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The Effect of Legalization of Abortion on Population Growth and Public Health

Author(s): Christopher Tietze

Source: Family Planning Perspectives, Vol. 7, No. 3 (May - Jun., 1975), pp. 123-127
Published by: Guttmacher Institute
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Family Planning Perspectives

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The Effect of Legalization of Abortion on
Population Growth and Public Health

By Christopher Tietze

In what ways has increased access to legal

induced abortion changed behavior; and
Legal abortion is responsible for 'one-fifth of the imputed de-
what has been the impact, if any, of such
cline of about one million births, from the 4.1 million expected
changes on population growth and public
in FY 1974 .... The number of deaths attributed to or associated
health? We will attempt in this article to
evaluate these phenomena, focusing on with abortion has declined dramatically in the United States ...
developed societies such as the United coinciding with the liberalization of abortion laws and prac-
States. It is not only possible but appro- tices.'
priate to implement intentions as to the
number and spacing of children in such tion, issues of privacy and dignity, and abortion has generated some concern. In
societies, where contraception and legal public awareness of the availability of the author's view, the contention that this
or illegal abortion have long been used to legal abortion services. has happened on a grand scale is not sup-
prevent some unplanned pregnancies and One would also expect a decline in the ported by available evidence. In any
births. number of births, because at least some event, the substitution of abortion for
In all societies, legalization of abortion women who would have been deterred contraception (or an increase in sexual
produces changes in the numbers of preg- from seeking illegal abortions would wantactivity), if such were the case, would in-
nancies that occur, and in the proportion to terminate their pregnancies by abor- crease the numbers of abortions and,
terminated by legal and illegal abortion tion if it is legal. This decline in births de- thus, of pregnancies, but it would not af-
and by live births. pends on the number of unintended preg- fect the number of births.
Other things being equal, one would nancies that occurred before legalization The preceding discussion has been con-
expect a decline in the number of illegal and the degree to which abortion remains cerned with expectations in the never-
abortions, because at least some women unacceptable to some women even after it never world of other things being equal.
who would have sought illegal abortions has been legalized. In the real world the 'other things' are
may obtain them legally. This substitu- To the extent that unintended births never equal, and the only firm data are
tion would not necessarily be immediate are replaced by legal abortions, the total the numbers of legal abortions and of live
nor would it entirely eliminate illegal number of legal and illegal induced abor- births. The numbers of illegal abortions
abortions, as evidenced by information tions increases subsequent to legalization. and, therefore, of total induced abortions
from such countries as Hungary, where However, because of the decline in illegal and total pregnancies were unknown be-
some illegal abortions still occur even abortions, the increment in the total num- fore the legalization of abortion, and re-
though legal abortion on request has been ber of induced abortions must be smaller, main unknown after the fact. However, it
available and widely employed since the absolutely and relatively, than the incre- is possible to estimate the numbers of il-
mid-1950s. The extent to which illegal ment in the number of legal abortions. legal abortions and unwanted births re-
terminations of pregnancy are replaced Because a higher incidence of abortion placed by legal abortions for New York
by legal ones is related to the nature of the enables more women to return to the fe- City, where the nation's most liberal
new law and to its implementation by the cundable state sooner than if they had abortion law came into force on July 1,
health services, involving social and fi- chosen to carry their pregnancies to term, 1970, and where that law was immedi-
nancial costs to the woman seeking abor- more than one abortion is required to re- ately and widely implemented in both the
place one birth. Thus, the total number of public and private sectors. '
Christopher Tietze is Senior Consultant with The
pregnancies tends to increase, even if no According to the author's estimate,
Population Council and directs the abortion re-
changes occur in the proportion of fecund about 70 percent of the legal abortions
search activities of that organization. This article
is a modified version of a paper presented at a women who are sexually active; in coital (50,000 per year) obtained by New York
conference on "Abortion: Public Policy and Mo- frequency; in contraceptive practice; City residents during the first two years
rality," held at the University of Notre Dame, and/or in contraceptive effectiveness. under the new law replaced illegal pro-
March 20-21, 1975. The author wishes to thank
The question of whether or not the cedures. This estimate implies that the
the organizers of the conference for their gracious
permission to publish the paper in Family Plan- legalization of abortion is likely to result total number of induced abortions, legal
ning Perspectives. in a replacement of contraception by plus illegal, increased about 40 percent

