Born Alive Abortion Reporting

The Importance of Accurate Data and What Might be Missing

You don't know what you don't know

When it comes to abortion data, contradicting news reports often publish nearly opposite opinions in the form of "facts," each claiming to possess the truth. One source explains why abortions are safe, another why they are not. Some claim abortion disproportionately affects certain races, while others claim to disprove those theories. One source is sure the populous supports abortion, and another is sure it does not.

Accurate information begins with accurate records. In order for reliable data to be gathered, reliable data must first be recorded, tracked, and tallied. When it comes to abortion, the United States is lacking sufficient records. Abortion recording requirements in the US are often either missing or else full of inconsistencies and gaps.

This analysis focuses on one specific type of abortion recording: born alive rates. Because born alive abortion rates are not effectively recorded in the United States, Canadian records are used as a case study by extrapolating data to the United States and estimating what we could be missing without accurate recording processes.   

Born alive abortions are failed abortion procedures which accidentally result in the live birth of an infant. Not all failed abortions result in a live birth, as many of them lead to a second abortion attempt. However, born alive abortions are specifically those which lead to an infant being accidentally born alive. This outcome is just one complication which the US fails to track consistently and reliably. In fact, only 10 out of 50 states require abortion facilities to report on born alive abortions.

Canada was used as a case study in this research for a few different reasons. First, healthcare in Canada is ranked relatively similarly to healthcare in the US. According to a study published by The Commonwealth Fund in 2021, Canada was ranked in 10th place and the US in 11th place for healthcare system performance throughout the world.   1   Second, Canada and the US perform mainly the same types of abortion procedures.  1.5&2  These are most often chemical or surgical and aspiration abortions. Finally, as was previously mentioned, Canada tracks born alive abortion rates more consistently than the United States.


1. Reporting Requirements and Legislation

Canada

Abortion health data from Canada is gathered by the CIHI (Canadian Institute for Health Information). The CIHI is a central government crown organization in Canada, meaning that it is both controlled by the Canadian government and has the potential to influence policy. Much of CIHI's funding comes from Health Canada, Statistics Canada, and other federal departments  2  .

CIHI abortion data is gathered through the DAD (District Abstract Database). This database acquires numbers directly from facilities or else through the territorial departments and ministers of health. Data is gathered following a method specified in the DAD Submission Manual. Facilities in the various Canadian provinces or territories are required by terittorial law to report specific data to CIHI except for those facilities in Quebec.   2  

 An inquiry was made directly to CIHI as to why Quebec is excluded. The answer: "Those breakdowns are not available in the aggregate abortion data file received by CIHI." 

The visual below shows how abortion data is collected in Canada.

The United States

Just 10 out of 50 states require reporting on infants who survive abortions. Each of these 10 states have a unique definition for what qualifies as a "born alive" infant, such as how old they must be gestationally, what signs of life they must exhibit, etc. Each of these 10 states also require different formats or processes when recording data.   3  

Here is a map of born alive reporting legislation and definitions in the US. Click on a state to see where its legal requirements can be found and what they are.

For a more detailed summary of each state's legislation, please click the link below.

Here we see a variety of definitions and legislation. Indiana does not count infants born alive during abortions unless they are further than 20 weeks gestation. On the other hand, Arizona records any infant born alive, no matter their gestational age. While some states are very specific about what it means for an infant to be born alive (umbilical cord pulsation, heartbeat, breathing, movement of voluntary muscles, etc.) other states, such as Ohio, assume that whether the infant is alive will be obvious and fail to define specifically what this means.

Out of the 10 states requiring government reports, 8 have made data for 2019 easily and publicly accessible. Born alive abortion numbers from these states have been collected by the Charlotte Lozier Institute and can be viewed below.   4  

Arizona - 15

Arkansas - 0

Florida - 2

Indiana - 0

Minnesota - 3

Oklahoma - 0

Texas - 6

 Note: Ohio's reporting legislation did not go into effect until 2022 

With such little data and variation among state legislation, it is obvious that large gaps exist in born alive abortion reporting in the US. Expansive accurate data is lacking. The director of abortion surveillance at the CDC, Dr. Willard Cates, estimated that 400-500 infants survive abortions every year.  4   The Abortion Survivors Network has come into contact with almost 600 survivors since its founding in 2012.

