Abortion Providers at Lowest Mark Since ’73

The number of abortion providers in the United States, depressed by the anti-abortion climate and the trend toward managed care, is at its lowest level since soon after the Supreme Court made abortion legal in 1973, the Alan Guttmacher Institute reported Thursday.

But the incidence of abortion, after falling steadily during the first half of the 1990s, has leveled off, according to the New York-based institute, a nonprofit group with expertise in reproductive health issues. About 26% of pregnancies now end in abortion, according to the institute.

The report found a partial return to the geographic availability of abortion immediately after the 1973 Roe vs. Wade ruling, with abortions readily obtainable in the biggest urban areas--particularly in California, Illinois and New York--but hard to come by in rural America.

“It is a question of attitudes in different parts of the country,” said Stanley Henshaw, the report’s author. “In conservative areas, you have women trying to avoid abortions and you have fewer providers.”

California’s Rate 4th in Nation

California’s abortion rate was 33 per 1,000 women of child-bearing age, fourth in the nation after Nevada, New York and New Jersey. With 492 abortion providers, California had the most in the nation--nearly double that of runner-up New York and nearly one-quarter of all providers in the country. By contrast, North Dakota and South Dakota had one provider each.

Nationally, 86% of counties had no abortion provider in 1996, a figure that has been rising for two decades. Although most of those were rural counties, the report found that “abortion services were effectively unavailable in one-third of U.S. cities.”

Altogether, nearly one-third of women live in counties without abortion providers--defined by the Guttmacher Institute as hospitals, clinics and doctors’ offices. About 70% of all abortions in 1996 were performed at the nation’s 452 abortion clinics. Only 16% of all short-term, general, nonfederal hospitals performed abortions that year.

Most of the drop in providers has been among hospitals and individual doctors. The drop in hospitals is partly a result of managed care, which encourages referrals to outpatient abortion clinics. It also may be attributable to increasing numbers of hospital mergers that, in many cases, have involved the takeover of nonprofit hospitals by Catholic hospitals, which will not allow abortion services.

It is unlikely that there will be a reversal soon in the trend toward fewer providers. A key factor is the dwindling number of obstetrics-gynecology residency programs that train residents in how to perform first-trimester abortions. Currently just 12% require training in first-trimester abortions and even fewer require it for second-trimester procedures.

Further undermining doctors’ confidence about making abortion part of their practice is the continuing violence against providers. While abortion rights supporters insist that, if anything, it has renewed the commitment of many doctors to perform the procedure, it cannot help but make some young doctors think twice, said Patricia Anderson, executive director of Medical Students for Choice, a Berkeley-based group.

Since 1993, there have been seven murders and 16 attempted murders of doctors who performed abortions as well as nearly 400 stalking incidents, according to statistics collected by the federal Bureau of Alcohol, Tobacco and Firearms and the National Abortion Federation.

The number of abortions was 1.36 million in 1996, about the same as in the previous year but down from a peak of 1.6 million in 1990. The institute’s preliminary data suggest that the number of abortions remained steady for 1997 as well.

The share of pregnancies ending in abortion has fallen steadily from a high of more than 30%.

Among the many factors related to the end of the decline in the number of abortions may be the drop in birth rates among unmarried women, according to Henshaw. Fewer births generally reflect a combination of better use of contraception and increasing incidence of abortion.

Other factors may be decreasing enthusiasm among women for using implant methods of contraception, such as NorPlant, which are highly reliable. With less effective contraception, unwanted pregnancies may be slightly more frequent and result in slightly more abortions.

“For a long period of time, there was a growing acceptance of having children without being married, and starting around 1995, the proportion of births to unmarried parents began to stabilize and even drop,’ Henshaw said.

According to the National Center for Health Statistics, the birth rate for unmarried women of child-bearing age is now at its lowest level since 1990.

“That may reflect changing societal attitudes towards having births without being married, and the result may be that now women are not as willing to continue in an unintended pregnancy,” Henshaw said.

Starting in 1995, Congress began to overhaul the federal welfare program and strongly promoted the idea that women should refrain from having children outside of marriage. In the welfare overhaul bill passed by Congress in 1996, the states were left with the flexibility to deny additional welfare benefits to women who had additional children while on welfare. The majority of women on welfare are unmarried.

For the first time, the Guttmacher survey attempted to quantify so-called dilation and extraction abortions. This abortion method, sometimes called “partial-birth” abortion, drew national attention several years ago when anti-abortion activists cited it to gain support for outlawing certain types of abortion.

According to a description by the American College of Obstetricians and Gynecologists, the method involves pulling the intact fetus out of the uterus feet first until all but the head has been removed, then puncturing the base of the skull and partly collapsing it by extracting the liquid before delivering the rest of the fetus.

Survey Estimates Abortion Numbers

Guttmacher researchers asked all abortion facilities if they perform this type of procedure and only eight of those responding said that they did. Extrapolating to the non-respondents, the Guttmacher study estimates that 14 facilities performed 650 abortions using this method in 1996.

Anti-abortion activists sharply criticized the institute’s numbers as far too low, pointing out that, in the weeks that followed initial publicity about the method, several abortion providers were quoted as saying they performed scores and in some cases hundreds of the procedures every year--although it was not entirely clear that all providers were referring to the same method.

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Abortion Trends

Number of abortions performed nationally, in millions

1996: 1,365,700

Abortions as a percentage of all pregnancies nationwide

1996: 26.1%

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The California Picture

Abortions

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U.S. California 1982 1,573,900 262,710 1992 1,528,900 304,200 1996 1,365,700 237,830

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Abortion Rates

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U.S. California 1982 28.8% 44.5% 1992 25.9% 42.1% 1996 22.9% 33.0%

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Providers

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U.S. California 1982 2,908 583 1992 2,380 554 1996 2,042 492

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