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Induced Termination of Pregnancy Before and After Roe v WadeTrends in the Mortality and Morbidity of Women
Council on Scientific Affairs, American Medical Association;
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
JAMA. 1992;268(22):3231-3239.
Abstract
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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)
Author Affiliations
Jacksonville, Fla; Durham, NC; Tucker, Ga; Beverly Hills, Calif; Minneapolis, Minn; Syracuse, NY; Tucson, Ariz; Macon, Ga; Cleveland, Ohio; New Orleans, La; Greenville, NC; Baltimore, Md; Chicago, Ill; Chicago, Ill; Chicago, Ill.
From the Council on Scientific Affairs, American Medical Association, Chicago, Ill.
Footnotes
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).
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