Volume 7, Number 3, May/June 1975 123

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The Effect of Abortion Legalization

from FY 1970 (the 12-month period end- abortions from 1969 to 1973. If 70 percent 100,000 live births was reported for
ing June 30) to FY 1972, allowing for a of the new legal abortions replaced about 1973.3 According to data collected by the
small number of legal abortions in the 500,000 illegal abortions, the remaining Center for Disease Control (CDC) for
earlier year, and a small residual of illegal 30 percent, or 250,000, could have re- 1973, there were 45 deaths associated
abortions in the later year. placed about 200,000 live births. The last with legal abortions during the two-year
The number of live births in New York figure is one-fifth of the imputed decline period 1972-1973.4 If we use as a denomi-
City declined by 25 percent from 1970 to of about one million births, from the 4.1 nator the 586,800 legal abortions reported
1972, taking into account changes in the million expected in FY 1974 on the basis by the CDC for 1972 plus the 745,400
age distribution of the female population. of the age-specific fertility rates in FY identified in the AGI survey for 1973,5 for
According to this estimate, the increased 1970, to the reported total of about 3.1 a total of 1,332,200, the death-to-case
number of legal abortions was responsible million births. The smaller contribution ratio was 3.4 per 100,000 legal abortions.
for about one-half of this decline in births;of legal abortion to the national decline in In the remainder of this article we will
other changes in reproductive behavior the number of births, compared with its employ a conservative (higher) estimate of
accounted for the remainder. There can contribution (50 percent) to the decline in five deaths per 100,000 legal abortions.
be little doubt that the most important ofNew York City over two years, reflects the Figures on mortality associated with il-
these changes was more general and/or lower abortion rates and ratios that pre- legal abortion are the least reliable ele-
more effective practice of fertility regula-vail in the rest of the nation, where many ment of the available information on
tion, which may reflect changing prefer- states continue in 1975 to enforce restric- deaths from abortion. It is generally rec-
ences regarding family size and birth tive abortion laws, two years after the ognized that mortality is much higher fol-
spacing or the greater availability of Supreme Court abortion decisions. lowing abortions that are self-induced, or
highly effective contraceptive methods, induced by other untrained persons, than
including a growing acceptance of surgi- following those performed in hospitals
Public Health Effects
cal sterilization. and clinics. However, as in all medical
Because about 45 percent of all legal Whereas the demographic impact of the procedures, mortality associated with il-
abortions of city residents during the two-legalization of abortion reflects primarily legal abortion reflects not only the skill of
year period 1970-1972 were obtained by the replacement of unwanted births by the person performing or initiating the
women who had never given birth, and induced abortions, the public health ef- abortion, but also the availability and uti-
almost 20 percent by women with only lization of medical and hospital services,
fect relates primarily to the substitution of
one prior birth, it can be assumed that legal abortions for illegal abortions. and the quality of care available when
about one-half of the aborted pregnancies Although abortion and its complica- complications occur. For developed coun-
would be made up at some future time. tions no longer constitute a major cause tries,
of where the majority of illegal abor-
Hence, the long-term effect of legalizationdeath in the United States and other de- tions are performed by medical practi-
would be reflected by about one-fourth ofveloped countries, the impact of legaliza- tioners and adequate facilities are avail-
the decline in the number of births from tion can be assessed most conveniently in able for the treatment of complications, a
FY 1971 to FY 1972, or in terms of total terms of mortality. The fact of death, at very low estimate of mortality associated
fertility rates by about 0.15 births in a de-least, is unequivocal, although its associa- with these procedures might be 40 per
cline from 2.4 births per woman in 1970 tion with abortion, legal or illegal, and its 100,000, roughly corresponding to mater-
to 1.8 two years later. appropriate documentation may be sub- nal mortality, excluding abortion-related
The experience for New York City can ject to interpretation. Definitions of mor- deaths, in the United States 20 years ago.
be extrapolated to the United States. bidity, including nonfatal complications, Since the risk to life associated with
While the number of legal abortions in are always to some degree arbitrary; they pregnancy and childbirth (14 per 100,000
the United States in 1969 is not known, reflect what is expected in the 'normal live births) is about three times higher
50,000 would seem to be a reasonable course of events'. For example, a blood than that assumed to be associated with
estimate, * and a high level of precision isloss of 300 or even 500 ml is frequently legal abortion (five per 100,000 abor-
not required for the argument. In 1973, seen during and after an uncomplicated tions), and the assumed risk with illegal
about 745,400 legal abortions were per- full-term delivery. The same amount of abortion (40 per 100,000) is eight times
formed, according to a nationwide survey bleeding occurs infrequently with an as- higher than that associated with legal
of hospitals, clinics and physicians spon- piration procedure at eight or 10 weeks' abortions, it follows that:
sored by The Alan Guttmacher Institute gestation, and is generally considered a * the substitution of legal abortions for
(AGI).2 Allowing for an undercount of 'major' hemorrhage by physicians. either live births or illegal abortions
five to 10 percent, a total of 800,000 is Three parameters of mortality must be would tend to reduce the total number of
probably a reasonable estimate, corre- considered in connection with the legal- deaths, and
sponding to an increment of 750,000 legal ization of abortion: maternal mortality, * a very large increment in the total
excluding deaths from abortion; mortalitynumber of abortions would be required to
* Only 22,670 abortions are recorded for that year
associated with legal abortion; and mor- offset this effect.
in the abortion surveillance summary published
by DHEW's Center for Disease Control (CDC). tality associated with illegal abortion. Table 1 presents a hypothetical model
However, only eight of the nine states that had In developed societies, levels of mater- of the reproductive intentions and behav-
abortion reform laws, and none of the states withnal mortality from complications of, or ior of a population of 24 million women
more restrictive laws, reported abortion data to associated with, pregnancy and child- 15-44 years of age (a total chosen to avoid
the CDC for that year; so an adjustment must be
birth, excluding induced abortion, have fractional numbers of deaths), living in a
made in these figures to account for the therapeu-
dropped sharply in recent decades. In the
tic abortions performed in the other 42 states and
developed country where a restrictive
the District of Columbia (see reference 4). United States, a rate of 14 deaths per abortion law is not vigorously enforced,

