Data on 'partial-birth' abortion in the United States

compiled by Wm. Robert Johnston
last updated 19 April 2007

Terminology and legal status:

'Partial-birth' abortion (PBA) may be understood as the non-technical term for a particular subset of abortion procedures. An illustrative definition is that contained in the U.S. Partial-Birth Abortion Act of 2003:

...the term 'partial-birth abortion' means an abortion in which the person performing the abortion--
(A) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and
(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus...[1]

PBA roughly corresponds to the procedure referred to in the medical community as intact dilation and extraction, a subset of dilation and extraction procedures. Neither of these medical terms has a one-to-one correspondence to procedures encompassed by the typical definition of PBA. While some issue has been made of this lack of correspondence, it is misleading to claim that one term or the other is useless as a consequence; there are a subset of abortion procedures which may be distinguished from most others on the basis of one term or the other.

The federal Partial-Birth Abortion Act of 2003 (H.R. 760, S. 3, Public Law 108-105) was signed into law 5 November 2003, but was delayed going into effect by district court rulings. In February 2006 the U.S. Supreme Court agreed to hear reviews of these rulings, and on 18 April 2007 the Supreme Court upheld the Partial-Birth Abortion Act.[27]

Over half of U.S. states have passed bans on partial-birth abortion. As of April 2007, 5 states ban PBA after viabililty (Georgia, Kansas, Montana, New Mexico, and Utah, with Utah's ban enjoined by court intervention); 8 states have general bans on PBA in effect (Indiana, Mississippi, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, and Tennessee) and 18 have such bans currently enjoined by court intervention (Alabama, Alaska, Arizona, Arkansas, Florida, Idaho, Illinois, Iowa, Kentucky, Louisiana, Michigan, Missouri, Nebraska, New Jersey, Rhode Island, Virginia, West Virginia, and Wisconsin). Of those states with general bans in effect, some may be unenforceable in view of the 2000 U.S. Supreme Court ruling in Stenberg v. Carhart regarding Nebraska's law.[2]

Number of PBAs performed:

Virtually no official statistics are available on the number of PBAs performed in the United States. The Centers for Disease Control compiles statistics on the number of abortions performed annually in the United States, but largely relies on voluntary reporting by the individual states which themselves have widely varying data collection practices. The CDC does not provide data on either 'partial-birth' abortions or 'dilation and extraction' abortions.

Only Kansas reports figures on abortions specifically identified as partial-birth abortions. Kansas reported 58 PBAs in 1998, 182 for Jan.-Oct. 1999, and none since Oct. 1999 (through the end of 2006). This is out of 11,000 to 12,000 total abortions per year reported in Kansas. Of the 240 reported PBAs in Kansas, all but 7 were for out-of-state residents.[3]

Four states report data on dilation and extraction abortions. Idaho reported 30 dilation and evacuation abortions total from 1993 to 2005, out of 700 to 1,000 total abortions per year.[4] Minnesota reported 3 dilation and extraction abortions total from Oct. 1998 to Dec. 2005, out of 13,000 to 15,000 total abortions per year.[5] Nebraska reported 7 dilation and excision abortions total from 2000 to 2004 out of about 4,000 total abortions per year.[6] Ohio reported 328 dilation and extraction abortions in 1999, 266 in 2001, 278 in 2002, 381 in 2003, 309 in 2004, and 255 in 2005, out of 34,000 to 37,000 total abortions per year.[7]

Other figures on dilation and extraction abortions have been reported by physicians in various forums. One published study discusses 120 intact dilation and extraction abortions at one New York hospital from June 1996 to June 2003.[8] Various reports cite figures of "up to 60" dilation and extraction abortions per year in Virginia,[9] and about 130 per year by one physician in New York.[10] M. Haskell, in an article which introduced the term 'dilation and extraction' abortion, reported having performed over 700 such procedures up to 1992.[11] J. McMahon, a California physician, submitted testimony to Congress regarding about 2,100 PBAs he had performed, and one New Jersey clinic was performing at least 1,500 PBAs per year in 1996.[12] Other reports in the medical literature make incidental reference to dilation and extraction abortions,[13] including studies published between 1992 and 2004 mentioning research use of tissue from fetal remains following elective dilation and extraction abortions.[14] A survey performed in 2004 reported that 36% of 185 obstetrics and gynecology residency programs surveyed in the Northeast and West coast reported training in performing dilation and extraction abortions.[15]

