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Policy Insights

To Reduce Abortion Incidence, Do Not Restrict Abortion Supply. Reduce Demand.

By Mark Levels
Source: areeya_ann

Making modern contraceptives cheap, available and socially acceptable is the only policy that works in reducing unintended pregnancies, demand for abortion services, and ultimately, abortion incidence.

Research into abortion has mostly looked into the relationship between individuals’ and/or societal characteristics and abortion incidence. An exclusive focus on this association is not enough to determine why people end pregnancies. Abortion is not a stand-alone act. It results from a process that starts with women’s decisions to use contraceptives, continues with the occurrence of a pregnancy and ultimately ends with the decision to actively terminate that pregnancy. To explain why women eventually have an abortion, and to understand the effects of policies and laws intended to regulate reproductive behaviours, this entire process must be examined.

In 2012, my colleagues and I examined this process (Levels et al., 2012). Our study looked at unintended pregnancy and induced abortion in the Netherlands for the period between 1952 and 2002. The Netherlands was among the first Western countries to legalise abortion in 1984, and safe abortion services have been accessible since 1971, when the first specialised abortion clinic opened. Based on the most recent and most elaborate retrospective individual-level data available on reproductive health and decision-making at that time, our study shows that abortion laws do indeed affect abortion behaviour. Liberalising the abortion law and increased access to abortion providers was associated with a higher probability that women turn to induced abortion to terminate an unintended pregnancy. However, that does not explain why Dutch abortion rates were and are so low. Our study strongly suggests that it is the availability and insured access to modern contraceptives that explains why abortion in the Netherlands is cheap, safe, legal and incredibly rare.

Let’s turn now to studies looking at the role played by laws prohibiting abortion. There is some controversy in the literature, but I would argue that overall, the research with the most convincing designs shows that restricting abortion access will probably reduce abortion, but only marginally. It has many other effects, though. The classic example is Romania's 1966 Anti-Abortion Decree. Fertility spiked after abortion was made illegal in the country (Berelson, 1979), but the initial fertility spike quickly petered out. Women, however, continued to rely on (illegal, unsafe) abortion for birth control, also in the absence of modern contraceptives. This led to a stark increase of maternal death rates (Grimes et al., 2006) that dropped after 1989 when the restrictive abortion law was overturned. At that time, Romania had the highest maternal death rate in Europe (Hord et al., 1991). Unintended effects ripple through the generations, as children born under the ban did worse at school and were less successful in the labour market (Pop-Eleches, 2006). Other countries also provide helpful evidence for how women seek abortions even in countries with restrictive laws. For example, Ireland had one of the most restrictive abortion laws. Large numbers of Irish women travelled to England to obtain abortions (Bloomer and O'Dowd, 2014). Same is true for Poland (Nowicka, 2006).

The problem with restricting abortion laws is that legal restrictions do not reduce the demand for abortion. Modern contraceptives do. Therefore, to reduce abortion incidence, improving access to modern, effective contraceptives is very likely the most effective policy.

 

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