Abortion services in the United States, 1981 and 1982

The U.S. abortion rate remained essentially stable in 1981 and 1982, after rising each year between 1973 and 1980. The increases had been due to widening availability of abortion services and rising unintended pregnancy rates caused by several factors, among them a shift from use of the pill and the IUD to use of less effective methods. The stabilization of the abortion rate since 1980 is the culmination of a pattern of smaller annual increases in the rate in previous years. There were 1.57 million legal abortions reported in the United States in 1982. About three percent of U.S. women of reproductive age obtained an abortion, and about 26 percent of all pregnancies were terminated by abortion during that year. There are still wide gaps in the geographic availability of abortion services. Seventy-eight percent of all U.S. counties--containing 28 percent of women aged 15-44--had no identified provider of abortion services in 1982. Only two percent of abortions were performed in nonmetropolitan counties in that year, although 26 percent of women of reproductive age live in such counties. Fully 87 percent of nonmetropolitan counties had no abortion providers at all in 1982. Despite the concentration of abortion services in urban areas, 47 percent of metropolitan counties also had no abortion service providers in 1982. Abortion services are most available, and rates are highest, in states on the East and West coasts. In 1982, 82 percent of abortions were performed in nonhospital facilities: 56 percent in clinics which specialize in abortion services, 21 percent in other kinds of clinics and five percent in physicians' offices.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends in rates of live births and abortions following state restrictions on public funding of abortion

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.     

Is there a trend of increased unwanted childbearing among young women in the United States?

PURPOSE: The majority of births to young women are unintended (either mistimed or unwanted), bearing an increased risk of poor health outcomes for both mother and child. In this analysis, we describe trends of unwanted, mistimed, and intended births reported by all women and specifically by young women in the National Survey of Family Growth (NSFG). METHODS: Using data from the 1982, 1988, 1995, and 2002 NSFG surveys, we calculated the proportion of unwanted, mistimed, and intended births by maternal age at birth. For the 1995 and 2002 NSFG surveys, we also assessed birth intentions among 15-24-year-old nulliparous women and the mean number of unwanted births in the past 5 years among all 15-24-year-old women. RESULTS: The proportion of unintended births decreased between 1988 and 1995 but increased between 1995 and 2002. This recent increase was attributed to the increased proportion of unwanted births reported by women <25 years of age from 10.4% in 1995 to 18.6% in 2002 (p < .01). Between 1995 and 2002, the proportion of 15-24-year-old nulliparous women who intended no future births increased from 8.1% to 10.4% (p < .05), and the mean number of unwanted births per 1000 women aged 15-24 years increased from 25 to 48 (p < .01). CONCLUSIONS: Our analyses suggest an increasing trend in unwanted childbearing among young women between 1995 and 2002. Further research is needed to understand the meaning and causes of increased unwanted childbearing among young women and to identify characteristics of those at risk.     

Highlights of trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96.

OBJECTIVES: This report presents key findings from a comprehensive report on pregnancies and pregnancy rates for U.S. women. The study incorporates birth, abortion, and fetal loss data to compile national estimates of pregnancy rates according to a variety of characteristics including age, race, Hispanic origin, and marital status. Summary data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity and contraceptive practices, as well as women's reports of pregnancy intentions. METHODS: Tabular and graphic data on pregnancy rates by demographic characteristics are presented and interpreted. Birth data are from the birth registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. RESULTS: In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.     

The impact of U.S. family planning programs on births, abortions and miscarriages, 1970-1979

This paper estimates births (as well as total pregnancies, abortions and miscarriages) averted by program enrollment during the 1970s based not on the common assumption of constant program impact on birth rates, but on assumptions that take into account the changing use of abortion. Estimates of births averted from two national studies are translated into estimates of unintended pregnancies averted and projections of program impact throughout the decade are made assuming constant program impact on pregnancy rates. The number of pregnancies averted is broken into births, abortions and miscarriages averted based on actual distribution of those unintended pregnancies that did occur each year. This methodology is more appropriate to the United States or any other country during a time period when use of abortion has been changing. It also focuses attention on the fact that births averted reflect only part of the program's impact and that much of the program's effect is on averting abortions. During the decade, an estimated 5,434,000 unintended pregnancies were averted by enrollment in the family planning program. In 1979, 4,486,000 women were enrolled in family planning clinics. An estimated 792,000 unintended pregnancies were averted as a direct result, 1 for every 5.7 patients. The 274,000 averted births would have increased the number of births in 1980 in the U.S. from 3,598,000 to 3,872,000, an increase of 8%. The estimated 420,000 abortions averted would have increased abortions in the U.S. about 25% higher, to about 2,000,000.     

