How Many Babies Have Been Aborted in America Since Abortion Became Legal
The U.Southward. Abortion Rate Continues to Drib: Once Again, State Abortion Restrictions Are Not the Master Driver
HIGHLIGHTS
- Abortion restrictions were not the master driver of the decline in the U.S. abortion rate betwixt 2011 and 2017. Rather, the decline in abortions appears to exist related to declines in births and pregnancies overall. In that location are a number of potential explanations for this wide turn down, some more than plausible than others.
- All the same, ballgame restrictions, particularly those imposing unnecessary, intentionally burdensome regulations on providers, played a role in shutting downwards abortion clinics in some states and thereby reducing access to ballgame.
- Understanding the factors driving the decline in the abortion rate has of import policy implications. However, attempts to reduce abortion through coercive restrictions are a directly violation of individuals' dignity, actual autonomy and reproductive freedom.
Between 2011 and 2017, the U.S. ballgame landscape changed significantly. As documented by the Guttmacher Institute's periodic abortion provider demography, all the main measures of abortion declined, including the number of abortions, the abortion rate and the abortion ratio.one,two The declines are part of trends that go dorsum decades.
- The number of abortions cruel past 196,000—a 19% decline from i,058,000 abortions in 2011 to 862,000 abortions in 2017.i,two
- The abortion charge per unit (the number of abortions per 1,000 women aged 15–44) barbarous by 20%, from xvi.9 in 2011 to 13.5 in 2017.
- The abortion ratio (the number of abortions per 100 pregnancies ending in either abortion or live birth) fell 13%, from 21.2 in 2011 to 18.4 in 2017.
The question of what is behind these trends has important policy implications, and the 2011–2017 period warrants detail attention because information technology coincided with an unprecedented wave of new abortion restrictions. During that timeframe, 32 states enacted a total of 394 new restrictions,3,4 with the vast majority of these measures having taken result (that is, they were non struck down by a court).
However, declines in abortion practise not serve patients if the reason behind the turn down is interference with individuals' decision making near their reproductive options. Reducing abortion past shuttering clinics and erecting logistical barriers for patients is in direct conflict with sound public wellness policy, and the contend should not exist framed based on the false premise that any reduction in ballgame is a expert outcome. Rather, it is critical to recall that timely and affordable access to abortion should exist available to anyone who wants and needs it. And it is equally of import to recognize that obstructing or denying care in the name of reducing abortion is a violation of individuals' dignity, actual autonomy and reproductive freedom.
With the bachelor testify, it is impossible to pinpoint exactly which factors collection recent declines, and to what caste. However, previous Guttmacher analyses take documented that abortion restrictions, while incredibly harmful at an individual level, were not the main driver of national declines in the ballgame rate in the 2008–2011five or 2011–20146 time periods. Much the aforementioned appears to hold true for the 2011–2017 timeframe, as detailed below. Rather, the reject in abortions appears to exist part of a broader decline in pregnancies, every bit evidenced by fewer births over the aforementioned period.
Ballgame Restrictions
Abortion restrictions target either individuals' power to access the process (such as by imposing coercive waiting periods and counseling requirements) or providers' ability to offer information technology (such as through unnecessary and intentionally crushing regulations). Whatsoever one of these restrictions could result in some people beingness forced to keep pregnancies they were seeking to stop; this could, in theory, lower the ballgame charge per unit.
Restrictions and Clinic Closures
Because 95% of all abortions reported in 2017 were provided at clinics—either those specializing in abortion or those where abortion is role of a broader gear up of medical services—changes in the number of clinics is a good proxy for changes in abortion access overall.1 Between 2011 and 2017, the number of clinics providing abortion in the United States declined by less than 4%, from 839 to 808.1,2
However, this seemingly modest alter masks meaning differences past region of the country: Between 2011 and 2017, the South had a internet decline of l clinics, with 25 in Texas solitary, and the Midwest had a internet reject of 33 clinics, including nine each in Iowa, Michigan and Ohio.one,2 The West lost a net of seven clinics. By contrast, the Northeast added a net 59 clinics, more often than not in New Bailiwick of jersey and New York.
