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Embryonic Trend

Thursday, June 1, 1995

After presidential candidate Bill Clinton vowed to make abortion "safe, legal, and rare," President Clinton and his administration devised a somewhat bizarre strategy to help accomplish that goal. Within days of assuming office, the president signed four executive orders addressing abortion: He lifted the ban on fetal tissue research; he ended the ban on abortion counseling in federally funded clinics; he began a process to approve the abortion pill RU 486; and he revoked the prohibition against abortions in military hospitals overseas. All these policies would seem to increase the accessibility and likelihood of abortion.

Even so, it is remarkable that abortion does seem to be slightly rarer. The total number of abortions in America dropped by 80,000 in 1992, hitting its lowest level since 1979. Abortion rates, declining for more than a decade, dropped again, to under 26 per 1,000 women of child-bearing age. There was a decrease as well in the percentage of pregnancies ending in abortion, from a high of about 30 percent in 1983-85 to less than 27.5 percent in 1992. For the first time since Roe v. Wade—the Supreme Court ruling that repealed every state law restricting abortion—we have seen significant declines in all three categories for measuring abortion in America. And, though statistics aren't yet available, abortion providers expect to see lower numbers for 1993 and 1994.

Why?

The evidence for a decline in abortion is, admittedly, incomplete. Many states don't collect the sort of data required to draw solid conclusions—such as precise, annual figures for abortions, teen pregnancies, and illegitimate births. And whatever the decline in abortion, the descent has not been terribly steep. From 1980 to 1990, the annual figure wobbled between 1.55 million and 1.61 million. Though abortions performed in 1992 dropped to 1.53 million, the figure represents only a 5 percent decline from its 1990 peak.

There seem to be at least four reasons for this slight decline. Over the last several years, we have witnessed a social movement to encourage teenagers to postpone sexual relations until marriage, increased professionalism and sensitivity in the nation's pro-life pregnancy care centers, growth in state laws fostering a fully informed abortion decision, and a decline in the number of doctors who perform abortions.

Learning to Wait

Until recently, the prevailing approach for reducing the level of abortion has been to encourage contraceptive use, while reserving abortion as a fall-back solution. The assumption of this approach is that it is impossible to reduce sexual activity among teens or adults outside of marriage. Advocates of this position hope there are fewer abortion clients because women are making more efficient use of contraceptives. According to Susan Tew of the Alan Guttmacher Institute, the proportion of unplanned pregnancies actually increased in the 1980s, from 54 percent in 1982 to 56 percent in 1988, the latest year for which figures are available. Tew says that women who are "young, poor, unwed, and minority" are more likely to have abortions, less likely to find access to contraceptives, and to understand the relative risks and benefits of various methods. More recent survey data indicates that the use of oral contraceptives and condoms is increasing; the latter may be due to heightened awareness of the dangers of sexually transmitted diseases.

However, part of the recent drop in abortions could be attributed more to a decline in teenage sexual activity than a rise in contraceptive use. Studies by the Centers for Disease Control have shown the proportion of sexually experienced highschoolers dropping: In 1989, 59 percent engaged in intercourse, in 1991 the figure was 54 percent, and in 1992 it dropped to 43 percent. A 1994 Roper Starch survey, conducted in association with the Sex Information and Education Council of the United States, found that only 36 percent of high schoolers said they had had sex. In the latter survey, many of those who had "done it" wished they hadn't: 62 percent of sexually experienced girls, and 54 percent of all experienced high schoolers, said they "should have waited."

Confirmation of these sentiments is found in an Emory University survey that asked 1,000 sexually active young teen girls what topic they wanted more information about. Nearly 85 percent checked "How to say no without hurting the other person's feelings." The meaning of politeness has shifted in one generation from "nice girls don't" to "nice girls have to."

Abstinence-education programs across the country have found that telling kids not to have sex is surprisingly successful. A Title XX performance evaluation found that, two years after the Sex Respect program, non-participants were twice as likely as participants to have gotten pregnant. When the Teen Aid program moved into a California junior-high school, 147 students were reported pregnant; two years later, only 20 girls were pregnant. At a Chicago middle school, each eighth-grade graduating class usually included some pregnant girls; but three years of Project Taking Charge yielded three classes with no pregnant graduates.

