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IV. INDUCED ABORTION AMONG ADOLESCENTS This section presents information on induced abortions among adolescent women in the United States. Data on abortions in the U.S. come from both federal and nonfederal sources. The Centers for Disease Control (CDC) carry out abortion surveillance which includes reports of abortions from most State health agencies, some hospitals, or from State participants in the Cooperative Health Statistics Registry of the National Center for Health Statistics (NCHS). Through this system, tabulations of abortions by characteristics are provided to CDC and released as an annual surveillance report. This report provides infor- mation on the distribution of abortions by age, race, parity and other characteristics. The Alan Guttmacher Institute (AGI) contacts abortion service pro- viders and thereby derives a more complete count of abortions, although no data are gathered regarding specific characteristics of the women. By combining information from both sources one can estimate the charac- teristics of women receiving abortions. For example, the CDC report of the percentage of abortions to teenagers can be applied to the total number of abortions reported through AGI. This is regularly done by AGI and CDC with some adjustments for differences in reporting systems, but it is not known how the characteristics of women differ in the two types of reporting. NCHS obtains some individual level data through reports of induced abortions submitted to state vital registration offices. These data provide cross-classification of abortions by several characteristics, such as age, race and parity, but are obtained for a very limited numb ber of states. For example, the report based on 1980 data covered only 295,932 abortions occurring in a twelve state area. A-77 / 429

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A-81 / 433 TABLE 4.1 - Table 4.1 presents the number and percentage distribution of legal abortions, the abortion rate and the percent of pregnancies terminated by abortion by the age of women. Data are tabulated by the Alan Gutt- macher Institute (AGI) on the basis of its annual survey of clinics and other abortion providers combined with data on patient character- istics reported by most states to the Centers for Disease Control. In 1982 there were 14,590 abortions to women under age 15, over 168,000 to women aged 15 to 17, and over 250,000 to women aged 18 to 19. Less than one percent of all abortions were obtained by women under age 15; 11 percent were to women aged 15 to 17; and 16 percent were to women aged 18 to 19. Nearly 30 percent of all abortions were to women less than 20 years of age. The total abortion rate in 1982 was 28.8 abortions per 1,000 women aged 15 to 44. For young women less than 15 years of age the abortion rate was 8.6 per 1,000 women, only slightly higher than the 1974 rate. The abortion rate for women aged 15 to 19, however, increased from 27 to 43 per 1,000 women aged 15 to 19 between 1974 and 1982. The abor- tion rate (excluding miscarriages and stillbirths) for women aged 18 to 19 has consistently been about twice as high as the rate for women aged 15 to 17. The proportion of pregnancies terminated by abortion for 15-to 19 year-old women increased by 40 percent from 1974 to 1981, from 29 to 40.6 percent. In 1981, 4 in 10 pregnancies among teens ended in in- duced abortion. The proportion of pregnancies to women younger than 20 terminated by abortion was higher than for any other age group with the exception of women over 40 years of age, (among whom 51 percent of pregnancies end in abortion). The number of abortions, the rate, the ratio, and the percent of pregnancies ending in abortion rose rapidly between 1973 and 1979. In 1982, however, the abortion rate and ratio, and the number of abortions obtained by teenagers declined slightly.

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A-83 / 435 TABLE 4.2 The percent change in abortion rates and in the number of preg- nancies terminated by abortion from 1974 to 1982 by age are shown in Table 4.2. As in Table 4.1, data are from the Alan Guttmacher Institute and the Centers for Disease Control (CDC). The abortion rate increased between 1974 and 1978 by 17 percent among women younger than age 15, 48 percent among women aged 15 to 19 and 55 percent among women aged 20 to 24. The increase in the propor- tion of pregnancies terminated by abortion was 36 percent for women aged 15 to 19, and 44 percent for women aged 20 to 24. The changes in the abortion rate and in the percent of pregnancies terminated by abortion were much lower between 1979 and 1981. The abortion rate increased by 4 percent for women under age 15 from 1979 to 1981, by 2 percent for women aged 15 to 19, and 2 percent for women aged 20 to 24. The proportion of pregnancies terminated by abortion rose less than one percent between 1979 and 1981 for young women under age 15, not at all for women aged 15 to 19, and 3 percent for women aged 20 to 24. For all women under age 20, there were slight decreases in the abortion rates between 1981 and 1982. Data on the percent of preg- nancies terminated by abortion for 1982 were not available.

