Confronting the Pro-Choice Stance, Honestly

Above: Pro-life youth demonstrate outside the Supreme Court; in the
background, a sign reads “Keep abortion safe and legal.”

Last week, The Atlantic published an article by Caitlin Flanagan entitled “The Dishonesty of the Abortion Debate: Why we need to face the best arguments from the other side.” I encourage you to read the whole thing. Flanagan, who is pro-choice, did an admirable job of identifying the best arguments on each side of the abortion debate.

For the pro-life side, she gave a heartfelt defense of children in the womb. While there are many other ways to arrive at the pro-life position—such as abortion’s harm to mothers, fathers, abortion survivors, people with disabilities, and society at large—I agree that the harm to the unborn child is paramount. And boy, does she write it well. No one can accuse her of failing to understand the opposing position:

What I can’t face about abortion is the reality of it: that these are human beings, the most vulnerable among us, and we have no care for them. How terrible to know that in the space of an hour, a baby could be alive—his heart beating, his kidneys creating the urine that becomes the amniotic fluid of his safe home—and then be dead, his heart stopped, his body soon to be discarded.

For the pro-choice side, she selected the fear of “back-alley” abortion as the strongest argument. This is apparently the argument that most convinces her personally. She tells the tragic stories of three mothers in the 1950’s who died after attempting to abort their babies with Lysol (which had a different formula than it does today). She concludes:

Women have been willing to risk death to get an abortion. When we made abortion legal, we decided we weren’t going to let that happen anymore. We were not going to let one more woman arrive at a hospital with her organs rotting inside of her. We accepted that we might lose that growing baby, but we were not also going to lose that woman.

It’s the best available argument for abortion. And it’s wrong, for at least three reasons.


(1) Roe v. Wade didn’t reduce the maternal death rate from illegal abortion. 

Flanagan assumes that making abortion legal made it safer, but doesn’t offer any evidence for that assumption beyond a correlation-is-causation argument; since women are no longer showing up in hospitals after surreptitious Lysol abortions, Roe must have been the answer! That’s a weak case, and the data just don’t back it up.

Whenever I give presentations on college campuses, I share this graph from the National Center for Health Statistics, showing maternal deaths from illegal abortions by year—but with the x-axis, the year, erased.

I then ask a brave audience volunteer to guess where 1973, the year of Roe v. Wade, falls on the graph. Most select a peak, in line with the narrative that Roe v. Wade caused maternal deaths to plummet. Invariably, they guess wrong:

Roe v. Wade isn’t even a blip on the graph. Forget “correlation doesn’t equal causation”—they don’t even have correlation! The real savior of women’s lives? Advances in antibiotics.

(2) A lot has changed since the 1950’s.

And not just antibiotics. Flanagan herself acknowledges that it “was illegal to advertise contraception nationally until 1977,” four years after Roe; today, you can pick up condoms at any corner drugstore, and prescription contraceptives are widely available. Pregnancy discrimination was perfectly legal at the time of Roe; today, it’s prohibited by federal law. Women couldn’t get credit cards in their own name at the time of Roe; today, it’s unquestioned. Marital rape wasn’t criminalized in all 50 states until two decades after Roe. And I haven’t even mentioned that today, pro-life pregnancy centers outnumber abortion businesses. Using the 1950’s to predict a post-Roe future is wildly unrealistic.

(3) Legal abortion is still killing women.  

Tonya Reaves. Jennifer Morbelli. Maria Santiago. Lakisha Wilson. Christin Gilbert. The list goes on. The pro-life movement can tell stories just as tragic as the “back-alley” stories Flanagan shares. The fact that their abortions were legal doesn’t make them any less dead.

I appreciate Flanagan’s attempt to engage the pro-life position honestly. It’s the best article from an abortion supporter I’ve seen since Shawna Kay Rodenberg’s piece in Salon two years ago. I hope Flanagan will keep digging, keep following her conscience, and become the next convert to the pro-life cause.

Confronting the Pro-Choice Stance, Honestly

Above: Pro-life youth demonstrate outside the Supreme Court; in the
background, a sign reads “Keep abortion safe and legal.”

Last week, The Atlantic published an article by Caitlin Flanagan entitled “The Dishonesty of the Abortion Debate: Why we need to face the best arguments from the other side.” I encourage you to read the whole thing. Flanagan, who is pro-choice, did an admirable job of identifying the best arguments on each side of the abortion debate.

