Home Page

Dr Pravin Thevathasan's Reviews page  

Dr Pravin Thevathasan's home page

Does the availability of legal abortion and contraception bring down the rates of abortion?

Dr Pravin Thevathasan

In an influential article in the Washington Post, this is precisely what is argued. I have asked two experts to comment on the article. David Paton is Professor of Industrial Economics at Nottingham University and has been doing research in this particular field for several years. Ann Farmer is author of several books on abortion, population control and eugenics. If we examine trends in the United States, we know that there has been a huge increase in contraceptive use since the nineteen eighties. Yet, the unintended pregnancy rate has hardly changed. The reduction in the US abortion rate is therefore not due to contraception but is due to more women with unintended pregnancies carrying them to term. 54% of unintended pregnancies ended in abortion in 1981. This had come down to 40% by 2008.

Why is this? Almost certainly because more young people are growing up in the knowledge that the foetus is a human person. When I was at medical school, we used to refer to the foetus as a "product of conception". Those days of de-humanising the unborn child are long gone thanks to developments in medical technology, and surely thanks to the excellent work of SPUC, LIFE, The Good Counsel Network and other groups. Also, there is greater recognition of women being hurt by abortion.

Will greater use of contraception always lead to a reduction in abortion rates? Not if you compare Europe in the nineteen fifties with the seventies and eighties. An exception to the rule is the former Soviet Union, but that is because women used abortion as a method of birth control there. Those who take for granted that contraception lowers the abortion rates fail to recognize that some women, especially those still in their teens, are inconsistent in their use of contraception. Also, a contraceptive mentality may lead to greater sexual activity. It is also noted that Long Acting Reversible Contraceptives have high rates of discontinuance.

Comments on lower abortion rates/teenage pregnancy in developed countries by David Paton
Abortion rates have gone down in many developed countries, but there is a mixed picture in recent years, e.g. significant decrease in countries like the US, Germany & Ireland but not others, e.g. Sweden and England. Also, some of the recent decreases (e.g. in France) follow an increase from the mid-2000s. Various factors will be involved in these aggregate trends including demographic change and the economic cycle.

In terms of access to contraception (and it is important to distinguish between the effect of changes in access to contraception and contraception use), there is no clear picture at all. Take England: we have long had universal access to free birth control but also big increases in funding of contraception services over the period, yet abortion rates have increased since 1990. In contrast, Ireland which is characterised by much less extensive access to and promotion of birth control (albeit access has increased over the period) has seen very significant decreases in abortion rates.

There have been big technological shifts over the period which are worth a bit more attention.

(i) increased availability of and access to emergency birth control: proponents claimed that this change could lead to a drastic reduction in unwanted pregnancy/abortion. In fact, virtually all the research finds that increased access to EBC does not reduce abortions/unwanted pregnancies (there is one paper that finds the opposite, but this is very much the exception). This research covers RCTs and population studies in a range of countries. So, although Chile introduced EBC in the early 1990s, we can be almost certain that this contributed little of nothing to lower abortion rates.

(ii) increased availability of and access to long acting reversible contraception (LARCs). This has been a more recent development. We might well expect this change to reduce abortion rates but, to date, there is little evidence that it does so. There was a paper in Obstetrics & Gynecology in 2013 claiming LARCs had reduced abortions in Missouri but this study was deeply flawed. I had a paper with a colleague looking at this issue specifically in the context of teen pregnancy in England and we found pretty much no effect from increased access. There is very limited research on LARCs to date. However, again a cursory view of the cross-country experience is revealing, specifically England has really been pushing LARCs since about 2008. Abortions have gone down a little since then but almost entirely due to teenage abortions.

More generally, the AGI suggestion that abortion rates are not lower in countries where abortion is restricted does not stand up to the slightest scrutiny when you compare like with like. Ireland & Northern Ireland are good example as they are countries where a. abortion is illegal and b. almost all abortions which take place do so in England and these are recorded by country of residence. The rate per 100 women in Ireland is about a quarter of the rate on England & Wales residents. Even allowing for a lot of underreporting, the abortion rate is massively lower in Ireland than England & Wales. Similarly for Northern Ireland.

