The U.S. abortion rate has fallen dramatically, by 25 percent, in recent years. The procedure continues to be common: 1 in 4 women will have an abortion by 45, according to a report published in the American Journal of Public Health on Thursday.
Researchers used data from three surveys, two conducted by the federal government and the third by the Guttmacher Institute, to estimate abortion rates. They found that in 2008, there were 19.4 abortions per 1,000 women ages 15 to 44. By 2014, the number had dropped to 14.6 per 1,000.
The period between 2008 and 2014 was an unusually turbulent one for women's reproductive rights in America. Numerous states — including Indiana, Kansas, Texas and North Carolina — enacted new restrictions, waiting periods or mandatory ultrasounds for women considering abortions in those states. In other parts of the country, the Affordable Care Act's Medicaid expansion helped women who might not otherwise have been able to get an abortion get insurance coverage for one.
While these policy changes are important and affecting women's access to and use of abortion in complex ways, co-authors Rachel K. Jones and Jenna Jerman, who work for Guttmacher's research division, suggested that the main factor driving the decline in abortions was much simpler: improvements in contraceptive use.
Definitive data on unintended pregnancies for that period isn't available yet, but there are other indicators that support this theory. The teen birthrate, for one, has been declining, hitting an all-time low in 2014, according to Centers for Disease Control and Prevention data. Experts have credited better access to contraception and more convenient and reliable contraception than in the past. They have also suggested that many teens may be having less sex.
Jones and Jerman noted that the decline in abortions was not uniform across all age, racial or income groups. The biggest decline in abortions, of 46 percent, was in women ages 15 to 19 years of age, and there has been strong evidence that contraceptive use, such as more reliance on long-acting methods and intrauterine devices, was responsible for that decrease. They also noted that for the first time in 20 years, failure rates for condoms improved.
One troubling finding in their report was that the abortion rate was the highest among women with incomes less than 100 percent of the federal poverty level — or about $19,790 for a family of three — and that abortions seem to be increasingly concentrated among the poor. About 49 percent of all abortion patients in the United States in 2014 were poor.
However, this is the first time in 20 years that the abortion rate has declined in this group.
The researchers said that we might have expected to see an even greater decline given the new state restrictions on abortions. “That this was not the case may be because of several factors,” Jones and Jerman wrote. One is that long-acting contraceptive use now appears to be as common in poor women as higher-income women. They also said that “it's possible more poor women in states where Medicaid pays for abortion acquired coverage and were able to use it to pay for their procedure.”
The divergence in abortion trends by income in the United States is similar to the divide that exists in the rest of the world. A recent study in the journal Lancet found that in wealthier countries, abortion rates are falling, while abortion rates are rising in developing countries, a situation that the authors say may be due to a lack of access to modern methods of contraception among the poor, leading to more unwanted pregnancies.