Abortion statistics wikipedia

Abortion statistics wikipedia DEFAULT

U.S. Abortion Statistics

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Primary nationwide abortion statistics for the United States are available from two sources—privately from the Guttmacher Institute (AGI) and publicly from the Centers for Disease Control (CDC). Guttmacher’s numbers, published every three years, come from direct surveys of all known and suspected abortion providers in the United States. The CDC numbers, published annually, are derived from actual counts of every abortion reported to state health departments. Unfortunately, California, Maryland, and New Hampshire do not publicly report abortion totals. As such, Guttmacher’s abortion numbers are more complete, but they are approximations. Since only 59% of queried providers responded to Guttmacher’s latest survey, health department data was used for an additional 19%. Abortion totals were estimated for the remaining 22%. All told, Guttmacher states that 89% of their 2017 abortion total was based on actual abortion counts. The remaining 11% was estimated. “It is possible,” Guttmacher concedes, “that we consistently underestimated or overestimated these caseloads, which would mean that our count is inaccurate.” The information on this page has been gleaned from Guttmacher and the CDC—along with public state health department data—to provide an overview of the frequency and demography of abortion. Additional secondary statistics have been taken from the National Abortion Federation's (NAF) teaching text on abortion, Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care.

ANNUAL ABORTION STATISTICS

  • Based on available state-level data, approximately 888,000 abortions took place in the United States in 2019, up from 876,000 abortions in 2018.
  • According to the Guttmacher Institute, an estimated 862,320 abortions took place in the United States in 2017—down from 926,240 in 2014. Guttmacher's selected annual abortion estimates for the last 20+ years are listed below: 
    20172014201120082005200220001996
    862,320926,2401,060,0001,210,0001,210,0001,290,0001,310,0001,360,000
    2017201420112008
    862,320926,2401,060,0001,210,000
    2005200220001996
    1,210,0001,290,0001,310,0001,360,000
  • Based on available state-level data, approximately 890,000 abortions took place in the United States in 2016—down from approximately 913,000 abortions in 2015.
  • In 2017, approximately 18% of U.S. pregnancies (excluding spontaneous miscarriages) ended in abortion.1
  • According to the United Nations' 2013 report, only nine countries in the world have a higher reported abortion rate than the United States. They are: Bulgaria, Cuba, Estonia, Georgia, Kazakhstan, Romania, Russia, Sweden, and Ukraine.*

    *Though the UN lists China's official abortion rate at 19.2, China's actual abortion rate is likely much higher. According to China's 2010 census, there were approximately 310 million women of reproductive age in the country. An estimated 13-23 million abortions happen annually in China, resulting in an adjusted abortion rate of 41.9-74.2. The abortion rate is the number of abortions per 1,000 women aged 15-44.

  • In 2017, the highest percentage of pregnancies were aborted in the District of Columbia (37%), New Jersey (32%), and New York (31%). The lowest percentage of pregnancies were aborted in Idaho (5%), South Dakota (4%), and Wyoming (2%). (AGI abortion data + CDC birth data).
  • In 2018, approximately 31% of all pregnancies in New York City (excluding spontaneous miscarriages) ended in abortion (CDC).
  • The annual number of legal induced abortions in the United States doubled between 1973 and 1979, and peaked in 1990 (CDC).
  • From 2009 to 2018, the total number of reported abortions decreased by 22%. The abortion ratio2—which measures abortions against live births—decreased by 16% (CDC).
  • More than 60 million legal abortions have occurred in the United States since 1973.

WHO HAS ABORTIONS?

  • In 2018, unmarried women accounted for 85% of all abortions (CDC).
  • Among married women, 4% of 2018 pregnancies (excluding spontaneous miscarriages) ended in abortion. Among unmarried women, 27% ended in abortion (CDC).
  • Women in their 20s accounted for the majority of abortions in 2018 and had the highest abortion rates (CDC).
  • Adolescents under 15 years obtained .2% of all 2018 abortions; women aged 15–19 years accounted for less than 10% (CDC).
  • Percentage of 2018 Reported Abortions by Age of Mother (CDC):
    <15 years15–19 years20–24 years25–29 years30–34 years35–39 years≥40 years
    0.2%8.8%28.5%29.4%18.8%10.7%3.5%
    <15 years15–19 years20–24 years25–29 years
    0.2%8.8%28.5%29.4%
    30–34 years35–39 years≥40 years
    18.8%10.7%3.5%
  • Women living with a partner to whom they are not married account for 25% of abortions but only about 10% of women in the population (NAF).
  • In 2018, women who had not aborted in the past accounted for 60% of all abortions; women with one or two prior abortions accounted for 34%, and women with three or more prior abortions accounted for 6% (CDC).
  • Among women who obtained abortions in 2018, 41% had no prior live births; 45% had one or two prior live births, and 14% had three or more prior live births (CDC).
  • Among white women, 10% of 2018 pregnancies (excluding spontaneous miscarriages) ended in abortion. Among black women, 25% ended in abortion (CDC).
  • Black women were more than 3.4 times more likely to have an abortion in 2018 than white women (CDC).
  • The abortion rate of non-metropolitan women is about half that of women who live in metropolitan counties (NAF).
  • The abortion rate of women with Medicaid coverage is three times as high as that of other women (NAF).
  • In 2014, 30% of aborting women identified themselves as Protestant and 24% identified themselves as Catholic (AGI).

WHY DO ABORTIONS OCCUR?

  • In 2004, the Guttmacher Institute anonymously surveyed 1,209 post-abortive women from nine different abortion clinics across the country. Of the women surveyed, 957 provided a main reason for having an abortion. This table lists each reason and the percentage of respondents who chose it.
  • The state of Florida records a reason for every abortion that occurs within its borders each year. In 2018, there were 70,083 abortions in Florida. This table lists each reason and the percentage of abortions that occurred because of it.

WHEN DO ABORTIONS OCCUR?

  • In 2018, 78% of all U.S. abortions occurred prior to the 10th week of gestation; 92% occurred prior to 14 weeks’ gestation (CDC).
  • Percentage of 2018 Reported Abortions by Weeks of Gestation* (CDC):
    ≤6 wks7-9 wks10-13 wks14-15 wks16-17 wks18-20 wks≥21 wks
    40.2.5%37.5%14.5%3.2%1.9%1.8%1.0%

    *Gestational weeks are measured from the first day of the woman's last menstruation and not from the day of conception. Though it does not provide an accurate fetal age (which is roughly 2 weeks less than the gestational age), it is the simplest way for an OB/GYN to age a pregnancy since the day of conception is often not known. Hence, if an abortion occurs at 8 weeks gestation, it is actually aborting a 6 week embryo. The images on our Prenatal Development and Abortion Pictures pages are more precisely captioned with fetal ages in accordance with standard teaching texts on prenatal development.

HOW DOES ABORTION TAKE PLACE?

WHO IS DOING THE ABORTIONS?

  • In 2017, abortions were performed in 1,587 different facilities, a 5% decline from 2014. (AGI).
  • In 2017, there were 808 abortion clinics in the United States, a 2% increase from 2014.
  • Between 2014 and 2017, the number of hospitals performing abortions declined by 19%, from 638 to 518 (AGI).
  • In 2017, 72% of U.S. abortion clinics performed abortion through 12 weeks’ gestation, 25% performed abortion through 20 weeks, and 10% performed abortion through 24 weeks (AGI).
  • In 2014, 4% of U.S. abortions occured in hospitals; 1% occured in physician's offices. The other 95% occured in freestanding abortion clinics—without any established doctor-patient relationship (AGI).

ABORTION FATALITY

  • In 2017, two women were reported to have died as a result of complications from induced abortion. Between 1973-2015, a reported 447 women died due to complications from legal abortion (CDC).
  • The number of deaths attributable to legal induced abortion was highest before the 1980s (CDC).
  • In 1972 (the year before abortion was federally legalized), a total of 24 women died from causes known to be associated with legal abortions, and 39 died as a result of known illegal abortions (CDC).

THE COST OF ABORTION

ABORTION AND CONTRACEPTION

  • Induced abortions usually result from unintended pregnancies, which often occur despite the use of contraception (CDC).
  • In 2014, 51% of women having abortions used birth control during the month they became pregnant. (AGI).
  • 9 in 10 women at risk of unintended pregnancy are using a birth control method (AGI).
  • Oral contraceptives, the most widely used reversible method of contraception, carry failure rates of 6 to 8% in actual practice (NAF).

ABORTION AND MINORS

  • 40% of minors having an abortion report that neither of their parents knew about the abortion (AGI).
  • 39 states currently enforce parental consent or notification laws for minors seeking an abortion: AL, AK, AR, AZ, CO, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, MT, NC, ND, NE, NH, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, WI, WV, and WY. The Supreme Court ruled that minors must have the alternative of seeking a court order authorizing the procedure (AGI).

ABORTION AND PUBLIC FUNDS

  • The U.S. 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 (AGI).
  • 17 states (AK, AZ, CA, CT, HI, IL, MA, MD, MN, MT, NJ, NM, NY, OR, VT, WA and WV) use public funds to pay for abortions for some poor women. About 14% of all abortions in the United States are paid for with public funds—virtually all from the state (AGI).
  • In 2014, 88,466 abortions in California were paid for with public funds. Public funds paid for 45,722 abortions in New York (AGI).

This page was last updated on August 04, 2021. To cite this page in a research paper, visit: "Citing Abort73 as a Source."

    Footnotes

  1. This percentage was arrived at by comparing the number of 2017 births reported by the CDC (3,855,887) and the number of abortions reported by AGI.
  2. The abortion ratio is the number of abortions per 1,000 live births.

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Abortion

Termination of a pregnancy

For other uses, see Abortion (disambiguation).

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus.[note 1] An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion" and occurs in approximately 30% to 40% of pregnancies.[1][2] When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion.[3][4]

When properly done, abortion is one of the safest procedures in medicine,[5]: 1 [6]: 1  but unsafe abortion is a major cause of maternal death, especially in the developing world,[7] while making safe abortion legal and accessible reduces maternal deaths.[8][9] It is safer than childbirth, which has a 14 times higher risk of death in the United States.[10]

Modern methods use medication or surgery for abortions.[11] The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy.[11][12] The most common surgical technique involves dilating the cervix and using a suction device.[13]Birth control, such as the pill or intrauterine devices, can be used immediately following abortion.[12] When performed legally and safely on a woman who desires it, induced abortions do not increase the risk of long-term mental or physical problems.[14] In contrast, unsafe abortions (those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) cause 47,000 deaths and 5 million hospital admissions each year.[14][15] The World Health Organization states that "access to legal, safe and comprehensive abortion care, including post-abortion care, is essential for the attainment of the highest possible level of sexual and reproductive health".[16]

Around 56 million abortions are performed each year in the world,[17] with about 45% done unsafely.[18] Abortion rates changed little between 2003 and 2008,[19] before which they decreased for at least two decades as access to family planning and birth control increased.[20] As of 2018[update], 37% of the world's women had access to legal abortions without limits as to reason.[21][22] Countries that permit abortions have different limits on how late in pregnancy abortion is allowed.[22] Abortion rates are similar between countries that ban abortion and countries that allow it.[23]

Historically, abortions have been attempted using herbal medicines, sharp tools, forceful massage, or through other traditional methods.[24]Abortion laws and cultural or religious views of abortions are different around the world. In some areas, abortion is legal only in specific cases such as rape, fetal defects, poverty, risk to a woman's health, or incest.[25] There is debate over the moral, ethical, and legal issues of abortion.[26][27] Those who oppose abortion often argue that an embryo or fetus is a person with a right to life, and they may compare abortion to murder.[28][29] Those who support the legality of abortion often hold that it is part of a woman's right to make decisions about her own body.[30] Others favor legal and accessible abortion as a public health measure.[31]

Types

Induced

Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[19][32] Most abortions result from unintended pregnancies.[33][34] In the United Kingdom, 1 to 2% of abortions are done due to genetic problems in the fetus.[14] A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus, which increases in size as the pregnancy progresses.[35][36] Specific procedures may also be selected due to legality, regional availability, and doctor or a woman's personal preference.

Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman; to prevent harm to the woman's physical or mental health; to terminate a pregnancy where indications are that the child will have a significantly increased chance of mortality or morbidity; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[37][38] An abortion is referred to as an elective or voluntary abortion when it is performed at the request of the woman for non-medical reasons.[38] Confusion sometimes arises over the term "elective" because "elective surgery" generally refers to all scheduled surgery, whether medically necessary or not.[39]

Spontaneous

Main article: Miscarriage

Miscarriage, also known as spontaneous abortion, is the unintentional expulsion of an embryo or fetus before the 24th week of gestation.[40] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is a "premature birth" or a "preterm birth".[41] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[42]Premature births and stillbirths are generally not considered to be miscarriages, although usage of these terms can sometimes overlap.[43]

Only 30% to 50% of conceptions progress past the first trimester.[44] The vast majority of those that do not progress are lost before the woman is aware of the conception,[38] and many pregnancies are lost before medical practitioners can detect an embryo.[45] Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[46] 80% of these spontaneous abortions happen in the first trimester.[47]

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo or fetus,[38][48] accounting for at least 50% of sampled early pregnancy losses.[49] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[48] Advancing maternal age and a woman's history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[49] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[50]

Methods

Medical

Main article: Medical abortion

Medical abortions are those induced by abortifacient pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of prostaglandinanalogs in the 1970s and the antiprogestogenmifepristone (also known as RU-486) in the 1980s.[11][12][51][52][53]

The most common early first-trimester medical abortion regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost) up to 10 weeks (70 days) gestational age,[54][55]methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.[51] Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone.[52] This regimen is effective in the second trimester.[56] Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.[55][57]

In very early abortions, up to 7 weeks gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue.[58] Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%.[57][59] If medical abortion fails, surgical abortion must be used to complete the procedure.[60]

Early medical abortions account for the majority of abortions before 9 weeks gestation in Britain,[61][62]France,[63]Switzerland,[64]United States,[65] and the Nordic countries.[66]

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second-trimester abortions in Canada, most of Europe, China and India,[53] in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.[67]

A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion.[68] Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion.[68] Safely permitting women to self-administer abortion medication has the potential to improve access to abortion.[68] Other research gaps that were identified include how to best support women who choose to take the medication home for a self-administered abortion.[68]

Surgical

A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).
1:Amniotic sac
2:Embryo
3:Uterine lining
4:Speculum
5:Vacurette
6:Attached to a suction pump

Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced abortion.[69]Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. These techniques can both be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.[67]

MVA, also known as "mini-suction" and "menstrual extraction" or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The World Health Organization recommends sharp curettage only when suction aspiration is unavailable.[70]

Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.[71]

Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.[72]

First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.[73]

Labor induction abortion

In places lacking the necessary medical skill for dilation and extraction, or where preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.[74] This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.[75]

Only limited data are available comparing this method with dilation and extraction.[75] Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.[75][76]

Other methods

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[77]: 44–47, 62–63, 154–55, 230–31 

In 1978 one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil.[78] Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as multiple organ failure,[79] such use is not recommended by physicians.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage.[80] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[81] One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.[81]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion is legal and available.[82]

Safety

A likely illegal abortion flyer in South Africa

The health risks of abortion depend principally upon whether the procedure is performed safely or unsafely. The World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.[83] Legal abortions performed in the developed world are among the safest procedures in medicine.[5][84] In the United States as of 2012, abortion was estimated to be about 14 times safer for women than childbirth.[10] CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,[85] while the US abortion mortality rate is 0.7 maternal deaths per 100,000 procedures.[6][86] In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term."[87] Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed [abortion] procedures constitute 13% of maternal mortality globally."[88] In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14-16 percent of maternal deaths resulted from abortion.[89]

In the US from 2000 to 2009, abortion had a lower mortality rate than plastic surgery, and a similar or lower mortality rate than running a marathon.[90] Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions.[91] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.[92] Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.[93]

There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation.[58] Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.[94][95]

Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.[96] Infections account for one-third of abortion-related deaths in the United States.[97] The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.[98] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures,[99] as they are believed to substantially reduce the risk of postoperative uterine infection;[73][100] however, antibiotics are not routinely given with abortion pills.[101] The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner.[102]

Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen.[103] The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period).[104][105] It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.[106][107]

Some purported risks of abortion are promoted primarily by anti-abortion groups,[108][109] but lack scientific support.[108] For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.[110]

In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record."[111]: 25  According to Rickie Solinger,

A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... [T]he historical evidence does not support such claims.[112]: 4 

Authors Jerome Bates and Edward Zawadzki describe the case of an illegal abortionist in the eastern U.S. in the early 20th century who was proud of having successfully completed 13,844 abortions without any fatality.[113]: 59  In 1870s New York City the famous abortionist/midwife Madame Restell (Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patients[114]—a lower mortality rate than the childbirth mortality rate at the time. In 1936 the prominent professor of obstetrics and gynecology Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that

With each decade of the past fifty years the actual and proportionate frequency of this accident [perforation of the uterus] has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus. [115]: 223 

Mental health

Main article: Abortion and mental health

Current evidence finds no relationship between most induced abortions and mental health problems[14][116] other than those expected for any unwanted pregnancy.[117] A report by the American Psychological Association concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain.[117][118] Some older reviews concluded that abortion was associated with an increased risk of psychological problems;[119] however, they did not use an appropriate control group.[116]

Although some studies show negative mental-health outcomes in women who choose abortions after the first trimester because of fetal abnormalities,[120] more rigorous research would be needed to show this conclusively.[121] Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome", but this is not recognized by medical or psychological professionals in the United States.[122]

A long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an abortion. Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later.[123]

Unsafe abortion

Main article: Unsafe abortion

Soviet poster circa 1925, warning against midwives performing abortions. Title translation: "Miscarriages induced by either grandma or self-taught midwives not only maim the woman, they also often lead to death."

