Abortion Laws Work
By: Candace S.
Tags: Abortion Laws, Politics, Abortion, Pro Life, Pro Choice

Credit: Maria Oswalt

“Making abortion illegal won’t reduce the number of abortions. It will only drive them underground, and make them unsafe.”

If you’ve spent any time reading about anti-abortion laws, whether on social media, blogs, or mainstream news organizations such as NBC, NPR, or the New York Times, you’ve likely read this claim before. Indeed, this is among the most popular arguments I have read in favor of keeping abortion legal. In addition to its popularity among pro-choicers, some who call themselves “personally pro-life” but don’t want abortion to be legally restricted also use this argument in support of their worldview.

The source for this claim is nearly always a joint study conducted by the Guttmacher Institute and the World Health Organization, published in the Lancet Journal. The authors compare abortion rates in world regions where abortion is legal (North America and Europe) to regions where it is broadly illegal (Latin America and Africa) and claim to find that regions where abortion is illegal have similar — if not higher — abortion rates.

This sounds compelling at first. However, this study doesn’t take into account different variables that might contribute to increased abortion demand. Latin America and Africa are mostly developing regions, so poverty, crime, domestic abuse, lack of access to contraception, and other factors may contribute to increased demand for abortions. In addition, abortions in countries where it is illegal must be entirely estimated, whereas countries with legal abortion (particularly among developed countries) tend to keep government records of the number of abortions performed. There is a much greater uncertainty among the estimates for illegal abortions than the estimates for legal abortions.

The Lancet study also doesn’t take into account how or if the laws are enforced. Some countries with restrictive laws on the books may not be that restrictive in practice. For example, the small island country of Seychelles has a law that doesn’t allow an abortion to be performed unless the mother’s life or health is at risk, the fetus has a malformation, or the mother was raped. However, hundreds of legal abortions are performed in the country every year, and given the low population, this leads to a high abortion rate of 27 per 1,000 women of reproductive age. On the other side, some Catholic influenced countries like Italy and Croatia permit abortion on request in law, but they can be difficult to get because relatively few doctors are willing to perform them.

A better way to measure the effectiveness of abortion laws is to measure what happens when abortion is made legal or illegal in the same country or region. Because of the difficulty of measuring illegal abortions, we can look at changes in birth rates — if births increase after abortion is restricted, then this would mean that more women are carrying to term, and not that all legal abortions are just being replaced by illegal ones. Similarly, if abortion laws are effective, then liberalizing the laws should decrease births. If abortion laws are generally ineffective in changing abortion rates, then they should not have any measurable impact on birthrates at all.

Did Legalizing Abortion Cause Lower birth rates?

Yes. This can be seen in the US and several other countries. For example, this peer-reviewed study found that states that legalized abortion before Roe v. Wade saw their fertility rates decline 4% relative to other states that did not. This study found that increased access to abortion for minors in the 1960s and 70s was more instrumental in lowering birthrates for this group than increased access to contraception. An additional study found a similar result — teen childbearing decreased as a result of legalized abortion both pre-and post-Roe.

Similar effects have been seen in other countries. For example, when Mexico City legalized abortion, birth trends decreased relative to prior trends and other areas, particularly among women ages 20–34.

In Nepal, closeness to a newly opened abortion center decreased the chances of a second birth after a first birth. In Uruguay, there was a similar effect with an 8% decrease in births from unplanned pregnancies. Spain also saw a decrease in births to young women after the 1985 liberalization of the law.

The fact that births decrease when abortion is legalized indicates that this isn’t a case of women simply trading off illegal abortions for legal ones — abortion rates rise.

Do Anti-abortion laws in the US decrease abortions?

Again, yes. Despite the fact that abortion is legal nationwide, some states have passed various restrictions on the practice. One example is not allowing state taxpayer funds to go to paying for abortions. In North Carolina and Michigan, a lack of public funds for abortions led to a decrease in abortions and an increase in births.

This study found that the closure of abortion clinics in Texas due to the HB2 law also had an effect on births. Another study in the US found that in areas with more abortion availability in the 1980s reduced the amount of infants relinquished for adoptions. One very recent study, published in November 2020, attributes state abortion laws to a 17% lower rate of resident abortion compared to states with fewer or no laws.

Interestingly, in addition to decreasing abortion by increasing birth, it’s possible that abortion laws have an effect on conceptions. Studies here, here, and here indicate that people likely increase their contraceptive behavior in response to more restrictive abortion laws.

State-by-State Abortion Rates

Another factor to consider when measuring the effects of abortion legislation is to compare states with more anti-abortion laws to states that are permissive on abortion. Studies have found that state restrictions have reduced abortions, but perhaps it could be the case that states with permissive abortion laws reduce abortion rates more through other means, such as more access to contraception, healthcare, and comprehensive sex education.

However, this is not the case. The Guttmacher Institute compares state abortion rates by residence, so this takes into account women who travel to another state for an abortion. Even with this considered, permissive states have higher abortion rates overall. The state with the highest resident abortion rate in 2016 was New Jersey, at 28.2 per 1,000 women ages 15–44. New York, Maryland, California, and Connecticut also had among the highest. The lowest abortion rates are found in Utah, South Dakota, Kentucky, Idaho, Nebraska, and Oklahoma.

Now there are other factors that predict high or low abortion rates aside from anti-abortion laws. Generally, states with more urban populations have higher abortion rates than rural states. However, even the very rural states of Vermont and Maine, while their abortion rates are lower than average, have higher abortion rates than other rural states with anti-abortion laws (such as Kentucky, South Dakota, and Arkansas).

