Editing Abortion (section)

==Safety==
[[File:Abortion Quick & Pain Free sign, Joe Slovo Park, Cape Town, South Africa-3869.jpg|thumb|right|A likely illegal abortion flyer in South Africa]]

The health risks of abortion depend principally on how, and under what conditions, the procedure is performed. The [[World Health Organization]] (WHO) defines [[unsafe abortion]]s as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.<ref name="who-unsafe-1992">{{cite web| publisher=World Health Organization |title=The Prevention and Management of Unsafe Abortion |date=April 1992| access-date=18 October 2017 |url=http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf | archive-url= https://web.archive.org/web/20100530072310/http://whqlibdoc.who.int/hq/1992/WHO_MSM_92.5.pdf| archive-date= 30 May 2010 | url-status= live}}</ref> Legal abortions performed in the [[developed country|developed world]] are among the safest procedures in medicine.<ref name="lancet-grimes" >{{cite journal | vauthors = Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH | title = Unsafe abortion: the preventable pandemic | journal = Lancet | volume = 368 | issue = 9550 | pages = 1908–1919 | date = November 25, 2006 | pmid = 17126724 | doi = 10.1016/S0140-6736(06)69481-6 | url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69481-6/fulltext | s2cid = 6188636 | url-access = subscription | access-date = 8 June 2023 | archive-date = 3 April 2023 | archive-url = https://web.archive.org/web/20230403232414/https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69481-6/fulltext | url-status = live }}</ref><ref name="grimes-overview">{{cite journal | vauthors = Grimes DA, Creinin MD | title = Induced abortion: an overview for internists | journal = Annals of Internal Medicine | volume = 140 | issue = 8 | pages = 620–626 | date = April 2004 | pmid = 15096333 | doi = 10.7326/0003-4819-140-8-200404200-00009 | doi-access = free | citeseerx = 10.1.1.694.3531 }}</ref> According to a 2012 study in ''Obstetrics & Gynecology'', in the United States the risk of maternal mortality is 14 times lower after induced abortion than after childbirth.<ref name=Grimes2012>{{cite journal | first1 = Elizabeth G| last1 = Raymond| last2=  Grimes |first2= David A | author-link2=David Grimes (physician)| title = The comparative safety of legal induced abortion and childbirth in the United States | journal = [[Obstetrics & Gynecology (journal)|Obstetrics & Gynecology]] | volume = 119 | issue = 2 Pt 1 | pages = 215–219 | date = February 2012 | pmid = 22270271 | doi = 10.1097/AOG.0b013e31823fe923 | quote = Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion. | s2cid = 25534071 }}</ref> The CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,<ref>{{cite journal | vauthors = Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM, Barfield W | display-authors = 6 | title = Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013-2017 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 18 | pages = 423–429 | date = May 2019 | pmid = 31071074 | pmc = 6542194 | doi = 10.15585/mmwr.mm6818e1 }}</ref> while the US abortion mortality rate was 0.43 maternal deaths per 100,000 procedures.<ref name="Ray2014">{{cite journal | vauthors = Raymond EG, Grossman D, Weaver MA, Toti S, Winikoff B | title = Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States | journal = Contraception | volume = 90 | issue = 5 | pages = 476–479 | date = November 2014 | pmid = 25152259 | doi = 10.1016/j.contraception.2014.07.012 | quote = Results: The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7 deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. }}</ref><ref>{{cite book|url=https://www.nap.edu/read/24950/chapter/4|title=Read "The Safety and Quality of Abortion Care in the United States" at NAP.edu|doi=10.17226/24950|pmid=29897702|year=2018|isbn=978-0-309-46818-3 | author2 = Health Medicine Division| author1 = National Academies of Sciences Engineering |author3=Board on Health Care Services|author4=Board on Population Health Public Health Practice|author5=Committee on Reproductive Health Services: Assessing the Safety Quality of Abortion Care in the U.S|access-date=26 May 2019|archive-date=24 July 2020|archive-url=https://web.archive.org/web/20200724204509/https://www.nap.edu/read/24950/chapter/4|url-status=live}}</ref><ref name=CDC_2022_AS>{{cite journal |last=Kortsmit |first=Katherine |date=2022 |title=Abortion Surveillance — United States, 2020 |url=https://www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm |journal=MMWR. Surveillance Summaries |language=en-us |volume=71 |issue=10 |pages=1–27 |doi=10.15585/mmwr.ss7110a1 |issn=1546-0738 |pmc=9707346 |pmid=36417304 |quote=The national case-fatality rate for legal induced abortion for 2013–2019 was 0.43 deaths related to legal induced abortions per 100,000 reported legal abortions. This case-fatality rate was lower than the rates for the previous 5-year periods. |access-date=14 November 2023 |archive-date=15 November 2023 |archive-url=https://web.archive.org/web/20231115033902/https://www.cdc.gov/mmwr/volumes/71/ss/ss7110a1.htm |url-status=live }}</ref> In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term."<ref>{{cite journal| vauthors = Donnelly L |title=Abortion is Safer than Having a Baby, Doctors Say|journal=The Telegraph|date=26 February 2011}}</ref> Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed [abortion] procedures constitute 13% of maternal mortality globally."<ref>{{cite journal | vauthors = Dixon-Mueller R, Germain A | title = Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator | journal = American Journal of Public Health | volume = 97 | issue = 1 | pages = 45–51 | date = January 2007 | pmid = 16571693 | pmc = 1716248 | doi = 10.2105/AJPH.2005.068056 }}</ref> In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14–16 percent of maternal deaths resulted from abortion.<ref>{{cite web |url=https://www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf |title=Abortion in Indonesia |publisher=Guttmacher Institute |year=2008 |access-date=13 October 2019 |archive-date=7 June 2020 |archive-url=https://web.archive.org/web/20200607212421/https://www.guttmacher.org/sites/default/files/report_pdf/ib_abortion_indonesia_0.pdf |url-status=live }}</ref>