124 Family Planning Perspectives

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City in FY 1973. Deaths associated with
Table 1. Model of reproductive intention and behavior: restrictive abortion law
abortion and childbirth have declined by
Reproductive intention Women Total Live Illegal
one-half from 540 to 264.
and behavior aged preg- births abortions
15-44 nancies*
In Table 3 (p. 126) it is assumed that
Total (OOOs) 24,000 2,520 1,800 720 one-sixth of all contraceptors (3.6 million
among 21.6 million, col. 1) have aban-
I. Pregnancies intended-
doned contraception in favor of legal
contraception not used (OOs) 2,400 1,200 1,200 na
abortion. In the absence of contraception
II. (Pregnancies not intended- (and assuming a moderate amount of
contraception used-000s)t (21,600)t (1,320)t (600)t (720)t
breast feeding), 2.5 abortions are required
1. Pregnancies carried to term (OOs) 10,800 600 600 na
to replace one live birth;7 hence 4.5
2. Pregnancies term. by abortion (OOs) 10,800 720 na 720
million legal abortions are added for a
Rate per 1,000 women aged 15-44 na 105 75 30 total of 5.4 million (col. 4). All other vari-
Ratio per 1,000 live births na na na 400 ables remain unchanged, including con-
Death per 100,000 pregnancies na na 14 40 traceptive effectiveness among the 18 mil-
Number of deaths (units) na 540 252 288 lion women continuing to use contracep-
* Excluding those ending in spontaneous fetal deaths. tion. Compared with Table 1, total preg-
t Subtotals in parentheses not included in totals. nancies (col. 2) have almost tripled and
Note: na = not applicable. abortions (col. 4) have increased 7.5
times, but the estimated number of deaths
thus making illegal abortion available would have brought their unintended from abortion and childbirth is still lower:
under relatively favorable conditions. The 473
pregnancies to term rather than risk il-compared with 540 (although the
small family pattern is well established legal abortions obtain legal terminations. number of deaths is substantially higher
and, at any given time, only 10 percent Compared with the data in Table 1, total than in the model that hypothesizes a con-
(2.4 million) of the women are noncon- pregnancies (col. 2) have marginally in- tinued high level of contraceptive use).
traceptors (col. 1), producing 1.2 million creased, live births are reduced by one-
intended live births per year (col. 2). The sixth (from 1.8 million to 1.5 million, col. Decline Not Hypothetical
remaining 21.6 million women use con- 3), and abortions have increased by one-
traception at a level of effectiveness of ap- half (from 720,000 illegal to 1.08 million A decline in the number of deaths due to
proximately 95 percent. One-half of the legal procedures, col. 4). Two-thirds of complications of abortion following legal-
contraceptors carry their unintended the legal abortions (720,000) replace an ization not only is a hypothetical con-
pregnancies to term; the other half termi- equal number of illegal abortions; one- struct but also has occurred in the real
nate them by illegal abortions. The num- third (360,000) replace a somewhat world. Table 4 (p. 127) summarizes the
ber of abortions (720,000, col. 4) required smaller number of live births (300,000) at relevant statistics for the United States
by the latter group exceeds by one-fifth a ratio of 1.2 abortions per live birth. The during the period 1958-1973. The top
the number of live births (600,000, col. 3) abortion ratio (bottom panel, col. 4) has panel shows the numbers of deaths attrib-
to the women who bring their unintended risen to 720 per 1,000 live births, about uted to the several categories of abortion,
pregnancies to term (1.2 abortions replac- the same ratio as obtained in New York as published by the National Center for
ing one live birth6). The general fertility
rate is 75 live births per 1,000 women
Table 2. Model of reproductive intention and behavior: abortion legalized, contraception
aged 15-44; the abortion ratio is 400 abor-
tions per 1,000 live births (bottom panel,
cols. 3 and 4). This rate and ratio com- Reproductive intention Women Total Live Legal
and behavior aged preg- births abortions
pare with a general fertility rate of 86 and
15-44 nancies*
an estimated (illegal) abortion ratio of 340
Total (000s) 24,000 2,580 1,500 1,080
in New York City in 1969. Application of
a mortality rate of 14 per 100,000 (col. 3) I. Pregnancies intended-
contraception not used (OOs) 2,400 1,200 1,200 na
to the 1.8 million live births, and of 40 per
100,000 (col. 4) to the 720,000 illegal II. (Pregnancies not intended-
abortions of the model population gener- contraception used-000s)t (21,600)t (1,380)t (300)t (1,080)t

