However, two of these reporting areas Illinois and Wisconsin reported characteristics for in-state residents but not for out-of-state residents. Four other reporting areas Arizona, Iowa, Louisiana, and Massachusetts provided only the total number of abortions for out-of-state residents without specifying individual states or areas of residence.
As a result, abortion statistics in this report by area of residence are minimum estimates. In particular, they might be disproportionately low for reporting areas from which many women travel to other states to obtain abortion services, if they go to states with incomplete residence reporting. For the purpose of evaluating trends in the overall number, rate, and ratio of reported abortions in the United States, data are presented for every year during Linear regression analysis was used to assess the overall rate of change during and during the first and second half of the period of analysis and In addition, the percentage change from the first to the last year was calculated for these three periods and from to Only the 45 reporting areas that provided data every year during were included in these analyses.
Similarly, for the analysis of certain additional variables abortions by maternal age, gestational age, race, and ethnicity , annual data are presented for areas that met reporting standards every year during , and the percentage change was calculated for the same time periods , , , and However, for other variables marital status, number of previous abortions, and number of previous live births , annual data are not presented, and areas were included as long as they provided data that meet reporting standards for the years needed for percentage change calculations.
To evaluate trends in the use of different methods for performing an abortion, reporting areas were included only if they met reporting standards and if they specifically included medical abortion as a method on their reporting form.
Because approval of mifepristone for medical abortion was granted by the Food and Drug Administration FDA in September 34 , was the first complete year during which early medical abortion was available in the United States. Thus, comparisons have been made between and and between and Because some of the 49 areas that reported in were not included in certain trend analyses, summary measures for comparisons over time might differ slightly from the point estimates presented for all areas that reported in CDC has reported data on abortion-related deaths periodically since information on abortion mortality first was included in the abortion surveillance report An abortion-related death is defined as a death resulting from a direct complication of an abortion legal or illegal , an indirect complication caused by a chain of events initiated by an abortion, or an aggravation of a preexisting condition by the physiologic or psychologic effects of abortion 35 or as a pregnancy-related death in which the pregnancy outcome was induced abortion, regardless of the causal relation between the abortion and the death.
An abortion is defined as legal if it is performed by a licensed clinician; an abortion is defined as illegal if it is performed by any other person. All deaths determined to be related causally to induced abortion have been classified as abortion related regardless of the time between the abortion and death. Sources of data for abortion-related deaths have included state vital records, public health agencies, maternal mortality review committees, health-care providers and provider organizations, private citizens and citizen groups, and media reports, including computerized searches of full-text newspaper and other print media databases.
For each death that possibly is related to abortion, CDC requests clinical records and autopsy reports. Two clinical epidemiologists review these reports to determine the cause of death and whether the death was abortion related. Each death is categorized by abortion type as legal induced, illegal induced, spontaneous, or unknown type. This report provides data on induced abortion-related deaths that occurred during ; data for have not been published previously and are the most recent data available.
Possible abortion-related deaths that occurred during are under investigation. Although national case-fatality rates the number of abortion-related deaths per , reported legal induced abortions have been published for , this measure could not be calculated with CDC data for ; because a substantial number of abortions have been documented in states that did not report to CDC during 3,12 , the total number of abortions was not available as the rate denominator.
Of these abortions, , Compared with the previous year , the total number of abortions decreased 0. However, regression analysis indicated that most of the decrease in the total number and rate of reported abortions occurred during the first half of the period of analysis. On average during , the number of reported abortions decreased by 3, abortions per year, and the abortion rate decreased by 0.
In contrast, during , average annual changes were slight. The number of reported abortions decreased by 1, abortions per year, and the abortion rate actually increased by 0. The change in abortion ratios was more consistent. On average, abortion ratios decreased by 2. Total abortion numbers, rates, and ratios have been calculated by individual reporting area of occurrence and the residence of the women who obtained the abortions Table 2.
