Griswold. Roe contains no argument that abortion is sufficiently similar to birth control to justify its inclusion within the protected zone of privacy. Blackmun observed that no social consensus existed that fetuses are human beings and that American law did not recognize the unborn as persons. But the state did have a compelling interest in “potential human life.” The state could also restrict abortion when necessary to protect the health of the mother. Each of these interests became strong enough to justify restrictions at different stages of pregnancy: maternal health at the end of the third month; potential life at the end of the sixth (when, according to medical authorities at the time, the fetus was viable outside the womb). Therefore, the constitutional right to choose abortion was a limited one. In the first trimester, the state had no power to restrict abortion; beginning with the second trimester, the state might regulate, but not prohibit, abortion; and in the third trimester, the state might prohibit abortion except when necessary for the mother's life or health.

More than thirty years after Roe was decided, it remains one of the most controversial decisions in Supreme Court history. Supporters of reproductive freedom welcomed the ruling enthusiastically. But Roe also led to the formation of the “right‐to‐life” movement. Even among Americans who opposed restrictions on abortion, many thought that the Court had usurped power belonging to the elected branches of government. Critics pointed to the absence of textual authority in the Constitution and demanded that the people's elected representatives decide what abortion laws they wanted and what the word “person” meant to them.

Efforts to counter Roe v. Wade have continued in full strength into the twenty‐first century. A constitutional amendment that defined “person” to include the unborn has been introduced in Congress several times. But neither this “human life amendment” nor a bill that attempted the same result through a federal law emerged from Congress. However, Congress and many state legislatures have repeatedly passed laws negating, or at least narrowing, the decision. These statutes attempt to make it harder for women seeking abortions to get them. The statutes are inevitably challenged in court. From 1973 to 1986, when William Rehnquist replaced Warren Burger as chief justice, the Supreme Court generally distinguished between obstacles to the choice of abortion and refusals to facilitate the choice, invalidating most of the former while upholding the latter. But in recent years the courts have expanded the government's power to restrict abortion.

Abortion and Public Funding

The Supreme Court has consistently upheld laws denying governmental support for abortion. The first “Hyde amendment,” a federal limitation on the use of Medicaid funds, was enacted in 1976. It and similar state laws, all of which make exceptions for abortions to save the mother's life, continue to survive judicial scrutiny. Justice Potter Stewart's majority opinion in Harris v. McRae (1981) is typical. “Although government may not place obstacles in the path of a woman's exercise of her freedom of choice, it need not remove those not of its own creation. Indigency falls in the latter category” (p. 316). Justices William Brennan, Thurgood Marshall, and Blackmun maintained that these laws make safe abortions unavailable for poor women, thus creating a double standard of constitutional rights. But Stewart's view prevailed. A constitutional challenge to these laws is even less likely to succeed now that Chief Justice Rehnquist, a dissenter in Roe, is the only holdover from that case still on the Court and several supporters of Roe have been replaced by opponents. Rust v. Sullivan (1991) further limited poor women's access to abortion by upholding the federal “gag rule” forbidding clinics receiving federal funds from even advising clients that abortion is available. This “gag rule” was revoked in Bill Clinton's first week as president and reinstated when George W. Bush took office.

Legal Limits on Reproductive Choice

Some statutory obstacles to abortion are direct: for example, a spousal consent requirement for a married woman or parental consent for a minor. The Supreme Court invalidated mandatory spousal consent in its first post–Roe abortion case (Planned Parenthood v. Danforth, 1976) and mandatory spousal notification in Planned Parenthood v. Casey (1992.) Parental consent and notification have proved more problematic. The constitutional rights of minors are not as extensive as those of adults, and parental consent is necessary before a minor can get medical treatment. Nevertheless, Danforth rejected a parental consent requirement, and the Court has never upheld a law that gives parents an absolute veto. But laws requiring parental involvement have been sustained. The Supreme Court upheld a parental notification requirement in H.L. v. Matheson (1981) and several laws requiring consent from either a parent or a judge (Bellotti v. Baird, 1979; Planned Parenthood v. Ashcroft, 1983; Ohio v. Akron Center for Reproductive Health, 1990.) In Hodgson v. Minnesota (1991), the Court upheld a law requiring consent from both parents or a judge. These “judicial bypass” provisions require a minor seeking an abortion to convince a judge that she is mature enough to make the decision and that the abortion is in her best interests.

Some legal obstacles are designed not so much to impede the choice of abortion as to discourage it. These deterrents include prohibitions on the use of certain abortion techniques, mandatory counseling or waiting periods, or requirements that abortions take place in hospitals (the vast majority of elective abortions are performed in clinics). The Supreme Court has yet to sustain the first type of restriction. As recently as 2000, Stenberg v. Carhart struck down a Nebraska law prohibiting what the anti‐choice movement calls “partial‐birth abortion” (a technique called dilation and extraction that is used in late term procedures) on the grounds that the law was unconstitutionally vague and excessively burdened the woman's choice.

