CONNECTICUT

CATHOLIC

PUBLIC

AFFAIRS
AVENUE

CONFERENCE,

INC.

134 FARMINGTON HARTFORD.

CONNECTICUT

06105-3784

~IAMFORD

MICHAEL

C. CULHANE
DIRECTOR

':'XECU7IVE

DEACON

DAVID
U!GISLAj'IVE

W. REYNOLDS
LIAISON

Contact: Michael C. Culhane (860) 524-7882 mculhane@ctcatholic.org

The Connecticut Catholic Public Affairs Conference Releases Report:

Thousands of Abortion Cases in Connecticut Appear To Go Unreported
HARTFORD, Conn. - (October 18, 2011) A report by the Connecticut Catholic Public Affairs Conference (CCPAC), the public policy and advocacy office of the Catholic Bishops in Connecticut, indicates that abortions are going unreported in Connecticut, which is a violation of state law. The CCPAC is urging Connecticut Department of Public Health Commissioner Dr. Jewel Mullen to review the report and take action. (A copy of the letter is enclosed). Connecticut state law mandates that every abortion, as soon as it is performed, be reported to the Department of Public Health (DPH) by Connecticut abortion providers, but the CCPAC discovered that over 19 percent of abortions in the state go unreported each year. This grievous reporting discrepancy was uncovered during an examination of data reported to the DPH by abortion' providers and data compiled directly by the Alan Guttmacher Institute (AGI), which is regarded nationally as the most accurate and comprehensive research organization on abortion activity. When the data from both agencies are compared, it shows that a total of 12,456 abortions went unreported during the four years examined.

This egregious discrepancy raises serious questions as to why abortion providers are not filling out the reporting form, which consists of 16 basic questions, including non-identifying information such as: age and gestation period. (Form can be found in the addendum of report). Why are these providers failing to comply with reporting laws? This lack of proper reporting not only obscures the DPH numbers, which are reported to the Center for Disease Control (CDC) each year, but it raises serious questions about compliance of providers with other statutory/regulatory requirements, such as mandatory counseling of minors prior to abortion, and the reporting of cases concerning the sexual assault of minors.

-moreREPRESENTING THE ARCHDIOCESE TELEPHONE, OF HARTFORD. DIOCESE OF BRIDGEPORT. EMAIL. DIOCESE OF NORWICH CCC@CTCATHOLIC AND UKRAINIAN CATHOLIC DIOCESE OF STAMFORD 18Sa} 524·7882· FAX IS601 525-0750· ORG • WEBSITE WWWCTCATHOLICORG

CCPAC Abortion Report/Page Two

Based on the findings of the report, the CCPAC recommends that the following actions be taken by the Department of Public Health (DPH) and the Connecticut General Assembly:

1) The DPH needs to enforce reporting requirements to insure that all abortions are reported by taking significant steps during its inspection of abortion clinics and medical offices, which is mandated by law in Connecticut. If abortion providers fail to comply with the law, they need to be fined, suspended or have their license revoked.

2) The Connecticut General Assembly needs to enact an adult notification law. The health and welfare of our teens should not be left to abortion providers who profit directly from the abortion and who have shown callous disregard for complying with state reporting requirements. The General Assembly should act to mandate parental involvement in a minor's abortion. Over the past nine years, 801 girls under the age of 18 entered Connecticut to recei ve abortions. 91 percent of these teens came from the bordering g states of Massachusetts and Rhode Island, which have strict parental consent laws. Thirty-seven states currently have some form of parental consent or notification laws in effect. The Connecticut General Assembly needs to address this issue in order to protect not only young girls from Connecticut, but also from our bordering states.

