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Researchers say the number of abortions at medical facilities is down. Getty Images
  • The rate of abortions performed at healthcare facilities is at its lowest level since Roe v. Wade was decided.
  • There’s been a 20 percent decline since 2011.
  • Researchers say the evidence points to birth control access as one major cause for this drop.
  • Medication-induced abortions may also be a reason for the drop.

The reported rate of abortion in the United States has reached its lowest level since the landmark decision of Roe v. Wade in 1973, researchers from the Guttmacher Institute announced last week.

The authors of the new report found that in 2017, the rate of abortion performed in healthcare facilities across the country was 13.5 per 1,000 women aged 15 to 44 years old. That represents a decline of 8 percent from 2014 and a decline of 20 percent from 2011.

When the authors probed their data for possible causes, they found no clear link between the enactment of new abortion restrictions or the closure of abortion clinics and the drop in reported abortions at a national level.

“Abortion restrictions were not the main driver of the decline in the U.S. abortion rate between 2011 and 2017,” the authors wrote.

“Rather, the decline in abortions appears to be related to declines in births and pregnancies overall,” they added.

In recent years, many states have passed laws that limit healthcare providers’ ability to perform abortions and patients’ ability to access them.

Between 2011 and 2017, 32 states passed a total of 394 new abortion restrictions. Those restrictions included many so-called TRAP laws, which require abortion providers to meet burdensome criteria.

Those laws have contributed to the closure of abortion clinics in many states, particularly in the South and Midwest regions of the country.

This has increased the barriers that people in those areas face to accessing abortions, forcing some to travel long distances, even across state lines.

But it’s not entirely clear what role those laws or clinic closures have played in changing abortion rates at national and state levels.

According to the new report from the Guttmacher Institute, the rate of abortions performed at healthcare facilities declined in most states from 2011 to 2017, regardless of whether or not those states had implemented new abortion restrictions or closed clinics during those years.

In fact, more than half of the reported decline in abortions occurred in states, as well as the District of Columbia, that didn’t pass any restrictions or close any clinics over that time period. This includes states that took steps to increase access to abortion, such as California.

The authors of the report also found that the national birth rate declined from 2011 to 2017.

This suggests that fewer abortions may be taking place because fewer people are getting pregnant, perhaps thanks to improved access to birth control.

Under the Affordable Care Act, most health insurance plans are now required to cover female contraception without patient copayments.

More people may also be performing abortions at home, using medications obtained online. Those self-managed abortions wouldn’t be captured in the abortion rate data collected by the Guttmacher Institute.

According to Nichole Austin, PhD, a postdoctoral researcher at McGill University in Montreal, Canada, the findings of the new report aren’t unique.

“Abortion rates have been declining steadily for many years, so the latest report is consistent with previous trends,” Austin said.

“A key question is whether the U.S. abortion rate is falling because of reduced need for abortion or because abortion has become less accessible,” she continued.

When Austin and one of her colleagues studied the effects of TRAP laws, they found that such laws are probably not the main driver of declining abortion rates at the national level.

However, Austin notes that TRAP laws may have meaningful effects on abortion rates at state and local levels.

Indeed, when the authors of the new Guttmacher report compared changes in abortions rates across state lines, they found some potentially meaningful differences.

Their data showed that abortion rates declined more steeply than the national average in several states that had been particularly hard-hit by TRAP laws, including Virginia, Texas, Ohio, and Arizona.

Some commentators have cautioned that the Guttmacher study was designed to assess changes in national rates of abortion, rather than fully explore the causes of those changes.

“Their research question was, what is the incidence of abortion in the U.S.? That limits their ability to fully explain the reasons for the decline,” Ushma Upadhyay, PhD, MPH, an associate professor in the department of obstetrics, gynecology, and reproductive science at the University of California, San Francisco, told Healthline.

“The cause for the decline is likely a combination of reasons, and a study intentionally designed to understand them is needed,” she added.

Even in cases when someone is able to get an abortion, restrictive abortion laws and clinic closures can make it much harder and more expensive.

“There is some evidence suggesting that the loss of a nearby clinic, for example, increases travel burdens, and the overall hardship of obtaining abortion increases out-of-pocket costs to women and may ultimately delay abortion receipt,” Austin explained.

“As you can imagine, increases in cost and distance may be much harder to overcome for women of lower socioeconomic position,” she added.

Along with TRAP laws and other recent restrictions, the 1976 Hyde Amendment has made abortion less accessible by restricting the use of Medicaid dollars and other federal funds to pay for abortion.

While it may not be clearly visible in national abortion rate data, there are cases when women are forced to carry unwanted pregnancies to term due to the barriers such laws pose.

“We have evidence of people being forced to carry to term, simply because they could not afford the abortion itself or the travel and other expenses incurred in obtaining an abortion,” Upadhyay said.