By reporting area of occurrence, a considerable range existed in the total number of reported abortions, ranging from four or fewer Wyoming to 89, New York City ; in the abortion rate, ranging from 4. Because of the substantial variation that also occurred among reporting areas in the percentage of abortions obtained by out-of-state residents, ranging from none Wyoming to However, these measures must be viewed with caution because of the variation across reporting areas in methods used to record maternal residence and the resulting Among the 47 areas that reported by maternal age for , women aged years accounted for the majority Among the 43 reporting areas that provided data every year during , this pattern across age groups was stable, with the majority of abortions and the highest abortion rates occurring among women in their 20s and the lowest percentages of abortions and abortion rates occurring among women in the youngest and oldest age groups Table 4.
However, during , the abortion rate and percentage of abortions accounted for by women in the youngest age groups decreased, whereas the abortion rate and percentage of abortions accounted for by older women increased.
However, among women aged years, abortion rates decreased during and then leveled off during However, for women aged years, this trend was reversed from to when abortion ratios increased Table 4. The adolescent abortion rate was Adolescents aged years accounted for the majority Among the 40 reporting areas that provided data every year during , this pattern across age groups was stable, with older adolescents accounting for the largest percentage of adolescent abortions and having the highest abortion rates Table 6.
However, during , the distribution of adolescent abortions shifted toward older adolescents, whereas abortion rates decreased among adolescents of all ages. The adolescent abortion ratio for was abortions per 1, live births.
Adolescent abortion ratios decreased with increasing age and were lowest among adolescents aged 19 years Table 5. The increase in abortion ratios among younger adolescents took place primarily during , whereas the decrease in abortion ratios among older adolescents took place primarily during Among the 40 areas that reported gestational age at the time of abortion for Table 7 , the majority A total of 7.
Among the 40 areas that reported by method type for and included medical abortion on their reporting form for medical providers, All other methods consistently accounted for a small percentage of abortions 0. Among the 35 areas that reported race for , white women including Hispanic and non-Hispanic white women accounted for the largest percentage In contrast, black women had higher abortion rates and ratios than white women and women in the other races category Table Among the 26 reporting areas that provided data every year during , the percentage distribution of abortions by race changed little; although the percentage of abortions among women in the other races category increased, the percentage remained low Table Abortion rates decreased among women of all races during However, among white women, decreases in abortion rates were greater during than during Among black women, decreases during did not continue during , and from to , abortion rates increased.
Abortion ratios decreased during among women of all races, and these decreases occurred both during and during However, this trend reversed among black women from to when their abortion ratio increased Table Hispanic women accounted for Non-Hispanic white women had the lowest abortion rates 8. Among the 32 areas that reported ethnicity for , Hispanic women accounted for Abortion rates and ratios decreased among Hispanic women during However, these decreases were greater during than during and did not continue from to Table Among the 40 areas that reported marital status for , Among the 41 areas that reported by the number of previous live births for , Among the 42 areas that reported the number of previous abortions for , the majority of women For women who had obtained zero or one to two previous abortions, the direction of change increase or decrease was consistent during and ; however, for women who had previously obtained three or more abortions, the increase occurred exclusively during However, whereas Conversely, Among women obtaining abortions in reporting areas that further categorized method type by gestational age, curettage accounted for the largest percentage of abortions within every gestational age category Table At weeks' gestation, curettage accounted for After 8 weeks' gestation, medical abortion accounted for 0.
Using national data from the Pregnancy Mortality Surveillance System 36 , CDC identified nine deaths for that were potentially related to abortion. These deaths were identified either by some indication of abortion on the death certificate, by reports from a health-care provider or public health agency, or from a media report. Investigation of these cases indicated that six of the nine deaths were related to legal abortion and none to illegal abortion Table One of the six deaths related to a legal induced abortion occurred after a medical nonsurgical abortion; this case has been described previously Of the three deaths that were determined not to be related to a legal induced abortion, two were determined to be causally unrelated to the pregnancy or the abortion, and one was associated with a pregnancy outcome other than induced abortion.
While the topic of abortion has long been the subject of fierce public and policy debate in the United States, an understanding of why women seek abortion has been largely missing from the discussion [ 1 ]. In an effort to maintain privacy, adhere to perceived social norms, and shield themselves from stigma, the majority of American women who have had abortions— approximately 1.
