North Carolina reported pregnancies

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North Carolina
ReportedPregnancies
1991
CL-FEB
24
N.C. ST. lY
NORTH CAROLINA
REPORTED PREGNANCIES
1991
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
STATE CENTER FOR HEALTH AND ENVIRONMENTAL STATISTICS
Digitized by the Internet Archive
in 2010 with funding from
State Library of North Carolina
http://www.archive.org/details/northcarolinarep02nort
STATE OF NORTH CAROLINA
James B. Hunt, Jr., Governor
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
Jonathan B. Howes, Secretary
STATE CENTER FOR HEALTH AND ENVIRONMENTAL STATISTICS
Delton Atkinson, M.S.P.H., M.P.H., Director
January 1993
700 copies of this public document were
printed at a cost of $ 1 ,364. 1 8 or $ 1 .95 per copy.
TABLE OF CONTENTS
Page
INTRODUCTION l-I
TRENDS AND PATTERNS IN PREGNANCY, LIVE BIRTH, ABORTION, AND FETAL DEATH 2-1
SUMMARY OF CHARACTERISTICS OF INDUCED ABORTIONS 3-1
OCCURRENCE DATA
PLACE OF OCCURRENCE 3-1
FACILITY OF OCCURRENCE 3-1
RESIDENT DATA
PLACE OF RESIDENCE 3-4
RACE 3-5
AGE 3-6
MARITAL STATUS 3-7
EDUCATIONAL ATTAINMENT 3-8
NUMBER OF LIVING CHILDREN 3-8
PREVIOUS ABORTIONS 3-9
GESTATION 3-9
COMPLICATIONS 3-10
TERMINATING PROCEDURES 3-10
SELECTED CHARACTERISTICS OF RESIDENT LIVE BIRTHS AND FETAL DEATHS 4-1
LIVE BIRTHS
RACE 4-1
MATERNAL AGE 4-1
UMMARRIED MOTHERS 4-2
LOW-WEIGHT BIRTHS 4-3
VERY LOW-WEIGHT BIRTHS 4-3
NO PRENATAL CARE 4-4
FETAL DEATHS
RACE 4-5
MATERNAL AGE 4-5
TABLES
STATE
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES REGIONS
PERINATAL CARE REGIONS
COUNTIES
APPENDIXES
A. N.C. INDUCED ABORTION CASE REPORT
B. N.C. CERTinCATE OF LIVE BIRTH
C. N.C. REPORT OF FETAL DEATH
D. DEFINITIONS
INTRODUCTION
This volume is the third pregnancy report for North Carolina. The data of this report include reported induced
abortions, live births, and fetal deaths. The sum of these events represents total reported pregnancies.
The following section uses tables, graphs, maps, and narrative to examine statewide trends and patterns in
pregnancy, live birth, abortion, and fetal death. Subsequent sections of this report examine selected characteristics
of abortions, live births, and fetal deaths with emphasis on abortions since they are not elsewhere reported. Finally,
for the state, regions, and 100 counties, one-page tables summarize resident abortions, live births, fetal deaths and
total pregnancies by race and age for total and unmarried women. These tables, which have been produced, but not
published, formany years, are frequently requested. This is the major impetus forpublishing the present report, rather
than the abortion report published prior to data year 1989.
Users should note a change in the case of newborn's race. For 1989 and prior years, race of child was based on
race of mother and race of the father (when known): A child was ascribed the darker of the two races. Beginning in
1990, race of the child is taken to be that of the mother regardless of race of father. This change serves to reduce the
number of nonwhite births and fetal deaths and increase the number of white events. Users should be aware of this
cliange when assessing trends before and after 1990. In 1 990, the change resulted in 3.5 percent fewerlive births and
2.0 percent fewer fetal deaths being coded nonwhite.
Throughout this report, data year 198 1 is used as the base to reflect changes during the past decade. Beginning in
1978, abortion providers voluntarily reported detailed characteristics on nearly alloftheirprocedures. Corresponding
data for earlier years were obtained from a sample and may not be representative.
Hospitals and clinics in North Carolina reported detailed information on an estimated 97 percent of all abortions
performed in 1991. For those facilities not reporting 100 percent, the characteristics data have been expanded in a
random manner to agree with each facility's total number of abortions. These adjustments should not seriously bias
the results. For live births and fetal deaths, reporting of the events is believed to be virtually 100 percent, although
the variables include a number of unknown or not stated values.
For the maps of this repwrt, a clustering routine from the Statistical Analysis System (SAS) was used to group
counties that are "most like each other" with respect to the statistic being examined. This procedure may result in
very large or very small groups, depending on how the counties differ from one another.
It is hoped that this report will serve many of the data needs of those individuals and agencies delivering and/or
planning health services for the childbearing population of the state. Users' comments are always welcomed. You
may contact this office at (919) 733^728, or address correspondence to:
State Center for Health and Environmental Statistics
Department of Environment, Health, and Natural Resources
P.O. Box 29538
Raleigh, North Carolina 27626-0538
1-1
TRENDS AND PATTERNS IN PREGNANCY, LIVE BIRTH,
ABORTION, AND FETAL DEATH
North Carolina's total resident pregnancy rate (pregnancies per 1,000 females ages 15^W) declined in 1983,
stabilized over the next three years, rose in each year 1987-1990 and declined in 1991 (see below). The increase
between 1987 and 1990 involved both races, especially nonwhites whose rate increase began in 1986 and exceeded
six percent in 1988 alone.
