In Sickness and in Health: Expert Discussions on Abortion Indications, Risks, and Patient-Doctor Relationships in Postwar Poland

This article analyzes expert debates relating to abortion in Poland between 1956 and 1993, a period when the procedure was legal and accessible. Through the pages of the primary Polish journal for gynecology and obstetrics, Ginekologia Polska, the author traces continuities and ruptures around three major intersecting themes: the procedure's indications, its (dis)connection to health, and the patient-doctor relationship. The journal became a forum showcasing interpretative tensions over indications for abortion and the malleability of the categories "therapeutic" and "social." In addition to these tensions, abortion was represented throughout this period as a potentially risky surgery, although this was initially nuanced with parallel representations of legal abortion combating maternal mortality. During the 1970s, abortion began to be linked to infertility, often in simplistic cause-and-effect terms. Simultaneously, opposition to abortion based on the idea of defense of the nation and fetal "life," surfaced in expert discourse.

'A disastrous blow': psychiatric risk, social indicators and medical authority in abortion reform in post-war Britain

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.

Dr. Bernard Nathanson: A story of metanoia

Bernard A. Nathanson (1926-2011), was a professionally well-recognized and successful New York obstetrician and gynecologist. An avowed atheist as a young man through his middle age, Nathanson was a co-founder of the National Association for the Repeal of Abortion Laws, whose activities are credited with hastening the liberalization of abortion law in New York State. Intent on increasing the accessibility and promoting the acceptance of abortion on demand, Dr. Nathanson taught and published journal articles on the operative techniques and on the results from large numbers of these procures. During his tenure as director of the largest abortion clinic in the Western World, Nathanson presided over 60,000 abortions, and he performed more than 1,500 in his own practice. His studies of embryology and evidence from emerging technologies to monitor and examine intrauterine fetal development led Nathanson to question the morality of voluntarily interrupting pregnancy, thence to rejecting abortion procedures from his own clinical practice altogether, and eventually to become involved in anti-abortion, pro-life activities. An influential writer, speaker and film maker, these experiences and witnessing the love and prayer of other pro-life supporters turned Nathanson to notions of God, and finally reading and personal prayer guided him from secular atheism to Christianity.

[[Getting Free from One's Own Nature? An Insight on Abortion as a Constitutional Issue].]

The right to abortion was the forerunner of a new idea of liberty, the liberty from gender roles which 'naturalize' oppressive social constructs. In Italy, in the Seventies of the 20th Century, some feminist opinions objected, in the name offemale liberty, to the battle for the right to abortion and against gender roles. This, they .argued, could cost women to disclaim their sex as a resource for self-identification and social change. Actually, forty years after its legalisation, abortion remains controversial, nor tells it much about female liberty. As a matter of fact, it did not create a principle of liberty in reproductive choices, and it is regarded as an unwanted and embarassing relative by supporters of LGTB's rights. Does this reveal that there is something flawed in the idea offreedom on which the right to abortion is built?

[[The Obstacles to the Application of the Law 194].]

Law 194 was introduced in Italy in 1978, following a campaign by women's groups, but alsofollowing the rise in illegal abortions and related deaths; after quite 40 years, we are now assisting to the dangerous return to illegality, related with the obstacles to the application of the law. The main causes of this phenomena are: the conscientious objection, the non- compliance of the law and the providers' "burn-out". The law permits to medical and non medical personnel to refuse to carry out abortions on conscientious groumds, but this right is greatly abused, with harmfil consequences on women's health. Another huge obstacle is represented by the non-compliance of the law: the hospital's "objection", the scarce accessibility to medical abortion, the lack of scientific, practical and ethic formation of the providers. The provider's "burn-out" is the last obstacle, a hidden but not secondary factor. A new, really non religious thought, becomes thus a necessity for our life and for women's health.

[[Abortion: An Unforgivable Sin?].]

Abortion has become something to hide, something you can't tell other people, something you have to expiate forever. Besides, abortion is more and more difficult to achieve because of the raising average of consciencious objection (from 70 to 90% of health care providers are conscientious objectors, 2014 data, Ministero della Salute) and illegal abortion is "coming back"from the 70s, when abortion was a crime (Italian law n. 194/1978). Abortion is often blamed as a murder, an unforgivenable sin, even as genocide. Silence against shouting "killers!" to women who are going to have an abortion: this is a common actual scenario. Why is it so difficult to discuss and even to mention abortion?