Women seeking an abortion may use unsafe methods, especially when it is legally restricted. They may attempt self-induced abortion or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs.[124]

Unsafe abortions are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97% taking place in developing countries.[5] Unsafe abortions are believed to result in millions of injuries.[5][125] Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade;[5][15][126] deaths from unsafe abortion account for around 13% of all maternal deaths.[127] The World Health Organization believes that mortality has fallen since the 1990s.[128] To reduce the number of unsafe abortions, public health organizations have generally advocated emphasizing the legalization of abortion, training of medical personnel, and ensuring access to reproductive-health services.[129] In response, opponents of abortion point out that abortion bans in no way affect prenatal care for women who choose to carry their fetus to term. The Dublin Declaration on Maternal Health, signed in 2012, notes, "the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women."[130]

A major factor in whether abortions are performed safely or not is the legal standing of abortion. Countries with restrictive abortion laws have higher rates of unsafe abortion and similar overall abortion rates compared to those where abortion is legal and available.[15][19][129][131][132][133][134][excessive citations] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[135] with abortion-related deaths dropping by more than 90%.[136] Similar reductions in maternal mortality have been observed after other countries have liberalized their abortion laws, such as Romania and Nepal.[137] A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of abortion in that state.[138] The analysis, however, did not take into account travel to other states without such laws to obtain an abortion.[139] In addition, a lack of access to effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available globally.[140] Rates of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".[141][142]

Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits,[22] while an additional 35 percent have access to legal abortion if they meet certain physical, mental, or socioeconomic criteria.[25] While maternal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[15] Complications of unsafe abortion account for approximately an eighth of maternal mortalities worldwide,[143] though this varies by region.[144] Secondary infertility caused by an unsafe abortion affects an estimated 24 million women.[132] The rate of unsafe abortions has increased from 44% to 49% between 1995 and 2008.[19] Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.[145]

Incidence

There are two commonly used methods of measuring the incidence of abortion:

  • Abortion rate – number of abortions annually per 1000 women between 15 and 44 years of age[146] (some sources use a range of 15–49)
  • Abortion percentage – number of abortions out of 100 known pregnancies (pregnancies include live births, abortions and miscarriages)

In many places, where abortion is illegal or carries a heavy social stigma, medical reporting of abortion is not reliable.[131] For this reason, estimates of the incidence of abortion must be made without determining certainty related to standard error.[19]

The number of abortions performed worldwide seems to have remained stable in recent years, with 41.6 million having been performed in 2003 and 43.8 million having been performed in 2008.[19] The abortion rate worldwide was 28 per 1000 women per year, though it was 24 per 1000 women per year for developed countries and 29 per 1000 women per year for developing countries.[19] The same 2012 study indicated that in 2008, the estimated abortion percentage of known pregnancies was at 21% worldwide, with 26% in developed countries and 20% in developing countries.[19]

On average, the incidence of abortion is similar in countries with restrictive abortion laws and those with more liberal access to abortion.[147] However, restrictive abortion laws are associated with increases in the percentage of abortions performed unsafely.[22][148][147] The unsafe abortion rate in developing countries is partly attributable to lack of access to modern contraceptives; according to the Guttmacher Institute, providing access to contraceptives would result in about 14.5 million fewer unsafe abortions and 38,000 fewer deaths from unsafe abortion annually worldwide.[149]

The rate of legal, induced abortion varies extensively worldwide. According to the report of employees of Guttmacher Institute it ranged from 7 per 1000 women per year (Germany and Switzerland) to 30 per 1000 women per year (Estonia) in countries with complete statistics in 2008. The proportion of pregnancies that ended in induced abortion ranged from about 10% (Israel, the Netherlands and Switzerland) to 30% (Estonia) in the same group, though it might be as high as 36% in Hungary and Romania, whose statistics were deemed incomplete.[150][151]

An American study in 2002 concluded that about half of women having abortions were using a form of contraception at the time of becoming pregnant. Inconsistent use was reported by half of those using condoms and three-quarters of those using the birth control pill; 42% of those using condoms reported failure through slipping or breakage.[152] The Guttmacher Institute estimated that "most abortions in the United States are obtained by minority women" because minority women "have much higher rates of unintended pregnancy".[153]

The abortion rate may also be expressed as the average number of abortions a woman has during her reproductive years; this is referred to as total abortion rate (TAR).

Gestational age and method

Histogram of abortions by gestational age in England and Wales during 2019. (left) Abortion in the United States by gestational age, 2016. (right)

Abortion rates also vary depending on the stage of pregnancy and the method practiced. In 2003, the Centers for Disease Control and Prevention (CDC) reported that 26% of reported legal induced abortions in the United States were known to have been obtained at less than 6 weeks' gestation, 18% at 7 weeks, 15% at 8 weeks, 18% at 9 through 10 weeks, 10% at 11 through 12 weeks, 6% at 13 through 15 weeks, 4% at 16 through 20 weeks and 1% at more than 21 weeks. 91% of these were classified as having been done by "curettage" (suction-aspiration, dilation and curettage, dilation and evacuation), 8% by "medical" means (mifepristone), >1% by "intrauterine instillation" (saline or prostaglandin), and 1% by "other" (including hysterotomy and hysterectomy).[154] According to the CDC, due to data collection difficulties the data must be viewed as tentative and some fetal deaths reported beyond 20 weeks may be natural deaths erroneously classified as abortions if the removal of the dead fetus is accomplished by the same procedure as an induced abortion.[155]

The Guttmacher Institute estimated there were 2,200 intact dilation and extraction procedures in the US during 2000; this accounts for <0.2% of the total number of abortions performed that year.[156] Similarly, in England and Wales in 2006, 89% of terminations occurred at or under 12 weeks, 9% between 13 and 19 weeks, and 2% at or over 20 weeks. 64% of those reported were by vacuum aspiration, 6% by D&E, and 30% were medical.[157] There are more second trimester abortions in developing countries such as China, India and Vietnam than in developed countries.[158]

Motivation

Personal

A bar chart depicting selected data from a 1998 AGImeta-studyon the reasons women stated for having an abortion.

The reasons why women have abortions are diverse and vary across the world.[155][159] Some of the reasons may include an inability to afford a child, domestic violence, lack of support, feeling they are too young, and the wish to complete education or advance a career.[160] Additional reasons include not being able or willing to raise a child conceived as a result of rape or incest[159][161]

Societal

Some abortions are undergone as the result of societal pressures.[162] These might include the preference for children of a specific sex or race, disapproval of single or early motherhood, stigmatization of people with disabilities, insufficient economic support for families, lack of access to or rejection of contraceptive methods, or efforts toward population control (such as China's one-child policy). These factors can sometimes result in compulsory abortion or sex-selective abortion.[163]

Maternal and fetal health

An additional factor is maternal health which was listed as the main reason by about a third of women in 3 of 27 countries and about 7% of women in a further 7 of these 27 countries.[155][159]

In the U.S., the Supreme Court decisions in Roe v. Wade and Doe v. Bolton: "ruled that the state's interest in the life of the fetus became compelling only at the point of viability, defined as the point at which the fetus can survive independently of its mother. Even after the point of viability, the state cannot favor the life of the fetus over the life or health of the pregnant woman. Under the right of privacy, physicians must be free to use their "medical judgment for the preservation of the life or health of the mother." On the same day that the Court decided Roe, it also decided Doe v. Bolton, in which the Court defined health very broadly: "The medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman's age—relevant to the well-being of the patient. All these factors may relate to health. This allows the attending physician the room he needs to make his best medical judgment."[164]: 1200–01 

Public opinion shifted in America following television personality Sherri Finkbine's discovery during her fifth month of pregnancy that she had been exposed to thalidomide. Unable to obtain a legal abortion in the United States, she traveled to Sweden. From 1962 to 1965, an outbreak of German measles left 15,000 babies with severe birth defects. In 1967, the American Medical Association publicly supported liberalization of abortion laws. A National Opinion Research Center poll in 1965 showed 73% supported abortion when the mother's life was at risk, 57% when birth defects were present and 59% for pregnancies resulting from rape or incest.

Cancer

The rate of cancer during pregnancy is 0.02–1%, and in many cases, cancer of the mother leads to consideration of abortion to protect the life of the mother, or in response to the potential damage that may occur to the fetus during treatment. This is particularly true for cervical cancer, the most common type of which occurs in 1 of every 2,000–13,000 pregnancies, for which initiation of treatment "cannot co-exist with preservation of fetal life (unless neoadjuvant chemotherapy is chosen)". Very early stage cervical cancers (I and IIa) may be treated by radical hysterectomy and pelvic lymph node dissection, radiation therapy, or both, while later stages are treated by radiotherapy. Chemotherapy may be used simultaneously. Treatment of breast cancer during pregnancy also involves fetal considerations, because lumpectomy is discouraged in favor of modified radical mastectomy unless late-term pregnancy allows follow-up radiation therapy to be administered after the birth.[166]

Exposure to a single chemotherapy drug is estimated to cause a 7.5–17% risk of teratogenic effects on the fetus, with higher risks for multiple drug treatments. Treatment with more than 40 Gy of radiation usually causes spontaneous abortion. Exposure to much lower doses during the first trimester, especially 8 to 15 weeks of development, can cause intellectual disability or microcephaly, and exposure at this or subsequent stages can cause reduced intrauterine growth and birth weight. Exposures above 0.005–0.025 Gy cause a dose-dependent reduction in IQ.[166] It is possible to greatly reduce exposure to radiation with abdominal shielding, depending on how far the area to be irradiated is from the fetus.[167][168]

The process of birth itself may also put the mother at risk. "Vaginal delivery may result in dissemination of neoplastic cells into lymphovascular channels, haemorrhage, cervical laceration and implantation of malignant cells in the episiotomy site, while abdominal delivery may delay the initiation of non-surgical treatment."[169]

History and religion

Main articles: History of abortion and Religion and abortion

"French Periodical Pills". An example of a clandestine advertisement published in a January 1845 edition of the Boston Daily Times.

Since ancient times abortions have been done using a number of methods, including herbal medicines, sharp tools, with force, or through other traditional methods.[24] Induced abortion has a long history and can be traced back to civilizations as varied as ancient China (abortifacient knowledge is often attributed to the mythological ruler Shennong),[171]ancient India since its Vedic age,[172]ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE).[24] One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.[81]

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions;[24] other scholars disagree with this interpretation,[24] and state that the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath.[173] The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus, although apparently not all doctors adhered to it strictly at the time. According to Soranus' 1st or 2nd century CE work Gynaecology, one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party—to which he belonged—was willing to prescribe abortions, but only for the sake of the mother's health.[174][175]Aristotle, in his treatise on government Politics (350 BCE), condemns infanticide as a means of population control. He preferred abortion in such cases, with the restriction[176] "[that it] must be practised on it before it has developed sensation and life; for the line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive".[177]

In Christianity, Pope Sixtus V (1585–90) was the first Pope before 1869 to declare that abortion is homicide regardless of the stage of pregnancy;[178] and his pronouncement of 1588 was reversed three years later by Pope Gregory XIV.[179] Through most of its history the Catholic Church was divided on whether it believed that early abortion was murder, and it did not begin vigorously opposing abortion until the 19th century.[24] Several historians have written that prior to the 19th century most Catholic authors did not regard termination of pregnancy before "quickening" or "ensoulment" as an abortion.[180][181][182] From 1750, excommunication became the punishment for abortions.[183] Statements made in 1992 in the Catechism of the Catholic Church, the codified summary of the Church's teachings, opposed abortion.[184]

A 2014 Guttmacher survey of US abortion patients found that many reported a religious affiliation—24% were Catholic while 30% were Protestant.[185] A 1995 survey reported that Catholic women are as likely as the general population to terminate a pregnancy, Protestants are less likely to do so, and Evangelical Christians are the least likely to do so.[155][159]Islamic tradition has traditionally permitted abortion until a point in time when Muslims believe the soul enters the fetus,[24] considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening.[186] However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.[187]

In Europe and North America, abortion techniques advanced starting in the 17th century. However, conservatism by most physicians with regards to sexual matters prevented the wide expansion of safe abortion techniques.[24] Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice (sometimes called restellism)[188] was banned in both the United States and the United Kingdom.[24] Church groups as well as physicians were highly influential in anti-abortion movements.[24] In the US, according to some sources, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer.[note 2] However, other sources maintain that in the 19th century early abortions under the hygienic conditions in which midwives usually worked were relatively safe.[189][190][191] In addition, some commentators have written that, despite improved medical procedures, the period from the 1930s until legalization also saw more zealous enforcement of anti-abortion laws, and concomitantly an increasing control of abortion providers by organized crime.[192][193][194][195][196]

Soviet Russia (1919), Iceland (1935), and Sweden (1938) were among the first countries to legalize certain or all forms of abortion.[197] In 1935, Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions.[198] Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries.[24]

Society and culture

Abortion debate

Main article: Abortion debate

Induced abortion has long been the source of considerable debate. Ethical, moral, philosophical, biological, religious and legal issues surrounding abortion are related to value systems. Opinions of abortion may be about fetal rights, governmental authority, and women's rights.

In both public and private debate, arguments presented in favor of or against abortion access focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion.[199] The World Medical Association Declaration on Therapeutic Abortion notes, "circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question as to whether or not the pregnancy should be deliberately terminated."[200] Abortion debates, especially pertaining to abortion laws, are often spearheaded by groups advocating one of these two positions. Groups who favor greater legal restrictions on abortion, including complete prohibition, most often describe themselves as "pro-life" while groups who are against such legal restrictions describe themselves as "pro-choice".[201] Generally, the former position argues that a human fetus is a human person with a right to live, making abortion morally the same as murder. The latter position argues that a woman has certain reproductive rights, especially the right to decide whether or not to carry a pregnancy to term.

Modern abortion law

Main article: Abortion law

See also: History of abortion law debate

Legal grounds for abortionby country[202]
 Legal or without punishment on woman's request
Legally restricted to cases of:
 Risk to woman's life, her health*, rape*, fetal impairment*, or socioeconomic factors
 Risk to woman's life, her health*, rape, or fetal impairment
 Risk to woman's life, her health*, or fetal impairment
 Risk to woman's life*, her health*, or rape
 Risk to woman's life or her health
 Risk to woman's life
 Illegal with no exceptions
 No information
* Does not apply to some countries in that category

Current laws pertaining to abortion are diverse. Religious, moral, and cultural factors continue to influence abortion laws throughout the world. The right to life, the right to liberty, the right to security of person, and the right to reproductive health are major issues of human rights that sometimes constitute the basis for the existence or absence of abortion laws.

In jurisdictions where abortion is legal, certain requirements must often be met before a woman may obtain a safe, legal abortion (an abortion performed without the woman's consent is considered feticide). These requirements usually depend on the age of the fetus, often using a trimester-based system to regulate the window of legality, or as in the U.S., on a doctor's evaluation of the fetus' viability. Some jurisdictions require a waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion.[203] Other jurisdictions may require that a woman obtain the consent of the fetus' father before aborting the fetus, that abortion providers inform women of health risks of the procedure—sometimes including "risks" not supported by the medical literature—and that multiple medical authorities certify that the abortion is either medically or socially necessary. Many restrictions are waived in emergency situations. China, which has ended their[204]one-child policy, and now has a two child policy,[205][206] has at times incorporated mandatory abortions as part of their population control strategy.[207]

Other jurisdictions ban abortion almost entirely. Many, but not all, of these allow legal abortions in a variety of circumstances. These circumstances vary based on jurisdiction, but may include whether the pregnancy is a result of rape or incest, the fetus' development is impaired, the woman's physical or mental well-being is endangered, or socioeconomic considerations make childbirth a hardship.[25] In countries where abortion is banned entirely, such as Nicaragua, medical authorities have recorded rises in maternal death directly and indirectly due to pregnancy as well as deaths due to doctors' fears of prosecution if they treat other gynecological emergencies.[208][209] Some countries, such as Bangladesh, that nominally ban abortion, may also support clinics that perform abortions under the guise of menstrual hygiene.[210] This is also a terminology in traditional medicine.[211] In places where abortion is illegal or carries heavy social stigma, pregnant women may engage in medical tourism and travel to countries where they can terminate their pregnancies.[212] Women without the means to travel can resort to providers of illegal abortions or attempt to perform an abortion by themselves.[213]

The organization Women on Waves has been providing education about medical abortions since 1999. The NGO created a mobile medical clinic inside a shipping container, which then travels on rented ships to countries with restrictive abortion laws. Because the ships are registered in the Netherlands, Dutch law prevails when the ship is in international waters. While in port, the organization provides free workshops and education; while in international waters, medical personnel are legally able to prescribe medical abortion drugs and counseling.[214][215][216]

Sex-selective abortion

Main article: Sex-selective abortion

Sonography and amniocentesis allow parents to determine sex before childbirth. The development of this technology has led to sex-selective abortion, or the termination of a fetus based on its sex. The selective termination of a female fetus is most common.

Sex-selective abortion is partially responsible for the noticeable disparities between the birth rates of male and female children in some countries. The preference for male children is reported in many areas of Asia, and abortion used to limit female births has been reported in Taiwan, South Korea, India, and China.[217] This deviation from the standard birth rates of males and females occurs despite the fact that the country in question may have officially banned sex-selective abortion or even sex-screening.[218][219][220][221] In China, a historical preference for a male child has been exacerbated by the one-child policy, which was enacted in 1979.[222]

Many countries have taken legislative steps to reduce the incidence of sex-selective abortion. At the International Conference on Population and Development in 1994 over 180 states agreed to eliminate "all forms of discrimination against the girl child and the root causes of son preference",[223] conditions also condemned by a PACE resolution in 2011.[224] The World Health Organization and UNICEF, along with other United Nations agencies, have found that measures to reduce access to abortion are much less effective at reducing sex-selective abortions than measures to reduce gender inequality.[223]

Anti-abortion violence

Main article: Anti-abortion violence

In a number of cases, abortion providers and these facilities have been subjected to various forms of violence, including murder, attempted murder, kidnapping, stalking, assault, arson, and bombing. Anti-abortion violence is classified by both governmental and scholarly sources as terrorism.[225][226] In the U.S. and Canada, over 8,000 incidents of violence, trespassing, and death threats have been recorded by providers since 1977, including over 200 bombings/arsons and hundreds of assaults.[227] The majority of abortion opponents have not been involved in violent acts.

In the United States, four physicians who performed abortions have been murdered: David Gunn (1993), John Britton (1994), Barnett Slepian (1998), and George Tiller (2009). Also murdered, in the U.S. and Australia, have been other personnel at abortion clinics, including receptionists and security guards such as James Barrett, Shannon Lowney, Lee Ann Nichols, and Robert Sanderson. Woundings (e.g., Garson Romalis) and attempted murders have also taken place in the United States and Canada. Hundreds of bombings, arsons, acid attacks, invasions, and incidents of vandalism against abortion providers have occurred.[228][229] Notable perpetrators of anti-abortion violence include Eric Robert Rudolph, Scott Roeder, Shelley Shannon, and Paul Jennings Hill, the first person to be executed in the United States for murdering an abortion provider.[230]

Legal protection of access to abortion has been brought into some countries where abortion is legal. These laws typically seek to protect abortion clinics from obstruction, vandalism, picketing, and other actions, or to protect women and employees of such facilities from threats and harassment.

