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On 24 July 2022, the landmark decision Roe v. Wade (1973), that secured a right to abortion for decades, was overruled by the US Supreme Court. The Court decision in Dobbs v. Jackson Women’s Health Organisation severely restricts access to legal abortion care in the USA, since it will give the states the power to ban abortion. It has been claimed that overruling Roe will have disproportionate impacts on women of color and that restricting access to abortion contributes to or amounts to structural racism. In this paper, we consider whether restricting abortion access as a consequence of overruling Roe could be understood as discrimination against women of color (and women in general). We argue that banning abortion is indirectly discriminatory against women of color and directly (but neither indirectly, nor structurally) discriminatory against women in general.

Background and objectivesAdolescent sexual and reproductive health and rights (SRHR) are of particular relevance given their potential short-term or long-term health consequences. This study evaluates recommendations and policies regarding access to care in this area in 31 European countries (European Union (EU) plus Iceland, Norway and Switzerland).MethodsAs part of the EU funded Models of Child Health Appraised project, data were gathered using a 43-item questionnaire sent to experts responsible for collecting information in each country.ResultsTen countries have not developed any formal policy or recommendation that guarantee the respect of confidentiality and the possibility of consulting a physician without parents knowing. Nearly half of the countries do not have centres specialised in adolescent healthcare, tackling comprehensive health issues or focusing specifically on SRH. Access to emergency contraception and information regarding pregnancy, including testing, is easy in most countries. However, oral contraception is delivered free of charge in only 10 countries. Twenty-three countries do not meet current standards in terms of providing policy-based pregnancy care, and only 13 have set up special programmes for pregnant adolescents. In only seven countries can adolescents definitely have their pregnancy terminated without their parents knowing (and in another seven countries in selected situations).ConclusionThe provision and availability of adolescent-friendly SRHR care are far from optimal in around half of the surveyed countries. These results call for the review and implementation of policies, specialised healthcare centres and training initiatives for primary care providers.

The Second World War lent impetus to the creation of new models and explanatory frameworks of risk, encouraging a closer reading of the relationship between individual psychiatric disorder and social disarray. This article interrogates how conceptions of psychiatric risk were animated in debates around abortion reform to forge new connections between social conditions and psychiatric vulnerability in post-war Britain. Drawing upon the arguments that played out between medical practitioners, I suggest that abortion reform, culminating in the 1967 Abortion Act, was both a response to and a stimulus for new ideas about the interaction between social aetiologies and medical pathologies; indeed, it became a site in which the medical and social domains were recognised as mutually constitutive. Positioned in a landscape in which medical professionals were seeking to assert their authority and to defend their areas of practice, abortion reform offered new opportunities for medical professionals to intervene in the social sphere under the guise of risk to women’s mental health. The debate in medical journals around the status of issues that were seen to bridge the social and the medical were entangled with increasing anxiety about patient agency and responsibility. These concerns were further underscored as conversations about psychiatric risk extended towards considerations of the potential impact on women’s existing families, bringing domestic conditions and the perceived psychosocial importance of family life into relief within medical journals. This article, then, argues that conceptions of psychiatric risk, as refracted through the creation of new synapses connecting the social and the medical domains, were critical to medical debates over abortion reform in post-war Britain.

A recent issue of the journal Bioethics discussed whether conscientious objectors within the healthcare context should be required to give their reasons to a specially convened tribunal, who would have the power to reject the objection. This is modeled on the context of military conscription. Advocates for such a tribunal offer two different justifications, one based on determining the genuineness of the applicant's beliefs, the other based on determining their reasonableness. I limit my discussion to a doctor's objection to abortion in the UK, and argue against both justifications: I thereby defend the status quo, where such doctors are not formally required to defend their beliefs. My argument has to do with the particular nature of the abortion debate in the UK, and the more general nature of ethical disagreement.

