RH Reality Check (U.S.), October 20, 2009
Guttmacher
Responds to Critics of Global Abortion Study
By Susan Cohen
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 incidence
An 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 We estimate that if the Hyde amendment were repealed, the annual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. 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.
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