1. Abortion in the United States
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A Note About the Data:
The data presented in this slide series are the most recent available as of June, Percentages might not add to 100 due to rounding.

2. US Public Opinions about Abortion

5. Incidence of Pregnancy and Abortion
The pregnancy or abortion rate is defined as the number of pregnancies or abortions per 1,000 women aged 15–44 (or within a more limited, specified age-group) in a given year.

6. Pregnancies in the United States (Approximately 6.3 Million Annually)
% of Pregnancies
Unintended Pregnancy and Contraception:
A birth is classified as unintended if the mother says that, at the time of conception, she wanted to have the birth later or wanted to have no more children. For the purposes of these statistics, all pregnancies ending in abortion were assumed to have been unintended.
More than 90% of couples report that they use a contraceptive method during any given month, although not always correctly or consistently.
Nevertheless, almost half of all pregnancies are unintended.
53% of women who have unintended pregnancies were using a contraceptive method during the month they became pregnant, although usually not correctly every time.
Unintended pregnancy is most likely to occur among teenagers, unmarried women, black and Hispanic women, and women with low incomes.
Intended
Unintended
Source: Henshaw, 1998
(1994 data)

7. Outcomes of Unintended Pregnancies (Approximately 3
Outcomes of Unintended Pregnancies (Approximately 3.0 Million Annually)
% of Unintended Pregnancies
Unintended Pregnancy Statistics:
A woman who has an unintended pregnancy is almost as likely to carry it to term as to have an abortion.
Four in 10 unintended pregnancies end in birth.
Source: Henshaw, 1998
(1994 data)

8. Source: Finer and Henshaw, 2005
Incidence of Abortion
In 2002, 1.29 million pregnancies were terminated by abortion in the United States.
Some 2.1% of all women aged 15–44 had an abortion in 2001.
Abortion is one of the most common surgical procedures in the United States.
Source: Finer and Henshaw, 2005

9. Abortion Rates Among Women Aged 15–44
Abortions per 1,000 women
Declining Abortion Rates:
The abortion rate is the number of abortions per 1,000 women of reproductive age in a given year. In 2002, 21 out of every 1,000 women aged 15–44 had an abortion.
The abortion rate has declined over time, most rapidly from 1990–1996.
Among the reasons for the overall decline are increased use of long-acting hormonal contraceptives (the injectables and implants), decreased pregnancy rate among teenagers and increased use of emergency contraception.
The declining pregnancy rate among teenagers is the result primarily of better contraceptive use, especially use of injectables and implants, and secondarily of lower rates of sexual activity (Darroch and Singh, 1999).
Source: Finer and Henshaw, 2005

10. Abortion Rates in Western Industrialized Countries
Abortions per 1,000 women
Abortion Rates Internationally:
The abortion rate in the United States is higher than rates in most other Western industrialized countries but lower than rates in eastern Europe and many developing areas.
Abortion rates have been falling slowly in most developed countries over the last 5–10 years.
Source: Finer and Henshaw, 2005; Henshaw et al., (1996 data)

11. Reasons for Abortions

12. Most Important Reason Given for Terminating an Unwanted Pregnancy
Inadequate finances %
Not ready for responsibility %
Woman’s life would be changed too much 16%
Problems with relationship; unmarried 12%
Too young; not mature enough 11%
Children are grown; woman has all she wants 8%
Fetus has possible health problem %
Woman has health problem %
Pregnancy caused by rape, incest %
Other %
Average number of reasons given
Reasons for Terminating an Unwanted Pregnancy:
In a national survey of 1,900 women having abortions, the most common reasons given for terminating an unwanted pregnancy were lack of economic support for a child (or another child) and not being ready to become a parent.
93% of women gave more than one reason. The average number of reasons given was 3.7.
Women who said that “life would be changed too much” include those women who wanted to continue their education or avoid interrupting their career, or who had other family responsibilities, such as taking care of an elderly parent.
Each year, at least 10,000–15,000 abortions occur among women whose pregnancies resulted from rape or incest.
Source: Torres and Forrest, 1988 (1987 data)

