Abortion

# Abortion

## Abstract

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons women give for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

When done legally in industrialized societies, induced abortion is one of the safest procedures in medicine. Unsafe abortions — those performed by people lacking the necessary skills, or in inadequately resourced settings — are responsible for between 5–13% of maternal deaths, especially in the developing world. However, medication abortions that are self-managed are highly effective and safe throughout the first trimester. Public health data show that making safe abortion legal and accessible reduces maternal deaths.

Modern methods use medication or surgery for abortions. The drug mifepristone (aka RU-486) in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimesters of pregnancy. The most common surgical technique involves dilating the cervix and using a suction device. Birth control, such as the pill or intrauterine devices, can be used immediately following abortion. When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term mental or physical problems. In contrast, unsafe abortions performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities cause between 22,000 and 44,000 deaths and 6.9 million hospital admissions each year. The World Health Organization states that "access to legal, safe and comprehensive abortion care, including post-abortion care, is essential for the attainment of the highest possible level of sexual and reproductive health". Historically, abortions have been attempted using herbal medicines, sharp tools, forceful massage, or other traditional methods.

Around 73 million abortions are performed each year in the world, with about 45% done unsafely. Abortion rates changed little between 2003 and 2008, before which they decreased for at least two decades as access to family planning and birth control increased. As of 2018, 37% of the world's women had access to legal abortions without limits as to reason. Countries that permit abortions have different limits on how late in pregnancy abortion is allowed. Abortion rates are similar between countries that restrict abortion and countries that broadly allow it, though this is partly because countries which restrict abortion tend to have higher unintended pregnancy rates.

Globally, there has been a widespread trend towards greater legal access to abortion since 1973, but there remains debate with regard to moral, religious, ethical, and legal issues. Those who oppose abortion often argue that an embryo or fetus is a person with a right to life, and thus equate abortion with murder. Those who support abortion's legality often argue that it is a woman's reproductive right. Others favor legal and accessible abortion as a public health measure. Abortion laws and views of the procedure are different around the world. In some countries abortion is legal and women have the right to make the choice about abortion. In some areas, abortion is legal only in specific cases such as rape, incest, fetal defects, poverty, and risk to a woman's health.

## Types

### Induced

An induced abortion is a medical procedure to end a pregnancy. In modern English, the term abortion, when used without further qualification, generally refers to induced abortion.

A pregnancy can be intentionally aborted in several ways. The abortion method depends upon the gestational age of the embryo or fetus, which gains mass as the pregnancy progresses. Abortion laws, regional availability, and the personal preference of the women and her doctor may inform the women's choice of a specific abortion procedure.

Abortions can be characterized as either therapeutic or elective. When an abortion is performed for medical reasons, the procedure is referred to as a therapeutic abortion. Medical reasons for therapeutic abortion include saving the life of the pregnant woman, preventing harm to the woman's physical or mental health, preventing the birth of a child who will have a significantly increased chance of mortality or morbidity, and reducing the number of fetuses to lessen health risks associated with multiple pregnancy. An abortion is referred to as elective or voluntary when it is performed at the request of the woman for non-medical reasons. Confusion sometimes arises over the term elective because " elective surgery " generally refers to all scheduled surgery, whether medically necessary or not.

About one in five pregnancies worldwide ends with an induced abortion. Most abortions result from unintended pregnancies. In the United Kingdom, 1 to 2% of abortions are done because of genetic problems in the fetus.

### Spontaneous

Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation. A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a " premature birth " or a "preterm birth". When a fetus dies in utero after viability, or during delivery, it is usually termed " stillborn ". Premature births and stillbirths are generally not considered to be miscarriages, although usage of these terms can sometimes overlap.

Studies of pregnant women in the US and China have shown that between 40% and 60% of embryos do not progress to birth. The vast majority of miscarriages occur before the woman is aware that she is pregnant, and many pregnancies spontaneously abort before medical practitioners can detect an embryo. Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman. 80% of these spontaneous abortions happen in the first trimester.

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus. Advancing maternal age and a woman's history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.

## Methods

### Medical

Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s.

The most common early first trimester medical abortion regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost) up to 10 weeks (70 days) gestational age, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone, particularly in the second trimester. Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.

In very early abortions, up to 7 weeks gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue. Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%. If medical abortion fails, surgical abortion must be used to complete the procedure.

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain, France, Switzerland, United States, and the Nordic countries.

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in Canada, most of Europe, China and India, in contrast to the United States where 96% of second trimester abortions are performed surgically by dilation and evacuation.

A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion. Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion. Safely permitting women to self-administer abortion medication has the potential to improve access to abortion. The review also noted a research gap concerning methods to support women who take medication at home for a self-administered abortion.

### Surgical

Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion. Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. Both techniques can be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.

MVA, also known as "mini-suction" and " menstrual extraction ", or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The World Health Organization recommends sharp curettage only when suction aspiration is unavailable.

Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.

Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.

First trimester procedures can generally be performed using local anesthesia, while second trimester methods may require deep sedation or general anesthesia.

### Labor induction abortion

In places lacking the necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary. This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.

Only limited data are available comparing labor-induced abortion with the dilation and extraction method. Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.

### Other methods

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Such herbs include tansy, pennyroyal, black cohosh, and the now-extinct silphium.

In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil. Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure, such use is not recommended by physicians.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.

Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion is legal and available.

## Safety

The health risks of abortion depend principally on how, and under what conditions, the procedure is performed. The World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Legal abortions performed in the developed world are among the safest procedures in medicine. According to a 2012 study in Obstetrics & Gynecology, in the United States the risk of maternal mortality is 14 times lower after induced abortion than after childbirth. The CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births, while the US abortion mortality rate was 0.43 maternal deaths per 100,000 procedures. In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term." Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed procedures constitute 13% of maternal mortality globally." In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14–16 percent of maternal deaths resulted from abortion.

In the US from 2000 to 2009, abortion had a mortality rate lower than plastic surgery, lower or similar to running a marathon, and about equivalent to traveling 760 miles (1,220 km) in a passenger car. Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions. The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth. Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.

### Safety of abortion methods

There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation. Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.

### Safety and gestational age

Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate. Infections account for one-third of abortion-related deaths in the United States. The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office. Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures, as they are believed to substantially reduce the risk of postoperative uterine infection; however, antibiotics are not routinely given with abortion pills. The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner.

