Download Abortion in the United States

An Overview of
Abortion
in the United
States
Developed by
Physicians for Reproductive Choice and Health® (PRCH) and The Alan Guttmacher Institute (AGI)
© January 2003
Objectives
 Provide an overview of unintended pregnancy and
abortion in the United States.
 Review the incidence of pregnancy and abortion.
 Identify who has abortions, why, and when in
pregnancy.
 Review the safety of abortion.
 Discuss the provision of and access to abortion
services.
 Provide a comparative international perspective on
abortion.
Incidence of
Pregnancy
and Abortion
Pregnancies in the United States
(Approximately 6.3 Million Annually)
60%
52%
48%
% of pregnancies
50%
40%
30%
20%
10%
0%
Intended
Unintended
Source: Henshaw, 1998
(1994 data)
Outcomes of Unintended Pregnancies
(Approximately 3.0 Million Annually)
% of unintended pregs.
60%
47%
50%
40%
40%
30%
20%
13%
10%
0%
Abortions
Births
Miscarriages
Source: Henshaw, 1998
(1994 data)
Incidence of Abortion
 In 2000, 1.31 million pregnancies were terminated by
abortion in the United States.
 Some 2.1% of all women aged 15–44 had an abortion
in 2000.
 Abortion is one of the most common surgical
procedures in the United States.
Source: Finer and Henshaw, 2003
Annual Number of Abortions
Per 1,000 Women Aged 15–44
35
Rate per 1,000
30
25
20
15
10
5
0
80
9
1
82
9
1
84
9
1
86
9
1
88
9
1
90
9
1
92
9
1
94
9
1
96
9
1
98
9
1
00
0
2
Source: Finer and Henshaw, 2003
Abortion Rates in Western
Industrialized Countries
30
Rate per 1,000
25
21.3
22.2
18.7
20
16.5
16.4
15.6
15
7.6
10
6.5
5
0
United
States
(2000)
Australia
Sweden Denmark
Canada
England Germany
& Wales
Holland
Source: Henshaw et al., 1999
(1996 data)
Reasons
for
Abortions
Most Important Reason Given for
Terminating an Unwanted Pregnancy
Inadequate finances
21%
Not ready for responsibility
Woman’s life would be changed too much
Problems with relationship; unmarried
Too young; not mature enough
Children are grown; woman has all she wants
Fetus has possible health problem
Woman has health problem
Pregnancy caused by rape, incest
Other
21%
16%
12%
11%
8%
3%
3%
1%
4%
Average number of reasons given
3.7
Source: Torres and Forrest, 1988
(1987 data)
Gestational Age
Abortions by Gestational Age
(Weeks Since Last Menstrual Period)
70%
% of abortions
60%
57.6%
50%
40%
30%
20.3%
20%
10.2%
10%
6.2%
4.3%
1.5%
0%
<9
9-10
11-12 13-15
Weeks
16-20
21+
Source: Elam-Evans et al., 2002
(1999 data)
Reasons for Abortions After
16 Weeks Since Last Menstrual
Period
Woman did not realize she was pregnant
71%
Difficulty making arrangements for abortion
Afraid to tell parents or partner
Needed time to make decision
Hoped relationship would change
Pressure not to have abortion
Something changed during pregnancy
Didn’t know timing was important
Didn’t know she could get an abortion
Fetal abnormality diagnosed late
Other
48%
33%
24%
8%
8%
6%
6%
5%
2%
11%
Average number of reasons
2.2
given
Source: Torres and Forrest, 1988 (1987 data)
Safety of Abortion
Deaths per 100,000
Deaths per 100,000
Abortions or Births
14
12
10
8
6
4
2
0
12.7
6.6
3.7
0.2
<9
0.3
0.6
1.8
9-10 11-12 13-15 16-20 21+
Abortions by gestation
0.6
All Births
abs.
