Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
MMWR Surveill Summ. 2016 Nov 25;65(12):1-44. doi: 10.15585/mmwr.ss6512a1.
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.
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 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births).
A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2.5 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. During 2004-2013, the decrease in abortion rates among adult women aged 20-39 years ranged from 8% to 27% across these age groups, whereas the abortion rate was stable for women aged ≥40 years. In 2013, adolescents aged <15 and 15-19 years accounted for 0.3% and 11.4% of all abortions, respectively, and had abortion rates of 0.6 and 8.2 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2004 to 2013, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 31% and their abortion rate decreased 46%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2013 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2004 to 2013 for women in all age groups, except for adolescents aged <15 years. In 2013, the majority (66.0%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.6%) were performed by ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.1%) or at ≥21 weeks' gestation (1.3%). From 2004 to 2013, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.5%) and among those performed at ≤13 weeks' gestation, the percentage performed at ≤6 weeks' gestation increased 16%. In 2013, among the 43 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 67.9% of abortions were performed by curettage at ≤13 weeks' gestation, 22.2% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.6% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.8% were completed by this method. From 2012 to 2013, the percentage of abortions reported as early medical abortions increased 5%. Deaths of women associated with complications from abortion for 2013 are being investigated as part of CDC's Pregnancy Mortality Surveillance System. In 2012, the most recent year for which data were available, four women were identified to have died as a result of complications from known legal induced abortion. No reported deaths were associated with known illegal induced abortion.
Among the 47 areas that reported data every year during 2004-2013, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2009-2012 continued from 2012 to 2013, resulting in historic lows for all three measures of abortion.
The data in this report can help program planners and policymakers identify groups of women with highest rates of abortion. Unintended pregnancy is the major contributor to abortion. Increasing access to and use of contraception, including the most effective methods, can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.
问题/状况：自 1969 年以来，疾病预防控制中心一直进行堕胎监测，以记录在美国获得合法人工流产的妇女的数量和特征。
2013 年。
每年，疾病预防控制中心都会向 52 个报告地区（50 个州、哥伦比亚特区和纽约市）的中央卫生机构请求堕胎数据。这些报告地区自愿提供这些信息。2013 年，收到了 49 个报告地区的数据。为了进行趋势分析，对 2004-2013 年期间每年报告数据的 47 个报告地区的堕胎数据进行了评估。分别使用人口普查和出生率数据来计算堕胎率（每千名妇女中的堕胎数）和比率（每千名活产中的堕胎数）。
2013 年，疾病预防控制中心共收到 664435 例堕胎报告。其中，98.2%来自于 2004-2013 年期间每年都提供数据的 47 个报告地区。在这 47 个报告地区中，2013 年的堕胎率为每 1000 名 15-44 岁的妇女中有 12.5 例，堕胎比为每 1000 例活产中有 200 例。从 2012 年到 2013 年，报告的堕胎总数、率和比均下降了 5%。从 2004 年到 2013 年，报告的堕胎总数、率和比分别下降了 20%、21%和 17%。2013 年，所有这三个指标均达到了整个分析期间（2004-2013 年）的最低水平。2013 年和整个分析期间，20 多岁的妇女占堕胎总数的大部分，堕胎率最高；30 岁及以上的妇女所占比例要小得多，堕胎率也较低。2013 年，年龄在 20-24 岁和 25-29 岁的妇女分别占所有堕胎的 32.7%和 25.9%，年龄在 20-24 岁和 25-29 岁的妇女的堕胎率分别为每 1000 名妇女 21.8 次和 18.2 次。相比之下，年龄在 30-34 岁、35-39 岁和≥40 岁的妇女分别占所有堕胎的 16.8%、9.2%和 3.6%，年龄在 30-34 岁、35-39 岁和≥40 岁的妇女的堕胎率分别为每 1000 名妇女 11.8 次、7.0 次和 2.5 次。2004-2013 年，20-39 岁成年妇女的堕胎率下降了 8%-27%，而≥40 岁妇女的堕胎率保持稳定。2013 年，年龄<15 岁和 15-19 岁的青少年分别占所有堕胎的 0.3%和 11.4%，年龄<15 岁和 15-19 岁的青少年的堕胎率分别为每 1000 名青少年 0.6 次和 8.2 次。2004-2013 年，15-19 岁青少年的堕胎比例下降了 31%，堕胎率下降了 46%。这些降幅大于任何年龄组妇女的降幅。与年龄相关的堕胎比例和堕胎率分布情况相反，2013 年和整个分析期间，青少年的堕胎率最高，而 30-39 岁的妇女的堕胎率最低。除了年龄<15 岁的青少年外，所有年龄组的堕胎率都从 2004 年到 2013 年有所下降。2013 年，≤8 周妊娠的堕胎占多数（66.0%），几乎所有（91.6%）都在≤13 周妊娠时进行。在 14-20 周妊娠（7.1%）或≥21 周妊娠（1.3%）时进行的堕胎很少。从 2004 年到 2013 年，所有在≤13 周妊娠时进行的堕胎中，有≥91.5%的比例保持在较高水平，而在≤13 周妊娠时进行的堕胎中，≤6 周妊娠的比例增加了 16%。2013 年，在包括堕胎报告表上的医疗（非手术）堕胎的 43 个报告地区中，≤13 周妊娠时，67.9%的堕胎是通过刮宫进行的，22.2%是通过早期医疗流产（≤8 周妊娠的非手术流产）进行的，8.6%是通过>13 周妊娠的刮宫进行的；其他方法都不常见。在符合早期医疗流产条件的≤8 周妊娠的堕胎中，有 32.8%是通过这种方法完成的。从 2012 年到 2013 年，报告的早期医疗流产比例增加了 5%。作为疾病预防控制中心妊娠死亡率监测系统的一部分，正在调查与 2013 年堕胎相关的妇女死亡情况。在 2012 年，也就是可获得数据的最近一年，有 4 名妇女被确定因已知合法人工流产引起的并发症而死亡。没有报告与已知的非法人工流产有关的死亡。
在 2004-2013 年期间每年都报告数据的 47 个地区中，2009-2012 年期间发生的堕胎总数、率和比的下降趋势从 2012 年持续到 2013 年，所有这三个堕胎指标均达到了历史最低水平。
本报告中的数据可以帮助规划人员和政策制定者确定堕胎率最高的妇女群体。意外怀孕是堕胎的主要原因。增加对包括最有效的方法在内的避孕措施的获取和使用，可以减少意外怀孕，并进一步减少在美国进行的堕胎数量。
