An Ecological Analysis of Urban Therapeutic Abortion Rates
.1!
I
Emily M. Nett Department of Sociology University of Manitoba Winnipeg, Manitoba, Canada
An exploratory ecological investigation of abortion was done in Winnipeg, Manitoba, Canada, using 1971 data. Abortion patients (376) were located by census tract (104), and rates computed per thousand females aged 15-45 years. Pearsonian correlation coefficients were computed for the dependent variable and thirteen other demographic and sociocultural variables. Significant associations (at the 0.01 level) were found between abortion rates and five variables. Positive associations were found with the sex ratio, the proportion of females never married, and the proportion of one person households, and negative associations with the proportion of single family households and income level. Results being different from those of clinical studies, statistical analyses of official abortion reports, a national patient survey, and studies of background factors involved in favorable attitudes to abortion, the study suggests that the characteristics of social areas as well as of persons involved should enter into explanations of behavior as complexly motivated as therapeutic abortion. ABSTRACT:
Since 1970, the first full calendar year after the Criminal Code Amendments on Abortion came into effect in Canada, the number of abortions performed legally in "accredited hospitals" with a therapeutic abortion committee has continued to increase. The rate of increase of reported induced abortions was greatest between 1970 and 1971 when there was a change of 177.3 per cent (Canada, Minister of Supply and Services, 1977). In succeeding years there was a sharp curtailment in the pace of annual growth, which was 11.4 per cent between 1973 and 1974. Therapeutic abortions since 1969 have undoubtedly been obtained in large part for psychological, social, and socioeconomic reasons rather than on strictly medical grounds. For the most part, therapeutic abortion represents unwanted pregnancy.
records of patients who received legal abortions at selected hospitals (Boyce and Osborn, 1970; Berston et al., 1972; Saunders, 1971). Additional sources of information are the annual reports on therapeutic abortions (Canada, Statistics Canada, 1972 ff.) which describe the background of women who have undergone therapeutic abortions in Canadian hospitals. More recently, the national patient survey conducted by The Committee on the Operation of the Abortion Law (Canada, Minister of Supply and Services, 1977) obtained information about women having abortions. The women in the patient survey represented a cross-section of patients who obtained abortions in 1976. From the different sources of information about women who have abortions in Canadian hospitals, several generalities emerge. These women have a higher level of education; fewer are Catholic women and there is an overrepresentation of members of other religious groups; higher
Numerous attempts have been made to characterize the women who have abortions in Canadian hospitals. Earlier in the decade there were clinical studies based on 235
Nett
236
rates are found as the number of pregnancies increases; there appears to be failure of women involved in abortion to have used contraceptive precautions or to use them correctly (but not due to ignorance or lack of exposure to such information); and, as a recent trend, higher rates are found among younger ages and unmarried. To my knowledge, no ecological study of the factors associated with abortion has been reported (see appendix of References, Canada, Minister of Supply and Services, 1977; Adams, 1973). This paper reports an investigation to determine whether abortion rates are related to the social characteristics of areas of the city as well as being more prevalent among patients with the characteristics cited above. The study is exploratory in nature, attempting to utilize a method which has been productive in providing explanations for a wide variety of social phenomena, including mental illness (Faris and Dunham, 1939; Redick and Goldsmith, 1972), crime and delinquency (Cressey, 1960), mortality (Quinney, 1964; Schwirian and Lagreca, 1971), and morbidity (Mabry, 19S8; Pollack et al., 1968). MATERIALS AND METHODS The procedure used was (1) to determine the distribution of abortion rates for 1971, by census tracts, in the city of Winnipeg, Manitoba, and (2) to relate the abortion rates to selected social and demographic characteristics of the 104 census tracts in the metropolitan area. Aside from the fact that the investigator was located in Winnipeg, the city had several advantages. It is sufficiently large and heterogeneous to provide a sizeable number of units (census tracts) to use in the statistical analysis; almost all abortions in 1971 were performed in one hospital which meant that one set of records could be used; and the Records Department of the
Social Biology
hospital was willing to make the records available to the investigator for the purpose of obtaining the permanent addresses of patients who had had a therapeutic abortion. The year 1971, the second year following the change of law, was chosen because it was the first year since 1966 for which census information was available.1 Addresses of the 376 Winnipeg patients who had had an abortion in 1971 were taken from the records.2 Each abortion performed was then plotted on a map of the city, by census tract, and the rates for each of the 104 census tracts were computed in the following manner: Abortion rate _ total number of abortions, 1971 total females, ages 15-45 years X 1,000. The average rate for the 104 census tracts was 3.4 abortions, with a standard deviation of 2.6. The map in Figure 1 shows the distribution by census tract. The seventeen census tracts with rates of 6.0 or more abortions per 1,000 females at risk