Kirti Singh states that dowry is widely considered to be both a cause and a consequence of son preference, and this may lead to girls being unwanted, sex selective abortion,  female infanticide  or abuse of female children. [ 144 ]


The  dowry system in India  is a major part of  Indian culture  and refers to the durable goods, cash, and real or movable property that the bride's family gives to the bridegroom, his parents, or his relatives as a condition of the marriage. [ 145 ]  Dowry consists of a payment in cash or some kind of gifts given to the bridegroom's family along with the bride and includes cash, jewelry, electrical appliances, furniture, bedding, crockery, utensils and other household items that help the newlyweds set up their home. [ 146 ]  Disputes regarding dowry sometimes lead to  dowry deaths .


The  Trivers–Willard hypothesis  argues that resource availability affects male  reproductive success  more than female and that, consequently, parents should prefer males when resources are plentiful and females when resources are scarce. This has been applied to resource differences between individuals in a society and also to resource differences between societies. Empirical evidence is mixed, with higher support in better studies, according to Cronk in a 2007 review. One example: in a 1997 study of a group with a preference for females was  Romani  in  Hungary , a low-status group. They "had a female-biased sex ratio at birth, were more likely to abort a fetus after having had one or more daughters, nursed their daughters longer, and sent their daughters to school for longer." [ 147 ]


Following the 1949 creation of the People's Republic of China, the issue of population control came into the national spotlight. In the early years of the Republic, leaders believed that telling citizens to reduce their fertility was enough, repealing laws banning  contraception  and instead promoting its use. However, the contraceptives were not widely available, both because of lack of supply and because of cultural taboo against discussing sex. Efforts were slowed following the famine of 1959–61 but were resumed shortly thereafter with virtually the same results. Then, in 1964, the Family Planning Office was established to enforce stricter guidelines regarding fertility and it was moderately successful. [ 148 ]


In 1979, the government adopted the  One-Child Policy , which limited many families to one child, unless specified by provincial regulations. It was instituted as an attempt to boost the Chinese economy. Under it, families who break rules regarding the number of children they are allowed are given various punishments (primarily monetary), dependent upon the province in which they live. [ 149 ]


As stated above, the sex ratios of a province are largely determined by the type of restriction placed upon the family, pointing to the conclusion that much of the imbalance in sex ratio in China can be attributed to the policy. Research by Junhong (2001) found that many parents are willing to pay to ensure that their child is male (especially if their first child is female), but will not do the same to ensure their child is female. [ 15 ]  Likely, fear of the harsh monetary punishments of the One-Child Policy make ensuring a son's birth a smart investment. Therefore, son's cultural and economic importance to families and the large expenses associated with multiple children are primary factors leading to China's disparate sex ratio.


In 2013, China announced plans to formally change the One-Child policy, making it less stringent. The National People's Congress has changed the policy to allow couples to have two children, so long as one of the partners is an only child. This change was not sparked by sex ratios, but rather by an aging population that is causing the workforce to become increasingly smaller. It is estimated that this new law will lead to two million more births per year and could cause a baby boom in China. In 2015, China officially relaxed its one child law. [ 150 ]  Unfortunately, many of China's social problems are based on overpopulation. So, it is unclear if this new law will actually lead to women being more valued in Chinese society as the number of citizens increases. [ 151 ]


The idea of "missing women" was first suggested by Amartya Sen, one of the first scholars to study high sex ratios and their causes globally, in 1990. In order to illustrate the gravity of the situation, he calculated the number of women that were not alive because of sex-selective abortion or discriminatory practices. He found that there were 11 percent fewer women than there "should" have been, if China had the natural sex ratio. This figure, when combined with statistics from around the world, led to a finding of over 100 million missing women. In other words, by the early 1990s, the number of missing women was "larger than the combined casualties of all famines in the twentieth century" (Sen 1990). [ 19 ]


This has led to particular concern due to a critical shortage of wives. In some rural areas, there is already a shortage of women, which is tied to migration into urban areas (Park and Cho 1995). [ 152 ]  In  South Korea  and  Taiwan , high male sex ratios and declining birth rates over several decades have led to cross-cultural marriage between local men and foreign women from countries such as mainland China, Vietnam and the Philippines. [ 153 ]  However, sex-selective abortion is not the only cause of this phenomenon; it is also related to migration and declining fertility. [ 152 ]


Some scholars argue that as the proportion of women to men decreases globally, there will be an increase in  trafficking  and sex work (both forced and self-elected), as many men will be willing to do more to obtain a sexual partner (Junhong 2001). [ 15 ]  Already, there are reports of women from  Vietnam ,  Myanmar , and  North Korea  systematically trafficked to mainland  China  and  Taiwan  and sold into  forced marriages . [ 154 ]  Moreover, Ullman and Fidell (1989) suggested that pornography and sex-related crimes of violence (i.e., rape and molestation) would also increase with an increasing sex ratio. [ 155 ]


As Park and Cho (1995) note, families in areas with high sex ratios that have mostly sons tend to be smaller than those with mostly daughters (because the families with mostly sons appear to have used sex-selective techniques to achieve their "ideal" composition). [ 152 ]  Particularly in poor areas, large families tend to have more problems with resource allocation, with daughters often receiving fewer resources than sons. [ 152 ]  Blake (1989) is credited for noting the relationship between family size and childhood "quality." Therefore, if families with daughters continue to be predominantly large, it is likely that the social gap between genders will widen due to traditional cultural discrimination and lack of resource availability. [ 156 ]


Guttentag and Secord (1983) hypothesized that when the proportion of males throughout the world is greater, there is likely to be more violence and war. [ 157 ]


Some scholars believe that when sex ratios are high, women actually become valued more because of their relative shortage. [ 152 ]  Park and Cho (1995) suggest that as women become more scarce, they may have "increased value for conjugal and reproductive functions" (75). Eventually, this could lead to better social conditions, followed by the birth of more women and sex ratios moving back to natural levels. [ 152 ]  This claim is supported by the work of demographer Nathan Keifitz. Keifitz (1983) wrote that as women become fewer, their relative position in society will increase. However, to date, no data has supported this claim. [ 158 ]


It has been suggested by Belanger (2002) that sex-selective abortion may have positive effects on the mother choosing to abort the female fetus. This is related to the historical duty of mothers to produce a son in order to carry on the family name. As previously mentioned, women gain status in society when they have a male child, but not when they have a female child. Oftentimes, bearing of a son leads to greater legitimacy and agency for the mother. In some regions of the world where son preference is especially strong, sonless women are treated as outcasts. In this way, sex-selective abortion is a way for women to select for male fetuses, helping secure greater family status. [ 159 ]


Goodkind (1999) [ 1 ]  argues that sex-selective abortion should not be banned purely because of its discriminatory nature. Instead, he argues, we must consider the overall lifetime possibilities of discrimination. In fact, it is possible that sex-selective abortion takes away much of the discrimination women would face later in life. Since families have the option of selecting for the fetal sex they desire, if they choose not to abort a female fetus, she is more likely to be valued later in life. In this way, sex-selective abortion may be a more humane alternative to infanticide, abandonment, or neglect. Goodkind (1999) poses an essential philosophical question, "if a ban were enacted against prenatal sex testing (or the use of abortion for sex-selective purposes), how many excess postnatal deaths would a society be willing to tolerate in lieu of whatever sex-selective abortions were avoided?"


There are many controversies surrounding sex-selective abortion. Just like the practice of sex-selective abortion has been criticized, the solutions proposed or enacted by governments have also been criticized. [ 160 ] [ 161 ]  Eklund & Purewal argued that the response to a patriarchal practice (sex selection) should not be another patriarchal practice (restricting women's reproductive rights), as such a situation creates a cycle: women's social status is lowered, which in turn leads to more sex-selective abortions. [ 161 ]  The association of public discourse on sex-selective abortion with the  anti-abortion movement  also complicates the situation. [ 162 ]  Furthermore, access to safe abortion is seen by some as important from a  public health  perspective; in India, although the abortion law is relatively liberal, most efforts are put into preventing sex-selective abortion, rather than adequate access to safe abortion, [ 161 ]  as a result nearly 78% of all abortions in India take place outside of health facilities, with such  unsafe abortions  representing the third largest cause of maternal death in India. [ 163 ]  Another controversy in that of  population planning  campaigns such as the  one child policy  in China, and efforts from the governments of several Asian countries, including India and South Korea, from the 1970s onward to limit the number of children a family could have, which have intensified the desire to quickly have a son. An article by  Al Jazeera  titled " How Western family planners helped curb the birth of girls in developing countries, the effects of which are felt today " claimed that it was such population policies (which included  forced sterilization ), which were fully supported, even pushed by the West, that contributed to unbalanced sex ratios. [ 164 ] [ 165 ]


MacPherson estimates that 100,000 sex-selective abortions every year continue to be performed in India. [ 99 ]  For a contrasting perspective, in the United States with a population  1 ⁄ 4 th of India, over 1.2 million abortions every year were performed between 1990 and 2007. [ 166 ]  In  England and Wales  with a population  1 ⁄ 20 th of India, over 189,000 abortions were performed in 2011, or a yearly rate of 17.5 abortions per 1,000 women aged 15–44. [ 167 ]  The average for the  European Union  was 30 abortions per year per 1,000 women. [ 168 ]


Many scholars have noted the difficulty in reconciling the discriminatory nature of sex-selective abortion with the right of women to have control over their own bodies. This conflict manifests itself primarily when discussing laws about sex-selective abortion. Weiss (1995:205) writes: "The most obvious challenge sex-selective abortion represents for  pro-choice  feminists is the difficulty of reconciling a pro-choice position with moral objections one might have to sex selective abortion (especially since it has been used primarily on female fetuses), much less the advocacy of a law banning sex-selective abortion." [ 169 ]
As a result, arguments both for and against sex-selective abortion are typically highly reflective of one's own personal beliefs about abortion in general. Warren (1985:104) argues that there is a difference between acting within one's rights and acting upon the most morally sound choice, implying that sex-selective abortion might be within rights but not morally sound. Warren also notes that, if we are to ever reverse the trend of sex-selective abortion and high sex ratios, we must work to change the patriarchy-based society which breeds the strong son preference. [ 170 ]


Laws against sex-selective abortion, especially those that exist in some  U.S. states , are controversial, because it is not clear how they can be enforced, and  pro-choice  activists argue that such laws are brought by  anti-abortion movement  forces who are using this as a  pretext  to restrict women's access to safe and legal abortion and to harass doctors who perform abortions:  NARAL  states that "For many years, anti-choice lawmakers have tried to ban abortion using every possible reason and excuse –including, now, on the grounds of purported concern about race or sex selection." [ 171 ]  There is concern that such bans may put women who seek sex-selective abortions in danger because they may seek unsafe abortions, and that these bans do not address the root cause of sex-selective abortion, including the pregnant women's fear that they or their future daughters will suffer abuse, violence and stigmatization. [ 160 ]


The practice of prenatal sex selection has been condemned internationally. It is often seen as a result of discriminatory social views which consider females inferior to males. In 1994 over 180 states signed the Programme of Action of the  International Conference on Population and Development , agreeing to "eliminate all forms of discrimination against the girl child". [ 172 ]  In 2011 the resolution of  PACE 's Committee on Equal Opportunities for Women and Men condemned the practice of prenatal sex selection. [ 173 ]


Many nations have attempted to address sex-selective abortion rates through a combination of media campaigns and policy initiatives.


