An Overview of Abortion
John B. Pryor
Illinois State University
US Public Opinions
about Abortion
Should Abortion be Legal in the US?
Percentage of People in the US
Saying Abortion should be Legal
When the woman or family cannot afford to raise
the child
36
When there is evidence that the baby may be
physically impaired
50
When there is evidence that the baby may be
mentally impaired
51
When the woman's mental health is endangered
61
When the pregnancy was caused by rape or
incest
75
When the woman's physical health is
endangered
82
When a woman's life is endangered
83
Gallup Poll (2011)
0
10
20
30
40
50
60
70
80
90
Incidence of Pregnancy
and Abortion
Pregnancies in the United States
(Approximately 6.4 Million Annually)
% of pregnancies
100%
80%
60%
51%
49%
40%
20%
0%
Intended
Unintended
Source: Finer et al., 2006
(2002 data)
Outcomes of Unintended Pregnancies
(Approximately 3.1 Million Annually)
% of unintended pregnancies (excluding miscarriages)
100%
80%
60%
48%
52%
Abortions
Births
40%
20%
0%
Source: Finer, 2006 (2002 data)
Incidence of Abortion
• In 2008, some 1.21 million pregnancies were
terminated by abortion in the United States.
• Almost 2% of all women aged 15–44 had an
abortion in 2008.
• Abortion is one of the most common surgical
procedures in the United States.
Abortion Rates Among Women
Aged 15–44
Abortions per 1,000 women
Disparities in Unintended Pregnancy
and Abortion Are Increasing
• The overall U.S. unintended pregnancy rate remained pretty
much the same over recent years.
• Unintended pregnancy has increased by among poor
women while decreasing among higher-income women.
• Forty-two percent of women obtaining abortions have
incomes below 100% of the federal poverty level ($10,830
for a single woman with no children).
• Twenty-seven percent of women obtaining abortions have
incomes between 100–199% of the federal poverty level.
Reasons for Abortions
Most Important Reason Given for
Terminating an Unwanted Pregnancy
Concern for/responsibility to other individuals
74%
Cannot afford a baby now
73%
A baby would interfere with school/
employment/ability to care for dependents
69%
Would be a single parent/
having relationship problems
48%
Has completed childbearing
38%
Source: Finer et al., 2005 (2004 data)
Gestational Age
Abortions by Gestational Age
(Weeks Since Last Menstrual Period)
% of abortions
Weeks
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
71%
48%
33%
24%
8%
8%
6%
Didn’t know timing was important
Didn’t know she could get an abortion
Fetal abnormality diagnosed late
Other
6%
5%
2%
11%
Source: Torres and Forrest, 1988 (1987 data)
Methods of Performing Abortions
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
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
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
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
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)
Methods of Abortion
IV. Surgical Removal Through
Caesarean Procedure
A. Hysterotomy
Safety of Abortion
An Abortion Is Safer the Earlier in
Pregnancy It Is Performed
Deaths per 100,000 abortions
10
8.9
7.1
8
6
3.4
4
1.7
2
0.1
0.2
0.6
0.4
0
<9
9–10
11–12
13–15
16–20
21+
All abs. Births
Abortions by gestation
Sources: All births and abortions: Grimes DA, 2006;
Abortion by gestation: Bartlett et al., 2004 (1988–1997 data)
Long-Term Safety of Abortion
• First trimester abortions pose virtually no risk of:
– Infertility
– Ectopic pregnancy
– Miscarriage
– Birth defect
– Preterm or low-birth-weight delivery
• There is no association between abortion and
breast cancer.
• Abortion does not pose a hazard to women’s
mental health.
Source: Boonstra, 2006
Abortion Risks in Perspective
Risk from terminating pregnancy:
Chance of death
per year:
Before 9 weeks
1 in 1,000,000
Between 9 and 10 weeks
1 in 500,000
Between 13 and 15 weeks
After 20 weeks
1 in 60,000
1 in 11,000
Risk to persons who participate in:
Motorcycling
Automobile driving
Power-boating
Playing football
1
1
1
1
in
in
in
in
1,000
5,900
5,900
25,000
Risk to women aged 15–44 from:
Having sexual intercourse (PID)
Using tampons
1 in 50,000
1 in 350,000
Source: Bartlett et al., 2004 (1988–1997 data)
Who Has Abortions?
Who has abortions?
