The effects of legal abortion on legitimate and illegitimate birth rates: the California experience

The availability of legal abortion in California appeared to affect California fertility in 1971 with a downward trend in both legitimate and illegitimate births. In 1972 legitimate birth rates continued to fall as rapidly as in 1971 but illegitimacy rates declined less rapidly. Unmarried women continued to be the dominant recipients of legal abortion. Illegitimacy remained at a high level, however, and its rise among white teenagers pointed to the phenomena of women deliberately electing unwed motherhood.     

Roe v Wade and American fertility.

OBJECTIVES: This article examines the effect of abortion legalization on fertility rates in the United States. METHODS: Fertility rates were compared over time between states that varied in the timing of abortion legalization. RESULTS: States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged. The relative reductions in births to teens, women more than 35 years of age, non-White women, and unmarried women were considerably larger. If women did not travel between states to obtain an abortion, the estimated impact of abortion legalization on birth rates would be about 11%. CONCLUSIONS: A complete recriminalization of abortion nationwide could result in 440,000 additional births per year. A reversal of the Roe v Wade decision leaving abortion legal in some states would substantially limit this impact because of the extent of travel between states.     

Race-specific patterns of abortion use by American teenagers.

Between 1972 and 1978, as legal abortion became more widely available nationally, abortion rates (abortions per 1,000 women) and ratios (abortions per 1,000 live births) increased for all American teenagers; from 1972 to 1975, the rates and ratios for teenagers for Black and other races increased faster than those for White teenagers. For all seven years, abortion rates were higher for teenagers of Black and other races than for white teenagers. This reflected both higher proportions of sexually active teenagers of Black and other races and a greater risk of pregnancy in these teenagers compared with White teenagers. Race-specific differences in legal abortion ratios narrowed during the seven-year interval, as did differences in alternative outcomes of teenage premarital pregnancies (term births, illegal abortions).     

Reproductive health of immigrant women in the Lazio region of Italy

The number of legal immigrant women living in the Lazio region of Italy has increased in recent years; there were 69,320 "permessi di soggiorno" (temporary residence permits) issued in 1992 but 119,778 issued in 2000. This analysis concerns women who left hospital after having a live birth, an induced abortion or a spontaneous abortion. The foreign women were compared with all (Italian and foreign) women living in Lazio. The general fertility rate is slightly higher among all women resident in Lazio than among the foreign women, but the latter have a higher rate at ages 18-24 years. The risk of induced abortion is higher (34.8/1000 women) among the foreigners than among all residents (10.5/1000 women). The spontaneous abortion ratio was also higher among the foreigners (213.8/1000 live births) than the residents (154.6/1000 live births). There is clear evidence of an increase in the demand from foreign women for medical services for reasons associated with reproduction. The provision of these services needs to be modified to take account of their particular needs.     

Fertility and family planning in the United States: insights from the National Survey of Family Growth

A review of about 50 studies based on the 1982 National Survey of Family Growth (NSFG) illustrates the ways in which the survey sheds new light on trends and differentials in such areas as fertility, contraceptive use, infertility and the use of family planning services in the United States. The total fertility rate declined by nearly 50 percent between 1960 and 1973, from 3.6 to 1.9 births per woman, and changed little from then until 1982. It would appear that growing use of the pill, the IUD and sterilization--but principally the pill--is the prime factor in the dramatic decline in unwanted and mistimed births among married couples. Their increasing reliance on sterilization between 1973 and 1982 reduced the proportion of unwanted births at ages 35 or older by half, but had little impact on overall birthrates because only about five percent of all births occurred at those ages in 1981. Although overall fertility has declined, the rate of premarital pregnancy has risen since the early 1960s. Research based on the NSFG suggests that this is a result both of the rapid increase in the percentage of women who have premarital intercourse and of the increasing length of exposure to premarital pregnancy. The latter trend is probably related both to earlier intercourse and to delayed marriage. Despite the increasing levels of premarital exposure, however, there was actually a decline in teenage birthrates in the 1970s, which was due in part to the rising abortion rates among teenagers. Finally, although racial differences in fertility have narrowed, black women still have higher fertility than whites. The 1982 NSFG data suggest that four factors are principally responsible for the higher birthrates of black women: Blacks begin having intercourse earlier than whites; black women are one-third less likely to use contraceptives at first intercourse; they are more likely to be currently exposed to the risk of unplanned pregnancy and not using a method; and they have higher pregnancy rates when they are using no contraceptives or less-effective methods, such as the condom, rhythm and withdrawal.     

