Abortion surveillance--United States, 1989.

Since 1980, the number of legal induced abortions reported to CDC has remained stable, varying each year by < 5%. In 1989, 1,396,658 abortions were reported--a 1.9% increase from 1988. The abortion ratio for 1989 was 346 legal induced abortions/1,000 live births, and the abortion rate was 24/1,000 women ages 15-44 years. The abortion ratio was highest for black women and women of other minority racial groups and for women < 15 years of age. Overall, women undergoing abortions tended to be young, white, and unmarried; to have had no previous live births; and to be having the procedure for the first time. Approximately half of all abortions were performed before the eighth week of gestation, and 87% were before the thirteenth week of gestation. Younger women tended to obtain abortions later in pregnancy than older women. This report also includes newly reported abortion-related deaths for 1986 and 1987, as well as an update on abortion-related deaths for the period 1978-1985. Ten deaths in 1986 and six deaths in 1987 were associated with legal induced abortion. The case-fatality rate in 1986 was 0.8 abortion-related deaths/100,000 legal induced abortions and 0.4/100,000 in 1987.     

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.     

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.     

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)     

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).     

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.     

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.     

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 abortions and births. Trends in seven counties, Norway, 1972-1983

This paper discusses the changes in the frequencies of induced abortions and births according to changes in the abortion legislation in Norway during the 1970s. The study material consists of women aged 15-44 years having undergone induced abortion or giving birth in seven Norwegian counties during the period 1972-83. Since the liberalization of the abortion legislation in 1976 and later when the law on abortion on women's request came into force in January 1979, the number of induced abortions per 1000 women 15-44 years of age has decreased by 20%, until December 31, 1983. For no age group has the number of induced abortions per 1000 women increased since the liberalization of the abortion legislation. While the number of terminations of pregnancy per 1000 women below the age of 25 has remained unchanged since 1975, the number of abortions per 1000 women aged 25-29 has decreased by nearly 18% and for women aged 30-44, by 34%. The number of terminated pregnancies per 1000 women of fertile age has shown a decrease corresponding to the reduction in births per 1000 women. Thus the liberalization of the abortion law cannot account for the decreased number of births after 1975.     

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.     

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.     

Abortion Incidence and Postabortion Care in Rwanda

Abortion is illegal in Rwanda except when necessary to protect a woman's physical health or to save her life. Many women in Rwanda obtain unsafe abortions, and some experience health complications as a result. To estimate the incidence of induced abortion, we conducted a national sample survey of health facilities that provide postabortion care and a purposive sample survey of key informants knowledgeable about abortion conditions. We found that more than 16,700 women received care for complications resulting from induced abortion in Rwanda in 2009, or 7 per 1,000 women aged 15–44. Approximately 40 percent of abortions are estimated to lead to complications requiring treatment, but about a third of those who experienced a complication did not obtain treatment. Nationally, the estimated induced abortion rate is 25 abortions per 1,000 women aged 15–44, or approximately 60,000 abortions annually. An urgent need exists in Rwanda to address unmet need for contraception, to strengthen family planning services, to broaden access to legal abortion, and to improve postabortion care.     

Induced abortion in eight provinces of China.

A survey of 12,000 women in eight provinces of China was carried out in 1988. One urban and one rural area were selected purposely in each province; data on lifetime and recent pregnancies were collected from married women aged 20-44. Data on abortions included reasons, gestational age, and complications. During the five years before the survey, the number of abortions per 100 live births was 102 in urban areas and 62 in rural areas. For those with one or more previous live births in urban areas, nearly all subsequent pregnancies ended in abortion. Also in urban areas, 31% of women with a recent abortion reported the reason was contraceptive failure. Over 80% of women are contraceptive users; the high abortion rates then reflect relatively low use-effectiveness of contraception and that most unplanned pregnancies are aborted.     

Estimated pregnancy rates for the United States, 1990-2000: an update.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-2000, updating a national series of rates extending since 1976. METHODS: Tabular data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and briefly described. RESULTS: In 2000 an estimated 6,401,000 pregnancies resulted in 4.06 million live births, 1.31 million induced abortions, and 1.03 million fetal losses. The 2000 pregnancy rate of 104.0 pregnancies per 1,000 women aged 15-44 years is 10 percent lower than the 1990 peak of 115.6. The teenage pregnancy rate dropped 27 percent during 1990-2000, reaching an historic low of 84.5 pregnancies per 1,000 women aged 15-19 years. Rates for younger teenagers declined relatively more than for older teenagers.     

Abortion in the United States: incidence and access to services, 2005

CONTEXT: Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. METHODS: All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. RESULTS: An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. CONCLUSION: The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services.     

Abortion incidence in Cambodia, 2005 and 2010

Although Cambodia now permits elective abortion, scarcity of research on this topic means that information on abortion incidence is limited to regional estimates. This estimation model combines national survey data from Demographic and Health Surveys (DHS) with national prospective data of abortion procedures from government health facilities, collected in 2005 and 2010, to calculate the national incidence of safe and unsafe abortion. According to DHS, the proportion of all induced abortions that took place in a health facility in the five years preceding each survey increased from almost 52% to 60%. Projecting from facility-based abortions to national estimates, the national abortion rate increased from 21 to 28 per 1000 women aged 15–44. The abortion ratio also increased from 19 to 28 per 100 live births. This research quantifies an increase in safely induced abortions in Cambodia and provides a deeper understanding of induced abortion trends in Cambodia.     

Abortion incidence and services in the United States in 2000

CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996.
METHODS: In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys.
RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15–44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nation's 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000.
CONCLUSIONS: Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.     

Births: preliminary data for 2001.

OBJECTIVES: This report presents preliminary data for 2001 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 2001. The records are weighted to independent control counts of all births received in State vital statistics offices in 2001. Comparisons are made with 2000 final data. RESULTS: The number of births, the crude birth rate, and the fertility rate all declined slightly between 2000 and 2001. The number of births was down by less than 1 percent, the crude birth rate declined 1 percent to 14.5 per 1,000 population, and the fertility rate was down slightly to 67.2 births per 1,000 women aged 15-44 years. Teenagers were less likely to give birth in 2001; the teen birth rate continued to fall, dropping 5 percent between 2000 and 2001 to 45.9 births per 1,000 females aged 15-19 years, another record low. The teen birth rate has fallen 26 percent since 1991. The birth rate for teenagers 15-17 years fell 8 percent, and the rate for teenagers 18-19 years was down 4 percent for 2000-2001. Since 1991 rates have fallen 35 percent for teenagers 15-17 years, and 20 percent for teenagers 18-19 years. Birth rates for women aged 20-24 declined by 2 percent, whereas rates for women 25-44 years increased. Childbearing among women aged 40-54 years was stable. The birth rate for unmarried women decreased modestly to 44.9 births per 1,000 unmarried women 15-44 years in 2001, still remaining below the peak reached in 1994. The number of births to unmarried women was up very slightly, but births to unmarried teens were down. The proportion of women who began prenatal care in the first trimester of pregnancy improved slightly to 83.4 percent, but the rate of low birthweight held at 7.6 percent. The total cesarean delivery rate jumped 7 percent between 2000 and 2001 to 24.4 percent of all births, the highest level ever reported from this data source; the primary rate of cesarean deliveries rose 5 percent, and the rate of vaginal births after previous cesarean delivery tumbled 20 percent.     

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.