In Canada, a group of MPs led by  Mark Warawa  are working on having the  Parliament  pass a resolution condemning sex-selective pregnancy termination. [ 174 ] [ 175 ]


The  United States Congress  has debated legislation that would outlaw the practice. [ 176 ]  The legislation ultimately failed to pass in the  House of Representatives . [ 177 ]


On the state level, laws against sex-selective abortions have been passed in a number of U.S. states; [ 178 ]  the law passed in  Arizona  in 2011 prohibits both sex-selective and race-selective abortion. [ 178 ] [ 179 ] [ 180 ]


The law on sex-selective abortion is unresolved in the United Kingdom. In order for an abortion to be legal, doctors need to show that continuing the pregnancy could threaten the physical or mental health of the mother. In a recent case, two doctors were caught on camera offering a sex-selective abortion but the Director of Public Prosecution deemed it not in the public interest to proceed with the prosecution. [ 181 ]  Following this incidence, MPs voted 181 to 1 for a Bill put forward by  Tessa Munt  and 11 other MPs aiming to end confusion about the legality of this practice. [ 182 ] [ 183 ]  Organisations such as  BPAS  and  Abortion Rights  have been lobbying for the decriminalisation of sex-selective abortions. [ 184 ] [ 185 ]


China's government has increasingly recognized its role in a reduction of the national sex ratio. As a result, since 2005, it has sponsored a "boys and girls are equal campaign." [ 186 ]  For example, in 2000, the Chinese government began the "Care for Girls" Initiative. [ 187 ] [ better source needed ]  Furthermore, several levels of government have been modified to protect the "political, economic, cultural, and social" rights of women. [ 186 ]  Finally, the Chinese government has enacted policies and interventions to help reduce the sex ratio at birth. In 2005, sex-selective abortion was made illegal in China. This came in response to the ever-increasing sex ratio and a desire to try to detract from it and reach a more normal ratio. [ 188 ]  The sex ratio among firstborn children in urban areas from 2000 to 2005 did not rise at all, so there is hope that this movement is taking hold across the nation. [ 15 ]


UNICEF and UNFPA have partnered with the Chinese government and grassroots-level women's groups such as All China Women's Federation to promote gender equality in policy and practice, as well engage various social campaigns to help lower birth sex ratio and to reduce excess female child mortality rates. [ 189 ] [ 190 ]


In India, according to a 2007 study by MacPherson, Prenatal Diagnostic Techniques Act (PCPNDT Act) was highly publicized by NGOs and the government. Many of the ads used depicted abortion as violent, creating fear of abortion itself within the population. The ads focused on the religious and moral shame associated with abortion. MacPherson claims this media campaign was not effective because some perceived this as an attack on their character, leading to many becoming closed off, rather than opening a dialogue about the issue. [ 99 ]  This emphasis on morality, claims MacPherson, increased fear and shame associated with all abortions, leading to an increase in unsafe abortions in India. [ 99 ]


The government of India, in a 2011 report, has begun better educating all stakeholders about its MTP and PCPNDT laws. In its communication campaigns, it is clearing up public misconceptions by emphasizing that sex determination is illegal, but abortion is legal for certain medical conditions in India. The government is also supporting implementation of programs and initiatives that seek to reduce gender discrimination, including media campaign to address the underlying social causes of sex selection. [ 90 ] [ 191 ]


Other recent policy initiatives adopted by numerous states of India, claims Guilmoto, [ 126 ]  attempt to address the assumed economic disadvantage of girls by offering support to girls and their parents. These policies provide  conditional cash transfer  and scholarships only available to girls, where payments to a girl and her parents are linked to each stage of her life, such as when she is born, completion of her childhood immunization, her joining school at grade 1, her completing school grades 6, 9 and 12, her marriage past age 21. Some states are offering higher pension benefits to parents who raise one or two girls. Different states of India have been experimenting with various innovations in their girl-driven welfare policies. For example, the state of Delhi adopted a pro-girl policy initiative (locally called  Laadli scheme ), which initial data suggests may be lowering the birth sex ratio in the state. [ 126 ] [ 192 ]


Socialist perspectives on abortion  vary. In  first world  regions such as North America, Europe and Australia, some socialist representatives and activists believe in the legalisation and right to elective  abortion  care [ 1 ]  as a public service, whereas others believe that abortion should be limited or not permitted for a number of reasons. In the  Third World , there are discussions regarding traditionalists,  natalists ,  Malthusians , and economic voices within society regarding whether (and if so, how) abortion should be permitted.


Socialism  influenced a significant number of countries in the 20th century and had long-standing influence on the law of the countries in which it took hold. [ 2 ]


Socialist parties can have diverging perspectives regarding the importance of the issue and where the issue derives from. In particular,  feminist socialists  believe that the oppression of women in society has resulted in restrictions surrounding abortion.  A  Marxist  group, though, may deem abortion as a secondary issue, [ 1 ]  instead focusing more on what it deems primary issues. At times, left-wing governments have restricted abortion due to concerns about the  total fertility rate  of the population being affected by high abortion rates.


Regardless of the diverging views and policies on abortion throughout history in Europe, socialist countries and non-socialist countries approached abortion access [ 3 ]  in a different manner. During the 1970s, there was a stronger socialist presence in Eastern Europe, under communism, and therefore a fertility policy that strongly favoured abortion rights and access. Historically, in Western Europe, many political ideologies have co-existed, and this has created more differences in opinion (and potential conflict) over suggested fertility policies due to the lack of universal approval. [ 3 ]  The  Eastern Bloc  under the Soviet Union restricted debate on the issues involved whereas elsewhere the debate involved many individuals from the health sector, such as physicians and psychologists, [ 4 ]  as well as church representatives, lawyers and economists.


Some people believe the socialist body used abortion regulations to create a more idealistic population, with the intention of strengthening and empowering the state. Elective abortion care was legalised in the  Union of Soviet Socialist Republics  (USSR) in 1955, [ 5 ]  with other Eastern European countries also legalising abortion in the years following, such as Bulgaria, Poland and Hungary. Abortion was legalised in 1920 until this action was reversed in 1936 and was once again prohibited until 1955. Prior to 1955, whilst it was illegal, abortions had still occurred and therefore posed a large threat to a woman's health after being treated by unskilled individuals in unfavourable conditions. The major push for legal abortion in the USSR was majorly driven by medical experts who explained the issue to the public. When observing the documentation during this period of abortion legislation comparative to the documents provided by gynaecologists and psychologists, the same language is present within both, with heavy emphasis on focusing on the collective. It is uncertain whether professionals felt pressured to make recommendations that complied with the USSR ideology, or if legal elective abortion services stemmed from the scientific recommendation. After legalisation, women had to request an abortion and pay a fee to an abortion committee. There was an increasing rate of abortions and a decreasing birth rate, so the government released propaganda and punished any doctor or physician who performed illegal abortions in order to ensure proper procedures were followed. In 1979, women who elected to have an abortion procedure were not given pay during their time off work, and the procedure wasn't paid for by the government. However, if the abortion was for health reasons, the fee was covered by the government and they still received paid leave. Additionally, all abortions required women to have one counselling session by a midwife. [ 6 ]  At this time, 273 abortions occurred per 100 births.


Regulations allowed women to leave work for three weeks following an abortion and receive pay during this absence from work. A woman was allowed an abortion if it was within the first two and a half months of pregnancy. Additionally, it could not be her first born child. A doctor could not refuse an abortion in any other circumstance; however, they could dissuade the patient from undergoing the operation. Although the socialist perspective on abortion allowed access to abortion during this period, there were still doctors opposed to terminating pregnancies. In some instances women were reportedly told that vacant hospital beds were full and could come back in two to three months, forcing them to seek illegal abortion. [ 6 ]  Doctors were more likely to give abortions to women who met criteria. A woman who was poor and had upwards of three children was generally granted an abortion request, and dispatched to the state hospital for the operation. However, a healthy woman with a higher socioeconomic status and one or two children was often persuaded to keep the unborn child. In some cases doctors would request that a woman observed an abortion operated on another female before undergoing one, in order to ensure this was the right decision for her.


