For the first time since 1975, the number of abortions in the United States dropped under one million (958,700 in 2013 and 926,200 in 2014), according to “Abortion Incidence and Service Availability in the United States, 2014,” by Rachel Jones and Jenna Jerman. The abortion rate also continued to decline, falling to 14.6 abortions per 1,000 women aged 15–44, the lowest rate ever recorded, and a 14% decline from 2011.

While the study did not directly investigate reasons behind the declining abortion rate, the authors suggest potential factors, both positive and negative, that are likely contributing to this trend. Improved contraceptive use in recent years has led to a decline in the U.S. unintended pregnancy rate, suggesting that women are increasingly able to plan their pregnancies and therefore have a decreased need for abortions. However, the wave of abortion restrictions passed at the state level over the last five years could also have contributed to the decline by making it more difficult for women to access needed services in highly restrictive states.

“Abortion restrictions and clinic closures mean that patients may need to travel greater distances to access services,” says Rachel Jones, lead author of the study. “The majority of abortion patients—75%—are poor or low-income, and nearly two-thirds are already parents. It can be very difficult for them to arrange for time off from work, transportation and child care. While many find ways to access care despite these obstacles, some of the abortion rate decline is likely attributable to women who were prevented from accessing needed services.”

Between 2011 and 2014, abortion rates declined in all regions of the United States and in all but six states (and the District of Columbia). The sharpest declines occurred in the West and the South (16% in each region), while smaller declines were seen in the Northeast (11%) and the Midwest (9%). The study did not find a clear and consistent relationship between state restrictions and changes in state abortion rates.

While the overall number of abortions declined in the country, the proportion of nonhospital abortions that were medication abortions increased from 24% in 2011 to 31% in 2014. Medication abortions represented nearly half (45%) of all abortions obtained up to nine weeks’ gestation. The study estimated that 87% of nonhospital abortion providers offered medication abortion as an option, and 23% offered only medication abortion.

The overwhelming majority of abortions—95%—were performed in clinics, and there were 6% fewer clinics providing abortions in 2014 than in 2011. However, there was no clear correlation between the number of clinics and abortion rates. For example, the number of clinics in the Midwest declined 22% during the study period, while the abortion rate in that region declined 9%. But in the Northeast, the number of clinics increased 14% and the abortion rate declined 11% between 2011 and 2014.

Ninety percent of all U.S. counties had no clinic that provided abortions in 2014, and 39% of women of reproductive age lived in those counties. These figures represent a slight increase from 2011, when 89% of counties were without a clinic and 38% of women aged 15­–44 lived in those counties.

“Restricting access to abortion may force women to delay the procedure or carry unwanted pregnancies to term,” says Megan Donovan, Guttmacher senior policy manager. “Instead, we should focus on increasing access to the full range of contraceptive methods, as well as to abortion services. Empowering women to prevent unintended pregnancies and plan their families is both a human rights priority and smart public health policy.”

This analysis was based on the Guttmacher Institute’s 17th census of all known abortion-providing facilities in the United States. The study, “Abortion Incidence and Service Availability in the United States, 2014,” is now available online in Perspectives on Sexual and Reproductive Health.