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An Overview of Abortion
in the United States
Guttmacher Institute August 2011
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Objectives
Provide an overview of unintended pregnancy andabortion 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.
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Incidence of UnintendedPregnancy and Abortion
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Pregnancies in the United States(Approximately 6.7 Million in 2006)
51 49
0
20
40
60
80
100
UnintendedIntended
% of pregnancies
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Outcomes of Unintended Pregnancies
(Approximately 3.2 Million in 2006)
43 57
0
20
40
60
80
100
Abortions Births
% of unintended pregnancies (excluding miscarriages)
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Incidence of Abortion
In 2008, some 1.21 million pregnancies wereterminated by abortion in the United States.
Almost 2% of all women aged 1544 had anabortion in 2008.
Abortion is one of the most common surgicalprocedures in the United States.
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Abortion Rates Among WomenAged 1544
0
5
10
15
20
25
30
1973 1978 1983 1988 1993 1998 2003 2008
Abortions per 1,000 women
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Gestational Age
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Abortions Overwhelmingly OccurEarly in Pregnancy
62
179 7
3 20
20
40
60
80
100
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Incidence of EarlyMedication Abortion, 2008
Early medication abortion accounted for 17%(199,000) of all nonhospital abortions, an increasefrom 6% in 2001.
An estimated one-quarter of eligible abortions (thoseperformed up to nine weeks) were early medicationabortions.
Fifty-nine percent of all known providers offer this
service, compared with 33% in early 2001.*
*Mifepristone was approved by the US Food and Drug Administration for use in earlymedication abortion in September 2000.
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Reasons for Abortions
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Most Important Reasons Given forTerminating an Unwanted Pregnancy
Concern for/responsibility to other individuals 74%
Cannot afford a baby now 73%
A baby would interfere with school/
employment/ability to care for dependents 69%
Would be a single parent/
having relationship problems 48%
Has completed childbearing 38%
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Reasons for Abortions After16 Weeks Since Last Menstrual Period
Did not recognize the pregnancy 71%
Had difficulty making arrangements for abortion 48%
Was afraid to tell parents or partner 33%
Needed time to make decision 24%
Hoped relationship would change 8%
Was pressured not to have abortion 8%
Something changed during pregnancy 6%
Did not know timing was important 6%Did not know abortion was an option 5%
Fetal abnormality was diagnosed late 2%
Other 11%
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Safety of Abortion
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Abortion Is Safer the Earlier inPregnancy It Is Performed
0.1 0.2 0.4
1.7
3.4
8.9
0.6
7.1
0
2
4
6
8
10
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Causes of Abortion-Related Deaths
27
24
17 16 15
0
20
40
60
80
100
Infection Hemorrhage Embolism Anesthesia Other
% of deaths
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Long-Term Safety of Abortion
First trimester abortions pose virtually no risk of
Infertility
Ectopic pregnancy
Miscarriage
Birth defect
Preterm delivery or low birth weight
Abortion is not associated with breast cancer.
Abortion does not pose a hazard to womensmental health.
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Who Has Abortions
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Disparities in Unintended Pregnancyand Abortion Are Increasing
The overall U.S. unintended pregnancy rateremained stagnant between 2001 and 2006.
Unintended pregnancy has increasedby 10%
among poor women while decreasing14%among higher-income women between 2001and 2006.
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Poor30%
Poor16%
Poor Women Account for a DisproportionateShare of Unintended Pregnancies
Women at risk of unintendedpregnancy
Unintended pregnancies by womenspoverty status
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42%
27%
14%
17%
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Black Women Account for a DisproportionateShare of Unintended Pregnancies
Black14% Black
26%
Women at risk of unintendedpregnancy
Unintended pregnancies by womens
racial status
Hi i W Al A t f
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Hispanic Women Also Account for aDisproportionate Share of Unintended
Pregnancies
Hispanic,14%
Hispanic,22%
Women at risk of unintended
pregnancy
Unintended pregnancies by womens
ethnic status
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And Both Groups Are OverrepresentedAmong Abortion Patients
Non-Hispanicwhite, 36%
Non-Hispanicblack, 30%
Non-Hispanicother, 9%
Hispanic, 25%
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Women in Their 20s Make Up theMajority of Abortion Patients
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Nearly Half of Abortions Are Obtainedby Never-Married Women
Married, 15%
Cohabiting,
not married,29%
Never-married,not cohabiting,
45%
Previouslymarried, notcohabiting,
11%
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Most Women Obtaining AbortionsReport a Religious Affiliation
Protestant,37%
RomanCatholic, 28%
Other, 7%
None, 28%
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Six in 10 Women Having Abortions AreAlready Mothers
Previousabortion, 13%
Previousabortion and
previousbirth, 37%
Previousbirth, 24%
Neither, 26%
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Who Provides Abortion Services
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Percentage of Abortions Performed byEach Type of Provider
0
20
40
60
80
100
1980 1984 1988 1992 1996 2000 2004 2008
Abortion clinic Other clinic Hospital Physician's office
% of abortions
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Number of Providers by Type
0
200
400
600
800
1,000
1,200
1,400
1,600
1980 1984 1988 1992 1996 2000 2004 2007
Abortion clinic Other clinic Hospital Physician's office
No. of providers
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Facilities Providing Only MedicationAbortion Had a Significant Impact
A minimum of 164 providers, or 9%, offered onlyearly medication abortion in 2008; most werenonspecialized clinics or physicians offices with
small abortion caseloads.
