Pregnancy rates for U.S. women continue to drop.

The pregnancy rate for U.S. women in 2009 was 102.1 per 1,000 women aged 15-44, the lowest level in 12 years; only the 1997 rate of 101.6 has been lower in the last 30 years. Rates for women under age 30 fell during 1990-2009, while rates for women aged 30 and over increased. Rates for teenagers reached historic lows in 2009, including rates for the three major race and Hispanic origin groups. Pregnancy rates have declined about 10% each for married and unmarried women since 1990. The birth rate for married women was 72% higher than the rate for unmarried women; the abortion rate for unmarried women was almost five times higher than the rate for married women. Pregnancy rates for women in the United States continued to decline in 2009, reaching the lowest level in 12 years (102.1 per 1,000 women aged 15-44). This level is 12% below the 1990 peak (115.8). The estimated number of pregnancies dropped to 6,369,000 (4,131,000 live births, 1,152,000 induced abortions, and 1,087,000 fetal losses). The drop in birth rates since 2007 has been well documented. However, it is important to examine the other outcomes of pregnancy to understand the full scope of current reproductive trends. The data in this report provide a comprehensive picture of pregnancies and pregnancy outcomes. Data on pregnancy outcomes by age, race and Hispanic origin, and marital status are presented using data from the National Vital Statistics System, the Abortion Surveillance System and Guttmacher Institute, and the National Survey of Family Growth (NSFG).

Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-2008, updating a national series of rates extending since 1976. METHODS: Tabular and graphical data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. RESULTS: In 2008, an estimated 6,578,000 pregnancies resulted in 4,248,000 live births, 1,212,000 induced abortions, and 1,118,000 fetal losses. The 2008 pregnancy rate of 105.5 pregnancies per 1000 women aged 15-44 is 9 percent below the 1990 peak of 115.8. The teen pregnancy rate dropped 40 percent from 1990 to 2008, reaching a historic low of 69.8 per 1000 women aged 15-19. Pregnancy rates have declined significantly for non-Hispanic white, non-Hispanic black, and Hispanic teenagers. Rates in 2008 for non-Hispanic black and Hispanic teenagers were two to three times higher than the rates for non-Hispanic white teenagers. Pregnancy rates for women in their early 20s declined to the lowest level in more than three decades, although the declines have been more modest than for teenagers. Pregnancy rates for women aged 25-29 have changed relatively little since 1990, while rates for women in their 30s and early 40s increased.

Induced abortion: incidence and trends worldwide from 1995 to 2008.

BACKGROUND: Data of abortion incidence and trends are needed to monitor progress toward improvement of maternal health and access to family planning. To date, estimates of safe and unsafe abortion worldwide have only been made for 1995 and 2003. METHODS: We used the standard WHO definition of unsafe abortions. Safe abortion estimates were based largely on official statistics and nationally representative surveys. Unsafe abortion estimates were based primarily on information from published studies, hospital records, and surveys of women. We used additional sources and systematic approaches to make corrections and projections as needed where data were misreported, incomplete, or from earlier years. We assessed trends in abortion incidence using rates developed for 1995, 2003, and 2008 with the same methodology. We used linear regression models to explore the association of the legal status of abortion with the abortion rate across subregions of the world in 2008. FINDINGS: The global abortion rate was stable between 2003 and 2008, with rates of 29 and 28 abortions per 1000 women aged 15-44 years, respectively, following a period of decline from 35 abortions per 1000 women in 1995. The average annual percent change in the rate was nearly 2·4% between 1995 and 2003 and 0·3% between 2003 and 2008. Worldwide, 49% of abortions were unsafe in 2008, compared to 44% in 1995. About one in five pregnancies ended in abortion in 2008. The abortion rate was lower in subregions where more women live under liberal abortion laws (p<0·05). INTERPRETATION: The substantial decline in the abortion rate observed earlier has stalled, and the proportion of all abortions that are unsafe has increased. Restrictive abortion laws are not associated with lower abortion rates. Measures to reduce the incidence of unintended pregnancy and unsafe abortion, including investments in family planning services and safe abortion care, are crucial steps toward achieving the Millennium Development Goals. FUNDING: UK Department for International Development, Dutch Ministry of Foreign Affairs, and John D and Catherine T MacArthur Foundation.

Legal abortion worldwide in 2008: levels and recent trends.

