Sep 25, 2008

Health - US; Tracking changes in who gets abortions & why

Charles Krupa

Abortion rates have dropped steadily since the 1980s, from a peak of 29.3 abortions per 1,000 women in 1981 to 19.4 in 2005. But behind this general decrease are striking changes in the demographics of abortion. Compared to 30 years ago, women having abortions today are older and more likely to be mothers and minorities, according to a study released Tuesday by the nonprofit, nonpartisan Guttmacher Institute.
The study looked at trends in abortion since 1974, the year after the Supreme Court passed Roe v. Wade, legalizing abortion in the United States. What researchers found is contrary to what pop culture phenoms, from "Juno" to Jamie Lynn Spears, might suggest: Teenagers are not the most likely to confront this issue, twenty-somethings are. "We're aware that, today, most of the women having abortions are moms struggling to take care of the children they already have," says Rachel Jones, senior research associate at the institute.
In fact, teens saw a bigger drop in abortion rate than any other demographic over the past 30 years. From 1974 to 1989, women aged 18-19 had the highest abortion rate among all age groups, varying from 32 to 62 per 1,000 women. In 2004, the latest year for which data is available, the abortion rate was 20.5. "We've done a great job educating kids about the risks of sexual behavior and proper contraceptive use," says Jones. So it's not the kids that researchers are most worried about--it's the age groups above them.
But the news isn't all good. While the teen abortion rate has declined by nearly 30 percent, the rate for women ages 20-24 is almost 10 points higher than it was in 1974. (In that group, rates hit 30.4 abortions per 1,000 women in 1974, spiking to 53.8 in 1989 and declining to 39.9 in 2004.) Women in the next age group, ages 25-29, follow a similar pattern, with a spike in the '80s and a decline in recent years. So while it's encouraging that abortion rates among 20- to 29-year-olds have been steadily declining since the late 1980s, those decreases have been much smaller than those among teenagers, and they still have not brought the abortion rate down to low levels of the 1970s.
Researchers cannot fully explain the reasons behind this trend. Some think it indicates a kind of oversight: Public health initiatives have focused on reducing pregnancy and abortions among teenagers but haven't put as much thought into how to educate older groups. Teenagers, after all, do seem like the most vulnerable group. Millions of dollars have been poured into programs to educate teenagers about safe sex and contraceptives. By most accounts, those efforts have been fairly successful in targeting and changing the sexual health habits of teens. Centers for Disease Control statistics show teenage contraceptive use to have gone up noticeably between 1995 and 2005. The decline in abortion rates among teens mirrors a decline in teen pregnancies--from 107 for every 1,000 teenagers ages 15-19 in 1982, to 75 per 1,000 teenagers in 2002 (the most recent year for which data is available).
But once they're out of high school and on their own, many women don't have an adequate support system when it comes to reproductive health. "We've done a lot for adolescents and teens but need to expand those efforts to reach adult women," says Jones. "We haven't taken care of women in their 20s." Experts say a lack of health insurance, more common among adults than teens, and access to affordable contraceptives are significant factors in causing abortion rates to stay at a level higher than that of the 1970s among older women. "You could full-well know that the pill or IUDs are effective [birth control], but if you don't have health insurance or don't have access to affordable family planning, that's not going to help you much," says Jones.

Financial barriers seem to be one of the most persistent obstacles in the fight to reduce socioeconomic disparities in abortion rates, say experts. Medicaid coverage of birth control varies by state, and the bureaucracy can be difficult to navigate. The current Guttmacher study did not look at the socioeconomic status of women having abortions, but the institute's previous research has shown the abortion rates for women below the federal poverty line to be much higher than for more economically advantaged women. "When you don't have access to affordable birth control, rates of unintended pregnancy are going to be higher. That's a sad and real-life consequence of the health insurance gap," says Laurie Rubiner, Planned Parenthood's vice president of public policy.
Other shifts in demographics bolster Rubiner's claim that the women having abortions today are increasingly under economic duress: Compared with 1974, they are much more likely to already have children, as well as to be unmarried. "Women are making a decision, 'Can I feed another mouth,'" says Kim Gandy, president of the National Organization of Women. "'Did my husband leave me with three other kids? Is this going to mean that I can't feed my kids?' There is a real life decision that a woman has to make." Many women, she thinks, are asking whether they can afford to have another child.
Another trend uncovered by the study that Planned Parenthood's Rubiner finds troubling is the consistently higher rate of abortion among minority women. While the abortion rates among African Americans and Hispanics have decreased since 1994 (the first year for which ethnic data is available), they are still dramatically higher than those of Caucasian women. The abortion rate for black women is 49.7 per 1,000 women, nearly five times that of non-Hispanic white women.
These sobering numbers leave reproductive health experts looking ahead to a whole new set of challenges even as they celebrate the significant strides they've made in the past 30 years. Closing a socioeconomic health-care gap decades in the making won't be easy.

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