In 2017, the abortion rate in the U.S. reached a historic low at 13.5 abortions per every 1,000 women aged 15-44. In 1973, when abortion became legal at the federal level with the U.S. Supreme Court decision in Roe v. Wade, it was 16.5.
While the number of abortions spiked initially following the court ruling in 1973, they’ve been steadily decreasing every single year since.
While abortion is an important aspect of overall health care, and all people with the ability to get pregnant deserve to have safe, affordable, easy access to it — it can also be traumatic; physically, emotionally, and mentally.
So, the fact that we’ve seen fewer people having abortions overall is encouraging — and it’s happened while Roe v. Wade has been the precedent for abortion access.
Does banning abortion actually help prevent abortion?
The reality is: Removing access to abortion is life-threatening, and isn’t actually an effective (or safe) way to reduce the number of abortions.
Preventing people from accessing abortion does not make them need abortions any less, but instead adds another barrier to safe reproductive healthcare.
A 2016 analysis published in The Lancet found that the average abortion rate in countries where it’s outlawed is 37 per 1,000 women — and 34 per 1,000 in countries where it is legal. In other words, there’s no evidence that banning abortion reduces the number of abortions.
There are, however, a few data-backed, safe, and effective ways to reduce the number of abortions that have nothing to do with banning it — and a lot to do with understanding why women have unintended pregnancies and seek abortion in the first place. However, if someone does seek an abortion, there should be no shame, stigma — or legal barrier — in making that deeply personal choice.
If you feel passionate about this, check out our guide to protecting safe and accessible reproductive care!
We’ve compiled a few approaches that actually do decrease abortion — and help folks who want to have children do so in safe, supported ways.
How you can actually decrease abortion without banning it —
1. Invest in comprehensive sex education
A 2011 study published in the National Library of Medicine found that states that primarily teach abstinence-only sex education have the highest rates of both teen pregnancy and teen birth.
With that in mind, sex education is only legally mandated in 22 states, and of these, only 12 mandate teaching about contraception and only seven require that the information be medically accurate, according to a 2013 report by the Center for American Progress.
So, if a majority of young people in America aren’t learning about contraception, consent, or healthy relationships, what happens? Aside from higher rates of sexually transmitted infections, lack of understanding of reproductive anatomy, and reports of sexual assault, unwanted pregnancy is a major byproduct of abstinence-only sex education.
Though teen pregnancies already make up a minority of abortions, in California’s case, abortions dropped from 76 per 1,000 teens in 1988 to 26 per 1,000 in 2005 after evidence-based, comprehensive sex education was introduced in schools.
Comprehensive sex ed includes evidence-based information about gender, sexuality, and reproduction, and according to the Guttmacher Institute, equips young people with “life skills including critical thinking, communication and negotiation, self-development and decision-making; sense of self; confidence; assertiveness; ability to take responsibility; ability to ask questions and seek help; and empathy.”
2. Prioritize the fight against sexual violence
Although the Guttmacher Institute reports that only 1% of women obtain abortions because they became pregnant after rape or sexual assault, putting an end to sexual violence will increase the wellbeing of folks everywhere — and subsequently reduce unwanted pregnancies.
Reducing sexual violence does begin from a young age, teaching enthusiastic consent from the start (which is a key part of comprehensive sex education).
However, we can also urge lawmakers to prioritize stricter laws against sexual violence, prosecute offenders of sexual violence (right now, less than 1% of reported assaults face conviction in America), and encourage more bystander training and community support across the country.
3. Improve access to contraception
Similar to how one might use sunscreen to prevent skin cancer or wear a mask to reduce their chances of contracting COVID-19, people use contraceptives to prevent pregnancy — and ultimately, prevent abortion.
Introducing preventative measures instead of curative measures is a key approach to public health.
In 2011, nearly half of all pregnancies in the U.S. were unintended, which is significantly higher in the U.S. than in other developed countries. Of those unwanted pregnancies, nearly half ended in abortion. To prevent these pregnancies, folks need affordable access to contraceptive care.
In 2007, the Contraceptive CHOICE Project launched and provided over 9,000 women with free contraceptive counseling and the contraception of their choice for two to three years.
Long-acting, reversible contraception (LARC) options, like IUDs and implants, are a highly effective way to prevent pregnancy, and consequently prevent the need for abortion. In that CHOICE program, among participants who used LARCs, there were only .27 unintended pregnancies per 100 women per year — among those who did not, there were 4.55.
Additionally, for six years beginning in 2009, Colorado gave teens and low-income women free IUDs and implants. By 2013, the teen birth rate dropped 40% and the abortion rate dropped 42%, according to the Colorado Department of Public Health and Environment.
