U.S. abortion rate drops to lowest level since Roe v. Wade

The abortion rate in the U.S. has dipped to its lowest level since the Supreme Court’s landmark 1973 decision that legalized the procedure nationwide, a survey released Tuesday finds.
The abortion rate in 2014 was 14.6 abortions per 1,000 women ages 15 to 44, according to the Guttmacher Institute, a research and policy group that backs abortion rights. In 1973, the year of the historic Roe v. Wade decision, the rate was 16.3.

The 2014 figure was also down 14% from the 16.9 abortions per 1,000 women reported in a 2011 Guttmacher survey. About 926,200 abortions were performed nationwide in 2014, the report found, compared with 1.06 million abortions in 2011.

The survey comes three days before Donald Trump, an avowed abortion opponent, is inaugurated the nation’s 45th president. The results also land 10 days before Kellyanne Conway, a top Trump adviser, speaks at the 44th annual March for Life on Jan. 27. Abortion rights advocates are concerned because Trump will be nominating a justice to replace the late Antonin Scalia, and some fear the 7-2 Roe v. Wade decision could be at risk.

Better birth control is a key to the declining number of abortions, says Megan Donovan, a senior policy manager at the Guttmacher Institute. "The primary driver behind the decline was most likely improved contraceptive use, which leads to fewer unintended pregnancies," she says. "This is good news because it suggests women are increasingly able to access the resources they need to plan their families and avoid unintended pregnancy."

For abortion opponents, the numbers indicate a different benchmark, says Randall O'Bannon, director of education and research for the National Right to Life Educational Trust Fund. "Though we've still quite a ways to go to restoring full legal and moral respect for the unborn, this is a critical milestone, getting below 1 million abortions for the first time since 1975."

Beyond contraception and laws limiting abortion access, O'Bannon says his group believes a societal shift may be in play. "One element that may not be getting its due is the increasing sense among Americans that abortion is a no real solution for mothers, for their babies, or for society in general." 

During a presidential debate this fall, Trump, who has called himself “pro-life,” said that if Roe is overturned, states will have the right to weigh the legality of abortion as they did before the Supreme Court decision.

However, the question of whether Roe could really be reversed has been up for debate. Even with Scalia's replacement, the court could remain one or even two votes shy of a majority to overturn the 44-year-old precedent.

In June, the court delivered its most consequential ruling on abortion in years, striking down restrictions on Texas clinics and doctors that threatened to prevent thousands of women from obtaining abortions. The court ruled 5-3 that a Texas law imposed undue hardships on women without sufficient health benefits. The restrictions threatened to close all but nine clinics and could have left the state unable to handle an estimated 65,000 to 70,000 abortions a year.

Donovan acknowledges that state abortion restrictions may have played a role in the survey's findings. Such restrictions include parental notification laws, 24-hour waiting periods and bans on abortions after six or 12 weeks.

"Between 2011 and 2014, over 200 abortion restrictions were passed in the states, an unprecedented attack on abortion rights following the 2010 midterm elections," she says. She singles out what are known as TRAP (targeted regulation of abortion provider) laws — standards abortion rights advocates say are arbitrary and aimed at closing abortion clinics.

But she notes that 28 states and Washington, D.C., did not have new abortion restrictions in place "and together they account for 62% of the decline" in the findings. "This indicates that something else is driving the decline, and the most likely explanation is improved contraceptive use."

Both abortion rights supporters and abortion foes are girding for a new administration — and potential new battlegrounds.

"Our hope for President-elect Trump is that he will appoint pro-life judges, and that the Congress will pass and the courts will approve measures that offer greater protection to the unborn and will reduce these numbers even further," National Right to Life President Carol Tobias says.

Donovan says abortion rights groups are prepping for a reality in which abortion and contraception are harder to access. "Rolling back policies that allow women to manage their reproductive health will have profound consequences, especially for low-income women, women of color and young people," Donovan says.

She notes an earlier institute study found 75% of abortion patients in 2014 were low-income individuals who can face obstacles beyond finances when seeking an abortion: leave from work, child care, travel arrangements. "For women who are already struggling to get by, accessing abortion services can be particularly challenging," she says. 

Other highlights of the report released Tuesday:

• 19% of pregnancies (excluding miscarriages) in 2014 ended in abortion.

• More than half of all U.S. abortion patients in 2014 were in their 20s; 12% were adolescents.

• Whites accounted for 39% of abortion procedures in 2014; blacks 28%; Hispanics 25%; other races and ethnicities 9%.

• The number of clinics providing abortion services declined 6% — from 839 to 788 — from 2011 to 2014.

© Drew Angerer, Getty Images Abortion rights supporters and opponents rally outside the Supreme Court on March 2, 2016, when oral arguments were heard in a Texas abortion case.

US abortion rate is lowest since Roe v Wade – but contraception access may go

The rate of abortion in the US reached a lower level in 2014 than in any other year since the procedure first became legal, a study has found, a decline that appears to be due to the widespread use of contraception producing a drop in unintended pregnancies.