Live births are the greatest contributorto total pregnancies, so it is not surprising that the slate'sfertility rate (live
births per 1 ,000 females ages 1 5-44) has followed the same course as the pregnancy rate. Again, the nonwhite increase
began earlier and exceeded that for whites. The nonwhite rate rose 13 percent between 1984 and 1991 while the white
rate rose less than eight percent during that period. The increase occurred in most age groups, but was more marked
in women over30.Recenttrends toward unmarried and/ordelayed childbearingmaybecontributingfactors.lt should
be expected that both white and nonwhite fertility has peaked, or will soon as the "baby boom" moves past the prime
childbearing years. However, no one can predict such confounding effects as new methods of birth control and tlie
return oftroops from the Middle East. The latter is known to have resulted in increased childbearing during late 199 1
,
although the number and rate of live births for 1991 were below 1990 levels.
120 -r
I
in
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a.
n 40
PREGNANCY RATES BY RACE
NORTH CAROLINA, 1981 - 1991
Nonwhite
FERTILITY RATES BY RACE
NORTH CAROLINA. 1981 - 1991
65 66 67
Year
Following a period of relative stability, the state's abortion rate (abortions per 1 ,000 females ages 15-44) spiked
in 1984, declined fortwo years, then rose fortwo years, and declined again in 1989-1991. The nonwhite rate rose
8.5 percent in 1988 to an all-time high, declined in 1989-1990 and rose again in 1991. The white rate has declined
steadily since 1988.
2-1
The statewide abortionfraction (abortions per 1 ,000 pregnancies) and the abortion rate are highly correlated. The
fraction, like the rate, spiked in 1984, increased slighdy between 1985 and 1988, andthen declined in 1989 and 1990
before rising slighfly in 1991.
In considering recent changes in abortion and fertility measures, especially those for nonwhites, one should be
aware ofchanges in the numberofstate-funded abortions. In July 1 985 , the North CarolinaGeneral Assembly enacted
legislation tightening the qualifications for those abortions, and the number paid for by state funds then dropped 58
percent in FY-1986 to less than 3,000 procedures. The following year, in FY-1987, the number rebounded to more
than 4,000 procedures. In FY- 1990, however, the State Abortion Fund received less than half its former
appropriation, and the number of procedures dropped to under 2,000. During the first 1 months of FY- 1992, a total
of2,322 procedures were funded. Changes in the statewide number and rate ofabortions almost certainly reflect these
changes in accessibility for poor women. Abortion opportunities and utilization, of course, also impact on fertility
and probably fetal death as well.
ABORTION RATES BY RACE
NORTH CAROLINA. 1981 - 1991
ABORTION FRACTIONS BY RACE
NORTH CAROLINA. 1981 - 1991
o 10
400-r
300
oo°200
Nonwhite
81 62 83 85 85 87
Year
ea 89 so si 62 83 84 85 86 87
Year
68 89 90 ei
2-2
FETAL DEATH RATES BY RACE
NORTH CAROLINA, 1981 - 1991
The final component of total reported pregnancies is
the relatively small number of fetal deaths (reported
stillbirths of 20 or more weeks gestation). The state's
fetal death rate (fetal deaths per 1,0(X) deliveries) de-clined
steadily between 1981 and 1985, but with no
improvement since. The white rate declined during most
of the past decade but rose in 1991. The nonwhite rate
fell in 1991 to about the same level as in 1986. Reduced
accessibility of abortion to poor (high-risk) womenmay
be a contributing factor.
For each year 1981-1991, the total and race- specific
measures discussed above are given in the following
table. Pregnancy and abortion rates for 1981-1983 are
not the same as published in some previous abortion
reports due to more recent use of updated population
estimates. In almost all cases, the updated rates are lower
than the rates previously published.
Pregnancy Rates, Fertility Rates, Abortion Rates,
Abortion Fractions and Fetal Death Rates:
North Carolina Residents, 1981-1991
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Pregnancy Rate
TOTAL 80.9 81.3 80.2 81.7 81.8 80.8 83.2 86.1 87.2 87.9 85.9
WHITE 71.8 72.7 72.3 73.7 74.3 72.3 74.4 75.9 76.5 77.9 75.7
NONWHIIE 106.0 104.6 101.1 103.0 101.1 103.3 106.8 113.5 115.2 113.5 112.5
Fertility Rate
TOTAL 59.1 59.9 57.7 58.1 59.6 58.9 60.5 62.4 64.6 65.6 63.8
WHITE 53.8 54.5 53.3 54.3 56.1 54.5 56.0 57.3 59.0 60.6 58.8
NONWHIlb 74.8 75.4 70.2 69.0 69.3 71.4 73.0 76.7 80.2 79.6 78.0
Abortion Rate
TOTAL 21.2 20.8 21.9 23.1 21.7 21.4 22.2 23.1 22.1 21.7 21.4
WHIIE 17.6 17.7 18.6 18.9 17.8 17.5 17.9 18.2 17.2 16.9 16.5
NONWHIIE 30.1 28.2 29.9 33.3 30.9 31.0 32.9 35.7 33.9 32.9 33.5
Abortion Fraction
TOTAL 274.7 268.2 273.6 282.4 264.8 265.2 267.0 268.2 253.1 247.0 249.8
WHll'b 258.6 256.6 257.1 257.0 240.0 241.7 241.2 240.2 224.7 216.7 218.2
NONWHIlb 295.5 279.9 295.6 322.9 306.0 299.9 308.3 314.6 294.7 289.4 297.7
Fetal Death Rate
TOTAL 10.2 9.9 9.7 8.8 8.6 8.8 8.6 8.9 8.7 8.6 8.6
WHIlb 8.1 8.4 7.8 7.7 7.2 7.1 7.4 6.7 6.6 6.5 6.7
NONWHIlb 14.5 13.2 13.8 11.3 11.8 12.5 11.3 13.4 13.0 13.3 12.5
2-3
On pages 2-5 through 2-18, maps and tables depict county-specific pregnancy, fertility, and abortion rates, as well
as abortion fractions for 1991 . Fetal death rates are not given due to the instability ofthe county rates for a single year
Users are referred to the five-year fetal death rates published in North Carolina Vital Statistics, Volume 1.
