Pengguguran: Perbezaan antara semakan

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Apabila dilakukan dengan betul, pengguguran adalah salah [[Pengguguran#Keselamatan|satu prosedur paling selamat dalam perubatan]],{{ r | lancet-grimes | p=1 | q=Unsafe abortion is a persistent, preventable pandemic. ... By contrast, legal abortion in industrialised nations has emerged as one of the safest procedures in contemporary medical practice, with minimum morbidity and a negligible risk of death. }} {{ r | Ray2014 | p=1 | q=Results: The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7 deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. }} tetapi pengguguran yang tidak selamat adalah penyebab utama [[kematian bersalin]], terutama di [[negara membangun]],<ref name="WHO-preventing-unsafe">{{Cite web |url=https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion |title=Preventing unsafe abortion |website=www.who.int |access-date=6 August 2019}}</ref> sambil menjadikan pengguguran yang selamat adalah sah dan diakses mengurangkan kematian bersalin.<ref>{{Cite journal |last1=Faúndes |first1=Anibal |last2=Shah |first2=Iqbal H. |date=1 October 2015 |title=Evidence supporting broader access to safe legal abortion |url=http://www.sciencedirect.com/science/article/pii/S0020729215001575 |journal=International Journal of Gynecology & Obstetrics |series=World Report on Women's Health 2015: The unfinished agenda of women's reproductive health |volume=131 |pages=S56–S59 |doi=10.1016/j.ijgo.2015.03.018 |pmid=26433508 |issn=0020-7292|doi-access=free | quote=A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. ... criminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates. }}</ref><ref>{{Cite journal |last1=Latt |first1=Su Mon |last2=Milner |first2=Allison |last3=Kavanagh |first3=Anne |date=5 January 2019 |title=Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries |journal=BMC Women's Health |volume=19 |issue=1 |pages=1 |doi=10.1186/s12905-018-0705-y |issn=1472-6874 |pmc=6321671 |pmid=30611257}}</ref> Ia lebih selamat daripada kelahiran anak, yang mempunyai risiko kematian 14 kali lebih tinggi di Amerika Syarikat.<ref name=Grimes2012>{{Cite journal|last1=Raymond|first1=E.G.|last2=Grimes|first2=D.A.|year=2012|title=The Comparative Safety of Legal Induced Abortion and Childbirth in the United States|journal=Obstetrics & Gynecology|volume=119|issue=2, Part 1|pages=215–19|doi=10.1097/AOG.0b013e31823fe923|pmid=22270271|s2cid=25534071|quote=Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion. }}</ref>
Apabila dilakukan dengan betul, pengguguran adalah salah [[Pengguguran#Keselamatan|satu prosedur paling selamat dalam perubatan]],{{ r | lancet-grimes | p=1 | q=Unsafe abortion is a persistent, preventable pandemic. ... By contrast, legal abortion in industrialised nations has emerged as one of the safest procedures in contemporary medical practice, with minimum morbidity and a negligible risk of death. }} {{ r | Ray2014 | p=1 | q=Results: The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7 deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. }} tetapi pengguguran yang tidak selamat adalah penyebab utama [[kematian bersalin]], terutama di [[negara membangun]],<ref name="WHO-preventing-unsafe">{{Cite web |url=https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion |title=Preventing unsafe abortion |website=www.who.int |access-date=6 August 2019}}</ref> sambil menjadikan pengguguran yang selamat adalah sah dan diakses mengurangkan kematian bersalin.<ref>{{Cite journal |last1=Faúndes |first1=Anibal |last2=Shah |first2=Iqbal H. |date=1 October 2015 |title=Evidence supporting broader access to safe legal abortion |url=http://www.sciencedirect.com/science/article/pii/S0020729215001575 |journal=International Journal of Gynecology & Obstetrics |series=World Report on Women's Health 2015: The unfinished agenda of women's reproductive health |volume=131 |pages=S56–S59 |doi=10.1016/j.ijgo.2015.03.018 |pmid=26433508 |issn=0020-7292|doi-access=free | quote=A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. ... criminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates. }}</ref><ref>{{Cite journal |last1=Latt |first1=Su Mon |last2=Milner |first2=Allison |last3=Kavanagh |first3=Anne |date=5 January 2019 |title=Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries |journal=BMC Women's Health |volume=19 |issue=1 |pages=1 |doi=10.1186/s12905-018-0705-y |issn=1472-6874 |pmc=6321671 |pmid=30611257}}</ref> Ia lebih selamat daripada kelahiran anak, yang mempunyai risiko kematian 14 kali lebih tinggi di Amerika Syarikat.<ref name=Grimes2012>{{Cite journal|last1=Raymond|first1=E.G.|last2=Grimes|first2=D.A.|year=2012|title=The Comparative Safety of Legal Induced Abortion and Childbirth in the United States|journal=Obstetrics & Gynecology|volume=119|issue=2, Part 1|pages=215–19|doi=10.1097/AOG.0b013e31823fe923|pmid=22270271|s2cid=25534071|quote=Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion. }}</ref>


