Also in this issue of Guttmacher Policy Review:

"Pay-for-Performance: Making It Work for Safety-Net Family Planning Centers and the Clients They Serve," by Adam Sonfield

"The State of Sexual and Reproductive Health and Rights In the State of Texas: A Cautionary Tale," by Kinsey Hasstedt

For the Record, "Federal Government Releases Updated Title X Programmatic Requirements and Clinical Guidelines for Family Planning Providers"

"Emerging Threat of Antibiotic-Resistant Gonorrhea Demands Response"

A new Guttmacher policy analysis notes that, paradoxically, the sharp divide over the means to make abortion rare has only grown more pronounced even as the U.S. abortion rate in 2011 reached its lowest level since 1973. The debate centers on whether the United States should strive to reduce abortion at all costs, or focus instead on reducing the need for it.

"The rival policy approaches of the antiabortion and prochoice movements have become mutually exclusive," says Joerg Dreweke, author of the analysis. "Antiabortion activists, starting in 2011, have enacted an unprecedented wave of coercive state laws that will likely force growing numbers of women to give birth rather than end an unwanted pregnancy. By contrast, reproductive health advocates back policies like the Affordable Care Act that expand access to contraceptive services to help women prevent unintended pregnancies in the first place, along with the abortions that often follow."

The analysis details the opposing explanations of why the U.S. abortion rate declined 13% between 2008 and 2011. Antiabortion activists argued that state-level abortion restrictions were responsible and dismissed the idea of contraception playing a role. However, not only did the abortion decline mostly predate the wave of new abortion restrictions, but it was also accompanied by a steep drop in the birthrate, indicating that pregnancy was down overall. This leads to the conclusion that improved contraceptive use, including use of highly effective methods like the IUD and implant, was likely the main driver of the abortion decline by helping to reduce women’s need for the service.

However, even though abortion restrictions appear not to have been a major factor in the most recent abortion decline, the analysis warns that such laws can have a severe financial and emotional impact on women even when falling short of deterring them from having an abortion. And research shows that the most coercive laws, those that significantly raise the economic cost for women seeking abortion care, can have a measurable impact on abortion incidence by making abortion unattainable for the poorest and most vulnerable women.

The antiabortion movement has taken this lesson to heart and is pursuing a deliberate strategy of increasing the economic cost to women of having an abortion by enacting a raft of severe state-level abortion restrictions. This includes unnecessary regulations targeting abortion providers that are forcing many clinics to shut down, thereby greatly increasing the distance women have to travel to obtain abortion care. Other coercive requirements, like mandatory abortion delays that compel women to make two separate trips to the provider, exacerbate the impact for affected women.

"Abortion opponents may try to cloak their policies in pro-woman rhetoric, but the simple fact remains that these laws are intended to push reproductive decision making in one direction: toward pregnancy and childbearing," says Dreweke. "Viewed this way, the question is not whether coercive approaches ‘work’ in reducing abortion incidence. The question is how to ensure that U.S. reproductive health policy is grounded in voluntarism and informed consent. Ultimately, supporting all of a woman’s pregnancy decisions not only works to reduce abortion incidence—it’s the only acceptable way of achieving that goal."