The Ups and Downs of Abortion: Fear, Poverty and Geography Impact Abortion Rates

01/25/2011 03:09 pm ET | Updated May 25, 2011

Is abortion going out of style? Not exactly, but abortion rates have generally fallen since the 1990s for various political, economic and social reasons. But in recent years, according to a new study by the Guttmacher Institute, abortion rates have stalled, raising questions about whether pregnant women have access to a full range of reproductive options and choice.

The study reports:

Nationwide, the number of abortions peaked in 1990, at 1.61 million, and dropped 25 percent, to 1.21 million, by 2005. Similarly, the abortion rate declined 29 percent over the same period, from 27.4 per 1,000 women aged 15-44 to 19.4 per 1,000.

But between 2005 and 2008, the rate ticked up by 1 percent. If this reflects a plateau in abortion rates, it’s unclear what’s driving the trend. Has contraception become too expensive? Harder to access? Has abstinence-only education kept young people from take precautions against unintended pregnancies? Whatever the reasons, here’s the message Guttmacher President Sharon Camp takes from the report:

In this time of heightened politicization around abortion, our stalled progress should be an urgent message to policymakers that we need to do more to increase access to contraceptive services to prevent unintended pregnancy, while ensuring access to abortion services for the many women who still need them.

Ensuring access to abortion can be difficult in an atmosphere where the government or insurance companies don’t want to pay for the procedure, federal and state lawmakers are drafting legislation to make abortions ever more difficult for women to obtain, and anti-abortion extremists are cranking up the hateful rhetoric and violence at clinics.

Then there are the economic barriers: Abortion might be prohibitively expensive for some low-income women. And they may have to drive to the next county to find a clinic  because, as Guttmacher reported in 2008, the number of U.S. abortion providers has been in a steady decline, peaking in 1982 at 2,900 facilities and falling to 1,800 by 2005. In that year, 87 percent of U.S. counties–home to 35 percent of women ages 15-44–lacked an abortion provider .

Even if women can reach a clinic, it might refuse to provide an abortion past a certain number of weeks into the pregnancy, or require a teenager to get her parent’s consent first. Another alarming trend Guttmacher researchers and others have identified is the routine harassment of abortion providers, which have ranged over the years from picketing to bombings to assassinations.

Among large non-hospital providers (those "offering 400 abortions or more") the proportion reporting harassment grew from 82 percent to 89 percent between 2000 and 2008.

The scarcity of providers reveals how abortion, as a public health issue, has been marginalized from mainstream healthcare discussions. In addition, one of the main reasons women decide to get abortions is that socioeconomic hardship makes childbearing and raising a family a huge burden. That means abortion is increasingly an issue not just of reproductive rights but also economic justice.

It's hard to discern clear patterns from the data, since abortion rates fluctuate heavily from state to state. Future studies may compare abortion trends with rates of unintended pregnancy and unintended birth, to figure out whether abortion is becoming more accessible to women dealing with unwanted pregnancy, or whether more women are being forced to carry unwanted pregnancies to term. There's one positive trend in the way women use abortion services: an increase in medication-induced abortion, which is associated with earlier, and thus safer, termination of unwanted pregnancy.

The new data helps illuminate the landscape of reproductive rights in the new decade: a complex mix of choice and limitations in health, wealth and geography, all of which conspire to make a woman’s deeply personal decision into an intensely political one.

A version of this article is cross-posted at Ms. Magazine Blog