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The Cost of Abortion, When Providers Offer Services, and Harassment of Abortion Providers All Remained Stable Between 2008 And 2012

July 18, 2014 Comments off

The Cost of Abortion, When Providers Offer Services, and Harassment of Abortion Providers All Remained Stable Between 2008 And 2012
Source: Guttmacher Institute

Access to abortion services is affected by a variety of factors, including the cost of the procedure, the gestational age limits at which providers offer services and antiabortion harassment. According to “Secondary Measures of Access to Abortion Services in the U.S., 2011-2012: Gestational Age Limits, Cost and Harassment,” by Jenna Jerman and Rachel Jones of the Guttmacher Institute, there was relatively little change in any of these measures between 2008 and 2011–2012. The new analysis relies on data from the Institute’s 16th census of all known abortion providers in the United States.

In 2011–2012, the median cost of a surgical abortion at 10 weeks’ gestation was $495, and an early medication abortion cost $500. By comparison, the inflation-adjusted charge in 2009 for the same procedures was $503 and $524, respectively. The cost varied by facility size: facilities with the largest caseloads charged the least ($450), while those that performed fewer than 30 procedures per year charged the most ($650). Because women were more likely to obtain abortions at facilities that charged less, on average, women paid $480 for a surgical procedure at 10 weeks in 2011–2012, compared with $483 in 2009 (adjusted for inflation).

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Debate on Ways to Reduce U.S. Abortion Rate Intensifies Even as Abortion Rate Continues to Decline

June 18, 2014 Comments off

Debate on Ways to Reduce U.S. Abortion Rate Intensifies Even as Abortion Rate Continues to Decline
Source: Guttmacher Institute

A new Guttmacher policy analysis notes that, paradoxically, the sharp divide over the means to make abortion rare has only grown more pronounced even as the U.S. abortion rate in 2011 reached its lowest level since 1973. The debate centers on whether the United States should strive to reduce abortion at all costs, or focus instead on reducing the need for it.

“The rival policy approaches of the antiabortion and prochoice movements have become mutually exclusive,” says Joerg Dreweke, author of the analysis. “Antiabortion activists, starting in 2011, have enacted an unprecedented wave of coercive state laws that will likely force growing numbers of women to give birth rather than end an unwanted pregnancy. By contrast, reproductive health advocates back policies like the Affordable Care Act that expand access to contraceptive services to help women prevent unintended pregnancies in the first place, along with the abortions that often follow.”

The analysis details the opposing explanations of why the U.S. abortion rate declined 13% between 2008 and 2011. Antiabortion activists argued that state-level abortion restrictions were responsible and dismissed the idea of contraception playing a role. However, not only did the abortion decline mostly predate the wave of new abortion restrictions, but it was also accompanied by a steep drop in the birthrate, indicating that pregnancy was down overall. This leads to the conclusion that improved contraceptive use, including use of highly effective methods like the IUD and implant, was likely the main driver of the abortion decline by helping to reduce women’s need for the service.

CRS — Abortion: Judicial History and Legislative Response (updated)

April 11, 2014 Comments off

Abortion: Judicial History and Legislative Response (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

In 1973, the U.S. Supreme Court concluded in Roe v. Wade that the U.S. Constitution protects a woman’s decision to terminate her pregnancy. In Doe v. Bolton, a companion decision, the Court found that a state may not unduly burden the exercise of that fundamental right with regulations that prohibit or substantially limit access to the means of effectuating the decision to have an abortion. Rather than settle the issue, the Court’s rulings since Roe and Doe have continued to generate debate and have precipitated a variety of governmental actions at the national, state, and local levels designed either to nullify the rulings or limit their effect. These governmental regulations have, in turn, spawned further litigation in which resulting judicial refinements in the law have been no more successful in dampening the controversy.

State Policy Trends: More Supportive Legislation, Even As Attacks on Abortion Rights Continue

April 10, 2014 Comments off

State Policy Trends: More Supportive Legislation, Even As Attacks on Abortion Rights Continue
Source: Guttmacher Institute

The 2014 legislative session got off to a fast start, with legislators introducing a combined 733 provisions related to sexual and reproductive health and rights in nearly all the states that have legislative sessions this year (legislatures in Montana, Nevada, North Dakota and Texas will not meet in 2014). See here for the full analysis of the first quarter of 2014.

