Clinics are under pressure from declining abortion rates and big Planned Parenthood expansions.
by Chuck Donovan
The U.S. Supreme Court heard a case Wednesday that could determine the fate of many health regulations on abortion facilities. Whole Woman’s Health v. Hellerstedt originated in Texas, where the legislature passed a law in 2013 that, among other things, required abortion clinics to meet the same standards as ambulatory surgical centers and required abortion doctors to have admitting privileges at nearby hospitals to handle any complications that might arise.
Challengers to the law contend that these standards—which have yet to take full effect—are unnecessary and draconian and that they have already forced some clinics to close and will, if upheld, force the closure of many more.
No one questions that the number of abortion facilities in Texas has dropped in recent years. But what if these closures have to do with changes in the abortion “market” itself? A brief filed in the case by the organization I head, the Charlotte Lozier Institute, and Citizen Link and Students for Life of America, makes exactly this argument.
It contends that facility closures are happening almost everywhere and that the reasons include an increasingly pro-life public and the willingness of more women to carry an unexpected pregnancy to term. Also cited are Planned Parenthood’s new business model of building mega-clinics that compete with smaller clinics, and changes in the financing of non-abortion services wrought by the Affordable Care Act.
Some history is in order. The abortion industry grew rapidly from the Roe v. Wade decision in 1973 until the 1980s. The number of abortion facilities, including hospitals willing to perform abortions, grew to more than 2,400 by 1978. According to the Guttmacher Institute, in 1981 the U.S. abortion rate reached nearly 30 per 1,000 women of childbearing age, where it remained for several years. Three decades ago, however, the annual number of abortions began a steady decline until today, when the abortion rate has dropped back close to its level in 1973.
Experts disagree on which trends led to this decline. Some argue that improved contraceptive usage is the cause, while others point to factors like less sexual activity among teenagers and more support for single mothers.
What does seem clear is that with decreasing demand the abortion industry has behaved like many others, flattening out and then declining, as large providers grew and smaller ones got squeezed out. One interesting factor on the demand side is the response of women to an unexpected pregnancy. The Guttmacher Institute, a research body allied with pro-choice views, has reported that the percentage of women experiencing such pregnancies who opt for abortion had declined from 54% in 1994 to 40% in 2008—during a period before the burst of restrictive state legislation like that in Texas.
As a Reuters news analysis recently pointed out, the Affordable Care Act has also provided private insurance to many women who formerly received services at an abortion facility. They can now go to providers within their insurance network. As a result, the analysis claimed, Planned Parenthood lost 6% of its patients in 2014 after the Affordable Care Act went into full effect. According to Planned Parenthood’s most-recent annual report, its client count dropped another 6% in 2015.
Clinic closures are happening in “blue” states as well as “red “ones. The Abortion Care Network, a Washington, D.C.-based association of independent abortion clinics, estimates that for every three closures in a conservative red state there have been two in liberal, or abortion-permissive, blue states.
In another example of adverse conditions for many clinics, America’s largest abortion network, Planned Parenthood, has been steadily eating up market share. In 1993 fewer than 10% of U.S. abortions were done in Planned Parenthood facilities. By 2011 Planned Parenthood’s total market share had increased to 32%. This expansion can easily be attributed to the building of mega-clinics. In Houston in 2010, Planned Parenthood built the largest administrative and medical abortion facility in the nation, stating that it sought to reach 30,000 more clients annually.
This is merely one of 21 mega-clinics—typically able to see more than 17,000 patients a year, versus 5,000 in an average clinic—Planned Parenthood has opened or planned nationally since 2004. Three of these were in Texas, including two that opened after the passage of the 2013 bill that is the subject of litigation. This increased capacity affects the competition no less than when a Lowe’s or Home Depot moves into an area and the local hardware store closes, or when locally run stores are unable to compete with national box-store giants like Wal-Mart.
The co-founder of a clinic that closed in Washington state in 2010 said, “We would not be closing today if Planned Parenthood had not started providing abortion services in the same town.” A June 23, 2008, article in The Wall Street Journal quoted clinic operator Amy Hagstrom Miller saying “This is not the Planned Parenthood we all grew up with . . . they now have more of a business approach, much more aggressive.” Ms. Hagstrom Miller, whose network of Whole Women’s Health clinics is now the plaintiff in the case against Texas that the Supreme Court will hear this week, told the Journal back then that Planned Parenthood “put local independent businesses in a tough situation.”
The market forces in the abortion industry, including Planned Parenthood’s expansions, are akin to the consolidations occurring in multiple industries, including health-care generally. Government funding allocations and limits are affecting U.S. health care across the board, and abortion in states that do fund the procedure may be just one more example.
In sum, the number of abortion facilities in Texas has gone down over time—but the state’s experience is not unique. The real news more than four decades after Roe v. Wade is that abortion is on the decline almost everywhere, with no signs of its becoming an accepted part of regular medical care.
This article appeared in the Wall Street Journal. Mr. Donovan is the president of the Charlotte Lozier Institute, the education and research arm of the Susan B. Anthony List. The List is a nonprofit organization that supports pro-life politicians.