The abortion rate in the U.S. is currently at its lowest since 1973, when the historic Roe v. Wade decision made it legal nationwide, according to a report out today from the Guttmacher Institute, an organization that advocates for legal abortion. As of 2014 (the most recent available data), the rate fell to 14.6 abortions for every 1,000 women age 15 to 44 in the U.S., down from its peak at 29.3 for every 1,000 in the 1980s.
The study authors suggest that there are likely both "positive and negative" factors contributing to the decline. On one hand, the rate of unplanned pregnancies is the lowest it's been in years (yay birth control!). But on the other, increased abortion restrictions might have made it more difficult for women to access abortion in some states, according to the report. Indeed, Kristi Hamrick, a representative of anti-abortion group Americans United for Life, cited the low rate as evidence that new regulations—such as mandatory ultrasounds before receiving an abortion—are having a "real, measurable impact on abortion," she told NPR.
There are a couple problems with that theory, though. First, we've had a relatively stable birth rate, says Sara Imershein, M.D., M.P.H., a board-certified ob-gyn. "If more people are giving birth because of these regulations, why aren't we seeing an increase in birth rate?" She says the answer is because people were preventing unintended pregnancies with birth control. After January 2012, the "no co-pay" birth control provisions provided by the Affordable Care Act probably helped the U.S. hit this all-time low, she says.
Plus, the report found no clear relationship between abortion restriction and rates. And in the northeast, the abortion rate decreased even though the number of clinics increased. We repeat: yay birth control.
But now that contraception is no longer going to be free, many worry that the abortion rate could go back up. "I do believe people will have less access to both birth control and abortions," says Dr. Imershein. "I believe they're going to shut down all kinds of clinics across the country, that we'll lose Title X (a provision that funds family planning resources and training), and Medicaid will exclude organizations that offer access to contraception." (Read more on how a Planned Parenthood collapse could impact women's health.) Not only does she believe that we will see an increase in both abortion and the birth rate due to the rising cost of birth control, but that this means the increased birth rate will be among the "most desperate patients."
Currently, about 25 percent of women with Medicaid (usually people with low incomes), who seek abortion end up delivering. That's because, in all but 15 states, Medicaid will not fund abortion as a result of the Hyde Amendment, which prohibits federal funds from being used for abortion services. And for women in the 35 states that follow this reform, some women simply cannot afford the approximately $500 fee. Not being able to obtain an abortion when one is wanted or needed not only has implications for the women being denied these services but also for public health in general. "The women who are forced to give birth even though they wanted an abortion are all high-risk pregnancies because they are unintended pregnancies," says Dr. Imershein. "In most cases, they didn't have prenatal care before getting pregnant and they are, and have been proven to be, at a higher risk for complicated pregnancies, pre-term birth, and low birth weight."
Regardless of your stance on abortion, we can pretty much all agree that no one ever wants to get one, so we definitely hope this number stays down—without compromising women's health and access to reproductive care.