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"Medical information and perspectives on abortion are not just data untinged by values. Throughout history medical facts and moral values regarding abortion have been inextricably intertwined, and the current era is no exception."

There is some confusion about the definition of abortion. Spontaneous abortion, or what is commonly termed a miscarriage, refers to a spontaneous loss of a pregnancy before viability (at about twenty-four weeks of gestation). Losses after that point in a pregnancy are termed preterm deliveries, or, in the case of the delivery of a fetus who has already died, stillbirths. The terminology commonly used in relation to induced abortion is different. Here, viability is not the key point. Rather, any termination of a pregnancy by medical or surgical means is termed an abortion, regardless of the stage of the pregnancy.

As of 2003, induced abortions performed within the first twelve weeks of pregnancy are among the safest and simplest forms of surgery and, based on maternal mortality ratios (number of deaths per 100,000 live births), both firstand second-trimester abortions, when performed by properly trained personnel, in general are safer than carrying a pregnancy to term (Cates and Grimes). As a result, ethical arguments against abortion tend to be restricted to areas other than maternal safety. Nonetheless, some aspects of medical safety and harm—including possible complications and psychological sequelae—continue to be important for ethical discourse, especially since a basic tenet of medical ethics is to avoid harm.

The major immediate complications of induced abortion, listed in order of frequency, are infection, hemorrhage, uterine perforation, and anesthesia-related complications. Overall complication rates for legal first-trimester abortions are less than 0.5 deaths per 100,000 abortions performed (as compared to more than four per 100,000 in the early 1970s, before the U.S. Supreme Court decision Roe v. Wade [1973] permitted medically supervised abortions). Medical complications associated with induced abortion are directly related to gestational age and the type of procedure used to terminate the pregnancy. Most abortions (over 90%) done in the United States are performed within the first twelve weeks of pregnancy, when abortion is safest. More serious complications may occur in procedures done later in pregnancy.

Questions have been raised about possible long-term harmful effects of induced abortion, especially for women who have had multiple abortions. Much of the concern centers on subsequent pregnancies, following one or more induced abortions. Medical evidence has consistently shown that a woman who has one properly performed induced abortion in the first trimester of pregnancy has the same chance of a normal outcome of a subsequent pregnancy as a woman who has never had an abortion. The evidence is less definitive for women who have had more than one induced abortion or an abortion with complications, although there is no reason to believe that additional abortion procedures, carried out by well-trained professionals, will have a long-term adverse effect. Overall, in terms of medical risk, abortion procedures, particularly those carried out in the first trimester of pregnancy, are among the safest of all surgical procedures.

A much grayer area is that of the psychological consequences of induced abortion. It is difficult to generalize about the emotional responses of patients to pregnancy termination but, like physical complications, psychological complications may be related to the type of procedure and the gestational age at the time of termination, with earlier suction curettage theoretically leading to fewer psychological complications than later procedures. However, most studies in this area suffer from methodological problems, including a lack of consensus about symptoms, inadequate study design, and lack of adequate follow-up. Furthermore, the so-called postabortion syndrome does not meet the American Psychiatric Association's definition of trauma (Gold).

Despite the many problems with most investigations, "the studies are consistent in their findings of relatively rare instance of negative responses after abortion and of decreases in psychological distress after abortion compared to before abortion" (Adler et al., p. 42). Former U.S. Surgeon General C. Everett Koop, at the request of the White House, undertook a major assessment of the literature on this topic and concluded in a 1989 congressional hearing that "the data were insufficient … to support the premise that abortion does or does not produce a postabortion syndrome and that emotional problems resulting from abortion are minuscule from a public health perspective" (Human Resources and Intergovernmental Relations Subcommittee of the Committee on Governmental Operations, p. 14). Given Koop's personal opposition to abortion, the conclusions of his assessment are of particular importance.

Approximately 10 percent of induced abortions in the United States take place between twelve and twenty weeks of gestation, and less than 1 percent take place between twenty and twenty-four weeks. This means that more than 150,000 second-trimester procedures occur each year, a much larger number than in other developed nations where abortion is legal. Most would agree that decreases in the total numbers of abortions would be highly desirable, particularly decreases in second-trimester procedures.

The most common reasons for these later procedures, particularly among younger teens, are indecision about termination and failure to recognize (or denial of) pregnancy. A smaller percentage of these later abortions occur because of medical or genetic reasons, which theoretically may correlate with greater psychological distress. Although techniques such as nuchal translucency measurement with serum screening, chorionic villus sampling, and early amniocentesis have allowed earlier diagnosis, the results of more commonly used techniques of antenatal fetal diagnosis with midtrimester amniocentesis are generally not available until well into the second trimester.

Choosing to terminate a pregnancy is a serious decision that is rarely made lightly. In addition to complete information about abortion procedure options, counseling should be made available to women faced with a decision about an unplanned pregnancy.