1. An Overview of Abortion John B. Pryor Illinois State University

2. US Public Opinions about Abortion

5. Incidence of Pregnancy and Abortion

6. Pregnancies in the United States (Approximately 6.4 Million Annually) UnintendedIntended Source: Finer et al., 2006 (2002 data) % of pregnancies

7. Outcomes of Unintended Pregnancies (Approximately 3.1 Million Annually) Source: Finer, 2006 (2002 data) % of unintended pregnancies (excluding miscarriages)

8. Incidence of Abortion In 2008, some 1.21 million pregnancies were terminated by abortion in the United States. Almost 2% of all women aged 15–44 had an abortion in 2008. Abortion is one of the most common surgical procedures in the United States.

9. Abortion Rates Among Women Aged 15–44 Abortions per 1,000 women

10. Disparities in Unintended Pregnancy and Abortion Are Increasing The overall U.S. unintended pregnancy rate remained stagnant between 2001 and 2006. Unintended pregnancy has increased by 10% among poor women while decreasing 14% among higher-income women between 2001 and 2006.

11. Reasons for Abortions

12. Most Important Reason Given for Terminating an Unwanted Pregnancy Concern for/responsibility to other individuals74% Cannot afford a baby now73% A baby would interfere with school/ employment/ability to care for dependents69% Would be a single parent/ having relationship problems 48% Has completed childbearing38% Source: Finer et al., 2005 (2004 data)

13. Gestational Age

14. Abortions by Gestational Age (Weeks Since Last Menstrual Period) Weeks % of abortions

15. Reasons for Abortions After 16 Weeks Since Last Menstrual Period Woman did not realize she was pregnant71% Difficulty making arrangements for abortion48% Afraid to tell parents or partner33% Needed time to make decision24% 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% Other11% Source: Torres and Forrest, 1988 (1987 data)

16. Methods of Performing Abortions

17. 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

18. 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

19. Methods of Abortion I. Suction Methods (continued) D. Dilation and Evacuation 1. Performed 13-16 weeks 2. Fetus is broken up with surgical instrument prior to suction 3. More dilation is needed

20. 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

21. 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)

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

23. Safety of Abortion

24. An Abortion Is Safer the Earlier in Pregnancy It Is Performed Sources: All births and abortions: Grimes DA, 2006; Abortion by gestation: Bartlett et al., 2004 (1988–1997 data) Deaths per 100,000 abortions Abortions by gestation

25. 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

26. Abortion Risks in Perspective Chance of death Risk from terminating pregnancy:per year: Before 9 weeks 1 in 1,000,000 Between 9 and 10 weeks1 in 500,000 Between 13 and 15 weeks1 in 60,000 After 20 weeks 1 in 11,000 Risk to persons who participate in: Motorcycling1 in 1,000 Automobile driving1 in 5,900 Power-boating 1 in 5,900 Playing football 1 in 25,000 Risk to women aged 15–44 from: Having sexual intercourse (PID)1 in 50,000 Using tampons 1 in 350,000 Source: Bartlett et al., 2004 (1988–1997 data)

27. Who Has Abortions

28. Women in Their 20s Make Up the Majority of Abortion Patients

29. Nearly Half of Abortions Are Obtained by Never-Married Women

30. Poor Women Are Also Overrepresented Among Abortion Patients 2010 Federal Poverty Level for 2 people: $14,570 Gross Annual Income

31. Who Has Abortions: Race/Ethnicity Source: Jones et al., 2002*Non-Hispanic

32. Most Women Obtaining Abortions Report a Religious Affiliation

33. Six in 10 Women Having Abortions Are Already Mothers

34. Who Provides Abortion Services

35. Percentage of Abortions Performed by Each Type of Provider % of abortions

36. Number of Providers by Type No. of providers

37. Factors Contributing to the Decline in the Number of Abortion Providers Anti abortion harassment and violence - More than half of abortion providers—and 89% of large providers— experienced some kind of antichoice harassment in 2008 Social stigma/marginalization Professional isolation/peer pressure The “graying of providers” Inadequate economic/other incentives Lack of medical training opportunities- Fewer than half (46%) of residency training programs in obstetrics and gynecology routinely provide training in first-trimester abortion Source: Jones & Kooistra (2008)

38. Percentage of Providers of 400 or More Abortions per Year Who Reported Harassment in 2008 Picketing88% Picketing with physical contact with patients37% Vandalism19% Picketing homes of staff members 7% Bomb threats 5% Patient pictures posted on the Internet 5%

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

40. Percentages of Counties with No Provider and of Women Living in Those Counties

41. Legal Restrictions on Abortion in the USA

42. Federal Laws & Policies about Abortion Hyde Amendment - 1977 Freedom of Access to Clinic Entrances Act - 1994 Federal Health Benefits Program

43. 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.

