an overview of abortion in the united states

7/29/2019 An overview of abortion in the United States

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An Overview of Abortion

in the United States

Developed by

Physicians for Reproductive Choice and Health (PRCH)

and the Guttmacher Institute

January 2008


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Objectives

Provide an overview of unintended pregnancy andabortion 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 provision of and access to abortion services.

Provide a comparative international perspective on

abortion.


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Incidence of Unintended

Pregnancy and Abortion


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Pregnancies in the United States

(Approximately 6.4 Million Annually)

51% 49%

0%

20%

40%

60%

80%

100%

UnintendedIntended

Source: Finer et al., 2006(2002 data)

% of pregnancies


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Outcomes of Unintended Pregnancies

(Approximately 3.1 Million Annually)

48% 52%

0%

20%

40%

60%

80%

100%

Abortions Births

Source: Finer, 2006 (2002 data)

% of unintended pregnancies (excluding miscarriages)


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Incidence of Abortion

In 2005, 1.21 million pregnancies were terminatedby abortion in the United States.

Almost 2% of all women aged 1544 had anabortion in 2005.

Abortion is one of the most common surgicalprocedures in the United States.

Source: Jones et al., 2008


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Abortion Rates Among Women

Aged 1544

0

5

10

15

20

25

30

1973 1977 1981 1985 1989 1993 1997 2001 2005

Source: Jones 2008

Abortions per 1,000 women


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Incidence of early medication abortion,

2005

Early medication abortion accounted for 13%(161,100) of all abortions, an increase from 6% in2001.

An estimated 22% of eligible abortions (thoseperformed up to 9 weeks) were early medicationabortions.

57% of all known providers offer this service,

compared to 33% in early 2001.



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Disparities in

Unintended Pregnancy

Overall unintended pregnancy rates havestagnated, yet

Unintended pregnancy has increasedby 29%

among poor women while decreasing20%among higher-income women.

Source: Finer et al., 2006 (2002 data)


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The 16% of women at risk of unintended

pregnancy who are poor

Poor ,

30%

Poor ,

16%

account for 30% of unintended

pregnancies

Source: Boonstra et al., 2006

Poor Women Account for a Disproportionate

Share of Unintended Pregnancies


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Black Women Account for a Disproportionate


Black,

14%


pregnancy who are black


pregnancies

Black,26%



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Hispanic Women Account for a Disproportionate


Hispanic,

14%


pregnancy who are Hispanic


pregnancies

Hispanic,

22%



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Reasons for Abortions


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Most Important Reason Given for

Terminating an Unwanted Pregnancy

Concern for/responsibility to other individuals 74%

Cannot afford a baby now 73%

A baby would interfere with school/

employment/ability to care for dependents 69%

Would be a single parent/

having relationship problems 48%

Has completed childbearing 38%

Source: Finer et al., 2005 (2004 data)


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Gestational Age


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Abortions by Gestational Age(Weeks Since Last Menstrual Period)

17%

63%

9%1%3%

7%

0%

20%

40%

60%

80%

100%


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Reasons for Abortions After

16 Weeks Since Last Menstrual Period

Woman did not realize she was pregnant 71%

Difficulty making arrangements for abortion 48%

Afraid to tell parents or partner 33%

Needed time to make decision 24%

Hoped relationship would change 8%

Pressure not to have abortion 8%

Something changed during pregnancy 6%

Didnt know timing was important 6%Didnt know she could get an abortion 5%

Fetal abnormality diagnosed late 2%

Other 11%

Source: Torres and Forrest, 1988 (1987 data)


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Safety of Abortion


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An Abortion Is Safer the Earlier in

Pregnancy It Is Performed

0.6

1.7

3.4

8.9

0.4

0.1 0.2

7.1

0

2

4

6

8

10


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Causes of Abortion-Related Deaths

16% 15%17%27%

24%

0%

20%

40%

60%

80%

100%

Infection Hemorrhage Embolism Anesthesia OtherSource: Bartlett et al., 2004 (19881997 data)

% of abortion deaths (on average, 8 per year)


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Long-Term Safety of Abortion

First trimester abortions pose virtually no risk of:

Infertility

Ectopic pregnancy

Miscarriage

Birth defect

Preterm or low-birth-weight delivery

There is no association between abortion andbreast cancer.