13. Gestational Age

14. Abortions by Gestational Age (Weeks Since Last Menstrual Period)
% of Abortions
Weeks of Gestation at Time of Abortion:
Almost 90% of abortions are performed in the first trimester of pregnancy (in the first 12 weeks after the first day of the last menstrual period).
More than half of abortions are performed before 9 weeks after the last menstrual period, or within 5 weeks of the first missed period.
The proportion of abortions performed very early in pregnancy (at 6 weeks or before) increased from 14% in 1992 to 25% in 2001.
Fewer than 2% of abortions are performed after 20 weeks.
An estimated 0.08% of abortions are performed after 24 weeks, when the fetus may be viable (AGI, 1997).
Weeks
Source: Strauss et al., 2004 (2001 data)

15. Reasons for Abortions After 16 Weeks Since Last Menstrual Period
Woman did not realize she was pregnant 71%
Difficulty making arrangements for abortion 48%
Afraid to tell parents or partner 33%
Needed time to make decision 24%
Hoped relationship would change 8%
Pressure not to have abortion 8%
Something changed during pregnancy 6%
Didn’t know timing was important 6%
Didn’t know she could get an abortion 5%
Fetal abnormality diagnosed late 2%
Other %
Average number of reasons given 2.2
Barriers that Cause Delay:
Because abortion is stigmatized, women often delay the acknowledgment of their unintended pregnancies. Many women do not feel the physical changes, hope that they are not pregnant or fail to recognize the pregnancy because of irregular periods.
Nearly half (48%) of women who had late abortions attributed the delay to difficulty in making arrangements for the procedure, meaning that they needed time to raise money or get a Medicaid card, they had to arrange transportation, there was no local abortion provider, they were minors subject to state laws requiring parental involvement, or they had difficulty securing child care.
Many of the difficulties in providing and obtaining access to abortion services would disappear if abortion were integrated with other health care services for women.
Source: Torres and Forrest, (1987 data)

16. Methods of Abortion I. Suction Methods A. Endometrial Aspiration
1. Performed 4-6 weeks after LMP
2. Use of flexible tube
3. May be done without pregnancy
confirmation
4. Side effects may include cramps &
intermittent menstrual bleeding

17. Methods of Abortion I. Suction Methods (continued) B. Early Abortion
1. Same as A. only pregnancy confirmed
C. Vacuum Curretage
1. Performed after 8 weeks
2. Larger fetal tissue
3. Use of rigid tube with more suction
4. Dilation of cervix is required

18. I. Suction Methods (continued)
Methods of Abortion
I. Suction Methods (continued)
D. Dilation and Evacuation
1. Performed weeks
2. Fetus is broken up with surgical
instrument prior to suction
3. More dilation is needed

19. II. Surgical Removal Through Cervix
Methods of Abortion
II. Surgical Removal Through Cervix
A. Dilation and Curretage
1. Performed 8-15 weeks
2. Lining of uterus is scraped with
surgical instrument

20. Methods of Abortion III. Induced Labor A. Saline Abortion
1. Performed early to middle parts of
2nd trimester
2. Saline injected into Amniotic sac
(kills fetus)

21. IV. Surgical Removal Through Caesarean Procedure
Methods of Abortion
IV. Surgical Removal Through Caesarean Procedure
A. Hysterotomy

