1. An Overview of Abortion in the United States
A Note About the Guttmacher Institute:
The Guttmacher Institute is a nonprofit organization that works to advance sexual and reproductive health worldwide through research, policy analysis and public education. The Institute has offices in New York and Washington, DC. For more information on the Guttmacher Institute, visit < or call
A Note About the Data:
The data presented in this slide series are the most recent available as of January Percentages might not add to 100 because of rounding.
Guttmacher Institute
© January 2014

2. Objectives
Provide an overview of unintended pregnancy and abortion in the United States.
Review the incidence of pregnancy and abortion.
Discuss provision of and access to abortion services.
Review the safety of abortion.
Identify who has abortions, why and when in pregnancy.
Provide a comparative international perspective on abortion.
Acknowledgments:
This presentation is periodically updated to reflect the most current data available. This version was updated by Rebecca Wind, Rachel Jones, Jenna Jerman and Elizabeth Nash.

3. Incidence of Unintended Pregnancy and Abortion
Incidence of Pregnancy and Abortion in the United States:
The typical American couple wants to have two children. To achieve this goal, a woman will spend roughly five years trying to become pregnant, pregnant or postpartum—and 30 years trying to avoid pregnancy.
Women, then, are highly motivated to use contraceptives, and virtually all women do. Ninety-nine percent of women who have ever had sex have used some method of contraception. But 30 years is a long time to use contraceptives flawlessly. Contraceptives can fail, and mistakes can happen.

4. Pregnancies in the United States (Approximately 6.6 Million in 2008)
% of pregnancies
Source: Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, doi: /AJPH
Unintended Pregnancy and Contraception:
More than half of all U.S. pregnancies are unintended.
The two-thirds of U.S. women at risk of unintended pregnancy who use contraceptives consistently and correctly throughout the course of any given year account for only 5% of all unintended pregnancies.
The 19% of women at risk who use contraceptives but do so inconsistently account for 44% of unintended pregnancies, while the 16% of women at risk who do not use contraceptives at all account for 52%.
Unintended pregnancy rates are highest among poor and low-income women, women aged 18–24, cohabiting women and minority women. 
Intended
Unintended

5. Outcomes of Unintended Pregnancies (Approximately 3.4 Million in 2008)
% of unintended pregnancies (excluding miscarriages)
Source: Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, doi: /AJPH
Unintended Pregnancy Statistics:
A woman who has an unintended pregnancy is more likely to carry it to term than to have an abortion.
Four in 10 unintended pregnancies end in abortion.
Of the approximately 6.6 million pregnancies in the United States in 2008, 3.4 million were unintended. Approximately 1.7 million unintended pregnancies resulted in births, 1.2 million in abortions and 549,000 in miscarriages.

6. Incidence of Abortion
In 2011, some 1.06 million pregnancies were terminated by abortion in the United States.
The abortion rate in 2011 was 16.9 abortions per 1,000 women aged 15–44.
Put differently, 1.7% of all women aged 15–44 had an abortion in 2011.
Source: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.

7. In 2011, U.S. Abortion Rates Reached Their Lowest Level Since 1973
Abortions per 1,000 women
Source: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.
Declining Abortion Rates:
The abortion rate has declined almost every year since 1980—most rapidly from 1990 to 1996—leveled off between 2005 and 2008, and continued to decline between 2008 and 2011.
Declines in teen abortion rates account for much of the decline in overall U.S. abortion rates, as they have declined at a higher rate than those of adult women.
The declining pregnancy rate among teenagers is the result primarily of better contraceptive use, especially use of injectables and implants, and secondarily of lower rates of sexual activity, leading to declining rates of abortion among this group. (Santelli JS, Morrow B, Anderson J and Lindberg LD, Contraceptive use and pregnancy risk among U.S. high school students, 1991–2003, Perspectives on Sexual and Reproductive Health, 2006, 38(2):106–111.)