were Tracts 3, 7, 8, 13, 15, 20, 24, 35, 43, 45, 46, 47, 113, 132, 532, 541, and 553. All but the last five are located in the inner city. Family Planning Clinics with abortion counseling were located in Tracts 15, 25, 27, 35, and 46, as indicated on the map. Rates of over 9.0 abortions per 1,000 females at risk (two standard deviations away from the statistical mean) were found in five census tracts, Nos. 13, 24, 46, 113, and 532.3 1 In retrospect a better method may have been to compute averages for 1970, 1971, and 1972 abortions, births, and illegitimate births for each census tract, thus eliminating chance fluctuations that occur in 2any given year. Excluded from the study were patients who gave addresses that were (1) out of province or out of the country, (2) in Manitoba towns and cities other than Winnipeg, and (3) rural route numbers which could not3 be located on the map of Winnipeg. The proximity of these census tracts to those in which Family Planning Clinics were located raises a
Vol. 25, No. 3
Urban Abortion Rates
237
FIG. 1.—Map of abortion rates for Winnipeg by census tract, 1971. Inner City Limits Family Planning Clinic 9 or more abortions per 1,000 women at risk 6-8 abortions per 1,000 women at risk 2-5 abortions per 1,000 women at risk 0-1 abortions per 1,000 women at risk
The lowest rates, 1.0 or less per 1,000 women at risk, were found in Tracts 31, 33, 36, 40, 41, SI, 103, 111, 112, 120, 502, S10, 531, 538, 539, 540. All except the first six are located outside the inner city, or in the suburbs. In addition to abortion rates, thirteen other demographic and sociocultural variables were selected for the study. The methodological problem which cannot be entirely resolved. I refer to the effect of the counseling at those clinics on the abortion rate in the same and neighboring census tracts. In future investigations, distance from counseling facilities might be included as an independent variable.
General Fertility Rate (total number of births in each census tract registered in 1971, divided by total number of women 15-44 years, times 1,000) and the Illegitimacy Rate (total number of illegitimate births in each census tract, divided by the total number of unmarried women 15-44 years, times 1,000) were computed for each of the 49 statistical districts in Winnipeg for which information was available from the Winnipeg Health Department. From the Census Tract Bulletins for Winnipeg (Canada, Minister of Industry, Trade, and Commerce, 1973,
Nett
Social Biology
The matrix of Pearsonian correlations, along with an indication of significant values, is presented in Table 1. Five of the thirteen census tract characteristics were significantly associated with Abortion Rates (AR) for the areas. They were as follows: Sex Ratio (SR); Proportion Females Never Married (FNM); Proportion One Person Households (OPH); Proportion of Single Family Households (SFH), negatively; and Income Level (IL), negatively.
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With the abortion rate as the dependent variable and the thirteen demographic and sociocultural measures as independent variables, Pearsonian correlation coefficients were computed. The level of 0.01 was accepted for tests of significance.
TRA TS, 1!
1974) information was obtained from which the following measures were computed for each of the 104 census tracts: Child/Woman Ratio (children under six years, divided by total number of women in the childbearing years, times 1,000); Sex Ratio (total males 15-44 years, divided by females 15-44 years, times 1,000); Proportion of Never-married Females (in the childbearing years); Proportion of One Person Households; Proportion of Single Family Households; Proportion of Catholics; Proportion of Foreign-born (after 1945); Ratio of Migrants/Nonmigrants; Education Ratio (university-educated divided by Grade 8 and under); Income Level (average total income per household); and Female labor Force Participation Rate (females 15 years and over in the labor force, divided by total females 15 years and over, times 1,000).
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Vol. 25, No. 3
Urban Abortion Rates
significantly correlated with Abortion Rates, the two indicators of household, One Person Households (OPH) and Single Family Households (SFH), correlated significantly with nine of the variables; Income Level (IL), with seven; Females Never Married (FNM), with six; and Sex Ratio (SR), with three. Detailed examination of these intercorrelations reveals certain patterns. One Person Households (OPH) is associated with Females Never Married (FNM), Illegitimacy Rate (IR), General Fertility Rate (GFR), Proportion Catholic (C), Proportion Foreign-born (F-B), Female Labor Force Participation Rate (FLFP); and negatively with Child/Woman Ratio (C/ WR), Single Family Households (SFH), and Income Level (IL). Single Family Households (SFH) is correlated negatively with Females Never Married (FNM), Illegitimacy Rate (IR), General Fertility Rate (GFR), One Person Households (OPH), Proportion Catholic (C), Proportion Foreign-born (F-B), Female Labor Force Participation Rate (FLFP); and positively with Child/Woman Ratio (C/WR) and Income Level (IL). Income Level (IL) is correlated negatively with Illegitimacy Rate (IR), General Fertility Rate (GFR), One Person Households (OPH), Education Ratio (ER), Proportion Catholic (C), and Proportion Foreign-born (F-B); it correlates positively with Single Family Households (SFH). Proportion of Females Never Married (FNM) correlates with the following six variables: negatively with Sex Ratio (SR), Child/Woman Ratio (C/WR), and Single Family Households (SFH); and positively with One Person Households (OPH), Migrant/Nonmigrant Ratio (M/NM), and Female Labor Force Participation Rate (FLFP). Some of the highest r's occur in association with this variable. And finally, Sex Ratio (SR) correlates with Females Never Married (FNM),
