Reasons given for having abortions in the United States by Wm. Robert Johnston

last updated 18 January 2016

Summary: This report reviews available statistics regarding reasons given for obtaining abortions in the United States, including surveys by the Alan Guttmacher Institute and data from seven state health/statistics agencies that report relevant statistics (Arizona, Florida, Louisiana, Minnesota, Nebraska, South Dakota, and Utah). The official data imply that AGI claims regarding "hard case" abortions are inflated by roughly a factor of three. Actual percentage of U.S. abortions in "hard cases" are estimated as follows: in cases of rape, 0.3%; in cases of incest, 0.03%; in cases of risk to maternal life, 0.1%; in cases of risk to maternal health, 0.8%; and in cases of fetal health issues, 0.5%. About 98.3% of abortions in the United States are elective, including socio-economic reasons or for birth control. This includes perhaps 30% for primarily economic reasons and possibly 0.1% each for sex selection and selective reduction of multifetal pregnancies.

Contents: Introduction

AGI studies

Issues with rape-related statistics

Abortions for sex selection

Abortions for ART selective reduction

State statistics

Federally-funded abortions

Adjusted figures

"Partial-birth" abortions and other late-term abortions

Summary and conclusions

Sources

Introduction: The reasons given for having abortions are relevant to the policy debate on the abortion issue. In many countries, abortions are permissible only for limited reasons.[1] In the United States, abortion on demand and for any reason is the existing state of law (with a few limitations in some states[2]). As debate continues regarding this practice, advocates of unrestrained abortion often cite the "hard cases"--cases of rape, incest, life or health of the mother or baby--in defending access to abortion. It is widely acknowledged that such cases are rare; however, available data suggest that some commonly cited figures are exaggerated.

Further, the prevailing preferences of the American electorate are often cited in regard to U.S. abortion legislation. Some will claim, for example, that most Americans support legal abortion. While majority opinion is irrelevant to issues of constitutionally stipulated human rights (regardless of what position on abortion one thinks is the one consistent with human rights), the claim itself is a half-truth. Most Americans would oppose banning abortions for hard cases, but at the same time most Americans would support limits on elective abortions, e.g. abortions for convenience or for sex selection.

This article will review some available data that addresses the reasons cited for abortions in the United States. First, survey-based data from the Alan Guttmacher Institute is reviewed, as it represented the most frequently cited data. Two specific issues, abortions in cases of rape and abortions for sex selection, are examined. Next, data on reasons for abortions from state agencies and other official sources is presented; this data represents an often overlooked statistical resource on the issue. Although reasons for "partial-birth" abortion are fundamentally different than those for abortions in general, available data is examined as well. Finally, the available statistical data is used to quantify reasons for abortions in the United States.

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AGI studies: The Alan Guttmacher Institute (AGI) has published several studies examining reasons for abortions in the United States. Two studies conducted in 1987 and 2004 surveyed a total of 3,900 women obtaining abortions, of whom 2,981 provided information. A third survey conducted in 2000-2001 surveyed abortion seekers about contraceptive use; this study provided some limited data relating to reasons for abortions for 10,683 women. These studies are discussed in chronological order.

The 1987 AGI study (published in 1988)[3] surveyed 1,900 women who had abortions. The results of this survey are among the most commonly cited figures regarding reasons for abortions in the United States. The 1,773 women who responded gave an average of 3.7 reasons from the list, with the most important reasons cited by respondents tabulated below. It should be noted that only rounded percentages, not raw numbers, were provided; an AGI review article in 1998 [4] cited the 1988 study but gave slightly different figures, shown below in parenthesis (the parenthetical figure for rape and incest is a range of uncertainty derived from breakdowns in the 1988 report).

REASONS GIVEN FOR ABORTIONS: AGI SURVEY, 1987 [3, 4] reason % of abortions rape or incest 1 (0.4-1.3) mother has health problems 3 (2.8) possible fetal health problems 3 (3.3) unready for responsibility 21 is too immature or young to have child 11 (12.2) woman's parents want her to have abortion <0.5 has problems with relationship or wants to avoid single parenthood 12 (14.1) husband or partner wants her to have abortion 1 has all the children she wanted or all children are grown 8 (7.9) can't afford baby now 21 (21.3) concerned about how having baby would change her life 16 doesn't want others to know she had relations or is pregnant 1 other 3

Another AGI study[5], conducted in 2000-2001, examined contraceptive use but provides some information relating to reasons for abortion. Some data from this survey of 10,683 women obtaining abortions is given below:

REASONS GIVEN FOR ABORTIONS: AGI SURVEY, 2000-2001 [5] reason or situation number % of abortions not using contraception 4,957 46.40 forced to have relations ~64 0.6 using contraception 5,726 53.60 contraceptive failed despite proper use ~1,808 16.9 total 10,683 100

In this survey, 0.6% reported being forced to have relations (although a figure as high as 0.8% is possible depending on data breakdown). It is also interesting to note that 17% of abortions were for pregnancies following "proper" use of contraception. This would tend to undermine the claims regarding the efficacy of contraception methods, something highly promoted by groups such as Planned Parenthood.

An AGI study published in 2005 [6] was modeled after the 1987 study, providing an update to that work. This survey was conducted from December 2003 to March 2004; of approximately 2,000 women obtaining abortions who were surveyed, 1,209 completed questionnaires. As with the 1987, only rounded percentages as opposed to raw numbers were reported. Again, respondents could give multiple reasons, and the median number of reasons given was four. The table below gives reported percentages for the most important reason and for all reasons cited.

REASONS GIVEN FOR ABORTIONS: AGI SURVEY, 2004 [6] reason % of abortions,

most important reason % of abortions,

all reasons rape <0.5 (1) incest (<0.5) mother has health problems 4 (12) possible fetal health problems 3 (13) unready 25 (32) is too immature or young to have child 7 (22) woman's parents want her to have abortion <0.5 (6) has problems with relationship or wants to avoid single parenthood 8 (48) husband or partner wants her to have abortion <0.5 (14) has all the children she wanted or all children are grown 19 (38) can't afford baby now 23 (73) --unmarried (42) --student or planning to study (34) --can't afford baby and child care (28) --can't afford basic life needs (23) --unemployed (22) --can't leave job to care for baby (21) --would have to find new place to live (19) --not enough support from husband/partner (14) --husband/partner unemployed (12) --currently on welfare or public assistance (8) concerned about how having baby would change her life (74) --would interfere with education plans 4 (38) --would interfere with career plans (38) --would interfere with care of children or dependents (32) doesn't want others to know she had relations or is pregnant <0.5 (25) other 6

Recent AGI literature has given figures of abortions following rape or incest. For example, an April 2005 information sheet [7] states that about 13,000 women have abortions following rape or incest. This is 1.0% of AGI-estimated annual abortions in 2000-2002. This figure appears to be derived from the 1987 survey percentage (or from preliminary results of the 2004 survey).