Far more common than physical violence is psychological pressure. In 2003, Chris Danze organized anti-abortion organizations throughout Texas to prevent the construction of a Planned Parenthood facility in Austin. The organizations released the personal information online, of those involved with construction, sending them up to 1200 phone calls a day and contacting their churches.[231] Some protestors record women entering clinics on camera.[231]

Non-human Examples

Further information: Miscarriage

Spontaneous abortion occurs in various animals. For example, in sheep it may be caused by stress or physical exertion, such as crowding through doors or being chased by dogs.[232] In cows, abortion may be caused by contagious disease, such as brucellosis or Campylobacter, but can often be controlled by vaccination.[233] Eating pine needles can also induce abortions in cows.[234][235] Several plants, including broomweed, skunk cabbage, poison hemlock, and tree tobacco, are known to cause fetal deformities and abortion in cattle[236]: 45–46  and in sheep and goats.[236]: 77–80  In horses, a fetus may be aborted or resorbed if it has lethal white syndrome (congenital intestinal aganglionosis). Foal embryos that are homozygous for the dominant white gene (WW) are theorized to also be aborted or resorbed before birth.[237] In many species of sharks and rays, stress-induced abortions occur frequently on capture.[238]

Viral infection can cause abortion in dogs.[239] Cats can experience spontaneous abortion for many reasons, including hormonal imbalance. A combined abortion and spaying is performed on pregnant cats, especially in trap–neuter–return programs, to prevent unwanted kittens from being born.[240][241][242] Female rodents may terminate a pregnancy when exposed to the smell of a male not responsible for the pregnancy, known as the Bruce effect.[243]

Abortion may also be induced in animals, in the context of animal husbandry. For example, abortion may be induced in mares that have been mated improperly, or that have been purchased by owners who did not realize the mares were pregnant, or that are pregnant with twin foals.[244] Feticide can occur in horses and zebras due to male harassment of pregnant mares or forced copulation,[245][246][247] although the frequency in the wild has been questioned.[248] Male gray langur monkeys may attack females following male takeover, causing miscarriage.[249]

Notes

  1. ^Definitions of abortion, as with many words, vary from source to source. Language used to define abortion often reflects societal and political opinions (not only scientific knowledge). For a list of definitions as stated by obstetrics and gynecology (OB/GYN) textbooks, dictionaries, and other sources, please see Definitions of abortion.
  2. ^By 1930, medical procedures in the US had improved for both childbirth and abortion but not equally, and induced abortion in the first trimester had become safer than childbirth. In 1973, Roe v. Wade acknowledged that abortion in the first trimester was safer than childbirth:

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  24. ^ abcdefghijkPaul, M; Lichtenberg, ES; Borgatta, L; Grimes, DA; Stubblefield, PG; Creinin, MD; Joffe, Carole (2009). "1. Abortion and medicine: A sociopolitical history"(PDF). Management of Unintended and Abnormal Pregnancy (1st ed.). Oxford: John Wiley & Sons. ISBN . OL 15895486W. Archived(PDF) from the original on 19 January 2012.
  25. ^ abcBoland, R.; Katzive, L. (2008). "Developments in Laws on Induced Abortion: 1998–2007". International Family Planning Perspectives. 34 (3): 110–20. doi:10.1363/3411008. PMID 18957353. Archived from the original on 7 October 2011.
  26. ^Paola, Adolf; Walker, Robert; LaCivita, Lois (2010). Nixon, Frederick (ed.). Medical ethics and humanities. Sudbury, MA: Jones and Bartlett Publishers. p. 249. ISBN . OL 13764930W. Archived from the original on 6 September 2017.
  27. ^Johnstone, Megan-Jane (2009). Bioethics a nursing perspective. Confederation of Australian Critical Care Nurses Journal. 3 (5th ed.). Sydney, NSW: Churchill Livingstone/Elsevier. pp. 24–30. ISBN . PMID 2129925. Archived from the original on 6 September 2017.
  28. ^Mark Driscoll (18 October 2013). "What do 55 million people have in common?". Fox News. Archived from the original on 31 August 2014. Retrieved 2 July 2014.
  29. ^Hansen, Dale (18 March 2014). "Abortion: Murder, or Medical Procedure?". The Huffington Post. Archived from the original on 14 July 2014. Retrieved 2 July 2014.
  30. ^Sifris, Ronli Noa (2013). Reproductive freedom, torture and international human rights: challenging the masculinisation of torture. Hoboken, NJ: Taylor & Francis. p. 3. ISBN . OCLC 869373168. Archived from the original on 15 October 2015.
  31. ^Swett, C. (2007). Unsafe abortion : global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003 (5th ed.). World Health Organization. ISBN . Archived from the original on 7 April 2018. Retrieved 24 March 2018.
  32. ^Cheng L. (1 November 2008). "Surgical versus medical methods for second-trimester induced abortion". The WHO Reproductive Health Library. World Health Organization. Archived from the original on 1 August 2010. Retrieved 17 June 2011.
  33. ^Bankole; et al. (1998). "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries". International Family Planning Perspectives. 24 (3): 117–27, 152. doi:10.2307/3038208. JSTOR 3038208. Archived from the original on 17 January 2006.
  34. ^Finer, Lawrence B.; Frohwirth, Lori F.; Dauphinee, Lindsay A.; Singh, Susheela; Moore, Ann M. (2005). "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives"(PDF). Perspectives on Sexual and Reproductive Health. 37 (3): 110–18. doi:10.1111/j.1931-2393.2005.tb00045.x. PMID 16150658. Archived(PDF) from the original on 17 January 2006.
  35. ^Stubblefield, Phillip G. (2002). "10. Family Planning". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN .
Sours: https://en.wikipedia.org/wiki/Abortion
  1. Cabins in brighton
  2. Fake bull rings
  3. Proverbio de hoy
  4. Caterpillar cutting edges
  5. Cheap naruto posters

Unsafe abortion

Sovietposter circa 1925. Title translation: "Abortions induced by grandma or self-taught midwivesnot only maim the woman, they also often lead to death"

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both.[1] An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention.[2] About 25 million unsafe abortions occur a year, of which most occur in the developing world.[3]

Unsafe abortions result in complications for about 7 million women a year.[3] Unsafe abortions are also one of the leading causes of deaths during pregnancy and childbirth (about 5-13% of all deaths during this period).[3] Most unsafe abortions occur where abortion is illegal,[4] or in developing countries where affordable and well-trained medical practitioners are not readily available,[5][6] or where modern birth control is unavailable.[7]

Unsafe abortion was and is a public health crisis.[8] More specifically, lack of access to safe abortion was and is a public health risk.[8] The more restrictive the law, the higher the rates of death and other complications.[8]

Overview[edit]

The World Health Organization (WHO) estimated that for the time period of 2010-14 there were 55.7 million abortions worldwide each year. Out of these abortions, approximately 54% were safe, 31% were less safe, and 14% were least safe. That means that 25 million (45%) abortions each year between 2010 and 2014 were unsafe, with 24 million (97%) of these in developing countries.[9] In 2003 approximately 42 million pregnancies were voluntarily terminated, of which 20 million were unsafe.[10] According to WHO and the Guttmacher Institute, at least 22,800[11] women die annually as a result of complications of unsafe abortion, and between two million and seven million women each year survive unsafe abortion but sustain long-term damage or disease (incomplete abortion, infection, sepsis, bleeding, and injury to the internal organs, such as puncturing or tearing of the uterus). They also concluded abortion is safer in countries where it is legal, but dangerous in countries where it is outlawed and performed clandestinely. The WHO reports that in developed regions, nearly all abortions (92%) are safe, whereas in developing countries, more than half (55%) are unsafe. According to WHO statistics, the risk rate for unsafe abortion is 1/270; according to other sources, unsafe abortion is responsible for at least 8% of maternal deaths.[12][11] Worldwide, 48% of all induced abortions are unsafe. The British Medical Bulletin reported in 2003 that 70,000 women a year die from unsafe abortion.[13] Incidence of such abortions may be difficult to measure because they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".[14][15]

An article pre-printed by the WHO called safe, legal abortion a "fundamental right of women, irrespective of where they live" and unsafe abortion a "silent pandemic".[14] The article states "ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative." It also states "access to safe abortion improves women’s health, and vice versa, as documented in Romania during the regime of President Nicolae Ceaușescu" and "legalisation of abortion on request is a necessary but insufficient step toward improving women’s health" citing that in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. WHO’s Global Strategy on Reproductive Health, adopted by the World Health Assembly in May 2004, noted: "As a preventable cause of maternal mortality and morbidity, unsafe abortion must be dealt with as part of the MDG on improving maternal health and other international development goals and targets."[16] The WHO's Development and Research Training in Human Reproduction (HRP), whose research concerns people's sexual and reproductive health and lives,[17] has an overall strategy to combat unsafe abortion that comprises four interrelated activities:[16]

  • to collate, synthesize and generate scientifically sound evidence on unsafe abortion prevalence and practices;
  • to develop improved technologies and implement interventions to make abortion safer;
  • to translate evidence into norms, tools and guidelines;
  • and to assist in the development of programmes and policies that reduce unsafe abortion and improve access to safe abortion and highquality postabortion care.

A 2007 study published in The Lancet found that, although the global rate of abortion declined from 45.6 million in 1995 to 41.6 million in 2003, unsafe procedures still accounted for 48% of all abortions performed in 2003. It also concluded that, while the overall incidence of abortion in both developed and developing countries is approximately equal, unsafe abortion occurs more often in less-developed nations.[18]

According to a new study in The Lancet that focused on data from 2010 to 2014, nearly 55 million pregnancies are terminated early and of that 55 million, nearly half, 25.5 million are deemed as unsafe.[19] The WHO and the Guttmacher Institute stress the need for access to a safe abortion for all women and that unsafe methods must be replaced. Africa, Asia and Latin America account for almost 97 percent of them of unsafe abortions. These regions are often poorer and underdeveloped and lack the access to safe abortion methods. Out of all abortions in these regions only 25% are considered safe. In developed countries these numbers improve drastically. Nearly all abortions in North America (99%) are considered safe. Overall nearly 88% of abortions in developed countries were actually considered safe, with the number of safe abortions in Europe slightly lower.

Conflating illegal and unsafe abortion[edit]

Unsafe abortions often occur where abortion is illegal.[4] However, the prevalence of unsafe abortion may also be determined by other factors, such as whether it occurs in a developing country that has a low level of competent medical care.[20]

Unsafe abortions sometimes occur where abortion is legal, and safe abortions sometimes occur where abortion is illegal.[21] Legalization is not always followed by elimination of unsafe abortion.[5][22] Affordable safe services may be unavailable despite legality, and conversely, women may be able to afford medically competent services despite illegality.[23]

When abortion is illegal, that generally contributes to the prevalence of unsafe abortion, but it is not the only contributor. In addition, a lack of access to safe and effective contraception contributes to unsafe abortion. It has been estimated that the incidence of unsafe abortion could be reduced by as much as 73% without any change in abortion laws if modern family planning and maternal health services were readily available globally.[7]

Illegality of abortion contributes to maternal mortality, but that contribution is not as great as it once was, due to medical advances including penicillin and the birth control pill.[24]

Frequency by continent[edit]

RegionNumber of unsafe abortions (thousands)Number of unsafe abortions per 100 live birthsNumber of unsafe abortions per 1000 women
Africa 4200 14 24
Asia* 10500 14 13
Europe 500 7 3
Latin America and the Caribbean 3700 32 29
North America Negligible incidence Negligible incidence Negligible incidence
Oceania ** 30 12 17
World190001414
* Excluding Japan
** Excluding Australia and New Zealand

Source: WHO 2006[25]

Abortion in the U.S. before 1973 (Roe v. Wade)[edit]

In 1973, the Supreme Court ruled 7–2 that laws prohibiting an abortion violated a woman’s right to privacy. The landmark case, Roe v. Wade, changed abortion in the United States.

Early abortion laws really only prohibited the use of toxic chemicals that were used to cause a miscarriage. The first such law was passed in Connecticut in 1821.[26]

Prior to 1973, the authority to legalize abortion rested with the state governments. Up through the 1960s 44 states had laws that outlawed abortions unless the health of the pregnant patient was at stake.[27]

In the 1940s, records show that more than 1,000 women died each year from abortions that were labeled as unsafe. Many of these abortions were self-induced. Unsafe abortion practices were such a concern in the United States that nearly every large hospital had some type of “septic abortion ward” that was responsible for dealing with the complications that accompanied an incomplete abortion. Incomplete abortions were the leading cause for OB-GYN services across the United States. In the 1960s, the National Opinion Research Center found that hundreds of women were attempting to self-abort with coat hangers, knitting needles and ballpoint pens, and by swallowing toxic chemicals like bleach and laundry detergent.[28] However, the number of deaths declined significantly into the 1960s and 1970s. The Centers for Disease Control and Prevention estimates that in 1972, 130,000 women attempted self-induced abortions or obtained illegal abortions, resulting in 39 deaths.[29]

Rates in the U.S. after 1973[edit]

In 2005, the Detroit News reported that a 16-year-old boy beat his pregnant, under-age girlfriend with a bat at her request to abort a fetus. The young couple lived in Michigan, where parental consent is required to receive an abortion.[30][31][32] In Indiana, where there are also parental consent laws, a girl by the name of Becky Bell died from an unsafe abortion rather than discuss her pregnancy and wish for an abortion with her parents.[33][34]

In 2011, Kermit Gosnell, a licensed doctor who provided abortion services in the American state of Pennsylvania, was indicted by a grand jury on murder charges after a woman died in his clinic. The grand jury found that the conditions in Gosnell's clinic were not only unsanitary and that Gosnell staffed his clinic with unlicensed individuals, he had also commonly conducted the lesser known practice of severing the spinal cords of newly born babies.[35]

Methods[edit]

Methods of unsafe abortion include:

  • Trying to break the amniotic sac inside the womb with a sharp object or wire (for example an unbent wire clothes hanger or knitting needle). This method can cause infection or injury to internal organs (for example perforating the uterus or intestines), resulting in death.[36] The uterus softens during pregnancy and is very easy to pierce, so one traditional method was to use a large feather.[37]
  • Pumping toxic mixtures, such as chili peppers and chemicals like alum, Lysol, permanganate, or plant poison into the body of the woman. This method can cause the woman to go into toxic shock and die.[38]
  • Inducing an abortion without medical supervision by self-administering abortifacient over-the-counter drugs or drugs obtained illegally or by using drugs not indicated for abortion but known to result in miscarriage or uterine contraction. Drugs that cause uterine contractions include oxytocin (synthetic forms are Pitocin and Syntocinon), prostaglandins, and ergot alkaloids. Risks include uterine rupture, irregular heartbeat, a rise in blood pressure (hypertension), a drop in blood pressure (hypotension), anemia requiring transfusion, cardiovascular problems, pulmonary edema, and death, as well as intense bronchospasms in women with asthma.[39]

Health risks[edit]

Unsafe abortion is a major cause of injury and death among women worldwide. It is estimated that nearly 25 million unsafe abortions take place annually.[40] WHO estimates that at least 7.9% of maternal deaths are due to unsafe abortion, with a greater proportion occurring in Latin America, the Caribbean, and sub-Saharan Africa and a lesser proportion in East Asia were access to abortion is generally legal.[41] 97% of these abortions take place in developing countries.[42] Unsafe abortion is believed to result in at least 22,800 deaths and millions of injuries annually.[42] The legal status of abortion is believed to play a major role in the frequency of unsafe abortion.[43][44] For example, the 1996 legalization of abortion in South Africa had an immediate positive impact on the frequency of abortion-related complications,[45] with abortion-related deaths dropping by more than 90%.[46] Groups such as the World Health Organization have advocated a public-health approach to addressing unsafe abortion, emphasizing the legalization of abortion, the training of medical personnel, and ensuring access to reproductive-health services.[44]

An unsafe abortion can lead to wide range of health risks that can affect the well-being of women. The major and most life-threatening complications that stem from unsafe abortions are infection, hemorrhaging and injury to internal organs.[47]

Abortion symptoms that can lead to additional health risks:

  • To provide the necessary treatment, an accurate assessment of an unsafe abortion is critical. Some signs and symptoms that require immediate attention by a licensed health care provider include: abdominal pain, vaginal infection, abnormal vaginal bleeding, shock (collapse of the circulatory system).[47]
  • It is difficult to diagnose complications that result from an unsafe abortion. A woman with an extra-uterine or ectopic pregnancy may have symptoms similar to those of incomplete abortion. Therefore, it is important for health care providers to refer individuals they are unsure about to a facility where a definitive diagnosis can be made and care can be provided.[48]

Complications and their treatments include:

  • Infection: antibiotics prescribed by a health care provider and removing tissue from the affected area.
  • Hemorrhage: swift treatment by a health care provider is imperative, as delays can be fatal.