Complications after second trimester abortion are similar to those after first trimester abortion, and depend somewhat on the method chosen. The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period). It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.

### Mental health

Current evidence finds no relationship between most induced abortions and mental health problems other than those expected for any unwanted pregnancy. A report by the American Psychological Association concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain. Some older reviews concluded that abortion was associated with an increased risk of psychological problems; however, later reviews of the medical literature found that previous reviews did not use an appropriate control group. When a control group is utilized, receiving abortion is not associated with adverse psychological outcomes. However, women seeking abortion who are denied access to abortion have an increase in anxiety after the denial.

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities, more rigorous research would be needed to show this conclusively. Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called " post-abortion syndrome ", but this is not recognized by medical or psychological professionals in the United States.

A 2020 long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later. The researchers also stated: "These results add to the scientific evidence that emotions about an abortion are associated with personal and social context, and are not a product of the abortion procedure itself."

### Safety in the abortion debate

Some purported risks of abortion are promoted primarily by anti-abortion groups, but lack scientific support. For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.

In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record."

According to Rickie Solinger,

A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... he historical evidence does not support such claims.

A 1940s American physician spoke of his pride in having performed 13,844 illegal abortions without any fatalities. In 1870s New York City, the abortionist/midwife Madame Restell (Anna Trow Lohman) is said to have lost very few women among her more than 100,000 patients —a lower mortality rate than the childbirth mortality rate at the time. In 1936, obstetrics and gynecology professor Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that

With each decade of the past fifty years the actual and proportionate frequency of this accident has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus.

### Unsafe abortion

Women seeking an abortion may use unsafe methods, especially when abortion is legally restricted. They may attempt self-induced abortion or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.

Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries. Unsafe abortions are believed to result in millions of injuries. Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade; deaths from unsafe abortion account for around 13% of all maternal deaths. The World Health Organization believes that mortality has fallen since the 1990s. To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.

A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to countries where abortion is legal and available. For example, the 1996 legalization of abortion in South Africa led to an immediate reduction in abortion-related complications, with abortion-related deaths dropping by more than 90%. Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal. A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state. The analysis, however, did not take into account travel to other states without such laws to obtain an abortion. In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally. Rates 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".

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits, while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria. While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year. Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide, though this varies by region. Secondary infertility caused by an unsafe abortion affects an estimated 24 million women. The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address consequences of unsafe abortion.

## Incidence

There are two commonly used methods of measuring the incidence of abortion:

- Abortion rate – number of abortions annually per 1,000 women between 15 and 44 years of age; some sources use a range of 15–49.

- Abortion percentage – number of abortions out of 100 known pregnancies; pregnancies include live births, abortions, and miscarriages.

In many places, where abortion is illegal or carries a heavy social stigma, medical reporting of abortion is not reliable. For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error. The number of abortions performed worldwide was characterized as stable in the early 2000s, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008. The abortion rate worldwide was 28 per 1000 women per year, though it was 24 per 1000 women per year for developed countries and 29 per 1000 women per year for developing countries. The same 2012 study indicated that in 2008, the estimated abortion percentage of known pregnancies was at 21% worldwide, with 26% in developed countries and 20% in developing countries.

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion. Restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely. The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.

The rate of legal, induced abortion varies extensively worldwide. According to the report of employees of Guttmacher Institute it ranged from 7 per 1000 women per year (Germany and Switzerland) to 30 per 1000 women per year (Estonia) in countries with complete statistics in 2008. The proportion of pregnancies that ended in induced abortion ranged from about 10% (Israel, the Netherlands and Switzerland) to 30% (Estonia) in the same group, though it might be as high as 36% in Hungary and Romania, whose statistics were deemed incomplete.

An American study in 2002 concluded that about half of women having abortions were using a form of contraception at the time of becoming pregnant. Inconsistent use was reported by half of those using condoms and three-quarters of those using the birth control pill; 42% of those using condoms reported failure through slipping or breakage. Of the other half of women, who were not using contraception at the time of becoming pregnant, the vast majority had used contraception at some point in the past, indicating some level of dissatisfaction with the contraceptive options available to them. Indeed, 32% of these contraceptive nonusers cited concerns about contraceptive methods as their reason for nonuse, and a more recent study found similar results. Taken together, these statistics suggest that new contraceptive methods, such as non-hormonal contraceptives or male contraceptives, could reduce unintended pregnancy and abortion rates.

The Guttmacher Institute has found that "most abortions in the United States are obtained by minority women" because minority women "have much higher rates of unintended pregnancy". In a 2022 analysis by the Kaiser Family Foundation, while people of color comprise 44% of the population in Mississippi, 59% of the population in Texas, 42% of the population in Louisiana, and 35% of the population in Alabama, they comprise 80%, 74%, 72%, and 70%, respectively, of those receiving abortions.

### Gestational age and method

Abortion rates vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention (CDC) reported that 26% of reported legal induced abortions in the United States were known to have been obtained at the end of 6 weeks of gestation or less, 18% at 7 weeks, 15% at 8 weeks, 18% at 9 through 10 weeks, 10% at 11 through 12 weeks, 6% at 13 through 15 weeks, 4% at 16 through 20 weeks and 1% at more than 21 weeks. 91% of these were classified as having been done by " curettage " (suction-aspiration, dilation and curettage, dilation and evacuation), 8% by " medical " means (mifepristone), >1% by " intrauterine instillation " (saline or prostaglandin), and 1% by "other" (including hysterotomy and hysterectomy). According to the CDC, due to data collection difficulties the data must be viewed as tentative and some fetal deaths reported beyond 20 weeks may be natural deaths erroneously classified as abortions if the removal of the dead fetus is accomplished by the same procedure as an induced abortion.

The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for <0.2% of the total number of abortions performed that year. Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 and 19 weeks, and 2% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical. There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.

There are both medical and non-medical reasons to have an abortion later in pregnancy (after 20 weeks). A study was conducted from 2008 to 2010 at the University of California San Francisco where more than 440 women were asked about why they experienced delays in obtaining abortion care, if there were any. This study found that almost half of individuals who obtained an abortion after 20 weeks did not suspect that they were pregnant until later in their pregnancy. Other barriers to abortion care found in the study included lack of information about where to access an abortion, difficulties with transportation, lack of insurance coverage, and inability to pay for the abortion procedure.

