Public Health Abortion
by
Andrzej Kulczycki
  • LAST REVIEWED: 15 June 2015
  • LAST MODIFIED: 24 May 2017
  • DOI: 10.1093/obo/9780199756797-0090

Introduction

An abortion refers to the termination of a pregnancy. It can be induced (see Definitions, Terminology, and Reference Resources) through a pharmacological or a surgical procedure, or it may be spontaneous (also called miscarriage). Both in the United States and globally, approximately one-fifth of all known pregnancies end in abortion, which is currently one of the safest procedures in medicine when performed by a trained professional in hygienic conditions using modern methods. In 2016, it was estimated that about 56 million abortions were induced worldwide each year from 2010 to 2014, corresponding to about 35 abortions per 1,000 women of childbearing age. However, it was previously estimated that about 21.6 million abortions performed annually were unsafe, causing some 47,000 maternal deaths or 13 percent of all maternal deaths. Abortion-related mortality may have since fallen, but multiple challenges with measurement and data quality persist. The incidence of abortion may be reduced through good access to a range of effective contraceptive methods, sex education, and appropriate support for women who want to have a child. Historically, women who underwent abortions risked their personal health and social standing. In the 20th century, this situation changed slowly in many countries as abortion procedures became safer and efforts to legalize abortion gained momentum. Nevertheless, abortion is often a controversial matter of health and social policy due to divergent views on such matters as when human life begins, women’s roles and rights, and the role of government in individuals’ private lives. This entry reflects the broad scope of public health issues concerning the demography of abortion, its epidemiology, legality, and abortion-related methods. It also provides a collection of resources on postabortion care. This article first briefly reviews the terminology used for different types of abortion and outlines resources that detail the history of abortion as well as its general public heath contours in the United States and the world. Less attention is paid to the ethical aspects of abortion, arguments for or against the practice, different cultural or religious views on abortion, and public or political aspects of conflict concerning abortion.

General Overviews

Although recent textbooks on the public health aspects of abortion are lacking, Faúndes and Barzelatto 2006 provides an accessible account of many pertinent issues written in plain language for nonspecialists. Singh, et al. 2009 summarizes recent trends in abortion incidence, with a focus on unsafe abortion, as well as changes in legality, safety, and accessibility of abortion services worldwide. Sedgh, et al. 2016 presents the most recent abortion estimates for major world regions. Paul, et al. 2009 offers an informative text written primarily for clinicians on the provision of abortion care. A well-referenced handbook, World Health Organization 2012 (WHO), gives guidance to health professionals inside and outside governments who are working to reduce poor maternal health on the many ways of ensuring access to abortion care as allowed by law. Several reference guides explore the evolution of the US abortion debate from various viewpoints and may assist those working in the medical, social science, historical, legal, and public health fields. McBride 2007 includes a collection of biographical sketches, chronology, and excerpts from key statutes and court cases that have pushed the abortion controversy into the public arena, and Rose 2008 provides a selection of forty-one primary source documents from medical workers, judges, feminists, religious leaders, and politicians from the 19th century through 2007.

  • Faúndes, Anibal, and José S. Barzelatto. 2006. The human drama of abortion: A global search for consensus. Nashville: Vanderbilt Univ. Press.

    E-mail Citation »

    This book includes overviews of why women have abortions, the scale of the practice, consequences of unsafe abortions, effective interventions, values, and conclusions about what can be done to reach a necessary and practical societal consensus.

  • McBride, Dorothy E. 2007. Abortion in the United States: A reference handbook. Santa Barbara, CA: ABC-CLIO.

    E-mail Citation »

    This reference volume covers multiple aspects of how abortion is considered in the United States. The guide also provides commentary on major Supreme Court cases and state laws regulating abortion policy as well as other background information.

  • Paul, Maureen, E. Steve Lichtenberg, Lynn Borgatta, David A. Grimes, Phillip G. Stubblefield, and Mitchell D. Creinin, eds. 2009. Management of unintended and abnormal pregnancy: Comprehensive abortion care. Oxford: Wiley-Blackwell.

    DOI: 10.1002/9781444313031E-mail Citation »

    This widely used evidence-based reference text in abortion care discusses abortion methods, pre- and postprocedure care, the management of ectopic and other abnormal pregnancies (including the risks of multiple pregnancies resulting from assisted reproductive technologies), and public health aspects of abortion service delivery.

  • Rose, Melody. 2008. Abortion: A documentary and reference guide. Westport, CT: Greenwood.

    E-mail Citation »

    This reference work carries primary documents and commentary on the public health situation and sociopolitical controversy concerning abortion in the United States. Excerpts are also included from popular women’s self-help books, memoirs of early abortion providers, important legal papers, and the text of Pope Paul VI’s 1968 encyclical, Humanae Vitae.

  • Sedgh, Gilda, Jonathan Bearak, Susheela Singh, Akirinola Bankole, Anna Popinchalk, Bela Ganatra, et al. 2016. Abortion incidence between 1990 and 2014: Global, regional, and subregional levels and trends. Lancet 388.10041: 258–267.

    DOI: 10.1016/S0140-6736(16)30380-4E-mail Citation »

    The most recent update on abortion levels and trends worldwide, including for countries and major regions in which abortion is legally permitted and generally available, as well as for those in which it is not. Available online for purchase or by subscription.

  • Singh, Susheela, Deirdre Wulf, Rubina Hussain, Akinrinola Bankole, and Gilda Sedgh. 2009. Abortion worldwide: A decade of uneven progress. New York: Guttmacher Institute.

    E-mail Citation »

    This report reviews changes in abortion incidence, legality, and safety, with greater attention paid to unsafe abortion and the situation in low-income countries. The report also examines the relation among unintended pregnancy, contraception, and abortion. Also available in Spanish.

  • World Health Organization. 2012. Safe abortion: Technical and policy guidance for health systems. 2d ed. Geneva, Switzerland: World Health Organization.

    E-mail Citation »

    This updated and expanded version of the report gives guidance to health professionals and others on actions to ensure the provision of safe, quality abortion services as allowed by law. It also provides an overview of the public health challenges, including clinical aspects of care, health system issues, and the legal, regulatory, and policy environment for improving the quality and accessibility of care.

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