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Why Are Fewer Women Getting Abortions?

Fewer abortions mean what? How the other side explains it. – Al Kresta

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Though the political debate in the U.S. has stagnated, the rate of procedures performed has been in decline since 1990.

American women are having significantly fewer abortions than in the past. Since 2010, the Associated Press recently reported, the number of abortions nationwide has decreased by about 12 percent. This decline has been happening, slowly and steadily, for a quarter of a century: Since 1990, the rate of abortions has fallen by more than a third, and the raw number of abortions has fallen by more than half.

But though the rate of abortions has changed, the politics of of this issue have become stale. There’s already evidence that the issue will play a role in the 2016, just as it has in nearly every election of the last four decades. Last week, for example, South Carolina Senator Lindsey Graham proposed a bill that would ban most abortions after 20 weeks of pregnancy nationwide, and Wisconsin Governor Scott Walker released an open letter in support of a similar ban in his state. For her part, Hillary Clinton hasn’t really made a point of expressing support for abortion and birth-control access since declaring her candidacy, but she also hasn’t shied away from affiliation with organizations like Planned Parenthood. In the 42 years since the Supreme Court’s ruling in Roe v. Wade, public opinion hasn’t changed much: Roughly half of Americans believe abortion should be legal only in certain circumstances, while slightly less than a third believe it should be legal under any circumstances and slightly less than a fifth oppose it altogether.

If public opinion has not shifted on the issue, then why are American women getting fewer abortions? There are a number of possible explanations, although none are fully satisfying. The decline seems to be driven by three very different groups of women: those who can’t access abortions; those who no longer need to get abortions because of the availability of contraception; and those who don’t want to get abortions. For all these groups, one thing that seems clear: Americans don’t just see abortion as a political issue, and certainly not just as a health issue. Despite Americans’ increasingly progressive attitudes toward nearly every other aspect of reproduction and sexuality over the last half century, abortion continues to be a source of cultural conflict, a deeply personal and moral choice that defies the neat application of political language like “rights” and “freedom.” Abortion was, and is, a major tension point of the culture wars, but it has not followed the same political trajectory as its sister issues.

So what has changed about abortion in America over the past five years? First, in many places, it’s getting harder to get an abortion. According to the Guttmacher Institute, a pro-choice research organization, states have enacted a total of 231 restrictions on abortion since the 2010 mid-term elections, when Republicans picked up a record 680 seats in state legislatures. These include limitations on insurance coverage, access for minors, the use of medication to induce abortion, and more. Many states established mandatory counseling and waiting periods: As of the beginning of June, 26 states required women to wait between one and three days to get an abortion after receiving counseling.

By and large, these restrictions have stood up to judicial scrutiny. In the 2000 case Planned Parenthood v. Casey, the Supreme Court ruled that a number of restrictions on abortion in Pennsylvania, including rules about minors, mandatory counseling, and required waiting periods, were constitutional. Last week, the Fifth Circuit Court of Appeals issued a decision that relied heavily on the precedent set in Casey; a panel of three judges ruled that most parts of a Texas law, known as H.B. 2, does not place an undue burden on a large fraction of Texas women who might seek an abortion. The law requires doctors who perform abortions to have admitting privileges at a hospital within 30 miles of their clinics; prohibits abortions 20 weeks after fertilization; and requires, in many cases, at least four in-person visits to a doctor within a two-week period. All clinics must be ambulatory surgical centers, which means they can perform outpatient surgeries; many do not currently meet these standards.

According to the Texas Policy Evaluation Project at the University of Texas, 23 clinics that provided abortion services have closed since 2012. Now, there are 18 clinics across the 267,000 square-mile state. Others that can’t comply with the new rules set out in H.B. 2 may also close.

These restrictions have made it more difficult for some women to get abortions, particularly women who live long distances from clinics and can’t afford childcare or multiple days off from work. But the restrictions also don’t fully explain the nationwide drop in the number of abortions. Five of the six states with the biggest decline in abortion rates “have passed no recent laws to restrict abortion clinics or providers,” the AP found.

Another explanation could be that the need for abortions has gone down. One important aspect of this is the decline in teen pregnancies. In 2010, teen pregnancy reached its lowest point in 30 years, and between 2002 and 2011, the rate of abortions among girls aged 15-19 decreased by 34 percent, according to the CDC. Over the last decade, teen pregnancy has “dropped off precipitously in a way that’s pretty amazing in terms of public-health outcomes,” said Mara Gandal-Powers, a lawyer at the National Women’s Law Center. “We know that’s because teens are, one, using contraception more and, two, using multiple methods of contraception at the same time.”

But among other American women, the situation is less clear. Since certain portions of the Affordable Care Act took effect in 2012, birth control has become free for many American women, since the law requires most insurance plans to cover contraception without charging individuals. According to the CDC, roughly 62 percent of American women of childbearing age used some sort of contraception as of 2013. Yet according to a report by a company that tracks the pharmaceuticals industry, women aren’t necessarily using more birth control. For example, the number of prescriptions for the pill—the most popular form of contraception—has only increased slightly the past half decade, rising from 93 to 95 million between 2009 and 2013.
Theoretically, more affordable birth control might lead to fewer unintended pregnancies. It’s still unclear how the Affordable Care Act will affect this number; the latest data available is from 2010, when roughly 37 percent of pregnancies were either unintended or mistimed, according to the CDC. (Guttmacher estimates that the rate of unintended pregnancies is higher—closer to half.)

All of this leaves a final, much murkier possibility: Fewer women feel comfortable getting an abortion. Predictably, this is what anti-abortion groups saw in the AP survey. “There’s an entire generation of women who saw a sonogram as their first baby picture,” Charmaine Yoest, the president of Americans United for Life, told the AP. This seems like a thin argument—real-time ultrasound machines have been available since at least the mid-1970s, and it seems doubtful that women’s views would be radically reshaped by the sonograms that theoretically bedecked the mantelpieces of their childhood homes.

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