A potential ulterior motive for abortion under the socialist state in 1957 was due to their pro-population stance following the war. [ 3 ]  They had the perspective that a woman's body was a resource that needed to be maintained at a high quality for reproduction. In order to ensure quality population growth and reproduction, they wanted to reduce the number of illegal abortions. Illegal abortions had the high possibility of harming a woman's reproductive organs and therefore posed a threat for future pregnancy and repopulation. They also advised minority women to have abortions, as they wanted women to have a minimum of two children in a heterosexual white family. [ 3 ]


In this bill, the commissions were eliminated from the abortion process and women had free access to abortions. This was after the discovery that abortions earlier in the pregnancy posed a lesser  threat to a woman's health comparative to later months. [ 3 ]


Per 100 childbirths, 400 abortion procedures occurred. [ 6 ]  This would assume that the average woman under Soviet control in 1967 would have, on average, nine abortions in her lifetime. The USSR was estimated to have spent $525M on abortion procedures this year. This was 17% of the world spend on fertility control during this period. [ 7 ]


In Armenia, abortion remains legalised upon request up to 12 weeks, after a three-day reflection period. Additionally, it is illegal to perform sex-selective abortions. [ 8 ]


Abortion in state-socialist Czechoslovakia was legalised early comparative to Western Europe. [ 3 ]  Abortion was legalised in 1957 under the Czechoslovak Act on Artificial Termination of Pregnancy. This policy allowed particular commissions, established by the government, the jurisdiction to give a woman access to elective abortion care. These commissions regulated the number of abortions, and were able to analyse the women requesting an abortions. [ 3 ]  Some people believe commissions used this restricted access to information with the purpose of acquiring more power, and approved access to abortion to strengthen the state, rather than ensuring women's health. The commission had the power to grant or deny a woman permission to receive an abortion.


The  state socialist  government collapsed in 1989. The increased access to the pill resulted in a reduction in the number of abortions, following a peak in the number of elective abortion from 1987 to 1992. This period in time had increased access to information on sex and contraception methods. Perspectives towards family orientation diverged from the norm during the state socialist reign. [ 7 ]


Following World War II, abortion was determined by medical judgement and professionalism. This changed in 1949 when communism was in the process of consolidating their power, which criminalised abortion. It was illegal even in circumstances where women provided medical reasons. [ 9 ]  Some people believe this decision was driven by the post war shortage of labour for the workforce. Instead of increasing the birthrate in the long term, the illegal birth rate increased. When abortion became legal in 1956 in Hungary the population struggled to replace itself, which meant that a lot of incentives were created to encourage procreation. After legalisation, there were still measure in place that could potentially limit a woman's ability to access abortion, such as the requirement to see a counsellor, the price of abortion doubled and doctors were allowed to decide whether they actually performed the procedure. [ 9 ]


The  National Abortion Campaign  was developed in the UK following the failure of a private member's bill by  Labour  MP  James White  in 1975 to amend the  1967 Abortion Act . [ 10 ]   During this time the 1967 Abortion Act was under scrutiny as it required two doctors to examine a woman's medical, psychological and social situation. [ 11 ]  The bill required a woman to admit that she was unfit to become a mother in order to receive approval for an abortion. [ 11 ]


The National Abortion Campaign, led by feminists, increased the ability for women to come together, lobbying for legal abortion to be maintained in British law and a woman's right to choose an abortion. [ 11 ]  Many socialist individuals partook in this woman's movement, and campaigned due to its alliance with their socialist beliefs regarding the emancipation of women. During this time, the  women's liberation movement  was growing and campaigning not only for legal abortion, but the economic, psychological and social freedom of women.


A diversity of views on abortion continue to be held within  Labour .  For example, when amendments to propose changes in the term limit (of 24 weeks of gestation) were put forward in Parliament in 2008, 17 Labour MPs voted for a 12-week limit, [ 12 ]  19 MPs for a 16-week limit, [ 13 ]  43 MPs for a 20-week limit, [ 14 ]  and 60 MPs for a 22-week limit. [ 15 ]


The Irish nationalist  Social Democratic and Labour Party  (SDLP) previously had a binding pro-life policy which was changed in 2018 to allow members to vote individually on grounds of conscience. [ 16 ]  The party's policy is that the right to life (including before birth) is the most basic human right and that matters of unwanted pregnancy should be approached with compassion and more support for mothers and the family unit. [ 17 ]


A socialist feminist in the 1970s typically had the choice to follow a Marxism perspective of society, or separate themselves and join the women's movement. [ 1 ]   The issue for a woman aligning herself with a Marxist group during this period, was the presence of male-domination within the group. They deemed woman's issues inferior to other political concerns, and tended to divide labour by gender. Often, abortion was justified by population control; however, socialist feminists believe the access to abortion is a necessity. Feminist socialists focused on overall equality of the sexes, focusing on abortion becoming free to all women free of charge or reason. There were different groups of feminists including separatist feminist, liberal feminist, and socialist feminist.


During the Women's Liberation Movement, the woman believed all voices shall be heard, and were anti-hierarchical, therefore not having a need for one specific leader. There was a large focus on ensuring women gained confidence about their sexuality and psychology, with abortion standing in the way of ownership of their body. Two reasons they believed that women in 1970 were oppressed was due to the economic dependence on men, as well as the sexual objectification of women. [ 18 ]


In  Israel , The left-wing party Meretz argues in favor of legalized abortion for reasons of personal liberty. In 2006, MK Zehava Gal-On of Meretz proposed a bill that would eliminate the termination committees, effectively decriminalizing unrestricted abortion. Gal-On argued that women with financial means can have abortions in private clinics, bypassing the committee and therefore gaining rights based on their wealth. The bill was rejected by a wide margin.


During the government of  Evo Morales , despite opposition by the church, the abortion by social and economic reasons was allowed. [ 19 ]


The abortion in Brazilian politics had never been subject of debate before the 2000s. The opinions about the issue by top names of socialism, like  Miguel Arraes  or  Leonel Brizola  are subject of doubt. While chief of executive of Rio de Janeiro state, Brizola approved a law supporting aid for women who wish to perform limited abortions, but accepted a asking by a bishop, and ask for the Assembly to revoke the law a few weeks later. [ 20 ]   Luiz Inácio Lula da Silva , before the 2010s decade, was against abortion. [ 21 ]   Heloísa Helena  and  Eduardo Campos , were also against abortion. [ 22 ] [ 23 ]
Nowadays, abortion on request is supported by the vast majority of socialists, like  Guilherme Boulos ,  Ciro Gomes ,  Manuela d'Ávila ,  Dilma Rousseff ,  Fernando Haddad  and Lula.


Socialist leader  Sukarno , never supported the abortion on request, preferring to think about a strong population for his country. Only after his deposition, his successor,  Suharto , established a birth control and family planning. [ 24 ]


In  Nicaragua , the  Sandinist  government often declares the children as subject of mothers' responsibility, and supports aiding from state to help these mothers. The Sandinist government, with support of Catholic Church, passed laws banning all forms of abortion, but uses the state to helping and praising women that bears the duty to becoming mothers. These laws and state positions sound controversial among media, because even underage mothers are seem as an example of parental praise. [ 25 ] [ 26 ]


Despite the opposition to abortion by socialist leader,  Julius Nyerere , the country always had a notable doctrine of family planning. [ 27 ]  The government supported the Family Planning Association of Tanzania, although it considers abortion not to be an alternative to contraception, but a termination of pregnancy.


During the socialist  Habib Bourguiba 's government, the country become the first Arab Muslim majority country to legalize abortion on request. [ 28 ]


During the government of socialist president  José Mujica , the country become the second Latino-American country to allows abortion on request. [ 29 ]


Christian socialists and followers of  liberation theology  often describes themselves as pro-life Catholics.  Paulo Freire  and  Óscar Romero  were examples of socialist pro-life Catholics. [ 30 ] [ 31 ]


Abortion in China is legal and generally accessible nationwide. [ 32 ] [ 33 ] [ 34 ] [ 35 ]


A  sooterkin  is a fabled small creature about the size of a mouse that certain women were believed to have been capable of giving birth to. The origin of this initially jocular fantasy lies in the 18th century, and some eminent physicians of the day considered it factual. It is attributed [ 1 ]  to a tendency of Dutch women to frequently sit on stoves or use them under their  petticoats  to keep warm, hence causing the breeding of a small kind of animal that would mature and be born.


The English physician  John Maubray  published a work entitled  The Female Physician , in which he proposed that it was possible for women to give birth to sooterkins. Maubray was an advocate for  maternal impression , a widely held belief that conception and pregnancy could be influenced by what the pregnant mother dreamt of, or saw. [ 2 ]  Maubray warned pregnant women that over-familiarity with household pets could make their children resemble those animals. He was involved in the case of  Mary Toft , who appeared to vindicate his theory by giving birth to rabbits, although the whole affair was eventually exposed for the hoax that it was. [ 3 ]


The eponymous character of EB White's children's novel  Stuart Little  is a sooterkin. [ citation needed ]


This  folklore -related article is a  stub . You can help Wikipedia by  expanding it .


A  termination for medical reasons  ( TFMR ) is an  induced abortion  motivated by  medical indications  involving the fetus or mother. [ 1 ]  In some countries, health risks are the only basis for obtaining a  legal abortion . [ 2 ]   Prenatal screening  can allow early diagnosis, and  abortion  if desired or necessary. [ 3 ]  Some medical organizations advocate the offer of diagnostic testing by  chorionic villi sampling , and  amniocentesis  to all  pregnant women , as a matter of course. [ 3 ]


Screening and diagnostic tests can provide the information needed to make a decision on whether or not to abort. TFMR is one of the least talked about types of pregnancy loss, but is more common than generally realised. [ 4 ]  It is stressful, and the involved people need support during the pregnancy and after its termination. [ 5 ]


A number of factors may influence a person's decision to terminate the pregnancy, including the severity of a condition, and its impact on life expectancy and quality of life.


Medical reasons for inducing or performing an abortion are usually due to concerns about  fetal viability  or disability.  These reasons include  chromosomal  and  genetic abnormalities , [ 6 ]   structural abnormalities , [ 7 ]  and  fetal reduction . [ 8 ]


The medical reasons may also be about the ability of the mother to survive the pregnancy without injury.


During  prenatal care  if a pregnancy is considered to be at high risk for a  genetic disorder ,  prenatal testing  can be undertaken to determine the health of the  embryo  or  fetus . Two such diagnostic tests are  chorionic villus sampling  (CVS) and  amniocentesis . [ 3 ] [ 9 ]


Individual states and countries vary on their restrictions for termination of pregnancy.


