1. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Abortion Surveillance in the United States: Future Directions and Challenges Karen Pazol, PhD, MPH Maternal and Infant Health Branch Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

2. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Abortion data are important for monitoring reproductive health Combined with data on births and fetal losses to calculate pregnancy rates Monitor clinical practice patterns and changes in use of procedures over time Guide efforts to reduce unintended pregnancy and assess the impact of changes in policy and the implementation of family planning programs

3. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Organizations collecting abortion data in the United States Organization Data SourceOrigin of Data Information ObtainedDates -,CDCNCCDPHP Division of Rep. Health State Vital Statistics Agencies Individual records from abortion providers Aggregate report: N’s + basictraits Annually,1969 present- Guttmacher Institute Abortion Provider Survey Counts from abortion providers TotalN’sPeriodically, 1974present Abortion Patient Survey Responses from women seeking abortion Basic traits1987, 1994, 2000, 2008- NCHS National Survey of Family Growth Responses from reproductive aged women N’s + basic traits 1982, 1988, 2001, &2006 2008 N-State Vital Statistics Agencies Individual records from abortion providers ’s + basic traits 19781994

4. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC’s Abortion Surveillance System and its strengths Challenges of combining data collected through independent state-run systems Efforts to facilitate work carried out in the states and integrate data collected through independent systems Talk overview

5. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Each year CDC requests aggregate data from the 50 states, NY City and DC Legally mandated and voluntary elements Most states (N=47) require provider reporting States submit data to CDC voluntarily, yet participation is high (N=49 areas in 2007) Most but not all states have a reporting system Prior to 1997, five states had no system Prior to 1998, CDC conducted surveys in hospitals and other abortion facilities CDC’s Abortion Surveillance System

6. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC compiles abortion data on a consistent annual basis 0.45 0.47 0.49 0.51 0.53 0.55 0.57 0.59 0.61 Calendar years with abortion counts CDC Guttmacher Institute

7. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Information collected by CDC: Gestational age Procedure type Place of Residence Maternal age Maternal race CDC proportions are applied to Guttmacher Institute total counts to estimate the incidence of abortion within population subgroups CDC compiles information on a wide range of variables ● Maternal ethnicity ● Marital status ● Number prior births ● Number prior abortions

8. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC counts closely track results from the Guttmacher Patient Survey

9. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC’s Abortion Surveillance System and its strengths Challenges of combining data collected through independent state-run systems Efforts to facilitate work carried out in the states and integrate data collected through independent systems Talk overview

10. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC does not obtain abortion counts from all 52 reporting areas 20% 40% 60% 80% 100% 2 12 22 32 42 52 197819831988199319982003 Central reporting agencyHospitals & other abortion facilities # areas contributing to CDC totals % contribution of areas that reported to CDC to the Guttmacher Institute totals

11. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 States vary considerably in the completeness of reporting 0%25%50%75%100% CDC counts by state as a percentage of Guttmacher Institute counts 2000(N=4) 2005 (N=45) Voluntaryreporting Mandatory reporting 2000(N=44) 2005 (N=3) 35% 69% 96%

12. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Active outreach to abortion providers can improve reporting

13. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 States vary in the amount of information they collect

14. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 States vary in the amount of information they collect

15. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 States vary in the level of detail provided for each variable 0 10 20 30 40 50 199719992001200320052007 Number areas reporting by procedure and with medical abortion as a separate category reported by procedure typemedical abortion separate category FDA approval of medical abortion

16. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 States vary in the level of detail provided for each variable

17. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC’s Abortion Surveillance System and its strengths Challenges of combining data collected through independent state-run systems Efforts to facilitate work carried out in the states and integrate data collected through independent systems Talk overview

18. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Analyses of trends over time based on continuously reporting areas

19. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Analyses of trends over time based on continuously reporting areas

20. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Revised analyses retain compatibility with current reporting

21. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Revised analyses retain compatibility with current reporting Medical (Nonsurgical) Abortion: A procedure (that) involves the administration of a medication or medications to induce an abortion. Medications (e.g., methotrexate, mifepristone, misoprostol, etc.) are used most frequently early in the first trimester of pregnancy. However, some medications (e.g., prostaglandin suppositories, injectable prostaglandins, etc.) may be administered during the second trimester of pregnancy to induce abortion.

22. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Revised analyses retain compatibility with current reporting

23. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Revised analyses retain compatibility with current reporting

24. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Revised analyses retain compatibility with current reporting

25. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Revised analyses retain compatibility with current reporting

26. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Establish improved dialogue with state vital statistics departments Increase the compatibility of CDC data requests with state data systems Develop more efficient methods for transferring aggregate reports to CDC CDC efforts to understand state systems and enhance collaboration

27. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 CDC has compiled the most consistent annual record of abortions CDC collects important information on maternal demographics, procedure type and gestational age CDC faces many challenges in combining data from 52 independent sources Conclusions

28. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Attempts to overcome variation and improve surveillance: Trends based on continuously reporting areas Revisions to analyses compatible with current reporting formats Increase communication and understanding of state systems to enhance collaboration Conclusions

29. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Douglas Cook, CDC Sonya Gamble, CDC Laura Hall, CDC Saeed Hamdan, CDC Wilda Parker, CDC Suzanne Zane, CDC Acknowledgements Elizabeth Nash, Guttmacher Institute Mary Chase, Colorado Department of Public Health & Environment