Abortion rate lowest in United States since ’75
Whether due to a decline in unintended pregnancies, shifts in attitudes, or reduced access to service providers, the rate of abortions in the United States has fallen to its lowest level since 1975, according to preliminary data published by the Centers for Disease Control and Prevention (CDC) in Atlanta.1
Between 1972 and 1980, the national abortion rate increased each year, CDC statistics show. The rate remained stable from 1981 to 1993, fluctuating between 22 and 24 abortions per 1,000 women of reproductive age. The 1995 rate of 20 represents the lowest recorded figure since 1975.
1990 saw the peak number of abortions in the United States, coupled with the peak number of births, says Lisa Koonin, MN, MPH, chief of surveillance with the CDC’s Division of Reproduc-tive Health. Since 1990, there has been a decline in the number of abortions and births. From 1994 to 1995, there was a 4.5% decrease in the number of abortions, with the number of births lowered by 1.5% over the same time period.
Age influences rate
It is important to look at the demographic makeup of U.S. women of reproductive age (15 to 44), Koonin says. Although the number of women of reproductive age has grown by 13% since 1980, the proportion who are in later, less fertile years has increased as well. From 1980 to 1995, the percentage of women of reproductive age who were 30 or younger (the group with the highest fertility) declined from 58% to 46%. At the same time, women 35 to 44 (the group with the lowest fertility) accounted for 25% and 36% respectively.
In 1995, there were 311 abortions performed for every 1,000 live births in the United States, the lowest figure for any year since 1976, Koonin says. While both the number of live births and abortions peaked in 1990, the percentage of decline from 1994 to 1995 in the annual number of abortions exceeded the percentage decline in the annual number of births (4.5% compared with 1.5%).
"People may think that when they see a decline in abortions, they will see an increase in births, since abortions and births are the primary outcomes of pregnancy," she observes. "However, we are not seeing an increase in births. We are seeing a decline in births, with fewer pregnancies terminating in abortion."
Many factors contribute to the continued drop in abortions, says Stanley Henshaw, PhD, deputy director of research with the Alan Guttmacher Institute (AGI) in New York City. The AGI compiles statistics from abortion providers, while the CDC records data from state and local health departments.
More women are using contraception rather than risking use of no method, Henshaw says. The major decline in non-use comes from adolescents, who are responding to "safe sex" messages in light of the rise of HIV/AIDS.
The debut of Norplant and DMPA (depo-medroxyprogesterone acetate) in the early 1990s also may account for the drop in the abortion rate, Henshaw says. "Norplant among teen-agers was used often by teen-agers who had a birth and did not want another baby at that time. We know that a lot of teen-agers who have had a baby do get pregnant again and have an abortion."
Fewer teen-agers are having abortions.1 In 1985, teens accounted for 26% of abortions; in 1995, this figure dropped to 20%.
The number of abortion providers is declining, especially in smaller cities and rural areas, which in turn may have some impact on abortion rates, Henshaw says, adding that more abortions are being performed in high-volume clinics. Fewer physicians are performing abortions just for their own patients, and there are fewer hospitals where just a few abortions are performed, he says.
This long-term trend has benefits and drawbacks, he adds. Clinics with a high volume of abortions are well-equipped to meet the needs of their patients, and complication rates are low due to the medical expertise of the staff physicians. On the other hand, women may have to travel farther to reach these clinics, since local abortion services may not be available in their area.
A 1993 nationwide survey of family practice programs revealed that only 12% offered abortion training to their residents.2 This finding may result in a shortage of trained physicians in communities that are already underserved.3
References
1. Abortion surveillance: preliminary analysis United States, 1995. MMWR 1997; 46:1,133-1,137.
2. Talley PP, Bergus GR. Abortion training in family practice residency programs. Fam Med 1996; 28:245-248.
3. Henshaw SK, Van Vort J. Abortion services in the United States, 1991 and 1992. Fam Plann Perspect 1994; 26:100-106.
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