Several rulings between 1976 and 1986 overturned the second and third types of restriction, either on grounds of vagueness and unreasonableness or because, as Justice Brennan wrote in Thornburgh v. American College of Obstetricians and Gynecologists (1986), “the states are not free, under the guise of protecting maternal health or potential life, to intimidate women into continuing pregnancies” (p. 759.)

The Conservative Retreat

The anti‐choice movement showed its electoral strength in 1980, when Ronald Reagan won the presidency. Reagan promised to appoint justices who would overrule Roe. He replaced members of the Roe majority with Sandra Day O'Connor, Anthony Kennedy, and Antonin Scalia. Reagan's successor, George H. W. Bush, replaced Brennan with David Souter and Marshall with Clarence Thomas. The Roe consensus began to unravel even before Rehnquist replaced Warren Burger. For example, Justice O'Connor's dissent in Akron v. Akron Center for Reproductive Health (1983) insisted that the trimester framework was “on a collision course with itself” (p. 458.) Medical advances, she argued, had made late abortion safer and had kept alive infants born earlier.

Webster v. Reproductive Health Services (1989) eliminated the trimester framework and represented a significant retreat from abortion rights. In upholding a Missouri law that declared that life began at conception, forbade the use of any public funds and facilities for abortion, and required viability testing in abortions after twenty weeks, the Court sustained restrictions similar to those it had invalidated in Akron and Thornburgh. Webster came within one vote of overturning Roe outright. O'Connor supported the restrictions but refused to join four other justices in reversal.

Roe Reaffirmed?

The replacement of Brennan and Marshall with David Souter and Clarence Thomas was widely regarded as the death knell for Roe. The new Court had its next opportunity to reverse the decision in Planned Parenthood v. Casey (1992). To the astonishment of virtually every Court‐watcher in the country, this did not happen. Justice Souter joined O'Connor and Kennedy in a plurality opinion reaffirming the “central holding of Roe” (p. 843): the right to an abortion before viability, a state's power to impose restrictions after viability, and a state's legitimate interests in protecting maternal health and fetal life throughout pregnancy. For the first time, the Court recognized discouraging abortion as a valid state interest. From now on, abortion laws would survive judicial scrutiny unless they imposed an “undue burden” (p. 874). Casey demoted abortion from the status of a constitutional right; restrictions need no longer pass the “compelling state interest” test of Roe. The Casey majority upheld an informed consent requirement, a mandatory twenty‐four‐hour waiting period, and a parental consent/judicial bypass provision.

Casey remains binding precedent. The government may not ban abortion outright, but laws that leave poor women, rural women, and minors without access to abortion may stand. The Court has not revisited the constitutionality of abortion laws in general. The election of an anti‐choice president in 2000, and the Republican control of Congress, worried reproductive‐choice advocates, especially as they anticipated George W. Bush's appointments to the Court. The development of RU‐486, an abortion‐inducing drug, may render the abortion controversy obsolescent. Anti‐abortion forces lost their battle against RU‐486 when the Food and Drug Administration gave the drug full marketing approval in 2000. It is now widely available. Mark A. Graber, Rethinking Abortion (1996); Eileen L. McDonagh, Breaking the Abortion Deadlock (1996); Karen O'Connor, No Neutral Ground? (1996); Rosalind P. Petchesky, Abortion and Woman's Choice (1990); Lawrence H. Tribe, Abortion: The Clash of Absolutes (1991).

— Judith A. Baer

For more information on abortion, visit Britannica.com.

Termination of the life of a foetus, after conception but before birth. The event may be intentionally induced or natural, although it is intentionally induced abortion that is the topic of moral philosophy. The issues divide conservatives or ‘pro-life’ supporters, who regard deliberately induced abortion as impermissible, and liberal or ‘pro-choice’ supporters, who regard the action as permissible in a variety of cases. The liberal attitude may extend to almost any case in which a mother wishes an abortion, or may involve a variety of restrictions, including the age of the foetus. Moderates restrict the permissible cases, but the debate has not been notable for moderation. Issues arising include the nature of personhood, and its beginning; the extent of the right to life; the fragile notion of the sanctity of life; the way in which conflicting rights should be treated; and the political and social issues of who has the right to decide moral and legal policy and to enforce it.