For the pro-life side, she gave a heartfelt defense of children in the womb. While there are many other ways to arrive at the pro-life position—such as abortion’s harm to mothers, fathers, abortion survivors, people with disabilities, and society at large—I agree that the harm to the unborn child is paramount. And boy, does she write it well. No one can accuse her of failing to understand the opposing position:

What I can’t face about abortion is the reality of it: that these are human beings, the most vulnerable among us, and we have no care for them. How terrible to know that in the space of an hour, a baby could be alive—his heart beating, his kidneys creating the urine that becomes the amniotic fluid of his safe home—and then be dead, his heart stopped, his body soon to be discarded.

For the pro-choice side, she selected the fear of “back-alley” abortion as the strongest argument. This is apparently the argument that most convinces her personally. She tells the tragic stories of three mothers in the 1950’s who died after attempting to abort their babies with Lysol (which had a different formula than it does today). She concludes:

Women have been willing to risk death to get an abortion. When we made abortion legal, we decided we weren’t going to let that happen anymore. We were not going to let one more woman arrive at a hospital with her organs rotting inside of her. We accepted that we might lose that growing baby, but we were not also going to lose that woman.

It’s the best available argument for abortion. And it’s wrong, for at least three reasons.


(1) Roe v. Wade didn’t reduce the maternal death rate from illegal abortion. 

Flanagan assumes that making abortion legal made it safer, but doesn’t offer any evidence for that assumption beyond a correlation-is-causation argument; since women are no longer showing up in hospitals after surreptitious Lysol abortions, Roe must have been the answer! That’s a weak case, and the data just don’t back it up.

Whenever I give presentations on college campuses, I share this graph from the National Center for Health Statistics, showing maternal deaths from illegal abortions by year—but with the x-axis, the year, erased.

I then ask a brave audience volunteer to guess where 1973, the year of Roe v. Wade, falls on the graph. Most select a peak, in line with the narrative that Roe v. Wade caused maternal deaths to plummet. Invariably, they guess wrong:

Roe v. Wade isn’t even a blip on the graph. Forget “correlation doesn’t equal causation”—they don’t even have correlation! The real savior of women’s lives? Advances in antibiotics.

(2) A lot has changed since the 1950’s.

And not just antibiotics. Flanagan herself acknowledges that it “was illegal to advertise contraception nationally until 1977,” four years after Roe; today, you can pick up condoms at any corner drugstore, and prescription contraceptives are widely available. Pregnancy discrimination was perfectly legal at the time of Roe; today, it’s prohibited by federal law. Women couldn’t get credit cards in their own name at the time of Roe; today, it’s unquestioned. Marital rape wasn’t criminalized in all 50 states until two decades after Roe. And I haven’t even mentioned that today, pro-life pregnancy centers outnumber abortion businesses. Using the 1950’s to predict a post-Roe future is wildly unrealistic.

(3) Legal abortion is still killing women.  

Tonya Reaves. Jennifer Morbelli. Maria Santiago. Lakisha Wilson. Christin Gilbert. The list goes on. The pro-life movement can tell stories just as tragic as the “back-alley” stories Flanagan shares. The fact that their abortions were legal doesn’t make them any less dead.

I appreciate Flanagan’s attempt to engage the pro-life position honestly. It’s the best article from an abortion supporter I’ve seen since Shawna Kay Rodenberg’s piece in Salon two years ago. I hope Flanagan will keep digging, keep following her conscience, and become the next convert to the pro-life cause.

Male abuser gets abortion pills online; vendor shows no remorse


Mother Jones has an article in its April/May issue entitled “She Started Selling Abortion Pills Online. Then the Feds Showed Up.”

Quick pause for alternate headlines that more accurately capture the tone of the piece:
  • She Broke The Law. But It Was An Abortion Law, So It Shouldn’t Have Counted.
  • Evil Police Fail to Recognize That Brave Abortion Provider is Above the Law. 
  • Abortion Access Uber Alles 
Anyway, moving on. The article is about Ursula Wing, who sold abortion drugs out of her apartment and advertised in the comments section of a blog. This is, unsurprisingly, illegal. As stated in the article, abortion drugs “may be distributed only in a clinical setting by a certified provider” per FDA regulations. 
Ms. Wing did it anyway, because “she needed money to pay legal fees during a protracted custody dispute with her former partner.” She didn’t see herself as an activist at first, although she was an abortion supporter and had herself terminated the life of one of her children with drugs purchased over the internet before becoming a vendor.
She sold abortion drugs to over 2,000 customers before finally getting caught. And how was she caught? Glad you asked:

An attorney told her that the FDA learned about her business when a Wisconsin man named Jeffrey Smith was arrested in February 2018 for allegedly slipping mifepristone into the drink of a woman who was pregnant with their child. Smith had twice ordered packages from Wing’s site, according to police documents. He has pleaded not guilty to attempted first-degree homicide of an unborn child. Wing is still waiting to be indicted.