Source: Gold 1990
(1981–1985 data)
Abortion Risks in Perspective
Risk from terminating pregnancy
Before 9 weeks
Between 9 and 10 weeks
Between 13 and 15 weeks
After 20 weeks
Chance of death
per year:
1 in 500,000
1 in 300,000
1 in 60,000
1 in 8,000
Risk to persons who participate in:
Motorcycling
Automobile driving
Power- boating
Playing football
1 in 1,000
1 in 5,900
1 in 5,900
1 in 25,000
Risk to women aged 15–44 from:
Having sexual intercourse (PID)
Using tampons
1 in 50,000
1 in 350,000
Source: Gold, 1990; Trussell, 1998
Who Has Abortions
Who Has Abortions: Age
35-39 years
8%
40-44 years
3%
<15 years
1%
15-19 years
19%
30-34 years
13%
25-29 years
23%
20-24 years
33%
Source: Jones et al., 2002
Who Has Abortions: Marital Status
Separated/ Divorced/
Widowed
16%
Married
17%
Never-married
67%
Source: Jones et al., 2002
Who Has Abortions:
Economic Status
% of the Federal Poverty Level
>300%
25%
<100%
27%
200-299%
18%
100-199%
30%
Source: Jones et al., 2002
Who Has Abortions:
Race/Ethnicity
Native American*
1%
Hispanic
20%
*Non-Hispanic
Black*
32%
Asian/Pacific Islander*
6%
White*
41%
Source: Jones et al., 2002
Who Has Abortions:
Religious Identification
None
22%
Protestant
43%
Other
8%
Catholic
27%
Source: Jones et al., 2002
Who Has Abortions:
Prior Pregnancies
None
27%
Previous Abortion
12%
Previous Abortion and
Previous Birth
36%
Previous Birth
25%
Source: Jones et al., 2002
Who Provides Abortion
Services
Percent of Abortions Performed by
Each Type of Provider
80%
70%
Abortion
clinic
50%
Other
clinic
Hospital
40%
30%
20%
Physician
office
10%
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
0%
1980
% of abortions
60%
Source: Finer and Henshaw, 2003
Factors Contributing to the Decline in
the Number of Abortion Providers
•Anti-choice harassment and violence
•Social stigma/marginalization
•Professional isolation/peer pressure
•The “graying of providers”
•Inadequate economic/other incentives
•The perception of abortion as an
unexciting field of medicine
Source: NAF & ACOG, 1991
Factors That Make It
Difficult
For Women to Obtain
Abortion Services
Percentage of Counties with No
Provider And % of Women Living in Those
Counties
100%
80%
Unserve
d
counties
60%
40%
Women
in
unserved
counties
20%
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
0%
Source: Finer and Henshaw, 2003
Medicaid Coverage of Abortion
States that cover abortion under Medicaid for reasons
beyond rape, incest and life endangerment, as of December,
2002:
Alaska
Arizona
California
Connecticut
Hawaii
Illinois
Indiana
Maryland
Massachusetts
Minnesota
Montana
New Jersey
New Mexico
New York
Oregon
Vermont
Washington
West Virginia
Source: AGI, 2002
Percentage of Providers of 400 or
More Abortions Per Year Who Have
Reported Harassment in 2000
•Picketing
80%
•Picketing with physical contact with patients
28%
•Vandalism
18%
•Picketing homes of staff members
14%
•Bomb threats
15%
Source: Henshaw and Finer, 2003
State Restrictions on Abortion
•Parental consent or notification
required for minors
32 states
•Mandatory delay and state-directed
counseling
18 states
•Limitations on private insurance
coverage for abortion
4 states
Source: AGI, 2002
International
Perspective
on Abortion
U.S. Share of Abortions Worldwide
United States
3%
97%
Rest of the World
Source: Henshaw et al., 1999
(1995 data)
Abortion Rate, United States and
World
35
Rate per 1,000 women
40
35
30
23
25
20
15
10
5
0
United States
World
Source: Henshaw et al., 1999
(1995 data)
Abortion in Developed and
Developing Countries
Annual abortions per 1,000 women 15-44
World
Developed Countries
Developing Countries
0
Legal
5
10
15
20
25
30
35
40
Illegal
Source: AGI, 1999
45
Many Abortions Occur in Countries
Where Abortion Is Illegal Under
Most Circumstances
44%
Legal
Illegal
56%
Abortions by legality
Source: Henshaw et al., 1999
(1995 data)
Percentage of Maternal Mortality
Worldwide Due to Unsafe Abortion
Maternal deaths (600,000 per year)
Unsafe abortion
13%
87%
Other causes
Source: WHO, 1998
(Estimates for 1995–2000)
Summary Points
Incidence of Pregnancy and
Abortion:
 Unintended pregnancy and abortion are
common among all groups of women.
 Almost half of all pregnancies are unintended.
 Almost half of unintended pregnancies end in
abortion.
Who Has Abortions, Why and
When in Pregnancy:
 Women having abortions are predominantly
young, single, from minority groups and lowincome.
 Most women have multiple reasons for
choosing to have an abortion.
 Almost 90% of abortions occur in the first
trimester.
Safety of Abortion:
 Abortion is one of the safest surgical
procedures for women in the United States.
 Laws criminalizing abortion make abortions
unsafe but do not eliminate them. In
developing countries, where abortion is often
illegal or highly restricted, abortion mortality
rates are hundreds of times higher than rates
in developed countries.
The Provision of and Access to
Abortion Services:
 Most abortions occur in abortion clinics.
 A steady decline in providers in the last two
decades has left the majority of counties in
the United States with no provider.
 Many of the difficulties in providing and
obtaining access to abortion would disappear
if the procedure were integrated with other
health care services.
International Perspective on
Abortion:

A very small proportion of abortions
worldwide take place in the United States.
 Most unsafe abortions occur in countries
where abortion is illegal.