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Results of a new analysis of 2017 data indicate that the U.S. abortion rate dropped to 13.5 abortions per 1,000 women of reproductive age, the lowest rate recorded since abortion was legalized in 1973 and an 8% decline from 2014.
• Factors that may have contributed to the decline include improvements in contraceptive use and increases in the number of individuals relying on self-managed abortions outside of a clinical setting, analysts noted.
• In five states, fewer than 10% of women lived in a county without a clinic. However, in Mississippi and Wyoming, more than 90% of women lived in a county without such a clinic, the analysis reported.
Results of a new analysis of 2017 data indicate that the abortion rate in the United States dropped to 13.5 abortions per 1,000 women of reproductive age, the lowest rate recorded since abortion was legalized in 1973 and an 8% decline from 2014.1 Rates of abortion have continued to decline since 1981, when the rate reached a high point of 29.3 per 1,000 women of reproductive age.1 Factors that may have contributed to the decline include improvements in contraceptive use and increases in the number of individuals relying on self-managed abortions outside of a clinical setting, analysts noted.
The Guttmacher Institute report identified 808 clinic facilities providing abortions in 2017, a 2% increase from 2014. However, regional and state disparities in abortion access persist: While the number of clinics increased in the Northeast by 16% and in the West by 4%, clinic numbers dropped by 6% in the Midwest and by 9% in the South. In five states — California, Connecticut, Hawaii, Nevada, and New York — fewer than 10% of women lived in a county without a clinic facility. However, in Mississippi and Wyoming, more than 90% of women lived in a county without such a clinic, analysis authors reported.1
“Abortion access, as measured by number of clinics, has become more polarized,” said Rachel Jones, PhD, principal research scientist at Guttmacher and lead author of the report, in a statement. “Individuals living in the Midwest and the South already have to deal with numerous abortion restrictions, and having fewer clinics that provide this care can put abortion out of reach for some groups, particularly low-income individuals.” 2
Data from the new analysis show growth in the prevalence of medication abortions. These accounted for 339,640 abortions in 2017, a 25% increase from 2014. Medication abortions accounted for 39% of all abortions in 2017, researchers indicated.1 The proportion of clinics with medication abortion services only rose from 26% in 2014 to 30% of all clinic facilities in 2017.
In 2017, 25% of all nonhospital facilities (including physicians’ offices) and 30% of clinics provided only early medication abortion. This is a small increase from 2014, when these figures were 23% and 26%, respectively. According to the new figures, a higher proportion of nonspecialized clinics (41%) than specialized abortion clinics (4%) offered only early medication abortion.1
Researchers also attempted to gauge whether an increasing share of abortions are occurring outside of medical facilities. According to the report, 18% of nonhospital facilities in 2017 reported that they had seen patients who had attempted to self-manage their abortion, representing an increase from 12% in 2014.
Drugs similar to those used in the U.S. medication abortion regimen now are available via the internet, as well as information on how to safely and effectively self-manage abortions. March 2018 saw the launch of Aid Access, which provides medication abortion via mail in the United States, with 2,500 prescriptions reportedly filled in that year.1
“Abortion care is evolving to meet people’s needs and preferences,” said Megan Donovan, JD, Guttmacher policy expert and study co-author. “It is important that policies and funding support these advances, so that individuals can access abortion in the way that works best for them.”
Are long-acting reversible contraceptive (LARC) methods reducing the need for abortion services? Between 2014 and 2016, the rate of women ages 15-44 using LARC methods grew by 23%, from 13% to 16%, while levels of sterilization were 25% and 26%, respectively.3 The move to highly effective methods matches a decline in the use of hormonal methods such as the pill and the contraceptive injection, which dropped from 29% to 25% of all contraceptive use. Researchers pointed out that state-level efforts to increase access to LARC methods also may have had a measurable effect, particularly in states with higher-than-average abortion rates.
“This is an important study that clearly demonstrates that contraception, not restrictive laws, deserves the credit,” says Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA. “States, like California, with liberal access to both highly effective contraception and abortion services also experienced decreased demand for the latter due to the former.”
The Guttmacher Institute analysts noted that restrictive policies do not appear to be the primary driver of declining abortion rates, since there is no consistent relationship between increases or decreases in clinic numbers and changes in state abortion rates. Abortion rates declined in all four regions and in most states, the analysts stated.
“Abortion laws affect those seeking services. Restrictions create barriers to access that can make it more difficult for already marginalized individuals, who may need to travel further or forgo other necessities to get the care they need,” said Elizabeth Nash, the Guttmacher Institute’s state policy analyst and co-author. “Protective laws can ensure people have access to abortion when they need it.”2
Financial Disclosure: Consulting Editor Robert A. Hatcher, MD, MPH, Nurse Planner Melanie Deal, MS, WHNP-BC, FNP-BC, Author Rebecca Bowers, Editor Jill Drachenberg, Associate Editor Journey Roberts, and Editorial Group Manager Leslie Coplin report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.