The sexual and reproductive behavior of American women, 1982-1988

Comparison of 1988 data from the National Survey of Family Growth with 1982 data reveals that the proportion of U.S. women who have had sexual intercourse rose slightly, from 86 percent to 89 percent. Among teenagers, the proportion sexually active rose from 47 percent to 53 percent; most of the change is attributable to increases occurring among white and nonpoor teenagers, thus narrowing racial and income differences. Among women aged 15-44 in 1988 who have ever had intercourse, 67 percent reported that they had had two or more sexual partners in their lifetime. The proportion was highest among women aged 20-34 (about 70 percent), but 58 percent of sexually active teenage women reported having had two or more sexual partners. About 67 percent of women of reproductive age in 1988 were exposed to the risk of unintended pregnancy, up from 63 percent in 1982. Among these women, 35 percent rely on contraceptive sterilization to prevent pregnancy and 55 percent use reversible methods, while 10 percent use no method. Poor women are much more likely than nonpoor women to be using no method of contraception (15 vs. eight percent); among poor teenagers, this proportion reaches 25 percent. The level of contraceptive use at first intercourse among teenage women improved substantially between 1982 and 1988, however, rising from 48 percent to 65 percent. During 1984-1988, almost four in 10 births and almost six in 10 pregnancies among American women were unintended; most of these were mistimed, but 12 percent of births were unwanted ever.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors associated with unintended pregnancy in Yamagata, Japan

Data on unintended pregnancy are scarce in Japan. The purpose of this study is to examine the association of sociodemographic, reproductive, and other health behavioral factors with unintended pregnancy. A survey was conducted from May through November 1999 in Yamagata, Japan. We distributed anonymous self-administered questionnaires to cervical and breast cancer screening participants aged 35-49 years. There were 564 eligible women, and the number of respondents was 421 (74.6%). The proportion of women who had experienced unintended pregnancy was 46.2%, and 40.1% of them had repeated experiences. Among 312 pre-menopausal married women who did not want to become pregnant, 15.4% were not using any contraception. Factors that were significantly associated with the experience of unintended pregnancy were age of husband being 4 or more years older [Odds ratio (OR) = 1.83], and age at initiation of sexual intercourse (OR = 1.86) and marriage during teens (OR = 11.14). Analysis of 1255 pregnancies that the subjects had experienced showed that 51.2% and 25.9% of mistimed and unwanted pregnancies occurred as a result of no contraceptive use, and 39.5% and 71.1% of these ended in abortions. The number of past unintended pregnancies was significantly (p < 0.001) correlated with the number of pregnancies (r(s) = 0.49), live births 0.20) and abortions (r(s) = 0.63). This is the first epidemiological study in Japan to examine factors associated with unintended pregnancy, and also contraceptive use and pregnancy outcome for each of the unintended pregnancy women had experienced. Unintended pregnancy is not a rare event among our target population, and many unintended pregnancies leading to abortion could be prevented by effective contraceptive use. Results suggest that Yamagata's family planning strategies need to target both the younger and older generations, and address the role of men. A woman's pregnancy history reflecting her past experience of unintended pregnancy could be used as an indicator for recognizing the woman's need for appropriate contraceptive counseling for the prevention of repeated unintended pregnancies.     

Characteristics of U.S. women having abortions, 1982-1983

In 1982 and 1983, as in previous years, the majority of abortions in the United States were obtained by young women (62 percent), white women (70 percent) and unmarried women (81 percent). Half of all abortions were performed eight or fewer weeks after the last menstrual period, and 91 percent, at 12 weeks or earlier. The proportion of abortions that were repeat procedures continued to rise, to 37 percent in 1982 and 39 percent in 1983. The rate of abortion, 29 per 1,000, has remained essentially the same since 1981. Women aged 18-19 continue to have the highest abortion rate of any age-group (60 per 1,000). While most abortions are obtained by white women, the nonwhite abortion rate is more than twice that of whites. Thirty percent of all pregnancies were terminated by abortion in 1983, the same proportion as in 1982 and 1981. The highest abortion ratios are found among unmarried women (63 percent), women 40 and older (51 percent), teenagers (42 percent) and nonwhites (40 percent). Teenage nonwhites and whites have about the same abortion ratios. After rising during the 1970s, the adolescent pregnancy rate peaked around 1980-1981 and fell slightly in 1982-1983. The relative differentials between the pregnancy, birth and abortion rates of nonwhite and white teenagers narrowed somewhat between 1978 and 1981, but then widened slightly between 1981 and 1983.     

