WASHINGTON, D.C. – Although abortion rates are declining, there were still nearly 700,000 babies aborted in 2012, newly released data from the federal government reveals.
Each year, Centers for Disease Control (CDC) requests abortion data from central health agencies of all the 50 states, the District of Columbia, and New York City. For 2012, data were received from 49 reporting areas.
A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003–2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003–2012).
In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20–24 and 25–29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20–24 and 25–29 years, respectively. In contrast, women aged 30–34, 35–39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of 12.4, 7.3, and 2.8 abortions per 1,000 women aged 30–34 years, 35–39 years, and ≥40 years, respectively. Throughout the period of analysis, abortion rates decreased among women aged 20–24, 25–29, and 30–34 years by 24%, 18%, and 10%, respectively, whereas they increased among women aged ≥40 years by 8%.
For 2012, a total of 699,202 abortions were reported to CDC. Of these abortions, 688,149 (98.4%) were from 47 reporting areas that submitted data every year during 2003–2012, thus providing the information necessary for evaluating trends. These 47 areas had an abortion rate of 13.2 abortions per 1,000 women aged 15–44 years and an abortion ratio of 210 abortions per 1,000 live births. Compared with 2011, this represents a 4% decrease in the total number (from 719,530) and ratio (from 219 abortions per 1,000 births), and a 5% decrease in the rate (from 13.9 abortions per 1,000 women) of reported abortions among the 47 continuously reporting areas. Because of the size of these decreases, combined with large decreases from the previous 3 years (15–17), all three measures of abortion reached their lowest level for the entire period of analysis (2003–2012).
In addition to highlighting changes that occurred among all women of reproductive age, this report underscores important age differences in abortion trends. During 2003–2012, women in their 20s consistently accounted for the majority of abortions (56%–58%) and therefore have contributed substantially to overall changes in abortion rates. Conversely, women aged ≥40 years consistently have accounted for a small percentage of abortions (≤3.7% during 2003–2012) and have had a much smaller contribution to overall abortion trends. Nonetheless, among women aged ≥40 years, abortion rates have shown an overall increase and the abortion ratio for this age group remains high. Together with the continuing small proportion of abortions performed later in gestation among these women, which potentially might be completed for maternal medical indications or fetal anomalies, these patterns suggest that unintended pregnancy is a problem that women encounter throughout their reproductive years.
The adolescent abortion trends described in this report are important for monitoring progress that has been made toward reducing adolescent pregnancies in the United States. During 1990–2009, the pregnancy rate for adolescents aged 15–19 years decreased 44% to an historic low (40). This decrease was associated with substantial decreases in both the rate of live births (58%) and abortions (60%) among adolescents (40). More recent data indicate that the birth rate for adolescents aged 15–19 years decreased by a further 29% from 2010 to 2014 (41–45). The 12% decrease from 2011 to 2012 in the adolescent abortion rate suggests that adolescent pregnancies in the United States are continuing to decrease and that this decrease continues to be accompanied by substantial decreases in adolescent abortions as well as live births.
The findings in this report indicate that the number, rate, and ratio of reported abortions has declined across all race/ethnicity groups, but that well-documented disparities (3–9) continue to persist. Comparatively high abortion rates and ratios among non-Hispanic black women have been attributed to higher unintended pregnancy rates and a higher percentage of unintended pregnancies ending in abortion (46,47). Data from certain recent reports suggest that differences in abortion between non-Hispanic black women and women of other races have narrowed (8,9). However, this pattern has not been observed in the data reported to CDC for 2012 or in previous years with similar declines among non-Hispanic white and black women. Higher abortion rates among Hispanic compared with non-Hispanic white women have been attributed to high pregnancy rates, including intended and unintended pregnancies, among Hispanic women (46,47). However, abortion ratios in these two groups have been more comparable: Hispanic women have had a slightly higher percentage of pregnancies that are unintended but are no more likely than non-Hispanic white women to end unintended pregnancies in abortion (46,47). Differences between non-Hispanic white and Hispanic women in abortion rates changed little from 2007 to 2012, with large declines again occurring in both groups of women.
The findings in this report indicate women are obtaining abortions earlier in gestation, when the risks for complications are lowest (48–51). Among the areas that reported data every year during 2003–2012, the percentage of abortions performed at ≤8 weeks’ gestation increased 7%. Moreover, among the areas that reported abortions at ≤13 weeks’ gestation by individual week, the distribution continued to shift toward earlier weeks of gestation with the percentage of early abortions performed at ≤6 weeks’ gestation increasing 24%. Nonetheless, the overall percentage of abortions performed at ≤13 weeks’ gestation changed little during 2003–2012, and findings from this and other reports suggest that delays in obtaining an abortion are more common among certain groups of women (52–54). Because of the small but persistent percentage of women who obtain abortions at >13 weeks’ gestation, a better understanding is needed of the factors that cause delays in obtaining abortions (52,54–58).