Of these, four studies two primarily quantitative, one primarily qualitative and one that used mixed methods were conducted in the US [ 7 — 10 ]. These categories were not mutually exclusive; women in nearly all of the studies reported multiple reasons for their abortion. The largest of the US studies included in the review, by Finer and colleagues [ 9 ], utilized data from a structured survey conducted in with 1, abortion patients across the US, as well as open-ended, in-depth interviews conducted with 38 patients from four facilities, nearly half of whom were in their second trimester of pregnancy.
Quantitative data from this study were compared to survey data collected from nationally representative samples in [ 11 , 12 ] and [ 13 ]. The most commonly reported reasons for abortion in selected from a researcher-generated list of possible reasons with write-in options for other reasons were largely similar to those found in the study [ 11 ]. Greater weeks of gestation were found to be related with citing concerns about fetal health as reasons for abortion. The authors did not examine associations between weeks of gestation with some of the other more frequently mentioned reasons for abortion.
According to national estimates for and , changes in the abortion rate varied by region, with the South and West seeing small declines, and the Northwest and Midwest seeing no change over that period [ 2 ]. Written and oral consent was obtained from all participants. Data for this study were drawn from baseline quantitative and qualitative data from the Turnaway Study, an ongoing, five-year, longitudinal study evaluating the health and socioeconomic consequences of receiving or being denied an abortion in the US.
While the study has followed women for two full years, this analysis relies on the baseline data which were collected from through the end of The study design, recruitment and research methods and some findings from this study have been published elsewhere [ 15 , 17 — 19 ].
This study overcomes several limitations of previous studies on this topic. Most importantly, we interviewed a large sample of both adult and adolescent women, including many women who sought abortions at later gestations of pregnancy.
We asked women about their reasons for abortion using an open-ended question, rather than relying on a checklist of researcher-generated reasons.
This paper draws on baseline data from interviews conducted one week after receiving or being denied an abortion at the recruitment facility. Women seeking abortion care at 30 US facilities abortion clinics, other clinics and hospitals between January and December were recruited to participate in the study. Facilities were identified using the National Abortion Federation membership directory, as well as through professional contacts in the abortion research community.
While the gestational limits of the recruitment facilities varied from 10 weeks to the end of the second trimester , they each had the latest gestational limit for providing abortion of any facility within miles. These sites were selected because we thought that women denied an abortion would be unlikely to get one elsewhere. The facilities performed an average of 2, abortions annually range —8, and were located in 21 states throughout the US representing every US region [ 17 ].
Abortion patients were eligible to participate in the study if they were English- or Spanish-speaking, aged 15 years or older, had no fetal diagnoses or demise, and were within the gestational age range of one of three study groups. At each facility, a designated point person was trained by Turnaway study researchers to oversee and conduct site recruitment activities. Facility staff then connected interested prospective participants to Turnaway study researchers by telephone.
Facility staff dialed and introduced participant by first name then passed the phone to the woman to speak with the interviewer. During the recruitment call, research staff explained the study in greater detail, screened for eligibility and obtained informed consent. Parental consent was obtained from women under the age of 18 living in states where parental notification or consent for an abortion is required.
In states without parental involvement laws, women under the age of 18 were screened for their ability to understand the risks and benefits of the study and, those who were determined to be able provided informed consent on their own behalf. For all patients who completed the recruitment call and consented to enroll, Turnaway study researchers scheduled their first telephone interview to take place eight days later.
These baseline interviews lasted approximately 40 minutes. The study is ongoing, with follow-up phone interviews being conducted every six months for five years. The interviewer training covered general interviewing guidelines, handling sensitive issues, confidentiality, data collection protocols, question-by-question reviews of both English and Spanish versions of the interview guide, role playing, and record-keeping.
During the data collection period, research staff worked closely with the interviewers to ensure data quality. Quality assurance strategies included making sure that interviewers understood the meaning of every question, how to ask the question and how to record answers, observation of live interviews, monitoring the data for missing values, and periodic inter-rater reliability tests.
All data from the interviews were entered manually. Qualitative responses in Spanish were translated to English by bilingual research staff. Overall, For the purposes of this analysis, all three groups are combined and analyzed by gestational age. The structured interview guide included questions on participant socio-demographic characteristics, experiences becoming pregnant, pregnancy planning, and the abortion decision-making process. The interview guide and study protocols were all first pilot tested among 64 women receiving or being denied an abortion at a local abortion facility.