IntroductionAbortion is a common feature of people’s reproductive lives. However, the economic implications of abortion and policies affecting abortion provision are poorly understood. This scoping review aims to systematically review social science literature for studies that have investigated the impact of abortion care (ie, un/safe abortion, post-abortion care) or abortion policies on economic outcomes at the micro-levels (ie, abortion seekers and their households), meso-levels (ie, communities and health systems) and macro-levels (ie, societies and nation states). Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline for protocols, this protocol details the scoping review’s methodological and analytical approaches.Methods and analysisThis scoping review will utilise the PRISMA extension for Scoping Reviews (PRISMA-ScR) tool. Studies reporting on qualitative and/or quantitative data from any world region will be considered. For inclusion, studies must examine one of the following economic outcomes at the micro-levels, meso-levels and/or macro-levels: costs, benefits, impacts and/or value of abortion care or abortion policies. Searches will be conducted in eight electronic databases. We will conduct the searches and application of inclusion/exclusion criteria according to the PRISMA-ScR flow approach. No assessments of items’ quality will be made, as the purpose of this scoping review is to synthesise and describe the coverage of the evidence. After extracting all data, we will inductively develop an economic framework around the economics of abortion. The analysis will synthesise the evidence base and identify knowledge gaps on the costs and benefits of abortion to stakeholders at various levels.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected in this study. The findings of this study will be disseminated through peer-reviewed publications, conference presentations, and condensed summaries for key stakeholders and partners in the field.

Since the UK Abortion Act (1967), women have travelled from Ireland to the UK for legal abortion. In 20114000 women did so. Knowledge and attitudes of medical students towards abortion have been published, however, this is the first such report from Ireland.To investigate medical students' attitudes towards abortion in Ireland.All medical students at the University of Limerick, and physicians who graduated from the university within the previous 12 months, were invited via email to complete an anonymous online survey. The questionnaire comprised 17 questions. Quantitative and qualitative analyses were performed.Response rate was 45% (n=169; 55% women; 88.2%30 years of age; 66.7% Irish; 29.2% North American). Outcomes were: abortion should not be legally available (7.1%), abortion should be allowed in limited circumstances only (35.5%), abortion should be legally available upon request (55%). 72.8% of respondents were moderately/strongly prochoice (74% of women/71% of men/72% and 76% of Irish and North American respondents, respectively). Students aged30 years were less likely to be prochoice (55%). While 95.2% believed that education on abortion should be offered within medical school curricula, 28.8% stated that they would decline to terminate pregnancies even if legally permitted. While 58.8% indicated that they might perform legal abortions once qualified, 25.7% would do so under limited circumstances only.The majority of participants wanted education regarding abortion. Despite being predominantly prochoice, considerably fewer students, irrespective of nationality, indicated that they would perform abortions.

This commentary discusses the current situation regarding Government policy on abortion in Britain. It begins by setting out the ways in which the policy of the Coalition Government appears to differ from that of the New Labour administration. The article notes that 2012 brought furious debate about abortion services, focusing on counselling, ‘sex-selection’ abortion, signing of HSA1 forms and, most recently, the upper time limit, and discusses what has emerged to date from these furores. Finally, thoughts are offered on how to respond to the problems raised by the current approach of policymakers. Under the New Labour government, in a departure from any previous policy modus operandi , an explicit ‘sexual health policy’ emerged. The two central programmes developed were the Teenage Pregnancy Strategy and the National Strategy for Sexual Health and HIV. It would be going too far to say a specific ‘abortion policy’ emerged as part of this, but the framework for abortion provision did evolve as part of this Government interest in ‘sexual health’. Taking the Royal College of Obstetricians and Gynaecologists (RCOG)'s evidence-based guidelines published from 2000 as a reference point,1 policy encouraged a set of linked developments. There was a shift in the timing of abortion procedures. The distribution of procedures between the first and second trimesters did not change, with the latter consistently constituting around 10% of procedures; but within the first trimester the distribution shifted to an increased proportion at under 9 weeks. The proportion of procedures performed using early medical abortion (EMA) increased. A larger proportion of women accessed abortions funded by the Department of Health; and independent sector providers provided a growing proportion of state-funded procedures under contract.2 While it is important not to overstate the role of policy in shifting abortion provision in these ways (the providers themselves have …