The report by the CCPAC did uncover some positive trends. The number of reported abortions continued to decline in Connecticut for the third straight year, based solely on DPH numbers. The state experienced a 2.1 percent decline in the actual number of abortions performed in the state from 2009 to 2010. Among teenagers, the decline was even more significant. In 2010, 827 young women under 18 years of age received an abortion in Connecticut compared to 914 in 2009, which reflects a 9.5 percent decrease in the number of abortions among teens. The number of abortions performed on minors under 16 - and those 12 and younger - also continued to decline. The abortion rate (abortions per 1000 women of childbearing age) also decreased across all age groups. The CCPAC report is released annually during the month of October in recognition of Respect Life Month within the Catholic Church. You can view the entire CTCatholic Conference Public Affairs Abortion Report at www.clcatholic.org. For

recommendations made by the Conference, refer to pages six and seven.

###

CONNECTICUT

CATHOLIC

PUBLIC

AFFAIRS
AVENUE

CONFERENCE,

INC.

134 FARMINGTON HARTFORD,

CONNECTICUT

06105-3784

STAMFORD

MICHAEL

C. CULHANE
DIREcTOR

EXECUTIVE.

DEACON

DAVID
L.EGISLAT1VE

W. REYNOLDS
LIAISON

October 13, 2011

Dr. Jewel Mullen, MD, MPH, MPA Commissioner Connecticut Department of Public Health 410 Capitol Avenue Hartford, CT 06134 Dear Commissioner Mullen: Enclosed please find a copy for your review of the fourth annual report of "The State of Abortion in Connecticut" produced by the Connecticut Catholic Public Affairs Conference (CCPAC). The Conference is the public policy advocacy office of the Catholic Bishops in Connecticut. The information contained in this report is based on an in-depth analysis of abortion and population information provided to us by the Connecticut Department of Public Health. The Conference realizes this report touches on a subject that is controversial in our society, but it strongly believes that facts, as contained in this report, should be available to the public as the debate on this issue continues. As you well know, abortion is not just a moral issue, but it also must be viewed as a very serious medical matter as it relates to the women participating in this procedure. The collection of accurate data by the Department of Public Health from abortion providers, and the analysis and presentation of that data to organizations such as ours, is central to the debate and monitoring of abortion services in Connecticut. Unfortunately, during our research for this report, the Conference noticed an extreme discrepancy between the number of abortions reported to DPH by Connecticut providers and the number reported by the same providers to the Alan Guttmacher Institute (AGI). As you may be aware, AGI is a nationally recognized research organization in the area of women's reproductive health. Its research techniques and close relationship with the abortion provider community lend strong credence to their numbers. A review of prior year information reveals that this discrepancy is not a one-time event and this specific data can be found on page four of our report. The most current year comparable, 2008, showed a discrepancy of 2,588 unreported abortions in Connecticut. The Conference is deeply concerned about the accuracy of abortion information being reported by all providers. If the assumption is made that the AGI numbers are more accurate, then in-state providers would consistently appear to be under reporting information that is

REPRESENTING

THE ARCHDIOCESE TELEPHONE (860.

OF HARTFORD. 52:4'7882

DIOCESE OF BRIDGEPORT, 525-0750 • EMAIL

DIOCESE

OF NORWICH

AND UKRAINIAN • WEBSITE

CATHOLIC

DIOCESE

OF STAMFORD

• FAX (860\

CCC@CTCATHOLIC.ORG

WWW.CTCATHOLlC.ORG

Dr. Jewel Mullen, MD, MPH, MPA Commissioner Connecticut Department of Public Health

Page 2

mandated by law to the DPH. Unreported abortions would reflect a clear disregard for state law by these providers. If abortion providers are failing to comply with reporting laws, then several other serious questions may be raised. Can providers who fail to meet mandatory reporting requirements be trusted to comply with other state requirements, such as mandatory counseling of minors prior to an abortion, or the reporting of cases concerning the sexual assault of minors? Are there just several abortion providers who are ignoring the law or is it more widespread? The Connecticut Catholic Public Affairs Conference is requesting that you exam this problem and take any and all action necessary to insure accurate reporting and compliance with state law by every abortion provider. Failure of the DPH to enforce their own reporting requirements may be viewed by a provider as lack of concern on the part of the DPH. This perception by the provider could lead to other abortion and health regulations being ignored. Although most medical providers make every effort to comply with the law, there are always those who will take advantage of a situation, thus placing their patients at risk or failing to protect minors by reporting abuse. Enforcement of a clear and simple reporting regulation is an easy and inexpensive way to send a strong message to abortion providers in our state that the DPH does care about how these providers carry out their practice. I look forward to your response concerning this issue and I want to thank you for your anticipated attention to this matter. Very trul Y yours,