Abortion does not pose a hazard to womens

mental health. Source: Boonstra, 2006


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Who Has Abortions


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Who Has Abortions: Age

2024 years,

33%

3034 years,

15%

2529 years,

23%

3539 years,

8%1519 years,

16%


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Rate of Abortion by Age-Group

0 10 20 30 40 50

40+

3539

3034

2529

2024

1519


Age-group

Source: Henshaw adjustments toStrauss et al., 2007 (2004 data)


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Who Has Abortions: Marital Status

Unmarried,

86%

Married, 14%



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Rate of Abortion by Economic Status

10

21

38

44

0 10 20 30 40 50

300%

200299%

100199%


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Who Has Abortions:

Race/Ethnicity

White*, 41%

Hispanic,

20%

Asian/Pacific

Islander*, 6%

Native

American*,

1%

Black*, 32%

Source: Jones et al., 2002*Non-Hispanic


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Rate of Abortion by Race/Ethnicity

28

50

14

0 10 20 30 40 50 60

Hispanic

Black

White

Race/ethnicity




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Who Has Abortions:

Religious Identification

Protestant,43%

Catholic, 27%

Other, 8%

None, 22%



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Who Has Abortions:

Prior Pregnancies

Previous

abortion, 12%

Previous

abortion and

previousbirth, 36%

Previous

birth, 25%

None, 27%



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Who Provides Abortion Services


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Percent of Abortions Performed by

Each Type of Provider

0%

20%

40%

60%

80%

100%

1980 1984 1988 1992 1996 2000 2004

Abortion

clinic

Other clinic

Hospital

Physicians'

office


% of abortions


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Number of Providers by Type

0

200

400

600

800

1000

1200

1400

1600

1980 1984 1988 1992 1996 2000 2004

Abortion

clinic

Other clinic

Hospital

Physicians'

office


No. of providers (defined as sites)


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Facilities providing only medication abortion

had a significant impact

A minimum of 119 providers, or 7% offered onlyearly medication abortion; most were non-specialized clinics or physicians offices with small

caseloads.

The number of abortion providers would havedecreased by 8% instead of 2% if not for these

facilities.



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Factors Contributing to the Decline in

the Number of Abortion Providers

Anti abortion harassment and violence

Social stigma/marginalization

Professional isolation/peer pressure

The graying of providers

Inadequate economic/other incentives

Lack of medical training opportunities

Source: NAF and ACOG, 1991

Percentage of Providers of 400 or More


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Percentage of Providers of 400 or More

Abortions Per Year Who

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


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Factors That Make It DifficultFor Women to Obtain

Abortion Services


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Percentages of Counties with No Provider

And Women Living in Those Counties

0%

20%

40%

60%

80%

100%

1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

Unserved counties Women in unserved counties



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Medicaid Coverage of Abortion

States that cover all or most medically necessary abortions under Medicaid

(May 2006):

Alaska Maryland New YorkArizona * Massachusetts Oregon

California Minnesota VermontConnecticut Montana WashingtonHawaii New J ersey West VirginiaIllinois * New Mexico

States that provide minimal Medicaid coverage of abortion beyond federal

requirements (May 2006):

Physical health Fetal abnormality

Indiana IowaUtah MississippiWisconsin Utah

Virginia Source: Guttmacher, 2006


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State Restrictions on Abortion

Parental consent or notification

required for minors 35 states

Mandatory counseling 32 states

Waiting periods 24 states

Limitations on private insurancecoverage for abortion 4 states

Source: Guttmacher, 2007


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International Perspective

on Abortion


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U.S. Share of Abortions Worldwide

97%

3% United States

Source: Sedgh, 2007

Other Countries


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Abortion Rate, United States and

World

21

29

0

10

20

30

40

United States World

Source: Sedgh, 2007

(data for 2003)


S


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98

171515

202021

0

5

10

15

20

25

30

United

States

Australia Sweden Denmark Canada England &

Wales

Germany Netherlands

Source: Sedgh, 2007


U.S. Abortion Rate Higher Than in

Many Other Industrialized Countries

20 illi f b i


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20 million unsafe abortions

occur each year

Annual abortions per 1,000 women 1544

0 5 10 15 20 25 30 35

Developing

countries

Developed

countries

World

Safe abortions Unsafe Abortions

Sedgh, 2007

Th l l t t f b ti d


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The legal status of abortion does

not predict its incidence

The lowest abortion rates in the worldlessthan 10 per 1,000 women of reproductiveageare in Europe, where abortion is legaland available.