One of the most unusual success stories is that of True Love Waits, a program begun by a Baptist youth pastor in Tennessee. It offers adolescents a chance to sign "pledge cards" vowing virginity until marriage. What sounds to hip and aging baby boomers like boring prudery was seized by teenagers with an eagerness their parents had reserved for hula hoops. In one year, 500,000 cards were signed, and the program has spread across 26 denominations, Catholic and Protestant. Last July, 20,000 kids staked 200,000 of the cards on the Washington Mall, and spent the day dancing and picknicking. President Clinton came by for a few minutes to join them.

Rising Moral Concerns

A rise in youthful morality about sex outside marriage is paralleled by moral concerns about abortion. A recent CBS/New York Times poll found that, while 46 percent of respondents said that abortion is murder, the age group most likely to voice that opinion was 18 to 29. In 1990, a series of focus groups was conducted by researchers for the Center for Population Options, exploring teens' attitudes toward abortion. To the authors' evident dismay, "In response to the question, 'What first comes into your head when you hear the word "abortion"?' participants—regardless of race, sex, or residence—most often responded with 'murder,' 'killing a baby' or 'death.'ÖIn general, the female participants were especially judgmental of other women's motives—in some cases not even sanctioning abortion in the case of rape. Comments focused on the 'innocence' of the baby, regardless of the circumstances."

The growing concern about the "innocence" of the baby has not yet led to a change in attitudes about the legality of abortion. For example, a periodic NBC/Wall Street Journal poll asks, "Do you think abortion should be illegal, or not?" In eight surveys between 1989 and 1993, those responding "illegal" wavered from 33 percent to 26 percent and back up to 35 percent, a wobbly but fairly consistent response. Nor does a conviction that abortion is wrong necessarily insure that the respondent would refuse to have one. While researching for my book, Real Choices, I interviewed women across the country who had had abortions, and found several who had been pro-life, committed Christians at the time. They fully believed that in choosing abortion they were killing their babies. A common coping mechanism was, "God, I'll send this baby back to you now, and when I'm ready you send it back to me." Anti-abortion opinions did not prevent them from having abortions when their situations felt overwhelmingly difficult.

The goal of my research project was to discover why women had abortions, in hopes that we could reduce the numbers by solving pregnancy problems. Like the Guttmacher Institute and other researchers' studies, I found that women usually have several interconnecting reasons for their abortions, involving job, school, finances, present concerns, and fears for the future. However, when I asked women to recount the story of their abortion decision, one factor emerged as determinative nearly every time: problems in personal relationships. Almost 90 percent of the women surveyed said the main reason for the abortion was to please or protect some other person, usually a partner or parents. When asked, "What would you have needed to continue the pregnancy?" the answer was consistent and emphatic: "Just one person. If I'd had only one person to stand by me, I would have had my baby."

Compassion and Persuasion

The pregnancy-care wing of the pro-life movement has been trying to provide that personal support and friendship for 30 years, with increasing professionalism and success. This care usually shows up in the form of pregnancy-care centers, humble storefront operations scattered across the land, where material and emotional support is given to women free. These centers are usually run on a shoestring—many have no paid staff—and they can only give what others donate, from maternity clothes and diapers to housing, job training, medical care, and advice on adoption and parenting.

In these pages a few years ago ("Victorian Secret," Spring 1992), Marvin Olasky suggested that aid to pregnant women was more effective than legal prohibitions in reducing abortion rates in the 19th century. Are advances in the provision of pregnancy support an element in the reduced number of abortions? "There just isn't enough information there to say, one way or the other," Olasky says. "But certainly the pregnancy-care movement has been tremendously effective in keeping the numbers as low as they are. Without pro-lifers offering support and shelter to pregnant women over the years, the abortion toll would have been far higher."

