May 26, 2011 — Summary of "Changes in Abortion Rates Between 2000 and 2008 and Lifetime Incidence of Abortion," Jones/Kavanaugh, Obstetrics & Gynecology, June 2011.
Slightly more than one in five U.S. pregnancies ends in abortion, one of the most common surgical procedures for women in the U.S. Abortion rates have declined overall and decreases in abortion have occurred in most subgroups of women with one notable exception: Poor women accounted for 42.4% of abortions in 2008, and their abortion rate increased 17.5% between 2000 and 2008. However, even groups for which abortion rates declined -- such as women in their 20s, women who live with their partners and African-American women are "overrepresented" among women seeking abortion care, according to Rachel Jones and Megan Kavanaugh of the Guttmacher Institute. Most abortions are the result of unintended pregnancies, and continued overrepresentation of certain subpopulations suggests that these groups have unmet needs for contraceptive and family planning services. Jones and Kavanaugh set out to determine the abortion rates between 2000 and 2008 and to update the lifetime incidence of abortion for women living in the U.S.
Materials and Methods
The study used data from the Guttmacher Institute's 2008 Abortion Patient Survey, the U.S. Census Bureau's Current Population Surveys from 2008 and 2009 and the 2006-2008 National Survey of Family Growth (NSFG). Guttmacher's most recent survey sampled 107 hospitals, clinics and physician offices where abortions were performed in 2005. The survey found that 12,866 abortions were performed between April 2008 and May 2009. The survey collected useable data -- including information about age, race, ethnicity, insurance coverage and method of payment -- from 9,493 women at 95 facilities.
The researchers used the Current Population Surveys and NSFG to collect characteristics on women ages 15 to 44. Specifically, the census data provided estimates for age, race, ethnicity, education, citizenship and income, while the NSFG collected data on pregnancy, childbearing and related issues from a national sample of 7,356 women living in the U.S. between July 2006 and July 2008.
Between 2000 and 2008, the national abortion rate for women ages 15 to 44 declined by 8%, from 21.3 to 19.6 abortions per 1,000 women. The study estimates that 1.96% of all women ages 15 to 44 had an abortion in 2008. Overall, women between ages 20 and 24 accounted for 404,920 abortions and had the highest rate of abortion at 39.9 abortions per 1,000 women. Women ages 18 and 19 had the second-highest rate of abortion, at 34.7, while women over age 40 had the lowest rate with 3.2 abortions per 1,000 women. Women between ages 15 and 17 had the most "pronounced" decline in abortion rate, which dropped by 22.4% from 14.6 to 11.3 abortions per 1,000 women.
Married women accounted for 14.8% of abortions, while 29.2% of abortions were attributed to women who lived with a male partner at the time of the abortion. Further, married women had the lowest abortion rate (6.6 abortions per 1,000 women), while cohabitating women had the highest rate (52 abortions per 1,000 women).
The study noted that 36% of abortions were obtained by white women, the most common racial and ethnic group among abortion patients. However, minorities were overrepresented and in turn, had higher abortion rates, according to the study. Although African-American women saw the largest decline in abortion rates -- 18.4% -- during the study period, they had the highest rate at 40.2 abortions per 1,000 women, followed by Hispanic women who had a rate of 28.7. Most women who had abortions were born in the U.S. They had an abortion rate of 19.7, while foreign-born women had a comparable rate of 18.8. Foreign-born Hispanic women represented 7.9% of all abortions among foreign-born women, but their abortion rate (18.2) was lower than the rate of all Hispanic women.
Nearly one in five abortion patients older than 20 had a college degree in 2008, and 39.5% of women who had an abortion had some college experience or earned an associate's degree. Among women ages 20 and older, college graduates had a substantially lower rate of abortion than all other groups. Women with some college or an associate's degree had the highest rate of abortion, followed by those who had not graduated high school and women who had graduated high school.
The majority of women seeking abortion in 2008 previously had given birth. The study also found that the majority of women having abortions in 2008 had some religious affiliation.
Poor women -- defined as women with family incomes lower than 100% of the federal poverty level -- accounted for 42.4% of abortions, or 514,040 procedures, the highest rate of all subgroups examined at 52.2 abortions per 1,000 women. The researchers noted that "as income levels increased, the abortion rate decreased," particularly among women with family incomes at or above 200% of the federal poverty level. This subgroup had a rate of 9.3 abortions, while the abortion rate increased overall by 17.5% for poor women over the eight-year study period. Poor white women accounted for 11.7% of abortions, 14.1% of abortions were among poor African-American women, and 13% of abortions were among poor Hispanic women. The authors wrote that abortion rates decreased for all groups between 2000 and 2008, except among poor, white and poor, African-American women.
"The economic recession that was occurring in 2008 may have made it harder for poor women to access contraceptive services, resulting in more unintended pregnancies" and possibly affecting the increased abortion rate among poor women, Jones and Kavanaugh wrote, adding that "poor women who might have felt equipped to support a child, or another child, when not in the midst of a recession may have decided that they were unable to do so during a time of economic turmoil."
Because most poor women obtaining abortion services often lack health insurance and pay for the procedure out-of-pocket, the increase in abortion among poor women suggests "that at least some are still able to access these services despite potential barriers," the authors explained. "Nonetheless, that abortion is increasingly concentrated among poor women means that this population is most affected when legal restrictions around abortion are implemented." In addition, because abortion rates are "highest for poor women within each racial and ethnic group," the pattern suggests "that poverty alone does not explain the highest abortion rates among minority women. There is tentative evidence to suggest that "the factors affecting the abortion rate for poor women were most pronounced for those who were white," the researchers wrote.
In addition, adolescents accounted for fewer than one in five abortions, and most abortions were concentrated among teens ages 18 to 19. However, the researchers noted that the abortion rates among teens between 15 and 17 in 2006 and 2008 were "nearly identical," despite a decrease in teen pregnancy rates.
Meanwhile, the "proportion of women expected to have an abortion by age 45 declined substantially, from 43% in 1992 to 30% in 2008," a pattern that "parallels the substantial decline in abortion rates during that time period," Jones and Kavanaugh said. Because "almost one-third of women are anticipated to have an abortion by age 45 suggests that it is not an uncommon procedure" and that it is "likely that a substantial partition of patients seen by many obstetricians and gynecologists will have had an abortion or will have one in the future," they write.
"Groups with higher-than-average abortion rates -- including women in their 20s, and cohabitating, minority, and poor women -- also have higher rates of contraceptive failure and higher rates of unintended birth," Jones and Kavanaugh write, adding, "Collectively, these patterns suggest that much more could be done to minimize the need for abortion by reducing unintended pregnancy." Suggestions include urging clinicians to devote extra time in discussing family planning goals and pregnancy prevention strategies with women in groups with high abortion rates.
The study concluded, "Despite its frequency, abortion remains stigmatized in both public discourse and in health care. Greater sensitivity to and awareness of this experience could help reduce stigma among both patients and health care professionals. Awareness among clinicians of the frequency of abortion, as well as the characteristics associated with abortion, should help to normalize abortion within the medical community."