Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
Oak Ridge Institute for Science and Education (ORISE) Fellow.
MMWR Surveill Summ. 2018 Nov 23;67(13):1-45. doi: 10.15585/mmwr.ss6713a1.
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 2015, data were received from 49 reporting areas. Abortion data provided by these 49 reporting areas for each year during 2006-2015 were used in trend analyses. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively.
A total of 638,169 abortions for 2015 were reported to CDC from 49 reporting areas. Among these 49 reporting areas, the abortion rate for 2015 was 11.8 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 188 abortions per 1,000 live births. From 2014 to 2015, the total number of reported abortions decreased 2% (from 652,639), the abortion rate decreased 2% (from 12.1 abortions per 1,000 women aged 15-44 years), and the abortion ratio decreased 2% (from 192 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). In 2015, all three measures reached their lowest level for the entire period of analysis (2006-2015). In 2015 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women aged ≥30 years accounted for a smaller percentage of abortions and had lower abortion rates. In 2015, women aged 20-24 and 25-29 years accounted for 31.1% and 27.6% of all reported abortions, respectively, and had abortion rates of 19.9 and 17.9 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 17.7%, 10.0%, and 3.5% of all reported abortions, respectively, and had abortion rates of 11.6, 7.0, and 2.5 abortions per 1,000 women aged 30-34, 35-39, and ≥40 years, respectively. From 2006 to 2015, the abortion rate decreased among women in all age groups. In 2015, adolescents aged <15 and 15-19 years accounted for 0.3% and 9.8% of all reported abortions, respectively, and had abortion rates of 0.5 and 6.7 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2006 to 2015, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 41%, and their abortion rate decreased 54%. This decrease in abortion rate was 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 2015 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 25-39 years. Abortion ratios decreased from 2006 to 2015 for women in all age groups. In 2015, almost two thirds (65.4%) of abortions were performed at ≤8 weeks' gestation, and nearly all (91.1%) were performed at ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.6%) or at ≥21 weeks' gestation (1.3%). During 2006-2015 the percentage of all abortions performed at >13 weeks' gestation remained consistently low (≤9.0%). Among abortions performed at ≤13 weeks' gestation, a shift occurred toward earlier gestational ages, with the percentage performed at ≤6 weeks' gestation increasing 11%. In 2015, 24.6% of all abortions were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), 64.3% were performed by surgical abortion at ≤13 weeks' gestation, and 8.8% were performed by surgical abortion at >13 weeks' gestation; all other methods were uncommon (≤2.2%). Among those that were eligible for early medical abortion on the basis of gestational age (i.e., performed at ≤8 weeks' gestation), 35.8% were completed by this method. In 2015, women with one or more previous live births accounted for 59.3% of abortions, and women with no previous live births accounted for 40.7%. Women with one or more previous induced abortions accounted for 43.6% of abortions, and women with no previous abortion accounted for 56.3%. Women with three or more previous births accounted for 14.2% of abortions, and women with three or more previous abortions accounted for 8.2% of abortions. Deaths of women associated with complications from abortion for 2015 are being assessed as part of CDC's Pregnancy Mortality Surveillance System. In 2014, the most recent year for which data were available, six women were identified to have died as a result of complications from legal induced abortion.
Among the 49 areas that reported data every year during 2006-2015, decreases in the total number, rate, and ratio of reported abortions resulted in historic lows for the period of analysis for all three measures of abortion.
