Abortion clinics are closing in the U.S. at a record pace. In four states — Mississippi, North Dakota, South Dakota and Wyoming — just one remains. American women were having fewer abortions before clinic closings accelerated in the last couple of years, which makes the connection between the closings and the abortion rate murky. So no one can be sure how much a push to restrict clinics in Republican-dominated states will reduce the number of abortions. But the new strategy adopted by abortion opponents, and the court battles it has set off, may define how far they can go in limiting abortion rights without overturning them.
At least a dozen Texas clinics stopped performing abortions in November, abortion providers estimate, after a federal appeals court and the U.S. Supreme Court let a restrictive new law take effect. Fewer than 30 stayed open. The law, which requires abortion doctors to have admitting privileges at local hospitals, is a case study in the way abortion opponents have changed the strategies they’ve used to try to keep women away from clinics: Sympathetic legislatures are more effective than the blockades and violence of the past. Through 2013, states had passed 205 abortion restrictions since a Republican-led state-legislative push began in 2011 — more than had passed in the prior decade. It’s working: During that time more than 70 clinics closed or stopped offering the procedure. Laws aimed at clinics (such as mandates to widen hallways and install high-tech surgical scrub sinks) are proving more potent than those aimed at patients (such as waiting periods or parental notification requirements). In 2014, abortion-rights supporters began to push back, introducing more state-level, pro-abortion bills than at any time since the early 1990s.
Abortion has persisted as a hot-button issue in American politics since the Supreme Court’s landmark Roe v. Wade decision in 1973 legalized it in all 50 states. The groundwork was laid to undermine that ruling in 1992, when the high court said states could pass restrictions that don’t present an “undue burden” to women seeking the service. Courts are now clogged with challenges to laws testing just what that means. The ranks of clinics have been thinning since the late 1980s, when the number of large nonhospital providers — those performing 400 or more abortions per year — peaked at 705; by 2011, the most recent year for which data are available, that number had fallen to 553. The abortion rate hit an all-time low since Roe of 16.9 per 1,000 women in 2011.
Both sides of the abortion debate have a stake in the proposition that restricting access to clinics, where almost all abortions in the U.S. are done, is holding abortion rates down. Health experts and social scientists say that is one factor, but not the whole story. Increasing cultural acceptance of single motherhood, the recession (which was accompanied by a decline in pregnancies) along with more (and more effective) contraceptive use are also behind the drop. Nearly half of the 6.7 million pregnancies each year are unintended, the driver of abortion (almost half of unintended pregnancies end this way), with the highest rates among the poor and minorities. One study found that if 31 states outlawed abortion tomorrow, the vast majority of women would still travel to states where it remained legal. But the impact on those unwilling or unable to travel could still produce a 15 percent drop in abortions nationally and as much as a 4.2 percent rise in the birth rate. Another study found that when women are turned away from clinics because they’re too late into pregnancy, most give birth instead of seeking other options. As access diminishes, abortion rights advocates argue, more women will resort to dangerous and illegal pre-Roe means to avert motherhood. There is evidence this is happening: In southwest Texas, women are buying drugs at flea markets to induce a miscarriage, part of a thriving black market.
The Reference Shelf
- Bloomberg News articles about abortion.
- The Guttmacher Institute researches and compiles medical statistics and legislative history about abortion.
- The Centers for Disease Control and Prevention collects data from most states for its abortion surveillance project.
- The American Congress of Obstetricians and Gynecologists offers a resource guide for abortion, including medical guidelines and research.