[[ABORTION BETWEEN CRIME AND CARE (ITALY, 1889-1943)].]

Perception of guilt and remorse is tied to the complicated question of what is an abortion. There is no doubt that abortion practices have had a long and complex history. Abortion is, in fact, a 'mobile' category, whose definition and identification depends on several factors and is related to the context and - not least - the complex question of identifying the actual voluntariness of the act. The frequency of spontaneous abortions, due to -excessive force or working conditions, and the inevitability of the appeal to the interruption of pregnancy in the absence of other means of fertility control methods, allowed a widespread lack of guilt, testified also by language even in the mid-twenties, when the fascist regime begins to structure a policy that culminates, during the thirties, in unprecedented emphasis on the role and the female body in an exclusively procreative function and configuration of maternity as a patriotic duty particularly enshrined in the new Penal code of 1930.

Abortion Liberalization in World Society, 1960-2009

Controversy sets abortion apart from other issues studied by world society theorists, who consider the tendency for policies institutionalized at the global level to diffuse across very different countries. The authors conduct an event history analysis of the spread (however limited) of abortion liberalization policies from 1960 to 2009. After identifying three dominant frames (a women's rights frame, a medical frame, and a religious, natural family frame), the authors find that indicators of a scientific, medical frame show consistent association with liberalization of policies specifying acceptable grounds for abortion. Women's leadership roles have a stronger and more consistent liberalizing effect than do countries' links to a global women's rights discourse. Somewhat different patterns emerge around the likelihood of adopting an additional policy, controlling for first policy adoption. Even as support for women's autonomy has grown globally, with respect to abortion liberalization, persistent, powerful frames compete at the global level, preventing robust policy diffusion.

Abortion in Iranian legal system: a review

Abortion traditionally means, "to miscarry" and is still known as a problem which societies has been trying to reduce its rate by using legal means. Despite the pregnant women and fetuses have being historically supported; abortion was firstly criminalized in 1926 in Iran, 20 years after establishment of modern legal system. During next 53 years this situation changed dramatically, so in 1979, the time of Islamic Revolution, aborting fetuses before 12 weeks and therapeutic abortion (TA) during all the pregnancy length was legitimate, based on regulations that used medical justification. After 1979 the situation changed into a totally conservative and restrictive approach and new Islamic concepts as "Blood Money" and "Ensoulment" entered the legal debates around abortion. During the next 33 years, again a trend of decriminalization for the act of abortion has been continuing. Reduction of punishments and omitting retaliation for criminal abortions, recognizing fetal and maternal medical indications including some immunologic problems as legitimate reasons for aborting fetuses before 4 months and omitting the fathers' consent as a necessary condition for TA are among these changes. The start point for this decriminalization process was public and professional need, which was responded by religious government, firstly by issuing juristic rulings (Fatwas) as a non-official way, followed by ratification of "Therapeutic Abortion Act" (TAA) and other regulations as an official pathway. Here, we have reviewed this trend of decriminalization, the role of public and professional request in initiating such process and the rule-based language of TAA.

Effects of abortion legalization in Nepal, 2001-2010

Background

Abortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion.

Methods

We conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010).

Results

23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75).

Conclusion

Over the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance of concerted efforts to improve access. Other countries contemplating changes to abortion policy can draw on the evidence and implementation strategies observed in Nepal.

Living through some giant change: the establishment of abortion services

This article traces the establishment of abortion clinics following Roe v Wade. Abortion clinics followed one of two models: (1) a medical model in which physicians emphasized the delivery of high quality medical services, contrasting their clinics with the back-alley abortion services that had sent many women to hospital emergency rooms prior to legalization, or (2) a feminist model in which clinics emphasized education and the dissemination of information to empower women patients and change the structure of women's health care. Male physicians and feminists came together in the newly established abortion services and argued over the priorities and characteristics of health care delivery. A broad range of clinics emerged, from feminist clinics to medical offices run by traditional male physicians to for-profit clinics. The establishment of the National Abortion Federation in the mid-1970s created a national forum of health professionals and contributed to the broadening of the discussion and the adoption of compromises as both feminists and physicians influenced each other's practices.

