Abortion: Definition, History, Cause, Law, Effects and Necessity

Abortion Overview

Abortion is the deliberate and planned termination of pregnancy, mostly during the first 24-28 weeks of pregnancy. During abortion, the foetus and products of conception, like the placenta and other pregnancy tissues, are removed. The WHO defines abortion as the termination of pregnancy before 20 weeks or when the foetus is less than 500g in weight. It is an old practice. The first written record of abortion is traced to Ancient Egypt around 1500 BC (Population Reference Bureau, 2008). The early Roman Catholic Church allowed abortion of a female foetus in the initial 80-90 days and for male foetuses in the initial 40 days (NIH, 1985). The church continued to change its positions for centuries. In 1920, the USSR became the first modern nation to legalise the practice. The legality changed depending on the need. 

Abortion remained a criminal offence in the United Kingdom under the person act of 1861. Later, abortion was regulated under the Abortion Act 1967 in Great Britain and under the Regulations 2020 in Northern Ireland. In England and Whales, there were 214,869 abortions in 2021, representing an age-restricted rate of 18.6 per 1000 women in the reproductive years (15-44 years). The rate was highest for women aged 22 (31.0/1000) and the lowest in the under 16 group (1.1/1000). Among these abortions, 87% were medically induced, and the rate of abortions is increasing (GOV.UK). 

Various reasons for induced abortions are socioeconomic concerns like inability to afford more children due to unemployment and poverty, desire to improve schooling and upbringing of existing children, family issues like lack of or poor support from the partner and career concerns like the disruption of employment and education. Abortion causes several negative effects on women's physical and psychological health. The physical issues include bleeding, gastrointestinal disturbances, pains, post-abortion infections, failure of abortions, damage to the cervix and uterus, causing uterine perforations, uterine rupture (very rare) etc. The psychological effects include depression, anxiety disorder, alcoholism, higher risk of suicide and drug abuse etc. 

Difference types of procedures are used, most of which don't require surgery or anaesthesia. Commonly, a combination of two medications is used, one causing the end of the hormonal backing of pregnancy and the other causing uterine contractions and expulsion of the foetus. After the expulsion of the foetus, painkillers and antibiotics are given for some days to manage pain and reduce the risk of infections. 

What is Abortion? 

The precise definition of abortion depends upon sources and local legislation. Medically, abortion is intentionally removing a foetus from the womb before reaching the stage of viability, which is 22-24 weeks of pregnancy in humans. Sometimes, it occurs spontaneously (miscarriage), and at other times, it is induced (induced abortion). During abortion, the foetus and other tissues like the placenta and foetal membranes are removed. The legal definitions of viability differ in different countries and states, and in the UK, the limit is 24 weeks of gestation. It means a baby born after 24 weeks has a chance of survival, and those born before 24 weeks don't have any chance as vital organs like lungs are not completely developed. 

What is the Cause of Abortion? 

The women choose to abort due to a variety of reasons. Sometimes, the reasons are very simple, like having medical complications, and other times, they are more complicated. It is unsafe, and the women must consult the gynaecologist before deciding. The causes of abortion are grouped into medical or non-medical. 

Medical grounds: Sometimes, doctors recommend abortions in case of some diseases or complications developing in the pregnancy that endanger the life. For example, the diagnosis of advanced-stage cancer that needs immediate chemotherapy or morning sickness that severely disrupts the food intake. 

Some issues affect the baby in the womb and indirectly affect the mother, too, like congenital fetal anomalies that have the risk of abortion. Mental health is as important as physical health, and sometimes, abortion is recommended if the woman is suffering from some long-term psychological illness like depression, as she often needs unsafe medications during pregnancy. Some women experience negative emotions during pregnancy that influence their life. 

Non-medical issues: Several other issues influence the well-being of women. Such factors are important, although some experts reject them as selfish lifestyle choices. Raising a child is a cumbersome job and requires much effort, both as physical and financial commitments. Not all couples are ready to take responsibility, and some opt for abortion. Some of such issues are;

• Disruption of career or education, particularly at sensitive stages,
• Having an unstable relationship or job
• Being in a poor position to provide for the family.
• The financial position is not good as required for bearing a child
• Being homeless as childbearing is challenging for homeless people
• Having a complete family as planned and no place for a new member. 
• Having too many dependents to care for and unwilling to take more. 

The reasons for choosing abortions are variable among different cultures. For example, in African people, the most commonly cited reason is the need for a space between the children in married women and family objections and young age in unmarried women (Sophia and Sheila, 2017). Some factors influencing abortion decision-making are financial status, pressure from family, spouse or partner, poor financial status, and fears of being excluded from the family. Some other factors like being a victim of sexual abuse like rape or incest, religious and social norms and stigmas about extramarital and pre-marital sex are responsible. 

Why Abortion Occurs?

Abortion is risky and must be conducted by qualified gynaecologists or doctors at licensed clinics or hospitals. In pregnancy below 10 weeks of age, at-home medical abortion is done after an appointment at the clinic or hospital. The patient needs to visit the doctor for the scan to determine the pregnancy age, or sometimes, consultation through video or audio call is enough. The process of abortion starts with a pre-abortion assessment. 

