Abortion Incidence and Service Availability In the United States, 2014

Abstract

CONTEXT National and state-level information about abortion incidence can help inform policies and programs intended to reduce levels of unintended pregnancy. METHODS In 2015–2016, all U.S. facilities known or expected to have provided abortion services in 2013 or 2014 were surveyed. Data on the number of abortions were combined with population data to estimate national and state-level abortion rates. The number of abortion-providing facilities and changes since a similar 2011 survey were also assessed. The number and type of new abortion restrictions were examined in the states that had experienced the largest proportionate changes in clinics providing abortion services. RESULTS In 2014, an estimated 926,200 abortions were performed in the United States, 12% fewer than in 2011; the 2014 abortion rate was 14.6 abortions per 1,000 women aged 15–44, representing a 14% decline over this period. The number of clinics providing abortions declined 6% between 2011 and 2014, and declines were steepest in the Midwest (22%) and the South (13%). Early medication abortions accounted for 31% of nonhospital abortions, up from 24% in 2011. Most states that experienced the largest proportionate declines in the number of clinics providing abortions had enacted one or more new restrictions during the study period, but reductions were not always associated with declines in abortion incidence. CONCLUSIONS The relationship between abortion access, as measured by the number of clinics, and abortion rates is not straightforward. Further research is needed to understand the decline in abortion incidence.

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search (Preprint)

“…We identified almost 800 abortion facilities, which is consistent with other estimates of abortion clinics and nonspecialized clinics providing abortion [1] but we found that these facilities are not distributed proportionately by population. Access to transportation is a barrier for people seeking all types of healthcare, in both urban and rural settings [26].…”

“…The high proportion of facilities offering only medication abortion reflects the opportunities provided by medication abortion: the skills required for clinicians to provide it are minimal (compared with aspiration or surgical abortion), the large majority of abortions in the United States (80.5%) occur at or before 10 weeks gestation (the current accepted limit by which medication abortion can be provided) [30], and the demand has increased with the proportion of women choosing this method now accounting for 31% of non-hospital abortions (compared to 6% in 2001) [1]. Additionally, states in the Northeast and West are less likely to have laws that limit the provision of medication abortion to physicians [31] and more likely to have policies that allow nurse practitioners, certified nurse midwives, and physicians assistants to offer medication abortion as part of their scope of practice.…”

“…Abortion is a common medical procedure [1], yet its availability has become more limited across the United States (US) over the past decade. Because 90 percent of US counties do not have an abortion provider, many women seeking abortion must travel outside their home counties to obtain care [1].…”

“…Because 90 percent of US counties do not have an abortion provider, many women seeking abortion must travel outside their home counties to obtain care [1]. Disparities continue to exist in access to abortion: women living in rural areas, the South and Midwest, and those seeking Medicaid-funded abortions are most likely to travel for services, often 100 miles or more one-way [2][3][4].…”

“…Disparities continue to exist in access to abortion: women living in rural areas, the South and Midwest, and those seeking Medicaid-funded abortions are most likely to travel for services, often 100 miles or more one-way [2][3][4]. Half of U.S. states experienced a decline in the number of abortion facilities from 2011-2014, with some regions experiencing up to an 18 percent decrease [1]; these shifts indicate that women in underserved areas must travel increasingly far for abortion care.…”