While the U.S. abortion rate leveled out between 2005 and 2008, the number of early medication abortions increased over the same period, according to a report released online Jan. 11 by the Guttmacher Institute.
In 2008 there were 19.6 abortions per 1,000 women aged 15-44 years, compared with 19.4 abortions per 1,000 women in 2005 – a 1% change. The total number of abortions in 2008 was virtually identical to the number in 2005 – 1.21 million, according to the report (Perspect. Sex. Reprod. Health 2011 [doi:10.1363/4304111]).
The new data mark the end of a long-term decline in abortion rates, dating back to the 1981 peak of 29.3 abortions for every 1,000 women, lead author Rachel K. Jones said during the teleconference.
"The long-term decline in abortion has stalled. We’re not going to say that that’s unilaterally a bad thing. If it’s an indicator that more women are having access to abortion, this would be good," she said.
However, the abortion ratio has not changed from 2005 to 2008 (22 abortions per 100 pregnancies). "So what this actually suggests is that we’re not making progress in helping women avoid unintended pregnancies," Ms. Jones said.
Interestingly, the number of medication abortions has gone up. The use of mifepristone (Mifeprix) in combination with misoprostol to terminate early pregnancies increased from 161,000 in 2005 to 199,000 in 2008.
The proportion of all nonhospital abortions performed as early medication procedures rose from 14% in 2005 to 17% in 2008. Mifepristone is indicated for the medical termination of pregnancy in the first 7 weeks.
"Early medical abortion has become an integral part of abortion care," said Ms. Jones. "This provides women with options."
The researchers also estimated that a quarter of early abortions (within the first 9 weeks) were medication abortions. In addition, more than half of all abortion facilities (59%) offered medication abortions in 2008.
"Our survey also suggests that mifepristone may be increasing access to abortion services," said Ms. Jones, who is a senior research associate at the Guttmacher Institute, New York.
The number of providers who offer only medication abortions increased from 119 in 2005 to 164 in 2008. If medication-only providers are in areas were there are no surgical abortion providers, this could increase access for women, she noted.
Medical abortions also may account for increasing rates of very early abortions. The percentage of early abortions (first trimester) has not changed much in the last 2 decades – hovering around 88%. However, "we’re seeing more and more very early abortions – abortions at 6 weeks or earlier," said Ms. Jones. "Our expectation is that mifepristone is contributing to that trend."
The number of providers offering abortion is virtually unchanged since 2005 (1,787 vs. 1,793 in 2008), according to the report, "Abortion Incidence and Access to Services in the United States, 2008."
A majority of U.S. counties (87%) have no abortion providers; 35% of women of reproductive age live in those counties.
Ms. Jones and her associate, Kathryn Kooistra of the State University of New York Downstate, Brooklyn, N.Y., said they had no relevant financial disclosures.