In the US from 2000 to 2009, abortion had a mortality rate lower than [[plastic surgery]], lower or similar to running a marathon, and about equivalent to traveling {{convert|760|miles}} in a passenger car.{{ r | Ray2014 }} Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions.<ref>{{cite journal | vauthors = Ralph LJ, Schwarz EB, Grossman D, Foster DG | title = Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study | journal = Annals of Internal Medicine | volume = 171 | issue = 4 | pages = 238–247 | date = August 2019 | pmid = 31181576 | doi = 10.7326/M18-1666 | s2cid = 184482546 }}</ref> The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.<ref>{{cite journal | vauthors = Raymond EG, Grimes DA | title = The comparative safety of legal induced abortion and childbirth in the United States | journal = Obstetrics and Gynecology | volume = 119 | issue = 2 Pt 1 | pages = 215–219 | date = February 2012 | pmid = 22270271 | doi = 10.1097/AOG.0b013e31823fe923 | s2cid = 25534071 }}</ref> Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.<ref>{{cite journal | vauthors = Abbas D, Chong E, Raymond EG | title = Outpatient medical abortion is safe and effective through 70 days gestation | journal = Contraception | volume = 92 | issue = 3 | pages = 197–199 | date = September 2015 | pmid = 26118638 | doi = 10.1016/j.contraception.2015.06.018 }}</ref>

=== Safety of abortion methods ===
There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation.<ref name="WHO FAQs 2006"/> Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.<ref>{{cite web| vauthors = Grossman D|date=3 September 2004|title=Medical methods for first trimester abortion: RHL commentary|work=Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://apps.who.int/rhl/fertility/abortion/dgcom/en/index.html|access-date=22 November 2011|url-status=dead|archive-url=https://web.archive.org/web/20111028054620/http://apps.who.int/rhl/fertility/abortion/dgcom/en/index.html|archive-date=28 October 2011}}</ref><ref>{{cite web|vauthors=Chien P, Thomson M |date=15 December 2006|title=Medical versus surgical methods for first trimester termination of pregnancy: RHL commentary|work=Reproductive Health Library|location=Geneva|publisher=World Health Organization|url=http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html |access-date=1 June 2010| archive-url= https://web.archive.org/web/20100517201143/http://apps.who.int/rhl/fertility/abortion/pccom/en/index.html| archive-date= 17 May 2010 | url-status= dead}}</ref>