Damage to the genital tract or internal organs: Admission to a health care facility is imperative, any delay can be fatal.[49]

Treatment of complications[edit]

Regardless if an abortion was legal or illegal, health care providers are required by law to provide medical care to patients, as it may be life-saving. In some cases, treatment for abortion complications may be administered only when the woman provides information about the abortion and any and all persons that were involved.[50]

It is difficult to get a confession from women seeking emergency medical care as a result of an illegal abortion because it puts women's lives at risk. However, it is a legal requirement for doctors to report cases of women who have undergone any type of abortion. Any delay in care increases the risks to women’s health and lives.[50]

See also[edit]

References[edit]

  1. ^Safe Abortion: Technical and Policy Guidance for Health Systems, page 12 (World Health Organization 2003): "a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skill or in an environment lacking the minimum medical standards, or both."
  2. ^"Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003"(PDF). World Health Organization. 2007. Retrieved March 7, 2011.
  3. ^ abc"Preventing unsafe abortion". www.who.int. Retrieved 19 April 2019.
  4. ^ abRosenthal, Elisabeth (October 2007). "Legal or Not, Abortion Rates Compare". New York Times. Retrieved 2009-06-30.
  5. ^ abBlas, Erik et al. Equity, social determinants and public health programmes, pages 182-183 (World Health Organization 2010).
  6. ^Chaudhuri, S.K. Practice Of Fertility Control: A Comprehensive Manual, 7th Edition, page 259 (Elsevier India, 2007).
  7. ^ abSingh, Susheela et al. Adding it Up: The Costs and Benefits of Investing in Family Planning and Newborn Health (New York: Guttmacher Institute and United Nations Population Fund 2009): "If women’s contraceptive needs were addressed...the number of unsafe abortions would decline by 73% from 20 million to 5.5 million." A few of the findings in that report were subsequently changed, and are available at: "Facts on Investing in Family Planning and Maternal and Newborn HealthArchived 2012-03-24 at the Wayback Machine" (Guttmacher Institute 2010).
  8. ^ abcHaddad LB, Nour NM (2009). "Unsafe abortion: unnecessary maternal mortality". Reviews in Obstetrics & Gynecology. 2 (2): 122–6. PMC 2709326. PMID 19609407.
  9. ^Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z, Alkema L (November 2017). "Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model". Lancet. 390 (10110): 2372–2381. doi:10.1016/S0140-6736(17)31794-4. PMC 5711001. PMID 28964589.
  10. ^"Unsafe abortion Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008, pg2" (World Health Organization 2011): "It was estimated that in 2003 approximately 42 million pregnancies were voluntarily terminated: 22 million safely and 20 million unsafely."
  11. ^ ab"Induced Abortion Worldwide". Guttmacher Institute. 2016-05-10. Retrieved 2018-03-08.
  12. ^Nour NM (2008). "An Introduction to Maternal Mortality". Reviews in Obstetrics & Gynecology. 1 (2): 77–81. PMC 2505173. PMID 18769668.
  13. ^Grimes, David A. (2003-12-01). "Unsafe Abortion: The Silent Scourge". British Medical Bulletin. 67 (1): 99–113. doi:10.1093/bmb/ldg002. PMID 14711757.
  14. ^ abGrimes, David. "Unsafe Abortion - The Preventable Pandemic*". Retrieved 2010-01-16.
  15. ^Nations MK, Misago C, Fonseca W, Correia LL, Campbell OM (June 1997). "Women's hidden transcripts about abortion in Brazil". Social Science & Medicine. 44 (12): 1833–45. doi:10.1016/s0277-9536(96)00293-6. PMID 9194245.
  16. ^ ab"Preventing unsafe abortion". WHO. Retrieved 2014-03-28.
  17. ^"New findings from the WHO Multicountry Survey on Maternal and Newborn Health". WHO. Retrieved 2014-03-28.
  18. ^Sedgh G, Henshaw S, Singh S, Ahman E, Shah IH (October 2007). "Induced abortion: estimated rates and trends worldwide". Lancet. 370 (9595): 1338–45. CiteSeerX 10.1.1.454.4197. doi:10.1016/S0140-6736(07)61575-X. PMID 17933648. S2CID 28458527.
  19. ^Welch, A. (2017, September 27). Report finds nearly half of all abortions worldwide are unsafe. Retrieved December 05, 2017, from https://www.cbsnews.com/news/report-finds-nearly-half-of-all-abortions-worldwide-are-unsafe/
  20. ^Chaudhuri, S.K. Practice Of Fertility Control: A Comprehensive Manual, 7th Edition, page 259 (Elsevier India, 2007).
  21. ^Faúndes, Aníbal and Barzelatto, José. The Human Drama of Abortion: a Global Search for Consensus, page 21 (Vanderbilt University Press 2006).
  22. ^"Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003"(PDF). World Health Organization. 2007. Retrieved March 7, 2011.
  23. ^Safe Abortion: Technical and Policy Guidance for Health Systems, page 15 (World Health Organization 2003).
  24. ^"Abortion Distortions: Senators from both sides make false claims about Roe v. Wade". August 22, 2005. Archived from the original on July 26, 2011. Retrieved February 20, 2021.
  25. ^WHO pre-print copy of Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH (November 2006). "Unsafe abortion: the preventable pandemic". Lancet. 368 (9550): 1908–19. doi:10.1016/s0140-6736(06)69481-6. PMID 17126724. S2CID 6188636.
  26. ^Wilson, Jacque (January 22, 2013). "Before and after Roe v. Wade". CNN. Retrieved December 7, 2017.
  27. ^Kliff, Sarah (January 22, 2013). "CHARTS: How Roe v. Wade changed abortion rights". Retrieved December 7, 2017.
  28. ^Culp-Ressler, Tara. "What Americans Have Forgotten About The Era Before Roe v. Wade". ThinkProgress. Retrieved February 20, 2021.
  29. ^"Lessons from Before Roe: Will Past be Prologue?". 22 September 2004.
  30. ^Cardenas, Edward; Hunter, George (5 January 2005). "Boy Faces Felony in Baseball Bat Abortion". Detroit News.
  31. ^White, Pamela (January 13–21, 2005). "Baseball Bat Abortion". Boulder Weekly. Retrieved 2009-05-31.
  32. ^"Michigan: Restrictions on Young Women's Access to Abortion". NARAL Pro-Choice America. Retrieved 2009-05-31.[dead link]
  33. ^"DEMOCRACY NOW!". January 22, 2003. Archived from the original on August 9, 2011. Retrieved February 20, 2021.
  34. ^Platner, Jon (2006-09-15). "Remembering Becky Bell". Planned Parenthood Golden Gate. Retrieved 2009-05-31.
  35. ^"Investigation of the Women's Medical Society Grand Jury Report". Archived from the original on July 10, 2017. Retrieved February 20, 2021.
  36. ^Soubiran, Andre (1969). Diary of a Woman in White (English ed.). Avon Books. pp. 98–99. citing Henri Modnor (1935). Fatal Abortions.
  37. ^Avery, Martin (1939). "My Family Speaks". Confessions of an Abortionist: Intimate Sidelights on the Secret Human, Sorrow, Drama and Tragedy in the Experience of a Doctor Whose Profession it is to Perform Illegal Operations (First ed.). Haldeman-Julius Company.. Accessed 14 December 2012.
  38. ^Walker, Andrew (April 7, 2008). "Saving Nigerians from risky abortions". BBC News. Retrieved February 20, 2021.
  39. ^"Uterine stimulants". Encyclopedia of Surgery. Retrieved February 20, 2021.
  40. ^Ganatra B, Gerdts C, Rossier C, Johnson Jr B R, Tuncalp Ö, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z, Alkema L. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017 Sep
  41. ^Say, L; Chou, D; Gemmill, A; Tunçalp, Ö; Moller, AB; Daniels, J; Gülmezoglu, AM; Temmerman, M; Alkema, L (June 2014). "Global causes of maternal death: a WHO systematic analysis". The Lancet. Global Health. 2 (6): e323-33. doi:10.1016/S2214-109X(14)70227-X. PMID 25103301.
  42. ^ abGrimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah IH (November 2006). "Unsafe abortion: the preventable pandemic"(PDF). Lancet. 368 (9550): 1908–19. doi:10.1016/S0140-6736(06)69481-6. PMID 17126724. S2CID 6188636.
  43. ^Berer M (November 2004). "National laws and unsafe abortion: the parameters of change". Reproductive Health Matters. 12 (24 Suppl): 1–8. doi:10.1016/S0968-8080(04)24024-1. PMID 15938152. S2CID 33795725.
  44. ^ abBerer M (2000). "Making abortions safe: a matter of good public health policy and practice". Bulletin of the World Health Organization. 78 (5): 580–92. PMC 2560758. PMID 10859852.
  45. ^Jewkes R, Rees H, Dickson K, Brown H, Levin J (March 2005). "The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change". BJOG. 112 (3): 355–9. doi:10.1111/j.1471-0528.2004.00422.x. PMID 15713153. S2CID 41663939.
  46. ^Bateman C (December 2007). "Maternal mortalities 90% down as legal TOPs more than triple". South African Medical Journal = Suid-Afrikaanse Tydskrif vir Geneeskunde. 97 (12): 1238–42. PMID 18264602.
  47. ^ ab"Preventing unsafe abortion". World Health Organization. Retrieved 7 December 2017.
  48. ^Vlassoff et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton, Institute of Development Studies, 2008 (IDS Research Reports 59).
  49. ^L Haddad. Unsafe Abortion: Unnecessary Maternal Mortality. Rev Obstet Gynecol. 2009 Spring; 2(2): 122–126.
  50. ^ abHuman Rights Committee; Committee Against Torture; Committee on the Elimination of Discrimination Against Women.

External links[edit]

Sours: https://en.wikipedia.org/wiki/Unsafe_abortion

Abortions worldwide this year:

Sources and methods:

Definition: An abortion is the termination of a pregnancy by the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. An abortion can occur spontaneously due to complications during pregnancy or can be induced. (definition from Wikipedia)

Abortion
as a term most commonly - and in the statistics presented here - refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.

"This year" refers to the period from Jan 1 at 00:00 up to now.

The data on abortions displayed on the Worldometer's counter is based on the latest statistics on worldwide abortions published by the World Health Organization (WHO).

According to WHO, every year in the world there are an estimated 40-50 million abortions. This corresponds to approximately 125,000 abortions per day.

In the USA, where nearly half of pregnancies are unintended and four in 10 of these are terminated by abortion [1] , there are over 3,000 abortions per day. Twenty-two percent of all pregnancies in the USA (excluding miscarriages) end in abortion. [2]

References and useful links:

  • Abortion (Wikipedia)
  • World Health Organization (WHO) - Statistics by the World Health Organization
  • [1] Finer LB and Henshaw SK, Disparities in rates of unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.
  • [2] Jones RK et al., Abortion in the United States: incidence and access to services, 2005, Perspectives on Sexual and Reproductive Health, 2008, 40(1):6–16
Sours: https://www.worldometers.info/abortions/

Wikipedia abortion statistics

Abortion Surveillance — United States, 2018

Methods

Description of the Surveillance System

Each year, CDC requests aggregated data from the central health agencies of the 50 states, the District of Columbia, and New York City to document the number and characteristics of women obtaining legal induced abortions in the United States. This report contains data voluntarily reported to CDC as of February 29, 2020. For the purpose of surveillance, a legal induced abortion* is defined as an intervention performed within the limits of state law by a licensed clinician (e.g., a physician, nurse-midwife, nurse practitioner, or physician assistant) intended to terminate a suspected or known intrauterine pregnancy and that does not result in a live birth.

In most states and jurisdictions, collection of abortion data is facilitated by a legal requirement for hospitals, facilities, and physicians to report abortions to a central health agency (27); however, reporting is not complete in all areas, including in some areas with reporting requirements (28). Central health agencies voluntarily report aggregate abortion data to CDC. Because the reporting of abortion data to CDC is voluntary, many reporting areas have developed their own data collection forms and therefore do not collect or provide all of the information requested by CDC. As a result, the level of detail reported by CDC on the characteristics of women obtaining abortions varies from year to year and by reporting area (18). To encourage uniform collection of data, CDC has collaborated with the National Association for Public Health Statistics and Information Systems to develop reporting standards and provide technical guidance for vital statistics personnel who collect and summarize abortion data within the United States.

Variables and Categorization of Data

Each year, CDC sends a suggested template to central health agencies in the United States for compilation of aggregated abortion data. Aggregate abortion numbers, without individual-level records, are requested for the following variables:

  • Age group in years of women obtaining legal induced abortions (<15, 15–19 by individual year, 20–24, 25–29, 30–34, 35–39, or ≥40)

  • Gestational age of pregnancy in completed weeks at the time of abortion (≤6, 7–20 by individual week, or ≥21)

  • Race (Black, White, or other [including Asian, Pacific Islander, other races, and multiple races]), ethnicity (Hispanic or non-Hispanic), and race by ethnicity

  • Method type (surgical abortion, intrauterine instillation, medical [nonsurgical] abortion, or hysterectomy/hysterotomy)

  • Marital status (married [including currently married or separated] or unmarried [including never married, widowed, or divorced])

  • Number of previous live births (0, 1, 2, 3, or ≥4)

  • Number of previous induced abortions (0, 1, 2, or ≥3)

  • Residence (the state, jurisdiction, territory, or foreign country in which the woman obtaining the abortion lived, or, if additional details are unavailable, in-reporting area versus out-of-reporting area)

In addition, the template provided by CDC requests that aggregate numbers for certain variables be cross-tabulated by a second variable. The cross-tabulations presented in this report include weeks of gestation separately by method type, by women’s age group, and by race/ethnicity.

Beginning with 2014 data, instead of reporting clinician’s estimates of gestational age or estimates of gestational age based on last menstrual period, some areas have reported “probable postfertilization age,” “clinician’s estimate of gestation based on date of conception,” and “probable gestational age” to CDC. To make data reported as postfertilization age consistent with data collection practices for gestational age recommended by CDC’s National Center for Health Statistics (29), 2 weeks were added to probable postfertilization age. This method was used to account for time after last menstrual period until ovulation in a standard 28-day cycle because fertilization occurs around the time of ovulation (30). No modifications were made to data reported as clinician’s estimate of gestation based on date of conception or data reported as probable gestational age.

In this report, medical and surgical abortions are further categorized by gestational age when available. Early medical abortion is defined as the administration of medications (typically mifepristone followed by misoprostol) to induce an abortion at ≤9 completed weeks’ gestation,§ consistent with the current Food and Drug Administration (FDA) labeling for mifepristone (implemented in 2016) (31). Medications (typically serial prostaglandins, sometimes administered after mifepristone) may also be used to induce an abortion at >9 weeks’ gestation. Surgical abortions are categorized as having been performed at ≤13 weeks’ gestation or at >13 weeks’ gestation because of differences in surgical technique at these gestational ages (32). Finally, because intrauterine instillations cannot be performed early in gestation, abortions reported to have been performed by intrauterine instillation at ≤12 weeks’ gestation are excluded from calculation of the percentage of abortions by known method type and are grouped with unknown type.

Measures of Abortion

Four measures of abortion are presented in this report: 1) the number of abortions in a given population, 2) the percentage of abortions among women by selected characteristics, 3) the abortion rate (number of abortions per 1,000 women within a given population), and 4) the abortion ratio (number of abortions per 1,000 live births within a given population). Abortion rates adjust for differences in population size. Abortion ratios measure the relative number of pregnancies in a population that end in abortion compared with live birth.

U.S. Census Bureau estimates of the resident female population were used as the denominator for calculating abortion rates (3342). Overall abortion rates were calculated from the population of women aged 15–44 years living in the reporting areas that provided data. For adolescents aged <15 years, abortion rates were calculated using the number of adolescents aged 13–14 years; for women aged ≥40 years, abortion rates were calculated using the number of women aged 40–44 years. For the calculation of abortion ratios, live birth data were obtained from CDC natality files and included births to women of all ages living in the reporting areas that provided abortion data (4345). For calculation of the total abortion rates and total ratios only, women with unknown data on selected characteristics (e.g., age, race/ethnicity, and marital status) were distributed according to the distribution of abortions among women with known information on the characteristic. For calculation of totals only, abortions for women with an unknown gestational age of pregnancy but known method type were distributed according to the distribution of abortions among women with known information on method type by gestational age to the following categories: surgical, ≤13 weeks’ gestation; surgical, >13 weeks’ gestation; medical, ≤9 weeks’ gestation; and medical, >9 weeks’ gestation.

Data Presentation and Analysis

This report provides aggregate and reporting area–specific abortion numbers, rates, and ratios for the 49 areas that reported to CDC for 2018, which excluded California, Maryland, and New Hampshire. In addition, this report describes characteristics of women who obtained abortions in 2018. The data in this report are presented by the reporting area in which the abortions were performed. Overall abortion rates and ratios are not presented for reporting areas with <20 total reported abortions because calculations are considered statistically unstable (46). Wyoming, which reported <20 abortions, was only included in total abortions overall and was excluded from all subsequent analyses.

The completeness and quality of data received varies by year and by variable; this report only describes the characteristics of women obtaining abortions in reporting areas that met CDC reporting standards (i.e., reported at least 20 abortions overall, provided data categorized in accordance with requested variables, and had <15% unknown values for a given characteristic). Cells with a value in the range of 1–4 or cells that would allow for calculation of these values have been suppressed in this report to maintain confidentiality.

Trends in the number, rate, and ratio of reported abortions and annual data are presented for the 48 areas that reported data every year during 2009–2018. The percentage change in abortion measures from the most recent past year (2017 to 2018) and during the 10-year period of analysis (2009 to 2018) were calculated for these 48 reporting areas.

Trends were also reported for abortions by age group of women obtaining abortions and by weeks of gestation. Annual data are presented for areas that met reporting standards every year during 2009–2018; the percentage change was calculated from the beginning to the end of the 10-year period of analysis (2009–2018), from the beginning to the end of the first and second halves of this period (2009–2013 and 2014–2018), and from the most recent past year (2017 to 2018). Consistent with previous reports, key findings for trends are presented to highlight observed changes over time and differences between groups. However, no statistical testing was performed. Comparisons do not imply statistical significance, and lack of comment regarding the difference between values does not imply that no statistically significant difference exists.

To calculate trends for early medical abortions (≤9 completed weeks’ gestation), areas were included if they met reporting standards and if they specifically included medical abortion as a method on their reporting form for the years needed for 10-year, 5-year, and 1-year percentage change calculations (2009 to 2018, 2009 to 2013, 2014 to 2018, and 2017 to 2018). These data are reported to monitor any changes in clinical practice that might have occurred with the accumulation of evidence on the safety and effectiveness of medical abortion past 63 days of gestation (≤8 completed weeks) (47), changes in professional practice guidelines published in 2013 and 2014 (48,49), and the 2016 FDA extension of the gestational age limit for the use of mifepristone for early medical abortion from 63 days to 70 days (≤9 completed weeks’ gestation) (50).

Data from some reporting areas are not included in trends if the data did not meet reporting standards every year during 2009–2018 (for overall, age, and gestational age trend analyses) or if data did not meet reporting standards for selected years of comparison (for early medical abortion trend analysis). As a result, aggregate measures for 2018 in trend analyses might differ from the point estimates reported for 2018.

Abortion Mortality

CDC has reported data on abortion-related deaths periodically since information on abortion mortality first was included in the 1972 abortion surveillance report (18,51). An abortion-related death is defined as a death resulting from a direct complication of an abortion (legal or illegal), an indirect complication caused by a chain of events initiated by an abortion, or an aggravation of a preexisting condition by the physiologic or psychologic effects of abortion (52). An abortion is categorized as legal when it is performed by a licensed clinician within the limits of state law.

Since 1987, CDC has monitored abortion-related deaths through PMSS (53,54). Sources of data to identify abortion-related deaths have included state vital records; media reports, including computerized searches of full-text newspaper and other print media databases; and individual case reports by public health agencies, including maternal mortality review committees, health care providers and provider organizations, private citizens, and citizen groups. For each death that is possibly related to abortion, CDC requests clinical records and autopsy reports. Two medical epidemiologists independently review these reports to determine the cause of death and whether the death was abortion related. Discrepancies are discussed and resolved by consensus. Each death is categorized by abortion type as legal induced, illegal induced, spontaneous, or unknown type.