The South and the Midwest also had the largest share of new abortion restrictions during that period, with nearly 86% of total restrictions nationwide enacted in those two regions. Information technology seems clear that these like geographic patterns are not a coincidence (see figure 1).i,two In particular, when researchers look at the bear upon of abortion restrictions on clinic numbers, one type of restriction stands out: TRAP (targeted regulation of ballgame providers) laws and administrative regulations did reduce the number of clinics providing abortion between 2011 and 2014.6,seven And although few clinic regulations were enacted between 2014 and 2017, enforcement of existing regulations played a role in the closure of some clinics during that catamenia.viii
Between 2011 and 2017, TRAP regulations resulted in the closure of roughly one-half of all clinics that provided ballgame in four states—Arizona, Kentucky, Ohio and Texas—and the closure of five clinics in Virginia, including two of the land'due south largest providers.1,2 The dispensary regulations in Texas were struck downwardly past the U.Southward. Supreme Court in 2016 (thereby prohibiting some of the near egregious TRAP laws nationwide) and the Virginia regulations were generally repealed in 2017.9,10 Even so, clinic numbers in the afflicted states did not increase significantly even with these restrictions eliminated, underscoring that once a clinic is forced to close, it tin can be challenging if non outright impossible for it to reopen.
Smaller changes in clinic numbers are also important, especially in states where access to abortion services is already extremely limited. Missouri, W Virginia and Wisconsin each lost i clinic in the 2011–2017 timeframe out of an already modest number in each state.1,2 In cases like this, the remaining clinics typically cannot absorb all the patients seeking abortion intendance and patients must face greater and sometimes insurmountable obstacles to obtaining an ballgame, such as longer travel distances and increased financial costs.eleven,12
Restrictions and Abortion Rates
While at that place appears to be a clear link in many states betwixt ballgame restrictions—and TRAP laws in particular—and clinic closures, at that place is no clear pattern linking ballgame restrictions to changes in the abortion rate. While 32 states enacted 394 restrictions betwixt 2011 and 2017,3,4 nearly every state had a lower abortion charge per unit in 2017 than in 2011, regardless of whether it had restricted abortion access (see figure ii).1,iv Several states with new restrictions really had abortion rate increases.1,four
Notably, 57% of the 2011–2017 decline in the number of abortions nationwide happened in the 18 states and the District Columbia that did not adopt any new abortion restrictions.thirteen Some of these states, such as California, even took steps to increase access.fourteen And even in states that enacted new restrictions and saw declines in abortion numbers, it is uncertain what role these restrictions, as opposed to other factors, played in the declines.
Similarly, at that place is no clear link, even indirectly, from new abortion restrictions to clinic closures to decreases in ballgame rates. Amidst the 26 states and the District of Columbia that had a decline in clinics between 2011 and 2017, 24 states saw declines in their abortion rate (come across Figure 3).1,2 However, 13 of the 15 states that added clinics too saw declines in their abortion rates, as did eight of the nine states where the number of clinics stayed the aforementioned.
The only exception here may once once more be TRAP laws. Four of the states hit hardest by the consequences of TRAP laws over this time period in terms of clinic closures also saw declines in the abortion rate that were larger than the national average of 20%: Arizona (27%), Ohio (27%), Texas (30%) and Virginia (42%).thirteen Kentucky, which lost 1 of its two clinics because of the implementation of TRAP regulations, had an ballgame rate pass up that was slightly lower than the national boilerplate (18%).
While at that place is no clear pattern linking restrictions and abortion declines, restrictions often exact a heavy cost on individuals seeking an abortion. In fact, restrictions are usually enacted with the explicit and savage intent of creating hardship. Most egregiously, restrictions practise keep some people from getting the abortions they want to obtain. And even for those who are able to overcome various barriers, restrictions tin cause serious financial and emotional consequences, including by causing delays in obtaining care.15 However people take long shown that they will endure these hardships, including by diverting money meant for rent, groceries or utilities to pay for their procedure.
Explaining the Declines
If abortion restrictions are non the principal commuter of the 2011–2017 ballgame reject, what tin can explain this trend? A number of possible explanations exist, some of them more plausible than others, including changes effectually ballgame attitudes and stigma, contraceptive utilise, sexual activeness, infertility and self-managed abortion.
Attitudes and Choices
Antiabortion activists frequently argue that more people are turning against ballgame rights and that this shift in attitudes tin can explicate broad-based declines in the number of abortions across the state, including in states that did not enact new restrictions. Under this theory, changes in public opinion compel more pregnant individuals to choose to requite birth rather than obtain an abortion. This theory is flawed on several levels.
