2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar, the 2004th year of the Common Era (CE) and Anno Domini (AD) designations, the 4th year of the 3rd millennium and the 21st century, and the 5th year of the 2000s decade.
Description of System: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973--1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. During 2000--2002, Oklahoma again reported these data, increasing the number of reporting areas to 49; for 2003 and 2004, Alaska again reported and West Virginia did not, maintaining the number of reporting areas at 49.
Results: A total of 839,226 legal induced abortions were reported to CDC for 2004 from 49 reporting areas, representing a 1.1% decline from the 848,163 legal induced abortions reported by 49 reporting areas for 2003. The abortion ratio, defined as the number of abortions per 1,000 live births, was 238 in 2004, a decrease from the 241 in 2003. The abortion rate was 16 per 1,000 women aged 15--44 years for 2004, the same since 2000. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998--2004. In 2003 (the most recent years for which data are available), 10 women died as a result of complications from known legal induced abortion. No death was associated with known illegal abortion.
Interpretation: During 1990--1997, the number of legal induced abortions gradually declined. When the same 47 reporting areas are compared, the number of abortions decreased during 1996--2001, then slightly increased in 2002 and again decreased in 2003 and 2004. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002 and a further decrease in both 2003 and 2004. In 2003, as in the previous years, deaths related to legal induced abortions occurred rarely.
CDC began conducting abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report is based on abortion data for 2004, provided voluntarily to CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Reproductive Health.Methods
For 2004, CDC compiled data that were voluntarily provided from 49 reporting areas in the United States: 47 states (excluding California, New Hampshire, and West Virginia), the District of Columbia (DC), and New York City (NYC). Legal induced abortion was defined as a procedure, performed by a licensed physician or someone acting under the supervision of a licensed physician, that was intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age (1,2). The total number of legal induced abortions was available from all reporting areas; however, not all areas collected data on some or all characteristics of women who obtained abortions, and the availability of such data varied by reporting area.
Overall, the annual number of legal induced abortions in the United States increased gradually from 1973 until it peaked in 1990, and it generally declined thereafter (Figure 1). In 2004, a total of 839,226 legal induced abortions were reported to CDC by 49 reporting areas. This change represents a 1.1% decline from 2003, for which 49 areas reported 848,163 legal induced abortions (Tables 1 and 2).
The national legal induced abortion ratio increased from 196 per 1,000 live births in 1973 (the first year that 52 areas reported) to 358 per 1,000 in 1979 and remained nearly stable through 1981 (Figure 1; Table 2). The ratio peaked at 364 per 1,000 in 1984 and since then has demonstrated a generally steady decline. In 2004, the abortion ratio was 238 per 1,000 in 49 reporting areas and 239 for the same 47 reporting areas for which data were available since 1998 (Table 2).
The national legal induced abortion rate increased from 14 per 1,000 women aged 15--44 years in 1973 to 25 per 1,000 in 1980. The rate remained stable, at 23--24 per 1,000 during the 1980s and early 1990s and at 20--21 per 1,000 during 1994--1997. The abortion rate remained unchanged at 17 per 1,000 during 1998--1999 and at 16 per 1,000 during 2000--2002 both overall and in the same 47 reporting areas. During 2003--2004, the abortion rate remained unchanged overall at 16 per 1,000, decreased to 15 per 1,000 in 2003, and to 16 in 2004 in the 47 reporting areas.
The numbers, ratios, and rates of reported legal induced abortions are presented by area of residence and by area of occurrence (Table 3). In 2004, the highest number of reported legal induced abortions occurred in Florida (91,710), NYC (91,673), and Texas (74,801); the fewest† occurred in Wyoming (12), South Dakota (814), and Idaho (963) (Table 3). The abortion ratios by state or area of occurrence ranged from 43 per 1,000 live births in Idaho to 770 per 1,000 in NYC. Among women aged 15--44 years, rates by occurrence ranged from three per 1,000 women in Idaho to 30 per 1,000 in New York. These ratios and rates should be viewed with consideration of the sizable variation by state in the percentage of abortions obtained by out-of-state residents. In 2004, approximately 8% of reported abortions were obtained by out-of-state residents (range: from 0.2% [in Alaska] to 53% [in DC]) (Table 3). Data by state of residence are incomplete because three states (California, New Hampshire, and West Virginia) did not report any data on abortion, and seven states (Alaska, Arizona, Florida, Iowa, Kentucky, Louisiana, and Massachusetts) did not provide data concerning the residence status of all women obtaining abortions in their state. Thus, ratios and rates by state of residence should be viewed with caution because of the substantial variation in completeness of reporting of residence information.