8. Abortion Service Providers

9. The Number of Abortion Providers Has Declined Substantially, Mainly Due to Fewer Hospitals Providing Abortion
No. of providers
Sources: 1973–1979, 1981, 1984, 1987, 1991, 1995, 1999: Special tabulations of The Alan Guttmacher Institute’s Abortion Provider Surveys. 1980: Henshaw SK et al., Abortion services in the United States, 1979 and 1980, Family Planning Perspectives, 1982, 14(1):5–15, Table : Henshaw SK, Forrest JD and Blaine E, Abortion services in the United States, 1981 and 1982, Family Planning Perspectives, 1984, 16(3):119–127, Table : Henshaw SK et al., Abortion services in the United States, 1985, Family Planning Perspectives, 1987, 19(2):63–70, Table : Henshaw SK and Van Vort J, Abortion services in the United States, 1987 and 1988, Family Planning Perspectives, 1990, 22(3):102–108 & 142, Table : Henshaw SK and Van Vort J, Abortion services in the United States, 1991 and 1992, Family Planning Perspectives, 1994, 26(3):100–106 & 112, Table : Henshaw SK, Abortion services in the United States, 1995–1996, Family Planning Perspectives, 1998, 30(6):263–267 & 287, Table : Finer LB and Henshaw SK, Abortion incidence and services in the United States in 2000, Perspectives on Sexual and Reproductive Health, 2003, 35(1):6–15, Table –2005: Jones RK et al., Abortion in the United States: incidence and access to services, 2005, Perspectives on Sexual and Reproductive Health, 2008, 40(1):6– –2008: Jones RK and Kooistra K, Abortion incidence and services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41– –2011: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.
Change in Number of Providers:
In 2011, the United States had 1,720 abortion providers.
The number of abortion clinics has declined slightly in recent years, but the number of other clinics (typically family planning facilities) has increased.

10. The Overwhelming Majority of Abortions Are Performed in Clinics
Source: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.
Facilities Providing Abortions:
In 2011, abortion clinics—defined as facilities where half or more of patient visits are for abortion services—provided 63% of all abortions. Other clinics, many of which focus on family planning services, provided most of the rest (31%). Hospitals performed 4% and physicians’ offices 1%.
The proportion of abortions performed in hospitals has declined markedly, from 22% in 1980 to only 4% in 2011.
At least 300 doctors are known to provide abortions in their offices, but most perform 100 or fewer procedures per year and many perform fewer than one abortion per week. Together, they account for only 1% of all abortions. Nevertheless, these providers are important to their patients in that they make abortion services available.

11. Facilities Providing Only Medication Abortion Had a Significant Impact
A minimum of 193 nonhospital providers, or 17%, offered only early medication abortion in 2011; most were nonspecialized clinics or physicians’ offices with small abortion caseloads.
The provision of medication abortion, particularly by providers who do not offer surgical abortion, is likely responsible for the stabilization in the number of abortion providers that has occurred since 2000.
Source: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.

12. Percentage of Providers of 400 or More Abortions per Year Who Reported Harassment in 2008
Picketing %
Picketing with physical
contact with patients %
Vandalism %
Picketing homes of staff members 7%
Bomb threats %
Patient pictures posted on the Internet 5%
Source: Jones RK and Kooistra K, Abortion incidence and access to services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41–50.
Antiabortion Violence and Harassment:
The majority of abortion clinics experience picketing, and many experience some other form of harassment or violence (Jones RK and Kooistra K, Abortion incidence and access to services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41–50.).
More than 6,100 acts of violence have been reported against abortion providers since 1977, including bombings, arson, death threats, murders, kidnappings and assaults, as well as more than 156,000 acts of disruption, including bomb threats and harassing calls (National Abortion Federation (NAF), NAF violence and disruption statistics: incidents of violence & disruption against abortion providers in the U.S. & Canada, 2009, < accessed Jan. 10, 2011.).
Small providers are much less likely than large ones to experience harassment. In 2008, 89% of nonhospital providers of 400 or more abortions reported experiencing picketing or other harassment, compared with only 35% of those that performed 30–399 abortions (Jones RK and Kooistra K, Abortion incidence and access to services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41–50.).
Many abortion patients experience emotional upset and postabortion depression if they encounter aggressive antiabortion protesters (Major B et al., Report of the APA Task Force on Mental Health and Abortion, Washington, DC: American Psychological Association, 2008, < >, accessed Oct. 4, 2010.).

