Advancing Sexual and Reproductive Health and Rights
 
In Brief

Facts on Induced Abortion in the United States


05/2006

INCIDENCE OF ABORTION

Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion.[1] Twenty-four percent of all pregnancies (excluding miscarriages) end in abortion.[2]

In 2002, 1.29 million abortions took place, down from 1.36 million in 1996. From 1973 through 2002, more than 42 million legal abortions occurred.[3]

Each year, two out of every 100 women aged 15–44 have an abortion; 48% of them have had at least one previous abortion.[4]

Abortions per 1,000 women aged 15-44

About half of American women have experienced an unintended pregnancy, and at current rates more than one-third will have had an abortion by age 45.[5]

WHO HAS ABORTIONS

Fifty-two percent of U.S. women obtaining abortions are younger than 25: Women aged 20–24 obtain 33% of all abortions, and teenagers obtain 19%.[6

Black women are almost four times as likely as white women to have an abortion, and Hispanic women are 2.5 times as likely.[7]

Forty-three percent of women obtaining abortions identify themselves as Protestant, and 27% as Catholic.[8]

Two-thirds of all abortions are among never-married women.[9]

Over 60% of abortions are among women who have had one or more children.[10]

The abortion rate among women living below the federal poverty level ($9,570 for a single woman with no children) is more than four times that of women above 300% of the poverty level (44 vs. 10 abortions per 1,000 women).[11]*

On average, women give four reasons for choosing abortion. Three-fourths of women cite concern for or responsibility to other individuals; three-fourths say they cannot afford a child; three-fourths say that having a baby would interfere with work, school or the ability to care for dependents; and half say they do not want to be a single parent or are having problems with their husband or partner.[12]

CONTRACEPTIVE USE

Fifty-four percent of women having abortions used a contraceptive method during the month they became pregnant. Among those women, 76% of pill users and 49% of condom users reported using their method inconsistently, while 13% of pill users and 14% of condom users reported correct use.[13]

Forty-six percent of women having abortions did not use a contraceptive method during the month they became pregnant. Of these women, 33% perceived themselves to be at low risk, 32% had concerns about contraceptive methods, 26% had unexpected sex and 1% were forced to have sex.[14]

Eight percent of women having abortions have never used a method of birth control; nonuse is greatest among those who are young, poor, black, Hispanic or less educated.[15]

About half of unintended pregnancies occur among the 11% of women at risk of unintended pregnancy who did not use contraceptives in the month they became pregnant. Most of these women had practiced contraception in the past.[17]

PROVIDERS AND SERVICES

The number of U.S. abortion providers declined by 11% between 1996 and 2000 (from 2,042 to 1,819). Eighty-seven percent of all U.S. counties lacked an abortion provider in 2000. These counties were home to 34% of all 15–44-year-old women.[18]

Thirty-seven percent of providers offer abortion at four weeks’ gestation, and 97% offer abortion at eight weeks. Thirty-three percent offer abortion at 20 weeks, after which the number of providers offering abortion services drops off sharply. Only 2% of all abortion providers provide abortions at 26 weeks’ gestation.[19]

The proportion of providers offering very early abortion (at four weeks’ gestation) increased from 7% in 1993 to 37% in 2001.[20]

In 2001, the cost of a nonhospital abortion with local anesthesia at 10 weeks’ gestation ranged from $150 to $4,000, and the average amount paid was $372.[21]

MEDICATION ABORTION

In September 2000, the U.S. Food and Drug Administration approved the abortion drug mifepristone to be marketed in the United States as an alternative to surgical abortion.

In nonhospital facilities offering mifepristone for use in medication abortion in 2001, the average cost of a medication abortion was $490.[22]

At one large network of providers, the proportion of early abortions performed with mifepristone increased from 9% of eligible women in 2001 to 24% in 2004.[23]

When women have Abortions

SAFETY OF ABORTION

The risk of abortion complications is minimal; fewer than 0.3% of abortion patients experience a complication that requires hospitalization.[24]

Abortions performed in the first trimester pose virtually no long-term risk of such problems as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or congenital malformation (birth defect), and little or no risk of preterm or low-birth-weight deliveries. [25]

Exhaustive reviews by panels convened by the U.S. and British governments have concluded that there is no association between abortion and breast cancer. There is also no indication that abortion is a risk factor for other types of cancer.[26]

In repeated studies since the early 1980s, leading experts have concluded that abortion does not pose a hazard to women’s mental health.[27]

The risk of death associated with abortion increases with the length of pregnancy, from one death for every one million abortions at or before eight weeks to one per 29,000 at 16–20 weeks—and one per 11,000 at 21 or more weeks.[28]

The risk of death associated with childbirth is about 12 times as high as that associated with abortion.[29]

Fifty-eight percent of abortion patients say they would have liked to have had their abortion earlier. Nearly 60% of women who experienced a delay in obtaining an abortion said it was because of the time it took to make arrangements and raise money.[30]

Teens are more likely than older women to delay having an abortion until after 15 weeks of pregnancy, when the medical risks associated with abortion are significantly higher.[31]

LAW AND POLICY

In the 1973 Roe v. Wade decision, the Supreme Court ruled that women, in consultation with their physician, have a constitutionally protected right to have an abortion in the early stages of pregnancy—that is, before viability—free from government interference.