Abortion as a moral problem is not discussed at length in Buddhist literature. However, there are sufficient references in the Pāli Canon and other ancient sources to indicate that the practice was regarded as gravely wrong. Buddhist disapproval of abortion is related to its belief in rebirth and its teachings on embryology. It is widely held that conception marks the moment of rebirth, and that any intentional termination of pregnancy after that time constitutes a breach of the first of the Five Precepts (see pañca-śīla). Broadly speaking, this continues to be the avowed view of most Buddhists, although this position is not always reflected in the abortion statistics in Buddhist countries. In the more conservative countries of south-east Asia abortion is generally illegal unless there is a threat to the mother's life. Illegal abortions, however, are common, with an annual figure of perhaps 300,000 per annum in Thailand. In certain east Asian countries abortions are even more numerous, and a figure of one million per annum or greater is sometimes cited for countries such as Japan and South Korea. In Japan a memorial service known as mizuko kuyō has evolved as a response to the large number of abortions carried out in recent decades.

To 1800

Records of abortions exist from throughout the American colonies in the seventeenth and eighteenth centuries. A variety of herbs and other plant products, including tansy, savin, pennyroyal, seneca snakeroot, and rue were used as abortifacients, some available from physicians but many attainable through herb gardens. Historians have had difficulty determining which were effective, which were not, and which were fatal to the mother, but they conclude that many of the concoctions taken were poisonous. Some have been determined so toxic it seems unlikely that women ingested them voluntarily, unless attempting suicide. It is possible that another person—often the man who impregnated her—would persuade the woman to ingest it. However, intense reactions to medication were viewed as proof of effectiveness, so vomiting and blistering were considered necessary side effects.

Because abortions were often performed at home and detailed records were rare, it is difficult to make precise estimations of abortion rates. However, it appears that rates in the colonial era were relatively low. Surgical abortions were rare. Lack of medical knowledge, particularly regarding infection, almost guaranteed the death of the mother if surgery were performed. Cases of infanticide were more common than surgical abortions, as pregnancies might be hidden until term under loose clothing and infanticide would at least protect the life of the mother.

The tendency toward abortion depended largely on community attitudes toward nonmarital pregnancy and childbearing in general, but it was also closely tied to economics. In a developing colonial society with a land-based economy, children were generally welcomed. Economic desperation was comparatively rare, resulting in relatively low rates of abortion and infanticide. In the case of non-marital pregnancy, social pressure to name the father and demands on him to pay support eased the burden on women of even the lowest means. Paternity suits were common, the vast majority of which ended in financial support or marriage or both. The rates of premarital pregnancy in the colonies increased dramatically in the late eighteenth century, with up to 30 percent of births occurring before nine months of marriage. There was generally much more pressure on men to take responsibility for pregnancy than chastisement of women for becoming pregnant.

Conception and "quickening"

New scientific notions of pregnancy and fetal development arose during the Age of Enlightenment as scientists and religious leaders debated the origins of life. Calvinists and Anglicans argued against abortion, citing numerous biblical passages stating that human life begins at conception. But the battle lines were not drawn simply between religion and science, as scientists disagreed among themselves about the origins of human life. Anton van Leewenhoek, famous for his development of the microscope, argued in the late seventeenth century that an entire human was contained in each male sperm, and was simply implanted in a woman. Other scientists, concerned about the waste of human lives if that held true, argued that an entire human life existed in a woman's egg, and was simply "activated" by male sperm.

Some historians have argued that until the mid-nineteenth century, human life was widely understood to begin at "quickening," the moment when a pregnant woman could first feel the fetus move—generally in the late fourth or early fifth month of pregnancy. Colonial common law instituted punishment for abortion only after quickening. Evidence shows that the scientific community, the religious community, and the community at large all believed that human life in some form began before quickening, but under common law, abortions before quickening were legal. After quickening, however, the fetus—although by no means "viable" (able to survive outside the uterus)—was considered a separate being. Until quickening, the best evidence of pregnancy was the absence of menses, which could have been a symptom of various other conditions. Until the mid-nineteenth century, women were often provided with abortifacients to remove a "blockage," and once menses resumed, she was considered treated. The cause of the blockage was not an issue of legal concern.

Women often had access to abortifacient plant products and the knowledge necessary to use them to "resume menses." Once experiencing quickening, however, she was more or less obligated to carry the fetus to term. Quickening offered better proof of pregnancy, and usually marked a pivotal point after which terminating a pregnancy was unquestionably more dangerous. Until the early nineteenth century, the power of deciding to terminate an early pregnancy essentially lay with the woman. However, by the late colonial period, others were becoming increasingly involved in the practice, as physicians and apothecaries were marketing and selling abortifacients. Even under the regulation of "experts," they were often deadly.

Restrictions on Abortion

The first legal restrictions on abortion in the United States were aimed at the sale of abortifacients. State laws of the 1820s and 1830s listed abortifacients as poisons and made their sale illegal. In some states, laws also regulated practitioners who performed surgical abortions. All of these laws were intended to protect the life of the mother, and domestic use of abortifacients before quickening was not a crime. By 1840, ten of the nation's twenty-six states had passed abortion regulations.