Abortion is permitted in many jurisdictions after the age at which an infant is viable on the basis of intensive neonatal care techniques. Does this cause special concerns for those involved in perinatal care and termination of pregnancy services or is the overlap mainly an abstract issue fretted over by ethicists and academics? In order to explore this question, a group of clinicians involved in this area of care were interviewed and their interviews analysed using qualitative measures. The clinicians concerned were exercised by the ethical issues and had various ways of resolving them which tended to reflect a gradualist, multifaceted and, to some extent, particularist approach to ethical decision-making in relation to the edges of human life. The ways in which those strands of ethical thought are instanced in the interview material are reported and discussed.

Objectives In parts of the UK, demand for termination of pregnancy exceeds local availability on the National Health Service. The study objective was to report on setting up and running a new outpatient service for early medical termination under 7 weeks9 gestation. Methods We describe the process of setting up the clinic within the confines of the Abortion Act 1967, the training of staff, acquisition of resources, cost analysis and negotiations with the Primary Care Trust. We report on running the service in the first 12 months, difficulties encountered and how these have been overcome. Our experience is compared with the limited published data available. Results Of 171 patients referred in the first year, 148 were offered an appointment and 100 women completed outpatient treatment for medical termination under 7 weeks9 gestation. 90% of patients attended follow-up at 2 weeks and the remainder were contacted by telephone. Clinical outcomes were similar to those reported in the literature apart from initially higher numbers of women undergoing evacuation of retained products of conception. The estimated cost per case in the first year was £156, which represented a considerable cost saving compared to £498 for surgical termination and £423 for inpatient medical termination. Conclusions Our service is successful, viable for the future and has acceptably good patient outcomes, which are improving all the time.

In 2002, a child was abandoned in a Burger King restaurant in Amsterdam by a Chinese woman, who hoped that the baby would be picked up by someone able to give the child a better life. She was convicted for child abandonment and imprisoned. Whereas some forms of child abandonment are criminalised, others are socially accepted and not even on the ethics agenda. This paper is an invitation to reflect on the inconsistency in the ways in which we prosecute, punish or try to correct some forms of child abandonment and yet make allowances for others.

From a liberationist, feminist, and Catholic point of view, this article attempts to understand the decision of abortion. People are constantly testing their principles and values against the question of abortion. Advances in technology, the rise of communitarianism and the rejection of individualism, and the commodification of children are factors in the way in which the abortion debate is being constructed in society. The paper offers solutions to end the ugliness of the abortion debate by suggesting that we would be able to progress further on the issue of abortion if we looked for the good in the opposing viewpoint. The article continues with a discussion of Catholics For a Free Choice's position on abortion, and notes firstly that there is no firm position within the Catholic Church on when the fetus becomes a person; secondly that the principle of probablism in Roman Catholicism holds that where the church cannot speak definitively on a matter of fact (in this case, on the personhood of the fetus), the consciences of individual Catholics must be primary and respected, and thirdly that the absolute prohibition on abortion by the church is not infallible. In conclusion, only the woman herself can make the abortion decision.

Abortion is one of the most controversial issues in today's world. People tend to turn to the law when trying to decide what is the best possible solution to an unwanted pregnancy. Here the author's views on abortion are discussed from a lawyer's and a woman's point of view. By taking into consideration the rights of the fetus an "antagonistic relationship" between the woman and her unborn child may occur. Therefore, women should have more autonomy in the issue. The article concludes with examples of cases in the United States and Ireland where the rights of the fetus are considered more important than those of the mother because of existing laws. This article suggests that a more inclusive ethics of abortion is required rather than a new ethics of abortion when "translating fetal life into law".