This report provides PMSS data on induced abortion-related deaths that occurred in 2017, the most recent year for which PMSS data are available. Data on induced abortion-related deaths that occurred during 1972–2015 have been published (1215,17,18,54). For 1998–2017, abortion surveillance data reported to CDC cannot be used alone to calculate national legal induced abortion case-fatality rates (number of legal induced abortion-related deaths per 100,000 reported legal induced abortions in the United States) because eight states** did not report abortion data every year during this period. Thus, denominator data for calculation of national legal induced abortion case-fatality rates were obtained from a published report by the Guttmacher Institute that includes estimated total numbers of abortions in the United States from a national survey of abortion-providing facilities (19). Because rates determined on the basis of a numerator of <20 deaths are unstable (46), national legal induced abortion case-fatality rates were calculated for consecutive 5-year periods during 1973–2017.

Sours: https://www.cdc.gov/mmwr/volumes/69/ss/ss6907a1.htm
The Abortion Rate Is At An All-Time Low, Why?

Abortion in the United States

Termination of a pregnancy in the United States

Abortion is legal throughout the United States and its territories, although restrictions and accessibility vary from state to state. Abortion is a controversial and divisive issue in the society, culture and politics of the U.S., and various anti-abortion laws have been in force in each state since at least 1900. Since 1976, the Republican Party has generally sought to restrict abortion access or criminalize abortion, whereas the Democratic Party has generally defended access to abortion and has made contraception easier to obtain.[1]

Before the Supreme Court of the United States decisions of Roe v. Wade and Doe v. Bolton decriminalized abortion nationwide in 1973, abortion was already legal in several states, but the decision in the former case imposed a uniform framework for state legislation on the subject. It established a minimal period during which abortion is legal (with more or fewer restrictions throughout the pregnancy). That basic framework, modified in Planned Parenthood v. Casey (1992), remains nominally in place, although the effective availability of abortion varies significantly from state to state, as many counties have no abortion providers.[2]Planned Parenthood v. Casey held that a law cannot place legal restrictions imposing an undue burden for "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus."[3]

The abortion rate has continuously fallen from a peak in 1980 of 30 per 1,000 women of childbearing age (15–44), to 11.3 abortions per 1,000 women by 2018.[4] In 2018, 77.7% of abortions were performed at 9 weeks or less gestation, and 92.2% of abortions were performed at 13 weeks or less gestation.[4] Increased access to birth control has been statistically linked to reductions in the abortion rate.[5][6][7]

The main actors in the abortion debate are often framed as "pro-choice", believing that a woman is entitled to choose whether to continue her pregnancy, versus "pro-life", believing that the fetus has a right to live, though most Americans are found to agree with some positions of each side.[8] A 2018 Gallup survey found the percentages of "pro-choice" or "pro-life" respondents were equal (at 48%), but more considered abortion morally wrong (48%) than morally acceptable (43%). The poll results also indicated that Americans harbor diverse and shifting opinions on the legal right to abortion. The survey found that 29% of respondents believed that abortion should be legal in all circumstances, 50% that it should be legal under some circumstances, and 20% that it should be illegal in all circumstances.[9] As of 2007[update], polling results found that 34% of Americans were satisfied with abortion laws.[10]

Terminology[edit]

Main article: Definitions of abortion

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense.[11] Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.[12]

In medical parlance, "abortion" can refer to either miscarriage or abortion until the fetus is viable. After viability, doctors call an abortion a "termination of pregnancy".

History[edit]

Rise of anti-abortion legislation[edit]

Abortion laws in the U.S. before Roe

  Illegal (30)

  Legal in case of rape (1)

  Legal in case of danger to woman's health (2)

  Legal in case of danger to woman's health, rape or incest, or likely damaged fetus (13)

  Legal on request (4)

[13]

When the United States first became independent, most states applied English common law to abortion. This meant it was not permitted after quickening, or the start of fetal movements, usually felt 15–20 weeks after conception.[14]

Abortion has existed in America since European colonization. The earliest settlers would often encourage abortions before the "quickening" stage in the pregnancy. There were many reasons given for this, including not having resources to bear children. By the late 1800s[clarification needed] states began to make abortions illegal. One reason given for the legislation was that abortions had been performed with dangerous methods and were often surgical. Because of this, many states decided to forbid abortions. As technology advanced and abortion methods improved, abortions still remained illegal. Women would resort to illegal unsafe methods, also known as "back alley" abortions.

Abortions became illegal by statute in Britain in 1803 with Lord Ellenborough's Act. Various anti-abortion statutes that codified or expanded common law began to appear in the United States in the 1820s. Some historian's argue a Connecticut law targeted apothecaries who sold "poisons" to women for purposes of inducing an abortion. However, additional research into the Connecticut law reveals the state legislation enacted the law based on the case of the State of Connecticut vs. Ammi Rogers.[15]New York made post-quickening abortions a felony and pre-quickening abortions a misdemeanor in 1829.[16] Other legal scholars have pointed out that some of the early laws punished not only the doctor or abortionist, but also the woman who hired them.[17]

A number of other factors likely played a role in the rise of anti-abortion laws. Physicians, who were the leading advocates of abortion criminalization laws, appear to have been motivated at least in part by advances in medical knowledge. Science had discovered that conception inaugurated a more or less continuous process of development, which produced a new human being. Quickening was found to be neither more nor less crucial in the process of gestation than any other step. Many physicians concluded that if society considered it unjustifiable to terminate pregnancy after the fetus had quickened, and if quickening was a relatively unimportant step in the gestation process, then it was just as wrong to terminate a pregnancy before quickening as after quickening.[18] Ideologically, the Hippocratic Oath and the medical mentality of that age to defend the value of human life as an absolute played a significant role in molding opinions about abortion.[18] Doctors were also influenced by practical reasons to advocate anti-abortion laws. For one, abortion providers tended to be untrained and not members of medical societies. In an age where the leading doctors in the nation were attempting to standardize the medical profession, these "irregulars" were considered a nuisance to public health.[19] The more formalized medical profession disliked the "irregulars" because they were competition, often at a cheaper cost.

Despite campaigns to end the practice of abortion, abortifacient advertising was highly effective and abortion was commonly practiced in the mid-19th century. While the precise abortion rate was not known, James Mohr's 1978 book Abortion in America documented multiple recorded estimates by 19th century physicians which suggested that between around 15% and 35% of all pregnancies ended in abortion during that period.[20] This era also saw a marked shift in the people who were obtaining abortions. Before the start of the 19th century, most abortions were sought by unmarried women who had become pregnant out of wedlock. Out of 54 abortion cases published in American medical journals between 1839 and 1880, over half were sought by married women, and well over 60% of the married women already had at least one child.[21] The sense that married women were now frequently obtaining abortions worried many conservative physicians, who were almost exclusively men. In the post-Civil War era, much of the blame was placed on the burgeoning women's rights movement.

Though the medical profession expressed hostility toward feminism, many feminists of the era were also opposed to abortion.[22][23] In The Revolution, operated by Elizabeth Cady Stanton and Susan B. Anthony, an anonymous contributor signing "A" wrote in 1869 about the subject, arguing that instead of merely attempting to pass a law against abortion, the root cause must also be addressed. Simply passing an anti-abortion law would, the writer stated, "be only mowing off the top of the noxious weed, while the root remains. [...] No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh! thrice guilty is he who drove her to the desperation which impelled her to the crime."[23][24][25][26] To many feminists of this era, abortion was regarded as an undesirable necessity forced upon women by thoughtless men.[27] Even the "free love" wing of the feminist movement refused to advocate for abortion and treated the practice as an example of the hideous extremes to which modern marriage was driving women.[28]Marital rape and the seduction of unmarried women were societal ills which feminists believed caused the need to abort, as men did not respect women's right to abstinence.[28]

However, physicians remained the loudest voice in the anti-abortion debate, and they carried their agenda to state legislatures around the country, advocating not only anti-abortion laws, but also laws against birth control. This movement presaged the modern debate over women's body rights.[29] A campaign was launched against the movement and the use and availability of contraceptives.

Criminalization of abortion accelerated from the late 1860s, through the efforts of concerned legislators, doctors, and the American Medical Association.[30] In 1873, Anthony Comstock created the New York Society for the Suppression of Vice, an institution dedicated to supervising the morality of the public. Later that year, Comstock successfully influenced the United States Congress to pass the Comstock Law, which made it illegal to deliver through the U.S. mail any "obscene, lewd, or lascivious" material. It also prohibited producing or publishing information pertaining to the procurement of abortion or the prevention of conception or venereal disease, even to medical students.[31] The production, publication, importation, and distribution of such materials was suppressed under the Comstock Law as being obscene, and similar prohibitions were passed by 24 of the 37 states.[32]

In 1900, abortion was a felony in every state. Some states included provisions allowing for abortion in limited circumstances, generally to protect the woman's life or to terminate pregnancies arising from rape or incest.[33] Abortions continued to occur, however, and became increasingly available. The American Birth Control League was founded by Margaret Sanger in 1921; it would become Planned Parenthood Federation of America in 1942.[34][35]

By the 1930s, licensed physicians performed an estimated 800,000 abortions a year.[36]

Sherri Finkbine[edit]

One notable case dealt with a woman named Sherri Finkbine. Born in the area of Phoenix, Arizona, Sherri had four healthy children. However, during her pregnancy with her fifth child, she had found that the child might have severe deformities.[37] Finkbine had been taking sleeping pills that contained a drug called thalidomide which was also used widely in several countries.[38] She had later learned that the drug was causing fetal deformities and she wanted to warn the general public. Finkbine strongly wanted an abortion, however the abortion laws of Arizona limited her decision. In Arizona, an abortion could only occur if the mother's life was in danger. She met with a reporter from The Arizona Republic and told her story. While Finkbine wanted to be kept anonymous, the reporter disregarded this idea. On August 18, 1962, Finkbine traveled to Sweden where she was able to obtain a legal abortion. It was also confirmed that the child would have been very much deformed.[39] Finkbine's story marks a turning point for women as well as the history of abortion laws occurring in the United States. Finkbine, unlike many other women, was able to afford going overseas to have the abortion. However, many women seeking abortions may not be able to afford travel. In such cases, women may turn to illegal forms of abortion.[40]

Pre-Roe precedents[edit]

In 1964, Gerri Santoro of Connecticut died trying to obtain an illegal abortion, and her photo became the symbol of an abortion-rights movement. Some women's rights activist groups developed their own skills to provide abortions to women who could not obtain them elsewhere. As an example, in Chicago, a group known as "Jane" operated a floating abortion clinic throughout much of the 1960s. Women seeking the procedure would call a designated number and be given instructions on how to find "Jane".[41]

In 1965, the U.S. Supreme Court case Griswold v. Connecticut struck down one of the remaining contraception Comstock laws in Connecticut and Massachusetts.[42] However, Griswold only applied to marital relationships. Eisenstadt v. Baird (1972) extended its holding to unmarried persons as well.[43] Following the Griswold case, the American College of Obstetricians and Gynecologists (ACOG) issued a medical bulletin accepting a recommendation from six years earlier that clarified that "conception is the implantation of a fertilized ovum";[44] and consequently birth control methods that prevented implantation became classified as contraceptives, not abortifacients.

In 1967, Colorado became the first state to decriminalize abortion in cases of rape, incest, or in which pregnancy would lead to permanent physical disability of the woman. Similar laws were passed in California, Oregon, and North Carolina. In 1970, Hawaii became the first state to legalize abortions on the request of the woman,[45] and New York repealed its 1830 law and allowed abortions up to the 24th week of pregnancy. Similar laws were soon passed in Alaska and Washington. In 1970, Washington held a referendum on legalizing early pregnancy abortions, becoming the first state to legalize abortion through a vote of the people.[46] A law in Washington, D.C., which allowed abortion to protect the life or health of the woman, was challenged in the Supreme Court in 1971 in United States v. Vuitch. The court upheld the law, deeming that "health" meant "psychological and physical well-being", essentially allowing abortion in Washington, D.C. By the end of 1972, 13 states had a law similar to that of Colorado, while Mississippi allowed abortion in cases of rape or incest only and Alabama and Massachusetts allowed abortions only in cases where the woman's physical health was endangered. In order to obtain abortions during this period, women would often travel from a state where abortion was illegal to one where it was legal. The legal position prior to Roe v. Wade was that abortion was illegal in 30 states and legal under certain circumstances in 20 states.[47]

In the late 1960s, a number of organizations were formed to mobilize opinion both against and for the legalization of abortion. In 1966, the National Conference of Catholic Bishops assigned Monsignor James T. McHugh to document efforts to reform abortion laws, and anti-abortion groups began forming in various states in 1967. In 1968, McHugh led an advisory group which became the National Right to Life Committee.[48][49] The forerunner of the NARAL Pro-Choice America was formed in 1969 to oppose restrictions on abortion and expand access to abortion.[50] Following Roe v. Wade, in late 1973, NARAL became the National Abortion Rights Action League.

Roe v. Wade[edit]

Main article: Roe v. Wade

Prior to Roe v. Wade, 30 states prohibited abortion without exception, 16 states banned abortion except in certain special circumstances (e.g., rape, incest, health threat to mother), 3 states allowed residents to obtain abortions, and New York allowed abortions generally.[51] Early that year, on January 22, 1973, the Supreme Court in Roe v. Wade invalidated all of these laws, and set guidelines for the availability of abortion. Roe established that the right of privacy of a woman to obtain an abortion "must be considered against important state interests in regulation".[52]Roe established the end of the first "trimester" (i.e., 12 week) as the threshold for state interest, such that states were prohibited from banning abortion in the first trimester but allowed to impose increasing restrictions or outright bans later in pregnancy.[52]

In deciding Roe v. Wade, the Supreme Court ruled that a Texas statute forbidding abortion except when necessary to save the life of the mother was unconstitutional. The Court arrived at its decision by concluding that the issue of abortion and abortion rights falls under the right to privacy (in the sense of the right of a person not to be encroached by the state). In its opinion, it listed several landmark cases where the court had previously found a right to privacy implied by the Constitution. The Court did not recognize a right to abortion in all cases:

State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother.[53]

The Court held that a right to privacy existed and included the right to have an abortion. The court found that a mother had a right to abortion until viability, a point to be determined by the abortion doctor. After viability a woman can obtain an abortion for health reasons, which the Court defined broadly to include psychological well-being.

A central issue in the Roe case (and in the wider abortion debate in general) is whether human life or personhood begins at conception, birth, or at some point in between. The Court declined to make an attempt at resolving this issue, noting: "We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer." Instead, it chose to point out that historically, under English and American common law and statutes, "the unborn have never been recognized ... as persons in the whole sense", and thus, the fetuses are not legally entitled to the protection afforded by the right to life specifically enumerated in the Fourteenth Amendment. So, rather than asserting that human life begins at any specific point, the court simply declared that the State has a "compelling interest" in protecting "potential life" at the point of viability.

Doe v. Bolton[edit]

Main article: Doe v. Bolton

Under Roe v. Wade, state governments may not prohibit late terminations of pregnancy when "necessary to preserve the life or health of the mother", even if it would cause the demise of a viable fetus.[54] This rule was clarified by the 1973 judicial decision Doe v. Bolton, which specifies "that the medical judgment may be exercised in the light of all factors — physical, emotional, psychological, familial, and the woman's age — relevant to the well-being of the patient".[55][56][57] It is by this provision for the mother's mental health that women in the US legally choose abortion after viability when screenings reveal abnormalities that do not cause a baby to die shortly after birth.[58][59][60][61]

Later judicial decisions[edit]

In the 1992 case of Planned Parenthood v. Casey, the Court abandoned Roe's strict trimester framework but maintained its central holding that women have a right to choose to have an abortion before viability.[62]Roe had held that statutes regulating abortion must be subject to "strict scrutiny"—the traditional Supreme Court test for impositions upon fundamental Constitutional rights. Casey instead adopted the lower, undue burden standard for evaluating state abortion restrictions,[63] but re-emphasized the right to abortion as grounded in the general sense of liberty and privacy protected under the constitution: "Constitutional protection of the woman's decision to terminate her pregnancy derives from the Due Process Clause of the Fourteenth Amendment. It declares that no State shall 'deprive any person of life, liberty, or property, without due process of law.' The controlling word in the cases before us is 'liberty'."[64]

The Supreme Court continues to grapple with cases on the subject. On April 18, 2007, it issued a ruling in the case of Gonzales v. Carhart, involving a federal law entitled the Partial-Birth Abortion Ban Act of 2003 which President George W. Bush had signed into law. The law banned intact dilation and extraction, which opponents of abortion rights referred to as "partial-birth abortion", and stipulated that anyone breaking the law would get a prison sentence up to 2.5 years. The United States Supreme Court upheld the 2003 ban by a narrow majority of 5–4, marking the first time the Court has allowed a ban on any type of abortion since 1973. The opinion, which came from justice Anthony Kennedy, was joined by Justices Antonin Scalia, Clarence Thomas, and the two recent appointees, Samuel Alito and Chief Justice John Roberts.

In the case of Whole Woman's Health v. Hellerstedt, the Supreme Court in a 5–3 decision on June 27, 2016, swept away forms of state restrictions on the way abortion clinics can function. The Texas legislature enacted in 2013 restrictions on the delivery of abortions services that created an undue burden for women seeking an abortion by requiring abortion doctors to have difficult-to-obtain "admitting privileges" at a local hospital and by requiring clinics to have costly hospital-grade facilities. The Court struck down these two provisions "facially" from the law at issue—that is, the very words of the provisions were invalid, no matter how they might be applied in any practical situation. According to the Supreme Court, the task of judging whether a law puts an unconstitutional burden on a woman's right to abortion belongs with the courts, and not the legislatures.[65]

The Supreme Court ruled similarly in June Medical Services, LLC v. Russo on June 29, 2020, in a 5–4 decision that a Louisiana state law, modeled after the Texas law at the center of Whole Woman's Health, was unconstitutional.[66] Like Texas' law, the Louisiana law required certain measures for abortion clinics that, if having gone into effect, would have closed five of the six clinics in the state. The case in Louisiana was put on hold pending the result of Whole Woman's Health, and was retried based on the Supreme Court's decision. While the District Court ruled the law unconstitutional, the Fifth Circuit found that unlike the Texas law, the burden of the Louisiana law passed the tests outlined in Whole Woman's Health, and thus the law was constitutional. The Supreme Court issued an order to suspend enforcement of the law pending further review, and agreed to hear the case in full in October 2019. It was the first abortion-related case to be heard by President Donald Trump's appointees to the Court, Neil Gorsuch and Brett Kavanaugh.[67] The Supreme Court found the Louisiana law unconstitutional for the same reasons as the Texas one, reversing the Fifth Circuit. The judgement was supported by Chief Justice John Roberts who had dissented on Whole Woman's Health but joined in judgement as to upholding the court's respect for the past judgement in that case.[66]

The Supreme Court granted certiorari to Dobbs v. Jackson Women's Health Organization in May 2021, a case that challenges the impact of Roe v. Wade in blocking enforcement of Mississippi's 2018 law that had banned any abortions after the first 15 weeks.[68] Oral arguments to Dobbs will be held in December 2021. On September 1, 2021, the state of Texas passed one of the most restrictive abortion laws in the nation, banning most procedures after six weeks.[69]

Current legal status[edit]

Federal legislation[edit]

Since 1995, led by congressional Republicans, the U.S. House of Representatives and U.S. Senate have moved several times to pass measures banning the procedure of intact dilation and extraction, commonly known as partial birth abortion. Such measures passed twice by wide margins, but PresidentBill Clintonvetoed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Congressional supporters of the bill argue that a health exception would render the bill unenforceable, since the Doe v. Bolton decision defined "health" in vague terms, justifying any motive for obtaining an abortion. Congress was unsuccessful with subsequent attempts to override the vetoes.