Widespread attempts at criminalization of abortion began in the 1850s. The American Medical Association (AMA), founded in 1847, played a major role here. For a number of reasons, its members promoted legislation to restrict abortion in various states. The AMA reflected a trend in the field of medicine that valued accreditation and expertise. Members of the AMA attacked physicians of an older generation, as well as homeopaths and midwives, as ill-trained and incompetent, and in its attempt to improve medicine it took control of the practice of abortion. Many of the new generation of physicians also viewed themselves as moral leaders, and in their crusades aimed at preserving and protecting human life, they attacked abortion on moral grounds. One element of this crusade lessened the significance of quickening, considering it simply one stage in fetal development. This laid the groundwork for prohibiting abortion at any stage.

To some extent, abortion regulation through the mid-nineteenth century might be considered in the larger context of social reform movements in America. However, in later decades the anti-abortion crusades reflected the increasing influence of the Victorian Era. Then, pregnancy—or at least illicit pregnancy—was considered a woman's punishment for immoral behavior. Abortion would allow a woman to go unpunished. Even access to methods to prevent such a pregnancy would facilitate such immoral behavior. A result was the passage of legislation to prohibit the practice of abortion and the sale and distribution of contraceptives and contraceptive information. The Comstock Law of 1873—named for the purity crusader Anthony Comstock—categorized abortion and birth control as obscenity, prohibiting them under federal anti-obscenity legislation.

Various states also criminalized abortion, except for cases in which the mother's life was endangered by pregnancy or childbirth. This gave physicians the authority to determine when an abortion could be permitted. In addition, state regulations prohibiting the sale or distribution of abortifacients were reworked to allow physicians to prescribe them.

In many cases, middle-and upper-class women who had personal physicians maintained comparatively easy access to abortion. However, abortion rates increased among the poor and ethnic minorities. By midcentury, national concerns over shifting demographics drew attention to birth rates among the "proper stock" as opposed to those among the "lesser stock." The growing trend among white middle-and upper-class women to seek abortions was an influential factor in criminalizing the procedure. Mass immigration resulted in a growing working class that was perceived as a threat to the dominant Anglo-Protestant culture. Many physicians commonly conducted abortions among the poor and minorities, some publicly declaring that white Protestant women should have more children.

Abortion and Women's Roles

The development of anti-abortion legislation not only reflected ideas of race and class, but also affected gender roles. Before the mid-nineteenth century, women held a stronger position in realm of pregnancy, childbearing, and abortion than afterward. Childbirth took place at home, often with the assistance of a midwife; pregnant women were looked after by other women; and individuals had access to natural herbs that were known abortifacients. In addition, only a pregnant woman knew when quickening took place. The devaluation of quickening by the medical community had already weakened a woman's authority in her own pregnancy. Criminalizing abortion, except under a doctor's recommendation, and abortifacients without a doctor's prescription, further weakened her authority.

Anti-abortion movements generally grew when women demanded more rights. From the mid-to the late nineteenth century, public condemnation of abortion paralleled the women's movement for political rights. Fears that women would forsake their proper social roles and the responsibility of motherhood if they had the right to abortion helped to shape the debate, and ultimately the success, of anti-abortion legislation. Equal opportunity in politics and in higher education appeared to reduce family size and some hoped that the prohibition of abortion and birth control might offset this trend. At the turn of the twentieth century, the women's movement included new demands for sexual freedom, and anti-abortion activists worked to limit abortions. Although widely criminalized, physicians still performed some abortions and illegal abortions were common. The separation of sexuality and procreation allowed greater sexual freedom for women, spurring new attacks on abortion.

Abortion and Contraception

In the 1910s, a powerful birth control movement took hold in America. Leaders of the movement, particularly Margaret Sanger, did not equate birth control with abortion. Rather, they argued that legalizing contraceptives would reduce abortion rates. Public opinion still accepted early-term abortions, and abortion was often the preferred method of birth control. With little access to contraceptives because of the Comstock Law, couples had few choices. Proponents of legal contraceptives reported graphic details of numerous self-induced abortions performed by desperate women, who often died as a result.

Clinics were established to provide contraceptives and contraceptive information. Medical professionals who opened clinics bypassed Comstock laws that barred contraceptives and contraceptive information from importation and from the U.S. mails. Critics feared that such information encouraged "free sex" among single women, when in fact it was primarily intended for married working-class couples who had no access to personal physicians. Critics of abortion similarly feared that single women were having abortions to facilitate an uninhibited sexual lifestyle. In fact, most women having abortions were married. Working-class women generally had children early, ending later pregnancies through abortion. Upper-class women generally delayed childbearing and often ended early pregnancies through abortion. In either case, they saw it as a form of birth control, although birth control advocates drew clear distinctions between contraception and abortion.

