Results

U.S. Totals

Among the 49 reporting areas that provided data for 2014, a total of 652,639 abortions were reported. Of these abortions, 642,317 (98.4%) were obtained from the 48 reporting areas that provided data every year during 2005–2014.¶¶ These same 48 areas had an abortion rate of 12.1 abortions per 1,000 women aged 15–44 years and an abortion ratio of 186 abortions per 1,000 live births (Table 1). From 2013 to 2014, the total number of reported abortions decreased 2% (from 654,458), the abortion rate decreased 2% (from 12.4 abortions per 1,000 women aged 15–44 years), and the abortion ratio decreased 7% (from 199 abortions per 1,000 live births). From 2005 to 2014, among the same 48 areas that reported every year during this period, the total number of reported abortions decreased 21% (from 809,354), the abortion rate decreased 22% (from 15.6 abortions per 1,000 women aged 15–44 years), and the abortion ratio decreased 21% (from 235 abortions per 1,000 live births) (Figure 1). Among these same 48 areas, the annual rate of decrease fitted from the regression analysis was greater during 2010–2014 than during 2005–2009 for all three measures of abortion. During 2010–2014, the number of reported abortions decreased by 29,583 abortions per year, the abortion rate decreased by 0.62 abortions per 1,000 women per year, and the abortion ratio decreased by 10.1 abortions per 1,000 live births per year. In contrast, during 2005–2009, the number of reported abortions decreased by 7,451 abortions per year, the abortion rate decreased by 0.16 abortions per 1,000 women per year, and the abortion ratio decreased by 2.3 abortions per 1,000 live births per year.

Occurrence and Residence

Abortion numbers, rates, and ratios for 2014 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 3.5 abortions per 1,000 women aged 15–44 years in South Dakota to 23.9 abortions per 1,000 women in New York [city and state combined]) and the abortion ratio (from 45 abortions per 1,000 live births in South Dakota to 293 abortions per 1,000 live births in the District of Columbia).*** Similarly, a considerable range existed by residence††† in the abortion rate (from 4.5 abortions per 1,000 women aged 15–44 years in Utah to 23.2 abortions per 1,000 women aged 15–44 years in New York [city and state combined]) and the abortion ratio (from 57 abortions per 1,000 live births in Utah to 293 abortions per 1,000 live births in Connecticut). Because of variation that occurred among reporting areas in the percentage of abortions obtained by out-of-state residents (from 0.9% in Hawaii to 55.6% in the District of Columbia), 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, 12.2% of abortions were reported to CDC without exact information on maternal residence.

Maternal Age

Among the 46 areas that reported by maternal age for 2014, women in their 20s accounted for the majority (58.9%) of abortions and had the highest abortion rates (21.3 and 18.4 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 3.6%, respectively) and had the lowest abortion rates (0.5 and 2.6 abortions per 1,000 women aged <15 and ≥40 years, respectively). Among the 42 reporting areas that provided data by maternal age every year during 2005–2014, 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 2005 to 2014, abortion rates decreased among all age groups <40 years, although the decreases for adolescents (62% and 49% for adolescents aged <15 and 15–19 years, respectively) were greater than the decreases for women aged 20–39 years (5%–27%). For all age groups, including women aged ≥40 years, decreases in the abortion rate were greater from 2010 to 2014 than from 2005 to 2009, and these decreases continued from 2013 to 2014 for all age groups <25 years.

In contrast to the percentage of abortions and abortion rates, abortion ratios in 2014 were highest among adolescents aged ≤19 years and lowest among women aged 30–39 years (Figure 2) (Table 3). Among the 42 reporting areas that provided data by maternal age for every year during 2005–2014, abortion ratios decreased among women in all age groups. The abortion ratio increased 12% for adolescents aged <15 years from 2005 to 2009 but decreased for all age groups from 2010 to 2014. In addition, for every age group with declines for both periods, the declines that occurred from 2010 to 2014 exceeded the declines from 2005 to 2009; for every age group, these declines continued from 2013 to 2014 (Table 4).

