The public health implications of abortion.

Abstract

Balancing the moral and public health issues surrounding abortion requires consideration of the current status of abortion the health effects of the procedure the critical events in the history of legal abortion and the implications of possible future scenarios. The number of legal abortions performed in the US has increased each year rising 75-80% from 1973-78. The total abortion rate (number of abortions a group of women would undergo if the age-specific rates for a given year persisted through their reproductive life) grew from 355/1000 in 1972 to 649/1000 in 1979 an 83% increase. Mortality related to legal abortion declined by over 40% from 1972-75 to 1976-79. The increased occurrence of repeat abortion (up from 100800 women in 1974 to 339200 in 1978) is not considered to reflect a decrease in the effectiveness or proper use of contraception. Women who seek legal abortions come from groups at greatest risk of perinatal and infant mortality leading to a favorable influence on these rates. The number of unplanned pregnancies among unmarried women was almost 3 times greater in 1979 than in 1970 indicating a need for pregnancy prevention research and more effective family planning services. 1st trimester abortions increased from 80% of all procedures in 1972 to 90% in 1978 and the recent trend toward use of dilatation and evacuation in 2nd trimester abortions has made the procedure less risky. Controversy about abortion is certain to continue and the course of future action around the issue is unclear. If abortion is restricted (e.g. through strict limits on the use of public funds for this purpose) 5 public health effects can be anticipated: 1) the number of legal abortions will decrease; 2) illegal abortions will increase; 3) live births will increase; 4) reproduction-realted mortality will rise due to the greater number of illegal abortions 2nd trimester abortions and term births; and 5) womens future reproduction will be impaired. Conversely continued permissive abortion practices will have the following implications: 1) legal abortions will continue to increase as long as the number of women of childbearing age increases 2) the number of illegal abortions will remain small 3) a fertility increase seems probable in the absence of a precedent for longterm trends of low fertility 4) reproduction-associated mortality should remain low and 5) some women may have impaired fertility after abortion.