44. 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."

45. Federal Laws in the Bush Era 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 case (Gonzales v. Carhart) and Planned Parenthood case (Gonzales v. Planned Parenthood), appellate courts declared the ban unconstitutional citing previous law established over the last thirty years.

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

47. Obama on Abortion President Obama signed an executive order on March 24, 2010 to reaffirm that the new health law he signed will not allow any federal funds for abortion.

48. Summary of state laws regarding abortion as of October 2010 Physician and Hospital Requirements: 38 states require an abortion to be performed by a licensed physician. 19 states require an abortion to be performed in a hospital after a specified point in the pregnancy, and 19 states require the involvement of a second physician after a specified point. Gestational Limits: 38 states prohibit abortions, generally except when necessary to protect the woman’s life or health, after a specified point in pregnancy, most often fetal viability.

49. Summary of state laws regarding abortion as of October 2010 “Partial-Birth” Abortion: 16 states have laws in effect that prohibit “partial-birth” abortion. 4 of these laws apply only to postviability abortions. Public Funding: 17 states use their own funds to pay for all or most medically necessary abortions for Medicaid enrollees in the state. 32 states prohibit the use of state funds except in those cases when federal funds are available: where the woman’s life is in danger or the pregnancy is the result of rape or incest. In defiance of federal requirements, South Dakota limits funding to cases of life endangerment only.

50. Summary of state laws regarding abortion as of October 2010 Coverage by Private Insurance: 4 states restrict coverage of abortion in private insurance plans to cases in which the woman’s life would be endangered if the pregnancy were carried to term. Additional abortion coverage is permitted only if the woman purchases it at her own expense. Refusal: 46 states allow individual health care providers to refuse to participate in an abortion. 43 states allow institutions to refuse to perform abortions, 16 of which limit refusal to private or religious institutions..

51. Summary of state laws regarding abortion as of October 2010 State-Mandated Counseling: 18 states mandate that women be given counseling before an abortion that includes information on at least one of the following: the purported link between abortion and breast cancer (6 states), the ability of a fetus to feel pain (10 states), long-term mental health consequences for the woman (7 states) or information on the availability of ultrasound (9 states).

52. Summary of state laws regarding abortion as of October 2010 Waiting Periods: 24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between when she receives counseling and the procedure is performed. 6 of these states have laws that effectively require the woman make two separate trips to the clinic to obtain the procedure.

53. International Perspective on Abortion

54. World Public Opinion Poll (2008)

55. U.S. Share of Abortions Worldwide Source: Sedgh, 2007 Other Countries

56. Abortion Rate, United States and World Source: Sedgh, 2007 (data for 2003) Abortions per 1,000 women

57. Source: Sedgh, 2007 Abortions per 1,000 women U.S. Abortion Rate Higher Than in Many Other Industrialized Countries

58. 20 million unsafe abortions occur each year Sedgh, 2007

59. The legal status of abortion does not predict its incidence The lowest abortion rates in the world—less than 10 per 1,000 women of reproductive age—are 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., 2007

60. Changes in abortion law between 1997 and 2009 Nineteen countries liberalized their laws to increase access to safe abortion: Australia*, Benin, Bhutan, Burkina Faso, Cambodia, Chad, Colombia, Ethiopia, Guinea, Iran, Mexico* Mali, Nepal, Portugal, Saint Lucia, Swaziland, Switzerland, Thailand and Togo. Three countries tightened restrictions on abortion: El Salvador, Nicaragua and Poland. *Changes in Mexico and Australia were not national, but in highly populous regions

61. High Rates of Abortion Occur in Countries that Severely Restrict Abortion Source: Boonstra, 2006 Abortions per 1,000 women 15–44

62. 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 abortion- related deaths. Singh, 2006; WHO 2007; Grimes 2006

63. Almost all abortion-related deaths occur in developing countries Deaths per 100,000 unsafe abortions, 2003 WHO, 2007

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

65. 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).

66. 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).

67. 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).

68. Munk-Olsen et al. (2011) New England Journal of Medicine Study of all girls and women born in Denmark between 1962 and 1993 who were alive and had no history of a mental disorder 9 months before a first-ever first- trimester induced abortion or first childbirth.

70. 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).

71. 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).