9.4.2: Termination of a Pregnancy

The termination of a pregnancy is often referred to as a miscarriage (or pregnancy loss) if it is spontaneous, and an abortion if it is caused by medical intervention. However, this differentiation fails to accurately describe the complexities of pregnancy termination. Sometimes an abortion (medical intervention) is necessary for a “missed” or incomplete miscarriage, in order to expel any remaining tissue which could cause infection. It is estimated that about 10-20% of known pregnancies end in miscarriage, however the total number is likely much higher as many miscarriages happen before the pregnancy is discovered (Mayo Clinic, 2023).

The CDC requests data on the number, type, gestational age, and demographics of abortion procedures each year from 50 states, the District of Columbia, and New York City. The most recent data (presented below) is from 2021, when 48 of these areas reported numbers - excluding California, Maryland, New Hampshire, and New Jersey (Kortsmit et al., 2023):

• Over 625,000 abortions were performed in 2021.
• When compared to the population of women in those reporting areas between the ages of 15-44, the rate was 11.6 per 1,000 women.
• When compared to the number of live births reported, the rate was 204 abortions per 1,000 live births.
• There was a 5% increase in abortions compared with the year prior (2020).
• Since 2012, there has been an 8% decrease in the number of abortions performed.
• For the 41 areas reporting gestational age at time of abortion in 2021:
• 80.8% of abortions occurred at < 9 weeks of gestation
• 93.5% of abortions occurred at < 13 weeks of gestation
• 5.7% of abortions occurred between 14-21 weeks of gestation
• 0.9% of abortions occurred after 21 weeks.

The decision to terminate a pregnancy with medical intervention is influenced by a variety of factors. Research suggests that the most common reasons given for choosing abortion have to do with economic factors (including job stability or finishing schooling), ability to care for other children, partner support or concerns about partner relationships, and concern for future children. These reasons haven’t really changed over the last few decades (Finer et al., 2005). For abortions that occur in the second trimester or later, several factors cited for delaying the procedure include: not knowing a pregnancy existed, a lack of access to abortion care or travel requirements, or the cost of an abortion. Later abortions are also often associated with the discovery of lethal fetal abnormalities as well as the development of maternal health risks (Gomez et al., 2024).

After the U.S. Supreme Court overturned Roe v. Wade in June of 2022 with the Dobbs v. Jackson Women’s Health Organization ruling, many states brought back old laws or enacted new ones to ban abortions. As of 2024, 14 states in the U.S. have total abortion bans. Some states have enacted bans with exceptions for rape, incest, and the life or health of the pregnant person, but often these exceptions also have legal processes and requirements that are difficult to interpret - which may delay the process to a point at which the abortion would no longer be permitted anyway (State Bans on Abortion throughout Pregnancy, 2024). Several states, including California, have voted to enshrine abortion rights in their state constitutions, while still banning abortion after the age of viability - meaning that abortion is permitted up until the point at which a fetus potentially could survive outside of the uterus. Although “viability” is not a medical designation, this is typically considered around 24-26 weeks of gestation and was the original limit of Roe v. Wade. Survivability of infants born at this gestational age is highly dependent on a variety of factors including the amount of medical intervention needed, as well as advances in medical technology (Guttmacher Institute, 2024, Gomez et al., 2024).

The World Health Organization states that ensuring access to safe, legal abortion care supports gender equality and the health and well-being of women and girls around the world (WHO, 2024c). One study assessed rates of unintended pregnancies and abortions around the world, comparing countries where it is legal to places where it is restricted. Researchers found that between 1990-2019, the number of unintended pregnancies globally has declined, yet the percentage of unintended pregnancies ending in abortion has increased. When comparing regions around the world with legal restrictions on abortions (from countries with outright bans to those with some exceptions), the abortion rates were no different than in countries where it was legal and accessible (Bearak et al., 2020). Restricting access to abortion does not actually reduce the number of abortions, it only increases the number of unsafe abortions, which come with much higher rates of maternal morbidity and mortality. While deaths from safely-performed abortions are less than 1 in 100,000, mortality rates from unsafe abortions are much higher, around 200/100,000 Legalization of abortion is not only associated with lower health risks, there may be other social benefits as well: when pregnancies and births are wanted, children and society benefit from better parental investments in their care and education. Further, the WHO asserts that restrictions to abortion care contribute to emotional distress, social stigma, financial hardships, and risks constituting human rights violations against women and girls (WHO, 2024c).