=== Safety and gestational age===
[[Vacuum aspiration]] in the first trimester is the safest method of surgical abortion, and can be performed in a [[primary care|primary care office]], [[abortion clinic]], or hospital. Complications, which are rare, can include [[uterine perforation]], [[endometritis|pelvic infection]], and retained products of conception requiring a second procedure to evacuate.<ref name="arch-fam-practice">{{cite journal | vauthors = Westfall JM, Sophocles A, Burggraf H, Ellis S | title = Manual vacuum aspiration for first-trimester abortion | journal = Archives of Family Medicine | volume = 7 | issue = 6 | pages = 559–562 | year = 1998 | pmid = 9821831 | doi = 10.1001/archfami.7.6.559 | url = http://archfami.ama-assn.org/cgi/content/full/7/6/559 | url-status = dead | archive-url = https://web.archive.org/web/20050405202853/http://archfami.ama-assn.org/cgi/content/full/7/6/559 | archive-date = 5 April 2005 | url-access = subscription }}</ref> Infections account for one-third of abortion-related deaths in the United States.<ref>{{cite journal | vauthors = Dempsey A | title = Serious infection associated with induced abortion in the United States | journal = Clinical Obstetrics and Gynecology | volume = 55 | issue = 4 | pages = 888–892 | date = December 2012 | pmid = 23090457 | doi = 10.1097/GRF.0b013e31826fd8f8 }}</ref> The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.<ref>{{cite journal | vauthors = White K, Carroll E, Grossman D | title = Complications from first-trimester aspiration abortion: a systematic review of the literature | journal = Contraception | volume = 92 | issue = 5 | pages = 422–438 | date = November 2015 | pmid = 26238336 | doi = 10.1016/j.contraception.2015.07.013 }}</ref> Preventive antibiotics (such as [[doxycycline]] or [[metronidazole]]) are typically given before abortion procedures,<ref>{{cite journal | vauthors =  | title = ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures | journal = Obstetrics and Gynecology | volume = 113 | issue = 5 | pages = 1180–1189 | date = May 2009 | pmid = 19384149 | doi = 10.1097/AOG.0b013e3181a6d011 | doi-access =  }}</ref> as they are believed to substantially reduce the risk of postoperative uterine infection;<ref name="NEJMDec2011" /><ref>{{cite journal | vauthors = Sawaya GF, Grady D, Kerlikowske K, Grimes DA | title = Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis | journal = Obstetrics and Gynecology | volume = 87 | issue = 5 Pt 2 | pages = 884–890 | date = May 1996 | pmid = 8677129 }}</ref> however, antibiotics are not routinely given with abortion pills.<ref>{{cite journal | vauthors = Achilles SL, Reeves MF | title = Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102 | journal = Contraception | volume = 83 | issue = 4 | pages = 295–309 | date = April 2011 | pmid = 21397086 | doi = 10.1016/j.contraception.2010.11.006 | doi-access = free }}</ref> The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a [[mid-level practitioner]].<ref>{{cite journal | vauthors = Barnard S, Kim C, Park MH, Ngo TD | title = Doctors or mid-level providers for abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD011242 | date = July 2015 | pmid = 26214844 | doi = 10.1002/14651858.CD011242.pub2 | pmc = 9188302 | url = https://researchonline.lshtm.ac.uk/2274695/1/Doctors%20or%20mid-level%20providers%20for%20abortion_GREEN%20VoR.pdf | access-date = 24 November 2019 | archive-date = 27 August 2021 | archive-url = https://web.archive.org/web/20210827202229/https://researchonline.lshtm.ac.uk/id/eprint/2274695/1/Doctors | url-status = live }}</ref>

Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen.<ref>{{cite journal | vauthors = Lerma K, Shaw KA | title = Update on second trimester medical abortion | journal = Current Opinion in Obstetrics & Gynecology | volume = 29 | issue = 6 | pages = 413–418 | date = December 2017 | pmid = 28922193 | doi = 10.1097/GCO.0000000000000409 | quote = Second trimester surgical abortion is well tolerated and increasingly expeditious | s2cid = 12459747 }}</ref> The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period).<ref>{{cite journal | collaboration = Committee on Practice Bulletins-Gynecology | vauthors = Steinauer J, Jackson A, Grossman D |title=Second-trimester abortion. Practice Bulletin No. 135. |journal=American College of Obstetrics & Gynecology - Practice Bulletins |date=June 2013 |url=https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion |access-date=4 December 2019 |quote=The mortality rate associated with abortion is low (0.6 per 100,000 legal, induced abortions), and the risk of death associated with childbirth is approximately 14 times higher than that with abortion. Abortion-related mortality increases with each week of gestation, with a rate of 0.1 per 100,000 procedures at 8 weeks of gestation or less, and 8.9 per 100,000 procedures at 21 weeks of gestation or greater. |archive-date=24 December 2019 |archive-url=https://web.archive.org/web/20191224111109/https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Second-Trimester-Abortion |url-status=live }}</ref><ref name=Bartlett2004>{{cite journal | vauthors = Bartlett LA, Berg CJ, Shulman HB, Zane SB, Green CA, Whitehead S, Atrash HK | title = Risk factors for legal induced abortion-related mortality in the United States | journal = Obstetrics and Gynecology | volume = 103 | issue = 4 | pages = 729–737 | date = April 2004 | pmid = 15051566 | doi = 10.1097/01.AOG.0000116260.81570.60 | quote = The risk factor that continues to be most strongly associated with mortality from legal abortion is gestational age at the time of the abortion | s2cid = 42597014 | doi-access = free }}</ref> It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.<ref name=Saccone2016>{{cite journal | vauthors = Saccone G, Perriera L, Berghella V | title = Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 214 | issue = 5 | pages = 572–591 | date = May 2016 | pmid = 26743506 | doi = 10.1016/j.ajog.2015.12.044 | url = https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf | access-date = 27 June 2020 | url-status = live | quote = Prior surgical uterine evacuation for either I-TOP[induced termination of pregnancy] or SAB[spontaneous abortion, - also known as miscarriage] is an independent risk factor for PTB[pre-term birth]. These data warrant caution in the use of surgical uterine evacuation and should encourage safer surgical techniques as well as medical methods. | archive-url = https://web.archive.org/web/20210827202228/https://www.iris.unina.it/retrieve/handle/11588/697884/158333/25%20Abortion%20PTB%20-%20AJOG%20-%20SACCONE.pdf | archive-date = 27 August 2021 }}</ref><ref>{{cite journal | vauthors = Averbach SH, Seidman D, Steinauer J, Darney P | title = Re: Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis | journal = American Journal of Obstetrics and Gynecology | volume = 216 | issue = 1 | page = 87 | date = January 2017 | pmid = 27596618 | doi = 10.1016/j.ajog.2016.08.038 | url = https://www.ajog.org/article/S0002-9378(16)30650-0/fulltext | access-date = 28 June 2020 | url-status = live | archive-url = https://web.archive.org/web/20210827202230/https://www.ajog.org/article/S0002-9378%2816%2930650-0/fulltext | archive-date = 27 August 2021 | doi-access =  | url-access = subscription }}</ref>

===Mental health===
{{Main|Abortion and mental health}}

Current evidence finds no relationship between most induced abortions and [[abortion and mental health|mental health problems]]<ref name=BMJ2014/><ref name=Hor2017>{{cite journal | vauthors = Horvath S, Schreiber CA | title = Unintended Pregnancy, Induced Abortion, and Mental Health | journal = Current Psychiatry Reports | volume = 19 | issue = 11 | page = 77 | date = September 2017 | pmid = 28905259 | doi = 10.1007/s11920-017-0832-4 | s2cid = 4769393 }}</ref> other than those expected for any unwanted pregnancy.<ref name="apa-press"/> A report by the [[American Psychological Association]] concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain.<ref name="apa-press">{{cite press release |publisher=American Psychological Association |title=APA Task Force Finds Single Abortion Not a Threat to Women's Mental Health |date=12 August 2008 |access-date=7 September 2011 |url=http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx |url-status=live |archive-url=https://web.archive.org/web/20110906022824/http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx |archive-date=6 September 2011 }}</ref><ref>{{cite web |url=http://www.apa.org/pi/women/programs/abortion/mental-health.pdf |title=Report of the APA Task Force on Mental Health and Abortion |publisher=American Psychological Association|location=Washington, DC |date=13 August 2008 |url-status=live |archive-url=https://web.archive.org/web/20100615020211/http://apa.org/pi/women/programs/abortion/mental-health.pdf |archive-date=15 June 2010 }}</ref> Some older reviews concluded that abortion was associated with an increased risk of psychological problems;<ref>{{cite journal | vauthors = Coleman PK | title = Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009 | journal = The British Journal of Psychiatry | volume = 199 | issue = 3 | pages = 180–186 | date = September 2011 | pmid = 21881096 | doi = 10.1192/bjp.bp.110.077230 | doi-access = free }}</ref> however, later reviews of the medical literature found that previous reviews did not use an appropriate control group.<ref name=Hor2017/> When a control group is utilized, receiving abortion is not associated with adverse psychological outcomes.<ref name=Hor2017/> However, women seeking abortion who are denied access to abortion have an increase in anxiety after the denial.<ref name=Hor2017/>

