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Department of awful statistics

16 Oct 2007 04:33 pm

I saw this on Feministing and thought: huh?

A new study by the Guttmacher Institute and the World Health Organization shows that abortion rates are similar in different countries whether the procedure is legal or not. Shocking, I know. Of course, what wasn't similar was the risk to women's health.
The study indicated that about 20 million abortions that would be considered unsafe are performed each year and that 67,000 women die as a result of complications from those abortions, most in countries where abortion is illegal.

Moral of the story? Safe, legal abortion is the best bet. Always.

This is a common meme among feminists; indeed, I myself was, in the long fled days of my youth, guilty of propagating it. I'm not quite sure why I thought that abortion was a magical exception to the rule that when you make something much harder and more costly to do, fewer people do it. In fact, the source for this oft-repeated claim turned out, when last I examined to to be fairly awful. This new claim comes with a better pedigree, but not, alas, noticeably better evidence. Here's what the New York Times has to say:

A comprehensive global study of abortion has concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women seeking it.

Moreover, the researchers found that abortion was safe in countries where it was legal, but dangerous in countries where it was outlawed and performed clandestinely. Globally, abortion accounts for 13 percent of women’s deaths during pregnancy and childbirth, and there are 31 abortions for every 100 live births, the study said.

The results of the study, a collaboration between scientists from the World Health Organization in Geneva and the Guttmacher Institute in New York, a reproductive rights group, are being published Friday in the journal Lancet.

“We now have a global picture of induced abortion in the world, covering both countries where it is legal and countries where laws are very restrictive,” Dr. Paul Van Look, director of the W.H.O. Department of Reproductive Health and Research, said in a telephone interview. “What we see is that the law does not influence a woman’s decision to have an abortion. If there’s an unplanned pregnancy, it does not matter if the law is restrictive or liberal.”

I can't see the Lancet study, which is gated. But the summary does not back up this claim. The study says that abortions are generally high in the developing world, where it is usually illegal, and low in the developed world, where it is usually legal. It also tells you that abortion is relatively unsafe in the developing world.

But it seems mad to extrapolate this to a blanket statement such as "Law does not influence a woman's decision to have an abortion." For one thing, we know of cases where the law absolutely and indisputably did exert such an influence, such as Communist Romania, where abortion bans caused the birth rate to soar. For another, societies where abortion is illegal are probably different from societies where abortion is legal in other ways, such as attitudes towards birth control. Also, enforcement of laws varies even when the laws don't (abortion was technically illegal in Germany for most of the post-war period). And finally, since the variation is almost entirely among developed countries where access to birth control may be spotty for economic, political or social reasons, this would not necessarily tell us much about developed nations. As I understand it, most abortions in America are obtained by women who have had more than one abortion, which seems to indicate that for at least some segment of the population abortion is a substitute for birth control, rather than birth.

Similarly, saying that "making abortion illegal doesn't reduce its incidence, but only makes it more dangerous" is nonsense on stilts when the comparison is largely between developed countries with legal abortion, and developing countries with illegal abortion. Having an abortion in Burundi would be more dangerous than having one in America even if their government legalized the procedure, made it free, and awarded a medal and a complimentary fruit basket to every woman who had one. I am pretty sure that abortion, like almost every other activity, gets more dangerous when it is legally prohibited. But from what I can make out, this study doesn't do a good job of demonstrating that truism.

Cross-country comparisons--what statisticians call latitudinal studies--are fraught with difficulty because of all the differences in law, enforcement, data collection, social norms, political culture, health care systems, and so forth. That's why it's important to also look at longitudinal studies--studies that examine the same place over time. And all the reputable studies I'm aware of, which to be sure are not an exhaustive list, show pretty much the expected result: if you legalize abortion, you get more of it.

In America, especially, the evidence that legalizing abortion resulted in more abortions seems pretty rock solid. Steve Levitt wrote about this in Freakonomics, and I blogged an excerpt some time ago:

In the first year after Roe v. Wade, some 750,000 women had abortions in the United States (representing one abortion for every four live births). By 1980, the number of abortions had reached 1.6 million (one for every 2.25 live births), where it levelled off. . .