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Issues with rape-related statistics: The AGI-based figure of 1% of abortions for cases of rape or incest is widely cited. However, it is the product of a limited survey by an organization with a stated objective of advocating unlimited access to abortion services. It is thus desirable to seek an independent source of such figures, such as that provided by the state reported statistics reviewed below. Evaluating this claim also involves issues of reliability of rape-related statistics.

If the AGI figure for 1987 is correct, it would imply that 15,600 abortions in 1987 were for such cases.[8] Since the FBI only reported 91,111 forcible rapes in the U.S. in that year[9], this would imply that one out of six rapes resulted in pregnancy. This is a higher fraction than appears to be supported by medical research--although this ratio does not yet account for underreporting of rapes.

According to the FBI, reported annual numbers of forcible rapes in the United States rose from about 90,000 in the mid 1980s to a peak of 109,062 in 1992, then dropped to about 89,000-95,000 for the years 1998-2009 and to 84,767 in 2010 [9]. A 2012 Department of Justice report [10] estimated rates of crime underreporting for 1994-2010; the fraction of unreported rapes and sexual assaults for this period ranged from 44% to 77%, or an average of 64%. These figures are not strictly applicable to forcible rape but provide a useful estimate. Further, these figures carry a high degree of uncertainty, as they imply annual figures for rapes (reported plus unreported) ranging from 168,000 to 424,000 over this period, with large year-to-year variability. Nonetheless, these figures may be used to estimate average annual figures for 1994-2010 as 93,000 reported forcible rapes and 184,000 more unreported, or 277,000 total per year.

Some sources claim much larger unreported numbers. Stewart and Trussell [11] cite 333,000 rapes and sexual assaults reported in 1998, and additionally cite a National Women's Study which claimed 683,000 rapes in 1992. The latter figure would mean 5.3 unreported rapes for every reported rape. The wide range in estimates of unreported rapes is evidence of the problem of quantifying these figures.

Another issue is the frequency of rape-related pregnancy. Some sources claim very low frequencies, citing medical studies, and conclude that the total number of pregnancies resulting from rape each year is on the order of 200-500.[12] Others obtain somewhat higher frequencies. Holmes et al. [13] surveyed 4,008 women and found a rate of pregnancy following rape of 5%. Additionally, of 34 cases of pregnancy after rape, they found 17 (50%) had an abortion, 11 (32%) kept the baby, 2 (6%) gave the baby up for adoption, and 4 (12%) miscarried.

Taking the 2005-2010 average annual reported rapes of 90,000 per year and assuming 5% result in pregnancy and 50% of these are aborted, this implies 4,500 pregnancies per year following rape of which 2,250 are aborted. The most extreme claimed rates of underreporting are necessary to bring this in line with AGI's claim of 13,000 rape-related abortions per year. Even higher levels of rape-related pregnancies have been claimed: Stewart and Trussell [11] cite the previously mentioned National Women's Study claiming 32,000 per year in 1992, and this figure is repeated by Holmes et al. [13] and by an AGI article in 2002 [14]. Stewart and Trussell extrapolate this to 25,000 per year in 1998 merely by considering lower crime rates. These higher rates, while somewhat dubious, are required to support the AGI claim of 1% of abortions for rape.

However, adopting the DOJ underreporting figures, average implied annual figures for 2005-2010 are as follows:

90,300 reported rapes (FBI figures);

265,000 total rapes, reported and unreported (using DOJ figures);

6,600 abortions in cases of rape (using Holmes et al. figures);

1,218,000 abortions (AGI figures);

0.54% of abortions in cases of rape.

Note that these statistical approaches carry large uncertainties. Circumstances surrounding both rape and abortion prompt degrees of both underreporting and inaccurate reporting. Regardless of the acutal rate of reporting, it is widely agreed that large numbers of rapes go unreported to authorities. Available information on reasons for abortion are generally self-reported by the abortion seeker and thus not verifiable. Some women seeking abortion might conceal rape as the actual reason. Alternately, some women might falsely claim rape as a reason, for example to obtain funding for an abortion (this appears to be an issue with federally funded abortions as discussed below). Thus, rape-related abortion data interpretation is hampered by the particularly traumatic circumstances of such cases. Nonetheless, it will be seen below that the larger sampling in states that report figures for rape-related abortions give consistent results, supporting the reasoning for lower figures than the AGI figures.

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Abortions for sex selection: While not a major issue in the United States, abortions for the purpose of selecting the sex of the child are quite common in Asia, where they are generally used to abort female fetuses. Several Asian countries, including the People's Republic of China, India, and South Korea, are beginning to show significant demographic impacts resulting from such practices. India and the PRC have both been compelled to legislate against sex-selection abortions despite their otherwise broad support of abortion practice.[15]

Regarding the United States, in 1998 JAMA published a study[16] reporting a 0.2% decrease in the ratio of male to female live births from 1970 to 1990. The authors of the 1998 study discuss a variety of health factors that could influence this ratio. Data from the CDC in 2002[17] suggested that the decrease in the male/female birth ratio was 0.3% from 1970 to 2000. In 2005 the CDC completed a more detailed analysis[18] of trends in the U.S. male/female birth ratio. The authors identified several up or down trends in the ratio between 1940 and 2002, including a 0.6% decline in the male/female birth ratio from 1970 to 2002. They analyzed possible factors (age of mother, birth order, ethnicity) and noted additional parental/environmental characteristics that naturally influence the birth ratio. They did note that family preference can affect the birth ratio (although they did not explicitly point out that this is via such means as sex selection abortions) and that this does affect it in some countries, but do not report any indication that it is a factor in the United States. The historical variation in U.S. male/female birth ratio is within the range observed in connection to biological influences (e.g. parental/environmental).

Nonetheless, of reported trends in male/female birth ratio by ethnic group, the 2005 CDC study finds the greatest increase from 1970 to 2002 among children of Chinese and Japanese ethnicity: a trend of an increase of 0.022 for Chinese and 0.013 Japanese children, respectively. The result is that births of Chinese ethnicity have the highest average male/female ratio in 1998-2002, 1.076 versus the national average of 1.048.[18]

The overall change in the male/female birth ratio from 1970 to 2002 represents about 13,000 fewer annual male births by 2002, which would correspond to about 1% of abortions.[19] Still, this is too small a change in sex ratio to be distinguished among other potential causes for the population at large. Some observers suggest that this is an issue in some ethnic groups[15]. Were the change in birth ratio among Asian Americans to be attributed to abortions, it would represent on the order of 1,000-2,000 abortions per year, or about 0.1% of abortions. This may be considered an upper limit.