Some pregnancy-care centers are independent operations, while others affiliate with national chains. The two largest chains are Birthright and Care Net, which together represent about 1,000 centers. In these chains and elsewhere, the last few years have seen a shift toward a philosophy sometimes summarized in the slogan, "Love them both." Pam Stearns, director of the Hope Unlimited Pregnancy Care Center in Paducah, Kentucky, says, "Before, we had pictures of aborted fetuses right in the lobby—we had an aggressive agenda of saving the baby. Now the focus has been enlarged, and our mission is to serve the client. Everything is done to make her feel comfortable, not used and manipulated." Today, a visitor to the Paducah center will see landscapes and flowers in the lobby, and be greeted by a volunteer who listens carefully to her needs and fears.

A unexpected phenomenon that may be implicated in the drop in abortion rates is being observed at these pregnancy-care centers: an increased demand for grief counseling, for men as well as women. Several pregnancy center directors say that this is becoming their fastest-expanding area of service. Staff at a center in South Carolina report, for example, that while they usually start one grief group per month, in January they had to start three, plus their first men's group.

For many years, abortion mourning had no outlet; as one Real Choices interviewee, Bette, put it, pro-choice friends needed her to continue affirming her decision, and she feared revealing to pro-lifers that "I did what you despise." Now, as women find the freedom to tell their friends about their heartbreak, it may become a form of negative word-of-mouth advertising that could cause others to avoid abortion. In theory, both pro-life and pro-choice forces have an interest in helping women make the best resolution they can, but Bette goes on, "I was surprised at the way [pro-life] people accepted me. They were able to recognize and validate my pain. The pro-choice side can't do that—they have too much need to pretend that it isn't there."

Legislating for Life

State laws to encourage informed decisions about abortion have multiplied in recent years and seem to have achieved some results. Nineteen states require that clinics provide information on the development of the baby, as well as the risks of and alternatives to abortion; 11 require women to wait 24 hours for "reflection"; 24 states require a parent to be involved before a teen's abortion.

It should be noted that none of these laws actually places restrictions on abortion. No one is prevented from having the procedure. The Supreme Court's stipulation in the Casey decision of 1992 was that such laws were valid only if abortion was still permitted in all situations, with no "undue burden" placed on the freedom to abort. If women are declining abortion because more information and time to think have increased their awareness of alternatives, that is an expansion of choice, not a restriction. No one's business has been inhibited. Big-city yellow pages still run display ads by providers offering to end pregnancies up through the 24th week, with specialists available around the country to perform them later on request.

In 1991, the American Journal of Public Health published an article examining the effect of a parental-notification law in Minnesota. During the four years the law was in effect, the abortion rate for minors fell dramatically—27 percent—while the birth rate continued to fall in accord with a long-term trend. Overall, teen pregnancy was down 21 percent. The hopeful conclusion is that the law did not merely stop abortions, but caused teens to be more careful about preventing pregnancy. According to the report, "Positive claims about these laws are that they promote responsibility (by encouraging teenagers to 'think before they act'), foster parent-child communication, facilitate mature decision making, and may reveal medical history information that would otherwise remain unknown to the physician."

Market Realities

Another explanation for the decline in abortions is that fewer doctors will perform the procedure. Between 1985 and 1988, there were an average of 33 fewer abortion providers every year; by the 1988 to 1992 period, the yearly loss had accelerated to 51. Part of this loss is due to the "graying of abortion providers," as the average age of a provider slips above the average age of physicians, and retirement claims an increasing proportion. Some doctors leave the field because of harassment or fear of violence; the increased cost of security is one reason the average price of an abortion rose from $250 in 1988 to $300 in 1992.

Why aren't younger doctors entering the field?

To an idealistic young doctor, abortion has little appeal—it's fundamentally a destructive operation, offering little professional challenge, and no ongoing doctor-patient relationship. In addition, other doctors hold abortion providers in low esteem. Warren Hern, an abortion specialist in Boulder, Colorado, complains that his fellow providers "are treated as a pariah by the medical community. At best, we are tolerated." In 1993, the controversial Project Choice survey (staged by pro-life activists under a sympathetic-sounding name) polled almost a thousand abortion providers; 69 percent said their profession was "not respected in the medical community" and 78 percent said that they did not feel "pro-choice organizations and politicians are doing enough to support those who provide abortion care."