22. Safety of Abortion

23. Deaths per 100,000 Abortions or Births
Safety of Abortion:
Abortion is one of the safest surgical procedures for women. The risk of death associated with abortion is low—approximately 0.7 deaths per 100,000 abortions—and the risk of major complications is less than 1%.
The risk of death when a pregnancy is continued to birth is about 10 times as great as the risk of death from induced abortion. (Note: The calculation of mortality from childbirth omits deaths from miscarriage and ectopic pregnancy.)
On average, 10 women each year die from induced abortion, compared with about 275 who die from pregnancy and childbirth.
Abortion is safe in part because the large majority of procedures are performed early in pregnancy.
The mortality statistics reported here are based on abortion mortality surveillance conducted by the Centers for Disease Control and Prevention (CDC). These statistics count all deaths associated with abortion, not just those attributed to abortion, and include significantly more abortion-related deaths than are reported on death certificates.
Sources: Birth: Henshaw, 2004 (1995–1997 data); Abortion: Bartlett et al., 2004 (1988–1997 data)

24. Abortion Risks in Perspective
Chance of death
Risk from terminating pregnancy: per year:
Before 9 weeks in 1,000,000
Between 9 and 10 weeks 1 in 500,000
Between 13 and 15 weeks 1 in 60,000
After 20 weeks in 11,000
Risk to persons who participate in:
Motorcycling 1 in 1,000
Automobile driving 1 in 5,900
Power-boating in 5,900
Playing football in 25,000
Risk to women aged 15–44 from:
Having sexual intercourse (PID) 1 in 50,000
Using tampons in 350,000
Risk of Death from Abortion in Perspective:
The risk of dying from an abortion is low compared with many other risks that people are exposed to.
PID is pelvic inflammatory disease, an infection of the upper reproductive organs in women, which can result from sexually transmitted infection.
Source: Bartlett et al., 2004 (1988–1997 data)

25. Who Has Abortions

26. Who Has Abortions: Age Source: Jones et al., 2002 Abortions by Age:
The majority (56%) of women having abortions are in their 20s.
Fewer than 1% are younger than 15, while 19% are aged 15–19. The abortion rate of teenagers has declined markedly in recent years, in large part because of use of long-acting hormonal contraceptives, mainly the injectable.
Abortion numbers and rates decline with age because fecundity declines, use of contraceptive sterilization increases and more women are married (which makes it easier to use contraceptives effectively and to continue an unintended pregnancy if it occurs).
Source: Jones et al., 2002

27. Who Has Abortions: Marital Status
Abortions by Marital Status:
Most abortions (67.3%) are obtained by never-married women. Married women account for a lower proportion of abortions (17%), in part because they have low rates of unintended pregnancy; those who do experience an unintended pregnancy are more likely than unmarried women to continue the pregnancy.
About 25% of abortions occur among women living with a male partner to whom they are not married, although such women make up only about 10% of all women aged 15–44 (not shown). This is a group at very high risk of unintended pregnancy and abortion.
The proportion of unintended pregnancies terminated by abortion ranges from 65% among formerly married women and 60% among never-married women to 37% among currently married women (Henshaw, 1998).
Source: Jones et al., 2002

28. Who Has Abortions: Economic Status
In 2007 the Federal
Poverty Level was
$11,750 per fear for
one person
Abortions by Family Income:
The need for abortion spans the economic spectrum; however, low-income women are overrepresented among abortion patients. 57% of women having abortions in 2000 were poor or low-income (living at less than twice the poverty level, or less than $28,300 for a family of 3), compared with 30% of women in the general population. Nearly a quarter of abortion patients were above 300% of the federal poverty level.
Even though they are less likely than high-income women to end an unintended pregnancy by abortion, low-income women have many abortions because they have such a high rate of unintended pregnancy.
Source: Jones et al., 2002

29. Who Has Abortions: Race/Ethnicity
Abortions by Race/Ethnicity:
The largest group having abortions (41%) are non-Hispanic white women.
Black and Hispanic women together make up more than half (51.8%) of women having abortions. This proportion is greater than their proportion in the population because they have a higher rate of unintended pregnancy, and, among black women, because they are more likely to resolve an unintended pregnancy through abortion.
About 7% of women having abortions are Asian, Pacific Islander or Native American.
*Non-Hispanic
Source: Jones et al., 2002

