The Vanishing U.S. Abortion Clinic

Hospital Hallway

Abortion clinics are closing in the U.S. at a record pace. In four states — Mississippi, North Dakota, South Dakota and Wyoming — just one remains. American women were having fewer abortions before clinic closings accelerated in the last couple of years. So no one can be sure how much the push to restrict clinics is connected to falling abortion rates. But the new strategy adopted by abortion opponents, and the court battles it has set off, may define how far abortion rights can be limited without being overturned.

The Situation

In mid-2015, abortion opponents in the U.S. Congress renewed a push to cut off federal funding for Planned Parenthood, a non-profit reproductive health network that is the country’s biggest abortion provider. This followed the release of videos by an anti-abortion group purporting to show the provider offering to sell fetal tissue, which is illegal. Planned Parenthood denies this, saying it sometimes charges researchers fees to cover handling costs after patients donate tissue for research. Efforts to overturn abortion rights entirely through state ballot initiatives giving the unborn the rights of a person have failed repeatedly. The more effective challenges have been less frontal. In November 2013, for instance, after a new law in Texas began requiring that clinics meet stricter building codes and that abortion doctors have admitting privileges at local hospitals, 19 facilities stopped performing abortions, leaving 22 in the state. The fate of another dozen or so hung in the balance after the Supreme Court in June 2015 blocked Texas from enforcing the new restrictions at least until the court decides whether to hear the case. The Texas law is a case study in the way abortion opponents have changed strategies, opting for legislative action over the clinic blockades and violence of the past. Through 2014, states had approved 231 abortion restrictions since a Republican-led state-legislative push began in 2011 — more than had passed in the prior decade. Laws aimed at clinics are proving more potent than those aimed at patients, such as waiting periods or parental notification requirements. Abortion-rights supporters have pushed back, introducing more state-level, pro-abortion bills than at any time since the early 1990s and challenging restrictive laws in court. Judges have blocked enforcement of such measures, pending further legal rulings, in Alabama and Oklahoma. Courts have ruled them unconstitutional in Wisconsin, Mississippi and North Carolina.

Source: Guttmacher Institute
Source: Guttmacher Institute

The Background

Abortion has persisted as a hot-button issue in U.S. politics since the Supreme Court’s landmark Roe v. Wade decision in 1973 legalized it in all 50 states. The groundwork was laid to undermine that ruling in 1992, when the high court said states could pass restrictions that don’t present an “undue burden” to women seeking the service. Courts are now clogged with challenges to laws testing just what that means. The ranks of clinics have been thinning since the late 1980s, when the number of nonhospital providers performing 400 or more abortions per year peaked at 705; by 2011, the most recent year for which data are available, that number had fallen to 553. Using states’ data, the Associated Press concluded that abortion had fallen 12 percent nationwide from 2010 to January 2015, with declines in states both with and without new limitations.

The Argument

Both sides of the abortion debate have a stake in the proposition that restricting access to clinics is holding abortion rates down. Health experts and social scientists say that is just one factor. Increasing cultural acceptance of single motherhood, the recession (which was accompanied by a decline in pregnancies) and more (as well as more effective) contraceptive use are also behind the drop. Almost half the 6.7 million pregnancies each year are unintended, and almost half of these end in abortion. One study concluded that if 31 states outlawed abortion tomorrow, the vast majority of women would still travel to states where it remained legal. But the impact on those unwilling or unable to travel could still produce a 15 percent drop in abortions nationally and as much as a 4.2 percent rise in the birth rate. As access diminishes, abortion rights advocates argue, more women will resort to dangerous and illegal pre-Roe means to avert motherhood.

The Reference Shelf

  • Bloomberg News articles about abortion.
  • The Guttmacher Institute researches and compiles medical statistics and legislative history about abortion.
  • The Centers for Disease Control and Prevention collects data from most states for its abortion surveillance project.
  • The American Congress of Obstetricians and Gynecologists offers a resource guide for abortion, including medical guidelines and research.

First Published Nov. 20, 2013

To contact the writer of this QuickTake:

Esmé E. Deprez in New York at

To contact the editor responsible for this QuickTake:

Lisa Beyer at