Abortion Surveillance — United States, 2015

Problem/Condition Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. Period Covered 2015. Description of System Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2015, data were received from 49 reporting areas. Abortion data provided by these 49 reporting areas for each year during 2006–2015 were used in trend analyses. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15–44 years) and ratios (number of abortions per 1,000 live births), respectively. Results A total of 638,169 abortions for 2015 were reported to CDC from 49 reporting areas. Among these 49 reporting areas, the abortion rate for 2015 was 11.8 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 188 abortions per 1,000 live births. From 2014 to 2015, the total number of reported abortions decreased 2% (from 652,639), the abortion rate decreased 2% (from 12.1 abortions per 1,000 women aged 15–44 years), and the abortion ratio decreased 2% (from 192 abortions per 1,000 live births). From 2006 to 2015, the total number of reported abortions decreased 24% (from 842,855), the abortion rate decreased 26% (from 15.9 abortions per 1,000 women aged 15–44 years), and the abortion ratio decreased 19% (from 233 abortions per 1,000 live births). In 2015, all three measures reached their lowest level for the entire period of analysis (2006–2015). In 2015 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women aged ≥30 years accounted for a smaller percentage of abortions and had lower abortion rates. In 2015, women aged 20–24 and 25–29 years accounted for 31.1% and 27.6% of all reported abortions, respectively, and had abortion rates of 19.9 and 17.9 abortions per 1,000 women aged 20–24 and 25–29 years, respectively. In contrast, women aged 30–34, 35–39, and ≥40 years accounted for 17.7%, 10.0%, and 3.5% of all reported abortions, respectively, and had abortion rates of 11.6, 7.0, and 2.5 abortions per 1,000 women aged 30–34, 35–39, and ≥40 years, respectively. From 2006 to 2015, the abortion rate decreased among women in all age groups. In 2015, adolescents aged <15 and 15–19 years accounted for 0.3% and 9.8% of all reported abortions, respectively, and had abortion rates of 0.5 and 6.7 abortions per 1,000 adolescents aged <15 and 15–19 years, respectively. From 2006 to 2015, the percentage of abortions accounted for by adolescents aged 15–19 years decreased 41%, and their abortion rate decreased 54%. This decrease in abortion rate was greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2015 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 25–39 years. Abortion ratios decreased from 2006 to 2015 for women in all age groups. In 2015, almost two thirds (65.4%) of abortions were performed at ≤8 weeks’ gestation, and nearly all (91.1%) were performed at ≤13 weeks’ gestation. Few abortions were performed between 14 and 20 weeks’ gestation (7.6%) or at ≥21 weeks’ gestation (1.3%). During 2006–2015 the percentage of all abortions performed at >13 weeks’ gestation remained consistently low (≤9.0%). Among abortions performed at ≤13 weeks’ gestation, a shift occurred toward earlier gestational ages, with the percentage performed at ≤6 weeks’ gestation increasing 11%. In 2015, 24.6% of all abortions were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks’ gestation), 64.3% were performed by surgical abortion at ≤13 weeks’ gestation, and 8.8% were performed by surgical abortion at >13 weeks’ gestation; all other methods were uncommon (≤2.2%). Among those that were eligible for early medical abortion on the basis of gestational age (i.e., performed at ≤8 weeks’ gestation), 35.8% were completed by this method. In 2015, women with one or more previous live births accounted for 59.3% of abortions, and women with no previous live births accounted for 40.7%. Women with one or more previous induced abortions accounted for 43.6% of abortions, and women with no previous abortion accounted for 56.3%. Women with three or more previous births accounted for 14.2% of abortions, and women with three or more previous abortions accounted for 8.2% of abortions. Deaths of women associated with complications from abortion for 2015 are being assessed as part of CDC’s Pregnancy Mortality Surveillance System. In 2014, the most recent year for which data were available, six women were identified to have died as a result of complications from legal induced abortion. Interpretation Among the 49 areas that reported data every year during 2006–2015, decreases in the total number, rate, and ratio of reported abortions resulted in historic lows for the period of analysis for all three measures of abortion. Public Health Action The data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is the major contributor to induced abortion. Increasing access to and use of effective contraception can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.


Introduction
This report summarizes abortion data for 2015 that were Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States (1). After nationwide legalization of abortion in 1973, the total number, rate (number of abortions per 1,000 women aged 15-44 years), and ratio (number of abortions per 1,000 live births) of reported abortions increased rapidly, reaching the highest levels in the 1980s before decreasing at a slow yet steady pace (2)(3)(4). During 2006-2008, a break occurred in the previously sustained pattern of decrease (5)(6)(7)(8), although this break has been followed in all subsequent years by even greater decreases (9)(10)(11)(12)(13)(14)(15)(16). Nonetheless, throughout the years, the incidence of abortion has varied considerably across subpopulations and remains higher in certain demographic groups than others (17)(18)(19)(20)(21)(22). Continued surveillance is needed to monitor changes in the incidence of abortion in the United States.

Description of the Surveillance System
Each year, CDC requests aggregated data from the central health agencies of 52 reporting areas (the 50 states, DC, and New York City) to document the number and characteristics of women obtaining legal induced abortions in the United States. This report contains data reported to CDC as of April 1, 2018. For the purpose of surveillance, a legal induced abortion* is defined as an intervention performed within the limits of state law by a licensed clinician (e.g., a physician, nurse-midwife, nurse practitioner, or physician assistant) that is intended to terminate a suspected or known intrauterine pregnancy.
In most states, collection of abortion data are facilitated by the legal requirement for hospitals, facilities, and physicians to report all abortions to a central health agency (23). These central health agencies then voluntarily report the abortion data they have collected through their independent surveillance systems (24). However, although reporting to CDC is voluntary, most reporting areas provide their abortion numbers.
Although CDC obtains abortion numbers from most of the central health agencies, it receives only aggregate numbers and reporting is not complete in all areas, including in certain areas with reporting requirements (24). Moreover, the level of detail received on the characteristics of women obtaining abortions varies considerably from year to year and by reporting area (15). To encourage more uniform collection of these details, CDC has collaborated with the National Association for Public Health Statistics and Information Systems to develop reporting standards and provide technical guidance for vital statistics personnel who collect and summarize abortion data within the United States. However, because the collection and reporting of abortion data are not federally mandated, many In 2015, 24.6% of all abortions were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), 64.3% were performed by surgical abortion at ≤13 weeks' gestation, and 8.8% were performed by surgical abortion at >13 weeks' gestation; all other methods were uncommon (≤2.2%). Among those that were eligible for early medical abortion on the basis of gestational age (i.e., performed at ≤8 weeks' gestation), 35.8% were completed by this method.
In 2015, women with one or more previous live births accounted for 59.3% of abortions, and women with no previous live births accounted for 40.7%. Women with one or more previous induced abortions accounted for 43.6% of abortions, and women with no previous abortion accounted for 56.3%. Women with three or more previous births accounted for 14.2% of abortions, and women with three or more previous abortions accounted for 8.2% of abortions.
Deaths of women associated with complications from abortion for 2015 are being assessed as part of CDC's Pregnancy Mortality Surveillance System. In 2014, the most recent year for which data were available, six women were identified to have died as a result of complications from legal induced abortion.
Interpretation: Among the 49 areas that reported data every year during 2006-2015, decreases in the total number, rate, and ratio of reported abortions resulted in historic lows for the period of analysis for all three measures of abortion.
Public Health Action: The data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is the major contributor to induced abortion. Increasing access to and use of effective contraception can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.