In 2004, for women from areas where weeks of gestation at the time of abortion were adequately reported (44 reporting areas), 61% of reported legal induced abortions were known to have been obtained at
For women whose type of procedure was adequately reported, 87% of abortions were known to have been performed by curettage (which includes dilatation and evacuation [D&E]) and 0.6% by intrauterine instillation (Table 8). A total of 35 reporting areas submitted information regarding performance of medical (nonsurgical) procedures (hereafter referred to as medical abortion). Known medical abortions make up approximately 10% of all procedures reported from the 45 areas with adequate reporting on type of procedure. In addition, two areas that did not collect data separately for medical abortions on their abortion reporting form included medical abortions in the \"other\" category. For the 35 areas that reported medical abortions separately, 66,033 medical abortion procedures were performed in 2004. Eight states reported that no medical abortions were performed in 2004 but did not specify whether such abortions were available. For the 32 reporting areas that reported one or more medical abortion for both 2003 and 2004, the data reflect an increase of 17%, from 54,703 in 2003 to 63,975 in 2004 (8). The extent to which the 66,033 medical abortions reported to CDC for 2004 represent the use of this procedure in all reporting areas is unknown. Hysterectomy and hysterotomy were included in the \"other\" procedure category and were used in
From the National Pregnancy Mortality Surveillance System, CDC identified 26 deaths for 2003 that were thought to be potentially related to abortion. These deaths were identified either by some indication of abortion on the death certificate, from health-care providers, or from information such as a news or public health report associated with the death. Investigation of the 2003 cases revealed that 10 of the 26 deaths were related to legal induced abortion and none to illegal induced abortion (Table 19). Four of the 10 legal induced abortion-related deaths occurred following a medical (nonsurgical) abortion procedure. Ten deaths were related to spontaneous abortion, and four deaths were found not to be abortion related. The remaining three deaths were found to be not pregnancy related. Numbers of deaths related to legal induced abortion were highest before the 1980s, with few deaths occurring in 2003. Possible abortion-related deaths that occurred during 2004--2007 are being investigated.Discussion
A total of 839,226 legal induced abortions were reported in the United States for 2004 from 47 states, DC, and NYC, reflecting a decline of 1.1% from the number of legal induced abortions reported for 2003. After five previous annual decreases, a slight increase of 0.1% in the number of abortions occurred in 2002, with another decline of 0.7% in 2003 and a further decline of 1.1% in 2004. This pattern also is apparent when the same 47 reporting areas that reported for all years, 1998--2004, are compared with those that reported for 2001--2004 (Table 2). Before 1998, a substantial number of legal induced abortions were estimated to have been performed in California (e.g., >23% of the U.S. total in 1997) (9). The lack of data for California for 2004 largely explains the majority of the 28% decrease from the annual number of abortions reported for 1997 (9) and part of the decrease in the total ratio and rate.
Overall, abortion ratios and rates have declined over time until 2002 (Figure 1). The abortion ratio for 2004 (238 per 1,000 live births for 49 reporting areas) decreased from the previous year (241). For the same reporting areas as 2000--2002, the abortion rate for women aged 15--44 years (16 per 1,000 women) remained identical to the rate reported since 2000, then was 15 per 1,000 women for 2003 and 16 for 2004 (Table 2). The overall declines in the abortion ratio and rate over time might reflect multiple factors, including a decrease in the number of unintended pregnancies (10); a shift in the age distribution of women toward the older and less fertile ages (11); reduced or limited access to abortion services, including the passage of abortion laws that affect adolescents (e.g., parental consent or notification laws and mandatory waiting periods) (12--16); and changes in contraceptive practices, including increased use of contraceptives (e.g., condoms and, among young women, long-acting hormonal contraceptive methods that were introduced in the early 1990s) (17--22). 59ce067264