Kaedah moden menggunakan [[pengguguran perubatan|ubat]] atau [[Pengguguran#Pembedahan|pembedahan]] untuk pengguguran.<ref name="1st_Methods">{{cite journal |last1=Kulier |first1=R |last2=Kapp |first2=N |last3=Gülmezoglu |first3=AM |last4=Hofmeyr |first4=GJ |last5=Cheng |first5=L |last6=Campana |first6=A |s2cid=205167182 |title=Medical methods for first trimester abortion |journal=The Cochrane Database of Systematic Reviews |date=9 November 2011 |issue=11 |pages=CD002855 |pmid=22071804 |doi=10.1002/14651858.CD002855.pub4|pmc=7144729 }}</ref> Dadah [[mifepristone]] dalam kombinasi dengan [[prostaglandin]] nampaknya selamat dan berkesan seperti pembedahan pada [[Kehamilan#Garis masa bagi kehamilan biasa|trimester pertama]] dan [[Kehamilan#Garis masa bagi kehamilan biasa|kedua]] kehamilan.<ref name="1st_Methods" /><ref name="Kapp2013" /> Teknik pembedahan yang paling biasa melibatkan melebarkan serviks dan menggunakan [[sedutan vakum|alat penyedut]].<ref>{{cite web |title=Abortion – Women's Health Issues |url=https://www.merckmanuals.com/home/women-s-health-issues/family-planning/abortion |website=Merck Manuals Consumer Version |access-date=12 July 2018 |archive-url=https://web.archive.org/web/20180713183550/https://www.merckmanuals.com/home/women-s-health-issues/family-planning/abortion |archive-date=13 July 2018 |url-status=live }}</ref> Alat [[kawalan kelahiran]], seperti [[pil pencegah kehamilan|pil]] atau [[Alat kontraseptif dalam rahim|alat intrauterin]], dapat digunakan segera setelah pengguguran.<ref name="Kapp2013">{{cite journal|last1=Kapp |first1=N |last2=Whyte |first2=P |last3=Tang |first3=J |last4=Jackson |first4=E |last5=Brahmi |first5=D |title=A review of evidence for safe abortion care |journal=Contraception |date=September 2013 |volume=88 |issue=3 |pages=350–63 |pmid=23261233 |doi=10.1016/j.contraception.2012.10.027}}</ref> Apabila dilakukan secara sah dan selamat pada wanita yang menginginkannya, pengguguran cetusan tidak meningkatkan risiko masalah [[Kesihatan mental|mental]] atau fizikal jangka panjang.<ref name="BMJ2014" /> Sebaliknya, pengguguran yang tidak selamat (yang dilakukan oleh individu yang tidak mahir, dengan peralatan berbahaya, atau di kemudahan yang tidak bersih) menyebabkan 47,000 [[Kematian bersalin|kematian]] dan 5 juta kemasukan ke hospital setiap tahun.<ref name="BMJ2014">{{Cite journal |last1=Lohr |first1=PA |last2=Fjerstad |first2=M |last3=Desilva |first3=U |last4=Lyus |first4=R |title=Abortion |journal = BMJ | volume = 348 | page = f7553 | year = 2014 | doi = 10.1136/bmj.f7553|s2cid=220108457 }}</ref><ref name="OBGY09">{{Cite journal|last1=Shah |first1=I |last2=Ahman |first2=E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=Journal of Obstetrics and Gynaecology Canada |volume=31 |issue=12 |pages=1149–58 |date=December 2009 |pmid=20085681 |url=http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |url-status=dead |archive-url=https://web.archive.org/web/20110716212405/http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |archive-date=16 July 2011 |doi=10.1016/s1701-2163(16)34376-6}}</ref> [[Pertubuhan Kesihatan Sedunia]] menyatakan bahawa "akses ke penjagaan pengguguran yang sah, selamat dan menyeluruh, termasuk penjagaan selepas pengguguran, sangat penting untuk mencapai tahap kesihatan seksual dan pembiakan setinggi mungkin."<ref>{{Cite web|title=Abortion|url=https://www.who.int/westernpacific/health-topics/abortion|access-date=2021-04-14|website=www.who.int|language=en}}</ref>
