Where The Real Action Is...

For all the debate in Washington, the battle over abortion is actually in the states, which are imposing more limits than ever. MISSOURI is a case study

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STEVE LISS FOR TIME

PRO-ROE: Advocates in St. Louis mark the 33rd anniversary of the decision

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No one so far has seriously tried to legislate the reasons a woman can have an abortion, but restrictions have taken many other forms. Do these laws actually bring about a reduction in the number of abortions, a goal that abortion-rights advocates also support? Even before many of the restrictions went into effect, the abortion rate and the overall number of abortions in the U.S. were on the decline. In 2000, the latest year for which Guttmacher has compiled statistics, the abortion rate was 21.3 abortions per 1,000 women ages 15 to 44, which was the lowest since 1974 and down from a peak of 29.3 abortions per 1,000 women in 1980 and 1981. In 2000 a total of 1.31 million pregnancies ended in abortion, down from a high of 1.61 million in 1990. In Missouri the reductions in both figures in recent years have been even sharper.

The reason for the declines is a matter of dispute. Economic growth, better contraception and safe-sex practices probably all contribute to the trend. But a 2004 study by researcher Michael J. New for the conservative Heritage Foundation found that states that have adopted laws regulating abortion experienced a larger decline than those that have not. Reductions are particularly steep, he found, in states that restricted the use of Medicaid funds to pay for poor women's abortions and those that required pre-abortion counseling about fetal development and abortion risks. (Lisa complied with that rule by phone.)

Some of those who deal with women seeking abortions have different theories. "The restrictions may stop some, but we think things like the 24-hour waiting period and the reduction of the numbers of clinics do not reduce abortions. They increase later abortion," says St. Louis--region Planned Parenthood CEO Paula Gianino, who has been at the organization for 15 years. While Missouri keeps no statistics that would back up that contention, a 2000 study by Guttmacher conducted in Mississippi found that the percentage of second-trimester abortions increased after the state adopted mandatory counseling and waiting periods in 1992.

Despite that, Gianino says, women overall are having abortions at earlier stages of gestation than ever, largely because better pregnancy tests are on the shelves of every drugstore. And there are alternatives to surgical abortion that weren't around years ago, which give women a greater incentive to make their abortion decision early in their pregnancy. Fully 24% of the St. Louis Planned Parenthood clinic's first-trimester abortions are being done with mifepristone, formerly called RU-486, which was federally approved in 2000 for use in the first 49 days of pregnancy. Two years ago, it was only 18%. And finally, there is an alternative that one side of the debate calls contraception and the other considers abortion: the so-called morning-after pill, which must be taken within 72 hours of intercourse to be effective. The Planned Parenthood affiliate in St. Louis performed about the same number of abortions (approximately 6,300) in 2004 as in 2003. But in the same time period, the number of morning-after kits they dispensed--containing a pregnancy test, four birth-control pills and a booklet advising the user not to take the pills if already pregnant--jumped, to 8,000 from 6,500.

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