Medical reasons for seeking an abortion later in pregnancy include fetal anomalies and health risk to the pregnant person. There are prenatal tests that can diagnose Down Syndrome or cystic fibrosis as early as 10 weeks into gestation, but structural fetal anomalies are often detected much later in pregnancy. A proportion of structural fetal anomalies are lethal, which means that the fetus will almost certainly die before or shortly after birth. Life-threatening conditions may also develop later in pregnancy, such as early severe preeclampsia, newly diagnosed cancer in need of urgent treatment, and intrauterine infection (chorioamnionitis), which often occurs along with premature rupture of the amniotic sac (PPROM). If serious medical conditions such as these arise before the fetus is viable, the person carrying the pregnancy may pursue an abortion to preserve their own health.

## Motivation

### Personal

The reasons why women have abortions are diverse and vary across the world. Some of the reasons may include an inability to afford a child, domestic violence, lack of support, feeling they are too young, and the wish to complete education or advance a career. Additional reasons include not being able or willing to raise a child conceived as a result of rape or incest.

### Societal

Some abortions are undergone as the result of societal pressures. These might include the preference for children of a specific sex or race, disapproval of single or early motherhood, stigmatization of people with disabilities, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion. In cultures where there is a preference for male children, some women have sex selective abortions, which have partially replaced the earlier practice of female infanticide.

### Maternal health

Some abortions are performed due to concerns over maternal health. In 1990s, women cited maternal health as their main motivating factor in about a third of abortions in three of 27 countries analyzed. In seven additional countries, about 7% of abortions were maternal health related.

In the U.S., the Supreme Court decisions in Roe v. Wade and Doe v. Bolton: "ruled that the state's interest in the life of the fetus became compelling only at the point of viability, defined as the point at which the fetus can survive independently of its mother. Even after the point of viability, the state cannot favor the life of the fetus over the life or health of the pregnant woman. Under the right of privacy, physicians must be free to use their "medical judgment for the preservation of the life or health of the mother." On the same day that the Court decided Roe, it also decided Doe v. Bolton, in which the Court defined health very broadly: "The medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient. All these factors may relate to health. This allows the attending physician the room he needs to make his best medical judgment."

#### Cancer

The rate of cancer during pregnancy is 0.02–1%, and in many cases, cancer of the mother leads to consideration of abortion to protect the life of the mother, or in response to the potential damage that may occur to the fetus during treatment. This is particularly true for cervical cancer, the most common type of which occurs in 1 of every 2,000–13,000 pregnancies, for which initiation of treatment "cannot co-exist with preservation of fetal life (unless neoadjuvant chemotherapy is chosen)". Very early stage cervical cancers (I and IIa) may be treated by radical hysterectomy and pelvic lymph node dissection, radiation therapy, or both, while later stages are treated by radiotherapy. Chemotherapy may be used simultaneously. Treatment of breast cancer during pregnancy also involves fetal considerations, because lumpectomy is discouraged in favor of modified radical mastectomy unless late-term pregnancy allows follow-up radiation therapy to be administered after the birth.

Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic effects on the fetus, with higher risks for multiple drug treatments. Treatment with more than 40 Gy of radiation usually causes spontaneous abortion. Exposure to much lower doses during the first trimester, especially 8 to 15 weeks of development, can cause intellectual disability or microcephaly, and exposure at this or subsequent stages can cause reduced intrauterine growth and birth weight. Exposures above 0.005–0.025 Gy cause a dose-dependent reduction in IQ. It is possible to greatly reduce exposure to radiation with abdominal shielding, depending on how far the area to be irradiated is from the fetus.

The process of birth itself may also put the mother at risk. According to Li et al., "aginal delivery may result in dissemination of neoplastic cells into lymphovascular channels, haemorrhage, cervical laceration and implantation of malignant cells in the episiotomy site, while abdominal delivery may delay the initiation of non-surgical treatment."

### Fetal health

Congenital disorders, revealed by prenatal screening, motivate some women to seek abortions. Health outcomes of preterm births include a significant probability of long-term neurodevelopmental impairment before gestational age of 29 weeks, with a higher probability with decreasing gestational age.

In the United States, public opinion shifted after television personality Sherri Finkbine 's was exposed to thalidomide, a teratogen, in her fifth month of pregnancy. Unable to obtain a legal abortion in the United States, Finkbine traveled to Sweden. From 1962 to 1965, an outbreak of German measles left 15,000 babies with severe birth defects. In 1967, the American Medical Association publicly supported liberalization of abortion laws. A National Opinion Research Center poll in 1965 showed 73% supported abortion when the mother's life was at risk, 57% when birth defects were present and 59% for pregnancies resulting from rape or incest.

## History and religion

Since ancient times, abortions have been done using a number of methods, including herbal medicines acting as abortifacients, sharp tools through the use of force, or through other traditional medicine methods. Induced abortion has a long history and can be traced back to civilizations as varied as ancient China (abortifacient knowledge is often attributed to the mythological ruler Shennong), ancient India since its Vedic age, ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE). One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.

In Judaism (Genesis2:7), the fetus is not generally considered to have a human soul until it is safely outside of the woman, is viable, and has taken its first breath. The fetus is considered valuable property of the woman and not a human life while in the womb (Exodus 21:22-23). While Judaism encourages people to be fruitful and multiply by having children, abortion is allowed and is deemed necessary when a pregnant woman's life is in danger. Several religions, including Judaism, which disagree that human life begins at conception, support the legality of abortion on religious freedom grounds. In Islam, abortion is traditionally permitted until a point in time when Muslims believe the soul enters the fetus, considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or at quickening. Abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade physicians in Ancient Greece from performing abortions; other scholars disagree with this interpretation, and state that the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath. The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus of Ephesus, although apparently not all doctors adhered to it strictly at the time. According to Soranus' 1st or 2nd century CE work Gynaecology, one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party to which he belonged was willing to prescribe abortions only for the sake of the mother's health. In Politics (350 BCE), Aristotle condemned infanticide as a means of population control. He preferred abortion in such cases, with the restriction that it "must be practised on it before it has developed sensation and life; for the line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive."

