Tessa Longbons   |  10 December 2020

The latest abortion surveillance report from the Centers for Disease Control and Prevention (CDC), with data from 2017 and 2018, brought good news: after decades of decline, abortions in the United States reached a record low in 2017, dropping to 11.2 abortions per 1,000 women ages 15-44.[i] However, consistent with a preliminary review of 2018 state data by the Charlotte Lozier Institute, the CDC report also notes a concerning increase in the abortion rate between 2017 and 2018.[ii]

The CDC report contains data for 49 reporting areas (47 states, the District of Columbia, and New York City), up from 48 reporting areas in the previous report, which covered 2016 data.[iii] As in prior years, California, Maryland, and New Hampshire did not provide abortion data to CDC, but D.C. resumed reporting after an interruption in 2016. Between 2017 and 2018, in these 49 reporting areas, both total abortions and the abortion rate (abortions per 1,000 women ages 15-44) increased by one percent.

Twenty-eight reporting areas reported increases in abortion. This increase was most prominent in a few areas that each reported over a thousand more abortions in 2018 than in the previous year (D.C., Florida, Georgia, Illinois, Nevada, New Jersey, Texas, and Virginia). Since some of these are large states with growing populations, some of the increases are less dramatic in context – Florida actually reported no change in its abortion rate, while Georgia's abortion rate increased by five percent from 2017 to 2018. However, D.C.'s abortion rate jumped by 30 percent, Nevada by 18 percent, and Illinois by nine percent. Mississippi, which reports relatively fewer abortions, showed a 16 percent increase in the abortion rate.

No doubt, many factors contributed to the increase in abortion rates in these 28 reporting areas, but the CDC report shows that chemical abortion played a significant role. In Florida, Georgia, and Texas, surgical abortions actually declined between 2017 and 2018, making chemical abortion responsible for the increase. In D.C., Nevada, and Virginia, both chemical and surgical abortions increased, but the growth in chemical abortions far outpaced that of surgical abortions. Illinois' abortion procedure data did not meet CDC standards to be included in the report, and New Jersey reports incomplete chemical abortion data. Of the 28 areas that reported increases, 26 reported usable procedure data. Among these 26 areas, 16 reported that surgical abortions decreased between 2017 and 2018, while nine reported increases in both chemical and surgical abortions. Of the states with increased abortion rates, only Colorado reported that chemical abortions went down.

Between 2016 and 2018, chemical abortion grew from 31 percent of all abortions of known abortion method to 40 percent. Reflecting the growing prevalence of chemical abortions, CDC expanded the definition of "early medical abortion" to align with the Food and Drug Administration's current recommendations.[iv] Early medical abortions are now considered to be those performed at or before nine completed weeks of gestation (i.e., 9 weeks, 6 days), one week more than the previous time frame of at or before eight completed weeks of gestation. Some abortion centers have now begun to advertise chemical abortion through 10 completed weeks of gestation, suggesting that the CDC may further expand the definition in future reports.

Despite the overall increase, there were decreases in the abortion rate in some states. In New York (with New York City and the rest of New York considered together), abortions fell by a total of 5,500. Missouri's abortion rate fell by 24 percent, and South Dakota's dropped 23 percent.

Supplementary data on the number of abortions performed in each state on residents from other states demonstrates that measuring abortion incidence in the U.S. is complex.[v] Not all states report the residence of women who get abortions with the same level of accuracy, so these numbers can vary from year to year. While Indiana reported a three percent increase in its abortion rate, abortions performed on Indiana residents (both in Indiana and in other states) dropped by four percent between 2017 and 2018. Conversely, while the number of abortions occurring in Missouri dropped dramatically in 2018, the number of abortions performed on Missouri residents went up seven percent due to an increase in Missouri women getting abortions in Illinois. The largest increases in resident abortions were reported by D.C. (23 percent), Nevada (20 percent), and Illinois (11 percent). Additionally, the CDC acknowledges that some states' reporting is incomplete compared with state-level estimates from the Guttmacher Institute. In 2017, there were 16 states whose official abortion totals were less than 90 percent of Guttmacher's 2017 estimates.[vi] In fact, improved reporting may have accounted for some of the increase in D.C. abortions: in 2017, D.C. reported 64 percent of the Guttmacher estimate, up from 48 percent in 2014.

Despite the gaps in the U.S. abortion reporting system, this latest report makes clear that the national abortion rate has plummeted by more than 50 percent from its record high in the 1980s, but that the long-term decline has slowed. As chemical abortion expands in the United States, the national abortion rate has ticked back up. Future reports will show whether the uptick is temporary or whether the U.S. abortion rate will continue to increase.

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[i] https://www.cdc.gov/mmwr/volumes/69/ss/ss6907a1.htm

[ii] https://lozierinstitute.org/new-abortion-trends-in-the-united-states-a-first-look/

[iii] https://www.cdc.gov/mmwr/volumes/68/ss/ss6811a1.htm

[iv] See Questions and Answers on Mifeprex, "What changes to the Mifeprex application did the FDA approve on March 29, 2016?" https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex

[v] See CDCs Abortion Surveillance System FAQs, "Are data available for my own analysis?" https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm

[vi] https://www.guttmacher.org/sites/default/files/report_pdf/abortion-incidence-service-availability-us-2017.pdf

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