Results

U.S. Totals

Among the 49 reporting areas that provided data for 2015, a total of 638,169 abortions were reported. All 49 of these areas provided data every year during 2006–2015.§§ In 2015, these areas had an abortion rate of 11.8 abortions per 1,000 women aged 15–44 years and an abortion ratio of 188 abortions per 1,000 live births (Table 1). From 2014 to 2015, the total number of reported abortions decreased 2% (from 652,639 to 638,169), the abortion rate decreased 2% (from 12.1 to 11.8 abortions per 1,000 women aged 15–44 years), and the abortion ratio decreased 2% (from 192 to 188 abortions per 1,000 live births). From 2006 to 2015, the total number of reported abortions decreased 24% (from 842,855), the abortion rate decreased 26% (from 15.9 abortions per 1,000 women aged 15–44 years), and the abortion ratio decreased 19% (from 233 abortions per 1,000 live births) (Figure 1). Among these same 49 areas, the annual rate of decrease fitted from the regression analysis was greater during 2011–2015 than during 2006–2010 for all three measures of abortion. During 2011–2015, the number of reported abortions decreased by 23,087 abortions per year, the abortion rate decreased by 0.48 abortions per 1,000 women per year, and the abortion ratio decreased by 7.4 abortions per 1,000 live births per year. In contrast, during 2006–2010, the number of reported abortions decreased by 19,280 abortions per year, the abortion rate decreased by 0.37 abortions per 1,000 women per year, and the abortion ratio decreased by 1.7 abortions per 1,000 live births per year.

Occurrence and Residence

Abortion numbers, rates, and ratios for 2015 have been calculated by reporting area of occurrence and the residence of the women who obtained the abortions (Table 2). By reporting area of occurrence, a considerable range existed in the abortion rate (from 2.8 abortions per 1,000 women aged 15–44 years in South Dakota to 23.1 abortions per 1,000 women in New York [city and state combined]) and the abortion ratio (from 36 abortions per 1,000 live births in South Dakota to 392 abortions per 1,000 live births in New York [city and state combined]).¶¶ Similarly, a considerable range existed by residence*** in the abortion rate (from 4.2 abortions per 1,000 women aged 15–44 years in South Dakota to 22.0 abortions per 1,000 women aged 15–44 years in New York [city and state combined]) and the abortion ratio (from 53 abortions per 1,000 live births in South Dakota to 374 abortions per 1,000 live births in New York [city and state combined]). Because of variation that occurred among reporting areas in the percentage of abortions obtained by out-of-state residents (from 0.3% in Hawaii to 49.0% in Kansas),††† abortion rates and ratios calculated by maternal residence might provide a more accurate reflection of the state-specific distribution of women obtaining abortions. However, because states vary in the level of detail they collect on maternal residence, 12.7% of abortions were reported to CDC with unknown information on maternal residence.

Maternal Age

Among the 47 areas that reported by maternal age for 2015, women in their 20s accounted for the majority (58.7%) of abortions and had the highest abortion rates (19.9 and 17.9 abortions per 1,000 women aged 20–24 and 25–29 years, respectively) (Figure 2) (Table 3). Women in the youngest (<15 years) and oldest (≥40 years) age groups accounted for the smallest percentages of abortions (0.3% and 3.5%, respectively) and had the lowest abortion rates (0.5 and 2.5 abortions per 1,000 women aged <15 and ≥40 years, respectively). Among the 44 reporting areas that provided data by maternal age every year during 2006–2015, this pattern across age groups was stable, with the majority of abortions and the highest abortion rates occurring among women aged 20–29 years and the lowest percentages of abortions and abortion rates occurring among women in the youngest and oldest age groups (Table 4). From 2006 to 2015, abortion rates decreased among all age groups, although the decreases for adolescents (58% and 54% for adolescents aged <15 and 15–19 years, respectively) were greater than the decreases for women in all older age groups, with decreases for women aged ≥20 years ranging from 4% among women aged ≥40 years to 33% among women aged 20–24 years. Decreases in the abortion rate for all age groups, except women aged 25–29 years, were greater from 2011 to 2015 than from 2006 to 2010, and the rates for all age groups either remained the same or decreased from 2014 to 2015.