To be sure, the legalization of abortion in America had myriad consequences. Infanticide fell dramatically. So did shotgun marriages, as well as the number of babies put up for adoption (which has led to the boom in adoptions of foreign babies). Conceptions rose by nearly 30 percent, but births actually fell by 6 percent, indicating that many women were using abortion as a method of birth control, a crude and drastic sort of insurance policy.

I'm still in favor of legalizing it, of course, for moral and practical reasons that I've gone into elsewhere. But the case for legal abortion stands on its own. It doesn't need nonsense statistics to back it up.

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Comments (25)

Having an abortion in Burundi would be more dangerous than having one in America even if their government legalized the procedure, made it free, and awarded a medal and a complimentary fruit basket to every woman who had one.

I don't see how you can responsibly toss out a vague, unsupported claim like that without even making a gesture at taking into consideration exactly what kind of fruit.

Well, anti-abortion activists have their nonsense statistics (abortion => breast cancer, for example), so it's only fair that pro-abortion activists should have some too.

I have mentioned this idea commenting on a Christian blog and was curious what sort of reception it would get here.

My “Biblical” belief is that life does not begin at conception. I believe, as is it says directly in Leviticus and is a major theme of the Bible, that “life is in the blood”.

If life is in the blood then there is a 22 day window when a woman may choose to terminate a pregnancy without taking a human life as the fetal heart starts beating on day 23.

This Biblical “fact” would be particularly politically convenient. Adopting the heartbeat as the start of human life makes it possible to support both a women’s right to choose and have an abolition on abortion after the life potential cells have been transformed into a human life.

I have never found a scripture that supports the life begins at conception argument, though clearly scripture does support that life begins in the womb and life begins before birth, but then I'm no theologian.

A few years ago this idea would have been a moot point, but now with day after conception pregnancy tests it seems to me there is an option for a pre-human life pregnancy termination window.

I wonder if China is considered part of "the developing world" for the study. If so, wouldn't that abnormality alone skew the results significantly enough to prevent inferences such as the claims made by the WHO/NYT?

Here's my question for you: do you really think, in the culture we live in, where affluent Americans are told again and again that they can have whatever they want, whenever they want it-- do you think these people are going to have a baby if they really, really don't want to? Do you think some rich 16 year old girl from Fairfield county or Westchester is going to have a baby, with all that that entails, when she and her parents really don't want her to? I don't know the data on whether criminalization reduces the abortion rate. But I do know that, one way or another, people with the economic resources will find a way to end their pregnancies. The question is, do you want to extend the same ability to the poor to have safe access to abortion? Because the rich will continue to get what they want. I simply don't understand how you could effectively prevent people from an outpatient procedure that can take place in hours in a small clinic.

Er, who are you asking your question of, Freddie? Who is it that you "simply don't understand"? In neither the post nor any of the comments before yours was anyone advocating any outlawing of abortion. Tom Kelley, at most, was advocating restriction of later-term abortions.

I am responding to Megan's assertion that criminalizing abortions will reduce the abortion rate, contrary to a published report. That argument is directly concerned with the ability of criminalization to prevent abortion. Er, what don't you understand about that?

As Levitt's statistics -- "Conceptions rose by nearly 30 percent, but births actually fell by 6 percent, indicating that many women were using abortion as a method of birth control" -- point out, legalized abortion in America turned out to be kind of like Homer Simpson's view of alcohol ("To alcohol, the cause of -- and the cure for -- all of life's problems"). Legalized abortion was supposed to be the cure for unwanted pregnancy, but it also turned out to be a major cause of the a new outbreak of unwanted pregnancies.

This, by the way, helps explain why Levitt's popular abortion-cut-crime theory turned out to be based on two technical errors Levitt had made. Levitt theorized that legalizing abortion increased "the wantedness" of babies and thus the quality of their upbringing, but as he admits here, it increased the number of unwanted pregnancies. The impact on who actually got born and how they were raised is unknown, but it's probably likely to have been small due to countervailing pressures.

