Why Are American Women Getting Fewer Abortions?

You might have heard that abortions have declined more than they have in decades. This week's report from the Guttmacher Institute, which surveyed abortion providers for the year 2014, showed that the number of women who had abortions in the U.S. dropped below 1 million for the first time since 1975. The number — 926,000 — is a 12% decline from 2011. But why? Is it because the pro-life movement is winning? Is it better birth control? Yes and probably yes — but it’s complicated. “It’s important to recognize that there are probably good and bad factors contributing to the decline,” says Rachel K. Jones, Ph.D., principal research scientist at the Guttmacher Institute and the lead author on the latest survey. “Certainly for some women in some states reduced access to abortion is contributing to the decline. But in a number of states, more women are using highly effective contraceptive methods, and in turn, there’s a reduced need for abortion.” First, the bad factor: Abortion clinics are closing. Despite the fact that abortion is still legal in the United States as a whole, lawmakers have spent the past five years chipping away at abortion rights on the state level. Since 2010, lawmakers across the country have passed an unprecedented 338 new abortion restrictions, including waiting periods, 20-week bans, and, most crucially, strict clinic regulations. These are called “targeted regulations of abortion providers” — a.k.a. TRAP Laws — and they have become especially popular in recent years. They require abortion clinics to meet the same standards as facilities for other, more complex procedures or surgeries even though it’s not medically necessary in cases of abortion. This includes details like widening hallways and having only doctors with admitting privileges at a hospital perform or authorize the procedure. These are expensive changes for clinics. And when clinics can’t afford to comply, they have to close, Dr. Jones says.

TRAP laws are likely what happened to the abortion rate in Texas, for example, Dr. Jones says. In 2013, the state legislature passed a law known as HB2. This is the law that made former state. Rep. Wendy Davis famous after her 11-hour filibuster. When it passed, more than half of the state’s 41 abortion clinics closed. (And although this law was struck down by the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt in 2016, many of the clinics remain shuttered. Once they close down, it’s extremely difficult to re-open, advocates say.) So it’s no surprise that the abortion rate in Texas declined by 28% between 2011 and 2014. Texas is not the only state where you can see this happening. Arizona also enacted four new TRAP laws between 2012 and 2014, and lost 6 of 15 abortion providers. In the end, the state saw a 22% decline in the abortion rate. Dr. Jones cautions that the researchers did not dig deeply into exactly how clinic regulations affected closings and abortion rates, but says that there is little doubt that the policy context is playing at least some role. “If there are fewer abortions because women want them but they can’t have them, that’s not unilaterally a good thing. It's important to look at the things that are contributing to that.”

Next, the good news: Access to long-term birth control is working.

The abortion rate was already on the decline by the time Guttmacher conducted its 2014 survey. That's because of a nationwide decrease in the rate of unintended pregnancies. In fact, between 2008 and 2011, unintended pregnancies dropped by 18%, largely due to more women using better, longer-lasting birth control methods, such as the IUD and implant. While it’s hard to say exactly how much a decline in unintended pregnancies overall has contributed to the 2014 decline across the country, effective birth control was pretty much the only reason the numbers declined in 2011, and Dr. Jones suspects that trend is continuing. Consider the following: Between 2007 and 2009, use of highly effective long-acting birth control methods, such as the IUD and the implant, shot up by 130%. By 2012, IUDs accounted for 9.5% of all contraceptives in use, compared to less than 2% in 2001. According to one study, the Affordable Care Act also virtually erased co-pays for IUDs for insured women, which may have made them more attractive to more women. Also, between 2011 and 2014, there was a smaller increase (from 7% in 2011 to 11% in 2014) among low-income women choosing these long-acting methods. This bump is important because low-income women account for 75% of the people who have abortions. Even a small increase in better birth control for these women can have a big impact on the abortion numbers. The fact that many of these long-acting methods can offer three, five, even 10 years of birth control, could mean that these same women who got them placed as early as 2007 are still using them, and that's continuing to contribute to the drop in abortion, Dr. Jones says.

Now, the tricky part: Women cross state lines to get abortions. Even with restrictions, women still want abortions, and many will still do what they need to do to get one. That means that the statistics are more complicated than a uniform national decline — some states have indeed seen reduced rates, whether because of reduced access or because of birth control (or both), but others have actually experienced increases. If they can afford to, women seeking abortions will cross state lines because it’s easier or because there is nowhere in their home state to go. That means that in the states where abortion is most accessible, the number might be higher because they are serving non-residents. For years, women who live in Mississippi have traveled to nearby states because Mississippi only has one abortion clinic. Many women who technically live in Maryland and Virginia cross state lines into the D.C. Metro area to get abortions simply because that's where most of the clinics are. For the first time in 2014, Ohio women have begun traveling to Michigan for abortions. While both Michigan and Ohio saw a 33% decline in clinics, and both states enacted multiple new restrictions including TRAP laws between 2012 and 2014, a few clinics in Detroit were able to meet the TRAP requirements and add services, so they were able to serve women from Ohio, Dr. Jones says. This may be why Michigan’s abortion rate actually rose slightly in 2014. Meanwhile, Missouri and Utah, the states with the two largest proportional declines in clinic numbers in 2014, still experienced declines in the abortion rate that were on par with the national average. Both of these states had TRAP laws in place prior to 2012. This suggests that the decline in the abortion rate in these two places was not overwhelmingly due to just TRAP laws, or just a decrease in demand, but instead a combination of factors.

The one thing that’s probably not contributing to the decline: Women giving birth to more babies. Could it also be the case that more women are simply choosing to give birth? Maybe. It is true that even before 2011, the abortion rate has been declining by 2% on average per year since 1990. But a shift in the number of women deciding to give birth is likely a much smaller factor, if it is one at all. If that explained it, then there’d be an equal increase in births. But in between 2011 and 2014, the number of abortions declined by a little over 132,000, while births increased by just 35,000 in the same time period. Poll data also suggest that people’s feelings about abortion haven’t changed very much since the late ‘90s, when the number of people who said they are morally opposed to abortion shot up from around 30% to roughly 45%. If changes in attitudes were the root cause, you’d expect “pro-life” numbers to be growing steadily and for them to peak suddenly in 2011 and 2014, the two years when there were steep declines in the abortion rate. The legal right to an abortion is an issue that many Americans struggle to reconcile, for sure, and that hasn’t changed since it was legalized. Though public opinion has changed dramatically over the years about things like birth control and gay marriage, attitudes about abortion’s legality have remained basically unchanged for the past four decades: Roughly half of Americans say it should be legal only under certain circumstances and around 30% think it should be legal in all circumstances. The remaining 20% believe abortion should be totally illegal. What this means is that even if “pro-life” politicians are succeeding in reducing people’s access to abortion, it doesn’t seem like their anti-choice movement is winning hearts and minds in any big way. It means we’re in a political gridlock — and neither side can truly claim the decline in abortion rates as a "win."

Looking for more stories about the continuing fight for reproductive rights? Watch the trailer for Shatterbox Anthology’s “Lucia, Before and After” above. This short film from director Anu Valia takes an unflinching look at the barriers to choice still faced by women across the United States.

Just 7% of 2016's top films were directed by women. Refinery29 wants to change this by giving 12 female directors a chance to claim their power. Our message to Hollywood? You can't win without women. Watch new films every month on Refinery29.com/Shatterbox and Comcast Watchable.