Abortion surveillance, 1986-1987

Since 1980, the number of legal abortions reported to CDC has remained fairly stable, varying each year by less than 3%. In 1986, 1,328,112 abortions were reported; in 1987, that number increased by approximately 2% to 1,353,671. The abortion ratio for 1986 was 354 legally induced abortions per 1,000 live births; the ratio for 1987 was 356 per 1,000. The national abortion rate was 23/1,000 females ages 15-44 years for 1986 and 24/1,000 females ages 15-44 years in 1987. Abortion ratios were higher among women of black and other minority races and among women less than 15 years of age. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to have had no previous live births, and 3) to be having the procedure for the first time. In 1987, approximately half of all abortions were performed before the eighth week of gestation, and greater than 85% were performed during the first trimester of pregnancy (less than 13 weeks of gestation).     

Abortion surveillance, United States, 1984-1985

Since 1983, the number of legal abortions reported to CDC increased by 5% to 1,333,521 in 1984; in 1985, that number decreased by less than 1% to 1,328,570. The national abortion rate was the same for both years-24 per 1,000 females ages 15-44 years. The abortion ratio for 1984 was 364 legally induced abortions per 1,000 live births; the ratio for 1985 was 354 per 1,000. Abortion ratios were higher among women of black and other minority races and among women younger than 15 years of age. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to have had no previous live births, and 3) to be having the procedure for the first time. Curettage was the procedure used in 96% of the reported cases. Eleven deaths were associated with legally induced abortions in 1984, and six in 1985. The case-fatality rate in 1985 was 0.5 deaths per 100,000 legally induced abortions, down from the 0.8 per 100,000 reported in 1983 and 1984. Overall, since 1980, the numbers and rates of abortion have had only slight year-to-year fluctuations. The steady increase in the percentage of repeat abortions since 1972 reflects the ongoing availability of legal abortions. Since the beginning of CDC's abortion mortality surveillance, the number of deaths related to legal abortions has decreased 75%, from 24 deaths in 1972 to six deaths in 1985.     

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.     

Abortion surveillance--United States, 1997.

PROBLEM/CONDITION: In 1969, CDC began abortion surveillance to document the number and characteristics of women obtaining legal induced abortions, to monitor unintended pregnancy, and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions. REPORTING PERIOD COVERED: This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States in 1997. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state where the abortion occurred. The data are received from 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. RESULTS: In 1997, a total of 1,186,039 legal abortions were reported to CDC, representing a 3% decrease from the number reported for 1996. The abortion ratio was 306 legal induced abortions per 1,000 live births, and since 1995, the abortion rate has remained at 20 per 1,000 women aged 15-44 years. The availability of information about characteristics of women who obtained an abortion in 1997 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions by state is reported by state of residence and state of occurrence; characteristics of women obtaining abortions in 1997 are reported by state of occurrence. Women who were undergoing an abortion were more likely to be young (i.e., aged < 25 years), white, and unmarried; approximately one half were obtaining an abortion for the first time. More than one half of all abortions for which gestational age was reported (55%) were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. Overall, 18% of abortions were performed at the earliest weeks of gestation (< or = 6 weeks), 18% at 7 weeks of gestation, and 20% at 8 weeks of gestation. From 1992 through 1997, increases have occurred in the percentage of abortions performed at the very early weeks of gestation. Few abortions were provided after 15 weeks of gestation--4% of abortions were obtained at 16-20 weeks, and 1.4% were obtained at > or = 21 weeks. A total of 19 reporting areas submitted information regarding abortions performed by medical (nonsurgical) procedures, comprising < 1% of procedures reported by all states. Younger women (i.e., aged < or = 24 years) were more likely to obtain abortions later in pregnancy than were older women. INTERPRETATION: From 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, and in 1997, the number of abortions in the United States declined to it lowest level since 1978. PUBLIC HEALTH ACTIONS: The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed and efforts to prevent unintended pregnancy can be evaluated.     

