Context: In the 1980s, the number of abortion providers in the United States began to decline, and more recently, so has the number of abortions performed. Whether the decline in service providers, which was last documented in 1992, is continuing and whether this influences the availability and number of abortions is of public interest.
Methods: In 1997, the Alan Guttmacher Institute conducted its 12th survey of all known abortion providers in the United States. The number and location of abortion providers and abortions were tabulated for 1995 and 1996, and trends were calculated by comparing these data with those from earlier surveys. Limited data were also gathered on types of abortion procedures.
Results: Between 1992 and 1996, the number of abortions fell from 1,529,000 to 1,366,000, and the abortion rate decreased from 26 to 23 per 1,000 women aged 15-44. The number of providers fell 14%, to 2,042, with the greatest decline among hospitals and physicians' offices rather than clinics. Eighty-six percent of counties had no known abortion provider, and 32% of women aged 15-44 lived in these counties. Of the country's 320 metropolitan areas, 89 had no known abortion provider, and for an additional 12, fewer than 50 abortions each were reported. Seventy percent of abortions were performed in specialized clinics and only 7% in hospitals. In the first half of 1997, early medical abortions were being offered in about 160 facilities, virtually all of which were also providers of surgical abortions.
Conclusions: While abortion services in some areas of the country have declined since 1992 and many women continue to have limited access to providers, other factors have probably had more influence on the level of abortions performed. Early medical abortion methods are too new to be a measurable factor in abortion access.
PIP: The aim of this research was to update information on the number and geographic distribution of abortion providers and rates in 1996 in the US. Data were derived from a national abortion survey by the Alan Guttmacher Institute (AGI). The AGI abortion survey included 1279 provider responses to questionnaires mailed to 3032 providers. Fear of reprisals hampered full reporting. Abortions amounted to 1,363,690 in 1995 and 1,365,730 in 1996. The abortion rate declined from 25.9 to 22.9/1000 women 15-44 years old. During 1995-96, the abortion ratio was 26 abortions/100 live births, which is a decline from 28/100 in 1990. California, New York, Florida, and Texas had the most abortions. Under 2000 abortions were performed in Wyoming, Idaho, and North and South Dakota. The highest abortion rates were in Nevada (45/1000 women age 15-44), New York (41/1000), and New Jersey (36/1000). Abortion rates were below 8/1000 in Idaho, Mississippi, South Dakota, West Virginia, and Wyoming. 86% did not have an abortion provider. 92% had no providers performing at least 400 abortions annually. 32% of women lived in counties without a provider. 41% lived in counties without a large provider. 95% of nonmetropolitan counties had no providers. About 50% of metropolitan counties were under served. The rate of decline of abortion services accelerated by 1996.