Abortion practices in the United States: a medical viewpoint.

To facilitate understanding of the controversial subject of abortion its historical background is reviewed followed by consideration of the contemporary indications for therapeutic abortion and the current legal abortion practices in the US. An ancient practice the records of almost every civilization indicate knowledge of abortifacient and abortion techniques. According to English common law the legal existence of the fetus was not recognized in criminal cases until "quickening" i.e. the 1st perception of fetal motion which usually occurs after the 4th month of pregnancy. In 1821 a Connecticut statute followed by similar statutes in 10 other states made abortion illegal only after quickening. Abortions were common in early America and it was not until 1845 that Massachusetts became the 1st state to make abortion or attempted abortion at any point in pregnancy a criminal offense. By 1880 anti-abortion legislation had been adopted in 40 states and territories. Into the early 1960s abortion was prohibited throughout the US unless the life of the pregnant woman would be endangered should the pregnancy be carried to term. Currently the term "therapeutic abortion" is used to describe interruptions of early pregnancy by licensed medical personnel. The vast majority of pregnancy terminations should be introduced as induced abortions. The term "therapeutic abortion" should be reserved for those instances when abortion is indicated for medical or fetal reasons. There continue to be numerous medical and fetal conditions for which a therapeutic abortion is warranted. Medical indications include cardiovascular disease gastrointestinal diseases renal disease neurologic and pulmonary disease diabetes mellitus and malignancy. Abortion for fetal indications may be recommended in 5 situations: where there has been an ingestion of certain harmful drugs during pregnancy; where certain viral infections have been contracted by the mother; where the mothers abdomen has been exposed to radiation during pregnancy; where there is substantial risk of fetal malformation due to genetic or congenital factors; and where there is a sensitization to the Rh factor in the bloodstream. In the US legalized abortion on request essentially has removed criminal abortion as a major health problem. By-products of this legislation include the widespread availability of contraceptive family planning and abortion services as well as improved medical expertise and the consequent reduction in the morbidity and mortality of abortion. Legal abortion is safe and the majority of abortion procedures can be safely performed in an outpatient or clinic setting with a significant reduction in the cost of medical care.