In the Catholic Church, opinion was divided on how serious abortion was in comparison with such acts as contraception, oral sex, and sex in marriage for pleasure rather than procreation. The Catholic Church did not begin vigorously opposing abortion until the 19th century. As early as ~100 CE, the Didache taught that abortion was sinful. Several historians argue that prior to the 19th century most Catholic authors did not regard termination of pregnancy before quickening or ensoulment as an abortion. Among these authors were the Doctors of the Church, such as St. Augustine, St. Thomas Aquinas, and St. Alphonsus Liguori. In 1588, Pope Sixtus V (r. 1585–1590) was the only Pope before Pope Pius IX (in his 1869 bull, Apostolicae Sedis) to institute a Church policy labeling all abortion as homicide and condemning abortion regardless of the stage of pregnancy. Sixtus V's pronouncement was reversed in 1591 by Pope Gregory XIV. In the recodification of 1917 Code of Canon Law, Apostolicae Sedis was strengthened, in part to remove a possible reading that excluded excommunication of the mother. Statements made in the Catechism of the Catholic Church, the codified summary of the Church's teachings, considers abortion from the moment of conception as homicide and called for the end of legal abortion.

Denominations that support abortion rights with some limits include the United Methodist Church, Episcopal Church, Evangelical Lutheran Church in America and Presbyterian Church USA. A 2014 Guttmacher survey of abortion patients in the United States found that many reported a religious affiliation: 24% were Catholic while 30% were Protestant. A 1995 survey reported that Catholic women are as likely as the general population to terminate a pregnancy, Protestants are less likely to do so, and evangelical Christians are the least likely to do so. A 2019 Pew Research Center study found that most Christian denominations were against overturning Roe v. Wade, which in the United States legalized abortion, at around 70%, except White Evangelicals at 35%.

Abortion has been a fairly common practice, and was not always illegal or controversial until the 19th century. Under common law, including early English common law dating back to Edward Coke in 1648, abortion was generally permitted before quickening (14–26 weeks after conception, or between the fourth and sixth month), and at women's discretion; it was whether abortion was performed after quickening that determined if it was a crime. In Europe and North America, abortion techniques advanced starting in the 17th century; the conservatism of most in the medical profession with regards to sexual matters prevented the wide expansion of abortion techniques. Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century when the practice, sometimes called restellism, was banned in both the United States and the United Kingdom.

Some 19th-century physicians, one of the most famous and consequential being the American Horatio Storer, argued for anti-abortion laws on racist and misogynist as well as moral grounds. Church groups were also highly influential in anti-abortion movements, and religious groups more so since the 20th century. Some of the early anti-abortion laws punished only the doctor or abortionist, and while women could be criminally tried for a self-induced abortion, they were rarely prosecuted in general. In the United States, some argued that abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer. Others maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe. Several scholars argue that, despite improved medical procedures, the period from the 1930s until the 1970s saw more zealous enforcement of anti-abortion laws, alongside an increasing control of abortion providers by organized crime.

In 1920, Soviet Russia became the first country to legalize abortion after Lenin insisted that no woman be forced to give birth. Iceland (1935) and Sweden (1938) would follow suit to legalize certain or all forms of abortion. In Nazi Germany (1935), a law permitted abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions. Beginning in the second half of the 20th century, abortion was legalized in a greater number of countries. In Japan, abortion was first legalized by the 1948 "Eugenics Protection Law" meant to prevent the births of "inferior" humans. As of 2022, due to Japan's continuing strongly patriarchal culture and traditional views on women's societal roles, women who want an abortion must normally get written permission from their partner.

## Society and culture

### Abortion debate

Induced abortion has long been the source of considerable debate. Ethical, moral, philosophical, biological, religious and legal issues surrounding abortion are related to value systems. Opinions of abortion may be about fetal rights, governmental authority, and women's rights.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or the justification of laws permitting or restricting abortion. The World Medical Association Declaration on Therapeutic Abortion notes, "circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question as to whether or not the pregnancy should be deliberately terminated." Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as " pro-life " while groups who are against such legal restrictions describe themselves as " pro-choice ".

### Modern abortion law

Current laws pertaining to abortion are diverse. Religious, moral, and cultural factors continue to influence abortion laws throughout the world. The right to life, the right to liberty, the right to security of person, and the right to reproductive health are major issues of human rights that sometimes constitute the basis for the existence or absence of abortion laws.

In jurisdictions where abortion is legal, certain requirements must often be met before a woman may obtain a legal abortion (an abortion performed without the woman's consent is considered feticide and is generally illegal). These requirements usually depend on the age of the fetus, often using a trimester -based system to regulate the window of legality, or as in the U.S., on a doctor's evaluation of the fetus' viability. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion. Other jurisdictions may require that a woman obtain the consent of the fetus' father before aborting the fetus, that abortion providers inform women of health risks of the procedure—sometimes including "risks" not supported by the medical literature—and that multiple medical authorities certify that the abortion is either medically or socially necessary. Many restrictions are waived in emergency situations. China, which has ended their one-child policy, and now has a three-child policy, has at times incorporated mandatory abortions as part of their population control strategy.

Other jurisdictions ban abortion almost entirely. Many, but not all, of these allow legal abortions in a variety of circumstances. These circumstances vary based on jurisdiction, but may include whether the pregnancy is a result of rape or incest, the fetus' development is impaired, the woman's physical or mental well-being is endangered, or socioeconomic considerations make childbirth a hardship. In countries where abortion is banned entirely, such as Nicaragua, medical authorities have recorded rises in maternal death directly and indirectly due to pregnancy as well as deaths due to doctors' fears of prosecution if they treat other gynecological emergencies. Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene. This is also a terminology in traditional medicine. In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in medical tourism and travel to countries where they can terminate their pregnancies. Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.

The organization Women on Waves has been providing education about medical abortions since 1999. The NGO created a mobile medical clinic inside a shipping container, which then travels on rented ships to countries with restrictive abortion laws. Because the ships are registered in the Netherlands, Dutch law prevails when the ship is in international waters. While in port, the organization provides free workshops and education; while in international waters, medical personnel are legally able to prescribe medical abortion drugs and counseling.

### Sex-selective abortion

Sonography and amniocentesis allow parents to determine sex before childbirth. The development of this technology has led to sex-selective abortion, or the termination of a fetus based on its sex. The selective termination of a female fetus is most common.

Sex-selective abortion is partially responsible for the noticeable disparities between the birth rates of male and female children in some countries. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Taiwan, South Korea, India, and China. This deviation from the standard birth rates of males and females occurs despite the fact that the country in question may have officially banned sex-selective abortion or even sex-screening. In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.

