A Matter of Facts — December 2023

From Our Acting CEO

As we approach 2024, I’d like to share what you can expect from Guttmacher in what promises to be a critical year for sexual and reproductive health and rights (SRHR).

In the United States, where abortion is now banned in 14 states and restricted in many others, we will continue to document the impact of the Dobbs decision. Our researchers will produce monthly estimates of facility-based abortion provision, and our policy experts will document state policy trends in real time. We’ll also test new approaches for measuring self-managed abortion in states with restrictive abortion policies, adapting methods we’ve developed in countries that restrict abortion. We’ll work with state advocates and policymakers to translate this evidence into policy change.

Meanwhile, we’ll be watching for the Supreme Court’s decision regarding provision of mifepristone, in a case brought by anti-abortion activists seeking to chip away at Americans’ access to medication abortion. Recognizing that attacks on abortion are part of a larger assault on bodily autonomy, we’ll continue to track restrictions on contraception and the effects of Dobbs on safety-net family planning providers, as well as attacks on gender-affirming care. Across all of our efforts, we’ll call attention to the disproportionate effects bans and restrictions have on marginalized communities.

Globally, we’re witnessing a similarly troubling wave of anti-SRHR attacks, often involving the same deep-pocketed ultraconservative activists behind Dobbs. Against this backdrop, we’ll highlight the continued importance of the Guttmacher–Lancet Commission’s visionary agenda for SRHR and release timely new evidence from two of Guttmacher’s flagship projects: our study that measures trends in abortion and unintended pregnancy around the world and our Adding It Up study analyzing the costs and benefits of investing in SRH services. We’ll also release new research on SRH needs in humanitarian contexts, including a major study of the reproductive health needs of Rohingya refugees in Bangladesh.

In 2024, our Board will embark on a search for a new CEO, who will lead us into the next chapter of our history. We’re excited about what the future holds while remaining laser-focused on meeting the urgency of this moment.

The partnership of our allies and supporters is critical to our success. Thank you for standing with us.

With heartfelt hope for a peaceful year ahead,

Jonathan Wittenberg, Acting CEO

Behind the Scenes

Daniel Arango Arango (left), of Fundación Oriéntame, poses with Ann M. Moore (right), of the Guttmacher Institute, and the three participants in the mystery client misoprostol project.

Abortion access in Colombia and beyond

A Q&A with Guttmacher’s Bixby Fellow Daniel Arango Arango

Daniel Arango Arango’s passion for public policy and gender justice serves him well in his role as the principal research associate at Fundación Oriéntame, a reproductive health care provider in Colombia and the main organizational partner on Guttmacher’s research work there. It’s also why we selected him as the 2022–2023 recipient of our Bixby International Leadership Fellowship. Fellows spend approximately one month at Guttmacher’s New York City office to collaborate with our researchers on in-country projects.

Global communications assistant Mariam Alburakeh spoke with Daniel about the projects he worked on during his recent tenure with us this autumn, the challenges of abortion access in Colombia and how his experience as a Bixby Fellow will help shape Guttmacher’s research efforts across Latin America.

How did you decide to focus your research on abortion access in Colombia?

Historically, Colombia has been a very conservative country in which the Catholic Church has had great influence. Because of this, abortion has been a taboo subject, considered by many people a sin and by the state as a crime. This has caused many barriers to access safe services and social stigma to persist, even after advances in legislation. For these reasons, it is important to understand the barriers that women and people with the capacity to bear children face when accessing abortion services and how these barriers specifically affect certain population groups.

How do those barriers differ from what people experience in the United States?

Abortion was completely prohibited in Colombia until 2006, with no exceptions whatsoever. That year, the Constitutional Court issued a ruling that decriminalized abortion in three exceptions, and last year the Court issued a new ruling decriminalizing it completely until the 24th week of gestation, after which the three exceptions continue to apply. However, there are many people who still consider it a crime and an improper practice. I think this is one of the main differences between the US and the Colombian context.

Despite the [regression] that the United States has experienced in recent years, almost 50 years of abortion legislation have established an important precedent in society, making the issue widely discussed and considered by many as an established right. In Colombia, the public discussion of abortion has not been so generalized, and it is a topic that has been treated more from the private sphere, which has made social stigma very large.

What was your experience as a Bixby Fellow like?