• Eighteen percent of U.S. women obtaining abortions are
teenagers; those aged 15–17 obtain 6% of all abortions,
teens aged 18–19 obtain 11%, and teens younger than
age 15 obtain 0.4%.
• Women in their 20s account for more than half of all
abortions; women aged 20–24 obtain 33% of all abortions,
and women aged 25–29 obtain 24%.
• Non-Hispanic white women account for 36% of abortions,
non-Hispanic black women for 30%, Hispanic women for
25% and women of other races for 9%.
Who has abortions?
• Thirty-seven percent of women obtaining
abortions identify as Protestant and 28% as
Catholic.
• Women who have never married and are
not cohabiting account for 45% of all
abortions
• About 61% of abortions are obtained by
women who have one or more children.
Who Provides Abortion Services
Percentage of Abortions Performed by
Each Type of Provider
% of abortions
Number of Providers by Type
No. of providers
Number of abortion providers in
Illinois, 1973-2008
Factors Contributing to the Decline in
the Number of Abortion Providers
• Anti abortion harassment and violence -More
than half of abortion providers—and 89% of large providers—
experienced some kind of antichoice harassment in 2008
•
•
•
•
Social stigma/marginalization
Professional isolation/peer pressure
The “graying of providers”
Inadequate economic/other incentives
Lack of medical training opportunities-Fewer than
•
half (46%) of residency training programs in obstetrics and gynecology
routinely provide training in first-trimester abortion
Source: Jones & Kooistra (2008)
Percentage of Providers of 400 or More
Abortions per Year Who
Reported Harassment in 2008
Picketing
88%
Picketing with physical
contact with patients
37%
Vandalism
19%
Picketing homes of staff members
7%
Bomb threats
5%
Patient pictures posted on the Internet
5%
Factors That Make It Difficult
For Women to Obtain
Abortion Services
Percentages of Counties with No Provider and
of Women Living in Those Counties
Legal Restrictions
on Abortion in the
USA
Federal Laws & Policies about
Abortion
• Hyde Amendment - 1977
• Freedom of Access to Clinic Entrances
Act - 1994
• Federal Health Benefits Program
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.
Stenberg v. Carhart, 530 U.S. 914
(2000)
• US Supreme Court overturned a Nebraska statute
banning "partial-birth abortion."
• Court found that the ban would outlaw the safest and most
commonly used methods of second-trimester abortion,
and therefore constituted an undue burden on women’s
right to obtain abortions.
• "the absence of a health exception will place women at an
unnecessary risk of tragic health consequences."
Federal Laws in the Bush Era
• 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 struck
down this law as unconstitutional. In January of 2006, 2 Federal Appeals
Courts upheld these rulings.
• On November 8, 2006 the U.S. Supreme Court heard
arguments in two challenges to the Federal Abortion Ban,
also known as the "Partial-Birth Abortion Ban Act of 2003."
In both the Center for Reproductive Rights case (Gonzales
v. Carhart) and Planned Parenthood case (Gonzales v.
Planned Parenthood), appellate courts declared the ban
unconstitutional citing previous law established over the last
thirty years.
APRIL 2007
• With Bush-appointed judges Alito and
Roberts, Supreme Court upholds the
Federal partial birth abortion ban in a 5-4
decision.
Obama on Abortion
• President Obama signed an executive
order on March 24, 2010 to reaffirm that the
new health law he signed will not allow any
federal funds for abortion.
State Laws Restricting Abortion as
of September 2013
Physician and Hospital Requirements: 39 states require an abortion
to be performed by a licensed physician. 20 states require an
abortion to be performed in a hospital after a specified point in the
pregnancy, and 18 states require the involvement of a second
physician after a specified point.
Gestational Limits: 41 states prohibit abortions, generally except
when necessary to protect the woman’s life or health, after a
specified point in pregnancy, most often fetal viability.
“Partial-Birth” Abortion: 19 states have laws in effect that prohibit
“partial-birth” abortion. 3 of these laws apply only to post-viability
abortions
State Laws Restricting Abortion as
of September 2013
Public Funding: 17 states use their own funds to pay for all or most
medically necessary abortions for Medicaid enrollees in the state. 32
states and the District of Columbia prohibit the use of state funds
except in those cases when federal funds are available: where the
woman’s life is in danger or the pregnancy is the result of rape or
incest. In defiance of federal requirements, South Dakota limits
funding to cases of life endangerment only.
