About half of all U.S. women having abortions in 2002 had already had a prior abortion, according to Repeat Abortion in the United States, released today by the Guttmacher Institute. Moreover, one in three women have given birth to a baby they had not planned for, and one in 10 have had two or more unintended births. Repeat unintended pregnancies that end either in abortions or unplanned births occur among women from all economic, racial and ethnic backgrounds, the authors point out, suggesting that the reproductive health care system in general is failing to provide women with the services and counseling they need.

"Our study challenges the misperception that women who have more than one abortion are different from other women," says lead author Rachel K. Jones, senior research associate at the Guttmacher Institute. "The typical woman having a second or third abortion is, in many ways, like the typical woman having her first abortion—and in turn, all types of American women have abortions. This suggests that we need to do a better job helping all women better prevent unwanted pregnancies, so they can avoid having to decide whether to seek abortions or raise children they are not prepared for."

In fact, the only notable differences between women obtaining a first abortion and those who had already had one or more abortions are that those obtaining repeat abortions tend to be older and to have more children. This makes sense, as older women have been at risk of unintended pregnancy longer than younger women. Overall, most women obtaining abortions are poor or low-income, and six in 10 are already mothers.

The authors found no evidence of women using abortion as their primary method of family planning. The majority of women having abortions were using contraceptives when they became pregnant, regardless of whether it was their first abortion or they had already had a prior abortion. In fact, women obtaining second and higher-order abortions were slightly more likely to have been using a highly effective hormonal method (such as the pill, the patch or the ring) when they became pregnant. These patterns suggest that most women who have abortions are trying to avoid unintended pregnancies but are having trouble doing so.

The time when a woman seeks an abortion is an opportunity to offer family planning services and counseling to help her prevent another unintended pregnancy. Yet a quarter of a century of government policies at the state, federal and international levels have impeded this process. For example, Colorado, Michigan, Ohio and Pennsylvania require strict separation between organizations providing state-funded family planning services and organizations providing abortion-related services. At the federal level, Title X–funded family planning programs must be "separate and distinguishable" from abortion-related activities. And in developing countries, clinics or hospitals where abortions are provided are prohibited from receiving U.S. assistance for any postabortion contraceptive services and counseling.

"The ‘wall of separation’ that the federal government has erected between family planning and abortion services is, paradoxically, leading to more abortions," says Sharon Camp, Guttmacher president and CEO. "While intended to distance publicly-funded family planning clinics from abortion services, an unintended consequence is that it is getting in the way of abortion providers’ ability to facilitate women’s access back to family planning clinics. These policies interfere with the ability of abortion providers to ensure that, following an abortion, every woman has an appropriate contraceptive method and is able to use it consistently. And it is poor and low-income women in this country—those who have the highest rates of unintended pregnancy and abortion—as well as women in the world’s poorest countries, who are paying the price. We’re failing to prevent abortions because we’re letting down women in the greatest need."