Adolescents

Among the 43 areas that reported maternal age by individual year among adolescents for 2014, adolescents aged 18–19 years accounted for the majority (66.8%) of adolescent abortions and had the highest adolescent abortion rates (10.6 and 14.3 abortions per 1,000 adolescents aged 18 and 19 years, respectively); adolescents aged <15 years accounted for the smallest percentage of adolescent abortions (2.8%) and had the lowest adolescent abortion rate (0.5 abortions per 1,000 adolescents aged 13–14 years) (Table 5). Among the 38 reporting areas that provided maternal age data for adolescents for each individual year of reporting during 2005–2014, the percentage of abortions accounted for by adolescents aged 18 and 19 years increased, whereas the percentage of abortions accounted for by adolescents aged <18 years decreased (Table 6). Among adolescents aged <18 years, abortion rates decreased by 57%–62%; among adolescents aged 18 and 19 years, the abortion rates decreased 50% and 43%, respectively. For all age groups, decreases in the abortion rate were greater from 2010 to 2014 than from 2005 to 2009, and these decreases continued from 2013 to 2014.

In 2014, the abortion ratio for adolescents decreased with increasing age and was lowest among adolescents aged 19 years (Table 5). During 2005–2014, 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 2014, the majority (67.0%) of abortions were performed by ≤8 weeks’ gestation, and 91.5% were performed at ≤13 weeks’ gestation (Table 7). Few abortions were performed at 14–20 weeks’ gestation (7.2%) or at ≥21 weeks’ gestation (1.3%). Among the 32 reporting areas that provided data on gestational age every year during 2005–2014, the percentage of abortions performed at ≤13 weeks’ gestation was stable (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 6% and the percentage of abortions performed at 9–13 weeks’ gestation decreasing 13%. For the entire period of analysis, abortions performed at >13 weeks’ gestation accounted for ≤8.5% of abortions.

Among abortions performed at ≤13 weeks’ gestation and reported by individual week of gestation for 2014, 40.7% 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: 18.5% were performed at 7 weeks’ gestation, and 2.9% were performed at 13 weeks’ gestation. Among the 32 areas that reported by exact week of gestation for abortions performed at ≤13 weeks’ gestation every year during 2005–2014, a shift occurred toward the earliest gestational age reported: abortions performed at ≤6 weeks’ gestation increased 21%, and those performed at 7–13 weeks’ gestation decreased 7%–20% (Table 10).

Method Type

Among the 43 areas that reported by method type for 2014 and included medical abortion on their reporting form for medical providers, 67.4% of abortions were surgical abortions at ≤13 weeks’ gestation, 22.6% were early medical abortions (a nonsurgical abortion at ≤8 weeks’ gestation), and 8.6% were surgical abortions at >13 weeks’ gestation; all other methods were uncommon (<2%) (Table 11). Among the 35 reporting areas that included medical abortion on their reporting form and provided these data for the relevant years of comparison (2005 versus 2014, 2005 versus 2009, 2010 versus 2014, and 2013 versus 2014),§§§ use of early medical abortion increased 1% from 2013 to 2014 (from 22.2% of abortions to 22.5%); from 2005 to 2014, use of early medical abortion increased 110% (from 10.7% of abortions to 22.5%). Increases in early medical abortion occurred both from 2005 to 2009 (from 10.7% of abortions to 16.5% [54% increase]) and from 2010 to 2014 (from 18.4% of abortions to 22.5% [22% increase]).

Among the 31 reporting areas that provided data by procedure and individual week of gestational age each year from 2011 to 2014, the percentage of abortions at 9 weeks’ gestation that were medical abortions did not change substantially between 2011, 2012, and 2013 (5.0%, 5.8%, and 6.8%, respectively), but then increased to 8.2% in 2014.

In contrast to the increase that occurred in use of early medical abortion, use of surgical abortion at ≤13 weeks’ gestation decreased 14% from 2005 to 2014 (from 78.8% of abortions to 67.5%). Surgical abortion at >13 weeks’ gestation consistently accounted for approximately 8.0% of all abortions, and all other methods consistently accounted for a small percentage of abortions (<0.1%–1.3%) during 2005–2014.

