[Termination of pregnancy after the 20-week ultrasonographic examination: haste and caution]

The recently introduced ultrasonographic screening programme for the detection of fetal structural anomalies at 20 weeks' gestation is leading to a growing number of cases with an unclear prognosis. This article presents the decision-making process which followed the screening of two women: one aged 36 years, where a post-screening work-up was conducted and swiftly led to well-balanced decision making to abort a fetus with trisomy 21, and one woman aged 30 years, in whom repeated non-decisive results of further diagnostic tests ultimately led to a hasty decision to abort the pregnancy. Up to 24 weeks, current Dutch law allows the couple to decide to have a termination of pregnancy; thereafter the legal possibility of having a termination is very limited. This may lead to rushed decision-making. It is argued that careful decisions in these matters are more important than staying within the 24-week limit. The national central committee ofexperts which is responsible for the evaluation of all abortions after 24 weeks gestation in the so-called category 2 cases (conditions which will lead to serious and irreparable functional disorders, such as severe spina bifida and hydrocephalus, but which are compatible with life) should take account of this dilemma ofhaste and caution.

Unsafe abortion in Kenya

Though pregnancy termination is highly restricted in Kenya, induced abortion remains common. Illegal abortion is often unsafe, putting women at risk of death or severe complications. In eastern Africa as a whole, an estimated 14% of all pregnancies end in abortion, and nearly one in five maternal deaths are due to unsafe abortion.

Beyond abortion: the looming battle over death in the 'culture wars'

By concentrating on abortion, the culture wars have avoided facing a crisis about the end of life. This paper explores four themes: (1) the technological transformation of birth and death into matters of decision, not matters of fact; (2) abortion as the nexus of Eros (sex) with Thanatos (death); (3) the real crisis, conveniently masked by our obsession with sex, looming at the end of life, not at its beginning; (4) the surplus-repression that protects us from assuming responsibility for choosing between life and death.

[Reflections about the obstetric attitude towards anencephalic fetuses]

Pregnancy of an anencephalic fetus generates deep thoughts about its diagnosis, treatment and management of maternal risk, having in mind the irreversibility of the fetal situation. At the present moment, there are no guidelines for labor care in these cases, probably because in most developed countries in which abortion is legal, these pregnancies are interrupted earlier. In Chile, where abortion is illegal we must deal with these situations at the end of the pregnancy period. Of 35,682 labors attended at our hospital, 14 were anencephalic fetuses. In 50% of these a cesarean section was done and in one, a hysterectomy was required due to uterine inertia.

Substantive due process after Gonzales v. Carhart

This Article begins in Part I with a doctrinal evaluation of the status of Washington v. Glucksberg ten years after that decision was handed down. Discussion begins with consideration of the Roberts Court's recent decision in Gonzales v. Carhart and then turns to the subject of Justice Kennedy's views in particular on substantive due process. In Part II, the Article goes on to consider whether the Glucksberg test for substantive due process decision making is correct in light of the original meaning of the Fourteenth Amendment. The Article concludes in Parts II and III that Glucksberg is right to confine substantive due process rights recognition to recognition only of those rights that are deeply rooted in history and tradition.

[Abortion and medical education in Mexico]

Medical education in Mexico has significant deficiencies in the area of sexual and reproductive health and does not offer students the information needed for dealing with abortion as a relevant problem in the professional practice of medicine. Medical education does not offer options for the clinical training of future physicians in integrated models for abortion care, which include the use of safe and effective technologies as well as a range of services to respond to women's needs. These limitations are especially relevant in countries such as Mexico where unsafe abortion continues to be a significant public health problem. In addition, the legal context for abortion has begun to change during the current decade; therefore, the search for alternatives to incorporate a broad approach to abortion in medical school programs is a task that cannot be postponed.

Abortion within and around the law in the Caribbean

Small island exigencies and a legacy of colonial jurisprudence set the stage for this three-year study in 2001-2003 of abortion practice on several islands of the northeast Caribbean: St. Martin, St. Maarten, Anguilla, Antigua and St Kitts. Based on in-depth interviews with 26 physicians, 16 of whom were performing abortions, it found that licensed physicians are routinely providing abortions in contravention of the law, and that those services, tolerated by governments and legitimised by European norms, are clearly the mainstay of abortion care on these islands. Medical abortion was being used both under medical supervision and through self-medication. Women travelled to find anonymous services, and also to access a particular method, provider or facility. Sometimes they settled for a less acceptable method if they could not afford a more comfortable one. Significantly, legality was not the main determinant of choice. Most abortion providers accepted the current situation as satisfactory. However, our findings suggest that restrictive laws were hindering access to services and compromising quality of care. Whereas doctors may have the liberty and knowledge to practise illegal abortions, women have no legal right to these services. Interviews suggest that an increasing number of women are self-inducing misoprostol abortions to avoid doctors, high fees and public stigma. The Caribbean Initiative on Abortion and Contraception is organising meetings, training providers and creating a public forum to advocate decriminalisation of abortion and enhance abortion care.

ABORTION-SEEKING BEHAVIOUR AMONG NIGERIAN WOMEN

This study used data from a community-based survey to examine women’s experiences of abortion in Nigeria. Fourteen per cent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two per cent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women’s socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman’s life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria.

Reducing unsafe abortion in Nigeria

Abortion is illegal in Nigeria except to save a woman's life. It is also common, and most procedures are performed under unsafe, clandestine conditions. In 1996, an estimated 610,000 abortions occurred (25 per 1,000 women of childbearing age), of which 142,000 resulted in complications severe enough to require hospitalization. The number of abortions is estimated to have risen to 760,000 in 2006. Unsafe abortions are a major reason Nigeria's maternal mortality rate--1,100 deaths per 100,000 live births--is one the world's highest. According to conservative estimates, more than 3,000 women die annually in Nigeria as a result of unsafe abortion.

The history of abortion-related acts and current issues in Japan

In Japan abortion is categorized into two types by law; one is illegal feticide and the other is legal abortion. The present criminal law forbids feticide in principle and the life of a fetus is protected. However, abortion can be practiced under the "Eugenic Protection Act" established in 1948 (currently referred to as the "Maternal Protection Act"), and is readily available in Japan. In this paper, I have traced the historical origins of abortion law and attempted to clarify the problems related to the current laws relating to artificial abortion. As a result, the existence of contradictions between attitudes toward the life of the fetus and that of the mother, women's right to self determination, and women's rights under current legislation has been clarified.