Differences in fertility patterns between urban and rural women in Washington State, 1983-1984 to 1993-1994

We use data on Washington State abortions and births for 1983-1984 and 1993-1994 to analyze trends for urban and rural women, using the demographic measures total abortion and total fertility rates. These express pacing of childbearing in a single number which is simple to calculate and interpret, and is age-standardized. We find significant urban-rural differences. Total abortion rates decline and total fertility rates increase in both areas. However, the relative magnitudes of pacing decreases in abortions for rural women and increases in births for urban women are striking. The demographic measures are useful interpretive tools, and can be applied to a broad range of questions.     

Unintended pregnancy among American women

This research note presents new estimates of the proportion of American women of reproductive age who experience unintended pregnancies, unintended births and abortions. The data are based on tabulations from the 1982 National Survey of Family Growth (NSFG) and the Alan Guttmacher Institute's 1981-1982 national survey of abortion providers. Of 6.1 million women who became pregnant in 1982, 3.7 million gave birth, 1.6 million had abortions and 0.9 million experienced miscarriages. An estimated 37% of all births in the 5 years preceding the 1982 NSFG were unintended. Applying that proportion to 1982 births results in an estimate of 1.3 million unintended births. It can be assumed that all 1.6 million abortions were terminations of unintended pregnancies. Respondents in the 1982 NSFG reported that 40% of the births they had ever had were unintended. 33% of NSFG respondents said that they had had at least 1 unintended birth during their life. Abortions were seriously underreported in the NSFG, as they have been in most other surveys. Only 47% of the abortions that occurred during the period 1977-1981 were reported. The real proportion of women of reproductive age who have ever had an abortion appears to be 21%. 65% of all women aged 40-44 in 1982 had had at least 1 unintended pregnancy, and more than 1/3 of them had had at least 1 abortion. It is probably inappropriate to view these levels as representative of the proportions of today's young women who will ever experience an unintended pregnancy or abortion. Estimates of the proportion of women who will have had abortions by age 45 indicate that 18% of women will have had a 1st abortion by age 20; 41% will have had one by age 30; and 46%, by age 45.     

Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator

Although several key elements of sexual and reproductive health are included in the United Nations Millennium Development Goals, a measure of women's capacity to regulate their fertility safely and effectively is missing. We considered the usefulness of 3 pairs of indicators in monitoring this component of reproductive health: contraceptive prevalence and total fertility; unmet need for contraception and unplanned births; and unsafe abortion and abortion mortality. A single measure of contraceptive use is insufficient. The risks women face from unplanned births and unsafe abortion should also be incorporated into the monitoring process, either directly within the Millennium Development Goals framework or as a parallel effort by reporting governments and other agencies.     

The consequences of the legalization of abortion within the Rostock area (GDR)

On March 9, 1972, the German Democratic Republic legalized abortion as one of the social and health policy measures with humanitarian goals to promote family life and improve living conditions. In evaluating the effect of the law, the development of fertility and frequency of abortion in Rostock District were studied for the years 1965 to 1973. In the first year after the new law went into effect, legal abortions increased about fivefold, which was expected; hospital abortions in 1973 decreased by about 40%. Compared to other Eastern European countries and to New York City, the frequency of abortion was still low. In the second year of the law, a further increase in abortions was not seen either in Rostock or the GDR as a whole. More women decided to continue their pregnancies; the number of women on oral contraceptives increased from about 1 million at the beginning of 1972 to about 1.2 million at the beginning of 1973. In 1972, for every 1000 women of reproductive age, there were 33 legal abortions in Rostock District; in the same period, for every 100 live births, there were 56 abortions.     

