Oct. 9, 2002 -- They feel like celebrating over at the National Campaign to Prevent Teen Pregnancy. That's because of a new study showing that the abortion rate for teens 15-17 years old dropped 39% during the late 1990s.
"This is a tremendous achievement. We should hold a big national block party for teens," Campaign director Sarah Brown tells WebMD. "The teen birth rate is going down over the same interval. The worry has always been that teens are getting pregnant a lot and just having abortions. This shows that the reason the teen birth rate is going down is that the teen pregnancy rate is going down."
There's more good news: It's not just teens. There was a nationwide 11% drop in the abortion rate -- that is, the number women who had an abortion per 1,000 women of childbearing age. This fell from 24 per 1,000 in 1994 to 21 per 1,000 in 2000. It continues a steady decline in the abortion rate since 1987.
On the other hand, there's been only a small decline in the percentage of pregnancies that end in abortion. That's held relatively steady: one in four U.S. pregnancies are aborted.
The findings come in a report from the Alan Guttmacher Institute, an independent affiliate of the Planned Parenthood Federation. AGI senior researcher Rachel K. Jones, PhD, and colleagues collected questionnaires from 10,683 women seeking abortions at eight U.S. hospitals and 92 clinics. They also used data collected in a recent survey of abortion providers.
Despite the good news on teens, Jones says, the study shows that unwanted pregnancy continues to be a huge problem for many Americans.
"A lot of people are emphasizing the decline in the abortion rate, but the fact that there were 1.3 million abortions in 2000 shows that unintended pregnancy is an issue that women need to deal with," Jones says. "Abortion isn't good or bad, it is a fact of life. Unintended pregnancy is a social problem we need to address. It's not just about abortion. There are plenty of unintended pregnancies that are carried to term. There are a lot of women who don't want to get pregnant who do get pregnant."
Perhaps the worst news from the AGI study is that abortion rates went up for the poorest women. Women whose household income is less than twice the federal poverty level -- $35,300 for a family of four -- have abortions 4.4 times as often as the wealthiest women in the study. These poorer women represent less than a third of all American women of reproductive age, yet they account for 57% of all abortions.
Carol J. Hogue, PhD, MPH, former director of reproductive health at the CDC, now is a professor of maternal and child health at Atlanta's Emory University. She notes that Medicaid now covers fewer poor women. Moreover, federal funds for Title X -- which pays for contraceptive services not covered by Medicaid -- have not increased since 1994.
"Poor women have suffered a tremendous blow to their ability to control their fertility," Hogue tells WebMD. "This study points out that social policies -- level funding of Title X, decline in the number of poor women eligible for Medicaid, and the push to employment for people on welfare -- increase abortions for poor women. They find themselves pregnant and choose to abort because have no means of taking care of a child. They have to work."
Randall K. O'Bannon, PhD, director of education and research for the National Right to Life Committee, partially agrees with Hogue.
"During the last administration we raised the point that welfare reform should not increase pressure on a young woman to have an abortion," O'Bannon tells WebMD. "If in that whole process there are people who feel their options are few -- or that there is no option -- that kind of thing can happen."
O'Bannon, however, does not think that the decline in the U.S. abortion rate is due to more widespread use of contraceptives.
"Among women who become pregnant, a smaller percentage is aborting their babies. That is not impacted by abstinence or contraception," O'Bannon says. "People now have a better sense of what the unborn child is like. ... The campaign to ban partial-birth abortion has opened a lot of people's eyes. When people began to find out this is not some side issue about rights, but that another human being is involved, I think that began to change a lot of people's minds. There also has been a tremendous outgrowth of pregnancy care centers, better known as pregnancy crisis centers. They have been out there letting women know there are alternatives to abortion. Women can get financial support, they can get things to help them understand adoption, and they can get help to work with their parents and the father of the child. Now, women don't feel forced to have an abortion. Now, women understand there are other life-affirming options for them."
Hogue says such efforts are misguided.
"If the right-to-life people want to help poor people they should advocate for increased Title X funding," she says. "If you don't want abortions, you should help keep people from facing the problem of unintended pregnancy. The only way for women to avoid making the choice to have abortions is for them to be able to avoid being pregnant when they don't want to be pregnant."
Hogue and Jones each say that while much of the focus has been on preventing teen pregnancy, the real issue is women in their early 20s. Women age 20-24 have the highest abortion rate of any age group.
"We've been focusing on the teens now for the last two decades, but the fact is that unintended pregnancy is largely a problem of adults," Hogue says. "If we don't have sex education in the schools, where are young men and women learning about responsible parenthood? They enter adulthood uninformed and with these reductions in services they are less capable as a group in controlling their fertility."
Brown says parents can do a lot now that will help their kids when they grow to adulthood. What's needed, she says, is for parents to give a very strong abstinence message while at the same time providing information on contraception.
"The good news from years of research is when you do this you raise the age of first intercourse, and when kids do become sexually active they use better contraception," Brown says. "Kids look to parents not just for what they should know but for what is wrong and right. You have to speak truthfully to your young people and you have to speak candidly. Forget "The Talk." This is an 18-year conversation. I don't know why people worry about a three-hour sex education class in a school. That has so little effect compared to 18 years at home."