Abortion in the
United States
Megan Squires, MPH/MSW Candidate, December 2013
[email protected]
A brief history of abortion in the US,
Overview
Introduction and epidemiology
Types of abortion procedures
Who receives abortions and why
National historical timeline
State policy differences
North Carolina vs. Massachusetts
Introduction
Abortions are very common. 1 out of 3 women in the U.S. will have
an abortion by the time they turn 45.
Abortion is one of the safest surgical procedures in the U.S.
No matter your personal view on abortion, pregnancy decisions are
Introduction
Contraceptive use is a key predictor
of whether or not a woman will seek
an abortion.
Women not using contraceptives
account for about half of all abortions.
The remainder of abortions occur
among women using contraceptives.
1 in 2 pregnancies continue to be
Epidemiology
Medical Abortion
May be used up to 9 weeks after the first day of a
woman’s last period.
The pill works by blocking the hormone
progesterone, allowing the lining of the uterus to
break down. Thus the pregnancy cannot continue.
A second medication, misoprostol, is administered
Medical Abortion
Side
effects
may
Include:
Pain and cramping
Bleeding
Gastrointestinal side effects
Thermoregulatory changes
Headache and dizziness
In-Clinic Abortion
Most common in-clinic procedure is referred to as
aspiration
Can be performed up to 16 weeks after a woman’s
last period
Another type of in-clinic abortion procedure, dilation
and evacuation (D&E), is usually performed later
than 16 weeks after a woman’s last period
Why do women seek abortions?
In-depth qualitative analyses reveal:
40%
36%
31%
29%
20%
19%
12% 5%
Financial reasons
Not the right time for
a baby
Partner-related
reasons
Need to focus on
other children
Interference with
future opportunities
Not emotionally or
mentally prepared
Health-related reasons
Influences from
Early History of Abortion
Internationally, abortion has been performed for
thousands of years in every society studied.
Among the earliest settlers, abortion was considered legal
up to the point at which a pregnant woman could feel her
fetus move in the womb.
During the 1800s, all surgical procedures, including legal
abortion were extremely risky.
And during the 1860s, many states criminalized abortion
National Historic Timeline
1860s
•
Abortion becomes illegal
1940s –
’50s
•
Legal abortions difficult to obtain by working
class women
1962
•
Rubella outbreak leads to increase in abortions
National Historic Timeline
1973
•
Roe v. Wade
1976
•
Hyde Amendment enacted
1976
•
First abortion clinic arson reported
1980
•
Republican Party platform drops its 40-year commitment to
National Historic Timeline
1989-‘9
2
•
Over 700 abortion restrictions considered in state
legislatures
2000
•
FDA approves mifepristone (RU-486) as option for early
abortion care
2006
•
South Dakota bans abortion in all cases except to save
the life of the mother
2011
•
State legislators introduced 1,100 provisions that
Timeline Summary
Abortion
Expansion
Intentional
Erosion
Decreased
Access
Chipping away
at Roe v. Wade
Political division
Feminism
Public Perceptions
A study conducted
by Jelen et al.
(2002) closely
examined
perceptions of
abortion stratified
by gender and
Shrinking
Middle
Ground
Shifting public
opinion, mostly
among moderate
voters
Election of
republican
governors in once
moderate or
abortion-friendly
states
Election of
republican
State Policies
Different states have different laws concerning:
Physician and hospital requirements
Gestational limits
Public funding
Coverage by private insurance
Refusal
State-mandated counseling
Waiting periods
Massachusetts vs. North
Carolina
The Pew Center for Research found that most abortion restrictions
take place in Southern and Midwestern states while the least
restrictions take place in Northeastern states.
Massachusetts, a state with liberalized healthcare reform currently
has very different abortion policies than the southern state of
North Carolina.
Massachusetts Abortion
Statistics
2008: 24,900 women obtained abortions
Abortion rate was 18.3 per 1,000 women ages
15-44.