Induced abortion and low birthweight in the following pregnancy

BACKGROUND: To examine whether induced abortion increases the risk of low birthweight in subsequent singleton live births. METHODS: Cohort study using the Danish Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), and the Induced Abortion Registry (IAR). All women who had their first pregnancy during 1980-1982 were identified in the MBR, the HDR, and the IAR. We included all 15,727 women whose pregnancy was terminated by a first trimester induced abortion in the induced abortion cohort and 46,026 women whose pregnancy was not terminated by an induced abortion were selected for the control cohort. All subsequent pregnancies until 1994 were identified by register record linkage. RESULTS: Low birthweight (<2500 g) in singleton term live births occurred more frequently in women with one, two, three or more previous induced abortions, compared with women without any previous induced abortion of similar gravidity, 2.2% versus 1.5%, 2.4% versus 1.7%, and 1.8% versus 1.6%, respectively. Adjusting for maternal age and residence at time of pregnancy, interpregnancy interval, gender of newborn, number of previous spontaneous abortions and number of previous low birthweight infants (control cohort only), the odds ratios (OR) of low birthweight in singleton term live births in women with one, two or more previous first trimester induced abortions were 1.9 (95% CI: 1.6, 2.3), and 1.9 (95% CI: 1.3, 2.7), respectively, compared with the control cohort of similar gravidity. High risks were mainly seen in women with an interpregnancy interval of more than 6 months. CONCLUSIONS: The findings suggest a positive association between one or more first trimester induced abortions and the risk of low birthweight in subsequent singleton term live births when the interpregnancy interval is longer than 6 months. This result was unexpected and confounding cannot be ruled out.     

Socioeconomic Inequalities in Unintended Pregnancy and Abortion Decision

Pregnancy planning allows women to better control their life trajectory and contributes to the future child’s health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education uncompleted had more unintended pregnancies (OR = 7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy. Font-Ribera, Pérez, Salvador, and Borrell are with the Health Information Service, Agency of Public Health of Barcelona, Barcelona, Spain; Pérez and Borrell are with the University Pompeu Fabra, Barcelona, Spain; Pérez and Borrell are with the CIBER in Epìdemiology and Public Health (CIBERESP), Barcelona, Spain; Pérez is with the Agency of Public Health of Barcelona, Barcelona, Spain.     

Use of contraception and use of family planning services in the United States: 1982-2002

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. METHODS: Data were collected through in-person interviews with 12,571 men and women 15-44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. RESULTS: The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999-2002, the proportion using a method at first premarital intercourse had risen to 79 percent.     

Estimated pregnancy rates by outcome for the United States, 1990-2004

OBJECTIVES: This report presents detailed pregnancy rates for 1990-2004, updating a national series of rates extending since 1976. Data from the National Survey of Family Growth (NSFG) are used to interpret trends in teenage pregnancy and in total pregnancy and fertility rates. METHODS: Tabular and graphical data on pregnancy rates by age, race and Hispanic origin, and by marital status are presented and described. Birth data are from the birth registration system for all births registered in the United States and reported by state health departments to the National Center for Health Statistics; abortion data are from the Guttmacher Institute and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and fetal loss estimates are from pregnancy history information collected by the NSFG. RESULTS: In 2004 an estimated 6,390,000 pregnancies resulted in 4.11 million live births, 1.22 million induced abortions, and 1.06 million fetal losses. The estimated pregnancy rate for 2004 was 103.0; the rate varied little between 1995 and 2004. The teenage pregnancy rate dropped 38 percent during 1990-2004, reaching an historic low of 72.2 pregnancies per 1,000 women aged 15-19 years. Rates for younger teenagers declined relatively more than for older teenagers.     

A portrait of American women who obtain abortions

In 1981, as in 1980, most abortions in the United States were obtained by young women, unmarried women and white women, and were performed in the first eight weeks following the last menstrual period (approximately six weeks after conception). The proportion of abortions obtained by unmarried women has increased slightly, and the fraction obtained by teenagers has decreased, mainly because of shifts in the distribution of these groups in the population. The percentage of abortions that are repeat procedures has increased, representing more than one-third of all abortions. The increase is due largely to the rise in the number of women who have had a first abortion, and who are, therefore, exposed to the risk of having a second procedure. Eighty-five percent of all abortions are performed by vacuum aspiration. Dilatation and evacuation is the method used in two-thirds of abortions performed more than 12 weeks past the last menstrual period, and in nine out of 10 abortions that are performed between the 13th and the 15th week. About three percent of women aged 15-44 obtained abortions in 1981, and 26 percent of pregnancies were terminated by abortion--the same fractions as in 1980. About six percent of 18-19-year-olds had abortions--the highest rate of any age-group. The abortion rate (the number of abortions per 1,000 women aged 15-44) and ratio (the number of abortions per 100 live births and abortions) are much higher for unmarried than for married women.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Partner effects on a woman's intention to conceive: 'not with this partner'

