Abortion facilities and the risk of death

While the number of abortions performed annually in the United States has increased steadily since 1969, the proportion of abortions performed in hospitals has been declining since 1975. Between 1974 and 1977, 1,229,000 abortions were performed at 12 or fewer weeks' gestation in U.S. hospitals, while 2,730,000 were performed in free-standing clinics and doctors' offices. Over the same period, there were 19 deaths which resulted from in-hospital procedures, and 17 from abortions performed in nonhospital facilities. The crude death-to-case rate are 1.5 deaths per 100,000 procedures for hospital abortions, and 0.6 deaths per 100,000 abortions performed in nonhospital facilities. When these rates are adjusted for the presence of preexisting medical conditions and for the concurrent performance of sterilizations, the death-to-case rates for first-trimester abortions performed in both kinds of facilities were about 0.7.

Adolescent abortions in the United States

Despite the fact that adolescent females have a more negative reaction to abortion than older women, they are apparently more likely to use legal abortion to prevent unplanned births. The most important variable affecting abortions among teenagers is the significantly later gestational age at which their procedures are performed. After adjusting for this factor, teenagers have generally lower morbidity and mortality rates from legally induced abortions than do older women. The scientific literature is inconclusive about whether present abortion methods will have any harmful effect on subsequent desired pregnancies. Current efforts to restrict abortion services for teenagers will probably produce a negative public health impact by encouraging delay in obtaining abortions after deciding to terminate a pregnancy.

Criminal abortion. Fact or fiction?

This is a review of the current status of legal and illicit abortions in England as related to the changes brought on by the United Kingdom Abortion Act or 1968. The controversy surrounding the Act is discussed, and a review of mortality statistics is also included.

Abortion and the NHS: the first decade

Analysis of statistics published since the Abortion Act showed that from 1972 about half the abortions carried out on residents of England and Wales had been performed within the National Health Service. Regional variations in the proportions of abortions performed within the NHS had persisted. In some health regions fewer abortions were being carried out than before. In 1975 about 40% of abortions on single women and women with no existing children were performed within the NHS. Trends in the concurrent sterilisation rate, gestational age at operation, duration of stay in hospital, and mortality and complication rates suggested a steady improvement in the effectiveness and efficiency of abortion services. Nevertheless, the NHS still compares poorly with the private sector and some other countries.

Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940 through 1976)

Both non-abortion-related maternal and abortion-related mortality declined prior to the Supreme Court decisions of 1973. In order to determine the effect of legalized abortion on maternal mortality, we have analyzed the secular trends in national abortion mortality ratios for 1940 through 1976, compared the trends to those maternal mortality ratios, and hypothesized reasons for differences between these trends. Between 1940 and 1950 and after 1965, deaths from abortion declined more rapidly than deaths from other causes associated with childbirth. However, between 1951 and 1965, maternal mortality related to pregnancy of childbirth declined more rapidly than abortion-related mortality. Five possible explanations exist for the more rapid decline in abortion deaths since 1965--selected underreporting, changes in coding practices, improved safety of illegal abortion, introduction of more effective contraception, and increased availability of legal abortion. We consider the last two explanations as the most likely reasons for the accelerated decline in abortion-related deaths.

Induced abortion

The morbidity and mortality of illegal abortion are briefly discussed with reference to South Africa, where it seems that 1 in every 8-10 pregnant women deals with an unwanted pregnancy in this way. A review of the literature regarding legal abortion has been undertaken, detailing mortality and morbidity with various methods in many countries. The medical problems resulting from a permissive abortion policy have been highlighted, and an attempt has been made to define the place of medically induced abortion in health services, as it is understood by countries with extensive experience in this field. It is hoped that this contribution will help to define the real issues in the current abortion debate in South Africa.

Comparative risk of death from legally induced abortion in hospitals and nonhospital facilities

The rapid emergence of nonhospital abortion facilities as alternatives to traditional hospital-based surgical care has raised important questions concerning their safety. Using 1974--1975 data from the Center for Disease Control's nationwide surveillance of abortion mortality and the Alan Guttmacher Institute's nationwide surveys of abortion providers, we have calculated the risk of death from legally induced abortion in the United States at less than or equal to 12 menstrual weeks' gestation in hospitals and nonhospital facilities (clinics and physicians' ofices). The adjusted death-to-case rate for hospitals was 1.1 deaths/100,000 abortions, compared with a crude rate of 1.0 for nonhospital facilities. The risk of death from legal abortion in nonhospital facilities is apparently similar to the risk in hospitals.

Death after legally induced abortion. A comprehensive approach for determination of abortion-related deaths based on record linkage

The sources for determination of abortion-related deaths in Georgia are the cause of death listed on the death certificate and reports from informal reporting channels. Although Georgia residents 10-44 years of age obtained 19,877 induced abortions in 1975, no deaths related to abortion were found through these two usual sources. To determine the sensitivity of this system, all abortion certificates for 1975 were compared with all death certificates of Georgia females aged 10-44 who died in 1975 and the first 2 months of 1976. Based on the age and racial distribution of the women who received abortions, approximately 13 deaths (from all causes) would be expected to have subsequently occurred during the period of time studied. The authors found only 10. From national death-to-case rates for legal abortion, the expected number actually atrributable to abortion was 0.78 death. Of the 10 deaths, 2 were potentially related to the previous abortion, but a causal relationship to the preceding abortion was not clearly evident for any of the 10 deaths. The data, therefore, tend to support the assertion that no large numbers of deaths related to abortion are undiscovered and that current measurements of abortion mortality are accurate.

The risk of dying from legal abortion in the United States, 1972-1975

Data gathered by the Center for Disease Control (CDC) through epidemiologic surveillance of deaths associated with legal abortions performed from 1972 through 1975 are analyzed by the type of procedure and the gestational age of the patients. Analysis shows that deaths increase at higher gestational ages and that the risk of death from abortion is highest with hysterotomy and hysterectomy and lowest with suction curettage. Second trimester instillation procedures are associated with higher rates of mortality than first trimester curettage procedures, even when dilatation and evacuation at 13-15 weeks' gestation is included as a curettage procedure. A case history of a patient who died as a result of legal abortion demonstrates that while legal abortion is a safe surgical procedure, some of the deaths that still occur can be prevented.

Legal abortion mortality in the United States. Epidemiologic surveillance, 1972-1974

As determined by the Center for Disease Control's epidemiologic surveillance of abortion mortality, the death-to-case rate for legal abortion in the United States for the three years 1972 to 1974 was 3.9/100,000 procedures. This mortality compares favorably with that from other commonly performed surgical procedures. Women who were older, were of nonwhite races, had the procedure in their state of residence, were at later gestational age, and who underwent intrauterine instillation or major abdominal surgery had the highest mortality. Duration of pregnancy proved to be the most important determinant of risk. Compared to mortality from pregnancy and childbirth, legal abortion in the first trimester was almost nine times safer.