Staying on top of what’s going on with abortion in the United States can feel like being on a freaking rollercoaster. Every new headline broadcasting an attack on abortion access leaves us scrambling to understand what it really means for people who might need abortions. Witnessing all these debates about whether or not we should have autonomy over our own bodies is also exhausting. Despite the ever-changing abortion landscape, one thing has remained constant: the steady decline of the abortion rate over the years.
Last month, the Guttmacher Institute released a study showing that in 2017, there were 13.5 abortions per 1,000 women aged 15 to 44. This marked an 8 percent decline since 2014 and a 54 percent decline since 1980, when the U.S. abortion rate peaked at 29.3 procedures per 1,000 women aged 15 to 44. It’s the lowest abortion rate recorded since the historic 1973 Roe v. Wade Supreme Court decision legalized abortion nationwide.
For researchers who have their fingers on the pulse of abortion trends, this is hardly a surprise, Abigail R.A. Aiken, M.D., Ph.D., assistant professor of public affairs at the University of Texas, tells SELF. “[The abortion rate] is doing exactly what it’s expected to do given the trajectory it’s been going in for three decades,” she says. “This decline has been happening over time.”
Contrary to what a lot of people think (and what anti-choice rhetoric may have you believe), this historically low abortion rate isn’t primarily due to legal restrictions that have popped up across the country. “While those regulations have certainly prevented some people from getting abortions, it’s not the main driver of the declines we’ve seen,” Rachel K. Jones, Ph.D., a principal research scientist at the Guttmacher Institute and co-author of this latest study, tells SELF.
For starters, the national number of places providing abortions didn’t decline in any significant way between 2014 and 2017, the study points out, although researchers are interested in charting how local clinic closures may influence abortion rates in the long-term. Also, people who need abortions will often do whatever they can to get them, no matter what restrictions are in place.
So, if not restrictions, what are the main drivers in this trend? Read on to find out.
Fewer people are getting pregnant overall.
According to a report the Centers for Disease Control and Prevention (CDC) published earlier this year, the U.S. fertility rate is steadily declining.
To clear up any confusion, the fertility rate in this context means the number of live births over a given time period (not the ability to conceive, which is what we often discuss when we talk about fertility). The number of live births in 2018 was around 3.8 million. That represented a 2 percent drop from the year before and the lowest national fertility rate we’ve seen in 32 years. When fewer people are getting pregnant overall, there are fewer people who might need abortions. It’s as simple as that.
We can point to a number of potential reasons behind this declining fertility rate. There is arguably less stigma around being child-free by choice than there has been in the past and less cultural emphasis on making people who can give birth—especially those who identify as women—feel obligated to become parents.
There’s also the fact that people are having less sex now overall, which has led to a lot of hand-wringing about a so-called “sex recession” (which is another story for another time).
Then there’s how our general trash fire of a world is making a lot of people feel about having babies. In the 2013 book Global Spread of Fertility Decline: Population, Fear and Uncertainty, authors Jay Winter and Michael Teitelbaum argue that fear and uncertainty are impacting attitudes toward potential parenthood. How many of your friends have said something along the lines of, “I’m not sure I want to bring a kid into this world when climate change is coming for us all” or “Between my student loans and this country’s absurd lack of paid parental leave, I can never afford to have kids”?
To round this one out, more people are now using the most effective forms of birth control we’ve ever had. This point is so important it deserves some extra exploration.
Contraception is more effective these days.
Thanks to better birth control, fewer people are dealing with unintended pregnancies. Consequently, fewer abortions are needed.
While research indicates that improved access to any kind of free contraception can lead to fewer unintended pregnancies, long-acting reversible contraceptive methods (or LARCs) like IUDs and arm implants are the real champs here. The number of women aged 15 to 44 using LARC methods rose from 13 to 16 percent between 2014 and 2016, a 23 percent increase overall, according to the Guttmacher Institute. This is a huge deal because LARCs are an unparalleled form of birth control.
