An Overview of Abortion in the United States Developed by Physicians for Reproductive Choice and Health ® (PRCH) and The Alan Guttmacher Institute (AGI)

An Overview of Abortion

in the United States

An Overview of Abortion

in the United States

Developed by Physicians for Reproductive Choice and Health® (PRCH) and The Alan Guttmacher Institute (AGI)

© January 2003

Developed by Physicians for Reproductive Choice and Health® (PRCH) and The Alan Guttmacher Institute (AGI)

© January 2003

Objectives

Provide an overview of unintended pregnancy and abortion in the United States.

Review the incidence of pregnancy and abortion.

Identify who has abortions, why, and when in pregnancy.

Review the safety of abortion.

Discuss the provision of and access to abortion services.

Provide a comparative international perspective on abortion.

Incidence of Pregnancy

and Abortion

Incidence of Pregnancy

and Abortion

Pregnancies in the United States(Approximately 6.3 Million Annually)

52%48%

0%

10%

20%

30%

40%

50%

60%

% of pregnancies

UnintendedIntendedSource: Henshaw, 1998 (1994 data)

Outcomes of Unintended Pregnancies(Approximately 3.0 Million Annually)

47%

40%

13%

0%

10%

20%

30%

40%

50%

60%

% of unintended pregs.

Abortions Births Miscarriages

Source: Henshaw, 1998 (1994 data)

Incidence of Abortion

In 2000, 1.31 million pregnancies were terminated by abortion in the United States.

Some 2.1% of all women aged 15–44 had an abortion in 2000.

Abortion is one of the most common surgical procedures in the United States.

Source: Finer and Henshaw, 2003

Annual Number of Abortions Per 1,000 Women Aged 15–44

0

5

10

15

20

25

30

35

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Rate per 1,000

Source: Finer and Henshaw, 2003

Abortion Rates in Western

Industrialized Countries

21.3 22.2

18.716.5 16.4 15.6

7.6 6.5

0

5

10

15

20

25

30

Rate per 1,000

UnitedStates(2000)

Australia Sweden Denmark Canada England& Wales

Germany Holland

Source: Henshaw et al., 1999 (1996 data)

Reasons for

Abortions

Reasons for

Abortions

Most Important Reason Given for Terminating an Unwanted Pregnancy

Inadequate financesInadequate finances 21%21%

Not ready for responsibilityNot ready for responsibility 21%21%

Woman’s life would be changed too muchWoman’s life would be changed too much 16%16%

Problems with relationship; unmarriedProblems with relationship; unmarried 12%12%

Too young; not mature enoughToo young; not mature enough 11%11%

Children are grown; woman has all she wantsChildren are grown; woman has all she wants 8% 8%

Fetus has possible health problemFetus has possible health problem 3% 3%

Woman has health problemWoman has health problem 3% 3%

Pregnancy caused by rape, incestPregnancy caused by rape, incest 1% 1%

OtherOther 4%4%

Average number of reasons givenAverage number of reasons given 3.7 3.7

Source: Torres and Forrest, 1988 (1987 data)

Gestational AgeGestational Age

Abortions by Gestational Age(Weeks Since Last Menstrual Period)

57.6%

20.3%

10.2%6.2% 4.3%

1.5%

0%

10%

20%

30%

40%

50%

60%

70%

% of abortions

<9 9-10 11-12 13-15 16-20 21+Weeks

Source: Elam-Evans et al., 2002 (1999 data)

Reasons for Abortions After 16 Weeks Since Last Menstrual

PeriodWoman did not realize she was pregnantWoman did not realize she was pregnant 71%71%

Difficulty making arrangements for abortionDifficulty making arrangements for abortion 48%48%

