Abortion

In the United States, Canada, and Western Europe, abortion has become not only the most common but also one of the safest operations being performed. This was not always the case. In the nineteenth and early twentieth centuries, abortion was quite dangerous, and many women died as a result.

Pregnancy itself is not a harmless condition; women can die during pregnancy. The maternal mortality rate (the proportion of women dying from pregnancy and childbirth) is found by dividing the number of women dying from all causes related to pregnancy, childbirth, and the puerperium (the six-week period following childbirth) by the total number of live births and then multiplying by a constant factor such as 100,000. For example, the maternal mortality rate in the United States in 1920 was 680 maternal deaths per 100,000 live births (Lerner and Anderson 1963). It had fallen to 38 deaths per 100,000 live births by 1960 and 8 deaths per 100,000 live births by 1994. Illegal abortion accounted for about 50 percent of all maternal deaths in 1920, and that was still true in 1960. By 1980, however, the percentage of deaths due to abortion had dropped to nearly zero (Cates 1982). The difference in maternal mortality rates due to abortion reflected the increasing legalization of abortion from 1967 to 1973 that permitted abortions to be done safely by doctors in clinics and hospitals. The changed legal climate also permitted the prompt treatment of complications that occurred with abortions.

The complication rates and death rates associated with abortion itself can also be examined. In 1970, Christopher Tietze of the Population Council began studying the risks of death and complications due to abortion by collecting data from hospitals and clinics throughout the nation. The statistical analyses at that time showed that the death rate due to abortion was about 2 deaths per 100,000 procedures compared with the current maternal mortality rate exclusive of abortion of 12 deaths per 100,000 live births. In other words, a woman having an abortion was six times less likely to die than a woman who chose to carry a pregnancy to term. Tietze also found that early abortion was many times safer than abortion done after twelve weeks of pregnancy (Tietze and Lewit 1972) and that some abortion techniques were safer than others. The Centers for Disease Control in Atlanta took over the national study of abortion statistics that had been developed by Tietze, and abortion became the most carefully studied surgical procedure in the United States. As doctors gained more experience with abortion and as techniques improved, death and complication rates due to abortion continued to decline. The rates declined because women were seeking abortions earlier in pregnancy, when the procedure was safer. Clinics where safe abortions could be obtained were opened in many U.S. cities across the country, improving access to this service.

By the early 1990s in the United States, the risk of death in early abortion was less than 1 death per 1 million procedures, and for later abortion, about 1 death per 100,000 procedures (Koonin et al. 1992). The overall risk of death in abortion was about 0.4 deaths per 100,000 procedures compared with a maternal mortality rate (exclusive of abortion) of about 9.1 deaths per 100,000 live births (Koonin et al. 1991a, 1991b).