Stanley K. Henshaw

Teenage pregnancy in developed countries: determinants and policy implications.

Because of the high adolescent fertility rates in the US, the Alan Guttmacher Institute (AGI) conducted a 1985 study of adolescent pregnancy and childbearing in 37 developed countries. This was an effort to unveil those factors responsible for determining teenage reproductive behavior. This article presents the data from that study. Birthrates were collected and separated into 2 age groups: for those under 18 and those women 18 to 19 years of age. A 42 variable questionnaire was sent to the public affairs officer of the American embassy and family planning organization in each foreign country to provide additional socioeconomic, behavioral, and educational data. Childbearing was found to be positively correlated with agricultural work, denoting a socioeconomic influence. Adolescent birthrates showed a positive correlation with levels of maternity leaves and benefits offered in the country. The lowest birthrates were found in those countries with the most liberal attitudes toward sex as demonstrated through media representation of female nudity, extent of nudity on public beaches, sales of sexually explicit literature, and media advertising of condoms. A negative correlation was seen for equitable distribution of income and the under 18 birthrate. The older teenage birthrate was found to be lower for countries with higher minimum ages for marriage. They also suggested a responsiveness to government efforts to increase fertility. Some general patterns emerged to explain the high teenage birthrate for the US: it is less open about sexual matters than countries with lower adolescent birthrates and the income in the US is distributed to families of low economic status. A more subtle factor is that although contraception is available, it is not that accessible to young men and women because of the cost. Case studies were presented to provide a more detailed understanding of the reasons for the high adolescent birthrates. Examined are desire for pregnancy, exposure to risk of pregnancy, contraceptive use, access to contraceptive and abortion services, and sex education.

Contraceptive use among U.S. women having abortions in 2000-2001.

CONTEXT Knowing the extent to which contraceptive nonuse, incorrect or inconsistent use, and method failure account for unintended pregnancies ending in abortion, as well as reasons for nonuse and imperfect use, can help policymakers and family planning providers support effective contraceptive use. METHODS Contraceptive use patterns among a nationally representative sample of 10,683 women receiving abortion services in 2000-2001 were examined, as well as reasons for nonuse, problems with the most frequently used methods and the impact emergency contraceptive pills have had on abortion rates. RESULTS Forty-six percent of women had not used a contraceptive method in the month they conceived, mainly because of perceived low risk of pregnancy and concerns about contraception (cited by 33% and 32% of nonusers respectively). The male condom was the most commonly reported method among all women (28%), followed by the pill (14%). Inconsistent method use was the main cause of pregnancy for 49% of condom users and 76% of pill users; 42% of condom users cited condom breakage or slippage as a reason for pregnancy. Substantial proportions of pill and condom users indicated perfect method use (13-14%). As many as 51,000 abortions were averted by use of emergency contraceptive pills in 2000. CONCLUSIONS Women and men need accurate information about fertility cycles and about the risk of pregnancy when a contraceptive is not used or is used imperfectly. Increased use of emergency contraceptive pills could further reduce levels of unintended pregnancy and abortion.

Measuring the extent of abortion underreporting in the 1995 National Survey of Family Growth.

CONTEXT Induced abortions are often severely underreported in national surveys, hampering the estimation and analysis of unintended pregnancies. To improve the level of abortion reporting, the 1995 National Survey of Family Growth (NSFG) incorporated new interview and self-report procedures, as well as a monetary incentive to respondents. METHODS The weighted numbers of abortions reported in the main interview of the 1995 NSFG (Cycle 5), in the self-report and in the two procedures combined are compared with abortion estimates from The Alan Guttmacher Institute. The Cycle 5 estimates are also compared with estimates from previous cycles of the NSFG. RESULTS The self-report produces better reporting than the main interview, but combining data from the two procedures yields the highest count of abortions. For the period 1991-1994, the level of reporting is 45% in the main interview, 52% in the self-report and 59% when the two methods are combined. The level of abortion reporting in the combined data ranges from 40% for women with an income less than the federal poverty level to more than 75% among women who were older than 35, those who were married at the time of their abortion and those with an income above 200% of the poverty level. The completeness of abortion reporting in the main interview of Cycle 5, though indicating a remarkable improvement over reporting in Cycle 4, is comparable to the levels in Cycles 2 and 3. CONCLUSIONS The usefulness of the NSFG remains extremely limited for analyses involving unintended pregnancy and abortion.

Abortion patients in 1994-1995: characteristics and contraceptive use.

