Abortion Rate at Historic Low Due to Increased Restrictions, Improved Access to Contraceptives

The abortion rate in the United States hit a historic low in 2014 with 2 likely contributing factors: improved access to contraceptives and increased restrictions to abortion services.

The abortion rate in the United States declined steadily between 2011 and 2014 to the lowest rate since abortion was legalized in 1973, according to a report from the Guttmacher Institute published in Perspectives on Sexual and Reproductive Health. In 2014, 19% of pregnancies (excluding miscarriages) ended in abortion, which is a decline of 11% from 2011. The overall abortion rate declined 14% from 2011 to 2014.

There are 2 likely contributing factors to this reduction in the abortion rate: improved access to contraception and increased restrictions to abortion services. While the abortion rate had declined steadily from 2011 to 2014, the year 2011 represented a remarkable year when the abortion rate had dropped 13% from 2008. Leading up to 2008, the abortion rate typically declined just an average of 2% per year.

“Fewer women had abortions in 2011 than in 2008 because fewer women became pregnant when they did not want to,” authors Rachel K. Jones and Jenna Jerman wrote.

An increased use in contraceptives was responsible for some of the decline, and “increased use may have continued into more recent years.” The Affordable Care Act’s contraceptive mandate went into effect in 2012.

The decline in the abortion rate may also reflect the fact that more women might have been unable to obtain an abortion when they wanted one. Between 2008 and 2011, more than 100 abortion restrictions were enacted. And since 2011, hundreds of new restrictions, such as mandated ultrasounds and in-person counseling, were enacted. However, the authors reported no strong evidence that restrictions on access to abortion services were a main reason why there was a decline in the abortion rate.

“Abortion is an important indicator of unintended pregnancy, but it is unclear whether the most recent decline in abortion is due to fewer women’s having unintended pregnancies, more women’s being unable to access abortion services or some combination of these dynamics,” Jones and Jerman wrote.

Jones and Jerman used the Guttmacher Institute’s 2014 Abortion Provider Census to identify national and state-level information about abortion incidence to help inform policies and programs to reduce unintended pregnancies in the United States.

The abortion rate declined across the country in all but 6 states and the District of Columbia. Every region recorded a drop in the abortion rate, but declines were far steeper in the West (16%) and the South (16%) than in the Midwest (9%) or the Northeast (11%). The abortion rate in the Northeast remains the highest, and it was the only region that had more clinics providing abortion services in 2014 compared with 2011. The number of clinics increased 14%, largely because the number of clinics in New Jersey increased from 24 to 41 during this time period.

In contrast with the Northeast, the Midwest had the largest decline in clinics, with the number decreasing 22%. Michigan lost 10 clinics, Ohio lost 6, and Iowa lost 5 during this time period. Overall, 90% of counties in the United States had no clinics that provided abortion care in 2014.

“Abortion restrictions and clinic closures mean that patients may need to travel greater distances to access services,” Rachel Jones, lead author of the study, said in a statement. “The majority of abortion patients—75%—are poor or low-income, and nearly two-thirds are already parents. It can be very difficult for them to arrange for time off from work, transportation and child care. While many find ways to access care despite these obstacles, some of the abortion rate decline is likely attributable to women who were prevented from accessing needed services.”

The authors wrote that the decline in abortions in some states may have been in response to increased abortion restrictions, but in other states, there may simply have been a drop in demand. When women experience fewer unintended pregnancies, there is less of a need for abortion services. As new abortion restrictions were passed in 2015 and 2016, there will need to be more research to monitor accessibility of abortion services, the authors wrote.

“Restricting access to abortion may force women to delay the procedure or carry unwanted pregnancies to term,” said Megan Donovan, Guttmacher senior policy manager. “Instead, we should focus on increasing access to the full range of contraceptive methods, as well as to abortion services. Empowering women to prevent unintended pregnancies and plan their families is both a human rights priority and smart public health policy.”