The Alan Guttmacher Institute in its periodic report for U.S. abortion in 2000 indicated 1,274 dilation and extraction procedures in 2000 and 742 in the first half of 2001 were reported to them, and they estimated a total of 2,200 such procedures were performed in 2000 by 31 providers.[16] Previously AGI stated 363 such procedures were reported in 1996 and 201 in the first half of 1997, and from this projected an estimate of 650 per year in 1996 [17]--an estimate clearly incorrect, given the report cited above of 1,500 PBAs performed in 1996 in one clinic alone. Ron Fitzsimmons of the National Coalition of Abortion Providers gave an estimate of 3,000-5,000 partial-birth abortions per year in 1997, of which 500 to 750 are performed in the third trimester.[18] This figure contradicted previous claims by Fitzsimmons of only 450 PBAs per year.[19] OBGYN and Reproduction Week reported in 2004 that 2,400 to 5,000 dilation and extraction procedures are performed annually in the U.S.[20]

The table below summarizes the available data at the state and national level on the number of partial-birth abortions or dilation and extraction abortions (note that this data is very incomplete):

yearknown procedures by stateknown procedures,
United States
various estimates,
total procedures,
United States
AL CA FL ID KS MN NE NJ NY OH PA VA TX
through 1992 2        700     702 
1993     1          1 
1994     6          6 
1995     2         2 4 
1996     3    1,500 ~139    1,642650
1997     4     ~17     2013,000-5,000
1998     1 58    ~17     76 
1999     1 182    ~17 328    528 
2000     3   2  ~17    1,2742,200
2001     1  1 1  ~17 266    742 
2002     1   1  ~17 278    297 
2003     3   2  ~9 381    395 
2004     1  2 1   309    3132,400-5,000
2005     3      255    258 
total to 2005 2 2,100 ~4 30 240 3 7 1,500 250 2,517 1 ~60 28,542 

About 8,500 partial-birth abortions in the U.S. up to 2005 can be documented; the actual number is significantly higher. Reasonable estimates of the annual number of PBAs in the U.S. range from 2,200 to 5,000, with somewhat higher numbers possible. This would imply 22,000 to 50,000 PBAs performed in the last decade.

Reasons for performing PBAs:

Again, minimal data is available regarding the reasons for partial-birth abortions. Available data does, however, contradict claims that most are for reasons of medical necessity.

Kansas requires physicians to report reasons for performing PBAs. Of the 240 PBAs reported in Kansas in 1998 and 1999, there were none where the mother's life was at risk; in every case the attending physician certified "that continuing the pregnancy will constitute a substantial and irreversible impairment of the patient's mental function" and that there was not a substantial physical risk to the mother from the pregnancy.[21]

Physicians who perform large numbers of PBAs have stated that many are performed for elective reasons. In an interview with American Medical News, M. Haskell stated that about 80% of the PBAs he performed were purely elective, with the remainder performed for genetic reasons.[22] In testimony to Congress, J. McMahon reported that for about 2,000-2,100 PBAs he had performed, 1,183 (56%) were for fetal "flaws" or "indicators", 175 (9%) were for maternal "indicators", and the remainder (about 700, or 35%) were elective.[23] McMahon further indicated that elective abortions comprised 20% of those he performed after 21 weeks gestation, and none of those he performed after 26 weeks.[24]

McMahon's 1995 testimony to the House Judiciary Committee gave more detailed statistics, which have been analyzed by physicians P. Smith and K. Dowling. Among maternal indicators, the single most frequent was maternal depression (39, or 1.9% of total), with 28 attributed to maternal health conditions "consistent with the birth of a normal child (e.g. sickle cell trait, prolapsed uterus, small pelvis)" (1.3% of total) and the remainder (5% of total) for other maternal factors ranging from maternal health risk to "spousal drug exposure" and "substance abuse". Those performed for fetal indicators included some for lesser conditions such as 9 (0.4% of total) for cleft lip-palate, 24 (1.1% of total) for cystic hydroma, and other for conditions either surgically correctable or involving lesser degrees of neurologic/mental impairment.[25]

