This Is Why Abortions Are Actually At A Historic Low

The answer seems to be widely available birth control and the rise of long-term contraception methods. Congress is deciding whether some of that that will continue.

Every month for the past few years, I've strolled into my pharmacy and out with my monthly birth control prescription without ever taking out my wallet. And every month I think to myself, Damn, that was easy.

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If this level of accessibility and affordability was available to everyone who wanted to have a say over if and when they become a parent, then it wouldn't be unreasonable to expect fewer unplanned pregnancies and abortions, would it? Interestingly enough, that's exactly what we saw happen in recent years.

The rates of abortion and unplanned pregnancy in the US are currently at record lows. And experts say that increased access to highly effective birth control is primarily responsible.

Let's start with the US abortion rate, which recently hit a record low in 2014.

Guttmacher Institute / Via guttmacher.org

As of 2014 (the most recent year available), the US abortion rate reached the lowest rate ever recorded at 14.6 abortions per 1,000 women aged 15-44, according to the most recent analysis by the Guttmacher Institute. This marks a 14% decline since 2011.

The data comes from a Guttmacher study in the journal Perspectives on Sexual and Reproductive Health. The numbers differ slightly from 2013 surveillance data from the CDC (the most recent year available), which put the abortion rate at 12.5 abortions per 1,000 women aged 15-44. The CDC requests their data from state health departments, while Guttmacher surveys their database of all US facilities known or suspected to perform abortions in a given time period. Neither offers a definitive number of abortions happening in the US each year, but they're the best estimates we have.

Experts say that abortions are down for reasons that have to do with birth control, not abortion restrictions.

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According to the Guttmacher study, the total number of abortion facilities dropped 3% between 2011 and 2014, but changes in clinic numbers didn't always correspond to fewer abortions in those states. Similarly, an increased number of abortion restrictions coincided with clinic closings in some, but not all, states.

"The best available evidence suggests that improvements in contraceptive use were responsible for the decline in abortion rates," Rachel K. Jones, PhD, principal research scientist at Guttmacher Institute, tells BuzzFeed Health.

How do we know that? Well, it's no coincidence that unplanned pregnancies have also dropped significantly in recent years.

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"We know that a little less than half of all unplanned pregnancies end in abortion," Rachel Fey, director of public policy at The National Campaign to Prevent Teen and Unplanned Pregnancy, tells BuzzFeed Health. So if there are fewer unplanned pregnancies, it would track that we would see fewer abortions.

The most recent nationwide data on unplanned pregnancy comes from 2011, and it shows a steep decline for the first time in the past three decades. Between 2008 and 2011, the rate of unplanned pregnancy in the US dropped 18%. Not surprisingly, the rate of abortion during that time also dropped 13%.

Over the past decade, we've seen a rise in the use of long-acting reversible contraceptive (LARC) methods that are less prone to user error, like the IUD and the implant.

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In 2002, just over 2% of birth control users had a LARC method, but that jumped to 8.5% in 2009 and then to 11.6% in 2012.

And it makes sense that having more people on highly effective birth control methods could mean fewer unplanned pregnancies and abortions. A study in Iowa found that between 2005 and 2012, the number of family planning patients using a LARC method increased from less than 1% to 15%; meanwhile, the number of abortions in the area decreased from 8.7 to 6.7 per 1,000 women aged 15-44. According to the study, abortions declined in Iowa "despite increased access to abortion services."

More people use highly effective birth control when they're actually able to access and afford it.

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Here's where the Affordable Care Act comes in, which went into effect in August 2012 and included no-cost, no-copay birth control for all FDA-approved contraceptive methods as long as you have health insurance (with some limitations explained here).

Suddenly, not only could you get your monthly birth control pills without a copay, you could also get one of those highly effective (but previously costly) methods like the IUD or implant, which could last you three to ten years.

Research shows that when cost isn't an issue, people who are introduced to LARC methods are more likely to choose them. Between 2012 and 2014, the proportion of women who had to pay an out-of-pocket cost for an IUD went from 58% to just 13%. Essentially, the Affordable Care Act is eliminating that financial barrier.

So that's where we are today: Access and affordability to a wide range of highly effective birth control methods have increased; meanwhile, the rates of unplanned pregnancy and abortion have decreased. Now what?

It's unclear what might happen to the Affordable Care Act's birth control coverage mandate. We don't know if all insured Americans will go back to paying a copay for birth control, which would likely make the highly effective LARC methods more expensive than other methods like the pill or ring. Already, birth control users are tweeting about getting the IUD and making appointments to get them put in now, just in case.

"If there are fewer women with health insurance, or health insurance that doesn't cover contraceptives, then women are not going to have the same capacity to prevent unplanned pregnancy," says Jones.

What we do know is that low-income women have a higher rate of unplanned pregnancy, and factors like Title X and Medicaid expansion have been helping many of them access free or low-cost birth control, which can bring that rate down.

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"If any of these pieces go away, we risk losing the progress that we've made," says Fey. In case you're unfamiliar with these:

* Title X is a federal grant program that provides funding for family planning services for low-income or uninsured individuals. It was created in 1970, is administered by the US Department of Health & Human Services, and distributes funds to various clinics, hospitals, and non-profits. Title X funds may not be used for abortion, but they can be used for birth control and other important family planning services.

* Medicaid expansion refers to states where you can qualify for Medicaid based on income alone (making below 133% of the federal poverty level). Medicaid provides free or low-cost health insurance for low-income individuals. Medicaid reimbursements to Planned Parenthood and other federally qualified health centers mean that someone with Medicaid can go to these centers for free or low-cost family planning services, but the Hyde Amendment blocks any Medicaid funding for abortion services (except in cases of rape, incest, or when the mother's life is in danger).

"To cut Medicaid expansion coverage or to reduce funding to Title X, anything you do like that reduces either the number of women who have coverage or the number of places they can go to use that coverage," says Fey. "Both of those pieces would have a profound effect on the ability to continue making progress in terms of reducing unplanned pregnancy and abortion."

And then there's Planned Parenthood. "Defunding" Planned Parenthood — which Republicans in Congress want — would prohibit them from getting Medicaid reimbursements or Title X funds, which means they could no longer serve low-income patients that rely on those programs.

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The non-partisan Congressional Budget Office also says that could drive unplanned pregnancies back up as it "would affect services that help women avert pregnancies" and would most significantly affect people in areas where there are no other clinics that serve low-income patients. They project that about 15% of these people would lose access to care.

Here's the clincher: "By CBO’s estimates, in the one-year period in which federal funds for Planned Parenthood would be prohibited under the legislation, the number of births in the Medicaid program would increase by several thousand, increasing direct spending for Medicaid by $21 million in 2017 and by $77 million over the 2017-2026 period."

If birth control and family planning services remain accessible and affordable, Fey says we can anticipate more increases in the most effective birth control methods and further declines in unplanned pregnancies. "What you don't want to do is go back."