13. Gestational Age

14. Abortions Overwhelmingly Occur Early in Pregnancy
% of abortions
Source: Guttmacher Institute, Special tabulations of data from the Centers for Disease Control and Prevention, Abortion surveillance—United States, 2010, Morbidity and Mortality Weekly Report, 2013, Vol. 66, No. SS-08.
Weeks of Gestation at Time of Abortion:
One-third of abortions occur at six weeks or earlier; 89% occur in first trimester of pregnancy (the first 12 weeks after the first day of the woman’s last menstrual period).
Sixty-three percent of abortions occur at or before eight weeks’ gestation—up from just 20% in 1970.
Just 1% of abortions are performed after 20 weeks.
Weeks

15. Incidence of Early Medication Abortion, 2011
Early medication abortion accounted for 23% (239,400) of all nonhospital abortions, an increase from 17% in 2008.
An estimated 36% of eligible abortions (those performed up to nine weeks) were early medication abortions.
Fifty-nine percent of all known providers offer this service, compared with 33% in early 2001.*
*Mifepristone was approved by the U.S. Food and Drug Administration for use in early medication abortion in September 2000.
Source: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.
Early Medication Abortion:
Recently developed technologies—including RU-486, or mifepristone, for early medication abortion—have made it possible for women to have an abortion earlier in pregnancy than ever before. Abortions can now occur within days of a missed period.

16. Early medication abortion as a percentage of all abortions
Number of abortions, in millions
Source: Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.

17. Safety of Abortion

18. Long-Term Safety of Abortion
First-trimester abortions pose virtually no risk of
Infertility
Ectopic pregnancy
Miscarriage
Birth defect
Preterm delivery or low birth weight
Abortion is not associated with breast cancer.
Abortion does not pose a hazard to women’s mental health.
Source: Boonstra H et al., Abortion in Women’s Lives, New York: Guttmacher Institute, 2006.
Long-Term Safety:
The preponderance of evidence from well-designed and well-executed studies indicates that first-trimester abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses.
Vacuum aspiration, the modern method most commonly used during first-trimester abortions, poses virtually no long-term risks of fertility-related problems.
Exhaustive reviews by panels convened by the U.S. and British governments have consistently found no association between abortion and breast cancer. The available evidence also indicates that abortion is not a risk factor for other types of cancer and may even protect against certain kinds of cancers.
The decision to terminate a pregnancy is often complex and sometimes difficult. However, well-designed studies continue to find that, among women who have an unplanned pregnancy, those who have a single abortion are at no greater risk of mental health problems than if they have a baby.

19. Abortion Is Safer the Earlier in Pregnancy It Is Performed
Deaths per 100,000 abortions
Sources: Grimes DA et al., Unsafe abortion: the preventable pandemic, Lancet, 2006, 368(9550):1908–1919; and Bartlett LA et al., Risk factors for legal induced abortion-related mortality in the United States, Obstetrics & Gynecology, 2004, 103(4):729–737.
Safety of Abortion:
Abortion is one of the safest surgical procedures for women. The risk of death associated with abortion is low—approximately 0.6 deaths per 100,000 abortions—and the risk of major complications is less than 1%.
The risk of death when a pregnancy is continued to birth is about 12 times as great as the risk of death associated with induced abortion. (Note: The calculation of mortality associated with childbirth omits deaths related to miscarriage and ectopic pregnancy.)
On average, eight women each year die from complications of induced abortion, compared with about 280 who die from complications of pregnancy and childbirth, excluding miscarriage and ectopic pregnancy.
Abortion is safer the earlier in pregnancy it is performed.
Gestation at abortion