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Abortions for ART selective reduction: In connection with the increased use of assisted reproductive technologies (ART) is increased use of abortion to selectively reduce the number of fetuses in multifetal pregnancies. ART births represented 1.65% of US live births in 2012 [38]. Evans et al. [39] discuss relative changes in the number of twin and higher-multiple pregnancies from 1989 to 2011. Much of these changes are attributed to increased use of ART and changes in plurality of ART births, both due to selection reduction abortions and to changes in numbers of ART-implanted embryos [40]. The post-2003 reductions in multiple births reported by [39] correspond to differences of 3,500-7,000 fetuses per year, which is partly attributable to selective reductions. These figures then suggest upper limits of 0.3-0.7% on selective reduction abortions among all abortions. Stone et al. [41] report on 1,000 selective reduction abortions at a single center from 1999-2006, about 120/year, relative to 2,000 annual in-vitro fertilization cycles at the same center [42]. Such figures scaled to the annual number of ART pregnancies implies selective reduction abortions are about 0.4% of all abortions.

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State statistics: In the United States, limited official statistics are available. Abortion reporting varies significantly from state to state. Seven states report data on the reasons given for obtaining abortions (with varying definitions and levels of detail). These figures are self-reported by women obtaining abortions, as in the case of the AGI studies discussed above. However, they are independent data and involve a larger sample. Below are results for these states--Arizona, Florida, Louisiana, Minnesota, Nebraska, South Dakota, and Utah:

REASONS GIVEN FOR ABORTIONS: ARIZONA, 1985-2013 [20] reason 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 medical 18 33 15 14 23 16 7 11 11 7 10 3 6 11 9 17 10 6 12 19 elective 8,961 10,193 10,511 13,328 14,611 15,274 14,300 15,228 14,068 11,078 13,075 13,504 12,709 11,739 11,891 10,588 10,768 11,012 14,144 10,390 unknown 299 347 2,013 322 240 314 148 376 271 490 805 375 178 102 360 1,133 90 3 450 247 total 9,278 10,573 12,539 13,664 14,874 15,604 14,455 15,615 14,350 11,575 13,890 13,882 12,893 11,852 12,260 11,738 10,868 11,021 14,606 10,656 reason 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 2013 total

1980-2013 % of abortions % of abortions,

known reasons medical 15 10 21 43 207 78 8 2 4 19 119 217 983 0.26 0.29 elective 9,614 8,210 9,910 9,602 10,770 9,987 10,436 10,482 10,377 10,017 0 0 337,816 89.80 99.71 unknown 2 6 466 449 1,324 381 62 14 15 9 13,221 13,184 10,992 9.94 N/A total 9,631 8,226 10,397 10,094 12,301 10,446 10,506 10,486 10,396 10,045 13,340 13,401 376,184 100.00 100.00 REASONS GIVEN FOR ABORTIONS: FLORIDA, 1998-2008 [21] reason 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Jan-Jun 2008 total Jan 1998-

Jun 2008 % of abortions % of abortions,

known reason physical condition 401 346 453 350 439 514 460 514 649 527 147 4,800 0.51 0.51 mental condition 159 150 143 109 72 80 19 54 144 86 9 1,025 0.11 0.11 abnormal fetus 470 474 430 454 482 457 501 606 676 463 240 5,253 0.56 0.56 personal choice 80,889 82,589 87,199 84,343 86,445 88,409 90,315 90,866 93,541 90,322 46,283 921,201 98.30 98.30 other 416 412 330 314 521 535 411 473 574 556 303 4,845 0.52 0.52 unknown 0 0 8 19 5 0 4 0 2 0 0 38 0.00 N/A total 82,335 83,971 88,563 85,589 87,964 89,995 91,710 92,513 95,586 91,954 46,982 937,162 100.00 100.00 REASONS GIVEN FOR ABORTIONS: FLORIDA, 2008-2009 [22] reason Jul-Dec 2008 2009 total Jun 2008-

Dec 2009 % of abortions rape 1,407 866 2,273 1.85 incest 45 0 45 0.04 life of mother 21 58 79 0.06 physical health of mother 60 139 199 0.16 emotional/psychological health of mother 41 131 172 0.14 serious fetal defect/deformity/abnormality 271 517 788 0.64 socio-economic reasons 3,320 6,580 9,900 8.08 elective 35,373 73,747 109,120 89.02 total 40,538 82,038 122,576 100.00 REASONS GIVEN FOR ABORTIONS: LOUISIANA, 1996-2012 [23] reason 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 total

1996-2012 % of abortions % of abortions,

known reason rape or incest 4 4 3 1 1 1 0 0 1 1 0 0 0 0 2 14 23 55 0.03 0.31 physical health 8 17 19 16 14 8 3 1 9 15 3 1 0 1 9 98 192 414 0.25 2.34 mental health 392 415 164 77 140 52 37 27 1 31 6 7 4 7 59 58 89 1,566 0.95 8.86 risk of fetal deformity 9 21 7 9 13 10 7 0 2 5 2 1 0 2 1 53 54 196 0.12 1.11 other 114 421 250 258 192 143 18 10 182 157 0 0 0 31 695 4,096 8,867 15,434 9.32 87.37 unknown 11,357 10,861 10,908 11,647 11,024 10,718 10,386 10,604 11,029 8,351 6,193 6,824 6,813 8,126 8,104 4,636 0 147,581 89.15 N/A total 11,884 11,739 11,351 12,008 11,384 10,932 10,451 10,642 11,224 8,860 6,204 6,833 6,817 8,167 8,870 8,955 9,225 165,546 100.00 100.00 REASONS GIVEN FOR ABORTIONS: MINNESOTA, 1998-2014 [24] reason* Oct-Dec

