Numbers don’t always tell the full story

Map of access to abortion providers in the United States

Last week, the Guttmacher Institute released its latest abortion provider survey with three talking points:

  1. the decline in the U.S. abortion rate has stalled;
  2. the number of providers remains unchanged; and
  3. abortion providers experience significant acts of harassment.

Each of these items deserves its own blog post, but to keep this one short, I will focus on #2—the stability in the number of providers.

As a reminder to the reader, the Guttmacher researchers define an abortion provider as a facility where abortions are performed. Guttmacher does not count the number of clinicians who perform the procedures but rather the sites where women can obtain services. According to Guttmacher’s data, the number of providers has been declining since 1982, when it reached the high of 2,900. In 2005, the last time the survey was conducted, there were 1,787 providers.

In the most recent survey, of abortion providers offering services in 2007 and 2008, the Guttmacher Institute calculates the number of providers at 1,793. Considering concerns about an abortion provider shortage, and the resultant impacts on women’s access to abortion care, even a slight increase in providers seems a reason for celebration. Perhaps the decline has stopped, indicating that access to abortion is improving.

Does data reflect full access to abortion services?

Digging a little deeper, however, I find several reasons to be concerned. First, the number of abortion providers includes the addition of 65 hospital-based abortion providers in California that were only recently discovered to be performing abortions. Collectively, these providers performed only 470 abortions in 2008, an average of 7 abortions per facility. It is likely that these facilities only offer abortion services when the pregnancy is compromised because of the health of the pregnant woman or fetus. It is unlikely that women who need abortions for the reason most women need abortions (because they can’t afford a(nother) child, because their relationship is unstable, or because they want to pursue other activities such as education or employment) would be able to obtain an abortion at any of these facilities.

Consequently, it is misleading to conclude that the number of abortion providers has remained stable. As the authors of the study recognize, were these newly found providers not included, the number of providers would actually have declined by 3%.

What about regional trends?

The regional distribution of the decline is also important. Even if these newly found providers did do abortions for more indications, their presence in California is of little meaning to women located in the Midwest or South, where the decline in the number of providers is reaching critical levels. According to the Guttmacher study, in the South, the number of abortion providers declined by 10% and in the Midwest, the decline was 5%. Women who live in these areas are not helped by the addition of new providers in the West, which experienced an overall increase of 15%. When considered by region, it appears that providers are only becoming more concentrated in the East and West, while the South and Midwest are experiencing critical shortages.

Several recent events provide anecdotal evidence of the regional trend picked up in the Guttmacher data. The assassination of George Tiller, MD, in May 2009 led to the closure of Women’s Health Services in Wichita, Kansas. Dr. Tiller was more than just another provider. His central tenet—“trust women”—has become the new mantra of the prochoice movement.

The death of William Harrison, MD, in Fayetteville, Arkansas, resulted not just in the closure of his clinic but a huge void among public advocates. Dr. Harrison routinely engaged his clinic’s protesters in conversation about abortion; he shared his stories with medical students; he posted his opinion on blogs. And more than anything, he stood up for abortion in a very public way.

And last month we lost Robin Rothrock, the owner of a vital clinic in Shreveport, Louisiana. While the clinic doors remain open, it is hard to imagine that someone else will have her fortitude, having sued the state of Louisiana over 30 times for its infringement of a woman’s right to abortion.

So as we think about whether the number of providers is up or down, we must remember that the quality of the providers, including where they are located and the breadth of women they will serve, may matter more than sheer numbers.

1. Source of map data: Rachel K. Jones and Kathryn Kooistra, “Abortion Incidence and Access to Services in the United States, 2008,” Perspectives on Sexual and Reproductive Health 43, no 1 (March 2011):45, doi:10.1363/4304111.

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