20. Deaths Associated with Abortion Declined Dramatically After Legalization
*By the end of 1970, four states had repealed their antiabortion laws, and 11 states had reformed them.
1965–1967: National Center for Health Statistics (NCHS), Vital Statistics of the United States, 1965: Vol. II—Mortality, Part A, Washington, DC: U.S. Government Printing Office (GPO), 1967; NCHS, Vital Statistics of the United States, 1966: Vol. II—Mortality, Part A, Washington, DC: GPO, 1968; and NCHS, Vital Statistics of the United States, 1967: Vol. II – Mortality, Part A, Washington, DC, GPO: To distribute deaths categorized as “spontaneous or unspecified,” it was assumed that the ratio of deaths associated with spontaneous abortion to those associated with pregnancy and childbearing (excluding miscarriage and ectopic pregnancy) was the same as the ratios during 1968–1972 and 1965–1967, and that the remaining “unspecified deaths” were associated with induced abortion. 1968–1971:Tietze C et al., The effect of legalization of abortion on population growth and public health, in: The Alan Guttmacher Institute (AGI), Abortion 1974–1975: Need and Services in the United States, Each State and Metropolitan Area, New York: AGI, 1976, pp. 110– –2009: Pazol K et al., Abortion Surveillance—United States, 2010, United States, 2013, Morbidity and Mortality Weekly Report, 2013, Vol. 62, No. SS-8.
Source Presentation: Trends in Abortion in the United States, 1973–2008

21. Causes of Abortion-Related Deaths
% of deaths
Source: Bartlett LA et al., Risk factors for legal induced abortion-related mortality in the United States, Obstetrics & Gynecology, 2004, 103(4):729–737.
Causes of Abortion-Related Deaths:
The most common causes of abortion-related death are infection and hemorrhage.

22. Who Has Abortions

23. Unintended Pregnancy Rates Have Risen Among Poor Women Even As They Have Fallen Among Higher Income Women
Source:  Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008,American Journal of Public Health, 2014, doi: /AJPH
Growing Disparities:
The rate of unintended pregnancy among poor women (those with incomes at or below the federal poverty level) in 2008 was 137 per 1,000 women aged 15–44, more than five times the rate among women at the highest income level (26 per 1,000).
• Poor women’s high rate of unintended pregnancy results in their also having high rates of both abortions (52 per 1,000) and unplanned births (70 per 1,000). In 2008, poor women had an unintended birth rate nearly six times as high as that of higher-income women (at or above 200% of poverty.)

24. Poor Women Account for a Disproportionate Share of Unintended Pregnancies
Sources: Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2013, <
pubs/win/contraceptive-needs-2010.pdf>; and Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, doi: /AJPH
Disparities:
The 17% of women at risk of unintended pregnancy who are poor account for 40% of unintended pregnancies.
Women at risk of unintended pregnancy
Unintended pregnancies by women’s poverty status

25. Poor Women Are Also Overrepresented Among Abortion Patients
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Abortions by Family Income:
The need for abortion spans the economic spectrum; however, low-income women are overrepresented among abortion patients. Some 69% of women having abortions in 2008 were poor or low-income (living at less than twice the poverty level, or less than $35,200 for a family of three), compared with 35% of women in the general population. Nearly one-fifth of abortion patients were above 300% of the federal poverty level.
Low-income women are less likely than high-income women to end an unintended pregnancy by abortion; however, because low-income women have high rates of unintended pregnancy, they have higher abortion rates than high-income women.