Variables and Categorization of Data
Each year, CDC sends suggested templates to the central health agencies for compilation of abortion data in aggregate. Aggregate abortion numbers, without individual-level records, are requested for the following variables: • Maternal age in years (<15, [15][16][17][18][19] by individual year, 20-24, 25-29, 30-34, 35-39,  foreign country in which the woman obtaining the abortion lived; or, if additional details are unavailable, in-reporting area versus out-of-reporting area) In addition, templates provided by CDC request that aggregate numbers for certain variables be cross-tabulated by a second variable. These cross-tabulations include gestational age (separately by maternal age, by method type, by race, by ethnicity, and by race/ethnicity) and maternal age and marital status (separately by race, by ethnicity, and by race/ethnicity).
Beginning with 2014 data, instead of reporting clinician's estimates of gestational age or estimates of gestational age on the basis of last menstrual period, certain areas reported "probable postfertilization age" and "clinician's estimate of gestation based on date of conception" to CDC. To make data reported as postfertilization age consistent with gestational age data collection practices recommended by the CDC's National Center for Health Statistics (25), 2 weeks were added to probable postfertilization age. This method was used to account for time after last menstrual period until ovulation in a standard 28-day cycle, because fertilization occurs around the time of ovulation (26). No modifications were made to data reported as clinician's estimate of gestation based on date of conception.
In this report, medical and surgical abortions are further categorized by gestational age. Early medical abortion is defined as the administration of medication or medications (typically mifepristone followed by misoprostol) to induce an abortion at ≤8 completed weeks' gestation § ; medical abortion at >8 completed weeks' gestation is defined as the administration of medication or medications (typically serial vaginal prostaglandins, sometimes after mifepristone) to induce an abortion at >8 weeks' gestation. For surgical abortions, abortions are categorized as having been performed at ≤13 weeks' gestation or at >13 weeks' gestation because of differences in technique used generally before and after 13 weeks (28). Finally, because intrauterine instillations cannot be performed early in gestation, abortions reported to have been performed by intrauterine instillation at ≤12 weeks' gestation are excluded from calculation of the percentage of abortions by known method type. ¶

Measures of Abortion
Four measures of abortion are presented in this report: 1) the number of abortions in a given population, 2) the percentage of abortions obtained by women in a given population, 3) the abortion rate (number of abortions per 1,000 women aged 15-44 years or other specific group within a given population), and 4) the abortion ratio (number of abortions per 1,000 live births within a given population). Although total numbers and percentages are useful for determining how many women have obtained an abortion, abortion rates adjust for differences in population size and reflect how likely abortion is among women in particular groups. Abortion ratios measure the relative number of pregnancies in a population that end in abortion compared with live birth. Abortion ratios are influenced both by the proportion of pregnancies in a population that are unintended and the proportion of unintended pregnancies that end in abortion. Abortion ratios also are influenced by the proportion of intended pregnancies that end in abortion; however, intended pregnancies account for a very limited percentage of abortions (<5%) (31).
U.S. Census Bureau estimates of the resident female population of the United States were used as the denominator † Includes aspiration curettage, suction curettage, manual vacuum aspiration, menstrual extraction, sharp curettage, and dilation and evacuation procedures. § CDC collects information only on the estimated number of weeks (not days) of gestation and acknowledges the conventional use of completed weeks of gestation to describe pregnancy duration. CDC's category ≤8 weeks' gestation thus includes abortions up through 8 weeks and 6 days. This closely corresponds to the performance measure for medical abortion proposed by the American College of Obstetricians and Gynecologists (27). ¶ The cutoff of ≤12 weeks was selected on the basis of the implausibility of this procedure being performed at earlier gestational ages and on the basis of early research assessing the safety of intrauterine instillations starting at 13 weeks' gestation (29,30). for calculating abortion rates (32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Overall abortion rates were calculated from the population of women aged 15-44 years living in the reporting areas that provided data. For adolescents aged <15 years, abortion rates were determined on the basis of the number of adolescents aged 13-14 years; similarly, for women aged ≥40 years, abortion rates were determined on the basis of the number of women aged 40-44 years. For the calculation of abortion ratios, live birth data were obtained from CDC natality files and included births to women of all ages living in the reporting areas that provided abortion data (42).

