On June 24, 2022, the U.S. Supreme Court officially struck down Roe v Wade and Planned Parenthood v Casey, and the federal abortion protections that had come with them.
The following analysis was originally published in May 2022, after a draft of Justice Samuel Alito’s majority opinion, striking down Roe v Wade, was leaked.
In the spring of 2022, the U.S. Supreme Court appeared poised to overturn the historic 1973 Roe v. Wade decision that made abortion access a right, leading to questions about the impact of such bans on abortion rates.
Laws that restrict or ban abortion have played a small or negligible part in reducing the rate of abortions, though this varies according to numerous studies we looked at. We also have to consider many other factors behind a reduction in abortion rates worldwide and in the United States.
What Are Current Abortion Rates?
First, let's understand the current data on abortion in the U.S. After an initial spike in the 1980s, abortion rates have declined steadily across the country — with a few exceptions in areas like Washington, D.C. — since Roe v. Wade. According to the Guttmacher Institute, considered to be the leading organization conducting research on sexual and reproductive health, current abortion rates are lower than what they were in 1973, and less than half of what they were at their peak in the 1980s.
The Institute reported a 19 percent decline in the number of abortions across the U.S. from 1,058,000 abortions in 2011 to 862,000 abortions in 2017.
Our past reporting also looked at abortion data from the Centers for Disease Control and Prevention (CDC), and found that the total number of reported abortions from 2010 to 2019 decreased by 18%, and in 2019, women in their 20s accounted for more than half of abortions, with more than three-quarters performed at less than nine weeks’ gestation. We also learned that the number of deaths from abortions have gone down steadily for a range of reasons.
Worldwide, the numbers vary between developed and developing countries. According to Guttmacher’s “Abortion Worldwide 2017” report: “As of 2010–2014, an estimated 36 abortions occur each year per 1,000 women aged 15–44 in developing regions, compared with 27 in developed regions. The abortion rate declined significantly in developed regions since 1990–1994; however, no significant change occurred in developing regions.”
A 2007 global study by the Guttmacher Institute and WHO found that abortion rates were similar in countries where it was legal and those where it was not. The 2017 Guttmacher report pointed out similar data: that abortions “occur as frequently in the two most restrictive categories of countries (banned outright or allowed only to save the woman’s life)” as they do in countries in the least restrictive categories, which is 37 and 34 per 1,000 women, respectively.
A 2020 report published in the Lancet from Guttmacher and various United Nations organizations, meanwhile, found that the average global unintended pregnancy rate had declined between 1990-1994 and 2015-2019, while the proportion of unintended pregnancies ending in abortion actually increased, showing the discrepancy between countries where abortion was restricted and where it was not.
They emphasized that “the global average abortion rate in 2015-2019 was roughly equal to the estimates for 1990-1994.” The same report stated that in “countries where abortion was restricted, the proportion of unintended pregnancies ending in abortion had increased.” Their findings suggested that “people in high-income countries have better access to sexual and reproductive health care than those in low-income countries.”
What is Behind the Overall Decline in the U.S.?
The decline in abortions is due to a number of factors, not all of which have to do with its legality, though we should note that the decline in the U.S. occurred gradually, after abortion access became a federal right.
In the U.S., attitudes about birth control have shifted considerably since Roe v. Wade in the 1970s. Now more women have access to other contraceptives. In 2018, Guttmacher Institute reported that 65% of U.S. women between the ages of 18 and 49 were using a contraceptive method — a steady percentage since 2002 — and nearly all sexually active women (99%) have used at least one contraceptive method as of 2008. The rate of pregnancies have decreased overall as more people opt for smaller families, and wait longer to get pregnant.
Access to contraceptives is a key factor that largely overlaps with countries where abortion is already legal. According to Gilda Sedgh, who was Guttmacher’s principal research scientist from 2004-2019, “The abortion rates in Northern and Western Europe — where abortion is broadly legal — are among the lowest in the world, because it is generally easy for women in these countries to obtain high-quality contraceptive services.”
However, one U.S.-focused report published in 2020, which looked at restrictive state policies and abortion rates from 2000-2014, found “evidence that a highly restrictive state legislative climate is associated with a lower abortion rate.” Researched by experts from Brown University, University of Chicago, and Washington State University, it analyzed data from 1,178 counties in 18 states. The report noted the researchers did not have access to more recent data from years where additional restrictive laws were implemented, and it is possible that their findings would change as a result.
