Better Prevention or Changing Attitudes?

If you don't know what to make of the news that abortion rates are dropping, don't feel bad: neither the pro-choice nor the pro-life lobby knows quite what to make of it either. On Thursday morning the Guttmacher Institute, a reproductive-health research organization, will release a report showing that in 2005 the abortion rate dipped to 19.4 per 1,000 women, its lowest level since 1974. The announcement continues a well-established trend: the rate of abortions performed in the United States has been dropping steadily since 1981.

But the report, based on the most recent available data, is far more complicated than the basic statistics suggest. Yes, abortions are down, but it's unclear why. Is it because of increased access to birth control? Decreased access to abortion clinics? Increased availability of new medications that end pregnancy? Or are more women simply choosing to continue their pregnancies?

Any of these factors could be at work, says Rachel Jones, an author of the report, and "we just aren't able to get at the reasons behind the decline." So, whether the report is good news or bad depends not just on your political views but also on which of those possible factors is really fueling the overall trend. Let's take them one at a time:

Better Birth Control
Planned Parenthood president Cecile Richards hails the new report as proof that "prevention works"—that increased access to birth control and emergency contraception is warding off unwanted pregnancies. If that's true, it's news that both sides of the issue might welcome. Women certainly have more contraceptive methods to choose from now than they did in the first half of 2001—which is when the Guttmacher Institute last surveyed the abortion rate. Emergency contraceptive medications, sometimes called "morning-after pills," such as Plan B, have grown in popularity. (They were introduced in the United States in 1999 but only approved for over-the-counter use in 2006.) Although Plan B's maker, Barr Pharmaceuticals, has not released sales figures, it sold about $40 million worth of the drug in 2006, its last year of prescription-only use, and said it expected that figure to double in 2007.

New low-dose birth-control pills may also be contributing to the drop in abortions, says Kim Gandy, president of the National Organization for Women. "Because of the lower levels of hormones, more women are physically able to take them," says Gandy.

Other surveys lend some support to the idea that increased birth-control use is helping to drive down the abortion rate, particularly among teenagers. Between 1995 and 2005, for instance, according to the Centers for Disease Control, contraceptive use among teens went way up. In roughly the same time period, both the number of women seeking abortions and the percentage of those women who were teenagers dropped. But that doesn't necessarily mean that in that period more teens managed to avoid unintended pregnancies using birth control. In fact, the opposite may be true. From 2005 to 2006 the teen birth rate went up for the first time in 14 years, from 4.05 to 4.19 percent (according to a 2007 Guttmacher report). Jones says it's still too early to say what that means in the context of this new data—whether more teens found it difficult to get abortions or whether, à la the hit film "Juno," they chose to go forward with their pregnancies. "We don't even know what happened with abortions in teenagers between 2005 and 2006," she says.

Teenagers aside, contraceptive use may not have increased among American women as a whole. A 2002 CDC study found that older women had actually started forgoing birth control in greater numbers. And, says Gandy, "there definitely are fairly concerted efforts in some areas to discourage the use of birth control or to refuse to provide it in pharmacies."

Lack of Provider Access
Overall, the United States has fewer abortion providers now that it did in the first half of 2001, according to Guttmacher's numbers. Since 2001 the number of providers has dropped by 2 percent. However, that decline appears small compared with previous Guttmacher studies. From 1996 through that first half of 2001, Guttmacher's data shows that the number of abortion providers dropped by 11 percent. And in the four-year period prior to that (1992-1996), there was a 14 percent decline.

But there has been one trend that may be counteracting the drop in traditional abortion providers: a rise in the number of new clinics that offer only "early medication abortion services," or RU486, a medication that terminates a pregnancy (in the first trimester) by blocking the effects of progesterone. Since the drug was introduced in the United States in September 2000, more than 840,000 women have taken it, and the Guttmacher study estimates that it is now used in 14 percent of all abortions (up from 6 percent in 2001). Clinics that offer only RU486—not surgical abortions—are growing in popularity. An increase in such clinics may explain why the overall drop in providers was as little as 2 percent in this report. When the RU486-only clinics are taken out of the equation, the drop in abortion providers since 2000 is in fact a much steeper 8 percent.

One thing is clear, at least: access to abortion is uneven nationwide. "In some states," says NOW's Gandy, "abortion has simply become more difficult to come by." Even Jones, the co-author of the Guttmacher study—who is reluctant to pinpoint a single cause nationwide—says the unevenness factor is playing a crucial role in driving down abortion rates in some parts of America. "Mississippi has a low abortion rate, and there we're pretty sure the drop is due to decreased access," she says. "They had two abortion clinics last time we did this study. Now they have only one." Several other states in the South, where restrictions on abortion are often toughest, showed substantial declines in abortion in the new study, and a surprising number of counties—87 percent—nationwide have no abortion provider at all.

More Babies by Choice
Randall K. O'Bannon, director of education and research for National Right to Life, says more women are choosing to go forward with their pregnancies because they're "better informed" about abortion and more familiar with fetal biology, thanks to technologies such as 4-D ultrasound. "There's been a lot of pro-life education and outreach, and a lot of people out there providing women with positive alternatives to abortion," says O'Bannon. "This data tells you that attitudes have changed."

Not so fast, says Jones, the Guttmacher researcher. Yes, more women are carrying to term, she says, but if that's because they've changed their political views she doesn't know. "We don't have any recent data on that, either," she says. Perhaps that's one thing both sides can agree on: the need for more statistics on pregnancies and abortion.