CONTEXT: Periodic assessments of abortion incidence are essential for monitoring trends in unintended pregnancy and gaps in contraceptive services and use. METHODS: Statistics and estimates of legal induced abortions in 2008 were compiled for 64 of the 77 countries in which legal abortion is generally available; the 64 are home to 98% of women aged 15-44 who live in the countries eligible for inclusion. Data sources included reports or completed questionnaires from national statistical offices and nationally representative surveys. The completeness of official figures was assessed by in-country and regional experts. Trends since 1996 and 2003 were examined. RESULTS: Of the 77 countries with liberal abortion laws, 36 are in the developing world. In 2008, abortion rates in the 25 countries with complete records-all of which were developed-ranged from seven (Germany and Switzerland) to 30 (Estonia) per 1,000 women aged 15-44. Abortion rates declined in about half of the 20 countries with consistently reliable information on trends between 1996 and 2008; declines were generally steeper than increases, although the pace of decline slowed after 2003. The highest observed abortion rates were in developing countries with incomplete estimates. For most developing countries that had liberal laws, the reported abortion rates were incomplete and varied widely. CONCLUSIONS: High abortion rates in some countries, and small increases in rates in others, indicate a great need for more effective family planning services for these populations. Reliable data collection systems, needed to ensure that trends can be effectively monitored, are lacking in many countries.

Legal abortion worldwide in 2008: levels and recent trends.

CONTEXT: Periodic assessments of abortion incidence are essential for monitoring trends in unintended pregnancy and gaps in contraceptive services and use. METHODS: Statistics and estimates of legal induced abortions in 2008 were compiled for 64 of the 77 countries in which legal abortion is generally available; these 64 are home to 98% of women aged 15-44 who live in the countries eligible for inclusion. Data sources included reports or completed questionnaires from national statistical offices and nationally representative surveys. The completeness of official figures was assessed by in-country and regional experts. Trends since 1996 and 2003 were examined. RESULTS: Of the 77 countries with liberal abortion laws, 36 are in the developing world. In 2008, abortion rates in the 25 countries with complete records-all of which were developed-ranged from seven (Germany and Switzerland) to 30 (Estonia) per 1,000 women aged 15-44. Abortion rates declined in most of the 20 countries with consistently reliable information on trends between 1996 and 2008; declines were generally steeper than increases, although the pace of decline slowed after 2003. The highest observed abortion rates were in developing countries with incomplete estimates. For most developing countries that had liberal laws, the reported abortion rates were incomplete and varied widely. CONCLUSIONS: High abortion rates in some countries, and small increases in rates in others, indicate a great need for more effective family planning services for these populations. Reliable data collection systems, needed to ensure that trends can be effectively monitored, are lacking in many countries.

Trends in abortion in the United States.

The US abortion rate peaked soon after 1973, remained fairly constant through the 1980s, and began a steady decline to 2005. A substantial drop in the abortion rates of teenagers and women ages 20 to 24 accounts for much of the decline from 1989 to 2004. All race and ethnic groups experienced declines in abortion rates over the past 30 years, but the rate of black, and to a lesser extent Hispanic, women remains higher than that of non-Hispanic whites. The number of abortion providers has declined in recent decades, but the introduction of early medical abortion may have slowed this trend.

Estimated pregnancy rates for the United States, 1990-2005: an update.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-2005, updating a national series of rates extending since 1976. METHODS: Tabular data on pregnancy rates by age, race and Hispanic origin, and by marital status are presented and briefly described. RESULTS: in 2005, an estimated 6,408,000 pregnancies resulted in 4.14 million live births, 1.21 million induced abortions, and 1.06 million fetal losses. The 2005 pregnancy rate of 103.2 pregnancies per 1000 women aged 15-44 years is 11 percent below the 1990 peak of 115.8. The teenage pregnancy rate dropped 40 percent from 1990 to 2005, reaching an historic low of 70.6 per 1000 women aged 15-19 years. Rates fell much more for younger than for older teenagers.

Estimated pregnancy rates by outcome for the United States, 1990-2004.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-2004, updating a national series of rates extending since 1976. Data from the National Survey of Family Growth (NSFG) are used to interpret trends in teenage pregnancy and in total pregnancy and fertility rates. METHODS: Tabular and graphical data on pregnancy rates by age, race and Hispanic origin, and by marital status are presented and described. Birth data are from the birth registration system for all births registered in the United States and reported by state health departments to the National Center for Health Statistics; abortion data are from the Guttmacher Institute and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; and fetal loss estimates are from pregnancy history information collected by the NSFG. RESULTS: In 2004 an estimated 6,390,000 pregnancies resulted in 4.11 million live births, 1.22 million induced abortions, and 1.06 million fetal losses. The estimated pregnancy rate for 2004 was 103.0; the rate varied little between 1995 and 2004. The teenage pregnancy rate dropped 38 percent during 1990-2004, reaching an historic low of 72.2 pregnancies per 1,000 women aged 15-19 years. Rates for younger teenagers declined relatively more than for older teenagers.