1i;~~,~~~
Michael C. Culhane Executive Director

The State of Abortion in Connecticut

Fourth Annual Report

October 2011

Prepared by the

CONNECTICUT CATHOLIC PUBLIC AFFAIRS CONFERENCE

134 Farmington Avenue, Hartford, CT 06105 Phone: 860-524-7882 Email: ccc@ctcathoiic.org Fax: 860-525-0750

The State of Abortion in Connecticut, October 2011
SIGNIFICANT FINDINGS • The number of reported abortions continued to decline in the state for the third straight year. • Thousands of abortions appear to go unreported in Connecticut each year in violation of state law. OVERVIEW • The number of reported abortions continued to decline in the state during 2010
). Connecticut continued to experience a decline in the number of abortions for a third straight year in 20101• ,based on an analysis of information submitted by
abortion providers to the Connecticut Department of Public Health. Abortions performed in Connecticut declined by 2.1 % between 2009 and 2010 (Table 1).
Table 1 Abortions Performed In Connecticut 2001-2010 16.000 14.000 12.000
0

z
a:I

0 0
c:(

10,000 8,000 6,000 4,000 2,000 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 YEAR

i=

It:

I The statistical information presented in this report has been compiled by the Connecticut Catholic Public Affairs Conference using data obtained from various reports of the State of Connecticut Department of Public Health.

~ Teen abortions in Connecticut also continued to decline in 2010. In the last ten years, teen abortions in Connecticut have declined by 29%. The 827 young women under 18 years of age receiving an abortion in Connecticut represents a decline of 9.5% between 2009 and 2010 (Table 2). The number of abortions performed on minors under 16 years of age, and those 12 years old and younger also continued to decline.
Table 2 Abortions Performed In Connecticut On Minors Under 18 Years Of Age 2001-2010 1,400 1,200 1,000

~

i=
0:::
¢

0

800 600 400 200 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

m

0

YEAR

~ Of the 863 abortions performed on minors from out-of-state between 2002 and 2010, 91 % of the cases came from bordering states with parental consent laws (Table 3).

Table 3 Abortions Performed In Connecticut on Out-at-State of Age By State

Minors Under 18 Years

500 450 400 U) 350 Z 300 ~ 250 0::: 200 150 ~ 100 50

2002-2010

g

tt~~===-=a:-:~9

o
NY
RI MA Other

STATE
Note: Available data begins with 2002

(RI and MA have strict parental consent laws, therefore more teens appear to avoid the law by coming Into Connecticut for an abortion)

2

~

The abortion rate, which is the most significant measurement of abortion activity, also declined by 7.2% since 2008 (Table 4). The rate for 2010 was 19.4
abortions per 1,000 women of childbearing age. The abortion rates for women in their twenties and those between 15 - 19 years of age also decreased significantly (Table 5).

Table 4 Abortions Performed In Connecticut Abortions Per 1,000 Women of Childbearing Age (15 - 44 Years of Age) 2001-2010

20

15 ABORTION RATE 10

5

o
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 YEAR

-+-15-19

--20 - 29
...... 5 - 44 1

Table 5 Abortions Performed In Connecticut Rate Per 1,000 Women Age Groups 15 -19, 20 - 29 and 15 -

44

45 40

2001-2010

~~~~~~====~~~~~----~~==~==~~~~~.

35t=~~~~~~~~~--~~~~r~~~
ABORTION RATE PER 1,000 WOMEN BY AGE GROUP

30+-~~~~~~~~~~~~==~~ 25
~~~~~~~~~~==~~r.r~~~~~----~

