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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.