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Rebecca Wind
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AFTER THREE DECADES OF LEGAL ABORTION, NEW RESEARCH DOCUMENTS DECLINES IN RATES, NUMBERS AND ACCESS TO ABORTION SERVICES

The U.S. abortion rate continues to decline and is now at the lowest level since 1974--21.3 abortions per 1,000 women aged 15-44 in 2000--according to new research from The Alan Guttmacher Institute (AGI). The abortion rate peaked in 1980 and 1981 at 29.3 abortions per 1,000 women. In 2000, a total of 1.31 million pregnancies ended in abortion, down from a high of 1.61 million in 1990. This information was gathered as part of AGI's 13th survey of all known abortion providers in the United States; AGI first collected data for 1973.

AGI also found that since its last survey of providers, in 1996, the abortion rate declined in every region of the country, in 35 states and in the District of Columbia. The abortion rate increased in 15 states, with the largest percentage increases in Delaware, Kansas and Idaho. Rates in 2000 ranged from 68.1 abortions per 1,000 women in the District of Columbia to 1.0 abortion per 1,000 women in Wyoming. (This analysis reports abortion rates by the state in which the abortions occurred, not the state in which women obtaining abortions lived.) In addition, the number of abortion providers declined in 38 states and the District of Columbia, increased in nine states and remained constant in three.

A new AGI analysis of trends in abortion in the 30 years since the U.S. Supreme Court's 1973 Roe v. Wade decision shows that the annual number of legal abortions at first increased dramatically, leveled off in the 1980s and declined through the 1990s. Before 1973, only four states had fully repealed restrictive abortion laws (Alaska, Hawaii, New York and Washington); in Roe v. Wade, the Supreme Court legalized abortion for women in all states. Although women of all backgrounds have abortions, abortion in the United States is increasingly likely to occur among single women, racial or ethnic minorities, low-income women and women who have had at least one child.

The number of providers is declining; one-third of American women now live in counties with no source of abortion services.

The number of physicians' offices, clinics and hospitals where abortions are performed in the United States increased until 1982 and has been declining since. In the most recent period studied, 1996-2000, the number of abortion providers declined from 2,042 to 1,819. This 11% decrease in providers was concentrated among physicians' offices, hospitals and clinics with small caseloads. The majority of abortions (93%) are performed in clinics, which account for 46% of all abortion providers.

The proportion of U.S. counties with no abortion provider has risen steadily since the early 1980s, reaching 87% in 2000. A third of women aged 15-44 lived in those counties, meaning they would have to travel to another county to obtain an abortion. Nearly one in four women obtaining an abortion in 2000 traveled more than 50 miles; 8% traveled more than 100 miles.

Within months of FDA approval of mifepristone, medical abortions accounted for 6% of all abortions.

Mifepristone received approval from the U.S. Food and Drug Administration (FDA) for use in early medical abortion in September 2000, and distribution of the drug began in November 2000. Early medical abortion accounted for 37,000 abortions, or 6% of all abortions, in the first half of 2001. About one-third of all providers (600) performed early medical abortions during this period. In European countries, where medical abortion was legalized a decade or more ago, the method has accounted for a growing share of early abortions each year without increasing the overall abortion rate.

"The United States has one of the highest rates of abortion among industrialized countries outside of eastern Europe, in large part because we have high levels of unintended pregnancy," said Sara Seims, president and CEO of AGI. "In addition to safeguarding access to abortion services, if we hope to continue to decrease the number and rate of abortions in this country, we must first address the factors responsible. Continued assaults on access to contraceptive information and services, particularly for young women and men, will only lead to more unplanned pregnancies and abortions."

Two new analyses, "Abortion Incidence and Services in the United States in 2000" and "The Accessibility of Abortion Services in the United States, 2001," both by Lawrence B. Finer and Stanley K. Henshaw, are based on AGI's 13th survey of all known abortion providers in the United States. These analyses appear in the January/February 2003 issue of Perspectives on Sexual and Reproductive Health, and include both national and state-level information.

In addition, graphic overviews of trends in abortion in the United States from 1973 to 2000 are available on-line:

• For the nation as a whole click here. [pdf] [powerpoint]

• For all 50 states and the District of Columbia click here .

A graphic overview of abortion in the United States, recently updated, is also available from AGI and Physicians for Reproductive Choice and Health at www.prch.org.

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