CONTEXT: Current definitions of pregnancy intention that are useful at aggregate levels are weak at the individual level. This is especially true in social contexts where childbearing and pregnancy often occur within casual or transient relationships. METHODS: Extensive data on lifetime partnerships and sexual behaviors, including pregnancies and births, from 250 low-income women who had experienced a total of 839 pregnancies are used to explore correlates of intention to conceive, as well as the extent to which women attribute their intentions to a current partnership. RESULTS: Some 57% of reported pregnancies were unintended. Overall, 21% of the women had not wished to conceive at least one of their pregnancies with the partner who impregnated them; that proportion rose to 33% among women who had had only unintended pregnancies. Even among women who had had no unintended pregnancies, 18% had had at least one conception that they had not wanted with their partner at the time of conception. Women were less likely to say they had not wanted to conceive with a particular partner if they were living with that partner than if they were not. The likelihood of not having wanted a pregnancy with a given partner rose with the lifetime number of serious partners. Pregnancies that were not wanted with a particular partner were more than twice as likely to end in abortion as were those that were (33% vs. 14%). CONCLUSIONS: Among these women, the desire to avoid childbearing relates more to the couple involved in the conception than to abstract notions of completed family size. It would therefore be useful to include items pertaining to partner relationships in future studies of pregnancy intention.     

Socioeconomic Disparities Among Ever-Married Turkish Women Who Had Unintended Pregnancies and Abortions in a Middle Anatolian City

Researchers undertook a cross-sectional study to examine socioeconomic disparities, unintended pregnancies, and decisions about induced abortions among ever-married women in the urban area of Sivas, Turkey. The data for the present study were gathered from a randomly-selected, household-based probability sample of 1,264 ever-married Turkish women. Unintended pregnancies accounted for 46.2% of total pregnancies and, of these, 30% ended in induced abortion. The proportion of induced abortion among all pregnancies was 21.7%. Multiple logistic regression analyses with adjusted odds ratios (aOR) showed that being aged less than 35 years (aOR = 2.14, p < 0.001), having less than a high school education (aOR = 2.18, p < 0.001), being unemployed (aOR = 2.77, p < 0.001), having more than three children (aOR = 1.54, p = 0.006), and having lower income (aOR = 2.11, p < 0.001) were associated with unintended pregnancies. Among women with unintended pregnancy, having more than three children (aOR = 3.06, p < 0.001), lower income (aOR = 3.39, p < 0.001), and age less than 35 years (aOR = 2.57, p < 0.001) were associated with induced abortion. These findings suggest that lower socioeconomic status was associated with induced abortion among women facing an unintended pregnancy. Women who experience unintended pregnancies, who have lower socioeconomic status and education level, should be the target group for midwives and other relevant healthcare providers for educational efforts regarding family planning and contraception.     

Exploratory spatial data analysis for the identification of risk factors to birth defects

Background

Nearly 10% of the population of Turkey lives in the Southeast Anatolian Project (SEAP) region. The population growth rate and the rate of unintended pregnancies are high and family planning services are insufficient in this region. Lifetime induced abortion rate is also high in this region. Public health problems of the SEAP region were investigated in the "SEAP Public Health Project" in 2001 and 2002. As it is one of the most important health problems of the women living in this region; induced abortion was also investigated in this project.

Methods

An optimumsample size representing the rural and urban area of the region (n = 1150) was chosen by the State Institute of Statistics by a sampling method proportional to size. 1126 of the area's 1150 houses have been visited and data about induced abortions have been obtained by applying a questionnaire to 1491 ever married women who live in the region.

Results

It has been found that 9.0% of these women who had at least one pregnancy in their life had at least one induced abortion. The lifetime induced abortion per 100 pregnancies was found to be 2.45. The primary reason given for induced abortions was "wanting no more children" (64.6%). Lifetime induced abortions were 5.3 times greater with women using a family planning method than women not using family planning methods. Lifetime induced abortions were 4.1 times greater with unemployed women than working women. Most of the women have used private doctors in order to have an induced abortion. Although 32.29% have not yet begun to use a contraceptive method after their last induced abortion, 43.75% of the women have since started to use an effective contraceptive method. 23.96% of them have begun to use an ineffective contraceptive method.