We also considered parity, and gestational age at recruitment 13 weeks or less, 14 to 19 weeks, and 20 weeks or more. Pregnancy intentions were measured with the London Measure of Unplanned Pregnancy. It is a continuous scale ranging from 1—12, with 0—3 indicating unplanned pregnancies, 4—9 ambivalent pregnancies and 10—12 planned pregnancies. Self-rated health is a dichotomous variable of rating health prior to pregnancy as good or very good versus fair, poor or very poor.
History of depression or anxiety diagnosis is a dichotomous variable indicating whether the participant has ever been told by a health professional if she suffers from a major depressive or anxiety disorder. All participants were asked two open-ended questions about their reasons for seeking an abortion. Therefore, the answers to both questions were combined to identify all reasons given by respondents for seeking abortion.
The analytic team was comprised of two of the study authors. A non-hierarchical list of themes was generated and agreed upon by both researchers after reviewing an initial responses. The next set of responses was coded using the agreed upon themes and were revised iteratively, as appropriate.
The list of themes was finalized after review of all responses. Once the final set of themes was generated, both researchers recoded all the responses until reaching consensus on all items. Occasionally the underlying reasons that motivated a particular response were not evident. Respondents could also be coded under multiple subthemes within an overarching theme e.
Once all of the codes were finalized, the reasons for abortion were analyzed quantitatively using Stata Version Multivariable mixed effects logistic regression was used to assess the characteristics associated with having higher odds of reporting each of the major themes as a reason for seeking abortion.
Continuous predictors included age, pregnancy intentions and parity. Additional categorical predictors included a four-part race variable, a three-part marital status variable, and a three-part gestational age variable.
Our quantitative analysis approach accounted for clustering by recruitment site. Two women did not answer either question on reason for seeking an abortion, leaving a final sample of A description of study participants is presented in Table 1.
Women gave a wide range of responses to explain why they had chosen abortion. The reasons were comprised of 35 themes which were categorized under a final set of 11 overarching themes Table 2. Many women reported multiple reasons for seeking an abortion crossing over several themes.
I already have one baby, money wise, my relationship with the father of my first baby, relationship with my mom, school. Six percent of women mentioned this as their only reason for seeking abortion.
I didn't have money to buy a baby spoon. If we had another child it would be undue burden on our financial situation. Four respondents 0. Due date was at the same time as my externship at school. Entering the workforce with a newborn would be difficult - I just wasn't ready yet. So busy with school and work I felt it [having an abortion] would be the right thing to do until I really have time to have one [a child].
It's like starting over and my nerves are bad. My son…he's going to be 2b0 next month and I don't want to start over. It's just bad timing. Six percent mentioned partners as their only reason for seeking abortion. For a more extensive analysis of partner-related reasons for seeking an abortion see Chibber et al.
Six percent of women mentioned only this theme. His treatment requires driving 10 hours and now we found out we need to go to New York for some of his treatment. In this report, medical and surgical abortions are further categorized by gestational age. Four measures of abortion are presented in this report: 1 the number of abortions in a given population, 2 the percentage of abortions obtained by women in a given population, 3 the abortion rate number of abortions per 1, women aged 15—44 years or other specific group within a given population , and 4 the abortion ratio number of abortions per 1, live births within a given population.
Although total numbers and percentages are useful for determining how many women have obtained an abortion, abortion rates adjust for differences in population size and reflect how likely abortion is among women in particular groups.
Abortion ratios measure the relative number of pregnancies in a population that end in abortion compared with live birth.
Census Bureau estimates of the resident female population of the United States were used as the denominator for calculating abortion rates 34 — Overall abortion rates were calculated from the population of women aged 15—44 years living in the reporting areas that provided data.
For the calculation of abortion ratios, live birth data were obtained from CDC natality files and included births to women of all ages living in the reporting areas that provided abortion data This report provides state-specific and overall abortion numbers, rates, and ratios for the 48 areas that reported to CDC for excludes California, DC, Maryland, and New Hampshire.
