Overview of Abortion in the United States

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An Overview of Abortion in the United States
Developed by Physicians for Reproductive Choice and Health (PRCH) and the Guttmacher Institute © January 2008
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 provision of and access to abortion services. ‡ Provide a comparative international perspective on abortion.
Incidence of Unintended Pregnancy and Abortion
Pregnancies in the United States (Approximately 6.4 Million Annually)
% of pregnancies
1 % % 6 % 4 % % %
Intended Unintended Source: Finer et al., ( data) 6
51%
49%
Outcomes of Unintended Pregnancies
(Approximately 3. Million Annually)
of unintended pregnancies (excluding miscarriages)
A ortions
Birt s
Source: Finer, ( data)
Incidence of Abortion
‡ In 2005, 1.21 million pregnancies were terminated by abortion in the United States.
‡ Almost 2% of all women aged 15±44 had an abortion in 2005.
‡ Abortion is one of the most common surgical procedures in the United States.
Source: Jones et al., 2008
Abortion Rates Among Women Aged ±44
Abortions per , women
7
77
7
Source: Jones
Incidence of early medication abortion, 200
‡ Early medication abortion accounted for 13% (161,100) of all abortions, an increase from 6% in 2001. ‡ An estimated 22% of eligible abortions (those performed up to 9 weeks) were early medication abortions. ‡ 57% of all known providers offer this service, compared to 33% in early 2001.
Source: Jones et al., 2008
Disparities in Unintended Pregnancy
‡ Overall unintended pregnancy rates have stagnated, yet«
‡ Unintended pregnancy has increased by 29% among poor women while decreasing 20% among higher-income women.
Source: Finer et al., 2006 (2002 data)
oor Women Account for a Disproportionate Share of Unintended regnancies
The 6 of women at risk of unintended pregnancy who are poor « « account for of unintended pregnancies
oor , 6
oor ,
Source: oonstra et al., 2
6
Black Women Account for a Disproportionate Share of Unintended Pregnancies
The 4 of women at risk of unintended pregnancy who are black « Black 4 « account for 26 of unintended pregnancies
Black 26
Source: Boonstra et al. 2006
Hispanic Women Account for a Disproportionate Share of Unintended Pregnancies
The of women at risk of unintended pregnancy who are Hispanic «
Hispanic
« account for 22 of unintended pregnancies
Hispanic 22
Source: Boonstra et al. 2006
Reasons for Abortions
Most Important Reason Given for Terminating an Unwanted Pregnancy
Concern for/responsibility to other individuals Cannot afford a baby now A baby would interfere with school/ employment/ability to care for dependents Would be a single parent/ having relationship problems Has completed childbearing 4 3
6
48 38
Source: Finer et al., 200 (2004 data)
Gestational Age
Abortions by Gestational Age
(Weeks Since Last Menstrual Period)
of abortions
00 80 63 60 40 20 0 < ± 0 ± 2
Weeks
3
3±
6±20
2 +
Source: Henshaw adjustments to Strauss et al., 200 (2004 data)
Reasons for Abortions After 6 Weeks Since Last Menstrual Period
Woman did not realize she was pregnant Difficulty making arrangements for abortion Afraid to tell parents or partner Needed time to make decision Hoped relationship would change Pressure not to have abortion Something changed during pregnancy Didn¶t know timing was important Didn¶t know she could get an abortion Fetal abnormality diagnosed late Other
Source: Torres and Forrest,
48 33 24 8 8 6 6 2
88 (
8 data)
Safety of Abortion
An Abortion Is Safer the Earlier in Pregnancy It Is Performed
Deaths per , abortions
All abs Abortions by gestation Sources: All births and abortions: Grimes DA, Abortion by gestation: artlett et al , ( ;
irths
data)
Causes of Abortion-Related Deaths
of abortion deaths (on avera e, per year)
nfe tion
e orrha e
bolis
Anesthesia
( ±
ther
data)
Sour e: Bartlett et al.,
Long-Term Safety of Abortion
‡ First trimester abortions pose virtually no risk of:
± Infertility ± Ectopic pregnancy ± Miscarriage ± Birth defect ± Preterm or low-birth-weight delivery
‡ There is no association between abortion and breast cancer. ‡ Abortion does not pose a hazard to women¶s mental health. Source: Boonstra, 2006
Who Has Abortions
Who Has Abortions: Age
ears ears ears ears
