Are there fewer abortions in countries where abortion is illegal?
The question sounds simple. But it’s hard to answer, says social demographer Jonathan Bearak of the Guttmacher Institute. That’s largely because in places with strict abortion laws, the procedure is almost completely hidden. Estimating the number of abortions is therefore extremely difficult.
Nevertheless, scientists from the World Health Organization and the Guttmacher Institute have developed tools over the past two decades to estimate the abortion rate around the world. Both institutions support abortion rights for people around the world. Last February, they published the abortion figures for almost every country for the first time. And they’ve also updated their analysis to look at how abortion rates vary between regions of the world — and whether the legality of the procedure is related to those rates.
“So let’s say you group the countries where abortion is broadly legal,” said Bearak, who led the study. “And then you group countries where abortion is completely banned, also without exception for women’s health.”
Which group has the highest abortion rate?
This is what they found. In countries where abortion is broadly legal, between 36 and 47 abortions are performed per 1,000 women aged 15 to 49 years. And what about countries where abortion is completely banned? “In these countries, there are an average of between 31 and 51 abortions per 1,000 women every year,” Bearak said.
“People may be surprised by the findings,” he says, “because the rates are basically the same in the two groups of countries.”
How is that possible?
In countries where abortion is generally legal, birth control use is quite high, Bearak and his team found. That’s because these countries tend to be wealthier and have strong health care systems. “If you have a stronger health care system and universal access to sexual reproductive health care, you should expect a lower unintended pregnancy rate,” Bearak says. And so, the rate of unintended pregnancies tends to be low (between 53 and 66 unintended pregnancies per 1,000 women, ages 15 to 49). But the percentage of those pregnancies that end in abortion is higher because abortions are generally accessible.
By contrast, in countries where abortion is severely restricted, birth control use is low, his team found. And so the rate of unintended pregnancies is high (between 70 and 91 unintended pregnancies per 1,000 women, ages 15 to 49). But the percentage of those pregnancies that end in abortion is low, probably because abortions are not easily accessible.
So, Bearak says, ultimately, highly restrictive abortion laws don’t correlate with a lower abortion rate. Instead, those laws correlate with more unintended pregnancies, ultimately leading to an abortion rate similar to what’s seen in countries where the procedure is accessible.
That finding is consistent with several previous studies, including a large one published in 2012 by the Guttmacher Institute and covered by Goats and Soda in 2014.
“Many studies have shown that making abortions illegal does not reduce the number of abortions,” Ana Langer of the Harvard TH Chan School of Public Health told NPR. “Once a procedure becomes illegal, the need is still there. Women will look for services, safe or unsafe, to terminate their pregnancy.”
Now, there are many caveats to the new study. For starters, health officials in some countries collect very little data on abortion procedures. So Bearak and his team had to estimate the number of abortions and unintended pregnancies based on a computer model. They built that model based on research data collected through a United Nations initiative that tracks the “prevalence of contraception and the unmet need for family planning” around the world.
“These are large global health surveys that are conducted at regular intervals,” Bearak says, “asking women, ‘Okay, you gave birth. Was this unintentional?'” His team then combined this data with known abortion statistics to create a computer model that could detect unintended consequences. pregnancies and abortion rates where data were insufficient. “Because these estimates are model-based, they involve uncertainty,” he explains.
In addition, Bearak says, their estimates cannot assess how change abortion laws in a country may or may not change rates in the short term. In the US, for example, some states, including Texas, are currently tightening abortion laws.
“So we can definitely see early evidence in Texas that people are having trouble accessing abortions, which makes intuitive sense,” Bearak says. And so the restrictions in Texas are likely to lead to lower abortion rates in the near term. “But exactly how that will work out in the long term remains to be seen. We don’t know how people will adapt.”
An important way women “adapt” is to request abortions in nearby places, where the procedure is legal, or to seek illegal abortions, said Fatima Juárez, a demographer at El Colegio de México in Mexico City. Juárez’s research focuses on the reproductive health of young people.
In places where abortion is illegal, she says, it can be difficult to get a safe abortion – that is, an abortion where the risk of serious complications is extremely low.
In a study published in 2019, Juárez and her colleagues interviewed women across Mexico about their experiences with abortions. The team focused on three states with varying levels of restriction, from few restrictions in the state of Mexico to high restrictions in the state of Queretaro.
“What we found was that in states where abortion is illegal, it’s very difficult for a woman to control the outcome of the abortion. There’s an element of chance,” Juárez says — a chance that the abortion could become unsafe.
So while the total number of abortions doesn’t correlate well with the legality of the procedure, the number of unsafe abortions shows a strong relationship with local abortion laws, says Dr. Bela Ganatra, who leads the World Health Organization’s Prevention of Unsafe Abortion.
“We found that in countries where abortion is legal — and available to women on request — 9 out of 10 abortions are safe,” says Ganatra. “But if you look at countries where abortion is the most restricted, only 1 in 4 abortions are safe.”
“But it’s not just the law that matters,” she adds. To reduce the number of unsafe abortions in a country, people should also: access to secure abortions, she says. “Just because the law changes and abortion is allowed doesn’t automatically mean that unsafe abortion will go away. Clinics must have the drugs, they must train practitioners, and they must actually make the services available.
“Changing the Law” [to allow abortions] necessary to reduce the number of unsafe abortions. It’s a step, but it’s not just about the law,” added Ganatra.