Kaedah moden menggunakan [[pengguguran perubatan|ubat]] atau [[Pengguguran#Pembedahan|pembedahan]] untuk pengguguran.<ref name="1st_Methods">{{cite journal |last1=Kulier |first1=R |last2=Kapp |first2=N |last3=Gülmezoglu |first3=AM |last4=Hofmeyr |first4=GJ |last5=Cheng |first5=L |last6=Campana |first6=A |s2cid=205167182 |title=Medical methods for first trimester abortion |journal=The Cochrane Database of Systematic Reviews |date=9 November 2011 |issue=11 |pages=CD002855 |pmid=22071804 |doi=10.1002/14651858.CD002855.pub4|pmc=7144729 }}</ref> Dadah [[mifepriston]] dalam kombinasi dengan [[prostaglandin]] nampaknya selamat dan berkesan seperti pembedahan pada [[Kehamilan#Garis masa bagi kehamilan biasa|trimester pertama]] dan [[Kehamilan#Garis masa bagi kehamilan biasa|kedua]] kehamilan.<ref name="1st_Methods" /><ref name="Kapp2013" /> Teknik pembedahan yang paling biasa melibatkan melebarkan serviks dan menggunakan [[sedutan vakum|alat penyedut]].<ref>{{cite web |title=Abortion – Women's Health Issues |url=https://www.merckmanuals.com/home/women-s-health-issues/family-planning/abortion |website=Merck Manuals Consumer Version |access-date=12 July 2018 |archive-url=https://web.archive.org/web/20180713183550/https://www.merckmanuals.com/home/women-s-health-issues/family-planning/abortion |archive-date=13 July 2018 |url-status=live }}</ref> Alat [[kawalan kelahiran]], seperti [[pil pencegah kehamilan|pil]] atau [[Alat kontraseptif dalam rahim|alat intrauterin]], dapat digunakan segera setelah pengguguran.<ref name="Kapp2013">{{cite journal|last1=Kapp |first1=N |last2=Whyte |first2=P |last3=Tang |first3=J |last4=Jackson |first4=E |last5=Brahmi |first5=D |title=A review of evidence for safe abortion care |journal=Contraception |date=September 2013 |volume=88 |issue=3 |pages=350–63 |pmid=23261233 |doi=10.1016/j.contraception.2012.10.027}}</ref> Apabila dilakukan secara sah dan selamat pada wanita yang menginginkannya, pengguguran cetusan tidak meningkatkan risiko masalah [[Kesihatan mental|mental]] atau fizikal jangka panjang.<ref name="BMJ2014" /> Sebaliknya, pengguguran yang tidak selamat (yang dilakukan oleh individu yang tidak mahir, dengan peralatan berbahaya, atau di kemudahan yang tidak bersih) menyebabkan 47,000 [[Kematian bersalin|kematian]] dan 5 juta kemasukan ke hospital setiap tahun.<ref name="BMJ2014">{{Cite journal |last1=Lohr |first1=PA |last2=Fjerstad |first2=M |last3=Desilva |first3=U |last4=Lyus |first4=R |title=Abortion |journal = BMJ | volume = 348 | page = f7553 | year = 2014 | doi = 10.1136/bmj.f7553|s2cid=220108457 }}</ref><ref name="OBGY09">{{Cite journal|last1=Shah |first1=I |last2=Ahman |first2=E |title=Unsafe abortion: global and regional incidence, trends, consequences, and challenges |journal=Journal of Obstetrics and Gynaecology Canada |volume=31 |issue=12 |pages=1149–58 |date=December 2009 |pmid=20085681 |url=http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |url-status=dead |archive-url=https://web.archive.org/web/20110716212405/http://www.sogc.org/jogc/abstracts/full/200912_WomensHealth_1.pdf |archive-date=16 July 2011 |doi=10.1016/s1701-2163(16)34376-6}}</ref> [[Pertubuhan Kesihatan Sedunia]] menyatakan bahawa "akses ke penjagaan pengguguran yang sah, selamat dan menyeluruh, termasuk penjagaan selepas pengguguran, sangat penting untuk mencapai tahap kesihatan seksual dan pembiakan setinggi mungkin."<ref>{{Cite web|title=Abortion|url=https://www.who.int/westernpacific/health-topics/abortion|access-date=2021-04-14|website=www.who.int|language=en}}</ref>


