Most abortions are to women over 24

​Pregnancy Help and Advertisers Need to Broaden Their Focus to Older Women

We have been very successful serving younger women. Now we need to reach out to their older peers.

Summary

• Fewer adolescent women (15–19) are having abortions, now only 10% of all.
• More than 60% of abortions are performed on women over 24.
• Pregnancy help has driven the decline in abortion numbers, especially with younger women.
• Pregnancy help centers, and pregnancy center advertising, should intentionally broaden their outreach to the older demographic.

​A few years back, the executive director of a local pregnancy help center observed that more clients were not just “abortion-vulnerable,” that is, just thinking about abortion; instead, they were “abortion-determined.” They weren’t calling up with questions about pregnancy and abortion, but asking how much an abortion would cost. They had made up their minds. They were just shopping.
 
Now some of this could be the result of changing mores, new attitudes to sex and relationships, or a changing sense among these young women of how one has to act in “the real world.” A bigger part of the answer, however, is a change in the demographics: more of the women seeking an abortion are older. Let’s take a look at abortion numbers over the long term, to see the trend.

​The most striking change since 1973, perhaps, is how the percentage of young abortion patients has gone down: those under 20 years old (the yellow bars) dropped from 33% then, to 9% in 2019 – a 73% decline. Look at the difference, however, in percentage of patients who were over 24 from 36% to 63% (the blue bars). That’s an increase of 80%.
 
Put this data together with the decline in the rates of abortions per 1,000 women of child-bearing age over the same period, and it is clear: not only are younger women a smaller group of all those having abortions; they are a smaller group of all women their age. The following chart shows the pattern clearly: the trend lines showing the proportion of those women 15–19 and 20–24 who are having abortions go down (the orange and gray lines). The trend lines for abortions among women 25–29 and 30–34 rise slightly (the yellow and blue lines).

​Why are younger women having fewer abortions? The proportion of those using contraceptives has increased somewhat from 2010.[1] Adolescents, however, are also less sexually active than in the past. In 1991, 54% of high school students had had sex; in 2019 that number was 38.4.[2] Many observers have seen a decrease in sexual activity generally, though it is most observable in younger women. A variety of reasons are given to explain it.[3] The result, of course, is fewer pregnancies that lead either to birth or abortion. Is it possible that the morning-after pill (“Plan B”) has played a role here? This is unlikely, as the declining abortion ratios began well before the widespread availability of the morning-after pill, and continued at the same rate after its availability. The relatively sexually and contraceptively inexperienced young woman, if anything, would be less likely to resort to it than her older peer.
 
Women 15–24 gradually became a smaller proportion of all age groups having abortions. They also became a smaller group of all those their age who were pregnant. For those 15–19, those ratios per thousand births dropped over 50% from 1985 to 2007; for those 20–24, they dropped 29%. The decline for those 25–29 was 16%.[4]
 
Could it be that the cohort of women who were open to abortion years ago were just getting older and were still open to abortion, while younger women were less so? Changing practical attitudes to abortion may play a role, but the age trends are lasting much longer than the reproductive years of any given cohort. Something else is happening here.[5]
 
Abortion ratios are the best measurement of factors affecting the pregnancy decision. When the proportion of pregnant women choosing life goes up, one naturally looks for a cause. The most obvious cause of reduced abortion ratios across the country is the increase in pregnancy help centers and the advertising of them. Abortion numbers began falling in the mid-1980s, just as the number of pregnancy help centers began increasing sharply. The abortion numbers have continued to fall steadily to the present, as more centers go up and as advertising for those centers becomes more widespread.
 
Has pregnancy help had an outsized effect upon adolescents and younger women? It is almost certainly so. When they become pregnant, younger women are more likely to be unsure of whether they are. When they have confirmation that they are pregnant, they are more likely to be uncertain of their next step, or of what they really want. They are more likely to be ambivalent about abortion, and find decision-making challenging.
 
