But the Changing Political Landscape Imperils Access to Essential Reproductive Health Care

In 2014, the U.S. abortion rate reached the lowest level ever recorded. A new analysis in the Guttmacher Policy Review argues that improved contraceptive use resulting in fewer unintended pregnancies likely played a larger role than new state abortion restrictions in the decline between 2011 and 2014. Although the available data suggest that both factors contributed to lower abortion rates, most of the decline in the number of abortions (62%) occurred in the 28 states (and DC) that did not have major new abortion restrictions in effect.

The analysis points to additional supporting evidence that fewer unintended pregnancies were the main factor in the recent abortion decline. Research shows that the decline during the previous period (2008–2011) was entirely due to fewer unintended pregnancies. There is also evidence that use of highly effective contraceptive methods—such as IUDs and implants—increased through 2012, and that some of this momentum may have continued through 2014, in part as a result of various provisions of the Affordable Care Act. Lastly, no comparable increase in births occurred during the period to offset the abortion decline; rather, there were fewer pregnancies overall between 2011 and 2014.

“Abortion restrictions are coercive in nature and unacceptable in principle,” says Joerg Dreweke, author of the analysis. “Policies must support all of a woman’s pregnancy decisions. Rather than seeking to reduce abortion at all cost, policymakers should focus on facilitating women’s access to the full range of contraceptive methods, ensuring their access to safe and affordable abortion care, and helping them achieve healthy pregnancies and raise their children with dignity.”

Dreweke predicts that antiabortion groups and policymakers will credit state abortion restrictions as the main driver behind recent declines to support their regressive policy agenda. However, even though restrictions likely contributed to abortion declines in some states, no national pattern links restrictions and abortion declines during the most recent period. The 22 states that had major new abortion restrictions in effect in 2012, 2013 and 2014 accounted for only about 38% of the abortion decline, and even in those states, new restrictions cannot explain all of the drop.

Although many women find ways to access abortion care in spite of obstacles, the analysis warns that state restrictions can make abortion more expensive and burdensome for patients, the majority of whom are poor or low-income. Dreweke says that targeted regulation of abortion provider (TRAP) laws in particular may have contributed to declines in both abortion clinics and abortion rates in most of the nine states where they were newly in effect during this period. Notably, the U.S. Supreme Court ruled two TRAP laws unconstitutional in the summer of 2016, arguing that these restrictions posed an undue burden to women.

Dreweke warns that the incoming administration and Congress are hostile toward abortion rights and programs that ensure access to affordable contraceptive care. Many of the harmful policies they are expected to pursue—from restricting abortion access to attacking family planning programs and providers—will be layered on top of the ongoing wave of restrictions at the state level.

“Taken together, this looming onslaught against a broad swath of reproductive health services threatens a massive rollback of women’s health, rights and autonomy,” says Dreweke. “It’s a dangerous policy mix that could stop or reverse progress in empowering women to avoid unintended pregnancies and more generally meet their childbearing goals.”

Reproductive Health in Crisis
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