Sekitar 56 juta pengguguran dilakukan setiap tahun di dunia,<ref>{{cite journal|last1=Sedgh|first1=Gilda|last2=Bearak|first2=Jonathan|last3=Singh|first3=Susheela|last4=Bankole|first4=Akinrinola|last5=Popinchalk|first5=Anna|last6=Ganatra|first6=Bela|last7=Rossier|first7=Clémentine|last8=Gerdts|first8=Caitlin|last9=Tunçalp|first9=Özge|last10=Johnson|first10=Brooke Ronald|last11=Johnston|first11=Heidi Bart|last12=Alkema|first12=Leontine|title=Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends|journal=The Lancet|date=May 2016|doi=10.1016/S0140-6736(16)30380-4|pmid=27179755|volume=388|issue=10041|pages=258–67|pmc=5498988}}</ref> dengan sekitar 45% dilakukan secara tidak selamat.<ref>{{cite web|title=Worldwide, an estimated 25 million unsafe abortions occur each year|url=https://www.who.int/mediacentre/news/releases/2017/unsafe-abortions-worldwide/en/|website=World Health Organization|access-date=29 September 2017|date=28 September 2017|archive-url=https://web.archive.org/web/20170929131145/http://who.int/mediacentre/news/releases/2017/unsafe-abortions-worldwide/en/|archive-date=29 September 2017|url-status=live}}</ref> Kadar pengguguran berubah sedikit antara tahun 2003 dan 2008,<ref name="Sedgh 2012">{{Cite journal |last1=Sedgh |first1=G. |last2=Singh |first2=S. |last3=Shah |first3=I.H. |last4=Åhman |first4=E. |last5=Henshaw |first5=S.K. |last6=Bankole |first6=A. |doi=10.1016/S0140-6736(11)61786-8 |title=Induced abortion: Incidence and trends worldwide from 1995 to 2008 |journal=The Lancet |volume=379 |issue=9816 |pages=625–32 |year=2012 |pmid=22264435 |s2cid=27378192 |url=http://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf |quote=Because few of the abortion estimates were based on studies of random samples of women, and because we did not use a model-based approach to estimate abortion incidence, it was not possible to compute confidence intervals based on standard errors around the estimates. Drawing on the information available on the accuracy and precision of abortion estimates that were used to develop the subregional, regional, and worldwide rates, we computed intervals of certainty around these rates (webappendix). We computed wider intervals for unsafe abortion rates than for safe abortion rates. The basis for these intervals included published and unpublished assessments of abortion reporting in countries with liberal laws, recently published studies of national unsafe abortion, and high and low estimates of the numbers of unsafe abortion developed by WHO. |url-status=live |archive-url=https://web.archive.org/web/20120206043854/http://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf |archive-date=6 February 2012 }}</ref> sebelum ia menurun sekurang-kurangnya dua dekad ketika akses ke [[perancang keluarga]] dan kawalan kelahiran meningkat.<ref name="worldtrends2007">{{Cite journal |vauthors=Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J |title=Legal abortion worldwide: incidence and recent trends |journal=International Family Planning Perspectives |volume=33 |issue=3 |pages=106–16 |date=September 2007 |pmid=17938093 |doi= 10.1363/3310607|url=http://www.guttmacher.org/pubs/journals/3310607.html |url-status=live |archive-url=https://web.archive.org/web/20090819122933/http://www.guttmacher.org/pubs/journals/3310607.html |archive-date=19 August 2009 |doi-access=free }}</ref> {{as of|2018}}, 37% wanita di dunia mempunyai akses ke pengguguran undang-undang tanpa had yang menjadi punca penurunan.<ref name=Gutt_2018_fact >{{ cite web | url=https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide | title=Induced Abortion Worldwide | work=[[Guttmacher Institute]] | date=2018-03-01 | access-date=2020-02-21 | quote=Of the world's 1.64 billion women of reproductive age, 6% live where abortion is banned outright, and 37% live where it is allowed without restriction as to reason. Most women live in countries with laws that fall between these two extremes. }}</ref><ref name=IJGO10 /> Negara yang membenarkan pengguguran mempunyai had yang berbeza mengenai seberapa lewat kehamilan pengguguran dibenarkan.<ref name=IJGO10>{{Cite journal|vauthors=Culwell KR, Vekemans M, de Silva U, Hurwitz M |title=Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion |journal=International Journal of Gynecology & Obstetrics |volume=110 |pages=S13–16 |date=July 2010 |pmid=20451196 |doi=10.1016/j.ijgo.2010.04.003|s2cid=40586023 }}</ref> Kadar pengguguran adalah serupa antara negara yang melarang pengguguran dan negara yang membenarkannya.<ref>{{Cite web|date=2020-05-28|title=Unintended Pregnancy and Abortion Worldwide|url=https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide|access-date=2021-03-09|website=Guttmacher Institute|language=en}}</ref>