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 total

Oct1998-Dec2014 % of abortions % of abortions,

known reason rape 30 113 124 98 81 75 69 71 90 91 76 58 65 51 69 62 74 1,297 0.62 0.82 incest 2 3 6 7 14 9 6 6 12 7 12 17 8 11 18 18 13 169 0.08 0.11 emotional health 270 653 793 859 844 1,001 1,019 1,206 699 828 848 615 748 873 776 737 747 13,516 6.46 8.53 physical health 149 510 584 636 622 844 778 808 588 651 647 487 492 486 564 542 595 9,983 4.77 6.30 pregnancy will impair major bodily function 22 49 44 34 30 27 31 20 30 21 34 42 29 46 43 41 37 580 0.28 0.37 fetal anomalies 86 177 210 158 113 147 133 129 162 155 150 160 182 204 171 193 188 2,718 1.30 1.71 economic reasons 734 1,601 2,379 2,512 2,546 2,499 2,647 4,091 5,020 5,148 4,254 3,886 3,727 3,796 2,924 2,725 2,712 53,201 25.43 33.57 does not want children now 1,215 4,449 5,618 6,482 6,080 5,655 5,576 8,281 9,598 10,190 9,368 7,881 7,284 7,431 7,191 6,852 6,998 116,149 55.52 73.28 other elective* 779 2,854 3,315 3,227 2,239 2,479 2,510 3,536 3,145 3,334 2,891 2,720 2,374 2,374 788 554 582 39,701 18.98 25.05 --single parent 749 788 724 359 802 752 793 791 1,024 941 841 825 650 103 2 4 10,148 4.85 6.40 --to pursue educational goals 551 754 872 419 500 270 838 616 886 691 609 358 501 83 15 15 7,978 3.81 5.03 --already have enough children 362 406 369 368 351 230 434 485 341 346 383 567 333 79 40 38 5,132 2.45 3.24 --relationship issues 307 490 498 356 335 182 417 318 364 270 234 180 250 66 49 49 4,365 2.09 2.75 --other 885 1,604 1,294 1,009 1,109 1,242 1,558 1,413 1,519 1,529 2,264 1,026 1,052 671 458 478 19,111 9.13 12.06 unknown 1,371 6,674 4,767 4,618 5,054 5,460 5,443 2,310 1,681 1,280 1,440 2,161 2,144 1,440 1,818 1,472 1,594 50,727 24.25 N/A total 3,508 14,342 14,477 14,833 14,186 14,174 13,791 13,362 14,065 13,843 12,948 12,388 11,505 11,071 10,701 9,903 10,123 209,220 100.00 100.00 Note: The Minnesota questionnaire allows respondents to indicate more than one reason. The category identified as "other elective" includes other reasons (some listed) from which respondents may select more than one. REASONS GIVEN FOR ABORTIONS: NEBRASKA, 2000-2014 [25] reason* 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 total

2000-2014 % of abortions % of abortions,

known reason rape 35 18 11 10 18 10 6 5 8 11 20 5 8 10 4 179 0.40 0.40 incest 0 0 1 1 1 0 0 0 0 0 0 2 0 0 0 5 0.01 0.01 maternal life endangered 2 6 1 6 8 3 1 2 1 3 14 3 8 16 7 81 0.18 0.18 maternal physical health 33 48 45 160 85 67 45 2 8 33 67 17 20 44 30 704 1.56 1.58 mental health 654 691 667 733 316 14 1 1 0 7 28 5 10 14 16 3,157 7.01 7.07 fetal anomaly 16 25 17 35 11 8 25 24 8 26 30 11 19 19 16 290 0.64 0.65 socio-economic 2,878 2,550 2,567 3,096 3,240 2,853 2,854 2,447 2,389 1,523 1,284 869 933 719 756 30,958 68.74 69.33 contraceptive failure 664 750 687 766 1,047 734 619 623 566 389 351 446 353 352 325 8,672 19.26 19.42 no contraception used 808 850 766 1,185 850 831 852 1,113 1,573 1,343 1,109 1,232 954 1,187 811 15,464 34.34 34.63 unknown 0 0 0 0 0 0 0 0 0 0 0 0 0 15 368 383 0.85 N/A total 4,178 3,982 3,775 3,990 3,584 3,173 2,927 2,481 2,813 2,551 2,464 2,372 2,299 2,177 2,270 45,036 100.00 100.00 Note: The Nebraska questionnaire allows respondents to indicate multiple reasons, so numbers add to more than total abortions.

REASONS GIVEN FOR ABORTIONS: SOUTH DAKOTA, 1999-2014 [26] reason* 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 total

1999-2014 % of abortions % of abortions,

known reason rape or incest 12 16 14 20 21 23 9 3 12 10 8 6 12 16 7 4 193 1.61 1.63 substantial/irreversible bodily impairment 7 9 19 16 16 29 22 11 12 20 24 14 20 14 20 34 287 2.40 2.43 emotional health 28 51 84 94 104 119 58 16 37 52 60 48 37 57 53 64 962 8.04 8.15 fetal abnormality* 6 16 14 16 14 12 7 7 3 3 10 108 0.90 0.91 can't afford child 176 233 353 384 366 397 205 160 237 361 386 329 299 317 290 263 4,756 39.74 40.27 doesn't want child 459 503 547 536 525 576 640 633 588 546 492 487 363 401 393 345 8,034 67.12 68.03 other 110 139 144 103 124 127 103 48 54 79 77 57 63 74 117 115 1,534 12.82 12.99 unknown 15 41 34 27 33 5 2 0 0 0 1 0 0 0 1 0 159 1.33 N/A total 740 878 895 826 819 814 805 748 707 848 769 737 597 634 601 551 11,969 100.00 100.00 Note: The South Dakota questionnaire allows respondents to indicate multiple reasons, so numbers add to more than total abortions. Number of abortions for reason of fetal abnormality is not reported, but number of abortions where a fetal abnormality was reported present (regardless of the reason for the abortion) is provided.

REASONS GIVEN FOR ABORTIONS: UTAH, 1996-2014 [27] reason 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 total

1996-2014 % of abortions % of abortions,

known reason rape 38 39 28 40 44 30 11 3 4 2 1 1 3 2 3 249 0.40 0.40 incest 2 3 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0.01 0.01 maternal life endangered 19 10 5 6 8 6 11 10 12 22 18 22 30 25 16 20 14 8 13 275 0.45 0.45 fetal malformation 21 17 5 8 7 20 8 8 11 13 32 20 33 34 49 42 27 27 35 417 0.68 0.68 HIV positive 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 3 0.00 0.00 therapeutic 3,154 3,054 3,184 3,092 3,206 3,289 3,251 3,304 3,327 3,220 3,207 3,201 2,970 2,630 2,761 2,465 2,596 2,831 2,372 57,114 92.53 92.73 elective 3 2 0 0 4 25 13 4 17 19 181 268 473 575 617 546 378 14 333 3,472 5.63 5.64 other 39 2 1 2 0 0 0 0 0 1 4 4 0 2 0 55 0.09 0.09 unknown 17 13 13 11 10 2 6 8 8 1 1 0 0 2 0 9 3 13 14 131 0.21 N/A total 3,293 3,140 3,237 3,160 3,279 3,372 3,300 3,338 3,379 3,279 3,444 3,516 3,510 3,270 3,446 3,081 3,018 2,893 2,767 61,722 100.00 100.00

Together, the available statistics from these seven states represent 1,929,415 abortions from 1980 to 2014, of which reasons were provided in 1,692,999 cases (this is a sample 124 times larger than the total for the three AGI studies cited above). The definitions and reporting of reasons vary from state to state, and the completeness and accuracy of the reporting has varied over time. Further, it should be noted that these states are not necessarily representative of the nation as a whole; some implications of this are analyzed below.