The issue of abortion has evolved since 1967. In this paper, the shift in the discourses of abortion are discussed. The article suggests that abortion is used as a "back-up" method of family planning and that this is broadly acceptable. Although there is little public opposition to abortion as such, there are influences that undermine abortion provision as it now exists. Growing concern about the status of the fetus shapes a number of debates. For example the issue of what the fetus feels during abortion influences abortion practice. Advances in technology and the increase in knowledge about the unborn fetus will not change a woman's decision about having a late termination. The article concludes with the idea that a woman is a moral, civilised human being that deserves the right to make decisions about her reproductive life. Key Words: Abortion • fetus • women • pregnancy • perspective • moral

The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies.This essay argues against the claim that abortion can be justified by acknowledging that women have property in their bodies or "persons." The essay does not present arguments on either side of the abortion issue; it simply addresses the notion of abortion rights emanating from ownership of self. The first argument notes that ownership implies duties as well as rights. Acknowledging that we have duties in regard to our bodies places limits on our rights in regard to them. Particular rights and obligations are also attendant upon a person's fertility as a capacity of that person's body, but other people are not necessarily encumbered with a duty either not to interfere with a person's method of fertility regulation or to help that person carry out a fertility-related action. This "commonsense" discussion of rights is further elaborated with reference to the writings of three legal scholars about theories of property rights. S. R. Munzer classified body rights into personal rights and weak and strong property rights. Munzer relies on W. N. Hohfeld's use of the terms "claim-right," "privilege," "power," and "immunity" and combines Hohfeld's analysis with that of Honore who specified standard legal "incidents" of ownership. Munzer is reluctant to consider bodies "property" because they cannot be sold. Thus, body rights present a "weak package" of limited property rights and are more likely personal rights than property rights. It is concluded that ownership of our bodies in any sense of the term is not crucial because ownership can be a basis but not a prerequisite for the possession of rights and duties. The question remains as to what bodily rights and duties entail.

This article examines the technique and legality of induced abortion of one or more fetuses in a multiple pregnancy, where the aim is the destruction of some but not all of the fetuses present (selective reduction of pregnancy). It concludes that since the legal status of the procedure in English law is unclear, it may be a criminal offence to perform selective reduction even where there is an ostensible clinical need. Moreover if the procedure is carried out negligently, and any infant damaged as a result is subsequently born alive, he or she may have a civil claim against the practitioner who carried out the procedure.

Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection.In California, whereas the state mandates the obligation of counties to provide abortion services for incarcerated and for incompetent women, the state also has "conscience clause" legislation which allows health care workers to be excused from providing abortions simply by signing a written declaration. The existence of this legislation can create a situation whereby a county must provide abortions but has difficulty locating a physician to perform the procedures. Whereas individuals must have the right not to engage in activities they find morally repugnant, the California conscience clause is flawed because it fails to consider the moral obligations of physicians to provide services and because it trivializes the process of moral decision-making since no actual justification is needed. Rather than being at complete liberty to choose which services to offer, physicians have an obligation to provide services. Therefore, the burden of proof lies with those who wish to be excused from certain activities. This obligation arises from the debt physicians owe to society through the receipt of extraordinary social benefits (partially taxpayer-supported education; the privilege of professional licensure; the monopoly granted for most types of medical care through state licensing; large salaries and prestige; and, in some cases, employment at taxpayer-supported institutions) and because of the social harm which would occur if services were not provided. California's conscience clause legislation should be amended to establish review boards to evaluate claims of moral objection to providing abortion. Possible criteria which the Boards could follow would include determining: 1) if the applicant has a sincere scruple-based objection, 2) if the scruple fits an otherwise coherent system of beliefs, 3) if the scruple is consistent with other beliefs and actions, and 4) if the scruple is a key component of the petitioner's moral or religious framework. If an exception is granted, all reasonable alternatives should be explored to ensure that physicians fulfill their obligation to provide service, including having the petitioner provide only follow-up care or substituting some other form of public-benefiting service.