Abortions in Massachusetts represent 2.1% of
North Carolina Abortion
Statistics
2008: 33,140 women had abortions
Abortion rate: 17.5 per 1,000 women ages 15-44
Abortions in NC represent 2.7% of all U.S.
abortions
For more information, visit:
Abortion Providers: MA vs. NC
Massachusetts
21 providers
29% of MA counties had no
provider
10% of women lived in
these counties
North Carolina
15 providers
86% of NC counties had no
provider
50% of NC women lived in
Abortion Restrictions: MA vs. NC
North Carolina
State-directed counseling is given to
discourage woman from having an abortion
and then wait 24 hours before the
procedure is provided.
Health plans offered in the state’s health
exchange established under ACA can only
cover abortion in case of woman's life
endangerment, rape or incest.
Abortion is covered in insurance policies for
public employees only in cases of life
endangerment, rape or incest.
The use of telemedicine for the
performance of medication abortion is
prohibited.
Parental consent of a minor required
Public funding is available for abortion only
in cases of life endangerment, rape or
incest.
Massachusetts
The parent of a
minor must provide
consent before an
abortion is
History of Abortion: MA
Overall, Massachusetts has been supportive of
reproductive rights.
Nurse practitioners can administer medical
abortions.
Perhaps most remarkably, Massachusetts's state
health insurance provision passed in 1996 requires
abortion coverage for state and municipal
History of Abortion in MA
December 30, 1994
: An abortion opponent killed two
Planned Parenthood receptionists and wounded five others
in Brookline, Massachusetts.
“The fear of violence has become part of the lives of every
MA Buffer Zone Law
In 2007, a law was passed which created a protected area for
patients and employees a fixed 35 feet from the entrances to health
centers. The law achieves a delicate balance between the free
History of Abortion in NC
In 1967, North Carolina became the second state to liberalize its
abortion laws
The new law allowed for therapeutic abortion in certain circumstances.
In general, North Carolina continued to witness development of
progressive policies that promoted public health based on scientific
evidence
Abortion in NC: 2011
Required women to seek counseling 24 hours
prior to procuring an abortion.
A woman must obtain an ultra sound prior to
having an abortion.
NC State Legislature moved to disqualify
Abortion in NC: 2013
Inaccurate sex education law stating abortion increases risk of
preterm birth.
Omnibus abortion law:
Limits abortion coverage in the health exchange in count and
city employee plans
Restricts medical abortion via telemedicine
Bans abortion for purposes of sex selection
Directs the state to revise abortion clinic regulation
For Future Consideration
Only 2% of America’s OB/GYNs perform 50% of abortions in the
United States.
Only 32% of med schools provide at least 1 lecture about abortion.
For Future Consideration
Abortion funds fill a
much-needed gap for
economically
disadvantaged women.
Funds help women pay
Summary
1 in 3 American women will have an abortion
Public opinion continues to remain supportive
of abortion in certain circumstances
Some states are still supportive of abortion
rights but this is a growing minority
Work at the policy, program, and individual
Implications for MCH
Improving racial and ethnic health
disparities in contraceptive and
abortion access
Repeal Hyde Amendment
Limit restrictions on clinics
Importance of using scientific
evidence in writing policy
Research
References
1. Abortion Facts. National Abortion Federation. http://www.prochoice.org/about_abortion/facts/index.html. Accessed
November 15, 2013.
2. State facts about abortion: North Carolina. Guttmacher Institute.
http://www.guttmacher.org/pubs/sfaa/north_carolina.html. Accessed November 15, 2013.
3. Unintended pregnancy and prevention. Centers for Disease Control and Prevention.
http://www.cdc.gov/reproductivehealth/unintendedpregnancy/. Published February 12, 2013. Accessed November 15, 2013.
4. Abortion. Centers for Disease Control and Prevention. http://www.cdc.gov/Reproductivehealth/Data_Stats/#Abortion.
Accessed November 15, 2013.
5. Contraception correlations. That Married Couple Plus Two.
http://www.thatmarriedcouple.com/2013/02/contraception-correlations.html. Published February 5, 2013. Accessed November 15, 2013.
