Abortion Decline




O

nce
upon a time, physicians- in-training learned to do abortions as
a routine part of their schooling. As a result, the roster of experienced
practitioners grew. What’s more, a network of freestanding
clinics developed and the number of abortions began to increase.
By 1980—seven years after the Supreme Court issued the Roe
v. Wade decision—29.3 of every 1,000 pregnancies were surgically
terminated. 


Flash
forward to 2003. According to a recent study by the Alan Guttmacher
Institute (AGI), the surgical abortion rate is now 21.3 per 1,000,
a 3 percent decline since 1996 and a 27 percent decline since l980.
Not surprisingly, the anti- abortion movement is ecstatic and its
leaders are patting themselves on the back for a job well done.
Some of their jubilation is well-founded. The anti-abortion movement
has clearly succeeded in getting states to promulgate onerous restrictions
on access; the percentage of teenagers having sexual intercourse
has fallen; and encounters with vitriolic picketers in front of
clinics have made many women think twice about ending a pregnancy. 


Nonetheless,
it is a mistake to give the antis full credit for the reduced number
of procedures. Indeed, AGI estimates that increased access to birth
control, including “morning after” emergency contraception,
has contributed to the abortion drop-off. According to AGI calculations,
51,000 abortions were prevented by emergency contraception in 2000
alone.Lawrence B. Finer, Assistant Director of Research at AGI,
also believes that mifepristone (formerly called RU-486) has played
a small but significant role in abortion provision: 6 percent of
all abortions—130,000 procedures—were done with mifepristone
during the first 6 months of 2001 and Finer believes that this percentage
will escalate as both providers and patients become more familiar
with the drug. 


Unfortunately,
that’s where the good news ends. The AGI study, released on
the 30th anniversary of the Roe decision, reveals a huge decrease
in the number of clinics, hospitals, and private physicians who
perform abortions, from 2,908 in 1982 to 1,819 today. This decrease
has had a significant pragmatic impact: 1 in 4 women now have to
travel at least 50 miles to obtain reproductive healthcare. Worse,
8 percent have to travel 100 miles or more. Overall, the picture
is stark: 86 of the country’s 276 metropolitan areas—cities
like Canton, Ohio; Myrtle Beach, South Carolina; Provo, Utah; and
Scranton, Pennsylvania—are without a single abortion facility
and only 3 percent of rural counties have providers. 


Part
of the blame for this limited access rests on the fact that 57 percent
of the doctors who perform abortions are aged 50 and older. Couple
this with a bewildering and costly array of state-imposed restrictions
on how, when, and where a provider can operate, and you can practically
see the number of clinicians dwindle before your eyes. 


The
restrictions, called Targeted Regulation of Abortion Provider (TRAP)
laws, allow states to place specific licensing or management obligations
on abortion facilities, restrictions that are not imposed on other
types of ambulatory health centers. Says the National Abortion Federation
(NAF), “TRAP laws are designed to discourage doctors from providing
abortion services.” Such laws are presently in effect in 17
states and Puerto Rico. 


 A
relatively new way to restrict access, they are already having a
disastrous impact. 


Take
South Carolina as a case in point. In 1995 providers there received
a 30-page document from the Department of Health and Environmental
Control dictating a bevy of licensing requirements for anyone performing
5 or more abortions a month in either a private office or clinic.
Among the requirements: 6 air changes per hour in the recovery and
operating rooms; temperature maintenance between 72 to 76 degrees
at all times; removal of grass and weeds from land surrounding the
office; and the installation of particular alarms in all restrooms.
The regulations also gave state health inspectors the right to peruse
patient records whenever they choose, confidentiality be damned.
Although a lower court found the law to be unconstitutional, in
September 2002 the U.S. Court of Appeals for the 4th Circuit overturned
the decision. “The rationality of distinguishing between abortion
and other medical services when regulating physicians or women’s
health care providers has long been acknowledged,” the judges
wrote. “Abortion is inherently different from other medical
procedures.” 


This
judicial go-ahead emboldened the antis and 10 states are presently
considering a variety of TRAP laws. “The bills come in two
flavors,” says Janet Crepps, an attorney with the Center for
Reproductive Law and Policy. “Some put all the details—air
current restrictions; staffing requirements; regulations about temperature
and door width—into the legislation. Other bills are very broad
and give state licensing departments the right to draft regulations
for abortion clinics. These restrictions leave providers vulnerable
to constant changes. A shift in the legislature can lead to a shift
in licensing staff so every two years there can be new rules. When
this happens abortion stops being medical care and becomes a political
football.” 


In
South Carolina there has been a 29 percent drop in the number of
providers since the state’s TRAP law took effect in 2001; 10
remaining clinics are concentrated in three cities: Charleston,
Columbia, and Greenville. Add to the mix the fact that the state
does not fund Medicaid abortions and requires young women to get
the consent of a parent or guardian before having the procedure,
and the reasons South Carolina’s abortion rate has declined
become exceedingly clear. 


Still,
at this juncture, one-third of all women in the U.S. will have an
abortion at some point between ages 15 and 45. This number may be
smaller than it used to be, but it is nevertheless significant. 


The
National Coalition of Abortion Providers (NCAP) is urging reproductive
health activists to not only fight burdensome TRAP laws, but to
reframe the debate by reclaiming the ethical ground that reproductive
choice represents. “While more than one million women a year
have abortions in the United states, abortion is a highly stigmatized
procedure,” NCAP’s website admits. “Most people are
uncomfortable talking about the issue and if they do it is often
in judgmental or uninformed terms. The stigma associated with abortion
can have unfortunate consequences. It can cause unnecessary guilt
or remorse and it can lead to a feeling of alienation or isolation…supporters
of legal abortion need to challenge the notion that abortion is
immoral. It is time to lift the veil of secrecy and candidly address
the core of the abortion experience: the relief, the conflict, the
confusion, the sadness and the empowerment.” 







Eleanor
J. Bader is the co-author of



Targets of Hatred: Anti-Abortion
Terrorism



and a frequent contributor to



In These
Times, Library Journal, the NY Law Journal,



and



the
Progressive