26. Black Women Account for a Disproportionate Share of Unintended Pregnancies
Sources: Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2013, <
pubs/win/contraceptive-needs-2010.pdf>; and Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, doi: /AJPH
Disparities by Race:
The 14% of women at risk of unintended pregnancy who are black account for 24% of unintended pregnancies.
Women at risk of unintended pregnancy
Unintended pregnancies by women’s racial status

27. Hispanic Women Also Account for a Disproportionate Share of Unintended Pregnancies
Sources: Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2013, <
pubs/win/contraceptive-needs-2010.pdf>; and Lawrence B. Finer and Mia R. Zolna.  Shifts in Intended and Unintended Pregnancies in the United States, 2001–2008. American Journal of Public Health: February 2014, Vol. 104, No. S1, pp. S43-S48. doi: /AJPH
Disparities by Ethnicity:
The 19% of women at risk of unintended pregnancy who are Hispanic account for 26% of unintended pregnancies.
Women at risk of unintended pregnancy
Unintended pregnancies by women’s ethnic status

28. And Both Groups Are Overrepresented Among Abortion Patients
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Abortions by Race/Ethnicity:
The largest group having abortions (accounting for 36% of procedures) are non-Hispanic white women.
Black and Hispanic women together make up more than half (55%) of women having abortions. This proportion is greater than their proportion in the population because they have a higher rate of unintended pregnancy; additionally, black women are more likely than other groups of women to resolve an unintended pregnancy through abortion.
About 9% of women having abortions are Asian, Pacific Islander or Native American.

29. Women in Their 20s Make Up the Majority of Abortion Patients
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Abortions by Age:
The majority (58%) of women having abortions are in their 20s.
Fewer than 1% are younger than 15, while 17% are aged 15–19.
More than four-fifths of pregnancies among teenagers are unintended, and teenagers account for more than one in five unintended pregnancies nationwide.
Abortion numbers and rates decline with age because fecundity declines, use of contraceptive sterilization increases and women’s likelihood of being married grows. Marriage makes it easier to use contraceptives effectively and to continue an unintended pregnancy if it occurs. For teens, abortion rates and numbers decline because of an increasing number of teens delaying first sex, improvements in teens’ contraceptive use and a relatively high likelihood of teens continuing unwanted pregnancies.

30. Nearly Half of Abortions Are Obtained by Never-Married Women
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Abortions by Marital Status:
Two-thirds of abortions are obtained by never-married women. Married women account for a low proportion of abortions (15%), in part because they have a low rate of unintended pregnancy; those who experience an unintended pregnancy are more likely than unmarried women to continue the pregnancy.
Twenty-nine percent of abortions occur among women living with a male partner to whom they are not married. This is a group at very high risk of unintended pregnancy and abortion.
The proportion of unintended pregnancies terminated by abortion ranges from 67% among formerly married women and 57% among never-married women to 27% among currently married women (Finer LB and Henshaw SK, Disparities in rates of unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.).

31. Most Women Obtaining Abortions Report a Religious Affiliation
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Abortions by Religious Identification:
When U.S. women having abortions are asked their religion, 37% say they are Protestant. By contrast, 50% of women aged 18–44 in the U.S. population identify themselves as Protestant. The difference suggests that Protestant women’s abortion rate is lower than that of all women.
The proportion of abortion patients who are Catholic is virtually identical to the proportion of all women who are Catholic. Thus, the abortion rate per 1,000 Catholic women aged 18–44 is comparable with that of all women.
One in five abortion patients say they are “born-again” or “evangelical” Christians.
Twenty-eight percent of abortion patients claim no religious identification, compared with only 16% of the population.

32. Six in 10 Women Having Abortions Are Already Mothers
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Abortions by Women’s Prior Pregnancies:
Six in 10 women having abortions are mothers.
If a sexually active woman were to use abortion as her means of birth control and wanted two children, she would have about 30 abortions by the time she reached age 45.

33. Reasons for Abortions

34. Most Important Reasons Given for Terminating an Unwanted Pregnancy
Concern for/responsibility to other individuals 74%
Cannot afford a baby now %
A baby would interfere with school/
employment/ability to care for dependents 69%
Would be a single parent/
having relationship problems %
Has completed childbearing %
Source: Finer LB et al., Reasons U.S. women have abortions: quantitative and qualitative perspectives, Perspectives on Sexual and Reproductive Health, 2005, 37(3):110–118.
Reasons for Terminating an Unwanted Pregnancy:
Most women who decide to have an abortion understand the responsibilities of parenthood; a majority already have children.
In a national survey of 1,209 women having abortions in 2004, some of the most common reasons women gave for terminating an unwanted pregnancy were inability to care for or afford a child and concern for the kind of life they could provide for a child (or another child).
Eighty-nine percent of women gave more than one reason. The average number of reasons given was four.
Each year, about 10,000–15,000 abortions occur among women whose pregnancies resulted from rape or incest.