In the UK, abortions after 24 weeks' gestational age are only legal to protect the mother's physical or mental health, or if the fetus is "seriously handicapped" due to "physical or mental abnormalities". [ 10 ]   As of 2020 [update] , in the UK, about 1.5% of abortions were due to serious physical or mental disability in the fetus; about half of these were due to  congenital malformation , and a quarter to  chromosomal abnormalities . [ 11 ]   About one in one thousand abortions in the UK involved  late termination of pregnancy  (performed after 24 weeks) due to fetal disability; most abortions involving fetal anomaly are performed earlier in pregnancy. [ 11 ]   Relatively few abortions – 128 out of more than 200,000 abortions in the UK each year – are intended to save the life of the mother or to prevent grave permanent injury to the mother's physical or mental health. [ 11 ]


TFMR has been legal since 1927 in Germany. [ 12 ]   In 1975, West German abortion law changed to permit abortions at any time if there was a serious danger to the mother's health and in case of fetal abnormalities through 22 weeks, in addition to permitting some abortions for non-medical reasons before 12 weeks. [ 12 ]   The law changed again during  German reunification .  In 2013, 4% of legal abortions in Germany were due to either medical reasons or because the pregnancy was the result of a crime, and 96% were for personal or social reasons. [ 12 ]


Pregnancy termination is a stressful experience. In some respects, the aftermath of TFMR is similar to any other type of pregnancy loss, including the need to grieve the lost child. [ 13 ]   Parents commonly experience distress,  depression , and  guilt  for several months afterwards, or even longer. [ 14 ] [ 13 ] [ 2 ]   In TFMR, the concept of abortion as a "choice" does not accurately capture the true complexities of deciding to end a wanted pregnancy. Approximately 72% of parents undergoing TFMR felt that their experience was not the same as other types of baby loss, and that they do not always feel they "fit in" with other types of baby loss support groups because of their specific experience. [ 15 ]


A number of factors may influence the decision to terminate.  Some common reasons are medical, such as the severity of the condition, the life expectancy and quality of life for the affected person, and available treatment options for the condition.  Other common reasons are non-medical, such as personal values and beliefs, financial and employment considerations, the general family situation, including other children, and the availability of social support.


Religious beliefs can influence whether parents accept TFMR if recommended.  Under Jewish laws, abortion to protect the mother's life or health is acceptable, and, to save the mother's life, abortion may be considered a requirement. [ 16 ]   Some Jewish authorities support abortion to protect the mother's mental health. [ 16 ]


When involved in psychotherapy for TFMR, the process may often include cognitive and behavioral approaches aimed at improving thoughts, feelings, and behaviors, to include positive coping strategies. According to Zareba et al. (2018), coping strategies most frequently mentioned in literature are: conversation (with the partner, family, friends, psychologist, physician), internalization of one's feelings, participation in support groups, psychotherapy, seeking information (in the literature, on the Internet, on television), denial and repression, concentrating on one's children, trying to conceive again quickly, seeking spiritual support, waiting, memorializing rituals, going on vacation or holiday with the partner or family. [ 17 ]


TFMR due to expected fetal disability (as opposed to life-threatening medical conditions that could kill the mother or fetus) has been criticized by some in the  disability rights movement . [ 18 ]


In the United Kingdom, a challenge based on  Article 8 of the European Convention on Human Rights  to the provisions in the  Abortion Act 1967  that allowed the late-term abortion of fetuses with  Down syndrome , failed in 2021. [ 19 ]  Attempts have been made to remove the ability to perform late-term abortions for disability reasons through legislation. [ 20 ]


An  unsafe abortion  is the termination of a  pregnancy  by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. [ 1 ]  An unsafe abortion is a life-threatening procedure. It includes  self-induced abortions ,  abortions  in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate  post-abortion attention . [ 2 ]  About 25 million unsafe abortions occur a year, of which most occur in the  developing world . [ 3 ]


Unsafe abortions result in complications for about 7 million women a year. [ 3 ]  Unsafe abortions are also one of the leading causes of  deaths during pregnancy and childbirth  (about 5–13% of all deaths during this period). [ 3 ]  Most unsafe abortions occur where modern  birth control  is unavailable, [ 4 ]  or in  developing countries  where affordable and well-trained medical practitioners are not readily available, [ 5 ] [ 6 ]  or  where abortion is illegal , [ 7 ]  with the more restrictive the law, the higher the rates of death and other complications. [ 8 ]


The  World Health Organization  (WHO) estimated that for the time period of 2010-14 there were 55.7 million abortions worldwide each year. Out of these abortions, approximately 54% were safe, 31% were less safe, and 14% were least safe. That means that 25 million (45%) abortions each year between 2010 and 2014 were unsafe, with 24 million (97%) of these in developing countries. [ 9 ]  In 2003 approximately 42 million pregnancies were voluntarily terminated, of which 20 million were unsafe. [ 10 ]  According to WHO and the  Guttmacher Institute , at least 22,800 [ 11 ]  women die annually as a result of complications of unsafe abortion, and between two million and seven million women each year survive unsafe abortion but sustain long-term damage or disease (incomplete abortion, infection,  sepsis , bleeding, and injury to the internal organs, such as puncturing or tearing of the uterus). They also concluded abortion is safer in countries where it is legal, but dangerous in countries where it is outlawed and performed clandestinely. The WHO reports that in developed regions, nearly all abortions (92%) are safe, whereas in developing countries, more than half (55%) are unsafe.  According to WHO statistics, the risk rate for unsafe abortion is 1/270; according to other sources, unsafe abortion is responsible for at least 8% of maternal deaths. [ 12 ] [ 11 ]  Worldwide, 48% of all induced abortions are unsafe. The  British Medical Bulletin  reported in 2003 that 70,000 women a year die from unsafe abortion. [ 13 ]   Incidence of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation". [ 14 ] [ 15 ]


An article pre-printed by the WHO called safe, legal abortion a " fundamental right  of women, irrespective of where they live" and unsafe abortion a "silent  pandemic ". [ 14 ]  The article states "ending the silent pandemic of unsafe abortion is an urgent  public-health  and  human-rights  imperative." It also states "access to safe abortion improves  women's health , and vice versa, as documented in  Romania  during the regime of President  Nicolae Ceaușescu " and "legalisation of abortion on request is a necessary but insufficient step toward improving women's health" citing that in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. WHO's Global Strategy on Reproductive Health, adopted by the World Health Assembly in May 2004, noted: "As a preventable cause of maternal mortality and morbidity, unsafe abortion must be dealt with as part of the MDG on improving maternal health and other international development goals and targets." [ 16 ]  The WHO's Development and Research Training in Human Reproduction (HRP), whose research concerns people's sexual and reproductive health and lives, [ 17 ]  has an overall strategy to combat unsafe abortion that comprises four interrelated activities: [ 16 ]


A 2007 study published in  The Lancet  found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003. It also concluded that, while the overall incidence of abortion in both developed and developing countries is approximately equal, unsafe abortion occurs more often in less-developed nations. [ 18 ]  The most repressive of laws still apply to over 40% of the world population. If found out, these women may face prosecution, and later incarceration.  [ 19 ]


According to a new study in  The Lancet  that focused on data from 2010 to 2014, nearly 55 million pregnancies are terminated early and of that 55 million, nearly half, 25.5 million are deemed as unsafe. [ 20 ]  The WHO and the Guttmacher Institute stress the need for access to a safe abortion for all women and that unsafe methods must be replaced. Africa, Asia and Latin America account for almost 97 percent of unsafe abortions. These regions are often poorer and underdeveloped and lack the access to safe abortion methods. Out of all abortions in these regions only 25% are considered safe. In developed countries these numbers improve drastically. Nearly all abortions in North America (99%) are considered safe. Overall nearly 88% of abortions in developed countries were actually considered safe, with the number of safe abortions in Europe slightly lower.


Unsafe abortions often occur  where abortion is illegal . [ 7 ]  However, the prevalence of unsafe abortion may also be determined by other factors, such as whether it occurs in a  developing country  that has a low level of competent medical care. [ 6 ]


Unsafe abortions sometimes occur where abortion is legal, and safe abortions sometimes occur where abortion is illegal. [ 21 ]   Legalization is not always followed by elimination of unsafe abortion. [ 5 ] [ 22 ]   Affordable safe services may be unavailable despite legality, and conversely, women may be able to afford medically competent services despite illegality. [ 23 ]


When abortion is illegal, that generally contributes to the prevalence of unsafe abortion, but it is not the only contributor.  In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally. [ 4 ]


Illegality of abortion contributes to  maternal mortality , but that contribution is not as great as it once was, due to medical advances including  penicillin  and the  birth control pill . [ 24 ]


Source: WHO 2006 [ 25 ]


In 1973, the Supreme Court ruled 7–2 that laws prohibiting an abortion violated a woman's right to privacy. The landmark case,  Roe v. Wade , changed abortion in the United States.