Significantly, legislators quickly showed a clear interest in protecting or expanding access to sexual and reproductive health care. Some 64 provisions have been introduced so far this year to expand or protect access to abortion, more than had been introduced in any year in the last quarter century. And only three months into the year, two new provisions protecting abortion rights have been enacted, and three others have passed one legislative chamber. Similarly, seven measures designed to expand access to other sexual and reproductive health services have passed at least one legislative body in six states and the District of Columbia.

As in recent years, however, state legislatures continued to take aim at abortion rights. Legislators in 38 states introduced 303 provisions seeking to limit women’s access to care. By March 31, three new abortion restrictions had been enacted, and 36 had passed one legislative chamber.

Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story

March 31, 2014 Comments off

Abortion Coverage Under the Affordable Care Act: The Laws Tell Only Half the Story
Source: Guttamacher Institute
From press release:

Consumers purchasing health coverage through the marketplaces created under the Affordable Care Act (ACA) have no easy way—and often no way at all—to find out whether a health plan covers abortion care, according to a new Guttmacher analysis. The analysis lays out how this lack of transparency can be addressed by the Obama administration, which has the authority to ensure health plan issuers make such information readily available to consumers nationwide.

U.S. abortion rates hit lowest level since 1973

February 3, 2014 Comments off

U.S. abortion rates hit lowest level since 1973
Source: Guttmacher Institute

The U.S. abortion rate declined to 16.9 abortions per 1,000 women aged 15–44 in 2011, well below the 1981 peak of 29.3 per 1,000 and the lowest since 1973 (16.3 per 1,000), according to “Abortion Incidence and Service Availability in the United States, 2011,” by Rachel Jones and Jenna Jerman. Between 2008 and 2011, the abortion rate fell 13%, resuming the long-term downward trend that had stalled between 2005 and 2008. The number of abortions (1.1 million in 2011) also declined by 13% in this time period.

While the study did not specifically investigate reasons for the decline, the authors note that the study period (2008–2011) predates the major surge in state-level abortion restrictions that started during the 2011 legislative session, and that many provisions did not go into effect until late 2011 or even later. The study also found that the total number of abortion providers declined by only 4% between 2008 and 2011, and the number of clinics (which provide the large majority of abortion services) declined by just 1%.

CRS — Abortion: Judicial History and Legislative Response

January 30, 2014 Comments off

Abortion: Judicial History and Legislative Response (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

n 1973, the U.S. Supreme Court concluded in Roe v. Wade that the U.S. Constitution protects a woman’s decision to terminate her pregnancy. In Doe v. Bolton , a companion decision, the Court found that a state may not unduly burden the exercise of that fundamental right with regulations that prohibit or substantially limit access to the means of effectuating the decision to have an abortion. Rather than settle the issue, the Court’s rulings since Roe and Doe have continued to generate debate and have precipitated a variety of governmental actions at the national, state, and local levels designed either to nullify the ru lings or limit their effect. These governmental regulations have, in turn, spawned further litigatio n in which resulting judicial refinements in the law have been no more successful in dampening the controversy.

Associations between Intimate Partner Violence and Termination of Pregnancy: A Systematic Review and Meta-Analysis

January 9, 2014 Comments off

Associations between Intimate Partner Violence and Termination of Pregnancy: A Systematic Review and Meta-Analysis
Source: PLoS Medicine

Background
Intimate partner violence (IPV) and termination of pregnancy (TOP) are global health concerns, but their interaction is undetermined. The aim of this study was to determine whether there is an association between IPV and TOP.

