A new report from the Centers for Disease Control and Prevention (CDC) shows that abortion rates are down across the board and suggests that people are able to more effectively plan their reproductive futures. Yet, the Trump administration has finalized a regressive set of health insurance policy changes that could roll back access to the very thing that has helped us get here: birth control.
For the report, the CDC looked at data from central health agencies in the District of Columbia, New York City, and 47 states (excluding California, Maryland, and New Hampshire) for every year from 2006 to 2015, and found a steep decline using every metric. In fact, all three metrics—the total number, rate, and ratio of abortions (the amount of abortions there are compared to live births)—reached historic lows for the study period (2006-2015).
The total number of reported abortions decreased 24 percent during this period, from 842,855 in 2006 to 638,169 in 2015. The rate of abortions among women aged 15 to 44 fell 26 percent, from 15.9 abortions per 1,000 women to 11.8. And the abortion ratio decreased as well, by 19 percent.
The report found that these numbers declined across all age groups, races, and ethnicities, yet “well-documented disparities persist.” For instance, abortion rates are 1.5 times higher among Hispanic women than among non-Hispanic white women, and 3.6 times higher among non-Hispanic black women than among non-Hispanic white women.
But the major factor behind these downward trends isn't our shrinking access to abortions (although that undoubtedly played a role)—it's our increased access to birth control. "Efforts to help women avoid pregnancies that they do not desire might reduce the number of abortions,” the report reads, continuing on to say that "providing contraception for women at no cost can increase use of these methods and reduce abortion rates.”
The CDC report follows previous research that showed that access to effective birth control could lead to lower abortion rates, likely by helping to prevent unintended pregnancies.
For instance, research from the Guttmacher Institute looking at data from 2008 to 2011 found that “the steep drop in unintended pregnancy—including births and abortions—was likely driven by improved contraceptive use.”
The researchers point specifically to increased use of highly effective long-acting reversible contraceptives (LARCs)—such as IUDs and implants—during this period. These forms of birth control "don’t have much room for user error, and so people are less likely to accidentally get pregnant,” Rachel Jones, Ph.D., principal research scientist at the Guttmacher Institute, tells SELF.
Later, the implementation of the Affordable Care Act (ACA) in 2012 bolstered this trend with its birth control mandate, which requires employers to offer insurance plans that cover at least one form of FDA-approved birth control from each method category at zero cost to the patient (meaning no co-pay or co-insurance). (The mandate included exemptions for churches and certain religious organizations, like Catholic hospitals.)
These provisions "appear to have spurred continued improvements in contraceptive use beyond 2012," according to Guttmacher. The mandate made it more economically feasible for women to afford contraceptives, and previously cost-prohibitive LARCs in particular, Jones says. A study of 417,221 women in Contraception found that between 2012 and 2014, the rate of women paying out of pocket for an IUD fell from 58 percent to 13 percent. And research shows that when financial barriers are removed, women are much more likely to choose LARC methods, and therefore less likely to experience an unintended pregnancy and subsequent abortion.
The CDC report mirrors this trend: The drop in abortion was much more dramatic during the period from 2011 to 2015 (after the ACA was implemented) than the period from 2006 to 2010. For example, the abortion ratio decreased by 7.4 abortions per 1,000 live births per year from 2011 to 2015, but by only 0.37 abortions per 1,000 live births per year from 2006 to 2010.
Despite these trends, the Trump administration has made moves to limit access to birth control on the basis of companies' religious or moral beliefs.
The final rules state that any privately or publicly held company, nonprofit, university, or individual may be exempted from the mandate if they hold religious or nonreligious beliefs against birth control.
If that sounds pretty vague to you, you’re right. The text does not lay out what constitutes a “non-religious moral conviction.” And the broad, ambiguous phrasing would seem to be potentially applicable to pretty much any person or entity who is against birth control on any grounds.
The rules will go into effect on January 7, 2019, barring lawsuits seeking to block them. As SELF previously reported, California and Pennsylvania have filed appeals after losing lawsuits against the federal government over early drafts of these rules, and more suits may be filed now that the rules are final.
The Department of Health and Human Services (DHHS) estimates that the exemptions will have minimal impact, affecting 200 or fewer employers and anywhere from 6,400 to 127,000 women. Jones says that her colleagues at Guttmacher also predict the effects will be “relatively small,” but it’s too soon to tell for sure. “To be honest, we don’t have any idea how many companies or organizations will take advantage,” she says.
Reproductive health experts see the move as a medically unsound threat to women's reproductive health and the declines in abortion.
The decreases we've seen are “largely due to people’s increased access to effective and affordable birth control,” Leana Wen, M.D., president of the Planned Parenthood Federation of America (PPFA), said in a statement. "And yet, in the midst of this unprecedented progress, the Trump-Pence administration and politicians in states across the country want to take away our rights and access to reproductive health care, including placing restrictions on what we know works—birth control."
On November 8, a broad consortium of medical organizations representing over 423,000 doctors and medical students—the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Psychiatric Association—issued a powerful joint statement rebuking the administration’s decision and urging them to withdraw the rules.
“By undercutting women’s access to contraception, a key preventive service, at no out-of-pocket cost in private insurance plans, the final rules conflict with our firmly held belief that no woman should lose the coverage she has today,” they write. “No-copay coverage of contraception has an undeniable positive effect on the health of women and families everywhere.” Correspondingly, “efforts to decrease access to contraceptive services will have damaging effects on public health.” (Plus, as SELF previously reported, hormonal contraception may come with a multitude of benefits that are unrelated to pregnancy, like making your period more manageable, managing pain from endometriosis, and lowering your risk for ovarian cancer.)
“The final rules follow an alarming pattern of medically unnecessary decisions in women’s health policy that, together, undermine women’s access to care,” Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists (ACOG), said in a statement. “This attack on birth control is only the latest in a series of attacks,” Dr. Wen said, such as changes to Title X funding and the proposed gag rule, and defunding Planned Parenthood.
The ultimate course of these policy changes is yet to be seen, but the medical community's response to this most recent move has been loud and clear: We need more access to reproductive healthcare, not less. "If we want to continue to reduce the rate of unintended pregnancy in this country," Dr. Wen said, "we must ensure that every person has access to the full range of birth control methods."