Afraid to tell parents or partnerAfraid to tell parents or partner 33%33%

Needed time to make decisionNeeded time to make decision 24%24%

Hoped relationship would changeHoped relationship would change 8% 8%

Pressure not to have abortionPressure not to have abortion 8% 8%

Something changed during pregnancySomething changed during pregnancy 6% 6%

Didn’t know timing was importantDidn’t know timing was important 6% 6%

Didn’t know she could get an abortionDidn’t know she could get an abortion 5% 5%

Fetal abnormality diagnosed lateFetal abnormality diagnosed late 2% 2%

OtherOther 11%11%

Average number of reasonsAverage number of reasons givengiven 2.22.2

Source: Torres and Forrest, 1988 (1987 data)

Safety of AbortionSafety of Abortion

Deaths per 100,000 Abortions or Births

0.2 0.3 0.61.8

3.7

12.7

0.6

6.6

0

2

4

6

8

10

12

14

Deaths per 100,000

<9 9-10 11-12 13-15 16-20 21+ Allabs.

Births

Abortions by gestationSource: Gold 1990 (1981–1985 data)

Abortion Risks in PerspectiveChance of deathChance of death

Risk from terminating pregnancyRisk from terminating pregnancy per year: per year:

Before 9 weeksBefore 9 weeks 1 in 500,0001 in 500,000 Between 9 and 10 weeksBetween 9 and 10 weeks 1 in 300,0001 in 300,000 Between 13 and 15 weeksBetween 13 and 15 weeks 1 in 60,0001 in 60,000 After 20 weeksAfter 20 weeks 1 in 8,0001 in 8,000

Risk to persons who participate in:Risk to persons who participate in:

MotorcyclingMotorcycling 1 in 1,000 1 in 1,000 Automobile drivingAutomobile driving 1 in 5,900 1 in 5,900 Power- boatingPower- boating 1 in 5,900 1 in 5,900 Playing footballPlaying football 1 in 25,0001 in 25,000

Risk to women aged 15–44 from:Risk to women aged 15–44 from:

Having sexual intercourse (PID)Having sexual intercourse (PID) 1 in 50,0001 in 50,000 Using tamponsUsing tampons 1 in 350,0001 in 350,000

Source: Gold, 1990; Trussell, 1998

Who Has AbortionsWho Has Abortions

Who Has Abortions: Age

20-24 years33%

25-29 years23%

30-34 years13%

35-39 years8% 15-19 years

19%

<15 years1%40-44 years

3%

Source: Jones et al., 2002

Who Has Abortions: Marital Status

Never-married67%

Married17%

Separated/ Divorced/ Widowed

16%

Source: Jones et al., 2002

% of the Federal Poverty Level

<100%27%

100-199%30%

200-299%18%

>300%25%

Who Has Abortions: Economic Status

Source: Jones et al., 2002

Who Has Abortions: Race/Ethnicity

White*41%

Black*32%

Native American*1%

Asian/Pacific Islander*6%

Hispanic20%

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

Who Has Abortions:Religious Identification

Protestant43%

Catholic27%

Other8%

None22%

Source: Jones et al., 2002

Who Has Abortions: Prior Pregnancies

Previous Abortion and Previous Birth

36%

Previous Birth25%

None27%

Previous Abortion12%

Source: Jones et al., 2002

Who Provides Abortion Services

Who Provides Abortion Services

Percent of Abortions Performed by Each Type of Provider

0%

10%

20%

30%

40%

50%

60%

70%

80%

198019811982198319841985198619871988198919901991199219931994199519961997199819992000

% of abortions

Abortionclinic

Otherclinic

Hospital

Physicianoffice

Source: Finer and Henshaw, 2003

Factors Contributing to the Decline in the Number of Abortion Providers

•Anti-choice harassment and violenceAnti-choice harassment and violence

•Social stigma/marginalizationSocial stigma/marginalization

•Professional isolation/peer pressureProfessional isolation/peer pressure

•The “graying of providers”The “graying of providers”

•Inadequate economic/other incentivesInadequate economic/other incentives

•The perception of abortion as an The perception of abortion as an unexciting field of medicineunexciting field of medicine