Methods and Findings
A systematic review based on a search of Medline, Embase, PsycINFO, and Ovid Maternity and Infant Care from each database’s inception to 21 September 2013 for peer-reviewed articles of any design and language found 74 studies regarding women who had undergone TOP and had experienced at least one domain (physical, sexual, or emotional) of IPV. Prevalence of IPV and association between IPV and TOP were meta-analysed. Sample sizes ranged from eight to 33,385 participants. Worldwide, rates of IPV in the preceding year in women undergoing TOP ranged from 2.5% to 30%. Lifetime prevalence by meta-analysis was shown to be 24.9% (95% CI 19.9% to 30.6%); heterogeneity was high (I2>90%), and variation was not explained by study design, quality, or size, or country gross national income per capita. IPV, including history of rape, sexual assault, contraceptive sabotage, and coerced decision-making, was associated with TOP, and with repeat TOPs. By meta-analysis, partner not knowing about the TOP was shown to be significantly associated with IPV (pooled odds ratio 2.97, 95% CI 2.39 to 3.69). Women in violent relationships were more likely to have concealed the TOP from their partner than those who were not. Demographic factors including age, ethnicity, education, marital status, income, employment, and drug and alcohol use showed no strong or consistent mediating effect. Few long-term outcomes were studied. Women welcomed the opportunity to disclose IPV and be offered help. Limitations include study heterogeneity, potential underreporting of both IPV and TOP in primary data sources, and inherent difficulties in validation.

Conclusions
IPV is associated with TOP. Novel public health approaches are required to prevent IPV. TOP services provide an opportune health-based setting to design and test interventions.

Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study

December 26, 2013 Comments off

Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study
Source: BMC Women’s Health

Background
Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

Methods
This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups.

Results
The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

Conclusion
Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

A Year of Magical Thinking Leads To…Unintended Pregnancy

November 21, 2013 Comments off

A Year of Magical Thinking Leads To…Unintended Pregnancy
Source: Guttmacher Institute

In-depth interviews with 49 women obtaining abortions in the United States found that most of the study participants perceived themselves to be at low risk of becoming pregnant at the time that it happened. According to “Perceptions of Susceptibility to Pregnancy Among U.S. Women Obtaining Abortions,” by Lori Frohwirth of the Guttmacher Institute et al., the most common reasons women gave for thinking they were at low risk of pregnancy included a perception of invulnerability, a belief that they were infertile, self-described inattention to the possibility of pregnancy and a belief that they were protected by their (often incorrect) use of a contraceptive method. Most participants gave more than one response.

The most common reason women gave for their perceived low risk of pregnancy was perceived invulnerability to pregnancy. Study participants understood that pregnancy could happen, but for reasons they couldn’t explain, thought they were immune or safe from pregnancy at the time they engaged in unprotected sex. One reported that she “always had good luck,” while another said, “…It’s like you believe something so much, like ‘I just really don’t want children,’ [and] for some reason, I thought that would prevent me from getting pregnant.” This type of magical thinking—that pregnancy somehow would not happen despite acknowledged exposure—suggests a disconnect between the actual risk of pregnancy incurred by an average couple who does not use contraceptives (85% risk of pregnancy over the course of a year) and a woman’s efforts to protect herself from unintended pregnancy.

Statutory Revision to Department of Defense Coverage of Abortions

November 8, 2013 Comments off

Statutory Revision to Department of Defense Coverage of Abortions (PDF)
Source: Assistant Secretary of Defense for Health Affairs

The purpose of this memorandum is to update Health Affairs Policy 96-030 regarding the provision of abOliion services in military treatment facilities (MTFs). Title 10, United States Code (U.S.C.), Section 1093(a) (Reference (a)), was amended by Section 704 of the National Defense Authorization Act for Fiscal Year 2013 to add an exception to the restriction on the use of DoD funding of abortions “in the case in which the pregnancy is the result of an act of rape or incest.” Reference (a) now permits the use of DoD facilities (in the Continental United States and Outside the Continental United States) and appropriated funds to perform abortions under the following circumstances: where the life of the mother would be endangered if the fetus were carried to term or in the case in which the pregnancy is the result of an act of rape or incest.