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A-84 / 436 TABLE 4 .3 Abortion Rate* Per 1, 000 Women, By Age-group And Race ~ Accord ing To Mar ital Status, 1979-81 Character istics Marr fed Unmarr fed Age-Group and Race All Races* * Less than 15*** -- 8. 4 15-19 17.7 31.3 15-17 15.4 21.7 18-19 18.4 47. 0 20-24 14.1 50.3 25-29 9.4 41.6 30-34 6.0 25. 7 35-39 2.7 9.0 white 6.5 33.3 Black 15.1 41.7 . . . Note: Includes separated, divorced, widowed and never-married women *Rates are three-year averages of induced terminations of pregnancy per 1,000 population of residence. **Includes races other than Black and White. ***There is no accurate estimate of the number of married women under 15. Sources: Abortions by aged-group and marital status--data on 11 states (Colorado, Kansas, Missouri, Montana, Oregon, Rhode Island, South Carolina, Ter~nessee, Utah, Vermont and Virginia). K. Prager, "Induced Terminations of Pregnancy: Report ing States, 1981" NCHS, Monthly Vital Statistics Report, Vol. 34, No. 4, July 1985.

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A-85 / 437 TABLE 4.3 Table 4.3 shows the abortion rate per 1,000 women by age and mari- tal status and by race and marital status for 1979-19810 Data are provided by 11 states to the National Center for Health Statistics (NCHS). Abortion rates in general were higher among unmarried women than among married women. The highest abortion rates among unmarried women were between the ages of 18 and 29, while the highest abortion rates for married women were for those women under age 20. Black women were considerably more likely to have an abortion than white women, particularly black married women. The abortion rates for black women for the 1979-1981 period were 15.1 per 1,000 married women and 41.7 per 1,000 unmarried women. For white women, the abortion rates were 6.5 per 1,000 married women and 33.3 per 1,000 unmarried women.

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A-86 / 438 TABLE 4~4 Estimated Abortion Rate Per 1,000 Women Aged 12-19* By Race, United States, 1971-1978 Abort ion Rate Black and Ratio of Black Rate Year White Other** to White Rate 1972 11.7 17.4 1.5 1973 14.1 25.4 1. 8 1974 16.0 34.0 2.1 1975 18.0 42.0 2.3 1976 19.8 48.1 2.4 1977 22.2 50.7 2.3 1978 24 .3 51.2 2. 1 *Based on age at concept ion. **including teenagers of all other racial minorities. Source: N.V. Ezzard, W. Cates, Jr., D.G. Kramer, and C . T ietze, "Race- Specif ic Patterns of Abortion Use by American Teenagers," American Journa1 of Public Health, 72: 809, 1982. Reprinted by permission.

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A-87 / 439 TABLE ~ . ~ Table 4 .4 shows the estimated abortion rate per 1, 000 females aged 12 to 19 by race f ram 1972 to 1978 e These data are f rom the Centers for D isease Control (CDC ~ . The rate of abortion per 1, 000 women more than doubled between 1972 and 1978 for teenagers of both races. For every 1, 000 white women there were 11 abortions in 1972 and 24 abortions in 1978. The abortion rate was 17 per one thousand black women in 1972 and 51 per 1, 000 in 1978. By 1978 the abortion rate for black teenagers had increased to twice the rate for whites.

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A-89 / 441 TABLE 4.5 Table 4.5 shows the number of legal abortions per 1,000 births (Abortion Ratio) by age at conception by race from 1972 to 1978. The data on abortions are from the Center for Disease Control (CDC) and the data on births are from National Center for Health Statistics (NCHS). From 1972 to 1978, the ratio of abortions per 1,000 live births more than doubled for all women aged 12 to 19 at conception. There were 270 abortions for every 1,000 live births to white teenage women in 1972 and 615 per 1,000 in 1978. The ratio of abortions per 1,000 live births for nonwhite (black and other) teenage women was lower than for white in 1972. Between 1972 and 1978, the ratio rose more rapidly among nonwhite teenagers than among white teenagers, and in 1978 the nonwhite ratio exceeded the white ratio for teenagers under age 15 and ages 18 and 19.