Data Presentation and Analysis
This report provides state-specific and overall abortion numbers, rates, and ratios for the 49 areas that reported to CDC for 2015 (excludes California, Maryland, and New Hampshire). In addition, this report describes the characteristics of women who obtained abortions in 2015.
Because the completeness of reporting on the characteristics of women varies by year and by variable, this report only describes the characteristics of women obtaining abortions in areas that met reporting standards (i.e., reported at least 20 abortions overall, provided data categorized in accordance with surveillance variables, and had <15% unknown values for a given characteristic). Abortion rates and ratios have been omitted for reporting areas with <20 abortions because results are considered unstable (43). Cells with a value in the range of 1-4 or cells that would allow for calculation of these values have been suppressed to maintain confidentiality.
Although most of the data are presented by the reporting area in which the abortions were performed, 48 reporting areas in 2015 also provided the number of abortions by maternal residence.** However, one area only reported abortions for its own residents (DC). Two other areas (Illinois and Wisconsin) reported abortions for in-state and out-of-state residents but did not report certain characteristics for out-of-state residents. Three other reporting areas (Iowa, Massachusetts, and New Mexico) provided only the total number of abortions for outof-state residents without specifying individual states or areas of residence from which these women came. As a result, abortion statistics in this report by area of residence should be interpreted with caution and might underestimate the incidence of abortion, especially for reporting areas from which multiple women travel to other states to obtain abortion services.
To evaluate overall trends in the number, rate, and ratio of reported abortions, annual data are presented for the 49 areas that reported every year during 2006-2015. Linear regression analysis was used to assess the overall rate of change among these areas during the entire 10-year period of analysis (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) and during the first and second halves of the period of analysis (2006-2010 and 2011-2015). The percentage change in abortion measures from the most recent past year (2014 to 2015) and from the beginning to the end of the 10-year period of analysis (2006 to 2015) also were calculated for these same 49 areas. Consistent with previous reports, key findings are highlighted to provide observed changes over time and differences between groups. However, comparisons do not infer statistical significance, and lack of comment regarding the difference between values does not imply that no statistically significant difference exists.
For the analysis of certain additional variables (i.e., abortions by maternal age and gestational age), annual data are presented for areas that met reporting standards every year during 2006-2015; the percentage change was calculated from the beginning to the end of the 10-year period of analysis (2006 to 2015), from the beginning to the end of the first and second halves of this period (2006 to 2010 and 2011 to 2015), and from the most recent past year (2014 to 2015). For other variables (i.e., race/ethnicity, method type, marital status, number of previous abortions, and number of previous live births), annual data are not presented; areas were included if they met reporting standards for the years needed for percentage change calculations. To evaluate trends in the use of different methods for performing an abortion, reporting areas were included only if they met reporting standards and if they specifically included medical abortion as a method on their reporting form. Trend analyses for race/ethnicity are limited to a 9-year span (2007-2015) because few reporting areas reported data on race by ethnicity (race/ethnicity) before 2007. Medical abortions performed at 9 completed weeks are also reported for 2011 to 2015. These data are reported to monitor any changes in clinical practice that might have occurred with the accumulation of evidence on the safety and effectiveness of medical abortion past 63 days of gestation (≤8 completed weeks) (44) and changes in professional practice guidelines published in 2013 and 2014 (45,46). Both of these events preceded the 2016 U.S. Food and Drug Administration (FDA) extension of the gestational age limit for the use of mifepristone for early medical abortion to 70 days (≤9 completed weeks) (47).
Some of the 49 areas that reported for 2015 are not included in certain trend analyses when data did not meet reporting standards. As a result, summary measures for comparisons over time might differ from the point estimates presented for all areas that reported for 2015.

Abortion Mortality
CDC has reported data on abortion-related deaths periodically since information on abortion mortality first was included in the 1972 abortion surveillance report (15,48). An abortion-related death is defined as a death resulting from a direct complication of an abortion (legal or illegal), an indirect complication caused by a chain of events initiated by an abortion, or an aggravation of a preexisting condition by the physiologic or psychologic effects of abortion (49). All deaths determined to be related causally to induced abortion are classified as abortion related regardless of the time between the abortion and death. In addition, any pregnancy-related death in which the pregnancy outcome was induced abortion regardless of the causal relation between the abortion and the death is considered an abortion-related death. An abortion is defined as legal only if it is performed by a licensed clinician within the limits of state law.
Since 1987, CDC has monitored abortion-related deaths through its Pregnancy Mortality Surveillance System (50,51). Sources of data for abortion-related deaths have included state vital records; media reports, including computerized searches of full-text newspaper and other print media databases; and individual case reports by public health agencies, including maternal mortality review committees, health care providers and provider organizations, private citizens, and citizen groups. For each death that possibly is related to abortion, CDC requests clinical records and autopsy reports. Two medical epidemiologists independently review these reports to determine the cause of death and whether the death was abortion related. Discrepancies are discussed and resolved by consensus. Each death is categorized by abortion type as legal induced, illegal induced, spontaneous, or unknown type.
This report provides data from the Pregnancy Mortality Surveillance System on induced abortion-related deaths that occurred in 2014, the most recent year for which data are available. Data on induced abortion-related deaths that occurred during 1972-2013 already have been published (15), and possible abortion-related deaths that occurred during 2015-2018 are being assessed. During 1998-2014, abortion surveillance data reported to CDC cannot be used alone to calculate national case-fatality rates (number of legal induced abortion-related deaths per 100,000 reported legal induced abortions in the United States) because certain states † † did not report abortion data every year during this period. Thus, national legal induced abortion case-fatality rates were calculated with denominator data from a provider census for the total number of abortions performed in the United States (16). Because rates determined on the basis of a numerator of <20 deaths are highly variable (43), national legal induced abortion case-fatality rates were calculated for consecutive 5-year periods during 1973-2007 and for a consecutive 7-year period during 2008-2014.

U.S. Totals
Among the 49 reporting areas that provided data for 2015, a total of 638,169 abortions were reported. All 49 of these areas provided data every year during 2006-2015. § § In 2015, these areas had an abortion rate of 11.8 abortions per 1,000 women aged 15-44 years and an abortion ratio of 188 abortions per 1,000 live births (Table 1). From 2014 to 2015, the total number of reported abortions decreased 2% (from 652,639 to 638,169), the abortion rate decreased 2% (from 12.

Occurrence and Residence
Abortion numbers, rates, and ratios for 2015 have been calculated by reporting area of occurrence and the residence of the women who obtained the abortions (  49.0% in Kansas), † † † abortion rates and ratios calculated by maternal residence might provide a more accurate reflection of the state-specific distribution of women obtaining abortions. However, because states vary in the level of detail they collect on maternal residence, 12.7% of abortions were reported to CDC with unknown information on maternal residence.