Early abortion laws generally only prohibited the use of toxic chemicals that were used to cause a miscarriage. The first such law was passed in Connecticut in 1821. [ 26 ]


Prior to 1973, the authority to legalize abortion rested with the state governments. Up through the 1960s, 44 states had laws that outlawed abortions unless the health of the pregnant patient was at stake. [ 27 ]


In the 1940s, records show that more than 1,000 women died each year from abortions that were labeled as unsafe. Many of these abortions were self-induced. Unsafe abortion practices were such a concern in the United States that nearly every large hospital had some type of "septic abortion ward" that was responsible for dealing with the complications that accompanied an incomplete abortion. Incomplete abortions were the leading cause for OB-GYN services across the United States. In the 1960s, the  National Opinion Research Center  found that hundreds of women were attempting to self-abort with coat hangers, knitting needles and ballpoint pens, and by swallowing toxic chemicals like bleach and laundry detergent. [ 28 ]  However, the number of deaths declined significantly into the 1960s and 1970s. The Centers for Disease Control and Prevention estimates that in 1972, 130,000 women attempted self-induced abortions or obtained illegal abortions, resulting in 39 deaths. [ 29 ]


In 2005, the  Detroit News  reported that a 16-year-old boy, at his pregnant, under-age girlfriend's request, repeatedly beat her abdomen with a bat to abort the fetus. The young couple lived in Michigan and were evading a state law requiring a minor to receive a parent's or a judge's consent to obtain a legal abortion. [ 30 ] [ 31 ] [ 32 ]  In Indiana, where there were also parental consent laws, 17-year-old  Becky Bell  died from an unsafe abortion in 1988 rather than discuss her pregnancy and wish for an abortion with her parents. [ 33 ] [ 34 ]   [ better source needed ]


Methods of unsafe abortion include:


Unsafe abortion is a major cause of injury and death among women worldwide. It is estimated that nearly 25 million unsafe abortions take place annually. [ 9 ]  WHO estimates that at least 7.9% of maternal deaths are due to unsafe abortion, with a greater proportion occurring in Latin America, the Caribbean, and sub-Saharan Africa and a lesser proportion in East Asia where access to abortion is generally legal. [ 40 ]  97% of these abortions take place in  developing countries . [ 41 ]  Unsafe abortion is believed to result in at least 22,800 deaths and millions of injuries annually. [ 41 ]  The legal status of abortion is believed to play a major role in the frequency of unsafe abortion. [ 42 ] [ 43 ]  For example, the 1996 legalization of abortion in  South Africa  had an immediate positive impact on the frequency of abortion-related complications, [ 44 ]  with abortion-related deaths dropping by more than 90%. [ 45 ]  Groups such as the  World Health Organization  have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductive-health services. [ 43 ]


An unsafe abortion can lead to wide range of health risks that can affect the well-being of women.Complications of unsafe abortion include severe hemorrhage, sepsis, perforation of the uterus or intestines, chronic pelvic pain, and infertility. Recent studies emphasize that timely post-abortion care significantly reduces fatal outcomes, yet access remains limited in many regions.  [ 46 ]


Abortion symptoms that can lead to additional health risks:


Complications and their treatments include:


Damage to the genital tract or internal organs: Admission to a health care facility is imperative, any delay can be fatal. [ 8 ]


Regardless if an abortion was legal or illegal, health care providers are required by law to provide medical care to patients, as it may be life-saving. In some cases, treatment for abortion complications may be administered only when the woman provides information about the abortion and any and all persons that were involved. [ 48 ]  In areas where abortion is illegal, people seeking care for complications of illegal abortions may face legal consequences.  This may deter people from seeking life-saving care. [ 48 ]


Globally, there is a high burden of complications from unsafe abortions. [ 49 ]  The costs of treating the complications can be significant in developing countries, where, in 2011, 98% of unsafe abortions occurred. [ 50 ]  An estimated 5.3 million women worldwide have developed complications or disabilities from unsafe abortion, which may be either temporary or permanent. [ 51 ]  Unsafe abortions cause an estimated 5 million lost  disability-adjusted life years  each year by women of reproductive age. [ 52 ]


The term  wrongful abortion  refers to an  abortion  that a pregnant woman undergoes as a result of negligent or malicious conduct by a physician or health care provider. [ 1 ]


There are at least two archetypal cases of wrongful abortion:


In a case of the first type, a pregnant woman seeks medical counseling regarding the possible perils related to the continuance of her  pregnancy . The adviser mistakenly maintains that the pregnancy is fraught with substantial risks for the woman, and she consequently decides to undergo an abortion. Later it is found that the information given by the adviser was wrong. [ 2 ] [ 3 ]


In a case of the second type, the woman seeks advice concerning the health and bodily integrity of her  fetus  ( see   genetic counseling ,  prenatal diagnosis ), and decides to undergo an abortion after being told that the fetus is deformed or disabled. Here, too, it is eventually realized that the information was wrong. [ 4 ] [ 5 ] [ 6 ]


"Wrongful abortion" is comparable to other types of birth-related  malpractice . One category of birth-related malpractice consists of cases in which negligence by the defendant resulted in the birth of a healthy yet unwanted child. The negligence may manifest itself in the manufacture, provision, or installation of contraceptives;  in the performance of vasectomy  or tubal ligation;  or in the carrying out of an abortion.  These cases are usually labeled "wrongful pregnancy" (or "wrongful conception" in appropriate cases). In a way, they represent a mirror image of wrongful abortion cases, although they are not exact reflections. In cases of wrongful pregnancy, the doctor's negligence makes the fulfillment of the parents’ will impossible, while in wrongful abortion cases the doctor's negligence instigates, but does not necessitate, a decision that turns out to be inconsistent with such will.


Another category of birth-related malpractice, [ 7 ]  more closely related to wrongful abortion, consists of cases in which a woman seeks medical advice regarding the health of her fetus, and decides to conceive or to continue her pregnancy once the adviser maintains that the fetus will not be born with congenital disabilities, a statement that is later found to be incorrect. The parents’ cause of action for their resulting losses is labeled " wrongful birth ," while the infant’s cause of action for their own losses is termed " wrongful life ."  Wrongful birth is a more accurate mirror image of wrongful abortion. [ 8 ]  The former deals with the non-prevention of the birth of an unwanted child, whereas the latter deals with the prevention of the birth of a wanted child. In both cases the defendant’s negligence does not make the fulfillment of the parent’s will physically impossible, but instigates a decision that turns out to be inconsistent with such will.


Wrongful birth  is a legal cause of action in some  common law  countries in which the  parents  of a congenitally diseased child claim that their doctor failed to properly warn of their risk of conceiving or giving birth to a child with serious genetic or congenital abnormalities. [ 1 ]  Thus, the plaintiffs claim, the defendant prevented them from making a truly informed decision as to whether or not to have the child. Wrongful birth is a type of medical malpractice tort. It is distinguished from  wrongful life , in which the  child  sues the doctor.


An example of the general elements of a wrongful birth claim, as established by the  California Supreme Court , are:


The plaintiff must establish the existence of a patient–doctor relationship by showing that the doctor gave the plaintiff a medical diagnosis or medical advice.


In a wrongful birth case, the plaintiff must show that the doctor failed to follow the standard of care with respect the diagnosis or disclosure of the plaintiffs' risk of transmitting genetic or congenital abnormalities to their children. [ 3 ]


If the plaintiffs allege that the defendant failed to properly diagnose the plaintiffs' risk of passing on a genetic disorder or other abnormality, then the plaintiffs must put forth expert testimony as to the standard of care for the diagnosis at issue. Lay juries do not have the necessary knowledge of medical practice to evaluate the conduct of doctors without the assistance of an expert witness. [ 4 ]


If the plaintiffs allege that the defendant failed to disclose the risk of conceiving a child with an abnormality, then the plaintiffs must show that the doctor had the duty to make the disclosure at issue. Doctors are under an obligation to disclose to their patients the risks of passing on a genetic condition to their prospective children. However, the doctor need not disclose all risks or recommend all available testing procedures. For example, in the case of  Munro v. Regents of the University of California , the court held that the doctor was not under an obligation to recommend a Tay–Sachs test when the doctor had no reason to suspect his patients were at any more at risk for  Tay–Sachs disease  than the general population, when the risk of Tay–Sachs among the general population was between 1 in 200 and 1 in 300, and when the Tay–Sachs test was "generally useless" for the vast majority of patients. [ 5 ]
The plaintiffs may also prove the negligence element by showing that the doctor failed to properly disclose the availability of genetic or prenatal screening procedures. [ 6 ]  As in other failure to disclose cases, the plaintiff will need to show that doctor owed a duty to make the disclosures at issue.


The plaintiffs in a wrongful birth case may claim that their harms consist in having a child with an undesired abnormality, or in having been denied the opportunity to make a fully informed choice as to whether to conceive or to abort the fetus.


In the past, plaintiffs have had to prove cause by showing that if the defendant had not been negligent, the child would have been normal. Under this standard, the defendant may argue that even if she or he failed to diagnose an existing fetus with a genetic or developmental abnormality, she or he did not cause the parents or fetus to have mutated genes or the fetus to develop the abnormality. Once the fetus is determined to have an abnormality, the doctor may not be able to treat the fetus, making the abnormality inevitable. If the doctor fails to diagnose the plaintiff's risk of transmitting a genetic disease, or fails to inform the plaintiff of that risk, then it is the combination of the parents' genetic mutations and choice to have a child that most directly results in the conception of an abnormal child. Because of difficulties in proving cause under this standard some courts disallowed wrongful birth suits. [ 7 ]


More recently, plaintiffs have been able to prove the causation element by showing that the defendant's negligence deprived them of the opportunity to fully consider the choice whether or not to conceive or abort their fetus. [ 8 ]  However, the plaintiffs must still prove that had the doctor acted properly they would have declined to conceive or would have aborted their abnormal fetus. This standard for causation has allowed plaintiffs to more easily prove the causation element. [ 9 ]  Still, the plaintiffs' claim that they would not have had an abnormal child is in some ways speculative. The decision whether or not to conceive given the risk of bearing an abnormal child would likely to be difficult and emotional, with an unpredictable outcome, as would the decision to abort an abnormal fetus. Additionally, some defendants have argued that the tort is subject to fraudulent claims, as proof of the claim that the plaintiffs would have aborted an abnormal fetus would often come in the form of the plaintiff's retrospective and subjective testimony. [ 10 ]


Most courts now only allow only the costs associated with raising an abnormal child, such as medical care that would not be needed for a healthy child. Thus, most courts do not allow the recovery of all costs associated with raising the plaintiffs' child. [ 11 ]  Some courts have ruled that plaintiffs may recover additional damages, such as those for emotional distress, loss of consortium, and physical pain suffered by the wife during delivery of an unhealthy child. See the example of the  Keel  case below.


