In all waves, the risk of all complications increased steadily with increasing gestational age, being lowest for women obtaining abortions at ≤ 8 weeks of gestation and increasing 2 to 10 times for procedures after 12 weeks of gestation. Complication rates were lowest among women whose abortions were performed using suction curettage and increased with more invasive procedures (those often used for more advanced pregnancies).
Trend data are also available on mortality. The annual number of legal-abortion-related deaths decreased from 24 deaths in 1972 to 6 in 1987, and the mortality rate decreased from 4.1 per 100,000 abortions in 1972 to 0.4 in 1987. As with overall complication rates, the risk of mortality is lower for abortions performed by suction or sharp curettage during the first trimester and for pregnancies of lower gestational age (Lawson et al., 1994). The risk of mortality is higher, however, for nonwhite women, women 35 years of age and older, and for women of higher parity.
The increased risk of both morbidity and mortality with increasing gestational age underscores the health risks averted by early rather than late abortion. At present, 11 percent of abortions are obtained after 12 weeks of pregnancy; these later abortions are obtained disproportionately by adolescents: for girls under age 15, 22 percent of abortions are done in the second trimester, whereas the comparable figure for women over age 20 is 9 percent (Rosenfield, 1994). Although late abortion may be due to delay in recognizing a pregnancy, in deciding what to do if the pregnancy is unwanted, or may be a consequence of a genetic defect not detected until the second trimester, public policies can also increase the chance that an abortion will be performed in the second rather than the first trimester. Policies that may discourage first-trimester abortions include mandatory waiting periods (now required in 13 states), parental involvement/judicial bypass laws (35 states), and various informed consent laws, many of which require that women be given antiabortion lectures and materials intended to discourage them from having an abortion (31 states) (National Abortion and Reproductive Rights Action League, 1994). Chapter 7 notes the important and related issues of insufficient training of providers in abortion techniques and of declining numbers of abortion providers.
Although the medical risks of abortion appear to be very small, the procedure may pose troubling moral and ethical problems to some women and providers as well. In addition, women (and those close to them) may find that confronting an unintended pregnancy and weighing the option of abortion are emotionally difficult experiences, and the procedure itself may involve appreciable pain and expense.