Coverage by Private Insurance: 8 states restrict coverage of
abortion in private insurance plans, most often limiting coverage
only to when the woman’s life would be endangered if the
pregnancy were carried to term. Most states allow the purchase of
additional abortion coverage at an additional cost.
State Laws Restricting Abortion as
of September 2013
Refusal: 46 states allow individual health care providers to refuse to
participate in an abortion. 43 states allow institutions to refuse to
perform abortions, 16 of which limit refusal to private or religious
institutions
State-Mandated Counseling: 17 states mandate that women be
given counseling before an abortion that includes information on at
least one of the following: the purported link between abortion and
breast cancer (5 states), the ability of a fetus to feel pain (12 states)
or long-term mental health consequences for the woman (8 states).
State Laws Restricting Abortion as
of September 2013
Waiting Periods: 26 states require a woman seeking an abortion to
wait a specified period of time, usually 24 hours, between when she
receives counseling and the procedure is performed. 9 of these
states have laws that effectively require the woman make two
separate trips to the clinic to obtain the procedure.
Parental Involvement: 39 states require some type of parental
involvement in a minor’s decision to have an abortion. 21 states
require one or both parents to consent to the procedure, while 13
require that one or both parents be notified and 5 states require
both parental consent and notification.
International Perspective
on Abortion
What should be the government's role in
abortion?
Average
Indonesia
Thailand
India
S. Korea
China
Nigeria
Iran
Palestinian ter.
Egypt
Turkey
Azerbaijan
Russia
Poland
Ukraine
Great Britain
France
USA
Mexico
52
10
23
60
28
22
15
35
37
27
26
24
62
31
67
42
15
6
18
8
43
28
39
38
11
31
47
25
8
48
48
45
20
24
31
62
14
15
22
66
64
16
17
81
6
3
15
95
69
70
0%
10%
20%
30%
21
15
40%
Leave these matters to the individual
Discourage usining criminal enflorcement
50%
60%
70%
80%
1
3 2
8
8
90%
100%
Discourage using only non-punitive methods
World Public Opinion Poll (2008)
U.S. Share of Abortions Worldwide
3%
United States
Other Countries
97%
Source: Sedgh, 2007
Abortion Rate, United States and
World
Abortions per 1,000 women
40
29
30
21
20
10
0
United States
World
Source: Sedgh, 2007
(data for 2003)
An increasing proportion of abortions
are unsafe
% of abortions that are unsafe
U.S. Abortion Rate Higher Than in
Many Other Industrialized Countries
Abortions per 1,000 women
30
25
21
20
20
20
15
15
17
15
8
10
9
5
0
United
States
Australia
Sweden
Denmark
Canada
England &
Wales
Germany Netherlands
Source: Sedgh, 2007
The legal status of abortion does
not predict its incidence
• The lowest abortion rates in the world—less
than 10 per 1,000 women of reproductive
age—are in Europe, where abortion is legal
and available.
• By contrast, in Africa and Latin America
and the Caribbean, where abortion law is
most restrictive, the regional rates are 29
and 31 per 1,000 women, respectively.
Sedgh et al., 2007
High Rates of Abortion Occur in
Countries that Severely Restrict Abortion
Nigeria
Mexico
Brazil
Dom. Rep.
Chile
Peru
0
10
20
30
40
50
60
Abortions per 1,000 women 15–44
Source: Boonstra, 2006
Complications of unsafe abortion
• An estimated five million women are hospitalized
each year for treatment of abortion-related
complications, such as hemorrhage and sepsis.
• Complications from unsafe abortion procedures
account for 13% of maternal deaths, or 67,000
per year.
• Approximately 220,000 children worldwide lose
their mothers every year because of abortionrelated deaths.
Singh, 2006; WHO 2007; Grimes 2006
Almost all abortion-related deaths
occur in developing countries
Deaths per 100,000 unsafe abortions, 2003
700
600
500
400
650
300
200
100
350
300
10
50
0
Developed Developing
countries
countries
Africa
Asia
Latin
America &
Caribbean
WHO, 2007
Research from Psychology
on the Possible
Psychological Impact of
Abortions upon Women who
have them
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).
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).
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).
Munk-Olsen et al. (2011) New
England Journal of Medicine
• Study of all girls and women born in
Denmark between 1962 and 1993 who
were alive and had no history of a mental
disorder 9 months before a first-ever firsttrimester induced abortion or first childbirth.
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).
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).