Depending on the specific type of LARC you use, failure rates are estimated to be between 0.01 and 0.8 percent, meaning that fewer than one person out of 100 will become pregnant within the first year of using these birth control methods. Compare that with, say, birth control pills, which have an estimated failure rate of 0.3 percent with perfect use. This may sound comparable, but perfect pill use can be wildly hard to pull off. It means taking your pill consistently and correctly every single time.
When we look at typical use instead of perfect use (which accounts for the fact that we’re very human and prone to making mistakes like forgetting to take a pill), the birth control pill failure rate rises to around 9 percent. That means nine out of every 100 people who mess up taking their birth control pills in some way will get pregnant within the first year of use.
The wide gap in failure rates between LARCs and birth control methods like the pill comes down to the fact that there’s little room for user error if you have an IUD or arm implant. Once they’re properly inserted, you can typically let them do their thing with little upkeep (besides getting them replaced by the recommended deadline). That doesn’t mean these types of contraception never fail, but when they do, it’s usually because of something like improper insertion rather than something you, the patient, can control. Science has shown time and time again how much this can affect pregnancy prevention.
For instance, a landmark 2012 study in Obstetrics & Gynecology noted a significant reduction in unplanned pregnancy and abortion after providing people at risk of unintended pregnancy with no-cost contraception, especially LARCs. Researchers enrolled 9,256 adolescents and women who were sexually active into the Contraceptive CHOICE Project, which offered participants their choice of reversible contraceptive methods for free. Just over 40 percent of the participants were uninsured, around 43 percent had private insurance, and around 16 percent had public insurance. Overall, 75 percent of participants chose a LARC method when cost wasn’t a barrier, which is much higher than the national rates of LARC use in the United States. As a result, researchers saw a significant reduction in unintended pregnancies compared to national rates.
Self-managed abortions are likely becoming more common.
Make no mistake: Self-managed abortions aren’t a new phenomenon. For a while now, people have been buying abortion pills online for medication abortions (non-surgical termination of early pregnancy, usually with the aid of the medicines mifepristone and misoprostol) or trying to end pregnancies on their own using non-pill methods, according to Dr. Aiken. Coat-hanger abortions aren’t a myth.
It’s hard to know exactly how many people are self-managing abortions (or trying to). As the Guttmacher Institute study points out, the number of people who seek medical care after attempting to end a pregnancy on their own can offer up some clues. In 2014, 12 percent of non-hospital facilities surveyed nationwide (like abortion clinics) said they’d seen at least one patient who’d tried to self-manage an abortion. In 2017, that number jumped to 18 percent. If self-managed abortion rates are rising but aren’t included in the overall abortion rate because they’re hard to track, it can cause the official abortion rate to go down.
It’s worth noting that the Guttmacher study didn’t account for self-managed abortion with the aid of telemedicine. In the context of the Guttmacher study, a self-managed abortion means you don’t have the help of a medical provider guiding you through a medication abortion at home, like if you buy abortion pills online. There’s currently such little regulation here that the U.S. Food and Drug Administration recommends people don’t try to self-manage their abortions for safety reasons. There’s just no guaranteeing what type of medication you’re going to get or that you’ll have the medical debriefing you need just in case something goes wrong.
Self-managing with the aid of telemedicine abortion, on the other hand, means receiving professional oversight for a medical abortion at home, meaning you have a direct line of communication with a medical professional throughout the process so you can ask questions and get support. For this reason, the Guttmacher Institute study actually categorized telemedicine abortions as clinic-based procedures.
“[Telemedicine abortion] has been a complete game-changer,” says Dr. Aiken. “People will often take the option that’s more convenient in life. If you have kids to look after, if you have a job, if you have other things going on, meeting people where they’re at is important. I think online telemedicine models do a really good job of that.”
So, what does a declining abortion really tell us?
Now that you know the main factors behind the U.S. abortion rate’s downswing, you might find yourself wondering, “Wait, is it good or bad that the abortion rate is going down?”
Given everything we explored above, it turns out it’s a little bit of both. “If it’s going down because fewer people are getting pregnant when they don’t want to, then that’s a good thing,” Jones says. “If it’s going down because [of] increased stigma, because they can’t afford it, because they don’t have a clinic to go to, then that’s a bad thing.”