Race/Ethnicity

Among the 30 areas that reported cross-classified race/ethnicity data for 2014, non-Hispanic white women and non-Hispanic black women accounted for the largest percentages of all abortions (38.0% and 36.0%, respectively), and Hispanic women and non-Hispanic women in the other race category accounted for smaller percentages (18.3% and 7.7%, respectively) (Table 12). Non-Hispanic white women had the lowest abortion rate (7.5 abortions per 1,000 women aged 15–44 years) and ratio (121 abortions per 1,000 live births) and non-Hispanic black women had the highest abortion rate (26.6 abortions per 1,000 women aged 15–44 years) and ratio (391 abortions per 1,000 live births). Data for 2014 are also reported separately by race and by ethnicity (Tables 13 and 14).

Among the 20 areas¶¶¶ that reported by race/ethnicity for 2007 (the first year with sufficient data), 2009, 2010, and 2014, abortion rates decreased substantially for all three major race/ethnicity groups: for non-Hispanic white women, the abortion rate decreased 26% (from 9.4 abortions per 1,000 women in 2007 to 7.0 in 2014), for non-Hispanic black women it decreased 27% (from 36.5 abortions per 1,000 women in 2007 to 26.7 in 2014), and for Hispanic women it decreased 41% (from 20.8 abortions per 1,000 women in 2007 to 12.3 in 2014). For women in all three major race/ethnicity groups, abortion rates decreased from 2007 to 2009 and from 2010 to 2014, but the decreases were greater during the later period, especially for non-Hispanic black and Hispanic women. From 2007 to 2009, the abortion rates decreased 6% for non-Hispanic white women (from 9.4 to 8.8 abortions per 1,000), 1% for non-Hispanic black women (from 36.5 to 36.3 abortions per 1,000), and 8% for Hispanic women (from 20.8 to 19.1 abortions per 1,000); by contrast from 2010 to 2014, the abortion rates decreased 18% for non-Hispanic white women (from 8.5 to 7.0 abortions per 1,000), 23% for non-Hispanic black women (from 34.9 to 26.7 abortions per 1,000), and 35% for Hispanic women (from 19.0 to 12.3 abortions per 1,000).

Abortion ratios also decreased from 2007 to 2014 for all three major race/ethnicity groups: for non-Hispanic white women, the abortion ratio decreased 23% (from 147 abortions per 1,000 live births in 2007 to 113 in 2014), for non-Hispanic black women it decreased 19% (from 514 abortions per 1,000 live births in 2007 to 417 in 2014), and for Hispanic women it decreased 22% (from 205 abortions per 1,000 live births in 2007 to 160 in 2014). As with abortion rates, decreases in abortion ratios were greater for women in all three major race/ethnicity groups from 2010 to 2014 as compared with 2007 to 2009, with the difference in the change between the two periods being most notable for non-Hispanic black and Hispanic women. From 2007 to 2009, abortion ratios decreased 3% among non-Hispanic white women (from 147 to 142 abortions per 1,000 live births) but increased 4% among non-Hispanic black women (from 514 to 535 abortions per 1,000 live births) and did not change among Hispanic women (205 abortions per 1,000 live births). By contrast, from 2010 to 2014, abortion ratios decreased among women in all three race/ethnicity groups. The abortion ratio decreased 18% for non-Hispanic white women (from 138 to 113 abortions per 1,000 live births), 21% for non-Hispanic black women (from 531 to 417 abortions per 1,000 live births), and 28% for Hispanic women (from 222 to 160 abortions per 1,000 live births).

Marital Status

Among the 42 areas that reported by marital status for 2014, 14.5% of all women who obtained an abortion were married, and 85.5% were unmarried (Table 15). The abortion ratio was 43 abortions per 1,000 live births for married women and 373 abortions per 1,000 live births for unmarried women. Among the 35 reporting areas**** that provided these data for the relevant years of comparison (2005 versus 2014, 2005 versus 2009, 2010 versus 2014, and 2013 versus 2014), the percentage of abortions among unmarried women increased 3% from 2005 to 2014 (from 83.5% to 85.7%), with a larger increase from 2005 to 2009 (2%) than from 2010 to 2014 (<1%). Among unmarried women, the abortion ratio decreased 23% from 2005 to 2014 (from 481 to 369 abortions per 1,000 live births), with a larger decrease also occurring from 2010 to 2014 (16%) than from 2005 to 2009 (10%). Among married women, the abortion ratio decreased 25% from 2005 to 2014 (from 55 to 41 abortions per 1,000 live births), with a larger decrease occurring from 2010 to 2014 (18%) than from 2005 to 2009 (7%).