In addition, this report describes the characteristics of women who obtained abortions in Because the completeness of reporting on the characteristics of women varies by year and by variable, this report only describes the characteristics of women obtaining abortions in areas that met reporting standards i.
Cells with a value in the range of 1—4 or cells that would allow for calculation of these values have been suppressed to maintain confidentiality. Although most of the data are presented by the reporting area in which the abortions were performed, 47 reporting areas in also provided the number of abortions by maternal residence. Three reporting areas Iowa, Massachusetts, and New Mexico provided only the total number of abortions for out-of-state residents without specifying individual states or areas of residence from which these women came.
As a result, abortion statistics in this report by area of residence should be interpreted with caution and might underestimate the incidence of abortion, especially for reporting areas from which a substantial proportion of women travel to or from other states to obtain abortion services. To evaluate overall trends in the number, rate, and ratio of reported abortions, annual data are presented for the 48 areas that reported every year during — Linear regression analysis was used to assess the overall rate of change among these areas during the entire year period of analysis — and during the first and second halves of the period of analysis — and — The percentage change in abortion measures from the most recent past year to and from the beginning to the end of the year period of analysis to also were calculated for these same 48 areas.
Consistent with previous reports, key findings are highlighted to provide observed changes over time and differences between groups. However, comparisons do not infer statistical significance, and lack of comment regarding the difference between values does not imply that no statistically significant difference exists. For the analysis of certain additional variables i. For other variables i. To evaluate trends in the use of different methods for performing an abortion, reporting areas were included only if they met reporting standards and if they specifically included medical abortion as a method on their reporting form.
Medical abortions performed at 9 completed weeks are also reported for to Both of these events preceded the U. Some of the 48 areas that reported for are not included in certain trend analyses when data did not meet reporting standards. As a result, summary measures for comparisons over time might differ from the point estimates presented for all areas that reported for CDC has reported data on abortion-related deaths periodically since information on abortion mortality first was included in the abortion surveillance report 17 , An abortion-related death is defined as a death resulting from a direct complication of an abortion legal or illegal , an indirect complication caused by a chain of events initiated by an abortion, or an aggravation of a preexisting condition by the physiologic or psychologic effects of abortion An abortion is categorized as legal when it is performed by a licensed clinician within the limits of state law.
Sources of data for abortion-related deaths have included state vital records; media reports, including computerized searches of full-text newspaper and other print media databases; and individual case reports by public health agencies, including maternal mortality review committees, health care providers and provider organizations, private citizens, and citizen groups.
For each death that possibly is related to abortion, CDC requests clinical records and autopsy reports. Two medical epidemiologists independently review these reports to determine the cause of death and whether the death was abortion related. Discrepancies are discussed and resolved by consensus. Each death is categorized by abortion type as legal induced, illegal induced, spontaneous, or unknown type.
This report provides PMSS data on induced abortion-related deaths that occurred in , the most recent year for which PMSS data were reviewed for abortion-related deaths. Data on induced abortion-related deaths that occurred during — already have been published 7 , Thus, denominator data for calculation of national legal induced abortion case-fatality rates were obtained from a published report by the Guttmacher Institute that includes estimated total numbers of abortions in the United States from a national survey of abortion-providing facilities Among the 48 reporting areas that provided data for , a total of , abortions were reported.
All 48 of these areas provided data every year during — Among these same 48 areas, the annual rate of decrease fitted from the regression analysis was greater during — than during — for abortion number and rate, whereas the annual rate of decrease was greater during — than during — for abortion ratio. During —, the number of reported abortions decreased by 25, abortions per year, the abortion rate decreased by 0.
During —, the number of reported abortions decreased by 17, abortions per year, the abortion rate decreased by 0. Abortion numbers, rates, and ratios for have been calculated by reporting area of occurrence and the residence of the women who obtained the abortions Table 2.
By reporting area of occurrence, a considerable range existed in the abortion rate from 3. Because of variation that occurred among reporting areas in the percentage of abortions obtained by out-of-state residents from 0.
