Indiana was the first state to pass a new abortion
law after the U.S. Supreme Court struck
down Roe v. Wade on June 24, 2022. Passed six weeks after the high
court’s Dobbs v. Jackson Women’s Health Organization decision, Indiana’s
law prohibits abortion except in cases of incest or rape, fatal fetal
anomaly, or to save or preserve the life of the mother. The ban was
short-lived as judges in two
separate lawsuits blocked it while the cases are litigated.
While those cases proceed, abortion remains legal up to 22 weeks of
gestational age. Though Indiana law cites post-fertilization age, most
analyses, including that by the Indiana Department of Health (IDH),
instead use gestational age, which is approximately two weeks greater
than post-fertilization age. Indiana’s Terminated
Pregnancy Reports, published annually by the IDH, outline the
details of abortion in the state. If the ban is upheld, they will also
serve as a historical record, illuminating the context of abortion and
revealing where it was most common and among what populations.
If Indiana’s abortion ban is overturned, the pending outcome of
federal lawsuits may impact its practice within the state and beyond.
U.S. District Judge Matthew Kacsmaryk ordered
in April 2023 a hold on federal approval of the drug mifepristone, one
of two drugs commonly used in medication abortions, while the case moves
forward challenging its FDA approval. The U.S. Supreme Court ultimately
issued a stay
on that decision, preserving access to the drug while the case is
decided by the Fifth Circuit Court.
Resolution regarding mifepristone’s legality is complicated by
another ruling
issued the same day by Judge Thomas O. Rice, District Judge for the
Eastern District of Washington, that prohibited the FDA from restricting
access to the drug. Rice’s order is limited to Washington, D.C. and the
17 states involved in the case. The competing orders may need to be
resolved by the U.S. Supreme Court.
If mifepristone’s FDA approval is revoked, and the Indiana ban is
overturned, medication abortions in the state would be limited to the
use of misoprostol. Although not as effective
as the combination of mifepristone and misoprostol, abortions using just
misoprostol, which induces cramping and bleeding to empty the uterus and
are common in places without access to mifepristone, could
continue.
Abortion access in a post-Dobbs world will likely be uncertain and
uneven for some time, and with it, the practice of abortion in Indiana
and beyond.
Context of abortion in Indiana 2014 to 2021
Abortions are often classified as either medical or surgical.
Medical abortions, sometimes referred to as medication abortions, use
medication to end a pregnancy and have become the most common, growing
an average 11.74% annually. Since the FDA expanded
the approved use of mifepristone from seven weeks of pregnancy to 10
weeks in 2016, medication abortions have increased 60% and become the
dominant method.
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Surgical abortion encompasses many procedures, sometimes called
different names, used at different gestational ages and with varying
degrees of complexity. The two surgical methods explicitly defined in
the reports
are dilation and evacuation and suction curettage. They are
differentiated by the methods used and the gestational ages when they
occur. Like suction curettage, dilation and evacuation abortions utilize
suction to empty the uterus but also tools like forceps and a curette;
they occur later in a pregnancy, typically midway during the second
trimester. Between 2014 and 2018, when Indiana stopped listing them
separately, 99.5% of surgical abortions were suction curettage, 0.3%
were dilation and evacuation and the remaining fraction included both
menstrual aspiration and ‘other’ categories.
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While the legality of Indiana’s new abortion ban and the legal
status of mifepristone remain unresolved, abortion in Indiana remains
legal through 22 weeks of gestational age. Total abortion increased 3.5%
between 2014 and 2021 but has fluctuated as much as 6.44% above and
8.17% below the 7,872 annual average. Over eight years, the annual
percentage increase has averaged 0.59%.
Much like the variation in annual abortion counts, monthly totals
vary widely and swing as much as 20% from their eight-year average of
611. In 2019, September swung from 468, 18% below its average of 572, to
639, 11.7% above its average in 2020, a shift of 29.8%.
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The variation is apparent when contrasting a month’s totals to its
eight-year average or to other years.
Abortion rates also vary by county. Fifty-five Indiana counties out
of 92 had rates below the average county rate of 2.51 abortions per
1,000 women of childbearing age (10 to 49 years-old). At 10.1, Marion
County’s average rate is 4 times higher than the state’s county average;
Switzerland County has the lowest average rate at 0.2 abortions per
1,000 women of childbearing age.
The age at which women get abortions has remained fairly consistent
since 2014. Women in their 20s get 60% of all abortions and those
between 20 and 34 years-old get 77%. Tracking changes in abortion among
the very young is difficult due to inconsistencies in the reports’
categorization of those under 16 years-old. In some years, the age
ranges start as young as nine, while in others, all abortions for those
under 16 are grouped in the same category. There was an average of 20
abortions annually by nine to 14 year-olds, 0.26% of all abortions,
between 2014 and 2019.
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Though women in the 20 to 34 year-old age range get the most
abortions, a high rate of women in that range within a county doesn’t
necessarily translate into a high county abortion rate. Of the 17
counties with high rates of 20 to 34 year-old women in 2021, nine have
high rates of abortion, five have medium rates and three have low rates.
Among the 27 counties with low rates of 20 to 34 year-olds, one has a
high abortion rate, 14 have medium abortion rates and 12 have low
abortion rates.
Map
Between 2014 and 2021, the abortion rate for women of childbearing
age in Indiana was 4.1 per 1,000, though it varies by race. In that
time, white women made up 85% of the state’s female population and
received 54% of all abortions, though they have the smallest population
of childbearing age women, 50%. The rate of abortion within that group
is fourth-lowest among all races. Black women were on average 10% of the
female population, had the second-lowest percentage of childbearing age
women at 57%, and had the highest rate of abortion per 1,000 women of
childbearing age at 13%. Asians, the third-largest racial group making
up 2% of the population, had the highest percentage of childbearing age
women, 66%, and the third-highest abortion rate.
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Abortion is most prevalent among women who have not completed higher
levels of education. Women with a high school diploma or GED made up
between 34% and 41% of all abortions between 2014 and 2021. There were
fewer abortions on average by women with a doctoral or professional
degree, 0.8%, than any other educational level.
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The number of clinics that perform abortions in Indiana has hovered
between 6 and 9 while the number of hospitals that performed at least
one abortion annually fluctuates between 2 and 6. Nearly all abortions
occur in clinics.
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Indiana began reporting the number of residents from nearby states
who received abortions in Indiana in 2019. Of the five listed, Kentucky
had the most with 851, four times as many as Illinois, the next highest
state.
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New laws and legislation are likely to continue altering the legal
landscape of abortion in Indiana. The degree to which the state’s
short-lived ban impacted 2022 abortion totals won’t be clear until the
IDH releases the year’s full data. As the legal fight over Indiana’s
abortion law continues, so too do battles over bans in neighboring Kentucky
and Ohio,
states whose residents’ abortions are often tallied in Indiana’s
reports. Where and how those residents access abortion services, and how
the federal fate of mifepristone plays out are just a few of the unknown
issues with potentially large impacts. The near-term future of abortion
in Indiana is unknown, but it’s likely to be different than its recent
past.
