February 17, 2014 (The Public Discourse) - On an issue associated with tragedy and mourning, there was good news this month. A new study finds that in 2011, the US abortion rate—the number of abortions per 1000 women of reproductive age—reached its lowest point since the Supreme Court’s Roe v. Wade decision legalized abortion in 1973. Abortions dropped to just over a million a year, from a high of 1.6 million in 1990.
And yes, see how jaded we have become. Only a million innocent lives destroyed each year? Still, things could be far worse, and they have been.
The study was published by the Guttmacher Institute, described by the Washington Post as a “pro-abortion-rights think tank.” Guttmacher is a former research affiliate of Planned Parenthood, the largest abortion provider in the nation. Because it is trusted by abortion providers and gets its information directly from them, Guttmacher’s abortion data are often more complete than those gathered by the federal government from state health departments. But the group also has an ideological agenda. So as we welcome its data, we need to be cautious of its “spin.”
That spin is in full gear. Based on little evidence, the authors dismiss the possibility that the decline in abortion could be due largely to the passage of pro-life state laws. (Even here, though, they make exceptions—conceding that abortion rates may be reduced by bans on public abortion funding, and by laws requiring women seeking an abortion to make two visits to a clinic separated by a 24-hour waiting period.) They also say the 13 percent drop in abortions from 2008 to 2011 is probably not due to a further decline in abortion providers, because their numbers are almost unchanged. Instead, they attribute the decline to wider use of contraception, and especially to increased use of “LARCs” (long-acting reversible contraceptives) like the IUD and hormonal implants. These, say Guttmacher, are less prone than other contraceptives to “user error.”
There is good reason to question each of these judgments. Before turning to pro-life laws and the decline in abortion providers, let’s explore the “wider use of contraceptives” theory.
It is worth noting at the outset that the LARCs welcomed by Guttmacher suppress fertility for three to ten years and can be removed only with the help of a doctor, regardless of whether the woman changes her mind. Rather than saying that they have less “user error,” it would be more accurate to say they are less subject to user “freedom of choice.” But to Guttmacher, it seems, any choice to consider having a baby is “error.”
The “reproductive rights” movement’s turn away from “choice” and toward semi-permanent sterilization of women merits a discussion of its own. But there are good reasons to doubt that the abortion decline is largely due to contraception of any kind.
First, numerous studies suggest that contraceptive programs don’t substantially reduce unintended pregnancies or abortions. “Reproductive rights” advocates are aware of these findings. That is why, in their frustration, they are increasingly pushing semi-permanent methods that are less subject to what some call “user motivation.” A few years ago, Princeton researchers who advocate wider use of “emergency contraception” (EC) analyzed twenty-three different studies of programs to boost use of EC. All but one study showed increased use of the drugs. “However,” they said, “no study found an effect on pregnancy or abortion rates.”
Second, it has long been known that women using contraception may reduce the likelihood of pregnancy, but the likelihood increases that any pregnancy that does occur will be ended by abortion. Statisticians call this an increase in the “abortion ratio,” the number of abortions per hundred pregnancies (excluding miscarriages). It is easy to understand why the abortion ratio may increase in such situations. If I’ve already acted to make sure the sexual act does not lead to procreation, and then the instrument for achieving that goal failed, I may see myself as having a right to fix that problem. The Supreme Court said as much in its Planned Parenthood v. Casey decision of 1992: many Americans have organized their lives in reliance on “the availability of abortion in the event that contraception should fail.”
Thus, if wider or more consistent use of contraception were the chief reason for the abortion decline, we would see a reduction in total pregnancies (that is, a reduction in the sum total of abortions plus births), but not as much of a reduction in abortions. Births would decline more than abortions do. Yet between 2008 and 2011, the opposite happened: Births declined by only 9 percent, while abortions declined by about one-and-a-half times as much (13 percent). Not only the abortion rate, but also the abortion ratio, has dropped to its lowest level in at least two decades. Four out of five women who do become pregnant are letting their babies live. That can’t be due to contraception.