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A-9 0 / 44 2 TABLE 4.6 Ratios of Induced Terminations of Pregnancy By Race And Age Of Woman, 1980: 12-State Area (Ratios Per 1,000 Live Births. Induced Terminations of Pregnancy And Live Births Are Only Those Occurr ing In The Area Among Residents Of The Area) Ratio Age of Woman All Racesa White Black All Ages 388.2 1, 337. 7 638. 7 Under 14 years 1, 868.1 2, 085.2 1, 749. 6 14 years 1,380.6 1,632.0 1,200.2 15-19 years 73 8. 7 78 6.3 644 . 5 15 years 97S.4 1,177.1 774.9 16 years 894.0 1,042.8 673.4 17 years 76S. 4 841 .8 621.2 18 years 794.1 847.5 669.0 19 years 603.1 613.0 591.5 20-24 years 411.6 362 .2 638. 6 25-29 years 247. 7 197.1 580.1 30-3 years 254 .2 201. 7 598.3 35-39 years 443.2 371.0 836.5 40 years and over 837.8 784.5 1,120.3 Note: The 12-State area includes Colorado, Kansas , Missour i Montana, New York, Oregon, Rhode Island, South Carolina, Tenne ssee, Utah, Ve rmont, and Vi rg in ia. aIr~cludes races other than white and black. Source: Elurnham, 1983: Table A; see references at end of this volume . —

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A-91 / 443 TABLE 4.6 Table 4.6 presents the number of induced terminations of pregnancy or abortions per 1,000 live births (abortion ratio) by race and age of women for the 12 state reporting area in 1980. The data, collected from 12 states, are provided by National Center for Health Statistics (NCHS). For women of all ages and races, there were 388 abortions per 1~000 live births. The abortion ratio was highest among women under age 20. For women under age 14 there were 1,868 abortions per 1,000 live births, and for women aged 14 there were 1,380 abortions per 1,000 live births. For all ages under age 20, the abortion ratio was higher for white women than for black women. Among women aged 20 and over, however, the number of abortions per 1,000 live births was higher for black women than for white women.

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A-92 / 444 TABLE 4.7 Percent of Induced Terminations of Pregnancy To Women With No Previous Induced Termination, By Age And Race Of Women: 12-State Area, 1980 {Data Inc. lude Only Induced Terminat ions Of Pregnancy Occur ring In The Report ing Area) Rat lo Age of Woman Alla Races White Black All Ages 65.7 68.9 57.8 Under 15 years 94.7 96.0 93. 5 15-17 years 87. 6 89. 1 83. 9 18-19 years 77.6 79.6 70.8 20-24 years 62.2 65.1 54.5 25-19 years 54.8 57.9 47.1 30-34 years 56.4 60.0 47.0 35-39 years 60.1 65.8 48.0 40 years and over 67.2 72.2 54.5 \ Note: The 12-State area includes Colorado, Kansas, Missouri, Montana, New York, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, and Virginia. aIncludes races other than white and black . Source: Burnham, 1983: Table E.; see references at the end of th is volume ~

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A-93 / 445 TABLE 4.7 . Table 4.7 shows the proportion of abortions obtained by women with no previous induced termination, by age and race of women for the 12 state reporting area in 1980. The data are from the National Center for Health Statistics (NCHS). The large majority of women, regardless of race, under age 20 having an abortion in 1980 were having their first abortion. Among young women under age 15, 94.7 percent had not had a previous abor- tion--96.0 percent of white women and 93.5 percent of black women. Among women aged 15 to 17 having an abortion, 87.6 percent had not had previous abortion--89.1 percent of white women and 83.9 percent of black women. Finally, among women aged 18 to 19 having an abortion in 1980, 77.6 percent had not had a previous abortion--79.6 percent of white women and 70.8 percent of black women.

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