20~~~~~~~~~~~~~~~ 15

+---------~~--4r--~~--~==~----~~~~~

10 ~~~~~~~~~

5~~~~~~~~~~~~~~~~~~~

o ~--~~~----~--~~~~--~--~----T_--_r--~
2001 2002 2003 2004 2005 2006
YEAR

2007

2008 2009

2010

3

• Thousands of abortions appear to go unreported in the state each year
On average, almost 19% of abortions in the state go unreported to the Connecticut Department of Public Health (DPH) by Connecticut abortion providers each year. The Connecticut Catholic Public Affairs Conference uncovered this grievous
reporting discrepancy during an examination of data reported to the DPH by abortion providers and data compiled directly from the providers by the Alan Guttmacher Institute (AGI) 2 from 2000 thru 2008 (Table 6). The Institute is supportive of abortion rights and providers, and was once part of the Planned Parenthood organization. AGI is recognized nationally as the most accurate and comprehensive research organization on abortion activity. Unreported abortions reflect a clear disregard of state law by providers. Connecticut state law mandates that every abortion, as soon as it is performed, be reported to the DPH (See addendum for state regulations and provider reporting form). This lack of compliance with mandatory reporting laws by state abortion providers means thousands of abortions go unreported in the state each year. Questions of compliance with other abortion regulations, especially those effecting minors, such as mandatory counseling for minors and mandated reporting of cases of sexual assault, cannot help but be raised. Can providers who fail to complete a one page report to the State be trusted to properly counsel minor girls receiving abortions as required by State law, or report instances of the sexual assault of minors as required by the mandatory reporting law? Hopefully, the abortion providers disregard of these reporting requirements does not reflect actions intended to cover-up questionable activities.
Table 6 Discrepancy In Abortion Reporting Connecticut DPH versus AGI Provider Survey 2000 - 2008

2008 2007 2005 2000
Discrepancy ODPH

0::

>

~

o

5,000

10,000

15,000

20,000

ABORTIONS Note: Years reported reflect years of AGI Survey

2

"Abortion Incidence and Access to Services in the United States, 2008", Perspectives on Sexual and Reproductive Health, Rachel Jones and Kathryn Koolstra, Alan Guttmacher Institute, March 2011.

4

This is not the first time abortion providers have been lax in providing information to the Department of Public Health. In 2008, the Connecticut Catholic Public Affairs Conference uncovered that a significant number of abortion providers were submitting incomplete documentation to DPH. Primarily, the age of the woman receiving the abortion or the gestation period of the child being aborted were not provided in 1,511 cases in 2008; every provider should know this information prior to performing an abortion to insure that proper medical care is given to the patient. DPH immediately sent out a clarification of the regulations requiring the reporting of the data. This year the number of cases where abortion providers failed to report the age of the patient or the weeks of gestation at the time of the abortion, as required by law, decreased by 68% between 2008 and 2010 (Table 7). However, this basic information was still not reported in 480 cases in 2010.
Table 7 Abortions Performed In Connecticut Without Legally Required Reporting of Age or Gestation Period By Provider

2001-2010 1,600 1,400 1,200
fI)

0
0::

z 1,000
800 600 400 200 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

i=
0

m c:(

YEAR

The lack of proper reporting not only obscures the DPH numbers, which are reported to the Center for Disease Control (CDC) each year, but it makes accurate reporting on other concerns related to abortion activity more difficult. Medical information that must be reported to the DPH, such as (1) the age of the woman receiving the abortion, (2) gestation period of the unborn child, (3) complications occurring during abortions, and (4) methods of abortion, are necessary to evaluate and insure compliance with various state laws and established medical practices. This information can be used to assist in determining compliance with Connecticut's late term abortion regulations, identifying providers with an increasing number of complications, and in determining the number of minors receiving abortions.