If Ms. Wing were actually “pro-choice,” actually a feminist, actually cared at all about women, you’d think she would be horrified that her product was used to end a wanted pregnancy against a woman’s will. You’d expect, at the very least, some discussion of how online abortion vendors might verify that their customers are actually pregnant. (Kind of like those FDA-certified people verify in a “clinical setting.” Gosh, might there be a reason for that requirement?)
But no, of course not.

Among people advocating or providing access to self-managed abortion, there is some tension between those who aim to serve women in need without drawing attention and those who want to stir things up. Wing has found herself unexpectedly in the latter group. She was glad to go on quietly undermining the law, providing pills to customers who came across her website. Now, against her own attorney’s advice, she’s speaking out. “I want some copycats,” she says. “There’s not enough people doing this.”

She wants copycats. She wants more women put at risk. She thinks she’s a hero
I hope Ms. Wing is indicted as an accessory to homicide, and soon, before anyone else gets hurt.
P.S.—In October 2017, the ACLU sued the FDA to get rid of the abortion drug restrictions. If the ACLU is successful, abortion will become even more “accessible” to abusive men. The lawsuit is ongoing.

Male abuser gets abortion pills online; vendor shows no remorse


Mother Jones has an article in its April/May issue entitled “She Started Selling Abortion Pills Online. Then the Feds Showed Up.”

Quick pause for alternate headlines that more accurately capture the tone of the piece:
  • She Broke The Law. But It Was An Abortion Law, So It Shouldn’t Have Counted.
  • Evil Police Fail to Recognize That Brave Abortion Provider is Above the Law. 
  • Abortion Access Uber Alles 
Anyway, moving on. The article is about Ursula Wing, who sold abortion drugs out of her apartment and advertised in the comments section of a blog. This is, unsurprisingly, illegal. As stated in the article, abortion drugs “may be distributed only in a clinical setting by a certified provider” per FDA regulations. 
Ms. Wing did it anyway, because “she needed money to pay legal fees during a protracted custody dispute with her former partner.” She didn’t see herself as an activist at first, although she was an abortion supporter and had herself terminated the life of one of her children with drugs purchased over the internet before becoming a vendor.
She sold abortion drugs to over 2,000 customers before finally getting caught. And how was she caught? Glad you asked:

An attorney told her that the FDA learned about her business when a Wisconsin man named Jeffrey Smith was arrested in February 2018 for allegedly slipping mifepristone into the drink of a woman who was pregnant with their child. Smith had twice ordered packages from Wing’s site, according to police documents. He has pleaded not guilty to attempted first-degree homicide of an unborn child. Wing is still waiting to be indicted.

If Ms. Wing were actually “pro-choice,” actually a feminist, actually cared at all about women, you’d think she would be horrified that her product was used to end a wanted pregnancy against a woman’s will. You’d expect, at the very least, some discussion of how online abortion vendors might verify that their customers are actually pregnant. (Kind of like those FDA-certified people verify in a “clinical setting.” Gosh, might there be a reason for that requirement?)
But no, of course not.

Among people advocating or providing access to self-managed abortion, there is some tension between those who aim to serve women in need without drawing attention and those who want to stir things up. Wing has found herself unexpectedly in the latter group. She was glad to go on quietly undermining the law, providing pills to customers who came across her website. Now, against her own attorney’s advice, she’s speaking out. “I want some copycats,” she says. “There’s not enough people doing this.”

She wants copycats. She wants more women put at risk. She thinks she’s a hero
I hope Ms. Wing is indicted as an accessory to homicide, and soon, before anyone else gets hurt.
P.S.—In October 2017, the ACLU sued the FDA to get rid of the abortion drug restrictions. If the ACLU is successful, abortion will become even more “accessible” to abusive men. The lawsuit is ongoing.