While worldwide abortion numbers are only partially affected by the legality of abortions, in certain restrictive environments, the lack of access can theoretically impact the abortion rate in the short-term. As mentioned earlier in a global report, the numbers of unintended pregnancies ending with abortion were actually higher in areas with more restrictions. But it is also difficult to determine the role these restrictions play in abortion rates, which must be considered alongside all the other factors we outlined above. As the Guttmacher Institute noted (emphasis ours):
Abortion restrictions target either individuals’ ability to access the procedure (such as by imposing coercive waiting periods and counseling requirements) or providers’ ability to offer it (such as through unnecessary and intentionally burdensome regulations). Any one of these restrictions could result in some people being forced to continue pregnancies they were seeking to end; this could, in theory, lower the abortion rate. [...]
While there appears to be a clear link in many states between abortion restrictions — and TRAP laws in particular — and clinic closures, there is no clear pattern linking abortion restrictions to changes in the abortion rate. While 32 states enacted 394 restrictions between 2011 and 2017, nearly every state had a lower abortion rate in 2017 than in 2011, regardless of whether it had restricted abortion access. Several states with new restrictions actually had abortion rate increases.
Multiple factors influence the incidence of abortion including the availability of abortion providers; state regulations, such as mandatory waiting periods, parental involvement laws, and legal restrictions on abortion providers; increasing acceptance of nonmarital childbearing; shifts in the racial/ethnic composition of the U.S. population; and changes in the economy and the resulting impact on fertility preferences and access to health care services, including contraception.
What Are the Effects of Restricting Abortion Access?
We have already detailed how abortions occur as frequently (if not more) in highly restrictive environments as they do in unrestricted environments. Plenty of evidence suggests that the illegality of abortion does not often deter people from seeking out abortions.
The Guttmacher Institute noted the key immediate impact of abortion restrictions:
While there is no clear pattern linking restrictions and abortion declines, restrictions often exact a heavy toll on individuals seeking an abortion. In fact, restrictions are usually enacted with the explicit and cruel intent of creating hardship. Most egregiously, restrictions do keep some people from getting the abortions they want to obtain. And even for those who are able to overcome various barriers, restrictions can cause serious financial and emotional consequences, including by causing delays in obtaining care. Yet people have long shown that they will endure these hardships, including by diverting money meant for rent, groceries or utilities to pay for their procedure.
According to a World Health Organization (WHO) fact sheet, “Evidence shows that restricting access to abortions does not reduce the number of abortions; however, it does affect whether the abortions that women and girls attain are safe and dignified.” The WHO adds that the proportion of unsafe abortions is much higher in countries with highly restrictive abortion laws than in countries with less restrictive laws. A Guttmacher and WHO study concluded that the vast majority of abortions are safer in countries where it is broadly legal, while most are unsafe in countries where it is illegal.
In our previous story, we noted how deaths from abortions had declined partly because procedures had become safer. Today, more than 90% of abortions are performed within the first 13 weeks of pregnancy — an important factor given that the risk of death associated with abortion increases with the length of pregnancy. Abortion providers in the U.S. today are able to prevent infections and provide adequate medical care.
Studies in a few countries show that untrained abortion providers—including pharmacists or market sellers, who may know little about misoprostol [the abortion pill]—are usually more plentiful, easier to find and less expensive than trained and informed ones. Reliance on poorly informed providers often means that the resulting abortion or advice is more likely to lead to an incomplete abortion. Moreover, if a first abortion attempt fails, a woman has to start again with another provider at an increasingly later stage of pregnancy. In addition to being riskier, abortions at later gestations tend to cost more because they require more-advanced training and specialized equipment (or in their absence, a traditional provider who is willing to perform a more difficult procedure). And if a woman cannot afford to go to a trained professional, she may resort to more traditional methods and risk more severe complications as the pregnancy advances.
A number of factors can determine the abortion rate, including accessibility, legality, overall pregnancy rates, access to contraceptives, evolving approaches to childbearing, and more, but it is difficult to pinpoint one main cause. We do know, however, that abortions will be in demand regardless of whether they are legal, and safer abortions are known to take place in countries where they are regulated and legal.
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