Abortion reporting in the United States: an examination of the federal-state partnership.

Over the past three years, several events have led policymakers, public health officials and the general public to focus renewed attention on abortion data in the United States. The information that is available on how many abortions are performed, when they take place and what methods are used has contributed to the public policy debate, but it also has proven inadequate in some instances to answer all the questions being asked. For example, in 1995 Ohio outlawed dilation and extraction abortions, an event seen by opponents of abortion as the first victory in a national campaign to ban procedures they later dubbed "partial birth" abortions. The proposed federal "PartialBirth Abortion Ban Act" has intensified the debate over abortion procedures, lateterm abortions and, ultimately, the incidence and timing of abortions in general. Yet the debaters were often frustrated because specific data on the frequency of late-term abortions are limited, and data on the use of dilation and extraction do not exist either at the state or national level. Moreover, at around the same time, Congress enacted a federal welfare reform law, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Among several provisions intended to discourage out-of-wedlock births is the socalled illegitimacy bonus: Every year, for the next four years, the federal government will award $20 million each to the five states that can demonstrate the largest reduction in out-of-wedlock births and a simultaneous decrease in abortion rates. While the legislation establishes 1995 as the baseline against which reductions and increases will be measured, it does not address the limitations of abortion data collection efforts, which pose a significant challenge for accurately establishing a baseline level of abortion in many states, as well as for establishing accurate subsequent levels. In 1996, as well, the Food and Drug Administration (FDA) took significant steps toward approving the use of medical (nonsurgical) abortion in the United States, essentially by "preapproving" the use of mifepristone, popularly known as RU 486, as an abortifacient; final approval is pending information on manufacturing and labeling. In addition, FDA cleared the way for clinical study by U.S. health care providers of a combination of two other drugsmethotrexate and misoprostol-used to induce early nonsurgical abortions. While it remains to be seen to what extent the advent of medical (nonsurgical) abortions will actually change the provision of abortion services in the United States, it is at least possible that such abortions will be administered by health care providers who, for whatever reasons, have been reluctant to provide surgical abortions. If new providers do indeed emerge, incorporating abortion reporting by these providers into current reporting procedures will be critical both to measuring the number of abortions provided in the United States, and to monitoring the drugs' use and safety. Furthermore, because medical abortion is used primarily in the first seven weeks of pregnancy, the provision of nonsurgical abortion may lead to a shift in the timing of abortions. Documenting this shift might prove important to the abortion debate, since many individuals support early abortion but grow increasingly uncomfortable with the procedure as the pregnancy continues. The Centers for Disease Control and Prevention (CDC), the government agency currently responsible for compiling U.S. abortion data, has been criticized by some people for its inability to answer all abortion-related inquiries-particularly, detailed questions relating to late-term abortions. However, such criticism does not consider that-in keeping with vital statistics tradition-CDC obtains its data through a voluntary federal-state partnership in which states are responsible for collecting and managing data in accordance with their own policies and systems, and submitting the information to the federal government. As a result, states ultimately determine the quality and availability of national, government-generated abortion data.