Source: NAF & ACOG, 1991

Factors That Make It Difficult

For Women to Obtain Abortion Services

Factors That Make It Difficult

For Women to Obtain Abortion Services

Percentage of Counties with No Provider And % of Women Living in Those

Counties

0%

20%

40%

60%

80%

100%

197819801982198419861988199019921994199619982000

Unservedcounties

Womeninunservedcounties

Source: Finer and Henshaw, 2003

Medicaid Coverage of AbortionStates that cover abortion under Medicaid for reasons States that cover abortion under Medicaid for reasons beyond rape, incest and life endangerment, as of beyond rape, incest and life endangerment, as of December, 2002:December, 2002:

AlaskaAlaska MinnesotaMinnesotaArizonaArizona MontanaMontanaCalifornia California New Jersey New Jersey Connecticut Connecticut New MexicoNew MexicoHawaiiHawaii New York New York IllinoisIllinois Oregon Oregon IndianaIndiana VermontVermontMaryland Maryland WashingtonWashingtonMassachusettsMassachusetts West Virginia West Virginia

Source: AGI, 2002

Percentage of Providers of 400 or More Abortions Per Year Who Have

Reported Harassment in 2000

•PicketingPicketing 80%80%

•Picketing with physical contact with patientsPicketing with physical contact with patients 28%28%

•VandalismVandalism 18%18%

•Picketing homes of staff membersPicketing homes of staff members 14%14%

•Bomb threatsBomb threats 15%15%

Source: Henshaw and Finer, 2003

State Restrictions on Abortion

•Parental consent or notificationParental consent or notificationrequired for minorsrequired for minors 32 states32 states

•Mandatory delay and state-directedMandatory delay and state-directedcounselingcounseling 18 states18 states

•Limitations on private insuranceLimitations on private insurancecoverage for abortioncoverage for abortion 4 states 4 states

Source: AGI, 2002 Source: AGI, 2002

International Perspective on Abortion

International Perspective on Abortion

U.S. Share of Abortions Worldwide3%

97%

United States

Rest of the WorldSource: Henshaw et al., 1999 (1995 data)

Abortion Rate, United States and World

23

35

0

5

10

15

20

25

30

35

40

Rate per 1,000 women

United States World

Source: Henshaw et al., 1999 (1995 data)

Abortion in Developed and Developing Countries

Annual abortions per 1,000 women 15-44

0 5 10 15 20 25 30 35 40 45

Developing Countries

Developed Countries

World

Legal Illegal

Source: AGI, 1999

Many Abortions Occur in Countries Where Abortion Is Illegal Under

Most Circumstances

Abortions by legality

44%

56%

Source: Henshaw et al., 1999 (1995 data)

Illegal

Legal

Percentage of Maternal Mortality Worldwide Due to Unsafe Abortion

Maternal deaths (600,000 per year)

87%

13%

Source: WHO, 1998(Estimates for 1995–2000)

Unsafe abortion

Other causes

Summary PointsSummary Points

Incidence of Pregnancy and Abortion:

Unintended pregnancy and abortion are common among all groups of women.

Almost half of all pregnancies are unintended.

Almost half of unintended pregnancies end in abortion.

Who Has Abortions, Why and When in Pregnancy:

Women having abortions are predominantly young, single, from minority groups and low-income.

Most women have multiple reasons for choosing to have an abortion.

Almost 90% of abortions occur in the first trimester.

Safety of Abortion:

Abortion is one of the safest surgical procedures for women in the United States.

Laws criminalizing abortion make abortions unsafe but do not eliminate them. In developing countries, where abortion is often illegal or highly restricted, abortion mortality rates are hundreds of times higher than rates in developed countries.

The Provision of and Access to Abortion Services:

Most abortions occur in abortion clinics.

A steady decline in providers in the last two decades has left the majority of counties in the United States with no provider.

Many of the difficulties in providing and obtaining access to abortion would disappear if the procedure were integrated with other health care services.

International Perspective on Abortion:

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

Most unsafe abortions occur in countries where abortion is illegal.