Hospital Hallway

The Vanishing U.S. Abortion Clinic

By | Updated Sept. 16, 2014

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. So no one can be sure how much the push to restrict clinics in Republican-dominated states is connected to falling abortion rates. But the new strategy adopted by abortion opponents, and the court battles it has set off, may define how far abortion rights can be limited without being overturned.

The Situation

Texas has been a focus of the battle. In November, after a 2013 law began requiring abortion doctors to have admitting privileges at local hospitals, 19 facilities stopped performing abortions, leaving 22 in the state. Only seven or eight would have remained under a provision requiring clinics to meet the physical standards of outpatient surgical centers. A federal judge in August, however, blocked enforcement of both rules, prompting Texas to appeal. The Texas law is a case study in the way abortion opponents have changed their strategies to keep women away from clinics: Sympathetic legislatures are more effective than the blockades and violence of the past. Through 2013, states had approved 205 abortion restrictions since a Republican-led state-legislative push began in 2011 — more than had passed in the prior decade. During that time more than 70 clinics closed or stopped offering the procedure. Laws aimed at clinics 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 and challenging restrictive laws in the courts. Judges have blocked enforcement of such measures, pending further legal rulings, in Wisconsin, Mississippi and Alabama.

The Background

Abortion has persisted as a hot-button issue in U.S. 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 nonhospital providers 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.

The Argument

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) and more (as well as more effective) contraceptive use are also behind the drop. Almost half the 6.7 million pregnancies each year are unintended, and almost half of these end in abortion, with rates highest among the poor and minorities. One study concluded 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. As access diminishes, abortion rights advocates argue, more women will resort to dangerous and illegal pre-Roe means to avert motherhood. There is evidence of this happening: After the Texas law went into effect, an illegal trade in pills that can induce a miscarriage emerged in flea markets in the southwestern part of the state.

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.

(First published Nov. 20, 2013)

To contact the writer of this QuickTake:

Esmé E. Deprez in New York at edeprez@bloomberg.net

 

To contact the editors responsible for this QuickTake:

Jonathan I. Landman at jlandman4@bloomberg.net

Lisa  Beyer at lbeyer3@bloomberg.net