239
negatively, and with Illegitimacy Rate (IR) and Child/Woman Ratio (C/WR). INDEPENDENT VARIABLES NOT SIGNIFICANTLY RELATED TO ABORTION
Some of the variables not associated with abortion rates were correlated significantly with the other independent variables as can be noted above. Among them are Illegitimacy Rate (with ten variables), Child/Woman Ratio (with eight), General Fertility Rate (with seven); and Education Ratio (with seven). Lower numbers of associated variables exist for Proportion Catholic (six), Proportion Foreign-born (the same six as for C), Female Labor Force Participation Rate (six), and Migrant/Nonmigrant Ratio (two). DISCUSSION
Abortions in Winnipeg in 1971 were not randomly distributed throughout the city; they occurred more frequently to women in areas of the city with certain social characteristics. High rates of abortion were generally found in the census tracts of the inner city. A few abortions were performed on women located in the suburbs, which for the most part had the lowest rates. The highest rates of all were found in the notorious "Main Street" and adjacent area, with its bars, cheap hotels, and public housing project. Census tract characteristics associated with abortion are (1) a high proportion of persons residing alone, (2) a low proportion of single family dwellings, (3) low average household income, (4) more men than women in the childbearing ages, and (5) a high proportion of women in the childbearing ages who had never married. Although abortion does not appear to be significantly associated with illegitimacy, a low birth rate, or a high ratio of children under six years to women in the childbearing years, these fertility factors are in turn
240
Nett
Social Biology
associated with both one person and multiple family households, as well as with a low level of income. Two of them, illegitimacy and a high child-woman ratio, are associated with a sex ratio imbalanced in favor of males. The birth rate (GFR) accounts for 64 per cent of the variance in illegitimacy (r = 0.80). Additionally, female labor force participation, although not itself a factor in abortion, tends to be higher in census tracts with some of the characteristics associated with abortion, notably other types of housing than single family residence and a high proportion of single females. Also found in those census tracts where housing and income are poor (two factors associated with abortion) are high proportions both of foreign-born and Catholics, two variables themselves not significantly related to each other, but similarly associated with the remaining variables. One of the most interesting aspects of this investigation is that the results of ecological analysis are quite dissimilar from the findings of studies on the characteristics of abortion patients (Boyce and Osborn, 1970; Berston et al., 1972; Saunders, 1971; Canada, Statistics Canada, 197 2ff; Canada, Minister of Supply and Services, 1977). They are also dissimilar from the findings of investigations which have described populations in terms of their attitudes toward abortion.4 The fact that the several approaches to abortion reveal different associated factors does not mean that one is "correct" and the others "incorrent." On the contrary, it would seem to indicate that to understand so multifaceted an issue as abortion many perspectives are required. Attitudes of
various segments of the population, backgrounds of individual patients, and residential characteristics combined should give a more comprehensive picture of the conditions under which abortion becomes a choice for an unwanted pregnancy. The fact that abortion patients (and persons generally favorable to abortion in polls and surveys) tend to be higher in socioeconomic status and non-Catholic, whereas abortion areas in the city are low in income level and more heavily Catholic, for example, are not necessarily contradictory findings. Aside from the well-known fact that attitudes and behaviors do not always coincide, it could mean that this is a situation similar to that discovered by Trute and Segal (1977) in their study of mental patients discharged to sheltered care facilities. They found census tract indicators of environmental circumstances surrounding the residence rather than personal characteristics to be strongly related to an individual's level of social integration. Specific to abortion, it is possible that the single woman, residing without family supervision or kin ties in an inner city neighborhood (characterized by low income and the associated factors of low education, high proportions of foreignborn, and high proportions of Catholics as well as both high birth rates and illegitimacy rates) is herself in the labor force, educated, and non-Catholic.5 In terms of her personal profile she is more likely to risk pregnancy, to be more favorable toward abortion, and therefore she is more likely to terminate an unwanted pregnancy. This hypothetical reconstruction, which is only one of several possible "explana-
4 On positive attitudes of higher income levels, see Balakrishnan et al., 1975, and Lipson and Wolman, 1972. On positive attitudes of the better educated, see Boydell and Grindstaff, 1971, and Rao, 1974. On negative attitudes and Catholic religiosity, see Arney and Trescher, 1976; Blake, 1971, 1973; Clayton and Talone 1973; Hedderson et al., 1974; Henripin and Lapierre-Adamcyk, 1974; Westoff et al., 1969.
5 The high proportion of persons with Grade 8 or less relative to the university educated, while not significantly associated with abortion rates in the census tracts, is certainly important in aggregate fertility patterns. As Table 1 shows, the education ratio is significantly related to the other three kinds of fertility behavior—the birth rate (GFR), the childwoman ratio, and the illegitimacy rate.