Available data indicates that partial-birth abortions are mostly performed for reasons other that for the life or physical health of the mother, reasons including either fetal defects (minor or major) or purely elective reasons. This tends to be consistent with reasons for abortions in general in the United States.[26]

Sources:

  1. --, 5 Nov. 2003, "Public Law 108-105," U.S. GPO, on line [http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=108_cong_public_laws&docid=f:publ105.108.pdf].
  2. Alan Guttmacher Institute, 1 April 2007, "State policies in brief: bans on 'partial-birth' abortion," AGI, on line [http://www.guttmacher.org/pubs/spib_BPBA.pdf].
  3. Kansas Department of Health and Environment, 29 March 1999, "Abortions in Kansas 1998, Preliminary Report," Kansas Department of Health and Environment, on line [http://www.kdheks.gov/hci/98itop1.pdf]; Kansas Department of Health and Environment, 24 March 2000, "Abortions in Kansas 1999, Preliminary Report," Kansas Department of Health and Environment, on line [http://www.kdheks.gov/hci/99itop1.pdf]; Kansas Department of Health and Environment, March 2006, "Abortions in Kansas 2005, Preliminary Report," Kansas Department of Health and Environment, on line [http://www.kdheks.gov/hci/05itop1.pdf].
  4. Idaho Department of Health and Welfare, Division of Health, Bureau of Health Policy and Vital Statistics, 2003, "Induced Abortion Data Summary, Idaho: Induced abortions occurring in Idaho and induced abortions to Idaho residents, 1992-2002," Idaho Department of Health and Welfare, on line [http://www.healthandwelfare.idaho.gov/_Rainbow/Documents\health/Abortion%20Summary%202002.pdf]; Idaho Department of Health and Welfare, Division of Health, Bureau of Health Policy and Vital Statistics, Feb. 2006, "Induced Abortion Data Summary, Idaho: Induced abortions occurring in Idaho and induced abortions to Idaho residents, 1994-2004," Idaho Department of Health and Welfare, on line [http://www.healthandwelfare.idaho.gov/site/3457/default.aspx]; Idaho Department of Health and Welfare, Division of Health, Bureau of Health Policy and Vital Statistics, Feb. 2007, "Induced Abortion Data Summary, Idaho: Induced abortions occurring in Idaho and induced abortions to Idaho residents, 1995-2005," Idaho Department of Health and Welfare, on line [http://www.healthandwelfare.idaho.gov/DesktopModules/DocumentsSortable/DocumentsSrtView.aspx?tabID=0&ItemID=6860&MId=10768&wversion=Staging].
  5. Minnesota Center for Health Statistics, July 2002, "Report to the Legislature: Induced Abortions in Minnesota, January-December 2001," Minnesota Department of Health, on line [http://www.health.state.mn.us/divs/chs/abrpt/abrpt01.pdf]; Minnesota Center for Health Statistics, July 2005, "Induced Abortions in Minnesota, January-December 2004: Report to the Legislature," Minnesota Department of Health, on line [http://www.health.state.mn.us/divs/chs/abrpt/2004abrpt.pdf].
  6. Nebraska Health and Human Services System, March 2001, "Nebraska 2000 Statistical Report of Abortions," Nebraska Health and Human Services System, on line [http://www.hhs.state.ne.us/]; Nebraska Health and Human Services System, March 2002, "Nebraska 2001 Statistical Report of Abortions," Nebraska Health and Human Services System, on line [http://www.hhs.state.ne.us/]; Nebraska Health and Human Services System, March 2003, "Nebraska 2002 Statistical Report of Abortions," Nebraska Health and Human Services System, on line [http://www.hhs.state.ne.us/srd/2003Abortion.pdf]; Nebraska Health and Human Services System, March 2004, "Nebraska 2003 Statistical Report of Abortions," Nebraska Health and Human Services System, on line [http://www.hhs.state.ne.us/srd/abortion-report2004.pdf]; Nebraska Health and Human Services System, 6 April 2005, "Nebraska 2004 Statistical Report of Abortions," Nebraska Health and Human Services System, on line [http://www.hhs.state.ne.us/srd/abortion-report2004.pdf].
