11 July 2018

Abortion Since Roe v. Wade

Roe v. Wade, 410 U.S. 959 (January 22, 1973) was on the books for 40 years in 2013, the latest year for which statistics are available in the World Almanac. 

This is especially relevant now since the U.S. Supreme Court will have a solidly conservative majority for the first time in decades and for decades to come if Trump's current U.S. Supreme Court nominee is approved. Due to the 51-49 partisan split in the U.S. Senate and the ill health of moderate Republican John McCain from Arizona who has brain cancer, means that Democrats can defeat a nomination if they hold all members of their coalition together and pick up just one Republican vote against the nominee defeating a nomination by 49-50. This could change after the 2018 midterm elections in either direction.

In 2013, there were 664,435 abortions, a ratio of 200 per 1000 live births and a rate of 13 per 1000 women (age 15-44).

In 1980, which was at or near the peak, there were 1,297,606 abortions, a ratio of 359 per 1000 live births and a rate of 29 per 1000 women.

The 2013 raw number of abortions and ratio per 1000 live births was the lowest since 1973, the year that Roe v. Wade was decided. The rate per 1000 women was the lowest since 1972, the year before Roe v. Wade was decided, following a long, mostly gradual downward trend by all measures since 1980.

Given the steady trend lines for abortion and tend lines for births which tend to track trend lines for abortions, in 2017 and in the first half of 2018, the total number of abortions in the U.S., the ratio of abortions to live births, and the rate of abortions per 1000 women are all almost surely lower than they were in 1973 and probably 1972 as well.

Attitudes about abortion as measured by opinion polls have changed very little in recent years and even the last decade or two. But, wider use of more effective birth control methods have not just reduced the total number of pregnancies, but have disproportionately reduced unplanned and unwanted pregnancies. 

Increased awareness of Plan B (high dose birth control pills within a few days of unprotected sex before you know if you are pregnant or not, which is to be distinguished from a medication abortion, discussed below, may also play a role in the declining abortion rate). Plan B has been legally available over the counter or with a "pharmacist prescription" rather than a doctor's prescription (for all women, not just adults) since 2013, although not all pharmacies carry it. The last five years of over the counter availability of Plan B could materially reduce the number of abortions now, relative to the latest available statistics, which are for 2013 (for which the approval took place half way through the year) and 2014, early on in the implementation of over the counter availability for this drug.

Another source reports roughly 50% more abortions in raw numbers, but the long term trends are identical, with its latest year (2014) at a record low since prior to 1973 in rate per 1000 women, a peak in 1981 (v. 1980), and a steady decline of about 50% in the aggregate of the rate per 1000 women from the peak in 1981 to the 2014 figure. It estimates that about 24% of U.S. women have at least one abortion prior to menopause, a minority (just one in eight members of the overall population), but a big one.

If Roe v. Wade were overturned many "red" states would ban abortion in at least some circumstances, but few "blue" and "purple" states would do so. But, it isn't clear how that would affect medication abortions. Many restrictions are targeted at late term abortions which make up a pretty modest share of the total.

Many "red" states have only a few facilities that provide abortion services:

The number of U.S. abortion-providing facilities declined 3% between 2011 and 2014 (from 1,720 to 1,671). The number of clinics providing abortion services declined 6% over this period (from 839 to 788). Ninety percent of all U.S. counties lacked a clinic in 2014, and 39% of women of reproductive age lived in those counties. 
In 2014, some 46% of abortion clinics offered very early abortions (at four weeks’ gestation or earlier, before the first missed period), and 99% offered the procedure up to eight weeks from the last menstrual period. Seventy-two percent of clinics offered abortions up to 12 weeks, 25% up to 20 weeks and 10% up to 24 weeks. 
In 2014, the average amount paid for an abortion in a nonhospital setting at 10 weeks’ gestation and with local anesthesia was $508. The average paid for an early medication abortion (up to 9 weeks’ gestation) was $535. . . . 
In September 2000, the U.S. Food and Drug Administration approved mifepristone to be marketed in the United States for nonsurgical abortion. 
According to U.S. Food and Drug Administration guidelines, medication abortion is approved for abortions up to 10 weeks’ gestation. The protocol involves two drugs—mifepristone and misoprostol—one of which can be taken at home following a provider visit. 
Medication abortions accounted for 31% of all nonhospital abortions in 2014, and for 45% of abortions before nine weeks’ gestation.
In 2014, some 87% of all nonhospital abortion providers—900 facilities—provided one or more medication abortions, and 26% of clinics provided only early medication abortion. 
Medication abortions increased from 6% of all nonhospital abortions in 2001 to 31% in 2014, even while the overall number of abortions continued to decline. Data from the Centers for Disease Control and Prevention show that the average time of abortion has shifted earlier within the first trimester; this is likely due, in part, to the availability of medication abortion services.

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