In 1992, the Court reaffirmed 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.

Thirty-four states currently enforce parental consent or notification laws for minors seeking an abortion. The Supreme Court ruled that minors must have an alternative, such as the ability to seek a court order authorizing the procedure.[32]

Even without specific parental involvement laws, six in 10 minors who have an abortion report that at least one parent knew about their procedure.[33]

Congress has barred the use of federal Medicaid funds to pay for abortions, except when the woman's life would be endangered by a full-term pregnancy or in cases of rape or incest.

Seventeen states do use public funds to pay for abortions for some poor women, but only four do so voluntarily; the rest do so under a court order.[34] About 13% of all abortions in the United States are paid for with public funds (virtually all from state governments).[35]

Family planning clinics funded under Title X of the federal Public Health Service Act have helped women prevent 20 million unintended pregnancies over the last 20 years. An estimated nine million of these pregnancies would have been expected to end in abortion.[36]

Sources

1. Finer LB et al., Disparities in unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.

2. Finer LB and Henshaw SK, Estimates of U.S. abortion incidence in 2001 and 2002, The Alan Guttmacher Institute (AGI), 2005, <http://www.guttmacher.org/pubs/2005/05/18/ab_incidence.pdf>, accessed May 17, 2005.

3. Ibid.

4. Jones RK, Darroch JE and Henshaw SK, Patterns in the socioeconomic characteristics of women obtaining abortions in 2000–2001, Perspectives on Sexual and Reproductive Health, 2002, 34(5):226–235.

5. Henshaw SK, Unintended pregnancy in the United States, Family Planning Perspectives, 1998, 30(1):24–29 & 46; and AGI, State facts about abortion: Texas, <http://www.guttmacher.org/pubs/sfaa/texas.html>, accessed Feb. 16, 2006.

6. Jones RK, Darroch JE and Henshaw SK, 2002, op. cit. (see reference 4).

7. Ibid.

8. Ibid.

9. Ibid.

10. Ibid.

11. Ibid.

12. Finer LB et al., Reasons U.S. women have abortions: quantitative and qualitative perspectives, Perspectives on Sexual and Reproductive Health, 2005, 37(3):110–118.

13. Jones RK, Darroch JE and Henshaw SK, Contraceptive use among U.S. women having abortions in 2000–2001, Perspectives on Sexual and Reproductive Health, 2002, 34(6):294–303.

14. Ibid.

15. Ibid.

16. Finer LB et al., 2006, op. cit. (see reference 1).

17. Ibid.; and Mosher WD et al., Use of contraception and use of family planning services in the United States: 1982–2002, Advance Data from Vital and Health Statistics, 2004, No. 350, pp. 1 and 21.

18. Finer LB and Henshaw SK, Abortion incidence and services in the United States in 2000, Perspectives on Sexual and Reproductive Health, 2003, 35(1):6–15.

19. Henshaw SK and Finer LB, The accessibility of abortion services in the United States, 2001, Perspectives on Sexual and Reproductive Health, 2003, 35(1):16–24.

20. Ibid.

21. Ibid.

22. Ibid.

23. Boonstra H et al., Abortion in Women’s Lives, New York: Guttmacher Institute, 2006.

24. Henshaw SK, Unintended pregnancy and abortion: a public health perspective, in: Paul M et al., eds., A Clinician’s Guide to Medical and Surgical Abortion, New York: Churchill Livingstone, 1999, pp. 11–22.

25. Boonstra H et al., 2006, op. cit. (see reference 23).

26. Ibid.

27. Ibid.

28. Bartlett LA et al., Risk factors for legal induced abortion-related mortality in the United States, 2004, Obstetrics and Gynecology, 103(4):729–737.

29. Grimes DA, Estimation of prgnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999, American Journal of Obstetrics & Gynecology, 2006, 194(1):92–94.

30. Finer LB et al., Timing of steps and reasons for delays in obtaining abortions in the United States, Contraception, 2006 (forthcoming).

31. Strauss LT et al., Abortion surveillance—United States, 2002, Morbidity and Mortality Weekly Report Surveillance Summaries, 2005, 54(SS-7), p. 30, Table 16.

32. Guttmacher Institute, Parental involvement, State Policies in Brief, April 2006, <http://www.guttmacher.org/statecenter/spibs/spib_PIMA.pdf>, accessed Apr. 28, 2006.

33.Henshaw SK and Kost K, Parental involvement in minors' abortion decisions, Family Planning Perspectives, 1992, 24(5):196–207 & 213.

34. Guttmacher Institute, State funding of abortion under Medicaid, State Policies in Brief, April 2006, <http://www.guttmacher.org/statecenter/spibs/spib_SFAM.pdf>, accessed Apr. 28, 2006.

35. Henshaw SK and Finer LB, 2003, op. cit. (see reference 19).

36. AGI, Fulfilling the Promise: Public Funding and U.S. Family Planning Clinics, New York: AGI, 2000.

Notes

*The poverty guidelines are updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 USC 9902(2) (http://aspe.hhs.gov/poverty/05poverty.shtml).