If abortion is the solution to unwanted children then maybe euthanasia is the solution to unwanted seniors (aka the Medicare funding problem).

"for at least some segment of the population abortion is a substitute for birth control"

Presumably this is the same segment of the population that can't figure out that condoms are cheaper than abortions.

Indeed, Levitt only cited European studies claiming that women who would have had abortions make worse mothers, because the Americans studies of the question tended to point in the opposite direction -- that the more organized, forward-looking young women were more likely to have abortions than their more lackadaisical peers.

guineapigfury writes: "Presumably this is the same segment of the population that can't figure out that condoms are cheaper than abortions."

Abortions are cheaper than children, so maybe you're a member of the dimmer segment.

Which reminds me of my favorite comment ever by a "pro-life" moron - "Abortion is wrong no matter how you slice it." That one made me laugh so hard I was afraid I'd be pissing blood.

...most abortions in America are obtained by women who have had more than one abortion, which seems to indicate that for at least some segment of the population abortion is a substitute for birth control, rather than birth.

Like Megan, I'm in favor of legal abortion. Nevertheless, I had my feminist faith shaken hard many years ago when a girlfriend confided that she'd had three abortions because she didn't like "messing around" with condoms or the pill. Until then I'd thought the whole "abortion = birth control for the lazy" was a right-wing canard aimed at "the poor" or "minorities," but this woman was your standard middle-class, college-educated white girl. Since then, I've known with other women who've had multiple abortions for similar reasons: They didn't like condoms, and they didn't want to bother with the pill/IUD/cervical cap for health and/or convenience reasons.

/anecdotes

If you promise to stop commenting about reports, policies, and studies that you have ADMITTEDLY NOT EVEN READ, I will buy you a cookie.

Freddie, I still don't get it.

When I read your comment, I see the pronoun "you" six times, context clearly showing that it was referring to someone who would deny (poor) people access to legal abortion. However, I cannot find an antecedent of the pronoun, because nobody prior to your comment even implied he or she would deny anyone access to legal abortion. So, I have to ask again, to whom was your question addressed?

I'm not quite sure why I thought that abortion was a magical exception to the rule that when you make something much harder and more costly to do, fewer people do it.

This is a rule? Really? Is this from the same book of rules that states demand always drops(not a single exception!) when prices rise? That's not the rulebook for playing real life. I'm guessing that since no one has objected to this statement that no one here has kids who suddenly become intensely interested in doing something that has just been ruled out of bounds by the parents.

Mollie at getreligion.org had a post on this on Sunday. The post is "Abortion by the numbers" and she does a very thorough job in a small space.

I have read the Lancet study, and it does not support many of the things said about it. The main thrust of the study is estimating abortion rates around the world (updating a previous set of estimates).

They also remark on the correlation between safe abortions and legality . . . when, by their definition of a safe abortion, every legal abortion is safe, and nearly every illegal abortion is unsafe (they put a few countries where abortions are de facto legal in with the safe abortions). That they observe a correlation is, perhaps, unsurprising.

The study is useful for providing further data for other studies, but they don't even provide the sketch of an analysis that would allow for the conclusions being bandied about.

Look, I doubt the Lancet study says everything people are trying to make it say. But Megan has the resources of the Atlantic at her back - the least we could expect from her is to obtain and read the study before criticizing. That's what journalists do - they RESEARCH.

"I'm not quite sure why I thought that abortion was a magical exception to the rule that when you make something much harder and more costly to do, fewer people do it."

"Much harder" might be the rub. Personally, I'd like to think that legalizing drugs would have little influence on their use - and honestly suspect that it would not make a great deal of difference - but then, right now, accessing drugs is really not "much harder" than it would be if it were legal. I've never had the opportunity to look for an illegal abortion, so I really can't compare.

I agree with most of your points, though.