By contrast, in Africa and Latin America

and the Caribbean, where abortion law ismost restrictive, the regional rates are 29and 31 per 1,000 women, respectively.

Sedgh et al., 2007

Ch i b ti l b t


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Changes in abortion law between

1995 and 2007

17 countries liberalized their laws toincrease access to safe abortion:Albania,Benin, Bhutan, Burkina Faso, Cambodia,

Chad, Colombia, Ethiopia, Guinea, Mali,

Nepal, Portugal, Saint Lucia, South Africa,

Swaziland, Switzerland and Togo.

Three countries tightened restrictions onabortion: El Salvador, Nicaragua andPoland.

Center for Reproductive Rights, 2007


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High Rates of Abortion Occur in

Countries that Severely Restrict Abortion

0 10 20 30 40 50 60

Peru

Chile

Dom. Rep.

Brazil

Mexico

Nigeria

Source: Boonstra, 2006

Abortions per 1,000 women 1544


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Complications of unsafe abortion

An estimated five million women are hospitalizedeach year for treatment of abortion-relatedcomplications, such as hemorrhage and sepsis.

Complications from unsafe abortion proceduresaccount for 13% of maternal deaths, or 67,000per year.

Approximately 220,000 children worldwide losetheir mothers every year because of abortion-related deaths.

Singh, 2006; WHO 2007; Grimes 2006

Al t ll b ti l t d d th


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Almost all abortion-related deaths

occur in developing countries

350

50

300

650

10

0

100

200

300

400

500

600

700

Developed

countries

Developing

countries

Africa Asia Latin

America &

Caribbean

Deaths per 100,000 unsafe abortions, 2003

WHO, 2007


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Summary Points

Incidence of Pregnancy and Abortion


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Incidence of Pregnancy and Abortion

in the United States

Unintended pregnancy and abortion are commonamong all groups of women.

Certain groups of women are at greater risk ofunintended pregnancy.

Almost half of all pregnancies are unintended.

Almost half of unintended pregnancies end inabortion.

Wh H Ab ti Wh d


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Who Has Abortions, Why and

When in Pregnancy

Disadvantaged women bear a disproportionateburden of unintended pregnancies and abortions.

The most frequent reasons given are thata(nother) child would limit the womans ability tomeet current responsibilities and that they cannotafford a child at this point in their lives.

Almost 90% of abortions occur in the firsttrimester.


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Safety of Abortion

Abortion is one of the safest common surgicalprocedures for women in the United States.

Abortion is safe over the long term and carrieslittle or no risk of fertility-related problems, canceror psychological illnesses.

Laws criminalizing abortion make abortionsunsafe, but do not eliminate them.

Th P i i f d A t


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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 dramatically increased thepercentage of counties in the United States withno provider.

Many women have to travel long distances to finda provider, which can pose significant problems forthose with limited resources, or work or familyresponsibilities.

Obstacles to Obtaining


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Obstacles to Obtaining

Abortion Services

Although most women obtain abortions early in pregnancy,some women face substantial obstacles to access.

Nearly four in 10 women receive coverage under Medicaid, yet32 states allow Medicaid funding for abortion only in cases ofrape, incest or life endangerment.

Lacking insurance coverage, a poor woman often requires time

to find the money to pay for an abortion, if she is able to at all. Legal requirements, such as parental consent for minors or

waiting periods, are likely to cause further delays, increasingthe risk of complications.


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International Perspective on Abortion

A very small proportion of abortionsworldwide take place in the United States.

Most unsafe abortions occur in countries

where abortion is illegal.


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About PRCH

PRCH exists to ensure that allpeople have the knowledge,

access to quality services andfreedom to make their ownreproductive health decisions.

For more information aboutPRCH, please click here.
http://www.prch.org/http://www.prch.org/


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About Guttmacher

The Guttmacher Institute is a nonprofitorganization that advances sexual andreproductive health worldwide throughresearch, policy analysis and public

education.

For more information about Guttmacher,please clickhere.

Read our report Abortion in WomensLiveshere
http://www.guttmacher.org/http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdfhttp://www.guttmacher.org/pubs/2006/05/04/AiWL.pdfhttp://www.guttmacher.org/

an overview of abortion in the united states

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