Qustered alone with thehighestpregnancy rate is Onslow County; most similar to itare Craven, Halifax and Vance
counties. These counties also had some of the highest fertility rates. Durham County had the highest abortion rate
and Orange County had the highest abortion fraction. Most sim ilar to it are generally the larger, more urban counties.
For total women ages 15-44, pregnancy rates vary by county from 53.0 to 1 1 2.2 per 1 ,000 women, fertility rates
vary from 32.4 to 89.3 per 1 ,000 women, abortion rates vary from 3 .0 to 33 .0 per 1 ,000 women, and abortion fractions
vary from 46.5 to 414.8 abortions per 1,000 pregnancies. Special attention should be given to counties with higli
pregnancy rates among teenagers (ages 15-19). Forexample, Edgecombe, Halifax, Montgomery, Swain, Vance, and
Wilson counties all had teenage pregnancy rates at least 25 percent higher than the statewide teenage pregnancy rate
of 101. 1. The county data from teenagers are tabled on pages 2-9 and 2-10.
2-4
PREGNANCY RATES
PREGNANCY RATES
BY COUNPi' OF RESIDENCE
112.2 to 112.2
M 91.0 to 100.8
E3 76.4 to 89.1
D 66.8 to 75.6
D 53.0 to 64.4
NORTH CAROLINA
1991
FERTILITY RATES
??^
FERTILIPf' RATES
BY COUNTY OF RESIDENCE
89.310 89.3
M 69.9 to 80.2
H 59.0 to 69.3
n 49.0 to 58.2
D 32.4 to 40.1
D .t.V^^I>-^^
NORTH CAROLINA
1991
2-5
ABORTION RATES
ABORTION RATES
BY COUNTY OF RESIDENCE
31 .2 to 33.0
B 21.7 to 29.2
El 15.1 to 20.9
D 11.4to14.7
n 3.0 to 11.2
NORTH CAROLINA
1991
ABORTION FRACTIONS
ABORTION FRACTIONS
BY COUNTY OF RESIDENCE
414.8 to 414.8
31 7.6 to 386.2
E] 220.4 to 309.4
D 140.8 to 212.4
D 46.5 to 134.6
NORTH CAROLINA
1991
2-6
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2-18
SUMMARY OF CHARACTERISTICS OF INDUCED ABORTIONS
During 1991, the licensed facilities ofNorth Carolina reported 36,420 abortions to the State Center for Health and
Environmental Statistics, an increase of 14 percent over the number reported in 198 1 . As in previous years, women
obtaining these abortions were most often white, between the ages of 15 and 24, and not married. Most had never
had a previous abortion and had no living children. The table on the next page displays these percentages for each
year 1981-1991.
Compared to abortees in at least 40 states reporting detailed data for 1988 [latest year reported by the Centers for
Disease Control (CDC)], women having abortions in North Carolina were more likely to be between the ages of 15
and 24, to be unmarried, to have had no previous abortions, to have had the present abortion at twelve or fewer weeks
of pregnancy, and to have had suction curettage.
Place of Occurrence
The table on page 3-3 details 1991 North Carolina occurrences according to region and county of occurrence. Of
the 36,420 abortions reported in North Carolina, 98 percent occurred in 10 counties. Twenty-four percent of the state
total occurred in Mecklenburg, 13 percent occurred in Guilford, and 13 percent occurred in Wake.
In 1991, a total of 996, or 2.9 percent, of North Carolina resident abortees received abortions in other states. Of
these, 52 percent occcurred in Virginia, 23 percent occurred in Georgia, and 20 percent occurred in South Carolina.
The remaining five percent occurred in Kansas, Kentucky, Maryland, Oklahoma, Rhode Island and Tennessee.
The number of 1991 abortions occurring in each North Carolina county is mapped below.
REPORTED INDUCED ABORTIONS
NUMBER OF ABORTIONS
BY CXDUNTY OF OCCURRENCE
481 6 to 8662
^ 2146 to 3424
552to1144
D 1 to 56
n OloO
NORTH CAROLINA
1991
Facility of Occurrence
Nationwide in 1 980, hospitals constituted 55 percent of aU providers, yet performed only 22 percent of all induced
abortions. In North Carolina, 93 hospitals (79 percent of providers) performed 19.5 percent of all abortions. More
than half of the hospital abortions occurred in ten hospitals.
