An Overview of Abortion

John B. PryorIllinois State University

US Public Opinions about Abortion

Should Abortion be Legal in the US?

Gallup Poll (2011)

Incidence of Pregnancy and Abortion

Pregnancies in the United States(Approximately 6.4 Million Annually)

51% 49%

0%

20%

40%

60%

80%

100%

UnintendedIntended

Source: Finer et al., 2006 (2002 data)

% of pregnancies

Outcomes of Unintended Pregnancies(Approximately 3.1 Million Annually)

48% 52%

0%

20%

40%

60%

80%

100%

Abortions Births

Source: Finer, 2006 (2002 data)

% of unintended pregnancies (excluding miscarriages)

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.

Abortion Rates Among Women Aged 15–44

Abortions per 1,000 women

Disparities in Unintended Pregnancy and Abortion Are Increasing

• The overall U.S. unintended pregnancy rate remained pretty much the same over recent years.

• Unintended pregnancy has increased by among poor women while decreasing among higher-income women.

• Forty-two percent of women obtaining abortions have incomes below 100% of the federal poverty level ($10,830 for a single woman with no children).

• Twenty-seven percent of women obtaining abortions have incomes between 100–199% of the federal poverty level.

Reasons for Abortions

Most Important Reason Given for Terminating 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%

Source: Finer et al., 2005 (2004 data)

Gestational Age

Abortions by Gestational Age(Weeks Since Last Menstrual Period)

Weeks

% of abortions

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 11%

Source: Torres and Forrest, 1988 (1987 data)

Methods of Performing Abortions

Methods of AbortionMethods 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

Methods of AbortionMethods 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

Methods of AbortionMethods 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

Methods of AbortionMethods 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

Methods of AbortionMethods 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)

Methods of AbortionMethods of Abortion

IV. Surgical Removal Through Caesarean Procedure

A. Hysterotomy

Safety of Abortion

An Abortion Is Safer the Earlier in Pregnancy It Is Performed

0.61.7

3.4

8.9

0.40.1 0.2

7.1

0

2

4

6

8

10

<9 9–10 11–12 13–15 16–20 21+ All abs. Births

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

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

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 weeks 1 in 500,000

Between 13 and 15 weeks 1 in 60,000 After 20 weeks 1 in 11,000

Risk to persons who participate in: Motorcycling 1 in 1,000 Automobile driving 1 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 350,000Source: Bartlett et al., 2004 (1988–1997 data)

Who Has Abortions?

Who has abortions?

• Eighteen percent of U.S. women obtaining abortions are teenagers; those aged 15–17 obtain 6% of all abortions, teens aged 18–19 obtain 11%, and teens younger than age 15 obtain 0.4%.

• Women in their 20s account for more than half of all abortions; women aged 20–24 obtain 33% of all abortions, and women aged 25–29 obtain 24%.

• Non-Hispanic white women account for 36% of abortions, non-Hispanic black women for 30%, Hispanic women for 25% and women of other races for 9%.

Who has abortions?

• Thirty-seven percent of women obtaining abortions identify as Protestant and 28% as Catholic.

• Women who have never married and are not cohabiting account for 45% of all abortions

• About 61% of abortions are obtained by women who have one or more children.

Who Provides Abortion Services

Percentage of Abortions Performed by Each Type of Provider

% of abortions

Number of Providers by Type

No. of providers

Number of abortion providers in Illinois, 1973-2008

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)

Percentage of Providers of 400 or More Abortions 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%

Factors That Make It Difficult For Women to Obtain

Abortion Services

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

Legal Restrictions on Abortion in the

USA

Federal Laws & Policies about Federal Laws & Policies about AbortionAbortion

• Hyde Amendment - 1977

• Freedom of Access to Clinic Entrances Act - 1994

• Federal Health Benefits Program

State Laws about AbortionState 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.

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."

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 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.

APRIL 2007

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

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.

State Laws Restricting Abortion as of September 2013

Physician and Hospital Requirements: 39 states require an abortion to be performed by a licensed physician. 20 states require an abortion to be performed in a hospital after a specified point in the pregnancy, and 18 states require the involvement of a second physician after a specified point. Gestational Limits: 41 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. “Partial-Birth” Abortion: 19 states have laws in effect that prohibit “partial-birth” abortion. 3 of these laws apply only to post-viability abortions

State Laws Restricting Abortion as of September 2013

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 and the District of Columbia 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. Coverage by Private Insurance: 8 states restrict coverage of abortion in private insurance plans, most often limiting coverage only to when the woman’s life would be endangered if the pregnancy were carried to term. Most states allow the purchase of additional abortion coverage at an additional cost.

State Laws Restricting Abortion as of September 2013

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  State-Mandated Counseling: 17 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 (5 states), the ability of a fetus to feel pain (12 states) or long-term mental health consequences for the woman (8 states).

State Laws Restricting Abortion as of September 2013

Waiting Periods: 26 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. 9 of these states have laws that effectively require the woman make two separate trips to the clinic to obtain the procedure.  Parental Involvement: 39 states require some type of parental involvement in a minor’s decision to have an abortion. 21 states require one or both parents to consent to the procedure, while 13 require that one or both parents be notified and 5 states require both parental consent and notification.  

International Perspective on Abortion

World Public Opinion Poll (2008)

U.S. Share of Abortions Worldwide

97%

3% United States

Source: Sedgh, 2007

Other Countries

Abortion Rate, United States and World

21

29

0

10

20

30

40

United States World

Source: Sedgh, 2007 (data for 2003)

Abortions per 1,000 women

An increasing proportion of abortions are unsafe

% of abortions that are unsafe

98

171515

202021

0

5

10

15

20

25

30

UnitedStates

Australia Sweden Denmark Canada England &Wales

Germany Netherlands

Source: Sedgh, 2007

Abortions per 1,000 women

U.S. Abortion Rate Higher Than in Many Other Industrialized Countries

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

High Rates of Abortion Occur in Countries that Severely Restrict Abortion

0 10 20 30 40 50 60

Peru

Chile

Dom. Rep.

Brazil

Mexico

Nigeria

Source: Boonstra, 2006

Abortions per 1,000 women 15–44

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

Almost all abortion-related deaths occur in developing countries

350

50

300

650

100

100

200

300

400

500

600

700

Developedcountries

Developingcountries

Africa Asia LatinAmerica &Caribbean

Deaths per 100,000 unsafe abortions, 2003

WHO, 2007

Research from Psychology on the Possible

Psychological Impact of Abortions upon Women who

have them

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).

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).

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).

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.

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).

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).