However, because states vary in the level of detail they collect on maternal residence, Among the 46 areas that reported by maternal age for , women in their 20s accounted for the majority Among the 44 reporting areas that provided data by maternal age every year during —, this pattern across age groups was stable, with the majority of abortions and the highest abortion rates occurring among women aged 20—29 years and the lowest percentages of abortions and abortion rates occurring among women in the youngest and oldest age groups Table 4.
Decreases in the abortion rate for all age groups, except women aged 25—29 years and 30—34 years, were greater from to than from to , and the rates for all age groups either did not change or decreased from to In contrast to the percentage of abortions and abortion rates, abortion ratios in were lowest among women aged 25—39 years Figure 2 Table 3.
Among the 44 reporting areas that provided data by maternal age for every year during —, abortion ratios decreased among women in all age groups.
Among the 43 areas that reported maternal age by individual year among adolescents for , adolescents aged 18—19 years accounted for the majority Decreases occurred among all adolescents from to During —, abortion ratios decreased among adolescents of all ages Table 6.
Among the 43 areas that reported by method type for and included medical abortion on their reporting form, Increases in early medical abortion occurred both from to from Among these same reporting areas that reported medical abortions by individual week of gestational age, Non-Hispanic white women had the lowest abortion rate 6. Data for also are reported separately by race and by ethnicity Tables 13 and Among the 42 areas that reported by marital status for , The abortion ratio was 41 abortions per 1, live births for married women and abortions per 1, live births for unmarried women.
Data from the 42 areas that reported the number of previous live births for women who obtained abortions in indicate that Data from the 41 areas that reported the number of previous abortions for women who obtained abortions in indicate that the majority For abortions among married women, the percentage was higher for non-Hispanic women in the other race group For abortions among unmarried women, the percentage was higher for non-Hispanic black women However, by maternal age, Conversely, Among abortions categorized by weeks of gestation and method type, surgical abortion accounted for the largest percentage of abortions within every gestational age category Table Using national PMSS data 52 , CDC identified three abortion-related deaths for , the most recent year for which data were reviewed for abortion-related deaths Table Investigation of these cases indicated that two deaths were related to legal abortion, no deaths were related to illegal abortion, and for one death, whether the abortion was induced or spontaneous was unknown.
The annual number of deaths related to legal induced abortion has fluctuated from year to year over the past 40 years Table Because of this variability and the relatively limited number of legal induced abortion-related deaths every year, national legal abortion case-fatality rates were calculated for consecutive 5-year periods during — and for a consecutive 8-year period.
The national legal induced abortion case-fatality rate for — was 0. This case-fatality rate was similar to the rate for most of the preceding 5-year periods but lower than the case-fatality rate of 2. For , a total of , abortions were reported to CDC by 48 areas. Among these areas, the abortion rate was All 48 of these reporting areas submitted data every year during the period of analysis from to , thus providing the information necessary for evaluating trends.
These findings underscore important maternal age differences in abortion trends. Because of the high rate and proportion of abortions that occurred among women in their 20s, women in this age group have contributed substantially to overall changes.
The adolescent abortion trends described in this report are important for monitoring progress that has been made toward reducing adolescent pregnancies in the United States. These findings indicate that decreases in adolescent pregnancies in the United States have been accompanied by large decreases both in adolescent births and abortions and that the pattern of decline is continuing 56 — In this report, abortion rates and ratios remained 1.
The comparatively high abortion rates and ratios among non-Hispanic black women have been attributed to higher unintended pregnancy rates and a greater percentage of unintended pregnancies ending in abortion Because procedures performed at earlier gestational ages have a lower risk for complications, a better understanding of factors that influence the gestational age at which abortions are performed is needed 59 — The trend of obtaining abortions earlier in pregnancy has been facilitated by changes in abortion practices.
However, subsequent advances in technology e. From to , the proportion of all abortions reported as early medical abortion increased from In early , FDA updated its approval for use of mifepristone for early medical abortions, extending the gestational age limit to 70 days Because the annual number of deaths related to legal induced abortion is small and statistically unstable, case-fatality rates were calculated for consecutive 5-year periods during — and for a consecutive 8-year period during — The national legal induced abortion case-fatality rate for — was fewer than 1 per , abortions, as it was for all of the preceding 5-year periods since the late s.