35. Reasons for Abortions After 16 Weeks Since Last Menstrual Period
Did not recognize the pregnancy 71%
Had difficulty making arrangements for abortion 48%
Was afraid to tell parents or partner 33%
Needed time to make decision %
Hoped relationship would change %
Was pressured not to have abortion %
Something changed during pregnancy 6%
Did not know timing was important %
Did not know abortion was an option %
Fetal abnormality was diagnosed late %
Other %
Source: Torres A and Forrest JD, Why do women have abortions? Family Planning Perspectives, 1988, 20(4):169–176.
Reasons for Later Abortions:
Eleven percent of women who obtain an abortion do so after the first trimester.
Some women obtaining abortions report delays in recognizing their pregnancies. Many women do not feel the physical changes, hope that they are not pregnant or fail to recognize the pregnancy because of irregular periods.
Nearly half (48%) of women surveyed in 1987 who had late abortions attributed the delay to difficulty in making arrangements for the procedure—they needed time to raise money, they had to arrange transportation, there was no local abortion provider, they were minors subject to state laws requiring parental involvement or they had difficulty securing child care.

36. Barriers to Abortion Access
Although most women who decide to have an abortion are able to obtain one fairly quickly and early in pregnancy, some women have to overcome substantial obstacles before they are able to get the procedure.

37. Many U.S. Counties Lack an Abortion Provider; About 1/3 of Women Live in Those Counties
Source: Jones RK and Kooistra K, Abortion incidence and access to services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1):41–50; Special tabulations of data from Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, doi: /46e0414.
Distance from an Abortion Provider:
Eighty-seven percent of U.S. counties had no abortion provider in As a result, many women must travel substantial distances to access the service.
In 2008, American women traveled an average of 30 miles to access abortion services. Sixty-seven percent of abortion patients traveled less than 25 miles, 16% traveled 25–49 miles, 11% traveled 50–100 miles and 6% traveled more than 100 miles, a significant distance and a documented barrier to timely care (Jones RK and Jerman J, How far did U.S. women travel for abortion services in 2008?  Journal of Women's Health, 2013, 22(8):706–713.)
The proportion of women in counties without a facility that provides even one abortion a year has increased, reaching 34% in 2011.
The proportion of women in unserved counties would be higher if not for the efforts of nonprofit organizations to establish and maintain clinics in areas without other providers.

38. Most Abortion Patients Have Health Coverage…
Source: Jones RK, Upadhyay UD and Weitz TA, At what cost?: Payment for abortion care by U.S. women, Women's Health Issues, 2013, 23(3):e173–e178; Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.
Insurance Coverage of Abortion:
In 2008, the average cost of a first-trimester abortion was $470.
Lower-income women are more likely to be uninsured than higher-income women.
Federal Medicaid funds only cover abortion in cases of rape, incest and life endangerment, and only 17 states have policies to use their own funds to cover abortions for women on Medicaid.
Most women who have abortions have health insurance, but most still pay out-of-pocket for abortion services. The most common reason women reported not using their insurance was that they believed their plan didn't cover it (46%)—either because they were told abortion was not covered or more often assumed it was not. About one in 10 women indicated that they did not want to use their insurance, presumably because of stigma or concerns about confidentiality.

39. …But Most Pay Out of Pocket for Abortion
Source: Jones RK, Finer LB and Singh S, Characteristics of U.S. Abortion Patients, 2008, New York: Guttmacher Institute, 2010.

40. More Abortion Restrictions Were Enacted in 2011–2013 Than in the Entire Previous Decade
205
189
Source: Nash E et al., Laws affecting reproductive health and rights: 2013 state policy review, 2014, < accessed Jan. 21, 2014.
State Abortion Restrictions:
More abortion restrictions were enacted between 2011 and 2013 than in the entire previous decade (2001–2010).