In 1991, 51 hospitals performed only four percent of abortions occurring in North Carolina. The remaining 96
percent occurred in 33 nonhospital facilities.
3-1
Summary of Characteristics of Women Receiving Abortions
North Carolina Occurrences, 1981-1991
Percent Distribution*
1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Total
Number 32,050 ;31,798 :32,952 34,458 32,923 33,765 35,544 37,629 36,799 36,494 36,420
Residence
In State 93.6 94.0 94.7 95.1 94.6 93.7 93.1 92.3 91.9 91.7 91.6
Out of State 6.3 6.0 5.2 4.8 5.3 6.3 6.9 7.7 8.1 8.3 8.4
Age
14 and under 1.4 1.3 1.5 1.6 1.6 1.6 1.3 1.3 1.2 1.1 1.0
15-19 31.4 29.9 29.7 29.2 29.0 28.9 28.6 28.4 27.1 25.6 23.7
20-24 35.5 35.9 35.0 35^2 34.7 33.2 33.1 33.1 33.5 34.4 35.6
25-29 18.0 18.5 18.8 19.2 19.2 19.2 19.5 19.4 19.6 19.6 19.9
30-34 8.7 8.8 9.2 9.3 9.4 10.2 10.2 10.5 11.2 10.8 11.2
35 and over 4.6 5.2 5.2 5.2 5.3 5.8 6.0 6.1 6.2 7.0 7.2
Mean 22.8 23.0 22.8 23.1 23.1 23.3 23.4 23.5 23.7 23.8 24.0
Race
White 62.3 63.7 62.7 61.0 60.9 60.7 59.9 58.6 57.5 57.5 56.9
Nonwhite 35.9 34.4 35.3 37.1 37.5 37.3 38.6 40.4 40.5 39.5 40.9
Marital Status
Married** 27.2 26.4 25.2 24.8 24.3 23.8 24.4 24.0 23.6 23.4 23.3
Unmarried 69.6 71.0 72.2 72.4 71.8 73.8 73.7 74.4 74.4 73.7 74.3
Education
8 and under 2.3 2.1 2.3 2.2 1.8 1.9 1.7 1.9 1.8 1.6 1.5
9-11 20.3 18.9 18.2 17.7 15.7 15.9 15.1 15.0 12.8 11.4 12.7
12 33.2 33.4 32.3 32.8 34.5 36.5 39.3 40.7 40.4 40.4 37.5
13 and over 29.5 30.3 29.3 29.5 30.6 31.8 32.2 32.8 30.3 30.2 32.0
Mean 12.3 12.4 12.4 12.4 12.6 12.6 12.6 12.6 12.6 12.7 12.6
Number of Living
Children
None 56.4 57.0 54.1 55.6 56.2 56.7 54.0 52.5 52.0 50.1 50.3
1 20.9 20.8 21.0 22.1 22.0 22.4 22.8 23.6 25.3 25.5 27.5
2 12.3 11.9 12.1 12.7 12.7 12.4 12.8 13.6 14.2 14.4 15.9
3 or more 6.3 5.6 5.9 5.5 5.3 5.2 5.4 5.6 5.9 5.9 5.9
Weeks ofGestation***
8 and under 42.0 42.5 42.1 41.4 43.8 44.3 43.5 45.3 46.0 49.2 48.8
9-12 43.3 42.6 41.8 40.2 41.3 40.4 41.1 38.9 38.8 37.3 37.9
13-1 7.7 8.0 8.8 9.4 8.2 8.5 8.4 8.3 7.8 7.2 7.0
16-20 3.3 3.5 3.5 6.1 3.1 3.3 3.0 3.3 3.1 2.4 2.3
21 and over 0.4 0.5 0.4 0.0 0.3 0.4 0.4 0.3 0.2 0.2 0.2
Mean 9.4 9.4 9.5 9.4 9.3 9.3 9.3 9.2 9.1 8.9 8.9
Percentages may not add to 100 percent due to not stated cases.