The findings in this report are subject to at least four limitations. First, because reporting to CDC is voluntary and reporting requirements are established by the individual reporting areas 27 , CDC is unable to obtain the total number of abortions performed in the United States.
In addition, whereas most reporting areas that send abortion data to CDC have laws requiring medical providers to submit a report for every abortion they perform to a central health agency, as of , reporting to a central health agency was not required in DC or New Jersey, which affects the representativeness of annual reported estimates for these jurisdictions Moreover, even in states that legally require medical providers to submit a report for all the abortions they perform, enforcement of this requirement varies, which might affect completeness from other reporting areas as well.
Second, because reporting requirements are established by the individual reporting areas, many states use reporting forms that differ from the technical standards and guidance that CDC developed in collaboration with the National Association for Public Health Statistics and Information Systems.
Consequently, many reporting areas do not collect all the information CDC compiles on the characteristics of women obtaining abortions e. Although missing demographic information can reduce the extent to which the statistics in this report represent all women in the United States, the most recent nationally representative survey of women obtaining abortions in 24 produced percentage distributions for most characteristics that are nearly identical to the percentage distributions reported by CDC.
The percentage of abortions accounted for by non-Hispanic black women is higher and by Hispanic women is lower in this report than the percentages reported from a recent nationally representative survey of women obtaining abortions In addition, certain areas collect gestational age on the basis of estimated date of conception or collect probable postfertilization age or probable gestational age.
Without medical guidance on how to report these data, the validity and reliability of gestational age for these reporting areas is uncertain. Third, abortion data are compiled and reported to CDC by the central health agency of the reporting area in which the abortion was performed rather than the reporting area in which the woman lived. Thus, the available population 34 — 43 and birth data 44 , which are organized by the states in which women live, differ in certain cases from the population of women who undergo abortions in a given reporting area.
This likely results in an overestimation of abortions for reporting areas in which a high percentage of abortions are obtained by out-of-state residents and an underestimation of abortions for states where residents frequently obtain abortions out of state. Limited abortion services, stringent regulatory requirements for obtaining an abortion, or geographic proximity to services in another state might influence where women obtain abortion services To examine these reporting biases, CDC attempts to categorize abortions by residence in addition to geographic occurrence.
However, in , CDC was unable to identify the reporting area, territory, or country of residence for Finally, the availability of demographic information is limited to what is collected on reporting forms. Therefore, performing stratified analyses by additional demographic variables e. Ongoing surveillance of legal induced abortion is important for several reasons. First, abortion surveillance can be used to help evaluate the success of programs aimed at preventing unintended pregnancies.
Although pregnancy intentions can be difficult to assess 80 — 85 , abortion surveillance provides an important measure of pregnancies that are unwanted Second, routine abortion surveillance is needed to assess trends in clinical practice patterns over time. Information in this report on the number of abortions performed through different methods e.
Finally, information on the number of pregnancies ending in abortion is needed in conjunction with data on births and fetal losses to estimate the number of pregnancies in the United States and determine rates for various outcomes of public health importance e. However, despite the multiple influences on abortion, because unintended pregnancy precedes nearly all cases of abortions 86 , efforts to help women avoid pregnancies that they do not desire may reduce the number of abortions 89 , Changing patterns of contraception use might have contributed to this decrease in unintended pregnancy.
The use of the most effective forms of reversible contraception i. Although the timing of these events is unknown, the majority of reported abortions in were among women with a previous birth, and a substantial proportion occurred among women with a previous induced abortion, events that also are opportunities for contraception counseling.
Contraception provision in the immediate postpartum and postabortion settings might increase access to these methods at a time when women are receiving health services. In addition, providing contraception for women at no cost can increase use of these methods and reduce abortion rates 89 — 91 , — Level of provider reimbursement and training, inadequate client-centered counseling, lack of youth-friendly services, and low client awareness of available contraceptive methods also are barriers to accessing contraception — Removing these barriers might help improve contraceptive use, potentially reducing the number of unintended pregnancies and the number of abortions performed in the United States.
E-mail: cdcinfo cdc. All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest.
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