Public opinion on abortion, while fluctuating at times, has remained remarkably stable over the long term. The Pew Research Centre plant that ballgame attitudes in 2018 were substantially the same as in the mid-1990s, with Gallup and an ABC News/Washington Mail service poll showing very similar trends.sixteen–18 More to the indicate, these major polls exercise not prove a decline in support for ballgame rights between 2011 and 2017. Moreover, if antiabortion activists were truly winning "hearts and minds," they would not demand to rely on always more farthermost and coercive ballgame restrictions, including an unprecedented moving ridge of abortion bans passed in a number of states in the get-go six months of 2019.19
A closely related statement focuses on the abortion ratio (the number of abortions per 100 pregnancies ending in either abortion or alive nascency), which fell 13% between 2011 and 2017.1,2 Ballgame opponents often aspect this decline to more than pregnant individuals deciding or being forced to deport a pregnancy to term. If this were the case, and then there would have been a respective increment in births over that time, which did not happen. Rather, both the number of U.South. abortions and the number of U.S. births declined from 2011 to 2017, with births dropping by 98,000 and abortions by 196,000.1,ii,20
Fewer Pregnancies
Because both abortions and births declined, it is clear that there were fewer pregnancies overall in the United States in 2017 than in 2011. The large question is why.
One possible contributing factor is contraceptive access and utilize. Since 2011, contraception has get more accessible, as most private health insurance plans are now required past the Affordable Intendance Act (ACA) to embrace contraceptives without out-of-pocket costs. In addition, thanks to expansions in Medicaid and private insurance coverage nether the ACA, the proportion of women anile 15–44 nationwide who were uninsured dropped more than xl% betwixt 2013 and 2017.21 There is bear witness that use of long-interim reversible contraceptive methods—specifically IUDs and implants—increased through at least 2014, especially amidst women in their early 20s, a population that accounts for a meaning proportion of all abortions.22 Another study suggests that the use of IUDs might have increased in the wake of the 2016 presidential election, spurred past fears that such methods could go more expensive to admission in the future.23 Notably, contraceptive use has driven the long-term decline in adolescent pregnancies and births, which continued through the 2011–2017 flow.24,25
Another possible contributing factor might be a decline in sexual action. Findings from ane national survey propose a long-term increase in the number of people in the United States—by and large younger men—reporting not having sexual practice in the by year.26,27 But in addition to a small sample size, it is unclear how well this survey captures data on sexual beliefs. Other data show that the proportion of high school students who have ever had sexual intercourse declined betwixt 2011 and 2017, with nigh of the decline happening in the 2013–2015 flow.28 Withal, this is unlikely to take had a major impact on the U.Southward. abortion charge per unit, as minors account for just 4% of abortions overall.29 In sum, the bachelor data practice non bespeak significant decreases in sex activity among women in their 20s and 30s, the groups that together account for 85% of all abortions nationally.
All the same another possibility is that infertility is increasing in the United States, thereby reducing the chances of getting pregnant and subsequently seeking to obtain an abortion. However, it is highly unlikely that there would have been a big enough spike in infertility to meaningfully bear upon pregnancy and abortion rates in the 2011–2017 timeframe.
More mostly, there are a host of other potential factors that could be driving declines in pregnancy rates, from individuals' evolving desires about whether and when to go parents to people's changing economic and social circumstances.
Cocky-Managed Abortion
Finally, it is possible that the 2011–2017 decline in ballgame was not as large as it appears from the Guttmacher Plant'south abortion provider census: At that place could have been an increment in cocky-managed abortions happening outside of medical facilities, which the census would be unable to capture. The Guttmacher abortion census providing information for 2017 institute that xviii% of nonhospital facilities reported having seen at least one patient who had attempted to finish a pregnancy on her own, an increase from 12% in 2014 (the start yr that question was included in the survey).i,7 The drugs used in a medication ballgame (misoprostol and mifepristone) are condign increasingly available online, as are resource about how to safely and finer cocky-manage an abortion exterior of a clinical setting (see "Cocky-Managed Medication Abortion: Expanding the Available Options for U.South. Abortion Care," 2018). More than show is necessary to improve understand these emerging trends and how to serve the needs of patients as technology and new options for cocky-managing an abortion are irresolute access to and availability of ballgame.
