By Randall K. O’Bannon, Ph.D. NRL Director of Education & Research
Editor’s note. There is always a lull—a gap —recently running three years between the year for which Guttmacher compiles abortion numbers and the actual publication date. For example, the study that appeared in 2017 dealt with abortion numbers for the year 2014. The following appeared previously but remains hugely important.
A study Guttmacher Institute confirms that in 2014, nearly half of abortions–44.8%– were actually repeat abortions, that is, abortions to women who have had at least one previous abortion.
Although this is something that many have known or suspected for years, there are details in this study from Planned Parenthood’s one-time in-house think tank that help us better understand why this happens and which women are most likely to have multiple abortions.
And as is so often the case, assessed objectively, these findings challenge some of the abortion lobby’s most constant arguments.
Guttmacher researchers Rachel Jones, Jenna Jerman, and Meghan Ingerick published their study “Which Abortion Patients Have Had a Prior Abortion? Findings from the 2014 U.S. Abortion Patient Survey” in the August 23, 2017 issue of the Journal of Women’s Health. Their basic finding was that 44.8% of women reported having at least one or more previous abortions.
Guttmacher compiled data from a national sample of 8,380 abortion patients from 87 non-hospital facilities scattered across the U.S. Women were asked about far more than whether they had previous abortions. Guttmacher asked about their age, race, ethnicity, education, prior births, contraceptive use, in addition to how they paid for their abortions, how far they traveled to obtain their abortions, and how many “disruptive events” they had experienced in the past year (more on this later).
While some of the results were pretty much as expected, other results were most assuredly not.
Basic Demographic Data
The older a woman was at the time of her abortion, the more likely she was to have had a prior abortion, which makes intuitive sense. For example, women having abortions in their 30s were two and a half times more likely to have undergone a prior abortion than those aged 20-24. Some of this is probably just that being older, there simply being more time and opportunity to have gotten pregnant.
This is also the case with women having prior births. It surprises many people, but most women having abortions – about six in ten — have already given birth to a child.
Women who had previously given birth were twice as likely to have had a prior abortion than those who had not given birth. Again, this may be partially attributable to age and an associated likelihood of having gone through more pregnancies, although concerns about family size and having children at a later age may have also been factors.
Black women have a much higher overall abortion rate. The U.S. Centers for Disease Control has found that black women have an abortion rate at least twice the national rate, and more than three times that of white women. Consequently, it is not surprising to find that black women are also more likely to have had a second or “repeat” abortion.
Aborting Hispanic women were close to the national average, with 43.7% reporting previous abortions. Aborting white women reported the lowest figure–39.2%.
More education appeared to be associated with fewer repeat abortions. Almost 47% of women who were high school graduates or had only some college having abortions in 2014 were experiencing a repeat abortion, according to Guttmacher. The figure for college graduates with at least one prior abortion was 40.7%.
Challenging Pro-Abortion Mantras on Contraception, Funding
For years, abortion advocates have maintained that the way to bring abortions down is to promote and provide (that is, pay for) more contraception. Data from this study does not appear to support this claim.
More than half (52.6%) of those having abortions were using contraception at the time they became pregnant. But whether they were using birth control or not, their likelihood of having a repeat abortion was about the same – so long as they had used contraception at some point in their reproductive lives. So Guttmacher found that those using contraception were about as likely to have had a previous abortion (44.3%) as those who were not (46.6%).
The one group least likely to report having a previous abortion? Those who had never used birth control before. Guttmacher reported that 40.5% of those women said they had a previous abortion.
Jones and her team point out that a woman’s exposure to or use of birth control may be traced to her original visit to the abortion clinic. They concede that “it is likely that many women who had a prior abortion obtained a method of contraception at that time, or at a follow up visit.” If this is so and Guttmacher’s data is accurate, this would mean that the clinic may be responsible for exposing those women to the factor that made a repeat abortion more likely.
Abortion advocates also repeatedly call for public funding of abortion and have scoffed at the efforts of pro-lifers to ensure that federal monies do not go to private insurance plans that cover abortion.
However, when it comes to repeat abortion, the data here actually validates pro-life concerns about the connection between abortion and funding.
50.4% of those women whose abortions were covered by insurance reported having previous abortions. About the same percentage of those receiving some sort of financial assistance for their abortions (49%) reported they had had abortions before. Slightly fewer than four in ten of those who paid for the abortions themselves indicated they had previous abortions.
The obvious, but perhaps not surprising takeaway here is that a woman is more likely to have a second or third abortion if someone else is paying for or subsidizing it. Amazingly, Guttmacher admits as much.
Given that first-trimester abortion cost around $500, Jones and her colleagues say that “Women may only be able to come up with the money to pay for the procedure one time. By contrast, women able to use insurance may not have to scrape money together, making abortion — including second- and higher-order procedures — easier to access.”