Maternal Age
Among the 47 areas that reported by maternal age for 2015, women in their 20s accounted for the majority (58.7%) of abortions and had the highest abortion rates (19.9 and 17.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively) ( Figure 2) (Table 3). Women in the youngest (<15 years) and oldest (≥40 years) age groups accounted for the smallest percentages of abortions (0.3% and 3.5%, respectively) and had the lowest abortion rates (0.5 and 2.5 abortions per 1,000 women aged <15 and ≥40 years, respectively). Among the 44 reporting areas that provided data by maternal age every year during 2006-2015, this pattern across age groups was stable, with the majority of abortions and the highest abortion rates occurring among women aged 20-29 years and the lowest percentages of abortions and abortion rates occurring among women in the youngest and oldest age groups (Table 4). From 2006 to 2015, abortion rates decreased among all age groups, although the decreases for adolescents (58% and 54% for adolescents aged <15 and 15-19 years, respectively) were greater than the decreases for women in all older age groups, with decreases for women aged ≥20 years ranging from 4% among women aged ≥40 years to 33% among women aged 20-24 years. Decreases in the abortion rate for all age groups, except women aged 25-29 years, were greater from 2011 to 2015 than from 2006 to 2010, and the rates for all age groups either remained the same or decreased from 2014 to 2015.
In contrast to the percentage of abortions and abortion rates, abortion ratios in 2015 were highest among adolescents aged ≤19 years and lowest among women aged 25-39 years ( Figure 2) (

Adolescents
Among the 45 areas that reported maternal age by individual year among adolescents for 2015, adolescents aged 18-19 years accounted for the majority (67.8%) of adolescent abortions and had the highest adolescent abortion rates (9.6 and 13.2 abortions per 1,000 adolescents aged 18 and 19 years, respectively). Adolescents aged <15 years accounted for the smallest percentage of adolescent abortions (2.7%) and had the lowest adolescent abortion rate (0.5 abortions per 1,000 adolescents aged 13-14 years) ( Table 5). Among the 40 reporting areas that provided maternal age data for adolescents for each individual year of reporting during 2006-2015, the percentage of abortions accounted for by adolescents aged 18-19 years increased, whereas the percentage of abortions accounted for by adolescents aged <18 years decreased ( Table 6). For adolescents of all ages, large decreases in abortion rates occurred from 2006 to 2015 (48%-64%) and were greater from 2011 to 2015 than from 2006 to 2010. Decreases continued among all adolescents aged ≥15 years from 2014 to 2015.
In 2015, the abortion ratio for adolescents was highest among adolescents aged <15 years (684 abortions per 1,000 live births among adolescents aged <15 years) and was lowest among adolescents aged ≥17 years (285, 292, and 247 abortions per 1,000 live births among adolescents aged 17, 18, and 19 years, respectively) (

Gestational Age
Among the 40 areas that reported gestational age § § § at the time of abortion for 2015, approximately two thirds (65.4%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.1%) were performed at ≤13 weeks' gestation (Table 7). Few abortions were performed at 14-20 weeks' gestation (7.6%) or at ≥21 weeks' gestation (1.3%). Among the 33 reporting areas that provided data on gestational age every year during 2006-2015, the percentage of abortions performed at ≤13 weeks' gestation declined minimally from 91.5% to 91.0% (Table 8). However, within this gestational age range, a shift occurred toward earlier gestational ages, with the percentage of abortions performed at ≤8 weeks' gestation increasing 3% and the percentage of abortions performed at 9-13 weeks' gestation decreasing 9%. For the entire period of analysis, abortions performed at >13 weeks' gestation accounted for ≤9.0% of abortions.
Among abortions performed at ≤13 weeks' gestation and reported by individual week of gestation for 2015, 37.6% were performed at ≤6 weeks' gestation ( Table 9). The percentage contribution to abortions performed at ≤13 weeks' gestation was progressively smaller for each additional week of gestation: 19.6% were performed at 7 weeks' gestation, and 3.1% were performed at 13 weeks' gestation. Among the 33 areas that reported by exact week of gestation for abortions performed at ≤13 weeks' gestation every year during 2006-2015, a shift occurred toward the earliest gestational age reported: abortions performed at ≤6 weeks' gestation increased 11%, those performed at 7-12 weeks' gestation decreased 3%-15%, and those performed at 13 weeks' gestation were stable (Table 10).

Method Type
Among the 43 areas that reported by method type for 2015 and included medical abortion on their reporting form, 64.3% of abortions were surgical abortions at ≤13 weeks' gestation, 24.6% were early medical abortions (a nonsurgical abortion at ≤8 weeks' gestation), and 8.8% were surgical abortions at >13 weeks' gestation; other methods (medical abortion at >8 weeks' gestation, intrauterine instillation, and hysterectomy/ hysterotomy) were uncommon (≤2.2%) ( Among the 30 reporting areas that provided data by procedure and individual week of gestational age each year from 2011 to 2015,**** when recent clinical guidelines extended mifepristone use to 70 days' gestation, the percentage of abortions at 9 completed weeks' gestation that were reported as medical abortions did not change substantially between 2011, 2012, 2013, and 2014 (5.0%, 5.7%, 6.7%, and 7.7%, respectively) and then increased to 13.0% in 2015. Among the 43 † † † † areas that reported by method type for 2015 and included medical abortion on their reporting form, 26.0% were medical abortions performed at ≤9 weeks' gestation. Of these medical abortions performed at ≤9 weeks' gestation, 94.6% were performed at ≤8 weeks and 5.4% were performed at 9 weeks.
In contrast to the increase that occurred in use of early medical abortion, use of surgical abortion at ≤13 weeks' gestation decreased 18% from 2006 to 2015 (from 79.2% of abortions to 64.7%). Surgical abortion at >13 weeks' gestation consistently accounted for approximately 8.0%-9.0% of all abortions, and all other methods combined consistently accounted for a limited percentage of abortions (1.4%-2.4%) during 2006-2015.