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Federally-funded abortions: Federal Medicaid funds may currently be used to pay for abortions in cases of rape, incest, or threat to the mother's life. This has been the case since 1977, when the Hyde Amendment took effect: federal Medicaid-funded abortions went from about 300,000 per year prior to 1976 to 182,000 in FY 1977, to 232 in FY 1986, and has remained in the hundreds per year through FY 2008 [28]. Some state-level data on these abortions by reason emerged in 2008 in an inquiry from Congress to the Secretary of Health and Human Services regarding a significant increase in such payments in one state. [29] Specifically, claims from Illinois for abortions in cases of rape increased by a factor of 18 from FY 2005 to FY 2007. Data are shown below:

FEDERALLY-FUNDED ABORTIONS IN THE CASE OF RAPE [29] state FY 2005 FY 2006 FY 2007 Alabama 0 0 0 Alaska 0 0 0 Arizona 0 0 1 Delaware 0 0 0 Georgia 0 1 0 Idaho 0 0 0 Iowa 0 1 0 Illinois 20 84 363 Kentucky 0 0 0 Maine 0 0 0 Michigan 0 0 0 Minnesota 7 8 3 New Hampshire 0 0 0 North Carolina 4 0 0 North Dakota 0 0 0 Ohio 2 1 0 South Carolina 0 1 1 South Dakota 0 0 0 Texas 0 0 0 Virginia 0 0 0 Wyoming 0 0 0 (unknown) 13 0 0 TOTAL 46 96 368 FEDERALLY-FUNDED ABORTIONS IN THE CASE OF INCEST [29] state FY 2005 FY 2006 FY 2007 Alabama 0 0 0 Alaska 0 0 0 Arizona 0 0 1 Delaware 0 0 0 Georgia 0 0 0 Idaho 0 0 0 Iowa 0 0 0 Illinois 0 0 5 Kentucky 0 0 0 Maine 0 0 0 Michigan 0 0 0 Minnesota 3 5 3 New Hampshire 0 0 0 North Carolina 0 0 0 North Dakota 0 0 0 Ohio 0 0 0 South Carolina 0 0 0 South Dakota 0 0 0 Texas 0 0 0 Virginia 0 0 0 Wyoming 0 0 0 TOTAL 3 5 9 FEDERALLY-FUNDED ABORTIONS IN THE CASE OF RISK TO MOTHER'S LIFE [29] state FY 2005 FY 2006 FY 2007 Alabama 6 2 10 Alaska 0 1 0 Arizona 0 0 1 Delaware 0 2 6 Georgia 1 6 1 Idaho 5 0 0 Iowa 1 3 0 Illinois 5 5 13 Kentucky 1 0 0 Maine 1 8 11 Michigan 0 0 3 Minnesota 1 0 2 New Hampshire 1 1 1 North Carolina 7 3 4 North Dakota 1 0 0 Ohio 14 18 10 South Carolina 17 11 6 South Dakota 1 0 0 Texas 17 4 4 Virginia 20 31 9 Wyoming 2 0 0 TOTAL 101 95 81

In the next table, the figures for abortions in the case of rape in Illinois are adjusted in the same manner as previously applied to state statistics, using an annual figure of 50,000 based on AGI estimates. Assuming that all abortions in cases of rape in Illinois were paid for by federal Medicaid, the FY 2007 figures are compatible with rates of rape-related abortions claimed by AGI, but they are 2-3 times higher than rates supported by analysis of data from other states. More importantly, the dramatic increase from FY 2005 to FY 2007 casts doubt on the reliability of the Illinois figures, suggesting that rape is falsely being claimed as a reason for many of these abortions in order to obtain Medicaid funding (the point raised in the congressional inquiry).

ILLINOIS CLAIMED FIGURES FOR ABORTIONS IN THE CASE OF RAPE region year(s) abortions where rape is cited forcible rapes during sample period [9] abortions in cases of rape as a percentage of reported rapes implied U.S. number of abortions in cases of rape in 2005 % of 2005 abortions [30] % number Illinois FY 2005 0.04 20 4,280 0.47 440 0.04 Illinois FY 2006 0.17 84 4,130 2.03 1,910 0.16 Illinois FY 2007 0.73 363 4,100 8.86 8,320 0.69

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Adjusted figures: Use of these figures to estimate nationwide percentages is affected by differences from state to state. By adjusting the state level percentages for variations in rates of occurrence of rape or variations in the fraction of pregnancies that end in abortion, corresponding nationwide estimates may be derived. The following tables provide estimates of the fraction of abortions in cases of rape, threat to mother's life or health, or fetal health issues, for 2008 (the latest year for which nation-wide abortion figures are available). Estimates are derived from each state-level data set and each AGI survey by applying the derived abortion rates per reported rape or health issue related abortion rates per known pregnancy.

For the case of abortions in cases of rape, adjustment for state-to-state and year-to-year variation in occurrence of rape is necessary. The respective state or survey data set is used to derive the rate at which abortions occur in connection to reported rapes, with these rates then applied to nationwide data to derive corresponding percentage estimates for 2004 and 2011.

ADJUSTED FIGURES FOR ABORTIONS IN THE CASE OF RAPE region year(s) abortions where rape is cited forcible rapes during sample period [9] abortions in cases of rape as a percentage of reported rapes implied U.S. number of abortions in cases of rape in 2004 % of 2004 abortions [30] implied U.S. number of abortions in cases of rape in 2011 % of 2011 abortions [30] % number Florida Jul 2008-Dec 2009 1.85 2,273 8,487 26.78 25,470 2.08 22,540 2.13 Louisiana 1996-2012 0.03 55 24,954 0.22 210 0.02 190 0.02 Minnesota Oct 1998-Dec 2014 0.62 1,297 32,379 4.01 3,810 0.31 3,370 0.32 Nebraska 2000-2014 0.40 179 9,093 1.97 1,870 0.15 1,660 0.16 South Dakota 1999-2014 1.61 193 6,521 2.96 2,810 0.23 2,490 0.24 Utah 1996-2010 0.50 249 13,548 1.84 1,750 0.14 1,550 0.15 USA (AGI survey) 1987 1 15,600 91,111 17.11 16,300 1.33 14,400 1.36 USA (AGI survey) 2000-2001 0.6 6,100 181,041 8.63 8,200 0.67 7,300 0.69 USA (AGI survey) 2004 0.5

1 6,100

12,200 95,089 6.43

12.85 6,100

12,200 0.50

1.00 5,400

10,800 0.51

1.02

Estimates based on data reported for these six states generally give results significantly below figures based on AGI studies. The sole exception is Florida, which like Illinois as discussed above likely represents inflated reporting of rape as a reason for abortion. For the states of Minnesota, Nebraska, South Dakota, and Utah, the derived national estimates (0.15-0.32%) are consistent despite the larger range in state-level percentages (i.e. factor of 2 range in national estimates versus factor of 4 range in state-level percentages). These estimates are also consistent with the previously derived estimate of 0.54% based on FBI and DOJ figures and the Holmes et al. study. Thus it is reasonable to conclude that, contrary to AGI figures, the fraction of abortions nationwide in cases of rape is closer to 0.3%.