Pre-abortion assessment: The pre-abortion assessment is done at clinics or hospitals. During it, the doctor discusses various issues like the reasons to go for the abortion and if the patient is sure about the decision and its consequences, the pros and cons of the process and the complications, various methods available for abortion and associated risk factors, the ultrasonography to see the age of the foetus, testing for sexually transmitted infections (STIs) and the testing for other health conditions. Once the patient has understood everything, she has to sign a consent paper and is given a date for the procedure. 

2 types of methods are available for abortion; medical abortion, in which medicines are used to terminate the pregnancy, and surgical abortion, in which the foetus and related structures are removed surgically. Both methods are recommended up to 24 weeks of pregnancy and rarely after 24 weeks. The choice of method depends upon the condition of the pregnancy, the doctor's recommendations and sometimes, the patient's personal choice. 

Medical abortion: During a medical abortion, two medicines are used, which work together to terminate the pregnancy. The medicines are prescribed by the doctors and are taken 1-2 days apart. The pregnancy is passed out after some hours of the second medicine. No anaesthesia or surgery is required for the process. First, a pill containing mifepristone prepares the body for the next phase. It is taken at home in case of a below 10-week pregnancy or at a clinic or hospital in case of complicated cases or advanced pregnancies. 

A second pill containing misoprostol is taken after 1-2 days. The tablet is placed inside the vagina, between the gums and cheeks or under the tongue. It is taken at home in case fewer than 10 weeks of pregnancy, or a visit to a hospital or clinic is required. After 4-6 hours of the second pill, the uterine lining breaks down, resulting in pregnancy loss, bleeding, and pain. Sometimes, higher doses are required to get the desired results, and many often, the process is ineffective and surgical removal becomes necessary. 

Surgical abortion: During the surgical abortion, local anaesthesia is applied to numb the cervix region or general anaesthesia is sometimes used. Some medicines are used 1-2 days before the surgery that causes the opening of the cervix, and then the process is carried out by either of the following processes;

Dilatation and evacuation (D&E): During D&E, instruments called forceps are inserted into the womb through the vagina that removes the pregnancy. It is performed under general anaesthesia or sedation. It is done for a pregnancy over 14 weeks old, takes 10-20 minutes, and the patients are discharged on the same day. 

Suction or vacuum aspiration: It is useful for pregnancy 14 weeks or less. During vacuum aspiration, a tube is inserted through the cervix to reach the womb. Suction is applied that removes the pregnancy. Suction is applied that removes the pregnancy. Sometimes, special instruments are required to complete the process. The procedure takes 5-10 minutes, and the patients are discharged after a few hours. 

After the process, the pregnancy scan is performed again to see if the process has been effective. Some temporary side effects of the medicine used in medical abortion, like nausea, abdominal cramps, vomiting and diarrhoea, are experienced. Likewise, in the case of surgical anaesthesia, the effects of sedation and anaesthesia take some days. Some issues like vaginal bleeding and stomach cramps are sometimes experienced for 1-2 weeks. The pain killers like paracetamol and ibuprofen are prescribed to control the discomfort and pain, and special precautions are used until the patients feel completely comfortable. 

What is the History about Abortion?

Abortion has a complex history and has been only recently legalised under the 1967 act with strict legal regulations like having the consent of at least two doctors before going for an abortion. The history of abortion is, however, very old, and the practice is as old as the concept of planned and unplanned pregnancies. Previously, women tried to end the pregnancy using charms and home remedies. Many of such methods were ineffective and often endangered the life of women. By the late 1800s, some traditional healers in the USA and Western Europe were providing abortion services to women and training other women on the procedure without any legal prohibitions. 

The anti-abortion laws (Lord Ellenborough’s acts) were passed in 1803 in Britain and continued to become stricter in the coming decades. The act implemented the death penalty for the purposeful and unlawful administration of any chemicals or position to terminate the pregnancy earlier. The provisions of the act were consolidated in the offences against the person act of 1828 in Britain and 1829 in Ireland. Both acts were combined into the offences against the person act of 1837. 

Besides the legal regulations, some philanthropist organizations started providing organised arrangements for the care of children produced from unwanted pregnancies, like Foundling Hospital in London (a part of the Orphanage movement). By the early 20th century, illegal abortions were very common, and an estimated 100,000 women struggled to get an abortion in 1914 (The Guardian, 2005). 

In 1929, the Infant Life Preservation Act criminalised the purposeful killing of a child that has the ability to born alive. It fixed the age of 28 weeks of age as the age of viability of the foetus. However, a lobbying group, the Abortion Law Reform Association, started working to modify the act in 1936. The efforts of pro and anti-abortion groups resulted in the Abortion Act of 1967. Introduced by David Steel, it aimed to clarify the legal position of abortion in the UK. The act allowed abortion on different grounds and provided sexual health services through NHS. The Human Fertilization and Embryology Act of 1990 amended the act, which required certification by at least 2 doctors before carrying out the procedure.

What are the Laws about Abortion?