(by the way, your "Remember personal info" doesn't seem to function at all - I have to re-enter everything EVERY time)

In my small, conservative home town, "good" school girls, especially the Catholics, were probably responsible for a large part of the abortion rate, both before and after it was legalized. They'd never take the pill or equip themselves with any contraceptive because that would be admitting to themselves that they intended to sin, but if they got pregnant theyd start thinking about the much worse sin of abortion. (Another Catholic/conservative influence: condoms could be purchased only at drug stores - not only did that make them much more expensive, but the stores closed at 5:00 so too bad for the boy that wasn't expecting to "get lucky" that night...) Likewise, I think a good part of Lancet's failure to find a consistent correlation between abortion laws and abortion rates is that in the countries with the strictest abortion laws, contraceptives are either banned or heavily discouraged socially. A ban on prescription pharmaceuticals and rubber devices is rather easier to enforce than a ban on doctors performing a well-known procedure using equipment that every gynecologist needs for other medical purposes.

IIRC, the very highest rates are in Japan and in some former Soviet countries, where abortion has long been legal and either more readily available or more widely used than contraception. I know that in Russia this was the effect of government policies - when the government ran the economy, keeping a supply of the Pill or rubber devices in the stores was never a government priority, but providing medical clinics with a certain minimum level of equipment and manning was - and that was sufficient for the clinics to perform abortions. The policies may have changed now, but the people are used to getting abortions instead of contraception, and its probably going to take generations for the realization that contraception is cheaper and safer to percolate through the society. I dont know about Japan, whether it started as a similar war-time market distortion, or there is some kind of cultural aversion to contraceptives coupled with less guilt about killing babies.

There really is something quite puzzling about people who have unprotected sex because they are too embarrassed/ashamed/cowed by religion, to buy some condoms or use other BC.

When I was a teenager, I loved buying condoms, because it was an outward sign (at least to the CVS clerk) that I was getting some. After all, if I wasn't happy about having sex, then why would I be having sex?

Meanwhile, my Catholic girlfriends would have unprotected sex quite frequently, and complain that they didn't even enjoy themselves, because, after all, it's sinful. They just let their boyfriends do what they wanted. I even heard several girls explain their unplanned pregnancies by saying that their boyfriends thought using birth control was a sin (I guess Jesus was totally thrilled that they were having adulterous relations).

If I could get one point across to teenaged girls it would be: boys will take sex any way they can have it, so for the love of Pete, at least make sure you want it and it's on your terms. And get on the Pill.

Well said.

As for the impact of legalization, I think it's spotty. Yeah, one woman might end up able to access an abortion at a clinic run by Charlotte Taft or Warren Hern. She, and others like her, will probably get safer abortions than if they'd had to fish around for somebody on the sly. But I know of three former criminal aborionists -- Milan Vuitch, Jesse Ketchum, and Benjamin Munson -- who had clean records prior to legalization, no maternal deaths attributed to them. All of them got sloppy in their practices after legalization. Each managed to kill two patients. Ketchum managed to kill two in just four months.

So the improvement in care for some women might be offset by the deterioration in care other women get. I think Vuitch's, Ketchum's, and Munson's patients would have been better off had these guys had the fear of prison sentences hanging over their heads.

The Milan Vuitch stuff is pretty horrible. Linda Greenhouse's obit is entitled "Milan Vuitch, 78, Fighter for Abortion Rights," and somehow manages to skip the perforated uteruses, sloppy medical practices, and wrongful deaths.

Freddie asks:

Here's my question for you: do you really think, in the culture we live in, where affluent Americans are told again and again that they can have whatever they want, whenever they want it-- do you think these people are going to have a baby if they really, really don't want to?

Freddie,

You have constructed a narrative that is useful for thinking about policy in moral terms (is it fair to ban abortion when the ban has a bigger impact on the poor's behavior than the rich's?).

Nevertheless, it does not tell us whether a ban will be effective in reducing the number of abortions by rich women because the narrative only has one protagonist. Of 100 such women, 95 have the abortion now, but fewer (say 80) would do it if it were illegal. That's still the vast majority, consistent with your story, but making something a little more costly (in terms of money, hassle, social status, whatever) always causes at least a few people, on the margin, to act differently.

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