Abortion rates in the United States have been falling steadily for decades, long before restrictive statutes began to make the procedure difficult to obtain in some areas. Experts say access to better birth control is one of the main reasons.
Abortions in the U.S. peaked in 1981, at a rate of 29.3 per 1,000 women between the ages of 15 and 44, according to the Centers for Disease Control and Prevention. Since then, the number has fallen by three-fifths. In 2019, the last year for which numbers are available, the rate was 11.4.
The decline has been seen in almost all states, regardless of whether abortion access was restricted, according to research by the Guttmacher Institute, a research group that supports abortion rights.
But that could change if the sweeping protections of Roe v. Wade are overturned.
Caitlin Knowles Myers, a professor of economics at Middlebury College, said if abortion is severely restricted or banned in the 26 states where that is anticipated should Roe be overturned, the number of abortions in the nation could fall as much as 13%.
Research has shown that increases in distance to clinics are associated with lower abortion rates, especially for women with limited resources and difficult personal circumstances.
Myers and her team calculated “the vast majority” of women in states where abortion likely would be banned or strictly limited would have to travel 200 miles or more to reach a provider. They estimated about two-thirds of women in those states would find a way to reach an open facility but one-third would not, resulting in 75,000 fewer abortions per year.
“I think it’s probably a conservative estimate,” she said.
In 2019 at least 629,898 abortions were reported in the United States, according to the CDC.
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Contraception driving the dive
Experts believe the decades-long decline in abortions has largely been driven by better access to birth control, especially long-term, reversible contraception.
“Fewer people are getting pregnant overall because of improved access,” said Sarah Munro, a health outcomes researcher and professor in the department of obstetrics and gynecology at the University of British Columbia in Canada.
The biggest shift has been in access to IUDs and contraceptive implants. These now go by the term LARC, long-acting reversible contraception, said Carole Joffee, a professor of reproductive sciences at the University of California, San Francisco.
“The first generation of these were very problematic and caused some deaths and injuries. Now they’re very safe,” she said.
IUDs are now the third-most-popular method of birth control among American women. Permanent contraception (sterilization) is first at 28%, birth control pills second at 21% followed by IUDs and birth control implants at 16%, according to the CDC.
The “get it and forget it” contraception methods last for up to 10 years and are very effective, Joffee said.
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Insurance made a difference
An increase in the number of Americans who have health insurance, brought on by the passage of the Affordable Care Act of 2010, is also thought to have contributed to the drop in abortions because more people had access to both health care and insurance that paid for contraception.
The cost of birth control for women decreased and the use of birth control increased, said Dr. Linda Rosenstock, an emeritus professor of medicine at the University of California, Los Angeles.
“Birth control went from representing more than 20% of all out-of-pocket health care costs down to 3%,” she said.
A 2020 survey found that two-thirds of OB-GYNs reported an increase in contraceptive uptake from their patients since the ACA was implemented.
The largest predictor of whether a woman will have an abortion is whether her pregnancy was unintended.
“In the United States each year, about half of pregnancies are unintended and about 40% of those lead to abortion,” said Rosenstock. “Access to birth control leads to fewer abortions.”
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Teens holding off
Another factor experts suggest is a reduction in teen sexual activity. The younger someone is, the more likely they are to have an unintended pregnancy. The highest rates are in sexually active women aged 15 to 19, according to the Guttmacher Institute.
Between 2009 and 2019, federal surveys show, the rate of high school students who had had sex fell from 46% to 38%. The number of lifetime sexual partners fell from 13.8 to 8.6, and the number who were sexually active fell from 34% to 27%.
The majority also used birth control.
The age at which teens initiate sexual activity is also rising. “It’s happening later now than compared to previous generations. It’s a trend we’re observing both in the United States and in Canada,” said Munro.
Exactly why teen sexual activity is diminishing and happening later isn’t entirely known, though better access to both sexual and reproductive health information may be playing a role, said Rosenstock.
Long-term that will lower the overall demand for abortions by decreasing the number of unwanted pregnancies, she said.
“The broader the access to proven family planning methods, the lower the unintended pregnancy rate and the lower the abortion rate,” she said. “We can’t underestimate the role of educating and empowering women – and men – about these issues.”
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