More information about abortion survivors, and personal stories, can be found on the Abortion Survivors Network website linked below.


2. Extrapolating Canadian Data

Here you can view cities with abortion clinics in Canada. Click on a city to see how many clinics it has and which province it serves.  5 

Canadian Cities with Abortion Clinics - Created by Alayna Shamo

Extrapolated abortion born alive rate from Canada to the United States...What might the United States be missing without thorough born alive abortion reporting requirements?

Based on the CDC's estimate of abortions per state, abortion counts were multiplied by Canada's 0.28% born alive abortion rate to estimate how many abortions resulted in a live birth in the United States in 2019.

According to this extrapolated data, the lack of effective failed abortion reporting requirements in the United States caused the overlook of approximately 1,780 born alive abortions in the year 2019 alone.

While Florida recorded 2 infants born alive after failed abortion procedures in 2019, Canadian rates suggest there could be 201 additional cases which were overlooked. Arizona recorded the highest number, at 15 born alive infants, and yet they still reported less than half of the 37 infants estimated based on Canada's 0.28% rate.


3. Conclusion

You don't know what you don't know.

Abortion is currently one of the hottest topics. Individuals and organizations on both sides of the argument make claims based on supposed "facts" gathered from data which is characterized by gaps and inconsistencies. The only way to examine accurate information is to first record accurate information. One of the most significant gaps in abortion statistics is related to born alive abortions. Few states require reporting on infants who survive abortions, and the ten who do have inconsistent definitions and record-keeping methods.

This analysis has attempted to determine what the United States could be missing by extrapolating data from a similar country--a country which does keep thorough records on infants who survive failed abortions. Canada has reporting requirements and accessible data. Geographic information systems software was used to create maps which show both Canadian statistics and United States estimates based on these statistics.

Canada's records have given some insight into what the United States could be overlooking. For the year 2019 alone, 1,780 infants are estimated to have survived failed abortions based on Canadas 0.28% rate. This number does not take into account the 3 states which fail to disclose abortion counts to the CDC (California, Maryland, and New Hampshire). Therefore, this number should realistically be even higher.

So far, public records in the US from the ten states with reporting data indicate that 26 infants survived abortions in 2019. When considering the estimate of Dr. Willard Cates, the former director of abortion surveillance at the CDC, that 400-500 infants survive abortions each year, and the 0.28% of Canadian abortions which result in a live birth, it becomes apparent that there were many more than 26 born alive infants in the US in 2019.

Every data point on these maps and every number on this page is representative of real people. Women who followed political and healthcare professionals without factual data and who may not even know that their child survived. Infants who are growing up to be adults without knowing their story and without accurate information in their birth records to make informed decisions about their healthcare. Every number in this analysis represents a person who deserved to know.

This is a gap in policy and practice that can no longer be ignored. Clearly, the United States is missing essential healthcare data for thousands of survivors who are living and working among our general public today. As some states choose to prohibit abortion, others are choosing to expand abortion and codify it in their legislation. This is a critical time. If accurate information which could influence policy and practice was ever needed, it is needed now.

Canada’s data has offered dramatic, key insights. Ultimately, however, records from the states themselves would offer a more accurate representation of abortion data. Well-written abortion recording legislation has the potential to improve our understanding of abortion, and therefore elevate the quality of abortion dialogue and policy initiatives on both sides of the aisle.


Alayna Shamo: Research and Policy Associate

The Author

Alayna Shamo is a Research and Policy Associate for the Abortion Survivors Network and Sapphire Strategies, LLC. She earned her bachelor of arts degree in political science from Brigham Young University - Idaho. You can contact Alayna at alayna@educationandpolicycenter.com.

Based on the CDC's estimate of abortions per state, abortion counts were multiplied by Canada's 0.28% born alive abortion rate to estimate how many abortions resulted in a live birth in the United States in 2019.

Alayna Shamo: Research and Policy Associate