**Married includes separated but not legally divorced.
***Gestation computed from last menstrual period.
3-2
REPORTED INDUCED ABORTIONS
BY DEHNR REGION, PERINATAL CARE REGION,
AND COUNTY OF OCCURRENCE
' NORTH CAROLINA, 1991
TOTAL TOTAL
COUNTY
CHOWAN -
CLAY -
CLEVELAND 3
COLUMBUS -
CRAVEN 14
CUMBERLAND 2,455
CURRITUCK -
DARE -
DAVIDSON 13
DAVIE -
DUPLIN -
DURHAM 2,447
EDGECOMBE -
FORSYTH 3,230
FRANKLIN 2
GASTON -
GATES -
GRAHAM -
GRANVILLE -
GREENE -
GUILFORD.; 4,881
HALIFAX -
HARNETT -
HAYWOOD -
HENDERSON -
HERTFORD -
HOKE -
HYDE -
IREDELL 45
JACKSON 5
JOHNSTON 13
JONES -
LEE 1
LENOIR 2
LINCOLN -
MCDOWELL -
MACON -
MADISON -
MARTIN -
MECKLENBURG 8,662
TOTAL
COUNTY
MITCHELL -
MONTGOMERY -
MOORE 39
NASH 18
NEW HANOVER 1,144
NORTHAMPTON -
ONSLOW 2,146
ORANGE 3,424
PAMLICO -
PASQUOTANK 1
PENDER -
PERQUIMANS -
PERSON -
PITT 17
POLK -
RANDOLPH -
RICHMOND -
ROBESON 29
ROCKINGHAM 1
ROWAN 6
RUTHERFORD -
SAMPSON 1
SCOTLAND -
STANLY -
STOKES -
SURRY 2
SWAIN -
TRANSYLVANIA -
TYRRELL -
UNION -
VANCE -
WAKE 4,816
WARREN -
WASHINGTON -
WATAUGA 1
WAYNE 2
WILKES 1
WILSON 552
YADKIN -
YANCEY -
TOTAL 36,420
DEHNR REGION
I ASHEVILLE 2,410
n CHARLOTTE 8,753
m WINSTON-SALEM 8,129
IV RALEIGH 11,273
V FAYETTEVILLE 2,526
VI GREENVILLE 39
Vn WILMINGTON 3,290
PC REGION
I WESTERN 2,354
n NORTHWESTERN 8,272
m SOUTHWESTERN 8,666
IV NORTHEASTERN 10,703
V SOUTHEASTERN 3,670
VI EASTERN 2,755
COUNTY
ALAMANCE -
ALEXANDER -
ALLEGHANY -
ANSON -
ASHE -
AVERY -
BEAUFORT 3
BERTIE -
BLADEN 2
BRUNSWICK -
BUNCOMBE 2,349
BURKE 56
CABARRUS 1
CALDWELL -
CAMDEN -
CARTERET -
CASWELL -
CATAWBA 35
CHATHAM -
CHEROKEE -
3-3
The remainder ofthe data appearing in this publication will be resident data. The base year appearing in the
trend graphs is 1981 to reflect changes during the past decade.
Place of Residence
During 1991, a total of 3,047 (8%) of abortions perfomied in North Carolina were to residents of other states. Of
these, 54 percent were residents of South Carolina and 35 percent were residents of Virginia. Tennessee accounted
for 3.0 percent of North Carolina's nonresident abortions; Georgia, 1.5 percent; and West Virginia, 1.3 percent.
Among abortions to residents ofNorth Carolina, Lhe distribution by county of residence varied widely during 199
1
with all 100 counties represented. The most populous counties accounted for the greatest frequencies, as shown
below.
REPORTED INDUCED ABORTIONS
NUMBER OF ABORTIONS
BY COUNTY OF RESIDENCE
1692 to 3965
M 651 to 928
n 274 to 475
n 155 to 257
D 6 to 137
NORTH CAROLINA
1991
34
Race ""
Of the 34,369 North Carolina women known to
have had abortions during 1991, a total of 19,453
(57%) were white; 13,106 (38%) were black; 253
(1%) were American Indian; and 840 (2%) were
other races. For the remainder, race of the abortee
was unknown. Nonwhite women have higher abor-tion
rates and fractions than white women (see page
2-2).
PERCENT INDUCED ABORTIONS BY RACE OF ABORTEE
NORTH CAROLINA 1981 - 1991
70 -r
White
Nonwhite,
eZ 83 64 85 66
Year
87 88 69 90
North Carolina resident induced abortions by race of abortee for 1981 through 1991 are given below.
Resident Induced Abortions
By Race of Abortee
North Carolina, 1981-1991
Year Total White Nonwhite
1981 30,000 18,562 10.863
1982 29,890 18,925 10,369
1983 31,892 20,038 11,235
1984 34,138 20,705 12,825
1985 32,478 19,648 12,328
1986 32,849 19,816 12.353
1987 34.344 20,457 13,346
1988 36,066 20,988 14,711
1989 34,907 19,966 14,242
1990 34,565 19,792 13.764
1991 34,369 19,453 14,199
NOTE: Race-specific counts do not sum to the total due to cases of unknown race.
3-5
Age
The mean age of North Carolina residents having
abortions during 1991 was 24.0 years. The highest
percentage ofabortions was to women between 20 and
24 years of age. The percentage at younger ages has
declined since 1981.
hi 1988, the most current year of age-specific data
from CDC, 56.7 percent of United States abortees
were between the ages of 15 and 24 years. This
compares to 61.3 percent of 1988 North Carolina
abortees and 59.0 percent of 1991 North Carolina
abortees.
In 1991, North Carolina's resident abortion rate
was 33.4 per 1,000 females ages 15-19 and 45.8 per
1,000 females ages 20-24, dropping substantially
tliereafter to 4.7 per 1,000 females ages 35-44. The
statewide abortion fraction was highest at ages 15-19
(330.5 per 1,000 pregnancies) and lowest at ages 30-
34 (167.0 per 1,000 pregnancies).