At first glance, the criminalization of abortion appeared to have a significant effect on abortion rates. In the mid-nineteenth century, some records show that as many as one out of five or six pregnancies ended in abortion, while some report that in 1900 only one in twenty did. However, the fact that abortions were a crime made it less likely that women would report them. Drawing from case reports of hospital personnel who treated women bleeding as the result of apparent abortion, scholars estimate as many as 2 million abortions per year at the end of the nineteenth century. One doctor estimated between six to ten thousand abortions were performed (many by the women themselves) in 1904 in Chicago alone. Because of criminalization, and because the abortion issue has been so politicized, it is difficult to determine accurate abortion rates. However, it is clear that criminalization did not prevent it.

The birth control movement's eventual success was linked to its alliance with the American Medical Association, which—as the movement gained strength—began to support the legalization of contraceptives. Sanger and the AMA worked hand in hand into the 1930s in efforts to condone birth control and to secure legislation to protect doctors from prosecution for prescribing contraceptives. Again, physicians gave themselves control of the distribution of contraceptives, with the support of the courts and legislative bodies. In 1936, the AMA officially abandoned its official opposition to birth control.

Black Market Abortions

The Great Depression of the 1930s created an environment in which birth control became an acceptable response to social ills because more families were economically desperate and unable to care for additional children. At the same time, however, the number of abortions performed was on the rise—so quickly that many considered it an epidemic. Scholars generally estimate that more than 500,000 took place each year in the United States during the depression. The cost of a "black market" abortion was usually under seventy-five dollars, far below the cost of feeding another child. In addition, women often lost their jobs to men during the depression, and a pregnant woman was almost certain to lose her job.

A few doctors began to support publicly the repeal of anti-abortion laws during the 1930s. However, the opposition was strong. First, Pope Pius XI's 1930 encyclical, Casti Connubii, pronounced that a developing fetus had a soul. Although America was not a Catholic nation, its largest denomination by then was Roman Catholicism, and the issue of abortion had taken on a new character in the international religious-political realm. The Soviet Union had legalized abortion in the 1920s and the procedure was viewed as tightly tied to a brand of socialist feminism in western Europe. Any connection between feminism and socialism that was tied to abortion would force legalization to confront considerable obstacles in the United States.

The demands on physicians to perform abortions were great and many received additional training in the procedure. The procedure most often used was dilation and curettage, but the injection of potassium soap solution was common by the 1930s. Physicians were legally protected as they were granted the right to conduct therapeutic abortions. Physician-abortionists were considered specialists in the medical community and general practitioners referred their patients to them. The profession officially condemned abortion, but doctors were widely involved, if not directly, then through making referrals. In essence, they could ensure their patients had access to abortion without actually performing them.

To perform an abortion except with the intent to save the life of the mother meant possible arrest. Physician-abortionists who devoted their practice exclusively to abortion risked police raids and prosecution. Raids were especially common in the 1940s and 1950s and served to expose publicly abortionists and their patients. Patients were commonly interrogated in police stations and courtrooms. Police and prosecutors went after patients rather than the referring physicians, who possessed more incriminating evidence than the women did. Because of the raids, many hospitals stopped conducting therapeutic abortions. Advances in medicine, particularly in the development of antibiotics and antiseptics, made hospitals the safest and cleanest places to have an abortion. However, hospital administrators were unwilling to face the publicity resulting from continual raids on clinics and arrests of physicians.

Medical advances also affected the ways in which the fetus was perceived. Imaging techniques allowed physicians to focus on the fetus as a developing human and they increasingly considered the uterus as the space in which the fetus developed. In the 1950s, a culture of family and children encouraged women to embrace motherhood and they were chastised for considering abortion. Other medical advances made pregnancy-related illnesses, complications, and deaths comparatively rare. Therefore, hospitals became less likely to offer therapeutic abortions.

In addition, improvements were made in sterilization procedures. In the 1950s, approximately half of the nation's hospitals offered women abortions if they agreed to simultaneous sterilization. Hospitals established therapeutic abortion committees not only to develop such regulations, but to decide in individual cases when an abortion would be permitted.

Calls for Reform and Repeal

In the mid-1950s, a small group of physicians and public health workers began a movement to reform abortion laws. They had seen the disastrous effects of criminalization on women and the medical profession that had developed in recent decades. In 1955, Planned Parenthood organized a small conference of health care professionals to organize against the existing laws. But they did not gain the momentum necessary to overturn legislation until the birth of the women's movement in the 1960s. An integral part of that movement was the demand for reproductive rights. The demand began at the grassroots level with one of the most influential organizations, Citizens for Humane Abortion Laws, founded in 1962 in California. That same year, Sherri Finkbine, a television celebrity, attracted the nation's attention when she traveled to Sweden to have an abortion after finding out that she had taken a drug containing thalidomide early in her pregnancy. In 1961, researchers discovered that thalidomide—which was commonly prescribed to pregnant women to combat sleeplessness and morning sickness—caused severe birth defects, primarily the stunting of fetal limb development.