Third, the decline in abortions since 2000 has been led by a sharp decline among teens aged 15 to 17, somewhat offset by higher rates among women in their 20s and 30s. An earlier Guttmacher study noted that in 2008, the likelihood of abortion among these teens had dropped to being a little over half the likelihood for all women of reproductive age. And during much of this same period, family planning advocates were lamenting a decline in adolescents’ use of “reproductive health services” such as family planning.
Fourth, Guttmacher speculates that people may have used contraception more consistently between 2008 and 2011 because the pressures of a sluggish economy made them less willing to procreate. Yet in their earlier study of 2008 abortion data, cited above, the same Guttmacher researchers suggested the opposite: The sluggish economy under Bush was constraining access to contraception and leading people to have more abortions, stalling the steady decline in abortion rates from 2000 to 2005. Are we to believe that a Bush recession produces abortions while an Obama recession produces contraception? This theory seems a bit desperate. Generally abortion rates are higher, not lower, among women in poverty.
Finally, what about the shift in methods of contraception, from more easily reversible measures to LARCs such as the IUD? There is indeed a study claiming that among those using contraception, the percentage using LARCs increased from 2.4 percent in 2002 to 8.5 percent in 2009. This single-digit change is even less significant than it looks, as it was accompanied by a 2 percent decrease in surgical sterilization, the most effective method of all. And this was not a change from “unprotected” sex to use of contraception, but a marginal change in effectiveness rates among those already using some method. (Here I will pass over the “reproductive health” industry’s penchant for encouraging women to replace condom use with methods that expose them to a higher risk of AIDS and other sexually transmitted diseases, another topic deserving its own discussion.) To say this trend is responsible for the lion’s share of a 13 percent abortion decline nationwide seems implausible, especially when we look at differences by state, discussed below. To say it’s responsible for the decline in the abortion ratio would be ridiculous.
Are there other ways to explain the abortion decline?
Let’s look at the supply side, the number of abortion providers. Guttmacher says there is only a small decline here: In 2011 there were 4 percent fewer providers overall (counting hospitals, clinics, and physicians’ offices), and only 1 percent fewer clinics doing abortions. So how can this be responsible for a 13 percent reduction in abortions? It is at this point that Guttmacher’s “spin” overwhelms its reporting.
The study admits that the blanket term “clinics” covers two different kinds of facility: multi-purpose clinics that chiefly provide family planning or broader health services (30 percent of providers, responsible for 31 percent of the abortions); and specialized “abortion clinics” (19 percent of providers, but responsible for a whopping 63 percent of the abortions). In most cases, each abortion clinic performs between one thousand and five thousand (yes, that’s five thousand) abortions a year. Closing even one such clinic could have a significant impact.
Did the number of dedicated abortion clinics decline, and if so by what percentage? This figure cannot be found in Guttmacher’s tables. But one table reports there were 329 such clinics in 2011; and the study’s text mentions that “in 2008 there were 49 more abortion clinics.” We can do the math ourselves. If there were forty-nine more in 2008, there were forty-nine fewer in 2011, so the number of abortion clinics dropped from 378 to 329, which is a decline of … 13%. If anything, the significance of this figure—which is identical to the percentage drop in abortions themselves—is underscored by Guttmacher’s apparent effort to hide it.
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In turn, what led so many abortion clinics to close? Guttmacher provides part of the answer. It laments the “disruption of services” produced by a law in Louisiana that made it easier to close such clinics (contributing to a 19 percent decline in the state’s abortion rate), and the 24-hour waiting period enacted by Missouri in 2009 (helping to give it a 17 percent decline from 2008 to 2010). More generally, it complains about “burdensome” laws regulating abortion clinics, many of which have been passed since 2011 and so can be expected to play a greater role in future abortion numbers.