Similarly, if it is assumed that abortions in cases where there are maternal or fetal health problems are a consistent fraction of known pregnancies, the implied nationwide percentages in such cases would be as given below. Note that "known pregnancies" for states includes only pregnancies ending in live births or reported abortions; this excludes miscarriages (small numbers in comparison) and stillbirths (for which little data is available). State-level abortion figures are generally based on state agency reported figures by state of occurrence, while U.S. figures for abortions and pregnancies use AGI abortion figures.[31] Since some states and the AGI surveys do not separate abortions in cases of threat to the mother's life from abortions in cases of threat to the mother's health, these are both included in the maternal health figures below. Figures for threat to the mother's life are then provided separately as available.

ADJUSTED FIGURES FOR ABORTIONS IN THE CASE OF MATERNAL PHYSICAL HEALTH PROBLEMS region year(s) abortions where mother's health is cited total known pregancies [31] cited abortions as a percentage of known pregnancies implied U.S. number of abortions in such cases in 2004 % of 2004 abortions [30] implied U.S. number of abortions in such cases in 2011 % of 2011 abortions [30] % number Arizona 1980-2009 0.19 647 2,598,843 0.025 1,330 0.11 1,250 0.12 Arizona 2012-2013 1.26 336 199,635 0.168 8,980 0.73 8,440 0.80 Florida Jan 1998-Jun 2008 0.51 4,800 3,190,470 0.150 8,030 0.66 7,540 0.71 Florida Jul 2008-Dec 2009 0.22 278 462,150 0.060 3,210 0.26 3,010 0.28 Louisiana 1996-2012 0.25 414 1,265,039 0.033 1,750 0.14 1,640 0.15 Minnesota Oct 1998-Dec 2014 5.05 10,563 1,340,568 0.788 42,030 3.44 39,490 3.73 Nebraska 2000-2014 1.74 785 436,403 0.180 9,600 0.79 9,020 0.85 South Dakota 1999-2014 2.40 287 196,506 0.146 7,790 0.64 7,320 0.69 Utah 1996-2014 0.45 275 1,009,624 0.027 1,450 0.12 1,370 0.13 USA (AGI survey) 1987 3 0.867 46,250 3.78 43,450 4.10 USA (AGI survey) 2004 4 0.973 51,900 4.25 48,770 4.61 ADJUSTED FIGURES FOR ABORTIONS IN THE CASE OF THREAT TO MATERNAL LIFE region year(s) abortions where risk to mother's life is cited total known pregancies [31] cited abortions as a percentage of known pregnancies implied U.S. number of abortions in such cases in 2004 % of 2004 abortions [30] implied U.S. number of abortions in such cases in 2011 % of 2011 abortions [30] % number Florida Jul 2008-Dec 2009 0.06 79 462,150 0.017 910 0.07 860 0.08 Nebraska 2000-2014 0.18 81 436,403 0.019 990 0.08 930 0.09 Utah 1996-2014 0.45 275 1,009,624 0.027 1,450 0.12 1,370 0.13 ADJUSTED FIGURES FOR ABORTIONS IN THE CASE OF FETAL HEALTH PROBLEMS region year(s) % of abortions where fetal health is cited total known pregancies [31] cited abortions as a percentage of known pregnancies implied U.S. number of abortions in such cases in 2004 % of 2004 abortions [30] implied U.S. number of abortions in such cases in 2011 % of 2011 abortions [30] % number Arizona 2012-2013 0.85 226 199,635 0.113 6,040 0.49 5,670 0.54 Florida Jan 1998-Jun 2008 0.56 5,253 3,190,470 0.165 8,780 0.72 8,250 0.78 Florida Jul 2008-Dec 2009 0.64 788 462,150 0.171 9,100 0.74 8,550 0.81 Louisiana 1996-2012 0.12 196 1,265,039 0.015 830 0.07 780 0.07 Minnesota Oct 1998-Dec 2014 1.30 2,718 1,340,568 0.203 10,810 0.88 10,160 0.96 Nebraska 2000-2014 0.64 290 436,403 0.066 3,540 0.29 3,330 0.31 South Dakota* 2003-2014 0.90 108 196,506 0.055 2,930 0.24 2,750 0.26 Utah 1996-2014 0.68 417 1,009,624 0.041 2,200 0.18 2,070 0.20 USA (AGI survey) 1987 3 0.867 46,250 3.78 43,450 4.10 USA (AGI survey) 2004 3 0.730 38,940 3.19 36,590 3.46 * In the case of South Dakota, data by reason for abortion is not available; figures are for abortions where fetal abnormalities were reported, regardless of the indicated reason for the abortion.

Again, the resulting estimates are generally lower than those reported based on the AGI surveys. For cases of risk to the mother's physical health, the state-based estimates vary significantly but are all lower than the AGI-based estimates, and in all but the case of Minnesota are lower by at least a factor of 4. For cases of threat to the mother's life, despite the factor of 7 range in state-level percentages among the three states, the derived national estimates are quite consistent, in the range 0.08-0.13%. For abortions in cases of fetal health issues, the derived national estimates from state data are all lower than the AGI-based estimates by at least a factor of 4.

The following table combines derived estimates of percentages of abortions in cases of threat to the mother's life from the federally funded abortion data and from the state agency data. The federally funded abortion cases are incomplete representations for some states (as this treatment assumes that all abortions in these cases were paid for by federal Medicaid, but likely not all states, and they tend to confirm the low percentages derived from the state agency data-based estimates.