Many countries have taken legislative steps to reduce the incidence of sex-selective abortion. At the International Conference on Population and Development in 1994 over 180 states agreed to eliminate "all forms of discrimination against the girl child and the root causes of son preference", conditions also condemned by a PACE resolution in 2011. The World Health Organization and UNICEF, along with other United Nations agencies, have found that measures to restrict access to abortion in an effort to reduce sex-selective abortions have unintended negative consequences, largely stemming from the fact that women may seek or be coerced into seeking unsafe, extralegal abortions. On the other hand, measures to reduce gender inequality can reduce the prevalence of such abortions without attendant negative consequences.

### Anti-abortion violence

Abortion providers and facilities have been subjected to violence, including murder, assault, arson, and bombing. Some scholars consider anti-abortion violence to be within the definition of terrorism, a view shared by some governments., In the U.S. and Canada, over 8,000 incidents of violence, trespassing, and death threats have been recorded by providers since 1977, including over 200 bombings/arsons and hundreds of assaults. Abortion clinics have also been targeted by acid attacks, invasions, and vandalism The majority of abortion opponents have not been involved in violent acts.

Physicians and other abortion clinic staff have been murdered by abortion opponents. In the United States, at least four physicians have been murdered in connection with their work at abortion clinics, including David Gunn (1993), John Britton (1994), Barnett Slepian (1998), and George Tiller (2009). In Canada, gynecologist Garson Romalis survived murder attempts in both 1994 and 2000. Besides physicians, killings have targeted other clinic staff, such as John Salvi's 1994 murder of two receptionists in Massachusetts clinic and Peter Knight's 2001 murder of a security guard in a Melbourne clinic. Notable perpetrators of anti-abortion violence include Eric Rudolph, Scott Roeder, Shelley Shannon, and Paul Hill, the first person to be executed in the United States for murdering an abortion provider.

Some countries have laws to protecting access to abortion. Such laws prevent abortion opponents from interfering with access to legal abortion services. For example, the American Freedom of Access to Clinic Entrances Act bars the use of threats or violence to interfere with abortion access. Abortion access laws may also establish safe access zones around abortion clinics, with limits on protests and enhanced penalties for anti-abortion violence.

Psychological pressure may also be used to limit abortion access. In 2003, Chris Danze organized anti-abortion organizations throughout Texas to prevent the construction of a Planned Parenthood facility in Austin. The organizations released the personal information online of those involved with construction, sent them up to 1200 phone calls a day and contacted their churches. Some protestors record women entering clinics on camera.

## Non-human examples

Spontaneous abortion occurs in various animals. For example, in sheep it may be caused by stress or physical exertion, such as crowding through doors or being chased by dogs. In cows, abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but can often be controlled by vaccination. Eating pine needles can also induce abortions in cows. Several plants, including broomweed, skunk cabbage, poison hemlock, and tree tobacco, are known to cause fetal deformities and abortion in cattle and in sheep and goats. In horses, a fetus may be aborted or reabsorbed if it has lethal white syndrome. Foal embryos that are homozygous for the dominant white gene (WW) are theorized to also be aborted or resorbed before birth. In many species of sharks and rays, stress-induced abortions occur frequently on capture.

Viral infection can cause abortion in dogs. Cats can experience spontaneous abortion for many reasons, including hormonal imbalance. A combined abortion and spaying is performed on pregnant cats, especially in trap–neuter–return programs, to prevent unwanted kittens from being born. Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect.

Abortion may also be induced in animals, in the context of animal husbandry. For example, abortion may be induced in mares that have been mated improperly, or that have been purchased by owners who did not realize the mares were pregnant, or that are pregnant with twin foals. Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation, although the frequency in the wild has been questioned. Male gray langur monkeys may attack females following male takeover, causing miscarriage.


Bessarabia Governorate

# Bessarabia Governorate

## Abstract

The Bessarabia Governorate was a province (guberniya) of the Russian Empire, with its administrative centre in Kishinev (Chișinău). It consisted of an area of 45,632.42 square kilometres (17,618.78 sq mi) and a population of 1,935,412 inhabitants. The Bessarabia Governorate bordered the Podolia Governorate to the north, the Kherson Governorate to the east, the Black Sea to the south, Romania to the west, and Austria to the northwest. It roughly corresponds to what is now most of Moldova and some parts of Chernivtsi and Odesa Oblasts of Ukraine.

It included the eastern part of the Principality of Moldavia along with the neighboring Ottoman -ruled territories annexed by Russia by the Treaty of Bucharest following the Russo-Turkish War (1806–1812). The Governorate was disbanded in 1917, with the establishment of Sfatul Țării, a national assembly which proclaimed the Moldavian Democratic Republic in December 1917. The latter united with Romania in April 1918.

Around 65% of the territory of the former governorate now belongs to the Republic of Moldova (including the breakaway region of Transnistria); around 35% belongs to Ukraine.

Then it becomes Moldavian SSR in early 1918 and in 1922, Romania annexed Moldova.

## History

### Annexation

As the Russian Empire noticed the weakening of the Ottoman Empire, it occupied the eastern half of the autonomous Principality of Moldavia, between the Prut and Dniester rivers. This was followed by six years of warfare, which were concluded by the Treaty of Bucharest (1812), by which the Ottoman Empire acknowledged the Russian annexation of the province.

In 1829, according to the Treaty of Adrianople, Turkey ceded to Russia the Danube Delta, which also became part of the Bessarabia Oblast.

Before the Russian annexation, the territory had no particular name, Moldavia being traditionally divided into Ţara de Sus (the Upper Lands, the area of the Carpathian Mountains) and Ţara de Jos (the Lower Lands, the plains which included this territory). Bessarabia was the southern part of this territory (now known as Budjak); it is believed that the region was named after the Wallachian house of Basarab, which may have ruled it in the 14th century. The Russians used the name "Bessarabia" for the whole region rather than the southern area.

Bessarabia had an area of 45,630 km², more than the rest of Moldavia and a population between 240,000 and 360,000, most of them being Romanians. The boyars of Bessarabia protested against the annexation, arguing that the Ottoman Empire had no right to cede a territory that was not theirs in the first place (Moldavia being only a vassal, not an Ottoman province), but this did not prevent the Sultan from signing the treaty in May 1812.