As the WaPo article suggests, where abortion rates have declined in recent years, this is primarily due to reductions in teenage pregnancy including in both births and abortions. We have seen big decreases in England since 2008. Some have claimed this is due to the English Teenage Pregnancy Strategy (which involved big investments in contraception services for young people) but this is incorrect. The Strategy started in 1999 and abortions barely changed for 10 years. From about 2007, spending on the Strategy started to decrease and in 2010 the Strategy was abandoned. Since then spending on many services has been slashed. Yet, teenage pregnancy rates have continued to go down, if anything at a faster rate. Further, the decrease in teen pregnancy has been seen in lots of countries (e.g. Ireland & New Zealand) which have not seen anything like the English teenage pregnancy strategy.

At the same time that TP rates have gone down, so has teenage drinking, smoking, drugs and crime. Although particular policies may have had some effect on pregnancy rates (e.g. abstinence education in the US, school improvement in England), we are seeing a much more general decrease in risk-taking behaviour by teens in many developed countries. This has not really been explained, though I have speculated that the growth of social networking/electronic gaming may have had an effect.

Now, it may well be that, in some countries, a decrease in desire by young people to get pregnant has resulted in higher rates of contraceptive take-up/use &/or higher rates of abstinence. But that does not mean that increased access to contraception (or abstinence education) has had a causal effect in reducing abortion rates.

To summarise, the weight of evidence so far continues to be that access to birth control has very little net impact on teenage pregnancy (i.e. births + abortions), teenage abortions or abortions more generally.

Comment by Ann Farmer

Abortion advocates have always exaggerated the scale of illegal abortion, but making something easier usually results in it becoming more prevalent - our abortion laws are a prime example.

As David Paton has shown, more contraception, especially among the young, who are the most inefficient users, leads to more abortion.
Both these factors were known to abortion campaigners many years ago - in fact they wanted abortion to be legalised so that women would be encouraged to use birth control - while publicly they argued that if birth control were made available, it would solve the illegal abortion problem.

It is possible that an increase in IUDs could have led to a decline in abortions; here in the UK we have the 'Pause' programme, that tries to get
teenagers who have had abortions to take injectable contraceptions -LARCs - which have serious negative health outcomes but may reduce the numbers of abortions. However, even with the Morning After Pill, LARCs and IUDs our abortion rate does not seem to have gone down.

The suggestion that popular TV programmes about teen pregnancy will lead to a decline in abortions is dubious, notwithstanding the number of 'googles' for the issues raised. Immature young people are more likely to copy irresponsible behaviour in the belief that they will succeed in avoiding problems where others have failed- the 'invulnerability of youth'.

The aim of abortion advocates is to make sure that there is no country where abortion, contraception, MAPs, LARC, IUDs are unavailable, because such countries would provide a useful 'control' in any studies of the efficacy of fertility control, like Ireland and Poland up until fairly recently (Irish women can come to the UK, but obviously it is harder, and this is reflected in their better rates of maternal mortality and infant mortality). Breast cancer is a difficulty for abortion advocates too - a comparison would indicate whether abortion is a factor, not to mention carcinogenic contraception.

In addition to the greater use of IUDs, there are two possibilities that suggest themselves, which might have the effect of reducing the official abortion rates inWestern countries - the greater availability of abortion pills on the internet, and a greater proportion of Muslim young people in the population. As Western birth rates decline, there are fewer women in the age bracket most likely to seek abortion - the 20-21 age group. Immigration has played a part in ensuring that there are more Muslims, who are less likely to use contraception and abortion and, of course, are more likely to come from intact families. The same is true for alcohol and drug use.

But the greatest test of any of these claims is the rate of STDs. If these have risen - and they are very high - it places the optimistic claims of abortion advocates in doubt



Copyright ©; Dr Pravin Thevathasan, Anne Farmer and David Patton 2017

Version: 14th March 2017

Home Page

Dr Pravin Thevathasan's Reviews page  

Dr Pravin Thevathasan's home page