Why America’s Abortion Rate Might Be Higher Than It Appears

The new Guttmacher report found that in-clinic abortions declined by 7 percent between 2014 and 2017, and cited increased use of contraception as a major reason. Rachel Jones, a physician and the lead Guttmacher researcher on this week’s report, said she thought self-managed abortions were still fairly marginal, but the report mentioned them as a factor for the first time. Other experts said they might be common enough to erase some of the recent measured reduction.

In a 2017 editorial in the American Journal of Public Health, Diana Greene Foster, a professor at the University of California, San Francisco, said the leading explanations for the drop in abortions — better contraception, less sexual activity among young people, and legal restrictions — didn’t suffice. Women using the most effective forms of contraception, she noted, seemed to come from different demographic subgroups than the groups with the biggest abortion declines.

“The total number of abortions may not be decreasing if women are looking outside the medical system to terminate their pregnancies,” she wrote.

Researchers have tried various ways to measure the practice. They’ve surveyed women about their experiences with self-managed abortions. They’ve counted the sales of abortion pills from Aid Access. And some have looked at related questions, like the frequency of abortion-related web searches.

Survey research found that around 1 percent of women at abortion clinics had tried to end a pregnancy with misoprostol. A broader survey of Texas women found that between 2 percent and 4 percent had attempted to perform an abortion on themselves, though sometimes with other, less effective methods.

Aid Access reported 21,000 requests for medications for self-induced abortions last year, in its first year in the country. Other vendors don’t report sales figures. Plan C, which provides information about self-managed medication abortions, reports about 40,000 online visitors a month.

There is also suggestive evidence from Texas, where a law (since overturned) temporarily imposed strict abortion restrictions. In-clinic abortion rates declined statewide, but fell more sharply close to the Mexican border. It’s an indication, researchers said, that people were probably buying pills in Mexico or ones brought across the border instead of driving hundreds of miles to a clinic.