In contrast to the percentage of abortions and abortion rates, abortion ratios in 2015 were highest among adolescents aged ≤19 years and lowest among women aged 25–39 years (Figure 2) (Table 3). Among the 44 reporting areas that provided data by maternal age for every year during 2006–2015, abortion ratios decreased among women in all age groups. The abortion ratio decreased for all age groups from 2011 to 2015; from 2006 to 2010, it decreased for women in all age groups, except for those aged <15 and 20–24 years. In addition, for every age group with declines for both periods, the declines that occurred from 2011 to 2015 exceeded the declines from 2006 to 2010. Declines occurred for all age groups from 2014 to 2015 with the exception of women aged 25–29 years (Table 4).

Adolescents

Among the 45 areas that reported maternal age by individual year among adolescents for 2015, adolescents aged 18–19 years accounted for the majority (67.8%) of adolescent abortions and had the highest adolescent abortion rates (9.6 and 13.2 abortions per 1,000 adolescents aged 18 and 19 years, respectively). Adolescents aged <15 years accounted for the smallest percentage of adolescent abortions (2.7%) and had the lowest adolescent abortion rate (0.5 abortions per 1,000 adolescents aged 13–14 years) (Table 5). Among the 40 reporting areas that provided maternal age data for adolescents for each individual year of reporting during 2006–2015, the percentage of abortions accounted for by adolescents aged 18–19 years increased, whereas the percentage of abortions accounted for by adolescents aged <18 years decreased (Table 6). For adolescents of all ages, large decreases in abortion rates occurred from 2006 to 2015 (48%–64%) and were greater from 2011 to 2015 than from 2006 to 2010. Decreases continued among all adolescents aged ≥15 years from 2014 to 2015.

In 2015, the abortion ratio for adolescents was highest among adolescents aged <15 years (684 abortions per 1,000 live births among adolescents aged <15 years) and was lowest among adolescents aged ≥17 years (285, 292, and 247 abortions per 1,000 live births among adolescents aged 17, 18, and 19 years, respectively) (Table 5). During 2006–2015 and 2011–2015, abortion ratios decreased among adolescents of all ages (Table 6).

Gestational Age

Among the 40 areas that reported gestational age§§§ at the time of abortion for 2015, approximately two thirds (65.4%) of abortions were performed by ≤8 weeks’ gestation, and nearly all (91.1%) were performed at ≤13 weeks’ gestation (Table 7). Few abortions were performed at 14–20 weeks’ gestation (7.6%) or at ≥21 weeks’ gestation (1.3%). Among the 33 reporting areas that provided data on gestational age every year during 2006–2015, the percentage of abortions performed at ≤13 weeks’ gestation declined minimally from 91.5% to 91.0% (Table 8). However, within this gestational age range, a shift occurred toward earlier gestational ages, with the percentage of abortions performed at ≤8 weeks’ gestation increasing 3% and the percentage of abortions performed at 9–13 weeks’ gestation decreasing 9%. For the entire period of analysis, abortions performed at >13 weeks’ gestation accounted for ≤9.0% of abortions.

Among abortions performed at ≤13 weeks’ gestation and reported by individual week of gestation for 2015, 37.6% were performed at ≤6 weeks’ gestation (Table 9). The percentage contribution to abortions performed at ≤13 weeks’ gestation was progressively smaller for each additional week of gestation: 19.6% were performed at 7 weeks’ gestation, and 3.1% were performed at 13 weeks’ gestation. Among the 33 areas that reported by exact week of gestation for abortions performed at ≤13 weeks’ gestation every year during 2006–2015, a shift occurred toward the earliest gestational age reported: abortions performed at ≤6 weeks’ gestation increased 11%, those performed at 7–12 weeks’ gestation decreased 3%–15%, and those performed at 13 weeks’ gestation were stable (Table 10).

