Improved contraceptive use was a major factor in the just-revealed U.S. abortion rate decline, but Republican attempts to gut critical healthcare programs could reverse those gains, experts warned Tuesday.
The Guttmacher Institute, which works to advance reproductive health and rights through research and policy initiatives, announced Tuesday that in 2014, the U.S. abortion rate reached the lowest level ever recorded. In addition, the number of abortions in the U.S. dropped under one million for the first time since 1975.
In an analysis published alongside the report, Guttmacher's Joerg Dreweke argues that while anti-choice organizations are sure to claim that increased abortion restrictions led to the decline, improved birth control use and access "likely played a larger role."
"Several data points support this hypothesis," he wrote:
Births do not appear to have replaced most abortions in the most recent period: The number of abortions declined by a little over 132,000, whereas the number of births increased by only about 35,000 (some of which could represent more intended births, as happened between 2008 and 2011). Antiabortion activists routinely fail to acknowledge that abortion declines can result from fewer unintended pregnancies, and instead pretend that any decline in the number of abortions is the result of women opting, or being compelled, to give birth rather than have an abortion. These activists often seize on declines in the abortion ratio—the proportion of all pregnancies ending in abortion—to showcase the supposed impact of their efforts. Although the abortion ratio fell 11 percent between 2011 and 2014, such a decline could occur if the proportion of pregnancies that are unintended decreases and, in turn, fewer pregnancies end in abortion. This likely happened to some degree during the most recent period.
Evidence suggests that contraceptive use contributed to the decline in abortion. In the previous period (2008–2011), the steep drop in unintended pregnancy—including births and abortions—was likely driven by improved contraceptive use, in particular, use of IUDs and implants, which are collectively known as long-acting reversible contraceptives (LARCs). LARC use continued to rise through at least 2012, providing women who choose to use these methods with multiple years of very effective protection against unintended pregnancy. Various provisions of the Affordable Care Act (ACA) that have increased insurance coverage and access to affordable contraceptive care appear to have spurred continued improvements in contraceptive use beyond 2012. Recent research also shows that improved contraceptive use accounted for the entire decline in teen pregnancy risk between 2007 and 2012, a trend that likely persisted beyond 2012, as teen birthrates have continued to plummet.
But with the Affordable Care Act (ACA), or Obamacare—which covers FDA-approved contraception—and Planned Parenthood on the chopping block under President-elect Donald Trump and the Republican majority in Congress, those trends could soon be reversed.
Repealing the ACA or cutting Medicaid "would result in many reproductive-age women losing insurance coverage altogether or seeing their health plan's contraceptive coverage severely degraded," Dreweke wrote. "Many of them might then seek out care from a family planning safety net that will itself be fighting for survival, even as it already struggles to serve those who remained uninsured under the ACA, including many immigrant women."
And as Planned Parenthood president Cecile Richards told NPR, "We shouldn't go backwards on access to birth control."
Of course, there's little doubt that state-level healthcare restrictions will proliferate under emboldened Republican-led legislatures—indeed, they already have. But whether those policies are effective or just is another question entirely.
For one thing, Dreweke noted,
there is no clear pattern linking restrictions and declines in abortion incidence (see chart). Of the 22 states with major new restrictions in effect, eight had abortion declines that were greater than the national average. But among the 28 states and the District of Columbia that did not have major new restrictions in effect, 10 states had larger-than-average declines as well. In addition, four of the 22 states with new restrictions actually saw increases in their abortion rates, compared with two states and DC in the group without new restrictions.
What's more, he added, "the question is not and should never be whether coercive approaches 'work' in reducing abortion incidence. Rather, these coercive approaches are unacceptable in principle."
"Taken together, this looming onslaught against a broad swath of reproductive health services threatens a massive rollback of women's health, rights, and autonomy," Dreweke said of the looming right-wing agenda. "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."