ears
ears ears
Source: Henshaw adjustments to Strauss et al. ( data)
Rate of Abortion by Age-Group
Age-group
± 20±24 2 ±2 30±34 3 ±3 40 0 0 20 30 40 0
Abortions per ,000 women
Source: Henshaw adjustments to Strauss et al., 200 (2004 data)
Who Has Abortions: Marital Status
Marri
n arri
Sourc : H nshaw a just Strauss t al. 200 (200
nts to ata)
Who Has Abortions: Economic Status
•300% of poverty, 25% <100% of poverty, 27%
200±299% of poverty, 18%
100±199% of poverty, 31%
Source: Jones et al., 2002
Rate of Abortion by Economic Status
of poverty level
•
Abortions per , Source: Jones et al.,
Who Has Abortions: Race/Ethnicity
ati e A erican* Asian/ aci ic s an er*
His anic
White* ac *
* on-His anic
Source: Jones et a .
Rate of Abortion by Race/Ethnicity
Race/ethnicity
White
1
ac
5
i
anic 1
Abortion er 1, women
Source: en haw adju tment to Strau et a ., ( data)
5
Who Has Abortions: Religious Identification
one
rotestant
ther
atholic
Source: Jones et al.
00
Who Has Abortions: Prior Pregnancies
Pre io s abortion one
Pre io s abortion an re io s birth Pre io s birth
So rce: Jones et al.
00
Who Provides Abortion Services
Percent of Abortions Performed by Each Type of Provider
of abortions
Abortion c inic ther c inic ospita Physicians' office
Source: Jones et a .,
Number of Providers by Type
No. of providers (defi ed s si es)
Abor io i i er i i ospi P ysi i offi e s
Sour e: Jo es e
.,
Facilities providing only medication abortion had a significant impact
‡ A minimum of 119 providers, or 7% offered only early medication abortion; most were nonspecialized clinics or physicians¶ offices with small caseloads. ‡ The number of abortion providers would have decreased by 8% instead of 2% if not for these facilities.
Source: Jones et al., 2008
Factors Contributing to the Decline in the Number of Abortion Providers
‡ ‡ ‡ ‡ ‡ ‡
Anti abortion harassment and violence Social stigma/marginalization Professional isolation/peer pressure The ³graying of providers´ Inadequate economic/other incentives Lack of medical training opportunities
Source: NAF and ACOG,
Percentage of Providers of 400 or More Abortions Per Year Who Reported Harassment in 2000
Picketing Picketing with physical contact with patients Vandalism Picketing homes of staff members Bomb threats 80
28 8 4
Source: Henshaw and Finer, 2003
Factors That Make It Difficult For Women to Obtain Abortion Services
Percentages of Counties with No Provider And Women Living in Those Counties
nserved counties
Women in unserved counties
Source: Jones et al.,
Medicaid Coverage of Abortion
States that cover all or most medically necessary abortions under Medicaid (May 2006): Alaska Arizona * California Connecticut Hawaii Illinois * Maryland Massachusetts Minnesota Montana New Jersey New Mexico New York Oregon Vermont Washington West Virginia
States that provide minimal Medicaid coverage of abortion beyond federal requirements (May 2006): Physical health Indiana Utah Wisconsin Fetal abnormality Iowa Mississippi Utah Virginia
Source: Guttmacher, 2006
State Restrictions on Abortion
Parental consent or notification required for minors Mandatory counseling Waiting periods Limitations on private insurance coverage for abortion
3 states 32 states 24 states
4 states
Source: Guttmacher, 200
International Perspective on Abortion
U.S. Share of Abortions Worldwide
% United States
Other Countries
%
Source: Sedgh, 200
Abortion Rate, United States and World
Abortions per , women
United States
World
Source: Sedgh, ) (data for
U.S. Abortion Rate Higher Than in Many Other Industrialized Countries
Abortions per 1,000 women
30 25 20 15 10 5 0
United States Australia Sweden Denmark Canada England & Wales Germany Netherlands
21
20
20 15 15 17
8
9
Source: Sedgh, 2007
20 million unsafe abortions occur each year
nnual abortions er 000 omen
orl e elo e countries e elo in countries 0 afe abortions 0 nsafe bortions
e h 200
20
2
0
The legal status of abortion does not predict its incidence
‡ The lowest abortion rates in the world²less than 10 per 1,000 women of reproductive age²are in Europe, where abortion is legal and available. ‡ By contrast, in Africa and Latin America and the Caribbean, where abortion law is most restrictive, the regional rates are 29 and 31 per 1,000 women, respectively.
