Abortion rate declines to historic low, with Obamacare a likely contributor, study says
Family planning protest
Photo: Planned Parenthood supporters in Los Angeles in 2015. (Nick Ut / Associated Press)
The U.S. abortion rate has hit its lowest point since the procedure became legal nationwide in 1973, according to a new study.
The researchers estimated that there were 926,200 abortions in 2014, or 14.6 abortions for every 1,000 women of reproductive age. That was down 14% from three years earlier.
“We saw declines in abortion in almost every single state,” said Jenna Jerman, a public health researcher at the Guttmacher Institute, a reproductive rights think tank in New York, and a coauthor of the study, which was published Tuesday in the journal Perspectives on Sexual and Reproductive Health.
Though the study did not look at the reasons for the decline, the authors and other experts suggested that improved access to contraception played the biggest role by preventing unintended pregnancies.
“We don’t think it’s because people are having less sex,” said Dr. Diane Horvath-Cosper, an obstetrician with the New York-based group Physicians for Reproductive Health who was not involved in the study. “It’s because people are protecting from pregnancy better than they used to.”
Research has shown a large increase in the use of IUDs and implants that release hormones — highly effective, long-acting methods that in recent years have become more affordable and been deemed safe for use in adolescent women.
Under the 2010 Affordable Care Act, which President-elect Donald Trump and the Republican leadership in Congress have vowed to eliminate and replace, insurers are required to cover a wide variety of contraceptive methods without charging a copayment or coinsurance.
The U.S. abortion rate peaked at 29 out of every 1,000 women of reproductive age in 1979, six years after the landmark Roe vs. Wade Supreme Court ruling established a woman’s right to abortion. Since 1982, it has steadily declined.
The Guttmacher Institute is considered an authority on the abortion rate, having tracked it since 1973 by conducting a census every few years of all known abortion providers. Its counts do not include abortions that were carried out outside of medical settings.
The new study is based on data the institute collected on abortions performed in 2013 and 2014. The rates fell in 44 states, with the sharpest declines in the West and the South, which both saw a 16% drop compared with 2011. The rates rose in six states: Arkansas, Kansas, Michigan, Mississippi, North Carolina and Vermont.
It is unclear to what degree recent restrictions on abortions contributed to the decline, experts said. From 2011 through 2015, 31 states passed 288 laws that required counseling or a waiting period, imposed regulations on abortion providers or targeted funding for family planning, among other measures. The new study found that 90% of U.S. counties had no clinics that provided abortions.
Jerman noted that the majority of the decline in abortions occurred in states that did not have major new abortion restrictions.
But Dr. Daniel Grossman, an obstetrician at UC San Francisco and director of the research group Advancing New Standards in Reproductive Health, said that his research in Texas showed a clear connection between restrictive laws and declining abortion rates.
In 2013, the state passed HB 2, which made it harder for doctors to prescribe abortion-inducing medications, required abortion providers to have admitting privileges at a local hospital, banned abortions after 20 weeks of pregnancy and required all abortions to take place in hospital-like facilities known as ambulatory surgical centers. Almost overnight, more than half of the state’s 41 clinics shut down.
“In Texas I don’t think that the decline in abortion has been related to improvements in contraceptive use,” Grossman said. “I think it has more to do with barriers to accessing contraception.”
Grossman and his colleagues evaluated the results of HB 2 and found that while the total number of abortions in Texas fell, the number performed during the second trimester rose. That suggested to the researchers that women were struggling to find abortion providers, resulting in delays and procedures that are riskier and more expensive.
Grossman contrasted Texas to California, which has long sought to make family planning available to all patients, with a program to provide free services for low-income women without access to Medicaid.
“There really has been a good family planning safety net here in California,” he said.
He and other experts worried that abortions would rise if Congress, in its effort to repeal the Affordable Care Act, does not preserve mandated insurance coverage for birth control.
“We would be taking a lot of steps back [in women’s health] if the ACA went away,” said Horvath-Cosper, who has provided abortions for more than a decade.
She lamented that eliminating the law could also take away access to maternity care, breastfeeding classes, preventive screenings and prenatal care.
“If we’re going to tell people you can’t have an abortion … then where’s the coverage and support for people who parent?” she said.