Declining abortions in the United States

Reporters, analysts, and advocates are all discussing newly released abortion data from the Centers for Decease Control and Prevention (CDC):

After years of holding steady, new Center for Disease Control data shows that the United States abortion rate has fallen to an all-time low. It dropped 5 percent between 2008 and 2009, the most recent years for which data is available, the largest decline in the past decade. (Source: The Washington Post) 

So, why did abortions go down so much between 2008 and 2009? Analysts and pundits have offered the following explanations:

Better contraception = fewer abortions. More women are using more effective methods of contraception. As a result, fewer pregnancies that do occur are unwanted, and therefore fewer pregnancies are terminated. A recent, much-discussed study indicated that, when women have greater access to more effective contraception-- when it was provided for free-- pregnancy and abortion rates went down.

From the CBS News report:

Some cite a government study released earlier this year suggesting that about 60 percent of teenage girls who have sex use the most effective kinds of contraception, including the pill and patch. That's up from the mid-1990s, when fewer than half were using the best kinds.

Experts also pointed to the growing use of IUDs. The IUD, or intrauterine device, is a T-shaped plastic sperm-killer that a doctor inserts into a woman's uterus. A Guttmacher Institute study earlier this year showed that IUD use among sexually active women on birth control rose from under 3 percent in 2002 to more than 8 percent in 2009.

IUDs essentially prevent "user error," said Rachel Jones, a Guttmacher researcher.

Ananat said another factor for the abortion decline may be the growing use of the morning-after pill, a form of emergency contraception that has been increasingly easier to get. It came onto the market in 1999 and in 2006 was approved for non-prescription sale to women 18 and older. In 2009 the age was lowered to 17.

If this is true, then we should expect to see continued declines in unwanted pregnancies and abortion rates in the future. More specifically, in surveys, we should see women identifying a lower percentage of pregnancies as being "unwanted." I'm not sure the survey evidence, at least, is there. My impression is that roughly half of all pregnancies in the United States have been reported as "unwanted" for a while, without big swings over time.

Also, what explains the size of the change from 2008 to 2009, relative to other years in which LARC use has been increasing steadily? Better contraception makes a lot of sense, but it does not appear to provide a complete explanation.

The Great Recession did it. A professor at Duke University, Elizabeth Ananat, was quoted in a few articles as suggesting that women "stick to the straight and narrow [during hard economic times] ... and they are more careful about birth control." Also from the CBS News report: 

You might think a bad economy would lead to more abortions by women who are struggling. However, John Santelli, a Columbia University professor of population and family health, said: "The economy seems to be having a fundamental effect on pregnancies, not abortions."

The reporter for the Washington Post cited a 2004 study that seems to contradict Professors Ananat and Santelli:

A 2004 paper in the journal Health Economics looked at the relationship between the economy and abortion rates at the state level. It found that, “As the economy moves into recession, a 1-point rise in the unemployment rate leads to about a 3 percent increase in abortion rates.” 

(Note that the linked study is actually from 1994, and is a working paper from the National Bureau of Economic Research.)

The idea that hard economic times influence women to make more of an effort to avoid unwanted pregnancies is intriguing, but I find it hard to swallow. If this were the case, wouldn't women living under difficult economic conditions in the United States always have fewer unwanted pregnancies than American women who are relatively well-off? I think the evidence, generally, indicates an opposite correlation between poverty, unwanted pregnancy, and abortion.

Furthermore, if this hypothesis is accurate, wouldn't the correlation hold over several economic cycles? This hypothesis, for example, would predict that the percentage of pregnancies that are "unwanted" would go up during good economic times and down during bad economic times. It doesn't seem to me that the economic performance of the United States from 1980 to now (up and down) matches up with trends in abortion rates during that period (slow and steady decline).

Restrictive abortion laws. This explanation is favored by pro-life activists and scholars like Michael J. New: Laws that make getting an abortion more difficult (waiting periods, defunding Planned Parenthood so it shutters abortion clinics, etc.) lower the number of abortions. 

Is there a correlation between ease of abortion access and the number of abortions? Maybe:

Mississippi had the lowest abortion rate, at 4 per 1,000 women of child-bearing age. The state also had only a couple of abortion providers, and has the nation's highest teen birth rate. New York was highest, with abortion rates roughly eight times higher than Mississippi's. New York is second only to California in number of abortion providers. (Source: CBS News)

Three comments on this. First, we don't know if women in Mississippi get fewer abortions, period, or fewer abortions in Mississippi (i.e., women might travel to get an abortion) or fewer abortions with abortion providers who report what they do (i.e., as in third-world countries, Mississippi women might self-abort or go to off-the-books abortion providers). So the number of reported abortions within a state does not tell the whole story of what is happening with pregnant women in that state. 

Second, this hypothesis does not explain why there is such a large and unexpected change between 2008 and 2009. Was there an increase in the implementation of abortion restrictions between 2008 and 2009 so pervasive that it caused such a precipitous drop? 

Third, not all states enacted greater abortion restrictions, so how can a national trend be explained by a phenomenon that only occurred in selected states? 

Americans are becoming more pro-life. Pro-life scholar Michael J. New suggested, in a post-election analysis, that Americans are becoming more and more pro-life in orientation. If this were the case, more women might decide to carry an unwanted pregnancy to term, thus lowering the number and rate of abortions. 

This assertion is not accurate. For example, surveys show that a high majority of Americans continue to believe that abortion should be legal in the early stages of pregnancy. Given that approximately 90% of abortions occur in the first 12 weeks of pregnancy-- in 2009 as in other years-- this cannot explain the change in abortion numbers from 2008 to 2009. 

One would also have to explain why 2009-- the year after Americans elected a pro-choice president and pro-choice Congress-- was such as banner year in the culture wars that abortions dropped severely as a result. 

So: What caused the numbers to change between 2008 and 2009? I don't think there is a single good answer-- yet. It may not be an explainable or useful phenomenon until we see what happened in 2010, and 2011, and so on-- was this an anomaly or a trend? While intriguing, we have to be careful to avoid over-reading the results of this single-year event. 

Links:

Article in The Washington Post (November 23, 2012): Surprise! The abortion rate just hit an all-time low

Articles on the CBS News site (November 21, 2012): U.S. abortion rates down 5 percent during Great Recession, biggest one-year decrease in a decade

Report from the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR)(November 23, 2012): Abortion Surveillance-- United States, 2009

Study (mentioned in the CBS News report and The Washington Post article that indicated that LARC use has gone up between 2002 and 2009) published in Fertility and Sterility (July 13, 2012): Changes in use of long-acting contraceptive methods in the U.S., 2007-2009

Study from the National Bureau of Economic Research Working Paper Series (1994): State abortion rates: The impact of policies, providers, politics, demographics, and economic environment