Who Has Abortions

Nearly half (49%) of all pregnancies that occur in the United States are not intended, and about half of unintended pregnancies are resolved by abortions. Most (58%) of the women who have abortions had been using some form of birth control but became pregnant because of the failure or misuse of the birth control product/method. By the age of forty-five, about 43 percent of women in the United States have experienced at least one abortion. Among the women choosing to have abortions at a given time, nearly half (43%) have had at least one previous abortion.

There is not one particular type of woman who is likely to have an abortion. More than half (55%) of the women having abortions have had at least one child already. About two-thirds of the women having abortions have never been married. The majority (52%) are younger than age twenty-five, but only 20 percent are teenagers.

Women of all racial and religious groups obtain abortions. The largest number (60%) of abortions are performed on white women, but black women are three times as likely and Hispanic women twice as likely as white women to have an abortion in a given year. Catholic women are equally likely to have abortions as all women nationwide, but the rate of induced abortion for Catholic women is actually 29 percent higher than the rate for Protestant women.

Abortions occur for many reasons, and women tend to have multiple explanations for their abortion decisions. The most common reason, given by three-quarters of women having abortions, is that having a baby at that time in their lives would conflict with major responsibilities such as work or school. Two-thirds of women having abortions give economic reasons for delaying or foregoing parenthood. Half of the women choosing abortion do not have the supportive relationship that they would like for becoming a parent—either they do not want to start out as a single mother or they are having problems in their relationship with a husband or partner. Approximately 14,000 women a year choose abortions to terminate pregnancies resulting from rape or incest.

When Abortion Was Illegal

Major complications from induced abortion are very rare in the United States, occurring in fewer than 1 percent of abortions. The risk of death from childbirth, an uncommon event in industrialized countries, is ten times greater than the mortality risk of abortion. The safety of legal abortion is in stark contrast to the danger women faced before abortion was decriminalized in the United States in 1973. In the 1950s, for example, there were about 1 million illegal abortions every year, with at least 1,000 deaths per year resulting.

Before legalization some courageous and qualified providers took considerable personal risks to offer safe procedures to women in need. Women with adequate financial and social resources were sometimes able to seek safe abortions in legal settings outside the United States. Desperation often drove other women to unskilled abortionists working in unsanitary conditions. Women who survived so-called back-alley abortions of this sort or attempts to self-abort sometimes suffered painful chronic illnesses, lost the ability to have children, or experienced trauma that affected their psychological health and well-being.

Judicial and Legislative Rulings

On January 22, 1973, the U.S. Supreme Court handed down the Roe v. Wade decision, which created a legal, though limited, right to abortion. Roe v. Wade concluded that the ''right of privacy . . . founded in the Fourteenth Amendment's concept of personal liberty . . . is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.'' Based on their individual right to privacy, women in consultation with their doctors were given the legal right to choose abortion in the first three months (or first trimester) of pregnancy. State laws were permitted to limit second-trimester abortions ''only in the interest of the woman's safety.'' In the final three months (third trimester) of pregnancy, Roe v. Wade allowed states to protect the fetus by restricting abortion unless there is potential danger to the life or health of the pregnant woman.

Roe v. Wade granted women the right to early abortion with a physician's consent, but it did not guarantee financial or medical access to abortion. In 1976 the U.S. Congress passed the Hyde amendment to a federal appropriations bill, eliminating federal reimbursement for induced abortions from Medicaid public insurance coverage for low-income women. Through 2001, Congress had annually reinstated this ban on federal funding of abortion, with narrow exceptions for rape, incest, and threats to the life of the woman if she continues the pregnancy. As of 1997 the cost of an abortion in a clinic or doctor's office ranged from $100 to $1,535, averaging between $316 and $401.

Funding issues have been only one arena of debate in the controversy over women's right to abortion. Religious and personal beliefs lead some people to reject abortion as an individual option for themselves. Among those with personal objections to abortion, some advocate for the right of other people to make their own decisions. Others attempt to use the judicial and legislative systems to return to the situation that existed before legalization. Attitudes toward sexuality and women's autonomy, as well as fundamental beliefs about social control over individual decision making, motivate activists on different sides of the abortion issue.