Induced abortion in Canada 1974-2005: trends over the first generation with legal access

BackgroundCanadian women currently entering menopause are the first generation with access to legal induced abortion throughout their reproductive years.Study DesignStatistics Canada data from 1974 to 2005 on age-specific abortion and first-abortion rates were analyzed to determine the proportion of the cohort hypothetically and actually undergoing at least one induced abortion, as well as the age-specific trends.ResultsAmong Canadian women who turned 45 years old in 2005, 31% had at least one abortion, with a median age at first abortion of 24 years. Since 1997, age-specific induced abortion rates overall and among teenagers have declined significantly, while rates among older women show less decline as age increases. Annually from 1974 to 2005, women aged 20–29 years account for 52% (SD 1.8%) of all abortions in Canada.ConclusionsInduced abortion is a common procedure experienced by nearly a third of Canadian women during their reproductive years. Consistently, half of all women accessing abortion are in their twenties. These findings suggest that Canadian women, particularly those in their twenties, experience a significant unmet need for effective contraception.     

Very young adolescent women in Georgia: has abortion or contraception lowered their fertility?

Despite a state law enacted in 1972 which allowed minors to obtain contraceptive services without parental consent, births to very young women in Georgia (age 14 and less) have risen in recent years. Beginning in 1974, however, this trend has reversed. Increased access to induced abortion following the 1973 U.S. Supreme Court decision appears to have been responsible for the decline. Supporting this assertion are: 1) the temporal relationship between increased access to abortion and the decline in births, 2) the geographic evidence that the decline in births occurred first in Atlanta where abortion utilization is the highest and then followed in areas with somewhat more limited utilization, and 3) a similar observation that the decline occurred earlier and more markedly among young white teenagers whose abortion utilization is higher. Although abortion appears to have had the most visible impact on births, most people would probably agree that efforts toward providing contraception to these young women remain worth the challenge. The ratio of young teenegers accepting contraceptives to young teenegers getting pregnant is suggested as a useful intermediator of the success of family planning programs.     

Singapore: resumption of rapid fertility decline in 1973.

Singapore's fertility decline began in the late 1950s, and continued until a record low of 44,562 births in 1969. Subsequently another upswing in the number of births took place, taking a downturn again to 48,269 in 1973. The decline in the crude birthrate in 1973 was entirely caused by a fall in fertility, and was retarded by the fact that there was a rise in the proportion of women in the reproductive ages. Indians and Malays contributed the most to the decline in fertility in 1973, while Chinese fertility only fell 6.6%. Government population legislation and social measures designed to lower the birthrate appear to have noticeably affected reproductive behavior.     

Legal abortion in Italy: 1980-1981

In 1980 and 1981, there were 446,430 legal abortions performed in Italy. There were about 345 legal abortions per 1,000 live births in 1980 and 363 in 1981. About 1.6 percent of women aged 15-49 obtained abortions in both years. An analysis of the characteristics of Italian women who obtained abortions indicates that most were married (about 70 percent), aged 18-36 (74 percent), had had less than a high school education (74 percent) and had had at least one previous live birth (70-75 percent). In 1981, 88 percent of abortions were obtained in public hospitals; 58 percent were carried out at eight or fewer weeks of gestation; and 78 percent were performed under general anesthesia. Only 20 percent were performed without an overnight stay in the hospital; and over 40 percent of women were hospitalized for two days or longer. Infection after the abortion was reported in only 0.03 percent of cases in 1981, and hemorrhage was reported in only 0.27 percent. In 1981, between 43 percent and 84 percent of gynecologists (depending on the region of the country) declined to perform abortions on grounds of conscience.     

Intermediate determinants of racial differences in 1980 U.S. nonmarital fertility rates

There are four major determinants of racial differences in nonmarital fertility rates in the U.S.: differential sexual activity (exposure to risk); differential in spontaneous and induced abortion; differential contraceptive use (including method efficacy); and differential legitimation, through marriage, of births conceived out of wedlock. Racial differences in all four indicators encourage higher black than white nonmarital fertility rates in every age-group examined; however, the relative contribution of each determinant to differences in nonmarital fertility varies according to age. The gap between whites and blacks in contraceptive use is of greatest concern to policy-makers, because family planning effectiveness can, at least theoretically, be changed by program effort. However, even if black women and white women had equivalent levels of contraceptive use, sexual activity and recourse to abortion, there would still be substantial racial differences in nonmarital fertility rates because of the greater propensity among whites to legitimate premaritally conceived births.     