41. In 2000, 13 States Were Considered Hostile to Abortion Rights
Source: Nash E et al., Laws affecting reproductive health and rights: 2013 state policy review, 2014, < accessed Jan. 21, 2014.
Supportive
Middle-ground
Hostile

42. In 2013, 27 States Were Considered Hostile to Abortion Rights
Source: Nash E et al., Laws affecting reproductive health and rights: 2013 state policy review, 2014, < accessed Jan. 21, 2014.
Supportive
Middle-ground
Hostile

43. International Perspective on Abortion

44. The Global Decline in the Abortion Rate Has Stalled
Abortions per 1,000 women aged 15––44
Source: Sedgh G et al., Induced abortion worldwide in 2008: levels and trends, Lancet, 2012, 379(9816):625 –632.
Global Abortion:
After declining substantially between 1995 and 2003, the global abortion rate stalled between 2003 and Between 1995 and 2003 , the abortion rate for the world overall dropped from 35 to 29. It remained virtually unchanged at 28 in 2008.
This plateau coincides with a slowdown in contraceptive uptake, which has been especially marked in developing countries. In Africa, the annual increase in modern contraceptive use fell from 0.8 percentage points in 1990–1999 to 0.2 percentage points in 2000–2009. 44

45. Highly Restrictive Abortion Laws Are Not Associated with Lower Abortion Rates
The abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 in Latin America, regions where abortion is illegal under most circumstances.
The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds.
Source: Sedgh G et al., Induced abortion worldwide in 2008: levels and trends, Lancet, 2012, 379(9816):625 –632.
Levels of abortion are much less directly tied to the legal status of abortion than to the incidence of unintended pregnancy.
Some of the world’s lowest abortion rates are in countries with the most liberal abortion laws. In the Netherlands, abortion is legal, free and widely available; however, the abortion rate is less than half of the U.S. rate. Dutch women, like American women, want small families, marry late and experience high rates of premarital sexual activity. However, in contrast to the United States, the Netherlands has a low incidence of unintended pregnancy, because of comprehensive sex education programs, easy access to contraceptives (including through a national health insurance program), effective contraceptive use and the high value society places on contraceptive use.
At the other end of the spectrum, abortion rates are often highest in many of the countries where the procedure is most severely restricted.

46. An Increasing Proportion of Abortions Are Unsafe
% of abortions that are unsafe
Source: Sedgh G et al., Induced abortion worldwide in 2008: levels and trends, Lancet, 2012, 379(9816):625 –632.
Abortion Safety:
Between 1995 and 2008, the proportion of all abortions that were unsafe increased from 44% to 49%.

47. 21.6 Million Unsafe Abortions Occur Each Year
Source: Sedgh G et al., Legal abortion worldwide: incidence and recent trends, International Family Planning Perspectives, 2007, 33(3):106–116.
Abortion in Developed and Developing Countries:
Abortion happens at about the same rate in regions of the world where it is highly restricted and where it is broadly legal. Overall abortion levels are strikingly similar among women living in developed and developing regions (39 per 1,000 and 34 per 1,000, respectively).
The key difference is safety. Women in developing countries with restrictive abortion laws often go to untrained providers.

48. Virtually All Abortions in Africa and Latin America Are Unsafe
% of abortions
Source: Sedgh G et al., Induced abortion worldwide in 2008: levels and trends, Lancet, 2012, 379(9816):625 –632.
Unsafe Abortion:
Virtually all unsafe abortions in Europe occur in Eastern Europe, where the abortion rate that is nearly four times that of Western Europe.
This discrepancy corresponds with Eastern Europe’s relatively low levels of modern contraceptive use and low prevalence of highly effective methods such as the pill and the IUD. After a striking decline in the abortion rate between 1995 and 2003, from 90 to 44 per 1,000 women, Eastern Europe experienced virtually no change in the rate between 2003 and 2008.

