It’s only a slight increase, but an increase nonetheless when you consider that the number of abortions in this country has been falling since 2009.

For the first time since then, the number of abortions is increasing. By 2018, the number rose to 619,591, according to the CDC. From 2009 to 2018, the number of abortions had decreased by 22% from 786,621. The abortion rate, that is, the number of abortions per 1,000 women, and the ratio, that is, the number of abortions per 1,000 live births, increased by 1% and 2%, respectively.

These numbers do not include numbers from California, Maryland, and New Hampshire. Other health researchers, like Carol Joffe of the University of California at San Francisco, didn’t see the increase as significant.

To put the numbers in context, there were 1.06 million abortions in this country in 2011. And that number was a 13% decrease from three years earlier.

The question, of course, is why the number is starting to increase. Longtime researchers aren’t sure why.

“We don’t know the exact reason for this increase,” Ushma Upadhyay, PhD, MPH told Medical Daily. “Funding for family planning programs under the Trump administration wasn’t cut until 2019. State laws prohibiting state funding of family planning programs may have been tightened. I haven’t seen any research on the subject that documents the reasons. “Dr. Upadhyay is the director of the Center for Women’s Health, Gender, and Empowerment at the University of California in San Francisco.

Data Affecting Abortion

Clinical closures, access to better contraceptive and abortion methods, legal restrictions, and changes to the sex education curriculum have been cited as reasons for affecting abortion rates, regardless of direction. What remains to be seen is the impact of the recent Supreme Court decision overturning a July Court of Appeal ruling on access to early medical abortion, which is increasingly becoming the abortion method of choice.

Abortion Number Influencer

Abortion clinics. Between 2011 and 2014, the number of abortion clinics decreased by 17% and has continued to decline. The Daily Beast reported that 755 clinics were still open in 2019.

Dr. Upadhyay said her research showed that nearly 90% of US states do not have an abortion provider. Women who live in 27 large cities called abortion deserts are at least 100 miles away from an abortion provider.

Dr. Joffe, Professor of Promoting New Standards for Reproductive Health at UCSF, attributed the decline in abortion rates over the past decade to better birth control.

“Unwanted pregnancy is a major contributor to induced abortion,” said Dr. Upadhyay. “Better access to and use of effective contraceptives can reduce unwanted pregnancies and further reduce the number of abortions performed in the US.”

A strategy paper by the Guttmacher Institute for 2019 examined the reasons for the decline in abortions between 2011 and 2017. The researchers found that abortion restrictions placed on providers who, in turn, have closed clinics helped reduce abortions. However, according to Guttmacher researchers, the main reason for the continued decline was the general decline in births and pregnancies between 2011 and 2017.

Medical abortion, part 1. Two drugs combined that can terminate a pregnancy within a few weeks of conception have had an impact on early abortion rates.

In 2000, the FDA approved the use of mifepristone in combination with another pill called misoprostol. The first pill limits the production of the hormone progesterone; The second has already been approved for the introduction of labor. Both are available as generics. Misoprostol, its generic name, became so in 2012 and mifepristone in 2019. Together, these pills can end a pregnancy long before the end of the first trimester. Misoprostol can be used on its own to terminate pregnancy.

The FDA has restricted immediate access to these pills requiring health care providers to be certified for their use and only allowing these drugs to be administered in hospitals, clinics and doctor’s offices by those certified providers.

Medical abortions, part II. As for its effects:

  • The use of pills to terminate pregnancy prematurely increased by 9% from 2017 to 2018 (from 34.7% of abortions to 37.7%).
  • From 2009 to 2018 the increase was 120% (from 17.1% of abortions to 37.7%).
  • By 2018, 77.7% of all abortions occurred before the 9th week of pregnancy.

Legal Restrictions. Researchers see no direct impact on abortion rates in laws that prohibit certain abortion procedures per se. A recent study that contradicts this view looked at the effects of an executive order in Texas. The order halted elective operations from March 22, 2020 to April 21, 2020. The study found that after the executive order was repealed, more abortions occurred in the 12th week of pregnancy than in the same period in 2019. The researchers suspect that the subsequent increase took place due to residues that arose during the embargo.

While researchers may not see a direct connection with restrictions directly imposed by law, they point out indirect restrictions such as: B. Doctors who need operating licenses in the hospital where they want to perform the procedure, which has a certain effect.

States have also placed restrictions on medical abortion. States, more than half of them, require that no one but a doctor – no other prescribing doctors, such as nurses and nurses – can prescribe the combination of abortions.

Guttmacher found that this type of layoffs increased from 5% in 2001 to 39% of all abortions in 2017, although the overall abortion rate fell.

Recently the FDA reported a lack of misoprostol. Both UC Davis and UCSF hospitals reported that there was a shortage in the spring of last year, but none of their patients were affected and that they are not currently aware of any shortages.

Dr. Joffe wrote in an email that women manage their own abortion with misoprostol and without medical assistance. It is estimated that 7% of women in the US will self-manage their abortion during their lifetime.

The combination of mifepristone and misoprostol is the standard of treatment in abortion clinics, said Dr. Yeah. “Misoprostol alone, however, is not quite as effective and can take longer than either drug.”

The World Health Organization declares that medical abortion care is critical to accessing safe, effective, and acceptable abortion care for all women seeking abortion.

Culture. One possible factor influencing abortion figures is cultural mores. In the 2010s, abstinence became the main message for young people, replacing information about birth control. In 2018, among the areas where age was reported by individual years, 18- and 19-year-olds had the majority (69.7%) of abortions and the highest juvenile abortion rates, which means the number of abortions per year 1,000 teenagers of the same age – 8.6 and 12.2 abortions per 1,000. Between 2014 and 2018, women 35 and over were the only age group without an increase in abortion rates. Women under the age of 20 had the most abortions among all other women.

“At the societal level,” wrote researchers in 2011 regarding sex education, “deeply ingrained cultural and religious norms regarding the sexuality of adolescents have shaped federal and state policies and practices, restricting extensive information on sexual and reproductive health as well as the Providing services in schools and schools. ” elsewhere.”

According to the CDC report, the decline in teenage births in the US between 2009 and 2018 was accompanied by a sharp decline in teenage abortions – the teenage birth rate fell 54% and the abortion rate fell 55%.

In July 2020, Judge Theodore D. Chuang of the Maryland District Court ruled that there was no need to request a personal visit during a pandemic for a medical abortion prescription. Mifepristone was available through the mail in all states except 19.

Dr. Upadhyay told Medical Daily that following the July decision, many telehealth clinics had opened to deliver these drugs through the mail. Misoprostol was already available in the mail. That all came to a halt on Jan. 12 when the Supreme Court ruled that mifepristone would only be available if a woman shows up in person to get the prescription from her provider.

Even approved, ready-to-ship prescriptions cannot be sent.

* Dr. Joffe is the co-author (with David S. Cohen) of Obstacle Course: The Everyday Fight Over An Abortion in America. (University of California Press, 2020.)

Yvonne Stolworthy MSN, RN graduated from Nursing School in 1984 and spent many years in critical care and as an educator in a variety of settings including clinical trials.

Christine Bahls is an editor at MedicalDaily.com.

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