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December 9, 1992, Vol 268, No. 22 >
ARTICLE | December 9, 1992

Induced Termination of Pregnancy Before and After Roe v Wade: Title and subTitle BreakTrends in the Mortality and Morbidity of Women FREE

Yank D. Coble, Jr, MD; E. Harvey Estes, Jr, MD; C. Alvin Head, MD; Mitchell S. Karlan, MD; William R. Kennedy, MD; Patricia Joy Numann, MD; William C. Scott, MD; W. Douglas Skelton, MD; Richard M. Steinhilber, MD; Jack P. Strong, MD; Christine C. Toevs; Henry N. Wagner, Jr, MD; Jerod M. Loeb, PhD; Robert C. Rinaldi, PhD; Janet E. Gans, PhD
[+] Author Affiliations

This report was presented to the House of Delegates of the American Medical Association at the June 1992 Annual Meeting as Report H of the Council on Scientific Affairs. The recommendation was adopted as amended and the remainder of the report was filed.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the scientific literature as of June 1992.

Reprint requests to Council on Scientific Affairs, American Medical Association, 515 N State St, Chicago, IL 60610 (Janet E. Gans, PhD).


JAMA. 1992;268(22):3231-3239. doi:10.1001/jama.1992.03490220075032
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References

The mortality and morbidity of women who terminated their pregnancy before the 1973 Supreme Court decision in Roe v Wade are compared with post—Roe v Wade mortality and morbidity. Mortality data before 1973 are from the National Center for Health Statistics; data from 1973 through 1985 are from the Centers for Disease Control and The Alan Guttmacher Institute. Trends in serious abortion-related complications between 1970 and 1990 are based on data from the Joint Program for the Study of Abortion and from the National Abortion Federation. Deaths from illegally induced abortion declined between 1940 and 1972 in part because of the introduction of antibiotics to manage sepsis and the widespread use of effective contraceptives. Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 death per 100 000 procedures), reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The risk of death from legal abortion is higher among minority women and women over the age of 35 years, and increases with gestational age. Legal-abortion mortality between 1979 and 1985 was 0.6 death per 100 000 procedures, more than 10 times lower than the 9.1 maternal deaths per 100 000 live births between 1979 and 1986. Serious complications from legal abortion are rare. Most women who have a single abortion with vacuum aspiration experience few if any subsequent problems getting pregnant or having healthy children. Less is known about the effects of multiple abortions on future fecundity. Adverse emotional reactions to abortion are rare; most women experience relief and reduced depression and distress.

(JAMA. 1992;268:3231-3239)

