Legislative Building in Raleigh, where the state budget is crafted
Legislative Building in Raleigh, Image courtesy of State Government Relations, UNC

By Hannah Critchfield

With the presence of six more conservative justices on the U.S. Supreme Court, many court observers anticipate that laws aimed at restricting access to abortion passed at the state level will eventually wend their ways through the court system to be heard before the high court as a challenge to the 1973 Roe v. Wade decision which made the procedure more widely available. 

In North Carolina, in the biennial legislative session that started in January, lawmakers have filed eight bills that would impact abortion access in North Carolina this legislative session. 

The bills include one which would prohibit terminating a pregnancy on the basis of a genetic abnormality such as Down syndrome and another bill supported by the Republican majority is a reprise of a bill proposed in 2019 that would criminalize physicians that do not move to resuscitate babies that survive an abortion attempt, an exceedingly rare event.

Democrats proposed some of the bills germane to abortion this session, such as one that would allow nurse practitioners or nurse midwives to perform the procedure after 20 weeks in the case of a medical emergency. Those bills died when they did not pass one chamber in time for crossover in May. 

Most of the bills move to restrict abortion within the state: one bill would ban the procedure once a fetal heartbeat can be detected, about six to eight weeks after conception, another provision would ensure telehealth is not permitted for abortions that only use pills to complete the procedure, even as this type of virtual service has been expanding for other types of health care.

Amid recent discourse in a debate that dates back to the Roe v Wade decision and the decades prior, North Carolina Health News took a look at the state of abortion in North Carolina today.

Abortions declining

In 2019, the most recent year for which complete data exists, 143,004 pregnancies among North Carolina residents were reported to the N.C. State Center for Health Statistics. In truth, this reported number is likely low, as many pregnancies end by miscarriage in early weeks.

Of those known pregnancies, 23,495 –  about 16 percent – were terminated through an abortion procedure. 

The vast majority of the people who underwent abortions were between 20 and 34 years old, and over half had at least one child already. Forty-six percent of these individuals were already parents, with two or more kids already, countering a common misconception that most who seek out abortions are looking to stave off parenthood. Most of the people who underwent abortions had over 13 years of education.

While children who have gone through puberty can get pregnant, the state only tracks these numbers in people between the ages of 15 and 44.

While it’s difficult to say how the novel coronavirus pandemic may have impacted trends last year, the rate of abortion has decreased overall in North Carolina in the last two decades. 

In 2000, the abortion rate* was 15 people per 1,000 people who can get pregnant and are of childbearing age. Ten years later, that rate was down to 13 people. In 2019, the abortion rate was 11 people per 1,000, where it has remained roughly stable over the last five years.

The state calculates abortion rates by dividing the number of abortions in a given year by the population of people assigned as female at birth of childbearing age, and multiplying the figure by 1,000. In this way, the abortion rate is the number of induced abortions per 1,000 people of reproductive age. This means some counties will show no data because their numbers of pregnancies, females of childbearing age or abortions are too low to accurately calculate a reliable statistic.

Abortion restrictions are likely not the driving factor behind this trend, reports the Guttmacher Institute, a research and policy think tank that studies reproductive health issues.

“We have better birth control these days and we have more access to it,” said Amy Bryant, OB/GYN and family planning professor in the medical school at University of North Carolina at Chapel Hill in the Department of Obstetrics and Gynecology. “It’s not perfect, but there are fewer barriers in place to getting it. Having that access to better contraception in general makes it less likely you’re going to need an abortion.”

When divided by race, Black people in North Carolina have the highest rates of abortion, at a rate of 21 per 1,000 people. Hispanic people have an abortion rate of 13, American Indian-Alaskan Native people a rate of 10, and whites six per 1,000 individuals of childbearing age. 

“While abortion numbers have definitely gone back down for all racial and ethnic groups, they’re still disproportionately higher among African Americans and among Latinas,” said Bryant. “I think that that speaks to a differential access to contraception, and other problems with that system that are making it harder for people to get the health care they need.”

Nationally, research has found higher abortion rates among Black, Latina and Indigenous people who can get pregnant due to a lack of access to consistent, high-quality contraceptive services.

Bryant said that in North Carolina, a lack of Medicaid expansion has contributed to this unequal access to contraceptives – and that the disparate rates along racial lines are a sign the state has more work to do.

“If we can have Medicaid expansion, that would actually help a lot of people in our state and prevent a lot of pregnancies I’m sure, and a lot of abortions,” she said. “Also, there is talk of extending pregnancy Medicaid to to go for an entire year postpartum, which would definitely decrease abortions. In my experience, people definitely come back within a year of having a baby, needing an abortion.”

Most of the abortions within the state – roughly 66 percent – happened before nine weeks of pregnancy.

Who gets an abortion, and where?

North Carolina tracks abortions by the person receiving the procedure’s county of residency, rather than the county where the abortion was performed — largely because abortion clinics are only available in a handful of cities within the state, said a spokesperson from the State Center for Health Statistics. 

This means many people have to travel to get an abortion. Fifteen clinics offer some form of abortion services in North Carolina in Wake, Mecklenburg, Orange, Durham, Guilford, Buncombe, Cumberland, Forsyth, and New Hanover counties respectively.

Mecklenburg County had the highest rate of residents receiving abortion procedures in 2019 — a figure that makes sense, given its status as the second-largest county by population in the state.

Cumberland County has a smaller population size than Wake County, North Carolina’s largest, by about 776,250 people. Yet it has a slightly higher abortion rate. It’s population skews younger overall, however, with a military base that draws people in their late teens and twenties from across the country. The county has almost double the Black population as Wake County, and two times the American Indian-Alaskan Native population.

Several counties in the top 10 places of residency for people having abortions were not among the 10 largest counties by population, including Edgecombe, Nash, Halifax and Granville.

Four hundred and two of the abortions performed in North Carolina were missing data on the person’s county of residency.

In a recent national poll conducted in May, Quinnipiac University found that 25 percent of respondents felt that abortion should be legal in all cases and 32 percent felt the procedure should be legal in most cases. Twenty-three percent of people answered they think abortion should be illegal in most cases, with an additional 14 percent saying it should be banned altogether.

The pollsters noted that attitudes on abortion have remained relatively constant over the past two decades.

“In June 2003, 21 percent of adults said abortion should be legal in all cases, 33 percent said it should be legal in most cases, 24 percent said illegal in most cases and 17 percent said illegal in all cases,” the results from the May poll read

The Pew Research Center polled North Carolinians in 2014 and found similar results.

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Critchfield is NC Health News' Report for America corps member. Report for America is a national service program that places talented emerging journalists in local newsrooms to report on under-covered...