Abortion Restrictions in U.S. Foreign Aid: The History and Harms of the Helms Amendment

September 30, 2013 Comments off

Abortion Restrictions in U.S. Foreign Aid: The History and Harms of the Helms Amendment
Source: Guttmacher Institute

Forty years ago, in the wake of Roe v. Wade, Congress enacted the Helms amendment to restrict U.S. foreign aid from going toward abortion. Specifically, the policy prohibits foreign assistance from paying for the “performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” Just on its face, the law is extreme and harmful. But its damaging reach has extended even further through the chilling impact it has had—on lawful abortion-related activities in particular, as well as more generally on U.S. sexual and reproductive health programs overseas. As such, supporters of women’s reproductive health are eager to see the law overturned altogether. However, given the impossibility of repealing this long-standing abortion restriction in the current political climate, there are steps that the administration can take in the interim to mitigate the impact of the Helms amendment.

Denial of Abortion Because of Provider Gestational Age Limits in the United States

August 21, 2013 Comments off

Denial of Abortion Because of Provider Gestational Age Limits in the United States (PDF)
Source: American Journal of Public Health
From press release (Guttmacher Institute):

In 2008, more than 4,000 U.S. women were denied abortions because of gestational age limits and, in turn, had to carry unwanted pregnancies to term, according to “Denial of Abortion Due to Gestational Age Limits in the United States,” by Ushma D. Upadhyay of the Bixby Center for Global Reproductive Health et al. Travel and procedure costs were the most important reasons women were delayed in seeking abortion care, and many were unable to reach an abortion provider until their pregnancy had exceeded the gestational age after which the provider no longer offered care.

The authors studied women seeking abortion care from “last stop” providers around the U.S., defined as facilities that offer abortion services at the latest gestational age limits among any facility within 150 miles. Women turned away from these providers because they presented too late were asked to list the barriers that prevented them from seeking care earlier in the pregnancy. Nearly six in 10 reported that travel and procedure costs prevented them from seeking an abortion earlier, while about half delayed seeking care because they did not immediately recognize that they were pregnant. Women also cited insurance problems, not knowing where to get care and not knowing how to get to a provider as barriers to accessing abortion services. About one-quarter (28%) of women denied an abortion were eventually able to obtain one from a different provider, while the remaining three-quarters continued their pregnancy.

Abortion Viewed in Moral Terms: Fewer See Stem Cell Research and IVF as Moral Issues

August 15, 2013 Comments off

Abortion Viewed in Moral Terms: Fewer See Stem Cell Research and IVF as Moral Issues
Source: Pew Forum on Religion & Public Life

Regardless of their views about the legality of abortion, most Americans think that having an abortion is a moral issue. By contrast, the public is much less likely to see other issues involving human embryos – such as stem cell research or in vitro fertilization – as a matter of morality.

Asked whether abortion is morally acceptable, morally wrong or not a moral issue, only about a quarter of U.S. adults (23%) say they personally do not consider having an abortion to be a moral issue, according to a survey by the Pew Research Center. Twice as many Americans (46%) say this about using in vitro fertilization. Asked about the morality of medical research that uses embryonic stem cells, more than a third of U.S. adults (36%) say they do not consider such research to be a moral issue. Roughly four-in-ten (42%) say the same about stem cell research that does not involve human embryos.

The percentage of U.S. adults who consider abortion to be morally wrong (49%) far exceeds the percentage who express this view about in vitro fertilization (12%), non-embryonic stem cell research (16%) or embryonic stem cell research (22%).

Only 15% of the public thinks that having an abortion is morally acceptable. By comparison, about a third of U.S. adults say they personally view IVF and both forms of stem cell research as morally acceptable practices.

These are some of the findings from a survey by the Pew Research Center’s Religion & Public Life Project conducted March 21 to April 8, 2013, among a representative sample of 4,006 adults nationwide. The margin of error for the survey is plus or minus 2.1 percentage points.

State-Level Assault on Abortion Rights Continues in First Half of 2013

July 8, 2013 Comments off

State-Level Assault on Abortion Rights Continues in First Half of 2013
Source: Guttmacher Institute

In the first six months of 2013, states enacted 106 provisions related to reproductive health and rights; issues related to abortion, family planning funding and sex education were significant flashpoints in several legislatures. Although initial momentum behind banning abortion early in pregnancy appears to have waned, states nonetheless adopted 43 restrictions on access to abortion, the second-highest number ever at the midyear mark and is as many as were enacted in all of 2012.

