The answer seems to be widely available birth control and the
rise of long-term contraception methods. Congress is deciding
whether some of that that will continue.
Posted on March 22, 2017, 18:46 GMT
Every month for the past
few years, I’ve strolled into my pharmacy and out with my
monthly birth control prescription without ever taking out my
wallet. And every month I think to myself, Damn, that was
@bedsider / Via instagram.com
If this level of accessibility and affordability was
available to everyone who wanted to have a say over if
and when they become a parent, then it wouldn’t be
unreasonable to expect fewer unplanned pregnancies and
abortions, would it? Interestingly enough, that’s exactly
what we saw happen in recent years.
The rates of abortion and
unplanned pregnancy in the US are currently at record lows. And
experts say that increased access to highly effective birth
control is primarily responsible.
Let’s start with the US
abortion rate, which recently hit a record low in
Guttmacher Institute / Via guttmacher.org
As of 2014 (the most recent year available), the US
abortion rate reached the lowest rate ever recorded at
14.6 abortions per 1,000 women aged 15-44, according to
the most recent analysis by the Guttmacher Institute. This marks a
14% decline since 2011.
The data comes from a Guttmacher study in the journal Perspectives
on Sexual and Reproductive Health. The numbers differ
slightly from 2013 surveillance data from the CDC
(the most recent year available), which put the abortion
rate at 12.5 abortions per 1,000 women aged 15-44. The
CDC requests their data from state health departments,
while Guttmacher surveys their database of all US
facilities known or suspected to perform abortions in a
given time period. Neither offers a definitive number of
abortions happening in the US each year, but they’re the
best estimates we have.
Experts say that
abortions are down for reasons that have to do with birth
control, not abortion restrictions.
Monik Markus / Creative Commons / Via Flickr: 42954113@N00
According to the Guttmacher study, the total number of
abortion facilities dropped 3% between 2011 and 2014, but
changes in clinic numbers didn’t always correspond to
fewer abortions in those states. Similarly, an increased
number of abortion restrictions coincided with clinic
closings in some, but not all, states.
“The best available evidence suggests that
improvements in contraceptive use were responsible for
the decline in abortion rates,” Rachel K. Jones, PhD,
principal research scientist at Guttmacher Institute,
tells BuzzFeed Health.
How do we know that?
Well, it’s no coincidence that unplanned pregnancies have
also dropped significantly in recent years.
“We know that a little less than half of all unplanned
pregnancies end in abortion,” Rachel Fey, director of
public policy at The National Campaign to Prevent Teen and
Unplanned Pregnancy, tells BuzzFeed Health. So if
there are fewer unplanned pregnancies, it would track
that we would see fewer abortions.
The most recent nationwide data on unplanned pregnancy
comes from 2011, and it shows a steep decline for the
first time in the past three decades. Between 2008 and
2011, the rate of unplanned pregnancy in the US dropped 18%. Not surprisingly, the
rate of abortion during that time also dropped 13%.
Over the past decade,
we’ve seen a rise in the use of long-acting reversible
contraceptive (LARC) methods that are less prone to user
error, like the IUD and the implant.
@buzzfeedhealth / Via instagram.com
In 2002, just over 2% of birth control users had a LARC
method, but that jumped to 8.5% in 2009 and then to 11.6% in 2012.
And it makes sense that having more people on highly
effective birth control methods could mean fewer
unplanned pregnancies and abortions. A study in Iowa found that between 2005
and 2012, the number of family planning patients using a
LARC method increased from less than 1% to 15%;
meanwhile, the number of abortions in the area decreased
from 8.7 to 6.7 per 1,000 women aged 15-44. According to
the study, abortions declined in Iowa “despite increased
access to abortion services.”
More people use highly
effective birth control when they’re actually able to access
and afford it.
@crafty_contraceptives / Via instagram.com
Here’s where the Affordable Care Act comes in, which went
into effect in August 2012 and
included no-cost, no-copay birth control for all
FDA-approved contraceptive methods as long as you have
health insurance (with some limitations explained
Suddenly, not only could you get your monthly birth
control pills without a copay, you could also get one of
those highly effective (but previously costly) methods
like the IUD or implant, which could last you three to
Research shows that when cost isn’t an issue, people
who are introduced to LARC methods are more likely to
Between 2012 and 2014, the proportion of women who
had to pay an out-of-pocket cost for an IUD went from 58%
to just 13%. Essentially, the Affordable Care Act is
eliminating that financial barrier.
So that’s where we are
today: Access and affordability to a wide range of highly
effective birth control methods have increased; meanwhile,
the rates of unplanned pregnancy and abortion have decreased.
It’s unclear what might happen to the Affordable Care Act’s
birth control coverage mandate. We don’t know if all insured
Americans will go back to paying a copay for birth control,
which would likely make the highly effective LARC methods
more expensive than other methods like the pill or ring.
Already, birth control users are
tweeting about getting the IUD and
making appointments to get them put in now, just in case.
“If there are fewer women with health insurance, or health
insurance that doesn’t cover contraceptives, then women are
not going to have the same capacity to prevent unplanned
pregnancy,” says Jones.
What we do know is that
low-income women have a higher rate of unplanned pregnancy, and
factors like Title X and Medicaid expansion have been helping
many of them access free or low-cost birth control, which can
bring that rate down.
@plannedparenthood / Via instagram.com
“If any of these pieces go away, we risk losing the
progress that we’ve made,” says Fey. In case you’re
unfamiliar with these:
* Title X is a federal grant program
that provides funding for family planning services for
low-income or uninsured individuals. It was created in
1970, is administered by the US Department of Health
& Human Services, and distributes funds to various
clinics, hospitals, and non-profits. Title X funds may
not be used for abortion, but they can be used for birth
control and other important family planning services.
* Medicaid expansion refers to states
where you can qualify for Medicaid based on income alone
(making below 133% of the federal poverty level).
Medicaid provides free or low-cost health insurance for
low-income individuals. Medicaid reimbursements to
Planned Parenthood and other federally qualified health
centers mean that someone with Medicaid can go to these
centers for free or low-cost family planning services,
but the Hyde Amendment blocks any Medicaid funding for
abortion services (except in cases of rape, incest, or
when the mother’s life is in danger).
“To cut Medicaid expansion coverage or to reduce funding
to Title X, anything you do like that reduces either the
number of women who have coverage or the number of places
they can go to use that coverage,” says Fey. “Both of
those pieces would have a profound effect on the ability
to continue making progress in terms of reducing
unplanned pregnancy and abortion.”
And then there’s Planned
Parenthood. “Defunding” Planned Parenthood — which
Republicans in Congress want — would prohibit them from
getting Medicaid reimbursements or Title X funds, which means
they could no longer serve low-income patients that rely on
@zoebuckman / Via instagram.com
The non-partisan Congressional Budget Office also says
that could drive unplanned pregnancies back up as it
“would affect services that help women avert pregnancies”
and would most significantly affect people in areas where
there are no other clinics that serve low-income
patients. They project that about 15% of these people
would lose access to care.
Here’s the clincher: “By CBO’s estimates, in the one-year
period in which federal funds for Planned Parenthood
would be prohibited under the legislation, the number of
births in the Medicaid program would increase by several
thousand, increasing direct spending for Medicaid by $21
million in 2017 and by $77 million over the 2017-2026
If birth control and
family planning services remain accessible and affordable, Fey
says we can anticipate more increases in the most effective
birth control methods and further declines in unplanned
pregnancies. “What you don’t want to do is go back.”
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