Sekitar 56 juta pengguguran dilakukan setiap tahun di dunia,<ref>{{cite journal|last1=Sedgh|first1=Gilda|last2=Bearak|first2=Jonathan|last3=Singh|first3=Susheela|last4=Bankole|first4=Akinrinola|last5=Popinchalk|first5=Anna|last6=Ganatra|first6=Bela|last7=Rossier|first7=Clémentine|last8=Gerdts|first8=Caitlin|last9=Tunçalp|first9=Özge|last10=Johnson|first10=Brooke Ronald|last11=Johnston|first11=Heidi Bart|last12=Alkema|first12=Leontine|title=Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends|journal=The Lancet|date=May 2016|doi=10.1016/S0140-6736(16)30380-4|pmid=27179755|volume=388|issue=10041|pages=258–67|pmc=5498988}}</ref> dengan sekitar 45% dilakukan secara tidak selamat.<ref>{{cite web|title=Worldwide, an estimated 25 million unsafe abortions occur each year|url=https://www.who.int/mediacentre/news/releases/2017/unsafe-abortions-worldwide/en/|website=World Health Organization|access-date=29 September 2017|date=28 September 2017|archive-url=https://web.archive.org/web/20170929131145/http://who.int/mediacentre/news/releases/2017/unsafe-abortions-worldwide/en/|archive-date=29 September 2017|url-status=live}}</ref> Kadar pengguguran berubah sedikit antara tahun 2003 dan 2008,<ref name="Sedgh 2012">{{Cite journal |last1=Sedgh |first1=G. |last2=Singh |first2=S. |last3=Shah |first3=I.H. |last4=Åhman |first4=E. |last5=Henshaw |first5=S.K. |last6=Bankole |first6=A. |doi=10.1016/S0140-6736(11)61786-8 |title=Induced abortion: Incidence and trends worldwide from 1995 to 2008 |journal=The Lancet |volume=379 |issue=9816 |pages=625–32 |year=2012 |pmid=22264435 |s2cid=27378192 |url=http://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf |quote=Because few of the abortion estimates were based on studies of random samples of women, and because we did not use a model-based approach to estimate abortion incidence, it was not possible to compute confidence intervals based on standard errors around the estimates. Drawing on the information available on the accuracy and precision of abortion estimates that were used to develop the subregional, regional, and worldwide rates, we computed intervals of certainty around these rates (webappendix). We computed wider intervals for unsafe abortion rates than for safe abortion rates. The basis for these intervals included published and unpublished assessments of abortion reporting in countries with liberal laws, recently published studies of national unsafe abortion, and high and low estimates of the numbers of unsafe abortion developed by WHO. |url-status=live |archive-url=https://web.archive.org/web/20120206043854/http://www.guttmacher.org/pubs/journals/Sedgh-Lancet-2012-01.pdf |archive-date=6 February 2012 }}</ref> sebelum ia menurun sekurang-kurangnya dua dekad ketika akses ke [[perancang keluarga]] dan kawalan kelahiran meningkat.<ref name="worldtrends2007">{{Cite journal |vauthors=Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J |title=Legal abortion worldwide: incidence and recent trends |journal=International Family Planning Perspectives |volume=33 |issue=3 |pages=106–16 |date=September 2007 |pmid=17938093 |doi= 10.1363/3310607|url=http://www.guttmacher.org/pubs/journals/3310607.html |url-status=live |archive-url=https://web.archive.org/web/20090819122933/http://www.guttmacher.org/pubs/journals/3310607.html |archive-date=19 August 2009 |doi-access=free }}</ref> {{as of|2018}}, 37% wanita di dunia mempunyai akses ke pengguguran undang-undang tanpa had yang menjadi punca penurunan.<ref name=Gutt_2018_fact >{{ cite web | url=https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide | title=Induced Abortion Worldwide | work=[[Guttmacher Institute]] | date=2018-03-01 | access-date=2020-02-21 | quote=Of the world's 1.64 billion women of reproductive age, 6% live where abortion is banned outright, and 37% live where it is allowed without restriction as to reason. Most women live in countries with laws that fall between these two extremes. }}</ref><ref name=IJGO10 /> Negara yang membenarkan pengguguran mempunyai had yang berbeza mengenai seberapa lewat kehamilan pengguguran dibenarkan.<ref name=IJGO10>{{Cite journal|vauthors=Culwell KR, Vekemans M, de Silva U, Hurwitz M |title=Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion |journal=International Journal of Gynecology & Obstetrics |volume=110 |pages=S13–16 |date=July 2010 |pmid=20451196 |doi=10.1016/j.ijgo.2010.04.003|s2cid=40586023 }}</ref> Kadar pengguguran adalah serupa antara negara yang melarang pengguguran dan negara yang membenarkannya.<ref>{{Cite web|date=2020-05-28|title=Unintended Pregnancy and Abortion Worldwide|url=https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide|access-date=2021-03-09|website=Guttmacher Institute|language=en}}</ref>