In Griswoldv. Connecticut (1965), the U.S. Supreme Court ruled in favor of Planned Parenthood staffers who had violated Connecticut state law in dispensing a contraceptive device to a married woman. The Court ruled on the grounds that their 1961 convictions were violations of the right to privacy. The case brought national attention to birth control laws that were considered repressive, and the right-to-privacy decision paved the way for privacy considerations in the issue of abortion. The public chastisement of women caught during clinic raids in the 1950s was often claimed to violate the right to privacy, but there was no strong legal precedent to turn to in those cases. The year 1966 marked the founding of the National Organization for Women (NOW), which would strengthen the attack on abortion laws. By the 1960s, the focus of abortion rights activists was shifting from a call for reform to a call for repeal of anti-abortion laws, and various women's groups addressed abortion at the national level. In 1969, abortion rights leaders held the first National Conference on Abortion Laws and formed the National Association for Repeal of Abortion Laws (NARAL). However, grassroots organizations remained instrumental as abortion was prohibited at the state level, and although banned in every state, it was regulated on different terms.

The landmark case in abortion history was Roe v. Wade (1973). In that case (which was supported by other cases), a twenty-three-year-old pregnant woman challenged Texas's abortion law, which the Supreme Court ultimately found unconstitutional. The decision, written by Justice Harry Blackmun and based on the residual right to privacy, overturned numerous statutes that had been in place for more than one hundred years. Restrictions on abortions during the first trimester of pregnancy were lifted and abortions in the second trimester were allowed with few restrictions. States were given the right to intervene during the second and third trimesters to protect the life of the woman and the potential life of the fetus.

The reaction to Roe v. Wade was swift and far-reaching. As a result of the case, NARAL changed its name to the National Abortion Rights Action League, preparing for opposition. The Catholic Church quickly professed its opposition and fundamentalist Protestants hastened their efforts to support a pro-life movement. In 1977, Congress prohibited the use of Medicaid funds for abortion except for therapeutic reasons, and in a few other cases. The religious right gained political momentum with the election of conservatives to Congress and Ronald Reagan and George Bush Sr. to the presidency during the 1980s. This resulted in the creation of an abortion "litmus test" for Supreme Court nominees, who were considered on the basis of their stand on abortion, regardless of their experience or positions on other issues. In Webster v. Reproductive Health Services (1989) the Supreme Court limited the scope of Roe v. Wade, and in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) it reaffirmed abortion rights while permitting further restrictions.

The 1990s saw a rise in extreme measures on the pro-life side, including the harassment of women entering clinics, the bombing of clinics, and attacks on physicians known to perform abortions. In the second half of the decade, Congress repeatedly passed a bill that would ban "partial-birth abortion," but President William Jefferson Clinton vetoed it.

Partial-birth abortions are conducted in the third trimester of pregnancy when a fetus is viable, and involve the dilation of the cervix and extraction of the fetus while puncturing the skull. Although very rare, accounting for 0.04 percent of all abortions, the procedure was used extensively in the public debate by anti-abortion activists. At the end of the decade, extremists continued to attract attention to the issue and the litmus test was predicted to be a factor under George W. Bush's administration. But the nation saw groups such as right-to-life feminists calling for better options for pregnant women and rising to provide alternative solutions such as better wages for women, pregnancy and child-care employment leave, and better support for young, unwed mothers. Recent studies have shown a decrease in abortion rates and an increase in births out of marriage, demonstrating a significant shift in social mores.

Bibliography

Baird-Windle, Patricia, and Eleanor J. Bader. Targets of Hatred: Anti-Abortion Terrorism. New York: St. Martin's Press, 2001.

Blanchard, Dallas A. The Anti-Abortion Movement and the Rise of the Religious Right: From Polite to Fiery Protest. New York: Twayne, 1994.

Craig, Barbara Hinkson, and David M. O'Brien. Abortion and American Politics. Chatham, N.J.: Chatham House, 1993.

Hull, N. E. H., and Peter Charles Hoffer. Roe v. Wade: The Abortion Rights Controversy in American History. Lawrence: University Press of Kansas, 2001.

Jacoby, Kerry N. Souls, Bodies, Spirits: The Drive to Abolish Abortion since 1973. Westport, Conn.: Praeger, 1998.

Jaffe, Frederick S., Barbara L. Lindheim, and Philip R. Lee. Abortion Politics: Private Morality and Public Policy. New York: McGraw-Hill, 1981.

Mohr, James C. Abortion in America: The Origins and Evolutions of National Policy, 1800–1900. New York: Oxford University Press, 1978.

Olansky, Marvin. Abortion Rites: A Social History of Abortion in America. Wheaton, Ill.: Crossways Books, 1992.

Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867–1973. Berkeley: University of California Press, 1997.

Solinger, Rickie, ed. Abortion Wars: A Half Century of Struggle, 1950–2000. Berkeley: University of California Press, 1998.

