Reported Drop in Clinic Abortions Didn’t Account for Self-Managed Abortions, Seasonal Variations

Abortions overseen by US clinicians fell by 6 percent between April and August, according to a new report from the Society of Family Planning (SFP). The net abortion drop attributable to new restrictions imposed after the Supreme Court overturned Roe v. Wade in June is probably smaller than 6 percent, however, because the tally did not take into account seasonal variation or self-managed abortions.

The full impact of the Court’s June 24 ruling in Dobbs v. Jackson’s Women’s Health Organization has not been felt yet, because the number of states with bans or severe restrictions on abortion is likely to grow. But these preliminary data illustrate both the power and the practical limitations of state laws that notionally require women to continue pregnancies they want to end.

The SFP’s #WeCount analysis, which Reason‘s Elizabeth Nolan Brown noted earlier today, is based on data from providers who accounted for 82 percent of abortions performed at or through medical facilities, augmented by estimates based on information from other sources. The net decline reflects both sharp decreases in some states and substantial increases in others, driven by women who traveled to obtain abortions. For some women, the costs of that option surely proved prohibitive, forcing them to continue their pregnancies. But it is hard to say how large that group was, since many women may have used drugs to induce abortions without the assistance of the medical professionals that the SFP surveyed. Given that option and uncertainty about the April baseline used in the study, the decline reported by the SFP should be viewed with caution.

“The estimated number of abortions provided by a clinician decreased from
85,020 abortions in April 2022, before the [Dobbs] decision, to 79,620 abortions in August 2022,” the SFP reports. “Since the Dobbs decision, there were 5,270 fewer abortions in July and 5,400 fewer abortions in August, for a cumulative total of 10,670 fewer people who had abortions in those months.”

Pro-life groups welcomed that finding. “We are celebrating the fact that at least 10,000 babies have a chance at life,” said Students for Life President Kristan Hawkins. But that reading of the results is misleading because of the study’s limitations.

“We did not account for seasonality-related changes in abortion volume, which usually means a decline in summer months,” the SFP report notes. In other words, some of the decline between April and August may be due to seasonal variation rather than new legal restrictions.

Self-managed abortions introduce further uncertainty. When a woman obtains abortion pills without contacting a clinic, the resulting termination of her pregnancy does not show up in the numbers compiled by the SFP, the Guttmacher Institute, or the Centers for Disease Control and Prevention. “While the overall decline suggests that many people who need[ed] Abortions did not travel to other states, we are unable to estimate the number of abortions that occurred outside the formal healthcare system, such as via Aid Access or volunteer ‘accompaniment’ networks in Mexico,” the SFP report notes. unable to estimate how many pregnant people self-managed their abortions versus carried to term.”

The share of abortions performed with drugs was rising even before Dobbs, and even before the Food and Drug Administration (FDA) made permanent a rule allowing the use of mifepristone without a medical visit last December. The recent proliferation of state restrictions has made that option more appealing to many women.

A JAMA Network Open study found that requests to Aid Access from Texas skyrocketed after a law banning abortion when fetal cardiac activity can be detected (typically around six weeks of gestation) took effect last September. A 30-state JAMA Study scheduled to be published tomorrow amplifies that finding by looking at increases in “requests for self-managed medication abortion provided using online telemedicine” after Dobbs.

The SFP report notes that “abortions provided by virtual-only clinics increased from 2,830 in April 2022…to 3,780 in August 2022,” which represents “an increase of 33% in the number of abortions provided from virtual-only services.” Those numbers reflect only the drug-induced abortions that clinicians covered by the SFP survey provided. The number of such abortions that women induced on their own is unknown.

One thing that is clear from the SFP report is that the impact of Dobbs has varied from one state to another. In states with strict bans, such as Alabama and Texas, the number of clinic abortions fell to zero or nearly zero between April and August. But several states where abortion remains legal saw sizable increases in clinic abortions. Those states include Illinois, where clinic abortions rose by 28 percent; Montana and Nebraska, both of which saw a 30 percent increase; Colorado (33 percent); Kansas (36 percent); and North Carolina (37 percent). All of those states are near jurisdictions with abortion bans.

Overall, the SFP says, “the estimated number of abortions provided by a clinician in states that banned or severely restricted abortion (such as a 6-week ban) decreased from 8,500 abortions in April before the decision to 460 abortions in August 2022.” In those states, “there were 7,870 fewer abortions in July and 8,040 states in August, for a cumulative total of 15,910 fewer people who had abortions in those states.” In states with substantial but less restrictions, “there were severe 2,160 fewer abortions in July and 4,460 fewer in August, for a cumulative total of 6,620 fewer people who had abortions in those states.”

Partially offsetting those numbers, “the estimated number of abortions provided by a clinician in states where abortion remained legal with few restrictions increased from 62,600 abortions in April…to 69,740 abortions in August.” Those states also saw increases in July, “for a cumulative total of 11,980 more people who had abortions.”

The difference between those two cumulative totals is more than 10,000—the number that pro-life title are highlighting. But as The New York Times notes, “the total decrease in abortions is likely to be lower” because of the methodological limitations that the SFP mentions.

Whatever the actual number, the effect was concentrated among women whose geographical, socioeconomic, and personal circumstances made traveling to other states for abortions especially difficult. “The declines in the numbers of abortion occurred in the same states with the greatest structural and social inequities in terms of maternal morbidity, mortality and poverty,” the SFP notes. “Thus, the impact of the Dobbs decision is not equally distributed. People of color and people working to make ends meet have been impacted the most. This inequity is corroborated by other studies, including one finding that after DobbsBlack, Indigenous, and other people of color experienced the greatest increases in travel time to abortion facilities.”

Before DobbsMiddlebury College economist Caitlin Knowles Myers noted that “a post-Roe United States isn’t one in abortion which isn’t legal at all.” Rather, “its one in which there’s’ tremendous inequality in abortion access.” That is the situation we are seeing now, which is why pro-choice organizations are trying to ameliorate those unequal burdens by helping women of modest means obtaining abortions.

Last year, based on a scenario in which 22 states banned abortion, Myers projected that the annual number of abortions in the US would fall by about 14 percent. Based on the Guttmacher Institute’s estimate for 2020, that would amount to something like 130,000 fewer abortions a year, more than twice the annual decline suggested by the SFP’s initial numbers. But legal changes are ongoing, so the ultimate impact may end up being closer to Myers’ projection.

The SFP counts 13 states that have “banned or severely restricted abortion”: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, and Wisconsin. The report counts nine states that have “restricted access” to abortion: Arizona, Florida, Georgia, North Dakota, Ohio, South Carolina, Utah, West Virginia, and Wyoming. Some states are apt to move from the second category to the first. In Arizona, for example, an 1864 ban could take effect next year, depending on the results of ongoing litigation. The situation in Utah is similar.

In addition to litigation and the pressures of public opinion (which makes a strict ban look politically iffy in Florida, for example), all of these states will have to contend with the fact that abortion remains “legal with few restrictions” in 28 states and the District of Columbia. They will also have to contend with the practical availability of abortion pills, a challenge that cannot be met simply by passing new laws. Since those pills are approved by the FDA and remain legal in most states as well as many other countries, that challenge is even more daunting than the one that the war on drugs has faced for more than a century.

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