Semakan pada 15:41, 9 Jun 2021

Pengguguran (bahasa Inggeris: abortion), juga aborsi[nota 1] ialah penamatan kehamilan dengan penyingkiran atau pengeluaran embrio atau janin.[note 1] Pengguguran yang berlaku tanpa intervensi dikenali sebagai keguguran atau "pengguguran spontan" dan berlaku pada kira-kira 30% hingga 40% kehamilan.[1][2] Apabila langkah-langkah yang disengaja diambil untuk mengakhiri kehamilan, ia disebut pengguguran cetusan, atau lebih jarang "keguguran cetusan". Kata pengguguran yang tidak diubah suai secara amnya merujuk kepada pengguguran cetusan.[3][4]

Apabila dilakukan dengan betul, pengguguran adalah salah satu prosedur paling selamat dalam perubatan,[5]:1 [6]:1 tetapi pengguguran yang tidak selamat adalah penyebab utama kematian bersalin, terutama di negara membangun,[7] sambil menjadikan pengguguran yang selamat adalah sah dan diakses mengurangkan kematian bersalin.[8][9] Ia lebih selamat daripada kelahiran anak, yang mempunyai risiko kematian 14 kali lebih tinggi di Amerika Syarikat.[10]

Kaedah moden menggunakan ubat atau pembedahan untuk pengguguran.[11] Dadah mifepriston dalam kombinasi dengan prostaglandin nampaknya selamat dan berkesan seperti pembedahan pada trimester pertama dan kedua kehamilan.[11][12] Teknik pembedahan yang paling biasa melibatkan melebarkan serviks dan menggunakan alat penyedut.[13] Alat kawalan kelahiran, seperti pil atau alat intrauterin, dapat digunakan segera setelah pengguguran.[12] Apabila dilakukan secara sah dan selamat pada wanita yang menginginkannya, pengguguran cetusan tidak meningkatkan risiko masalah mental atau fizikal jangka panjang.[14] Sebaliknya, pengguguran yang tidak selamat (yang dilakukan oleh individu yang tidak mahir, dengan peralatan berbahaya, atau di kemudahan yang tidak bersih) menyebabkan 47,000 kematian dan 5 juta kemasukan ke hospital setiap tahun.[14][15] Pertubuhan Kesihatan Sedunia menyatakan bahawa "akses ke penjagaan pengguguran yang sah, selamat dan menyeluruh, termasuk penjagaan selepas pengguguran, sangat penting untuk mencapai tahap kesihatan seksual dan pembiakan setinggi mungkin."[16]

Sekitar 56 juta pengguguran dilakukan setiap tahun di dunia,[17] dengan sekitar 45% dilakukan secara tidak selamat.[18] Kadar pengguguran berubah sedikit antara tahun 2003 dan 2008,[19] sebelum ia menurun sekurang-kurangnya dua dekad ketika akses ke perancang keluarga dan kawalan kelahiran meningkat.[20] Setakat 2018, 37% wanita di dunia mempunyai akses ke pengguguran undang-undang tanpa had yang menjadi punca penurunan.[21][22] Negara yang membenarkan pengguguran mempunyai had yang berbeza mengenai seberapa lewat kehamilan pengguguran dibenarkan.[22] Kadar pengguguran adalah serupa antara negara yang melarang pengguguran dan negara yang membenarkannya.[23]

Definisi

Berikut merupakan istilah-istilah perubatan untuk mengkategorikan pengguguran:

  • Pengguguran spontan (keguguran): Kematian atau penyingkiran bayi dari rahim akibat trauma tidak sengaja atau sebab semula jadi. Keguguran sebegini boleh disebabkan replikasi kromosom tidak betul, atau faktor persekitaran lain.
  • Pengguguran aruhan: Pematian atau penyingkiran bayi dari rahim yang dilakukan dengan sengaja oleh manusia sendiri. Pengguguran seperti ini boleh dikategorikan kepada:
    • Pengguguran terapeutik: Pengguguran yang dilakukan bagi:
      • Menyelamatkan nyawa wanita yang hamil
      • Memelihara kesihatan fizikal atau mental wanita
      • Menghentikan kehamilan yang akan melahirkan bayi yang mempunyai gangguan kongenital yang membawa maut atau keadaan tak sihat yang teruk
      • Mengurangkan jumlah fetus secara berpilih, untuk mengurangkan risiko kesihatan yang berkaitan dengan kemahilan berganda
    • Pengguguran elektif: Pengguguran untuk sebab-sebab lain.

Perkataan "pengguguran" sendiri selalunya dikaitkan dengan pengguguran yang didorong (induced abortion).

Kejadian

Histogram pengguguran di UK mengikut umur hamil pada 2019.

Kekerapan serta sebab-sebab pengguguran bayi berbeza di seluruh dunia mengikut rantau. Kira-kira 46 juta pengguguran dilakukan di seluruh dunia setiap tahun. Dalam itu, 26 juta merupakan pengguguran sah, manakala 20 juta yang lain itu melanggar undang-undang. Nisbah pengguguran dunia ialah 26 per 100 kehamilan diketahui.[24]

Carta palang tentang sebab-sebab pengguguran pada 1998.