The analysis of trends in induced abortion in Japan—An increasing consequence among adolescents

Objectives  The purpose of this study was to examine trends in induced abortions in Japan. Methods  The Ministry of Health, Labour, and Welfare compiled data on induced abortions, live births, and the population of women aged 15–49 years. These data were provided by 47 prefectures in Japan and were used to examine the number of induced abortions and various characteristics of women who received abortions from 1955 through 2001. We examined abortion numbers, abortion ratios (number of legal abortions per 1,000 live births), and abortion rates (number of legal abortions per 1,000 women aged 15–49). We were particularly interested in examining abortion trends among adolescents. These trends were also compared to those in the United States. Results  A total of 341,588 legal induced abortions were reported in Japan in 2001, representing a 2.5% increase from 1998 to 2001. From 1998 to 2001, the abortion ratio (292) increased by 5.4%; from 1996 through 2001, the abortion rate (11.8) increased by 8.3%. Women less than 20 years old contributed most to these increases. In 1999, the abortion ratio among Japanese adolescents was 5.7 times as high as the ratio among U.S. adolescents, while the abortion rate among U.S. adolescents was 1.8 times as high as the rate among Japanese adolescents. Conclusions  Recent increases in induced abortion among Japanese women may be related to several factors, including changes in sexual behavior among adolescents and a decline in their use of contraceptives. More appropriate educational efforts and interventions are needed to prevent unintended pregnancies.     

Abortion-related maternal mortality in the Russian Federation

This study examines characteristics and determinants of maternal mortality associated with induced and spontaneous abortion in the Russian Federation. In addition to national statistical data, the study uses the original medical files of 113 women, representing 74 percent of all women known to have died after undergoing an abortion in 1999. The number of abortions and abortion-related maternal deaths fell fairly steadily during the 1991-2000 decade to levels of 56 percent and 52 percent of the 1991 base, respectively. Regional and urban-rural variation is limited. Nine percent of abortion-related maternal mortality is due to spontaneous abortion; 24 percent is related to induced abortions performed inside and 67 percent to those performed outside a medical institution. In the latter group, older women, usually with a history of several pregnancies, are overrepresented. The high rate of abortion-related maternal mortality is due largely to the number of abortions performed at 13-21 weeks' and 22-27 weeks' gestation both inside and outside medical institutions. Improving access to safe second-trimester abortion, preventing delays during the abortion procedure, and adequate treatment of complications are key strategies for reducing abortion-related maternal mortality.     

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).     

Induced abortion: a world review, 1990

The worldwide trend toward liberalization of abortion laws has continued in the last four years with changes in Canada, Czechoslovakia, Greece, Hungary, Romania, the Soviet Union and Vietnam. Forty percent of the world's population now lives in countries where induced abortion is permitted on request, and 25 percent lives where it is allowed only if the woman's life is in danger. In 1987, an estimated 26 to 31 million legal abortions and 10 to 22 million clandestine abortions were performed worldwide. Legal abortion rates ranged from a high of at least 112 abortions per 1,000 women of reproductive age in the Soviet Union to a low of five per 1,000 in the Netherlands. In recent years, abortion rates have been increasing in Czechoslovakia, England and Wales, New Zealand and Sweden and declining in China, France, Iceland, Italy, Japan and the Netherlands. In most Western European and English-speaking countries, about half of abortions are obtained by young, unmarried women seeking to delay a first birth, while in Eastern Europe and the developing countries, abortion is most common among married women with two or more children. Mortality from legal abortion averages 0.6 deaths per 100,000 procedures in developed countries with data. Abortion services are increasingly being provided outside of hospitals, and for those performed in hospitals, overnight stays are becoming less common. National health insurance covers abortions needed to preserve the health of a pregnant woman in all developed countries except the United States, where Medicaid and federal insurance programs do not cover abortion unless the woman's life is in danger.     

Mortality of induced abortion,other outpatient surgical procedures and common activities in the United States

Objective

The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities.

Methods

We calculated the abortion-related mortality rate during 2000–2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving.

Results

The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8–1.7 deaths per 100,000 plastic surgery procedures, 0–1.7deaths per 100,000 dental procedures, 0.6–1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007–2011 was about equal to the abortion-related mortality rate.

Conclusions

The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health.     

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.     

Mortality and morbidity associated with legal abortions in Hungary, 1960-1973.

In Hungary, with 10 million inhabitants, the number of induced abortions in the 1960's first approached and then reached 200,000 cases annually. These data mean that the number of induced abortions has increased substantially compared with earlier decades. A qualitative change has also occurred, from criminal abortions to, in most cases, legally induced abortions performed in hospitals. On the basis of 32 deaths directly resulting from legal induced abortion in the first trimester during 1960-1972, maternal mortality is about 1.5 per 100,000 abortions in Hungary, the lowest rat observed until the present anywhere in the world. According to a special survey conducted in Budapest in 1966, the overall morbidity rate was 41.6 per 1,000 abortions of which 0.9 was due to perforations, 22.7 to post-abortal hemorrhages, and 18.0 to inflammatory complications, i.e., early post-abortal complications had to be reckoned with in every 25th case. Data in the present study suggest a correlation between induced abortions and the incidence of placenta previa, premature separation of the placenta, and premature births.     