The data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is the major contributor to induced abortion. Increasing access to and use of effective contraception 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在进行堕胎监测，以记录美国合法人工流产的妇女数量和特征。
2015 年。
每年，疾病预防控制中心都从 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。在 2015 年，从 49 个报告地区收到了堕胎数据。这些报告地区在 2006-2015 年期间每年提供的堕胎数据用于趋势分析。人口普查和出生率数据分别用于计算堕胎率（每 1000 名 15-44 岁妇女的堕胎数）和比率（每 1000 名活产的堕胎数）。
从 49 个报告地区向疾病预防控制中心报告了 2015 年的 638169 例堕胎。在这 49 个报告地区中，2015 年的堕胎率为每 1000 名 15-44 岁妇女 11.8 例，堕胎比率为每 1000 名活产 188 例。2014 年至 2015 年，报告的堕胎总数减少了 2%（从 652639 例），堕胎率下降了 2%（从每 1000 名 15-44 岁妇女 12.1 例），堕胎比率下降了 2%（从每 1000 名活产 192 例）。2006 年至 2015 年，报告的堕胎总数减少了 24%（从 842855 例），堕胎率下降了 26%（从每 1000 名 15-44 岁妇女 15.9 例），堕胎比率下降了 19%（从每 1000 名活产 233 例）。2015 年，所有这三个指标都达到了整个分析期间（2006-2015 年）的最低水平。2015 年和整个分析期间，20 多岁的妇女占所有堕胎的大部分，堕胎率最高；年龄≥30 岁的妇女所占比例较小，堕胎率较低。2015 年，20-24 岁和 25-29 岁的妇女分别占所有报告堕胎的 31.1%和 27.6%，其堕胎率分别为每 1000 名 20-24 岁和 25-29 岁妇女 19.9 和 17.9 例。相比之下，年龄在 30-34 岁、35-39 岁和≥40 岁的妇女分别占所有报告堕胎的 17.7%、10.0%和 3.5%，其堕胎率分别为每 1000 名 30-34 岁、35-39 岁和≥40 岁妇女 11.6、7.0 和 2.5 例。2006 年至 2015 年，所有年龄组的堕胎率都有所下降。2015 年，年龄<15 岁和 15-19 岁的青少年分别占所有报告堕胎的 0.3%和 9.8%，其堕胎率分别为每 1000 名<15 岁和 15-19 岁青少年 0.5 和 6.7 例。2006 年至 2015 年，15-19 岁青少年的堕胎比例下降了 41%，堕胎率下降了 54%。这种堕胎率的下降幅度大于任何年龄组妇女的下降幅度。与年龄分布的堕胎百分比和堕胎率相反，2015 年和整个分析期间，堕胎比率在青少年中最高，在 25-39 岁的妇女中最低。堕胎比率从 2006 年至 2015 年在所有年龄组中下降。2015 年，近三分之二（65.4%）的堕胎发生在≤8 周妊娠时，几乎所有（91.1%）的堕胎发生在≤13 周妊娠时。在 14-20 周妊娠（7.6%）或≥21 周妊娠（1.3%）时进行的堕胎很少。2006-2015 年期间，所有超过 13 周妊娠的堕胎百分比一直保持在较低水平（≤9.0%）。在≤13 周妊娠的堕胎中，妊娠时间提前，在≤6 周妊娠的堕胎百分比增加了 11%。2015 年，所有堕胎中有 24.6%是通过早期药物流产（≤8 周妊娠的非手术流产）完成的，64.3%是通过≤13 周妊娠的手术流产完成的，8.8%是通过>13 周妊娠的手术流产完成的；其他所有方法都很少见（≤2.2%）。在符合≤8 周妊娠进行早期药物流产的条件的那些人中，35.8%的人通过这种方法完成。2015 年，有一个或多个先前活产的妇女占堕胎的 59.3%，没有先前活产的妇女占 40.7%。有一个或多个先前人工流产的妇女占堕胎的 43.6%，没有先前流产的妇女占堕胎的 56.3%。有三个或更多先前分娩的妇女占堕胎的 14.2%，有三个或更多先前流产的妇女占堕胎的 8.2%。疾病预防控制中心妊娠死亡率监测系统正在评估 2015 年与堕胎并发症相关的妇女死亡情况。在 2014 年，也就是可以获得数据的最近一年，确定有 6 名妇女因合法人工流产的并发症而死亡。
在 2006-2015 年期间每年报告数据的 49 个地区中，报告堕胎总数、率和比的下降导致了所有三个堕胎指标的历史最低点。
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。意外怀孕是人工流产的主要原因。增加对有效避孕措施的获取和使用可以减少意外怀孕，进一步减少美国的堕胎数量。
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