Abortion, Induced Health Article

Definition

Induced abortion is the intentional termination of a pregnancy before the fetus can live independently. An abortion may be elective (based on a woman's personal choice) or therapeutic (to preserve the health or save the life of a pregnant woman).

Purpose

An abortion may be performed whenever there is some compelling reason to end a pregnancy. An abortion is termed "induced" to differentiate it from a spontaneous abortion in which the products of conception are lost naturally (also called a miscarriage).

An abortion is considered to be elective if a woman chooses to end her pregnancy, and it is not for maternal or fetal health reasons. Some reasons a woman might choose to have an elective abortion are:

• Continuation of the pregnancy may cause emotional or financial hardship.
• The woman is not ready to become a parent.
• The pregnancy was unintended.
• The woman is pressured into having one by her partner, parents, or others.
• The pregnancy was the result of rape or incest.

A therapeutic abortion is performed in order to preserve the health or save the life of a pregnant woman. A health care provider might recommend a therapeutic abortion if the fetus is diagnosed with significant abnormalities or not expected to live, or if it has died in utero. Therapeutic abortion may also be used to reduce the number of fetuses if a woman is pregnant with multiples; this procedure is called multifetal pregnancy reduction (MFPR).

A therapeutic abortion may be indicated if a woman has a pregnancy-related health condition that endangers her life. Some examples of such conditions include:

• severe hypertension (high blood pressure)
• cardiac disease
• severe depression or other psychiatric conditions
• serious kidney or liver disease
• certain types of infection
• malignancy (cancer)
• multifetal pregnancy

Demographics

Abortion has been a legal procedure in the United States since 1973. Since then, more than 39 million abortions have taken place. It is estimated that approximately 1.3–1.4 million abortions occur in the United States annually. Induced abortions terminate approximately half of the estimated three million unplanned pregnancies each year and approximately one-fifth of all pregnancies.

In 2000 an estimated 21 out of 1,000 women aged 15–44 had an abortion. Out of every 100 pregnancies that year that ended in live birth or abortion, approximately 24 were elective terminations. The highest abortion rates in 2000 occurred in New Jersey, New York, California, Delaware, Florida, and Nevada (greater than 30 per 1,000 women of reproductive age). Kentucky, South Dakota, Wyoming, Idaho, Mississippi, Utah, and West Virginia had the lowest rates (less than seven per 1,000 women).

In 2000 and 2001, the highest percentage of abortions were performed on women between the ages of 20 and 30, with women ages 20–24 having the highest rate (47 per 1,000 women). Adolescents ages 15–19 accounted for 19% of elective abortions, while 25% were performed on women older than 30. Approximately 73% of women having an abortion had previously been pregnant; 48% of those had a previous abortion.

Non-hispanic, white women reported the highest percentage of abortions in 2000 and 2001 (41%). African American women accounted for 32%, Hispanic women for 20%, Asian and Pacific Islander women for 6%, and Native American women for 1%. The highest abortion rates occurred among African American women (49 per 1,000 women), with Hispanic and Asian women also reporting higher-than-average rates (33 and 31 per 1,000 women, respectively). The rate was the lowest among white women (13 per 1,000 women).

Description

Abortions are safest when performed within the first six to 10 weeks after the last menstrual period (LMP). This calculation is used by health care providers to determine the stage of pregnancy. About 90% of women who have abortions do so in the first trimester of pregnancy (before 13 weeks) and experience few complications. Abortions performed between 13 and 24 weeks (during the second trimester) have a higher rate of complications. Abortions after 24 weeks are extremely rare and are usually limited to situations where the life of the mother is in danger.

Although it is safer to have an abortion during the first trimester, some second trimester abortions may be inevitable. The results of genetic testing are often not available until 16 weeks gestation. In addition, women, especially teens, may not have recognized the pregnancy or come to terms with it emotionally soon enough to have a first trimester abortion. Teens make up the largest group having second trimester abortions.

Very early abortions cost between $200 and $400. Later abortions cost more. The cost increases about $100 per week between the thirteenth and sixteenth week. Second trimester abortions are much more costly because they often involve more risk, more services, anesthesia, and sometimes a hospital stay. Private insurance carriers may or may not cover the procedure. Federal law prohibits federal funds (including Medicaid) from being used to pay for an elective abortion.