WASHINGTON — The number of abortion providers in the United States, depressed by the anti-abortion climate and the trend toward managed care, is at its lowest level since soon after the Supreme Court made abortion legal in 1973, the Alan Guttmacher Institute reported Thursday.
But the incidence of abortion, after falling steadily during the first half of the 1990s, has leveled off, according to the New York-based institute, a nonprofit group with expertise in reproductive health issues. About 26% of pregnancies now end in abortion, according to the institute.
The report found a partial return to the geographic availability of abortion immediately after the 1973 Roe vs. Wade ruling, with abortions readily obtainable in the biggest urban areas--particularly in California, Illinois and New York--but hard to come by in rural America.
"It is a question of attitudes in different parts of the country," said Stanley Henshaw, the report's author. "In conservative areas, you have women trying to avoid abortions and you have fewer providers."
California's Rate 4th in Nation
California's abortion rate was 33 per 1,000 women of child-bearing age, fourth in the nation after Nevada, New York and New Jersey. With 492 abortion providers, California had the most in the nation--nearly double that of runner-up New York and nearly one-quarter of all providers in the country. By contrast, North Dakota and South Dakota had one provider each.
Nationally, 86% of counties had no abortion provider in 1996, a figure that has been rising for two decades. Although most of those were rural counties, the report found that "abortion services were effectively unavailable in one-third of U.S. cities."
Altogether, nearly one-third of women live in counties without abortion providers--defined by the Guttmacher Institute as hospitals, clinics and doctors' offices. About 70% of all abortions in 1996 were performed at the nation's 452 abortion clinics. Only 16% of all short-term, general, nonfederal hospitals performed abortions that year.
Most of the drop in providers has been among hospitals and individual doctors. The drop in hospitals is partly a result of managed care, which encourages referrals to outpatient abortion clinics. It also may be attributable to increasing numbers of hospital mergers that, in many cases, have involved the takeover of nonprofit hospitals by Catholic hospitals, which will not allow abortion services.
It is unlikely that there will be a reversal soon in the trend toward fewer providers. A key factor is the dwindling number of obstetrics-gynecology residency programs that train residents in how to perform first-trimester abortions. Currently just 12% require training in first-trimester abortions and even fewer require it for second-trimester procedures.
Further undermining doctors' confidence about making abortion part of their practice is the continuing violence against providers. While abortion rights supporters insist that, if anything, it has renewed the commitment of many doctors to perform the procedure, it cannot help but make some young doctors think twice, said Patricia Anderson, executive director of Medical Students for Choice, a Berkeley-based group.
Since 1993, there have been seven murders and 16 attempted murders of doctors who performed abortions as well as nearly 400 stalking incidents, according to statistics collected by the federal Bureau of Alcohol, Tobacco and Firearms and the National Abortion Federation.
The number of abortions was 1.36 million in 1996, about the same as in the previous year but down from a peak of 1.6 million in 1990. The institute's preliminary data suggest that the number of abortions remained steady for 1997 as well.
The share of pregnancies ending in abortion has fallen steadily from a high of more than 30%.
Among the many factors related to the end of the decline in the number of abortions may be the drop in birth rates among unmarried women, according to Henshaw. Fewer births generally reflect a combination of better use of contraception and increasing incidence of abortion.
Other factors may be decreasing enthusiasm among women for using implant methods of contraception, such as NorPlant, which are highly reliable. With less effective contraception, unwanted pregnancies may be slightly more frequent and result in slightly more abortions.
"For a long period of time, there was a growing acceptance of having children without being married, and starting around 1995, the proportion of births to unmarried parents began to stabilize and even drop,' Henshaw said.
According to the National Center for Health Statistics, the birth rate for unmarried women of child-bearing age is now at its lowest level since 1990.
"That may reflect changing societal attitudes towards having births without being married, and the result may be that now women are not as willing to continue in an unintended pregnancy," Henshaw said.
