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Abortion monitoring --- united States, 2000Laurie D. Elam-Evans, Ph.D.

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Lilo T. Strauss, M.A. happiness Herndon, M.S. Wilda Y. Parker Sonya V. Bowens, M.S. Suzanne Zane, D.V.M. Cynthia J. Berg, M.D. division of Reproductive health National facility for Chronic disease Prevention and Health PromotionAbstractProblem/Condition: began abortion surveillance in 1969 to file the number and also characteristics of females obtaining legal induced abortions.Reporting period Covered: This report summarizes and also describes data reported to about legal induced abortions obtained in the United claims in 2000.Description that System: because that each year due to the fact that 1969, has actually compiled abortion data by state or area that occurrence. Throughout 1973--1997, data were got from or estimated for 52 reporting locations in the united States: 50 states, the ar of Columbia, and new York City. In 1998 and also 1999, compiled abortion data native 48 report areas. Alaska, California, brand-new Hampshire, and also Oklahoma did not report, and data for these locations were not estimated. In 2000, Oklahoma again reported this data, increasing the number of reporting areas to 49. Results: A total of 857,475 legit induced abortions to be reported come because that 2000 indigenous 49 reporting areas, representing a 0.5% decrease from the 861,789 legal induced abortions report by 48 reporting locations for 1999 and a 1.3% decrease for the same 48 reporting locations that reported in 1999. The abortion ratio, defined as the variety of abortions every 1,000 live births, was 246 in 2000 (for the exact same 48 reporting locations as 1999), compared with 256 reported because that 1999. This represents a 3.8% decrease in the abortion ratio. The abortion rate (for the very same 48 reporting areas as 1999) was 16 every 1,000 women aged 15--44 years because that 2000. This was additionally a 3.8% decrease native the price reported for actions performed throughout 1997--1999 because that the same 48 reporting areas.The greatest percentages of report abortions to be for ladies aged 8 weeks of gestation, and also 88% to be performed prior to 13 weeks. Indigenous 1992 (when detailed data concerning early abortions were first collected) with 2000, steady increases have developed in the percentage of abortions performed in ~ 6 weeks of gestation. Few abortions were performed after 15 weeks of gestation; 4.3% were derived at 16--20 weeks and 1.4% were obtained at >21 weeks. A complete of 31 reporting areas submitted data stating the they performed medical (nonsurgical) procedures, comprising 1.0% of all reported measures from the 42 locations with enough reporting on kind of procedure.In 1998 and 1999 (the most recent years because that which data space available), 14 women died as a an outcome of complications from well-known legal induced abortion. Ten of this deaths developed in 1998 and four emerged in 1999; no deaths were associated with well-known illegal abortion.Interpretation: indigenous 1990 with 1997, the variety of legal induced abortions gradually declined. In 1998 and 1999, the variety of abortions ongoing to decrease once comparing the same 48 reporting areas. In 2000, also with one added reporting state, the number of abortions decreased slightly. In 1998 and 1999, as in previous years, deaths related to legal induced abortions occurred rarely ( Public wellness Action: Abortion monitoring in the joined States proceeds to administer data essential for analyzing trends in numbers and characteristics of females who achieve legal induced abortions and for increasing understanding of one additional aspect of the spectrum of pregnant outcomes. Plan makers and also program planners require these data to enhance the health and well-being that women and also started conducting abortion monitoring in 1969 to document the number and also characteristics of females obtaining legit induced abortions and also to screen one result of unintentional pregnancies. This report is based upon abortion data for 2000 detailed to"s National center for Chronic condition Prevention and also Health promotion (NCCDPHP), division of Reproductive Health.MethodsFor 2000, compiled data that were voluntarily listed from 49 reporting areas in the unified States: 47 says (excluding Alaska, California, and brand-new Hampshire), the district of Columbia, and brand-new York City. Legal induced abortion was defined as a procedure, perform by a licensed medical professional or someone exhilaration under the supervision that a licensed physician, the was to plan to terminate a doubt or recognized intrauterine pregnancy and to produce a nonviable fetus at any type of gestational period (1,2). The total variety of legal induced abortions was available from all reporting areas; however, not all of these areas gathered data about some or all of the attributes of ladies who acquired abortions. Thus, the accessibility of data on characteristics of women obtaining an abortion varied by reporting area in 2000.Most reporting locations (46 states, the ar of Columbia, and brand-new York City) accumulated and reported enough data (i.e., data categorized in accordance with monitoring variables and with 15% unknown values) by age of the woman, whereas just 29 states, the district of Columbia, and brand-new York City accumulated and reported enough data by spain ethnicity. Therefore, the findings in this report reflect attributes of women only from reporting locations that submitted enough data for the qualities being examined. Because that the majority of state tables, the portion data incorporate a category for unknown values. However, for tendency data, out-of-area residents, adolescent ages, and also two-characteristics tables, percentages gift are based on known worths only.For the 49 report areas, data worrying the number of women obtaining legit induced abortions were provided by the central health agency.