Number, rates of legal abortions declined nationwide from 2013 to 2022
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Key takeaways:
- Total reported abortions, rates and ratios decreased from 2021 to 2022.
- In 2022, more than half of abortions were for women aged 20 to 29 years and most were performed at 9 weeks’ gestation or earlier.
The number and rate of reported abortions decreased in the U.S. while abortion ratios increased from 2013 to 2022, according to surveillance data published in Morbidity and Mortality Weekly Report.
“Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States,” Stephanie Ramer, MPH, of the division of reproductive health at the National Center for Chronic Disease Prevention and Health Promotion at the CDC, and colleagues wrote. “After nationwide legalization of abortion in 1973, the total number, rate ... and ratio ... of reported abortions increased rapidly, reaching the highest levels in the 1980s before decreasing at a slow yet steady pace.”
The CDC requested abortion data from central health agencies for all U.S. states, the District of Columbia and New York City and obtained data from 48 areas for 2022, of which 47 areas had yearly abortion data from 2013 to 2022. Researchers calculated abortion rates — the number of abortions per 1,000 women aged 15 to 44 years — and abortion ratios — the number of abortions per 1,000 live births.
Overall, 609,360 reported abortions occurred from 2013 to 2022.
In 2022, the abortion rate was 11.2 abortions per 1,000 women aged 15 to 44 years and the abortion ratio was 199 per 1,000 live births.
From 2021 to 2022, total reported abortions decreased 2%, abortion rates decreased 3% and abortion ratios decreased 2%. From 2013 to 2022, total reported abortions decreased 5%, abortion rates decreased 10% and abortion ratios increased 1%.
More than half (56.5%) of abortions reported in 2022 were for women aged 20 to 29 years, with the highest percentages among women aged 20 to 24 and 25 to 29 years. Adolescents and women aged 40 years or older had the lowest percentage of abortions and lowest abortion rates; however, abortion ratios were highest for adolescents aged 19 years or younger and lowest for women aged 30 to 39 years.
Among women aged 20 years or older, abortion rates decreased while remaining unchanged for adolescents from 2021 to 2022. From 2013 to 2022, abortion rates decreased for all age groups except for women aged 30 to 34.
In 2022, 78.6% of abortions were performed at 9 weeks’ gestation or earlier and 92.8% of abortions were performed at 13 weeks’ gestation or earlier, trends that mirrored 2013-2022 data.
In 2022, 53.3% of abortions were performed with medication abortion at 9 weeks’ gestation or earlier, 35.5% with surgical abortion at 13 weeks’ gestation or earlier, 6.9% with surgical abortion at more than 13 weeks’ gestation and 4.3% with medication abortion at more than 9 weeks’ gestation.
Researchers noted five women died as a result of complications from legal induced abortions in 2021, the most recent year Pregnancy Mortality Surveillance System data were reviewed.
According to the researchers, ongoing abortion surveillance is important to evaluate programs aimed at promoting equitable access to patient-centered contraceptive care, to assess changes in clinical practice patterns and to estimate the number of pregnancies in the U.S., in conjunction with data on births and fetal losses.
“Multiple factors influence measures of abortion, including access to health care services and contraception, the availability of abortion providers and clinics, changes in legal restrictions and regulations, parental involvement laws and economic considerations that influence family planning decisions and contraceptive use,” the researchers wrote.
Perspective
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The CDC data reports a 2% drop in abortions from 2021 to 2022, the year Roe was overturned. But to assume the number of abortions went down because of Dobbs would be wrong.
First, we wouldn't expect to see the full impact of Dobbs in this report, given that many post-Dobbs bans did not go into effect immediately that year. The CDC data has other limitations as well; for instance, not all states — including California and Maryland, which are notably unrestricted states — report their abortion data to the CDC. If the number of abortions did decline from 2021 to 2022, I would posit it is more likely to be for the same reasons the number had been declining since 2013: namely, better access to family planning services and contraception thanks to the Affordable Care Act.
Second, we know from more recent data collected from all 50 states, that the number of abortions in the U.S. is currently, in fact, at a record high. This data not only reflects abortion numbers from all 50 U.S. states, but also includes medication abortions provided via telehealth, in addition to medication and procedural abortions provided by clinics and other health care facilities.
The CDC report reflects a growing trend toward medication abortion, which between 2021 and 2022 did account for more than half of all abortions performed at or before 9 weeks, which represents a continued shift away from procedural abortion in early pregnancy. The growing proportion of medication abortion in the CDC's data is likely due to a number of factors — increased use of telehealth, being one — that has helped to expand access to medication for those seeking it.
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