Method Type

Among the 43 areas that reported by method type for 2015 and included medical abortion on their reporting form, 64.3% of abortions were surgical abortions at ≤13 weeks’ gestation, 24.6% were early medical abortions (a nonsurgical abortion at ≤8 weeks’ gestation), and 8.8% were surgical abortions at >13 weeks’ gestation; other methods (medical abortion at >8 weeks’ gestation, intrauterine instillation, and hysterectomy/hysterotomy) were uncommon (≤2.2%) (Table 11). Among the 34 reporting areas¶¶¶ that included medical abortion on their reporting form and provided these data for the relevant years of comparison (2006 versus 2015, 2006 versus 2010, 2011 versus 2015, and 2014 versus 2015), use of early medical abortion increased 8% from 2014 to 2015 (from 22.5% of abortions to 24.2%); from 2006 to 2015, use of early medical abortion increased 114% (from 11.3% of abortions to 24.2%). Increases in early medical abortion occurred both from 2006 to 2010 (from 11.3% of abortions to 18.4% [63% increase]) and from 2011 to 2015 (from 19.2% of abortions to 24.2% [26% increase]).

Among the 30 reporting areas that provided data by procedure and individual week of gestational age each year from 2011 to 2015,**** when recent clinical guidelines extended mifepristone use to 70 days’ gestation, the percentage of abortions at 9 completed weeks’ gestation that were reported as medical abortions did not change substantially between 2011, 2012, 2013, and 2014 (5.0%, 5.7%, 6.7%, and 7.7%, respectively) and then increased to 13.0% in 2015. Among the 43†††† areas that reported by method type for 2015 and included medical abortion on their reporting form, 26.0% were medical abortions performed at ≤9 weeks’ gestation. Of these medical abortions performed at ≤9 weeks’ gestation, 94.6% were performed at ≤8 weeks and 5.4% were performed at 9 weeks.

In contrast to the increase that occurred in use of early medical abortion, use of surgical abortion at ≤13 weeks’ gestation decreased 18% from 2006 to 2015 (from 79.2% of abortions to 64.7%). Surgical abortion at >13 weeks’ gestation consistently accounted for approximately 8.0%–9.0% of all abortions, and all other methods combined consistently accounted for a limited percentage of abortions (1.4%–2.4%) during 2006–2015.

Race/Ethnicity

Among the 30 areas that reported cross-classified race/ethnicity data for 2015, non-Hispanic white women and non-Hispanic black women accounted for the largest percentages of all abortions (36.9% and 36.0%, respectively), and Hispanic women and non-Hispanic women in the other race category accounted for smaller percentages (18.5% and 8.7%, respectively) (Table 12). Non-Hispanic white women had the lowest abortion rate (6.8 abortions per 1,000 women aged 15–44 years) and ratio (111 abortions per 1,000 live births) and non-Hispanic black women had the highest abortion rate (25.1 abortions per 1,000 women aged 15–44 years) and ratio (390 abortions per 1,000 live births). Data for 2015 also are reported separately by race and by ethnicity (Tables 13 and 14).

Among the 20 areas§§§§ that reported by race/ethnicity for 2007, 2010, 2011, 2014, and 2015, abortion rates decreased substantially for the three largest race/ethnicity groups: for non-Hispanic white women, the abortion rate decreased 30% (from 9.4 abortions per 1,000 women in 2007 to 6.6 in 2015), for non-Hispanic black women it decreased 29% (from 36.5 abortions per 1,000 women in 2007 to 25.8 in 2015), and for Hispanic women it decreased 45% (from 21.0 abortions per 1,000 women in 2007 to 11.6 in 2015). For women in the three largest race/ethnicity groups, abortion rates decreased both from 2007 to 2010 and from 2011 to 2015, although the decreases were greater during the later period. From 2007 to 2010, the abortion rates decreased 10% for non-Hispanic white women (from 9.4 to 8.5 abortions per 1,000), 4% for non-Hispanic black women (from 36.5 to 34.9 abortions per 1,000), and 10% for Hispanic women (from 21.0 to 19.0 abortions per 1,000); by contrast, from 2011 to 2015, the abortion rates decreased 19% for non-Hispanic white women (from 8.1 to 6.6 abortions per 1,000), 20% for non-Hispanic black women (from 32.3 to 25.8 abortions per 1,000), and 31% for Hispanic women (from 16.9 to 11.6 abortions per 1,000).

