Abortion Rates Alone Don’t Tell Us What We Need to Know About the State of Reproductive Wellness

Earlier this week the Associated Press released a report that found the abortion rate in the United States is declining by about 12 percent in almost all states. Across mainstream media reporting on this new statistic, abortion rights advocates argue this decline may be a combination of increased access to contraception and decreased access to abortion, while anti-choice advocates claim it’s a sign that their restrictive laws are having their intended impact and that the American people in general are rejecting abortion. Given these varying interpretations and the limitations of the data, it’s hard to know what a declining abortion rate really signifies.

So what’s really behind the declining abortion rate? And why do we care so much?

The documented decline in abortion rates seems to be linked to both worrisome trends and encouraging ones. Alarmingly, abortion is becoming significantly more difficult to access, especially for people in the South and Midwest and for people at or below the poverty level. The AP report states that at least 70 abortion clinics have closed since 2010, limiting access to reproductive health care for people across the country. We also know that insurers and employers are increasingly restricting coverage of abortion care. This means that more and more people have to choose between paying their rent and paying for an abortion. At the same time, the Affordable Care Act stipulates that insurers must completely cover contraception without co-pay, so more people than ever are able to access birth control options without the hurdle of affordability.

Taken together, these data present an incomplete picture. The “good news” may be that more people are having the pregnancies and births they want when they want: Unintended pregnancy rates are mostly falling The bad news? People are likely not able to access the abortions they need. Various factors can impact the abortion rate, and some of these factors suggest that the existing need for abortion is going unmet: new targeted regulation of abortion providers (TRAP) laws; new patient hurdles like increased waiting periods; meager emergency savings both overall and among women; and fewer insurance plans covering abortion. The frustrating truth is that we don’t yet have specific data that can help us know for sure which factors are most responsible for the current change in abortion rates.

It is tempting to focus on lowered abortion rates alone as a metric of success, especially for legislators and anti-choice activists with a stake in this claim. Here’s the question we should be imploring ourselves and others to ask: Does a lower abortion rate truly signal an increase in reproductive wellness? Reproductive wellness might mean people being able to avoid unintended pregnancies; having access to good quality, shame-free preventive care, abortion, contraception, and prenatal care; and receiving the community and institutional support they need to achieve their reproductive hopes and dreams. We can’t really know if we’re achieving those goals without understanding what other events are happening in people’s reproductive lives.

Focusing on abortion rates alone can’t tell us what’s really important about the state of reproductive well-being, and also has the dangerous possibility of stigmatizing abortion. Highlighting this decreased abortion rate as a “success” suggests that abortion is happening more than it should, and that there are some conditions for which abortions should and should not occur. It also implies that there is something wrong with abortion, that the abortion rate should be low because abortion is inherently “different” from other parts of health care. As sociologist Tracy Weitz states, advocating for a lower abortion rate also sets up an unrealistic expectation that there’s a magic number of abortions that are acceptable, and once we reach that number, abortion will cease to be a divisive issue in U.S. culture. What we want is a decrease in the political and cultural conflict over abortion, not a decrease in abortions themselves.

Instead of focusing on the lowered abortion rate, let’s ask more complex research questions: What social and emotional factors contribute to people’s decision making related to an unintended pregnancy? How do people’s perceptions of their community’s social norms around pregnancy impact what they think they should do about an unintended pregnancy? A lower abortion rate in and of itself doesn’t tell us much without placing it in the social, cultural, and emotional context of people’s lives. Focusing only on a lowered abortion rate as metric of health and well-being is both inaccurate and stigmatizing of abortion.

Author’s note: Thanks to Roula AbiSamra for her help with this piece.