For years feminists and prochoicers have pointed out that women have abortions whether or not the procedure is legal.
That was true here before Roe v. Wade, and it is true today in countries where abortion is restricted or banned. The difference is that when abortion is legal it is a remarkably safe procedure; when it is illegal, women are injured, women die, children are left motherless. (True, these are already-existing, sinful children, not embryos or fetuses, but still.) This simple public health argument has gotten lost in a thicket of theology, sexual morality, “family values,” politics, spin and outright disinformation. The coat hanger has become a political cliché, a relic of the ’60s, like the peace sign. Oh, that old thing.
Now comes an article in The Lancet that shows in cold hard data how right we’ve been all along. “Induced Abortion: Estimated Rates and Trends Worldwide,” a study conducted by the World Health Organization and the Guttmacher Institute, is the first global analysis of abortion incidence since 1995. It finds that rates of abortion (the number of abortions per 1,000 women) are relatively unaffected by whether it is legal. Thus, in South America, where abortion is largely illegal, the rate is 33; in northern America, where it is legal, the rate is 21. “The legal status of abortion doesn’t predict whether abortions occur,” study co-author Gilda Sedgh told me by phone. “It predicts whether they are safe. South Africa liberalized its abortion laws in l997, and maternal deaths from unsafe abortion have plummeted by 90 percent.” Around the world 48 percent of abortions are unsafe–that’s more than 20 million. Some 67,000 women die from unsafe abortions–13 percent of maternal deaths, almost all of them in the developing world, where abortion is mostly restricted or banned. Many times that number are injured or maimed.
The good news is that the global trend is toward legalization: as Susan Cohen reports in the upcoming Guttmacher Policy Review, since the Beijing conference on women seventeen countries have liberalized their abortion laws, while three have tightened restrictions (including, most recently, Nicaragua, where abortion is now illegal even to save the woman’s life–thank you, Daniel Ortega). The bad news is that, due to population growth, the percentage of abortions that are unsafe has increased since 1995.
The big takeaway from the Lancet article is this: there is basically only one thing that lowers the rate of abortion for more than the minute and a half it takes women to figure out how to evade a new legal restriction: contraception. The countries with the lowest abortion rates, like the Netherlands, have few abortion restrictions and lots of birth control. Consider Eastern Europe. Under communism, abortion was virtually the only family planning method. As contraception has become more available, the abortion rate has plummeted–from 90 in 1995 to 44 in 2003. Indeed, Eastern Europe accounts for almost the entire worldwide decline in abortion in the period covered by the study. Meanwhile, for all our Sturm und Drang, with women in many states having to jump through more hoops than a circus tiger, the decline in the US abortion rate has been small.