Transcript Abortion Surveillance in the United States: Future

Abortion Surveillance in the
United States:
Future Directions and Challenges
Karen Pazol, PhD, MPH
Maternal and Infant Health Branch
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Abortion data are important for
monitoring reproductive health

Combined with data on births and fetal losses
to calculate pregnancy rates
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Monitor clinical practice patterns and
changes in use of procedures over time

Guide efforts to reduce unintended
pregnancy and assess the impact of changes
in policy and the implementation of family
planning programs
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Organizations collecting abortion
data in the United States
Information
Organization Data Source Origin of Data
Obtained
CDC, NCCDPHP State Vital
Individual records Aggregate
Division of Rep. Statistics
from abortion
report: N’s +
Health
Agencies
providers
basic traits
Abortion
Counts from
Total N’s
Guttmacher
Provider
abortion providers
Institute
Survey
Abortion
Responses from
Basic traits
Patient
women seeking
Survey
abortion
National
Responses from
N’s + basic
NCHS
Survey of
reproductive aged traits
Family
women
Growth
State Vital
Individual records N’s + basic
Gateway to the Future:
Statistics
from abortion
traits
the National Vital Statistics System
Agencies Improving
providers
St. Louis, MO
June 6th – June 10th, 2010
Dates
Annually, 1969 present
Periodically,
1974 -present
1987, 1994,
2000, 2008
1982, 1988,
2001, & 2006 2008
1978 -1994
Talk overview

CDC’s Abortion Surveillance System and its
strengths

Challenges of combining data collected
through independent state-run systems

Efforts to facilitate work carried out in the
states and integrate data collected through
independent systems
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
CDC’s Abortion Surveillance System

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Each year CDC requests aggregate data from
the 50 states, NY City and DC
Legally mandated and voluntary elements



Most states (N=47) require provider reporting
States submit data to CDC voluntarily, yet
participation is high (N=49 areas in 2007)
Most but not all states have a reporting system
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
Prior to 1997, five states had no system
Prior to 1998, CDC conducted surveys in
hospitals and other abortion facilities
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
CDC compiles abortion data on a
consistent annual basis
Calendar years with abortion counts
0.61
0.59
0.57
0.55
0.53
0.51
0.49
0.47
0.45
Gateway to the Future:CDC
Guttmacher
Institute
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
CDC compiles information on a wide
range of variables

Information collected by CDC:
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




Gestational age
Procedure type
Place of Residence
Maternal age
Maternal race
●
●
●
●
Maternal ethnicity
Marital status
Number prior births
Number prior
abortions
CDC proportions are applied to Guttmacher
Institute total counts to estimate the incidence
of abortion within population subgroups
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
CDC counts closely track results from
the Guttmacher Patient Survey
50%
Percentage distribution of abortions - measured
by CDC and the Guttmacher Institute, 2000
40%
30%
20%
10%
0%
<15 15-19 20-24 25-29 30-34 35-39 ≥ 40
maternal age (yrs)
CDC
0
1
≥2
prior live births
Gateway to the Future:
Improving the National Vital Statistics System
Guttmacher Institute
St. Louis, MO
June 6th – June 10th, 2010
Talk overview