* these agencies detailed data on numbers of abortions and characteristics of ladies obtaining abortions by the state in i beg your pardon the abortions were performed (i.e., state of occurrence). For most states, abortion totals were also obtainable by the woman"s state the residence. However, three says (Delaware, Maryland, and Wisconsin) reported features only because that women who were residents and who obtained abortions in the state, however not for ladies from out of state; and one state (Iowa) detailed numbers and characteristics only for state residents. Two states (Florida and Louisiana) did not report abortion totals by resides status, and two says (Arizona and also Massachusetts) listed only the total number of abortions for out-of-state residents without point out individual claims or areas of residence.This report provides overall and also state-specific abortion statistics. Because that all features for which birth or population data to be available, abortion ratios (number of abortions every 1,000 live births) or abortion prices (number that abortions per 1,000 females in a given age group) space provided. Starting with 1996, abortion ratios to be calculated by utilizing the variety of live births to occupants of every area, from bear data report to"s National facility for wellness Statistics (NCHS); numbers had previously been obtained from state health and wellness departments. The population data provided for calculating abortion rates had actually previously been derived from the U.S. Census office postcensual data. However, due to the fact that of the affect of transforms in Office of Management and also Budget (OMB) requirements in 1997 that allowed for multiple gyeongju selections ~ above the 2000 Census, no population data were released by the Census Bureau. NCHS connected race and also ethnicity data were provided for calculating abortion rates; this requires a version that equates multiple gyeongju responses because that an individual right into the one, single response the the design predicts the separation, personal, instance most likely would have actually reported under the 1977 OMB criter (3).Women who derived legal induced abortions were categorized by 5-year period groups and also by single years of age for teens aged 15--19 years. Abortion numbers, ratios and also rates room presented by age group. Because nearly all (94%) abortions among women age 4), the populace of females aged 13--14 year was provided as the denominator because that calculating abortion rates for ladies >40 year were based on the number of women aged 40--44 years. Rates for all ladies who acquired abortions, however, were based upon the populace of females aged 15--44 years.Race to be categorized by three groups: white, black, and also other races. Various other races consisted of Asian/Pacific Islander, American Indian, Alaska Native, and also women classified together "other" race. Ethnicity was categorized as Hispanic and also non-Hispanic. Together in previous reports, race and ethnicity were listed as different characteristics and also abortions were not cross-classified by race and ethnicity. Abortion numbers, ratios and also rates room presented by race and by ethnicity.Marital status was reported as either married (including women who were married or separated) or unmarried (including those who were never married, divorced, or widowed). Abortion numbers and ratios room presented by marital status. Gestational age (in weeks) at the time of abortion was categorized as 6, 7, 8 and also 8, 9--10, 11--12, 13--15, 16--20, and also >21. Weeks of gestation were estimated in 20 reporting locations as the time elapsed since the woman"s critical menstrual period. For 17 various other states, gestational period was reported based on the physician"s calculation (data indigenous the clinical examination including ultrasound results). Because that the continuing to be six states, gestational age came from a combination of physician"s estimates and also the time elapsed due to the fact that the woman"s critical menstrual period. Most areas (41 the 43) the reported adequate data on mainly of gestation at the time of abortion likewise reported abortions performed in ~ 8 weeks separately for 6, 7, and also 8 weeks of gestation. Abortion numbers are presented through gestational has periodically report data on abortion-related deaths due to the fact that these deaths were very first included in the Abortion security Report in 1972 (5,6). One abortion-related death was identified as a death resulting from 1) a direct complication of one abortion, 2) one indirect complication resulted in by the chain of events initiated by abortion, or 3) aggravation that a preexisting condition by the physiologic or psychologic impacts of the abortion (1,2). Sources of data for abortion-related deaths contained national and state an essential records, maternal mortality review committees, surveys, private citizens and groups, media reports, health-care providers, clinical examiners" reports, and also computerized searches the full-text newspaper databases. Every deaths associated with any form of abortion, induced or spontaneous, were investigated. Because that each fatality possibly pertained to an induced abortion or an abortion that unknown type, clinical records and also autopsy reports to be requested and also reviewed by 2 clinically experienced medical epidemiologists to identify the reason of death and whether the death was abortion related. Each abortion-related death was then categorized as legal induced, illegal induced, spontaneous, or unknown (whether induced or spontaneous). Abortion-related deaths for 1972--1999 are noted in this report. Abortion mortality data room updated whenever added information is provided to The 1999 data have actually not been published previously and also are the many recent data available. Nationwide case-fatality prices were calculated as the number of known legit induced abortion-related deaths every 100,000 report legal induced abortions. Case-fatality prices for 1972--1997 are noted in this report. Case-fatality rates for 1998--1999 cannot be calculated since a substantial variety of abortions emerged in the four nonreporting states, and the total number of abortions (the denominator) is unknown.ResultsOverall, the annual variety of legal induced abortions in the United states increased gradually until it peaked in 1990, and it has decreased in many years after that (Figure 1). In 2000, a complete of 857,475 legal induced abortions to be reported come by 49 report areas. This represents a 0.5% decrease indigenous 1999, because that which 861,789 legitimate induced abortions were reported native 48 reporting areas (Table 1) and also a 1.3% decrease in the exact same 48 reporting locations as 1999 (Table 2).The nationwide legal induced abortion ratio raised from 196 every 1,000 live births in 1973 (the very first year that 52 locations reported) come 358 every 1,000 live births in 1979 and also remained almost stable v 1981 (Figure 1) (Table 2). The ratio peaked in ~ 364 every 1,000 live births in 1984 and