### Oblast and governorate

After the annexation, the local boyars, led by Gavril Bănulescu-Bodoni, the Metropolitan of Chișinău and Hotin, petitioned for self-rule and the establishment of a civil government based on the Moldavian traditional laws. In 1818, a special autonomous region was created, which had both Romanian and Russian as languages used in the local administration. Bănulescu-Bodoni also obtained permission for opening a seminary and a printing press, with the Bessarabian church being an eparchy of the Russian Orthodox Church.

After the death of Bănulescu-Bodoni in 1821, Bessarabia lacked a strong leader and as the Russians feared nationalism, which triggered the anti-Ottoman 1821 Wallachian Revolution in neighbouring Wallachia, the local authorities began a gradual retraction of many of the freedoms.

Nicholas I of Russia, crowned in 1825, began a campaign of reforms which had the goal of gaining more control over the western provinces. Autonomy of the region was retracted in 1829, with the new constitution written by the governor of New Russia and Bessarabia, Mikhail Semyonovich Vorontsov. In 1834, Romanian was banned in schools and government facilities, and soon, books, the press, and churches despite 80% of the population being Romanian. Those who fought the changes could be exiled to Siberia. The constitution no longer made the usage of Romanian compulsory for public announcements and in 1854, Russian was made the official language. Also around 1850, Romanian was no longer used in schools and the importation of books from Moldavia and Wallachia was banned.

Integration within the Russian Empire continued with the introduction of the zemstva in 1869. Although this system was meant to increase the participation of the locals in civic affairs, it was run by Russians and other non-Moldavian functionaries brought from across the Empire.

The Moldavian boyars protested against the reforms, which decreased their own powers, but their protests were not well organized and they were mostly ignored. Some Moldavian boyar families were however integrated in the Russian nobility, but most of the nobles of Bessarabia were foreigners: in 1911, there were 468 noble families in Bessarabia, of which only 138 were Moldavian. In the beginning of the 20th century, the Jewish population made up to 40% of Chisinau.

Romania became independent in 1878, but millions of ethnic Romanians lived outside its borders and as such it had aspirations toward Transylvania, as well as Bessarabia.

### Southern Bessarabia returned to Moldavia

In 1856, under the terms of the Treaty of Paris, Russia was forced to return a significant territory in Southern Bessarabia (organised as the Cahul and Ismail counties, with the Bolgrad later split from the second) to Moldavia, which joined Wallachia in 1859 to form Romania.

In 1877, the Russian Empire and Romania signed a treaty by the terms of which, Romania and Russia were allies against the Ottoman Empire, while Russia recognized Romania's independence and guaranteed its territorial integrity after the war. However, at the end of the Russo-Turkish War (1877–1878), Russia took southern Bessarabia, Alexander Gorchakov justifying this as a "matter of national honour" for Russia and arguing that the territory was ceded in 1856 to Moldavia, not to Romania and that the Russian guarantee of territorial integrity was directed against Turkish claims.

The Romanian politicians and public were angered by this action: Romanian politician Mihail Kogălniceanu accused Russia of deception and of treating an ally like a conquered province. He even started a memorandum against Russia to try to influence the Western governments, denouncing not only the annexation of Southern Bessarabia, but the 1812 annexation of Bessarabia as well. Despite this, none of the European powers wanted to risk a conflict with Russia.

According to the Treaty of Berlin (1878), Romania gained Dobruja as a compensation for the loss of Southern Bessarabia. Despite being a larger territory, Romanians considered it an unfair exchange and accepted it reluctantly, because there was no other alternative.

## Culture

As a consequence of Russification policy, Bessarabia was the most backward of the western provinces of the Russian Empire. In 1897, literacy was just 15.4% for the whole Bessarabia, with only 6% of ethnically Moldavians being literate, the main reason behind this being that Russian was the only language of instruction. As of 1920, an estimated ten percent of men and one percent of women were able to read and write.

Alexander II 's reign brought a policy of establishing schools in every parish: 400 rural schools were founded in the 1860s in Bessarabia, but the Orthodox Church insisted everything be taught in Russian, whereas neither priests (who were teachers in most villages) nor pupils were speaking it. Thus, by the 1880s only 23 schools remained.

As a result, the literature and cultural life stagnated, only a few notable literary figures arising from Bessarabia, among them being Alexandru Hasdeu (1811–1872), Constantin Stamati (1786–1869) and Teodor Vârnav (1801–1860). In the second half of the 19th century, all links with Romanian literature were cut and no literary currents or schools of criticism developed in Bessarabia. In fact, in 1899, a visitor found no Romanian books in the Chişinău public library.

## Kishinev pogroms

The Kishinev pogrom was an anti-Jewish riot that took place in Kishinev, then the capital of the Bessarabia Governorate in the Russian Empire, on April 19 and 20, 1903. A further pogrom erupted in October 1905. In the first wave of violence, which was associated with Easter, 49 Jews were killed, large numbers of Jewish women were raped and 1,500 homes were damaged. American Jews began large-scale organized financial help, and assisted in emigration. The incident focused worldwide negative attention on the persecution of Jews in Russia.

## Politics

There was no Moldavian political party or movement in Bessarabia until 1905, when two major groups were founded. The moderates, led by landowner Pavel Dicescu, organized around the Societatea pentru Cultură Naţională ("The Society for National Culture"), argued for the usage of Romanian as a language of instruction in schools, but against social reforms. In 1909, they were successful in passing a resolution in the zemstvo of the gubernia related to the usage of Romanian in schools.

The radicals (national democrats), mostly students educated at Russian universities and influenced by socialist revolutionaries, wanted a real national awakening, as well as social justice. They founded a newspaper called Basarabia (first issue on 24 May 1906) led by Constantin Stere, which called for autonomy of Bessarabia and more rights to protect their language and culture, while making clear that they do not want secession from the Russian Empire.

Their movement had little success because in 1907, the extreme right won in the elections for the second Duma. In March 1907, the newspaper published Deşteaptă-te, române! ("Wake up, Romanian!"), a Romanian patriotic song, which made Kharuzin, the governor of Bessarabia, to order the closure of the newspaper only nine months after its first issue. Most of the contributors of the newspaper fled to Iaşi afterwards.