Centering the Needs of Individuals
We know that abortion restrictions were non the main driver of ballgame declines betwixt 2011 and 2017, nor were shifts in public stance near abortion. However, in many ways, that is all abreast the point. The reality is that a refuse in the abortion charge per unit should non be an cease in and of itself.
Rather, declines in abortion rates and the number of clinics are strong reminders that nosotros need to go along to support those seeking abortion, so that they receive timely, attainable, affordable and supportive care. Because despite nearly forty years of declines in abortion numbers, one in 4 women of reproductive age nationally will have an ballgame in her lifetime.xxx Moreover, the legal, logistical and financial barriers to abortion are growing, and these burdens are largely borne by low-income individuals, people of color and young people.
Rather than trying to coerce pregnant individuals into giving birth equally their only option, and stigmatizing and targeting abortion patients and providers in the name of reducing abortion, we must middle individuals' needs in their detail circumstances. That means policies must be grounded in medical ethics, including the principles of informed and voluntary consent, which support data on, referral for and access to all pregnancy options. Centering each person'south needs also means providing affordable, high-quality contraceptive and prenatal care, making resource available to raise children with dignity, and improving access to safe, affordable and timely ballgame intendance.
References
1. Jones RK, Witwer E and Jerman J, Abortion Incidence and Service Availability in the United states, 2017, New York: Guttmacher Institute, 2019, https://www.guttmacher.org/report/abortion-incidence-service-availability-the states-2017.
2. Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2011, Perspectives on Sexual and Reproductive Health, 2014, 46(one):iii–14, https://www.guttmacher.org/journals/psrh/2014/02/abortion-incidence-and-service-availability-united-states-2011.
3. Nash Due east et al., Policy trends in u.s.a., 2017, New York: Guttmacher Institute, 2018, https://world wide web.guttmacher.org/commodity/2018/01/policy-trends-states-2017.
four. Special analysis of state ballgame policies.
five. Dreweke J, New clarity for the U.South. abortion debate: A steep drop in unintended pregnancy is driving recent abortion declines, Guttmacher Policy Review, 2016, 19:xvi–22, https://world wide web.guttmacher.org/gpr/2016/03/new-clarity-united states of america-abortion-debate-steep-drop-unintended-pregnancy-driving-recent-abortion.
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7. Jones RK and Jerman J, Abortion incidence and service availability in the United States, 2014, Perspectives on Sexual and Reproductive Wellness, 2017, 49(1):17–27, https://www.guttmacher.org/journals/psrh/2017/01/ballgame-incidence-and-service-availability-united-states-2014.
8. Shafer SS, Lexington ballgame clinic to close, Courier-Journal, Jan. 14, 2017, https://www.courier-journal.com/story/news/local/2017/01/14/lexington-abortion-clinic-close-leaving-1-ky/96587994/.
9. Domonoske C, Supreme Court strikes downward abortion restrictions in Texas, NPR, June 27, 2016, https://www.npr.org/sections/thetwo-way/2016/06/27/483686616/supreme-courtroom-strikes-downwards-abortion-restrictions-in-texas.
10. Virginia Department of Health, Regulations for licensure of abortion facilities, https://townhall.virginia.gov/Fifty/viewchapter.cfm?chapterid=2813.
11. Fuentes L et al., Women's experiences seeking abortion care shortly afterward the closure of clinics due to a restrictive police in Texas, Contraception, 2016, 93(4):292–297, https://world wide web.contraceptionjournal.org/article/S0010-7824(fifteen)00708-8/fulltext.
12. Gerdts C et al., Impact of dispensary closures on women obtaining abortion services after implementation of a restrictive police in Texas, American Journal of Public Wellness, 2016, 106(v):857–864, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985084/.
13. Special analysis of data from the Guttmacher Establish's 2011 and 2017 Abortion Provider Census.
xiv. Kliff S, California just passed America's offset law expanding abortion access since 2006, Washington Postal service, Oct. 10, 2013, https://www.washingtonpost.com/news/wonk/wp/2013/x/ten/california-just-passed-americas-first-law-expanding-abortion-access-since-2006/.