also since then has shown a almost steady decline. In 2000, the abortion proportion was 245 every 1,000 live births in 49 reporting areas and 246 because that the exact same 48 report areas available for 1999. This to represent a 3.8% decrease native 1999 (256 per 1,000 live births) for the 48 reporting locations (Table 2) (6).The national legal induced abortion rate boosted from 14 abortions per 1,000 women aged 15--44 year in 1973 come 25 every 1,000 in 1980. In the 1980s and early 1990s, the rate remained steady at 23--24 abortions every 1,000 women aged 15--44 years, and during 1994--1997 the again stabilized in ~ 20--21. The abortion rate remained unmodified at 17 per 1,000 females aged 15--44 year from 1997 through 1999 in the exact same 48 report areas. In 2000, the abortion rate declined to 16 every 1,000 women aged 15--44 years (overall and also in the very same 48 reporting locations as 1999).The numbers, ratios, and rates of report legal induced abortions are presented by area the residence and also by area of occurrence (Table 3). In 2000, the greatest numbers of reported legal induced abortions emerged in brand-new York City (94,466), Florida (88,563), and Texas (76,121); the fewest† arisen in Idaho (801), southern Dakota (878), and also North Dakota (1,341) (Table 3). The abortion ratios by state or area of occurrence ranged native 39 every 1,000 live births in Idaho come 869 every 1,000 live births in the ar of Columbia. The rates by incident ranged from 3 per 1,000 women aged 15--44 years in Idaho to 46 per 1,000 women aged 15--44 year in the district of Columbia. These ratios and also rates should be regarded with factor to consider of the sizable sport by state in the percentage of abortions acquired by out-of-state residents. In 2000, about 9% of report abortions were acquired by out-of-state residents. The percentages ranged native 0.4% in Hawaii come 56% in the ar of Columbia (Table 3). Data by state of residence space incomplete due to the fact that three claims (Alaska, California, and new Hampshire) did not report and also five says (Arizona, Florida, Iowa, Louisiana, and Massachusetts) go not carry out any data concerning the residence condition of all women obtaining abortions in their state.Women aged 20--24 year were well-known to have acquired 33% of every abortions for which age was adequately reported. Females aged Table 4). Abortion ratios were highest possible for the youngest females (708 abortions per 1,000 live births for ladies aged figure 2) (Table 4). In contrast to abortion ratios, among women for whom age was reported, abortion rates were highest possible for females aged 20--24 years (33 abortions every 1,000 women) and also lowest for ladies at the extremes the reproductive age (2 abortions every 1,000 ladies aged 13--14 years and 2 every 1,000 women aged 40--44 years) (Table 4). Among teens (aged § and lowest because that those age 19 years (324 per 1,000 live births) (Table 5). Conversely, the rates of abortions to be lowest for adolescents aged Table 5). Abortion fads by age indicate that due to the fact that 1973, abortion ratios for women aged number 3). For women aged 19 years and also those age >40 years, the abortion ratio increased as whole from 1974 v the beforehand 1980s and declined afterwards (Figure 3). The abortion ratio for ladies aged 20--34 years (the teams with the highest fertility rates) (7) has actually remained basically stable since the mid-1980s. The abortion proportion for women aged 35--39 years has actually gradually declined over time.In 2000, for females whose mainly of gestation at the time of abortion to be adequately reported, 57% of reported legal induced abortions were recognized to have actually been obtained at 8 main of gestation, and 87% at Table 6). Overall, 23% of abortions were well-known to have been performed at 6 weeks of gestation, 18% in ~ 7 weeks, and also 17% at 8 weeks (Table 7). Couple of reported abortions emerged after 15 mainly of gestation; 4.3% to be at 16--20 weeks, and 1.4% to be at >21 weeks.For women whose type of procedure to be adequately reported, practically all (97%) abortions were recognized to have actually been performed by curettage and 0.4% by intrauterine instillation (Table 8). Hysterectomy and hysterotomy were included in the "other" procedure category and were well-known to have actually been supplied in fewer than 0.01% of every abortions. Thirty-one reporting areas submitted data stating the they performed clinical (nonsurgical) procedures,¶ hereafter referred to as medical abortions. Medical abortions make up approximately 1% that all procedures reported from the 42 areas with adequate reporting on kind of procedure. However, three locations included medical abortions in the "other" category since data for clinical abortions are not collected as a separate group on your abortion reporting form. Because that 2000, a full of 6,895 medical abortion measures were it is registered by the 28 reporting locations that reported clinical abortions separately. This reflects an increase of 10% from the 6,278 medical abortions report by 26 reporting locations for 1999 (6). We do not know to what extent the 6,895 clinical abortions report to for 2000 represent the use of this procedure in all reporting areas.In the 41 locations for which gyeongju was adequately reported, approximately 55% of females who acquired legal induced abortions were well-known to it is in white, 35% were black, and 7% to be of other races; because that 3% of the women, gyeongju was unknown. (Table 9). The abortion proportion for black ladies (503 every 1,000 live births) was 3.0 times the proportion for white women (167 every 1,000 live births). Additionally, the abortion proportion for ladies of various other races (329 every 1,000 live births) was 2.0 times the ratio for white women. The abortion rate for black females (30 every 1,000 women) to be 3.1 time the price for white women (10 every 1,000 women), whereas the abortion rate for ladies of other races (22 every 1,000 women) to be 2.2 time the price for white women. Twenty-nine states, the district of Columbia, and brand-new York City reported enough data** worrying the ethnicity of females who acquired legal induced abortions (Table 10). The percentage of abortions known to have actually been acquired by Hispanic females in this reporting locations was 17% overall and also ranged indigenous For women whose marital standing was adequately reported, 78% of women who acquired abortions were known to it is in unmarried (Table 11). The abortion ratio for