IUDs, Not State Laws, Are Behind the Decline in U.S. Abortions

In 2011 the abortion rate in the U.S. hit its lowest level since 1973, the year the procedure was legalized nationally, according to a new study released by the Guttmacher Institute, a reproductive-health research organization. In 2008 there were 1.21 million abortions performed in the U.S., which translated to a rate of 19.4 per thousand women aged 15 to 44. In 2011 an estimated 1.1 million women received abortions, or a rate of 16.9 per thousand. That’s a 13 percent decline since 2008, and the reason behind the drop isn’t what most people think.

While the rash of state laws restricting abortion are the most obvious reaction for explaining why abortions have declined, the researchers say there’s “no evidence” that such legislation is behind the reduction. The abortion rate fell across the country, and most of the laws that could lead to closures didn’t kick in until after 2011. That’s not to say they won’t have an impact—that could still be the case—but the data aren’t yet available.

Instead, Guttmacher posits that one primary reason abortions may be falling is because more women are using long-term, highly effective contraception, most notably intrauterine devices, or IUDs. These methods “are more than 99% effective at preventing pregnancy, last 3–12 years and, unlike methods such as the pill, leave little to no room for user error,” the report says.

IUDs are small, T-shaped devices that are implanted in a woman’s uterus and prevent sperm from fertilizing eggs (PDF). Their effects are reversible, so once an IUD is removed, a woman can still become pregnant. IUDs fell out of favor for decades following the demise of Dalkon Shield, a popular IUD that was pulled from the market in 1974 because of a slew of medical problems and eventually a flood of lawsuits. The new IUDs, however, do not include the design flaw that made the Dalkon Shield unsafe, and the U.S. Food and Drug Administration approved Teva Pharmaceutical’s ParaGard in 1984 and Bayer’s Mirena in 2000.

At first, IUDs were used by women in long-term, monogamous relationships, or those who’d already had children. Over time, IUDs have gained broader adoption, and Bayer recently began marketing a smaller IUD, called Skyla, targeting women who haven’t given birth. In 2002, IUDs accounted for just 2 percent of all contraceptive use, and by 2009 that number had jumped to 7.7 percent, according to a separate report by the Guttmacher Institute (PDF). The increase was particularly pronounced among younger women, who are more likely to have unplanned pregnancies.

Essentially no women aged 18 to 19 used IUDs and other similar implants in 2002. By 2009, IUDs and implants made up 6.6 percent of the contraceptive use among that age group. It’s not hard to imagine that usage will continue to grow, because the Affordable Care Act covers IUDs, which can cost as much as $1,000 to buy and have inserted.

Even with their recent growth, IUDs are still far less popular than traditional contraception such as condoms and the pill, but because IUDs are so effective—20 times more so than the pill, patch, or ring—they could continue to have a meaningful impact on the abortion rate.

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