Twenty eight patients with thalassaemia intermedia and their parents were interviewed using specifically designed questionnaires to evaluate psychosocial burden. Hospital notes were analysed for clinical burden. A wide variation was found for both patients and parents, ranging from virtually unaffected to severely affected. Normal sexual function and setting up a family were mentioned by patients and parents as being particularly important for quality of life. Over half (58%) of the patients had problems with sexual maturation and functioning, and continuous monitoring of all patients with thalassaemia intermedia by a paediatric endocrinologist is therefore strongly indicated. Most parents said, in light of their experiences, that they would opt for prenatal diagnosis and termination of affected pregnancies even if a genotype predicting the mild form of disorder were discovered.

To conduct a number of studies into the prevalence of neural tube defects (NTD) in the area covered by the Oxford Record Linkage Study (ORLS), multiple sources were used to build a local register of cases occurring in Oxfordshire and West Berkshire between 1968-1990. One source of potential cases--namely, termination and congenital malformation monitoring data available for the locality from the Office of Population Censuses and Surveys (OPCS) data--were kept separate. Comparison of the local cases recorded by OPCS and those known to the register from 1974-1990, using the method of capture-recapture, suggested that national data are only about two thirds complete, but that this underreporting is likely to be reasonably consistent from year to year. OPCS data can therefore be used to study NTD trends if not absolute risks. The local register seemed, by the same yardstick, to be very complete and is being used in a variety of studies of the occurrence of NTD. Survival to one year in this area, over the period 1968-1990, has only improved in the recent past, if at all. Most NTD pregnancies now end in termination rather than birth, and there has been a true decline in the occurrence of NTDs, and likewise the different subtypes.

To compare sexual behaviour and HIV risk behaviour between women in three clinical settings and to investigate the effect of socio-economic status and ethnic origin upon these behaviours.A questionnaire was administered to 1,950 women attending clinics for genitourinary medicine (GUM) family planning and termination of pregnancy (TOP), all in inner London.A quarter of women attending the GUM and TOP clinics were not using any regular form of contraception. Differences in the median numbers of sexual partners in the past year (1-2) and over lifetime (4-6) between the three groups were slight. Amongst the women in all three groups: more than half (54.8-64.9%) had had a non-regular partner in the preceding twelve months; fewer than one-fifth (10.4-17.1%) reported always using condoms with their regular partners, and fewer than two-fifths (31.3-39.7%) always used them with their non-regular partners; approximately one in five women (18.6-23.9%) reported one or more major HIV risk behaviours. Some parameters of sexual behaviour were found to be influenced by socio-economic status and/or ethnic origin.The behaviour of women attending these three clinics is very similar. Women attending clinics for family planning or termination of pregnancy need advice on sexually transmitted diseases and HIV infection, and women attending genitourinary medicine or termination clinics need advice on contraception. Closer integration between disciplines is required to provide a comprehensive sexual health service for women.In England between November 1989 and February 1991, 917 new female patients at a department of genitourinary medicine (GUM), a family planning clinic (FPC), and an abortion clinic, all in inner London, completed a questionnaire so researchers could examine sexual behavior and HIV risk behavior between these women and to determine the effect of ethnic origin and socioeconomic status on these behaviors. 25.3% of GUM women and 25% of women at the abortion clinic did not use any contraception. The median numbers of sexual partners in the last 1-2 years and 4-6 years were essentially the same in all 3 groups (1.5-2.0 and 6.8-11.1, respectively). 54.8-68.9% of the women had had sexual intercourse with a nonregular sexual partner in the last 12 months. Few (10.4-17.1%) always used a condom with their regular partners. The percentage who always used a condom with nonregular partners was also low (31.3-39.7%). 18.6-23.9% of the women had at least 1 major HIV risk behavior. Age at first intercourse was younger in women of lower socioeconomic class than those of higher class (17.39 years vs. 18.04 years; p 0.0001). Whites had more lifetime sexual partners (10.34 vs. 5.18; p = 0.02) and were more likely to have practiced fellatio and anal sex (p 0.0001 and p 0.05) than did Afro-Caribbean women. Whites were more likely to have had a history of genital herpes (4.6% vs. 1%; p 0.02) and to have had sex with an IV drug user (6.9% vs. 1.5%; p = 0.005) than Afro-Caribbean women. Yet, Afro-Caribbean women were more likely to have at least 1 HIV risk behavior than Whites (29.5% vs. 21.4%; p = 0.01), almost entirely because they had had intercourse with a man from Sub-Saharan Africa. These findings suggest that staff at FPCs and abortion centers should provide women advice on sexually transmitted diseases and HIV infection and that staff at GUM clinics need to offer contraception advice. The 3 clinical disciplines must be integrated so women can receive more comprehensive sexual health services.