5

Recommendations:
Based on the findings of this report, the Connecticut Catholic Public Affairs Conference recommends that the following actions be taken by the Department of Public Health and the Connecticut General Assembly. ~ The Department of Public Health needs to enforce reporting requirements to insure all abortions are reported. This enforcement will help in determining compliance with various state regulations relating to abortion providers. It will also reflect the commitment that the State Department of Public Health has to enforcing abortion regulations. Lack of enforcement of these regulations may be misinterpreted by the abortion provider that the State of Connecticut is not seriously concerned in monitoring their activities. Such a lack of enforcement has lead to numerous horror stories concerning some abortion clinics around the nation, most recently in Pennsylvania.' • The Connecticut Department of Public Health should take significant steps during its inspection of abortion clinics and medical offices to insure all abortions are being accurately reported. The Department should immediately remind all medical providers of the state regulation requiring immediate reporting of an abortion. • The Connecticut Department of Public Health should continue in its efforts, which began in 2008, to insure that all providers report the age of the woman and the gestation period of the child at the time of the abortion. This basic information should be readily available prior to any provider performing an abortion. • The General Assembly should modify state law to allow fines or license suspensions/revocations to be used against abortion providers for failing to comply with the mandatory abortion reporting requirements. ~ The health and welfare of our teens should not be left to abortion providers who profit directly from the abortion and who have shown callous disregard for complying with state reporting requirements. The General Assembly should act to mandate parental involvement in a minor's abortion. Over the past nine years, 801 girls under the age of eighteen entered Connecticut to receive abortions. 91 % of these teens came from the bordering states of Massachusetts and Rhode Island, which have strict parental consent laws. This trend is a clear indication that, for various reasons, many teens come to Connecticut to have an abortion so they can avoid the parental consent laws in their home state. Avoidance of parental consent or notification laws, and traveling across state lines to do so, can occur for many reasons. However, the ability to do so makes it easier for young girls to be placed into a situation where they could be forced to have an abortion in order to cover up a sexual assault or under pressure from the birth father's family.

3

"Pennsylvania Abortion Doctor Charged With 8 Counts of Murder", www.huflingtonpost.comI2011/01/19/kermit--gosnell-chanredn810976.html.

January 19,2011.

6

Thirty-seven states currently have some form of parental consent or notification laws in effect. The Connecticut General Assembly needs to address this issue in order to protect not only young girls from Connecticut, but also from our bordering states. The Connecticut General Assembly should immediately consider the: • Enactment of an adult notification law in Connecticut to insure that the parents or another significant adult in a teenage girl's life is informed of her medical condition, thus insuring that her best interests are protected. The adult would also be more likely to report an incidence of sexual assault. • Enactment of a law to prevent out-of-state minors from receiving abortions in Connecticut, especially when their state of residence has a parental consent/notification law. If the resident state of a minor has a parental notification or consent law, that law should be respected in Connecticut.

Report produced by the Connecticut Catholic Public Affairs Conference Michael C. Culhane, Executive Director Deacon David Reynolds, Legislative Liaison

7

ADDENDUM

8

Connecticut Department of Public Health Regulations

19-13-054. Abortions
(a) No abortion shall be performed at any stage of pregnancy except by a person licensed to practice medicine and surgery in the state of Connecticut. (b) All induced abortions will be reported within seven days by the physician performing the procedure to the state commissioner of public health who will maintain such reports in a confidential file and use them only for statistical purposes except in cases involving licensure. Such reports will specify date of abortion, place where performed, age of woman and town and state of residence, approximate duration of pregnancy, method of abortion, and explanation of any complications. The name of the woman will not be given. These records will be destroyed within two years after date of receipt. In addition, a fetal death certificate shall be filed for each fetus born dead which is the result of gestation of not less than twenty weeks, or a live birth certificate shall be filed for each fetus born alive regardless of gestational age, as provided in sections 7-48 and 7-60 of the Connecticut General Statutes. If a live born fetus subsequently dies, a death certificate shall be filed as provided in section 7-62b of the Connecticut General Statutes. (c) All induced abortions after the second trimester as verified by ultrasound, last menstrual period and pelvic exam, shall be done only in a licensed hospital with a department of obstetrics and gynecology and a department of anesthesiology. (d) All outpatient clinics operated by corporations or municipalities where abortions are performed shall develop standards to control the quality of medical care provided to women having abortions. These standards shall include but not necessarily be limited to: (1) verification of pregnancy and determination of duration of pregnancy; (2) pre-operative instruction and counseling; (3) operative permission and informed consent; (4) pre-operative history and physical examination; (5) pre-operative laboratory procedure for blood Rh factor; (6) prevention of Rh sensitization; (7) examination of the tissue by a pathologist; (8) receiving and recovery room facilities; (9) a standard operating room; (10) post-operative counseling including family planning; and (11) a permanent record. (e) There shall be a mechanism for continuing review to evaluate the quality of records and the quality of clinical work. This review shall include all deaths, complications, infections and such other cases as shall be determined by the chief of the department of obstetrics and gynecology of the hospital or the clinic medical director. (f) No person shall be required to participate in any phase of an abortion that violates his or her judgment, philosophical, moral or religious beliefs. (g) If the newborn shows signs of life following an abortion, those measures used to support life in a premature infant shall be employed.\ (h) During the third trimester of pregnancy, abortions may be performed only when necessary to preserve the life or health of the expectant mother. (Effective February 25, 1974; Amended effective December 30, 1996; August 1,2005.)

