Deinitions used to evaluate these statistically include: (1) abortion ratio-the number of abortions per 1000 live births, and (2) abortion rate-the number of abortions per 1000 women aged 15 to 44 years. Overall, abortions most likely are underreported in the United States because clinics inconsistently list medically induced abortions. For example, the Guttmacher Institute found that 926,000 procedures were performed in 2014 Oones, 2017). But for 2013, only about 664,400 elective abortions were reported to the Centers for Disease Control and Prevention Oatlaoui, 2016). Of these, 66 percent were pregnancies aged ;8 weeks' gestation, and 92 percent of abortions were completed beforei; 13 weeks. he abortion ratio was 200 per 1000 live births, and the abortion rate was 12.5 per 1000 women.
herapeutic abortion refers to termination of pregnancy for medical indications. Inclusive medical and surgical disorders are diverse and discussed throughout this text. In cases of rape or incest, many consider termination. The most frequent indi cation currently is to prevent birth of a fetus with a signiicant anatomical, metabolic, or mental deformity.
the interruption of pregnancy before viability at the request of the woman, but not for medical reasons. Most abortions done today are elective, and thus, it is one of the most frequently performed medical procedures.
• Abortion in the United States
The legality of elective abortion was established by the United States Supreme Court in the case ofRoe v. Wae. The Court defined the extent to which states might regulate abortion and ruled that firsttrimester procedures must be let to the medical judgment of the physician. ter this, the state could regulate abortion procedures in ways reasonably related to maternal health. Finally, subsequent to viability, the state could promote its interest in the potential of human life and regulate and even proscribe abortion, except for preservation of the life or health of the mother.
Other legislation soon followed. he 1976 Hyde Amendment forbids use of federal funds to provide abortion services except in case of rape, incest, or life-threatening circumstances. The Supreme Court in 1992 reviewed Planned Parenthood v. Casy and upheld the fundamental right to abortion, but established that regulations before viability are constitutional as long as they do not impose an "undue burden" on the woman. Subsequently, many states introduced counseling requirements, waiting periods, parental consent for minors, facility requirements, and funding restrictions. Such limits are often called targeted regulation of abortion providers (TRAP) laws. One major choice-limiting decision was the 2007 Supreme Court decision that reviewed Gonales v. Carhart and upheld the 2003 Partial-Birth Abortion Ban Act. This was problematic because there is no medically approved definition of partial-birth abortion according to the American College of Obstetricians and Gynecologists (20 14a). In 2016, some TAP laws were dialed back by the Supreme
Court ruling in the case of Who/� Woman 5 Health v. Helerstedt. With this, the justices noted that abortion laws must confer health safety benefits that outweigh burdens on access.
The American College of Obstetricians and Gynecologists (2014a, 2017 d) supports the legal right of women to obtain an abortion prior to fetal viability and advocates for improved access. he College also (2017 a) supports abortion training, and the Accreditation Council for Graduate Medical Education mandates that obstetrics and gynecology residency education must include access to experience with induced abortion. The Kenneth J. Ryan Residency Training Program was established in 1999 to work with residency programs to improve abortion and contraceptive training. Moreover, postresidency training in these techniques is available in formal 2-year Family Planning fellowships.