An investigation into the ancient abortion laws: comparing ancient Persia with ancient Greece and Rome

Since the dawn of medicine, medical rights and ethics have always been one of mankind's concerns. In any civilisation, attention paid to medical laws and ethics depends on the progress of human values and the advancement of medical science. The history of various civilisations teaches that each had its own views on medical ethics, but most had something in common. Ancient civilisations such as Greece, Rome, or Assyria did not consider the foetus to be alive and therefore to have human rights. In contrast, ancient Persians valued the foetus as a living person equal to others. Accordingly, they brought laws against abortion, even in cases of sexual abuse. Furthermore, abortion was considered to be a murder and punishments were meted out to the mother, father, and the person performing it.

"He is still unwanted": women's assertions of authority over abortion in letters to the Royal Commission on the Status of Women in Canada

Throughout the 1960s, the public abortion debate was dominated by men. While women's voices were not absent, they are harder to locate. This article highlights one forum in which women eloquently expressed their feelings about abortion. In submissions to the Royal Commission on the Status of Women in Canada, women demonstrated their "right" to speak on the issue in many ways, including by sharing their experiences as mothers or with unplanned and unwanted pregnancies; referencing their professional lives, especially in care giving fields; and drawing moral authority from or opposing religious beliefs. This article analyzes women's efforts to convey their authority to speak to the legality of abortion, highlighting a component of the 1960s abortion law reform discussion often overlooked.

"Lonely, tragic, but legally necessary pilgrimages": transnational abortion travel in the 1970s

This article explores the work of the Calgary Birth Control Association with a particular focus on their referral service to help Albertan women obtain abortions in Seattle. The fact that Canadian women were travelling to the United States for abortions highlights the shortcomings of the Canadian health-care system and the legal changes in the 1969 omnibus bill. Cross-border travel is also compelling evidence for the argument that reproductive rights are an international issue. More particularly, this study demonstrates the tensions that reproductive-rights activists faced in addressing the needs of individual women vs the long-term objective of changing the laws and improving accessibility.

[Abortion and crime]

In this article we address the issue, with a tentative empirical application to the Italian data, of the relationship, very debated mainly in north America, between abortion legalization and reduction of crime rates of youth. The rationale of this relationship is that there is a causal factor at work: the more unwanted pregnancies aborted, the less unwanted children breeding their criminal attitude in an hostile/deprived family environment. Many methodological and empirical criticisms have been raised against the proof of the existence of such a relationship: our attempt to test if this link is valid for Italy cannot endorse its existence. The data we used made necessary some assumptions and the reliability of official estimates of crime rates was debatable (probably downward biased). We conclude that, at least for Italy, the suggested relationship is unproven: other reasons for the need of legal abortion have been and should be put forward.

Designs of devices: the vacuum aspirator and American abortion technology

In 1965, 71% of legal abortions in the United States were performed using the surgical procedure of dilation and curettage. By 1972, a mere seven years later, approximately the same percentage (72.6%) of legal abortions in the United States were performed using a completely new abortion technology: the electrical vacuum aspirator. This article examines why, in less than a decade, electric vacuum suction became American physicians' abortion technology of choice. It focuses on factors such as political and professional feasibility (the technology was able to complement the decriminalization of abortion in the US, and the interests, abilities, commitments, and personal beliefs of physicians); clinical compatibility (it met physician/patient criteria such as safety, simplicity and effectiveness); and economic viability (it was able to adapt to market factors such as production, cost, supply/demand, availability, and distribution).

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.

Forty years on

Since the Abortion Act was passed 40 years ago, great advances have been made, and many women now have early, chemically induced terminations. Nurses have always been involved but their role is likely to expand.

"A fifth freedom" or "hideous atheistic expediency"? The medical community and abortion law reform in Scotland, c.1960-1975

The purpose of the Medical Termination of Pregnancy Bill, published on 15 June 1966, was to amend and clarify the law relating to termination of pregnancy by a registered medical practitioner. When David Steel, a young Liberal MP from the Scottish Borders, put this bill forward, some suggested that a Scottish politician had no need to introduce abortion reform since Scots law was already satisfactory in this regard. Certainly, abortion law in Scotland was more flexible than its English counterpart, and the number of prosecutions few. The line between criminal and non-criminal abortion was, however, just as indistinct, with great medical uncertainty in this area. On becoming law, the 1967 Abortion Act was the first piece of abortion-related legislation to cover Scotland, England and Wales collectively. None the less, for a variety of legal and moral reasons, abortion policy and practice continued to differ on either side of the Border.