The basis of abortion law in the united kingdom is the Offences Against the Person Act of 1861. The act criminalised all forms of abortions and deemed anyone using instruments or poisons to terminate the pregnancy as misdemeanours, and the convict was punished with imprisonment. An amendment was introduced in the act in 1961, allowing the process to save a mother's life. In 1938, another revision was done to allow doctors to carry out abortions in case the pregnancy is thought to be detrimental to the woman's mental health. The revision was made when a doctor was arrested for performing an abortion on a victim of rape. 

Ultimately, some major and minor revisions were adjusted to frame the 1967 Act. The act legalised the practice under some conditions. However, the act was an amendment to the 1861 law that was never repealed. So, a deliberate termination of pregnancy is still a punishable crime. The law explains abortion as not the individual's right; it just provides a window to carry out abortions when at least two medical professionals agree about the need. It is a limited provision compared to many European countries that allow abortions whenever demanded. 

The original provisions in the act allowed the conditional termination of pregnancy up to 28 weeks. In 1991, it was lowered to 24 weeks. After that age, abortion is illegal unless necessary for the mother or if the child is likely to be born with some severe congenital disability. According to the 1967 act, abortion must be performed at licensed clinics or hospitals. However, during the COVID-19 pandemic, the at-home delivery of abortion pills was allowed for women seeking abortion within the first 10 weeks of pregnancy. In August 2020, the measure was legalised after the MPs voted. 

Still, the reformists are campaigning to decriminalise abortion, end its legal status, and make it a healthcare matter. The 1967 act was further amended by the Human Fertilisation and Embryology Act 1990, which allows the termination of parents under the following grounds;

Ground A; the life of pregnant women is at severe risk

Ground B: To prevent a permanent mental or physical injury to the pregnant woman. 

Ground C: There is a risk of injury to pregnant women's physical or mental health at less than 24 weeks of age. 

Ground D: A high risk of physical or mental injury to the existing children of the pregnant woman up to 24 weeks of pregnancy. 

Ground E: There is a high risk that the newborn child will suffer from mental or physical congenital abnormalities and lead a crippled and disabled life. 

Ground F: To save the life of the pregnant woman. 

Ground G: Allowed in emergencies where pregnancy compromises women's mental and physical health. 

The amendment allowed the limit to be lowered to 24 weeks in case of grounds C and D, as the advances in healthcare have allowed premature babies to live. Recently, findings of a study from SACHA with funding from NHS recommended that the midwives and nurses must be authorised to approve abortion, and the abortion services must be included among the local reproductive and sexual health services.

How Are Abortions Performed?

Different methods are available for abortion. The choice depends upon the doctor and rarely is the patient given a choice to choose a method. Two types of procedures are available. 

Vacuum aspiration (suction absorption): Most medical abortions are performed in the first trimester of pregnancy (before 12 weeks). At that stage, the vacuum aspiration or suction Abortion is effective. Cervix dilation is not required before 12 weeks. However, after 12 weeks of pregnancy, the doctors often need to open the cervix to allow the medical instruments to pass. Mostly, the little sticks called the laminaria are inserted that expand by absorbing moisture. Laminaria are made of sterilized seaweed. The patient is placed on the examination table with the legs and feet on the stirrups. 

After sedation, the speculum is inserted into the vagina to remain open, and the cervix and vagina are swabbed with betadine, an antiseptic solution. After injecting an anaesthetic into the cervix, the cervix is held with the help of a grasping instrument. A small tube attached to a suction machine or a handheld syringe is inserted into the uterus to remove the contents by suction. The procedure is completed in a matter of minutes. The doctors then examine the patient to see if the procedure is successful and keep the patient under close observation for 30-60 minutes.

Dilatation and evacuation (D&E): If the pregnancy has advanced beyond 12 weeks, more preparatory work is needed before the procedure. The vacuum aspirations are not done beyond 14 weeks, and D&E is preferred in the 2nd trimester. The first step is dilating the cervix using laminaria sticks. Sometimes, misoprostol or related medications are used to soften up the uterus and dilation tools are used to keep it open. The patient is made to lie on the examination table with legs in the stirrups. The cervix and vagina are swabbed with betadine, and an anaesthetic is injected. A griping tool is used to keep the cervix open during the procedure. Besides suction, the doctors use forceps, a curette and other tools to pull out the uterine contents by scrapping its internal lining. The suction is used as an addition to ensure the contents are cleared out. 

Afterwards, the medications are given to reduce bleeding, cause uterine contractions and manage other side effects. The procedure takes place in 10-20 minutes, but the patient is required to spend a further 30-60 in close watch. 

Dilatation and extraction (D&X): To perform abortions after 24 weeks, the dilatation and extraction procedure (D&X) or dilatation and curettage (D&C) is used. The procedure needs to be performed by an experienced and specialised professional. It is a complicated and risky procedure recommended only if there are grave issues related to the mother's or foetus's health. All procedures leading to the extraction process are the same as those used for D&E. 

Other abortion methods include hysterectomy, hysterotomy and the medical induction of labour. These methods are risky and must be done only if the alternative is worse than the expected complications, and the healthcare professionals recommend it.