However, this year is notable also for positive action on other reproductive health issues in a handful of states, with important new provisions enacted to expand access to comprehensive sex education, expedited partner treatment for STIs and emergency contraception for women who have been sexually assaulted.

World Abortion Policies 2013

June 14, 2013 Comments off

World Abortion Policies 2013

Source: United Nations

World Abortion Policies 2013 wall chart provides up-to-date and objective information on abortion policies, i.e., legal grounds on which abortion is permitted, for each of the 193 Member States and three non-Member States of the United Nations. The wall chart also includes information on national estimates of abortion rate (where available), fertility rate, maternal mortality ratio, levels of contraceptive use and unmet need for family planning, and government support for family planning, as well as regional estimates of unsafe abortion rate. (6.7 MB)

Data Table (Excel)

CRS — Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy

February 18, 2013 Comments off

Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

This report details legislation and policies that restrict or place requirements on U.S. funding of abortion or family planning activities abroad. The level and extent of federal funding for these activities is an ongoing and controversial issue in U.S. foreign assistance and will likely continue to be a point of contention during the 113th Congress.

These issues have been debated for over four decades in the context of a broader domestic abortion controversy that began with the Supreme Court’s 1973 ruling in Roe v. Wade, which holds that the Constitution protects a woman’s decision to terminate her pregnancy. Since Roe, Congress has enacted foreign assistance legislation placing restrictions or requirements on the federal funding of abortions and on family planning activities abroad. Many of these provisions, often referred to by the name of the lawmakers that introduced them, have been included in foreign aid authorizations, appropriations, or both, and affect different types of foreign assistance. Examples include

• the “Helms amendment,” which prohibits the use of U.S. funds to perform abortions or to coerce individuals to practice abortions;
• the “Biden amendment,” which states that U.S. funds may not be used for biomedical research related to abortion or involuntary sterilization;
• the “Siljander amendment,” which prohibits U.S. funds from being used to lobby for or against abortion;
• the “Kemp-Kasten amendment,” which prohibits funding for any organization or program that, as determined by the President, supports or participates in the management of a program of coercive abortion or involuntary sterilization; and
• the “Tiahrt amendment,” which places requirements on voluntary family planning projects receiving assistance from USAID.

The executive branch has also engaged in the debate over international abortion and family planning. In 1984, President Ronald Reagan issued what has become known as the “Mexico City policy,” which required foreign non-governmental organizations receiving USAID family planning assistance to certify that they would not perform or actively promote abortion as a method of family planning, even if such activities were conducted with non-U.S. funds. The policy was rescinded by President Bill Clinton and reinstituted by President George W. Bush. It was rescinded by President Barack Obama in January 2009 and remains a controversial issue in U.S. foreign assistance.
This report focuses primarily on legislative restrictions and executive branch policies related to international abortion and family planning.

For information on domestic abortion laws and international population assistance, including funding levels and U.S. programs, see
• CRS Report RL33467, Abortion: Judicial History and Legislative Response, by Jon O. Shimabukuro, and
• CRS Report RL33250, International Family Planning Programs: Issues for Congress, by Luisa Blanchfield.

Abortion Research Package

January 22, 2013 Comments off

Abortion Research Package

Source: Pew Forum on Religion & Public Life

A Pew Forum research package includes results from a new public opinion survey, a slideshow on how opinion differs among various demographic groups, a discussion of the legal issues and a summary of religious groups’ positions.

2012 Saw Second-Highest Number of Abortion Restrictions Ever

January 7, 2013 Comments off

2012 Saw Second-Highest Number of Abortion Restrictions Ever
Source: Guttmacher Institute

Reproductive health and rights were once again the subject of extensive debate in state capitols in 2012. Over the course of the year, 42 states and the District of Columbia enacted 122 provisions related to reproductive health and rights. One-third of these new provisions, 43 in 19 states, sought to restrict access to abortion services. Although this is a sharp decrease from the record-breaking 92 abortion restrictions enacted in 2011, it is the second highest number of new abortion restrictions passed in a year.

Abortion Surveillance — United States, 2009

November 23, 2012 Comments off

Abortion Surveillance — United States, 2009

Source: Morbidity and Mortality Weekly Report (CDC)

Problem/Condition: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.

