Abortion Count Trends
We analyzed 752,227 abortions in Georgia between 1994 and 2016, 675,995 (89.9%) for Georgia residents and 76,232 (10.1%) for contiguous state residents. 35.3% more women from contiguous states received abortion services in Georgia in 2016 than in 1994 (3115 to 4216), although trends in individual states varied. Nearly three-fourths (70.5%) of contiguous state residents coming to Georgia for abortion came from Alabama (n = 19,689) and South Carolina (n = 34,027). Residents from North Carolina and Tennessee obtained 4409 and 14,834 abortions, respectively, in Georgia. Florida residents comprised the smallest contributor to abortions in Georgia, with only 3273 abortions over the 23-year period. Figure 1 displays the proportion of abortions for each contiguous state in Georgia.
Alabama and South Carolina residents’ reliance on Georgia for abortion services increased throughout the study period 74.8% (800 to 1398) and 99.0% (905 to 1801), respectively. Florida, North Carolina, and Tennessee residents obtaining abortions in Georgia decreased during the study period: − 44.0% (200 to 112), − 26.9% (212 to 155), and − 24.8% (998 to 750). A higher proportion of residents from all contiguous states except South Carolina sought abortions in the Atlanta region compared to elsewhere in Georgia. Women from Florida, North Carolina, and Tennessee traveled to Atlanta more than 90% of the time (91.7%, 95.7%, and 97.9%, respectively). Alabama women obtaining services went to Atlanta 71.8% of the time and South Carolina residents travelled to Atlanta 22.4% of the time.
Residents of Georgia averaged an abortion ratio of 224 over the study period, compared to a ratio of 1115 for contiguous state residents. Tennessee had the highest abortion ratio of 7159 (range 5140 to 10,464), and North Carolina had the second highest abortion ratio ranging between 4228 in 1996 and low of 641 in 2013. Alabama, Florida, and South Carolina abortion ratios remained within the range of 1405 (South Carolina, 2007) and 404 (Alabama, 2005). The abortion ratios of all states included in the study, over time, can be found in Fig. 2. These values reveal that women in contiguous states travel to Georgia more often for abortions than for delivery services.
Demographic data are displayed in Tables 1 and 2, and are categorized by state of residency and time period. When examining contiguous states separately, all exhibited similar trends in ethnicity, education, marital status, and maternal age across time. The proportion of black women receiving abortions increased for Georgia residents from 52.7% (17,351) in 1994 to 68.9% (18,110) in 2016 and for contiguous state women from 37.0% (1152) in 1994 to 60.4% (2400) in 2016. The proportion of Hispanic patients who received abortion services between 1994 and 2016 increased in each state, from 2.6 to 7.4% among Georgia residents and 0.9% to 4.5% among contiguous state residents.
Education and marital status were similar among Georgia and contiguous state residents, while the proportion of first pregnancy differed between the two populations. The proportion of college-educated women increased while the proportion of women with 9–11th grade education decreased. For both Georgia residents and contiguous state residents, abortion trends by marital status remained stable between 1994 and 2016; married women comprised 13.8–19.4% of all Georgia residents and 12.8–17.6% of all contiguous state residents obtaining abortions in Georgia annually. Both populations had similar trends for maternal age, including a decrease in the proportion of women < 20 years of age, from 18.8 to 8.6% for Georgia residents and from 28.9 to 10.4% for contiguous state residents. The proportion of primigravid women decreased steadily throughout the 23-year study period in all contiguous states, from 40.4 to 28.9%, while it remained stable (25.2–29.8%) for Georgia residents during the study period.
Across all time points, between 97.5 and 98.6% of abortion procedures took place at a gestational age of < 20 weeks for Georgia residents; this proportion ranged from 82.1 to 95.2% for contiguous state residents receiving abortions in Georgia. Only 2.0% of procedures were at ≥ 20 weeks gestational age for Georgia residents, compared with 13.8% for women from contiguous states. Figure 3 displays the percentage of abortions that were at a gestational age of ≥ 20 weeks for contiguous state residents.
Across the 23-year period, suction curettage was the most common abortion procedure, accounting for 83.7% of all procedures for Georgia residents and 60.0% for contiguous state residents. All states experienced a decrease in the use of suction curettage over time but had upticks in its use in 2006 and 2010–2011. By 2016, mifepristone had become the second-most common abortion procedure for residents of all states in the study. In 2016, the highest proportion of mifepristone use was among South Carolina residents (38.8%), and the lowest proportion was among North Carolina residents (16.1%). D&E procedures remained consistent, until 2007, when they began to increase. Figures 4 and 5 display the relative proportions of different abortion procedures for Georgia and contiguous state residents.
While Georgia and contiguous state residents had similar trends for mifepristone, curettage, and D&E, the proportional use of these methods differed at various time points. Georgia residents had the highest proportion of suction curettage in 1994 at 91.2%, which decreased to 49.8% by 2016. North Carolina residents had the lowest use of suction curettage in 1994 at 14.6%, which increased to 27.1% by 2016. D&E procedures were utilized in a lower proportion by residents from Georgia (9.8%) compared to women from contiguous states (31.9%).
Results of Statistical Testing
In all time periods, our populations were statistically significantly different for all variables, except the following instances in which the populations were not statistically significantly different for one variable in one year: marital status in 2006, 2007, 2013, 2014, and 2015; first pregnancy in 2013–2015; and education completed in 2012, 2013, and 2015.