PERCENT INDUCED ABORTIONS BY AGE OF ABORTEE
NORTH CAROLINA, 1981 - 1991
40
30--
o 20
25-29
30-34
35 and over
85 86 67
Year
88 89 90 91
Age-adjusting the North Carolina abortion rates for women ages 15-44, using the July 1980 North Carolina female
population as tlie standard, yields the following:
Age-
Crude Adjusted
Rate Rate
1981 21.2 21.0
1982 20.8 21.0
1983 21.9 22.3
1984 23.1 23.6
1985 21.7 22.3
1986 21.4 22.3
1987 22.2 23.3
1988 23.1 24.5
1989 22.1 23.7
1990 21.7 23.9
1991 21.4 23.7
Comparing the adjusted rates across years, it is seen that the rate rose about six percent in each of 1983 and 1984,
then declined before increasing again in 1987 and 1988. The net increase between 1981 and 1991 was about 13
percent. The following table corroborates age-specific increases in abortion rates during tlie 1980s; increased rates
are observed in all age groups, except ages 15-19. However, the abortion fraction has declined at ages 15-19, 30-34,
and 35-44.
3-6
ABORTION RATES AND ABORTION FRACTIONS BY AGE
NORTH CAROLINA, 1981-1991
Age 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
Rates 15-19 35.2 34.1 36.9 39.6 38.1 37.6 38.7 40.1 37.0 36.5 33.4
Fractions 385.3 372.4 398.4 416.0 399.9 400.6 402.2 399.5 365.1 346.4 330.5
Rates 20-24 37.6 37.7 39.0 41.4 38.7 38.0 39.9 42.7 42.5 44.8 45.8
Fractions 265.7 265.1 280.9 291.3 271.5 268.7 274.0 283.1 274.6 272.8 283.1
Rates 25-29 21.0 21.2 22.6 24.2 22.7 22.7 24.1 25.3 24.8 24.2 24.6
Fractions 180.8 179.5 189.2 206.1 189.5 190.1 194.3 196.9 186.8 182.6 193.2
Rates 30-34 10.9 10.7 11.8 12.5 11.8 12.6 13.1 13.9 14.0 13.0 13.4
Fractions 178.4 172.2 187.0 189.0 174.7 182.9 179.1 185.3 179.0 164.6 167.0
Rates 35^4 3.6 3.9 4.1 4.2 4.0 4.2 4.4 4.6 4.3 4.6 4.7
Fractions 297.5 295.6 303.0 292.9 281.5 284.6 279.1 276.1 246.9 255.1 254.0
Rates All Ages 21.2 20.8 21.9 23.1 21.7 21.4 22.2 23.1 22.1 21.7 21.4
Fractions 274.7 268.2 273.6 282.4 264.8 265.2 267.0 268.2 253.1 247.0 249.8
Marital Status
Only 23.2 percent of North Carolina residents
receiving abortions during 1991 were legally mar-ried
at the time ofthe procedure. This compares to 27
percent in 198 1 . Among all states reporting to CDC
in 1988, 20 percent of the abortees were married.
Unmarried women (those widowed, divorced or
never married) constituted 74.3 percent of North
Carolina resident abortees during 1991. This com-pares
to 69 percent in 1981. Among abortions re-ported
to CDC in 1988, about 80 percent of abortees
were unmarried.
PERCENT INDUCED ABORTIONS
BY MARITAL STATUS OF ABORTEE
eo_ NORTH CAROLINA. 1981 - 1991
Unmarried
o 40--
V
a.
Married
0-1 1 1 1 1 1 1 1 1 1
1
61 82 83 84 85 86 87 88 89 90 91
Year
3-7
PERCENT INDUCED ABORTIONS
BY EDUCATION OF ABORTEE
NORTH CAROLINA, 1981 - 1991
82 63 85 86 87
Yeor
88 69 90 91
Number of Living Children
Fifty percent of North Carolina resident abortees
in 1991 had no living children. The percentage
having three or more living children has decreased,
from 6.3 in 1981 to 6.0 in 1991.
The number ofNorth Carolina women obtaining
abortions in 1991 was inversely related to the num-ber
of living children. This pattern has prevailed
since 1981.
Educational Attainment
The mean educational attainment of residents
receiving abortions during 1991 was 12.6 years.
Seventy percent had at least 12 years of education;
this compares to 63 percent during 1981.
Educational attainment has remained a high non-response
variable in the reporting of abortions.
Sixteen percent ofNorth Carolina resident abortion
reports for 1991 did not specify educational attain-ment
of the abortee.
40
P 30
20--
PERCENT INDUCED ABORTIONS
BY NUMBER OF LIVING CHILDREN
NORTH CAROLINA. 1981 - 1991
One
Two
Three or more
81 82 83 84 85 86 87 88 89 90 91
Year
3-8
«)
30
o
'a
20
PERCENT INDUCED ABORTIONS
BY PREVIOUS ABORTION
NORTH CAROLINA. 1981 - 1991
81 62 63 84 66
Year
Previous Abortions
The issue ofrepeat abortion is amatterofconcern;
35 percent of North Carolina women having abor-tions
during 1991 reported at least one previous
abortion. This compares to 26 percent in 1981.
Of the 1 1 ,959 abortees reporting a prior abortion,
72 percent reported one, 20 percent reported two,
and eight percent reported three or more.
Based on 1988 data reported to CDC, abortees in
other states were more lilcely than North Carolina
abortees to report a previous abortion.
Gestation
During 1991, 87 percent of North Carolina resi-dent
abortions were performed within the first 12
menstrual weeks of pregnancy. Eight percent of
womenobtained abortions in the 13- 16 weekinterval
while 1.0 percent obtained later abortions. In 1981,
86 percent of women obtained abortions within 12
menstrual weeks.