Previous Live Births and Abortions

Data from the 40 areas that reported the number of previous live births for women who obtained abortions in 2014 indicate that 40.4%, 45.7%, and 13.8% of these women had zero, one to two, or three or more previous live births, respectively (Table 16). Among the 32 reporting areas†††† that provided these data for the relevant years of comparison (2005 versus 2014, 2005 versus 2009, 2010 versus 2014, and 2013 versus 2014), the percentage of women obtaining abortions who had no previous live births was stable; by contrast, the percentage decreased for women who had one to two previous live births and increased for women who had three or more previous live births. Among the areas included in this comparison, 40.4%, 47.0%, and 12.6% of women had zero, one to two, or three or more previous live births, respectively, in 2005; 40.8%, 45.5%, and 13.7% of women had zero, one to two, or three or more previous live births, respectively, in 2014.

Data from the 40 areas that reported the number of previous abortions for women who obtained abortions in 2014 indicate that the majority (55.1%) had no previous abortions, 36.3% had one to two previous abortions, and 8.6% had three or more previous abortions (Table 17). Among the 33 reporting areas§§§§ that provided data for the relevant years of comparison (2005 to 2014, 2005 versus 2009, 2010 versus 2014, and 2013 versus 2014), the percentage of women who had zero or one to two previous abortions did not change substantially over time, but the percentage of women who had three or more previous abortions increased from 2005 to 2014. Among the areas included in this comparison, 55.5%, 36.6%, and 7.9% of women had zero, one to two, or three or more previous abortions, respectively, in 2005; 55.3%, 36.1%, and 8.6% of women had zero, one to two, or three or more previous abortions, respectively, in 2014.

Maternal Age and Marital Status by Race/Ethnicity

In certain 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%–0.4%) and the largest percentage occurring among women aged 20–24 years (27.3%–33.8%) (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 (68.5%–91.9%) than among those who were married (8.1%–31.5%) (Table 19). However, for abortions among unmarried women, the percentage was higher for non-Hispanic black women (91.9%) than for non-Hispanic white (83.1%) or Hispanic women (84.7%) (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, race, 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, 43.0% of adolescents aged <15 years and 56.5% of adolescents aged 15–19 years obtained an abortion by ≤8 weeks’ gestation, compared with 63.2%–72.5% of women in older age groups (Figure 3) (Table 20). Conversely, 22.6% of adolescents aged <15 years and 12.5% of adolescents aged 15–19 years obtained an abortion after 13 weeks’ gestation, compared with 8.0%–9.5% for women in older age groups. By race/ethnicity, 61.0% of non-Hispanic black women obtained an abortion at ≤8 weeks’ gestation, compared with 69.7%–72.6% 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 (9.8% for non-Hispanic black women, compared with 7.2%–8.1% 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 (67.8%) than at any other stage of gestation. At 9–20 weeks’ gestation, surgical abortion accounted for 96.6%–98.8% of all abortions; this percentage then decreased to 90.2% of abortions at ≥21 weeks’ gestation. By contrast, at ≤8 weeks’ gestation early medical abortion accounted for 32.2% of abortions then decreased to 3.3% at 9–13 weeks and 1.0%–1.4% at 14–17 weeks before increasing to 3.0% at 18–20 weeks and 9.0% at ≥21 weeks. Throughout gestation, abortions performed by intrauterine instillation or hysterectomy/hysterotomy were rare (<0.01%–0.7% of abortions).

Abortion Mortality

Using national data from the Pregnancy Mortality Surveillance System (49), CDC identified four abortion-related deaths for 2013 (Table 23). These deaths were identified either by some indication of abortion on the death certificate, by reports from a health care provider or public health agency, or from a media report. Investigation of these cases indicated that all four 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 small 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 6-year period during 2008–2013. The national legal induced abortion case-fatality rate for 2008–2013 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 2014–2017 are being assessed.