Abortion surveillance--United States, 2009.

PROBLEM/CONDITION: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.

REPORTING PERIOD COVERED

DESCRIPTION OF SYSTEM

Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2009, data were received from 48 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 45 areas that reported data every year during 2000-2009. Census and natality data, respectively, were used to calculated abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births).

RESULTS

A total of 784,507 abortions were reported to CDC for 2009. Of these abortions, 772,630 (98.5%) were from the 45 reporting areas that provided data every year during 2000-2009. Among these same 45 reporting areas, the abortion rate for 2009 was 15.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 227 abortions per 1,000 live births. Compared with 2008, the total number and rate of reported abortions for 2009 decreased 5%, representing the largest single year decrease for the entire period of analysis. The abortion ratio decreased 2%. From 2000 to 2009, the total number, rate, and ratio of reported abortions decreased 6%, 7%, and 8%, respectively, to the lowest levels for 2000-2009. In 2009 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women aged ≥30 years accounted for a much smaller percentage of abortions and had lower abortion rates. In 2009, women aged 20-24 and 25-29 years accounted for 32.7% and 24.4% of all abortions, respectively, and had an abortion rate of 27.4 abortions per 1,000 women aged 20-24 years and 20.4 abortions per 1,000 women aged 25-29 years. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 14.7%, 8.8%, and 3.3% of all abortions, respectively, and had an abortion rate of 13.3 abortions per 1,000 women aged 30-34 years, 7.6 abortions per 1,000 women aged 35-39 years, and 2.7 abortions per 1,000 women aged ≥40 years. Throughout the period of analysis, abortion rates decreased among women aged 20-24 and 25-29 years, whereas they increased among women aged ≥40 years. In 2009, adolescents aged 15-19 years accounted for 15.5% of all abortions and had an abortion rate of 13.0 abortions per 1,000 adolescents aged 15-19 years. Throughout the period of analysis, the percentage of all abortions accounted for by adolescents and the adolescent abortion rate decreased. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2009 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2000 to 2009 for women in all age groups except for those aged <15 years, for whom they increased. In 2009, most (64.0%) abortions were performed at ≤8 weeks' gestation, and 91.7% were performed at ≤13 weeks' gestation. Few abortions (7.0%) were performed at 14-20 weeks' gestation, and even fewer (1.3%) were performed at ≥21 weeks' gestation. From 2000 to 2009, the percentage of all abortions performed at ≤8 weeks' gestation increased 12%, whereas the percentage performed at >13 weeks' decreased 12%. Moreover, among abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of these abortions performed at ≤6 weeks' gestation increasing 47%. In 2009, 74.2% of abortions were performed by curettage at ≤13 weeks' gestation, 16.5% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.1% were performed by curettage at >13 weeks' gestation. Among abortions that were performed at ≤8 weeks' gestation and thus were eligible for early medical abortion, 25.2% were completed by this method. The use of early medical abortion increased 10% from 2008 to 2009. Deaths of women associated with complications from abortions for 2009 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2008, the most recent year for which data were available, 12 women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions.

INTERPRETATION

Among the 45 areas that reported data every year during 2000-2009, the gradual decrease that had occurred during previous decades in the total number and rate of reported abortions continued through 2005, whereas year-to-year variation from 2006 to 2008 resulted in no net change during this later period. However, the change from 2008 to 2009 for both the total number of abortions and the abortion rate was the largest single year decrease during 2000-2009, and all three measures of abortion (total numbers, rates, and ratios) decreased to the lowest level observed during this period.

PUBLIC HEALTH ACTIONS

Unintended pregnancy is the major contributor to abortion. Because unintended pregnancies are rare among women who use the most effective methods of reversible contraception, increasing access to and use of these methods can help further reduce the number of abortions performed in the United States. The data in this report can help program planners and policy makers identify groups of women at greatest risk for unintended pregnancy and help guide and evaluate prevention efforts.