To determine the rate of pregnancy and outcome in teenagers in areas of different socioeconomic conditions, and to assess the implication for achievement of government and local targets in reducing unwanted pregnancies in teenagers.Records of pregnancies were obtained from hospital discharge files and rates of live and still births and abortions calculated for each postcode sector. Postcodes were grouped by categories of deprivation and by local government district.Tayside, Scotland.Teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90.Conception in girls aged under 16 by area of residence and relative proportion leading to live births or terminations. Rate of different outcomes in girls under the age of 20 by area of residence.The pregnancy rate in girls aged under 16 was three times as high, and in all girls under 20 six times as high in the most deprived areas as in the most affluent areas. The proportion of teenage pregnancies ending in abortions was higher in the affluent areas, where two out of three ended in abortion compared with one out of four in the deprived areas.Although there was a higher pregnancy rate in teenagers in more deprived areas, the proportion ending in abortion was greater in more affluent areas, possibly due to social and parental pressure. The wide geographical variation in patterns of teenage pregnancy indicates the need for a small area rather than a regional approach to setting targets and devising measures of achieving them.The objective was to determine the rate of pregnancy in teenagers in areas of different socioeconomic conditions to reduce unwanted pregnancies. Details of all patients admitted to Tayside, Scotland, hospitals between 1 January 1980 and 31 December 1990 were obtained and rates of live and still births and abortions were calculated for postcode sectors categorized by deprivation. Pregnancy outcomes were also evaluated in teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90, as well as live births or terminations in girls aged under 16 by area of residence and outcomes in girls under the age of 20 by area of residence. During the 1980s the rate of conception in girls under 16 was 3 times higher in the most deprived areas than in the most affluent. In the deprived areas, however, 1 in 2 pregnancies ended in abortion compared to 2 in 3 in the most affluent areas. The annual rate in Dundee District was 11.6 conceptions/1000 girls aged 13 to 15 compared to 5.4/1000 in Perth and Kinross and 8.3/1000 in Angus. Between 1980 and 1990, 40% of the girls who conceived before their 16th birthday did not give birth or have their pregnancy terminated until after they were 16. The overall rate of teenage pregnancies increased dramatically from the most affluent to the most deprived areas. In the most deprived sectors, about 1 in 4 pregnancies ended in abortion compared with about 2 in 3 in the most affluent sectors. Between 1980 and 1990 there were 1075 girls who had had 2 pregnancies: 18% (193) were married on both occasions, and 175 had 2 live births. Among single girls at the end of both pregnancies, 32% (225) had live births (or still births) on both occasions compared with 20% (142) terminating their pregnancies on both occasions. Although there was a higher pregnancy rate in more deprived areas, the proportion ending in abortion was greater in more affluent areas, possibly occasioned by social and parental pressure.

