Abortion in the United States

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Abortion in the United States
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US Public Opinions about Abortion
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Incidence of Pregnancy and Abortion
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Pregnancies in the United States(Approximately
6.3 Million Annually)
of Pregnancies
Unintended
Intended
Source Henshaw, 1998 (1994 data)
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Outcomes of Unintended Pregnancies(Approximately
3.0 Million Annually)
of Unintended Pregnancies
Source Henshaw, 1998 (1994 data)
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Incidence of Abortion

• In 2002, 1.29 million pregnancies were terminated
  by abortion in the United States.
• Some 2.1 of all women aged 1544 had an abortion
  in 2001.
• Abortion is one of the most common surgical
  procedures in the United States.

Source Finer and Henshaw, 2005
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Abortion Rates Among Women Aged 1544
Abortions per 1,000 women
Source Finer and Henshaw, 2005
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Abortion Rates in Western Industrialized
Countries
Abortions per 1,000 women
Source Finer and Henshaw, 2005 Henshaw et al.,
1999 (1996 data)
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Reasons for Abortions
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Most Important Reason Given for Terminating an
Unwanted Pregnancy
Inadequate finances 21 Not ready for
responsibility 21 Womans 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)
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Gestational Age
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Abortions by Gestational Age(Weeks Since Last
Menstrual Period)
of Abortions
Weeks
Source Strauss et al., 2004 (2001 data)
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Reasons for Abortions After 16 Weeks Since Last
Menstrual Period
Woman did not realize she was pregnant 71 Diffic
ulty 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 Didnt know timing was important 6 Didnt
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)
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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

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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

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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

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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

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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)

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Methods of Abortion

• IV. Surgical Removal Through Caesarean Procedure
• A. Hysterotomy

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Safety of Abortion
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Deaths per 100,000 Abortions or Births
Deaths per 100,000
Sources Birth Henshaw, 2004 (19951997 data)
Abortion Bartlett et al., 2004 (19881997 data)
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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 1544 from Having sexual
intercourse (PID) 1 in 50,000 Using
tampons 1 in 350,000
Source Bartlett et al., 2004 (19881997 data)
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Who Has Abortions
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Who Has Abortions Age
Source Jones et al., 2002
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Who Has Abortions Marital Status
Source Jones et al., 2002
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Who Has Abortions Economic Status
In 2007 the Federal Poverty Level was 11,750
per fear for one person
Source Jones et al., 2002
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Who Has Abortions Race/Ethnicity
Source Jones et al., 2002
Non-Hispanic
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Who Has AbortionsReligious Identification
Source Jones et al., 2002
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Who Has Abortions Prior Pregnancies
Source Jones et al., 2002
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Who Provides Abortion Services
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Number of Providers by Type
Number of Providers
Source Finer and Henshaw, 2003
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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
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Factors That Make It Difficult For Women to
Obtain Abortion Services
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Percentage of Counties with No Provider And of
Women Living in Those Counties
Source Finer and Henshaw, 2003
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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 Pick
eting homes of staff members 14 Bomb
threats 15
Source Henshaw and Finer, 2003
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Legal Restrictions on Abortion
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Federal Laws Policies about Abortion

• Hyde Amendment - 1977
• Freedom of Access to Clinic Entrances Act - 1994
• Federal Health Benefits Program

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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.

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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 womens right to
  obtain abortions.
• "the absence of a health exception will place
  women at an unnecessary risk of tragic health
  consequences."

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Federal Laws in the Works

• 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?s case (Gonzales v.
  Planned Parenthood), appellate courts declared
  the ban unconstitutional citing previous law
  established over the last thirty years.

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APRIL 2007

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

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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.

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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.

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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?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.

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February 22, 2006South 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).

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International Perspective on Abortion
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U.S. Share of Abortions Worldwide
Source Henshaw et al., 1999 (1995 data)
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Abortion Rate, United States and World
Abortions per 1,000 Women
Sources Finer and Henshaw, 2005 Henshaw et al.,
1999 (1995 data)
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Abortion in Developed and Developing Countries
Source AGI, 1999
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Many Abortions Occur in Countries Where Abortion
Is Illegal Under Most Circumstances
Illegal
Legal

Source Henshaw et al., 1999
(1995 data)
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Maternal Mortality Worldwide Due to Unsafe
Abortion
Unsafe abortion
Other causes
Source WHO, 2004 (2000 data)
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Research from Psychology on the Possible
Psychological Impact of Abortions upon Women who
have them
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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).

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Normative Psychological Responses to Abortion

• Lazarus (1985)
• 292 women studied 2 weeks after
• 76 reported happiness
• 17 reported guilt

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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).

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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
  aredelays in seeking abortion, medical or
  genetic indications for abortion, and severe
  pre-existing or concurrent psychiatric illness
  (Lazarus, 1985).

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Normative Psychological Responses to Abortion

• Russo Zierk (1992) -measured self-esteem -
• women who had abortions gt women who had not had
  abortions
• women who had abortions gt women who unwanted
  births
• The 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).

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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).

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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).

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Summary Points
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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.

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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.

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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.

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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.

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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.