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,<ref name="apa-2008">{{cite web |title=Mental Health and Abortion |url=http://www.apa.org/pi/women/programs/abortion/index.aspx |publisher=[[American Psychological Association]] |year=2008 |access-date=18 April 2012 |url-status=live |archive-url=https://web.archive.org/web/20120419174044/http://www.apa.org/pi/women/programs/abortion/index.aspx |archive-date=19 April 2012}}</ref> more rigorous research would be needed to show this conclusively.<ref name="Steinberg2011">{{cite journal |vauthors=Steinberg JR |title=Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research | journal = Women's Health Issues |volume=21 |issue=3 Suppl |pages=S44–S48 |year=2011 |pmid=21530839 |doi=10.1016/j.whi.2011.02.002}}</ref> Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "[[post-abortion syndrome]]", but this is not recognized by medical or psychological professionals in the United States.<ref>{{cite journal |vauthors=Kelly K |title=The spread of 'Post Abortion Syndrome' as social diagnosis |journal=Social Science & Medicine |volume=102 |pages=18–25 |date=February 2014 |pmid=24565137 |doi=10.1016/j.socscimed.2013.11.030}}</ref>

A 2020 long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later.  The researchers also stated: "These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself."<ref>{{cite journal | vauthors = Rocca CH, Samari G, Foster DG, Gould H, Kimport K | title = Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma | journal = Social Science & Medicine | volume = 248 | page = 112704 | date = March 2020 | pmid = 31941577 | doi = 10.1016/j.socscimed.2019.112704 | doi-access = free | quote=We found no evidence of emerging negative emotions or abortion decision regret; both positive and negative emotions declined over the first two years and plateaued thereafter, and decision rightness remained high and steady (predicted percent: 97.5% at baseline, 99.0% at five years). At five years postabortion, relief remained the most commonly felt emotion among all women (predicted mean on 0-4 scale: 1.0; 0.6 for sadness and guilt; 0.4 for regret, anger and happiness). Despite converging levels of emotions by decision difficulty and stigma level over time, these two factors remained most important for predicting negative emotions and decision non-rightness years later. }}</ref>

=== Safety in the abortion debate ===
Some purported risks of abortion are promoted primarily by anti-abortion groups,<ref name="JASEN"/><ref name=Cancer_Linacre>{{cite journal | vauthors = Schneider AP, Zainer CM, Kubat CK, Mullen NK, Windisch AK | title = The breast cancer epidemic: 10 facts | journal = The Linacre Quarterly | volume = 81 | issue = 3 | pages = 244–277 | date = August 2014 | pmid = 25249706 | pmc = 4135458 | doi = 10.1179/2050854914Y.0000000027 | publisher = Catholic Medical Association | quote = an association between [induced abortion] and breast cancer has been found by numerous Western and non-Western researchers from around the world. This is especially true in more recent reports that allow for a sufficient breast cancer latency period since an adoption of a Western life style in sexual and reproductive behavior. | doi-access = free }}</ref>
but lack scientific support.<ref name="JASEN">{{cite journal | vauthors = Jasen P | title = Breast cancer and the politics of abortion in the United States | journal = Medical History | volume = 49 | issue = 4 | pages = 423–444 | date = October 2005 | pmid = 16562329 | pmc = 1251638 | doi = 10.1017/S0025727300009145 }}</ref> For example, the question of a link between [[abortion-breast cancer hypothesis|induced abortion and breast cancer]] has been investigated extensively. Major medical and scientific bodies (including the WHO, [[National Cancer Institute]], [[American Cancer Society]], [[Royal College of Obstetricians and Gynaecologists|Royal College of OBGYN]] and [[American Congress of Obstetricians and Gynecologists|American Congress of OBGYN]]) have concluded that abortion does not cause breast cancer.<ref>Position statements of major medical bodies on abortion and breast cancer include:
* World Health Organization: {{cite web|url=https://www.who.int/mediacentre/factsheets/fs240/en/ |title=Induced abortion does not increase breast cancer risk (Fact sheet N°240) |publisher=World Health Organization |access-date=6 January 2011 |archive-url=https://web.archive.org/web/20110213141046/http://www.who.int/mediacentre/factsheets/fs240/en/ |archive-date=13 February 2011 }}
* National Cancer Institute: {{cite web|url=http://www.cancer.gov/cancertopics/factsheet/risk/abortion-miscarriage |title=Abortion, Miscarriage, and Breast Cancer Risk |publisher=National Cancer Institute |access-date=11 January 2011 |archive-url=https://web.archive.org/web/20101221084337/http://www.cancer.gov/cancertopics/factsheet/Risk/abortion-miscarriage |archive-date=21 December 2010 |url-status=live |date=20 February 2003 }}
* American Cancer Society: {{cite web|url=http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer |publisher=American Cancer Society|date=23 September 2010 |access-date=20 June 2011 |title=Is Abortion Linked to Breast Cancer? |quote=At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer. |archive-url=https://web.archive.org/web/20110605204701/http://www.cancer.org/Cancer/BreastCancer/MoreInformation/is-abortion-linked-to-breast-cancer |archive-date=5 June 2011 |url-status=live }}
* Royal College of Obstetricians and Gynaecologists: {{cite web|url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf |title=The Care of Women Requesting Induced Abortion |page=9 |publisher=Royal College of Obstetricians and Gynaecologists |access-date=29 June 2008 |quote=Induced abortion is not associated with an increase in breast cancer risk. |url-status=dead |archive-url=https://web.archive.org/web/20130727105037/http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBAbortionSummary.pdf |archive-date=27 July 2013 }}
* American Congress of Obstetricians and Gynecologists: {{cite web|url=http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm |title=ACOG Finds No Link Between Abortion and Breast Cancer Risk |date=31 July 2003 |publisher=American Congress of Obstetricians and Gynecologists |access-date=11 January 2011 |archive-url=https://web.archive.org/web/20110102030744/http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm |archive-date=2 January 2011 |url-status=dead }}</ref>