Severity and cost of unsafe abortion complications treated in Nigerian hospitals.

CONTEXT: Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality. METHODS: In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Women's abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances. RESULTS: Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the country's restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira). CONCLUSIONS: Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.

Abortion in the United States: incidence and access to services, 2005.

CONTEXT: Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. METHODS: All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. RESULTS: An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. CONCLUSION: The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services.

Legal abortion worldwide: incidence and recent trends.

CONTEXT: Information on abortion levels and trends can inform research and policies affecting maternal and reproductive health, but the incidence of legal abortion has not been assessed in nearly a decade. METHODS: Statistics on legal abortions in 2003 were compiled for 60 countries in which the procedure is broadly legal, and trends were assessed where possible. Data sources included published and unpublished reports from official national reporting systems, questionnaires sent to government agencies and nationally representative population surveys. The completeness of country estimates was assessed by officials involved in data collection and by in-country and regional experts. RESULTS: In recent years, more countries experienced a decline in legal abortion rates than an increase, among those for which statistics are complete and trend data are available. The most dramatic declines were in Eastern Europe and Central Asia, where rates remained among the highest in the world. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will have close to three abortions each, on average, in their lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but remained higher than rates in many Northern and Western European countries. Rates increased in the Netherlands and New Zealand. The official abortion rate declined by 21% over seven years in China, which accounted for a third of the world's legal abortions in 1996. Trends in the abortion rate differed across age-groups in some countries. CONCLUSIONS: The abortion rate varies widely across the countries in which legal abortion is generally available and has declined in many countries since the mid-1990s.

Legal abortion worldwide: incidence and recent trends.

CONTEXT: Information on abortion levels and trends can inform research and policies affecting maternal and reproductive health, but the incidence of legal abortion has not been assessed in nearly a decade. METHODS: Statistics on legal abortions in 2003 were compiled for 60 countries in which the procedure is broadly legal, and trends were assessed where possible. Data sources included published and unpublished reports from official national reporting systems, questionnaires sent to government agencies and nationally representative population surveys. The completeness of country estimates was assessed by officials involved in data collection and by in-country and regional experts. RESULTS: In recent years, more countries experienced a decline in legal abortion rates than an increase, among those for which statistics are complete and trend data are available. The most dramatic declines were in Eastern Europe and Central Asia, where rates remained among the highest in the world. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will have close to three abortions each on average in their lifetimes. The U.S. abortion rate dropped by 8% between 1996 and 2003, but remained higher than rates in many Northern and Western European countries. Rates increased in the Netherlands and New Zealand. The official abortion rate declined by 21% over seven years in China, which accounted for a third of the world's legal abortions in 1996. Trends in the abortion rate differed across age-groups in some countries. CONCLUSIONS: The abortion rate varies widely across the countries in which legal abortion is generally available and has declined in many countries since the mid-1990s.

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.

CONTEXT: Many pregnancies are unintended, particularly in certain population groups. Determining whether unintended pregnancy rates and disparities in rates between subgroups are changing may help policymakers target reproductive health services to those women most in need. METHODS: To calculate rates of unintended pregnancy and related outcomes, data on pregnancy intendedness from the 2002 National Survey of Family Growth were combined with birth, abortion and population data from federal, state and nongovernmental sources. RESULTS: In 2001, 49% of pregnancies in the United States were unintended. The unintended pregnancy rate was 51 per 1,000 women aged 15-44, meaning that 5% of this group had an unintended pregnancy. This level was unchanged from 1994. The rate of unintended pregnancy in 2001 was substantially above average among women aged 18-24, unmarried (particularly cohabiting) women, low-income women, women who had not completed high school and minority women. Between 1994 and 2001, the rate of unintended pregnancy declined among adolescents, college graduates and the wealthiest women, but increased among poor and less educated women. The abortion rate and the proportion of unintended pregnancies ending in abortion among all women declined, while the unintended birth rate increased. Forty-eight percent of unintended conceptions in 2001 occurred during a month when contraceptives were used, compared with 51% in 1994. CONCLUSIONS: More research is needed to determine the factors underlying the disparities in unintended pregnancy rates by income and other characteristics. The findings may reflect a need for increased and more effective contraceptive use, particularly among high-risk groups.