Abortion ratios also decreased from 2007 to 2015 for the three largest race/ethnicity groups: for non-Hispanic white women, the abortion ratio decreased 27% (from 147 abortions per 1,000 live births in 2007 to 108 in 2015), for non-Hispanic black women it decreased 22% (from 514 abortions per 1,000 live births in 2007 to 403 in 2015), and for Hispanic women it decreased 26% (from 205 abortions per 1,000 live births in 2007 to 152 in 2015). From 2007 to 2010, abortion ratios only decreased among non-Hispanic white women (6% from 147 abortion per 1,000 live births in 2007 to 138 in 2010), whereas abortion ratios increased among non-Hispanic black women (3% from 514 abortions per 1,000 live births in 2007 to 531 in 2010) and Hispanic women (8% from 205 abortion per 1,000 live births in 2007 to 222 in 2010). By contrast, from 2011 to 2015, abortion ratios decreased among all women in the three largest race/ethnicity groups. The abortion ratio decreased 18% for non-Hispanic white women (from 132 to 108 abortions per 1,000 live births), 20% for non-Hispanic black women (from 501 to 403 abortions per 1,000 live births), and 28% for Hispanic women (from 211 to 152 abortions per 1,000 live births).

Marital Status

Among the 39 areas that reported by marital status for 2015, 14.3% of all women who obtained an abortion were married, and 85.7% were unmarried (Table 15). The abortion ratio was 41 abortions per 1,000 live births for married women and 373 abortions per 1,000 live births for unmarried women. Among the 30 reporting areas¶¶¶¶ that provided these data for the relevant years of comparison (2006 versus 2015, 2006 versus 2010, 2011 versus 2015, and 2014 versus 2015), the percentage of abortions among unmarried women increased 3% from 2006 to 2015 (from 83.6% to 85.9%), with a larger increase from 2006 to 2010 (2%) than from 2011 to 2015 (<1%). Among unmarried women, the abortion ratio decreased 21% from 2006 to 2015 (from 415 to 327 abortions per 1,000 live births), with a larger decrease also occurring from 2011 to 2015 (14%) than from 2006 to 2010 (6%). Among married women, the abortion ratio decreased 31% from 2006 to 2015 (from 49 to 34 abortions per 1,000 live births), with a larger decrease occurring from 2011 to 2015 (19%) than from 2006 to 2010 (10%).

Previous Live Births and Abortions

Data from the 40 areas that reported the number of previous live births for women who obtained abortions in 2015 indicate that 40.7%, 45.1%, and 14.2% of these women had zero, one or two, or three or more previous live births, respectively (Table 16). Among the 35 reporting areas***** that provided these data for the relevant years of comparison (2006 versus 2015, 2006 versus 2010, 2011 versus 2015, and 2014 versus 2015), the percentage of women obtaining abortions with no previous live births was stable; by contrast, the percentage decreased 3% for women who had one or two previous live births and increased 13% for women with three or more previous live births. Among the areas included in this comparison, 40.6%, 46.6%, and 12.8% of women had zero, one to two, or three or more previous live births, respectively, in 2006; by comparison 40.6%, 45.0%, and 14.4% of women had zero, one or two, or three or more previous live births, respectively, in 2015.

Data from the 39 areas that reported the number of previous abortions for women who obtained abortions in 2015 indicate that the majority (56.3%) had no previous abortions, 35.4% had one or two previous abortions, and 8.2% had three or more previous abortions (Table 17). Among the 35 reporting areas††††† that provided data for the relevant years of comparison (2006 versus 2015, 2006 versus 2010, 2011 versus 2015, and 2014 versus 2015), the percentage of women who had no previous abortions increased minimally (from 55.6% to 56.0%), whereas there was a 3% decrease for women who had one or two previous abortions and a 9% increase for women who had three or more previous abortions from 2006 to 2015. However, the percentage of women who had no previous abortions decreased 1% from 2006 to 2010 (from 55.6% to 54.8%) and then increased 4% from 2011 to 2015 (from 53.8% to 56.0%). By contrast, the percentage of women who had three or more previous abortions increased 12% from 2006 to 2010 (from 7.8% to 8.7%) then decreased 9% from 2011 to 2015 (from 9.3% to 8.5%). The percentage of women who had one or two previous abortions remained stable from 2006 to 2010 (36.6% to 36.5%) and then decreased 4% from 2011 to 2015 (from 36.9% to 35.5%).