unmarried ladies was 8.8 times the ratio for married females (570 versus 65 abortions every 1,000 live births).For ladies for who data on ahead live births was adequately reported, 39% of women who derived legal induced abortions were known to have had actually no previous live births, and also 86% had had 2 or fewer previous live births (Table 12). The abortion ratio was highest for women who had three vault live births (285 every 1,000 live births) and also lowest for ladies who had one vault live bear (194 per 1,000 live births).In 2000, of females who derived an abortion and whose variety of previous abortions was adequately reported, 53% to be reported come have derived an abortion because that the first time. Eighteen percent of females were reported to have had actually two or much more previous abortions (Table 13).For ladies whose age and also race were known, white women had a slightly greater percentage the abortions in the youngest (19 years) and oldest (>35 years) age groups compared with females of black or various other races (19% versus 17% and 12% matches 10%, respectively) (Table 14). For women whose marital status and also race to be both known, the percent of report abortions among black or other races that were acquired by unmarried females (84%) was greater than that derived by unmarried white ladies (79%). Among women obtaining abortions whose age and Hispanic ethnicity to be known and also reported adequately (29 report areas) the portion of abortions obtained by older females (>35 years) the non-Hispanic ethnicity (12%) was greater than the for older ladies of hispanic ethnicity (9%)(Table 15). For women whose marital status and ethnicity to be known and also reported adequately (27 report areas), the percent of reported abortions derived by unmarried females was somewhat higher for non-Hispanic contrasted to Hispanic females (82% matches 80%) (Table 15). Data were not obtainable to cross-classify race by spain ethnicity.As in the past, about 88% of all abortions (for i beg your pardon gestational age at the time of abortion was reported adequately) were obtained during the very first 12 main of gestation (Table 1). The portion of females who obtained an abortion at 8 mainly of gestation raised with age, v the exemption of females aged 35--39 years (Figure 4) (Table 16). This association is most pronounced because that abortions obtained at 6 weeks" gestation (Table 17). The portion of women who derived an abortion in ~ >21 mainly of gestation decreased with period for women through 25--29 year (Table 16). Among women with adequately reported race and weeks the gestation, white women and women of various other races were an ext likely than black women to acquire abortions in ~ 6 or 7 weeks of gestation (Table 17). Among women through adequately reported known ethnicity and weeks of gestation, 25% of hispanic women derived abortions in ~ 6 main of gestation and 59% obtained abortions in ~ 8 weeks" gestation. This is slightly an ext than the 57% the non-Hispanic women who obtained abortions in ~ 8 weeks" gestation (Table 17).For ladies whose kind of procedure and weeks of gestation to be adequately reported, about 99% of report abortions derived at 15 main of gestation to be performed by using curettage (primarily suction procedures) (Table 18). About 88% of the 6,229 reported medical abortions were performed at 8 weeks" gestation, representing 1.6% of all abortions that were performed at 8 weeks" gestation. In ~ >16 main of gestation, clinical abortions (n = 559) also made increase 1.6% of every abortions. Medical abortions comprised >16 weeks of gestation.From the nationwide Pregnancy Mortality surveillance System, established 22 maternal deaths for 1998 and also 17 maternal deaths because that 1999 the were believed to be potentially related to abortion. These maternal deaths were established either by part indication the abortion top top the death certificate or from info such together a news report associated with the death. Examination of these situations showed that 10 that the 22 deaths in 1998 and also four that the 17 deaths in 1999 were pertained to legal induced abortion and also none to illegal induced abortion (Table 19). Because that 1998, 11 deaths were as result of spontaneous abortion, and one death was found not to it is in abortion related. Because that 1999, 10 deaths were as result of spontaneous abortion, and three deaths were uncovered not to it is in abortion related. Number of deaths as result of legal induced abortion to be highest prior to the 1980s, through very few deaths emerging in 1999 (Table 19). Feasible abortion-related deaths that developed during 2000--2002 are at this time being investigated.DiscussionA complete of 857,475 legitimate induced abortions were reported because that 2000 in the United says from 47 states, the ar of Columbia, and new York City. This is a decrease of 0.5% indigenous the legitimate induced abortions reported for 1999 indigenous 48 reporting locations (6). A decrease of 1.3% in the number of abortions is seen once the same 48 reporting locations from 1999 are compared with those for 2000 (6). Before 1998, a substantial number of legal induced abortions were estimated to have been perform in California (e.g., >23% of the U.S. Complete in 1997) (8). Start in 1998, data to be no longer approximated for nonreporting states. The absence of data because that California for 2000 explains most the the 28% decrease from the annual variety of abortions reported in 1997 (8) and a section of the to decrease in the total ratio and also rate.Overall, abortion ratios and also abortion rates have decreased over time (Figure 1). The abortion ratio for 2000 (246 per 1,000 live births for the very same 48 reporting locations as 1999) was a 3.8% decrease from the ahead year. The abortion price (16 per 1,000 females aged 15--44 years for the very same 48 reporting locations as 1999) was likewise a decrease of 3.8% from the price reported in 1999 (Table 2). The overall declines in the abortion ratio and rate end time might reflect multiple factors, consisting of a to decrease in the number of unintended pregnancies (9); a change in the age circulation of women toward the older and also less fertile periods (7); decreased or minimal access come abortion services, including the passage of abortion laws that affect teens (e.g., parental consent or notice laws and also mandatory waiting periods) (10--14); and also changes in contraceptive practices, including an raised use the contraception, such together condoms, and, among