After the end of procedures and spending time in close supervision, the patient is kept in a recovery area for relaxation. Antibiotics are prescribed to reduce the risk of infections. The patients are then released. However, if the patient is sedated for the procedure, she is not recommended to drive herself. Light bleeding and cramping are often experienced for some days. The pains are treated using over-the-counter painkillers like codeine, acetaminophen and ibuprofen. More days of rest are recommended in case of more invasive procedures, and the patient is forbidden from lifting any heavy object. Sexual life must only be resumed when things have turned normal after consulting the doctor. To see the recovery status, some healthcare professionals require the patient to come for an additional appointment after 1-4 weeks of the procedure.

Is Abortion Legal?

Yes, abortion has been legal in the United Kingdom since the introduction of the abortion act in 1967. The UK is very consistent about these laws, which provide a legal basis for abortion rights in the country. The legality of abortion in the country depends upon many conditions. The act legalises abortion in case of grave risk to the mother's life, incest, rape, death of the foetus, the child having permanent physical and mental anomalies, or the foetus is deemed unviable. 

The act sets the viability threshold at 24 weeks and does allow abortion after 24 weeks in case of severe emergencies. At least two medical professionals must approve the need. The act is thus an effort to balance the right to have an abortion and the baby's right to live. Regular amendments in the act are being introduced that influence the legal status of abortion, and the UK society is rapidly moving towards the complete freedom of women’s reproductive rights.  

What are the Psychological Effects of Abortion?

Abortion puts immense emotional strain on women and increases the risk of mental health conditions by 2-3 folds (Fergusson and colleagues, 2013). The woman is alone to face it as it is difficult to talk with her family and friends. The partner, most of the time, finds it hard to understand. Some women have a higher risk and develop more serious signs due to factors like moral norms in some societies that oppose abortion, other mental health conditions like depression and anxiety and social isolation and pressure from society. The common post-abortion psychological issues are;

• Development of eating disorders
• Development of self-harming behaviours like cutting etc., due to the subconscious desire to punish oneself due to the perceived sense of shame and guilt for the death of a baby and the violation of moral and religious codes
• The stomach upsets (knots) 
• Nightmares about the procedure 
• Difficulty in sleeping and poor quality sleep
• Severe depression that causes crying, loss of interest in activities and thoughts of self-harm and suicide
• Apathy towards others
• Obsession with again becoming pregnant
• Loss of emotional bond with the other children

If a woman develops psychological issues after abortion, she needs a healthy environment and consultation with a psychologist to process her emotions and come out of depression properly.

What are the Risks of Abortion?

Abortions are very safe if conducted by qualified and experienced professionals. The majority of the women don't experience severe life-threatening risks and complications. However, the risk is there. The risk of complications increases as the stage of pregnancy at the time of abortion advances. Sometimes, the complications result in death. The complications and risk factors are;

1. Complications of abortion: Some complications of abortion are; 

• Incomplete removal of pregnancy
• Introduction of infections in the womb
• Heavy bleeding and haemorrhages during the abortion
• Irregular and very heavy bleeding after the abortion
• Nausea, vomiting, dizziness, drowsiness and cramping 
• Sepsis and septic shock
• Scar formation inside the reproductive organs
• Abdominal pain and fever
• Passing out small to large clots 
• Strong smell from the vaginal discharge
• Development of mental health issues 
• Failure to achieve abortion and continuation of pregnancy (with or without severe damage to the foetus). 

In case of complications, further treatment and sometimes surgery are required. 

Effects on future pregnancies (fertility): Research published in the British Journal of Obstetrics and Gynaecology in 1993 noted that induced abortion does not influence fertility. It doesn't affect the incidence of issues like placental retention, ectopic pregnancy and miscarriage. Many women don't conceive for some months after the abortion. The uterus needs time to heal and must be consulted with the gynaecologist. 

Bleeding: Abortion is dangerous, and every woman experiences some degree of bleeding. In the case of medical abortion, the bleeding is mostly observed on the day when misoprostol was used. The bleeding is more severe in medical cases and continues for 9 days on average. Surgical abortion is associated with minimal bleeding in the initial days. Some bleeding is observed after 3-5 days, mostly like ordinary period bleeding. For some women, the light bleeding continues for up to 2 weeks in case of medical and surgical abortion.  

Pains and abdominal cramps: Cramping is the consequence of uterine contractions and the involution. It is more common in medical abortions and is experienced by 57.7% of women undergoing medical abortions (Venla Kemppainen and colleagues, 2020). In the case of surgical abortion, the cramps are more severe but of shorter duration, feel like regular menstrual pain and gain severity after 3-5 days. The women experiencing pain and cramps include women with advanced pregnancy, young age, who have never given a vaginal birth before, have a history of dysmenorrhea (painful periods) and suffering from emotional issues.
 Miscellaneous side effects: Some side effects are not experienced by all women, e.g., 

• Chest and breast pain: The breast tenderness occasionally starts before the abortion and continues for some days after the procedure. It stays long and is often the last symptom to disappear. 
• Diarrhoea, nausea and vomiting: The gastrointestinal symptoms are experienced in surgical and medical abortion. In the case of surgical abortion, they last for 24 hours, and in the case of medical abortion, the symptoms continue for many days. Severe and prolonged signs must be reported to the doctor.
• Discharge: The discharge resembles mucus and ranges in colour from red and purple to brownish and pinkish. Sometimes, the blood is present in the discharge. 
• Fatigue: The body's systems are engaged to handle the situation and heal the wounds. So, it is normal to feel exhausted as the body needs rest to recover. Feeling sleepy and lethargic is among the side effects of some medications. 
• Chills: Shivering and chills are reported by some women after the procedure. If a fever accompanies these signs, the patients must report to the doctor as a fever indicates infection in the body.