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Urban Abortion Rates
241
tions," requires two further comments. One concerns the abortion data themselves. The assumption may be questioned that the permanent address given by a patient upon entering the hospital, which is located in Tract 27, was a correct one. Establishing the validity of the data would have been difficult considering the twoyear interval between abortion and use of the records, but the researcher finds it hard to see what motives a patient already identified by name would have in falsifying her address for hospital records. The second matter is the possible inference of a middle-class bias in the "explanation" for the apparent differences between aggregate and individual characterizations of abortion predisposition. There is no intention of implying that the response of lower-income persons to available medical care for preventative services is negligible. On the contrary, studies made in the United States, summarized in Harkavey et al. (1969) indicated that "when modern family planning services are offered with dignity and energy, the response of the poor has been considerable."
Even prior to the application of more sophisticated techniques of analysis and more inclusive factors, it is obvious that the approach can provide useful information relevant to the practical and moral issues centering around education and policy in this area of social behavior. At the simplest level, merely knowing the location of women likely to have abortions should be helpful for decisions about where to locate family planning clinics or mobile units. Beyond this, knowing the social characteristics of areas with high abortion rates should provide some insights into the kinds of birth planning educational programs most likely to be effective in reaching the population in those areas. And finally, ecological findings about the relationship between various attributes of neighborhoods and abortion rates further recall that personal behaviors are very closely tied to social conditions. It serves as a reminder that not only educating persons, but also improving the quality of personal, family, and community life is important if fertility behavior is to be altered.
The general conclusion of this preliminary study is that abortion differentials can be explained in terms of the structure of population aggregates as well as with reference to patient background and experience. With a factor analysis it may be possible to determine more precisely the nature of the associations between demographic, social, and cultural conditions, as represented by the selected measures introduced into the correlation matrix of this study. It suggests an investigation by census tracts of the women who have abortions.
ACKNOWLEDGMENTS This investigation was initially funded by a University of Manitoba research grant, January-March, 1973. Thanks are due to the following persons who provided cooperation and assistance in various aspects of the project: Mr. Robert A. Mac Gregor, Research Assistant (1973), and Professor Abdel Latif, both of the Department of Sociology, University of Manitoba; Mr. Scringer, Administration Branch, City of Winnipeg Health Department; Miss R. Ostopovich, Records Department, Winnipeg General Hospital; and Dr. T. M. Roulston, Obstetrics and Gynecology, University of Manitoba.
REFERENCES in attitudes toward abortion, 1972-1975. Fam. ADAMS, D. 1973. Therapeutic abortion: An annoPlan. Persp. 8:117-124. tated bibliography. McMaster University Medical Centre, Hamilton. BALAKRISHNAN, T. R., J. E. KANTNER, and J. D. ALLINGHAM. 1975. Fertility and family planning ARNEY, W. R., and W. H. TRESCHER. 1976. Trends
242
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in a Canadian metropolis. McGill-Queen's Univ. Press, Montreal. BERNSTON, L., and J. CAMERON, M. DIVORKIND, G. JOHNSON, and L. LAWSON. 1972. The
abortion patient. McGill Med. J. 4 1 (Fall):3-9. BLAKE, J. 1971. Abortion and public opinion: The 1960-1971 decade. Science 171:540-555. . 1973. Elective abortion and reluctant citizenry: Research on public opinion in the United States, p. 447-467. In H. J. Osofsky and J. D. Osofsky (eds.), The abortion experience. Harper and Row, New York. BLASI, A., P. J. MACNEIL, and R. O'NEIL. 1975.
The relationship between abortion attitudes and Catholic religiosity. Soc. Sci. 50:34-39. BOYCE, R. M., and R. W. OSBORN. 1970. Thera-
peutic abortion in a Canadian city. Canad. Med. Assoc. J. 103:310-327. BOYDELL, C. L., and C. F. GRINDSTAFF. 1971.
Public attitudes toward legal sanctions for drug and abortion offences. Canad. J. Criminol. Correct. 13:209-232. CANADA. MINISTER OF INDUSTRY, TRADE, AND
COMMERCE. 1973. Census of Canada, 1971. Population and housing characteristics, Winnipeg. Census Tract Bulletin, Series A. Ottawa. . 1974. Census of Canada, 1971. Population and Housing Characteristics, Winnipeg. Census Tract Bulletin, Series B. Ottawa.
Social Biology
HEDDERSON, J., L. G. HODGSON, M. BROGAN, and
T. CROWLEY. 1974. Determinants of abortion attitudes in the United States in 1972. Cornell J. Soc. Relat. 9:261-276. HENRIPIN, J., and E. LAPIERRE-ADAMCYK. 1974.
La fin de la revanche des berceaux: Ou'en pensent les Quebecoises? Les Prenses de l'Université de Montreal, Montreal. HOSPITAL ADMINISTRATION IN CANADA. 1972. The
care and treatment of therapeutic abortion patients in Canadian hospitals, Jan. 1 to Sep. 30, 1971: A nation-wide survey. March, pp. 25-31. LIPSON, G., and D. WOLMAN. 1972. Polling Amer-
icans on birth control and population. Fain. Plann. Persp. 4:39-42. MABRY, J. H. 1958. Some ecological contributions to epidemiology, p. 49-54. In E. G. Jaco (ed.), Patients, physicians and illness. The Free Press, Glencoe, Ill. MILETI, D. S., and L. D. BARNETT. 1972. Nine
demographic factors and their relationship toward abortion legalization. Soc. Biol. 19:43-50. POLLACK, E. S., R. W. REDICK, and C. A. TAUBE.