young women, that long-acting hormonal contraceptive approaches that were introduced in the at an early stage 1990s (15--18).The abortion price reported right here for the United says was higher than recent rates reported for Canada and Western europe countries and also lower than rates reported for China, Cuba, many Eastern europe countries, and several of the newly Independent states of the previous Soviet Union (19,20).As in vault years, the abortion proportion in 2000 varied considerably by age. Return the abortion ratio was highest possible for teens in 2000, the ratio has gradually decreased for women aged number 3). Various other studies additionally have indicated a decrease in birth prices for women aged 15--19 years during 1991--2000 and a decrease in adolescent pregnancy rates 1991--1997 (7,21--26).The percentage circulation of abortions by well-known weeks the gestation has shifted slightly because the so late 1970s. Native 1992 (when thorough data on beforehand abortions were first available) v 2000, data have indicated steady increases in steps performed in ~ 6 weeks" gestation v decreases emerging in the percent of abortions performed at 8, 9--10, and also 11--12 weeks" gestation. The boost in the portion of abortions recognized to have been performed in ~ 6 weeks may be connected to rise in accessibility of beforehand abortion services due to the fact that 1992 and to boost in medical and also surgical steps that have the right to be performed early in gestation (27,28). Abortions performed early in pregnant are associated with lower risks of mortality and morbidity (29). The proportions that abortions performed later in pregnancy (>13 weeks) have actually varied very little since 1992. The gestational period at i beg your pardon an abortion is derived can be influenced by several factors in addition to those because that which security data are available (age the the woman, race, marital status). These extr factors include level of education, availability and availability of abortion services, timing of check of pregnancy, time of personal decision-making, time of prenatal diagnosis, level of fear of exploration of pregnancy, and also denial of the pregnancy (30--32).Since the mid-1990s, two clinical regimens --- methotrexate and also mifepristone, each supplied in conjunction v misoprostol --- have actually been tested in clinical trials and used by clinical practitioners to perform beforehand medical abortions (28,33). surveillance data suggest that >50% of every U.S. Abortions room performed at 8 weeks of gestation, which is the time of the regimen authorized for both mifepristone and also methotrexate (34). The medical steps reported most regularly for abortions performed early in gestation (7 weeks) space use of methotrexate with misoprostol and also mifepristone through misoprostol (35,36). Mifepristone for clinical abortion was approved by the Food and Drug management (FDA) for use and also distribution in the United says in September 2000. This approval might result in early medical abortions becoming an ext widespread (37,38). The FDA-approved protocol have the right to be initiated up to 49 work of gestation and also requires three office access time by the patient: management of oral mifepristone, management 48 hours later of oral misoprostol in the health care provider"s office, and a follow-up visit in roughly 14 days. Clinical research studies of alternative medical abortion regimens have been carry out in various countries and also are recurring (39--46).In 1997, the U.S. Traditional Report the Induced discontinuation of Pregnancy, released by the National center for health Statistics (NCHS) and also used by companies for abortion reporting to state health departments, was revised to include a group for "medical (nonsurgical)" actions (47). Medical abortion procedures have actually been had in this report due to the fact that then as a separate category. will proceed to monitor at an early stage medical procedures and also to report the variety of these steps (Table 8).The percentage of abortions well-known to be performed through curettage (which has dilatation and also evacuation ) boosted from 88% in 1973 come 98% in 2000 (Table 1), when the percent of abortions perform by intrauterine instillation decreased sharply, from 10% come 0.4%. The boost in use of D&E is likely as result of the reduced risk for complications linked with the procedure (48,49). The portion of abortions performed by D&E (curettage) in ~ >13 weeks" gestation enhanced from 31% in 1974 (the very first year for which these data were available) to 96% in 2000; the percent of abortions perform by intrauterine instillation in ~ >13 weeks" gestation decreased from 57% come 1.7% (Table 18)(50).The differential between the abortion proportion for black women and that for white women has increased from 2.0 in 1989 (the first year because that which black and also other races to be reported separately) come 3.0 in 2000 (51). In addition, the abortion price for black color women has actually been about 3 times as high as that for white women (range: 2.6--3.1) because 1991 (the very first year because that which rates by race were published) (52). These prices by race are substantially lower than rates formerly published by NCHS and suggest the the reporting areas for the 2000 report can not be totally representative that the U.S. Black color female populace of reproductive age. Census bureau estimates and birth certificate data suggest that the huge majority of Hispanic females report themselves as white (7). Therefore, data for some white females actually stand for Hispanic women.In 2000, 41 states, the district of Columbia and new York City reported hispanic ethnicity of females who derived abortions. Since of concerns concerning the completeness of such data (>15% unknown data) in certain states, in 2000, data from just 29 states, the district of Columbia, and new York City were used to recognize the number and percentage of abortions acquired by females of hispanic ethnicity. This geographic locations represent approximately 46% of all reproductive-age Hispanic ladies in the United states for 2000 and approximately 47% of U.S. Hispanic births (53). Thus, the number of Hispanic ladies who acquire abortions is underestimated, and also the number, ratio, and also rate of abortions for Hispanic females in this report are not generalizable to the in its entirety Hispanic populace in the joined States.The abortion ratio for Hispanic females (225 every 1,000 live births) was lower than the proportion