Estimating the incidence of abortion in Pakistan

This study applies an indirect estimation method to develop comprehensive national and provincial estimates of the prevalence of abortion and abortion-related morbidity in Pakistan. Data from a health facilities survey and a health professionals survey from 2002 are analyzed to develop estimates of postabortion hospitalizations and of the abortion rate, abortion ratio, and unwanted pregnancy rate. We estimate that 890,000 induced abortions are performed annually in Pakistan, and estimate an annual abortion rate of 29 per 1,000 women aged 15-49. The abortion rate is found to be higher in provinces where contraceptive use is lower and where unwanted childbearing is higher. The unwanted pregnancy rate is estimated at 77 per 1,000 women, or about 37 percent of all pregnancies. Abortions account for termination of one in seven pregnancies. An estimated 197,000 women are treated annually in public hospitals and private teaching hospitals for induced abortion complications, a number equivalent to an annual rate of 6.4 women hospitalized as a result of unsafe induced abortions per 1,000 women aged 15-49.     

Reproductive health in Romania: reversing the Ceausescu legacy

As a result of the restrictive reproductive health policies enforced under the 25-year Ceausescu dictatorship, Romania ended the 1980s with the highest recorded maternal mortality of any country in Europe--159 deaths per 100,000 live births in 1989. An estimated 87 percent of these maternal deaths were caused by illegal and unsafe abortion. Under the Ceausescu regime, all contraceptive methods were forbidden and induced abortion was available only for women who met extremely narrow criteria. Immediately after the December 1989 revolution that overthrew Ceausescu, the new government removed restrictions on contraceptive use and legalized abortion. This legislative change has had beneficial effects on women's health, seen in the drop in maternal mortality in 1990 to 83 deaths per 100,000 live births--almost half the ratio in 1989. In addition, changes instituted since the revolution have led to the improved availability of reproductive health services and to the creation of new educational and training opportunities related to reproductive health services and to the creation of new educational and training opportunities related to reproductive health. The newly created contraceptive and abortion services have presented health system managers and policymakers with many challenges as they work to expand the availability of high-quality, comprehensive reproductive health care in a setting of economic hardship, political unrest, insufficient infrastructure, and outdated medical knowledge and practice.     

Death after legally induced abortion. A comprehensive approach for determination of abortion-related deaths based on record linkage

The sources for determination of abortion-related deaths in Georgia are the cause of death listed on the death certificate and reports from informal reporting channels. Although Georgia residents 10-44 years of age obtained 19,877 induced abortions in 1975, no deaths related to abortion were found through these two usual sources. To determine the sensitivity of this system, all abortion certificates for 1975 were compared with all death certificates of Georgia females aged 10-44 who died in 1975 and the first 2 months of 1976. Based on the age and racial distribution of the women who received abortions, approximately 13 deaths (from all causes) would be expected to have subsequently occurred during the period of time studied. The authors found only 10. From national death-to-case rates for legal abortion, the expected number actually atrributable to abortion was 0.78 death. Of the 10 deaths, 2 were potentially related to the previous abortion, but a causal relationship to the preceding abortion was not clearly evident for any of the 10 deaths. The data, therefore, tend to support the assertion that no large numbers of deaths related to abortion are undiscovered and that current measurements of abortion mortality are accurate.     

Characteristics of U.S. women having abortions, 1987

In 1987, as in earlier years, women having abortions were predominantly white (65 percent), younger than 25 (59 percent), and unmarried (82 percent). A majority had no previous live births (53 percent), and most had no previous abortions (58 percent). About half the abortions were performed before nine weeks of gestation, and 97 percent were curettage procedures, usually suction curettage. Comparisons with 1980 data reveal a six percent decline in the U.S. abortion rate after changes in age, race and marital status within the population are controlled for; however, the decline occurred only among the white population and not among minority races. Among teenagers aged 15-19, the abortion rate declined slightly for whites and increased for minorities. The rate also increased among women younger than age 15.     

