Almost half (45%) of U.S. abortion patients have already had at least one previous abortion, according to "Which Abortion Patients Have Had a Prior Abortion? Findings from the 2014 U.S. Abortion Patient Survey," by Guttmacher Institute researchers Rachel Jones, Jenna Jerman and Meghan Ingerick, recently published in the Journal of Women’s Health. This proportion decreased from 50% in 2008, likely due to an overall decline in abortion incidence in the United States during this time period.
The authors examined characteristics associated with abortion patients’ likelihood of having had a previous abortion. Age was the characteristic with the strongest association: 60% of patients aged 35 and older reported having a prior abortion, compared with 38% of those aged 20–24. Patients who had at least one birth were also more likely to have already had an abortion than those who had never given birth, even after taking age and other characteristics into consideration.
"The longer a woman is alive, the longer she is at risk of unintended pregnancy, and so it is not surprising that older women are more likely to have had a previous abortion," says Rachel Jones, lead author of the study. "Reducing or eliminating barriers to abortion care would better serve those who want or need an abortion at any point in their lifetime."
Some characteristics associated with having had a prior abortion were beyond patients’ control. Patients who had been exposed to two or more disruptive life events in the previous year were more likely to have had a prior abortion than those who had not experienced such events. A disruptive event, such as losing a job or breaking up with a romantic partner, could motivate some individuals to end pregnancies that they had originally planned to carry to term.
Patients who paid for their abortion procedure with their own funds were less likely to have had a prior abortion than those who used health insurance or received financial assistance. Three-quarters of abortion patients are poor or low-income, and it is likely that many patients who pay out of pocket may face ongoing financial barriers to obtaining an abortion—barriers that may be reduced for those patients who use their health insurance to cover abortion or who are able to access financial assistance.
A large body of research has established that distance from an abortion provider can be a barrier to accessing abortion services. The authors found that the likelihood of having had a prior abortion decreased as the distance a patient lived from the facility increased. Nearly half of patients who lived less than 25 miles from the facility where they obtained care had already had an abortion, compared with 32% of those who lived at least 100 miles away. It is possible that individuals who lived farther away were unable to arrange for the transportation, time off from work and childcare necessary to obtain an abortion more than one time. It also may be that those who live closer to an abortion facility are more aware of its existence than those who live farther away, and may therefore have a better knowledge of where to seek care.
"Ongoing efforts to restrict access to abortion at the federal level and in many states are harmful to women and families, and are simply bad public policy," says Megan Donovan, Guttmacher policy expert. "Individuals across the country must be able to readily access abortion care whenever they seek it."
The researchers found no evidence of individuals using abortion as their primary method of family planning. The majority of abortion patients (53%) were using a contraceptive method at the time they became pregnant, and those who were not using contraception were no more or less likely to have had a prior abortion. The authors conclude that every abortion is a unique event that occurs in the context of many other facets of an individual’s life. It is therefore critical that federal and state policies support individuals in accessing the reproductive health services they need throughout a lifetime, including abortion services, to achieve their childbearing goals.
"Which Abortion Patients Have Had a Prior Abortion? Findings from the 2014 U.S. Abortion Patient Survey," by Rachel Jones, Jenna Jerman and Meghan Ingerick, is currently available online and will appear in a forthcoming issue of the Journal of Women’s Health.