Trends in therapeutic abortion in San Francisco

Positive and negative aspects of therapeutic abortion are discussed upon review of trends found in the 6201 abortions performed in San Francisco between 1968 and 1970 (since Abortion was legalized in California in 1967). On the positive side, legalized abortion appears to have reduced the septic abortion rate (68 per 1000 live births in 1967 to 22 per 1000 in 1969) indicating a decline in criminal abortion. Maternal mortality has also declined from 8 per 100,000 to just over 3 per 100,000 from 1967 to 1969. Patients requesting abortion have averaged in age from 20-24 (26% were less than 19) and approximately half have been nulliparous. 37% of teenagers had saline abortions. Negative aspects have included the increasing morbidity rate associated with saline abortion, a second-trimester method. Compared to abortions performed at 12 weeks' gestation or less (usually done by vacuum aspiration), saline abortions required 5.7% second admissions (only 1.2% of the early abortions required readmission) and necessitated transfusion 3 times as often (in 2.3% of the cases). Regardless of the procedure used, later abortion involved a greater risk of hermorrhage and infection (2.7% incidence at 5-6 weeks' gestation compared to 12.9% at 11-12 weeks). Morbidity accompanying saline abortion was similar at 15 and 20 weeks however. Fortunately a trend toward earlier abortion is indicated. (74% of abortions were by suction and 22% by saline in 1970). Hysterotomy plus tubal ligation and hysterectomy accounted for only 4% of abortions but were accompanied by hemorrhage rates of 31% and 27% respectively and had respective infection rates of 13% and 22%. Private patients received abortions 3 times more often than ward patients although ward patients were subjected to more traumatic procedures: hysterectomies for ward patients were 2.0% vs .9% for private patients; sterilization by tubal ligation following suction abortion was 3.5% vs 1.7%. Additionally, black women had later abortions more often than white patients (33% of the black women were seen after 14 weeks gestation compared to 20% of the white women). Obstructions to early abortion must be eliminated to avoid such discrepancies in opportunity. Psychiatric examinations are unnecessary and causes for administrative delays must be remedied. Cost still presents a barrier for some women. The long-term effects of abortion now suggested by data from countries such as Czechoslovakia indicate that abortion is best viewed as a back-up measure to contraception making increased sex education, counseling and contraceptive practice essential.