The accessibility of abortion services in the United States, 2001.

CONTEXT: A woman's ability to obtain an abortion is affected both by the availability of a provider and by access-related factors such as cost, convenience, gestational limits and the provision of early medical abortion services. METHODS: In 2001-2002, The Alan Guttmacher Institute surveyed all known abortion providers in the United States, collecting information on their delivery of abortion services and on the number of abortions performed. RESULTS: A minority of abortion providers offer services before five weeks from the last menstrual period (37%) or after 20 weeks (24% or fewer), but the proportions have increased since 1993. Providers estimate that one-quarter of women having abortions in nonhospital facilities travel 50 miles or more for services, and that 7% are initially unsure of their abortion decision. The majority of providers (59%) say that these clients usually receive abortions during a single visit. An average self-paying client was charged $372 for a surgical abortion at 10 weeks in 2001, up from $319 in 1997; only 26% of clients receive services billed directly to public or private insurance. Early medical abortions are becoming increasingly available but are more expensive than surgical abortions. More than half (56%) of providers experienced antiabortion harassment in 2000, but types of harassment other than picketing have declined since 1996. CONCLUSIONS: Abortion at very early and late gestations and early medical abortion are more available than before, but charges have increased and antiabortion picketing remains at high levels. Thus, many women still face substantial barriers to obtaining an abortion.

Abortion incidence and services in the United States in 2000.

CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996. METHODS: In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys. RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15-44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nations 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000. CONCLUSIONS: Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.

Patterns in the socioeconomic characteristics of women obtaining abortions in 2000-2001.

CONTEXT: Information about the socioeconomic characteristics of women obtaining abortions in the United States can help policymakers and family planning providers determine which groups of women need better access to contraceptive services. METHODS: A representative sample of more than 10,000 women obtaining abortions from a stratified probability sample of 100 U.S. providers were surveyed in 2000-2001; survey data are used to examine the demographic characteristics of women who terminate pregnancies. This information, along with other national-level data, is used to estimate abortion rates and ratios for subgroups of women and examine recent changes in these measures. RESULTS. In 2000, 21 out of every 1,000 women of reproductive age had an abortion. Women who are aged 18-29, unmarried, black or Hispanic, or economically disadvantaged-including those on Medicaid-have higher abortion rates. The overall abortion rate decreased by 11% between 1994 and 2000. The decline was greatest for 15-17-year-olds, women in the highest income category, those with college degrees and those with no religious affiliation. Abortion rates for women with incomes below 200% of poverty and for women with Medicaid coverage increased between 1994 and 2000. The rate of decline in abortion among black and Hispanic adolescents was lower than that among white adolescents, and the abortion rate among poor teenagers increased substantially. CONCLUSIONS: Increased efforts are needed to help both adolescent women and adult women of all economic statuses avoid unintended pregnancies.

Contraceptive use among U.S. women having abortions in 2000-2001.

CONTEXT: Knowing the extent to which contraceptive nonuse, incorrect or inconsistent use, and method failure account for unintended pregnancies ending in abortion, as well as reasons for nonuse and imperfect use, can help policymakers and family planning providers support effective contraceptive use. METHODS: Contraceptive use patterns among a nationally representative sample of 10,683 women receiving abortion services in 2000-2001 were examined, as well as reasons for nonuse, problems with the most frequently used methods and the impact emergency contraceptive pills have had on abortion rates. RESULTS: Forty-six percent of women had not used a contraceptive method in the month they conceived, mainly because of perceived low risk of pregnancy and concerns about contraception (cited by 33% and 32% of nonusers respectively). The male condom was the most commonly reported method among all women (28%), followed by the pill (14%). Inconsistent method use was the main cause of pregnancy for 49% of condom users and 76% of pill users; 42% of condom users cited condom breakage or slippage as a reason for pregnancy. Substantial proportions of pill and condom users indicated perfect method use (13-14%). As many as 51,000 abortions were averted by use of emergency contraceptive pills in 2000. CONCLUSIONS: Women and men need accurate information about fertility cycles and about the risk of pregnancy when a contraceptive is not used or is used imperfectly. Increased use of emergency contraceptive pills could further reduce levels of unintended pregnancy and abortion.