Women Will Get Abortions, Legal or Not, so Keep it Safe

For years feminists and abortion rights supporters 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 clichA-A?A 1/2, 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, 17 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 storm and stress, with women in many states having to jump through more hoops than a circus tiger, the decline in the U.S. abortion rate has been small.

I was curious to know how abortion opponents would respond to what certainly seems like a devastating refutation of their position. "Anybody can look at data and pick and choose whatever they want," Jim Sedlak, vice president of the American Life League, told me. "The real fact is that abortion is ending life in the womb and should never be legal." I asked him if he accepted the finding that abortion was more dangerous where it was illegal. No, he said. "When something is illegal, people are more careful." So legal abortion is more unsafe? According to Sedlak, it is indeed.

As for contraception lowering the rate of abortion, that's an illusion: Contraception is abortion. "Most methods of birth control kill babies in the womb by preventing implantation," said Sedlak, who'd like to see the pill, the IUD and most other methods outlawed. The American Life League, although not an official Catholic organization, explicitly follows Catholic teaching -- unlike most Catholics, as Sedlak admitted. But so far as I know (and Sedlak agreed with me here) there is no organization that opposes abortion and endorses contraception. Not one. Even Democrats for Life of America has refused to support congressional legislation expanding funding for contraception. "Between Title X and Medicaid, the government has made a tremendous investment in contraception," DLA Executive Director Kristen Day told me. Actually, the government has done the opposite. Title X, which finances contraception for low-income women, has 61 percent less money in real terms than it had in 1980, to serve a much larger population. Had funding merely kept pace with inflation, it would be more than $725 million, instead of $283 million. As for Medicaid, skewed eligibility rules actually deny contraceptive benefits to many poor women who qualify for pregnancy care.

In the past few months, due to a technicality in the 2005 Deficit Reduction Act, the price of contraception in campus clinics has skyrocketed, from around $15 for a pack of pills to more than $50. Some college health centers have simply stopped offering the pill. When you consider that 3 million college women take the pill -- 38 percent of female students -- you can see the disaster in the making. That won't bother the new head of the Health and Human Services Office of Family Planning, Susan Orr, a longtime opponent of birth control formerly with the Family Research Council. "We're quite pleased, because fertility is not a disease," Orr told The Washington Post in 2001, praising a Bush proposal to stop mandating contraceptive coverage in federal employees' health plans.

Between facts and theology, abortion opponents choose the latter every time.

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