Race/Ethnicity
Among the 30 areas that reported cross-classified race/ ethnicity data for 2015, non-Hispanic white women and non-Hispanic black women accounted for the largest percentages of all abortions (36.9% and 36.0%, respectively), and Hispanic women and non-Hispanic women in the other race category accounted for smaller percentages (18.5% and 8.7%, respectively) (Table 12). Non-Hispanic white women had the lowest abortion rate (6.8 abortions per 1,000 women aged 15-44 years) and ratio (111 abortions per 1,000 live births) and non-Hispanic black women had the highest abortion rate (25.1 abortions per 1,000 women aged 15-44 years) and ratio (390 abortions per 1,000 live births). Data for 2015 also are reported separately by race and by ethnicity (Tables 13 and 14). § § § Arkansas and Texas reported probable postfertilization age. Two weeks were added to the probable postfertilization age to provide a corresponding measure to gestational age on the basis of the clinician's estimate. Virginia reported clinician's estimate of gestational age based on date of conception; no modifications were made to these data. ¶  Among the 20 areas § § § § that reported by race/ethnicity for 2007, 2010, 2011, 2014, and 2015, abortion rates decreased substantially for the three largest race/ethnicity groups: for non-Hispanic white women, the abortion rate decreased 30% (from 9.4 abortions per 1,000 women in 2007 to 6.6 in 2015), for non-Hispanic black women it decreased 29% (from 36.5 abortions per 1,000 women in 2007 to 25.8 in 2015), and for Hispanic women it decreased 45% (from 21.0 abortions per 1,000 women in 2007 to 11.6 in 2015). For women in the three largest race/ethnicity groups, abortion rates decreased both from 2007 to 2010 and from 2011 to 2015, although the decreases were greater during the later period. From 2007 to 2010, the abortion rates decreased 10% for non-Hispanic white women (from 9.4 to 8.5 abortions per 1,000), 4% for non-Hispanic black women (from 36.5 to 34.9 abortions per 1,000), and 10% for Hispanic women (from 21.0 to 19.0 abortions per 1,000); by contrast, from 2011 to 2015, the abortion rates decreased 19% for non-Hispanic white women (from 8.1 to 6.6 abortions per 1,000), 20% for non-Hispanic black women (from 32.3 to 25.8 abortions per 1,000), and 31% for Hispanic women (from 16.9 to 11.6 abortions per 1,000).
Abortion ratios also decreased from 2007 to 2015 for the three largest race/ethnicity groups: for non-Hispanic white women, the abortion ratio decreased 27% (from 147 abortions

Marital Status
Among the 39 areas that reported by marital status for 2015, 14.3% of all women who obtained an abortion were married, and 85.7% were unmarried (Table 15). The abortion ratio was 41 abortions per 1,000 live births for married women and 373 abortions per 1,000 live births for unmarried women. Among the 30 reporting areas ¶

Previous Live Births and Abortions
Data from the 40 areas that reported the number of previous live births for women who obtained abortions in 2015 indicate that 40.7%, 45.1%, and 14.2% of these women had zero, one or two, or three or more previous live births, respectively (Table 16) , the percentage of women obtaining abortions with no previous live births was stable; by contrast, the percentage decreased 3% for women who had one or two previous live births and increased 13% for women with three or more previous live births. Among the areas included in this comparison, 40.6%, 46.6%, and 12.8% of women had zero, one to two, or three or more previous live births, respectively, in 2006; by comparison 40.6%, 45.0%, and 14.4% of women had zero, one or two, or three or more previous live births, respectively, in 2015.
Data from the 39 areas that reported the number of previous abortions for women who obtained abortions in

Maternal Age and Marital Status by Race/Ethnicity
In select reporting areas, abortions that were categorized by maternal race and race/ethnicity were further categorized by maternal age and by marital status (Tables 18 and 19). A consistent pattern existed for abortions by maternal age across all race/ethnicity groups, with the smallest percentage of abortions occurring among adolescents aged <15 years (0.2%-0.3%) and the largest percentage occurring among women aged 20-24 years (26.5%-32.2%) and 25-29 years (26.7%-28.8%) ( Table 19). A consistent pattern also existed for abortions by marital status across all race/ethnicity groups, with a higher percentage of abortions occurring among women who were unmarried (69.0%-91.8%) than among those who were married (8.2%-31.0%) ( Table 19). For abortions among married women, the percentage was higher for non-Hispanic women in the other race group (31.0%) than for non-Hispanic white women (17.0%), Hispanic (15.6%) women, or non-Hispanic black women (8.2%). For abortions among unmarried women, the percentage was higher for non-Hispanic black women (91.8%) than for non-Hispanic white (83.0%) women, Hispanic (84.4%) women, or non-Hispanic women in the other race group (69.0%) ( Table 19).

Weeks of Gestation by Maternal Age, Race/Ethnicity, and Method Type
In certain reporting areas, abortions that were categorized by weeks of gestation were further categorized by maternal age and race/ethnicity (Tables 20 and 21). In every subgroup for these three variables, the largest percentage of abortions occurred at ≤8 weeks' gestation. However, by maternal age, 39.0% of adolescents aged <15 years and 56.7% of adolescents aged 15-19 years obtained an abortion by ≤8 weeks' gestation, compared with 63.5%-70.5% of women in older age groups ( Figure 3) (Table 20). Conversely, 24.3% of adolescents aged <15 years and 12.3% of adolescents aged 15-19 years obtained an abortion after 13 weeks' gestation, compared with 8.0%-9.4% for women in older age groups. By race/ethnicity, 59.1% of non-Hispanic black women obtained an abortion at ≤8 weeks' gestation, compared with 67.5%-70.3% of women from other race/ethnicity groups. Differences in abortions after 13 weeks' gestation across race/ethnicity groups were less apparent than differences across age groups (10.5% for non-Hispanic black women, compared with 8.0%-8.5% for women in the remaining race/ethnicity groups).
Among abortions categorized by weeks of gestation and method type, surgical abortion accounted for the largest percentage of abortions within every gestational age category (Table 22). At ≤8 weeks' gestation, surgical abortion accounted for a smaller percentage of abortions (64.2%) than at any other stage of gestation; at 9-20 weeks' gestation, surgical abortion accounted for 94.5%-99.2% of all abortions and at ≥21 weeks' gestation, it accounted for 94.5% of abortions. By contrast, at ≤8 weeks' gestation, medical abortion accounted for 35.8% of abortions then decreased to 5.5% at 9-13 weeks and 0.7%-1.9% at 14-20 weeks before increasing to 4.5% at ≥21 weeks. Throughout gestation, abortions performed by intrauterine instillation or hysterectomy/hysterotomy were rare (<0.1%-0.7% of abortions).

Abortion Mortality
Using national data from the Pregnancy Mortality Surveillance System (51), CDC identified six abortion-related deaths for 2014 (Table 23). Investigation of these cases indicated that all six deaths were related to legal abortion and none to illegal abortion.
The annual number of deaths related to legal induced abortion has fluctuated from year to year over the past 40 years (Table 23) This case-fatality rate was similar to the rate for most of the preceding 5-year periods but lower than the case-fatality rate of 2.09 legal induced abortion-related deaths per 100,000 reported legal abortions for the 5-year period (1973)(1974)(1975)(1976)(1977) immediately following nationwide legalization of abortion in 1973. Possible abortion-related deaths that occurred during 2015-2018 are being assessed.