So states that have more progressive policies on contraception, sex education, Planned Parenthood, and healthcare — in addition to permissive abortion laws — have higher abortion rates than conservative anti-abortion states. There are probably a variety of reasons for this, but it’s clear that more progressive states have not achieved fewer abortions.

Delaware’s Abortion Reduction

Over the past year or so, I’ve often seen pro-choice people point to Delaware as an example of a state that dramatically reduced abortion via contraceptive LARC programs and without passing any anti-abortion laws. Guttmacher’s 2017 abortion report noted that Delaware had the largest decline in the rate of abortions occurring in the state, at -37%. Pro-choice commentators have attributed the decline to a free LARC program enacted by the state in 2014.

Unfortunately, these analyses lack key context. First of all, unlike most states, Delaware experienced a large spike in the abortion rate from 2005–2007, so there was a lot more room for the abortion rate to fall compared to the majority of states that have experienced general declines since 1980. Also, Delaware’s abortion rate sharply decreased starting in 2010 (years before the LARC program was implemented) and fell at a slower pace starting in 2013.

Some other important context is that Delaware’s rate of occurrence fell by 37%, but their rate of residence decline was much more modest, indicating that a lot of the 37% decline is due to more Delaware women obtaining abortions in other states.

It’s certainly possible that the LARC program contributed to Delaware’s decline (I would assume it did), and it’s good news to see the state’s abortion rate reach a new low after a large spike. But it’s important to note that Delaware’s resident abortion rate is still higher than average (16.1 in 2016, compared to 13.7 in the whole US) and much higher than anti-abortion states overall.

Colorado’s Abortion Reduction

Before Delaware, there was Colorado. The LARC program in the state, which started back in 2009, garnered wide praise from the media for its “startling success.” In 2015, news outlets reported that the teen abortion rate in Colorado decreased 42% in 5 years (2009–13), and 57% in 8 years (09–16). All of this certainly sounds very impressive. And I do believe that Colorado is a better example than Delaware for pro-choicers to cite.

However, context also tends to be missing in a lot of the glowing reports. Note that the teen abortion rate declined by 57%, not the overall abortion rate (this is a common misunderstanding). Teenage abortion rates have been declining more steeply than abortion rates for older age groups across the country. For example, here is a comparison of Colorado’s teen abortion decline to the decline in the whole country.

Colorado’s teen abortion decline tracks very well with national trends. Colorado’s overall abortion rate for reproductive aged women also closely matches the national decline. Colorado’s abortion rate decline for all ages was -26% from 2010–17, and in the whole US, it was -24%.

This doesn’t mean that Colorado’s program was ineffective. I believe it did contribute to abortion declines in the state, but the decline was not particularly unique compared to the rest of the country. Also, Colorado’s abortion rate, while lower than the average, isn’t as low as many of the anti-abortion states mentioned above.

Are there more Back-alley abortions in conservative states?

There has been a lot of reporting in the past couple of years suggesting that abortion declines in anti-abortion states are at least partly being driven by an increase in women ending pregnancies on their own, particularly those that travel down to Mexico to buy misoprostol from pharmacies.

But actual data suggests this probably is not a significant factor. The Guttmacher Institute found in their surveys of abortion patients that in 2014, only 2.2% reported a self-abortion attempt. That was a small change from 2008, despite many laws being passed in that time frame. A study from 2017 found that 1.4% of women ever attempted to self-induce in her lifetime, and of these, 28% were successful, 31% got a clinic abortion, and 13% had a live birth.

Also, another point to note is that there have been no injuries or deaths from an self-abortion in an anti-abortion state in the news thus far. If illegal abortions are as unsafe as pro-choicers say they are, then we should expect several women to be dying of them, given the large population in the US. Pro-choice EMTs and OBGYNs could easily go to the highly sympathetic media to report seeing large numbers of women injured or dead from such procedures, and in the process lower public support for abortion restrictions.

That this has not happened indicates to me that self-abortions are either not very common or they are very, very safe.

How to Reduce abortion rates

Up until a few years ago, I used to believe that abortion laws didn’t work. I thought that the proven methods to get abortion rates down were affordable or free contraception, sex education, and social safety nets for mothers. If these things were implemented, I thought, abortions were guaranteed to go down.

I still believe these policies can reduce abortions, though I’m less convinced that the social safety net has a substantial effect because the US studies on this topic tend to find mixed results (example).

One of the first facts I learned that threw a wrench into my previous beliefs was that Sweden, the progressive paradise, has a higher abortion rate. And unlike the US, their abortion rate has been relatively stable. Similarly, France and the UK have had their abortion rates increase to levels above the US over the past decade, and both of these countries have universal health care that provides contraception. Similarly, the fact that conservative states had generally lower abortion rates than progressive states also challenged my thinking on this issue.

There are various reasons for differing abortion rates, both in Europe and the United States. But I had been led to believe that there was a strong association between certain progressive policies and low abortion rates, and that anti-abortion policies were ineffective at best, and increased abortions at worst.

As I did more research, I found countless studies that demonstrated clearly that abortion laws have a strong effect on the number of abortions. None of this proves that we should implement these policies, of course. If you are pro-choice and believe that abortion is a woman’s right, then it should be legal regardless of how many more abortions would occur.

On the other hand, if you believe abortion is morally wrong but have been convinced not to support pro-life laws due to claims that these laws are ineffective, I hope you will read the sources I cited with an open mind.