ADVOCATES FOR YOUTH

The Facts

Adolescents and Abortion

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Each year, 750,000 to 850,000 teenage women in the United States experience pregnancy^1,2 Moreover, 74 to 95 percent of these pregnancies are unintended.^3,4 In 1999, the most recent year for which data are available, over 148,000 teenage pregnancies ended in abortion.⁵ Around the world, women of reproductive age have some 50 million abortions, 20 million under unsafe conditions that result in high rates of injury and death.6In the United States, legal abortion is a very safe procedure.⁵ Yet, U.S. adolescents' access to legal abortion is increasingly restricted.

Abortion Occurs More Frequently among Adult Women than among Adolescent Women.

• In 1995, 61 percent of U.S. women reported that their pregnancies were intended; 38 percent as unintended. Among 15- to 19-year-old women, 26 percent reported their pregnancies as intended; 74 percent as unintended.⁴ [Mistimed and unwanted pregnancies are counted here as unintended.
• In 1999, women in the United States obtained nearly 862,000 abortions. Women under age 20 accounted for 19 percent of U.S. abortions while women ages 20 and older accounted for 81 percent.⁵
• The teenage abortion ratio is 375 abortions per 1,000 births to women ages 15 to 19. The teenage abortion rate is 18 per 1,000 women ages 15 to 19.⁵
• Eighty-eight percent of all U.S. abortions for which gestational age was known occurred in the first 12 weeks of pregnancy; 58 percent in the first eight weeks. Eighty-three percent of abortions in teenage women occurred during the first 12 weeks of pregnancy; 48 percent in the first eight weeks.⁵
• Researchers in the United States identified several associations between socioeconomic disadvantage and adolescent reproductive behavior. Whether measured at the individual, the family, or the community level, being disadvantaged was associated with teens' earlier age at first intercourse, less reliance on or poorer use of contraception, less motivation to avoid having a child, less likelihood of having an abortion, and greater likelihood of bearing a child premaritally.⁷
• In general, teens from families that are better off financially and who have higher expectations for the future have been more likely to choose to end a pregnancy with abortion than teens from poor homes or who have low hopes for the future.⁸

In the United States, State Laws Restrict Adolescents' Access to Abortion.

• In the United States, 43 states have requirements that a woman under age 18 must notify or get consent from one or both parents before she can obtain an abortion. Of these, 32 states' requirements were in effect as of August 2002: consent in Alabama, Idaho, Indiana, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Missouri, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Wisconsin, and Wyoming and notification in Arkansas, Delaware, Georgia, Iowa, Kansas, Maryland, Minnesota, Nebraska, Ohio, South Dakota, Texas, Utah, Virginia, and West Virginia. Courts have enjoined the laws from taking effect in Alaska, Arizona, California, New Mexico, Oklahoma, Colorado, Florida, Illinois, Montana, Nevada, and New Jersey.⁹
• In one study, parental notification laws had almost no effect on an adolescent's decision to talk with her parent or guardian about her decision prior to an abortion. The chief factor determining whether a teen consulted her parent was, not legislation, but the quality of the teen's relationship with her parent.^10,11
• In states with parental consent or notification laws, many adolescents who did not consult their parents said it was because they feared emotional and/or physical abuse, including eviction from their homes.¹⁰
• The Supreme Court requires states with parental consent or notification laws to allow teens to obtain an abortion by appealing to another adult, such as a judge, doctor, or minister (bypass procedures). Although bypass procedures are an important safeguard for teens who reside in states with parental consent or notification laws, studies have shown that forcing pregnant teens to apply to a court, physician, or other authority figure may have significant, adverse physical and emotional effects on these young women.¹⁰

Globally, Safe, Legal Abortion Is Very Different from Unsafe or Clandestine Abortion.