The Born-Alive Infants Protection Act of 2002 ("BAIPA") was enacted August 5, 2002 by an Act of Congress and signed into law by George W. Bush. It asserts the human rights of infants born after a failed attempt to induce abortion. A "born-alive infant" is specified as a "person, human being, child, individual". "Born alive" is defined as the complete expulsion of an infant at any stage of development that has a heartbeat, pulsation of the umbilical cord, breath, or voluntary muscle movement, no matter if the umbilical cord has been cut or if the expulsion of the infant was natural, induced labor, cesarean section, or induced abortion.

On October 2, 2003, with a vote of 281–142, the House approved the Partial-Birth Abortion Ban Act to ban partial-birth abortion, with an exemption in cases of fatal threats to the woman. Through this legislation, a doctor could face up to two years in prison and civil lawsuits for performing such a procedure. A woman undergoing the procedure could not be prosecuted under the measure. On October 21, 2003, the United States Senate passed the bill by a vote of 64–34, with a number of Democrats joining in support. The bill was signed by President George W. Bush on November 5, 2003, but a federal judge blocked its enforcement in several states just a few hours after it became public law. The Supreme Court upheld the nationwide ban on the procedure in the case Gonzales v. Carhart on April 18, 2007, signaling a substantial change in the Court's approach to abortion law.[70] The 5–4 ruling said the Partial Birth Abortion Ban Act does not conflict with previous decisions regarding abortion.

The current judicial interpretation of the U.S. Constitution regarding abortion, following the Supreme Court of the United States's 1973 landmark decision in Roe v. Wade, and subsequent companion decisions, is that abortion is legal but may be restricted by the states to varying degrees. States have passed laws to restrict late-term abortions, require parental notification for minors, and mandate the disclosure of abortion risk information to patients prior to the procedure.[71]

The official report of the U.S. Senate Judiciary Committee, issued in 1983 after extensive hearings on the Human Life Amendment (proposed by Senators Orrin Hatch and Thomas Eagleton), stated:

Thus, the [Judiciary] Committee observes that no significant legal barriers of any kind whatsoever exist today in the United States for a mother to obtain an abortion for any reason during any stage of her pregnancy.[72]

One aspect of the legal abortion regime now in place has been determining when the fetus is "viable" outside the womb as a measure of when the "life" of the fetus is its own (and therefore subject to being protected by the state). In the majority opinion delivered by the court in Roe v. Wade, viability was defined as "potentially able to live outside the mother's womb, albeit with artificial aid. Viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks". When the court ruled in 1973, the then-current medical technology suggested that viability could occur as early as 24 weeks. Advances over the past three decades allow survival of some babies born at 22 weeks.[73]

As of 2006[update], the youngest child to survive a premature birth in the United States was a girl born at Kapiolani Medical Center in Honolulu, Hawaii, at 21 weeks and 3 days gestation.[74] Because of the split between federal and state law, legal access to abortion continues to vary by state. Geographic availability varies dramatically, with 87 percent of U.S. counties having no abortion provider.[75] Moreover, due to the Hyde Amendment, many state health programs do not cover abortions; currently 17 states (including California, Illinois and New York) offer or require such coverage.[76]

The legality of abortion is frequently a major issue in nomination battles for the U.S. Supreme Court. Nominees typically remain silent on the issue during their hearings, as the issue may come before them as judges.

The Unborn Victims of Violence Act, commonly known as "Laci and Conner's Law" was passed by Congress and signed into law by President Bush on April 1, 2004, allowing two charges to be filed against someone who kills a pregnant mother (one for the mother and one for the fetus). It specifically bans charges against the mother and/or doctor relating to abortion procedures. Nevertheless, it has generated much controversy among pro-abortion rights advocates who view it as a potential step in the direction of banning abortion.

The Pain-Capable Unborn Child Protection Act is a United States Congress bill to ban late-term abortions nationwide after 20 weeks post-fertilization on the basis that the fetus is capable of feeling pain during an abortion at and after that point of pregnancy. The bill was first introduced in Congress in 2013. It successfully passed the House of Representatives in 2013, 2015, and 2017, but has yet to pass the Senate. Opponents of the bill reject the claims made by the bill's supporters regarding fetal development, and argue that such a restriction would endanger women's health.

State-by-state legal status[edit]

Main articles: Abortion in the United States by state and Types of abortion restrictions in the United States

Abortion is legal in all U.S. states, and every state has at least one abortion clinic.[77][78] Abortion is a controversial political issue, and regular attempts to restrict it occur in most states. Two such cases, originating in Texas and Louisiana, led to the Supreme Court cases of Whole Woman's Health v. Hellerstedt (2016) and June Medical Services, LLC v. Russo (2020) in which several Texas and Louisiana restrictions were struck down.[79][80]

The issue of minors and abortion is regulated at the state level, and 37 states require some parental involvement, either in the form of parental consent or in the form of parental notification. In certain situations, the parental restrictions can be overridden by a court.[81] Mandatory waiting periods, mandatory ultrasounds and scripted counseling are common abortion regulations. Abortion laws are generally stricter in conservative Southern states than they are in other parts of the country.

In 2019, New York passed the Reproductive Health Act (RHA), which repealed a pre-Roe provision that banned third-trimester abortions except in cases where the continuation of the pregnancy endangered a pregnant woman's life.[82][83]

Abortion in the Northern Mariana Islands, a United States Commonwealth territory, is illegal.

Alabama House Republicans passed a law on April 30, 2019, that will criminalize abortion if it goes into effect.[84] Dubbed the "Human Life Protection Act", it offers only two exceptions: serious health risk to the mother or a lethal fetal anomaly.[85] It will also make the procedure a Class A felony.[86] Twenty-five male Alabama senators voted to pass the law on May 13.[87] The next day, Alabama governor Kay Ivey signed the bill into law, primarily as a symbolic gesture in hopes of challenging Roe v. Wade in the Supreme Court.[88][89]

Since Alabama introduced the first modern anti-abortion legislation in April 2019, five other states have also adopted abortion laws including Mississippi, Kentucky, Ohio, Georgia and most recently Louisiana on May 30, 2019.[90]

In May 2019, the U.S. Supreme Court upheld an Indiana state law that requires fetuses which were aborted be buried or cremated.[91] In a December 2019 case, the court declined to review a lower court decision which upheld a Kentucky law requiring doctors to perform ultrasounds and show fetal images to patients before abortions.[92]

On June 29, 2020, previous Supreme Court rulings banning abortion restrictions appeared to be upheld when the U.S. Supreme Court struck down the Louisiana anti-abortion law[93] Following the ruling, the legality of laws restricting abortion in states such as Ohio was then called into question.[94] It was also noted that Supreme Court Chief Justice John Roberts, who agreed that the Louisiana anti-abortion law was unconstitutional, had previously voted to uphold a similar law in Texas which was struck down by the U.S. Supreme Court in 2016.[95]

In May 2021, Texas lawmakers passed the Texas Heartbeat Act, banning abortions as soon as cardiac activity can be detected, typically as early as six weeks into pregnancy and often before women know they are pregnant. In order to avoid traditional constitutional challenges based on Roe v. Wade, the law provides that any person, with or without any vested interest, may sue anyone that performs or induces an abortion in violation of the statute, as well as anyone who "aids or abets the performance or inducement of an abortion, including paying for or reimbursing the costs of an abortion through insurance or otherwise."[96] The law was challenged in courts, though had yet to have a full formal hearing as its September 1, 2021, enactment date came due. Plaintiffs sought an order from the U.S. Supreme Court to stop the law from coming into effect, but the Court issued a denial of the order late on September 1, 2021, allowing the law to remain in effect. While unsigned, Chief Justice John Roberts and Justice Stephen Breyer wrote dissenting opinions joined by Justices Elena Kagan and Sonia Sotomayor that they would have granted an injunction on the law until a proper judicial review.[97][98]

On September 9, 2021, Attorney General Merrick Garland, the head of the United States Department of Justice sued the State of Texas over the Texas Act on the basis that "the law is invalid under the Supremacy Clause and the Fourteenth Amendment, is preempted by federal law, and violates the doctrine of intergovernmental immunity".[99] Garland further noted that the United States government has “an obligation to ensure that no state can deprive individuals of their constitutional rights.”[100] The Complaint avers that Texas enacted the law "in open defiance of the Constitution".[101] The relief requested from the U.S. District Court in Austin, Texas includes a declaration that the Texas Act is unconstitutional, and an injunction against state actors as well as any and all private individuals who may bring a SB 8 action.[101][100] The idea of asking a federal court to impose an injunction upon the entire civilian population of a state is unprecedented and has drawn eyebrows.[102][103]

In response to the coronavirus pandemic[edit]

Main article: Impact of the COVID-19 pandemic on abortion in the United States

Amid the COVID-19 pandemic, anti-abortion government officials in several American states enacted or attempted to enact restrictions on abortion, characterizing it as a non-essential procedure that can be suspended during the medical emergency.[104] The orders have led to several legal challenges and criticism by human rights groups and several national medical organizations, including the American Medical Association.[105] Legal challenges on behalf of abortion providers, many of which are represented by the American Civil Liberties Union and Planned Parenthood, have successfully stopped most of the orders on a temporary basis.[104]

One challenge was made against the FDA's rule on the distribution of mifepristone (RU-486), one of the two-part drug regimen to induce abortions. Since 2000, it is only available through health providers under the FDA's ruling. Due to the COVID-19 pandemic, access to mifepristone was a concern, and the American College of Obstetricians and Gynecologists along with other groups sued to have the rule relaxed to allow women to be able to access mifepristone at home through mail-order or retail pharmacies. While the Fourth Circuit issued a preliminary injunction against the FDA's ruling that would have allowed wider distribution, the Supreme Court ordered in a 6–3 decision in January 2021 to put a stay on the injunction, maintaining the FDA's rule.[106]

Sanctuary city for the unborn[edit]

Since 2019, the anti-abortion movement in the United States has been pushing for anti-abortion rules such as declarations of "sanctuary city for the unborn".[107]

In June 2019, the city council of Waskom, Texas, voted to outlaw abortion in the city, declaring Waskom a "sanctuary city for the unborn" (the first such city to designate itself as such), as state governments elsewhere in the United States also were drafting abortion bans.[108][109] There is currently no abortion clinic in the city.[110][111] The Waskom ordinance has led other small cities in Texas (and, as of April 2021, in Nebraska) to vote in favor of becoming "sanctuary cities for the unborn."[112][113][114]

On April 6, 2021, Hayes Center, Nebraska, became the first city in Nebraska to outlaw abortion by local ordinance, declaring itself a "sanctuary city for the unborn."[115]

The city of Blue Hill, Nebraska, followed suit and enacted a similar ordinance outlawing abortion on April 13, 2021.[116][117]

On May 2021, Lubbock, Texas, voted to become the largest city in the U.S. to ban abortion with the "sanctuary city for the unborn".[118][119][120]

Qualifying requirements for abortion providers[edit]

Map showing which states require parental involvement (minors).

  Parental notification or consent not required

  One parent must be informed beforehand

  Both parents must be informed beforehand

  One parent must consent beforehand

  Both parents must consent beforehand

  One parent must consent and be informed beforehand

  Parental notification law currently enjoined

  Parental consent law currently enjoined

Mandatory waiting period laws in the U.S.

  No mandatory waiting period

  Waiting period of less than 24 hours

  Waiting period of 24 hours or more

  Waiting period law currently enjoined

Abortion counseling laws in the U.S.

  No mandatory counselling

  Counselling in person, by phone, mail, and/or other

  Counselling in person only

  Counselling law enjoined

[needs update]
Mandatory ultrasound laws in the U.S.

  Mandatory. Must display image.

  Mandatory. Must offer to display image.

  Mandatory. Law unenforceable.

  Not mandatory. If ultrasound is performed, must offer to display image.

  Not mandatory. Must offer ultrasound.

  Not mandatory.

Qualifying requirements for performing abortions vary from state to state,[121] and are currently being changed in several states by lawmakers who anticipate the possibility that Roe v. Wade may soon be overturned.[122] Currently, New York,[123] Illinois,[124] and Maine[125] allow non-physician health professionals, such as physician assistants, nurse practitioners, and certified nurse midwives, acting within their scope of practice, to perform abortion procedures; their laws do not explicitly specify which types of abortions these non-physicians may do. California, Oregon, Montana, Vermont, and New Hampshire allow qualified non-physician health professionals to do first-trimester aspiration abortions and to prescribe drugs for medical abortions. Washington State, New Mexico, Alaska, Maryland, Massachusetts, Connecticut, and New Jersey allow qualified non-physicians to prescribe drugs for medical abortions only.[126] In all other states, only licensed physicians may perform abortions.[127] In 2016, the FDA issued new guidelines recommending that qualified non-physician health-care professionals be allowed to prescribe mifepristone in all states; however, these guidelines are not binding, and states are free to determine their own policies regarding mifepristone.[128]

Statistics[edit]

Main article: Abortion statistics in the United States

Because reporting of abortions is not mandatory, statistics are of varying reliability. Both the Centers For Disease Control (CDC)[129] and the Guttmacher Institute[130][131] regularly compile these statistics.

Chart source: CDC, 2005[132]
Graph of U.S. abortion rates, 1973-2017, showing data collected by the Guttmacher Institute[130][131]

Number of abortions[edit]

The annual number of legal induced abortions in the US doubled between 1973 and 1979, and peaked in 1990. There was a slow but steady decline throughout the 1990s. Overall, the number of annual abortions decreased by 6% between 2000 and 2009, with temporary spikes in 2002 and 2006.[133]

By 2011, abortion rate in the nation dropped to its lowest point since the Supreme Court legalized the procedure. According to a study performed by Guttmacher Institute, long-acting contraceptive methods had a significant impact in reducing unwanted pregnancies. There were fewer than 17 abortions for every 1,000 women of child-bearing age. That was a 13%-decrease from 2008's numbers and slightly higher than the rate in 1973, when the Supreme Court's Roe v. Wade decision legalized abortion. The study indicated a long-term decline in the abortion rate.[134][135][136][137]

In 2016, the CDC reported 623,471 abortions, a 2% decrease from 636,902 in 2015.[138]

Medical abortions[edit]

A Guttmacher Institute survey of abortion providers estimated that early medical abortions accounted for 17% of all non-hospital abortions and slightly over one-quarter of abortions before 9 weeks gestation in the United States in 2008.[139] Medical abortions voluntarily reported to the CDC by 34 reporting areas (excluding Alabama, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, Pennsylvania, Tennessee, Vermont, Wisconsin, and Wyoming) and published in its annual abortion surveillance reports have increased every year since the September 28, 2000 FDA approval of mifepristone (RU-486): 1.0% in 2000, 2.9% in 2001, 5.2% in 2002, 7.9% in 2003, 9.3% in 2004, 9.9% in 2005, 10.6% in 2006, 13.1% in 2007, 15.8% in 2008, 17.1% in 2009 (25.2% of those at less than 9 weeks gestation).[140] Medical abortions accounted for 32% of first-trimester abortions at Planned Parenthood clinics in 2008.[141]

Abortion and religion[edit]

A majority of abortions are obtained by religiously identified women. According to the Guttmacher Institute, "more than 7 in 10 U.S. women obtaining an abortion report a religious affiliation (37% protestant, 28% Catholic, and 7% other), and 25% attend religious services at least once a month. The abortion rate for protestant women is 15 per 1,000 women, while Catholic women have a slightly higher rate, 20 per 1,000."[142]

Abortions and ethnicity[edit]

Abortion rates tend to be higher among minority women in the U.S. In 2000–2001, due to lower access to health care and contraception, the rates among black and Hispanic women were 49 per 1,000 and 33 per 1,000, respectively, vs. 13 per 1,000 among non-Hispanic white women. Note that this figure includes all women of reproductive age, including women that are not pregnant. In other words, these abortion rates reflect the rate at which U.S. women of reproductive age have an abortion each year.[143]

In 2004, the rates of abortion by ethnicity in the U.S. were 50 abortions per 1,000 black women, 28 abortions per 1,000 Hispanic women, and 11 abortions per 1,000 white women.[144][145]

Reasons for abortions[edit]

A 1998 study revealed that in 1987 to 1988, women reported the following as their primary reasons for choosing an abortion:[146][147]

Percentage

of women

Primary reason for choosing an abortion
25.5% Want to postpone childbearing
21.3% Cannot afford a baby
14.1% Has relationship problem or partner does not want pregnancy
12.2% Too young; parent(s) or other(s) object to pregnancy
10.8% Having a child will disrupt education or employment
7.9% Want no (more) children
3.3% Risk to fetal health
2.8% Risk to maternal health
2.1% Other

The source of this information takes findings into account from 27 nations including the United States, and therefore, these findings may not be typical for any one nation.

