Transcript Abortion in the United States

Abortion
in the United
States
PRCH & Guttmacher © 2005
US Public Opinions
about Abortion
©The Alan Guttmacher Institute
Presentation Title
PRCH & Guttmacher © 2005
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Incidence of Pregnancy
and Abortion
PRCH & Guttmacher © 2005
Pregnancies in the United States
(Approximately 6.3 Million Annually)
% of Pregnancies
60%
52%
50%
48%
40%
30%
20%
10%
0%
Intended
©The Alan Guttmacher Institute
Unintended
Source: Henshaw, 1998
Presentation Title
(1994 data)
PRCH & Guttmacher © 2005
Outcomes of Unintended Pregnancies
(Approximately 3.0 Million Annually)
% of Unintended Pregnancies
60%
50%
47%
40%
40%
30%
20%
13%
10%
0%
Abortions
©The Alan Guttmacher Institute
Births
Miscarriages
Source: Henshaw, 1998
Presentation Title
(1994 data)
PRCH & Guttmacher © 2005
Incidence of Abortion
In 2002, 1.29 million pregnancies were
terminated by abortion in the United States.
Some 2.1% of all women aged 15–44 had an
abortion in 2001.
Abortion is one of the most common surgical
procedures in the United States.
©The Alan Guttmacher Institute
Source: Finer and
Presentation Title
Henshaw, 2005
PRCH & Guttmacher © 2005
Abortion Rates Among Women Aged
15–44
Abortions per 1,000 women
30
25
20
15
10
5
©The Alan Guttmacher Institute
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
19
80
0
Presentation Title
Source: Finer and Henshaw, 2005
PRCH & Guttmacher © 2005
Abortion Rates in Western
Industrialized Countries
Abortions per 1,000 women
30
25
20.9
20
22.2
18.7
16.5
16.4
15.6
15
7.6
10
6.5
5
0
United
States
(2002)
Australia Sweden Denmark Canada
©The Alan Guttmacher Institute
England Germany
& Wales
Holland
Source: Finer and Henshaw, 2005;
Presentation Title
Henshaw et al., 1999 (1996 data)
Reasons for Abortions
PRCH & Guttmacher © 2005
Most Important Reason Given for
Terminating an Unwanted Pregnancy
Inadequate finances
Not ready for responsibility
Woman’s life would be changed too much
Problems with relationship; unmarried
Too young; not mature enough
21%
21%
16%
12%
11%
Children are grown; woman has all she wants
Fetus has possible health problem
Woman has health problem
Pregnancy caused by rape, incest
8%
3%
3%
1%
Other
4%
Average number of reasons given
3.7
©The Alan Guttmacher Institute
Presentation Title
Source: Torres and Forrest, 1988 (1987 data)
Gestational Age
PRCH & Guttmacher © 2005
Abortions by Gestational Age
(Weeks Since Last Menstrual Period)
% of Abortions
100%
80%
60%
59.1%
40%
19.0%
20%
10.0%
6.2%
4.3%
13-15
16-20
1.4%
0%
<9
9-10
11-12
21+
Weeks
©The Alan Guttmacher Institute
Presentation Title
Source: Strauss et al., 2004 (2001 data)
PRCH & Guttmacher © 2005
Reasons for Abortions After
16 Weeks Since Last Menstrual Period
Woman did not realize she was pregnant
Difficulty making arrangements for abortion
Afraid to tell parents or partner
Needed time to make decision
Hoped relationship would change
Pressure not to have abortion
Something changed during pregnancy
Didn’t know timing was important
Didn’t know she could get an abortion
Fetal abnormality diagnosed late
Other
71%
48%
33%
24%
8%
8%
6%
6%
5%
2%
11%
Average number of reasons given
2.2
©The Alan Guttmacher Institute
Presentation Title
Source: Torres and Forrest, 1988 (1987 data)
PRCH & Guttmacher © 2005
Methods of Abortion
I. Suction Methods
A. Endometrial Aspiration
1. Performed 4-6 weeks after LMP
2. Use of flexible tube
3. May be done without pregnancy
confirmation
