By Rose Hoban

Fewer women in North Carolina got pregnant and gave birth in 2013 than in the previous two years, according to data from the North Carolina State Center for Health Statistics, and paralleling that drop in pregnancies was a falling rate of abortions.

North Carolina’s pregnancy statistics mirror a national trend in which fewer women have gotten pregnant and had abortions. National statistics show that in 2009, pregnancy rates in the United States hit a 12-year low (national statistics lag behind North Carolina statistics by several years). And nationally, in 2011 the abortion rate hit its lowest rate since 1973.

“As people have gotten more reliable contraception, the percentage of unplanned pregnancies has gone down,” said Elizabeth Finlay from the Adolescent Pregnancy Prevention Campaign of North Carolina. “Those [unintended] pregnancies are more likely to end in abortion.”

These trends in pregnancy and abortion are likely to be discussed and dissected in coming weeks, as abortion again becomes a topic of discussion – and possibly legislative action – at the General Assembly.

Click on a county to find information about pregnancy and abortion rates and rates of change since 2011.

New rules governing abortion clinics were presented by the state Department of Health and Human Services late last year and the comment period for those rules ended last week. The new rules include requirements for clinics to establish quality-assurance boards, attempt to create formal transfer agreements with nearby hospitals and staff a 24-hour phone line to handle calls from patients.

Abortion opponents have complained that the new rules don’t go far enough to regulate the practice.

“I would expect abortion clinic rules that come out of a McCrory administration to be more favorable to the pro-life point of view,” said Tami Fitzgerald, head of the North Carolina Family Values Coalition. She has urged lawmakers to require anesthesiologists at all clinics and require hospital admitting privileges.

Meanwhile, the proposed rules have been praised by groups supporting abortion access.

In the state rule-making process, if as few as 10 people oppose a proposed rule, the legislature can step in and rewrite the rules, overriding the usual administrative rule-making process.

Last week, Democratic lawmakers held a press conference urging their Republican colleagues to allow the proposed rules to stand.

Some reasons for rate drop

According to data in a recent report from the Guttmacher Institute, which tracks trends in reproductive health, about half of pregnancies in the U.S. are unintended. Forty percent of those unwanted pregnancies ended in abortion.

The report also found that two-thirds of women consistently use contraception and that only 5 percent of those who do had unwanted pregnancies. Most of the unwanted pregnancies come for women who are not using contraception regularly. Those women tend to be low income and younger, with fewer years of education. Black women also have a higher rate of unintended pregnancy, about 92 per 1,000 women, as compared with 38 per 1,000 for whites.

Guttmacher researchers also took a recent look at the number of abortions nationally, and found the rate declined through 2011, the latest year for national data. Several neighboring states have had similar drops in abortion rates over the same time period.

Data courtesy Stanley Henshaw
Data analysis courtesy Stanley Henshaw

“One thing that came to the forefront was improvements in contraceptive use,” said Rachel Jones, a senior researcher at Guttmacher who examined data from the National Survey of Family Growth. “More people are using [long-acting reversible contraceptives], such as the IUD and the implant.”

According to data compiled by the American College of Obstetricians and Gynecologists, the use of LARCs tripled from 2002 to 2009. The rate of unwanted pregnancies for women using short-acting contraceptives such as condoms and the pill were 22 times greater than for women using LARCs.

Some analysts, including those from Guttmacher, have noted that the rate of pregnancy decline accelerated around the time of the economic downturn, indicating that families were putting off having children until job and economic prospects improved. A survey done by Guttmacher researchers in 2009 found just around half of women delaying childbearing until the economy improved, and most of those women had also concluded they wanted to get pregnant later and wanted fewer children.

“People are more motivated to avoid having baby, so they’re more careful,” said retired Guttmacher Institute statistician Stanley Henshaw, who lives in Chapel Hill. “That means fewer abortions as well.”

Both Jones and Henshaw said the decline in pregnancies directly affects the abortion rate.

“It’s not just that fewer women are having abortions, it’s that fewer women were getting pregnant in the first place,” Jones noted.

In North Carolina, Finley pointed to efforts in places like Gaston County, where the health department did targeted interventions in areas where many teens had gotten pregnant. In Gaston, the rate of teen pregnancy was cut by more than half over a five-year period.

The role of state restrictions

Jones dismissed the argument made by some abortion opponents that restrictions on abortion procedures enacted by states are what’s behind the decline in rates.

She said that if more people were choosing to give birth rather than have an abortion, “We’d see an increase in birth rates; we wouldn’t see that substantial decline in birth rates.”

Henshaw said that it’s been only in the past three years that many states have enacted more restrictions on abortion, such as longer waiting periods, building-code changes that have forced clinic closures and limitations of insurance coverage of the procedure.

But the declines in abortions came before those restrictions were in place.

“A lot of the laws that have subsequently gone into effect have more teeth,” Jones said. A Guttmacher report published in January notes that now more than half of U.S. women live in states with five or more abortion restrictions.

Data courtesy Guttmacher Institute
Data courtesy Guttmacher Institute

“There was no strong evidence that it contributed to the decline we were measuring, but that might be different going forward,” she said.

In 2011, the North Carolina General Assembly passed a law that would mandate that abortion providers show women an ultrasound of their fetuses while reading a description of the developmental level, among other changes to the law. The Women’s Right to Know Act gives women the option to decline hearing the description. That provision has been in the courts and has not been enacted, while other parts of the law are in place.

A move to impose more restrictions on abortion clinics came in 2013, when Republican lawmakers looked to impose clinic building restrictions that would have closed many, if not most of North Carolina’s clinic. The compromise language in Senate Bill 353 eventually assigned DHHS to write new regulations governing clinics; those are the regulations now being bandied about on Jones Street.

But North Carolina data are available only until 2013, so it remains unclear whether laws passed by the legislature have had any effect on the rate of abortions in the state since then.

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