On February 19, 1975, the Texas Supreme Court's ruling in the case  Jacobs v. Theimer  made Texas the first state in America to declare a woman could sue her doctor for a wrongful birth. [ 12 ] [ 13 ] [ 14 ]  That case involved Dortha Jean Jacobs (later Dortha Biggs), who caught  rubella  while pregnant and gave birth to Lesli, who was severely disabled. [ 14 ] [ 12 ]  Dortha and her husband sued her doctor, saying he did not diagnose the rubella or warn them how it would affect the pregnancy. [ 14 ]


Twenty-five U.S. states now recognize the wrongful birth cause of action. [ 15 ]


However, some states have statutorily banned wrongful birth actions. [ 16 ]  See for example Idaho Code §5-334(1): "A cause of action shall not arise, and damages shall not be awarded, on behalf of any person, based on the claim that but for the act or omission of another, a person would not have been permitted to have been born alive but would have been aborted." [ 17 ]


There is some controversy as to whether or not the wrongful birth cause of action should be recognized.


Allowing the wrongful birth cause of action may increase the rate of  abortion , a practice some consider unethical.  Doctors under threat of being sued for wrongful birth have an incentive to be vigilant in detecting the risk that prospective parents will have a congenitally diseased child, in disclosing any risks to the prospective parents, and in recommending various tests to determine the risk or existence a congenital abnormality. [ citation needed ]  Thus, more prospective parents will become aware of that their fetuses have congenital abnormalities, giving them reason to abort.  Academics concerns have also been raised that wrongful birth suits restrict rather than advance the freedom of choice by parents and doctors. [ 18 ]


Most disability activists consider these actions to be unethical and indicative of social intolerance toward disabled individuals. For instance, in 2012, several disability rights organizations wrote a letter to the ACLU protesting its language in support of wrongful birth lawsuits. [ 19 ]  It is generally felt that allowing wrongful birth lawsuits for things like Down Syndrome and Spina Bifida sends a clear message that such individuals should not be born. [ 20 ]


The prospective parents of any child have an autonomy interest in making informed decisions about whether or not to procreate. Many prospective parents might want to know if they are at high risk for passing a genetic disease to their offspring. They also might want to know whether their fetus has some kind of congenital abnormality. A doctor who fails to adequately disclose the risk that his patients might have an abnormal child, or who fails to properly diagnose an abnormal fetus, is depriving the prospective parents of the chance to make a fully informed procreative decision. In light of the great importance many people place on their procreative decisions and the care with which they make them, a doctor whose negligence interferes with those decisions should be held responsible for the consequences of that negligence. [ citation needed ]


In the Alabama case of  Keel v. Banach  the plaintiffs were a man and his pregnant wife, who both sought to avoid having a child with genetic or developmental abnormalities. The man's previous stillborn child had a spinal cord defect and other abnormalities known to have a hereditary basis, placing the man at increased risk of fathering a second child with such abnormalities. The defendant was an obstetrician who performed several sonograms on the woman and her developing fetus. The defendant did not detect any abnormalities and assured the parents that their child was developing normally. However, the child was born with a variety of severe congenital abnormalities, requiring multiple surgeries. The child died at the age of six. [ 21 ]


The parents sued on a theory of wrongful birth. The court ruled "the parents of a congenitally defective child may maintain an action for its wrongful birth if the birth was the result of the negligent failure of the attending physician to discover and inform them of the existence of fetal defects." [ 8 ]  The plaintiffs could recover for any medical expenses caused by the defendant's negligence as well as for the physical pain of the wife, loss of consortium and mental and emotional suffering. [ 22 ]


Wrongful life  is a legal cause of action in which a congenitally-diseased child sues the doctor, claiming that but for the negligence of the doctor, the child would not have been born into a life of pain and suffering. The child claims he or she would have been better off never having been born than having been born with a congenital disease. [ 23 ]  Unlike wrongful birth causes of action, most states do not recognize the wrongful life cause of action. [ 24 ]   Some courts have reasoned that wrongful life claims call for the court to answer a metaphysical question better left to philosophers: whether it is better never to be born than to be born with a congenital disease. [ 25 ]  However, some courts, starting with California, have recognized the wrongful life claim. The  California Court of Appeal  held in 1980 that "a reverent appreciation of life compels recognition that [a wrongful life] plaintiff, however impaired she may be, has come into existence as a living person with certain rights" – i.e. the right to recover against a doctor whose negligence resulted in her disease. [ 26 ]  In 1982, the  Supreme Court of California  largely endorsed and adopted the Court of Appeal's holding in a different case but limited the child's recovery to special damages. [ 27 ]


In a wrongful conception case, the plaintiffs claim that their doctor negligently performed a  vasectomy ,  tubal ligation , or other sterilization procedure, resulting in an  unwanted pregnancy  or birth. The resulting child is usually healthy, though unwanted. [ 28 ]


In 2003, the  Indiana Supreme Court  recognized the medical malpractice tort of "wrongful pregnancy" when a woman became pregnant after a failed sterilization procedure. The court decided that the damages may include the cost of the pregnancy but may not include the ordinary cost of raising the child, as the benefits of rearing the child could not be calculated. [ 29 ]


In a wrongful adoption case, the plaintiffs are adoptive parents of an unhealthy child, who claims that the adoption agency failed to disclose facts necessary for the plaintiffs to make an informed decision about what child to adopt, such as the background, health or genetic status of potential adoptees. [ 30 ]


Wrongful life  is the name given to a  cause of action  in which someone is sued by a severely  disabled  child (through the child's  legal guardian ) for failing to prevent the child's birth. Typically, a child and the child's parents will sue a  doctor  or a  hospital  for failing to provide information about the disability during the pregnancy, or a genetic disposition before the pregnancy.  Had the mother been aware of this information, it is argued, she would have had an  abortion , or chosen not to conceive at all.


The term "wrongful life" is also sometimes applied to what are more accurately described as  wrongful living  claims [ 1 ]  alleging that doctors or hospitals failed to follow a patient's end-of-life directive (for example, a  MOLST  or  POLST ) and kept the patient alive longer than preferred, thereby causing unnecessary and unwanted suffering. [ 2 ]   However, the confusion between the two is understandable and readily explained. Although wrongful life and wrongful living claims arise at opposite ends of the human lifespan, they are related in the sense that both types of claims seek the same relief: a judgment awarding monetary damages for "unwanted life." [ 1 ]


Historically, only parents could sue for their  own  damages incurred as a result of the birth of a disabled child (e.g., the mother's own pregnancy medical bills and cost of psychiatric treatment for both parents' emotional distress resulting from the realization that their child was disabled).  This cause of action is known as  wrongful birth .  But the child could not sue for his or her own damages, which were often much more substantial, in terms of the cost of round-the-clock personal care and special education.


In four  U.S. states —California, Maine, New Jersey, and Washington—the child is allowed to bring a wrongful life  cause of action  for such damages. [ 3 ]   In a 1982 case involving hereditary  deafness , the  Supreme Court of California  was the first  state supreme court  to endorse the child's right to sue for wrongful life, but in the same decision, limited the child's recovery to special damages. [ 4 ] [ 5 ]  This rule implies that the child can recover objectively provable economic damages, but cannot recover general damages like subjective "pain and suffering"—that is, monetary compensation for the entire experience of having a disabled life versus having a healthy mind and/or body.


The Supreme Court of California's 1982 decision, in turn, was based on the landmark  California Court of Appeal  decision in  Curlender v. Bio-Science Laboratories  (1980). [ 6 ]  The  Curlender  decision involved a child who was allegedly born with  Tay–Sachs disease  after the parents relied upon the defendants' representations about the reliability of their genetic tests in refraining from proceeding with  amniocentesis .


The most famous passage [ 7 ] [ 8 ] [ 9 ] [ 10 ]  from the  Curlender  opinion is as follows:


The circumstance that the birth and injury have come hand in hand has caused other courts to deal with the problem by barring recovery. The reality of the "wrongful-life" concept is that such a plaintiff both exists and suffers, due to the negligence of others. It is neither necessary nor just to retreat into meditation on the mysteries of life. We need not be concerned with the fact that had defendants not been negligent, the plaintiff might not have come into existence at all. The certainty of genetic impairment is no longer a mystery. In addition, a reverent appreciation of life compels recognition that plaintiff, however impaired she may be, has come into existence as a living person with certain rights.


Curlender  was not the first appellate decision to authorize a cause of action for wrongful life—it noted that a 1977 decision of the  intermediate appellate court of New York  had taken the same position, and was promptly overruled by the  highest court of that state  a year later.  However,  Curlender  stands as the first such appellate decision which was  not  later overruled.


Most other jurisdictions, including all  U.S. states  except California, Maine, New Jersey, and Washington, [ 3 ]   England and Wales , [ 11 ]   Ontario , [ 12 ]  and  Australia , [ 13 ] [ 14 ]  have refused to allow the wrongful life cause of action.