4. Side effects may include cramps &
intermittent menstrual bleeding
©The Alan Guttmacher Institute
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Methods of Abortion
I. Suction Methods (continued)
B. Early Abortion
1. Same as A. only pregnancy
confirmed
C. Vacuum Curretage
1. Performed after 8 weeks
2. Larger fetal tissue
3. Use of rigid tube with more
suction
4. Dilation of cervix is required
©The Alan Guttmacher Institute
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PRCH & Guttmacher © 2005
Methods of Abortion
I. Suction Methods
(continued)
D. Dilation and Evacuation
1. Performed 13-16 weeks
2. Fetus is broken up with
surgical
instrument prior to suction
3. More dilation is needed
©The Alan Guttmacher Institute
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Methods of Abortion
II. Surgical Removal Through
Cervix
A. Dilation and Curretage
1. Performed 8-15 weeks
2. Lining of uterus is scraped
with
surgical instrument
©The Alan Guttmacher Institute
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Methods of Abortion
III. Induced Labor
A. Saline Abortion
1. Performed early to middle parts of
2nd trimester
2. Saline injected into Amniotic sac
(kills fetus)
©The Alan Guttmacher Institute
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Methods of Abortion
IV. Surgical Removal
Through Caesarean
Procedure
A. Hysterotomy
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Safety of Abortion
PRCH & Guttmacher © 2005
Deaths per 100,000
Abortions or Births
Deaths per 100,000
10
8.9
7.1
8
6
3.4
4
2
1.7
0.1
0.2
0.7
0.4
0
<9
9-10 11-12 13-15 16-20
Abortions by gestation
©The Alan Guttmacher Institute
21+
All
abs.
Births
Sources: Birth: Henshaw, 2004 (1995–1997 data);
Presentation Title
Abortion: Bartlett et al., 2004 (1988–1997 data)
PRCH & Guttmacher © 2005
Abortion Risks in Perspective
Risk from terminating pregnancy:
Before 9 weeks
Between 9 and 10 weeks
Between 13 and 15 weeks
After 20 weeks
Chance of death
per year:
1
1
1
1
in
in
in
in
1,000,000
500,000
60,000
11,000
1
1
1
1
in
in
in
in
1,000
5,900
5,900
25,000
Risk to persons who participate in:
Motorcycling
Automobile driving
Power-boating
Playing football
Risk to women aged 15–44 from:
Having sexual intercourse (PID)
Using tampons
©The Alan Guttmacher Institute
1 in 50,000
1 in 350,000
Presentation Title
Source: Bartlett et al., 2004 (1988–1997 data)
Who Has Abortions
PRCH & Guttmacher © 2005
Who Has Abortions: Age
40-44 years,
3.1%
35-39 years,
8.1%
<15 years,
0.7%
15-19 years,
18.6%
30-34 years,
13.5%
25-29 years,
23.1%
©The Alan Guttmacher Institute
20-24 years,
33.0%
Presentation Title
Source: Jones et al., 2002
PRCH & Guttmacher © 2005
Who Has Abortions: Marital Status
Separated/
Divorced/
Widowed,
15.6%
Married,
17.0%
©The Alan Guttmacher Institute
Nevermarried,
67.3%
Presentation Title
Source: Jones et al., 2002
PRCH & Guttmacher © 2005
Who Has Abortions:
Economic Status
% of the Federal Poverty Level
>300%,
24.6%
<100%,
26.6%
In 2007 the Federal
Poverty Level was
$11,750 per fear for
one person
200-299%,
18.0%
©The Alan Guttmacher Institute
100-199%,
30.8%
Presentation Title
Source: Jones et al., 2002
PRCH & Guttmacher © 2005
Who Has Abortions:
Race/Ethnicity
Native
American*,
0.9%
Asian/Pacific
Islander*,
6.4%
Hispanic,
20.1%
White*,
40.9%
Black*,
31.7%
©The Alan Guttmacher Institute
*Non-Hispanic
Presentation Title
Source: Jones et al., 2002
PRCH & Guttmacher © 2005
Who Has Abortions:
Religious Identification
None,
22.2%
Protestant,
42.8%
Other,
7.6%
