This observation is important from the point of view of the relative risks to life and health associated with the use of contraception and abortion as methods of fertility control. A few years ago, I wrote a paper in which I could show that the risk to life experienced by a group of women using no contraception and terminating all pregnancies by early abortion was approximately equal to the risk of dying from pulmonary embolism experienced by a group of women using the oral contraceptives then available. However, if the women had used a moderately effctive method of contraception. without fatal side effects but with early abortion as a backstop, the risk to life would have been reduced by somewhere between fourfifths and nine-tenths. On the basis of this stud yI concluded that, in turns of a risk to the woman's life, the most rational procedure for regulating fertility is the use of a perfectly safe, although not 100 percent effective, method of contraception backed up by the early termination of unwanted pregnancies. In the course of the 4 years since this study was published, levels of mortality associated with legal abortion and with oral contraception have bee nreduced, but the basic argument remains uneffected." At this point, I should like to summarize my overall evaluation of legal abortion from the medical and public health point of view. In my opinion, legal abortion is a necessary component of a complete system of voluntary fertility control. Other components, such as sex education and contraceptive services, are equally necessary but legalization of abortion is the only way to replace dangerous discriminatory, undignified, and costly illegal abortions by legal abortions, performed under medical auspices, with minimum risks to life and health and accessible to pregnant women in all economic and social groups throughout the Nation. I am now ready to answer any questions you may wish to put to me. Senator BAYH. Doctor, would you go back to the original question I asked you about your testimony, about how you arrived at the 70 percent figure of illegal abortions. Dr. TIETZE. I shall be happy to do so and if I may I would like to read from my article in the Winter 1973 issue of Family Planning Perspectives, condensing the material as I go along. During the first year of the new abortion law, that is from July 1, 1970 through June 30, 1971, about 67,400 resident women obtained legal abortions in New York City which represents an increment of about 65,000 over those performed during the preceding 12 months. Most pregnancies terminated during the 12 months ending June 30, 1971, would have produced full-term infants during 1971. The number of live births registered in New York City during that year was about 131,900. Application of the age-specific fertility rates of 1970 to the age distribution of women in 1971 generates an expected total of 150,700 births, thus creating an imputed decline of 18,800 births or 12.6 percent. Accepting the imputed decline of 18,800 in New York City from 1970 to 1971 as a first approximation of the number of births prevented or postponed by legal abortion, the next step is to estimate the number of abortions required to achieve this decline. Available information on the practice of contraception among the population of New York City suggests that a ratio of 1.2 abortions replacing one live birth is probably an appropriate estimate. Hence, 22,600 legal abortions or 35 percent of the increment of 65,000 legal abortions from 1969-1970 to 1970-1971, may have been required to prevent 18,800 births 6 months later. This estimate suggests further that, during the first year under the new law about 44,200 of the legal abortions of New York City residents involved pregnancies which, without legalization, would have been terminated by illegal abortion, or, possibly included some pregnancies resulting from a deterioration of contraceptive practice. During the second year under the liberalized abortion law, the estimated number of abortions of New York City residents was 75.100 representing an increase of only 7,700 over the corresponding total for the preceding 12 months. Live births during 1972 numbered 115.500. Application of the agespecific fertility rates of 1971 to the projected age distribution of women in 1972 generates a total of 134,500 expected births, 19,000 more than the number registered in 1972. Hence, the decline in the number of births from 1971 to 1972 was about 2.5 times the estimated increment in the number of legal abortions among local residents 6 months earlier. There is no evidence that the number of pregnancies increased during the second year of the liberalized abortion law, which makes it highly unlikely that a significant number of pregnancies resulting from a deterioration of contraceptive practice occurred even during the first year. Hence, virtually all of the increment in legal abortions in 1970-1971 which did not replace unwanted or mistimed (mostly out-of-wedlock) births terminated pregnancies which would otherwise have been terminated by illegal abortions. It is unlikely that the sharp decline in illegal abortion from 19691970 to 1970-1971 continued in the next 12 months, partly because illegal abortions had already reached a low level. Changes in reproductive behavior other than more frequent legal abortions contributed significantly to the decline in the number of births in New York City from 1971 to 1972. If the proposition is accepted that 1.2 abortions were required to replace one birth, about 6,400 births were prevented by the increment of 7,700 legal abortions from 1970-71 to 1971-72, or fewer if illegal abortions continued even a modest decline. This leaves a residual of perhaps as many as 12,600 births prevented or postponed by other changes in reproductive behavior. These factors must have been operative on a major scale in 1971-72 and probably also in 1970-71. Hence, our original estimate of 18,800 unwanted births prevented or postponed by legal abortions during the first year of the liberal abortion law is probably too high, and the corresponding estimate of 44,200 illegal abortions replaced by legal abortions, too low. We may assume, arbitrarily and solely for purposes of illustration, that the impact in 1971 of changes in reproductive behavior other than increased utilization of legal abortion was one-half of what it appears to have been in 1972, or the equivalent of 6,300 fewer births. Under this assumption, the unexplained decline in the number of births from 1970 to 1971 would be