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Fewer Providers Limit Abortion Access

But 'Morning-After' Contraception Big Factor in Lower Abortion Rate
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WebMD Health News

Jan. 17, 2003 -- Nearly nine in 10 U.S. counties lack an abortion provider. That's only one of several factors that limit Americans' access to abortion, according to a new report.

The study comes from the Alan Guttmacher Institute, a not-for-profit sexual and reproductive health research group. Although the now-independent AGI once was a division of Planned Parenthood Federation of America, anti-abortion groups generally accept its data as accurate.

AGI researchers Stanley K. Henshaw, PhD, and Lawrence B. Finer, PhD, note that the U.S. abortion rate continues to drop. This decline pretty much matches the decline in the number of abortion providers.

"It's difficult to say which causes which," Finer tells WebMD. "One thing that could be behind the decline is fewer unintended pregnancies. Emergency contraception -- that's the morning-after pill -- appears to have played a role in the abortion-rate decline. In the year 2000, women using emergency contraception averted up to 51,000 abortions."

Randall K. O'Bannon, PhD, director of education and research for the National Right to Life Committee, has a different take on the numbers.

"They talk about increased contraceptive use, but over the last 10-15 years a strong abstinence movement began in the U.S.," O'Bannon told WebMD in an October 2002 interview. "Even among women who become pregnant, a smaller percentage of those are aborting their babies. That is not impacted by abstinence or contraception. Women now have a better sense of what the unborn child is like. We have been involved in an educational campaign about telling what is going on in the womb."

Finer notes that though the abortion rate -- the number of abortions per 100,000 women -- has declined, the proportion of U.S. pregnancies that end in abortion remains the same: one in five. This is linked to another statistic: half of all U.S. pregnancies are unintended.

Yet women who want abortions face significant obstacles. Those identified in the AGI study include:

  • Providers limit the gestational ages at which they will perform abortions. However, the new report finds that both early and late abortions are increasing.
  • The cost of abortion is going up -- and most U.S. women pay directly for abortion care.
  • 8% of women must travel more than 100 miles to get an abortion. About 16% travel 50-100 miles.
  • Though extreme harassment of abortion seekers has declined, 80% of large abortion clinics face picketing. Up to 28% face more extreme harassment. Though 15% of clinics reported bomb threats in 2000, that's fewer than the 48% that received such threats in 1985.

One other factor is changing the abortion landscape: so-called medical abortion. This nonsurgical abortion uses an abortion drug -- usually Mifeprex, formerly known as RU-486. The AGI finds that 6% of pregnancy terminations are now drug induced.

Though no surgery is involved, such abortions often cost more. That's because more counseling is needed to make sure the drugs are used in the right way. And it takes two office visits: one to prescribe the drugs and another to make sure the pregnancy is terminated.

"We expect that the 6% number will probably increase," Finer says. "But medical abortion will not replace surgical abortion. Each method has advantages and disadvantages. Surgical abortion is quicker. But if a woman doesn't want a surgical procedure and wants a more private procedure, she may opt for medical abortion."

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