In 1 99 1 , the percentage ofwomen obtaining abor-tions
beyond the 20th week of gestation was 0.4, the
same as in 1985. The mean gestational weeks of
pregnancy was 9.3 in 1985 and 1986, 9.4 in 1987, 9.2
in 1988 and 1989, and 9.0 in 1990 and 1991.
Compared to abortees in other states in 1988
(CDC data). North Carolina abortees were more
likely to have the procedure during the first eight
weeks and less likely to have it beyond the sixteenth
week.
•w
30--
PERCENT INDUCED ABORTIONS
BY WEEKS OF GESTATION
NORTH CAROLINA. 1981 - 1991
20--
10
9-12
13 and over
81 62 83 6+ 85 86
Year
87 68 89 90 81
3-9
Complications
Abortion providers report relatively few complications associated with abortion. Compared to 3.2 percent in 198 1
,
only 0.4 percent of resident abortions during 1991 involved reported complications. The most frequendy reported
condition was "hemorrhage."
Terminating Procedures
Suction curettage accounted for 97.6 percent of all resident abortion procedures reported for 1991. This was
followed by prostaglandin injection (1 . 1 %), other procedures not specified (0.5%), saline injection (0.4%) and sharp
curettage (0.3%). Major abdominal operations for abortions (hysterectomy) accounted for only 0.01 percent of total
abortion procedures.
During the first twelve weeks of gestation, suction curettage is commonly used. As more abortees have utilized
clinics and obtained earlier abortions, the percentage of abortions performed by suction curettage has increased from
95.7 percent in 1981 to the present 97.6 percent.
3-10
SELECTED CHARACTERISTICS OF RESIDENT LFVE BIRTHS
AND FETAL DEATHS
Live Births
Following many years of steady decline, the state's fertility rate bottomed out during the 1980's and then rose
steadily during 1987-1990. In absolute numbers, the upward trend amounts to an increase of 22 percent since 1981
to 102,309 resident live births in 1991. This means an additional 19,000 live births per year in a time when many
physicians are leaving obstetrical practices or refusing Medicaid patients. Moreover, women at high risk of
unfavorable pregnancy outcomes are contributing disproportionately to the increase.
Here, we examine several live birth trends that evoke particular public health concern because of possible
economic, emotional, and health consequences to mother/child. Several other publications available from this office
offer more detail about live births and theirmatemal and medical characteristics. Region, county, and some city data
are also available.
Race
As depicted graphically on page 2- 1 , recent increases in the fertility rate have been greater for nonwhites than for
whites. The table below shows tlie absolute numbers of live births by race. The white number rose 22 percent, while
the nonwhite number rose 23 percent between 1981 and 1991.
Resident Live Births by Race of Child
North Carolina, 1981-1991
fEAR TOTAL WHITE NONVVHITE
1981 83,752 56,756 26,996
1982 85,908 58,149 27,759
1983 83,854 57,446 26.408
1984 85,986 59,399 26,587
1985 89,391 61,766 27,625
1986 90,228 61,746 28,482
1987 93,481 63,876 29,605
1988 97,560 65,937 31,623
1989 102,091 68,455 33,636
1990 104,439 71,095 33,344
1991 102,309 69,233 33,076
Maternal Age
Tlie graphs on the next page depict trends in age-specific white and nonwhite fertility rates. Recent increases are
observed for whites 35-44, and for nonwliites 15-19 and 30-34.
Of particular concern are the rising rates among younger and older mothers, among whom health consequences
to mother and her child are often more frequent and severe. The higherbut declining fetal death rates of older mothers
are shown in the table on page 4-5.
4-1
WHITE FERTILITY RATES BY AGE
NORTH CAROLINA, 1981 - 1991
12U-
25-29
100- y^^-^^^^^^^^y^
20-24
80- -
30-34
60- ^ ^^__—'''''^ 15-19^—-^
AO- "
20-
35-44
J 1 1 1 1 1 1 1 1
\
1
83 64 85 66 87
Year
68 69 90 SI
NONWHITE FERTILITY RATES BY AGE
NORTH CAROLINA. 1981 - 1991
160- ^—
^
140-
y^
/ 20-24
120-
'- ^^--.^"'^^^
25-29
100- /^X^^^
^-^^:^ --^:^^^-^
80-
60- 30-34
40-
~^ ^""^
20- 35-44
0- 1 1 1
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i \
1
61 82 63 64 65 86 67
Yeor
88 69 90 91
Unmarried Mothers
High divorce rates and the widespread tendency to
delay marriage to older ages have both contributed to
growth in the unmarried female population. In addi-tion,
the fertility rate of unmarried women has
increased. Together, these factors have resulted in a
steady rise in the percentage of live births occurring
out of wedlock.
Beginning at 19.4 in 1981, the percentageofNorth
Carolina live births to unmarried mothers reached
31.6 in 1991. By race, the white percentage more
than doubled, from 6.5 to 16.0, while the nonwhite
percentage rose by 38 percent, from 46.4 to 64.2. The
numerical increases in births to unmarried mothers
have been 200 percent for whites and 70 percent for
nonwhites—a total of 99 percent more unwed births
in 1991 than in 1981.