While these are more effective than condoms, daily pills, or monthly patches, they’re also more expensive, which makes access for teens and lower-income families challenging.
Implementing programs or funding that provides them free of charge to those who want or need them would be a highly effective way to reduce unintended pregnancies.
Another form of contraceptive care is a vasectomy, a simple, often low-cost procedure for men that provides a highly successful, permanent form of birth control — that can be reversed.
4. Require federal paid family leave
Paid family leave is a critical component of reproductive healthcare, allowing parents to heal from childbirth, offer financial stability, and develop nurturing relationships and environments for their children.
According to the Guttmacher Institute, around 75% of abortion patients in 2014 had an income below the federal poverty level ($15,730 for a family of two) or were low-income (100-199% of the federal poverty level).
Guttmacher also found that one of the most common reasons given for having an abortion is that the person cannot afford a child or another child.
And yet, the United States is one of only two nations in the world that does not guarantee paid family leave for parents, according to the International Labour Organization.
The Family and Medical Leave Act of 1993 is the most current federal law, which requires larger employers to allow a new parent up to 12 weeks of unpaid leave after the birth of a child, meaning that new parents can only take time off from work if they can afford to do so.
Countries that offer generous paid family leave — like South Korea and Norway — have excellent education, health, and wellbeing statistics for children, as well.
5. Offer universal health care
Another overwhelming cost of parenthood comes with giving birth. According to Forbes, the U.S. is the most expensive nation in the world to give birth.
Depending on location, average medical bills for giving birth, with insurance, can range from $4,500 to $11,200 for a vaginal delivery. For C-sections, patients can anticipate paying between $5,100 and $15,000. Without insurance, or with additional health complications, costs can be much higher.
Parents are often forced to take out payment plans, go into debt, rely on social programs like Medicaid, or move to a different state — all to pay for the few days before their child even comes home.
As mentioned, the most common reason for folks to seek an abortion is a lack of financial freedom. The journal of Obstetrics and Gynecology found that women who live in poverty account for 42.4% of abortions.
Offering universal health care makes maternity and birth much more accessible and safe — and much more desirable. For example, in Norway, parents get a full year of paid parental leave following the birth of a child — which is completely free across the country.
Not only is this helpful for decreasing abortion, but it demonstrates a benefit to maternal mortality as a whole. The United States has the highest maternal mortality rate of all developed countries with 23.8 deaths per 100,000 live births, compared to Norway with 2 deaths per 100,000 live births.
6. Offer affordable or free childcare options
For parents facing financial strain, affordable or free childcare is necessary to facilitate a safe and healthy pregnancy and early childhood.
Child allowances — like the expanded Child Tax Credit — are shown to support children and families and boost the economy, as well as reduce abortions.
Three academic studies have tested this; one using a child allowance program in Spain, one using a “baby bonus” in Italy, and others using changes in the enforcement of child support in U.S. states. All found the same thing: when mothers get more financial support for childbearing, they are far less likely to pursue abortion, according to the American Enterprise Institute.
Whether affordable childcare is approached through these financial allowances, subsidizing childcare, or introducing bills that cap the cost of childcare per household, the solutions are there; if only the government will embrace them.
7. Reduce disparities in pregnancy outcomes by prioritizing racial equity in healthcare
In the United States, Black Americans have the highest infant mortality rate of any racial or ethnic group. Structural racism upholds these pregnancy outcomes, as racial inequality in health and social services often leads to poorer quality care.
In addition, weathering — a term that encompasses the cumulative biological impact of racism and sexism — puts Black mothers at higher risk for mental and physical health conditions, such as preeclampsia, eclampsia, embolisms, and mental health conditions, according to the Center for American Progress.
Concern for personal and fetal health is one of the most common reasons someone might seek an abortion, according to the Guttmacher Institute. Pregnancy puts a unique and irreversible strain on the body, which can ultimately lead to lifelong health conditions, ongoing mental illness, and chronic pain; all things that would influence someone’s decision to bear a child.
To combat these racial disparities, Black parents need tools to navigate the healthcare system, as well as a system that actually supports and uplifts them in their individual maternal experiences.
We must increase access to birth options like midwives and doulas, halt the overuse of c-sections in the United States, eliminate maternity care deserts, screen and treat women for preterm births, and strengthen already existing reproductive support programs.
8. Provide quality prenatal and postnatal care
Although Black Americans face a devastating disparity in maternal healthcare and should be prioritized in the advancement of the entire health system, all birthing parents need increased quality and access to prenatal and postnatal care.
According to the National Partnership for Women and Families, almost 20% of pregnant people are unable to have their first prenatal visits as soon as they want it, citing financial, insurance, and other reasons for this undesirable delay. Additionally, nearly 10% of parents have no postpartum visit or no postpartum care for the same reasons.