A better question is, in the face of these discouragements, why did older doctors join the field? Thirty years ago, doctors were still seeing women come into emergency rooms injured by self-abortion or illegal abortion, and it was possible to see the provision of legal abortion as a noble, lifesaving act. Seventy-one percent of the Project Choice respondents had "personally [seen] a tragedy as a result of an illegal abortion," another subtle indication of their age. Younger doctors have not had that galvanizing experience. On the other hand, they have had experience with more recent medical advances: sonograms and fetoscopy, fetal surgery, and the rescuing of ever-younger preemies. All of these make indelibly visible what abortion—legal or illegal—destroys. Likewise, it was easier to feel positive about delivering abortions when only a few desperate cases were envisioned; the routine toll of 1.5 million a year sours everybody.

Abortion provision is a specialty that is not intrinsically rewarding, is held in low esteem by the public and medical colleagues alike, and exposes one to the risk of hatred or even violence from protesters. When an aspiring doctor thinks, "What do I want to be?" a great many other options will come to mind before this.

The dwindling ranks of abortion providers seem to be helping to bring down the abortion rates in some states. Nationally, there are about four providers per 100,000 women of reproductive age. In Hawaii, where the relative number of providers is 19.6, the abortion rate is the second highest in the country. In states such as Kentucky and Missouri, with fewer than 1.5 providers, the abortion rate hovers between one fourth and one half the national average.

If there are fewer abortion providers available, would women, in large numbers, resort to self-inflicted abortions? Or would they simply cross state lines to have abortions elsewhere? The answers are no and perhaps. Though the number of providers has already dropped, there is simply no evidence that illegal abortion has returned. It may be that illegal abortion has been so thoroughly discredited that no woman wants to risk it.

Some travel would undoubtedly occur: In 1987, more Wyoming women had abortions out-of-state than in-state. (In Cheyenne, the state's largest city, no abortions were performed in 1992.) On the other hand, abortion rates tend to be higher for poor non-white or Hispanic women, who are less likely to have the resources to travel. Then again, they are more likely to live in metropolitan areas where providers already cluster (94 percent of non-metropolitan areas now have no provider). Making state-by-state predictions is maddeningly uncertain, however. Between 1988 and 1992, North Dakota went from three providers to one, and the abortion rate dropped 28 percent. South Dakota remained steady with only one provider, and the rate rose 19 percent.

The Age Factor

A final consideration of the drop in abortions involves age: As the baby boomers get older, the cohort of women of reproductive age (15 to 44) is weighted more heavily toward the end, where fewer pregnancies occur. Since two thirds of all abortions are performed on women under 25, the abortion rate should drop when the size of that group shrinks. The decline in the ranks of females age 15 to 22 from 1988 to 1992 could account for one-sixth of the decline in abortions over this period.

Among the uncertainties regarding the abortion decline, one unhappy certainty looms: A great many more women are choosing single parenting. In 1981, births to unwed mothers occurred at the rate of 30 per 1,000 women of childbearing age, rising to 39 by 1988 and 45 by 1991. Pregnancy-care centers report that most of their unwed clients who choose birth opt for single parenting, while only a tiny number choose adoption. Amid a growing social consensus that unwed parenting damages both mother and child, these statistics are discouraging. Prochoice advocates may think that abortion would have been a better choice; pro-lifers would rather see these children born than aborted, but would prefer their moms either marry or place the child for adoption. Both sides agree that prevention is better than cure.

The drop in abortion numbers in 1992 is a tantalizingly cryptic event. Analyzing it is like trying to follow the action of a play with the curtain risen only far enough to show the actors' ankles. No one on any side in this debate, much less the confused folks in the middle, can predict what will happen next. But a scrap of information like this does tantalize, because the abortion issue reverberates with meanings beyond itself. Abortion asks us big questions about "Life, the Universe, and Everything." It asks ultimate questions like, "Who belongs in our human family?" "Who may kill?" and "When does life begin?"

For the last question, at least, there is an answer. It is 23. Life begins at 23 pairs of chromosomes—or, for those with Down's syndrome, 23 pairs plus one. Unless that number were somehow repealed, it matters little whether the other numbers are a million-point-five or a million-point-six. It's still more than 4,000 every day, more than 31 million since Roe v. Wade; it's still a number that prods our weary consciences, a little more sternly every day.