Christopher Tietze

Abortion in the United States 1976-1977.

In 1976, about 1.2 million, and in 1977 some 1.3 million, abortions were performed in the U.S. More than half a million women were without the abortion services that they wanted. Poor, rural, young and black women were disporportionately represented among those not yet served.

Mortality Associated with the Control of Fertility

The sharp decline in U.S. births that has occurred in the last decade and a half has been attributed almost entirely to the reduction of unplanned births, associated in turn with the widespread dissemination of a highly effective fertility control technology—namely, the pill, IUDs, new techniques of sterilization, and suction abortion.1 The welcome accorded modern methods for making possible far more effective control over fertility than had ever before been available has been tempered by continuing concern over short- and long-term adverse and, in very rare cases, fatal side effects that have been associated with these methods. It is acknowledged that better understanding of the comparative effectiveness and safety of the various regimens is needed by the individuals who use them, the health services that provide them, and the agencies that regulate them. In September 1969, one of the authors (C.T.), using a simple paper and pencil model, compared the morbidity risks associated with the use of different methods of fertility regulation with those associated with unwanted births resulting from no use of fertility control. In that comparative framework—the only kind of framework in which the meaning of the various risks can be understood—he concluded:

Repeat abortions--why more?

This article challenges the theory that a high repeat abortion rate in the United States is evidence that the legalization of abortion has led couples to relax contraceptive efforts and rely on abortion as a primary method of birth control. Statistics collected in New York City and 12 states in 1974-1976 and demonstrably representative of the nation as a whole show that repeat abortions have almost doubled and that the repeat abortion rate is much higher than the first abortion rate. The increase in the number of repeat abortions can be explained by the increase in the number of women who have had 1st abortions. The higher risk of repeat abortions can be explained by several factors: As a group women with abortion experience are generally older more sexually active and more fecund than the group of women who have never had an abortion. Furthermore women who have once chosen an abortion can be expected to chose to terminate a future pregnancy while the group of women who have never had an abortion includes a substantial number who would never choose abortion to end an unintended pregnancy. Only a few women find abortion easier as a means of birth control than consistent contraception. Hence a repeat abortion rate that is higher than a first abortion rate is to be expected regardless of contraceptive practice.

New estimates of mortality associated with fertility control.

Recent data on mortality related to pregnancy and to use of various contraceptive methods show that up to age 30 the risk to life among noncontraceptors from pregnancy and childbirth is far in excess of that experienced by users of any method. After age 30, the mortality risk experienced by pill users who smoke rises dramatically, but among nonsmokers the risk remains relatively low--and is lower than the risk of death among noncontraceptors even after age 40. Safest at all ages is condom or diaphragm backed up by abortion.

Teenage Pregnancies: Looking Ahead to 1984

About 1.1 million teenagers are giving birth, obtaining abortions, or having miscarriages or stillbirths each year; another 200,000 are getting pregnant as teenagers, although the pregnancy outcome doesn’t occur until they are past 20. Few teenage pregnancies are intended; most occur outside of wedlock. The adverse health, social, psychological, and economic consequences of such pregnancies have received widespread publicity. Girls just turning 14, many of whom are beginning to risk pregnancy because they have become biologicOnliney fecund and have initiated sexual activity, will be 20 years old in 1984. Just how Orwellian is their adolescent reproductive future likely to be? How many will become mothers, obtain abortions, get pregnant while still in their teens? Aside from the very few 14 year olds who have already been pregnant, this is entirely an open question. If legal barriers (e.g., parental notification or consent laws) reduce the accessibility of contraception to teenagers, or if the proportion sexuOnliney active increases, or if more adolescents initiate sexual activity at younger ages, teenage pregnancies will be likely to increase. On the other hand, if teenagers’ contraceptive practices improve, if fewer become sexuOnliney active, or if initiation of sex is postponed, the number of pregnancies should be smOnlineer.

Legal abortion in the United States, 1975-1976.

A nationwide survey conducted by The Alan Guttmacher Institute shows that more than 1 million legal abortions were reported in the U.S. during 1975 and more than 1.1 million are estimated to have been performed in 1976. States varied greatly in the numbers performed. Legal abortion seems to be the most frequently performed surgical procedure in the nation. The number performed annually is rising. Figures are given for all states and comparisons made with rates in other countries. There has been a concentration of services among relatively few providers mainly clinics in larger cities indicating the failure of hospitals to provide abortions. Public hospitals are less likely than private hospitals to provide abortion services thus discriminating against young poor and rural women. The entire need for abortion is still not being met adequately by the nations health facilities.

Abortion need and services in the United States, 1974-1975.

More than one million legal abortions were performed in the United States last year--but one-half to three-quarters of a million women in need of abortion services were still unable to obtain them. Ninety percent of all abortions are now performed in the womans home state, but services are still highly concentrated within states--typically in one or two metropolitan centers where most services are provided by nonhospital clinics. Only one-fourth of hospitals-and fewer than one-fifth of public hospitals-provide any abortion services. Many poor, rural and teenage women who can least afford to travel to obtain legal abortions will continue to be denied access to the services they want and need.

The mathematics of repeat abortion: explaining the increase.

In any given population, an increase in the proportion of repeat abortions, and a repeat-abortion rate that is substantially higher than the first-abortion rate, can be anticipated to occur over a number of years after abortion has been legalized. These are the findings of an analysis of repeat abortion for a population of women aged 15--44, using simple mathematical models based on the assumptions that the risk of abortion is constant over time and independent of prior abortion experience. The data generated by the models explain both the rapidly increasing percentage and the high rate of repeat abortion following legalization and refute assertions that making abortion widely available discourages the practice of contraception.

Induced Abortion: A World Review 1981

The worldwide trend toward liberalization of abortion laws has continued in the last four years with changes in Canada, Czechoslovakia, Greece, Hungary, Romania, the Soviet Union and Vietnam. Forty percent of the worlds population now lives in countries where induced abortion is permitted on request, and 25 percent lives where it is allowed only if the womans life is in danger. In 1987, an estimated 26 to 31 million legal abortions and 10 to 22 million clandestine abortions were performed worldwide. Legal abortion rates ranged from a high of at least 112 abortions per 1,000 women of reproductive age in the Soviet Union to a low of five per 1,000 in the Netherlands. In recent years, abortion rates have been increasing in Czechoslovakia, England and Wales, New Zealand and Sweden and declining in China, France, Iceland, Italy, Japan and the Netherlands. In most Western European and English-speaking countries, about half of abortions are obtained by young, unmarried women seeking to delay a first birth, while in Eastern Europe and the developing countries, abortion is most common among married women with two or more children. Mortality from legal abortion averages 0.6 deaths per 100,000 procedures in developed countries with data. Abortion services are increasingly being provided outside of hospitals, and for those performed in hospitals, overnight stays are becoming less common. National health insurance covers abortions needed to preserve the health of a pregnant woman in all developed countries except the United States, where Medicaid and federal insurance programs do not cover abortion unless the womans life is in danger.

Repeat Abortion in the United States: New Insights

The increasing numbers and proportions of repeat abortions in the United States, including higher order repeat abortions, can be adequately explained by the increasing numbers of women at risk and the heterogeneity of the population in regard to the need for and utilization of abortion services. The same factors, rather than a deterioration of contraceptive practice following abortion, explain the higher levels of repeat abortion rates compared with first abortion rates.