1. An Overview of Abortion in the United States
A Note About PRCH:
Physicians for Reproductive Choice and Health® (PRCH) is a national, physician-led, not-for-profit organization, representing more than 2,800 physician members from every state in the country and more than 2,400 non-physician members.
PRCH’s mission is to enable physicians to become more active and visible in support of universal reproductive health.  PRCH believes that all people should have the knowledge, equal access to quality services and freedom of choice to make their own reproductive health care decisions.
For more information on PRCH or to become a member, visit or call x14.
A Note About AGI:
The Alan Guttmacher Institute (AGI) is a not-for-profit organization focused on reproductive health research, policy analysis and public education, with offices in New York and Washington, D.C. For more information on AGI, visit or call
A Note About the Data:
The data presented in this slide series are the most recent available as of January, Percentages might not add to 100 due to rounding.
Developed by
Physicians for Reproductive Choice and Health® (PRCH) and The Alan Guttmacher Institute (AGI)
© January 2003

2. 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.
Acknowledgments:
This presentation was updated by Lawrence B. Finer, PhD, Stanley K. Henshaw, PhD, and Rachel K. Jones, PhD, The Alan Guttmacher Institute (AGI), and Annie Keating, Physicians for Reproductive Choice and Health® (PRCH). AGI and PRCH gratefully thank the following individuals who reviewed earlier drafts of this presentation and provided valuable information and advice: Susan Tew, MPH, formerly of The Alan Guttmacher Institute, Vicki Breitbart, EdD, MSW, Planned Parenthood of New York City; Anne Davis, MD; Susan Eisendrath, MPH, American Medical Women’s Association, Reproductive Health Initiative; Harry S. Jonas, MD, PRCH Board; Maureen Paul, MD, MPH; Carol Petraitis, Clara Bell Duvall Project, ACLU-PA, American Civil Liberties Union of PA; Barbara Santee, PhD, Oklahoma affiliate of the National Abortion and Reproductive Rights Action League; Eric Schaff, MD; Albert Thomas, MD; and Carolyn Westhoff, MD.

3. 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.

4. Pregnancies in the United States (Approximately 6.3 Million Annually)
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 and at every act of intercourse.
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)

5. Outcomes of Unintended Pregnancies (Approximately 3
Outcomes of Unintended Pregnancies (Approximately 3.0 Million Annually)
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 of unintended pregnancies end in an unplanned birth.
Source: Henshaw, 1998
(1994 data)

6. 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

7. Annual Number of Abortions Per 1,000 Women Aged 15–44
Declining Abortion Rates:
The abortion rate is the number of abortions per 1,000 women of reproductive age in a given year. In 2000, 21 out of every 1,000 women aged 15–44 had an abortion.
The abortion rate has declined slightly but steadily over time, and more rapidly since 1990 than in the previous decade.
Among the reasons are use of long-acting hormonal contraceptives (injectables and implant) , a lower pregnancy rate among teenagers and growing 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, 2003

8. Abortion Rates in Western Industrialized Countries
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: Henshaw et al., (1996 data)

9. Reasons for Abortions

10. Most Important Reason Given for Terminating an Unwanted Pregnancy
Inadequate finances %
Not ready for responsibility 21%
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 3%
Woman has health problem %
Pregnancy caused by rape, incest %
Other %
Average number of reasons given
Source: Torres and Forrest, 1988
(1987 data)
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 not interrupt 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.

11. Gestational Age

12. Abortions by Gestational Age (Weeks Since Last Menstrual Period)
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 22% in 1999.
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).
Source: Elam-Evans et al., 2002
(1999 data)

13. 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 their delay to “difficulty making arrangements for the procedure” because 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)

14. Safety of Abortion

15. 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 approximately 0.6 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 11 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.)
Each year, about 10 women, on average, die from induced abortion, compared with about 260 who die from pregnancy and childbirth.
Abortion is so 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.
Source: Gold (1981–1985 data)

16. Abortion Risks in Perspective
Chance of death
Risk from terminating pregnancy per year:
Before 9 weeks in 500,000
Between 9 and 10 weeks in 300,000
Between 13 and 15 weeks in 60,000
After 20 weeks in 8,000
Risk to persons who participate in:
Motorcycling in 1,000
Automobile driving 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
Source: Gold, 1990; Trussell, 1998
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.