According to a 1987 study that included specific data about late abortions (i. e., abortions "at 16 or more weeks' gestation"),[148] women reported that various reasons contributed to their having a late abortion:

Percentage

of women

Reasons contributing to a late abortion
71% Woman did not recognize she was pregnant or misjudged gestation
48% Woman had found it hard to make arrangements for an earlier abortion
33% Woman was afraid to tell her partner or parents
24% Woman took time to decide to have an abortion
8% Woman waited for her relationship to change
8% Someone had earlier pressured woman not to have abortion
6% Something changed some time after woman became pregnant
6% Woman did not know timing is important
5% Woman did not know she could get an abortion
2% A fetal problem was diagnosed late in pregnancy
11% Other

In 2000, cases of rape or incest accounted for 1% of abortions.[149]

A 2004 study by the Guttmacher Institute reported that women listed the following amongst their reasons for choosing to have an abortion:[147]

Percentage

of women

Reason for choosing to have an abortion
74% Having a baby would dramatically change my life
73% Cannot afford a baby now
48% Do not want to be a single mother or having relationship problems
38% Have completed my childbearing
32% Not ready for another child
25% Do not want people to know I had sex or got pregnant
22% Do not feel mature enough to raise a(nother) child
14% Husband or partner wants me to have an abortion
13% Possible problems affecting the health of the fetus
12% Concerns about my health
6% Parents want me to have an abortion
1% Was a victim of rape
less than .5% Became pregnant as a result of incest

A 2008 National Survey of Family Growth (NSFG) shows that rates of unintended pregnancy are highest among Blacks, Hispanics, and women with lower socio-economic status.[150]

  • 70% of all pregnancies among Black women were unintended
  • 57% of all pregnancies among Hispanic women were unintended
  • 42% of all pregnancies among White women were unintended

When women have abortions (by gestational age)[edit]

Abortion in the United States by gestational age, 2016[151]

According to the Centers for Disease Control, in 2011, most (64.5%) abortions were performed by ≤8 weeks' gestation, and nearly all (91.4%) were performed by ≤13 weeks' gestation. Few abortions (7.3%) were performed between 14 and 20 weeks' gestation or at ≥21 weeks' gestation (1.4%). From 2002 to 2011, the percentage of all abortions performed at ≤8 weeks' gestation increased 6%.[151]

Safety of abortions[edit]

See also: Abortion § Safety

In the US, the risk of death from carrying a child to term is approximately 14 times greater than the risk of death from a legal abortion.[152] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth through at least 21 weeks' gestation.[153][154][155]

Birth control effects[edit]

Main article: Birth control

Increased access to birth control has been statistically linked to reductions in the abortion rate.[5][6][7] As an element of family planning, birth control was federally subsidized for low income families in 1965 under President Lyndon B. Johnson's War on Poverty program. In 1970, Congress passed Title X to provide family planning services for those in need, and President Richard Nixon signed it into law. Funding for Title X rose from $6 million in 1971 to $61 million the next year, and slowly increased each year to $317 million in 2010, after which it was reduced by a few percent.[156]

In 2011, the Guttmacher Institute reported that the number of abortions in the US would be nearly two-thirds higher without access to birth control.[157] In 2015, the Federation of American Scientists reported that federally mandated access to birth control had helped reduce teenage pregnancies in the US by 44 percent, and had prevented more than 188,000 unintended pregnancies.[158]

Public opinion[edit]

See also: Societal attitudes towards abortion, United States abortion-rights movement, and United States anti-abortion movement

Trend percent of Americans self-identifying as either "pro-life" or "pro-choice"

Americans have been equally divided on the issue; a May 2018 Gallup poll indicated that 48% of Americans described themselves as "pro-choice" and 48% described themselves as "pro-life".[9] A July 2018 poll indicated that 64% of Americans did not want the Supreme Court to overturn Roe v. Wade, while 28% did.[159] The same poll found that support for abortion being generally legal was 60% during the first trimester, dropping to 28% in the second trimester, and 13% in the third trimester.[160]

Support for the legalization of abortion has been consistently higher among more educated adults than less educated,[161] and in 2019, 70% of college graduates support abortion being legal in all or most cases, compared to 60% of those with some college, and 54% of those with a high school degree or less.[162]

In January 2013, a majority of Americans believed abortion should be legal in all or most cases, according to a poll by NBC News and The Wall Street Journal.[163] Approximately 70% of respondents in the same poll opposed Roe v. Wade being overturned.[163] A poll by the Pew Research Center yielded similar results.[164] Moreover, 48% of Republicans opposed overturning Roe, compared to 46% who supported overturning it.[164]

Gallup declared in May 2010 that more Americans identifying as "pro-life" is "the new normal", while also noting that there had been no increase in opposition to abortion. It suggested that political polarization may have prompted more Republicans to call themselves "pro-life".[165] The terms "pro-choice" and "pro-life" do not always reflect a political view or fall along a binary; in one Public Religion Research Institute poll, seven in ten Americans described themselves as "pro-choice" while almost two-thirds described themselves as "pro-life". The same poll found that 56% of Americans were in favor of legal access to abortion in all or some cases.[166]

Date of poll "Pro-life" "Pro-choice" Mixed / neither Don't know what terms mean No opinion
2016, May 4–846%47%3%3%2%
2015, May 6–1044%50%3%2%1%
2014, May 8–1146%47%3%3%-
2013, May 2–748%45%3%3%2%
2012, May 3–650%41%4%3%3%
2011, May 5–845%49%3%2%2%
2010, March 26–2846%45%4%2%3%
2009, November 20–2245%48%2%2%3%
2009, May 7–1051%42%-07%
2008, September 5–743%51%2%1%3%

By gender and age[edit]

Pew Research Center polling shows little change in views from 2008 to 2012; modest differences based on gender or age.[167]
(The original article's table also shows by party affiliation, religion, and education level.)

2011–2012 2009–2010 2007–2008
LegalIllegalDon't KnowLegalIllegalDon't KnowLegalIllegalDon't Know
Total53%41%6%48%44%8%54%40%6%
Men51%43%6%46%46%9%52%42%6%
Women55%40%5%50%43%7%55%39%5%
18-2953%44%3%50%45%5%52%45%3%
30-4954%42%4%49%43%7%58%38%5%
50-6455%38%7%49%42%9%56%38%6%
65+48%43%9%39%49%12%45%44%11%

By educational level[edit]

Support for the legalization of abortion is significantly higher among more educated adults than less educated, and has been consistently so for decades.[161] In 2019, 70% of college graduates support abortion being legal in all or most cases, as well as 60% of those with some college education, compared to 54% of those with a high school degree or less.[162]

2019
Educational attainmentLegal in all or most casesIllegal in all or most cases
College grad or more70%30%
Some college60%39%
High school or less54%44%

By gender, party, and region[edit]

A January 2003 CBS News/The New York Times poll examined whether Americans thought abortion should be legal or not, and found variations in opinion which depended upon party affiliation and the region of the country.[168] The margin of error is +/- 4% for questions answered of the entire sample ("overall" figures) and may be higher for questions asked of subgroups (all other figures).[168]

By trimester of pregnancy[edit]

A CNN/USA Today/Gallup poll in January 2003 asked about the legality of abortion by trimester, using the question, "Do you think abortion should generally be legal or generally illegal during each of the following stages of pregnancy?"[169] This same question was also asked by Gallup in March 2000 and July 1996.[170][171] Polls indicates general support of legal abortion during the first trimester, although support drops dramatically for abortion during the second and third trimester.

Since the 2011 poll, support for legal abortion during the first trimester has declined.

2018 Poll 2012 Poll 2011 Poll 2003 Poll 2000 Poll 1996 Poll
LegalIllegalLegalIllegalLegalIllegal LegalIllegalLegalIllegalLegalIllegal
First trimester60%34%61%31%62%29%66%35%66%31%64%30%
Second trimester28%65%27%64%24%71%25%68%24%69%26%65%
Third trimester13%81%14%80%10%86%10%84%8%86%13%82%

By circumstance or reasons[edit]

According to Gallup's long-time polling on abortion, the majority of Americans are neither strictly "pro-life" or "pro-choice"; it depends upon the circumstances of the pregnancy. Gallup polling from 1996 to 2021 consistently reveals that when asked the question, "Do you think abortions should be legal under any circumstances, legal only under certain circumstances, or illegal in all circumstances?", Americans repeatedly answer 'legal only under certain circumstances'. According to the poll, in any given year 48-57% say legal only under certain circumstances, 21-34% say legal under any circumstances, and 13-19% illegal in all circumstances, with 1-7% having no opinion.[170]

"Do you think abortions should be legal under any circumstances, legal only under certain circumstances, or illegal in all circumstances?"

Legal under any circumstances Legal only under certain circumstances Illegal in all circumstances No opinion
2021 May 3-1832%48%19%2%
2020 May 1-1329%50%20%2%
2019 May 1-1225%53%21%2%
2018 May 1–1029%50%18%2%
2017 May 3–729%50%18%3%
2016 May 4–829%50%19%2%
2015 May 6–1029%51%19%1%
2014 May 8–1128%50%21%2%
2013 May 2–726%52%20%2%
2012 Dec 27-3028%52%18%3%
2012 May 3–625%52%20%3%
2011 Jul 15-1726%51%20%3%
2011 June 9–1226%52%21%2%
2011 May 5–827%49%22%3%
2009 Jul 17-1921%57%18%4%
2009 May 7–1022%53%23%2%
2008 May 8–1128%54%18%2%
2007 May 10–1326%55%17%1%
2006 May 8–1130%53%15%2%

According to the aforementioned poll,[170] Americans differ drastically based upon situation of the pregnancy, suggesting they do not support unconditional abortions. Based on two separate polls taken May 19–21, 2003, of 505 and 509 respondents respectively, Americans stated their approval for abortion under these various circumstances:

Poll CriteriaTotalPoll APoll B
When the woman's life is endangered78%82%75%
When the pregnancy was caused by rape or incest65%72%59%
When the child would be born with a life-threatening illness54%60%48%
When the child would be born mentally disabled44%50%38%
When the woman does not want the child for any reason32%41%24%

Another separate trio of polls taken by Gallup in 2003, 2000, and 1996,[170] revealed public support for abortion as follows for the given criteria:

Poll criteria2003 Poll2000 Poll1996 Poll
When the woman's life is endangered85%84%88%
When the woman's physical health is endangered77%81%82%
When the pregnancy was caused by rape or incest76%78%77%
When the woman's mental health is endangered63%64%66%
When there is evidence that the baby may be physically impaired56%53%53%
When there is evidence that the baby may be mentally impaired55%53%54%
When the woman or family cannot afford to raise the child35%34%32%

Gallup furthermore established public support for many issues supported by the anti-abortion community and opposed by the abortion rights community:[170]

Legislation2011 Poll2003 Poll2000 Poll1996 Poll
A law requiring doctors to inform patients about alternatives to abortion before performing the procedure88%86%86%
A law requiring women seeking abortions to wait 24 hours before having the procedure done69%78%74%73%
Legislation2005 Poll2003 Poll1996 Poll1992 Poll
A law requiring women under 18 to get parental consent for any abortion69%73%74%70%
A law requiring that the husband of a married woman be notified if she decides to have an abortion64%72%70%73%

An October 2007 CBS News poll explored under what circumstances Americans believe abortion should be allowed, asking the question, "What is your personal feeling about abortion?" The results were as follows:[169]

Permitted in all casesPermitted, but subject to greater restrictions than it is nowOnly in cases such as rape, incest, or to save the woman's lifeOnly permitted to save the woman's lifeNeverUnsure
26%16%34%16%4%4%

Additional polls[edit]

Results of Gallup opinion poll in USA since 1975 - legal restriction of abortion[172]
  • A June 2000 Los Angeles Times survey found that, although 57% of polltakers considered abortion to be murder, half of that 57% believed in allowing women access to abortion. The survey also found that, overall, 65% of respondents did not believe abortion should be legal after the first trimester, including 72% of women and 58% of men. Further, the survey found that 85% of Americans polled supported abortion in cases of risk to a woman's physical health, 54% if the woman's mental health was at risk, and 66% if a congenital abnormality was detected in the fetus.[173]
  • A July 2002 Public Agenda poll found that 44% of men and 42% of women thought that "abortion should be generally available to those who want it", 34% of men and 35% of women thought that "abortion should be available, but under stricter than limits it is now", and 21% of men and 22% of women thought that "abortion should not be permitted".[174]
  • A January 2003 ABC News/The Washington Post poll also examined attitudes towards abortion by gender. In answer to the question, "On the subject of abortion, do you think abortion should be legal in all cases, legal in most cases, illegal in most cases or illegal in all cases?", 25% of women responded that it should be legal in "all cases", 33% that it should be legal in "most cases", 23% that it should be illegal in "most cases", and 17% that it should be illegal in "all cases". 20% of men thought it should be legal in "all cases", 34% legal in "most cases", 27% illegal in "most cases", and 17% illegal in "all cases".[174]
  • Most Fox News viewers favor both parental notification as well as parental consent, when a minor seeks an abortion. A Fox News poll in 2005 found that 78% of people favor a notification requirement, and 72% favor a consent requirement.[175]
  • An April 2006 Harris poll on Roe v. Wade, asked, "In 1973, the U.S. Supreme Court decided that states' laws which made it illegal for a woman to have an abortion up to three months of pregnancy were unconstitutional, and that the decision on whether a woman should have an abortion up to three months of pregnancy should be left to the woman and her doctor to decide. In general, do you favor or oppose this part of the U.S. Supreme Court decision making abortions up to three months of pregnancy legal?", to which 49% of respondents indicated favor while 47% indicated opposition. The Harris organization has concluded from this poll that, "49 percent now support Roe vs. Wade".[176]
  • Two polls were released in May 2007 asking Americans "With respect to the abortion issue, would you consider yourself to be pro-choice or pro-life?" May 4–6, a CNN poll found 45% said "pro-choice" and 50% said pro-life.[177] Within the following week, a Gallup poll found 50% responding "pro-choice" and 44% pro-life.[178]
  • In 2011, a poll conducted by the Public Religion Research Institute found that 43% of respondents identified themselves as both "pro-life" and "pro-choice".[179]

"Partial birth abortion"[edit]

See also: Partial-Birth Abortion Ban Act

"Partial-Birth abortion" is nomenclature for a procedure called intact dilation and extraction generally used by those who oppose the procedure. A Rasmussen Reports poll four days after the Supreme Court's opinion in Gonzales v. Carhart found that 40% of respondents "knew the ruling allowed states to place some restrictions on specific abortion procedures." Of those who knew of the decision, 56% agreed with the decision and 32% were opposed.[180] An ABC poll from 2003 found that 62% of respondents thought partial-birth abortion should be illegal; a similar number of respondents wanted an exception "if it would prevent a serious threat to the woman's health".

Gallup has repeatedly queried the American public on this issue, as seen on its Abortion page:[170]

Legislation201120032000200020001999199819971996
A law which would make it illegal to perform a specific abortion procedure conducted in the last six months (or second and/or third trimester) of pregnancy known by some opponents as a partial birth abortion, except in cases necessary to save the life of the mother64%70%63%66%64%61%61%55%57%

Abortion financing[edit]

State Medicaid coverage of medically necessary abortion services.
Navy blue: Medicaid covers medically necessary abortion for low-income women through legislation
Royal blue: Medicaid covers medically necessary abortions for low-income women under court order
Gray: Medicaid denies abortion coverage for low-income women except for cases of rape, incest, or life endangerment.

The abortion debate has also been extended to the question of who pays the medical costs of the procedure, with some states using the mechanism as a way of reducing the number of abortions. The cost of an abortion varies depending on factors such as location, facility, timing, and type of procedure. In 2005, a non-hospital abortion at 10 weeks' gestation ranged from $90 to $1,800 (average: $430), whereas an abortion at 20 weeks' gestation ranged from $350 to $4,520 (average: $1,260). Costs are higher for a medical abortion than a first-trimester surgical abortion.

Medicaid[edit]

The Hyde Amendment is a federal legislative provision barring the use of federal Medicaid funds to pay for abortions except for rape and incest.[181] The provision, in various forms, was in response to Roe v. Wade, and has been routinely attached to annual appropriations bills since 1976, and represented the first major legislative success by the pro-life movement. The law requires that states cover abortions under Medicaid in the event of rape, incest, and life endangerment. Based on the federal law:

  • 32 states and D.C. fund abortions through Medicaid only in the cases of rape, incest, or life endangerment. SD covers abortions only in the cases of life endangerment, which does not comply with federal requirements under the Hyde Amendment. IN, UT, and WI have expanded coverage to women whose physical health is jeopardized, and IA, MS, UT, and VA also include fetal abnormality cases.
  • 17 states (AK, AZ, CA, CT, HI, IL, MD, MA, MN, MT, NJ, NM, NY, OR, VT, WA, WV) use their own funds to cover all or most "medically necessary" abortions sought by low-income women under Medicaid, 12 of which are required by State court orders to do so.[182]

Private insurance[edit]

  • 5 states (ID, KY, MO, ND, OK) restrict insurance coverage of abortion services in private plans: OK limits coverage to life endangerment, rape or incest circumstances; and the other four states limit coverage to cases of life endangerment.
  • 11 states (CO, KY, MA, MS, NE, ND, OH, PA, RI, SC, VA) restrict abortion coverage in insurance plans for public employees, with CO and KY restricting insurance coverage of abortion under any circumstances.
  • U.S. laws also ban federal funding of abortions for federal employees and their dependents, Native Americans covered by the Indian Health Service, military personnel and their dependents, and women with disabilities covered by Medicare.[183]

Mexico City policy[edit]

Main article: Mexico City policy

Under this policy, US federal funding to NGOs that provide abortion is not permitted.

Positions of U.S. political parties[edit]

Though members of both major political parties come down on either side of the issue, the Republican Party is often seen as being anti-abortion, since the official party platform opposes abortion and considers fetuses to have an inherent right to life. Republicans for Choice represents the minority of that party. In 2006, pollsters found that 9% of Republicans favor the availability of abortion in most circumstances.[184] Of Republican National Convention delegates in 2004, 13% believed that abortion should be generally available, and 38% believed that it should not be permitted. The same poll showed that 17% of all Republican voters believed that abortion should be generally available to those who want it, while 38% believed that it should not be permitted.[185]

The Republican party was supportive of abortion rights prior to their 1976 convention, at which they supported an anti-abortion constitutional amendment as a temporary political ploy to gain more support from Catholics, though this stance brought many more social conservatives into the party resulting in a large and permanent shift toward support of the anti-abortion position.[186]

The Democratic Party platform considers abortion to be a woman's right. Democrats for Life of America represents the minority of that party. In 2006, pollsters found that 74% of Democrats favor the availability of abortion in most circumstances.[184] Of Democratic National Convention delegates in 2004, 75% believed that abortion should be generally available, and 2% believed that abortion should not be permitted. The same poll showed that 49% of all Democratic voters believed that abortion should be generally available to those who want it, while 13% believed that it should not be permitted.[187]

The Green Party of the United States supports legal abortion as a woman's right.

The Libertarian Party platform (2012) states that "government should be kept out of the matter, leaving the question to each person for their conscientious consideration".[188] Abortion is a contentious issue among Libertarians, and the Maryland-based organization Libertarians for Life opposes the legality of abortion in most circumstances.

