Following the widely covered release of a new Guttmacher Institute study on global abortion trends—which found that increases in contraceptive use have contributed to worldwide declines in the rates of both unintended pregnancy and abortion—some anti-choice activists have criticized our findings and policy recommendations. I’d like to take this opportunity to respond.
Abortion policy and abortion incidenceAn overarching finding of our study is that the legal status of abortion is not highly correlated with the extent to which abortions actually occur in a given country or region. In fact, the study found that abortion rates are about equal in countries where the procedure is broadly legal and countries where it is highly restricted. Antiabortion activists attempt to challenge this finding using the United States as an example. They point to recent Guttmacher research showing that the Hyde amendment—which prohibits the use of federal Medicaid funds to pay for abortions—deters some women from obtaining an abortion. They also note that in the years immediately after abortion was legalized nationwide in 1973, the U.S. abortion rate rose.
Those who claim that Medicaid funding restrictions have significantly reduced the incidence of abortion in the United States are fundamentally misreading the Guttmacher Institute’s study on the impact of the Hyde amendment. Indeed, our study concluded that one in four of America’s poorest women who would have an abortion if it were paid for by Medicaid instead continue the pregnancy to term. However, that does not mean the Hyde amendment has reduced abortions significantly, as some antiabortion activists have claimed, nor would restoration of public funding have a substantial impact in reverse. We estimate that if the Hyde amendment were repealed, the annual number of abortions nationwide would increase by approximately 33,000—increasing the U.S. abortion rate by only 2.5 percent (there were a total of 1.21 million abortions in 2005).
Our study documents that the Hyde amendment leaves some of the country’s poorest and most vulnerable women with no choice but to carry unwanted pregnancies to term. It also proves the larger point that large numbers of women will go to great lengths to terminate an unwanted pregnancy. When denied Medicaid funding, three out of four indigent women still manage to scrape together the funds for a procedure, not to mention arrange for the transportation and child care they need and comply with state consent and waiting period requirements (which likewise have not been shown to have any significant impact on abortion rates), in order to obtain an abortion they feel they need. This often comes at great expense to themselves and their families, as money meant for rent, utilities or groceries is instead used for the procedure.
In developing countries, the stakes are much higher, as the abortions women obtain are usually illegal or clandestine, posing terrible risks to their lives and health. As our report notes, there are about 20 million unsafe abortions annually, and 70,000 women die from unsafe, clandestine procedures each year. Fully eight million suffer severe complications, only five million of whom receive treatment for these complications.
More broadly, it’s important to note that the new Guttmacher Institute study on global abortion trends does not claim that the legal status of abortion has no effect. Rather, its conclusion is as follows: “The fact that the abortion rate in the less developed world, where the procedure is legally restricted in many countries, is quite similar to that in the more developed world, where abortion is largely permitted on broad grounds in almost all countries, confirms the lack of an inherent relationship between the prevalence of abortion and its legal status. Abortion rates can be quite low in some countries where the procedure is legal on broad grounds, and quite high in many countries where it is highly restricted. Restricting abortion by law does not guarantee a low abortion rate, nor does permitting it on broad grounds guarantee a high rate.” (The lack of a strong relationship between abortion legality and incidence is also underscored by our finding that the decline in worldwide abortion occurred alongside a global trend toward liberalizing abortion laws. Nineteen countries have significantly reduced restrictions in their abortion laws since 1997, while only three countries have substantially increased legal restrictions.)
As for abortion trends in the United States post-nationwide legalization in 1973, anti-choice activists tell only part of the story. True, in the years immediately following Roe v Wade, documented abortions in the country increased—to a considerable extent, however, this was a case of legal procedures replacing previous illegal procedures. The official U.S. abortion rate peaked at 29.3 per 1,000 women aged 15–44 in 1981, but—as the national rate of unintended pregnancy declined with increased contraceptive use, especially among unmarried women—the abortion rate also declined steadily to 19.4 abortions per 1,000 women of childbearing age by 2005. The number of abortions declined as well, to a total of 1.2 million in 2005, 25 percent below the all-time high of 1.6 million abortions in 1990.
Change takes time
Critics of our report—as the example above indicates—often cite selective time periods to make their points about the impact of abortion legalization, focusing on short-term outcomes (like the increase in the United States right after abortion was legalized), but not mentioning long-term changes (like consistent decline in the U.S. rate after 1980).
In fact, reducing unintended pregnancy and the need for abortion takes time, and the time required for policy changes to have an impact can vary widely from country to country. The bottom line, however, is that—notwithstanding the legality and wide availability of abortion—where contraceptive services are widely available and accessible, levels of contraceptive use will increase and will be accompanied, over time, by falling abortion rates.
Consider the experiences of countries like South Korea and Russia. South Korea experienced a dramatic decrease in desired family size beginning in the 1960s. As women’s motivation for small families intensified, abortion and contraceptive prevalence rates rose. Although it took a number of years, the abortion rate eventually leveled off and then began to fall, however, as contraceptive use continued to increase.
In contrast, Russia—which historically had some of the world’s highest abortion rates— saw dramatic changes within a relatively short period of time. Until the 1980s, it was not uncommon for a Russian woman wanting only two children to have 10 or more abortions in her lifetime, because modern contraceptives were essentially unavailable in the country. The situation changed dramatically in the late 1980s, when foreign-made modern contraceptives became widely available: Russia’s unintended pregnancy and abortion rates decreased by half in less than one decade. (Similarly, as our new study found, the decline in global abortion rates over the past decade was heavily concentrated in Eastern Europe, where abortion is broadly legal but use of modern contraceptives has increased dramatically.)
The Key Role of Contraception
Fundamentally, some anti-choice activists simply cannot accept the fact that that increases in contraceptive use contribute to declines in unintended pregnancy and abortion. Â They persist in claiming that contraception is ineffective and only leads to more unintended pregnancies and abortions.
The link between declining abortion incidence and increased contraceptive use is well established (and well illustrated by many of the above examples). Behind nearly every abortion is an unintended pregnancy, and it is clear that the best way for a sexually active person to avoid unintended pregnancy is to use contraception consistently and correctly.
A recent Guttmacher Institute analysis shows just how important contraceptive use is for U.S. women. It found that the two-thirds of U.S. women at risk of unintended pregnancy who use contraception consistently and correctly account for only 5 percent of unintended pregnancies. In other words, the one-third of women who use contraception intermittently or not at all account for fully 95 percent of all unintended pregnancies. Other research indicates that using any contraceptive method reduces a couple’s chances of having an unintended pregnancy by 85 percent, and properly using the most effective methods virtually eliminates that risk.
Of course, no contraceptive method is perfect, just as no human being is perfect. Unintended pregnancy will never be reduced to zero, and accordingly, there will always be a need for safe, legal abortion. But one thing is certain: Nonuse of contraception, as anti-choice activists appear to advocate, is hardly an answer. It would only lead to dramatic increases in both unintended pregnancy and abortion in the United States and around the world.