17. Who Has Abortions

18. 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 age 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

19. 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

20. Who Has Abortions: Economic Status
Abortions by Family Income:
The need for abortion spans the economic spectrum; however, low-income women are overrepresented among abortion patients. Fifty-seven percent 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

21. 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.
Source: Jones et al., 2002
*Non-Hispanic

22. 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

23. Who Has Abortions: Prior Pregnancies
Abortions by Number of Prior Abortions:
More than half (52%) of women having abortions have had no prior abortion, and 61% have had a prior birth.
Women who have had an abortion are at an elevated risk of having another because they are more likely to be sexually active, to be able to become pregnant, to have difficulty using contraceptives effectively, to be willing to end an unintended pregnancy by abortion and to belong to subgroups with high rates of unintended pregnancy.
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 so, the large majority of abortions would be repeat abortions.
Source: Jones et al., 2002

24. Who Provides Abortion Services

25. Percent of Abortions Performed by Each Type of Provider
Facilities Providing Abortions:
Abortion clinics—defined as facilities where half or more of patient visits are for abortion services—provide 71% of all abortions. Other clinics, including some group practices, provide most of the rest.
The proportion of abortions performed in hospitals has declined markedly, from 22% in 1980 to only 5% in 2000.
About 400 doctors offices perform fewer than 400 abortions per year in their offices; together they account for only a small proportion of all abortions. Many of these physicians perform less than one abortion per week. Nevertheless, these physicians are important to their established patients in that they make abortion services easily available.
Source: Finer and Henshaw, 2003

26. Factors Contributing to the Decline in the Number of Abortion Providers
Anti-choice harassment and violence
Social stigma/marginalization
Professional isolation/peer pressure
The “graying of providers”
Inadequate economic/other incentives
The perception of abortion as an unexciting field of medicine Source: NAF & ACOG, 1991
Factors Contributing to the Decline in Abortion Providers:
Anti-choice 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).

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

28. 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 nonmetropolitan 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 unserved 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

29. Medicaid Coverage of Abortion
States that cover abortion under Medicaid for reasons beyond rape, incest and life endangerment, as of December, 2002:
Alaska Minnesota
Arizona Montana
California New Jersey
Connecticut New Mexico
Hawaii New York
Illinois Oregon
Indiana Vermont
Maryland Washington
Massachusetts West Virginia
Source: AGI, 2002
Abortion Cost and Medicaid Coverage:
An abortion costs $300–500 during the first trimester, but much more if the woman is past 12 weeks from her last menstrual period (Henshaw and Finer, 2003).
A majority of women do not have insurance that covers abortion or do not want to use their insurance because of confidentiality concerns (Henshaw and Finer, 2003).
The federal Medicaid program pays for abortions only in cases of life endangerment, rape and incest. Although some states voluntarily pay for Medicaid abortions with their own funds, most do not.
The states listed above cover abortion under Medicaid, but in some cases only if the woman’s physical health is threatened. In 2000, 13% of all abortions were paid for with state Medicaid funds (Jones, 2002).
One-third to one-fifth of Medicaid-eligible women continue an unwanted pregnancy if Medicaid funding is not available (Cook, 1999).

30. 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 %
Source: Henshaw and Finer, 2003
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, kidnapping 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).

31. State Restrictions on Abortion
Parental consent or notification
required for minors 32 states
Mandatory delay and state-directed
counseling states
Limitations on private insurance
coverage for abortion 4 states
Source: AGI, 2002
State Restrictions:
State restrictions on abortion may prevent some women from gaining access to services, cause some abortions to be delayed and increase the difficulty of providing services.
Where parental involvement is required of minors, a minor may have the option of seeking a court order exempting her from the requirement if she demonstrates that she is mature enough to make an informed decision or that the abortion is in her best interest.
Four states (ID, KY, MO, ND) prohibit insurance coverage of abortion, and one (PA) requires health plans that cover abortion to also offer a policy that expressly excludes coverage of abortion.

32. International Perspective on Abortion

33. 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)

34. Abortion Rate, United States and World
Abortion Rates:
The U.S. abortion rate is lower than that of the world as a whole.
Source: Henshaw et al., 1999
(1995 data)

35. Abortion in Developed and Developing Countries
Whether a woman lives in a developed or a developing country, her average chance of having an abortion is much the same.
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

36. Many Abortions Occur in Countries Where Abortion Is Illegal Under Most Circumstances
Illegal Abortions Worldwide:
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)

37. Percentage of 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 78,000 of the almost 600,000 pregnancy-related deaths that occur each year result from unsafe abortions.
Source: WHO, 1998
(Estimates for 1995–2000)
Other causes

38. Summary Points

39. 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.

40. 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.

41. 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.

42. 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.

43. 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.