Catholic,
27.4%
©The Alan Guttmacher Institute
Presentation Title
Source: Jones et al., 2002
PRCH & Guttmacher © 2005
Who Has Abortions:
Prior Pregnancies
None,
27%
Previous
Birth,
25%
©The Alan Guttmacher Institute
Previous
Abortion,
12%
Previous
Abortion
and
Previous
Birth,
36%
Presentation Title
Source: Jones et al., 2002
Who Provides Abortion
Services
PRCH & Guttmacher © 2005
Number of Providers by Type
Number of Providers
1600
1400
1200
Abortion
clinic
1000
800
Other clinic
600
Hospital
400
Physicians'
office
200
0
1980
1984
1988
©The Alan Guttmacher Institute
1992
1996
2000
Presentation Title
Source: Finer and Henshaw, 2003
PRCH & AGI © 2005
Factors Contributing to the Decline in
the Number of Abortion Providers
Antichoice harassment and violence
Social stigma/marginalization
Professional isolation/peer pressure
The “graying of providers”
Inadequate economic/other incentives
Lack of medical training opportunities
©The Alan Guttmacher Institute
Presentation Title
Source: NAF & ACOG, 1991
Factors That Make It Difficult
For Women to Obtain
Abortion Services
PRCH & Guttmacher © 2005
Percentage of Counties with No Provider
And % of Women Living in Those Counties
100%
80%
60%
40%
20%
0%
1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
Unserved counties
©The Alan Guttmacher Institute
Women in unserved counties
Presentation Title
Source: Finer and Henshaw, 2003
PRCH & Guttmacher © 2005
Percentage of Providers of 400 or More
Abortions Per Year Who Have
Reported Harassment in 2000
Picketing
80%
Picketing with physical contact with patients
28%
Vandalism
18%
Picketing homes of staff members
14%
Bomb threats
15%
©The Alan Guttmacher Institute
Presentation Title
Source: Henshaw and Finer, 2003
PRCH & Guttmacher © 2005
Legal
Restrictions on
Abortion
©The Alan Guttmacher Institute
Presentation Title
PRCH & Guttmacher © 2005
Federal Laws & Policies about
Abortion
Hyde Amendment - 1977
Freedom of Access to Clinic
Entrances Act - 1994
Federal Health Benefits Program
©The Alan Guttmacher Institute
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State Laws about Abortion
In 1992, the US Supreme Court
upheld the right to abortion in
Planned Parenthood v. Casey.
However, the ruling significantly
weakened the legal protections
previously afforded women and
physicians by giving states the
right to enact restrictions that do
not create an "undue burden" for
women seeking abortion.
©The Alan Guttmacher Institute
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Stenberg v. Carhart, 530 U.S. 914
(2000)
US Supreme Court overturned a Nebraska statute banning
"partial-birth abortion."
Court found that the ban would outlaw the safest
and most commonly used methods of secondtrimester abortion, and therefore constituted an
undue burden on women’s right to obtain
abortions.
"the absence of a health exception will place women at an
unnecessary risk of tragic health consequences."
©The Alan Guttmacher Institute
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PRCH & Guttmacher © 2005
Federal Laws in the Works
Despite that ruling, Congress passed an almost identical ban on socalled “partial birth abortion” that was signed into law by President
George W. Bush on November 5, 2003.
Also on November 5, 2003, minutes after Bush signed it into law, a
Nebraska federal judge issued a temporary restraining order
preventing the first-ever federal abortion ban from being enforced
against the plaintiffs in the Nebraska lawsuit challenging the ban.