Reporting Period Covered: 2009.

Description of System: Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2009, data were received from 48 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 45 areas that reported data every year during 2000–2009. Census and natality data, respectively, were used to calculated abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births).

Results: A total of 784,507 abortions were reported to CDC for 2009. Of these abortions, 772,630 (98.5%) were from the 45 reporting areas that provided data every year during 2000–2009. Among these same 45 reporting areas, the abortion rate for 2009 was 15.1 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 227 abortions per 1,000 live births. Compared with 2008, the total number and rate of reported abortions for 2009 decreased 5%, representing the largest single year decrease for the entire period of analysis. The abortion ratio decreased 2%. From 2000 to 2009, the total number, rate, and ratio of reported abortions decreased 6%, 7%, and 8%, respectively, to the lowest levels for 2000–2009.

In 2009 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women aged ≥30 years accounted for a much smaller percentage of abortions and had lower abortion rates. In 2009, women aged 20–24 and 25–29 years accounted for 32.7% and 24.4% of all abortions, respectively, and had an abortion rate of 27.4 abortions per 1,000 women aged 20–24 years and 20.4 abortions per 1,000 women aged 25–29 years. In contrast, women aged 30–34, 35–39, and ≥40 years accounted for 14.7%, 8.8%, and 3.3% of all abortions, respectively, and had an abortion rate of 13.3 abortions per 1,000 women aged 30–34 years, 7.6 abortions per 1,000 women aged 35–39 years, and 2.7 abortions per 1,000 women aged ≥40 years. Throughout the period of analysis, abortion rates decreased among women aged 20–24 and 25–29 years, whereas they increased among women aged ≥40 years.

In 2009, adolescents aged 15–19 years accounted for 15.5% of all abortions and had an abortion rate of 13.0 abortions per 1,000 adolescents aged 15–19 years. Throughout the period of analysis, the percentage of all abortions accounted for by adolescents and the adolescent abortion rate decreased.

In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2009 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30–39 years. Abortion ratios decreased from 2000 to 2009 for women in all age groups except for those aged <15 years, for whom they increased.

In 2009, most (64.0%) abortions were performed at ≤8 weeks’ gestation, and 91.7% were performed at ≤13 weeks’ gestation. Few abortions (7.0%) were performed at 14–20 weeks’ gestation, and even fewer (1.3%) were performed at ≥21 weeks’ gestation. From 2000 to 2009, the percentage of all abortions performed at ≤8 weeks’ gestation increased 12%, whereas the percentage performed at >13 weeks’ decreased 12%. Moreover, among abortions performed at ≤13 weeks’ gestation, the distribution shifted toward earlier gestational ages, with the percentage of these abortions performed at ≤6 weeks’ gestation increasing 47%.

In 2009, 74.2% of abortions were performed by curettage at ≤13 weeks’ gestation, 16.5% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks’ gestation), and 8.1% were performed by curettage at >13 weeks’ gestation. Among abortions that were performed at ≤8 weeks’ gestation and thus were eligible for early medical abortion, 25.2% were completed by this method. The use of early medical abortion increased 10% from 2008 to 2009.

Deaths of women associated with complications from abortions for 2009 are being investigated under CDC’s Pregnancy Mortality Surveillance System. In 2008, the most recent year for which data were available, 12 women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions.

Interpretation: Among the 45 areas that reported data every year during 2000–2009, the gradual decrease that had occurred during previous decades in the total number and rate of reported abortions continued through 2005, whereas year-to-year variation from 2006 to 2008 resulted in no net change during this later period. However, the change from 2008 to 2009 for both the total number of abortions and the abortion rate was the largest single year decrease during 2000–2009, and all three measures of abortion (total numbers, rates, and ratios) decreased to the lowest level observed during this period.

Public Health Actions: Unintended pregnancy is the major contributor to abortion. Because unintended pregnancies are rare among women who use the most effective methods of reversible contraception, increasing access to and use of these methods can help further reduce the number of abortions performed in the United States. The data in this report can help program planners and policy makers identify groups of women at greatest risk for unintended pregnancy and help guide and evaluate prevention efforts.

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