PERCENT LIVE BIRTHS TO UNMARRIED MOTHERS
NORTH CAROLINA. 1981 - 1991
70T
Nonwhite
40--
30--
20-i
Total
White
62 63 B4 85 66 67
Yeor
68 89 90 91
4-2
Low-Weight Births
Low birthweight (5 pounds, 8 ounces orless) is the
single greatest contributor to infant mortality and
morbidity. Thus, it is a matter of urgent concern that
North Carolina's low-birthweight rate of 8.4 percent
in 1991 was no better than that observed at mid-century.
North Carolina's rate is also among the
highest in the nation.
The accompanying graph reveals a relatively
steady rate among whites followed by an upturn in
1991 and an increased rate among nonwhites since
1986. In absolute numbers, white and nonwhite low-weight
births have risen by 30 and 35 percent
respectively since their low points of the 1981-1 99
1
period.
PERCENT LOW-WEIGHT BIRTHS BY RACE
NORTH CAROLINA, 1981 - 1991
14-
12--
10
4--
2--
Nonwhita
Total
White
82 83 84 85 86 87
Year
88 89 SO 91
PERCENT VERY LOW-WEIGHT LIVE BIRTHS BY RACE
NORTH CAROLINA, 1981 - 1991
3t
2-
Totol
White
85 86 87
Year
88 89 SO 91
Very Low-Weight Births
These babies have birthweights of 3 pounds, 4
ounces or less. As shown by the accompanying
graph, the percentage of newborns at these weights
has fluctuated around 1 .0 for whites andbetween 2.5
and 2.9 fornonwhites over the 1981-1991 period. In
absolute numbers, white and nonwhite births at
these very low weights have risen by 37 and 44
p)ercent respectively since thei rlow poinLs ofthe past
decade.
4-3
No Prenatal Care
Although still representing a relatively small frac-tion
of aU live births, the increasing percentage of
birtlis to mothers who had no prenatal care is a major
concern. That percentage has risen sharply since
1984 and is almost twice its 1 98 1 level. The increase
has been 60 and 83 percent for whites and nonwhites
respectively. In absolute numbers, 86 percent more
whites and 128 percent more nonwliites had no
prenatal care in 1991 than in 1981. However, it is
somewhat encouraging that the nonwhite percent-age
did fall in both 1990 and 1991, while the white
percentage also declined in 1991.
PERCENT LIVE BIRTHS WITH NO PRENATAL CARE
BY RACE
NORTH CAROLINA, 1981 - 1991
4-r
Nonwhite
85 86 87
Year
Fetal Deaths
As shown graphically on page 2-3, both whites and nonwhites experienced some reduction in fetal mortality over
the 1981-1991 period. However, the state's overall rate remains one of the highest in the nation.
This section examines trends in white and nonwliite fetal death by race and maternal age. Race-specific fetal death
rates for regions, counties, and cities are available in North Carolina Vital Statistics, Volume 1 , and fetal death rates
for the various maternal characteristics and medical risk factors wiU be examined in the forthcoming Bi rth and Infant
Mortality report, scheduled for production in 1993. Counties are urged to use five-year fetal death rates, rather than
the less stable single-year rates.
4-4
Race
Since 198 1 , the decrease in fetal mortality (fetal deaths per 1 ,000 deliveries) has been about the same for whites
(17%) as for nonwhites ( 14%). However, as shown in the table below, there has been virtually no change for either
race in the number of fetal deaths.
Resident Fetal Deaths by Race
North Carolina, 1981-1991
fEAR TOTAL WHITE NONWHITE
1981 864 466 398
1982 863 492 371
1983 818 449 369
1984 766 461 305
1985 775 445 330
1986 800 440 360
1987 814 477 337
1988 872 443 429
1989 899 455 444
1990 911 463 448
1991 884 465 419
Maternal Age
Because of the instability of the fetal death rates by race and age, they are not graphed here. However, the table
below serves to pxjint up the higher rates among mothers 35 and older as well as the age-race-specific declines since
1981. By 1991, the rate for whites 35 and older had dropped 31 percent since 1981. However, the rate for older
nonwhites was the same in 1991 as in 1981.
Fetal Death Rates by Age and Race
North Carolina, 1981-1991
Year
AGE and RACE 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
15-19 White 11.9 9.7 7.5 10.5 9.3 7.2 8.1 7.5 8.5 9.0 8.0
Nonwhite 16.4 11.3 13.2 10.1 12.5 12.8 10.4 14.9 12.5 12.3 11.8
20-24 White 8.1 8.6 7.6 6.9 7.6 7.2 6.2 6.6 5.9 6.2 5.0
Nonwhite 11.7 13.1 12.8 10.1 11.6 10.8 9.3 12.2 12.7 12.5 10.5
25-29 White 6.8 6.9 7.3 6.5 5.9 6.3 7.4 5.9 6.3 5.5 6.5
Nonwhite 13.6 14.8 12.2 11.0 10.0 12.5 11.8 11.9 12.0 12.2 13.3
30-34 White 5.7 7.7 7.6 8.2 6.8 7.5 7.2 6.3 5.8 6.1 7.4
Nonwhite 17.5 9.8 18.5 13.4 11.0 13.3 13.8 10.2 13.9 14.4 13.1
35-44 White 12.4 14.9 11.5 11.3 8.5 8.8 11.7 8.0 8.1 7.8 8.6
Nonwhite 21.3 23.0 22.6 20.9 19.3 18.2 18.1 18.5 16.7 21.3 21.3
4-5
STATE
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