In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian [[Linda Gordon]] states: "In fact, illegal abortions in this country have an impressive safety record."<ref>{{cite book | vauthors = Gordon L | title = The Moral Property of Women | publisher = University of Illinois Press | year = 2002 | isbn = 0-252-02764-7 }}</ref>{{rp|25|}}

According to [[Rickie Solinger]],
{{Blockquote|
A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... [T]he historical evidence does not support such claims.<ref>{{cite book | vauthors = Solinger R | chapter = Introduction | veditors = Solinger R | title = Abortion Wars: A Half Century of Struggle, 1950–2000 | pages = [https://archive.org/details/abortionwarshalf0000soli/page/1 1–9] | publisher = University of California Press | year = 1998 | isbn = 978-0-520-20952-7 | url = https://archive.org/details/abortionwarshalf0000soli/page/1 }}</ref>{{rp|4}}
}}
A 1940s American physician spoke of his pride in having performed 13,844 illegal abortions without any fatalities.<ref>{{cite book | last1 = Bates | first1 = Jerome E | last2 = Zawadzki | first2 = Edward S | title = Criminal Abortion: A Study in Medical Sociology | publisher = Charles C. Thomas | year = 1964 | isbn = 978-0-398-00109-4 |oclc =299149| page = 59| quote = In my practice I average three operations a day. By working a six day week, I complete approximately eighteen operations in this time. This amounts to seventy-two operations a month. In my sixteen years of specializing, I have successfully performed about 13,844 abortions.<br/> This was without the loss of the life of a single one of my patients. I feel those figures are something of which to be proud. I feel—I’m sure—that the work I have been engaged in these past years has been a contribution to Society and has helped to straighten out the messed up lives of many people.}}</ref>
In 1870s New York City, the abortionist/midwife [[Madame Restell]] (Anna Trow Lohman) is said to have lost very few women among her more than 100,000 patients<ref>{{cite book | vauthors = Keller A | title = Scandalous Lady: The Life and Times of Madame Restell | publisher = Atheneum | year = 1981 | isbn = 978-0-689-11213-3 }}</ref>—a lower mortality rate than the childbirth mortality rate at the time. In 1936, obstetrics and gynecology professor  [[Frederick J. Taussig]] wrote that a cause of increasing mortality during the years of illegality in the U.S. was that
{{Blockquote|With each decade of the past fifty years the actual and proportionate frequency of this accident [perforation of the uterus] has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus.<ref>{{cite book | last = Taussig | first= Frederick J. | author-link = Frederick J. Taussig | title = Abortion Spontaneous and Induced: Medical and Social Aspects | publisher = C.V. Mosby | year = 1936 |location = St. Louis | page = 223 |url = https://archive.org/details/b29818394/page/223/mode/1up | oclc = 1041029321 }}</ref>
}}