  7. Ohio Department of Health, 26 Feb. 2004, "Table 7: Induced abortions reported in Ohio, by method of termination and county of occurrence, 2001," Ohio Department of Health, on line [http://www2.odh.ohio.gov/Data/ABR/2001/abtab7.pdf]; Ohio Department of Health, 26 Feb. 2004, "Table 7: Induced abortions reported in Ohio, by method of termination and county of occurrence, 2002" Ohio Department of Health, on line [http://www2.odh.ohio.gov/Data/ABR/2002/2002abtab7.pdf]; Ohio Department of Health, 14 Dec. 2004, "Table 7: Induced abortions reported in Ohio, by method of termination and county of occurrence, 2003," Ohio Department of Health, on line [http://www2.odh.ohio.gov/Data/ABR/2003/Table7.pdf]; Pregnant Pause, 16 April 2001, "Abortion methods (statistics)," Pregnant Pause, on line [http://www.pregnantpause.org/numbers/methods.htm]; Ohio Department of Health, Sept. 2005, "Induced Abortions in Ohio, 2004," Ohio Department of Health, on line [http://www.odh.ohio.gov/ASSETS/1204604AE83F4382B233C72F9C8EB7B7/2004AbortionReport.pdf]; Ohio Department of Health, Sept. 2006, "Induced Abortions in Ohio, 2005," Ohio Department of Health, on line [http://www.odh.ohio.gov/ASSETS/73B9FE32F57941CAB08F531B66F9CF00/2005%20Abortion%20Report.pdf].
  8. Chasen, Stephen T., Robin B. Kalish, Meruka Gupta, Jane E. Kaufman, William K. Rashbaum, and Frank A. Chervenak, 2004, "Dilation and evacuation at >=20 weeks: comparison of operative techniques," American Journal of Obstetrics and Gynecology, 190:1180-1183.
  9. Robinson, B. A., 11 Feb. 2004, "D&X/PBA procedures: introduction," Ontario Consultants on Religious Tolerance, on line [http://www.religioustolerance.org/abo_pba1.htm].
  10. U.S. Senate Republican Policy Committee, 13 May 1997, "H.R. 1122--Partial-Birth Abortion Ban Act of 1997," U.S. Senate Republican Policy Committee, on line [http://rpc.senate.gov/_files/51397Abortion.pdf].
  11. Haskell, Martin, 13 Sept. 1992, "Dilation and extraction for late second trimester abortion," in Second Trimester Abortion: From Every Angle, Fall Risk Management Seminar, 27-34, National Abortion Federation (Washington, DC), on line at National Right to Life [http://www.nrlc.org/abortion/pba/Haskellinstructional.pdf].
  12. Sprang, M. LeRoy, and Mark G. Neerhof, 1998, "Rationale for banning abortions late in pregnancy," Journal of the American Medical Association, 280:744-747.
  13. Harger, James H., et al., 2002, "Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women," Obstetricss and Gynecology, 100:260-265; Wapner, Ronald J., Thomas M. Jenkins, Neil Silverman, Marion Kaufmann, Cheryl Hannau, and Peter McCue, 2001, "Prenatal diagnosis of cogenital nephrosis by in utero kidney biopsy," Prenatal Diagnosis, 21:256-261.
  14. Lu, Wenge, Jason A. Gersting, Akhil Maheshwari, Robert D. Christensen, and Darlene A. Calhoun, 2005, "Developmental expression of chemokine receptor genes in the human fetus," Early Human Development, 81:489-496; Parker, C. Richard Jr., Ana K. Stankovic, Cindy Harlin, and Lana Carden, 1992, "Adrenocorticotropin interferes with transforming growth factor-β-induced growth inhibition of neocortical cells from the human fetal adrenal gland," Journal of Clinical Endrocrinology and Metabolism, 75:1519-1521; Parker, C. R. Jr., A. K. Stankovic, C. N. Falany, O. Faye-Petersen, and W. E. Grizzle, 1995, "Immunocytochemical analyses of dehydroepiandrosterone sulfotransferase in cultured human fetal adrenal cells," Journal of Clinical Endrocrinology and Metabolism, 80:1027-1031; Stankovic, A. K., W. E. Grizzle, C. R. Stockard, and C. R. Parker, Jr., 1994, "Interactions between TGF-beta and adrenocorticotropin in growth regulation of human adrenal fetal zone cells," American Journal of Physiology--Endrocrinology and Metabolism, 266:E495-E500; Zhang, Yin, R. Ann Word, Susan Fesmire, Bruce R. Carr, and William E. Rainey, 1996, "Human ovarian expression of 17β-hydroxysteroid dehydrogenase types 1, 2, and 3," Journal of Clinical Endocrinology and Metabolism, 81:3594-3598.