15. Jones RK, Upadhyay UD and Weitz TA, At what cost? Payment for abortion intendance by U.South. women,Women'due south Health Issues,2013, 23(iii):e173–e178, https://www.guttmacher.org/article/2013/05/what-price-payment-abortion-care-us-women.
16. Pew Research Center, Public opinion on ballgame, 2019, https://www.pewforum.org/fact-sheet/public-stance-on-abortion/.
17. Gallup, Abortion, 2019, https://news.gallup.com/poll/1576/abortion.aspx.
xviii. Guskin E and Clement Due south, Ballgame support is the highest it's been in two decades as challenges mount, Washington Post, July 10, 2019, https://www.washingtonpost.com/politics/2019/07/10/abortion-support-is-highest-its-been-two-decades-two-decade-high-challenges-roe-mount/.
19. Nash E et al., State policy trends at mid-year 2019: States race to ban or protect ballgame, New York: Guttmacher Constitute, 2019, https://www.guttmacher.org/commodity/2019/07/state-policy-trends-mid-yr-2019-states-race-ban-or-protect-abortion.
20. Martin JA et al., Births: terminal information for 2017, National Vital Statistics Reports, 2018, Vol. 67, No. 8, https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf.
21. Guttmacher Institute, Gains in insurance coverage for reproductive-age women at a crossroads, News in Context, Dec. 4, 2018, https://www.guttmacher.org/article/2018/12/gains-insurance-coverage-reproductive-historic period-women-crossroads.
22. Kavanaugh ML and Jerman J, Contraceptive method use in the United States: trends and characteristics betwixt 2008, 2012 and 2014, Contraception, 2017, 97(1):fourteen–21, https://www.guttmacher.org/article/2017/ten/contraceptive-method-apply-united-states-trends-and-characteristics-between-2008-2012.
23. Pace LE et al., Utilization of long-acting reversible contraceptives in the United States after vs. before the 2016 U.Due south. presidential election, JAMA Internal Medicine, 2019, 179(3):444–446.
24. Lindberg L, Santelli JS and Desai S, Changing patterns of contraceptive use and the decline in rates of pregnancy and birth among U.S. adolescents, 2007–2014, Periodical of Boyish Health, 2018, 63(2):253–256, https://world wide web.guttmacher.org/article/2018/08/irresolute-patterns-contraceptive-use-and-decline-rates-pregnancy-and-nascency-among-us.
25. Boonstra H, What is behind the declines in teen pregnancy rates? Guttmacher Policy Review, 2014, 17(3):15–21, https://www.guttmacher.org/gpr/2014/09/what-backside-declines-teen-pregnancy-rates.
26. Ingraham C, The share of Americans not having sex activity has reached a tape loftier, Washington Mail service, Mar. 29, 2019, https://www.washingtonpost.com/business/2019/03/29/share-americans-not-having-sex-has-reached-record-high/.
27. Twenge JM, Sherman RE and Wells BE, Declines in sexual frequency among American adults, 1989–2014, Archives of Sexual Behavior, 2017, 46(viii):2389–2401.
28. Witwer E, Jones RK and Lindberg LD, Sexual Behavior and Contraceptive and Rubber Use Among U.S. High Schoolhouse Students, 2013‒2017, New York: Guttmacher Constitute, 2018, https://world wide web.guttmacher.org/report/sexual-behavior-contraceptive-safety-apply-u.s.-high-school-students-2013-2017.
29. Jerman J, Jones RK and Onda T, Characteristics of U.Due south. Abortion Patients in 2014 and Changes Since 2008, New York: Guttmacher Found, 2016, https://www.guttmacher.org/written report/characteristics-us-ballgame-patients-2014.
30. Jones RK and Jerman J, Population grouping ballgame rates and lifetime incidence of abortion: United States, 2008–2014,American Periodical of Public Wellness, 2017, 107(12):1904–1909, https://www.guttmacher.org/article/2017/10/population-group-abortion-rates-and-lifetime-incidence-abortion-united-states-2008.
Acquittance
This commodity has been made possible past a grant from The California Endowment. The views expressed are those of the authors and practice not necessarily reflect the positions and policies of the donor.
Source: https://www.guttmacher.org/gpr/2019/09/us-abortion-rate-continues-drop-once-again-state-abortion-restrictions-are-not-main
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