for non-Hispanic females (233 every 1,000 live births). This differs from the findings because that abortions performed in 1999 and also reflects a go back to the previously observed pattern amongst Hispanic females of slightly lower or similar ratios come those for non-Hispanic women. Together in the past, the abortion rate per 1,000 Hispanic ladies (16) was higher than the rate per 1,000 non-Hispanic women (13). This finding is regular with another study (18) yet differs substantially from abortion prices by ethnicity that were published previously by NCHS (25). The differences are likely because of the method used to account for underreporting of abortions by adjusting tabulations to nationwide totals. This finding likewise suggests the the reporting areas for the 2000 report space not completely representative the the U.S. Hispanic female populace of reproductive age. Race-specific and ethnicity-specific distinctions in legitimate induced abortion ratios and also rates could reflect differences amongst groups in factors such together socioeconomic status, access to family members planning and also contraceptive services, contraceptive use, and incidence of unintended pregnancies.NCHS critical statistics reports suggest that fertility and live birth rates were substantially higher for Hispanic ladies as a whole than because that non-Hispanic women for all age groups in 2000 (7). However, because fertility and also live birth rates differ substantially amongst the spain subgroups (Mexican, Puerto Rican, Cuban, various other Hispanic), and these differ significantly from rates among the non-Hispanic subgroups (white, black, other), comparisons in between Hispanic and also non-Hispanic groups are of limited value (7). Currently available abortion surveillance data carry out not permit cross-classification of race by spain ethnicity. Efforts are under method to provide a cross-classification of race and also ethnicity in future reports come comply through OMB Directive 15, which specifies federal criter for the repertoire of data on race and ethnicity (54).Compared with 1972, the annual number of deaths linked with well-known legal induced abortion in the so late 1990s has reduced by approximately 70% (Table 19). In 1972, 24 women passed away from reasons known to be connected with legitimate abortions and also 39 passed away as a an outcome of known illegal abortions. In 1999, four died as a an outcome of legitimate induced abortion and none passed away as a an outcome of illegal induced abortion. Number of legal, induced abortion-related deaths because that 1998 and 1999, figured out for all 52 report areas, are comparable to those reported over the previous 18 years. However, nationwide case-fatality rates for 1998 and 1999 can not be calculated since a substantial variety of abortions occurred in 4 nonreporting states, and also the total number of abortions (the denominator) is unknown.Because these data room reported voluntarily, several limitations exist. First, abortion data are compiled and reported come by report area whereby the abortion to be performed quite than by wherein the woman resides. This inflates the numbers, ratios, and rates that abortions for locations where a high ratio of legal abortions are acquired by out-of-state residents and undercounts procedures for says with minimal abortion services or more stringent legal needs for obtaining one abortion (causing females to look for abortions elsewhere). Second, 4 states (Alaska, California, new Hampshire, and also Oklahoma) did no collect or report abortion data in 1998--1999 and three states (Alaska, California, and brand-new Hampshire) did no report in 2000. Data for California and also Oklahoma had actually been estimated before 1998; however, data because that nonreporting states have actually not been estimated because 1997. Third, data detailed to state or area health and wellness departments through providers can be incomplete (55). Fourth, the overall number, ratio, and also rate the abortions are conservative estimates due to the fact that the complete numbers of legit induced abortions listed by main health agencies and also reported to for 2000 to be probably lower than the numbers in reality performed. Additionally, abortion totals because that 2000 noted to by main health agencies are 20% reduced than the reported for 2000 because that the same reporting areas by The Alan Guttmacher Institute, a private organization that contact abortion providers straight (56). A previous report documented a discrepancy of around 12% (57); the reasons for this larger discrepancy room unclear. Fifth, no all states collected or report data for all attributes (e.g., age, race, and also weeks the gestation) of women obtaining a legitimate induced abortion in 2000. Thus, the numbers, rates, and ratios derived in this analysis might no be representative the all ladies who derived abortions.Despite this limitations, result from ongoing nationwide surveillance of legitimate induced abortion are useful for several purposes. First, public health agencies usage data indigenous abortion security to identify features of ladies who space at high threat for unintended pregnancy. Second, ongoing yearly surveillance is used to monitor fads in the number, ratio, and rate of abortions in the joined States. Third, statistics concerning the variety of pregnancies ending in abortion are provided in conjunction v birth data and fetal fatality computations to estimate pregnancy prices (e.g., pregnant rates amongst adolescents) (21--25). Fourth, abortion and also pregnancy rates can be provided to evaluate the effectiveness of household planning programs and also programs for avoiding unintended pregnancy. Fifth, continuous surveillance gives data because that assessing changes in clinical exercise patterns related to abortion (e.g., longitudinal changes in the types of procedures and trends in main of gestation at the time of abortion). Finally, numbers of abortions are offered as the denominator in calculating abortion mortality prices (29).The wellness Insurance Portability and also Accountability plot (HIPAA) that 1996 was legislated come facilitate the digital transfer of health data relating greatly to insurance coverage and also transferability (58). Congress included into HIPAA provisions the mandated fostering of federal privacy protections for specific individually identifiable health information, and also the U.S. Department of Health and also Human services issued the Privacy ascendancy with April 14, 2003, as the date for