Back to the future of abortion law: Roe's rejection of America's history and traditions

In Roe v. Wade much of Justice Blackmun's judgment was devoted to the history of abortion in Anglo-American law. He concluded that a constitutional right to abortion was consistent with that history. In Webster v. Reproductive Health Services, 281 American historians signed an amicus brief which claimed that Roe was consistent with the nation's history and traditions. This article respectfully questions Justice Blackmun's conclusion and the historians' claim.

[Eugenic indication for abortion--a historical background]

BACKGROUND

Modern discussions on fetal diagnostics and abortion frequently leave the impression that the eugenic clause in the Norwegian abortion act is a heritage from the eugenics movement in the 1930s. However, although much has been written on this, few have systematically pursued the historical development of the eugenic clause.

MATERIAL AND METHODS

The article describes the development of Norwegian abortion legislation in general, and the eugenic clause in particular, from the discussions in the 1930s, through the Nazi abortion law during the German occupation (which is relatively unknown in the historiographic literature), and to the legislation that was finally passed after the war. The sources are primarily official documents (committee reports, drafts for legislation, debates in parliament) as well as discussions in the Journal of the Norwegian Medical Association. Various proposals are discussed according to two criteria: a) the role hereditary arguments played in the formulation of a eugenic clause; and b) the extent to which such a clause is justified by social, as opposed to individual, concerns.

RESULTS AND INTERPRETATION

Although social concerns every now and then figure in justifications for the eugenic clause, the lack of eugenic argumentation in Norwegian abortion debates until 1960 is striking. There are traces of a clear eugenic or racial hygienic approach in the 1930s, but this thinking was left dead by the abortion act instituted by the Nazi regime.

Uneasy allies: pro-choice physicians, feminist health activists and the struggle for abortion rights

Abortion represents a particularly interesting subject for a social movements analysis of healthcare issues because of the involvement of both feminist pro-choice activists and a segment of the medical profession. Although both groups have long shared the same general goal of legal abortion, the alliance has over time been an uneasy one, and in many ways a contradictory one. This paper traces points of convergence as well as points of contention between the two groups, specifically: highlighting the tensions between the feminist view of abortion as a women-centred service, with a limited, 'technical' role for the physicians, and the abortion-providing physicians' logic of further medicalization/professional upgrading of abortion services as a response to the longstanding marginality and stigmatisation of abortion providers. Only by noting the evolving relationships between these two crucial sets of actors can one fully understand the contemporary abortion rights movement. We conclude by speculating about similar patterns in medical/lay relationships in other health social movements where 'dissident doctors' and lay activists are similarly seeking recognition for medical services that are controversial.

Embryonic discourse: abortion, stem cells and cloning

This Article interprets the debate about abortion and the debate about embryonic research and therapeutic cloning as aspects of a larger history of ideas. The Article suggests that embryos increasingly stand for different truths in discourse about abortion on the one-hand and about embryonic stem cell research and therapeutic cloning on the other. More specifically, the Article suggests that the contemporary debate about the meaning of the embryo in the context both of abortion and of embryonic research bespeaks a widespread transformation in Western, and especially American, society during the last three or four decades. At base, that transformation involves displacement of an understanding of personhood, particularly in domestic settings that depended on the submersion of individualism with an understanding of personhood that values autonomous individuality and that envisions community as the consequence of individuals' distinct choices rather than as a pre-existing, hierarchically structured whole.

A time to regulate? Possible implications of European human rights law on abortion in Northern Ireland

Since the introduction of the Abortion Act 1967 the legality and status of abortion in Northern Ireland, being excluded from the provisions of the 1967 Act, has remained shrouded in uncertainty. In light of the introduction of the Human Rights Act 1998, this article will explore whether this inconsistency in the UK is in breach of the provisions laid down in Articles 8 and 14. It will be shown that while compelling arguments can be built under these provisions, perhaps the most persuasive arguments in favour of law reform are the inequities that the current legal regime has perpetuated.

The American College of Obstetricians and Gynecologists and the evolution of abortion policy, 1951-1973: the politics of science

The autonomy granted to physicians is based on the claim that their decisions are grounded in scientific principles. But a case study of the evolution of the American College of Obstetricians and Gynecologists' abortion policy between 1951 and 1973 shows that decisions were only secondarily determined by science. The principal determinant was the need to preserve physician autonomy over the organization and delivery of services. As a result, the organization representing physicians who specialized in women's reproductive health was marginal to the struggle for legalized abortion. But, the profession was central to decisions about whether physicians would perform abortions and how they would be done. This case study finding has implications for understanding the role that organized medicine might take in the ongoing debates about national health policy.