Induced Abortion

Introduction

The California therapeutic abortion became effective 8 November 1967. It provides that abortions may be performed in hospitals accredited by the Joint Commission on Accreditation of Hospitals when a committee of the hospital's medical staff finds that there is a substantial risk that the continuance of the pregnancy would gravely impair the physical or mental health of the mother, or if the pregnancy resulted from rape or incest. The law specifically prohibits therapeutic abortions after 20 weeks of gestation. Along with the act, the California Assembly passed a resolution requesting the Department of Public Health to accumulate data on abortion practices and to present the findings in an annual report to the legislature. As a result of this resolution, a reporting system was established in which each accredited hospital makes reports quarterly to the department. These reports are the basis for the data presented here. The material includes a description of the patient population, geographic and hospital variations in therapeutic abortion, an estimate of the potential induced abortions in the state and a brief review of deaths associated with abortion.

Basic Statistics

The abortion experience for the 26-month period November 1967-December 1969 is described in this report. During this time 22,646 applications were received from 279 hospitals; 20,888 of the applications (92 percent) were approved and the abortions performed. Nearly 92 percent of the applications indicated that continuance of the pregnancy would gravely impair the mental health of the mother. Slightly over 3 percent (647) of the applications were based on danger to the physical health of the mother, and the remaining 985 applications (5 percent) were because of rape or incest. Although the experience analyzed at this time is relatively brief, some trends are evident. First, the number of applications has been increasing in each quarter of reporting. Second, both the proportion of applications approved and operations performed have increased from 92 percent approved and 89 percent performed in 1968 to 97 percent and 94 percent, respectively, in 1969.

There was also a shift in the reason for the application. In 1967, impairment of the mental health of the woman was given in 80 percent of the applications; by 1969, this reason accounted for over 93 percent of the applications. Further trends are noted when abortions are related to live births (Table 1). In 1968, approximately 15 therapeutic abortions were performed for each 1,000 live births and in 1969 there were nearly 44 abortions per 1,000 live births. Preliminary figures for the first six months of 1970 show over 23,000 abortions with a projected total for the year of about 60,000. This indicates a ratio of 170 therapeutic abortions per 1,000 live births was reached in 1970. Patient characteristics descriptive information on the 20,888 women who had therapeutic abortions before January 1970 is presented in following paragraphs. Where applicable, the characteristics of women having abortions are compared with those of California women who had a live birth during 1967- 1969.

Induced Abortion as a Risk Factor

Prenatal complications following ...