The Bixby Fellowship was a great experience. Having the opportunity to work in the offices of the Guttmacher Institute allowed me to meet many people, discuss various topics and come up with some ideas for possible future projects. During my stay, I worked on the project we are currently developing, on the sale of misoprostol online. Working onsite made communication and collaboration with colleagues on the team much easier, which in turn facilitated feedback, decision making and problem solving.

I am a historian and a specialist in public policy and gender justice, so my training and research experience is more focused on the qualitative field. The Bixby Fellowship allowed me to familiarize myself with the methodology that Guttmacher scientists use to conduct their research, particularly with quantitative analysis. I was also learning how to use Stata [statistical software], which will be very useful to reinforce the quantitative analysis of the data.

Daniel (right) and a group of Guttmacher staffers attended a Major League Soccer game at Citi Field, in New York City, in September during his fellowship visit.

What’s your research plan for the misoprostol project?

For this study, we implemented a mystery client methodology, in which we trained three women to contact sellers offering medication abortion online. These women posed as customers and filled out a survey about the interaction they had with each of the sellers. The purpose of this project is to evaluate the quality of the service and the veracity of the information provided by the sellers. These kinds of studies allow us to understand a hard-to-reach population of online drug sellers.

How can abortion advocates outside of Colombia better understand and support efforts to promote abortion rights there?

It is important to understand that the work here is not finished. Many organizations and groups are actively trying to overturn the [February 2022] ruling and impose a more restrictive agenda. Another important issue is social stigma, which remains high and affects free access to safe abortion services. Coverage and the situation of vulnerable communities, such as Indigenous, Afro and immigrant communities, are other issues that also require attention.

Fast Facts

Latest findings from the Monthly Abortion Provision Study

The Dobbs decision triggered a chaotic series of changes to abortion policies across the United States. With state laws, litigation against bans and new state constitution protections for abortion rights affecting access to care, the need for up-to-date data on abortion in the United States has never been greater. Our Monthly Abortion Provision Study, which started releasing national and state estimates in September, is responding to that need. It provides near-real-time insights into how abortion access nationwide is affected by the rapidly shifting state policy landscape.

What does the study tell us? It produces estimates on procedural and medication abortions provided within the formal US health care system—services offered at facilities and through telehealth providers. This effort has already yielded notable results:

• The latest data show a 7% national increase in the number of abortions provided between July and August 2023.

• Indiana’s total abortion ban, which went into effect in August, resulted in zero abortions provided that month, down from almost 700 the month prior.

• As of August, abortions in North Carolina had decreased by 28% since June, when new restrictions and a 12-week ban went into effect.

What’s ahead in the December update? In the coming days, we’ll release data on the share of patients traveling across state lines to access abortion care. We’ll also post estimates showing the impact of South Carolina’s six-week abortion ban, which went into effect on August 23.

Churning the numbers monthly is a lot of work. We collect data each month from a selection of abortion providers, then, using a statistical model, combine those numbers with our historical data on the caseload of every US provider to generate our estimates.

But it’s worth the effort. After Roe fell, we anticipated big disruptions in people’s ability to get abortion care. With this initiative, we’re expanding the body of evidence to document this consequential change.

We Recommend...

• “This book made me so mad,” says senior development assistant Rhea Goveas of author Elinor Cleghorn’s Unwell Women: Misdiagnosis and Myth in a Man-Made World—a historical and global exploration of how the medical system has failed women. Spoiler alert: “Not much has changed from ancient times to 2022.”

• Senior digital communications assistant Gigi Singer thought so highly of the Minneapolis Institute of Art’s free exhibition, “The last safe abortion,” in which artist Carmen Winant presents photographs of the work done by abortion providers in the Midwest, that she sent her parents to see it. (They found it “quite impactful.”)

• Director of institutional giving Victoria Mora lauded the You’re Wrong About podcast’s great compilation of personal abortion stories submitted by listeners.

• The hands-down neatest way to understand the menstrual cycle, according to editor Jenny Sherman, is with this interactive data visualization produced by Harvard T.H. Chan School of Public Health for the Apple Women’s Health Study.

Notions

Art can play a powerful role in social movements by amplifying the voices of marginalized communities and inspiring solidarity. We see this clearly in the work of Los Angeles–based artist Ashley Lukashevsky, whose bold illustrations center reproductive justice, racial and LGBTQ+ equality, voting rights and more. Created in partnership with Planned Parenthood of Greater New York, Ashley’s artwork reminds us that abortion is an essential part of health care for all.

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