Within 7 days to the Commissioner of the Department of Public Health by the physician who performed the procedure. MAIL TO: Department of Public Health, 410 Capitol Avenue, MS#l1PSI, P.O. Box 340308, Hartford, CT 06134

TheconndcutpnbliCH:::~:U:~~~~~~~~~~:~::o ~e
1. Name of Place Where Performed:
3. Type of Place Where Performed: a. Free standing clinic MDoffice

0

2.

Address of Place Where Performed:

b. c.

D

Zip Code:

d. e.

0 Hospital out-patient 0 Other place D
Hospital in-patient '
I

4. Patient's State of Residence:

5.Patient's City/Town of Residence: !

6, Patient's Age:

7. Education: (Highest grade completed) Elementary/Secondary ( 0-12) College (1-4 or 5+)

8.

Race:

9.• Of Hispanic origin? b. Black

a. White

D

e. Chinese
1. Other

D
0

D

c. American Indian g. Japanese

f. Filipino

0

0
_

0

d. Asian Indian

h. Korean

0

0

a. Yes

0
0

b. No

0

c. Unknown

0

a1. Mexican a2. Cuban a4. Other

i. Vietnamese

D (specify)

j. Other Asian

D k. Other

Pacific Islander

0

0
0 (specify) 0
_

a3. Puerto Rican

10. Patient's Marital Status:ta. b. Married

D

c.

Not Married D Unknown 0

~=-=_=_==-==---I-l.-Pr-eV1-·-ous__rP-r-e=.gn-an-c-ie-s-: =-==:::::--==-=~=~::--------t LIVE BIRTHS OTHER TERMINATIONS 11a. Now Living: l lb, Now Deceased: l lc. Spontaneous: l l d. Induced: (Do not include this termination) Number Number Number,____ Number.---None D None D None D None D 13. Date of induced abortion: __ month day__year __ 14. Clinical estimate of gestation: ---weeks

12. Date last menses began: month Unknown day____year

0
15. TYPE OF PROCEDURE

15a Procedure that. terminated pregnancy

i

!,15b. Additional procedures used for this termination, if any

Dilation and Evacuation (D&E)

o

o

1~ Medical Complications:

a. No

0

b. Yes

D

(Specify)

MeR 155 REV 812007

INSTRUCfIONS

FOR REPORTING THE INDUCED TERMINATION (ABORTION) PERFORMED IN CONNECfICUT

OF PREGNANCY

1. PLACE WHERE pregnancy occurred.

PERFORMED:

Enter the full name of the place where the induced termination of

2. ADDRESS OF PLACE WHERE PERFORMED: Enter the complete address of the place where the induced termination of pregnancy occurred, including zip code. 3. TYPE OF PLACE WHERE PERFO~D: Cleek the box that best describes the type of place where the induced termination- of pregnancy occurred, Note the distinction between Pree standing ainU: and Hcspita1 0ItPatient. A F'Ja! Starrling C1inii: is a clinic that is physically and adminiStratively separate from a hospital. The Ha;pital 0uipJtient category-refers to a facility or clinic that is either physically situated within a hospital, or is administratively a part of a hospital 4. PATmNT'S 5. PATmNT'S STATE OF RESIDENGE: OTY/TOWN Enter the full name of the patient's state of residence. Enter the full name of the patient's city/town of residence