ates a total of 540 deaths (col. 2) associ- 1. Pregnancies carried to term (0OOs) 5,400 300 300 na
ated with pregnancy and childbirth, 252 2. (Pregnancies term. by abortion-O??s)t (16,200)t (1,080)t na (1,080)t
of which are associated with delivery and a) Replacing illegal abortions (0OOs) 10,800 720 na 720
288 with illegal abortion. b) Replacing live births (OOs) 5,400 360 na 360
Table 2 presents the same population
Rate per 1,000 women aged 15-44 na 107.5 62.5 45.0
except that abortion has been legalized
Ratio per 1,000 live births na na na 720
and made readily available to all women
Deaths per 100,000 pregnancies na na 14 5
who want to avail themselves of this ser-
Number of deaths (units) na 264 210 54
vice. Reproductive intentions, number of
* Excluding those ending in spontaneous fetal death.
wanted pregnancies and contraceptive
t Subtotals in parentheses not included in totals.
practice remain unchanged. However, in
Note: na = not applicable.
this model, one-half of the women who

Volume 7, Number 3, May/June 1975 125

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The Effect of Abortion Legalization

increasing experience of physicians as well

Table 3. Model of reproductive Intention and behavior: abortion legalized, contraception
partially abandoned as the slowly declining proportion of
abortions performed during the second
Reproductive intention Women Total Live Legal
trimester of pregnancy.
and behavior aged preg- births abortions
15-44 nancies* Notwithstanding the inconsistencies of
Total (000s) 24,000 6,850 1,450 5,400 statistical practice, there can be no doubt
that the number of deaths attributed to or
I. Pregnancies intended-
associated with abortion has declined dra-
contraception not used (OOs) 2,400 1,200 1,200 na
matically in the United States, and that
II. (Pregnancies not intended-O??s)t (21,600)t (5,650)t (250)t (5,400)t the decline has been even steeper in the
A. Contraception not used (OOs) 3,600 4,500 0 4,500 category of "other-than-legal" abortions.
B. (Contraception used-OOOs)t (18,000)t (1,150)t (250)t (900)t Accepting for this group 287 deaths an-
1. Pregnancies carried to term (OOs) 4,500 250 250 0 nually in 1958-1962, 142 deaths in 1969,
2. (Pregnancies term. by abortion-OOOs)t (13,500)t (900)t (?)t (900)t and 27 deaths in 1973, one obtains annual
a) Replacing illegal abortions (OOs) 9,000 600 0 600 rates of decline of eight percent for the
b) Replacing live births (OOs) 4,500 300 0 300 earlier period and 34 percent for the later
period, coinciding with the liberalization
Rate per 1,000 women aged 15-44 na 285.4 60.4 225
of abortion laws and practices (see Figure
Ratio per 1,000 live births na na na 3,724
Deaths per 100,000 pregnancies na na 14 5
Prior to accepting the decline in abor-
Number of deaths (units) na 473 203 270
* Excluding those ending in spontaneous fetal death. tion mortality as a numerical indicator of
declining numbers of illegal abortions, we
t Subtotals in parentheses not included in totals.
need to consider three additional factors:
Note: na = not applicable.
* Not all abortion-related deaths are cor-
rectly identified on the death certificate.
Health Statistics (NCHS), based on the shown in the bottom panel of Table 4, this While the extent of such misreporting is
registration of deaths by cause. 8 procedure generates 27 deaths after legal not known, there is reason to believe that
In the second panel, deaths attributedabortion in 1970 and 42 in 1971. Based on the quality of registration of deaths by
to abortion not specified as induced or 193,500 legal abortions in the former year cause has improved since the early 1960s,