The use of medication abortion, particularly byproviders who do not offer surgical abortion, has
slowed the decline in providers seen in previousyears.
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Factors Contributing to the Decline in
the Number of Abortion Providers
Antiabortion harassment and violence
Social stigma/marginalization
Professional isolation/peer pressure
The graying of providers
Inadequate economic/other incentives
Lack of medical training opportunities
Percentage of Providers of 400 or More
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Percentage of Providers of 400 or MoreAbortions per Year Who
Reported Harassment in 2008
Picketing 88%
Picketing with physical
contact with patients 37%
Vandalism 19%
Picketing homes of staff members 7%
Bomb threats 5%
Patient pictures posted on the Internet 5%
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Factors That Make It DifficultFor Women to Obtain
Abortion Services
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Percentages of Counties with No Provider andof Women Living in Those Counties
0
20
40
60
80
100
1978 1983 1988 1993 1998 2003 2008
Unserved counties Women in unserved counties
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State Restrictions on Abortion
Parental consent or notificationfor minors 36 states
Mandatory counseling 34 states
Waiting periods 24 states
State Policies on
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State Policies onMedicaid Coverage of Abortion
State pays for all or most medicallynecessary abortions
State does not pay for abortion
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State Policies on Private InsuranceCoverage of Abortion
Prohibit coverage except in cases of lifeendangerment
Prohibit coverage except in cases of lifeendangerment, rape or incest
Restrict abortion coverage only in plans thatwill be offered through the state exchanges
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International Perspectiveon Abortion
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Abortion has declined worldwide
0
10
20
30
40
50
60
1995 2003 1995 2003 1995 2003
World Moredevelopedcountries
Less developedcountries
3529 29
39
26
34
Abortions per 1,000 women aged 1544
Th L l S f Ab i D
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The Legal Status of Abortion DoesNot Predict Its Incidence
The lowest abortion rates in the worldlessthan 10 per 1,000 women of reproductiveageare in Europe, where abortion is legaland available.
By contrast, in Africa and in Latin America
and the Caribbean, where abortion law ismost restrictive, the regional rates are 29and 31 per 1,000 women, respectively.
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20 Million Unsafe AbortionsOccur Each Year
0 10 20 30 40
Developingcountries
Developedcountries
World
Annual abortions per 1,000 women 1544
Safe abortions Unsafe abortions
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Complications of Unsafe Abortion
An estimated five million women are hospitalizedeach year for treatment of abortion-relatedcomplications, such as hemorrhage and sepsis.
Complications from unsafe abortion proceduresaccount for 13% of maternal deaths, or 67,000per year.
Approximately 220,000 children worldwide losetheir mothers every year because of abortion-related deaths.
Al All Ab i R l d D h
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Almost All Abortion-Related DeathsOccur in Developing Countries
10
350
650
300
500
100
200
300
400
500
600
700
Developedcountries
Developingcountries
Africa Asia Latin America& Caribbean
Deaths per 100,000 unsafe abortions, 2003
Ch i Ab ti L B t
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Changes in Abortion Law Between1995 and 2007
Seventeen countries liberalized their laws toincrease 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.
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Summary Points
I id f P d Ab ti
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Incidence of Pregnancy and Abortion
in the United States
Women in all social, economic and demographicgroups experience unintended pregnancies.
Certain groups of womenpoor, cohabiting, andminority women; those aged 1824; and those withone previous birthare at greater risk ofunintended pregnancy than are others.
Almost half of all pregnancies are unintended.
About four in 10 unintended pregnancies end in
abortion.
Wh H Ab ti Wh d
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Who Has Abortions, Why andWhen in Pregnancy
Disadvantaged women bear a disproportionateburden of unintended pregnancies and abortions.
The most frequent reasons women give are thathaving a child or another child would limit theirability to meet current responsibilities and that theycannot afford a child at this point in their lives.
Almost 90% of abortions occur in the firsttrimester.
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Safety of Abortion
Abortion is one of the safest common surgicalprocedures for women in the United States.
Abortion is safe over the long term and carrieslittle or no risk of fertility-related problems, canceror psychological illnesses.
Laws criminalizing abortion make abortionsunsafe, but do not eliminate them.
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Provision of and Access toAbortion Services
Most abortions occur in abortion clinics.
Many women have to travel long distances to find
a provider, which can pose significant problems forthose with limited resources, or work or familyresponsibilities.
Obstacles to Obtaining
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Obstacles to ObtainingAbortion Services
Although most women obtain abortions early in pregnancy,some women face substantial obstacles to access.
Nearly four in 10 women of reproductive age receive coverageunder Medicaid, yet 32 states allow Medicaid funding forabortion only in cases of rape, incest or life endangerment.
Lacking insurance coverage, poor women often require time to
find the money to pay for an abortion, if they are able to at all. Legal requirements such as parental consent for minors or
waiting periods are likely to cause further delays, increasing therisk of complications.
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International Perspective on Abortion
A very small proportion of abortionsworldwide take place in the United States.
Most unsafe abortions occur in countries
where abortion is illegal.
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About Guttmacher
The Guttmacher Institute is a nonprofitorganization that advances sexual andreproductive health worldwide throughresearch, policy analysis and public
education.
For more information about Guttmacher,please click here.
Read our report Abortion in WomensLives here.
http://www.guttmacher.org/http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdfhttp://www.guttmacher.org/pubs/2006/05/04/AiWL.pdfhttp://www.guttmacher.org/