When the February Revolution happened in Petrograd in 1917, the governor of Bessarabia Governorate, Mihail Mihail Voronovici, stepped down on 13 March and passed his legal powers to Constantin Mimi, the President of the Gubernial Zemstvo, which was named the Comissar of the Provisional Government in Bessarabia, with Vladimir Criste his deputy. Similar procedures took place in all regions of the Empire: the chiefs of the Tsarist administrations passed their legal powers to the chiefs of the County and Governorate Zemstvos, which were then called County/Governorate Commissars.

## Demographics

According to Bessarabian historian Ștefan Ciobanu, at the beginning of the 19th century the ethnic Romanians (Moldavians) proportion was approximately 95% (1810), not including the territories formerly under direct Turkish administration (Budjak and Khotyn), which also purportedly had a Romanian majority. The Russian rule resulted in important changes in the ethnic structure of Bessarabia, especially due to the Russian policy of immigration from neighbouring provinces and Russification. The immigration was not uniform: in some districts in the northern and southern parts of Bessarabia (for instance Hotin and Akkerman), the immigration resulted in Ukrainians outnumbering Romanians, while the rural areas of the centre were mostly Romanian.

Initially, the purpose of the colonization policy was unrelated to the ethnic makeup, being to increase the population of the rather sparsely populated area, in order to better exploit its resources. It was part of the larger campaign of colonization of Novorossiya, under which Russia appealed to everyone who wanted to work and live under its authority, no matter if they came from the Russian Empire or from elsewhere.

Most of the Moldavians of Bessarabia were free peasants, of which most being landless, leasing their land from landlords and monasteries, while 12% (in 1861) were răzeşi (" yeomen "). The Emancipation reform of 1861 had little effects in Bessarabia, where there were few serfs: just 12,000 most of which being brought from Russia for non-agricultural activities.

The urban population was quite low, amounting just 14.7% in 1912, most of the cities being just local administrative centres and having little industry. Also, few of the urban dwellers were Moldavians, in 1912, 37.2% being Jewish, 24.4% Russian, 15.8% Ukrainian, with just 14.2% Moldavian.

## Administrative divisions

From 1812 to 1818, there were 12 counties, which were then merged into 6, afterwards split into 9 counties (ținuturi): Hotin, Soroca, Iași, Orhei, Bender, Hotărniceni, Greceni, Codru, Reni (Ismail). The original terms for county were Romanian: ținut and județ (in Russian: tsynut, uyezd).

Two of the latter, Cahul County and Ismail County were returned to Moldavia in 1856. There they were known as Southern Bessarabia with three counties because a Bolgrad County was split out of Ismail County. When again annexed by the Russian Empire in 1878, these there were lumped together as one Ismail County, thus from 1878 till 1917, there were 8 counties.

## Church

Split from the Metropolis of Moldavia, the orthodox church in Bessarabia became an eparchy of the Russian Orthodox Church, and after Bănulescu-Bodoni 's death, it became an agent in the state policy of Russification.

All the archbishops after 1821 tried to bring the eparchy in conformity with the regulations of the Russian Orthodox Church and because of that, all the high-ranked clerics were brought from Russia, because they were more familiar with the rules of the Russian church.

Archbishop Irinarh Popov (1844–1858) tried to promote Russian nationalism and loyalty to the tsar and brought clerics from Russia. Archbishop Pavel Lebedev forced Moldavian churches and monasteries to use Russian during the religious service, making knowledge of Russian compulsory for becoming a priest, but despite his attempts, by the end of his rule (1882), there were still 417 churches which used only Romanian in the liturgy.

Following the 1905 Russian Revolution, the church decided to allow the usage of Romanian by the village priests and the re-establishment of the eparchy printing press, which would publish religious literature and of a newspaper.


Alessio Sakara

# Alessio Sakara

## Abstract

Alessio Sakara (born September 2, 1981) is an Italian professional mixed martial artist, former professional boxer and Sanshou kickboxer, currently competing in the Light Heavyweight division. A professional competitor since 2002, Sakara has also formerly competed for the UFC, Bellator MMA, Jungle Fight, Cage Warriors, and M-1 Global.

## Background

Born in Rome, Sakara began to compete in soccer at the age of five and was talented, playing the midfielder position. He began training in boxing at the age of 11. At the age of 18 Sakara began training with Roberto Almeida in Brazilian jiu-jitsu, later earning a black belt under former UFC veteran Marcus "Conan" Silveira. Sakara turned to mixed martial arts after competing in amateur boxing matches because he did not think he would be able to support himself with the little money that boxers in Italy receive, and also did not prefer the tactical approach of the sport. Sakara was also attracted to the rising sport of mixed martial arts after his uncle showed him a VHS tape of UFC 5, which featured a bout between future UFC Hall of Famers Ken Shamrock and Royce Gracie, when Sakara was 19 years old. Shortly afterwards in 2000, Sakara relocated to Brazil in order to train with names like Ricardo De La Riva, Antônio Rodrigo Nogueira and Antônio Rogério Nogueira.

## Mixed martial arts career

### Early career

Sakara made his professional mixed martial arts debut in 2002, and compiled a record of 13–3 before being signed by the UFC.

### Ultimate Fighting Championship

Sakara made his UFC debut at UFC 55, fighting against Ron Faircloth. The bout was ruled a no contest due to an inside leg kick to Sakara's groin.

Sakara next fought Elvis Sinosic at UFC 57 on February 4, 2006. He won the bout via a unanimous decision despite having a point deducted due to an illegal elbow.

Sakara was submitted in his next bout at UFC 60 by decorated grappling specialist and former King of the Cage Middleweight Champion Dean Lister.

Sakara was next expected to face Wilson Gouveia at UFC 65 on November 18, 2006. However, Gouveia withdrew from the bout due to an injury and was replaced by Drew McFedries. Sakara lost the bout via first-round TKO.

Sakara rebounded from these losses when he fought Victor Valimaki at UFC 70 on April 21, 2007. He won via TKO at 1:44 of the first round.

At UFC 75 on September 8, 2007, Sakara lost for the third time in four fights, losing via first round TKO to Houston Alexander.

Sakara was part of UFC 80 on January 19, 2008, where he won via TKO in the first round against veteran James Lee.

#### Move down to middleweight

Following his victory over Lee, Sakara announced that he would be moving down to the Middleweight division. He made his middleweight debut against former WEC Middleweight Champion Chris Leben at UFC 82 on March 1, 2008. He lost the fight via first-round knockout.