1968. The application of census socioeconomic and familial data to the study of morbidity from mental disorders. Amer. J. Publ. Hlth. 58:83-89. QUINNEY, R. 1964. Mortality differentials in a metropolitan area. Soc. Forc. 43(Dec.):222-230. RAO, S. L. N., and L. F. BOUVIER. 1974. Socioeco-
1977. Report of the Committee on the Operation of the Abortion Law. Ottawa.
nomic correlates of attitude toward abortion in Rhode Island, 1971. Amer. J. Publ. Hlth. 64:765-774.
CANADA. STATISTICS CANADA. 1972. Therapeutic
REDICK, R. W., and H. F. GOLDSMITH. 1972. 1970
CANADA. MINISTER OF SUPPLY AND SERVICES.
abortion, 1971. Department of Industry, Trade and Commerce, Ottawa. (For subsequent years, annually.)
census data used to indicate areas with different potentials for mental health and related problems. Methodology Reports, Series C., No. 3. National CLAYTON, R. and W. L. TALONE. 1973. Religiosity Institute of Mental Health, Bethesda, Md. and attitudes toward induced abortion: An elab- SAUER, R. 1974. Attitudes to abortion in America, oration of the relationship. Sociol. Anal. 34:27-39. 1800-1973. Pop. Stud. 28:53-67. CLAUSEN, J. A., and M. L. KOHN. 1954. An ecologi- SAUNDERS, T. C. 1971. Therapeutic abortion. cal approach to social psychiatry. Amer. J. Sociol. Canad. Med. Assoc. J. 108(Sept. 18): 638-639. 60(Sept.): 140-149. CRESSEY, D. R. 1960. Epidemiology and individual SCHWIRIAN, K. P., and A. J. LAGRECA. 1971. An ecological analysis of urban mortality rates. Soc. conduct: A case from criminology. Pacif. Sociol. Sci. Quart. 51(Dec.):574-587. Rev. 3(Fall):47. FARIS, R. E. L., and H. W. DUNHAM. 1939. Mental
TRUTE, B. and S. P. SEGAL. 1976. Census tract
disorders in urban areas. Univ. of Chicago Press, Chicago.
predictors and social integration of sheltered care residents. Soc. Psychiat. 11(4): 153-162.
HARKAVEY, O., F. S. JAFFE, and S. M. WISHIK.
WESTOFF, C. F., E. C. MOORE, and N. B. RYDER.
1969. Family planning and public policy: Who is misleading whom? Science 25(July):367-373.
1969. The structure of attitudes toward abortion. Milbank Mem. Fund Quart. 47:11-37.
.1!
I
Emily M. Nett Department of Sociology University of Manitoba Winnipeg, Manitoba, Canada
An exploratory ecological investigation of abortion was done in Winnipeg, Manitoba, Canada, using 1971 data. Abortion patients (376) were located by census tract (104), and rates computed per thousand females aged 15-45 years. Pearsonian correlation coefficients were computed for the dependent variable and thirteen other demographic and sociocultural variables. Significant associations (at the 0.01 level) were found between abortion rates and five variables. Positive associations were found with the sex ratio, the proportion of females never married, and the proportion of one person households, and negative associations with the proportion of single family households and income level. Results being different from those of clinical studies, statistical analyses of official abortion reports, a national patient survey, and studies of background factors involved in favorable attitudes to abortion, the study suggests that the characteristics of social areas as well as of persons involved should enter into explanations of behavior as complexly motivated as therapeutic abortion. ABSTRACT:
Since 1970, the first full calendar year after the Criminal Code Amendments on Abortion came into effect in Canada, the number of abortions performed legally in "accredited hospitals" with a therapeutic abortion committee has continued to increase. The rate of increase of reported induced abortions was greatest between 1970 and 1971 when there was a change of 177.3 per cent (Canada, Minister of Supply and Services, 1977). In succeeding years there was a sharp curtailment in the pace of annual growth, which was 11.4 per cent between 1973 and 1974. Therapeutic abortions since 1969 have undoubtedly been obtained in large part for psychological, social, and socioeconomic reasons rather than on strictly medical grounds. For the most part, therapeutic abortion represents unwanted pregnancy.
