The abortion rate is at its lowest level since 1974, according to a new nationwide survey, continuing a 20-year decline that is likely due to increased contraceptive use, and more recently, the availability of new contraceptive options and the increased use of the "morning-after" pill to prevent pregnancy.
A total of 1.31 million abortions was performed in the United States in 2000, the study found -- a rate of 21.3 abortions per 1,000 women aged between 15 and 44.
This number is significantly down from the country's peak abortion rate in 1980 and 1981 of 29.3 abortions per 1,000 women.
The study, published today in the journal Perspectives on Sexual and Reproductive Health, was greeted as good news by reproductive health specialists and both abortion rights activists and antiabortion groups.
"Any decrease in the numbers would be something for us to rejoice in," said Jan Carroll, legislative analyst with the California ProLife Council in Sacramento.
Nancy Sasaki, chief executive officer of Planned Parenthood Los Angeles, said: "Overall, it is good news.... I think it is clear that the work that we're doing at Planned Parenthood and other reproductive health-care providers is making a difference in the abortion rate." The study also reported that the numbers of abortion providers had declined 11% since 1996, and that so-called chemical abortions -- in which pregnant women take the drugs mifepristone or methotrexate to terminate a pregnancy -- have quickly become a significant fraction of abortions. Within months of the approval of mifepristone (formerly known as RU-486) by the Food and Drug Administration in September 2000, ending pregnancies with chemicals accounted for 6% of all abortions.
The study was conducted by the Alan Guttmacher Institute, a nonprofit reproductive health research center based in New York and Washington, that has been tracking abortion rates across the nation since 1973. This is the institute's 13th national survey.
The last survey, conducted in 1996, also had reported a decline in the abortion rate and numbers of abortion providers. The figures released today reported a 5% drop in the abortion rate since 1996.
The institute sent questionnaires to 2,442 clinics and hospitals it believed provided abortions requesting information on the number performed at each facility in 1999 and 2000. Information from 1,931 facilities was included in the final analysis.
Abortion rates, the study found, had dropped in 35 states (including California) and the District of Columbia. The greatest decreases were seen in Kentucky and Wyoming. Abortion rates rose slightly in 15 states, with the largest percentage rise observed in Delaware.
It is not clear why abortion rates are decreasing, said study co-author Lawrence B. Finer, the institute's assistant director of research. But he added there is evidence that emergency contraception -- in which the hormones used in birth control pills are taken within a few days of sexual intercourse -- could account for as much as 43% of the decline in abortions since 1994.
In December, the Guttmacher Institute published a study estimating that about 51,000 abortions were prevented in 2000 by emergency contraception.
"Finally this is beginning to appear as a reasonable alternative to women. Women are learning about it and becoming more sophisticated about using it and physicians are prescribing it," said Dr. Ruth Shaber, director of women's health services for Kaiser Permanente Northern California.
In some states, such as California, emergency contraception can be provided by a pharmacist without a prescription.
It is also likely that a greater availability of other contraceptive methods is contributing to the decline, experts said. In the last few years, American women have been presented with a range of new contraceptive choices such as a patch, vaginal ring, monthly shots and new intrauterine devices with fewer side effects.
"The more methods you have the better the chance an individual will find a method that suits her lifestyle and her body," said Finer.
Because these methods do not depend upon taking a pill once a day, women are more likely to use them correctly, avoiding an unwanted pregnancy, experts said.
There are also anecdotal reports that teenagers are less likely to engage in intercourse, and that their sexual behavior may be more focused on oral sex and other activities that do not involve risk of pregnancy. Declines in abortion rates between 1994 and 2000 were most notable in teenagers, according to the institute.
But the Washington-based National Right to Life Committee argues that the gradual decline cannot be completely explained by improved contraception or abstinence. The group's analysis suggests that more women, faced with an unwanted pregnancy, are opting to carry the child to term, said Douglas Johnson, legislative director of the organization.Today, 87% of the counties in the U.S. -- predominantly in rural areas -- lack an abortion provider. Although the number of providers has decreased since 1996, experts don't believe this has contributed significantly to the abortion rate decline.
Experts are more concerned about the aging of doctors who provide abortions. A 1997 survey found that 57% of obstetricians and gynecologists providing abortions were age 50 or older.
Young doctors do not want to deal with the harassment that can come from antiabortion groups, said Dr. Mildred Hanson, an obstetrician-gynecologist in private practice and a former medical director of Planned Parenthood of Minnesota and South Dakota. "Young doctors didn't live through the time when we saw women coming to emergency rooms with sepsis and hemorrhage, fighting for their lives," she said. "They are not as committed as some of us older folks."
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A survey of U.S. abortion providers reveals:
* 49% of pregnancies are unintended. Half of those are terminated by abortion.
* 52% of women obtaining abortions are younger than 25; 19% are teenagers.
* Black women are more than three times as likely as white women to have an abortion.
* 54% of women who have abortions used a contraceptive method during the month they became pregnant.
* 87% of all counties lacked an abortion provider in 1996.
* As much as 43% of the decline in abortions between 1994 and 2000 is attributed to the use of emergency contraception.
Source: Alan Guttmacher Institute
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A 20-year decline
Abortions per 1,000 women aged 15-44, by year
1973: 16.3 (Roe vs. Wade Supreme Court decision)
1998: 21.5* (Morning-after pill approved)
2000: 21.3 (RU-486 pill approved)
*estimated; 2000 figures are the latest available
Source: Alan Guttmacher Institute