6. The abortion pill (medication abortion). Planned Parenthood.
http://www.plannedparenthood.org/health-topics/abortion/abortion-pill-medication-abortion-4354.asp. Accessed November 15, 2013.
7. Expected side effects of medical abortion. National Abortion Federation.
http://www.prochoice.org/education/cme/online_cme/m2expected2.asp. Published 2010. Accessed November 15, 2013.
8. RU 486/Medical abortion. NARAL Pro-Choice America.
http://www.prochoiceamerica.org/what-is-choice/abortion/abortion-ru-486.html. Accessed November 15, 2013.
9. In-clinic abortion procedures. Planned Parenthood.
http://www.plannedparenthood.org/health-topics/abortion/in-clinic-abortion-procedures-4359.asp. Accessed November 15, 2013.
10. U.S. women who have abortions. Guttmacher Institute.
References
11. Racial and ethnic disparities in reproductive health outcomes. Guttmacher Institute.
http://www.guttmacher.org/media/infographics/racial-ethnic-disparities2.html. Accessed November 15, 2013.
12. Douglas E. Abortion rate lowest since legalization; racial disparities persist. RH Reality Check.
http://rhrealitycheck.org/article/2008/09/23/us-abortion-rate-lowest-since-legalization-racial-disparities-persist/. Published September 23, 2008. Accessed November 15, 2013.
13. Biggs AM, Gould H., Foster DG. Understanding why women seek abortions in the US. BMC Women’s Health.
2013;29:1-13.
14. Rose M. Abortion. Westport, Connecticut: Greenwood publishing group. 2008.
15. History of Abortion. National Abortion Federation. http://www.prochoice.org/about_abortion/history_abortion.html.
Accessed November 15, 2013.
16. Acevdeo Z. Abortion in early America. Women’s Health. 1979;4(2):159-167.
17. Halfmann D. Doctors and Demonstrators. Chicago, Illinois: The university of Chicago press books. 2011.
18. Chamberlain C. Epidemic played large role in shift of attitudes on abortion, author says. Illinois News Bureau.
http://news.illinois.edu/news/10/0623abortion.html. Published June 23, 2010. Accessed November 15, 2013.
19. Lessons from before Roe: Will past be prologue? The Guttmacher Report on Public Policy. March 2003;6(1).
http://www.guttmacher.org/pubs/tgr/06/1/gr060108.html. Accessed November 15, 2013.
20. McFarlane DR, Meier KJ. The Politics of Fertility Control: Family Planning and Abortion Policies in the United States.
Washington, DC: CQ press, 2000.
21. Public funding for abortion: Medicaid and the Hyde Amendment. National Abortion Federation.
References
22. History of violence. National Abortion Federation.
http://www.prochoice.org/about_abortion/violence/history_violence.html. Accessed November 15, 2013. 23. Hout M. Abortion politics in the United States, 1972-1994: From single issue to ideology. Gender Issues. 1999;17(2):3-34.
24. Mifepristone. NARAL Pro-Choice America. http://www.prochoiceamerica.org/media/fact-sheets/abortion-ru486-politics.pdf. Published January 1, 2013. Accessed November 15, 2013.
25. Abortion. Gallup. http://www.gallup.com/poll/1576/abortion.aspx#1. Accessed November 15, 2013. 26. Jelen TG, Damore DF, Lamatsch T. Gender, employment status, and abortion: A longitudinal analysis.
Sex Roles. 2002;47(7/8):321-330.
27. Gold RB, Nash E. Troubling trend: More states hostile to abortion rights as middle ground shrinks.
Guttmacher Policy Review. 2012;15(1):14-19.
28. State policies in brief: An overview of abortion laws. Guttmacher Institute.
http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf. Accessed November 15, 2013. 29. Masci D. The new legal battlefield over abortion. Pew Research Center.
http://www.pewresearch.org/fact-tank/2013/07/31/the-new-legal-battlefield-over-abortion/. Published July 31, 2013. Accessed November 15, 2013.
