Census Bureau data on the population of women aged 15–44 on July 1, 2013, and July 1, 2014, were used as denominators for calculating abortion rates for the entire United States and for each state and the District of Columbia.20 We estimated the national abortion ratio as the proportion of pregnancies (excluding those ending in miscarriages) that ended in abortion. To do this, we combined our abortion counts with National Center for Health Statistics data on the number of U.S. births in the one-year periods beginning on July 1 of 2013 and 2014 (to match conception times for births with those for abortions).21 –23 We distinguished among four types of abortion-providing facilities: abortion clinics, nonspecialized clinics, hospitals and physicians’ offices. Abortion clinics are defined as non-hospital facilities in which half or more of patient visits are for abortion services, regardless of annual abortion case-load. Nonspecialized clinics are nonhospital sites in which fewer than half of patient visits are for abortion services. Physicians’ offices are defined as facilities that provide fewer than 400 abortions per year and have names suggesting that they are private practices. Physicians’ offices that provide 400 or more abortions per year were categorized as nonspecialized clinics; because of their relatively large case-load, we assume that their service provision more closely mirrors that of a nonspecialized clinic.
Eighty percent of nonhospital facilities provided information on early medication abortion, 60% provided information on self-induced abortion and 63% answered items about lost service days. Response rates to these measures varied by facility type and caseload, and we constructed weights to account for these differences.
Our analysis takes a particularly close look at states that experienced the largest changes in clinics of both types between 2011 and 2014. Specifically, we examined the 10 states that experienced the proportionately largest declines in clinics and the 10 that exhibited the largest increases, and compared three measures: the percentage change in abortion rate between 2011 and 2014, the number of abortion restrictions enacted between 2012 and 2014, and whether the state had a TRAP law. Information on state laws came from the Guttmacher Institute.24 –27 Appendix Table 1 (Supporting Information) provides a list of laws and the states in which they were implemented.