Guttmacher’s spin doctors call these “TRAP” laws (“targeted regulation of abortion providers”), even when they only bring abortion clinics into line with standards already governing other clinics doing ambulatory surgery. For years, the abortion industry has been dragging these laws into court, claiming they place an “undue burden” on women’s access to abortion and will make clinics close entirely. Taking into account that these claims may be exaggerated or overheated to win a legal victory, does Guttmacher now want to claim that its allies have been lying in court? If not, it seems pro-life laws really do have an impact on the abortion “supply.”
Also suggestive are differences by state. Guttmacher mentions six states where the decline in abortion rates from 2008 to 2011 was much sharper than the national average of 13 percent. There’s one fluke here: Delaware. The state had a 28 percent decline, but it previously had the very highest abortion rate in the nation, and still has a much higher rate than average. The other five already had low abortion rates, and these sharply declined further: Kansas (a 35 percent decline), South Dakota (30 percent), the above-cited Missouri (21 percent), Utah (21 percent) and Oklahoma (20 percent).
In 2010, the year before the abortion decline was measured, all these states ranked in the top half of the country for having laws protecting life, according to the annual scorecard by Americans United for Life. Oklahoma was second in the country, and South Dakota was sixth. Utah comes in just under the wire at twenty-fifth, but AUL says that is because it does not have laws against cloning, embryo research or assisted suicide. In general, these are socially “conservative” states on matters of family and sexuality. They are hardly the states most likely to be pushing LARCs on their population; in fact, some of them have worked to reduce or eliminate funding for Planned Parenthood. Rather, their pro-life laws help reduce the abortion rate and abortion ratio, as other research has shown.
The states where the abortion rate increased from 2008 to 2011, or decreased much less than the national average, are Alaska, Maryland, Montana, New Hampshire, West Virginia, and Wyoming. All of these were ranked by AUL as being in the bottom half of the country in terms of pro-life laws. Maryland has a “Freedom of Choice Act” establishing a statewide “right” to abortion that is more extreme than Roe; Montana’s supreme court has found a similar expansive right in the state constitution and has legalized abortions performed by non-physicians; Alaska’s similar state supreme court ruling has forced the state to fund abortions and invalidated conscience protection for hospitals that do not wish to perform abortions. The states showing little or no decline in abortions were among the states with the most pro-abortion legal policies.
To be sure, the abortion decline is probably based on more than particular pro-life laws as such. After all, the governors and legislators making those laws were elected by the state’s voters, who wanted pro-life lawmakers. The laws are made possible by a culture and public attitude against abortion, which can also influence women’s attitudes and behavior directly. Sentiment against abortion, and acceptance of the “pro-life” label, has been growing nationwide (especially among young people), though surely more in some states than others. The national debate in the late 1990s on the grisly partial-birth abortion technique, the revelations about criminally dangerous abortionists like Kermit Gosnell, and the greater visibility of the unborn child due to advances like 4-D ultrasound have no doubt all played a role.
And that sentiment can be found in the medical profession itself, a trend that may scare the abortion industry most of all. The pro-abortion American College of Obstetricians and Gynecologists could not have been happy a few years ago, when its own journal reported that only 14 percent of ob/gyns ever perform abortions. Those who do perform them have long complained that their morale is low, that their medical colleagues look down on them, and that when they retire there may be no one willing to replace them. Some abortion practitioners have even publicly admitted that abortion is an act of violence, hoping that their candor will free them to persuade their colleagues that it is necessary violence.
Maybe this is all pretty simple after all: if you want fewer abortions, oppose abortion; if you want lots of abortions, promote abortion. And maybe more Americans are learning what abortion is: a violent act against life, a grief for women, a corruption of medicine, and an embarrassment to a civilized society. Education to further advance that understanding should be accompanied by positive steps to help women at risk of abortion, and to help health-care professionals and policymakers address these women’s real needs.
In short, pro-life Americans should rejoice at the good news, and redouble their efforts to help pregnant women and their unborn children. Notwithstanding the spin doctors of the abortion industry, we are seeing some light at the end of that long dark tunnel.
Reprinted with permission from The Public Discourse