Liberalized abortion in Oregon: effects on fertility, prematurity, fetal death, and infant death.

An analysis of Oregon Vital Statistics data from 1965 to 1975 was conducted to assess the impact of Oregon's 1969 abortion legislation, which substantially increased the number of reported medically induced abortions. This increase was associated with a slight increase in the age-adjusted 1970 fertility rate and there was no decrease in births to women in the age groups obtaining proportionately the most abortions. A significant and persistent 11 per cent reduction in premature births to women over age 20 (p less than .001) and a 22 per cent reduction in spontaneous fetal deaths (p less than .05) were associated with liberalized abortion. Decreases in neonatal and postneonatal infant mortality were observed, but were indistinguishable from an ongoing trend toward improved infant health. A gradual 25 per cent decline in the age-adjusted fertility rate occurred between 1969 and 1975, but the increase in the number of reported abortions could account for only one-fourth of this decrease. A seven-fold increase in the use of family planning clinics between 1970 and 1973 and more liberalized laws regarding provision of family planning service appeared to account for a much higher proportion of the decreased fertility than did liberalized abortion.     

Epidemiology of legal abortion in Italy

The paper reports on the trends of induced abortion in Italy since its legalization in 1978. Data collected through the national surveillance system show that the abortion rates and ratios in Italy, after an initial increase, have been stable in the last four years, and are comparable to those of other European countries. Italian women seeking abortion, however, are generally older and more frequently married and parous than in most other western countries. The data on abortion services and procedures show a slow improvement with increasing use of local rather than general anaesthesia, suction rather than surgical curettage, and outpatient rather than inpatient admissions. Post-abortion complications are infrequent and there have been no cases of death from legal abortion. The paper attempts to analyse the effect of legal abortion on fertility and on other maternal and child health indices, reaching tentative conclusions on the contribution of the legalization of abortion to the improvement of reproductive health. Uneven availability of abortion services, however, is currently a major problem; in many of the less developed areas of the country, it is estimated that as many as 50% of abortions are still performed outside the legal abortion service network.     

Family planning and abortion: have they affected fertility in Tennessee?

In Tennessee between 1975 and 1978, birth rates among teenagers decreased while they increased among older age groups. This trend was unlike previous years and coincided temporally with the increased availability of legal abortion services in Tennessee and the special efforts to prevent unwanted pregnancies among teenagers. Increased use of family planning services was significantly associated with the drop in the fertility rate for Black teenagers; legal abortion use was significantly associated with the change in the fertility rate for Black females aged 20 years or older.     

Births: preliminary data for 1999.

OBJECTIVES: This report presents preliminary data for 1999 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented. METHODS: Data in this report are based on more than a 97-percent sample of births for 1999. The records are weighted to independent control counts of births received in State vital statistics offices in 1999. Comparisons are made with 1998 final data. RESULTS: The crude birth rate in 1999 was 14.5 per 1,000 population, a slight decline from 1998 (14.6), returning to the level observed in 1997. However, the fertility rate, which is limited to women aged 15-44 years, was 65.8 in 1999, a slight increase over the rate for 1998 (65.6). The birth rate for teenagers continued to decline for 1998-99, dropping 3 percent to 49.6 births per 1,000 females aged 15-19 years. The 1999 rate for teenagers is 20 percent lower than the recent high point in 1991. The rate for young teenagers 15-17 years fell 6 percent, and the rate for teenagers 18-19 years declined 2 percent. Since 1991, rates have fallen 26 percent for teenagers 15-17 years, and 15 percent for teenagers 18-19 years. Birth rates for women aged 20-24 years declined slightly between 1998 and 1999 whereas the rate for women aged 25-29 years rose 2 percent. Birth rates for women in their thirties and forties continued their long increase. Rates for women in their thirties increased 2 to 3 percent and were the highest in three decades. The birth rate for women aged 40-44 years was the highest level reported since 1970. The birth rate for unmarried women in 1999 was 43.9 per 1,000, 1 percent lower than in 1998 and 6 percent lower than the peak level reported for 1994 (46.9). However, the number of births to unmarried women was up about 1 percent due to the continued increase in the number of unmarried women of childbearing age. The rate of prenatal care utilization continued to improve. The total cesarean rate increased 4 percent between 1998 and 1999 and continued a 3-year rise. The low birthweight rate remained unchanged at 7.6 percent.     