Guttmacher also points out that women may have learned about financial assistance, such as discounts and subsidies clinics sometimes make available to poorer women, when obtaining their first abortion. This awareness of possible assistance might have been a factor in their having a subsequent abortion.
Distance Does Make a Difference
Abortion advocates have long complained about the distance that women must travel to obtain their abortions. That was a feature argument in the Supreme Court’s 2016 Hellerstedt case. The study here demonstrates that distance does make a difference; it helps to save the lives of unborn children.
The percentages of those women reporting previous abortions were highest for those closest to the clinics — 48.5% for those less than 10 miles away, 46.8% for those 10-24 miles distant. Both were higher than the overall 44.8% national norm Guttmacher found.
If a woman lived further than 25 miles away from the abortion clinic, the percentages reporting previous abortions were lower than the national norm: 41.3% for those traveling 25-49 miles; 35.7% for those traveling 50-99 mile; and 31.9% for those traveling a distance of a hundred miles or more.
Without granting the obvious, Guttmacher indicates that distance may be a factor in some unborn babies not being aborted. “One potential explanation,” say Jones and company, “is that women who lived further from the facility where they obtained care, were not necessarily at decreased risk of repeat unintended pregnancy but, rather, were unable to access abortion care multiple times.”
In other words, although perhaps just as likely to get pregnant as those living closer to a clinic, women living more than 25 miles away were less likely to travel that distance a second time to have another abortion.
What it all means
The combined message of these elements? If you fund abortion; if there are more abortion clinics and they are close by; and if you offer birth control as your solution to unsought pregnancy, when women become pregnant again, you can expect to see more returning for another abortion.
Guttmacher says it less directly, but admits that
“one implication of the above associations [distance, funding] is that the incidence of prior abortion might increase if barriers to abortion were remove; for example, if all women with insurance could use it to pay for abortion care, or if there were more clinics and women did not have to travel so far, more women would be able to access abortion each time they needed it.”
Put another way, they are essentially saying, “Give us the policies we’ve repeatedly asked for, the ones we’ve claimed are the solutions needed for these problems, and there will be more, not less, repeat abortions.”
As noted above one other factor Guttmacher measured was “disruptive events.” These were events such as the death of a close friend, problems paying rent/mortgage, moving, separation, incarceration or arrest of partner, giving birth, extended unemployment, etc.
Certain of these events, or a combination of several, Guttmacher says, may have been a motivating factor in a woman deciding to abort a baby she had initially planned to carry to term. The presence of these was associated with more repeat abortions, their absence with fewer. For women experiencing two of more of these events, the repeat abortion rate was 51.8%. Women reporting none of these had a repeat percentage of 39.6%.
Though Guttmacher gives examples of these sorts of “events,” nothing in this published study gives any correlation to any particular sort of event, keeping this from being particularly useful or informative. The loss of a job and a sudden inability to pay the rent, the father (or the mother) being incarcerated would all be obvious existential stressors.
But to include these in the same category as “giving birth” which should not be a negative event, or moving, which may be an improvement, mixes bad and potentially good events and makes the data difficult to interpret.
If Guttmacher were interested in reducing the number of repeat abortions, what would the data appear to recommend? Abortions should be self -paid, not funded or subsidized or covered by insurance; that there should be fewer clinics, farther apart; and that reliance on birth control is misplaced.
Special concern would be directed toward minorities, particularly blacks, who have high abortion rates; to those out of high school and in college; and to women that are older and have already given birth to one or more children.
Of course, Guttmacher and its allies don’t see reducing the number of repeat abortions as an imperative. Actually just the opposite. The authors here declare, “The findings from this study suggest that continued and expanded access to abortion services is essential for women experiencing an unintended pregnancy.”
It is hard to fathom the thinking behind such a statement. But when Guttmacher says the circumstances surrounding each repeat abortion are often beyond a person’s ability to control and may be unique to their individual situation, there is no obvious policy solution.
But, true to form, Jones and her team still contend that “reducing or eliminating barriers to abortion care may enable those who want or need abortion services, at any point in their lifetime, to more readily access care.”
What is this supposed to mean? Are they saying that eliminating these distances and funding “barriers” will help even things out by bringing repeat abortion rates for these women with low repeat rates up to the “norm”?
The authors say that “While ‘repeat abortion’ is sometimes characterized as problematic, the ability to access abortion care when it is needed — even if more than once — should be prioritized.”
Activists quoted at Rewire (9/13/17) think the answer lies in “destigmatizing” repeat abortion. Kenya, a 42-year old working at the clinic where she had her abortions, told Rewire that
“I started to ask myself why I wouldn’t say that I’ve had multiple abortions aloud. Maybe it can help someone else not feel bad about their choices or not feel judged. There’s nothing to be ashamed about. Multiple abortions are necessary, and a lot of women do it.”