Between 1972 and 1982, 186 women died as a result of legal abortion in the United States. The overall death rate resulting from legal abortion dropped nearly fivefold, from 4.1 per 100,000 abortions in 1972 to 0.8 in 1982. Women who were older, black, of high parity, and had abortions at a later gestational age were at increased risk of death throughout the 11 years of surveillance. During this period, the death rate decreased for abortions at all stages of gestation; the greatest decrease was with abortions performed during the second trimester. For the entire interval, mortality rates were highest for abortions performed by hysterotomy or hysterectomy and lowest for abortions performed by curettage. Before 1977, the most common causes of abortion-related death were infection, hemorrhage, and general anesthesia complications, respectively. Thereafter, hemorrhage became the most common cause of abortion-related death, followed in number by general anesthesia complications. Our findings suggest that there has been a marked decrease in septic legal abortion deaths, but potentially preventable deaths from general anesthesia and hemorrhage remain an important concern. Use of general anesthetics during first-trimester abortions should be carefully reviewed.