• The World Health Organization characterizes unsafe abortion by the lack of skilled providers, safe techniques, and/or sanitary facilities.¹² Although legality does not ensure safety, where abortion is illegal, it is too often also unsafe—performed by unskilled providers in hidden, often hazardous circumstances.¹³
• The World Health Organization estimated that 30 million legal abortions and 20 million clandestine (illegal) abortions occurred throughout the world each year in 1995 through 2000.⁶
• In a recent tabulation, deaths in the developing world from unsafe, usually clandestine, abortion accounted for 64 percent of the 687,000 women who died as a result of unintended pregnancy between January 1995 and December 2000.¹² The mortality rate due to unsafe abortion in less developed nations was 330 per 100,000 abortions: in Africa, 680; in southern and southeastern Asia, 283; and in Latin America, 119 per 100,000.¹³
• Most recent data on mortality due to legal induced abortion in the United States indicated less than one death (0.6) per 100,000 legal abortions.^5,13 In other developed nations, where abortion is also legal, the rates were similarly low— Canada, 0.1; Netherlands, 0.2; England and Wales, 0.4; Denmark, 0.5; Finland, 0.7; and Scotland, 1.0 per 100,000 legal abortions.¹³
• Although abortion is a very safe procedure in the United States, the probability of complications and death increases with the length of gestation. For example, abortion at eight weeks or less of gestation has a fatality rate of 0.4 per 100,000 abortions. At 16 to 20 weeks, the fatality rate is nearly seven deaths per 100,000 abortions.¹³
• In some countries, complications of unsafe abortion are the leading cause of death among teenage women. For example, in Nigeria, a study found that 72 percent of all deaths among women under age 19 are due to consequences of unsafe abortion. Moreover, young women who survive unsafe abortion may suffer complications leading to infertility.¹⁴
• When women resort to unsafe abortion, the methods most likely to result in their death include penetration with sharp objects—such as knives and coat hangers which can perforate the uterus—and insertion into the cervix of contaminated materials and/or unclean instruments.¹³

References

1. Kaufmann RB et al. The decline in US teen pregnancy rates, 1990-1995. Pediatrics 1998; 102:1141-47.
2. Centers for Disease Control & Prevention. National and state-specific pregnancy rates among adolescents, United States, 1995-1997. Morbidity & Mortality Weekly Report 2000; 49:605-11.
3. Centers for Disease Control & Prevention. State-specific pregnancy and birth rates among teenagers, United States, 1991-92. Morbidity & Mortality Weekly Report 1995; 44:677-84.
4. Abma JC et al. Fertility, Family Planning, and Women's Health: New Data from the 1995 National Survey of Family Growth. [Vital & Health Statistics; series 23, no. 19] Hyattsville, MD: National Center for Health Statistics, 1997.
5. Elam-Evans LD et al. Abortion surveillance, United States, 1999. Morbidity & Mortality Weekly Report, Surveillance Summaries 2002; 51(SS-9):1-28.
6. World Health Organization. Unsafe Abortion: Global and Regional Estimates of Incidence of and Mortality Due to Unsafe Abortion. Geneva: The Organization, 1998.
7. Singh S et al. Socioeconomic disadvantage and adolescent women's sexual and reproductive behavior: the case of five developed countries. Fam Plann Perspect 2001; 33:251-258+.
8. Alan Guttmacher Institute. Sex and America's Teenagers. New York: The Institute, 1994.
9. Henry J. Kaiser Family Foundation. Abortion Policy and Politics. [Issue Update]. Menlo Park, CA: The Foundation, 2002.
10. American Academy of Pediatrics et al v Lunngren et al; 1996 Cal. LEXIS 1387, testimony of Robert Blum, MD.
11. Blum RW et al. The impact of a parental notification law on adolescent abortion decision-making. Amer J Public Health 1987; 77:619-620.
12. Daulaire N et al. Promises to Keep: The Toll of Unintended Pregnancy on Women's Lives in the Developing World. Washington, DC: Global Health Council, 2002.
13. Alan Guttmacher Institute. Sharing Responsibility: Women, Society & Abortion Worldwide. New York: The Institute, 1999.
14. Shane B. Family Planning Saves Lives. 3rd ed. Washington, DC: Population Reference Bureau, 1997.

Written by Sue Alford
January 2003 © Advocates for Youth

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