ADJUSTED FIGURES FOR ABORTIONS IN THE CASE OF THREAT TO MATERNAL LIFE state time period data type abortions where risk to mother's life is cited total abortions [31] total known pregancies [31] cited abortions as a percentage of known pregnancies implied U.S. number of abortions in such cases in 2008 % of 2008 abortions [30] % number Alabama Oct 2004 - Sep 2007 federal 18 0.05 34,160 221,470 0.008 440 0.04 Alaska Oct 2004 - Sep 2007 federal 1 0.02 5,640 37,910 0.003 140 0.01 Arizona Oct 2004 - Sep 2007 federal 1 0.00 32,860 331,850 0.000 20 0.00 Delaware Oct 2004 - Sep 2007 federal 8 0.06 13,810 48,930 0.016 890 0.07 Florida Jul 2008 - Dec 2009 state 79 0.06 122,576 462,150 0.017 930 0.08 Georgia Oct 2004 - Sep 2007 federal 8 0.01 93,740 528,230 0.002 80 0.01 Idaho Oct 2004 - Sep 2007 federal 5 0.14 3,670 75,340 0.007 360 0.03 Iowa Oct 2004 - Sep 2007 federal 4 0.00 134,730 675,400 0.001 30 0.00 Illinois Oct 2004 - Sep 2007 federal 23 0.12 19,100 138,950 0.017 900 0.07 Kentucky Oct 2004 - Sep 2007 federal 1 0.01 11,870 184,610 0.001 30 0.00 Maine Oct 2004 - Sep 2007 federal 20 0.25 7,990 50,370 0.040 2,170 0.18 Michigan Oct 2004 - Sep 2007 federal 3 0.00 75,920 456,100 0.001 40 0.00 Minnesota Oct 2004 - Sep 2007 federal 3 0.01 41,260 258,590 0.001 60 0.00 Nebraska Jan 2000 - Dec 2011 state 50 0.13 38,290 346,504 0.014 790 0.07 New Hampshire Oct 2004 - Sep 2007 federal 3 0.03 9,360 52,600 0.006 310 0.03 North Carolina Oct 2004 - Sep 2007 federal 14 0.01 100,840 479,890 0.003 160 0.01 North Dakota Oct 2004 - Sep 2007 federal 1 0.03 3,790 29,420 0.003 190 0.02 Ohio Oct 2004 - Sep 2007 federal 42 0.04 98,770 547,460 0.008 420 0.03 South Carolina Oct 2004 - Sep 2007 federal 34 0.09 37,300 218,570 0.016 850 0.07 South Dakota Oct 2004 - Sep 2007 federal 1 0.04 2,290 37,760 0.003 140 0.01 Texas Oct 2004 - Sep 2007 federal 25 0.01 239,000 1,423,880 0.002 100 0.01 Utah Jan 1996 - Dec 2010 state 220 0.44 49,963 794,030 0.028 1,510 0.12 Virginia Oct 2004 - Sep 2007 federal 60 0.07 81,170 401,740 0.015 820 0.07 Wyoming Oct 2004 - Sep 2007 federal 2 0.10 2,020 24,520 0.008 450 0.04 TOTAL Oct 2004 - Sep 2007 federal 277 0.02 1,260,119 7,826,274 0.004 190 0.02

Some states report maternal mental health issues as a reason for abortion. This is a far more subjective determination that the previously reviewed cases, a subjectivity partly illustrated by the case of Utah where 92.5% of abortions from 1996-2014 are reported as "therapeutic". The percentages of abortions reported in cases of maternal mental health issues are: 0.11% in Florida (1998-2008 data), 0.14% in Florida (2008-2009 data), 0.95% in Louisiana (1996-2012 data), 6.46% in Minnesota (1998-2014 data), 7.01% in Nebraska (2000-2014 data), and 8.04% in South Dakota (1999-2014 data).

- - - - -

"Partial-birth abortions" and other late-term abortions: Because of the particularly controversial nature of late-term and "partial-birth abortions" (PBAs), some statistics regarding these abortions has emerged. Partial-birth abortion roughly corresponding to what the medical community describes as intact dilation and extraction. Available data indicates that PBAs are mostly performed for reasons other than for the life or physical health of the mother, reasons including either fetal defects (minor or major) or purely elective reasons.

Kansas requires physicians to report reasons for performing PBAs. Of the 240 PBAs reported in Kansas in 1998 and 1999, there were none where the mother's life was at risk; in every case the attending physician certified "that continuing the pregnancy will constitute a substantial and irreversible impairment of the patient's mental function" and that there was not a substantial physical risk to the mother from the pregnancy.[32] No PBAs have been reported since 1999 in Kansas, but other abortions performed at 22 weeks gestation or later must similarly be reported. For these as well, few if any are cited as involving risk to the mother's life; typically, risk to the mother of "substantial and irreversible impairment of a major bodily function" is cited.[32]

Physicians who perform large numbers of PBAs have stated that many are performed for elective reasons. In an interview with American Medical News, M. Haskell stated that about 80% of the PBAs he performed were purely elective, with the remainder performed for genetic reasons.[33, 34, 35, 36] In testimony to Congress, J. McMahon reported that for about 2,000-2,100 PBAs he had performed, 1,183 (56%) were for fetal "flaws" or "indicators", 175 (9%) were for maternal "indicators", and the remainder (about 700, or 35%) were elective.[34, 35, 37] McMahon further indicated that elective abortions comprised 20% of those he performed after 21 weeks gestation, and none of those he performed after 26 weeks.[35]

McMahon's 1995 testimony to the House Judiciary Committee gave more detailed statistics, which have been analyzed by physicians P. Smith and K. Dowling. Among maternal indicators, the single most frequent was maternal depression (39, or 1.9% of total), with 28 attributed to maternal health conditions "consistent with the birth of a normal child (e.g. sickle cell trait, prolapsed uterus, small pelvis)" (1.3% of total) and the remainder (5% of total) for other maternal factors ranging from maternal health risk to "spousal drug exposure" and "substance abuse". Those performed for fetal indicators included some for lesser conditions such as 9 (0.4% of total) for cleft lip-palate, 24 (1.1% of total) for cystic hydroma, and other for conditions either surgically correctable or involving lesser degrees of neurologic/mental impairment.[35, 36]

Estimates of the annual numbers of PBAs in the United States range from 2,200 to 5,000, with documented annual numbers between 1996 and 2005 ranging from 76 to 1,642.[37]

- - - - -

Summary and conclusions: Based on the preceding analyses, the following composite estimated percentages are suggested (with parenthetical values giving the ranges of values from the above studies and analyses):

REASONS FOR ABORTIONS: COMPILED ESTIMATES rape 0.3 % (0.1-0.6 %) incest 0.03 % (0.01-0.1 %) physical life of mother 0.1 % (0.01-0.2 %) physical health of mother 0.8 % (0.1-3 %) fetal health 0.5 % (0.1-1.0 %) mental health of mother ?? (0.1-8 %) elective

--too young/immature/not ready for responsibility

--economic

--to avoid adjusting life

--mother single or in poor relationship

--enough children already

--sex selection

--selective reduction 98.3% (87-99 %)

--? (32 %)

--30% (25-40 %)

--? (16 %)

--? (12-13 %)

--? (4-8 %)

--0.1% (<0.1-? %)

--0.1% (<0.1-0.4 %)

Note that quantifying cases involving the "mental health" of the mother is difficult due to the highly subjective use of this term (as demonstrated by the wide range in percentage of abortions reported for this reason). It is likely that the number of cases involving clinical mental illness falls towards the low end of the range given above.

These official state statistics suggest that the commonly cited AGI figures for the "hard cases" are high, perhaps by factors of three to five. In any case, it is clear that the hard cases--rape, incest, life/health of mother or baby--are a very small fraction of cases. They are arguably a poor premise for formulating general public policy regarding abortion. At the other extreme, AGI's surveys of 1987 and 2004 (as well as the detailed statistics from Minnesota) suggest that a significant fraction of abortions are obtained by mothers who have the means to care for a child but do not want their lives inconvenienced. Even sex selective abortions may be more common than those for some of the hard cases. This illustrates the consequences of the current extreme policy in the United States regarding abortion.