Sedgh et al., 200
Changes in abortion law between and 200
‡ 17 countries liberalized their laws to increase access to safe abortion: Albania, Benin, Bhutan, Burkina Faso, Cambodia, Chad, Colombia, Ethiopia, Guinea, Mali, Nepal, Portugal, Saint Lucia, South Africa, Swaziland, Switzerland and Togo. ‡ Three countries tightened restrictions on abortion: El Salvador, Nicaragua and Poland.
Center for Reproductive Rights, 200
High Rates of Abortion Occur in Countries that Severely Restrict Abortion
igeria e ico ra il o Re Chile eru
Abortions er ,
wo en
± Source: oonstra,
Complications of unsafe abortion
‡ An estimated five million women are hospitalized each year for treatment of abortion-related complications, such as hemorrhage and sepsis. ‡ Complications from unsafe abortion procedures account for 13% of maternal deaths, or 67,000 per year. ‡ Approximately 220,000 children worldwide lose their mothers every year because of abortionrelated deaths.
Singh, 2006; WHO 200 ; Grimes 2006
Almost all abortion-related deaths occur in developing countries
eaths per , unsa e abortions,
e v e lo p e d c o u n trie s
e v e lo p in g c o u n trie s
A ric a
As ia
a tin Am e ric a & a rib b e a n
WHO,
Summary Points
Incidence of Pregnancy and Abortion in the United States
‡ Unintended pregnancy and abortion are common among all groups of women. ‡ Certain groups of women are at greater risk of unintended pregnancy. ‡ Almost half of all pregnancies are unintended. ‡ Almost half of unintended pregnancies end in abortion.
Who Has Abortions, Why and When in Pregnancy
‡ Disadvantaged women bear a disproportionate burden of unintended pregnancies and abortions. ‡ The most frequent reasons given are that a(nother) child would limit the woman¶s ability to meet current responsibilities and that they cannot afford a child at this point in their lives. ‡ Almost 90% of abortions occur in the first trimester.
Safety of Abortion
‡ Abortion is one of the safest common surgical procedures for women in the United States. ‡ Abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses. ‡ Laws criminalizing abortion make abortions unsafe, but do not eliminate them.
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 dramatically increased the percentage of counties in the United States with no provider. ‡ Many women have to travel long distances to find a provider, which can pose significant problems for those with limited resources, or work or family responsibilities.
Obstacles to Obtaining Abortion Services
‡ Although most women obtain abortions early in pregnancy, some women face substantial obstacles to access. ‡ Nearly four in 10 women receive coverage under Medicaid, yet 32 states allow Medicaid funding for abortion only in cases of rape, incest or life endangerment. ‡ Lacking insurance coverage, a poor woman often requires time to find the money to pay for an abortion, if she is able to at all. ‡ Legal requirements, such as parental consent for minors or waiting periods, are likely to cause further delays, increasing the risk of complications.
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.
About PRCH
PRCH exists to ensure that all people have the knowledge, access to quality services and freedom to make their own reproductive health decisions. For more information about PRCH, please click here.
About Guttmacher
The Guttmacher Institute is a nonprofit organization that advances sexual and reproductive health worldwide through research, policy analysis and public education. For more information about Guttmacher, please click here. Read our report ³Abortion in Women¶s Lives´ here