records of patients who received legal abortions at selected hospitals (Boyce and Osborn, 1970; Berston et al., 1972; Saunders, 1971). Additional sources of information are the annual reports on therapeutic abortions (Canada, Statistics Canada, 1972 ff.) which describe the background of women who have undergone therapeutic abortions in Canadian hospitals. More recently, the national patient survey conducted by The Committee on the Operation of the Abortion Law (Canada, Minister of Supply and Services, 1977) obtained information about women having abortions. The women in the patient survey represented a cross-section of patients who obtained abortions in 1976. From the different sources of information about women who have abortions in Canadian hospitals, several generalities emerge. These women have a higher level of education; fewer are Catholic women and there is an overrepresentation of members of other religious groups; higher
Numerous attempts have been made to characterize the women who have abortions in Canadian hospitals. Earlier in the decade there were clinical studies based on 235
Nett
236
rates are found as the number of pregnancies increases; there appears to be failure of women involved in abortion to have used contraceptive precautions or to use them correctly (but not due to ignorance or lack of exposure to such information); and, as a recent trend, higher rates are found among younger ages and unmarried. To my knowledge, no ecological study of the factors associated with abortion has been reported (see appendix of References, Canada, Minister of Supply and Services, 1977; Adams, 1973). This paper reports an investigation to determine whether abortion rates are related to the social characteristics of areas of the city as well as being more prevalent among patients with the characteristics cited above. The study is exploratory in nature, attempting to utilize a method which has been productive in providing explanations for a wide variety of social phenomena, including mental illness (Faris and Dunham, 1939; Redick and Goldsmith, 1972), crime and delinquency (Cressey, 1960), mortality (Quinney, 1964; Schwirian and Lagreca, 1971), and morbidity (Mabry, 19S8; Pollack et al., 1968). MATERIALS AND METHODS The procedure used was (1) to determine the distribution of abortion rates for 1971, by census tracts, in the city of Winnipeg, Manitoba, and (2) to relate the abortion rates to selected social and demographic characteristics of the 104 census tracts in the metropolitan area. Aside from the fact that the investigator was located in Winnipeg, the city had several advantages. It is sufficiently large and heterogeneous to provide a sizeable number of units (census tracts) to use in the statistical analysis; almost all abortions in 1971 were performed in one hospital which meant that one set of records could be used; and the Records Department of the
Social Biology
hospital was willing to make the records available to the investigator for the purpose of obtaining the permanent addresses of patients who had had a therapeutic abortion. The year 1971, the second year following the change of law, was chosen because it was the first year since 1966 for which census information was available.1 Addresses of the 376 Winnipeg patients who had had an abortion in 1971 were taken from the records.2 Each abortion performed was then plotted on a map of the city, by census tract, and the rates for each of the 104 census tracts were computed in the following manner: Abortion rate _ total number of abortions, 1971 total females, ages 15-45 years X 1,000. The average rate for the 104 census tracts was 3.4 abortions, with a standard deviation of 2.6. The map in Figure 1 shows the distribution by census tract. The seventeen census tracts with rates of 6.0 or more abortions per 1,000 females at risk were Tracts 3, 7, 8, 13, 15, 20, 24, 35, 43, 45, 46, 47, 113, 132, 532, 541, and 553. All but the last five are located in the inner city. Family Planning Clinics with abortion counseling were located in Tracts 15, 25, 27, 35, and 46, as indicated on the map. Rates of over 9.0 abortions per 1,000 females at risk (two standard deviations away from the statistical mean) were found in five census tracts, Nos. 13, 24, 46, 113, and 532.3 1 In retrospect a better method may have been to compute averages for 1970, 1971, and 1972 abortions, births, and illegitimate births for each census tract, thus eliminating chance fluctuations that occur in 2any given year. Excluded from the study were patients who gave addresses that were (1) out of province or out of the country, (2) in Manitoba towns and cities other than Winnipeg, and (3) rural route numbers which could not3 be located on the map of Winnipeg. The proximity of these census tracts to those in which Family Planning Clinics were located raises a
Vol. 25, No. 3
Urban Abortion Rates
237
FIG. 1.—Map of abortion rates for Winnipeg by census tract, 1971. Inner City Limits Family Planning Clinic 9 or more abortions per 1,000 women at risk 6-8 abortions per 1,000 women at risk 2-5 abortions per 1,000 women at risk 0-1 abortions per 1,000 women at risk
The lowest rates, 1.0 or less per 1,000 women at risk, were found in Tracts 31, 33, 36, 40, 41, SI, 103, 111, 112, 120, 502, S10, 531, 538, 539, 540. All except the first six are located outside the inner city, or in the suburbs. In addition to abortion rates, thirteen other demographic and sociocultural variables were selected for the study. The methodological problem which cannot be entirely resolved. I refer to the effect of the counseling at those clinics on the abortion rate in the same and neighboring census tracts. In future investigations, distance from counseling facilities might be included as an independent variable.
General Fertility Rate (total number of births in each census tract registered in 1971, divided by total number of women 15-44 years, times 1,000) and the Illegitimacy Rate (total number of illegitimate births in each census tract, divided by the total number of unmarried women 15-44 years, times 1,000) were computed for each of the 49 statistical districts in Winnipeg for which information was available from the Winnipeg Health Department. From the Census Tract Bulletins for Winnipeg (Canada, Minister of Industry, Trade, and Commerce, 1973,
Nett
Social Biology
The matrix of Pearsonian correlations, along with an indication of significant values, is presented in Table 1. Five of the thirteen census tract characteristics were significantly associated with Abortion Rates (AR) for the areas. They were as follows: Sex Ratio (SR); Proportion Females Never Married (FNM); Proportion One Person Households (OPH); Proportion of Single Family Households (SFH), negatively; and Income Level (IL), negatively.