When Could Abortion be Necessary?

While some women opt to abort because they don't want a baby, there are some situations when abortion becomes a medical necessity, and it is needed to save the life of the mother and avert other negative health outcomes like babies born with congenital deformities. It is supported by the fact that the lowest risks associated with a complicated pregnancy are more risky than the highest risks associated with abortion care in the first trimester. 98% of abortions in 2021 were conducted on ground C when the continuation of pregnancy seriously threatens a woman's physical and mental well-being (www.gov.uk).  

In these situations, it is impossible to save the life of both, and the life of the mother is a priority. These conditions are;

Ectopic pregnancy: In a normal pregnancy, the fertilized egg is attached inside the uterus (implantation). Sometimes, the implantation occurs at abnormal places like the fallopian tubes and the condition is known as ectopic pregnancy. It is potentially fatal for the mother. The rupture of fallopian tubes in advanced ectopic pregnancies often results in death due to internal bleeding. Moreover, the foetus is not viable, and abortion is the only choice. 

Pulmonary hypertension: Higher pressure in the blood vessels that connect the lungs and heart puts a heavy strain on the body. The heart has to work hard to circulate blood into the lungs. A pregnant woman's heart is already under stress as it has to circulate the blood into the womb to nourish the foetus. Pulmonary hypertension increases the risk of fatal heart failure in women, and the mortality rate is as high as 30-56% in pregnant women (John Monagle and colleagues, 2015). Often, abortion becomes necessary to save the life of the mother.  

End-stage kidney diseases: Kidney diseases increase the risk of pregnancy complications. The condition becomes critical if hypertension and hyperglycemia are present alongside kidney diseases. As pregnancy increases the pressure on the kidneys, a woman having advanced-stage kidney disease is at a higher risk of kidney failure in pregnancy. Although the risk of severe complications is not there for every woman with kidney disease, the risk for both the mother and child is too high and often, abortion is recommended. 

Fatal anomalies in the foetus: Sometimes, due to genetic mutations, family history and nutritional deficiencies, the foetuses develop life-threatening conditions like anencephaly, in which the skull and brain are not fully developed, or neural tube defects due to folic acid deficiency. Such defects are detectable by prenatal screening. As the baby has a poor chance of survival and is likely to lead a miserable life of survived, abortion is recommended. 

Cancer: The efficacy and safety of cancer treatments are increasing daily. However, some treatments like radiotherapy are unsafe during pregnancy and put the life of the mother and foetus at risk. So, it becomes necessary to abort the baby to allow the mother to continue treatment without worrying about pregnancy complications. The legal restrictions in the way of abortion in cancer in some states make the cancer prognosis poor as the patients do not get a particular treatment that is necessary. 

Preeclampsia: Some women develop a dangerous condition known as preeclampsia in the middle of pregnancy, which causes extremely high blood pressure that causes damage to the other organs. As the pregnancy termination risk is too high, induced abortion is recommended. Some serious preeclampsia-related issues are stroke, seizures and damage to the liver and kidney and other organs.

What Countries Legalised Abortion?

Significant progress is done worldwide to improve women's access to abortion in the past few decades. Consequently, abortion rights are being liberalised throughout the world. Although nearly 90% of counties allow abortion in medical emergencies, some countries have legalised abortion rights for women. 

There are total 73 counties that allow the abortion and include, Albania, Argentina, Armenia, Australia, Austria, Azerbaijan, Belarus, Belgian, Bosnia- Herzegovina, Bulgaria, Cambodia, Canada, Cape Verde, China, Croatia, Cuba, Cyprus, Czech Republic, Democratic Republic of Korea, Denmark, Estonia, France, French Guiana, Georgia, Germany, Greece, Guinea Bissau, Guyana, Hungary, Iceland, Ireland, Italy, Ireland, Kosovo, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Maldives, Moldova, Mongolia, Montenegro, Mozambique, Nepal, Netherlands, New Caledonia, New Zealand, Northern Ireland, Norway, Portugal, Puerto Rico, Republic of North Macedonia, Romania, Russian Federation, Sao Tome & Principe, Serbia, Singapore, Slovak Republic, Slovenia, South Africa, Spain, Sweden, Switzerland, Tajikistan, Thailand, Tunisia, Turkey, Turkmenistan, The United States, Uruguay, Uzbekistan and Vietnam. Amount these, some countries like France have included abortion in health insurance plans, and some have organisations that support women's reproductive rights and provide abortion services to women. 

There are more than 20 countries where abortion is illegal. These are Andorra, Aruba, Curacao, Dominican Republic, Laos, El Salvador, Haiti, Honduras, Iraq, Jamaica, Palestine, Madagascar, Malta, Mauritania, Nicaragua, Palau, Suriname, Philippines, Republic of the Congo, San Marino, Senegal, Sierra Leone and Tonga. 