As we explored earlier, both health concerns and financial limitations are major factors in terminating a pregnancy. Improved prenatal and postnatal care give parents the tools they need to have successful pregnancies.
Prenatal and postnatal care are umbrella terms for many of the care approaches we’ve already covered. Access to paid parental leave, access to affordable healthcare (this means those expensive prenatal vitamins, too!), improved reproductive health education, and well-developed social support nets make for healthier — and more desired — pregnancy outcomes.
9. Provide mental health support in postpartum
Postpartum depression impacts one in seven parents who recently gave birth, according to the Cleveland Clinic. Though highly treatable, those who have a personal or family history with depression, have limited social support, relationship conflict, ambivalence about the pregnancy, pregnancy complications, and are young or single parents, face a higher risk of experiencing this condition.
In addition, postpartum depression can result in ongoing mood or anxiety disorders, affecting one in five postpartum parents, according to the Journal of Health Affairs.
Still, many newly postpartum parents report that depression is not discussed during their postpartum care, according to the National Partnership for Women and Families.
Similarly, those who seek abortions report doing so for similar postpartum depression high-risk identifiers, such as having little social support, a history of mental health conditions, or simply not wanting to be pregnant.
Increasing access to mental healthcare postpartum can mean the difference between life-changing support, and lifelong struggles with mental illness.
One case study is (again) the Netherlands, where in the first week postpartum, all birthing parents receive daily care from maternity nurses, as well as optional access to “POP” care, which is a multidisciplinary approach to psychiatry, obstetrics, and pediatrics, according to Cambridge University.
Perhaps the U.S. could take a page out of their book, including mental healthcare in their overhaul of maternal healthcare.
10. Ensure access to safe and affordable housing
New data from the National Low Income Housing Coalition found that nearly half of American workers (whose median wage is $21 per hour) can’t afford a one-bedroom rental (which, on average, requires workers to make $20.40 per hour).
“The federal government has long used 30% of income as a threshold for affordable rent,” described The Guardian. “For affluent households, this still leaves plenty of money for essential purchases, but research has found that low-income families begin to cut back on necessities when housing costs exceed the 30% threshold.”
For an individual, a couple, or a family who is already paying more than 30% of their income to housing, bringing a child into the equation can feel untenable.
It’s clear that when families don’t have access to affordable housing, they become vulnerable to a variety of negative impacts.
For kids this includes poorer health, poorer performance in school, increased lifetime risk of depression, higher risk of asthma, and lower average weight.
And for adults, this includes less ability to afford nutritious food, reduced access to care, higher rates of debt, higher risk of homelessness, and higher rates of mental distress.
All of these points correlate with the experiences of those who choose to terminate a pregnancy.
By ensuring access to affordable housing, especially in places where there is currently a shortage, more people who find themselves with an accidental pregnancy will have the stability they need to provide a healthy future for themselves and their children.
11. Create more reliability and consistency in abortion laws
After the news following the Supreme Court’s leaked draft opinion that would significantly change abortion access in America, folks have been feeling existential, impending fear about reproductive rights.
Confusing information sends people spiraling, wondering if abortion is even legal (yes, it still is); what states will soon ban abortion (about half of them); or how to access emergency contraception (like Plan B or Ella).
This mass panic about reproductive care has led people to purchase abortion pills online (which, for the record, are different than emergency contraceptives).
Formal abortion bans will cause this demand to skyrocket even more, experts say. While it’s great that this care is accessible, increased demand means limited options will soon become a reality.
And those seeking care from medical experts in-person now face an even tougher decision. Following the Texas abortion ban, which only allows abortion up to the sixth week of pregnancy, clinics saw an increase of pregnant people rushing to get care.
According to a Slate article, healthcare providers at Houston Women’s Reproductive Services see that many patients are “coming in so early that their pregnancies are undetectable by the ultrasound machine, even if their pregnancy tests come back positive.”
The narrow window to obtain a legal abortion in Texas has influenced people to feel pressured to make a decision: terminate the pregnancy immediately, or have a state-mandated childbirth.
“They frequently tell us, ‘I just don’t feel like I’ve had enough time to think about this,’” patient counselor Marjorie Eisen told Slate.
Legislators were hoping this ban would encourage Texans to have fewer abortions,“but in fact, in some ways, we think it’s rushing people,” Eisen said.
If legislators truly want to decrease abortion, they must create consistency, access, and equity in all aspects of reproductive care.
Having nuanced discussions about the needs, health, safety, and social impact of pregnancy and child-rearing in America is the only way to truly improve the lives of parents and their children.