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With the abortion rate as the dependent variable and the thirteen demographic and sociocultural measures as independent variables, Pearsonian correlation coefficients were computed. The level of 0.01 was accepted for tests of significance.
TRA TS, 1!
1974) information was obtained from which the following measures were computed for each of the 104 census tracts: Child/Woman Ratio (children under six years, divided by total number of women in the childbearing years, times 1,000); Sex Ratio (total males 15-44 years, divided by females 15-44 years, times 1,000); Proportion of Never-married Females (in the childbearing years); Proportion of One Person Households; Proportion of Single Family Households; Proportion of Catholics; Proportion of Foreign-born (after 1945); Ratio of Migrants/Nonmigrants; Education Ratio (university-educated divided by Grade 8 and under); Income Level (average total income per household); and Female labor Force Participation Rate (females 15 years and over in the labor force, divided by total females 15 years and over, times 1,000).
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238
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Vol. 25, No. 3
Urban Abortion Rates
significantly correlated with Abortion Rates, the two indicators of household, One Person Households (OPH) and Single Family Households (SFH), correlated significantly with nine of the variables; Income Level (IL), with seven; Females Never Married (FNM), with six; and Sex Ratio (SR), with three. Detailed examination of these intercorrelations reveals certain patterns. One Person Households (OPH) is associated with Females Never Married (FNM), Illegitimacy Rate (IR), General Fertility Rate (GFR), Proportion Catholic (C), Proportion Foreign-born (F-B), Female Labor Force Participation Rate (FLFP); and negatively with Child/Woman Ratio (C/ WR), Single Family Households (SFH), and Income Level (IL). Single Family Households (SFH) is correlated negatively with Females Never Married (FNM), Illegitimacy Rate (IR), General Fertility Rate (GFR), One Person Households (OPH), Proportion Catholic (C), Proportion Foreign-born (F-B), Female Labor Force Participation Rate (FLFP); and positively with Child/Woman Ratio (C/WR) and Income Level (IL). Income Level (IL) is correlated negatively with Illegitimacy Rate (IR), General Fertility Rate (GFR), One Person Households (OPH), Education Ratio (ER), Proportion Catholic (C), and Proportion Foreign-born (F-B); it correlates positively with Single Family Households (SFH). Proportion of Females Never Married (FNM) correlates with the following six variables: negatively with Sex Ratio (SR), Child/Woman Ratio (C/WR), and Single Family Households (SFH); and positively with One Person Households (OPH), Migrant/Nonmigrant Ratio (M/NM), and Female Labor Force Participation Rate (FLFP). Some of the highest r's occur in association with this variable. And finally, Sex Ratio (SR) correlates with Females Never Married (FNM),
239
negatively, and with Illegitimacy Rate (IR) and Child/Woman Ratio (C/WR). INDEPENDENT VARIABLES NOT SIGNIFICANTLY RELATED TO ABORTION
Some of the variables not associated with abortion rates were correlated significantly with the other independent variables as can be noted above. Among them are Illegitimacy Rate (with ten variables), Child/Woman Ratio (with eight), General Fertility Rate (with seven); and Education Ratio (with seven). Lower numbers of associated variables exist for Proportion Catholic (six), Proportion Foreign-born (the same six as for C), Female Labor Force Participation Rate (six), and Migrant/Nonmigrant Ratio (two). DISCUSSION
Abortions in Winnipeg in 1971 were not randomly distributed throughout the city; they occurred more frequently to women in areas of the city with certain social characteristics. High rates of abortion were generally found in the census tracts of the inner city. A few abortions were performed on women located in the suburbs, which for the most part had the lowest rates. The highest rates of all were found in the notorious "Main Street" and adjacent area, with its bars, cheap hotels, and public housing project. Census tract characteristics associated with abortion are (1) a high proportion of persons residing alone, (2) a low proportion of single family dwellings, (3) low average household income, (4) more men than women in the childbearing ages, and (5) a high proportion of women in the childbearing ages who had never married. Although abortion does not appear to be significantly associated with illegitimacy, a low birth rate, or a high ratio of children under six years to women in the childbearing years, these fertility factors are in turn
240
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Social Biology
associated with both one person and multiple family households, as well as with a low level of income. Two of them, illegitimacy and a high child-woman ratio, are associated with a sex ratio imbalanced in favor of males. The birth rate (GFR) accounts for 64 per cent of the variance in illegitimacy (r = 0.80). Additionally, female labor force participation, although not itself a factor in abortion, tends to be higher in census tracts with some of the characteristics associated with abortion, notably other types of housing than single family residence and a high proportion of single females. Also found in those census tracts where housing and income are poor (two factors associated with abortion) are high proportions both of foreign-born and Catholics, two variables themselves not significantly related to each other, but similarly associated with the remaining variables. One of the most interesting aspects of this investigation is that the results of ecological analysis are quite dissimilar from the findings of studies on the characteristics of abortion patients (Boyce and Osborn, 1970; Berston et al., 1972; Saunders, 1971; Canada, Statistics Canada, 197 2ff; Canada, Minister of Supply and Services, 1977). They are also dissimilar from the findings of investigations which have described populations in terms of their attitudes toward abortion.4 The fact that the several approaches to abortion reveal different associated factors does not mean that one is "correct" and the others "incorrent." On the contrary, it would seem to indicate that to understand so multifaceted an issue as abortion many perspectives are required. Attitudes of