Discussion
For 2015, a total of 638,169 abortions were reported to CDC by 49 areas. Among these areas, the abortion rate was 11.8 abortions per 1,000 women aged 15-44 years and the abortion ratio was 188 abortions per 1,000 live births. All 49 of these reporting areas submitted data every year during the period of analysis from 2006 to 2015, thus providing the information necessary for evaluating trends. Among these areas, the number, rate, and ratio of reported abortions decreased 2% from 2014 to 2015, which, in combination with decreases that occurred during previous years (11)(12)(13)(14)(15), resulted in the lowest values for all three measures for the entire period of analysis. Among areas that reported by age every year of the analysis, women in their 20s accounted for the majority of abortions (57%-59%) and had the highest abortion rates, whereas decreases in the abortion rate were greater for adolescents aged <20 years than for any other age group. In addition, throughout the period of analysis, ≤9% of abortions each year were performed after 13 weeks' gestation; approximately two thirds of abortions were performed at ≤8 weeks' gestation, and this percentage increased from 63.5% in 2006 to 65.4% in 2015. Among areas that included medical abortion on their reporting form every year, the percentage of all abortions performed by early medical abortion increased from 11.3% in 2006 to 24.2% in 2015.
These findings underscore important maternal age differences in abortion trends. Because of the high rate and proportion of abortions that occurred among women in their 20s, women in this age group have contributed substantially to overall changes. Conversely, during 2006-2015, women aged ≥40 years had consistently low abortion rates and accounted for a limited percentage of abortions (≤3.7%); therefore, they have had a much smaller contribution to overall abortion trends. Nonetheless, among women aged ≥40 years, the abortion ratio continues to be higher than among women in their mid to late 20s and 30s. Because of the limited proportion of abortions that are performed later in gestation among women aged ≥40 years, which might be completed for maternal medical indications or fetal anomalies, the continuing high abortion ratio among these older women suggests that unintended pregnancy is a problem that women encounter throughout their reproductive years (52).
The adolescent abortion trends described in this report are important for monitoring progress that has been made toward reducing adolescent pregnancies in the United States. National birth data indicate the birth rate for adolescents aged 15-19 years decreased 47% during 2006-2015 (53,54), compared with a 54% decrease in the abortion rate for adolescents aged 15-19 years during the same period. Recent national birth data indicate the birth rate decreased an additional 16% from 2015 to 2017 (55,56). These findings indicate that declines in adolescent pregnancies in the United States have been accompanied by large decreases in both adolescent births and abortions and that the pattern of decline is continuing (53)(54)(55)(56).
The findings in this report indicate that the number, rate, and ratio of reported abortions have declined across all race/ ethnicity groups but that well-documented disparities persist (3,4,(17)(18)(19)(20)(21)(22). In this report, abortion rates and ratios remained 1.5 and 1.3 times higher for Hispanic compared with non-Hispanic white women and 3.6 and 3.5 times higher for non-Hispanic black compared with non-Hispanic white women. The comparatively high abortion rates and ratios among non-Hispanic black women have been attributed to higher unintended pregnancy rates and a greater percentage of unintended pregnancies ending in abortion (52). Data from certain reports suggest that differences in abortion indicators between non-Hispanic black women and women of other groups narrowed from 1994 to 2008 (4,21), but remained steady from 2008 to 2014 (22).
The findings in this report indicate the majority of women obtaining abortions do so early in gestation (≤8 weeks), when the risks for complications are lowest (57)(58)(59)(60). Among the areas that reported gestational age data every year during 2006-2015, the percentage of abortions performed at ≤8 weeks' gestation increased 3%. Moreover, among the areas that reported abortions at ≤13 weeks' gestation by individual week, the distribution continued to shift toward earlier weeks of gestation, with the percentage of early abortions performed at ≤6 weeks' gestation increasing 11% from 2006 to 2015. Nonetheless, the overall percentage of abortions performed at ≤13 weeks' gestation was stable during 2006-2015. Reports indicate that delays in obtaining an abortion are more common among certain groups of women (61-63); among women obtaining abortions in this report, a smaller percentage of adolescents aged ≤19 years and non-Hispanic black women, compared with women in other age and race/ethnicity groups, obtained abortions at ≤8 weeks' gestation. Because of the small but persistent percentage of women who obtain abortions at >13 weeks' gestation, a better understanding is needed of how to address delays in obtaining abortions (61,(63)(64)(65)(66).
The trend of obtaining abortions earlier in pregnancy has been facilitated by changes in abortion practices. Research conducted in the United States during the 1970s indicated that surgical abortion procedures performed at ≤6 weeks' gestation, compared with 7-12 weeks' gestation, were less likely to result in successful termination of the pregnancy (67). However, subsequent advances in technology (e.g., improved transvaginal ultrasonography and sensitive pregnancy tests) have allowed very early surgical abortions to be performed with completion rates exceeding 97% (68)(69)(70). Likewise, the development of early medical abortion regimens has allowed for abortions to be performed very early in gestation, with completion rates for regimens that combine mifepristone and misoprostol reaching 96%-98% (71). In 2015, 65.4% of all reported abortions were performed at ≤8 completed weeks' gestation; thus, the women receiving these abortions were eligible for early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation) on the basis of gestational age; 35.8% of abortions at ≤8 weeks' gestation and 24.6% of all abortions were reported as early medical abortions, with the proportion of all abortions reported as early medical abortion up from 11.3% in 2006. Moreover, in addition to abortions meeting the definition of early medical abortion, the percentage of abortions at 9 weeks' gestation reported as medical has increased in recent years (from 5.0%-7.7% during 2011-2014 to 13.0% in 2015). On the basis of evidence that early medical abortion is safe and effective beyond 63 days' gestation (44), professional clinical practice guidelines were updated midyear in 2013 and 2014 to extend the gestational age eligibility for early medical abortion from 63 to 70 days (≤9 completed weeks) (45,46). In early 2016, FDA updated its approval for use of mifepristone for early medical abortions, extending the gestational age limit to 70 days (47). CDC will continue to monitor medical abortions at 9 weeks' gestation.
The annual number of deaths related to legal induced abortion has fluctuated from year to year over the past 40 years. Because of this variability and the relatively limited number of abortionrelated deaths every year, national legal abortion case-fatality rates were calculated for consecutive 5-year periods during 1973-2007 and for a consecutive 7-year period during 2008-2014. The national legal induced abortion case-fatality rate for 2008-2014 was similar to the case-fatality rate for most of the preceding 5-year periods but was much lower than the case-fatality rate for the 5-year period (1973)(1974)(1975)(1976)(1977)(1978)) that immediately followed nationwide legalization of abortion in 1973.

