Abortion Surveillance, United States, 2021: CDC's Annual Figures

Reporting areas told CDC of 625,978 legal induced abortions in 2021. Among the 47 areas that reported every year from 2012 to 2021, the number, rate and ratio of abortions fell over the decade but rose from 2020 to 2021. This is a summary of CDC's annual abortion surveillance report, which documents the number and characteristics of women obtaining legal induced abortions and the number of deaths related to abortion.

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 abortion data. Reporting is voluntary. For 2021, 48 areas sent aggregate data; California, Maryland, New Hampshire and New Jersey did not. CDC therefore cannot give a national total: in 2020, according to the Guttmacher Institute's survey of providers, those four states accounted for about 25% of all U.S. abortions. Two measures put the counts in context:

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

The trend

Number, rate and ratio of abortions, 47 reporting areas (excluding California, the District of Columbia, Maryland, New Hampshire and New Jersey), 2012–2021. CDC.

From 2020 to 2021 the number rose 5%, the rate 5% and the ratio 4%. From 2012 to 2021 the number fell 8%, the rate 11% and the ratio 1%.

The authors note that many factors influence abortion numbers: access to health care and contraception, the availability of providers and clinics, state rules such as waiting periods, parental-involvement laws and restrictions on providers, and the economy's effect on family planning.

Who obtained abortions in 2021

• Age. Women in their 20s accounted for 57.0%. Those aged 20–24 and 25–29 had the largest shares (28.3% and 28.7%) and the highest rates (19.7 and 19.4). Girls under 15 and women 40 and over had the smallest shares (0.2% and 3.6%) and rates (0.4 and 2.5). Ratios, though, were highest among adolescents (805 under 15, 381 at 15–19) and lowest at 30–34 and 35–39 (137 and 141).
• Adolescents. From 2012 to 2021 the abortion rate fell 50% among those under 15 and 41% among 15–19-year-olds, the largest falls of any age group. Over the same years the birth rate for 15–19-year-olds fell 53%, so fewer adolescent births have been accompanied by far fewer adolescent abortions.
• Race and ethnicity (33 areas). Black women accounted for 41.5% of abortions, White women 30.2%, Hispanic women 21.8% and women of other races 6.5%. White women had the lowest rate (6.4) and ratio (116); Black women the highest (28.6 and 498). Compared with White women, rates and ratios were 4.5 and 4.3 times higher among Black women and 1.9 and 1.6 times higher among Hispanic women. The authors point to differences in unintended pregnancy, unequal access to quality family planning, economic inequities and mistrust of the medical system.
• Marital status (37 areas). 12.7% were married and 87.3% unmarried; the ratio was 41 for married and 404 for unmarried women.
• Previous births (42 areas). 39.3% had no previous live births, 24.3% one, 20.0% two, 9.8% three and 6.6% four or more.
• Previous abortions (42 areas). 57.3% had none, 24.5% one, 10.5% two and 7.7% three or more.

When in pregnancy, and how

• Timing (41 areas). 80.8% of abortions were at 9 weeks' gestation or earlier and 93.5% at 13 weeks or earlier; 5.7% were at 14–20 weeks and 0.9% at 21 weeks or later. Adolescents were more likely than older women to obtain one after 13 weeks (19.5% of those under 15 and 8.9% of those 15–19, against 5.7%–7.2% of women 20 and over). Over the decade, abortions shifted earlier: the share at 6 weeks or earlier rose from 35.0% in 2012 to 39.5% in 2021.
• Method (46 areas). 53.0% were early medication abortions (non-surgical, at 9 weeks or earlier), 37.6% surgical at 13 weeks or earlier, 6.4% surgical after 13 weeks and 3.0% medication after 9 weeks; other methods were under 0.1%. Of abortions at 9 weeks or earlier, two thirds (66.6%) were by medication. In the 37 areas reporting every year, early medication abortion rose from 22.1% of abortions in 2012 to 52.3% in 2021.

The authors link the shift to earlier abortion to better ultrasound and more sensitive pregnancy tests, which let very early surgical abortions succeed more than 97% of the time, and to medication regimens combining mifepristone and misoprostol, with completion rates of 96%–98%; the FDA extended mifepristone's gestational limit from 63 to 70 days in 2016.

Deaths

CDC's Pregnancy Mortality Surveillance System found six deaths from complications of legal induced abortion in 2020, the latest year reviewed. For 2013–2020 the case-fatality rate was 0.45 deaths per 100,000 legal abortions, lower than in earlier five-year periods; every period since 1978 has been below 1 per 100,000.

Limitations

• Reporting is voluntary and requirements differ, so there is no national total, and enforcement of reporting varies.
• Many areas' forms differ from national guidance, so some do not collect age, race or ethnicity, or record gestational age inconsistently; only 33 areas' race and ethnicity data met CDC's standards.
• Data come from where the abortion took place, not where the woman lived, which overstates rates in areas many people travel to and understates them where residents travel out.
• Income, education and other characteristics are not collected.

Why it matters

The authors say the surveillance helps evaluate programmes that promote equitable access to contraception to reduce unintended pregnancy (up to 42% of U.S. pregnancies are unintended), tracks changes in clinical practice and provides the denominators for studying the safety of different methods, and, with birth and fetal-loss data, helps estimate the number of pregnancies in the country.

Sources

• Kortsmit K, Nguyen AT, Mandel MG, Hollier LM, Ramer S, Rodenhizer J, Whiteman MK. "Abortion Surveillance — United States, 2021." MMWR Surveillance Summaries. https://www.cdc.gov/mmwr/volumes/72/ss/ss7209a1.htm