The issue of abortion has become deeply politicized: in 2002, 84% of state Democratic platforms supported the right to having an abortion while 88% of state Republican platforms opposed it. This divergence also led to Christian Right organizations like Christian Voice, Christian Coalition and Moral Majority having an increasingly strong role in the Republican Party. This opposition has been extended under the Foreign Assistance Act: in 1973 Jesse Helms introduced an amendment banning the use of aid money to promote abortion overseas, and in 1984 the Mexico City Policy prohibited financial support to any overseas organization that performed or promoted abortions. The "Mexico City Policy" was revoked by President Bill Clinton and subsequently reinstated by President George W. Bush. President Barack Obama overruled this policy by Executive Order on January 23, 2009,[citation needed] and it was reinstated on January 23, 2017, by President Donald Trump. On January 28, 2021, U.S. President Joe Biden signed a Presidential Memorandum which repealed the restoration of Mexico City policy and also called for the United States Department of Health and Human Services to "suspend, rescind or revoke" restrictions which were made to Title X.[189]

Effects of legalization[edit]

The 2013 winter issue of Ms.magazinewas about abortion rights.

The risk of death due to legal abortion has fallen considerably since legalization in 1973, due to increased physician skills, improved medical technology, and earlier termination of pregnancy.[190] From 1940 through 1970, deaths of pregnant women during abortion fell from nearly 1,500 to a little over 100.[190] According to the Centers for Disease Control, the number of women who died in 1972 from illegal abortion was thirty-nine.[191]

The Roe effect is a hypothesis which suggests that since supporters of abortion rights cause the erosion of their own political base by having fewer children, the practice of abortion will eventually lead to the restriction or illegalization of abortion. The legalized abortion and crime effect is another controversial theory that posits legal abortion reduces crime, because unwanted children are more likely to become criminals.

Since Roe v. Wade, there have been numerous attempts to reverse the decision. In the 2011 election season, Mississippi placed an amendment on the ballot that redefined how the state viewed abortion. The personhood amendment defined personhood as "every human being from the moment of fertilization, cloning or the functional equivalent thereof". If passed, it would have been illegal to get an abortion in the state.[192]

On July 11, 2012, a Mississippi federal judge ordered an extension of his temporary order to allow the state's only abortion clinic to stay open. The order will stay in place until U.S. District Judge Daniel Porter Jordan III can review newly drafted rules on how the Mississippi Department of Health will administer a new abortion law. The law in question came into effect on July 1, 2012.[193]

According to a 2019 study, if Roe v. Wade is reversed and abortion bans are implemented in trigger law states and states considered highly likely to ban abortion, "increases in travel distance are estimated to prevent 93,546 to 143,561 women from accessing abortion care."[194]

Unintended live birth[edit]

Although it is uncommon, women sometimes give birth in spite of an attempted abortion.[195][196][197][198][199][200][201] Reporting of livebirth after attempted abortion may not be consistent from state to state, but 38 were recorded in one study in upstate New York in the two-and-a-half years before Roe v. Wade.[202] Under the Born-Alive Infants Protection Act of 2002, medical staff must report live birth if they observe any breathing, heartbeat, umbilical cord pulsation, or confirmed voluntary muscle movement, regardless of whether the born-alive is non-viable ex utero in the long term because of birth defects, and regardless of gestational age, including gestational ages which are too early for long-term viability ex utero.[203][204][205][206][207]

See also[edit]

Notable cases
  • Becky Bell, an American teenage girl who died as a result of an unsafe abortion in 1988.
  • Rosie Jimenez, an American woman who was the first recorded death due to an unsafe abortion after federal Medicaid funds for abortions were removed by the Hyde Amendment in 1977.
  • Gerri Santoro, an American woman who died because of an unsafe abortion in 1964.
  • Gerardo Flores, convicted in 2005 on two counts of capital murder for giving his girlfriend, who was carrying twins, an at-home abortion.
  • Gianna Jessen, an American woman who was born alive in 1977 after an attempted saline abortion.
  • Sherri Finkbine, an actress who had difficulty seeking an abortion for her thalidomide deformed baby in 1962.

References[edit]

  1. ^Wilson, Joshua C. (2020). "Striving to Rollback or Protect Roe: State Legislation and the Trump-Era Politics of Abortion". Publius: The Journal of Federalism. 50 (3): 370–397. doi:10.1093/publius/pjaa015. S2CID 225601579.
  2. ^Alesha Doan (2007). Opposition and Intimidation: The Abortion Wars and Strategies of Political Harassment. University of Michigan Press. p. 57. ISBN .
  3. ^Casey, 505 U.S. at 877.
  4. ^ abKortsmit, K; Jatlaoui, TC; Mandel, MG (2020). "Abortion Surveillance — United States, 2018". MMWR. Surveillance Summaries. Centers for Disease Control and Prevention. 69 (7): 1–29. doi:10.15585/mmwr.ss6907a1. PMC 7713711. PMID 33237897. Retrieved July 9, 2021.
  5. ^ abPeipert, Jeffrey F.; Madden, Tessa; Allsworth, Jenifer E.; Secura, Gina M. (December 2012). "Preventing Unintended Pregnancies by Providing No-Cost Contraception". Obstetrics & Gynecology. 120 (6): 1291–1297. doi:10.1097/AOG.0b013e318273eb56. PMC 4000282. PMID 23168752.
  6. ^ abGuyot, Katherine; Sawhill, Isabel V. (July 29, 2019). "Reducing access to contraception won't reduce the abortion rate". Brookings Institution. Retrieved January 22, 2021.
  7. ^ abDreweke, Joerg (March 18, 2016). "New Clarity for the U.S. Abortion Debate: A Steep Drop in Unintended Pregnancy Is Driving Recent Abotion Declines". Guttmacher Institute. Retrieved January 22, 2021.
  8. ^Saad, Lydia (August 8, 2011). "Plenty of Common Ground Found in Abortion Debate". Gallup.com. Retrieved August 8, 2013.
  9. ^ abJeffrey Jones (June 11, 2018). "U.S. Abortion Attitudes Remain Closely Divided". Gallup.
  10. ^"Abortion | Gallup Historical Trends". Gallup.com. June 22, 2007. Retrieved August 10, 2014.
  11. ^According to the Supreme Court's decision in Roe v. Wade:

    (a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician.

    (b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health.

    (c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother.

    Likewise, Black's Law Dictionary defines abortion as "knowing destruction" or "intentional expulsion or removal".

  12. ^Watson, Katie (December 20, 2019). "Why We Should Stop Using the Term "Elective Abortion"". AMA Journal of Ethics. 20 (12): 1175–1180. doi:10.1001/amajethics.2018.1175. PMID 30585581.
  13. ^Linton, P. B. (1989). "Roe v. Wade and the history of abortion regulation". American Journal of Law & Medicine. 15 (2–3). pp. 227–33. PMID 2690604.
  14. ^Levene, Malcolm et al. Essentials of Neonatal Medicine (Blackwell 2000), page 8. Retrieved February 15, 2007.
  15. ^Jacobson, Donna (2019). "When Abortion Became Illegal". Connecticut History Review. 58 (2): 49–81. doi:10.5406/connhistrevi.58.2.0049.
  16. ^Buell, Samuel (1991). "Criminal Abortion Revisited". New York University Law Review. 66:1774 (6): 1774–831. PMID 11652642 – via duke.edu.
  17. ^Alford, Suzanne M. (2003). "Is Self-Abortion a Fundamental Right?". Duke Law Journal. 52 (5): 1011–29. JSTOR 1373127. PMID 12964572. Archived from the original on January 22, 2019. Retrieved January 21, 2007.
  18. ^ abJames C. Mohr (1978). Abortion in America: The Origins and Evolution of National Policy. Oxford University Press. pp. 35–36. ISBN .
  19. ^James C. Mohr (1978). Abortion in America: The Origins and Evolution of National Policy. Oxford University Press. p. 34. ISBN .
  20. ^James C. Mohr (1978). Abortion in America: The Origins and Evolution of National Policy. Oxford University Press. pp. 76–82. ISBN .
  21. ^James C. Mohr (1978). Abortion in America: The Origins and Evolution of National Policy. Oxford University Press. pp. 100–101. ISBN .
  22. ^Gordon, Sarah Barringer. "Law and Everyday Death: Infanticide and the Backlash against Woman's Rights after the Civil War."Lives of the Law. Austin Sarat, Lawrence Douglas, and Martha Umphrey, Editors. (University of Michigan Press 2006) p. 67
  23. ^ abSchiff, Stacy."Desperately Seeking Susan." October 13, 2006, The New York Times. Retrieved February 5, 2009.
  24. ^"Marriage and Maternity". The Revolution. Susan B. Anthony. July 8, 1869. Retrieved April 21, 2009.
  25. ^Susan B. Anthony, "Marriage and Maternity", Archived October 5, 2011, at the Wayback MachineThe Revolution (July 8, 1869), via University Honors Program, Syracuse University.
Sours: https://en.wikipedia.org/wiki/Abortion_in_the_United_States

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Abortion statistics in the United States

Both the Centers for Disease Control and Prevention (CDC)[1][2] and the Guttmacher Institute[3] regularly report abortion statistics in the United States. They use different methodologies, so they report somewhat different abortion rates, but they show similar trends. The CDC relies on voluntary reporting of abortion data from the states and the District of Columbia.[2] The Guttmacher Institute, on the other hand, attempts to contact every abortion provider.[3]

Abortion statistics are commonly presented as the number of abortions, the abortion rate (the number of abortions per 1,000 women ages 15 to 44), and the abortion ratio. The CDC defines the abortion ratio as the number of abortions per 1,000 live births,[2] and the Guttmacher Institute defines it as the number of abortions per 100 pregnancies ending in an abortion or a live birth.[3]

Trends in abortion statistics[edit]

As of December 2020, the CDC had reported abortion data for the years 1970 through 2018, and the Guttmacher Institute had reported abortion data for the years 1973 through 2017.

The Guttmacher Institute has always found a higher abortion rate than the CDC. For 2017, the Guttmacher Institute reported 13.5 abortions and the CDC reported 11.2 abortions per 1,000 women of childbearing age.

Here are some of the reasons the CDC’s data is incomplete:

  • States are not legally required to report abortion data to the CDC. For 2018, California, Maryland, and New Hampshire failed to report abortion data. In particular, the lack of data from California, a populous state with a high abortion rate, reduces the reported overall abortion rate.
  • New Jersey and the District of Columbia do not require abortion providers to report abortions to a governmental health agency, so data for these areas may be incomplete.
  • Among states that require abortion providers to report abortions, compliance varies. [2]

The Guttmacher Institute’s data is incomplete in a different way: it does not collect abortion data for every year. Currently, it skips every third year and estimates data for missing years by interpolation.[3]

In 1973, the Roe v. Wade Supreme Court decision legalized abortion in all 50 states. From 1973 to 1980, the abortion rate rose almost 80%, peaking at 29.3 abortions per 1,000 women of childbearing age according to the Guttmacher Institute and at 25 abortions per 1,000 women of childbearing age according to the CDC.

From 1981 through 2017, the abortion rate fell approximately in half. It did not fall every single year, but it has not risen two years in a row since 1979 and 1980. The abortion rate fell below the 1973 rate in 2012 and continued to fall through 2017. In 2017, the abortion rate stood at 13.5 abortions per 1,000 women of childbearing age according to the Guttmacher Institute, and at 11.2 abortions per 1,000 women of childbearing age according to the CDC. In 2018, according to the CDC, the abortion rate rose for the first time since 2006, to 11.3 abortions per 1,000 women of childbearing age.

During the 1980s, the population of women of childbearing age grew faster than the abortion rate fell, so the number of abortions performed did not peak until 1990. From 1991 through 2017, the number of abortions generally fell. The largest percentage decrease in the number of abortions occurred in 2013, the year the contraceptive mandate of the Affordable Care Act took effect for most health insurance plans. The Guttmacher Institute reports that 862,320 abortions were performed in 2017.

From 1973 to 1983, the abortion ratio, defined by the Guttmacher Institute as the number of abortions per 100 pregnancies ending in an abortion or a live birth, rose about 60%, peaking at 30.4 in 1983. From 1984 through 2016, the abortion ratio fell about 40%, falling more rapidly in Democratic administrations than in Republican ones. It hit a low of 18.3 in 2016 and rose slightly to 18.4 in 2017. The abortion ratio was slightly lower in 2016 and 2017 than in 1973 because a 40% decrease more than offsets a 60% increase. The CDC defines the abortion ratio differently but reports similar trends. According to the CDC, the abortion ratio peaked in 1984, fell to its lowest point in 2017, and increased slightly in 2018.

Abortion data for the two most recent years reported by the Guttmacher Institute appears below. The abortion rate is the number of abortions per 1,000 women of childbearing age and the abortion ratio is the number of abortions per 100 pregnancies ending in an abortion or a live birth. The number of abortions and the abortion rate fell in 2017, but, for the first time since 2008, the abortion ratio rose.[3]

yearnumber of abortionsabortion rateabortion ratio
2016874,10013.718.3
2017862,30013.518.4


Abortion data for the two most recent years reported by the CDC appears below. The number of abortions is the number reported in 47 states and the District of Columbia, excluding California, Maryland, and New Hampshire. The abortion rate is the number of abortions per 1,000 women of childbearing age and the abortion ratio is the number of abortions per 1,000 live births. All these numbers rose slightly in 2018.[2]

yearnumber of abortionsabortion rateabortion ratio
2017612,71911.2185
2018619,59111.3189

Independent clinics provide 60% of abortions in the United States while Planned Parenthood provides 35% of abortions in the United States.[4]

CDC surveillance reports[edit]

The Centers for Disease Control and Prevention began abortion surveillance reports in 1969 to document the number and characteristics of women obtaining legal induced abortions. CDC compiles the information that the states and the District of Columbia collect to produce national estimates. Because New York City and the rest of New York State report separately, there are a total of 52 reporting areas. The CDC numbers, published annually, are derived from actual counts of every abortion reported to state health departments. Reporting to the CDC is not mandatory,[1] Some states choose not to report abortions to the CDC, and different states fail to report in different years. The CDC’s surveillance system compiles information on legal induced abortions only. Because reporting is voluntary, CDC surveillance reports undercount the actual number of abortions in the United States.

Graph of U.S. abortion rates, 1970-2018, showing data collected by the CDC[5][6][7][2]

To estimate the percentage change in the abortion rate from one year to the next most accurately, we must compare data from the same group of states in both years. Unfortunately, different states report their data to the CDC in different years. The black, blue, green, and purple pieces of the graph allow us to make accurate apples-to-apples comparisons. Each differently colored piece shows data from a different group of states. For example, the blue piece shows data from 46 reporting areas that reported continuously from 1997 through 2006. To estimate the change in the abortion rate from 1996 to 1998, we use the black part of the graph for 1997 and the blue part for 1998. The black part shows a 4.8% decrease in 1997, and the blue part shows a 2.3% decrease in 1998. The gap between the black and blue sections in 1997 occurs because data from California, a populous state with high abortion rates, was not available after 1997.

The rapid increase in the reported abortion rates from 1970 through 1972, prior to Roe v. Wade, was due in part to improved reporting of the abortions that occurred.[8]

Graph of mean annual changes in the U.S. abortion rate by Presidential administration, 1974-2018, calculated from CDC data.[5][6][7][2]

The means in the graph above are geometric means. For example, the mean annual increase during the Carter administration was 4.46%, because the abortion rate rose 19% in the Carter administration, and 104.46%*104.46%*104.46%*104.46%=119%.

Guttmacher Institute estimates[edit]

Unlike the CDC, the abortion rights research and policy organization Guttmacher Institute does not rely only on state reports but instead periodically surveys abortion providers in all states to estimate the number of abortions in the United States.[3]

For 2017, the Guttmacher Institute reported 862,320 abortions, an abortion rate of 13.5 abortions per 1,000 women aged 15 to 44 years, and 18.4 abortions per 100 pregnancies ending in abortion or live birth.[9][3]

Graph of U.S. abortion rates, 1973-2017, showing data collected by the Guttmacher Institute[10][3]

Graph of number of abortions and abortion ratios in the U.S., 1973-2017, showing data collected by the Guttmacher Institute[10][3]

References[edit]

  1. ^ ab"Abortion | Data and Statistics | Reproductive Health | CDC". www.cdc.gov. 2019-01-16. Retrieved 2019-07-24.
  2. ^ abcdefgKortsmit, Katherine; Jatlaoui, Tara C.; Mandel, Michele G.; Reeves, Jennifer A.; Oduyebo, Titilope; Petersen, Emily; Whiteman, Maura K. (November 27, 2020). "Abortion Surveillance -- United States, 2018". Morbidity and Mortality Weekly Report. 69 (7): 14. Graphs in this Wikipedia article take CDC data for 2015-2018 from this source.
  3. ^ abcdefghiJones, Rachel K.; Witwer, Elizabeth; Jerman, Jenna (September 2019). "Abortion Incidence and Service Availability in the United States, 2017". doi:10.1363/2019.30760. Retrieved December 12, 2020.
  4. ^https://abortioncarenetwork.org/wp-content/uploads/2020/07/6-infographic-poster-7-b.pdf
  5. ^ abGamble, Sonya B.; Strauss, Lilo T.; Parker, Wilda Y.; Cook, Douglas A.; Zane, Suzanne B.; Hamdan, Saeed (November 28, 2008). "Abortion Surveillance - United States, 2005". MMWR. Surveillance Summaries. 57 (SS-13): 16. Graphs in this Wikipedia article take CDC data for 1970-1997 from this source.
  6. ^ abPazol, Karen; Gamble, Sonya B.; Parker, Wilda Y.; Cook, Douglas A.; Zane, Suzanne B.; Hamdan, Saeed (November 27, 2009). "Abortion Surveillance - United States, 2006". MMWR. Surveillance Summaries. 58 (SS-8): 13. Graphs in this Wikipedia article take CDC data for 1997-2006 from this source.
  7. ^ abJatlaoui TC, Boutot ME, Mandel MG, Whiteman MK, Ti A, Petersen E, Pazol K (November 2018). "Abortion Surveillance - United States, 2015". MMWR. Surveillance Summaries. 67 (13): 20. doi:10.15585/mmwr.ss6713a1. PMC 6289084. PMID 30462632. Graphs in this Wikipedia article take CDC data for 2006-2015 from this source.
  8. ^"Current Trends Abortion Surveillance: Preliminary Analysis -- United States, 1981". Morbidity and Mortality Weekly Report. 33 (26): 373–375. July 6, 1984.
  9. ^"Induced Abortion in the United States". Guttmacher Institute. September 2019. Retrieved 2020-01-24.
  10. ^ abJones, Rachel K.; Kooistra, Kathryn (March 2011). "Abortion Incidence and Access to Services in the United States, 2008"(PDF). Perspectives on Sexual and Reproductive Health. 43 (1): 41–50. doi:10.1363/4304111. PMID 21388504. Retrieved December 8, 2017.
Sours: https://en.wikipedia.org/wiki/Abortion_statistics_in_the_United_States


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