===Unsafe abortion===
{{Main|Unsafe abortion}}

[[File:RussianAbortionPoster.jpg|thumb|Soviet poster {{Circa|1925}} (after Russia legalized abortion in 1920) warning against abortions performed by folk practitioners]]

Women seeking an abortion may use unsafe methods, especially when abortion is legally restricted. They may attempt [[self-induced abortion]] or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, [[sepsis]], hemorrhage, and damage to internal organs.<ref>{{cite journal | vauthors = Okonofua F | title = Abortion and maternal mortality in the developing world | journal = Journal of Obstetrics and Gynaecology Canada | volume = 28 | issue = 11 | pages = 974–979 | date = November 2006 | pmid = 17169222 | doi = 10.1016/S1701-2163(16)32307-6 | url = http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf | url-status = dead | archive-url = https://web.archive.org/web/20120111121431/http://www.jogc.org/abstracts/full/200611_WomensHealth_1.pdf | archive-date = 11 January 2012 }}</ref>

Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in [[developing country|developing countries]].<ref name="lancet-grimes"/> Unsafe abortions are believed to result in millions of injuries.<ref name="lancet-grimes"/><ref name="Haddad-2009">{{cite journal | vauthors = Haddad LB, Nour NM | title = Unsafe abortion: unnecessary maternal mortality | journal = Reviews in Obstetrics & Gynecology | volume = 2 | issue = 2 | pages = 122–126 | year = 2009 | pmid = 19609407 | pmc = 2709326 }}</ref> Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;<ref name="lancet-grimes"/><ref name="OBGY09">{{cite journal |vauthors=Shah I, Ahman E |date=December 2009 |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |url=http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |url-status=dead |journal=Journal of Obstetrics and Gynaecology Canada |volume=31 |issue=12 |pages=1149–1158 |doi=10.1016/s1701-2163(16)34376-6 |pmid=20085681 |s2cid=35742951 |archive-url=https://web.archive.org/web/20110716212405/http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |archive-date=16 July 2011}}</ref><ref name=Loz2012>{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | display-authors = 6 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–2128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | url = https://zenodo.org/record/2557786 | access-date = 14 March 2020 | url-status = live | hdl-access = free | s2cid = 1541253 | archive-date = 19 May 2020 | archive-url = https://web.archive.org/web/20200519152712/https://zenodo.org/record/2557786 | hdl = 10536/DRO/DU:30050819 }}</ref> deaths from unsafe abortion account for around 13% of all [[maternal deaths]].<ref>{{cite book| vauthors = Speroff L, Darney PD |title=A clinical guide for contraception|year=2010|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-1-60831-610-6|page=406|edition=5th }}</ref> The [[World Health Organization]] believes that mortality has fallen since the 1990s.<ref name="WHO2011">{{cite book |last=World Health Organisation |title=Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 |publisher=World Health Organisation |year=2011 |edition=6th |page=27 |isbn=978-92-4-150111-8 |url=http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20140328093307/http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf |archive-date=28 March 2014}}</ref> To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.<ref name="berer-who">{{cite journal |vauthors=Berer M | title=Making abortions safe: a matter of good public health policy and practice |journal=Bulletin of the World Health Organization |volume=78 |issue=5 |pages=580–592 |year=2000 |pmid=10859852 |pmc=2560758}}</ref>

