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.

Resgate histórico do primeiro programa público de interrupção da gestação por estupro no Brasil / Historical rescue of the first public rape pregnancy program in Brazil

Os autores apresentam a evolução histórica dos caminhos percorridos até a criação do primeiro programa público de interrupção legal da gestação no Brasil. Mencionam o atendimento antes desse programa, que era realizado por poucos, de maneira dissimulada e sem publicidade nem publicações para a preservação das equipes. Mencionam como o Hospital Municipal Dr. Arthur Ribeiro de Saboya foi escolhido para esse desafio. Resgatam a luta das mulheres e dos movimentos feministas, e a criação da portaria que determinava a obrigatoriedade do atendimento para a realização do abortamento legal nos casos de antijuricidade, pela Prefeitura Municipal de São Paulo. Mencionam os difíceis caminhos até a constituição das equipes de atendimento e o desenrolar de uma sequência de fatos históricos, passando pelo início do atendimento imediato às vítimas no sentido de realizar as profilaxias pertinentes, a utilização de aspiração manual intrauterina (AMIU) como técnica principal para atendimento ao abortamento em todas as suas situações, os Fóruns Nacionais de Aborto Legal realizados pelo Cemicamp, Ministério da Saúde e Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), entre outros, que culminaram com tudo o que temos hoje em termos de atendimento integral à saúde da mulher, mormente no que tange aos direitos sexuais e reprodutivos, à violência sexual e à interrupção legal da gestação.(AU)

The authors present the historical evolution of the paths traveled until the creation of the First Public Program for Legal Interruption of Pregnancy in Brazil. They mention the care before this program that was carried out by a few, in a covert way and without advertisements or publications for the preservation of the team. Mention as the Municipal Hospital Dr. Arthur Ribeiro de Saboya was chosen for this challenge. They rescued the struggle of women and feminist movements, the creation of the ordinance that determined the mandatory care for the performance of legal abortion in cases of anti-juristy, by the city of São Paulo. They mention the difficult paths to the constitution of care teams and the development of a sequence of historical facts, through the beginning of immediate care to victims in order to perform the relevant prophylaxis, in the use of the AMIU as the main technique for abortion care in all its situations, the National Legal Abortion Forums held by Cemicamp, Ministry of Health and Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), among others, which culminated in all that we have today in terms of comprehensive care for women's health, especially with regard to sexual and reproductive rights, sexual violence and legal interruption of pregnancy.(AU)

'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.

En Argentina, durante 2018 el aborto salió del armario pero no de la clandestinidad / In Argentina, during 2018 abortion came out of the closet but not from hiding

La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)

The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)

[Abortion law in France]. / Interruption volontaire de grossesse : le cadre juridique français.

The French law of 17 January 1975 relative to abortion, called Veil law decriminalized abortion. Since intervened many legislative changes that now allow completion of the surgical or medical abortion. This text provides an update on legislative developments and case law for practice.

Implementation of the risk and harm reduction strategy against unsafe abortion in Uruguay: From a university hospital to the entire country.

The history of the creation of the risk and harm reduction model applied to unsafe abortion is reviewed, from its initial implementation by a small group of gynecologists at the Pereira Rossell Hospital Center in Uruguay to its spread to the rest of the country. Its ethical rationale, its successful application in the hospital, the decision to disseminate it with the cooperation of the International Federation of Gynecology and Obstetrics (FIGO), and the intervention procedures are explained. It was evaluated from the epidemiological and anthropological viewpoints, from the changes in professionals' and users' perception of the care offered and its impact on complications and maternal deaths. A very favorable change was seen in the number and quality of the services, the providers' attitude, and maternal morbidity and mortality were reduced. It also brought visibility to women with unplanned and unwanted pregnancies and an improved understanding of their problems, which contributed to the legislative changes that were made subsequently.

[[Abortion: An Unforgivable Sin?].] / Aborto: Un Peccato Imperdonabile?

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)].] / "Io Non Dovevo Avere Nessun Rimorso". Il Procurato Aborto Tra Reato e Cura (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.

[[The Obstacles to the Application of the Law 194].] / Gli Ostacoli All'Applicazione Della Legge 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.

[[Getting Free from One's Own Nature? An Insight on Abortion as a Constitutional Issue].] / Aborto: L'Ambigua Liberazione Dalla "Natura".

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?

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 law reform in Nepal.

Across four decades of political and social action, Nepal changed from a country strongly enforcing oppressive abortion restrictions, causing many poor women's long imprisonment and high rates of abortion-related maternal mortality, into a modern democracy with a liberal abortion law. The medical and public health communities supported women's rights activists in invoking legal principles of equality and non-discrimination as a basis for change. Legislative reform of the criminal ban in 2002 and the adoption of an Interim Constitution recognizing women's reproductive rights as fundamental rights in 2007 inspired the Supreme Court in 2009 to rule that denial of women's access to abortion services because of poverty violated their constitutional rights. The government must now provide services under criteria for access without charge, and services must be decentralized to promote equitable access. A strong legal foundation now exists for progress in social justice to broaden abortion access and reduce abortion stigma.

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.

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.

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.