Faktor peribadi dan sosial

Mengikut satu kajian tahun 1997, terdapat beberapa sebab wanita-wanita memilih untuk menggugurkan kandungan mereka, termasuk: keingingan menangguhkan atau menghentikan kegiatan melahirkan anak, kerisauan akan gangguan kehamilan terhadap pekerjaan atau pendidikan, isu kewangan, kestabilan perhubungan dengan pasangan, atau tanggapan ketidakmatangan.[25] Kajian di Amerika Syarikat pada 2004 menunjukkan bahawa 1% daripada wanita yang hamil adalah akibat perogolan dan 0.5% akibat sumbang mahram.[26] Satu lagi kajian pula menunjukkan bahawa 54% daripada wanita yang menggugurkan anak menggunakan kaedah pencegahan hamil.[27] Di United Kingdom, tinjauan yang dibuat pada 1994 menerangkan bahawa wanita yang menggugurkan anak sering berada dalam golongan sosial yang tinggi, ataupun bersekedudukan atau bercerai. Kajian itu juga menyatakan bahawa wanita yang mempunyai teman seks yang banyak mempunyai kadar pengguguran yang lebih tinggi berbanding dengan wnita yang mempunyai pasangan seks tunggal.[28]

Ada juga pengguguran yang berlaku akibat tekanan masyarakat. Hal ini termasuk diskriminasi terhadap orang kurang upaya, kecederungan menginginkan bayi jantina tertentu, keengganan atau ketidaksetujuan menjadi ibu tunggal, keadaan ekonomi yang tidak sesuai untuk melahirkan bayi baru, tidak mempunyai akses kepada keadah pencegahan hamil serta kawalan penduduk (seperti dasar anak tunggal di China).

Pengguguran tak selamat

Di negara sedang membangun di mana pengguguran adalah tidak sah, wanita kadangnya terpaksa menggunakan prosedur pengguguran aruhan sendiri. Pertubuhan Kesihatan Sedunia menggangarkan bahawa 19 juta pengguguran seperti ini berlaku di dunia setiap tahun dan boleh dikelaskan sebagai pengguguran tak selamat.[29]