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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Mohr JC. Abortion in America: The Origins and Evolution of National Policy, 1800-1900 . New York, NY: Oxford University Press; 1978;.
2 +
Sarvis B, Rodman H. The Abortion Controversy . 2nd ed. New York, NY: Columbia University Press; 1974;.
3 +
Gold RB.Abortion and Women's Health:A Turning Point for America . New York, NY: The Alan Guttmacher Institute; 1990;.
4 +
Institute of Medicine. Legalized Abortion and the Public Health: Report of a Study Committee of the Institute of Medicine . Washington, DC: National Academy of Sciences; 1975;.
5 +
National Abortion Rights Action League. Who Decides:A State-by-State Review of Abortion Rights, 1991 . Washington, DC: The National Abortion Rights Action League Foundation; 1991;.
6 +
Lupfer M, Silber BC.  How patients view mandatory waiting periods for abortion. Fam Plann Perspect . 1981;;13:75-79.
7 +
Crosby MC, English A.  Mandatory parental involvement/judicial bypass laws: do they promote adolescents' health? J Adolesc Health Care . 1991;; 12:143-147.
8 +
Greenberger MD, Connor K.  Parental notice and consent for abortion: out of step with family law principles and policies. Fam Plann Perspect . 1991;; 23:31-35.
9 +
Cartoof VG, Klerman LV.  Parental consent for abortion: impact of the Massachusetts law. Am J Public Health . 1986;;76:397-440.
10 +
Henshaw SK, Wallisch LS.  The Medicaid cutoff and abortion services for the poor. Fam Plann Perspect . 1984;;16:170-180.
11 +
House of Delegates, American Medical Association. Resolution 17: Publication of Health Concerns Associated With Induced Abortions in the Pre—Roe v Wade Era . Chicago, Ill: American Medical Association; June 1991;.
12 +
Klitsch M.  Public abortion views unchanged. Fam Plann Perspect . 1991;;23:148.
13 +
Centers for Disease Control. Abortion Surveillance, 1981 . Atlanta, Ga: Centers for Disease Control; 1985;.
14 +
Henshaw SK, Van Vort J. Abortion Factbook: 1992 Edition: Readings, Trends, and State and Local Data to 1988 . New York, NY: The Alan Guttmacher Institute; 1992;.
15 +
Lawson HW, Atrash HK, Saftlas AF, Koonin LM, Ramick M, Smith JC.  Abortion surveillance, United States, 1984-85. MMWR . 1989;;38:1-45.
16 +
Tietze C.  The public health effects of legal abortion in the United States. Fam Plann Perspect . 1984;;16:26-28.
17 +
Cates N Jr.  Legal abortion: the public health record. Science . 1982;;215:1586-1590.
18 +
Burkman RT, King TM, Burnett LS, Atienza MF.  University abortion programs: one year later. Am J Obstet Gynecol . 1974;;119:131-136.
19 +
Darney PD, Landy U, MacPherson S, Sweet RL.  Abortion training in US obstetrics. Fam Plann Perspect . 1987;;19:158-162.
20 +
Centers for Disease Control.  Abortion surveillance, 1988. MMWR . 1991;;40:15-42.
21 +
Binkin N.  Trends in induced legal abortion morbidity and mortality. Clin Obstet Gynecol . 1986;;13: 83-93.
22 +
Atrash HK, Lawson HW, Smith JC.  Legal abortion in the US: trends and mortality. Contemp OB/ GYN . 1990;;35:58-69.
23 +
Henshaw SK, Forrest J, Van Vort J.  Abortion services in the United States: 1984-1985. Fam Plann Perspect . 1987;;19:63-70.
24 +
Henshaw SK, Van Vort J.  Abortion services in the United States, 1987 and 1988. Fam Plann Perspect . 1990;;22:102-108, 142.
25 +
Binkin N, Gold J, Cates W Jr.  Illegal-abortion deaths in the United States: why are they still occurring? Fam Plann Perspect . 1982;;14:163-167.
26 +
Cates W Jr, Rochat RW, Grimes DA, Tyler CW Jr.  Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940-1976). Am J Obstet Gynecol . 1978;;132:211-214.
27 +
Dornblaser C.  Comment on abortion-related mortality—United States, 1977. Natl Abortion Fed Q . 1979;;2:11.
28 +
Tietze C.  Abortion on request: its consequences for population trends and public health. Sem Psychiatry . 1970;;2:375-381.
29 +
Cates W Jr, Smith JC, Rochat RW, Grimes DA.  Mortality from abortion and childbirth: are the statistics biased? MMWR . 1982;;248:192-196.
30 +
National Center for Health Statistics. Vital Statistics of the United States, 1940 . Washington, DC: US Public Health Service; 1940;;2.
31 +
National Center for Health Statistics. Vital Statistics of the United States, 1945 . Washington, DC: US Public Health Service; 1945;;2.
32 +
National Center for Health Statistics. Vital Statistics of the United States, 1950 . Washington, DC: US Public Health Service; 1950;;2.