How Does Religion Stand Against Abortion?

There are hundreds of known religions worldwide, and 5 major religions, Christianity, Islam, Hinduism, Buddhism, and Judaism, have different stances on abortion. Although disagreements exist among scholars, and every religion has some room for medically necessary abortions, religions generally hate abortion as an interference in the creation work of God.

Christianity: There is no agreement between the scholars on the Christian teachings about abortion in the New Testament or the Old Testament. Some scholars think that abortion at any stage is a grave sin. However, the gravity of the sin is debated. Some other classical scholars have argued that the embryo lacks a soul at conception and that abortion at that stage is not considered murder. The counsels in the early church used to punish the women seeking abortion and who indulged in other sexual crimes. Similar punishments were inflicted on the people engaged in the business of abortifacient drugs. Some scholars like Maximus the Confessor and Gregory of Nyssa think life begins at conception. Others like Augustine of Hippo affirm the ensoulment concept sometimes occurs after conception; thus, abortion during that time is not considered murder. However, both groups are unanimous in their dislikeness for abortion on moral grounds.

Similarly, various Christian churches like the Eastern Orthodox Church, Catholic Church, Evangelical Protestants and oriental orthodoxy oppose deliberate abortion. Some other groups, like the United Church of Christ and the Presbyterian Church of the USA, are more permissive to abortion. There are sizeable groups within the major groups that disagree with the opinion of the major groups.

Islam: The Quran and Hadith, the major sources of Islamic jurisprudence, condemn infanticide. The four major schools of thought in Sunni Islam, i.e., Hanafi, Maliki, Shafi'i and Hanbali, have different opinions and reservations about whether it should be allowed. Maliki's school of thought is of the opinion that ensoulment is done at the time of conception and rejects abortion. However, some Hanafi scholars believe that abortion before 120 days is permissible, although the act is considered the Makruh (discouraged/ disapproved). The other schools of thought consider that the life of the mother is more important, and abortion is allowed when the life of the mother is at risk. 

There is much disagreement among scholars about the time of ensoulment, which ranges between 40-120 days. Islamic jurisprudence protects the foetus's right to be born even if it is not considered a full human. Some scholars have allowed abortion before 120 days if the foetus has a deadly anomaly or deformity. Shia Islam prohibits abortion after conception, and the Iranian Supreme Leader Ayatollah Khomeini has issued a Fatwa to support it. The Khomeini did, however, allow abortion before 10 weeks if the foetus had thalassemia. Most scholars, however, agree that the mother's life can't be compromised even after 120 days as a mother is a living human being with responsibilities, and the foetus will ultimately die if the mother dies. 

Hinduism: Abortion is strongly disapproved of and condemned in most classical Hindu texts. However, an ancient Hindu text Sushuruta Samhita has approved it in case of a defective foetus. According to a BBC report, the Hindu attitude about abortion is to avoid or at least choose the least harmful path for all parties involved, i.e., the mother, the baby and the society. India has a strong culture of preferences for sons, which often overrules the religious ban on abortion. Some Hindu theologians believe that personhood develops between 3-5 months of gestation, thus providing a window for medically necessary abortions. Most theologians, however, think that abortion after 3 months destroys the current body of the soul leading to severe spiritual consequences. 

Buddhism: Buddhism is highly divided in its view about abortion. Some classical sources hold that new life starts at conception, and any form of its deliberate destruction is prohibited. The Buddhist belief that life is a continuation without any starting point adds complexity, so no official viewpoint exists among Buddhist scholars. The Dalai Lama has declared abortion inappropriate but defended his belief that it must be approved when necessary. Abortion or anything assisting it is a serious issue for both the Vajrayana and Theravada monks, and the nuns and monks were expelled from the temples for assisting in abortion. 

There is no distinction between early and late-stage abortion, but the moral stigma associated with abortion grows with the advancing age of the foetus. Traditional Buddhist sources don't link abortion to the health of the mother. However, modern Buddhist scholars have recognised a significant risk to the physical or mental health of the mother as a strong justification for abortion, and the abortion laws in many Buddhist countries do allow it conditionally. However, Buddhist scholars still consider abortion a despicable act with negative moral and spiritual consequences. 

Judaism: In Orthodox Jewish beliefs, abortion is allowed to protect the mother's life. However, it still opposes the right to free and safe abortion, and many reconstructionists and reformists oppose it. The Jewish opinion about abortion is derived from the teachings of the Talmud and the Hebrew Bible, the Responsa, case decisions, and classical Jewish literature. The orthodox opinion opposes abortion after 40 days unless there is a medical emergency. 

The opinions are not uniform, as the Talmud considers a foetus to be a person only after birth. However, the Torah calls it a punishable act with punishment ranging from a fine to the death penalty. There are beliefs in Judaism that God knows the identity of every developing foetus and has a plan, and abortion seems to frustrate or interfere with that plan. The saying is attributed to Jeremiah, which many scholars consider to show Jeremiah's prophethood and special status. In Hebrew Bible, the Book of Numbers mentions a story in which a priest administered bitter water to the supposedly unfaithful wife or a man. Some consider it to allow the use of abortifacients in certain situations.