CDC’s Abortion Surveillance System and its
strengths

Challenges of combining data collected
through independent state-run systems

Efforts to facilitate work carried out in the
states and integrate data collected through
independent systems
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
CDC does not obtain abortion counts
from all 52 reporting areas
% contribution
of areas that
reported
to CDC
#
areas
contributing
to
CDC
totals
to the Guttmacher Institute totals
100%
52
42
80%
32
60%
22
40%
12
20%
2
Gateway to1993
the Future:1998
1978 1983 1988
2003
Improving the National Vital Statistics System
Central reporting agency
& other
abortion facilities
St. Louis, MO Hospitals
June 6th – June
10th, 2010
States vary considerably in the
completeness of reporting
CDC counts by state as a percentage of Guttmacher Institute counts
Voluntary reporting
2000 (N=4)
69%
35%
2005 (N=3)
Mandatory reporting
96%
2000 (N=44)
96%
2005 (N=45)
0%
25% Gateway to50%
the Future:
75%
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
100%
Active outreach to abortion providers
can improve reporting
Reported abortions, 1993-2006
1,000
# reported in Colorado x 1,000
10
800
8
600
6
400
4
200
2
0
0
1993
1995
Colorado
1997
Gateway
Future: 2003
1999 to the
2001
2005
Improving the National Vital Statistics System
Continuously
th, 2010in the US
St. Louis,
MO
June reporting
6th – June 10areas
# reported in the US x 1,000
12
States vary in the amount of
information they collect
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
States vary in the amount of
information they collect
60
100%
# reporting areas
50
80%
40
60%
30
40%
20
20%
10
0
0%
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
% of total abortions categorized
Number of reporting areas and percentage
of abortions categorized, 2007
States vary in the level of detail
provided for each variable
Number areas reporting by procedure and
with medical abortion as a separate category
50
40
30
20
FDA approval of
medical abortion
10
0
1997
1999
2001
2003
Gateway to the Future:
2005
2007
Improving the National Vital Statistics System
reported by procedure
type medical
abortion separate category
St. Louis, MO
June 6th – June 10th, 2010
States vary in the level of detail
provided for each variable
Level of detail - residence status, 2007
100%
87%
% of reported abortions
80%
60%
40%
20%
0%
12%
1%
Assigned to 1 of 50 states, Out-of-state but exact
Unknown residence
Gateway
to
the
Future:
District of Columbia,
residence not specified
Improving the National Vital Statistics System
Canada or MexicoSt. Louis, MO June 6th – June 10th, 2010
Talk overview

CDC’s Abortion Surveillance System and its
strengths

Challenges of combining data collected
through independent state-run systems

Efforts to facilitate work carried out in the
states and integrate data collected through
independent systems
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Analyses of trends over time based
on continuously reporting areas
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Analyses of trends over time based
on continuously reporting areas
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Revised analyses retain
compatibility with current reporting
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Revised analyses retain
compatibility with current reporting
Medical (Nonsurgical) Abortion:
A procedure (that) involves the administration of a
medication or medications to induce an abortion.
Medications (e.g., methotrexate, mifepristone,
misoprostol, etc.) are used most frequently early in
the first trimester of pregnancy. However, some
medications (e.g., prostaglandin suppositories,
injectable prostaglandins, etc.) may be administered
during the second trimester of pregnancy to induce
abortion.
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Revised analyses retain compatibility
with current reporting
50,000
50%
40,000
40%
30,000
30%
20,000
20%
10,000
10%
0
0%
≤6
7
8
9
10 11 12
13 14
15Future:
16 17 18 19 20 ≥21
Gateway
to the
Improving the National Vital Statistics System
weeks of gestation
St. Louis, MO
June 6th – June 10th, 2010
% of all abortions reported as medical
# medical abortions reported
Medical Abortions, 2007
Total # and percentage of all abortions
reported by weeks of gestation
Revised analyses retain compatibility
with current reporting
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Revised analyses retain
compatibility with current reporting
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Revised analyses retain compatibility
with current reporting
25
100%
20
80%
15
60%
10
40%
5
20%
0
0%
2006
Gateway to the Future:2007
Improving the National Vital Statistics System
reporting yearth
St. Louis, MO
June 6 – June 10th, 2010
% of reported abortions
# reporting areas
Abortions cross-classified by race-ethnicity,
# of reporting areas and percentage of total abortions
CDC efforts to understand state
systems and enhance collaboration

Establish improved dialogue with state
vital statistics departments
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Increase the compatibility of CDC data
requests with state data systems
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Develop more efficient methods for
transferring aggregate reports to CDC
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Conclusions
CDC has compiled the most consistent
annual record of abortions
 CDC collects important information on
maternal demographics, procedure type
and gestational age
 CDC faces many challenges in combining
data from 52 independent sources

Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Conclusions

Attempts to overcome variation and
improve surveillance:


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Trends based on continuously reporting areas
Revisions to analyses compatible with current
reporting formats
Increase communication and understanding of
state systems to enhance collaboration
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010
Acknowledgements
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Douglas Cook, CDC
Sonya Gamble, CDC
Laura Hall, CDC
Saeed Hamdan, CDC
Wilda Parker, CDC
Suzanne Zane, CDC
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Elizabeth Nash,
Guttmacher
Institute
Mary Chase,
Colorado
Department of
Public Health &
Environment
Gateway to the Future:
Improving the National Vital Statistics System
St. Louis, MO
June 6th – June 10th, 2010