spontaneous have been distribued pro and 485,800 in the latter,"I a plausible and that this improvement has extended
rata among the other categories. The sequence of death-to-case ratios emerges: to more complete reporting of abortion-
third panel of Table 4 shows for 1972 and14.0 per 100,000 in 1970 and 8.6 per related deaths, owing to the intense
1973 the numbers of abortion-associated100,000 in 1971; the continuing decline public to debate about abortion.
deaths identified by the CDC; these are 3.4 in 1972-1973 nresumablv reflects the
* A decline in abortion-related mortality
larger than those attributed to abortion
by the NCHS.9 The numbers of deaths
Figure 1. Deaths associated with abortion, United States, 1958-1973, by legal status of
shown for 1958-1967 in the top panel of abortion
Table 4 are not comparable to those given
No. of deaths
for later years, because the Seventh Revi-
300 4
sion of the International Classification of
Diseases (ICD) allocated all deaths associ- 280 28
ated with "therapeutic" abortion to the 260
procedure rather than to the disease lead- 240
ing to the termination of the pregnancy.
220 4 1963-1967_1968_1969_1970_1971_1972 _1973
The Eighth Revision of the ICD, used
since 1968, reverses the order of priority
by stipulating that the category "induced180
for medical indications" is "not to be 160
used if the complication of pregnancy or
other condition requiring induction is 1403
known."10 However, such cases would be 120
reported as abortion-associated by the 100 18 4
Comparability over time can be ap-
proximated, however, by increasing the 60 80 21

numbers of deaths after abortion of all 40 24

types in 1968-1971 (second panel, Table 20
4) by the appropriate ratio of the number
of deaths associated with each type of
abortion in 1972-1973 (third panel) to the 1958-1962 1963-1967 1968 1969 1970 1971 1972 1973
number of similarly attributed deaths Deaths from other-than-legal abortions FILegal abortion deaths
during the same years (second panel). As

126 Family Planning Perspectives

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than the proportional decline in the num-
Table 4. Deaths attributed to and associated with abortion, by type of abortion: United
ber of illegal abortions. The absolute
States, 1958-1973
numbers of illegal abortions at the begin-
Year or Deaths, by type of abortion
period Total Legal Other than legal
ning and end of the period under consid-
average Total Illegal Sponta- Undeter- eration remain unknown.
neous mined
Although more general and more effec-
Deaths attributed to abortion (NCHS)
tive use of contraceptives, notably the pill
1958-1962 292 5 287 112 175 and the IUD, and increasing acceptance
1963-1967 222 4 218 91 127 of surgical sterilization certainly con-
1968 133 2 131 55 22 54 tributed to the decline in illegal abortions,
1969 132 1 131 59 16 56 it is difficult not to link the acceleration of
1970 128 10 118 58 9 51 the downward trend to the legalization of
1971 99 15 84 32 9 43

1972 70 10 60 26 12 22
1973 36 8 28 11 3 14

"Undetermined" distributed pro rata 1. C. Tietze, "Two Years' Experience with a lib-

1968 133 3 130 93 37 na eral Abortion Law: Its Impact on Fertility Trends
in New York City," Family Planning Perspectives,
1969 132 2 130 102 28 na
5:36, 1973.
1970 128 17 111 96 15 na
2. E. Weinstock, C. Tietze, F. S. Jaffe and J. G.
1971 99 26 73 57 16 na
Dryfoos, "Legal Abortions in the United States
1972 70 15 55 38 17 na Since the 1973 Supreme Court Decisions," Family
1973 36 13 23 18 5 na Planning Perspectives, 7:23, 1975.