  15. Eastwood, Katherine L., Jennifer E. Kacmar, Jody Steinauer, Sherry Weitzen, and Lori A. Boardman, 2006, "Abortion training in United States obstetrics and gynecology residency programs," Obstetrics and Gynecology, 108:303-308.
  16. Finer, Lawrence B., and Stanley K. Henshaw, 2003, "Abortion incidence and services in the United States in 2000," Perspectives on Sexual and Reproductive Health, 35:6-15, on line at AGI [http://www.guttmacher.org/pubs/journals/3500603.html].
  17. Henshaw, Stanley K., 1998, "Abortion incidence and services in the United States, 1995-1996," Family Planning Perspectives, 30:263-287.
  18. U.S. Senate Republican Policy Committee, 13 May 1997, "H.R. 1122--Partial-Birth Abortion Ban Act of 1997," U.S. Senate Republican Policy Committee, on line [http://rpc.senate.gov/_files/51397Abortion.pdf].
  19. Robinson, B. A., 11 Feb. 2004, "D&X/PBA procedures: introduction," Ontario Consultants on Religious Tolerance, on line [http://www.religioustolerance.org/abo_pba1.htm].
  20. OBGYN and Reproduction Week, 26 April 2004, "Abortion: doctor testifies that banned type of abortion needs more study," OBGYN and Reproduction Week, p. 7.
  21. Kansas Department of Health and Environment, 29 March 1999, "Abortions in Kansas 1998, Preliminary Report," Kansas Department of Health and Environment, on line [http://www.kdheks.gov/hci/98itop1.pdf]; Kansas Department of Health and Environment, 24 March 2000, "Abortions in Kansas 1999, Preliminary Report," Kansas Department of Health and Environment, on line [http://www.kdheks.gov/hci/99itop1.pdf]; Kansas Department of Health and Environment, March 2006, "Abortions in Kansas 2005, Preliminary Report," Kansas Department of Health and Environment, on line [http://www.kdheks.gov/hci/05itop1.pdf].
  22. Gianelli, D. M., 3 March 1997, "Abortion rights leader urges end to 'half truths'," American Medical News, pp. 3-4, 55-56; Statement of representative Charles T. Canady (R-Fla), 27 March 1996, Congressional Record; Sprang, M. LeRoy, and Mark G. Neerhof, 1998, "Rationale for banning abortions late in pregnancy," Journal of the American Medical Association, 280:744-747.
  23. National Right to Life, 1996, "For what reasons are partial-birth abortions usually performed?," NRLC, on line [http://www.nrlc.org/abortion/pba/pbafact10.html]; Statement of representative Charles T. Canady (R-Fla), 27 March 1996, Congressional Record; Sprang, M. LeRoy, and Mark G. Neerhof, 1998, "Rationale for banning abortions late in pregnancy," Journal of the American Medical Association, 280:744-747.
  24. Statement of representative Charles T. Canady (R-Fla), 27 March 1996, Congressional Record.
  25. Statement of representative Charles T. Canady (R-Fla), 27 March 1996, Congressional Record; National Right to Life, 1996, "For what reasons are partial-birth abortions usually performed?," NRLC, on line [http://www.nrlc.org/abortion/pba/pbafact10.html].
  26. W. R. Johnston, 4 Dec. 2006, "Reasons given for having abortions in the United States," Johnston's Archive, on line [http://www.johnstonsarchive.net/policy/abortion/abreasons.html].
  27. U.S. Supreme Court, 18 April 2007, "Gonzalez, Attorney General v. Carhart et al.," U.S. Supreme Court, on line [http://www.supremecourtus.gov/opinions/06pdf/05-380.pdf].


© 2006, 2007 by Wm. Robert Johnston.
Last modified 19 April 2007.
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