Standardized mortality rates associated with legal abortion: United States, 1972-1975

The U.S. Department of Health, Education, and Welfare's Center for Disease Control has collected data on abortion deaths since 1972. These data, controlled for age and race, show that abortions perfomed before the 16th week of pregnancy are safer than childbirth. 104 women died of causes associated with legal abortion in the years 1972-1975; 1/2 of these women were white and the other 1/2 nonwhite. Both infection, often terminating in septic shock, and embolic events, accounted for slightly more than 1/4 of the deaths. The data showed the age distribution of women obtaining abortions in the 1972-1975 period remaining relatively constant; the proportion of nonwhites increased. There was a significant shift in the period toward earlier abortions. Older women tended more often to obtain earlier abortions. Abortion-related mortality declined in this period, due to: 1) the trend toward earlier abortions, and 2) improved operative skill of the physicians. Childbirth-related mortality figures for the same period were much higher in each of the component groups. Women in the age group 20-24 had a 2.3 times greater mortality risk in childbirth than in abortion and women over 35 had an 8.1 times greater risk.     

Trends in therapeutic abortion in San Francisco.

Positive and negative aspects of therapeutic abortion are discussed upon review of trends found in the 6201 abortions performed in San Francisco between 1968 and 1970 (since Abortion was legalized in California in 1967). On the positive side, legalized abortion appears to have reduced the septic abortion rate (68 per 1000 live births in 1967 to 22 per 1000 in 1969) indicating a decline in criminal abortion. Maternal mortality has also declined from 8 per 100,000 to just over 3 per 100,000 from 1967 to 1969. Patients requesting abortion have averaged in age from 20-24 (26% were less than 19) and approximately half have been nulliparous. 37% of teenagers had saline abortions. Negative aspects have included the increasing morbidity rate associated with saline abortion, a second-trimester method. Compared to abortions performed at 12 weeks' gestation or less (usually done by vacuum aspiration), saline abortions required 5.7% second admissions (only 1.2% of the early abortions required readmission) and necessitated transfusion 3 times as often (in 2.3% of the cases). Regardless of the procedure used, later abortion involved a greater risk of hermorrhage and infection (2.7% incidence at 5-6 weeks' gestation compared to 12.9% at 11-12 weeks). Morbidity accompanying saline abortion was similar at 15 and 20 weeks however. Fortunately a trend toward earlier abortion is indicated. (74% of abortions were by suction and 22% by saline in 1970). Hysterotomy plus tubal ligation and hysterectomy accounted for only 4% of abortions but were accompanied by hemorrhage rates of 31% and 27% respectively and had respective infection rates of 13% and 22%. Private patients received abortions 3 times more often than ward patients although ward patients were subjected to more traumatic procedures: hysterectomies for ward patients were 2.0% vs .9% for private patients; sterilization by tubal ligation following suction abortion was 3.5% vs 1.7%. Additionally, black women had later abortions more often than white patients (33% of the black women were seen after 14 weeks gestation compared to 20% of the white women). Obstructions to early abortion must be eliminated to avoid such discrepancies in opportunity. Psychiatric examinations are unnecessary and causes for administrative delays must be remedied. Cost still presents a barrier for some women. The long-term effects of abortion now suggested by data from countries such as Czechoslovakia indicate that abortion is best viewed as a back-up measure to contraception making increased sex education, counseling and contraceptive practice essential.     

Abortion trends in Japan, 1975-95

In this study, recent trends in the incidence of induced abortion are analyzed in order to identify the target population and its requirements for family planning policy in Japan. Abortion statistics from 1975 to 1995 from the Ministry of Health and Welfare are reviewed. The abortion rate (the number of cases of induced abortion per 1,000 women per year) for women younger than 20 increased during the study period. The abortion ratio (number of cases per 1,000 live births) remained the highest among women aged 40-44. An increase in the abortion ratio was seen in the two youngest groups (younger than 20 and 20-24), especially among those who were born after 1955. The proportion of abortions experienced by women younger than 25 increased from 18 percent between 1976 and 1980 to 30 percent between 1991 and 1995, and a slight increase was also observed among women aged 40-44. The proportion of abortions performed after eight weeks of a pregnancy for the two youngest groups remained higher than that for older age groups during 1975-95. The analysis demonstrates that women younger than 25 should be the principal concern of family planning policy in Japan. Further investigations on unintended pregnancy are recommended.     

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.     

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.