Epidemiology of abortion

This brief summary presents information on the epidemiology of abortion requested by IPPF. In 1975, 8% of the world's population lived in areas where the law prohibits abortion completely, and 27% lived in areas where abortions are severely restricted. Over 2 years, 40,000 hospitalizations for abortion complications were reported in such countries, with 168 deaths. 21% of women hospitalized for a diagnosis related to abortion died. In Latin America, hospitalization and death because of illegal abortion led to epidemiological studies. In Chile, surveys indicate that 1/4 women has had an abortion. Colombia data state that 10 women die/week from abortion complications. Bangladesh identified 31 abortion deaths. When related to live births occurring in the area from which the deaths were reported, the abortion mortality ratio was 19/1000,000 live births. Data from Romania showed that before 1966, when abortion was legal, there were fewer than 100 reported deaths. After 1966, when abortion was restricted, crude birth rate increased from 15-40/1000 total population. During the following 4 years, the birth rate dropped until it was below 25, but concomitant deaths due to abortion increased. In 1965, 64 abortion-related deaths occurred, whereas by 1971, abortion-related deaths increased to 364. In North America abortion deaths and number of illegal abortions decreased dramatically after 1973, when abortion became legal in the U.S. In 1972, illegal abortions led to the deaths of 41 women, but in 1974 only 5 such deaths occurred. If women with unplanned or unwanted pregnancies all underwent abortion within the 1st 8 weeks of pregnancy, 90% of the deaths due to legal abortion could be prevented.     

Births: preliminary data for 2000.

OBJECTIVES: This report presents preliminary data for 2000 on births in the United States. U.S. data on births are shown by age, race, and Hispanic origin of mother. Data on marital status, prenatal care, cesarean delivery, and low birthweight are also presented. METHODS: Data in this report are based on more than 96 percent of births for 2000. The records are weighted to independent control counts of births received in State vital statistics offices in 2000. Comparisons are made with 1999 final data. RESULTS: The number of births rose 3 percent between 1999 and 2000. The crude birth rate increased to 14.8 per 1,000 population in 2000, 2 percent higher than the 1999 rate. The fertility rate rose 3 percent to 67.6 per 1,000 women aged 15-44 years between 1999 and 2000. The birth rate for teenagers, which has been falling since 1991, declined 2 percent in 2000 to 48.7 births per 1,000 females aged 15-19 years, another historic low. The rate for teenagers 15-17 years fell 4 percent, and the rate for 18-19 year olds was down 1 percent. Since 1991, rates have fallen 29 percent for teenagers 15-17 years and 16 percent for teenagers 18-19 years. Birth rates for all of the older age groups increased for 1999-2000: 1 percent among women aged 20-24 years, 3 percent for women aged 25-29 years, and 5 percent for women in their thirties. Rates for women aged 40-54 years were also up for 2000. The birth rate for unmarried women increased 2 percent to 45.2 births per 1,000 unmarried women aged 15-44 years in 2000, but was still lower than the peak reached in 1994. The number of births to unmarried women was up 3 percent, the highest number ever reported in the United States. However, the number of births to unmarried teenagers declined. The proportion of women who began prenatal care in the first trimester of pregnancy (83.2 percent) did not improve for 2000, nor did the rate of low birthweight (7.6 percent). The total cesarean rate rose for the fourth consecutive year to 22.9 percent, the result of both a rise in the rate of primary cesarean deliveries and a decline in the rate of vaginal births after previous cesarean delivery.