Sikhism: Sikhism has no direct opinion about abortion. However, it does prohibit the practice of killing girls, which some interpret as prohibiting female foeticide. The sacred text of Sikhs, the Guru Granth Sahib, has no view of abortion, and many Sikhs use different verses of the text to make personal decisions based on the situation. Overall, Sikh scholars are abhorrent to and negatively view abortion as an interference in the creation work of God. Abortion is, however, very common in the Sikh community in India, particularly the practice of female foeticide due to cultural preferences for sons.

How Does Society Respond to Abortion?

Abortion is legal in the UK with the introduction of the 1967 Act. The act allowed abortions under certain conditions when the age of the foetus had not exceeded 24 weeks. However, abortion remains a controversial topic in British society. The attitude of the British public towards abortion rights is reflected in the parliamentary debates on the topic. In 2008, the voting to reduce the age limit of the foetus to 12, 16, 20 and 22 all failed, with the majority of the MPs voting to retain the higher limits. Jeremy Hunt, a conservative MP, started a campaign to reduce the age limit to 12 weeks. Although the movement failed, it attracted the support of some important figures like David Cameroon (former PM). 

The attitudes of the British public are reflected in various surveys. One such survey published by NatCen noted that 90% of the people supported that abortion should be allowed when the women's life is in jeopardy. It barely changed from 87% in 1983. When asked if women should be allowed to have abortions on their wish, 62% answered in the affirmative, while just 37% supported the idea in 1983. The younger generation is more supportive of women's abortion rights than the previous one. The support was lower in the religious class, with only 39% of the Catholics and 56% of the Anglicans supporting the idea. The non-religion group showed the greatest support, with 73% approving the idea. The educated class tends to support the idea as 67% of graduates supported it, compared to 53% without any qualification.

How Does Abortion Affect Women Reproductive Rights?

Reproductive rights are the rights related to reproductive health, the right to access information about one's reproductive organs and the legal rights to have fertility treatment, abortion and contraception. Reproductive rights are aimed at ensuring women's freedom to make decisions about their body's ability to reproduce or not reproduce and are very important for women's sexual well-being. Some groups advocate safe and legal abortion as among the basic reproductive rights. 

Social groups like Safe Abortion Action Fund and Women’s Equality Party advocate that banning or restricting access to abortion jeopardises women's privacy rights and the rights to be free from violence, to have a family and even the right to life. The impact of bans on abortion is particularly important for the marginalised communities with less access to basic healthcare services. That's why several social and political groups are actively campaigning and urging the government to legalise abortion completely, trust the women and allow them to decide what is best for their lives and physical and mental health by ensuring complete freedom of abortion. 

How Does Cultural Ideology Vary in Different Countries About Abortion?

Before the 19th century, cultural standards, religious law and common law influenced the legality and frequency of abortion. Sex, sexuality and reproduction are delicate matters and are targets of stigma and taboo in many cultures. The sociocultural values and norms relate to the public attitude about intimacy and reproduction. There are two types of societies, the traditional and liberal, which differ in their response to various social values.

Traditional societies

In many countries and cultures, like in Islamic countries, religion strongly influences social values and norms. Most religions promote a traditional view of sexuality and focus on a monogamous and heterosexual bond and provide complimentary roles for both genders. In traditional cultures, sexual drive is mainly related to males and women are objectified and sexualised. Women are tasked with the birth and upbringing of the next generation, and thus abortion and other types of women's reproductive rights are frowned upon as the intentional betrayal of their social role. 

A case example is the South Asian culture encompassing India, Pakistan and Bangladesh. The role of religious leaders, who are the upholders of traditional concepts of moral values, gender roles and social fabric, is very strong, and the movements to support women's reproductive rights and freedom are met with severe opposition and criticism. One such example is the working of Rutgers, an organisation working to protect reproductive and sexual rights and health globally. Its activities, like promoting the reproductive rights of women, LGBT, transgender people and gender diversity, are opposed in conservative societies like Pakistan and Uganda, and often, the governments advise it to consult and take the consent of local religious leaders and such debates are discouraged.

Liberal societies 

The right-based and liberal societies, like in America and Western Europe, takes the view that reproduction is a fundamental human right and all humans, irrespective of sexual orientation and gender, must be free to make reproductive and sexual choices, and everyone must respect the rights of others. Western culture and society are far more open to such topics, and many countries have legalised abortion in favour of women's reproductive rights. Even in countries with strong traditional classes like the UK, the movements about abortion rights are gaining momentum, and the legislation is rapidly evolving. 

Oriental societies

In oriental countries like China, the booming population is the major drive of attitudes about abortion, and it was legalised in China in 1953. Then a nationwide program was launched in 1973 to control population growth. So, Chinese society is moving away from the traditional notions of women's roles and duties in reproduction towards a more rights-based approach, and China has one of the largest abortion rates in the world. In addition, various other factors that have contributed to the current abortion culture in the UK are the marketisation of abortion, insufficient sexual education, family pressure and strong legislation by the government. 

