One of the challenges of the Guttmacher survey effort is the complete identification of a wide range of abortion providers, particularly given the associated stigma and security concerns abortion providers face.  AAP’s field consultants were able to make a modest but important contribution to Guttmacher’s efforts by working with Guttmacher researchers to connect with providers in their states.

Looking at the Guttmacher report, a few key trends are particularly striking for AAP.

First, state-to-state variability is highly visible in both the rate of abortion and also the number of providers. Some states show greater need than others: Mississippi lost 2 out of 4 providers in 5 years, while California added an additional 24 providers to their original 400. Even taking into account differences in population, these numbers highlight the vastly different access pictures in each state, and reinforce the importance of state-tailored work.  AAP’s new Least Access States Initiative is the latest example of our commitment to working with stakeholders to understand and respond to the unique conditions and needs of each of our project states.  As implied in its name, LASI is targeting those states that the Guttmacher report and other sources identify as having the least access to abortion care.

According to Guttmacher, location of providers and distance for patients remains a key barrier to abortion access – a reality for women that AAP is also seeing clear evidence of at the community level in our work to improve access for women in rural communities. 97% of non-metro areas continue to have no abortion provider. There has been no improvement to the proportion of women who must travel more than 100 miles for abortion care in the 5 years captured by the Guttmacher data. Targeted efforts to cultivate abortion providers in rural communities and to explore other strategies that will facilitate access to abortion care for rural women, like AAP’s new Rural Abortion Provider Initiative, are needed.

Finally, medication abortion matters. Medication abortion accounted for 13% of the all abortions from 2000 to 2005. More importantly, new medication abortion providers, particularly within non-specialized or primary care settings, are credited with significantly slowing the decline in abortion providers. AAP’s past projects focused on developing smaller providers working in private practice or non-specialized clinics. As we shift our efforts to ensure that new providers also mean increased access for women, early medication abortion continues to be a valuable tool in our current projects as we train new medication abortion providers in underserved areas.

The overall decline in the national abortion rate reported in the Guttmacher survey is reflective both of positive gains in prevention and of alarming barriers to access. State variations are startling:  for example, the abortion rate substantially declined in Oregon, a state that had devoted considerable funds to family planning and sex education, while Mississippi’s 17% drop in abortion incidence could be a result of the state losing 50% of its already small number of providers.   

Addressing these disparities is AAP’s first priority and we are growing to meet the challenge that widening disparities present.  The data show that positive gains are being made, but without this work, access will not increase for those women who at present, have little or none.