on the order of 12,500; the number of legal abortions required to achieve this decline would be about 15,000 or 23 percent of the increment of 65,000 legal abortions over those performed during 1969-70; and the number of illegal abortions replaced by legal abortions would be on the order of 50,000 during the first year of the liberalized abortion law and probably about the same during the second year. With 142,500 resident women obtaining legal abortions during the 2 years from July 1, 1970, through June 30, 1972, it would appear that 70 percent of these abortions replaced illegal procedures. Senator BAYH. I heard every word you said; I am not sure I understood it. We have this article, I am advised by counsel. Perhaps I had better go back over it when I have a chance to study it in closer detail. You are convinced that at least the 1-year experience substantiates your 70-percent figure? [The article referred to was submitted for the record at this point.] Two Years' Experience Reprinted from Perspectives Volume 5, No. 1 Winter 1973 By Christopher Tietze, M.D. 515 Madison Avenue Two Years' Experience with a Liberal Abortion Law: Its Impact on Fertility Trends in New York City By Christopher Tietze, M.D. There has been a sharp decline in fertility in New York City - sharper than for the rest of the nation since New York State liberalized its abortion law in 1970 to make termination of pregnancy by a licensed physician legally available virtually upon request up to 24 weeks of gestation. There has been an even greater decline reversing a long-term trend in illegiti macy. We seek to study in this article what has been the actual impact of the New York abortion law of 1970 on fertility trends in New York City. Between July 1, 1970 (when New York State's liberalized abortion law took effect) and June 30, 1972, approximately 402,000 pregnancies were terminated legally in New York City 173,900 in the first year and 228,100 in the second year.1 These figures are based on: ⚫ pretabulated reports mailed weekly to the New York City Health Services Administration by proprietary, voluntary and some municipal hospitals, and by freestanding clinics; totals of abortions performed as reported weekly by telephone by the remaining municipal hospitals, and ⚫ estimates made by the Health Services Administration for periods for which no weekly reports were submitted by some hospitals and clinics. Weekly reports by mail and telephone account for about 92 percent of the total of 402,000 abortions, and estimates for about eight percent. During the same two-year period, 334,900 individual certificates of termination of pregnancy, 83.3 percent of the estimated total, were filed with the New York City Department of Health. Although health regulations require that certificates of termination of pregnancy be filed withChristopher Tietze is Associate Director of the Biomedical Division of The Population Council. in 48 hours, many are delayed far beyond the prescribed period. It appears likely that no certificates were filed or will ever be filed for some of the terminations performed during 1970-1972. To study the impact of legal abortions on fertility trends, it was necessary to separate local residents from women who came to New York City from other areas to have their pregnancies terminated, because only abortions of residents can be related to comparable pregnancies or births, or to women capable of becoming pregnant or giving birth. Residence status appears only on the certificates of termination of pregnancy filed with the health department. Hence, it was necessary to estimate the numbers of abortions of resident and nonresident women, based on the total numbers of legal abortions reported by mail or by telephone, or officially estimated for each category of institution, and on preliminary tabulations of certificates of termination, by date of reporting, made available by the health department." Residents and Nonresidents Table 1 presents estimated numbers of legal abortions and percent distributions for New York City residents. Between 1970-1971 and 1971-1972, the total number of abortions of residents increased by 7,700 or 11 4 percent from 67,400 to 75,100. They represented about 39 percent of all legal abortions in the first year, and about 33 percent in the second year.† In 1970-1971, less than one percent of the resident women were younger than 15 years of age at the time their pregnancies were terminated, about six percent were under 18, 17 percent were under 20 years and almost three in five were in their twenties. The following 12-month period, from July 1, 1971 to June 30, 1972, brought a very slight shift toward younger ages. The New York City Department of Health tabulates abortions by pregnancy order. In order to facilitate comparison with live births, which are tabulated by birth order, the distribution by pregnancy order was converted to a distribution by number of prior births using a cross-tabulation of the abortions reported to the Joint Program for the Study of Abortion (JPSA), in which about one-half of the total number was performed in New York City 2 In the first year of the liberal abortion law, almost one-half (47 percent) of the residents of New York City undergoing abortion were nulliparous, i.e., had experienced no prior birth. In 1971-1972, the proportion of nulliparous women was somewhat smaller and the share of women with prior births was correspondingly greater. Women with four or more prior births represented less than 10 percent of the total in either year. In 1970-1971, roughly equal numbers of white and nonwhite (mostly black) • The numbers of abortions of resident and nonresident women presented in this report are estimates prepared by the author who is, therefore, professionally responsible for them. While the author believes that his estimates are very close to the facts and probably the best that can be made on the basis of available data, they will be subject to revision when the New York City De partment of Health releases its definitive tabula tions of certificates of termination by date of occurrence rather than by date of reporting. Because of the unofficial character of these estimates, the numbers of abortions have been rounded to the nearest hundred; percentages, ratios and rates were computed from unrounded figures. The estimates for both years may be too high. since some nonresident women may have given local addresses in order to obtain abortions in the municipal hospitals or on the general services of voluntary hospitals. |