Although surgical methods of abortion have changed little in the past 50 years, the expanding interest in pharmacologic agents has both increased reproductive options and broadened the range of possible complications. Even with optimum use of medical-based protocols, the need for surgery to complete a failed procedure or to manage complications requires a thorough knowledge of operative technique.
EPIDEMIOLOGY OF INDUCED ABORTION
The Centers for Disease Control and Prevention (CDC) define induced abortion as a procedure to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age (Koonin, 1999). In 2008, approximately 50 percent of more than 6.5 million pregnancies in the United States were unintended, defined as either mistimed or unwanted. Of these, 40 percent—excluding spontaneous losses—ended in legal abortion (Finer, 2014). The national rate of unintended pregnancies has fallen, which is perhaps due to more effective contraception. Still, approximately 20 percent of sexually active, reproductive-aged women in the United States who do not use effective contraception account for more than 40 percent of unintended pregnancies (Gold, 2009). Thus, most of these conceptions, and therefore induced abortions, are preventable.
Beginning in 1969, the number and selected characteristics of women who underwent legal abortions were monitored on an annual basis by the CDC. Since 1990, when the number of legal abortions in the United States peaked at 1.43 million, the absolute number has declined. In 2002, the total was 854,122, and by 2011, this had fallen to 730,322 (Pazol, 2014). At the same time, estimates world-wide exceed 40 million (Sedgh, 2007). Data are also collected regarding patient demographics and include age, race, marital status, state of residency, and gestational age. In addition, the recorded method—curettage, medical, instillation, and other—is gathered.
Despite this, many of the associated demographic and abortion-method data are not reported. The CDC depends on cooperation between abortion providers and the state agencies to supply statistics. Thus, their summary data are likely underestimated, although data trends should be reliable. Indeed, the CDC reports that for 2011, their totals are approximately 70 percent of estimates recorded by the Guttmacher Institute. This privately funded agency also collects and publishes analyses of abortion data obtained through periodic direct contact with identified abortion providers (Jones, 2014). This implies that in 2011, approximately 1.04 million legal abortions were performed in the United States.
Notable trends include declines in proportions of adolescent pregnancies and increased proportions of parous women and women of color selecting abortion (Jones, 2009). Poor women were identified as having the greatest absolute increase in the abortion rate between 2000 and 2008. Overall, an estimated 30 percent of women aged 15 to 44 years in 2008 will have had an abortion by age 45 (Jones, 2011a).
The CDC also computes the abortion rate, which is the number of abortions per 1000 women of reproductive age. In ...