The papers included in this supplement were first given at a meeting, The New Ethics of Abortion, organised by the British Pregnancy Advisory Service (BPAS) in Senate House at the University of London on 21 February 2000. The British Pregnancy Advisory Service is primarily a provider of abortion services. Each year, the organisation provides almost 50,000 abortions, more than half of which are performed on behalf of the National Health Service (NHS), which means they are free of charge to women. We are also a major source of comment to the media on issues relating to unwanted pregnancy and so we frequently face the challenge of debating those who insist that abortion is morally wrong and medically unjustifiable. The New Ethics of Abortion was organised to provide a forum in which pro-choice and anti-choice perspectives could be discussed in an atmosphere of mutual respect. We are aware that advances in technology and changed perspectives on rights—of men, of children, of the fetus, of the disabled—can have an impact on the abortion debate. We are aware that these issues are hotly contested by both those who support and those who oppose the liberal provision of abortion, and we feel that as providers of abortion care to so many women we have an important part to play. The staff at BPAS consultation centres and clinics understand abortion from the perspective of women—not women campaigners (who have their own political agenda)—but women with problem pregnancies in need of abortion care. This is a perspective that is often pushed aside when abortion is regarded as an abstract political or ethical issue. Abortion has become accepted as a part of British life. Since the 1967 Abortion Act became law in April 1968 more than five million women have benefited from safe, legal abortion in Britain. …

A fetus may survive an intentional interference with its intrauterine environment (1) if gestational age is mistaken and the procedure of induced abortion does not kill the fetus, (2) if a change of heart takes place after abortifacient drugs are taken and the abortion does not proceed, and (3) if a high-multiple pregnancy is reduced to a singleton or a twin pregnancy to improve the likelihood that the remaining fetuses will reach viability. In each case, through cause or coincidence, an abnormal baby may be born. The well-intentioned physician, responding to a patient's medical or psychological needs, risks a legal action in negligence or assault brought by a deformed surviving child. This hazard means that medical termination of pregnancy and selective pregnancy reduction put the practising physician at substantial risk in a way not usually associated with induced abortion.The issue of unfinished feticide is one of great importance to practicing physicians. Because of possible legal repercussions, a discussion of these repercussions will be of a great benefit. Abortion is a procedure that women need and as such it should be developed to the greatest possible degree. Nonsurgical abortion and selective feticide are both examples of this development. However, they also both present risks to physicians. The dangers of unfinished feticide are clear and present for the medical profession. Both can fail or go unfinished and result in the birth of a abnormal infant. This can lead to legal action against the practicing physician. Currently there is little legal protection for physicians in the civil law. The author's recommendation is that doctors can best protect themselves by ensuring that induced abortions are quick, clean and final.

A legal amendment that should bring clarity to the arbitrary cut-off of 20 weeks’ gestation for abortion needs urgent redrafting, writes Nikhil Datar

In the genetics clinic we meet many parents whose pregnancy has been complicated by the unexpected finding of a serious fetal malformation. Many of these couples terminate their pregnancy but some continue and allow nature to take its course. We summarise the experience of five couples and highlight various aspects showing the inappropriateness of routine obstetric care for these women. These were five consecutive couples (see table 1) known to the genetics department who agreed to a semistructured, tape recorded interview at varying intervals (one week to eight months) after their pregnancies. View this table: Table 1 Summary of case histories in the five cases ### of options Three of the five women thought that the options of termination and continuation of the pregnancy had been adequately discussed from an early stage. One commented that it had been made clear that there were “different choices for different people.” Another couple (case 5) were not aware that continuation of the pregnancy was a real option until they reported to the labour ward for “induction” at 21 weeks. Up to that point the word “termination” had not been used. “It was like we were in a tunnel and there was only one way out. I just didn't think that I had any choice but to go with what was suggested. I don't understand why they didn't discuss all the options. I don't think that we thought of the consequences of what we were doing. I went in to have the baby induced—that was the word used. It didn't register with us that they were going to terminate the pregnancy.” Once the couple realised what induction meant they decided not to proceed and returned home. Appreciation was expressed by other couples about the positive aspects of their care. Time given for decision making in a relaxed atmosphere seemed of particular value, …

