As of March 2018, the Charlotte Lozier Institute (CLI) had produced articles reviewing the most recent annual abortion reports from 11 states. The reports were released by Alabama, Alaska (for both 2016 and 2017), Illinois, Minnesota, Missouri, Nebraska, Ohio, Pennsylvania, South Carolina, South Dakota, and Wisconsin. This ongoing state series is an extension of the study of state abortion reporting that CLI conducted in 2016 and initiated in 2012. The current state-specific series highlights four key abortion trends over one year of reporting: total abortions, total chemical abortions, abortion rate, and the Planned Parenthood abortion market share.
Abortion in the United States continues to decline. Of the 12 state reports, nine showed that total abortions decreased over the year-long reporting period (see Table 1). This is consistent with long-term trends identified by the U.S. Centers for Disease Control and Prevention and the Guttmacher Institute. According to numbers reported by the Guttmacher Institute, abortion in the United States fell by 32 percent between 1995 and 2014.
Of the 11 states, 10 reported all abortions occurring in-state, and one reported only abortions performed on residents (see Table 2).
Table 1 Total Abortion Trends in Reviewed States
Table 2 Reporting of Total In-State Abortion Occurrence vs. Only Abortions Performed on Residents
However, while total abortions are falling, chemical abortions continue to rise. Of the 12 state abortion reports reviewed, all except South Carolina included chemical abortion data. Six reports revealed that chemical abortions increased from the previous year, with the largest jump occurring in Ohio, where chemical abortions rose by 219 percent from 2015 to 2016. Nine reports showed that chemical abortions’ percentage of total abortions increased over the reporting year (see Table 3).
Table 3 Chemical Abortion Trends in Reviewed States
Most chemical abortions are induced using Mifeprex, the brand name of the drug mifepristone (also called RU-486), which was approved by the Food and Drug Administration (FDA) in 2000. In 2016, the FDA modified its guidelines for approved use of Mifeprex, increasing the maximum gestational age at which Mifeprex is recommended as an abortifacient from seven weeks to 10 weeks. However, Mifeprex carries risks of complications and injury and becomes less effective later in pregnancy. Improved state reporting of complications resulting from each type of abortion procedure is particularly necessary as chemical abortions are on the rise across the country. Of all 50 states, New York City, and Washington, D.C., the only jurisdictions to specify the abortion method for reported complications in 2016 were Pennsylvania, Idaho, and Michigan.
Most of the 12 reviewed state reports did not include the state abortion rate, or the number of abortions performed per 1,000 resident women of childbearing age. The five that did were inconsistent with one another – some reported the rate based on all abortions performed in the state, while others calculated the rate based on abortions performed on residents only. The Charlotte Lozier Institute estimated the rate for five additional reports using this equation: (total number of abortions performed in the state ÷ number of resident women ages 15-44) x 1,000. Of the 10 reports with some rate information provided or estimated, five showed that the rate fell between 2015 and 2016, while two reported no change to the rate (see Table 4). Only three reported an increase in the state abortion rate.
Table 4 State Abortion Rate Calculations
Planned Parenthood’s Market Share
Planned Parenthood is the largest abortion provider in the United States, and its abortion market share is growing. However, of the 12 state reports, only two provided information on the number of abortions performed by abortion centers that allowed for a calculation of Planned Parenthood’s state market share. In Alabama, Planned Parenthood’s market was 12.5 percent of all abortions performed in the state that year. In Minnesota, the abortion behemoth’s share was a whopping 56.6 percent of all abortions in the state.
Areas for Improvement
Of the 11 states that published the 12 reports, five provided no information on complications resulting from abortion (AL, AK, MO, SC, and SD). One state, Illinois, did not display this information; Illinois suppresses small numbers as an extra precautionary step to protect women’s privacy.
By listing the names and types of facilities where abortions take place, states can illuminate some of the reasons behind abortion trends – for example, whether a chronically unsafe abortion clinic is experiencing changes in patient volume or whether certain types of facilities are affected by heightened state standards. However, only two states reported the names of facilities where abortions were performed, and one state listed the types of facilities (AL and MN reported the names, and OH reported the types).
Method of Payment
In Alaska, Medicaid expansion under the Affordable Care Act increased the number of abortions paid for with state tax dollars from 33 percent in 2015 to 44 percent in 2016 and then to 51 percent in 2017.
Yet just three states reported the methods of payment used to fund abortion (AK, MN, and SD).
Infants Born Alive during Abortion
Babies are surviving at earlier and earlier gestational ages with active care, but only one state, Minnesota, reported whether any babies were born alive during botched abortions.
Some states were missing information on the women seeking abortion: three did not report mothers’ levels of education (IL, PA, and SC). While four states reported their reason for choosing abortion, seven did not (AL, AK, MO, OH, PA, SC, and WI), and the reasons reported by Illinois were very vague. Illinois reported whether each abortion was performed upon request or for some other, unspecified reason.
CLI recommends that states collect and report these and other data elements to provide an accurate view of abortion trends in the United States. States like Minnesota, which releases its comprehensive state abortion report at an annual cost of only $4,000 to taxpayers, demonstrate that abortion reporting can be timely, thorough and affordable. Many states, including Indiana and Idaho, recognize the need for improved reporting and have already taken steps to strengthen their reporting processes. Still, the contrast between states like Minnesota and Maryland, which does not report abortion incidence at all, only underscores the need for standardized reporting nationwide. For more information on each of the state reports reviewed here, please see:
Tessa Longbons is a research associate for the Charlotte Lozier Institute.