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Assisted reproductive technology surveillance--United States, 2013
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December 4, 2015
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Journal Article:MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries
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Description: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: 2012.
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 2012, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2003–2012. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births).
Results: A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003–2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003–2012).
In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20–24 and 25–29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20–24 and 25–29 years, respectively. In contrast, women aged 30–34, 35–39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of 12.4, 7.3, and 2.8 abortions per 1,000 women aged 30–34 years, 35–39 years, and ≥40 years, respectively. Throughout the period of analysis, abortion rates decreased among women aged 20–24, 25–29, and 30–34 years by 24%, 18%, and 10%, respectively, whereas they increased among women aged ≥40 years by 8%.
In 2012, adolescents aged <15 and 15–19 years accounted for 0.4% and 12.2% of all abortions, respectively, and had abortion rates of 0.8 and 9.2 abortions per 1,000 adolescents aged <15 and 15–19 years, respectively. From 2003 to 2012, the percentage of abortions accounted for by adolescents aged 15–19 years decreased 27% and their abortion rate decreased 40%. These decreases were greater than the decreases for women in any older age group.
In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2012 and throughout the entire period of analysis were highest among adolescents aged ≤19 years and lowest among women aged 30–39 years. Abortion ratios decreased from 2003 to 2012 for women in all age groups.
In 2012, the majority (65.8%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.4%) were performed by ≤13 weeks' gestation. Few abortions (7.2%) were performed between 14–20 weeks' gestation or at ≥21 weeks' gestation (1.3%). From 2003 to 2012, the percentage of all abortions performed at ≤8 weeks' gestation increased 7%; the percentage performed at >13 weeks remained consistently low (≤9.0%).
In 2012, among the 40 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 69.4% of abortions were performed by curettage at ≤13 weeks' gestation, 20.8% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.7% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible on the basis of gestational age for early medical abortion, 30.8% were completed by this method. The percentage of abortions reported as early medical abortions increased 10% from 2011 to 2012.
Deaths of women associated with complications from abortions for 2012 are being investigated as part of CDC's Pregnancy Mortality Surveillance System. In 2011, the most recent year for which data were available, two women were identified 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 47 areas that reported data every year during 2003–2012, the notable decreases that occurred during 2008–2011 in the total number, rate, and ratio of reported abortions continued from 2011 to 2012 and resulted in historic lows for all three measures of abortion.
Public Health Actions: The data in this report can help to identify groups of women at greatest risk for abortion and can be used to guide and evaluate prevention efforts. Because unintended pregnancy is the major contributor to abortion, and unintended pregnancies are rare among women who use the most effective methods of contraception, increasing access to and use of these methods can help further reduce the number of unintended pregnancies, and therefore abortions, performed in the United States.
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