49. Consequences of Unsafe Abortion
Complications from unsafe abortion procedures account for 13% of all maternal deaths, or 47,000 per year.
8.5 million women experience complications that require medical attention each year; 3 million do not receive care.
Virtually all of these deaths and injuries occur in the developing world.
Sources: Unsafe Abortion: World Health Organization (WHO), Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011.; Sedgh G et al., Induced abortion worldwide in 2008: levels and trends, Lancet, 2012, 379(9816):625 –632.; and Singh S, Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries, Lancet, 2006, 368(9550):1887–1892.
Consequences of Unsafe Abortion:
Abortion-related mortality rates are hundreds of times higher in developing countries, where abortion is often illegal or highly restricted, than in developed countries.
According to World Health Organization (WHO) estimates, unsafe abortions account for 13% of all maternal deaths worldwide. Abortions occur where abortion is illegal.
WHO estimates that 47,000 pregnancy-related deaths that occur each year result from unsafe abortions.
Unsafe abortion has significant negative consequences beyond its immediate effects on women’s health. Other costs include: loss of women’s productivity; economic burden of health care costs on poor families; considerable costs health care systems, which are already unable to meet demand for health care and in extreme cases, maternal deaths that leave children motherless.

50. Law Reforms in Developing Countries Have Been Followed by Declines in Morbidity and Mortality
South Africa (1997): annual number of abortion-related deaths decreased by 91% after the law was liberalized.
Nepal (2002): abortion-related complications as a proportion of all of maternal illnesses (in facilities in eight districts) decreased by 48%.
Ethiopia (2005): abortion complications per 100,000 live births (one large hospital) decreased by about 70%.
Sources: Jewkes R and Rees H, Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act, South African Medical Journal, 2005, 95(4):250. Pradhan A et al., Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of Preliminary Findings, Kathmandu, Nepal: Family Health Division, Department of Health Services, Ministry of Health, Gebrehiwot Y and Liabsuetrakul T, Trends of abortion complications in a transition of abortion law revisions in Ethiopia, Journal of Public Health, 2009, 31(1):81–87. 50

51. Summary Points

52. Incidence of Pregnancy and Abortion in the United States
Unintended pregnancy and abortion are common among all groups of women.
Certain groups of women are at greater risk of unintended pregnancy than are others.
Half of all pregnancies are unintended.
Four in 10 unintended pregnancies end in abortion.

53. Provision of and Access to Abortion Services
Most abortions occur in abortion clinics.
Many women have to travel significant distances to find a provider, which can pose problems for those with limited resources, or work or family responsibilities.

54. Safety of Abortion
Abortion is one of the safest common surgical procedures for women in the United States.
Abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses.
Laws criminalizing abortion make abortions unsafe, but do not eliminate them.

55. Who Has Abortions, Why and When in Pregnancy
Disadvantaged women bear a disproportionate burden of unintended pregnancies and abortions.
The most frequent reasons women give are that having a child or another child would limit their ability to meet current responsibilities and that they cannot afford a child at this point in their lives.
Almost 90% of abortions occur in the first trimester.

56. Obstacles to Obtaining Abortion Services
Although most women obtain abortions early in pregnancy, some women face substantial obstacles to access.
Nearly four in 10 women of reproductive age receive coverage under Medicaid, yet 32 states allow Medicaid funding for abortion only in cases of rape, incest or life endangerment.
Lacking insurance coverage, poor women often require time to find the money to pay for an abortion, if they are able to at all.
More than 200 state abortion restrictions were enacted between 2011 and 2013, making it more difficult for women to obtain timely services.

57. International Perspective on Abortion
A very small proportion of abortions worldwide take place in the United States.
Most unsafe abortions occur in countries where abortion is illegal.

58. About Guttmacher
The Guttmacher Institute is a nonprofit organization that advances sexual and reproductive health worldwide through research, policy analysis and public education.
For more information about Guttmacher, please click here.
Read our report “Abortion in Women’s Lives” here.