By Rob Stein
Washington Post Staff Writer
Tuesday, January 11, 2011; 12:00 AM
The rate at which women are getting abortions and the total number of procedures being performed in the United States, both of which had been falling steadily for nearly two decades, appear to have hit a plateau, according to an authoritative survey released Tuesday.
The stall between 2005 and 2008 marks a stark shift in the trend in abortions, which had peaked at 1.61 million in 1990 and then declined almost every year since until 2005, when it hit 1.21 million - the lowest level since 1976.
"What we found was essentially no change," said Rachel K. Jones, a senior research associate at the Guttmacher Institute, a nonprofit reproductive health research center that gathers the most comprehensive data on abortion in the United States. "It seems the long-term decline in abortion has stalled."
The sudden plateau, which caused concern among anti-abortion activists and pro-choice advocates, raises the possibility that the decline could be reversing, though more data is needed to know for sure, said Jones, whose survey of nearly 1,800 providers is being published in the journal Perspectives on Sexual and Reproductive Health.
"It's kind of a wake-up call that we need to increase access to contraceptives services so we can continue to prevent unintended pregnancies and the decline in abortions can continue again," she said.
The survey, which has been conducted periodically since 1974 but had not been done since 2005, found the total number of procedures had crept up 0.5 percent by 2008 - from 1.206 million to 1.212 million. The abortion rate in 2008 rose 1 percent in 2008, to 19.6 per 1,000 women ages 15 to 44. That's after the rate had peaked in 1981 and had fallen nearly every year since until 2005, when it hit the lowest level since 1974 at 19.4.
The survey did not gather data on the reasons for the shift. But other evidence supports the idea that the recent recession may have played a role - making it harder for women to afford contraceptives, leading to more unplanned pregnancies, and more women to decide they can't afford another child, Jones said.
"One explanation is that women who were poor who found themselves with an unintended pregnancy in the middle of a recession who in other circumstances would have said 'Okay, I'll go ahead and have a baby' would just say, 'I just can't do this right now' and get an abortion," she said. "That would slow down the decline."
An earlier survey from the federal Centers for Disease Control and Prevention had found no increase in contraceptive use between 2006 and 2008, Jones noted. At the same time, poor women are the most likely to seek abortions, and a 2008 Guttmacher survey found an increase in the proportion of poor women undergoing the procedure.
Previous recessions did not have a major impact on the trend in the abortion rate, but those economic downturns were not nearly as severe, Jones said.
Other observers agreed, saying women were making the painful economic calculus to skip a few routine bills to cover a $400 to $600 abortion rather than face supporting another child.
"We hear from women who are selling possessions and forgoing paying certain bills in order to afford the abortion care they need," said Vicki Saporta of the National Abortion Federation, which represents abortion providers. "Many of these women already have children and are struggling to care for the children they have and are very clear they can't afford to have another child."
Another factor may have been the stalling in the drop in pregnancies in teenage girls that occurred in the same period.
"We had been seeing substantial declines in teen abortion rates since the early 1990s and those have been an important driver in the decline in abortion rates nationally," Jones said.
But others disagreed. Randall K. O'Bannon of the National Right-to-Life Committee argued that increased efforts to promote abortions, especially medical abortions using the drug known as RU-486, probably playing a greater role.
"The abortion industry has been busy promoting its products," O'Bannon said. "It's trying to change what the image of abortion is - like it's as safe and simple as taking a pill. That's certainly a major factor."
The survey, which was conducted in 2009 and 2010, found use of RU-486, also known as mifepristone, continued to increase, jumping 24 percent, from 161,000 to 199,000, to account for 17 percent of all abortions. Although that increase was enough to account for the stall, Jones said research suggests that the availability of RU-486 has not yet increased the overall number of women having abortions.
While the overall abortion rate remained unchanged, there were significant shifts in individual regions and states . Generally, abortion rates were highest in the Northeast and West and lowest in the South and Midwest. But the rates also vary sharpy from state to state. For example, the District's abortion rate plummeted nearly 44 percent, tumbling from 54 to 30 per 1,000 women. The rate in Maryland fell 8 percent (31.5 to 29), while Virginia's rate increased 7 percent (16.5 to 17.6). The D.C. drop was probably because of two clinics closing, which could have contributed to the increase in Virginia as women sought abortions there instead, Jones said.