Nota

  1. ^ [a-bor-si], pinjaman Belanda: abortie, lebih digunakan di Indonesia

Rujukan

  1. ^ The Johns Hopkins Manual of Gynecology and Obstetrics (ed. 4). Lippincott Williams & Wilkins. 2012. m/s. 438–439. ISBN 9781451148015. Diarkibkan daripada yang asal pada September 10, 2017.
  2. ^ "How many people are affected by or at risk for pregnancy loss or miscarriage?". www.nichd.nih.gov. Julai 15, 2013. Diarkibkan daripada yang asal pada April 2, 2015. Dicapai pada Mac 14, 2015.
  3. ^ "Home : Oxford English Dictionary". www.oed.com.
  4. ^ "Abortion (noun)". Oxford Living Dictionaries. Diarkibkan daripada yang asal pada 28 May 2018. Dicapai pada 8 June 2018. [mass noun] The deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy
  5. ^ Ralat petik: Tag <ref> tidak sah; teks bagi rujukan lancet-grimes tidak disediakan
  6. ^ Ralat petik: Tag <ref> tidak sah; teks bagi rujukan Ray2014 tidak disediakan
  7. ^ "Preventing unsafe abortion". www.who.int. Dicapai pada 6 August 2019.
  8. ^ Faúndes, Anibal; Shah, Iqbal H. (1 October 2015). "Evidence supporting broader access to safe legal abortion". International Journal of Gynecology & Obstetrics. World Report on Women's Health 2015: The unfinished agenda of women's reproductive health. 131: S56–S59. doi:10.1016/j.ijgo.2015.03.018. ISSN 0020-7292. PMID 26433508. A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. ... criminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates.
  9. ^ Latt, Su Mon; Milner, Allison; Kavanagh, Anne (5 January 2019). "Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries". BMC Women's Health. 19 (1): 1. doi:10.1186/s12905-018-0705-y. ISSN 1472-6874. PMC 6321671. PMID 30611257.
  10. ^ Raymond, E.G.; Grimes, D.A. (2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology. 119 (2, Part 1): 215–19. doi:10.1097/AOG.0b013e31823fe923. PMID 22270271. S2CID 25534071. Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.
  11. ^ a b Kulier, R; Kapp, N; Gülmezoglu, AM; Hofmeyr, GJ; Cheng, L; Campana, A (9 November 2011). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews (11): CD002855. doi:10.1002/14651858.CD002855.pub4. PMC 7144729. PMID 22071804. S2CID 205167182.
  12. ^ a b Kapp, N; Whyte, P; Tang, J; Jackson, E; Brahmi, D (September 2013). "A review of evidence for safe abortion care". Contraception. 88 (3): 350–63. doi:10.1016/j.contraception.2012.10.027. PMID 23261233.
  13. ^ "Abortion – Women's Health Issues". Merck Manuals Consumer Version. Diarkibkan daripada yang asal pada 13 July 2018. Dicapai pada 12 July 2018.
  14. ^ a b Lohr, PA; Fjerstad, M; Desilva, U; Lyus, R (2014). "Abortion". BMJ. 348: f7553. doi:10.1136/bmj.f7553. S2CID 220108457.
  15. ^ Shah, I; Ahman, E (December 2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges" (PDF). Journal of Obstetrics and Gynaecology Canada. 31 (12): 1149–58. doi:10.1016/s1701-2163(16)34376-6. PMID 20085681. Diarkibkan daripada yang asal (PDF) pada 16 July 2011.
  16. ^ "Abortion". www.who.int (dalam bahasa Inggeris). Dicapai pada 2021-04-14.
  17. ^ Sedgh, Gilda; Bearak, Jonathan; Singh, Susheela; Bankole, Akinrinola; Popinchalk, Anna; Ganatra, Bela; Rossier, Clémentine; Gerdts, Caitlin; Tunçalp, Özge; Johnson, Brooke Ronald; Johnston, Heidi Bart; Alkema, Leontine (May 2016). "Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends". The Lancet. 388 (10041): 258–67. doi:10.1016/S0140-6736(16)30380-4. PMC 5498988. PMID 27179755.
  18. ^ "Worldwide, an estimated 25 million unsafe abortions occur each year". World Health Organization. 28 September 2017. Diarkibkan daripada yang asal pada 29 September 2017. Dicapai pada 29 September 2017.
  19. ^ Sedgh, G.; Singh, S.; Shah, I.H.; Åhman, E.; Henshaw, S.K.; Bankole, A. (2012). "Induced abortion: Incidence and trends worldwide from 1995 to 2008" (PDF). The Lancet. 379 (9816): 625–32. doi:10.1016/S0140-6736(11)61786-8. PMID 22264435. S2CID 27378192. Diarkibkan (PDF) daripada yang asal pada 6 February 2012. Because few of the abortion estimates were based on studies of random samples of women, and because we did not use a model-based approach to estimate abortion incidence, it was not possible to compute confidence intervals based on standard errors around the estimates. Drawing on the information available on the accuracy and precision of abortion estimates that were used to develop the subregional, regional, and worldwide rates, we computed intervals of certainty around these rates (webappendix). We computed wider intervals for unsafe abortion rates than for safe abortion rates. The basis for these intervals included published and unpublished assessments of abortion reporting in countries with liberal laws, recently published studies of national unsafe abortion, and high and low estimates of the numbers of unsafe abortion developed by WHO.
  20. ^ Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J (September 2007). "Legal abortion worldwide: incidence and recent trends". International Family Planning Perspectives. 33 (3): 106–16. doi:10.1363/3310607. PMID 17938093. Diarkibkan daripada yang asal pada 19 August 2009.
  21. ^ "Induced Abortion Worldwide". Guttmacher Institute. 2018-03-01. Dicapai pada 2020-02-21. Of the world's 1.64 billion women of reproductive age, 6% live where abortion is banned outright, and 37% live where it is allowed without restriction as to reason. Most women live in countries with laws that fall between these two extremes.
  22. ^ a b Culwell KR, Vekemans M, de Silva U, Hurwitz M (July 2010). "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion". International Journal of Gynecology & Obstetrics. 110: S13–16. doi:10.1016/j.ijgo.2010.04.003. PMID 20451196. S2CID 40586023.
  23. ^ "Unintended Pregnancy and Abortion Worldwide". Guttmacher Institute (dalam bahasa Inggeris). 2020-05-28. Dicapai pada 2021-03-09.
  24. ^ Henshaw, Stanley K., Singh, Susheela, & Haas, Taylor. (1999). The Incidence of Abortion Worldwide. International Family Planning Perspectives, 25 (Supplement), 30 – 8. Retrieved 2006-01-18.
  25. ^ Bankole, Akinrinola, Singh, Susheela, & Haas, Taylor. (1998). Reasons Why Women Have Induced Abortions: Evidence from 27 Countries. International Family Planning Perspectives, 24 (3), 117-127 & 152. Retrieved 2006-01-18.
  26. ^ Finer, Lawrence B., Frohwirth, Lori F., Dauphinee, Lindsay A., Singh, Shusheela, & Moore, Ann M. (2005). Reasons U.S. women have abortions: quantative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37 (3), 110-8. Retrieved 18 January 2006.
  27. ^ Jones, Rachel K., Darroch, Jacqueline E., Henshaw, Stanley K. (2002). Contraceptive Use Among U.S. Women Having Abortions in 2000-2001. Perspectives on Sexual and Reproductive Health, 34 (6). Retrieved June 15, 2006.
  28. ^ Wellings, K., et al. (1994). Sexual Behaviour in Britain: The National Survey of Sexual Attitudes and Lifestyles. London, UK: Penguin Books.
  29. ^ World Health Organization. (2004). Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000. Retrieved 2006-01-12.

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