A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to countries where abortion is legal and available.<ref name="OBGY09"/><ref name="Sedgh 2012"/> For example, the [[Choice on Termination of Pregnancy Act, 1996|1996 legalization of abortion in South Africa]] led to an immediate reduction in abortion-related complications,<ref name="jewkes">{{cite journal |vauthors=Jewkes R, Rees H, Dickson K, Brown H, Levin J |title=The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change |journal=BJOG |volume=112 |issue=3 |pages=355–359 |date=March 2005 |pmid=15713153 |doi=10.1111/j.1471-0528.2004.00422.x |s2cid=41663939 |doi-access=}}</ref> with abortion-related deaths dropping by more than 90%.<ref name="bateman-samj">{{cite journal |vauthors=Bateman C |title=Maternal mortalities 90% down as legal TOPs more than triple |journal=South African Medical Journal = Suid-Afrikaanse Tydskrif vir Geneeskunde |volume=97 |issue=12 |pages=1238–1242 |date=December 2007 |pmid=18264602 |url=http://samj.org.za/index.php/samj/article/view/642 |url-status=live |archive-url=https://web.archive.org/web/20170830200316/http://samj.org.za/index.php/samj/article/view/642 |archive-date=30 August 2017}}</ref> Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as [[Romania]] and [[Nepal]].<ref>{{cite journal |vauthors=Conti JA, Brant AR, Shumaker HD, Reeves MF |title=Update on abortion policy |journal=Current Opinion in Obstetrics & Gynecology |volume=28 |issue=6 |pages=517–521 |date=December 2016 |pmid=27805969 |doi=10.1097/GCO.0000000000000324 |s2cid=26052790}}</ref> A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state.<ref>{{cite journal| vauthors=New MJ |s2cid=53314166|title=Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era |journal=State Politics & Policy Quarterly|date=15 February 2011|volume=11|issue=1|pages=28–47|doi=10.1177/1532440010387397}}</ref> The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.<ref>{{cite journal| vauthors = Medoff MH, Dennis C |title=Another Critical Review of New's Reanalysis of the Impact of Antiabortion Legislation|journal=State Politics & Policy Quarterly|date=21 July 2014 |volume=14|issue=3|pages=269–76|doi=10.1177/1532440014535476|s2cid=155464018}}</ref> In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally.<ref name="Singh">{{cite web |url=http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |title=Facts on Investing in Family Planning and Maternal and Newborn Health |publisher=Guttmacher Institute|year=2010 |access-date=24 May 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120324101905/http://www.guttmacher.org/pubs/FB-AIU-summary.pdf |archive-date=24 March 2012 }}</ref> Rates of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".<ref name="lancet-grimes"/><ref name=Brazil_Unsafe>{{cite journal |vauthors=Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM |title=Women's hidden transcripts about abortion in Brazil |journal=Social Science & Medicine |volume=44 |issue=12 |pages=1833–1845 |date=June 1997 |pmid=9194245 |doi=10.1016/s0277-9536(96)00293-6}}</ref>

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,<ref name="IJGO10"/> while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.<ref name="Dev98-07"/> While [[maternal death|maternal mortality]] seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.<ref name=OBGY09/> Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,<ref name="Maclean">{{cite book| vauthors=Maclean G |chapter-url=https://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299|chapter=XI. Dimension, Dynamics and Diversity: A 3D Approach to Appraising Global Maternal and Neonatal Health Initiatives |pages=299–300|title=Trends in Midwifery Research| veditors=Balin RE |publisher=Nova Publishers|year=2005|isbn=978-1-59454-477-4|url-status=live|archive-date=15 March 2015|archive-url=https://web.archive.org/web/20150315113348/http://books.google.com/books?id=u4Aeiu2eDMAC&pg=PA299}}</ref> though this varies by region.<ref>{{cite journal| vauthors=Salter C, Johnson HB, Hengen N |year=1997 |url=http://info.k4health.org/pr/l10edsum.shtml |title=Care for Postabortion Complications: Saving Women's Lives |journal=Population Reports |volume=25 |issue=1 |publisher=Johns Hopkins School of Public Health |url-status=dead |archive-url=https://web.archive.org/web/20091207070103/http://info.k4health.org/pr/l10edsum.shtml |archive-date=7 December 2009}}</ref> Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.<ref name="WHO-unsafe-2007">{{cite web |year=2007 |title=Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 |url=http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf |url-status=live |archive-url=https://web.archive.org/web/20110216141018/http://whqlibdoc.who.int/publications/2007/9789241596121_eng.pdf |archive-date=16 February 2011 |access-date=7 March 2011 |publisher=World Health Organization}}</ref> The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.<ref name="Sedgh 2012" /> Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion.<ref>{{cite web|title=Packages of interventions: Family planning, safe abortion care, maternal, newborn and child health|author1=UNICEF |author2=UNFPA |author3=WHO |author4=World Bank|year=2010|access-date=31 December 2010|url-status=dead|url= https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html |archive-url=https://web.archive.org/web/20101109224916/http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/fch_10_06/en/index.html|archive-date=9 November 2010}}</ref>