Nineteen percent of pregnancies ended in abortion in 2014 – the lowest abortion rate since the supreme court handed down Roe v Wade in 1973, legalizing the procedure – and the number of abortions between 2011 and 2014 also fell, by 12%.

But the researchers found strong indications to link the decline in the abortion rate to the wider availability of highly effective contraception – which could be imperiled by efforts to repeal Obamacare by the incoming Republican administration.

The study appears in the latest issue of Guttmacher Institute’s scholarly journal, Perspectives on Sexual and Reproductive Health, and was conducted by two of the institute’s researchers, Rachel K Jones and Jenna Jerman.

The researchers made an estimate of the number of abortions by surveying local health department data and abortion clinics, which may be hampered by clinics that did not respond. Guttmacher is a thinktank that supports access to reproductive care, but its data is widely trusted by supporters and opponents of abortion rights alike.

The decline in the abortion rate was greatest in the midwest, south and north-east. Abortion is still a common procedure – in 2014, Jones and Jerman estimate, US women had 926,200 abortions – but there were nevertheless shifts in how abortions were performed. The number performed with medication, which is only effective early in a pregnancy, rose 7% to account for 31% of abortions outside a hospital setting.

There are competing theories to explain the decline in the abortion rate. The drop coincided with the enactment of the Affordable Care Act (ACA), which made more effective and expensive methods of contraception, such as IUDs, available to millions more women for no “copay” or prescription charge. But the decline also aligned with a historic spike in new, state-level abortion restrictions.

Some data – such as trends in contraception usage – that could help determine the reasons for the decline are not yet available for 2014. Still, the researchers predicted that the drop in the abortion rate had less to do with new restrictions than with changes in contraception usage and a reduction in unintended pregnancies.

One clue is that more than 60% of the decline in the abortion rate took place in states that had not enacted new hurdles to getting the procedure.

If the drop is due to contraception, it would have alarming implications for Republicans’ breakneck campaign to repeal the ACA. The law says that most health insurance plans must cover a broad range of contraceptive drugs and devices at no copay – the so-called contraception mandate. Public health advocates have credited this provision with an explosion in women’s access to more affordable and more effective birth control.

Between the fall of 2012 and spring 2014, a separate Guttmacher study found, the share of privately insured women who had no copay for contraception quadrupled. By 2015, the federal Department of Health and Human Services (HHS) found, 55.6 million US women had access to FDA-approved methods of contraception without a copay.

If Republicans were to repeal Obamacare, it is not clear that their replacement would contain a similar provision. Tom Price, Trump’s nominee to lead the HHS, has put forth several proposals for an Obamacare replacement that do not contain a contraception mandate.

Separately, the vice-president-elect, Mike Pence, has proposed issuing a rule, through the HHS, that would allow business owners to refuse to cover contraception if doing so violates religious beliefs.

“Their agenda … could stop or reverse progress in empowering women to meet their childbearing goals, including by avoiding unintended pregnancy,” Joerg Dreweke, of Guttmacher, wrote in a policy brief accompanying the new study.

“There is strong evidence from recent abortion declines that supporting women’s decision-making across the spectrum of reproductive healthcare is very much compatible with reducing abortion incidence.”

The Guttmacher researchers found less evidence to link the decline in abortions or to new abortion restrictions. About 38% of the decline in the number of abortions was observed in 22 states that had enacted new restrictions significant enough to potentially impact women’s access to abortion.

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These included laws that imposed extra counseling for an abortion. But only eight of those 22 states had abortion declines that outranked the national average, and four states – Arkansas, Michigan, Mississippi and North Carolina – actually saw an increase in their abortion rates.

There was, however, one type of abortion restriction that seemed to cause a decline in the abortion rate. These were laws that placed medically unnecessary regulations on abortion clinics in order to shut them down.

The number of abortion clinics fell by 6% between 2011 and 2014, and the loss of access appeared to be linked with a decrease in abortions – although it could not account for the entire declines observed in those states. In June 2016, the supreme court ruled these kinds of laws to be unconstitutional.

On Tuesday, groups opposed to abortion linked the decline in the rate and number of abortions to laws that impose new restrictions. Clarke Forsythe, the acting president of the legal group Americans United for Life, said in a statement that those laws were a factor.

“Another factor in lowering the number of abortions is the power of beautiful pictures of life inside the womb, through ultrasound,” he said. “Such pictures are worth more than a thousand words when it comes to helping people understand whose lives are on the line.”

“Although Planned Parenthood and the abortion industry wants to say that this is a contraception story, the fact is, contraception has been around since the 1950s,” added Kristi Hamrick, a spokeswoman for AUL.

The decline in the abortion rate from 2011 to 2014 continues a long downward trend. The US also saw its abortion rate drop between 2008 and 2011, driven, according to Guttmacher, by a steep decline in unintended pregnancies, probably explained by improvements in the use of contraception. As the abortion rate fell, the birth rate did not rise commensurately.

In particular, the rise of the use of highly effective, long-acting, reversible contraception, such as IUDs, might account for the drop in abortions.

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