Deaths associated with abortion (CDC) 3. National Center for Health Statistics, DHEW
1972 83 21 62 38 22 2 (NCHS), "Summary Report: Final Mortality Sta-
1973 51 24 27 17 8 2 tistics, 1973," Monthly Vital Statistics Report,
Vol. 23, No. 11, Supplement (2), 1975, Table 11.
Attributed deaths after legal abortion
adjusted to associated deaths 4. Center for Disease Control, DHEW (CDC),
1968 150 5 145 95 50 na Abortion Surveillance, Annual Summary, 1973,
Atlanta, 1975, Table 1 (in press).
1969 145 3 142 104 38 na
1970 145 27 118 98 20 na 5. E. Weinstock et al., 1975, op. cit.

1971 122 42 80 58 22 na 6. R. Potter, "Additional Births Averted When

Note: na = not applicable. Abortion Is Added to Contraception," Studies in
Family Planning, Vol. 3, No. 4, 1972, p. 53.

could reflect improved treatment facilities entirely possible that the death-to-case 7. Ibid.
and practices. Two of the major fatal ratio following illegal abortion is now 8. For 1958-1969: NCHS, Vital Statistics of the
complications of induced abortion are in- higher, not lower, than it was 10 or 15 United States, Vol. II, Mortality, U.S. Govern-
fection and hemorrhage, which are also years ago. ment Printing Office, Washington, D.C., various
years; for 1970-1973: NCHS, "Summary Report:
important causes of maternal mortality * Some of the deaths attributed to other-
Final Mortality Statistics," Vol. 22, No. 11, Sup-
that is not abortion-related.'2 Deaths at- than-legal abortions (although not neces- plement, 1974, Table 7; Vol. 23, No. 3, Supple-
tributed to puerperal sepsis and hemor- sarily the numbers shown in Table 4) ment, 1974, Table 7; Vol. 23, No. 8, Supplement
rhage totaled 433 in 1960, corresponding probably resulted from complications of 2, 1974, Table 7; and Vol. 23, No. 11, Supple-
ment (2), 1975, Table 11.
to a rate of 10.2 per 100,000 live births. genuinely spontaneous abortions. The
By 1973, the number of deaths from these ratio of spontaneous abortions to births is 9. CDC, 1975, op. cit.

two causes had dropped to 158, and the not likely to have changed substantially 10. World Health Organization, International
rate had declined to 5.0 per 100,000 live from 1960 to 1973, and the number of Classification of Diseases, 1965 Revision, Geneva,
1967, Vol. 1, p. 431.
births. Adjustment for changes in the age- births was only one-fourth smaller in the
distribution of births raises the 1973 rate later than in the earlier year. Hence, the 11. CDC, 1975, op. cit.

to 6.2 per 100,000. decline in the number of deaths from il- 12. G. S. Berger, C. Tietze, J. Pakter and S. H.
It would be inappropriate, however, to legal abortions must have been greater Katz, "Maternal Mortality Associated with Legal
extrapolate to abortion-related mortality than the decline shown for all other-than- Abortion in New York State: July 1, 1970-June 30,
1972," Obstetrics and Gynecology, 43:315, 1974.
this 40 percent reduction in mortality legal abortions.
from infection and hemorrhage that is not In view of these considerations, we con-
abortion-related. In the 1960s, a substan- clude that the number of illegal abortions
tial proportion of illegal abortions in the in the United States has declined from the
United States were performed by physi- early 1960s to 1973 at least as rapidly as,
cians, including some highly experienced and probably more rapidly than, the re-
practitioners. This is no longer true. ported number of deaths attributed to
Women who had recourse to illegal abor- other-than-legal abortions. Since the
tions in 1973 were probably the poorest number of women of childbearing age has Cover design, charts (pp. 99-102, 113, 126) and
illustrations (pp. 104, 105, 109) by Rudolph de
and least educated, and were most likely increased 25 percent over the same
Harak; p. 112: B. P. Wolff, Photo Researchers; p.
to obtain the services of unqualified prac- period, the decline in the illegal abortion 114: K. Heyman; p. 117: R. Burri, Magnum; p.
titioners or to attempt self-abortion. It is rate must have been substantially greater 133: L. Freed, Magnum.

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