—Kathleen A. Tobin

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This entry contains information applicable to United States law only.

The spontaneous or artificially induced expulsion of an embryo or fetus. As used in legal context, usually refers to induced abortion.

History

English common law generally allowed abortion before the "quickening" of the fetus (i.e., the first recognizable movement of the fetus in the uterus), which occurred between the sixteenth and eighteenth weeks of pregnancy. After quickening, however, common law was less clear as to whether abortion was considered a crime. In the United States, state legislatures did not pass abortion statutes until the nineteenth century. After 1880, abortion was criminalized by statute in every state of the union, owing in large measure to strong anti-abortion positions taken by the American Medical Association. Despite the illegality, many thousands of women every year sought abortions. Under a heavy cloak of shame and secrecy, women often had abortions performed in unsafe conditions, and many died or suffered complications from the procedures.

The abortion laws developed in the late nineteenth century existed largely unchanged until the 1960s and 1970s, when a number of different circumstances combined to bring about a movement for their reform. Women's rights groups, doctors, and lawyers began an organized abortion reform movement to press for changes, in part because many of them had witnessed the sometimes deadly complications resulting from illegal abortions. Women's organizations also began to see abortion reform as a crucial step toward the goal of equality between the sexes. They argued that women must be able to control their pregnancies in order to secure an equal status in American life. In addition, new concerns regarding explosive population growth and its effect on the environment increased public awareness of the need for birth control. At the same time, other countries developed far more permissive laws regarding abortion. In Japan and Eastern Europe, abortion was available on demand, and in much of Western Europe, abortion was permitted to protect the mother's health.

Public awareness of the abortion issue also increased through two incidents in the early 1960s that caused a greater number of children to be born with physical defects. In 1961, the drug thalidomide, used to treat nausea during pregnancy, was found to cause serious birth defects. And a 1962-65 German measles epidemic caused an estimated fifteen thousand children to be born with defects. Pregnant women who were affected by these incidents could not seek abortions because of the strict laws then in existence.

Reacting to these and other developments, and inspired by the successes of the civil rights movement of the 1950s and 1960s, women's rights organizations — including the National Organization for Women (NOW), formed in 1966 — sought to reform abortion laws through legislation and lawsuits. They hoped to educate a largely male dominated legal and judicial profession about this important issue for women. Their work, supported by such groups as the American Civil Liberties Union (ACLU), quickly began to have an effect. Between 1967 and 1970, twelve states adopted abortion reform legislation. However, the abortion activist groups began to see the abortion issue as a question of social justice and began to press for more than reform. Under the rallying cry of reproductive freedom, they began to demand an outright repeal of existing state laws and unobstructed access for women to abortion.

The increase in abortion-related cases before the courts eventually resulted in the need for clarification of the law by the Supreme Court. After considering many abortion-related appeals and petitions, on May 31, 1971, the Court accepted two cases, Roe v. Wade, 410 U.S. 113, 93 S. Ct. 705, 35 L. Ed. 2d 147 (1973), and Doe v. Bolton, 410 U.S. 179, 93 S. Ct. 739, 35 L. Ed. 2d 201 (1973), for hearing.

Roe v. Wade and Doe v. Bolton

Although the two cases before the Court appeared by their titles to involve the fates of two individuals, Roe and Doe, in reality both suits were brought by many people representing many different interests. Roe v. Wade was argued on behalf of all women of the state of Texas — in legal terminology, it was a class action suit. Thirty-six abortion reform groups filed briefs, or reports, with the court on Roe's behalf. These included women's, medical, university, public health, legal, welfare, church, population control, and other groups. The anti-abortion side of the case included representatives from seven different anti-abortion groups and the attorneys general of five states.

Roe involved a person using the pseudonym Jane Roe — actually Norma McCorvey, who revealed her identity in 1984. Roe, an unmarried, pregnant woman from Texas, wanted to have an abortion, but an existing abortion statute prevented her from doing so. The Texas statute, originally passed in 1857, outlawed abortion except to save the mother's life. Roe filed a lawsuit in federal district court on behalf of herself and all other pregnant women. She sought to have the abortion statute declared unconstitutional as an invasion of her right to privacy as guaranteed by the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. She also sought to have an injunction, or court order, issued against the statute's enforcement so that she might go forward with the abortion. The abortion reform movement attached two other cases to Roe's in an attempt to represent a wider range of the interests involved in the issue. A physician, James Hallford, who was being prosecuted under the statute for two abortions he had performed, also filed suit against the Texas law, as did a childless couple, the Does.

The three-judge district court combined Roe's case with the cases of Hallford and the Does, but later dismissed the suit brought by the Does on the grounds that neither had violated the law and the woman was not pregnant. The district court agreed with Roe that the law was unconstitutionally vague and violated her right to privacy under the Ninth Amendment — which allows for the existence of rights, like that of privacy, not explicitly named in the Constitution's Bill of Rights — and the Fourteenth Amendment. It refused, however, to grant the injunction allowing her to go ahead with the abortion. Roe then appealed the denial of the injunction to the U.S. Supreme Court.