In  Germany , the  Federal Constitutional Court  declared wrongful life claims unconstitutional. The court reasoned that such a claim implies that the life of a disabled person is less valuable than that of a non-disabled one. Therefore, claiming damages for one's life as such violates the  human dignity  principle codified in the first article of the  German Basic Law . [ 15 ]


Nevertheless, the  German Federal Court  stuck to its previous practice of granting to suffered families indemnification in form of living expenses for a child. [ 16 ]  It emphasized that damages referred to did not imply the existence of the child by itself but the economical obligation of parents to pay maintenance. It was finally upheld by the  Constitutional Court  in 1998, stating no matter what was the difference between existence of a child and parents' obligation to pay maintenance in terms of damage, because the recognition of a child as a person after Art. 1 I GG  did not lay on the undertaking that obligation by parents. [ 17 ]


In 2005, the  Dutch Supreme Court  fully upheld a wrongful life claim in the  Netherlands ' first wrongful life case ever. [ 18 ]


Since wrongful life suits are a relatively new application of human rights, doctors and scholars have not come to consensus regarding their place in medical ethics. [ 19 ] [ 20 ]   Others have objected to wrongful life claims on conceptual grounds, including the question of whether there exist rights and duties with regards to non-existent persons. [ 21 ]


Belsky


Obstetrics  is the field of study concentrated on  pregnancy ,  childbirth  and the  postpartum period . [ 1 ]  As a  medical specialty , obstetrics is combined with  gynecology  under the discipline known as  obstetrics and gynecology  (OB/GYN), which is a surgical field. [ 2 ]


Prenatal care is important in screening for various  complications of pregnancy . [ 3 ]  This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low-risk pregnancies: [ 4 ]


Routine tests in the first  trimester  of pregnancy generally include:


Genetic screening for  Down syndrome  (trisomy 21) and  Edwards syndrome  (trisomy 18), the national standard in the United States, is rapidly evolving away from the AFP- quad screen , done typically in the second trimester at 16–18 weeks. [ 11 ]  The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an  ultrasound  of the fetal neck (thicker nuchal skin correlates with higher risk of Down syndrome being present) and two chemicals (analytes),  pregnancy-associated plasma protein A  and  human chorionic gonadotropin  (pregnancy hormone level itself [ 12 ] ). It gives an accurate risk profile very early. A second blood screen at 15 to 20 weeks refines the risk more accurately. [ 13 ]  The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test, but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States. [ 14 ] [ 15 ] [ 16 ]


Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes). The standard modified criteria have been lowered to 135 since the late 1980s. [ 21 ]


Obstetric ultrasonography  is routinely used for dating the gestational age of a pregnancy from the size of the  fetus , determine the number of fetuses and  placentae , evaluate for an  ectopic pregnancy  and first trimester bleeding, the most accurate dating being in first trimester before the growth of the foetus has been significantly influenced by other factors. [ 22 ]  Ultrasound is also used for detecting congenital anomalies (or other foetal anomalies) and determining the  biophysical profiles  (BPP), which are generally easier to detect in the second trimester when the foetal structures are larger and more developed. [ 23 ]


X-rays  and  computerized tomography  (CT) are not used, especially in the first trimester, due to the  ionizing radiation , which has  teratogenic  effects on the foetus. [ 24 ]  No effects of  magnetic resonance imaging  (MRI) on the foetus have been demonstrated, [ 25 ]  but this technique is too expensive for routine observation. Instead,  obstetric ultrasonography  is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no  radiation , is portable, and allows for realtime imaging. [ 26 ]


The safety of frequent ultrasound scanning has not been confirmed. Despite this, increasing numbers of women are choosing to have additional scans for no medical purpose, such as gender scans, 3D and 4D scans. [ 27 ]  A normal gestation would reveal a  gestational sac ,  yolk sac , and  fetal pole . [ 28 ]


The  gestational age  can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6.  Multiple gestation  is evaluated by the number of  placentae  and  amniotic sacs  present. [ 29 ]


Other tools used for assessment include:


A pregnant woman may have a  pre-existing disease , that may become worse or become a risk to the pregnancy, or to  postnatal development  of the offspring [ 35 ]


Induction is a method of artificially or prematurely stimulating labour in a woman. [ 47 ]  Reasons to induce can include  pre-eclampsia , foetal distress, placental malfunction, intrauterine growth retardation and failure to progress through labour increasing the risk of infection and foetal distresses. [ 48 ]


Induction may be achieved via several methods:


During labour, the obstetrician carries out the following tasks:


The main emergencies include:


The  World Health Organization  makes a distinction between the use of  postpartum care  when it concerns the care of the mother after giving birth, and  postnatal care  when the care of the newborn is concerned. [ 73 ]
 Postpartum care  is provided to the mother following childbirth.


A woman in the Western world who gives birth in a  hospital  may leave the hospital as soon as she is medically stable, and chooses to leave, which can be as early as a few hours later, but usually averages a stay of one or two days; the average postnatal stay following delivery by  caesarean section  is three to four days. [ 74 ]


During this time the mother is monitored for  bleeding ,  bowel  and  bladder  function, and baby care. The  infant 's health is also monitored. [ 75 ]


Prior to the 18th century, caring for pregnant women in Europe was  confined exclusively to women , and rigorously excluded men. [ 76 ]  The expectant mother would invite close female friends and family members to her home to keep her company during  childbirth . [ 77 ] : 96–98   Skilled  midwives  managed all aspects of the labour and delivery. [ 78 ]  The presence of physicians and surgeons was very rare and only occurred if a serious complication had taken place and the midwife had exhausted all measures at her disposal. [ 79 ]  Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty. [ 80 ] : 1050–1051  [ 81 ]


Prior to the 18th and 19th centuries,  midwifery  was well established but obstetrics was not recognized as a specific medical specialty. However, the subject matter and interest in the  female reproductive system  and sexual practice can be traced back to Ancient Egypt [ 82 ] : 122   and Ancient Greece. [ 83 ] : 11    Soranus of Ephesus  sometimes is called the most important figure in  ancient  gynecology. [ 79 ]  Living in the late first century AD and early second century, he studied anatomy and had opinions and techniques on abortion, contraception – most notably  coitus interruptus  – and birth complications. After his death, techniques and works of gynecology declined; very little of his works were recorded and survived to the late 18th century when gynecology and obstetrics reemerged as a medical specialism. [ 82 ] : 123


The 18th century marked the beginning of many advances in European  midwifery , based on better knowledge of the physiology of pregnancy and labour. [ 84 ]  By the end of the century, medical professionals began to understand the anatomy of the uterus and the physiological changes that take place during labour. [ 85 ]  The introduction of  forceps in childbirth  also took place at this time. All these medical advances in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery. [ 80 ] : 1051–1052


The addition of the male-midwife (or man-midwife) is historically a significant change to the profession of obstetrics. [ 86 ]  In the 18th century medical men began to train in area of childbirth and believed with their advanced knowledge in anatomy that childbirth could be improved. [ 87 ]  In France these male-midwives were referred to as  accoucheurs , a title later used all over Europe. The founding of  lying-in  hospitals also contributed to the medicalization and male-dominance of obstetrics. [ 88 ]  These early  maternity hospitals  were establishments where women would come to have their babies delivered, as opposed to the practice since time immemorial of the midwife attending the home of the woman in labour. [ 89 ]  This institution provided male-midwives with endless patients to practice their techniques on and was a way for these men to demonstrate their knowledge. [ 90 ]


Many midwives of the time bitterly opposed the involvement of men in childbirth. Some male practitioners also opposed the involvement of medical men like themselves in midwifery and even went as far as to say that male-midwives only undertook midwifery solely for perverse erotic satisfaction. The accoucheurs argued that their involvement in midwifery was to improve the process of childbirth. These men also believed that obstetrics would forge ahead and continue to strengthen. [ 80 ] : 1050–1051


18th-century physicians expected that obstetrics would continue to grow, but the opposite happened. Obstetrics entered a stage of stagnation in the 19th century, which lasted until about the 1880s. [ 77 ] : 96–98   The central explanation for the lack of advancement during this time was the rejection of obstetrics by the medical community. [ 91 ]  The 19th century marked an era of medical reform in Europe and increased regulation over the profession. Major European institutions such as The College of Physicians and Surgeons [ where? ]  considered delivering babies ungentlemanly work and refused to have anything to do with childbirth as a whole. Even when  Medical Act 1858  was introduced, which stated that medical students could qualify as doctors,  midwifery  was entirely ignored. [ 92 ]   This made it nearly impossible to pursue an education in midwifery and also have the recognition of being a doctor or surgeon. Obstetrics was pushed to the side. [ 80 ] : 1053–1055


By the late 19th century, the foundation of modern-day obstetrics and midwifery began developing. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth. [ 87 ]  Midwifery also changed during this era due to increased regulation and the eventual need for midwives to become certified. [ 93 ]  Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency. Midwives were no longer uneducated in the formal sense. [ 94 ]


As midwifery began to develop, so did the profession of obstetrics near the end of the century. [ 95 ]  Childbirth was no longer unjustifiably despised by the medical community as it once had been at the beginning of the century. But obstetrics was underdeveloped compared to other medical specialities. Many male physicians would deliver children but very few would have referred to themselves as obstetricians. The end of the 19th century did mark a significant accomplishment in the profession with the advancements in  asepsis  and  anaesthesia , which paved the way for the mainstream introduction and later success of the  Caesarean section . [ 94 ] [ 96 ]


Before the 1880s mortality rates in lying-hospitals would reach unacceptably high levels and became an area of public concern. Much of these maternal deaths were due to  puerperal fever , then known as childbed fever. In the 1800s  Ignaz Semmelweis  noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth by physicians in lying-hospitals. His investigation discovered that washing hands with an  antiseptic  solution before a delivery reduced childbed fever fatalities by 90%. [ 97 ]  So it was concluded that it was physicians who had been spreading disease from one labouring mother to the next. Despite the publication of this information, doctors still would not wash. It was not until the 20th century when advancements in aseptic technique and the understanding of disease would play a significant role in the decrease of  maternal mortality  rates among many populations. [ citation needed ]


The development of obstetrics as a practice for accredited doctors happened at the turn of the 18th century and thus was very differently developed in Europe and in the Americas due to the independence of many countries in the Americas from European powers. "Unlike in Europe and the British Isles, where  midwifery  laws were national, in America, midwifery laws were local and varied widely". [ 98 ]


Gynaecology and Obstetrics gained attention in the American medical field at the end of the nineteenth century through the development of such procedures as the ovariotomy. [ 99 ]  These procedures then were shared with European surgeons who replicated the surgeries. This was a period when antiseptic, aseptic or anaesthetic measures were just being introduced to surgical and observational procedures and without these procedures surgeries were dangerous and often fatal. [ 100 ]  Following are two surgeons noted for their contributions to these fields include  Ephraim McDowell  and  J. Marion Sims . [ 101 ]


Ephraim McDowell developed a surgical practice in 1795 and performed the first ovariotomy in 1809 on a 47-year-old widow who then lived on for 31 more years. [ 102 ]  He had attempted to share this with John Bell whom he had practiced under who had retired to Italy. Bell was said to have died without seeing the document but it was published by an associate in  Extractions of Diseased Ovaria  in 1825. [ 103 ]  By the mid-century the surgery was both successfully and unsuccessfully being performed. Pennsylvanian surgeons the Attlee brothers made this procedure very routine for a total of 465 surgeries – John Attlee performed 64 successfully of 78 while his brother William reported 387 – between the years of 1843 and 1883. [ 104 ]  By the middle of the nineteenth century this procedure was successfully performed in Europe by English surgeons Sir  Spencer Wells  and  Charles Clay  as well as French surgeons  Eugène Koeberlé ,  Auguste Nélaton  and  Jules Péan . [ 82 ] : 125


