Interview: Why Abortion Rates Have Declined in Pennsylvania, America

Contraceptives work, it turns out.

Some interesting facts gleaned from this week’s Guttmacher Institute study of abortion rates around the United States: Pennsylvania women are slightly less likely to have an abortion than other women — the state reported 15.1 abortions for every 1,000 women of childbearing age, compared to a rate of 16.9 abortions for similar women in the country as a whole. The national rate was the lowest in more than 20 years of study.

Rachel Jones

It may be, however, that Pennsyvlania women are allowing themselves to get pregnant less often than other women. After all, Pennsylvania women who do get pregnant end up delivering live births as often as women in the rest of the country—67 percent of the time. And the percentage of Pennsylvania pregnancies that end in abortion (17 percent) is barely distinguishable from the national number of 18 percent. So how to explain the lower rate? Sift through the math, and it’s easy to conclude: Pennsylvania women may be a little more fastidious about using contraception than most American women. The number of intended pregnancies here? Forty-five, for every 1,000 woman of reproductive age; the national number is 51

Rachel Jones, a senior research associate at the Guttmacher Institute, talked with Philly Mag about the numbers, the policy lessons we can learn from the study, and the impact of Kermit Gosnell on abortion policy:

What do you make of the overall (national) decline?

The best available evidence suggests this is due, in part, to women using highly effective methods of contraception, such as IUD.

Much of the last three years in Pennsylvania we’ve been focused on Kermit Gosnell—he had a grisly operation in West Philadelphia, which produced a case where a patient died. But your numbers suggest women very rarely experience complications from abortion. Which policy lessons should we be learning from all of this?

Abortion is an extremely safe medical procedure. First-trimester abortions, surgical abortions, have a complication rate of .05 percent—very safe surgical and medical procedure. CDC tracks mortality and finds, again, that abortion is a very safe medical procedure. You can look to other studies, and that’s a very clear policy message.

The report says: “The very small group of American women who are at risk of experiencing an unintended pregnancy but are not using contraceptives account for more than half of all abortions.” Is that an access issue, or are there some other issues involved in the non-use of contraception?

Of the women who weren’t using contraception, very few of them identified inability to access contraception as a barrier, because admittedly, most of us are aware of where to go to get free condoms or condoms at a low cost if we had to get them. If you’d asked these same women, “Can you afford birth control pills, can you afford an IUD?” you might’ve got a different answer. But to ask a woman, “Do you know where you can get a method,” they at least know where to get a method.

When you’re talking about low-cost methods, such as condoms, that involves the cooperation of another person, right? But we did find in the survey that women who didn’t use contraceptives would list reasons like, “I didn’t expect to have sex, I didn’t think I could get pregnant, I didn’t have condoms on hand,” those types of issues are more prominent than issues of access.

Would that suggest that lowering the abortion rate further might be a tough nut to crack?

No. I think one of the messages out of our survey, the best available behind the decline in abortion is that more women are using effective methods of contraception, such as the IUD. We have seen, over the last decade, increased awareness of the IUD among both health care providers and among women. We’ve seen more health care providers and clinics taking on this method—a decade ago it was difficult to find a facility or a provider who had IUDs in stock, and had the skills and ability to insert them. We’ve seen just a big increase in awareness and availability.

The expectation going forward—our study stopped in 2011—the expectation is since that time, even more women have access to an IUD. And of course, with health care reform, we’re going to have more women with health insurance. One of the rules about health insurance now is that women don’t have to have co-pays for contraceptive methods. This going to make the IUD more accessible to a lot of women.

Not to put to fine a point on it, but Obamacare could reduce the abortion rate?

It’s always been clear from our research that women who have health insurance are better at using contraception, better at using more effective methods. So when you have policies that make it so more women have health insurance, the expectation is that more women will have access to highly effective contraceptive methods.

In 2011, 87 percent of Pennsylvania counties had no abortion clinic. 49 percent of Pennsylvania women lived in these counties. Travel is pretty easy these days—does that relative scarcity of clinics in rural areas affect abortion rates there?

Admittedly, we don’t have definitieve research on that. But the expectation is, women who live in rural areas are going to have lower abortion rates, for a variety of reasons, but one of them being that they have greater difficulty finding and getting to an abortion provider.

What else should I know?

We know that since our study period, a number of states have implemented even more onerous restrictions around abortion, so going forward, we’ll be closely monitoring if and to what extent these restrictions have impacted access to abortion services. If [IN] our next study, we see a continued decline in abortion, we can’t assume it’s for the good reason of better contraceptive use.

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