30. Results of surveyUSA news poll #6570. Survey USA. http://www.surveyusa.com/client/PollReport.aspx? g=bfac6edd-d312-49e2-b520-7628f2d88103. Published August 26, 2006. Accessed November 15, 2013. 31. 31. Results of surveyUSA news poll #6582. Survey USA.
References
32. State facts about abortion: Massachusetts. Guttmacher Institute.
http://www.guttmacher.org/pubs/sfaa/massachusetts.html. Accessed November 15, 2013.
33. Access to abortion care in Massachusetts (2011). NARAL Pro-Choice Massachusetts.
http://www.prochoicemass.org/media/2011abortion.shtml. Published October, 2011. Accessed, November 15, 2013.
34. Hoban R. Interactive: Women’s reproductive health and abortion. North Carolina Health News.
http://www.northcarolinahealthnews.org/interactive-womens-reproductive-health-and-abortion/. Accessed November 15, 2013.
35. Abortion providers in Massachusetts. NARAL Pro-Choice Massachusetts.
http://www.prochoicemass.org/assets/bin/pdfs/providerchart.pdf. Published July 2, 2013. Accessed November 15, 2013.
36. North Carolina. Abortion Clinics On-line. http://www.gynpages.com/ACOL/northcarolina.html. Accessed November 15,
2013.
37. Abortion care in Massachusetts. NARAL Pro-Choice Massachusetts.
http://www.prochoicemass.org/media/abortioncareresources.shtml. Accessed November 15, 2013.
38. Boston Women’s Health Book Collective. Our Bodies Ourselves for the New Century. New York, NY: Touchstone; 1998.
39. Kifner J. Anti-abortion killings: The overview. The New York Times.
http://www.nytimes.com/1994/12/31/us/anti-abortion-killings-overview-gunman-kills-2-abortion-clinics-boston-suburb.html. Published December 31, 1994. Accessed November 15, 2013.
40. History of abortion in the U.S. Our Bodies Ourselves Health Resources Center.
http://www.ourbodiesourselves.org/book/excerpt.asp?id=27. Accessed November 15, 2013.
41. Loth R. A zone that should be left alone. The Boston Globe.
References
42. Walker WB, Hulka JF. Attitudes and practices of North Carolina obstetricians: the impact of the North Carolina Abortion Act of 1967. South Med J. 1971;64(4):441-445.
43. History of violence: Arsons and bombings. National Abortion Federation.
http://www.prochoice.org/about_abortion/violence/arsons.asp. Accessed November 15, 2013.
44. Associated Press. Bomb at NC abortion clinic explodes partially; no injures. Los Angeles Times. http://articles.latimes.com/1999/ mar/14/news/mn-17306. Published March 14, 1999. Accessed November 15, 2013.
44. States enact record number of abortion restrictions in 2011. Guttmacher Institute.
http://www.guttmacher.org/media/inthenews/2012/01/05/endofyear.html. Published January 5, 2012. Accessed November 15, 2013. 45. Monthly state update: Major developments in 2013. Guttmacher Institute.
http://www.guttmacher.org/statecenter/updates/index.html. Accessed November 15, 2013.
46. Crisis pregnancy centers. NARAL Pro-Choice Massachusetts. http://www.prochoicemass.org/get-the-facts/certifiedtruth/. Accessed November 15, 2013.
47. The truth revealed: North Carolina’s crisis pregnancy Centers. NARAL Pro-Choice North Carolina Foundation.
http://www.prochoicenc.org/assets/bin/pdfs/2011NARAL_CPCReport_V05_web.pdf. Published October 24, 2011. Accessed November 15, 2013.
48. Our work. Medical Students for Choice. http://www.msfc.org/our-work . Accessed November 15, 2013. 49. Abortion access and training. American Congress of Obstetrics and Gynecology.
http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/ Abortion_Access_and_Training. Published January 24, 2009. Accessed November 15, 2013.
50. Landecker H. As states limit abortion, future doctors fight for training. The Chronicle of Higher Education. http://chronicle.com/article/As-States-Try-to-Curb/139831. Published June 17, 2013. Accessed November 15, 2013.