Three Federal Courts in New York, California, and Nebraska have
struck down this law as unconstitutional. In January of 2006, 2 Federal
Appeals Courts upheld these rulings.
On November 8, 2006 the U.S. Supreme Court heard
arguments in two challenges to the Federal Abortion Ban,
also known as the "Partial-Birth Abortion Ban Act of 2003."
In both the Center for Reproductive Rightsﾕ case
(Gonzales v. Carhart) and Planned Parenthoodﾕs case
(Gonzales v. Planned Parenthood), appellate courts
declared the ban unconstitutional citing previous law
established over the last thirty years.
©The Alan Guttmacher Institute
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APRIL 2007
With Bush-appointed judges Alito and
Roberts, Supreme Court upholds the
Federal partial birth abortion ban in a
5-4 decision.
©The Alan Guttmacher Institute
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STATES ENACTED 52 LAWS
RESTRICTING ABORTION IN 2005
Of the 195 state-level abortion restrictions
adopted since 2000, one-quarter were
enacted in 2005 alone.
©The Alan Guttmacher Institute
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State Laws Restricting Abortion
Twenty-nine states mandate that a woman
seeking an abortion be given counseling including
information intended to discourage her from
obtaining the procedure;
24 states require a woman seeking an abortion to
wait a specified period of time, usually 24 hours,
between when she receives counseling and when
the procedure is performed.
©The Alan Guttmacher Institute
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State Laws Restricting Abortion
Thirty-three states and the District of Columbia prohibit the
use of public funds to pay for abortion for low-income
women, even when it is medically necessary, generally
making exceptions only in cases of life endangerment,
rape or incest. Only 17 states use their own funds to pay
for all or most medically necessary abortions for Medicaid
enrollees.
Thirty-four states require some type of parental
involvement in a minorﾕs decision to have an abortion:
Twenty-one states require one or both parents to consent
to the procedure, while 13 require that a parent be notified.
©The Alan Guttmacher Institute
Presentation Title
February 22, 2006:South
Dakota lawmakers approved the
nation's most far-reaching ban on
abortion
The measure, which passed the state
Senate 23 to 12, makes it a felony for
doctors to perform any abortion, except to
save the life of a pregnant woman. The
proposal was signed by Gov. Mike Rounds
(R) on March 6, 2006. In November of
2006, South Dakotans voted to reject the
ban (55% to 45%).
International Perspective
on Abortion
PRCH & Guttmacher © 2005
U.S. Share of Abortions
Worldwide
3% United States
Rest of the World
97%
©The Alan Guttmacher Institute
Source: Henshaw et al., 1999
Presentation Title
(1995 data)
PRCH & Guttmacher © 2005
Abortion Rate, United States and
World
Abortions per 1,000 Women
40
35
35
30
25
21
20
15
10
5
0
United States
©The Alan Guttmacher Institute
World
Sources: Finer and Henshaw, 2005;
Presentation Title
Henshaw et al., 1999 (1995 data)
PRCH & Guttmacher © 2005
Abortion in Developed and
Developing Countries
Annual abortions per 1,000 women 15-44
World
Developed
Countries
Developing
Countries
0
Legal
10
20
30
40
50
Illegal
©The Alan Guttmacher Institute
Presentation Title
Source: AGI, 1999
PRCH & Guttmacher © 2005
Many Abortions Occur in Countries Where
Abortion Is Illegal Under
Most Circumstances
Illegal
44%
Legal
56%
Abortions by legality
©The Alan Guttmacher Institute
Source: Henshaw et al., 1999
Presentation Title
(1995 data)
PRCH & Guttmacher © 2005
Maternal Mortality Worldwide Due to
Unsafe Abortion
Maternal deaths (520,000 per year)
13%
Unsafe abortion
Other causes
87%
©The Alan Guttmacher Institute
Source: WHO, 2004
Presentation Title
(2000 data)
Research from
Psychology on the
Possible Psychological
Impact of Abortions
upon Women who have
them
PRCH & Guttmacher © 2005
Women who have abortions
Up to 98 percent of the women who have
abortions have no regrets and would make
the same choice again in similar
circumstances (Dagg, 1991).