Sources: United Nations Population Division, 2007, World Abortion Policies 2007, United Nations (New York, NY), on line at United Nations [http://www.un.org/esa/population/publications/2007_Abortion_Policies_Chart/2007AbortionPolicies_wallchart.htm]. Alan Guttmacher Institute, 2008, "State policies in brief," Alan Guttmacher Institute, on line [http://www.guttmacher.org/statecenter/spibs/index.html]. Torres, Aida, and Jacqueline Darroch Forrest, July/Aug. 1988, "Why do women Have abortions?", Family Planning Perspectives (20:4:169-176). Bankole, Akinrinola, Sushella Singh, and Taylor Hass, Aug. 1998, "Reasons why women have induced abortions: Evidence from 27 Countries," International Family Planning Perspectives (24:3:117-127,152), on line [http://www.guttmacher.org/pubs/journals/2411798.html]. Jones, Rachel K., Jacqueline E. Darroch, and Stanley K. Henshaw, Nov./Dec. 2002, "Contraceptive use among women having abortions in 2000-2001," Perspectives on Sexual and Reproductive Health (34:6), on line at AGI [http://www.guttmacher.org/pubs/journals/3429402.html]. Finer, Lawrence B., Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore, Sept. 2005, "Reasons U.S. women have abortions: Quantitative and qualitative perspectives," Perspectives on Sexual and Reproductive Health, 37(3):110-118, on line at AGI [http://www.guttmacher.org/pubs/journals/3711005.pdf]. Alan Guttmacher Institute, April 2005, "Induced abortion in the United States," AGI, on line [http://www.agi-usa.org/pubs/fb_induced_abortion.pdf]. Based on figure of 1,559,100 abortions in 1987, from Henshaw, Stanley K., Nov./Dec. 1998, "Abortion incidence and services in the United States, 1995-1996," Family Planning Perspectives (30:6), on line at AGI [http://www.guttmacher.org/pubs/journals/3026398.html]. Federal Bureau of Investigation, 2012, "UCR table building tool," Uniform Crime Reporting Statistics, on line [http://www.ucrdatatool.gov/Search/Crime/Crime.cfm]. Langston, Lynn, Marcus Berzofsky, Christopher Krebs, and Hope Smiley-McDonald, 9 Aug. 2012, "Victimizations not reported to the police, 2006-2010," Bureau of Justice Statistics, on line [http://bjs.ojp.usdoj.gov/index.cfm?ty=pbdetail&iid=4393]. Stewart, Felicia H., and James Trussell, Nov. 2000, "Prevention of pregnancy resulting from rape: A neglected preventive health measure," American Journal of Preventive Medicine, 19(4):228-229. Willke, J. C., and Willke, "Why can't we love them both?", on line [http://www.abortionfacts.com/online_books/love_them_both/why_cant_we_love_them_both_contents.asp]; Hilger, Thomas W., cited in "Abortion: What about rape & incest?" at Lutherans for Life, on line [http://www.lutheransforlife.org/abortion/rape_or_incest.htm]. Holmes, M. M., H. S. Resnick, D. G. Kilpatrick, and C. L. Best, "Rape-related pregnancy: Estimates and descriptive characteristics from a national sample of women," Aug. 1996, American Journal of Obstetrics and Gynecology, 175(2):320-324. Boonstra, Heather, "Emergency contraception: Steps being taken to improve access," Dec. 2002, The Guttmacher Report on Public Policy, 5(5):10-13, on line at AGI [http://www.guttmacher.org/pubs/tgr/05/5/gr050510.pdf]. Chamie, Joseph, 29 May 2008, "The Global Abortion Bind," YaleGlobal Online, on line [http://yaleglobal.yale.edu/content/global-abortion-bind]. Davis, Devra Lee, Michelle B. Gottlieb, and Julie R. Stampnitzky, "Reduced ratio of male to female births in several industrial countries: A sentinel health indicator?", 1 April 1998, Journal of the American Medical Association (279:13:1018-1023) [http://jama.jamanetwork.com/article.aspx?articleid=187397]. Centers for Disease Control, "Births: Final data for 2000," 12 Feb. 2002, National Vital Statistics Reports (50:5), on line at CDC [http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_05.pdf]. Mathews, T. J., and Brady E. Hamilton, "Trend analysis of the sex ratio at birth in the United States," 14 Jun. 2005, National Vital Statistics Reports (53:20), on line at CDC [http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_20.pdf]. Based on figure of 1,269,000 abortions in 2002, from Henshaw, Stanley K., and Kathryn Kost, Aug. 2008, "Trends in the characteristics of women obtaining abortions, 1974 to 2004," Alan Guttmacher Institute, on line [http://www.guttmacher.org/pubs/2008/09/18/Report_Trends_Women_Obtaining_Abortions.pdf]. Arizona Dept. of Health Services, on line: Mrela, Christopher K., 2001, "Abortion surveillance report, Arizona, 1985-1995," [http://www.hs.state.az.us/plan/abortion/abortion.htm]; Batsche, Kurt, 1997, "Abortions by reason for termination and year, Arizona, 1985-1995," [http://www.hs.state.az.us/plan/abortion/tables/abt9.htm]; ADHS, 2002, "Abortions by reason for termination and year, Arizona, 1990-2000," [http://www.azdhs.gov/plan/report/ahs/ahs2000/pdf/085_086t1d1.pdf]; ADHS, 2011, "Characteristics of women receiving abortions, Arizona, 1999-2009," [http://www.azdhs.gov/plan/report/ahs/ahs2009/pdf/1d1.pdf]. Florida Department of Health, "Induced terminations of pregnancy," Florida Department of Health, on line: 1999, [http://www.flpublichealth.com/VSBOOK/pdf/1998/termination.pdf]; 2000, [http://www.flpublichealth.com/VSBOOK/pdf/1999/termination.pdf]; 2001, [http://www.flpublichealth.com/VSBOOK/pdf/2000/termination.pdf]; 2002, [http://www.flpublichealth.com/VSBOOK/pdf/2001/termination.pdf]; 2003, [http://www.flpublichealth.com/VSBOOK/pdf/2002/termination.pdf]; 2004, [http://www.flpublichealth.com/VSBOOK/pdf/2003/termination.pdf]; 2005, [http://www.flpublichealth.com/VSBOOK/pdf/2004/termination.pdf]; 2006, [http://www.flpublichealth.com/VSBOOK/pdf/2005/termination.pdf]; 2007, [http://www.flpublichealth.com/VSBOOK/pdf/2006/termination.pdf]; Florida Office of Vital Statistics, 16 Sept. 2008, "Reported induced terminations of pregnancy by reason and by weeks of gestation for the State of Florida 2008," Web Parish, on line [ www.webparish.com/pdfs/2008FLAbortionSummaryByReason.pdf ].