Limitations
The findings in this report are subject to at least four limitations. First, because reporting to CDC is voluntary and reporting requirements are established by the individual reporting areas (24), CDC is unable to obtain the total number of abortions performed in the United States. Although most reporting areas collect and send abortion data to CDC, three of the 52 reporting areas (California, Maryland, and New Hampshire) did not provide CDC data for 2006-2015 on a consistent annual basis. During the period covered by this report, the total annual number of abortions reported to CDC was 68%-71% of the number recorded by the Guttmacher Institute through a national census of abortion providers (8,9,16). § § § § § In addition, whereas most reporting areas that send abortion data to CDC have laws requiring medical providers to submit a report for every abortion they perform to a central health agency, in New Jersey and DC medical providers submit this information voluntarily (23). As a result, the abortion numbers these areas report to CDC are likely incomplete. ¶ ¶ ¶ ¶ ¶ Moreover, even in states that legally require medical providers to submit a report for all the abortions they perform, enforcement of this requirement varies, and as a consequence, numbers from multiple other reporting areas are likely incomplete as well.****** Second, because reporting requirements are established by the individual reporting areas, many states use reporting forms that differ from the technical standards and guidance CDC developed in collaboration with the National Association for Public Health Statistics and Information Systems. Consequently, many reporting areas do not collect all the information CDC compiles on the characteristics of women obtaining abortions (e.g., maternal age, race, and ethnicity) or do not report the data in a manner consistent with this guidance (e.g., gestational age). Although missing demographic information can reduce the extent to which the statistics in §  this report represent all women in the United States, five nationally representative surveys of women obtaining abortions in 1987, 1994-1995, 2001-2002, 2008, and 2014 (17-20,22) produced percentage distributions for most characteristics that are nearly identical to the percentage distributions reported by CDC. The exception is the percentage distribution of abortions by race/ethnicity. The percentage of abortions accounted for by non-Hispanic black women is higher and by Hispanic women is lower in this report than the percentages reported from a recent nationally representative survey of women obtaining abortions (22). Differences might be attributable to the fact that the number of states that report to CDC by race/ethnicity continues to be somewhat lower than for other demographic variables. Certain reporting areas that have not reported to CDC or have not reported cross-classified race/ethnicity data (e.g., California, Florida, and Illinois) have sufficiently large populations of minority women that the absence of data from these areas reduces the representativeness of CDC data. In addition, certain areas collect gestational age on the basis of estimated date of conception or collect probable postfertilization age. Without medical guidance on how to report these data, the validity and reliability of gestational age for these reporting areas is uncertain.
Despite challenges in capturing medical abortions for reporting (8,16,23,72), a comparison of CDC data with mifepristone sales data † † † † † † suggests that CDC's Abortion Surveillance System accurately describes the use of early medical abortion relative to other abortion methods in the United States (73). However, because of recent changes in clinical practice guidelines for the use of mifepristone and misoprostol through 9 completed weeks of gestation, CDC's current definition of early medical abortion does not represent abortions performed through this method. Nonetheless, for 2015, of the medical abortions reported at ≤9 weeks, only 5.4% were performed at 9 weeks, and CDC continues to monitor these changes in clinical practice.
Third, abortion data are compiled and reported to CDC by the central health agency of the reporting area in which the abortion was performed rather than the reporting area in which the woman lived. Thus, the available population (32-41) and birth data (42), which are organized by the states in which women live, differ in certain cases from the population of women who undergo abortions in a given reporting area. This likely results in an overestimation of abortions for reporting areas in which a high percentage of abortions are obtained by out-of-state residents and an underestimation of abortions for states where residents frequently obtain abortions out of state. Limited abortion services, more stringent regulatory requirements for obtaining an abortion, or geographic proximity to services in another state might influence where women obtain abortion services. To examine these reporting biases, CDC attempts to categorize abortions by residence in addition to geographic occurrence. However, in 2015, CDC was unable to identify the reporting area, territory, or country of residence for 12.7% of reported abortions.
Finally, because reporting areas provide CDC with aggregate numbers, not individual-level data, and because available demographic information is limited by what reporting areas collect on their reporting forms, it is not possible to perform stratified analyses by additional demographic variables (e.g., socioeconomic status).

Public Health Implications
Ongoing surveillance of legal induced abortion is important for several reasons. First, abortion surveillance is needed to guide and evaluate the success of programs aimed at preventing unintended pregnancies. Although pregnancy intentions can be difficult to assess (74)(75)(76)(77)(78)(79), abortion surveillance provides an important measure of pregnancies that are unwanted. Second, routine abortion surveillance is needed to assess trends in clinical practice patterns over time. Information in this report on the number of abortions performed through different methods (e.g., medical or surgical) and at different gestational ages provides the denominator data that are necessary for analyses of the relative safety of abortion practices (80). Finally, information on the number of pregnancies ending in abortion is needed in conjunction with data on births and fetal losses to more accurately estimate the number of pregnancies in the United States and determine rates for various outcomes of public health importance (e.g., adolescent pregnancies) (81).
According to the most recent national estimates from 2010, 18% of all pregnancies in the United States end in induced abortion (82). Multiple factors influence the incidence of abortion, including access to health care services and contraception (83)(84)(85); the availability of abortion providers (8,9,16,(86)(87)(88)(89); state regulations, such as mandatory waiting periods (66), parental involvement laws (90), and legal restrictions on abortion providers (91,92); increasing acceptance of nonmarital childbearing (93,94); shifts in the race/ethnicity composition of the U.S. population (95,96); and changes in the economy and the resulting impact on fertility preferences and use of contraception (97,98). However, despite † † † † † † Because the sole distributor of mifepristone in the United States only sells this medication to licensed physicians, who must sign and return a prescriber's agreement, sales data from this company are not limited by individual state reporting requirements or the difficulties of identifying smaller providers within the wider medical community. the multiple influences on abortion, because unintended pregnancy precedes nearly all cases of abortions, § § § § § § efforts to help women avoid pregnancies that they do not desire might reduce the number of abortions (83)(84)(85).
Recent data indicate that the proportion of pregnancies in the United States that were unintended decreased from 51% in 2008 to 45% during 2011-2013, after a slight increase from 2001 to 2008 (52). Changing patterns of contraception use might have contributed to this decrease in unintended pregnancy. The use of the most effective forms of reversible contraception (i.e., intrauterine devices and hormonal implants) (99) has recently increased among all women (100)(101)(102)(103), and the use of contraception overall appears to be increasing among adolescents (104). Of reported abortions in 2015, the majority were among women with a previous birth, and a substantial proportion occurred among women with a previous induced abortion, events that are also opportunities for contraception counseling. Contraception provision in the immediate postpartum and postabortion settings might increase access to these methods at a time when women are receiving health services. In addition, providing contraception for women at no cost can increase use of these methods and reduce abortion rates (83)(84)(85)105). Insufficient provider reimbursement and training, inadequate client-centered counseling, lack of youth-friendly services, and low client awareness of available contraceptive methods are also barriers to accessing contraception (106)(107)(108)(109). Removing these barriers might help improve contraceptive use, potentially reducing the number of unintended pregnancies and the number of abortions performed in the United States.