implementation. The Privacy rule states that protected health information for public health and wellness purposes is freed from the Privacy dominion and, thus, extended entities may provide protected health and wellness information, there is no individual authorizations, to a public health and wellness authority, such as, whose proclaimed purpose is to prevent and control disease. Repertoire of surveillance data because that this report is freed from the Privacy Rule. However, the complexity of the rule might result in difficulty in that interpretation and therefore in collecting monitoring data on the component of details contributing organ (58).Induced abortions usually an outcome from unintended pregnancies, which often occur despite the use of contraception (15,59,60). Research has actually indicated that roughly 49% of every pregnancies in 1994 to be unintended in ~ conception (61). Additionally, 31% the births in 1995 to be reported together unintended at conception; 21% were thought about mistimed and also 10% were taken into consideration unwanted (9,61). Unintended pregnancy is a problem not just for adolescents, unmarried women, or bad women; that is a pervasive public health problem for all females of reproductive period (9,15,52,61).A palliation in unintended pregnancy, and thus abortion, will call for several complicated strategies. In a research of abortion patients conducted during 2000--2001, 54% of patients reported the they were using contraception during the month they became pregnant. However, their use of contraception could have to be inconsistent or not correct (18). In 1995, as soon as the most recent NSFG to be conducted, approximately 29% of sexually energetic U.S. Women who offered only dental contraceptives because that birth regulate reported the they to let go a birth-control pill one or more times throughout the 3 months before their NSFG interview. In addition, approximately 33% of U.S. Women who were using just coitus-dependent contraceptive methods†† throughout the 3 months prior to the interview used these techniques inconsistently (9). No all wellness insurance plans administer contraceptive services (62). Therefore, education about abstinence, contraceptive use and practices too as accessibility to and education concerning safe, effective, and affordable contraception and also family-planning services might aid reduce the incidence the unintended pregnant and, therefore, the number of legal induced abortions in the United states (63--65).Copies the this and also other MMWR reports include statistical and also epidemiologic data around abortions have the right to be obtained through the website at authors say thanks to Elizabeth Fitch, division of Reproductive Health, NCCDPHP,, because that her work on graphics, and also Stephanie Ventura, department of an essential Statistics, NCHS,, because that her evaluation of this monitoring report.References Abortion surveillance, 1977. Atlanta: us Department of Health, Education, and also Welfare, Public wellness Service,, 1979:7. Abortion surveillance, 1978. Atlanta: united state Department of Health and Human Services, Public health and wellness Service,, 1980:7. Ingram DD, Parker JD, Schenker N, et al. United states Census 2000 populace with bridged race categories. Hyattsville, MD: us Department that Health and also Human Services,, National center for wellness Statistics, 2003. (Vital and also health statistics; series 2, no. 135). Spitz AM, Velebil P, Koonin LM, et al. Pregnancy, abortion, and also birth rates amongst US adolescents---1980, 1985, and also 1990. JAMA 1996;275:989--94. Abortion surveillance, 1972. Atlanta: united state Department the Health, Education, and also Welfare, Public health Service,, 1974:5. young name JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: final data for 2000. Hyattsville, MD: us Department the Health and also Human Services,, National center for health and wellness Statistics, 2002. (National vital statistics reports; vol.50 no. 5). Abma JC, Chandra A, Mosher WD, Peterson LS, Piccinino LJ. Fertility, family members planning, and also women"s health: new data from the 1995 nationwide Survey of household Growth. Hyattsville, MD: us Department that Health and Human Services,, 1997; DHHS publication no. (PHS)97-1995. (Vital and also health statistics; series 23, no. 19). Henshaw SK. Determinants hindering access to abortion services. Fam Plann Perspect 1995;27:54--9. Henshaw SK. Abortion incidence and also services in the united States, 1995--1996. Fam Plann Perspect 1998;30:263--70, 287. Ellertson C. Mandatory parental involvement in minors" abortions: impacts of the legislations in Minnesota, Missouri, and also Indiana. Am J Public wellness 1997;87:1367--74. Henshaw SK, Finer LB. The ease of access of abortion services in the unified States, 2001. Perspect Sex Reprod wellness 2003, 35:16--24. Piccinino LJ, Mosher WD. Trends in contraceptive use in the joined States: 1982--1995. Fam Plann Perspect 1998;30:4--10, 46. Abma JC, Sonenstein F. Sexual task and contraceptive practices among teens in the unified States, 1988 and 1995. Hyattsville, MD: us Department that Health and also Human Services,, National center for health and wellness Statistics. 2001; DHHS publishing No (PHS) 2001-2997. (Vital and also health statistics; collection 23, no. 21). Jones RK, Darroch JE, Henshaw SK. Contraceptive use among US women having actually abortion in 2000--2001. Perspect Sex Reprod health and wellness 2002;34:294--303. Henshaw SK, sink S, Haas T. The incidence that abortion worldwide. Int Fam Plann Perspect 1999;25(Suppl):S30--S37. Statistics Canada. Induced (therapeutic) abortions, 2000. The Daily. Ottawa: Minister that Industry, march 28, 2003. Ventura SJ, Mathews TJ, Hamilton BE. Teenage births in the unified States: State rends, 1991--2000, one update. Hyattsville, MD: us Department the Health and Human Services,, National facility for wellness Statistics, 2002. (National crucial statistics reports; vol. 50 no. 9). Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Fads in pregnancies and pregnancy rates by outcome: estimates for the joined States, 1976--1996. Hyattsville, MD: united state Department the Health and Human Services,, National center for wellness Statistics, 2000; DHHS publishing no. (PHS) 2000-1934. (Vital and also health statistics; collection 21, no. 56). Ventura SJ, Mathews TJ, Hamilton BE. Births to teens in the unified States, 1940--2000. Hyattsville, MD: room of Health and Human Services,, National center for health and wellness Statistics, 2001. (National critical statistics reports; vol. 49 no. 10.) Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Trends in pregnancy rates for the unified States, 1976--97: an update. Hyattsville, MD: department of Health and Human Services,, National center for wellness Statistics, 2001. (National an important statistics reports; vol. 49, no. 4). Ventura SJ, Curtin SC, Mathews TJ. Variations in teenage bear rates, 1991--98: national and state trends. Hyattsville, MD: us Department that Health and also Human Services,, National facility for health Statistics, 2000. (National an important statistics reports; vol. 48 no. 6). Edwards J, Carson SA. Brand-new technologies permit safe abortion at much less than six weeks" gestation and provide timely detection of ectopic gestation. To be J Obstet Gynecol 1997;176:1101--6. Creinin MD, Edwards J. Beforehand abortion: surgical and also medical options. Curr Probl Obstet Gynecol Fertil 1997;20:1--32. Lawson HW, Frye A, Atrash HK, blacksmith JC, Shulman HB, Ramick M. Abortion mortality, united States, 1972 v 1987. To be J Obstet Gynecol 1994;171:1365--72. Evans MI, Wapner RJ. Future directions. Clin Perinatol 2001;28:477--80. Fielding WL, Sachtleben MR, Friedman LM, Friedman EA. Comparison of females seeking early and also late abortion. To be J Obstet Gynecol 1978;131:304--10. Tietze C, Henshaw SK. Induced abortion: a world review, 1986. 6th ed. Brand-new York: Alan Guttmacher Institute, 1986:29--52. Kahn JG, Becker BJ, Macisaa L, et al. The efficacy of clinical abortion: a meta-analysis. Contraception 2000;61:29--40. Joffe C. Medical abortion in society context. To be J Obstet Gynecol 2000;183(Suppl):S10--S15. Pymar HC, Creinin MD. Choices to mifepristone regimens for medical abortion. To be J Obstet Gynecol 2000;183 (Suppl):S54--S64. Goldberg AB, Greenberg MB, Darney PD. Medicine therapy: misoprostol and pregnancy. N Engl J Med 2001;344:38--47. Joffe C. Reaction to medical abortion among providers of surgical abortion: an early snapshot. Fam Plann Perspect 1999:31:35--8. Koenig JD, Tapias MP, Hoff T, Stewart FH. Space US health professionals likely come prescribe mifepristone or methotrexate? J am Med Womens Assoc 2000:55(Suppl):155--60. human being Health organization Task pressure on Post-Ovulatory approaches of Fertility Regulation, comparison of 2 doses the mifepristone in mix with misoprostol for early medical abortion: a randomized trial, Br J Obstet Gynaecol 2000;107:524--530. McKinley C, Thong KJ, Baird DT. The effect of dose of mifepristone and gestation ~ above the efficacy of clinical abortion with mifepristone and also misoprostol. Hum Reprod 1993;8:1502--5. El-Refaey H, Rajasekar R, Abdalla M, Calder L, Templeton A. Induction that abortion through mifepristone (RU 486) and also oral or quality misoprostol. N Engl J Med 1995;332:983--7. Ashok PW, Templeton A. Nonsurgical mid-trimester discontinuation of pregnancy; a testimonial of 500 continuous cases. Br J Obstet Gynaecol 1999;106:706--10. Ashok PW, Penney GC, Flett GM, Templeton A. An efficient regimen for beforehand medical abortion: a report the 2,000 consecutive cases. Hum Reprod 1998;13:2962--5. Schaff EA, Fielding SL, Westhoff C, et al. Randomized attempt of vaginal misoprostol administered 1, 2, or 3 work after mifepristone for at an early stage medical abortion: a randomized trial. JAMA 2000;284:1948--1953. Elul B, Hajri S, Ngoc NTN, et al. Have the right to women in less-developed countries use a simplified medical abortion regimen? Lancet 2001;357:1402--5. Jones RK, Henshaw SK. Mifepristone for early medical abortion: experience in France, an excellent Britain and also Sweden. Perspect Sex Reprod health 2002;34:154--61. Handbook ~ above the reporting of induced discontinuation of pregnancy. Hyattsville, MD: us Department of Health and also Human Services,, National center for wellness Statistics, 1998; DHHS publishing no. (PHS)98-1117;1--18. Cates W Jr, Schulz KF, Grimes DA, et al. Dilatation and evacuation procedures and also second-trimester abortion: the role of medical professional skill and also hospital setting. JAMA 1982;248:559--63. Grimes DA. Second-trimester abortions in the unified States. Fam Plann Perspect 1984;16:260--6. Abortion surveillance, 1974. Atlanta: us Department of Health, Education, and Welfare, Public wellness Service,, 1976:1--49. Koonin LM, blacksmith JC, Ramick M, Lawson HW. Abortion surveillance---United States, 1989. In: security Summaries, September 4, 1992. MMWR 1992;41(No. SS-5):1--33. Revisions to the standards for the group of commonwealth data ~ above race and also ethnicity. Commonwealth Register. October 30, 1997;62:58782-58790. Henshaw SK, Feivelson DJ. Teenage abortion and also pregnancy statistics by state, 1996. Fam Plann Perspect 2000;32:272--80. Finer LB, Henshaw SK. Abortion incidence and also services in the United states in 2000. Perspect Sex Reprod wellness 2003;35:6--15. Torres A, Forrest JD. Why perform women have abortions? Fam Plann Perspect 1988;20:169--76. Henshaw SK. Unintended pregnancy in the unified States. Fam Plann Perspect 1998;30:24--9,46. yellow RB, Darroch JE, Frost JJ. Mainstreaming contraceptive services in regulated care---five states" experiences. Fam Plann Perspect 1998;30:204--11. Westoff CF. Contraceptive routes toward the reduction of unintentional pregnancy and also abortion. Fam Plann Perspect 1988;20:4--13. Forrest JD. Public health of unintended pregnancy and also contraceptive use. Am J Obstet Gynecol 1994;170(Suppl):1485--8. Gonen JS. Value purchasing: investing in women"s health. Washington DC: Jacobs institute of Women"s Health. 2000. * contains state wellness departments and also the health and wellness departments of new York City and also the district of Columbia.† Wyoming reported 6 abortions in 2000. However, due to the fact that of the inappropriateness of computer abortion rates and also ratios because that this small number, Wyoming was not included in these calculations.§ Ratios for females aged Table 4 and also Table 5 since a different number of areas are reporting; Table 4 contains 48 reporting areas, and also Table 5 contains 46. ¶ clinical (nonsurgical) abortion steps involve the management of a medication or medications to induce abortion. ** After exemption of 10 states for which ethnicity data to be unknown for >15% of ladies who acquired an abortion.†† Coitus-dependent contraceptive methods encompass male or woman condoms, diaphragm, sponge, cream, jelly, or other approaches that have to be supplied at the moment intercourse occurs.Table 1

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