guttmacher report: Fewer abortions, more polarization

What It looks like

We see political polarization around us all the time, and much of it has to do with the “social issues,” including abortion. If anyone thought that the prosecution of Gosnell, the abortionist and murderer who ran the “House of Horrors” in Philadelphia, would result in a widespread revulsion at late-term abortions and infanticide, he or she was woefully mistaken. Outright infanticide has been accepted effectively by Virginia’s Governor, Ralph Northam, who is also a physician. New York has passed a bill that permits abortion up to birth, and lets doctors deny treatment to a child who survives a late-term abortion. (This is one reason I am not particularly hopeful when one or another abortion atrocity is uncovered: people aren't paying attention. We've had 46 years since Roe v. Wade, and little has changed in the general public perception of abortion. We, however, are paying attention.) 

What's Really Happening

Away from the public eye, however, we are winning. This can hardly be emphasized enough. Most public pro-life activity is focused on the supply side of the equation: cut abortion access off with laws, and we’ll solve the problem. That has had some success, but it doesn’t account for what we’ve seen with the numbers. It’s on the demand side that we are seeing gain after gain: pregnancy help has driven the numbers lower, year after year. The Alan Guttmacher Institute, at one time Planned Parenthood’s research arm, has just issued its report for 2017, and it confirms that abortion numbers are continuing to fall. Abortion rates (per thousand women 15-44) across the U.S. dropped 7% from 2014’s numbers to 13.5 (an estimated total of 862,320). Most interesting for us is what they say about state abortion laws and numbers of clinics: “Although the number of state abortion restrictions continued to increase in the Midwest and South between 2014 and 2017, these restrictive policies do not appear to have been the primary driver of declining abortion rates. There was also no consistent relationship between increases or decreases in clinic numbers and changes in state abortion rates” (“Key Points,” emphasis added).

I think Guttmacher can be trusted here: their researchers may be morally blind on abortion, but they’re dealing with things that can be checked: abortion laws, clinic numbers, and abortion numbers. At the risk of being repetitious – something else beside laws and clinic numbers is driving the drop in abortion ratios: the increase in pregnancy help.​

Guttmacher is guessing

When the Guttmacher report goes on to say that “it is unlikely that the decline in abortion was due to an increase in unintended births” (emphasis added), we can be suspicious. It’s in their ideological self-interest to think so. How would we know that unintended births haven’t increased? Unintended births are measured by interviews of subjects, and so are not as cut-and-dried as numbers of births, or even as numbers of abortions; how members of groups answer interviewers’ questions may vary from year to year, or decade to decade. (In the “Turnaway Study” of women who had borne their children after being refused an abortion, 38% said in interviews after the births that they had never sought an abortion! Pregnancy and birth can be something like the Twilight Zone!) It’s true, a couple of studies showed unintended births declining in the past, and this might indicate that contraception, especially widespread use of the most effective contraception, is one reason. But then another, longer-term, study showed unintended births going up from 30.6 per 100 live births, to 37.1, an increase of 7%, from 1995 to 2010. All that time, abortion ratios were going down. So Guttmacher is going out on a limb when it says, without further study, that it is unlikely that unintended births did not increase.

Similarly, when they claim that “improvements in contraceptive use and increases in the number of individuals relying on self-managed abortions outside of a clinical setting” are among the “factors that may have contributed to the decline” (emphasis added), they are guessing. It is true that so-called “Long-Acting Reversible Contraception,” or “LARC,” is more effective at preventing pregnancy than the other forms, but the number of women who are using it is not great enough to explain the drop in abortion rates. There was a simultaneous decline in use of the more common forms of contraception, too, so there was probably no net gain in contraception. In any case, as used in real life, common contraceptives (condom, diaphragm, pill) do not reduce unintended pregnancy rates, but in fact increase those rates.

What about "self-managed" abortions?

What of an increase “in the number of individuals relying on self-managed abortions outside of a clinical setting”? This is a new problem, and one we'll consider in a future post. It makes statistical assessments difficult: who reports these, apart from hospitals that report incomplete abortions done elsewhere? And why would we think that they are not the reason for the decline? Again, we look at longer-term trends. In the graph of Pennsylvania’s first and repeat abortions, below, we see that first abortions have been decreasing faster since 2008 (the first year repeat abortions were reported) than repeat abortions, 25% to 20%. (Repeat abortions were 47% of all PA abortions in 2017). This trend, which likely is the same in many other states, pre-dates the appearance of chemical abortion pills (mifepristone, misoprostol) bought over the Internet, and would be unaffected by it. (This same argument could be mounted against the view that Plan B and similar, so-called emergency contraceptives (EC) reduced abortion ratios when they appeared on the scene: the downward trend in abortion ratios long pre-dates EC.)
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What proportion of young women who seek a first abortion would resort to buying pills through the Internet? I submit that it would not be large. The Guttmacher report notes that “one national survey of U.S. adult women, conducted in 2017, found that only 1.4% reported ever having attempted to end a pregnancy on their own.” Women who have a second abortion, or a third or more, however, might come to view abortion pills as just another form of birth control. Yet again, the number of women who are having second, or third, or fourth abortions or more, has been decreasing for at least nine years in Pennsylvania. It is unlikely that “self-managed” abortions played a significant role in the decline in the U.S. abortion rate. The future, however, may be a different story.

As society is becoming politically polarized, so it is becoming polarized in its abortion practices: the number of all pregnant women having abortions in general is falling, but likely fewer U.S. women, and not just Pennsylvania women, are having first abortions. Randall K. O’Bannon of National Right to Life points out something else: “Most of the overall abortion decline happened at high volume abortion clinics performing between a thousand and 4,999 abortions a year. (It should be noted that the country’s nineteen mega-abortion mills – those performing 5,000 abortions or more a year – experienced an increase of about 8,000, or about 428 more abortions per abortion mill)” (Randall K. O’Bannon, “New Numbers from Guttmacher Show Continued Abortion Drop,” NRL News Today, September 18, 2019.) I would bet anything that most of the clients at those mega-abortion mills are having repeat abortions, and that for many abortion has become birth control for them.

The bottom line? Polarization in abortion practices or not, abortion ratios over the long-term continue their constant decrease, as the number of pregnancy help centers is increasing. In Pittsburgh, we’re showing that advertising makes the existing pregnancy medical centers even more effective in saving lives.

Chris Humphrey, Ph.D.
​Executive Director