An Overview of Abortion John B Pryor Illinois

An Overview of Abortion John B. Pryor Illinois State University

US Public Opinions about Abortion

Should Abortion be Legal in the US? Gallup Poll (May 2009) Never 23% Under any circumstances 22% Under certain circumstances 54%

Incidence of Pregnancy and Abortion

Pregnancies in the United States (Approximately 6. 4 Million Annually) % of pregnancies Intended Unintended Source: Finer et al. , 2006 (2002 data)

Outcomes of Unintended Pregnancies (Approximately 3. 1 Million Annually) % of unintended pregnancies (excluding miscarriages) 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 stagnant between 2001 and 2006. • Unintended pregnancy has increased by 10% among poor women while decreasing 14% among higher-income women between 2001 and 2006.

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 71% 48% Afraid to tell parents or partner Needed time to make decision 33% 24% 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 8% 8% 6% 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 2 nd 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 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: Before 9 weeks Chance of death per year: 1 in 1, 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 1 in 1, 000 Automobile driving 1 in 5, 900 Power-boating 1 in 5, 900 Playing football 1 in 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

Women in Their 20 s Make Up the Majority of Abortion Patients

Nearly Half of Abortions Are Obtained by Never-Married Women

Poor Women Are Also Overrepresented Among Abortion Patients 2010 Federal Poverty Level for 2 people: $14, 570 Gross Annual Income

Who Has Abortions: Race/Ethnicity *Non-Hispanic Source: Jones et al. , 2002

Most Women Obtaining Abortions Report a Religious Affiliation

Six in 10 Women Having Abortions Are Already Mothers

Who Provides Abortion Services

Percentage of Abortions Performed by Each Type of Provider % of abortions

Number of Providers by Type No. of providers

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 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 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.

Summary of state laws regarding abortion as of October 2010 • Physician and Hospital Requirements: 38 states require an abortion to be performed by a licensed physician. 19 states require an abortion to be performed in a hospital after a specified point in the pregnancy, and 19 states require the involvement of a second physician after a specified point. • Gestational Limits: 38 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.

Summary of state laws regarding abortion as of October 2010 • “Partial-Birth” Abortion: 16 states have laws in effect that prohibit “partial-birth” abortion. 4 of these laws apply only to postviability abortions. • 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 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.

Summary of state laws regarding abortion as of October 2010 • Coverage by Private Insurance: 4 states restrict coverage of abortion in private insurance plans to cases in which the woman’s life would be endangered if the pregnancy were carried to term. Additional abortion coverage is permitted only if the woman purchases it at her own expense. • 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. .

Summary of state laws regarding abortion as of October 2010 • State-Mandated Counseling: 18 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 (6 states), the ability of a fetus to feel pain (10 states), long-term mental health consequences for the woman (7 states) or information on the availability of ultrasound (9 states).

Summary of state laws regarding abortion as of October 2010 Waiting Periods: 24 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. 6 of these states have laws that effectively require the woman make two separate trips to the clinic to obtain the procedure.

International Perspective on Abortion

Average Indonesia Thailand 52 23 15 What should be the government's role in 10 28 abortion? 60 22 35 India 37 24 S. Korea Iran Palestinian ter. Egypt 31 67 15 8 43 28 38 39 11 31 47 48 Azerbaijan 48 25 8 45 20 24 31 62 14 22 Poland 66 Ukraine 64 Great Britain 15 16 6 17 81 3 15 95 France USA 6 18 42 Turkey Russia 26 62 China Nigeria 27 3 2 69 Mexico 70 Leave these matters to the individual Discourage usining 20% criminal enflorcement 0% 40% 1 21 8 15 non-punitive 8 Discourage using only methods 60% 80% 100% 120% World Public Opinion Poll (2008)

U. S. Share of Abortions Worldwide Other Countries Source: Sedgh, 2007

Abortion Rate, United States and World Abortions per 1, 000 women Source: Sedgh, 2007 (data for 2003)

U. S. Abortion Rate Higher Than in Many Other Industrialized Countries Abortions per 1, 000 women Source: Sedgh, 2007

20 million unsafe abortions occur each year 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

Changes in abortion law between 1997 and 2009 • Nineteen countries liberalized their laws to increase access to safe abortion: Australia*, Benin, Bhutan, Burkina Faso, Cambodia, Chad, Colombia, Ethiopia, Guinea, Iran, Mexico* Mali, Nepal, Portugal, Saint Lucia, Swaziland, Switzerland, Thailand Togo. • Three countries tightened restrictions on abortion: El Salvador, Nicaragua and Poland. *Changes in Mexico and Australia were not national, but in highly populous regions

High Rates of Abortion Occur in Countries that Severely Restrict 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 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).