Abortion Surveillance in the United States, 2022: CDC’s Annual Report

Since 1969, CDC has collected data on legal induced abortions in the United States — how many there are and who obtains them — along with deaths from abortion complications. This is its report for 2022.

How the data are collected

Each year CDC asks the central health agencies of the 50 states, the District of Columbia and New York City for aggregate data. Reporting is voluntary, and areas differ in what they collect. For 2022, 48 areas reported; California, Maryland, New Hampshire and New Jersey did not. Trends are measured across the 47 areas that reported every year from 2013 to 2022.

Two measures are used:

• the abortion rate — abortions per 1,000 women aged 15–44;
• the abortion ratio — abortions per 1,000 live births.

The report uses "women" to match the population data behind these rates, while noting that not everyone who obtains an abortion identifies as a woman. A legal induced abortion is one performed within the law by a licensed clinician; the definition excludes care for miscarriage, fetal death or ectopic pregnancy.

Number, rate and ratio of reported abortions, 2013–2022. Credit: Centers for Disease Control and Prevention.

The totals

613,383 abortions were reported from 48 areas in 2022. In the 47 continuously reporting areas:

For context, the report traces the longer history: after nationwide legalization in 1973, numbers rose quickly to a peak in the 1980s, then declined slowly, with a pause in 2006–2008, increases of 1%–3% from 2018 to 2019, and increases of 4%–5% from 2020 to 2021.

Age

• Women in their 20s accounted for 56.5% of abortions; those aged 20–24 and 25–29 had the highest rates (18.1 and 18.7 per 1,000).
• Girls under 15 and women 40 and older accounted for the fewest (0.2% and 3.6%) and had the lowest rates (0.4 and 2.5 per 1,000).
• Ratios were highest among adolescents 19 and under and lowest among women 30–39.
• From 2013 to 2022, rates fell in every age group except women 30–34, with the biggest drop among adolescents. The abortion rate among 15- to 19-year-olds fell 34% while their birth rate fell 49% — suggesting fewer adolescent pregnancies overall.

Race and ethnicity

Compared with White women, abortion rates were 4.3 times as high and ratios 4.0 times as high among Black women, and 2.0 and 1.6 times as high among Hispanic women. The report stresses that race and ethnicity are markers, not causes: differences in unintended pregnancy, unequal access to quality family planning, economic inequities and mistrust of the medical system can all contribute. Only 32 areas reported race and ethnicity data meeting CDC's standards.

Timing and method

• About four of five abortions took place at 9 weeks' gestation or earlier, when complication risks are lowest, and 92.8% at 13 weeks or earlier. The share after 13 weeks stayed at 8.7% or less throughout 2013–2022. The share at 6 weeks or earlier rose from 34.8% in 2013 to 41.6% in 2022.

Among abortions at 9 weeks or earlier, 70.2% were medication abortions. In continuously reporting areas that track method, the share by early medication abortion rose 129% from 2013 to 2022. Advances such as better ultrasound and more sensitive pregnancy tests allow early surgical abortions with completion rates above 97%, and regimens combining mifepristone and misoprostol reach 96%–98%. In 2016, the Food and Drug Administration extended the gestational limit for mifepristone from 63 to 70 days.

Deaths

In 2021, the latest year reviewed through CDC's Pregnancy Mortality Surveillance System, five women died from complications of legal induced abortion. The case-fatality rate for 2013–2021 was 0.46 per 100,000 abortions, and every period since 1978 has been under 1 per 100,000.

Limitations

• Reporting is voluntary, so CDC can't give a national total. In 2020, the four non-reporting states accounted for about 20% of U.S. abortions, according to the Guttmacher Institute. Completeness varies, and reporting of telehealth abortions may vary too.
• Many areas use forms that differ from national guidance, so some variables, such as race and ethnicity or gestational age, are missing or inconsistent.
• Data are reported by where the abortion occurred, not where the patient lived, which can overstate measures in areas that serve many out-of-area residents and understate them elsewhere. Studies show more out-of-area abortions among residents of states with legal restrictions.
• Trends describe the 47 areas together; individual areas may differ.
• Income, education and other characteristics aren't collected.

Why it's tracked

Up to 42% of U.S. pregnancies are unintended. The report says surveillance can help evaluate programs that promote equitable access to patient-centered contraceptive care; improving access and removing barriers such as cost has been linked to lower abortion rates.

Sources

Based on Ramer S, Nguyen AT, Hollier LM, Rodenhizer J, Warner L, Whiteman MK, "Abortion Surveillance — United States, 2022," MMWR Surveillance Summaries 73(7), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.