At UFC Fight Night 15, Sakara defeated Joe Vedepo via KO in the first round with a head kick, which earned him Knockout of the Night honors.

Sakara was then expected to face Jake Rosholt at UFC Fight Night 17 on February 7, 2009, but the bout was cancelled when Sakara had to pull out due to a shoulder injury and was replaced by Dan Miller.

Sakara was then scheduled to face Rousimar Palhares at UFC 99 on June 13, 2009. However, for unknown reasons the bout was moved to take place at UFC 101 on August 8, 2009. Eventually, Palhares ended up withdrawing from the bout due to an injury and was replaced by former title challenger Thales Leites. Sakara won the bout via split decision.

The bout with Palhares was re-booked to take place on December 5, 2009, at The Ultimate Fighter 10 Finale, but Sakara had to withdraw after suffering an undisclosed injury while training. He was replaced by Lucio Linhares.

Sakara defeated James Irvin via first-round TKO on March 21, 2010, at UFC LIVE: Vera vs. Jones.

Sakara was forced to pull out of his fight with Nate Marquardt on July 3, 2010 at UFC 116 due to the death of his father.

Sakara was then scheduled to face Jorge Rivera on August 28, 2010 at UFC 118, but Rivera pulled out of the bout with an injury and was replaced by Gerald Harris In turn, Sakara was forced off the card with an injury and replaced by Joe Vedepo.

His bout with Rivera was then rescheduled and was expected to take place on November 13, 2010, at UFC 122, but the fight was cancelled, Sakara intended on competing despite experiencing flu-like symptoms, but the bout was terminated due to Sakara vomiting backstage.

Sakara was expected to face Maiquel Falcão on March 3, 2011 at the UFC Live: Sanchez vs. Kampmann event. However, Falcão was injured while training and replaced by Rafael Natal. Then in early February, Natal pulled out of the bout due to a knee injury, and was replaced by promotional newcomer Chris Weidman. Sakara lost a unanimous decision after getting repeatedly taken down and controlled by Weidman's wrestling.

The bout between Sakara and Rivera was rescheduled again for August 6, 2011 at UFC 133, but Sakara was forced out of the bout after tearing the ACL in his knee while training and was replaced by Costas Philippou.

Sakara faced Brian Stann on April 14, 2012, at UFC on Fuel TV: Gustafsson vs. Silva. He lost the fight via KO in the first round.

Sakara lost to Patrick Côté due to disqualification on November 17, 2012, at UFC 154 after rocking Côte with elbows, only to get caught up in the moment and land multiple blows to the back of Côté's head. Sakara's team immediately appealed the result, but the Quebec commission denied the appeal.

In late November 2012, Sakara signed a new four-fight contract with the UFC.

A rematch was briefly linked with Côté for March 16, 2013 at UFC 158. However, Sakara was forced out of the bout with a kidney illness.

Sakara was slated to face Tom Watson at UFC Fight Night 30. However, Watson was forced out of the bout with an injury and was replaced by Magnus Cedenblad. Subsequently in early October, Cedenblad was forced out of the Sakara bout with an injury and replaced by newcomer Nico Musoke. Sakara lost the fight by submission due to an armbar in the first round and was released from the promotion shortly after.

### Final Fight Championship

After a nine-month delay, on July 24, 2014, Sakara signed a three-fight deal with the European promotion Final Fight Championship. During the press conference he stated that his UFC career was compromised because he had enormous trouble cutting weight at 84 kg (185 pounds) and that he will continue his career in the Light Heavyweight division.

Sakara's Final Fight Championship debut took place on December 6, 2014 against Maciej Browarski. The fight was stopped in the first round when Sakara wasn't able to continue after getting injured from tearing his bicep. First Browarski was awarded the victory via TKO (injury), the result was later overturned to a No Contest by the Croatian MMA Federation.

In his next fight, Sakara faced off against Lebanon 's Dib Akil. Following the opening seconds of the round, in which Akil threw wild hooks that unsuccessfully landed, Sakara took Akil to the ground and piled up punches until the TKO stoppage.

### Bellator MMA

On November 27, 2015, it was announced that Sakara signed a three-fight contract with Bellator MMA.

Sakara made his promotional debut against Brian Rogers at Bellators first event in Sakara's native Italy on April 16, 2016 at Bellator 152. He won via knockout in the second round.

On September 21, 2016, it was announced that Sakara would be facing Joey Beltran in the co-main event of Bellator 168 on December 10, 2016. He won via knockout in the first round.

#### Bellator title shot

Sakara challenged Rafael Carvalho for the Bellator Middleweight Championship on December 9, 2017 at Bellator 190. He lost via knockout in the first round.

#### Post title shot reign

Sakara headlined Bellator 211 against Kent Kauppinen on December 1, 2018. He lost the fight via knockout in the first round.

Sakara faced Canaan Grigsby at Bellator Milan on October 12, 2019. He won the fight via TKO in the first round.

Sakara was scheduled to face Darwin Rodriguez at Bellator Milan 3 on October 3, 2020. However, Sakara ended up withdrawing from the bout due to an undisclosed injury.

On July 10, 2021, it was announced that he was no longer under contract with Bellator. However, in early 2023 news surfaced that Sakara was still under contract with Bellator.

## Bare-knuckle boxing

In February 2023, it was announced that Sakara had signed a multi-fight contract with Bare Knuckle Fighting Championship.

## Personal life

Sakara has two sons from a previous marriage. Recognizable for his many tattoos, Sakara has the words "Senatus Populusque Romanus" on his forearm, a common marking of soldiers of the Roman Empire, as well as several other tattoos that are a tribute to his ethnic background and love of Roman history. His surname comes from Saqqara, which was a Roman colony in Egypt.

### Autobiography

In May 2020, a book in Italian about Sakara – Ogni giorno in battaglia. La mentalità del legionario – was published (ISBN 978-8885493957).

## Championships and accomplishments

- Ultimate Fighting Championship Knockout of the Night (One time) vs. Joe Vedepo

- Knockout of the Night (One time) vs. Joe Vedepo

- Italy Chinese Kung Fu Association Italian Heavyweight Pro Sanshou Champion

- Italian Heavyweight Pro Sanshou Champion

- World Chinese Kung Fu Association (World Pro Sanshou Championship) Silver Medal in Pro Sanshou: Heavyweight Class

- Silver Medal in Pro Sanshou: Heavyweight Class