30. Who Has Abortions: Religious Identification
Abortions by Religious Identification:
When U.S. women having abortions are asked their religion, 43% say they are Protestant. This is a lower proportion than the approximately 51% of women 18–44 in the U.S. population who identify themselves as Protestant, which means that their abortion rate is lower than that of all women.
The proportion of abortion patients who are Catholic is slightly lower than the Catholic proportion of the population. Thus, the abortion rate of Catholics (abortions per 1,000 female Catholics aged 18–44 in the population) is slightly lower than that of all women.
13% of abortion patients say they are “born-again or evangelical Christians” (not shown).
22% of abortion patients claim no religious identification, compared with only about 16% of the population. The high proportion of abortion patients without a religion could reflect a reluctance of women having an abortion to claim a religion; it could also result from greater willingness of nonreligious women to resolve an unwanted pregnancy by abortion, or a higher rate of unintended pregnancy among this group.
Source: Jones et al., 2002

31. Who Has Abortions: Prior Pregnancies
Abortions by Number of Prior Abortions:
Six in 10 women having abortions are mothers.
If a sexually active woman were to use abortion as her means of birth control and wanted two children, she would have about 30 abortions by the time she reached age 45.
Use of abortion as a primary method of birth control is not common. If it were, the large majority of abortions would be repeat abortions.
Source: Jones et al., 2002

32. Who Provides Abortion Services

33. Number of Providers by Type
Change in Number of Providers:
There has been a sharp decrease in the number of hospitals where abortions are performed and in the number of physicians’ offices performing a small number of abortions (fewer than 400 per year).
For physicians’ offices, the decline accelerated in the period 1992–1996, but was less steep between 1996–2000.
The number of abortion clinics has remained relatively constant.
Source: Finer and Henshaw, 2003

34. Antichoice harassment and violence Social stigma/marginalization
Factors Contributing to the Decline in the Number of Abortion Providers
Antichoice harassment and violence
Social stigma/marginalization
Professional isolation/peer pressure
The “graying of providers”
Inadequate economic/other incentives
Lack of medical training opportunities
Factors Contributing to the Decline in Abortion Providers:
Antichoice harassment and violence are significant factors. If abortion were integrated into mainstream medical care, these factors would decrease notably.
Fewer than half (46%) of residency training programs in obstetrics and gynecology routinely provide training in first-trimester abortion (Almeling et al., 2000).
Source: NAF & ACOG, 1991

35. Factors That Make It Difficult For Women to Obtain Abortion Services

36. Percentage of Counties with No Provider And % of Women Living in Those Counties
Distance from an Abortion Provider:
87% of U.S. counties had no abortion provider in In non-metropolitan areas, 97% of counties had no provider. As a result, many women must travel substantial distances to access the service.
About 1 in 4 women who have an abortion travel 50 miles or more for the procedure, a significant distance and a documented barrier to timely care (Henshaw and Finer, 2003).
The proportion of un-served counties has increased steadily since 1978.
The proportion of women in counties without a facility that provides even one abortion a year has also increased and reached 34% in 2000.
The proportion of women in unserved counties would be higher if not for the efforts of nonprofit organizations to establish and maintain clinics in areas without other providers.
Source: Finer and Henshaw, 2003

37. Percentage of Providers of 400 or More Abortions Per Year Who Have Reported Harassment in 2000
Picketing %
Picketing with physical contact with patients 28%
Vandalism %
Picketing homes of staff members 14%
Bomb threats %
Antichoice Violence and Harassment:
The majority of abortion clinics experience picketing, and many experience some other form of harassment or violence (as reported by an AGI survey of all abortion providers).
More than 2,400 acts of violence have been reported against abortion providers since 1977, including bombings, arson, death threats, murders, kidnappings and assaults (NARAL, 2001).
Small providers are much less likely than large ones to experience harassment. In 2000, 82% of nonhospital providers of 400 or more abortions reported experiencing picketing or other harassment, compared with only 24% of those who performed fewer abortions (Henshaw and Finer, 2003).
Many abortion patients experience emotional upset and postabortion depression if they encounter aggressive antiabortion protestors (Cozzarelli and Major, 1994).
Source: Henshaw and Finer, 2003

