An Overview of Abortion in the United States

Guttmacher Institute August 2011

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 6.7 Million in 2006)

% of pregnancies
100 80 60 40 20 0 51

49

Intended

Unintended

Outcomes of Unintended Pregnancies

(Approximately 3.2 Million in 2006)
% of unintended pregnancies (excluding miscarriages)

100 80 60 43 40 20 0 Abortions Births 57

Incidence of Abortion
In 2008, some 1.21 million pregnancies were terminated by abortion in the United States.

Almost 2% of all women aged 1544 had an abortion in 2008.

Abortion is one of the most common surgical procedures in the United States.

Abortion Rates Among Women Aged 1544

Abortions per 1,000 women

30 25 20 15 10

5
0 1973 1978 1983 1988 1993 1998 2003 2008

Gestational Age

Abortions Overwhelmingly Occur Early in Pregnancy

% of abortions

100 80 62 60 40 20

17
9

7 1315

0 <9 910 1112

Weeks

1620

21+

Incidence of Early Medication Abortion, 2008

Early medication abortion accounted for 17% (199,000) of all nonhospital abortions, an increase from 6% in 2001. An estimated one-quarter of eligible abortions (those performed up to nine weeks) were early medication abortions. 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 early
medication abortion in September 2000.

Reasons for Abortions

Most Important Reasons 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 74% 73%

69%

48% 38%

Reasons for Abortions After 16 Weeks Since Last Menstrual Period

Did not recognize the pregnancy Had difficulty making arrangements for abortion Was afraid to tell parents or partner Needed time to make decision Hoped relationship would change Was pressured not to have abortion Something changed during pregnancy Did not know timing was important Did not know abortion was an option Fetal abnormality was diagnosed late Other 71% 48% 33% 24% 8% 8% 6% 6% 5% 2% 11%

Safety of Abortion

Abortion Is Safer the Earlier in Pregnancy It Is Performed

Deaths per 100,000 abortions 10 8 6 3.4 4 1.7 2 0.1
<9

8.9 7.1

0.2
910

0.4

0.6

0
1112 1315 1620 21 All Births abortions

Gestation at abortion

Causes of Abortion-Related Deaths

% of deaths
100

80

60

40
27

24 17

16

15

20

Infection

Hemorrhage

Embolism

Anesthesia

Other

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 womens mental health.

Who Has Abortions

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.

Poor Women Account for a Disproportionate Share of Unintended Pregnancies

Poor 16%
Poor 30%

Women at risk of unintended pregnancy

Unintended pregnancies by womens poverty status

Poor Women Are Also Overrepresented Among Abortion Patients

17% 42%

% of poverty
<100% of poverty 100199% of poverty 200299% of poverty 300% of poverty

14%

27%

Black Women Account for a Disproportionate Share of Unintended Pregnancies

Black 14%

Black 26%

Women at risk of unintended pregnancy

Unintended pregnancies by womens racial status

Hispanic Women Also Account for a Disproportionate Share of Unintended Pregnancies

Hispanic, 22%
Hispanic, 14%

Women at risk of unintended pregnancy

Unintended pregnancies by womens ethnic status

And Both Groups Are Overrepresented Among Abortion Patients

Hispanic, 25%

Non-Hispanic other, 9%

Non-Hispanic white, 36%

Non-Hispanic black, 30%

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

4044 years, 3% 3539 years, 8% <15 years, 0% 15-17 years, 6% 18-19 years, 11% 3034 years, 14%

2024 years, 33%

2529 years, 24%

Nearly Half of Abortions Are Obtained by Never-Married Women

Previously married, not cohabiting, 11% Married, 15%

Cohabiting, not married, 29% Never-married, not cohabiting, 45%

Most Women Obtaining Abortions Report a Religious Affiliation

Protestant, 37%

None, 28%

Other, 7%

Roman Catholic, 28%

Six in 10 Women Having Abortions Are Already Mothers

Previous abortion, 13% Neither, 26%

Previous abortion and previous birth, 37%

Previous birth, 24%

Who Provides Abortion Services

Percentage of Abortions Performed by Each Type of Provider

% of abortions
100

80

60

40

20

0 1980 1984
Abortion clinic

1988

1992
Other clinic

1996
Hospital

2000

2004

2008

Physician's office

Number of Providers by Type

No. of providers 1,600 1,400 1,200 1,000 800 600 400 200 0 1980 1984 1988 1992 1996
Hospital

2000

2004

2007

Abortion clinic

Other clinic

Physician's office

Facilities Providing Only Medication Abortion Had a Significant Impact

A minimum of 164 providers, or 9%, offered only early medication abortion in 2008; most were nonspecialized clinics or physicians offices with small abortion caseloads.

The use of medication abortion, particularly by providers who do not offer surgical abortion, has slowed the decline in providers seen in previous years.

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 Abortions per Year Who Reported Harassment in 2008
Picketing
Picketing with physical contact with patients

88%

37%

Vandalism
Picketing homes of staff members Bomb threats Patient pictures posted on the Internet

19%
7% 5% 5%

Factors That Make It Difficult For Women to Obtain Abortion Services

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

100
80 60 40 20 0 1978

1983

1988

1993

1998

2003

2008

Unserved counties

Women in unserved counties

State Restrictions on Abortion

Parental consent or notification for minors
Mandatory counseling Waiting periods

36 states 34 states 24 states

State Policies on Medicaid Coverage of Abortion

State pays for all or most medically necessary abortions State does not pay for abortion

State Policies on Private Insurance Coverage of Abortion

Prohibit coverage except in cases of life endangerment Prohibit coverage except in cases of life endangerment, rape or incest Restrict abortion coverage only in plans that will be offered through the state exchanges

International Perspective on Abortion

Abortion has declined worldwide

Abortions per 1,000 women aged 1544 60
50 40 30 20 10 0 1995 2003 World 1995 2003 More developed countries 1995 2003 Less developed countries

39 35 34

29
26

29

The Legal Status of Abortion Does Not Predict Its Incidence

The lowest abortion rates in the worldless than 10 per 1,000 women of reproductive ageare in Europe, where abortion is legal and available.
By contrast, in Africa and in Latin America and the Caribbean, where abortion law is most restrictive, the regional rates are 29 and 31 per 1,000 women, respectively.

20 Million Unsafe Abortions Occur Each Year

Annual abortions per 1,000 women 1544

World Developed countries Developing countries 0

Safe abortions

10
Unsafe abortions

20

30

40

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.

Almost All Abortion-Related Deaths Occur in Developing Countries

Deaths per 100,000 unsafe abortions, 2003
700
600 500 400

300
200 100 0
Developed countries Developing countries

650

350
10
Africa

300 50
Asia Latin America & Caribbean

Changes in Abortion Law Between 1995 and 2007

Seventeen 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.

Summary Points

Incidence of Pregnancy and Abortion in the United States

Women in all social, economic and demographic groups experience unintended pregnancies.
Certain groups of womenpoor, cohabiting, and minority women; those aged 1824; and those with one previous birthare at greater risk of unintended pregnancy than are others.

Almost half of all pregnancies are unintended.

About four in 10 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 women give are that having a child or another child would limit their 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.

Provision of and Access to Abortion Services

Most abortions occur in abortion clinics. 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 of reproductive age receive coverage under Medicaid, yet 32 states allow Medicaid funding for abortion 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 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 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 Abortion in Womens Lives here.