Risk factors for legal induced abortion-related mortality in the United States.
OBJECTIVE
To assess risk factors for legal induced abortion-related deaths.


METHODS
This is a descriptive epidemiologic study of women dying of complications of induced abortions. Numerator data are from the Abortion Mortality Surveillance System. Denominator data are from the Abortion Surveillance System, which monitors the number and characteristics of women who have legal induced abortions in the United States. Risk factors examined include age of the woman, gestational length of pregnancy at the time of termination, race, and procedure. Main outcome measures include crude, adjusted, and risk factor-specific mortality rates.


RESULTS
During 1988-1997, the overall death rate for women obtaining legally induced abortions was 0.7 per 100000 legal induced abortions. The risk of death increased exponentially by 38% for each additional week of gestation. Compared with women whose abortions were performed at or before 8 weeks of gestation, women whose abortions were performed in the second trimester were significantly more likely to die of abortion-related causes. The relative risk (unadjusted) of abortion-related mortality was 14.7 at 13-15 weeks of gestation (95% confidence interval [CI] 6.2, 34.7), 29.5 at 16-20 weeks (95% CI 12.9, 67.4), and 76.6 at or after 21 weeks (95% CI 32.5, 180.8). Up to 87% of deaths in women who chose to terminate their pregnancies after 8 weeks of gestation may have been avoidable if these women had accessed abortion services before 8 weeks of gestation.


CONCLUSIONS
Although primary prevention of unintended pregnancy is optimal, among women who choose to terminate their pregnancies, increased access to surgical and nonsurgical abortion services may increase the proportion of abortions performed at lower-risk, early gestational ages and help further decrease deaths.


METHODS
II-2
Bartlett
Linda A
LA
Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia 30341, USA. L.Barlett@CDC.gov
Berg
Cynthia J
CJ
Shulman
Holly B
HB
Zane
Suzanne B
SB
Green
Clarice A
CA
Whitehead
Sara
S
Atrash
Hani K
HK
D000029:Abortion, Legal / Q000009:adverse effects* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008423:Maternal Age; D008428:Maternal Mortality; D010298:Parity; D011159:Population Surveillance; D011183:Postoperative Complications; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012307:Risk Factors; D014481:United States / Q000453:epidemiology