38. Legal Restrictions on Abortion

39. Federal Laws & Policies about Abortion
Hyde Amendment
Freedom of Access to Clinic Entrances Act
Federal Health Benefits Program

40. State Laws about Abortion
In 1992, the US Supreme Court upheld the right to abortion in Planned Parenthood v. Casey. However, the ruling significantly weakened the legal protections previously afforded women and physicians by giving states the right to enact restrictions that do not create an "undue burden" for women seeking abortion.

41. Stenberg v. Carhart, 530 U.S. 914 (2000)
US Supreme Court overturned a Nebraska statute banning "partial-birth abortion."
Court found that the ban would outlaw the safest and most commonly used methods of second-trimester abortion, and therefore constituted an undue burden on women’s right to obtain abortions.
"the absence of a health exception will place women at an unnecessary risk of tragic health consequences."

42. Federal Laws in the Works
Despite that ruling, Congress passed an almost identical ban on so-called “partial birth abortion” that was signed into law by President George W. Bush on November 5, 2003.
Also on November 5, 2003, minutes after Bush signed it into law, a Nebraska federal judge issued a temporary restraining order preventing the first-ever federal abortion ban from being enforced against the plaintiffs in the Nebraska lawsuit challenging the ban.
Three Federal Courts in New York, California, and Nebraska have struck down this law as unconstitutional. In January of 2006, 2 Federal Appeals Courts upheld these rulings.
On November 8, 2006 the U.S. Supreme Court heard arguments in two challenges to the Federal Abortion Ban, also known as the "Partial-Birth Abortion Ban Act of 2003." In both the Center for Reproductive Rightsﾕ case (Gonzales v. Carhart) and Planned Parenthoodﾕs case (Gonzales v. Planned Parenthood), appellate courts declared the ban unconstitutional citing previous law established over the last thirty years.

43. APRIL 2007
With Bush-appointed judges Alito and Roberts, Supreme Court upholds the Federal partial birth abortion ban in a 5-4 decision.

44. STATES ENACTED 52 LAWS RESTRICTING ABORTION IN 2005
Of the 195 state-level abortion restrictions adopted since 2000, one-quarter were enacted in 2005 alone.

45. State Laws Restricting Abortion
Twenty-nine states mandate that a woman seeking an abortion be given counseling including information intended to discourage her from obtaining the procedure;
24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between when she receives counseling and when the procedure is performed.

46. State Laws Restricting Abortion
Thirty-three states and the District of Columbia prohibit the use of public funds to pay for abortion for low-income women, even when it is medically necessary, generally making exceptions only in cases of life endangerment, rape or incest. Only 17 states use their own funds to pay for all or most medically necessary abortions for Medicaid enrollees.
Thirty-four states require some type of parental involvement in a minorﾕs decision to have an abortion: Twenty-one states require one or both parents to consent to the procedure, while 13 require that a parent be notified.

47. February 22, 2006:South Dakota lawmakers approved the nation's most far-reaching ban on abortion
The measure, which passed the state Senate 23 to 12, makes it a felony for doctors to perform any abortion, except to save the life of a pregnant woman. The proposal was signed by Gov. Mike Rounds (R) on March 6, In November of 2006, South Dakotans voted to reject the ban (55% to 45%).

