abortion in the united states. ©the alan guttmacher institutepresentation title prch &...

Abortion in the United

States

©The Alan Guttmacher Institute Presentation Title

PRCH & Guttmacher © 2005

US Public Opinions about Abortion



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Incidence of Pregnancy and Abortion



Pregnancies in the United States(Approximately 6.3 Million Annually)

52%48%

0%

10%

20%

30%

40%

50%

60%

UnintendedIntended

Source: Henshaw, 1998 (1994 data)

% of Pregnancies



Outcomes of Unintended Pregnancies

(Approximately 3.0 Million Annually)

13%

47%40%

0%

10%

20%

30%

40%

50%

60%

Abortions Births Miscarriages

Source: Henshaw, 1998 (1994 data)

% of Unintended Pregnancies



Incidence of Abortion

In 2002, 1.29 million pregnancies were terminated by abortion in the United States.

Some 2.1% of all women aged 15–44 had an abortion in 2001.

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

Source: Finer and Henshaw, 2005



Abortion Rates Among Women Aged 15–44

0

5

10

15

20

25

30

19801982 19841986 198819901992 19941996 19982000 2002


Abortions per 1,000 women



Abortion Rates in Western Industrialized Countries

6.57.6

15.616.416.518.7

22.220.9

0

5

10

15

20

25

30

UnitedStates(2002)

Australia Sweden Denmark Canada England& Wales

Germany Holland

Source: Finer and Henshaw, 2005; Henshaw et al., 1999

(1996 data)

Abortions per 1,000 women

Reasons for Abortions



Most Important Reason Given for Terminating an Unwanted Pregnancy

Inadequate finances 21%

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 3%

Pregnancy caused by rape, incest 1%

Other 4%

Average number of reasons given 3.7

Source: Torres and Forrest, 1988 (1987 data)

Gestational Age



Abortions by Gestational Age(Weeks Since Last Menstrual Period)

6.2% 4.3% 1.4%10.0%

59.1%

19.0%

0%

20%

40%

60%

80%

100%

<9 9-10 11-12 13-15 16-20 21+

Source: Strauss et al., 2004 (2001 data)

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%

Average number of reasons given 2.2

Source: Torres and Forrest, 1988 (1987 data)



Methods of AbortionMethods of Abortion

I. Suction MethodsA. Endometrial Aspiration

1. Performed 4-6 weeks after LMP2. Use of flexible tube3. May be done without pregnancy

confirmation4. Side effects may include cramps

& intermittent menstrual

bleeding




I. Suction Methods (continued)B. Early Abortion

1. Same as A. only pregnancy confirmedC. Vacuum Curretage

1. Performed after 8 weeks2. Larger fetal tissue3. Use of rigid tube with more

suction4. Dilation of cervix is required




I. Suction Methods (continued)D. Dilation and Evacuation

1. Performed 13-16 weeks2. Fetus is broken up with

surgical instrument prior to

suction3. More dilation is needed




II. Surgical Removal Through CervixA. Dilation and Curretage

1. Performed 8-15 weeks2. Lining of uterus is scraped

with surgical instrument




III. Induced Labor A. Saline Abortion

1. Performed early to middle parts of

2nd trimester2. Saline injected into Amniotic sac

(kills fetus)




IV. Surgical Removal Through Caesarean ProcedureA. Hysterotomy

Safety of Abortion



Deaths per 100,000 Abortions or Births

7.1

0.20.1 0.4

8.9

3.4

1.70.7

0

2

4

6

8

10

<9 9-10 11-12 13-15 16-20 21+ Allabs.

BirthsAbortions by gestation

Sources: Birth: Henshaw, 2004 (1995–1997 data); Abortion: Bartlett et al., 2004 (1988–

1997 data)

Deaths per 100,000



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 350,000

Source: Bartlett et al., 2004 (1988–1997 data)

Who Has Abortions



Who Has Abortions: Age

20-24 years, 33.0%

30-34 years, 13.5%

25-29 years, 23.1%

35-39 years, 8.1% 15-19 years,

18.6%

<15 years, 0.7%

40-44 years, 3.1%

Source: Jones et al., 2002



Who Has Abortions: Marital Status

Never-married, 67.3%

Married, 17.0%

Separated/ Divorced/ Widowed,

15.6%




% of the Federal Poverty Level

<100% , 26.6%

>300% , 24.6%

200-299% , 18.0% 100-199% ,

30.8%

Who Has Abortions: Economic Status


In 2007 the FederalPoverty Level was $11,750 per fear for one person



Who Has Abortions: Race/Ethnicity

White* , 40.9%

Hispanic, 20.1%

Asian/ Pacific I slander* ,

6.4%

Native American* ,

0.9%

Black* , 31.7%

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



Who Has Abortions:Religious Identification

Protestant, 42.8%

Catholic, 27.4%

Other, 7.6%

None, 22.2%




Who Has Abortions: Prior Pregnancies

None, 27%

Previous Birth, 25%

Previous Abortion

and Previous

Birth, 36%

Previous Abortion,

12%


Who Provides Abortion Services



Number of Providers by Type

0

200

400

600

800

1000

1200

1400

1600

1980 1984 1988 1992 1996 2000

Abortionclinic

Other clinic

Hospital

Physicians'office


Number of Providers


PRCH & AGI © 2005

Factors Contributing to the Decline in the Number of Abortion Providers

Antichoice harassment and violence Social stigma/marginalization Professional isolation/peer pressure The “graying of providers” Inadequate economic/other incentives Lack of medical training opportunities