Conclusions

Induced abortion is still an important problem at the SEAP region. The results of the study remind us that unemployed women and women who have more than four children is our target group in the campaign against induced abortions. Most of the women use private doctors in order to have an induced abortion. Thus, priority must be given to educate private gynecologists with respect to induced abortion. After induced abortions, a qualified family planning consultant can be given to women and they can be secured to use a suitable contraceptive method.     

Observation: contraceptive method use following an abortion

Researchers comparing 1st and repeat abortion patients directly, have found that the latter were using methods that are only slightly or no more effective than those used by 1st-abortion patients at the time they became pregnant. It is here argued that such direct comparisons are not appropriate because repeat patients are not typical of all women who have ever had an abortion. Most women who use effective methods consistently after a 1st abortion, will never appear in the repeat abortion statistics. Therefore, in terms of contraceptive use, repeat abortion patients overrepresent women who use no method or the least effective method. This point is illustrated using 1981-82 data collected by the Minnesota Department of Health on virtually all the state's residents obtaining abortions in the state during a 2-year period. A total of 22,070 women obtained 1st abortions and 8734 women repeat abortions. The data is collected by method used and shows the monthly contraceptive failure rate per woman, the number of users per failure, the estimated % distribution of women at risk of a 1st abortion, the acutal distribution of those obtaining a 1st abortion, and the estimated distribution of women at risk of a repeat abortion. Comparisons of these statistics show that of the women exposed to the risk of abortion, those acutally obtaining one are disproportionately using no cotraceptives (70%) or the least effective method. The pill and sterilization were the methods used most commonly by the group exposed to the risk of a repeat abortion. By contrast, at the time of the 1st abortion, only 5% of women had been using the pill and less than 1% had depended on sterilization. Only 9% of women at risk of a repeat abortion used no method, compared with 70% before the 1st abortion. Thus although women who have an abortion tend to be relatively poor contraceptive users, after the abortion, they use methods at least as effective as those used by women at risk of a 1st abortion. The data suggest a marked improvement in contraceptive practice subsequent to a 1st abortion. While a number of factors may contribute to this improvement, it is probable that the abortion experience and the contraceptive services offered at the time of the abortion play an important role in improving contraceptive practice.     

Emergency postcoital contraception

Both birth control technology and its use are imperfect. As such, approximately 60% of all pregnancies in the US are unplanned and unintended, with almost 45% of all live births being the result of unintended pregnancy. More than 50% of unintended pregnancies and 33% of all pregnancies in the US end in abortion. That emergency postcoital contraception (EPC) is used only rarely in the US is one reason why unintended pregnancy rates are higher in that country relative to other developed countries. EPC is a method for managing unprotected coital exposure by the pharmacologic or mechanical inhibition of fertilization or implantation. Knowledge and easy access to EPC could prevent an estimated 2.3 million unintended pregnancies per year in the US and reduce the number of abortions by 800,000 annually. The author stresses the moral and professional responsibility which family planning providers have to provide their clients with postcoital contraception.     

The resolution of teenage first pregnancies

First conceptions occuring in tennage women in the U.S., the outcomes of the pregnancies, the marital status of the teenage women at conception and at the outcome, whether the pregnancy was intended or not, and whether contraception was used to prevent the pregnancy are discussed. It was determined that 30% of a cross section of teenage women have had premarital intercourse and 58% of those married had premarital intercourse. Of those experiencing premarital intercourse, 30% were pregnant before marriage, i.e., fewer than 10% of all females 15-19. Twice as many blacks have premarital intercourse than whites, and twice as many of these become pregnant. 35% of those who have a premarital first pregnancy marry before the baby is born. 64% of premarital first pregnancies are unintended. Of those who did not want to become pregnant, 13-16% used contraception to prevent the premarital pregnancy. 86% of births to blacks from first pregnancies are illegitimate compared with 23% for whites. More than 1/5 of the women who do not marry end the pregnancy by induced abortion. White teenagers who do not marry prior to the outcome of the pregnancy are 7 times more likely to have an induced abortion than blacks. 18% of the whites who have illegitimate births from first pregnancies give up their children for adoption compared with 2% blacks. Fewer than 30% of postmarital first pregnancies of teenage women are unintended. Blacks appear to display less anxiety than whites over illegitimate births. It may be that escape via abortion and marriage is less accessible to blacks than to whites both economically and psychologically.