1. Marco Teórico
1.7 Sistema Constructivo
1.7.1 Estructuras Metálicas
Women aged 20 to 24 years have had the highest abortion rates (Figure 6.5), and since 2000 abortions in this age group have represented approximately 24% of all abortions annually. However, the decline in abortions was also the greatest in this age group, from 32 (in 1995) to 23 per 1,000 women in 2008. Rates have declined less dramatically for the other age groups except in women aged 35 and over, which showed a consistent but slight increase to above 10 per 1,000 women. Similarly, a study examining changing patterns in women seeking pregnancy termination from a South Australian service provider found a signifi cant increase in older women (aged 30 to 50 years) having a termination from 1996 to 2006.12
Year
Rate (per 1,000 women)
0 5 10 15 20 25 30 35 20-24 15-19 25-34 35+ All ages 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994
Figure 6.5: Induced abortion rates by age group: Medicare item 35643, Australia, 1994 to 2008
Note: Age groups 25–29 and 30–34 combined into 25–34 group. Medicare item 35643: evacuation of the contents of the gravid uterus.
Source: Medicare Australia www.medicareaustralia.gov.au/statistics/mbs_item.shtml, accessed Jul2010, denominator from ABS population estimates.
The reasons for these trends need further study. For example, does the decline in younger women refl ect either better availability of, or access to, effective contraception, or a move towards continuing with unplanned pregnancies rather than termination? In older women, what are the factors behind decisions to terminate pregnancies? Some may represent termination of fetal abnormalities, but may also include completion of family, or balancing the prospect of a child with career pathways.
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Two population-based surveys have collected information about induced abortion. The Australian Longitudinal Study on Women’s Health (ALSWH), established in 1996, was a random sample of women in three cohorts; young (18 to 23 years), middle-aged (45 to 50 years) and older (70 to 75 years) respectively when fi rst surveyed.13 Data collected in
1996 from women in the mid-age cohort who had largely completed child bearing by survey time showed 19.8% have had at least one abortion.14
The second survey, the Australian Study of Health and Relationships (ASHR), which interviewed over 9,000 women in 2001 on reproductive outcomes, found that among women aged 16 to 59 years who had ever been pregnant, 22.6% reported an abortion.15 The survey results represent
an accumulation over the reproductive years for each respondent and are close to annual cross-sectional rates derived from Medicare item 35643 for all 15 to 44 year old women. Assuming that the majority of women who do have an abortion have only one in a lifetime or are unlikely to have more than one in a calendar year, then the validity of Medicare item 35643 as an indicator of induced abortion would appear to be robust, especially for jurisdictions where abortion is overwhelmingly provided in private settings.
6.2.1 Demographic data –
characteristics of women
seeking or reporting
abortion
Medicare, the NHMD and private termination clinics do not collect detailed demographic data that would allow assessment of trends in abortion by population subgroups such as Aboriginal and Torres Strait Islander women, women from Culturally and Linguistically Diverse (CALD) backgrounds or in women with disabilities. However, data collected by health surveys do provide limited information on socio-demographic variation in abortion rates.
The ALSWH found that women in the younger cohort who reported teenage terminations were likely to be less well educated, and those reporting teenage terminations were more likely to be in a de facto relationship, have no private health insurance and be a victim of partner violence.16,17
In contrast the ASHR15 showed that women with higher
education levels were signifi cantly more likely to have had an abortion. Women identifying as lesbian or bisexual were signifi cantly more likely to report an abortion than heterosexual women. The survey showed no difference in regional rates of reported abortion. The ASHR showed no correlation between abortion and having a non-English speaking background, income or occupational classifi cation. In an audit of a Victorian Pregnancy Advisory Service in which 90% of women were seeking abortion (n=3,598), 6.9% preferred a language other than English, 12% lived in rural Victoria or interstate, 2.1% identifi ed as Aboriginal or Torres Strait Islander (compared to 0.6% of the Victorian population), 42.2% already had one child and 51.3% were holders of a Health Care Card (compared to 23% of the overall Australian population).18
Whilst these survey data are important they should be viewed with care. The information sources are limited, and there are no population comparisons available at a national level to allow thorough interpretation.
6.2.2 International
comparisons
Australia’s abortion rate, while less than that reported worldwide, is comparable to other developed countries (excluding Eastern Europe, Table 6.4), and is at the upper end of countries with comparable health services, abortion legislation and reporting processes (Table 6.5).
6.2 Estimates of Induced Abortion Based
on National Population Health Surveys
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Table 6.4: Global abortion estimates
Table 6.5: Rates of abortion for 2003 in developed countries where reporting is relatively complete
Sources: Sedgh et al. 2007. Induced abortion: estimated rates and trends worldwide. Lancet 370:1138–45, †McLennan W. Australian social trends 1998. Canberra: Australian Bureau of Statistics, 1998, ABS Cat. No. 4102.0 and ‡Grayson N, Hargreaves J, Sullivan EA 2005. Use of routinely collected national data sets for reporting on induced abortion in Australia. AIHW Cat. No. PER 30. Sydney: AIHW National Perinatal Statistics Unit (Perinatal Statistics Series No. 17).
Note: International comparisons of abortion data should be interpreted cautiously as abortion data collection methods, defi nitions and
completeness vary. Australia may have more complete abortion reporting than some of the countries included in this table (e.g. the United States) and some international differences will refl ect different approaches to reporting and recording abortion.
Source: Sedgh et al. 2007. Legal abortion worldwide: incidence and recent trends. International Family Planning Perspectives 2007, 33 (3): 106–116.
AREA ABORTION RATE
(PER 1,000 WOMEN AGED 15 TO 44 YEARS)
1995 2003
World 35 29
Developed countries 39 26
Excluding Eastern Europe 20 19
Developing countries 34 29 Excluding China 33 30 Region Africa 33 29 Asia 33 29 Europe 48 28 Latin America 37 21 North America 22 21 Oceania 21 17 Australia 22† 20‡
COUNTRY ABORTION RATE
(PER 1,000 WOMEN AGED 15 TO 44 YEARS)
New Zealand 35
United States 39
Australia 20
Sweden 34
England and Wales 33
Canada 15
Singapore 15
Scotland 12
Netherlands 9
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The discrepancy between the MBS and NHMD data for in-hospital claims was small (<2%), but does indicate the extent of inaccuracy in fi gures for induced abortion. The fi nal abortion estimate was calculated as the sum of the NHMD abortion separations and non-hospital MBS claims, plus an additional 13.1% of the MBS estimate to account for unclaimed services (Table 6.6).
Based on state of usual residence, the number of abortions in women resident in NSW was 33,088 in 2003 and 31,619 in 2004, corresponding to rates of 23.2 and 22.1 per 1,000 women in 2003 and 2004, respectively. Only 2.1 to 2.5% of women from NSW had an induced abortion interstate.