OF RESIDENCE:

6. P.A1':IENT'S AGE: Enter the patient's age in years at her

last birthday:

7. EDUCATION: Enter the highest number of years of regular schooling completed by the patient "in either the spate for elemenrary/secondaryschool orthe space for college. An entry should be made in only one of the spaces. The other space should be left blank. Report only those years of school that were completed. A person wlio enrolls in college but does not complete one full year should not be identified wi#l any college education in this item. Count formal schooling. Do not include beauty; barber, trade, business, technical, or other special schools when determining the highest grade completed.
0

8. RACE: Check the box that describes the race of the patient. The entry in this item. should reflect the response of the patient. Specify a race if checking the "Other" box. If the patient is of mixed race, check "Other" and enter both races or origins. 9. OF mSl? ANIC ORIGIN? Check the box that describes whether the patient states she is of Hispanic Origin. If "Yes" is-ch.eckedrchoose-the..speci£ic_gro~btain~pa~~~is-th@aked,spe~-g._thepatient indicates that she is of multiple Hispanic origin, enter the origins as reported.
0

10• MARlT AL STATUS: Cleek the box that describes the patient's marital status.
0

l1a-b. LIVE BIRTHS l1a. Now Living: Enter the number of children bom alive to this opatient who are still living at the time of this termination, Do not include children by adoption. Check "None" if all previous children are deceased.
0

lib. Now Deceased: Enter the number of children bom alive to this patient who are no longer living at the time of this termination, Do not include children by adoption. Check "None" if all previous children are still living.
ttc-d, OTlIER TERMINA,TIONS l1e. Spontaneous: Enter the number of previous pregnancies that ended spontaneously and did not result in a live born infant. This should ~ot include induced terminations. Check "None" if the patient has had no previous pregnancies or if all previous pregnancies ended in live bom infants.
o~
0

. l1d. Induced: Enter the number of previous induced terminations (induced abortions) that this patient has had. Do not include this termination. Check "None" if the patient has had no previous induced terminations. .

BEGAN: Enter the exact date, (month, day and year) of the first day of the patient's lastnormal menstrual period. Enter the full name of the month-January;.February, March, etc. Do not use a number or abbreviation to designate the month. Enter unknown if the date cannot be determined. 12. DATE 13. DATE OF INDUCED ABOR'PON: Enter the date the pregnancy acruallyterminated, 'This may not necessarily be the date the procedure. was begun. Ezceptionr for termination procedures performed by medical " (non-sUrgical) methods, the date of the termination should be recorded as the actual date "the .i:nitia1 dosage of the ' medication was given-not the actual date of termination of pregnancy. Enter the full name of the month-January; February; March, etc. Do not use a number or abbreviation to designate the month, . 14: CLINICAL ESTI¥NfE OF GESTATION: estimated by-the attending physician. Enter the length

LAST MENSES

-ms

of gestation in completed

menstrual

weeks, as

15a-h. TYPE" OF PROCEDURE " 15a. Procedure That Terminated the Pregnancy: Check the box that describes the pr.i.maty procedu:re thar actually terminated this pregnancy. Check only one box. If more than one procedure Was used, identify the additional procedure(s) in item 16b. If a procedure not listed was used, check "Other" and specify the procedure on the line provided, lSb. Additional Procedures Used for This Termination, If Any: Cb.eck the box(es) that describes the additional procedurefs) used. If no addi:tional procedures were used, leave all boxes blank. If a procedure not listed was used, check "Other" and specify on the line provided." " 16. MEDICAL. COMPLICATIONS:" Check the box that indicates whether the patient has experienced medical complications. If "Yes" is checked, specify the type of compli,catinri rhat has occurred,

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