48. International Perspective on Abortion

49. U.S. Share of Abortions Worldwide
Abortion Worldwide:
The United States accounts for approximately 5% of the world’s population and only 3% of abortions worldwide.
Source: Henshaw et al., 1999
(1995 data)

50. Abortion Rate, United States and World
Abortions per 1,000 Women
Abortion Rates:
The U.S. abortion rate is lower than that of the world as a whole.
Sources: Finer and Henshaw, 2005; Henshaw et al., 1999 (1995 data)

51. Abortion in Developed and Developing Countries
If women living in developed and developing regions are compared, their overall abortion levels are strikingly similar (39 per 1,000 and 34 per 1,000, respectively).
About half of abortions in developing countries are illegal.
Source: AGI, 1999

52. Many Abortions Occur in Countries Where Abortion Is Illegal Under Most Circumstances
Illegal Abortions Worldwide:
A negligible number of legal abortions occur in countries where abortion is highly restricted.
About 26 million women worldwide have legal abortions each year, and another 20 million have abortions in countries where abortion is restricted or prohibited by law.
Laws criminalizing abortion make abortions unsafe but do not eliminate them.
Source: Henshaw et al., 1999
(1995 data)

53. Maternal Mortality Worldwide Due to Unsafe Abortion
Unsafe Abortion and Maternal Mortality:
Abortion mortality rates are hundreds of times higher in developing countries, where abortion is often illegal or highly restricted, than in developed countries.
According to World Health Organization (WHO) estimates, unsafe abortions account for 13% of all maternal mortality worldwide. Most unsafe abortions occur where abortion is illegal.
WHO estimates that 68,000 of the more than 520,000 pregnancy-related deaths that occur each year result from unsafe abortions.
Other causes
Source: WHO, 2004
(2000 data)

54. Research from Psychology on the Possible Psychological Impact of Abortions upon Women who have them

55. Women who have abortions
Up to 98 percent of the women who have abortions have no regrets and would make the same choice again in similar circumstances (Dagg, 1991).
More than 70 percent of women who have abortions express a desire for children in the future (Torres & Forrest, 1988). There is no evidence that women who have had abortions make less loving or suitable parents (Bradley, 1984).

56. Normative Psychological Responses to Abortion
• Lazarus (1985)
292 women studied 2 weeks after
76% reported happiness
17% reported guilt

57. Post-abortion depression?
Mild, transient, immediately postoperative depressive symptoms that quickly pass occur in less than 20 percent of all women who have had abortions (Adler et al., 1990; Zabin et al.,1989).
Similar symptoms occur in up to 70 percent of women immediately following childbirth (Ziporyn, 1984).

58. Serious psychological disturbances?
Serious psychological disturbances after abortion are less frequent than after childbirth.
Researchers suggest that the predictors of severe psychological disturbances after abortion are:delays in seeking abortion, medical or genetic indications for abortion, and severe pre-existing or concurrent psychiatric illness (Lazarus, 1985).

59. Normative Psychological Responses to Abortion
• Russo & Zierk (1992) -measured self-esteem -
• women who had abortions > women who had not had abortions
• women who had abortions > women who unwanted births
The positive relationship of abortion to well-being may be due in part to abortion's role in controlling fertility and its relationship to coping resources (Russo & Zierk, 1992; Russo & Dabul, 1997).

60. Abortion and teen pregnancy
A study of a group of teenagers who obtained pregnancy tests at one of two Baltimore clinics found that the young women who chose to have abortions were far more likely to graduate from high school at the expected age than those of similar socioeconomic status who carried their pregnancies to term or who were not pregnant. They showed no greater levels of stress at the time of the pregnancy and abortion and no greater rate of psychological problems two years after the abortion than did the other women (Zabin et al., 1989).

61. Abortion vs. adoption?
The psychological responses to abortion are far less serious than those experienced by women bringing their unwanted pregnancy to term and relinquishing the child for adoption (Sachdev, 1993).

62. Summary Points

63. 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.

64. 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.

65. 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.

66. 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.

67. 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.
Scientific studies do not suggest a link between abortion and subsequent psychological problems in women.