The trend of obtaining abortions earlier in pregnancy has been facilitated by changes in abortion practices. Research conducted in the United States during the 1970s indicated that surgical abortion procedures performed at ≤6 weeks’ as compared with 7–12 weeks’ gestation were less likely to result in successful termination of the pregnancy (58). However, subsequent advances in technology (e.g., improved transvaginal ultrasonography and sensitive pregnancy tests) have allowed very early surgical abortions to be performed with completion rates exceeding 97% (51,59–61). Likewise, the development of medical abortion regimens has allowed for abortions to be performed very early in gestation, with completion rates for regimens that combine mifepristone and misoprostol reaching 96%–98% (62). In 2012, 65.8% of abortions were performed at ≤8 weeks’ gestation, and thus the women receiving these abortions were eligible for early medical abortion on the basis of gestational age; 30.8% of these abortions at ≤8 weeks’ gestation and 20.8% of all abortions were reported as early medical abortions. Moreover, the use of early medical abortion has continued to rise: from 2003 to 2012, the percentage of all reported abortions accounted for by this method increased 140%, with large increases observed both from 2003 to 2007 and 2008 to 2012.
The annual number of deaths related to legal induced abortions has fluctuated annually during 1973–2011. Because of this variability and the relatively small number of abortion-related deaths every year, national legal abortion case-fatality rates were calculated for consecutive 5-year periods during 1973–2007 and a 4-year period during 2008–2011. The national legal induced abortion case-fatality rate for 2008–2011 was similar to the case fatality rate for most of the preceding 5-year periods, but was much lower than the case fatality year for the period of 1973–1977 that immediately followed nationwide legalization of abortion in 1973.
PUBLIC HEALTH IMPLICATIONS
Ongoing surveillance of legal induced abortions is important for several reasons. First, abortion surveillance is needed to guide and evaluate the success of programs aimed at preventing unintended pregnancies. Although pregnancy intentions are difficult to assess (66–73), abortion surveillance provides an important measure of pregnancies that are unwanted. Second, routine abortion surveillance is needed to assess trends in clinical practice patterns over time. Information in this report on the number of abortions performed through different methods (e.g., medical or curettage) and at different gestational ages provides the denominator data that are necessary for analyses of the relative safety of abortion practices. Finally, information on the number of pregnancies ending in abortion are needed in conjunction with data on births and fetal losses to more accurately estimate the overall number of pregnancies in the United States as well as rates by various characteristics (e.g., adolescents) (40,74).
According to the most recent national estimates, 18% of all pregnancies in the United States end in abortion (40). Multiple factors influence the incidence of abortion including the availability of abortion providers (13,14,75–77); state regulations, such as mandatory waiting periods (78), parental involvement laws (79), and legal restrictions on abortion providers (80,81); increasing acceptance of nonmarital childbearing (82,83); shifts in the racial/ethnic composition of the U.S. population (84,85); and changes in the economy and the resulting impact on fertility preferences and access to health care services, including contraception (86,87). However, because unintended pregnancy precedes nearly all abortions (24),§§§§§§ efforts to reduce the incidence of abortion need to focus on helping women, men, and couples avoid pregnancies that they do not desire.
Providing women and men with the knowledge and resources necessary to make decisions about their sexual behavior and use of contraception can help them avoid unintended pregnancies. However, efforts to improve contraceptive use and reduce the proportion of pregnancies that are unintended in the United States have been challenging. Findings from the National Survey of Family Growth (NSFG), the primary national source of data on unintended pregnancy in the United States, suggest that unintended pregnancy decreased during 1982–1995 in conjunction with an increase in contraceptive use among women at risk for unintended pregnancy (88–90). However, data from the 2002 and 2006–2010 NSFGs indicate little further improvement in contraceptive use (89,91). Moreover, although use of the most effective forms of reversible contraception (i.e., intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy) (92) has increased (93–95), use of these methods in the United States remains among the lowest of any developed country (94,96), and the percentage of pregnancies that are unintended remains high at approximately 50% (46,47). Research has shown that providing contraception for women at no cost increases use of the most effective methods and can reduce abortion rates (97,98). Removing cost as a barrier and increasing access to the most effective contraceptive methods can help to reduce the number of unintended pregnancies and consequently the number of abortions performed in the United States.