The U.S. Supreme Court heard another major abortion case in July 1992. In Planned Parenthood v. Casey, the court reviewed a Pennsylvania statute that required women seeking abortions to receive counseling from physicians in favor of continuing their pregnancies, and then to wait at least twenty-four hours before obtaining an abortion procedure. Notification of spouses and parents about requests for abortions was also required. Only the provision for spousal notification was considered to impose an undue burden on women by the Supreme Court, and this provision was thus judged unconstitutional. The Court acknowledged the situation of women in abusive relationships, with the potential for violence perceived as part of the burden for women wishing to act independently of their partners. Other provisions of the statute were left intact, although most were seen by the Court as medically unnecessary and burdensome to a lesser extent.

Although Roe v. Wade was not overturned by the Supreme Court in the Planned Parenthood v. Casey decision, the Court's strict interpretation of undue burden set a precedent for states to impose numerous restrictions on women exercising their right to abortion. As of January 2001, the majority (31) of states had parental notification or consent laws in effect for adolescents seeking abortions. The participation of at least one parent is expected in these states. In most states it is possible for a teen to receive a ''judicial bypass'' of parental involvement, but only if the teen has the information and resources to bring a persuasive request to a court.

Access to Abortion

Restrictions on abortion and lack of broad access to abortion services are unique for a legal medical procedure. The controversy over abortion and associated violence and harassment of patients and provid ers have resulted in a limited number of active abortion providers, especially in rural areas of the United States. In 1996 out of all U.S. counties only 14 percent had practicing providers, and the number appeared to be declining. Nearly one-third (32%) of women aged fifteen to forty-four were living in counties without local abortion services.

The majority of medical residents specializing in obstetrics and gynecology are not required to perform first-trimester induced abortions as part of their training. In 1995 only 12 percent of obstetrics and gy-necology residency programs routinely offered abortion training, though nearly half (46%) reported provision of routine training in 1998 subsequent to new guidelines from the Accreditation Council for Graduate Medical Education. Family practice residents have limited experience with either contraception or abortion. The approval in 2000 by the Food and Drug Administration of pharmaceutical agents to induce abortion medically rather than surgically could increase the number of providers. At the time of approval, however, both women and doctors indicated the importance of maintaining a range of abortion choices, since preferences are influenced by many practical, physiological, and psychological factors.

See also: BIRTH; REPRODUCTIVE TECHNOLOGIES Bibliography

The Alan Guttmacher Institute. "Facts in Brief.'' In the Alan Gutt-macher Institute [web site]. New York, 2000. Available from http://www.agi-usa.org/pubs/fb_induced_abortion.html; INTERNET.

Almeling, Rene, Laureen Tews, and Susan Dudley. "Abortion Training in U.S. Obstetrics and Gynecology Residency Programs, 1998.'' Family Planning Perspectives 32 (2000):268-320. American Civil Liberties Union Freedom Network. ''Reproductive Rights: Public Funding for Abortion.'' In the American Civil Liberties Union [web site]. New York, 2000. Available from http://www.aclu.org/library/funding.html; INTERNET. The Boston Women's Health Book Collective. The New Our Bodies,

Ourselves. New York: Simon and Schuster, 1992. Henshaw, Stanley K. "Abortion Incidence and Services in the United States, 1995-1996.'' Family Planning Perspectives 30 (1998):263-270, 287. Koonin, Lisa K., Lilo T. Strauss, Camaryn E. Chrisman, and Wilda Y. Parker. "Abortion Surveillance—United States, 1997.'' Morbidity and Mortality Weekly Report 49 (SS11) (2000):1-44. MacKay, H. Trent, and Andrea P. MacKay. "Abortion Training in Obstetrics and Gynecology Residency Programs in the United States, 1991-1992.'' Family Planning Perspectives 27 (1995):112-115.

Steinauer, Jody E., Teresa DePineres, Anne M. Robert, John Westfall, and Philip Darney. ''Training Family Practice Residents in Abortion and Other Reproductive Health Care: A Nationwide Survey.'' Family Planning Perspectives 29 (1997):222-227.

Trude Bennett Dennie Nadeau

Planned Parenthood, headquartered in Boston, Massachusetts, provides abortion counseling at satellite offices across the country. (AP/Wide World Photos)
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