FIGURE 3. Percentage* distribution of gestational ages at time of abortion, by age of woman -selected reporting areas, † United States, 2015
* Based on the total number of abortions reported with known weeks of gestation. † § § Reporting area reported abortion numbers for both in-state and out-of-state residents; for out-of-state residents, the state or area of residence was not provided. ¶ ¶ Data from hospitals and licensed ambulatory care facilities only; because reporting is not mandatory for private physicians and women's centers, a complete count of the number of abortions performed in New Jersey could not be obtained. *** Total abortion number <20. † † † Abortion rates and ratios and percentage of abortions obtained by out-of-state residents were not calculated for Wyoming because results based on a small number of abortions are unstable. * Data from 47 reporting areas; excludes five reporting areas (California, Florida, Maryland, New Hampshire, and Wyoming) that did not report, did not report by age, or did not meet reporting standards. † Percentages for the individual component categories might not add to 100 because of rounding. § Percentage is calculated as the number of abortions reported by known age divided by the sum of abortions reported by known and unknown age. ¶ Cells with a value in the range of 1-4 or cells that would allow for calculation of these small values have been suppressed. ** Because reporting is not mandatory, information could not be obtained for all abortions performed in the District of Columbia. † † Includes residents only. § § Data from hospitals and licensed ambulatory care facilities only; because reporting is not mandatory for private physicians and women's centers, information could not be obtained for all abortions performed in New Jersey. ¶ ¶ Percentage based on a total of 560,589 abortions reported among the areas that met reporting standards for age. *** Number of abortions obtained by women in a given age group per 1,000 women in that same age group. Women aged 13-14 years were used as the denominator for the group of women aged <15 years, and women aged 40-44 years were used as the denominator for the group of women aged ≥40 years. Women aged 15-44 years were used as the denominator for the overall rate. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area. † † † Number of abortions obtained by women in a given age group per 1,000 live births to women in that same age group. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area. Hampshire, Vermont, and Wyoming) that did not report, did not report by age, or did not meet reporting standards for ≥1 year. † Number of abortions obtained by women in a given age group per 1,000 women in that same age group. Women aged 13-14 years were used as the denominator for the group of women aged <15 years, and women aged 40-44 years were used as the denominator for the group of women aged ≥40 years. Women aged 15-44 years were used as the denominator for the overall rate. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area. § Number of abortions obtained by women in a given age group per 1,000 live births to women in that same age group. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area.  § Cells with a value in the range of 1-4 or cells that would allow for calculation of these small values have been suppressed. ¶ Because reporting is not mandatory, information could not be obtained for all abortions performed in the District of Columbia. ** Includes residents only. † † Data from hospitals and licensed ambulatory care facilities only; because reporting is not mandatory for private physicians and women's centers, information could not be obtained for all abortions performed in New Jersey. § § Number of abortions obtained by adolescents in a given age group per 1,000 adolescents in that same age group. Adolescents aged 13-14 years were used as the denominator for adolescents aged <15 years. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area. ¶ ¶ Number of abortions obtained by adolescents in a given age group per 1,000 live births to adolescents in that same age group. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area. year. † Number of abortions obtained by adolescents in a given age group per 1,000 adolescents in that same age group. Adolescents aged 13-14 years were used as the denominator for adolescents aged <15 years. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area. § Number of abortions obtained by adolescents in a given age group per 1,000 live births to adolescents in that same age group. For each reporting area, abortions for women of unknown age were distributed according to the distribution of abortions among women of known age for that area.     .) 491,630 485,709 487,837 469,055 460,424 434,216 411,526 393,570 380,683 371     Wyoming) that did not report, did not report by method type, or did not meet reporting standards. † Includes aspiration curettage, suction curettage, manual vacuum aspiration, menstrual extraction, sharp curettage, and dilation and evacuation procedures. § Intrauterine instillations reported at ≤12 weeks' gestation are not presented with abortions reported by known method type. ¶ Percentages for the individual component categories might not add to 100 because of rounding. ** Percentage is calculated as the number of abortions reported by known method type divided by the sum of abortions reported by known and unknown method type. † † Cells with a value in the range of 1-4 or cells that would allow for calculation of these small values have been suppressed. § § Numbers for surgical procedures at ≤13 weeks versus >13 weeks and for medical abortion at ≤8 weeks versus >8 weeks are not presented because gestational age data were not provided or were provided in incompatible categories. ¶ ¶ Because reporting is not mandatory, information could not be obtained for all abortions performed in the District of Columbia. *** Data from hospitals and licensed ambulatory care facilities only; because reporting is not mandatory for private physicians and women's centers, information could not be obtained for all abortions performed in New Jersey. † † † All abortions were reported as surgical or chemically induced. For this report, all surgical abortions were classified as surgical and all chemical abortions as medical. § § § Surgical abortions reported without a gestational age were distributed among the surgical abortion categories according to the distribution of surgical abortions at known gestational age. ¶ ¶ ¶ Medical abortions reported without a gestational age were distributed among the medical abortion categories according to the distribution of medical abortions at known gestational age. **** Percentage is based on a total of 538,678 abortions reported among the areas that met reporting standards for method type.