J. Marion Sims was the surgeon responsible for being the first treating a  vesicovaginal fistula [ 82 ] : 125   – a condition linked to many caused mainly by prolonged pressing of the foetus against the pelvis or other causes such as rape, hysterectomy, or other operations – and also having been doctor to many European royals and the 20th President of the United States James A. Garfield after he had been shot. Sims does have a controversial medical past. Under the beliefs at the time about pain and the prejudice towards African people, he had practiced his surgical skills and developed skills on slaves. [ 105 ]  These women were the first patients of modern gynecology. One of the women he operated on was named  Anarcha Westcott , the woman he first treated for a fistula. [ 105 ]


Women and men inhabited very different roles in natal care up to the 18th century. [ 106 ]  The role of a physician was exclusively held by men who went to university, an overly male institution, who would theorize anatomy and the process of reproduction based on theological teaching and philosophy. Many beliefs about the female body and menstruation in the 17th and 18th centuries were inaccurate; clearly resulting from the lack of literature about the practice. [ 82 ] : 123–125   Many of the theories of what caused menstruation prevailed from Hippocratic philosophy. [ 83 ] : 16    Midwives , meaning "with woman", were those who assisted in the birth and care of both born and unborn children, a position historically held mainly by women. [ 107 ]


During the birth of a child, men were rarely present. Women from the neighbourhood or family would join in on the process of birth and assist in many different ways. [ 108 ]  The one position where men would help with the birth of a child would be in the sitting position, usually when performed on the side of a bed to support the mother. [ 77 ] : 130


Men entered the field of obstetrics in the nineteenth century, resulting in a change of focus within the profession. [ 109 ]  Gynecology developed as a new and separate field of study from obstetrics, focusing on the curing of illness and indispositions of female sexual organs, [ 110 ]  encompassing conditions such as menopause, uterine and cervical problems, and tissue damage as a result of childbirth. [ 111 ]


The following  outline  is provided as an overview of and topical guide to obstetrics:


Obstetrics  – medical specialty dealing with the care of all women's reproductive tracts and their children during  pregnancy  (prenatal period),  childbirth  and the  postnatal  period.


Obstetrics can be described as all of the following:


At the end of  pregnancy , the  fetus  must take the journey of  childbirth  to leave the  reproductive   mother . Upon its entry to the air-breathing world, the  newborn  must begin to adjust to life outside the  uterus . This is true for all  viviparous  animals; this article discusses humans as the most-researched example. [ citation needed ]


The outside environment is a drastic change for the neonate, therefore the neonate must be assessed frequently and thoroughly. The  Apgar scale  is an assessment performed immediately following birth. It consists of the assessment of heart rate, respiratory effort, muscle tone, reflex irritability, and generalized skin color. Apgar scoring is performed one minute and five minutes after birth. Scoring ranges from 0 to 10, with 0 indicating severe neonatal distress and 10 indicating a smooth transition to extrauterine life. [ 1 ]


Newborns transitioning into extrauterine life will undergo periods of reactivity. These periods are divided into three stages. The first stage occurs in the first 30 minutes of life; during this stage the infant is alert and responsive with heart rate peaking at 160-180 beats per minute and then stabilizes to a baseline rate of 100-120 beats per minute. Crackles upon auscultation and irregular respirations are a normal finding. In the second stage, there is a decrease in responsiveness and motor activity which is often manifested as sleep. This period can last from 1–2 hours. The third stage marks the second period of reactivity. This period can occur anywhere in the first 2 to 8 hours after birth and lasts anywhere from 10 minutes to several hours.  Tachycardia  and  tachypnea  may be present during brief periods. Passing of  meconium  also occurs. [ 1 ]


Physiology: In utero, the placenta delivers oxygenated blood to the fetus through the umbilical vein. Upon delivery, the umbilical cord is cut. The cardiovascular system must now adapt. Blood CO 2  rises because it is now not removed by the placenta. This is a powerful stimulus for the infant to start breathing. Breathing sharply increases O 2  in the lungs, thus quickly reverting hypoxic pulmonary vasoconstriction that had held the pulmonary vascular resistance high during the uterine life. Lung ventilation also extends the so far convoluted, shrunk pulmonary vessels, also contributing to the quick and marked drop in the pulmonary vascular resistance. As a result, much higher proportion of the right ventricle output flows into the pulmonary vessels than into the systemic circulation through the ductus arteriosus.
The detachment of the placenta causes an increase in systemic vascular resistance, which leads to an increase in pressure gradient from the left atrium. [ 2 ]  The left atrium now has higher pressure than the right atrium causing the  foramen ovale  to close. Within the first 10 minutes of birth, blood begins to flow left-to-right through the  ductus arteriosus . This causes a significant increase in output of the left ventricle and increase in stroke volume. Subsequently,  calcium channel  activity increases and potassium channel decreases furthering ductal constriction. Functional closure of the ductus arteriosus occurs within the first 24 hours, with permanent closure following within 4 weeks. Lastly cardiac output increases to nearly double what it was in utero.
All of these  cardiovascular system  changes result in the adaptation from fetal circulation patterns to an  adult   circulation  pattern. During this transition, some types of congenital heart disease that were not symptomatic  in utero  during fetal circulation will present with  cyanosis  or  respiratory  signs.


Manifestations: When the newborn cries, there is a reversal of blood flow through the foramen ovale which causes the newborn to appear mildly cyanotic in the first few days of life.
The heart rate of the newborn should be between 110 and 160 beats per minute and it is common for the heart rate to be irregular in the first few hours following birth. The heart sounds will have a variation in pitch, duration, and intensity than that of an adult. Blood pressure readings should range from 60 to 80 mm Hg systolic and 40–50 mm Hg diastolic. Mean arterial pressure should be the same as the weeks of  gestation  at birth. Within the first hour after birth, there may be a drop of up to 15 mm Hg in the systolic blood pressure. [ 1 ]


Delayed cord clamping  is defined as waiting more than 2 minutes to clamp the newborn's  umbilical cord . This has been proven to be beneficial in improving hematocrit and iron while also decreasing anemia. These benefits can last up to 6 months for the newborn. [ 3 ]


Assessments/Interventions: Assessment and monitoring of vital signs and skin color are important in detecting cardiovascular issues in the infant.
The apical pulse rate should be auscultated for one full minute when the newborn is calm or sleeping. Any irregular heart rate after the first few hours of life that is not related to crying or another outside factor should be monitored and evaluated. [ 1 ]
Blood pressure will be taken with an appropriately sized cuff, preferably when the newborn is at rest.
Consistent tachycardia should be evaluated for conditions such as anemia, hyperthermia, hypovolemia, and sepsis. Consistent bradycardia could be an indication of congenital heart block or hypoxemia. Pallor and central cyanosis (cyanosis in hands and feet is a common and normal finding) can also indicate cardiovascular issues. [ 1 ]


Physiology: Upon birth, the newborn's lungs become the center for gas exchange. There are a variety of factors that influence newborn respiratory functions; these factors include chemical, mechanical, thermal, and sensory. Respirations begin when fetal aortic and carotid chemoreceptors are stimulated by the varying concentrations of oxygen and carbon dioxide. During vaginal birth, the newborn's chest is compressed by the birth canal. Upon delivery, negative pressure allows air into the lungs. The first cries of the infant allow for alveoli expansion and absorption of fetal lung fluid. Temperature changes and other sensory stimulation contributes to respiratory function as well.


Manifestations: Breathing patterns are often irregular and shallow. The infants respiration rate should be between 30 and 60 breaths per minute with preference for nasal breathing. Ribs expands horizontally. Breath sounds should be clear and equal in both lungs. Abdominal breathing is normal. Acrocyanosis is a normal finding. [ 1 ]


Assessments/Interventions: Suctioning of nasal and oral secretions promotes fluid clearance. Auscultation of lung sounds to assess for any abnormalities. Pulse oximetry is performed to determine oxygen saturation. Monitor signs of respiratory distress such as: nasal flaring, grunting, central cyanosis. [ 1 ]


Physiology: At birth, the newborn is cut off from the mother's glucose supply and will begin to rely on stored fat for energy.  Glycogen  stores are maximal at term. Within the first hour of life, blood glucose will typically reach its lowest point and then stabilize within 2 to 4 hours, hence  breastfeeding  is promoted immediately. In cases where feeding is delayed, the neonate can use  lactate , free-fatty acids, and ketone bodies.


Manifestations: Normal blood glucose levels range from 40 to 50 mg/dl. [ 1 ]
Rooting and sucking reflex should be present and the neonate will eat small amounts frequently. All vital signs should be within normal limits coinciding with the neonates presentation of calmness and satiation.


Assessments/Interventions: Monitor blood glucose level and encourage breastfeeding or formula feeding as early as possible. Lactation and breastfeeding education should be provided as appropriate.


Physiology: Newborns lack the ability of thermogenesis due to underdeveloped shivering mechanism. Body heat is lost through conduction, convection, and radiant heat. [ 1 ]  Thermoregulation is achieved through several methods: the metabolism of brown fat and Kangaroo care, also known as skin to skin.  "Brown fat"  is specialized adipose tissue with a high concentration of mitochondria designed to rapidly oxidize fatty acids in order to generate metabolic heat. [ citation needed ]   Skin to skin to care is the immediate placement of the neonate directly onto a caregiver's bare chest. This promotes thermoregulation of the neonate through heat generated from caregiver.


Manifestations: Normal temperature ranges from 97.7 to 100.0 °F (36.5 to 37.8 °C). Cold infants may cry or appear restless. The neonates' arms and legs maintain a fetal position, lessening their body surface area and reducing heat loss. [ 1 ]