1 Historical perspective on induced abortion through the ages and its links with maternal mortality James Owen Drife, MD FRCOG FRCPE FRCSE FCOGSA FFSRH, Emeritus professor of obstetrics and gynaecology * University of Leeds, Department of Paediatrics, Obstetrics and Gynaecology, Level D, Clarendon Wing, Belmont Grove, Leeds LS2 9NS, UK Keywords: criminal abortion maternal mortality women’s rights air embolism puerperal sepsis Abortion is mentioned in ancient medical texts but the effective- ness of the methods described is doubtful. Attitudes varied from apparent disapproval by Hippocrates to open approval in Ancient Rome. In mediaeval times abortion was practised by women in secret and this continued during the 19th and early 20th centuries. Despite being illegal in England induced abortion became more common in Victorian times as the population grew. At the same time the link between criminal abortion and maternal mortality became increasingly clear, and if a woman died after a procedure the abortionist (sometimes a midwife) could be sentenced to death. The law was more tolerant of abortions performed by registered doctors. In the 20th century pressure grew for its legalisation. At the time of the 1967 Abortion Act, abortion was the leading cause of maternal death in the UK but within fifteen years death from illegal abortion had been abolished. Ó 2010 Elsevier Ltd. All rights reserved. Although induction of abortion has been practised for millennia, accurate information is scanty until the 19th and 20th centuries. This chapter summarises what can be gleaned from older sources and then traces the story in more detail from 1800 onwards, when major changes were taking place in society. It focuses mainly on the UK, where the Lancet was founded in 1823 and the predecessor of the BMJ first appeared in 1840. Both archives have recently been placed on line and these primary sources give graphic accounts of the death toll of criminal abortion and the debate about what should be done about it. * Tel.: þ44 113 392 3888; Fax: þ44 113 392 3902. E-mail address: j.o.drife@leeds.ac.uk Contents lists available at ScienceDirect Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn 1521-6934/$ – see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.bpobgyn.2010.02.012 Best Practice & Research Clinical Obstetrics and Gynaecology 24 (2010) 431–441