Provider questions state's historic decline in abortions

Minnesota on Thursday reported a historic 8% decline in abortions from 2019 to 2020, but reporting problems amid the COVID-19 pandemic might have led to an undercount that masked a smaller decline or an increase.

The annual report released each July 1 by the Minnesota Department of Health showed 9,108 elective abortions in 2020, down from 9,945 in 2019, but it also showed a decline from 2,114 to 137 in abortions provided by Whole Woman's Health. The chief executive of that clinic, normally the state's second-largest provider, said it provided 1,266 abortions last year and that a location move to Bloomington from Minneapolis likely disrupted the state's reporting.

If true, that means Minnesota didn't show an 8% decline, which otherwise would be the largest single-year drop since at least 1980. Abortion numbers have been steadily declining since 2000, but Amy Hagstrom Miller of Whole Woman's Health said an increase wouldn't have been surprising in 2020 given the pressures caused by the pandemic and its economic impact.

"People are losing their jobs. They're losing their child care. They're losing their health insurance coverage," said Hagstrom Miller, the clinic's president and chief executive. "They're not able to build a family in the same way that they had planned. ... People might not be able to access contraception and preventive medicine in the same way."

Other providers and advocates said the reported decline was plausible. National and international surveys showed declines in sex during the pandemic, and things from COVID-19 restrictions to bar closures might have reduced the encounters resulting in unplanned pregnancies.

Access to abortion services and counseling declined amid the pandemic as well, though providers responded with virtual visits and more access to medical abortions rather than surgical procedures.

"We believe the pandemic exacerbated existing barriers to abortion care, which likely also contributed to the decreased number of abortions last year," Planned Parenthood North Central States said in a statement. The St. Paul-based family planning organization provided 7,491 abortions in 2020 — 82% of the procedures reported last year in Minnesota.

More than half of reported abortions involved women in their 20s, and fewer than 1 in 10 involved teenagers. Minorities made up a disproportionate share of the total — with Black women receiving nearly 31% of the abortions among state residents despite making up less than 10% of the state's female population.

An abortion opponent called the apparent decline "very positive news," but also noted an increase in abortions through medications, primarily mifepristone, including by at least one provider offering the drugs by mail. The number of reported medical abortions available at 10 weeks gestation or less increased 33% while surgical abortions declined by the same rate.

"Especially during the COVID-19 pandemic, abortion supporters have sought to make chemical abortions more widespread, even at the expense of women's safety," said Scott Fischbach, executive director of Minnesota Citizens Concerned for Life, raising concern about the lack of medical oversight when drugs are delivered by mail.

Abortions involving out-of-state residents declined, but Minnesota saw an increase from 99 to 152 in recipients from South Dakota. Restrictions in the state during the pandemic forced Planned Parenthood to stop providing abortions temporarily in Sioux Falls, though they have since resumed.

Planned Parenthood has become the dominant provider in Minnesota, providing 35% of abortions a decade ago and 65% in 2019. Its exact share in 2020 is muddled by the questions raised by Whole Woman's Health.

The state also has no specific record of medical abortions provided by mail by Just The Pill, a national organization that expanded to Minnesota in 2020. The state report lists 225 abortions last year by independent physicians who performed 10 or fewer, an increase from 107 in 2019.

The exact role of the pandemic on measures of reproductive and sexual health is unclear, though 11 women cited it as one of the reasons for their abortions last year.

Fewer pregnancies during the pandemic could simply mean fewer abortions, said Jill Farris, director of an adolescent sexual health training and education program at the University of Minnesota Medical School. "Preliminary data for 2020 shows a declining birthrate nationally. Since Minnesota tends to follow national trends, it is reasonable to assume that our pregnancy rate probably declined as well."

The number of women who didn't disclose reasons for their abortions increased to 30% in 2020. Of those who did, 1,671 cited economic reasons while 5,217 said they did not want children at this time.

Jeremy Olson • 612-673-7744