Maternal Age and Marital Status by Race/Ethnicity

In select reporting areas, abortions that were categorized by maternal race and race/ethnicity were further categorized by maternal age and by marital status (Tables 18 and 19). A consistent pattern existed for abortions by maternal age across all race/ethnicity groups, with the smallest percentage of abortions occurring among adolescents aged <15 years (0.2%–0.3%) and the largest percentage occurring among women aged 20–24 years (26.5%–32.2%) and 25–29 years (26.7%–28.8%) (Table 19). A consistent pattern also existed for abortions by marital status across all race/ethnicity groups, with a higher percentage of abortions occurring among women who were unmarried (69.0%–91.8%) than among those who were married (8.2%–31.0%) (Table 19). For abortions among married women, the percentage was higher for non-Hispanic women in the other race group (31.0%) than for non-Hispanic white women (17.0%), Hispanic (15.6%) women, or non-Hispanic black women (8.2%). For abortions among unmarried women, the percentage was higher for non-Hispanic black women (91.8%) than for non-Hispanic white (83.0%) women, Hispanic (84.4%) women, or non-Hispanic women in the other race group (69.0%) (Table 19).

Weeks of Gestation by Maternal Age, Race/Ethnicity, and Method Type

In certain reporting areas, abortions that were categorized by weeks of gestation were further categorized by maternal age and race/ethnicity (Tables 20 and 21). In every subgroup for these three variables, the largest percentage of abortions occurred at ≤8 weeks’ gestation. However, by maternal age, 39.0% of adolescents aged <15 years and 56.7% of adolescents aged 15–19 years obtained an abortion by ≤8 weeks’ gestation, compared with 63.5%–70.5% of women in older age groups (Figure 3) (Table 20). Conversely, 24.3% of adolescents aged <15 years and 12.3% of adolescents aged 15–19 years obtained an abortion after 13 weeks’ gestation, compared with 8.0%–9.4% for women in older age groups. By race/ethnicity, 59.1% of non-Hispanic black women obtained an abortion at ≤8 weeks’ gestation, compared with 67.5%–70.3% of women from other race/ethnicity groups. Differences in abortions after 13 weeks’ gestation across race/ethnicity groups were less apparent than differences across age groups (10.5% for non-Hispanic black women, compared with 8.0%–8.5% for women in the remaining race/ethnicity groups).

Among abortions categorized by weeks of gestation and method type, surgical abortion accounted for the largest percentage of abortions within every gestational age category (Table 22). At ≤8 weeks’ gestation, surgical abortion accounted for a smaller percentage of abortions (64.2%) than at any other stage of gestation; at 9–20 weeks’ gestation, surgical abortion accounted for 94.5%–99.2% of all abortions and at ≥21 weeks’ gestation, it accounted for 94.5% of abortions. By contrast, at ≤8 weeks’ gestation, medical abortion accounted for 35.8% of abortions then decreased to 5.5% at 9–13 weeks and 0.7%–1.9% at 14–20 weeks before increasing to 4.5% at ≥21 weeks. Throughout gestation, abortions performed by intrauterine instillation or hysterectomy/hysterotomy were rare (<0.1%–0.7% of abortions).

Abortion Mortality

Using national data from the Pregnancy Mortality Surveillance System (51), CDC identified six abortion-related deaths for 2014 (Table 23). Investigation of these cases indicated that all six deaths were related to legal abortion and none to illegal abortion.

The annual number of deaths related to legal induced abortion has fluctuated from year to year over the past 40 years (Table 23). For example, nine legal induced abortion-related deaths occurred in 1998, four in 1999, and 11 in 2000. Because of this variability and the relatively limited number of legal induced abortion-related deaths every year, national legal abortion case-fatality rates were calculated for consecutive 5-year periods during 1973–2007 and for a consecutive 7-year period during 2008–2014. The national legal induced abortion case-fatality rate for 2008–2014 was 0.62 legal induced abortion-related deaths per 100,000 reported legal abortions. This case-fatality rate was similar to the rate for most of the preceding 5-year periods but lower than the case-fatality rate of 2.09 legal induced abortion-related deaths per 100,000 reported legal abortions for the 5-year period (1973–1977) immediately following nationwide legalization of abortion in 1973. Possible abortion-related deaths that occurred during 2015–2018 are being assessed.