Results of a 1994-1995 national survey of 9,985 abortion patients reveal that women who live with a partner outside marriage or have no religious identification are 3.5-4.0 times as likely as women in the general population to have an abortion. Nonwhites, women aged 18-24, Hispanics, separated and never-married women, and those who have an annual income of less than +15,000 or who are enrolled in Medicaid are 1.6-2.2 times as likely to do so; residents of metropolitan counties have a slightly elevated likelihood of abortion. When age is controlled, women who have had a live birth are more likely to have an abortion than are those who have never had children. Catholics are as likely as women in the general population to have an abortion, while Protestants are only 69% as likely and Evangelical or born-again Christians are only 39% as likely. Since 1987, the proportion of abortions obtained by Hispanic women and the abortion rate among Hispanics relative to that for other ethnic groups have increased. The proportion of abortion patients who had been using a contraceptive during the month they became pregnant rose from 51% in 1987 to 58%. Nonuse is most common among women with low education and income, blacks, Hispanics, unemployed women and those who want more children. The proportion of abortion patients whose pregnancy is attributable to condom failure has increased from 15% to 32%, while the proportions reporting the failure of other barrier methods and spermicides have decreased.

The characteristics and prior contraceptive use of U.S. abortion patients.

Hispanic women are 60 percent more likely than non-Hispanics to have an unintended pregnancy that they terminate by abortion, but they are less likely than nonwhites to do so. Women who profess no religion have a higher abortion rate than do women who report some religious affiliation; among the latter, Catholics are about as likely to obtain an abortion as are all women nationally, while Protestants and Jews are less likely to do so. One in six abortion patients in 1987 described themselves as born-again or Evangelical Christians; such women are half as likely as other American women to obtain abortions. Unmarried cohabiting women are nine times as likely as married women living with their husbands to have an abortion, and separated women are also at high risk. Other characteristics associated with an above-average likelihood of abortion are current school enrollment, current employment, low income, Medicaid coverage, intention to have no more children and residence in a metropolitan county. Half of all abortion patients in 1987 were practicing contraception during the month in which they conceived, and a substantial proportion of those who were not doing so had stopped using a method only a few months before becoming pregnant. The majority of abortion patients who had stopped using a method prior to becoming pregnant said they had most recently used the pill. Nonuse of a method of birth control among abortion patients is greatest for those who are young, poor, black, Hispanic or less educated.

Teenage Abortion and Pregnancy Statistics by State, 1992

CONTEXT State-level teenage pregnancy rates, birthrates and abortion rates are needed for state-specific programs and policies. Accurate and complete state-level data were last published in 1992. METHODS Teenage abortion rates according to state of residence, race and ethnicity were calculated from the results of The Alan Guttmacher Institutes survey of abortion providers and from information compiled by state health statistics agencies and the Centers for Disease Control and Prevention. Natality data were obtained from the National Center for Health Statistics, and population denominators from the Census Bureau. RESULTS In 1996, some 97 pregnancies, 54 births and 29 abortions occurred per 1,000 U.S. women aged 15-19. At the national level and in virtually all states, these rates have fallen since 1992, yet they remain higher than rates in most other developed countries. The decline in the teenage abortion rate (from 36 per 1,000 in 1992) has been proportionately greater than the drop in the birthrate (from 61 per 1,000), indicating that an increasing proportion of pregnant teenagers are continuing their pregnancies. Pregnancy rates, birthrates and abortion rates vary enormously among the states for reasons that are largely unexplained. Pregnancy rates and birthrates tend to be highest in the South and Southwest, while abortion rates are highest in the most urban states. CONCLUSIONS Teenage pregnancy is declining in all parts of the country. Although rates have fallen, further progress is possible, as is indicated by the low rates in certain states and in other developed countries. More research is needed to identify the factors influencing the reproductive behavior of adolescents.

Severity and Cost of Unsafe Abortion Complications Treated in Nigerian Hospitals

CONTEXT Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality. METHODS In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Womens abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances. RESULTS Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the countrys restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira). CONCLUSIONS Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.

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.

Characteristics of U.S. women having abortions, 1987.

In 1987, as in earlier years, women having abortions were predominantly white (65 percent), younger than 25 (59 percent), and unmarried (82 percent). A majority had no previous live births (53 percent), and most had no previous abortions (58 percent). About half the abortions were performed before nine weeks of gestation, and 97 percent were curettage procedures, usually suction curettage. Comparisons with 1980 data reveal a six percent decline in the U.S. abortion rate after changes in age, race and marital status within the population are controlled for; however, the decline occurred only among the white population and not among minority races. Among teenagers aged 15-19, the abortion rate declined slightly for whites and increased for minorities. The rate also increased among women younger than age 15.

The impact of requirements for parental consent on minors' abortions in Mississippi.

Mississippi data for 1993 indicate that the states new parental consent requirement had little effect on the abortion rate among minors. In a comparison of Mississippi residents who had abortions during the five months before and the six months after the law went into effect, the ratio of minors to adults who sought abortions in the state declined by 13%, a decrease offset by a 32% increase in the ratio of minors to adults who obtained abortions out of state. There was also a 28% drop in the ratio of minors to adults from other states who had abortions in Mississippi. The parental consent requirement increased by 19% the ratio of minors to adults who obtained their procedure after 12 weeks of gestation.