various segments of the population, backgrounds of individual patients, and residential characteristics combined should give a more comprehensive picture of the conditions under which abortion becomes a choice for an unwanted pregnancy. The fact that abortion patients (and persons generally favorable to abortion in polls and surveys) tend to be higher in socioeconomic status and non-Catholic, whereas abortion areas in the city are low in income level and more heavily Catholic, for example, are not necessarily contradictory findings. Aside from the well-known fact that attitudes and behaviors do not always coincide, it could mean that this is a situation similar to that discovered by Trute and Segal (1977) in their study of mental patients discharged to sheltered care facilities. They found census tract indicators of environmental circumstances surrounding the residence rather than personal characteristics to be strongly related to an individual's level of social integration. Specific to abortion, it is possible that the single woman, residing without family supervision or kin ties in an inner city neighborhood (characterized by low income and the associated factors of low education, high proportions of foreignborn, and high proportions of Catholics as well as both high birth rates and illegitimacy rates) is herself in the labor force, educated, and non-Catholic.5 In terms of her personal profile she is more likely to risk pregnancy, to be more favorable toward abortion, and therefore she is more likely to terminate an unwanted pregnancy. This hypothetical reconstruction, which is only one of several possible "explana-
4 On positive attitudes of higher income levels, see Balakrishnan et al., 1975, and Lipson and Wolman, 1972. On positive attitudes of the better educated, see Boydell and Grindstaff, 1971, and Rao, 1974. On negative attitudes and Catholic religiosity, see Arney and Trescher, 1976; Blake, 1971, 1973; Clayton and Talone 1973; Hedderson et al., 1974; Henripin and Lapierre-Adamcyk, 1974; Westoff et al., 1969.
5 The high proportion of persons with Grade 8 or less relative to the university educated, while not significantly associated with abortion rates in the census tracts, is certainly important in aggregate fertility patterns. As Table 1 shows, the education ratio is significantly related to the other three kinds of fertility behavior—the birth rate (GFR), the childwoman ratio, and the illegitimacy rate.
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Urban Abortion Rates
241
tions," requires two further comments. One concerns the abortion data themselves. The assumption may be questioned that the permanent address given by a patient upon entering the hospital, which is located in Tract 27, was a correct one. Establishing the validity of the data would have been difficult considering the twoyear interval between abortion and use of the records, but the researcher finds it hard to see what motives a patient already identified by name would have in falsifying her address for hospital records. The second matter is the possible inference of a middle-class bias in the "explanation" for the apparent differences between aggregate and individual characterizations of abortion predisposition. There is no intention of implying that the response of lower-income persons to available medical care for preventative services is negligible. On the contrary, studies made in the United States, summarized in Harkavey et al. (1969) indicated that "when modern family planning services are offered with dignity and energy, the response of the poor has been considerable."
Even prior to the application of more sophisticated techniques of analysis and more inclusive factors, it is obvious that the approach can provide useful information relevant to the practical and moral issues centering around education and policy in this area of social behavior. At the simplest level, merely knowing the location of women likely to have abortions should be helpful for decisions about where to locate family planning clinics or mobile units. Beyond this, knowing the social characteristics of areas with high abortion rates should provide some insights into the kinds of birth planning educational programs most likely to be effective in reaching the population in those areas. And finally, ecological findings about the relationship between various attributes of neighborhoods and abortion rates further recall that personal behaviors are very closely tied to social conditions. It serves as a reminder that not only educating persons, but also improving the quality of personal, family, and community life is important if fertility behavior is to be altered.
The general conclusion of this preliminary study is that abortion differentials can be explained in terms of the structure of population aggregates as well as with reference to patient background and experience. With a factor analysis it may be possible to determine more precisely the nature of the associations between demographic, social, and cultural conditions, as represented by the selected measures introduced into the correlation matrix of this study. It suggests an investigation by census tracts of the women who have abortions.
ACKNOWLEDGMENTS This investigation was initially funded by a University of Manitoba research grant, January-March, 1973. Thanks are due to the following persons who provided cooperation and assistance in various aspects of the project: Mr. Robert A. Mac Gregor, Research Assistant (1973), and Professor Abdel Latif, both of the Department of Sociology, University of Manitoba; Mr. Scringer, Administration Branch, City of Winnipeg Health Department; Miss R. Ostopovich, Records Department, Winnipeg General Hospital; and Dr. T. M. Roulston, Obstetrics and Gynecology, University of Manitoba.
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