Doe v. Bolton involved a 1968 Georgia statute that allowed abortion if necessary to save the mother's life, in the case of pregnancy resulting from rape or incest, or if the baby was likely to be born with serious birth defects (Ga. Crim. Code § 26-1202 a,b). However, the statute also created procedural requirements that effectively would have allowed few abortions. Those requirements included hospital accreditation, committee approval, two-doctor agreement, and state residency. The case concerned Mary Doe, who had sought an abortion at Grady Memorial Hospital, in Atlanta. She claimed that she had been advised that pregnancy would endanger her health, but the hospital's Abortion Rights Committee denied her the abortion. She sought a declaratory judgment holding that the Georgia law unconstitutionally violated her right to privacy as well as her Fourteenth Amendment guarantees of due process and equal protection. She also sought an injunction against the law's enforcement.

Roe and Doe were filed in March and April of 1970, and the women's pregnancies would not have lasted through December 1970. The Court heard the cases in December 1971 and October 1972, and they were not resolved until January 1973, when the Court announced its decisions.

In Roe, the Court, on a 7-2 vote, found the Texas abortion statute unconstitutional. In its opinion, written by Justice Harry A. Blackmun, the Court held that the law violated a right to privacy guaranteed by the Due Process Clause of the Fourteenth Amendment. However, the Court further held that such a right is a "qualified" one and subject to regulation by the state. The state has "legitimate interests in protecting both the pregnant woman's health and the potentiality of human life" (i.e., the life of the fetus). To specify when the state's interests emerge, the Court divided pregnancy into twelve-week trimesters. In the first trimester, the state cannot regulate abortion or prevent a woman's access to it. It can only require that abortions be performed by a licensed physician and under medically safe conditions. During the second trimester, the state can regulate abortion procedures as long as the regulations are reasonably related to the promotion of the mother's health. In the third trimester, the state has a dominant interest in protecting the "potentiality" of the fetus's life. A state may prohibit abortions during this time except in cases where they are essential to preserve the life or health of the mother. The Court also cited judicial precedent in holding that the fetus is not a "person" as defined by the Fourteenth Amendment.

In Doe, the Court found the Georgia statute to be unconstitutional as well, holding that it infringed on privacy and personal liberty by permitting abortion only in restricted cases. The Court ruled further that the statute's four procedural requirements — hospital accreditation, hospital committee approval, two-doctor agreement, and state residency — violated the Constitution. The state could not, for example, require that abortions be performed only at certain hospitals, because it had not shown that such restrictions advanced its interest in promoting the health of the pregnant woman. Such a requirement interfered with a woman's right to have an abortion in the first trimester of pregnancy, which the Court in Roe had declared was outside the scope of state regulation.

After Roe v. Wade

After the Supreme Court decisions in Roe v. Wade and Doe v. Bolton, states began to liberalize their abortion laws. However, abortion quickly became a divisive political issue for Americans. Grassroots opposition to abortion — supported by such influential institutions as the Catholic Church— was strong from the start. By the early 1980s, the anti-abortion movement had become a powerful political force. President Ronald Reagan, who came to office in 1981 and served through 1989, strongly opposed abortion and used his administration to try to change abortion rulings. He appointed a surgeon general, Dr. C. Everett Koop, who opposed abortion, and he made it a top priority of his Justice Department to effect a reversal of Roe. Reagan even published a book on the subject in 1984, Abortion and the Conscience of a Nation, which contains many of the essential positions of the anti-abortion movement. Reagan argued that the fetus has rights equal to those of people who are already born. He also cited figures indicating that 15 million abortions had been performed since 1973, and he stated his belief that the fetus experienced great pain as a result of the abortion procedure. He quoted a statement by Mother Teresa, the famed nun who helped the poor of Calcutta: "[T]he greatest misery of our time is the generalized abortion of children." While abortion rights, or pro-choice, adovcates argued that there were public health advantages of the new abortion laws, opponents of abortion, such as Reagan, referred to abortion as a "silent holocaust."

The anti-abortion, or pro-life, movement has challenged abortion in a number of different ways. It has sponsored constitutional amend- ments that would effectively reverse Roe, as well as legislation that would limit and regulate access to abortion, including government financing of abortion procedures. Some anti-abortion groups have practiced civil disobedience, attempting to disrupt and block abortion clinic activities. The most extreme opponents have resorted to violence and even murder in an attempt to eliminate abortion.

All these methods have resulted in a great deal of litigation and added to the complexity of the abortion issue. Many of the subsequent cases have come before the Supreme Court. Observers have often expected the Court to overturn its Roe decision, particularly after the Reagan administration appointed three justices to the Co