This is reflected in the fact that younger women have a lower proportion of early abortions than older women, and a higher proportion of later abortions. We can see this in the gestational ages at which most abortions are performed: 9 weeks or under. In the chart below, showing CDC data from 2019, notice that about 36% of aborting women 15–19 had their abortions at 6 weeks or less. Of those women a little older, 20–24, 41% had abortions within the same period. If you follow the six-weeks-and-under line (blue) to the right, you see that the older a woman was, the more likely it was that she had an abortion early in pregnancy.

The blue line (abortions performed at 6 weeks gestation and under) shows that 15-19-year-olds were a minority of those having abortions at that stage (36%). More of them (38%) waited until 7-9 weeks gestation to abort (the first point on the orange line). The rising blue line shows that the older women were, the more likely it was that they had their abortions earlier in pregnancy.

The declining lines for 7-9 weeks gestation (orange), for 10–13 weeks gestation (gray), and, for 14-15 weeks (yellow) show similarly that the younger women waited longer to have their abortions.
 
So it appears that younger women are more uncertain and ambivalent regarding abortion than those a few years older. It is no surprise that more younger women who have an opportunity to find support, have increasingly turned away from abortion over the years than older women. It is also no surprise that, as abortion numbers have gone down, our success with younger women means that other, older clients seem more “abortion-determined” than ever.
 
Pregnancy help centers are staffed, in many cases, with older women who serve as advisors or mentors for women whose family situations make such mentors invaluable. These older women are effectively surrogate “moms,” taking the right amount of interest in the well-being of their clients, while respecting the freedom of these adult “children” to make their own decisions. These “moms” care, and inasmuch as their clients get to know them, their clients know that they care. It is this, and the information, practical advice, and moral and spiritual support that they provide, that has had the effects we see in my first two charts: younger women, women more ready to accept those falling into a “mom” role, are less likely to abort than those over 24.
 
The result, however, is that the women that pregnancy help centers have to reach are more and more “determined.” That is, they are more experienced, and less impulsive (something that both males and females face, as the brain matures in the twenties[6]). They are surer of themselves, and perhaps more cynical as a result of their experiences. About 60% are moms already, and over 40% have had one abortion or more before.
 
From about 2015 on, ratios of abortions to births for 15–19-year-olds began to climb again. The same was true for those 20–24, though the increase was smaller. Pregnancy help centers cannot ignore this group of pregnant young women, for whom they have done and can do so much, and despite the fact that this group has become smaller. Without ceasing to appeal to those under 25 (aiming at the high schools and colleges, and so forth), pregnancy help centers would do well to reach out to older women, who in many cases face more complicated situations than their younger peers. Despite the challenges, many still respond if they are given the opportunity.
 
 
Chris Humphrey, Ph.D.
Co-Founder, Vision for Life
www.visionforlifepgh.org

[1] “In terms of overall trends in contraceptive use between 2008 and 2014, there was no significant change in the proportion of women who used a method among either all women (60%) or those at risk of unintended pregnancy (90%)” (Megan L.Kavanaugh, Jenna Jerman, “Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014,” in Contraception, Volume 97, Issue 1, January 2018, pp. 14-21, https://www.sciencedirect.com/science/article/pii/S001078241730478X).
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[2] Kate Julian, “Why Are Young People Having So Little Sex?” The Atlantic, December 2018 (https://www.theatlantic.com/magazine/archive/2018/12/the-sex-recession/573949/); CDC, Youth Risk Behavior Survey: Data Summary and Trends Report, 2009–2019, p. 12 (https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf).

[3] Julian, op. cit.

[4] Calculations were made using “Table 12 (page 1 of 2). Legal abortions and legal abortion ratios, by selected patient characteristics: United States, selected years 1973–2007,” from the 2011 CDC Abortion Surveillance Report (https://www.cdc.gov/nchs/data/hus/2011/012.pdf).

[5] I am indebted to my fellow Heartbeat International Board member Gary Thorne for this observation, and to Jor-El Godsey, President of Heartbeat, for helpful suggestions.

​[6] https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know
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