Between February 2002 and January 2004 in the Adigrat Zonal Hospital, covering one-fifth of the large Tigray region of North West Ethiopia, there were 907 admissions with a diagnosis of abortion. Among these, 521 were induced by traditional, unsafe methods.1 Unsafe abortion was the leading cause of admission, accounting for 12.6% of all bed occupancy throughout this general hospital and 60.6% of the gynecological admissions. About 57% of patients admitted with unsafe abortions had serious complications, including tubo-ovarian abscess, vaginal laceration, uterine perforation, generalised peritonitis and renal failure. Three women died from complications of unsafe abortion. Five years later in the same hospital, between July 2009 and September 2010 unsafe abortion cases had declined, becoming the tenth cause of hospital admission. There were no deaths and no severe complications. This remarkable change in a poor rural area, with a weak infrastructure and where half of all women are illiterate, was the outcome of a pilot project testing whether all levels of health providers could be trained to provide medical abortion and to refer appropriately. The Comprehensive Abortion Care (CAC) project, conducted in the Tigray region of NW Ethiopia, was a partnership between the Regional Health Bureau, Venture Strategies Innovations and the Bixby Center for Population, Health and Sustainability at the University of California, Berkeley, USA. In most of sub-Saharan Africa abortion remains illegal, but nevertheless abortion abounds, and it is a major cause of maternal mortality and morbidity. In 2005, …

This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss "objectionable" options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise.

A study has found that the ratio of boy to girl babies is higher in wealthy families than in poorer ones. Dinsa Sachan considers the implications of a surplus of boys and how this is being tackled

Reduction in female mortality has been counterbalanced by sex selective abortions The concept of “missing women,” which was presented in an editorial I wrote in this journal 11 years ago, refers to the terrible deficit of women in substantial parts of Asia and north Africa, which arises from sex bias in relative care.1 The numbers are very large indeed. For example, using as the standard for comparison the female:male ratio of 1.022 observed in sub—Saharan Africa (since women in that region receive less biased treatment), I found the number of missing women in China to be 44m, in India 37m, and so on, with a total that easily exceeded 100m worldwide,a decade or so ago. Others used different methods and got somewhat different numbers—but all very large (for example, Stephan Klasen's sophisticated demographic model yielded 89m for the countries in question).2 How have things moved more recently? At one level they have not changed much. The ratio of women to men in the total population, while changing slowly (getting a little worse in China and a little better in India, Bangladesh, Pakistan, and west Asia), has not altered radically in any of these countries. Even though the total numbers of missing women have continued to grow (Klasen's 89m is now 93m for the same countries and 101m for the …

I first met Nesta at about 2 am. She had been brought to the hospital late evening, confused, febrile, and hypotensive. I diagnosed septic shock, and we treated her with intravenous fluids and antibiotics. Initially, I was not too alarmed by the lack of urine in her bladder. This, I thought should remedy itself with our treatment. I was, however, uncertain about the history she insisted was hers. It is after all unusual practice to perform a dilatation and curettage for chronic pelvic pain. Still this was Liberia, and I’d seen far stranger. By morning, and several litres of intravenous fluid and high doses of diuretic later, I was becoming more concerned about our failure to extract any of Nesta’s urine. She was increasingly confused, but still able to adamantly deny that she had had an abortion. Being a pragmatist I washed out her bladder and thereby confirmed her pregnancy. Dilatation and curettage showed offensive products of conception, but her abdomen was soft with no evidence of a perforation. Fabulous. It doesn’t matter how often you check, flush the catheter, or press on a patient’s bladder. If …

A season of documentary films from the 1950s, ’60s, and ’70s on topics such as family planning, polio, and epilepsy give insight into the social attitudes of the time, writes Peter Davies