Source: NAF & ACOG, 1991

Factors That Make It Difficult

For Women to Obtain Abortion Services



Percentage of Counties with No Provider And % of Women Living in Those Counties

0%

20%

40%

60%

80%

100%

1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Unserved counties Women in unserved counties




Percentage of Providers of 400 or More Abortions Per Year Who HaveReported Harassment in 2000

Picketing 80%

Picketing with physical contact with patients 28%

Vandalism 18%

Picketing homes of staff members 14%

Bomb threats 15%

Source: Henshaw and Finer, 2003



Legal Restrictions on

Abortion



Federal Laws & Policies about Federal Laws & Policies about AbortionAbortion

Hyde Amendment - 1977Freedom of Access to Clinic Entrances Act - 1994Federal 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."


PRCH & Guttmacher © 2005Federal Laws in the WorksDespite 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 ﾕ case (Gonzales v. Carhart) and Planned Parenthood ﾕ s 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.



STATES ENACTED 52 LAWS RESTRICTING ABORTION IN 2005

Of the 195 state-level abortion restrictions adopted since 2000, one-quarter were enacted in 2005 alone.



State Laws Restricting Abortion

Twenty-nine states mandate that a woman seeking an abortion be given counseling including information intended to discourage her from obtaining the procedure; 24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between when she receives counseling and when the procedure is performed.



State Laws Restricting Abortion

Thirty-three states and the District of Columbia prohibit the use of public funds to pay for abortion for low-income women, even when it is medically necessary, generally making exceptions only in cases of life endangerment, rape or incest. Only 17 states use their own funds to pay for all or most medically necessary abortions for Medicaid enrollees.Thirty-four states require some type of parental involvement in a minor ﾕ s decision to have an abortion: Twenty-one states require one or both parents to consent to the procedure, while 13 require that a parent be notified.

February 22, 2006:South Dakota lawmakers approved the

nation's most far-reaching ban on abortion

The measure, which passed the state Senate 23 to 12, makes it a felony for doctors to perform any abortion, except to save the life of a pregnant woman. The proposal was signed by Gov. Mike Rounds (R) on March 6, 2006. In November of 2006, South Dakotans voted to reject the ban (55% to 45%).

International Perspective on Abortion



U.S. Share of Abortions Worldwide

97%

3% United States

Rest of the World

Source: Henshaw et al., 1999 (1995 data)



Abortion Rate, United States and World

21

35

0

5

10

15

20

25

30

35

40

United States World

Sources: Finer and Henshaw, 2005; Henshaw et al., 1999

(1995 data)

Abortions per 1,000 Women



Abortion in Developed and Developing Countries

Annual abortions per 1,000 women 15-44

0 10 20 30 40 50

DevelopingCountries

DevelopedCountries

World

Legal I llegal

Source: AGI, 1999



Many Abortions Occur in Countries Where Abortion Is Illegal Under

Most Circumstances

Abortions by legality

44%

56%

Source: Henshaw et al., 1999 (1995 data)

Illegal

Legal



Maternal Mortality Worldwide Due to Unsafe Abortion

Maternal deaths (520,000 per year)

87%

13%

Source: WHO, 2004 (2000 data)

Unsafe abortion

Other causes

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).



Normative Psychological Normative Psychological Responses to AbortionResponses to Abortion

Normative Psychological Normative Psychological Responses to AbortionResponses to Abortion

• Lazarus (1985) 292 women studied 2 weeks

after76% reported happiness17% reported guilt



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).



Normative Psychological Responses Normative Psychological Responses to Abortionto Abortion

Normative Psychological Responses Normative Psychological Responses to Abortionto Abortion

• Russo & Zierk (1992) -measured self-esteem -• women who had abortions > women who had

not had abortions• women who had abortions > women who

unwanted birthsThe positive relationship of abortion to well-being may be due in part to abortion's role in controlling fertility and its relationship to coping resources (Russo & Zierk, 1992; Russo & Dabul, 1997).



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).

Summary Points



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.



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.



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.



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.



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.

Scientific studies do not suggest a link between abortion and subsequent psychological problems in women.

abortion in the united states. ©the alan guttmacher institutepresentation title prch &...

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