33 +
National Center for Health Statistics. Vital Statistics of the United States, 1955 . Washington, DC: US Public Health Service; 1955;;2.
34 +
National Center for Health Statistics. Vital Statistics of the United States, 1960 . Washington, DC: US Public Health Service; 1960;;2.
35 +
National Center for Health Statistics. Vital Statistics of the United States, 1965 . Washington, DC: US Public Health Service; 1965;;2.
36 +
National Center for Health Statistics. Vital Statistics of the United States, 1970 . Washington, DC: US Public Health Service; 1970;;2.
37 +
National Center for Health Statistics. Vital Statistics of the United States, 1972 . Washington, DC: US Public Health Service; 1972;;2.
38 +
Tietze C.  The effect of legalization of abortion on population growth and public health. Fam Plann Perspect . 1975;;7:110-113.
39 +
Centers for Disease Control. Abortion Surveillance, 1976 . Atlanta, Ga: Centers for Disease Control; 1978;.
40 +
Cates W Jr, Rochat RW.  Illegal abortions in the United States: 1972-1974. Fam Plann Perspect . 1976;;8:86-92.
41 +
Atrash HK, Koonin LH, Lawson HW, Franks AL, Smith JC.  Maternal mortality in the United States, 1979-1986. Obstet Gynecol . 1990;;76:1055-1060.
42 +
Koonin LM, Atrash HK, Lawson HW, Smith JC.  Maternal mortality surveillance, United States, 1979-1986. MMWR . 1991;;40:1-13.
43 +
Cates W Jr, Tietze C.  Standardized mortality rates associated with legal abortion: United States, 1972-1975. Fam Plann Perspect . 1978;;10:109-112.
44 +
LeBolt SA, Grimes DA, Cates W Jr.  Mortality from abortion and childbirth: are the populations comparable? MMWR . 1982;;248:188-191.
45 +
Henshaw SK.  Induced abortion: a world review, 1990. Farn Plann Perspect . 1990;;22:76-89.
46 +
Hilgers TW, O'Hare D.  Abortion-related maternal mortality: an in-depth analysis.  In: Hilgers TW, Horan DJ, Hall D, eds. New Perspectives on Human Abortion . Frederick, Md: University Publications of America Inc; 1981;:69-91.
47 +
Cates W Jr, Smith JC, Rochat RW, Patterson JE, Dolman A.  Assessment of surveillance and vital statistics data for monitoring abortion mortality, United States, 1972-1975. Am J Epidemiol . 1978;; 108:200-206.
48 +
Roht LH, Sherwin R, Henderson MM.  The impact of legal abortion: redefining the maternal mortality rate. Health Serv Rep . 1974;;89:267-273.
49 +
Rubin G, McCarthy B, Shelton J, Rochat RW, Terry J.  The risk of childbearing re-evaluated. Am J Public Health . 1981;;71:712-716.
50 +
Centers for Disease Control.  Misclassification of maternal deaths—Washington State. MMWR . 1986;;35:621-623.
51 +
Centers for Disease Control.  Enhanced maternal mortality surveillance—North Carolina, 1988 and 1989. MMWR . 1991;;40:469-471.
52 +
Speckhard ME, Comas-Urrutia AC, Rigau-Perez JG, Adamsons K.  Intensive surveillance of pregnancy-related deaths, Puerto Rico, 1978-1979. Bol Asoc Med P R . 1985;;77:508-513.
53 +
Jewett JF.  Changing maternal mortality in Massachusetts. N Engl J Med . 1957;;256:395-400.
54 +
Ziskin LZ, Gregory M, Kreitzer M.  Improved surveillance of maternal deaths. Int J Gynecol Obstet . 1979;;16:281-286.
55 +
Smith JC, Hughes JM, Pekow PS, Rochat RW.  An assessment of the incidence of maternal mortality in the United States. Am J Public Health . 1984;;74:780-783.
56 +
Centers for Disease Control.  Maternal mortality: pilot surveillance in seven states. MMWR . 1985;; 34:709-711.
57 +
Cates W Jr, Grimes DA.  Morbidity and mortality of abortion in the United States.  In: Hodgson JE, ed. Abortion and Sterilization: Medical and Social Aspects . New York, NY: Academic Press Inc; 1981;:155-180.
58 +
Tietze C, Henshaw SK. Induced Abortion: A World View, 1986 . New York, NY: The Alan Guttmacher Institute; 1986;.
59 +
Hakim-Elahi E, Tovell HMM, Burnhill MS.  Complications of first-trimester abortion: a report of 170,000 cases. Obstet Gynecol . 1990;;76:129-135.
60 +
Hart G, Macharper T.  Clinical aspects of induced abortion in South Australia from 1970-1984. Aust N Z J Obstet Gynecol . 1986;;26:219-224.
61 +
Barlett RH, Yahia C.  Management of septic chemical abortion with renal failure: report of five consecutive cases with five survivors. N Engl J Med . 1969;;281:747-753.
62 +
Steer CM.  Maternal mortality at Sloane. Bull Sloane Hosp Women . 1968;;14:146-157.
63 +
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