"How To Reduce Abortion" (What Delaware's Stunning Abortion Rate Reduction Reveals)

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        How To Reduce Abortion (What Delaware's Stunning Reduction Tells Us)

By David Leonhardt Opinion Columnist

The recent decline in Delaware’s abortion rate is pretty stunning. Between 2014 and 2017 — the latest years for which data exist — the rate fell 37 percent. There is now only about one abortion for every 100 women of childbearing age each year in the state.

This decline was the biggest of any state in the country. It was also in keeping with a larger trend: The abortion rate has fallen to its lowest level since the Supreme Court legalized abortion nationwide, according to the Guttmacher Institute.

The best part is that both sides of the abortion debate should welcome the decline. Abortions don’t appear to be decreasing because of reduced access (although that is a problem in some places). The rate seems to be falling because of increased use of effective birth control.

That’s why I want to highlight Delaware. It has been arguably the most aggressive state in expanding access to long-acting forms of birth control, like IUDs and implants. Less than a decade ago, Delaware had the nation’s highest rate of unplanned pregnancies, and its governor at the time — Jack Markell, a Democrat — came to believe it was a major cause of economic hardship for mothers and their families.

“We launched this effort several years ago because we feel so strongly about the link between unintended pregnancies and reduced economic opportunities,” Markell told me yesterday.

Or as PBS NewsHour has put it: “Contraceptives allow women greater control of whether and when to become mothers. As a result, they improve women’s ability to invest in their education and careers, which can have a positive impact on lifelong earnings.”

In a Times story last year, Margot Sanger-Katz described the program that Delaware has created:

When a woman of childbearing age goes to the doctor in most places, she gets standard queries about her smoking, drinking, seatbelt use and allergies. In Delaware, she is now also asked: ‘Do you want to get pregnant in the next year?’

If her answer is no, clinics are being trained to ensure she gets whatever form of birth control she wants that very day, whether a prescription or an implant in her arm. … Working with an organization called Upstream, Delaware has rolled out the program to nearly every medical provider in the state over the past three years. It’s having big effects on the number of women requesting and receiving contraception.

There is still a lot of room for progress, though — especially in states that have not been as ambitious about expanding access to IUDs.

For more …

“The 2017 abortion rate of 13.5 abortions per 1,000 women aged 15-44 represented an 8 percent decline from 2014,” Rachel K. Jones, Elizabeth Witwer and Jenna Jerman of the Guttmacher Institute have written. About 18 percent of pregnancies ended in abortion in 2017.

“Birth control pills are currently the most popular contraceptive among American women, followed by condoms. These methods are especially susceptible to human error and have high failure rates. Of 100 women who rely on birth control pills, about six get pregnant every year,” Sarah Kliff, then of Vox, wrote in 2016. “By contrast, long-acting reversible contraceptives (LARCs) like IUDs and implants … are 20 times more effective at preventing pregnancy than the pill.”

Massachusetts, North Carolina and Washington have launched similar programs to Delaware, all with Upstream, and South Carolina has an initiative called Choose Well, according to PBS.

For an alternate view: Christine Dehlendorf and Kelsey Holt of the Person-Centered Reproductive Health Program in San Francisco argue against thinking of birth control as a tool to reduce poverty. “This sort of language should set off alarm bells because the idea that limiting women’s reproduction can cure society’s ills has a long, shameful history in the United States,” they wrote in a Times Op-Ed this year.