More than 70 percent of women who have
abortions express a desire for children in
the future (Torres & Forrest, 1988). There is
no evidence that women who have had
abortions make less loving or suitable
parents (Bradley, 1984).
©The Alan Guttmacher Institute
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Normative Psychological
Responses to Abortion
• Lazarus (1985)
292 women studied 2 weeks
after
76% reported happiness
17% reported guilt
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Post-abortion depression?
Mild, transient, immediately
postoperative depressive symptoms
that quickly pass occur in less than 20
percent of all women who have had
abortions (Adler et al., 1990; Zabin et
al.,1989).
Similar symptoms occur in up to 70
percent of women immediately
following childbirth (Ziporyn, 1984).
©The Alan Guttmacher Institute
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Serious psychological disturbances?
Serious psychological disturbances after
abortion are less frequent than after
childbirth.
Researchers suggest that the predictors
of severe psychological disturbances
after abortion are:delays in seeking
abortion, medical or genetic indications
for abortion, and severe pre-existing or
concurrent psychiatric illness (Lazarus,
1985).
©The Alan Guttmacher Institute
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Normative Psychological Responses
to Abortion
• Russo & Zierk (1992) -measured self-esteem • women who had abortions > women who had
not had abortions
• women who had abortions > women who
unwanted births
The positive relationship of abortion to well-being
may be due in part to abortion's role in controlling
fertility and its relationship to coping resources
(Russo & Zierk, 1992; Russo & Dabul, 1997).
©The Alan Guttmacher Institute
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Abortion and teen pregnancy
A study of a group of teenagers who obtained
pregnancy tests at one of two Baltimore clinics
found that the young women who chose to have
abortions were far more likely to graduate from high
school at the expected age than those of similar
socioeconomic status who carried their pregnancies to
term or who were not pregnant. They showed no
greater levels of stress at the time of the pregnancy
and abortion and no greater rate of psychological
problems two years after the abortion than did the
other women (Zabin et al., 1989).
©The Alan Guttmacher Institute
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Abortion vs. adoption?
The psychological responses to
abortion are far less serious than
those experienced by women bringing
their unwanted pregnancy to term and
relinquishing the child for adoption
(Sachdev, 1993).
©The Alan Guttmacher Institute
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Summary Points
PRCH & Guttmacher © 2005
Incidence of Pregnancy and Abortion
Unintended pregnancy and abortion are
common among all groups of women.
Almost half of all pregnancies are
unintended.
Almost half of unintended pregnancies end in
abortion.
©The Alan Guttmacher Institute
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Who Has Abortions, Why and
When in Pregnancy
Women having abortions are predominantly
young, single, from minority groups and
low-income.
Most women have multiple reasons for
choosing to have an abortion.
Almost 90% of abortions occur in the first
trimester.
©The Alan Guttmacher Institute
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Safety of Abortion
Abortion is one of the safest surgical
procedures for women in the United States.
Laws criminalizing abortion make abortions
unsafe but do not eliminate them. In
developing countries, where abortion is
often illegal or highly restricted, abortion
mortality rates are hundreds of times higher
than rates in developed countries.
©The Alan Guttmacher Institute
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The Provision of and Access to
Abortion Services
Most abortions occur in abortion clinics.
A steady decline in providers in the last two
decades has left the majority of counties in
the United States with no provider.
Many of the difficulties in providing and
obtaining access to abortion would
disappear if the procedure were integrated
with other health care services.
©The Alan Guttmacher Institute
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International Perspective on
Abortion
A very small proportion of abortions worldwide take
place in the United States
Most unsafe abortions occur in countries where
abortion is illegal.
Scientific studies do not suggest a link between
abortion and subsequent psychological problems in
women.
©The Alan Guttmacher Institute
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