Japan was a traditional society until the end of WW2, and concepts like foetal spiritualism were prevalent. The result was a population boom experienced in the later nineteenth and early twentieth century. However, the attitudes began to change after the American occupation when it entered the Western orbit, and Japan has one of the highest abortion rates in the world, leading to a decline in population growth and an ageing population.

What is the Opinion of Health Care Providers about Abortion?

The opinions of healthcare providers worldwide are nearly uniform, and most agree that pregnancy complications are far more than the complications of abortion. The opinions of healthcare providers are influenced by the culture and social norms of society, and various studies have noted it. In Sweden and Italy, a study was conducted to document the attitude and opinions of healthcare providers on the topic. 68% of the healthcare professionals in Sweden and 59% in Italy consider abortion justifiable on the grounds laid down in the local law. Another 32% of Swedish and 36% of Italian professionals consider it justifiable only for medical reasons, and 5% don't think it justifiable. In both countries, doctors, nurses and other health-concerning people believed there is a need to improve women's psychological and physical care during and after the procedure. 

A similar study was conducted in Southeast Asia and Sub-Saharan Africa and was published as a systemic literature review in 2015. Various factors influencing the decision-making by the healthcare professionals in these counties were human rights, religion, gender, quality of life, access to basic healthcare, unpreparedness, social victimisation and stigma, quality of healthcare and ambivalence. The healthcare providers in these regions expressed reservations based on gender and social and moral norms. These perceptions influenced people's attitudes towards abortion and impacted the relationship between the woman and the healthcare provider. The study confirmed the need to clarify the opinions of healthcare providers in developing countries.

The role of International healthcare agencies is more vivid. For example, the experts of the UN Human Rights Office of the High Commissioner consider abortion among the basic healthcare and urge that women's health must be prioritised over political differences and factors. The UN observes International Safe Abortion on September 28 every year to create public awareness about the issue.

What is the Statistics of Abortion for the Past 3 Years?

The statistics of abortion change each year with the change in legislation. In response to the coronavirus pandemic, women in both England and Whales were allowed to use Abortion medications (misoprostol and mifepristone) at home without the need to visit a clinic or hospital. The decision by the secretary of state for Health and Social Care was made to control the spread of the pandemic. The temporary measure was made permanent on February 24, 2022. As a result, 2021 saw the greatest number of abortions since the Act’s introduction and 214,256 abortions were recorded compared to 210,860 within the same period in 2020 (www.gov.uk). 

It gives the age-standardised rate of 18.6 per 1000 women. The abortion rates show variations with age. For example, the rate has a falling curve for women under 18 (fell from 15.0 to 6.9 between 2011 and 2020). Among these, 87% were medically induced, and the NHS funded 99%. The women were travelling from Northern Ireland to England for abortions, and 1,014 did so in 2019 and 371 in 2020. Despite decriminalising abortion in Northern Ireland in 2019, 161 women still travelled to England for the same purpose. 

In 2022, 123,219 abortions were recorded in England and Whales between January and June, a 17% increase from the same period in the last year. Most abortions were performed at early stages, as 67% were done under 7 weeks of gestation, 93% up to 12 weeks and 98% up to 17 weeks. The white ethnicities recorded the highest number of abortions, as 78% of the recorded abortions were performed by them, and the Chinese showered the lowest rate of under 1%. 98.6% of the abortions were performed under Category C means the pregnancy has not yet exceeded 24 weeks, and a continuation of pregnancy poses a serious threat to the physical and mental health of the women (www.gov.uk). The supporting legislation is likely to result in a further increase in the abortion rate, and nearly one-quarter of babies are lost to abortion each year.

Is Miscarriage Considered Abortion?

No, miscarriage and abortion are different things. Miscarriage is the spontaneous loss of pregnancy before the 20th week, due to pathological or physiological causes like foetus abnormalities, injuries or exposure to some toxins. It is not a planned event and causes emotional stress for the woman or the couple. It accounts for 25% of all pregnancies lost for any reason. Abortion, on the other hand, is a deliberate and planned termination of pregnancy which medical professionals carry out due to socioeconomic, medical or personal reasons. The abortions are conducted both by using medications or surgical procedures and need the approval of 2 healthcare professionals. The two terms are often used interchangeably but have different meanings, contexts and implications for the patient.

Does Drinking Alcohol while Pregnant Can Lead to Abortion?

Yes, the use of alcohol at any stage in pregnancy is extremely dangerous and causes fetal abnormalities, foetal death and abortion. There is no safe level or limit on the use of alcohol, and all women wanting to have a pregnancy and baby must avoid all forms of beer and wine. Alcohol reaches the baby by crossing through the placenta leading to stillbirth, miscarriage and various abnormalities in the baby like intellectual, behavioural and physical disabilities. 

All of these abnormalities fall under the spectrum of foetal alcohol spectrum disorders (FADs). The FADs result in problems related to behaviour and learning, the development of muscles, bones, joints and other organs, poor development of emotional and social skills, poor self-control and hyperactivity and poor communication. The risk increases with the increase in the amount of alcohol. Drinking alcohol at any stage of pregnancy has risks, but it doesn't mean that all these issues develop surely, and it's never too late to avoid using alcohol during pregnancy.