More evidence that abortion restrictions decrease abortion rates.

As a follow up to our previous post (Pro-life laws stop abortions. Here’s the evidence.) here in chronological order are more studies suggesting that abortion restrictions do decrease abortion—and not just legal abortion, but abortion in general. Note how many of the studies focus on how abortion policy affects birth rates rather than only the abortion rate itself.

“If all states observed the Hyde Amendment restrictions, many thousands of Medicaid-eligible women who would have obtained abortions under the 1977 funding policy would not receive them.” The impact of restricting Medicaid financing for abortion. Family Planning Perspectives, June 1980

“Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States.” Trends in rates of live births and abortions following state restrictions on public funding of abortion. Public Health Reports, December 1990

“The data show that 13% fewer had abortions in August through December than would have been expected on the basis of the number who had abortions in January through July.” The Effects of Mandatory Delay Laws on Abortion Patients and Providers, Family Planning Perspectives, October 1994

“A maximal estimate suggests that 22 percent of the abortions among low-income women that are publicly funded do not take place after funding is eliminated.” State Abortion Rates: The Impact of Policies, Providers, Politics, Demographics, and Economic Environment, Journal of Health Economics, October 1996.

“Access variables, including the restrictiveness of state laws regulating abortion, state funding of abortions for poor women and the availability of hospital abortions, affect abortion rates directly.” The role of access in explaining state abortion rates, Social Science & Medicine, April 1997

“The incidence of abortion is found to be lower in states where access to providers is reduced and state policies are restrictive.” The effects of economic conditions and access to reproductive health services on state abortion rates and birthrates. Family Planning Perspectives, April 1997

“The decline in geographic access to abortion providers during the 1980s accounted for a small but significant portion of the rise in the percentage of women heading families.” State abortion policy, geographic access to abortion providers and changing family formation. Family Planning Perspectives. December 1998.

“States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged.” Roe v. Wade and American fertility, American Journal of Public Health, February 1999

“The Texas parental notification law was associated with a decline in abortion rates among minors from 15 to 17 years of age.” Changes in Abortions and Births and the Texas Parental Notification Law, The New England Journal of Medicine, March 2006

“Our results indicate that much of the reduction in fertility at the time abortion was legalized was permanent in that women did not have more subsequent births as a result.” Abortion Legalization and Lifecycle Fertility, The Journal of Human Resources, 2007

“The empirical results find that increases in the price of an abortion and the enforcement of a Parental Involvement Law decrease the number of infants available for adoption in a state. States that do not fund Medicaid abortions do not have higher rates of infant relinquishment.” The effect of abortion costs on adoption in the USA, International Journal of Social Economics, 2008

“Overall, the results show that laws that increased minors’ access to abortion in the 1960s and 1970s had a larger impact on minors’ birthrates than laws that increased oral contraceptive access.” Fertility Effects of Abortion and Birth Control Pill Access for Minors, Demography, November 2008

“Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable.” Restrictions on Medicaid Funding for Abortions: A Literature Review, Guttmacher Institute, June 2009

“Robustness tests supported the association between access to abortion and decreased birthrates, while the relationship between access to the pill and birthrates received less support.” Abortion or Pill Access Is Associated with Lower Birthrates Among Minors, Perspectives on Sexual and Reproductive Health, March 2009

“Minors in states with mandatory waiting periods were more than two times as likely to report an unintended birth.” How Are Restrictive Abortion Statutes Associated With Unintended Teen Birth? Journal of Adolescent Health, August 2010

“A series of regressions on a comprehensive time series cross-sectional data set provides evidence that several types of state-level anti-abortion legislation result in statistically significant declines in both the abortion rate and the abortion ratio.” Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era, State Politics & Policy Quarterly, March 2011

“[If Roe v. Wade were overturned] abortion rates would fall by 14.9 percent nationally, resulting in at most, 178,800 additional births or 4.2 percent of the U.S. total in 2008. A ban in 17 states would result in a 6.0 percent decline in abortions and at most, 1.7 percent rise in births.” Back to the Future? Abortion Before & After Roe, National Bureau of Economic Research, August 2012

“The empirical results add to the substantial body of peer-reviewed research which finds that public funding restrictions, parental involvement laws, and properly designed informed consent laws all reduce the incidence of abortion.” Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era – A Reassessment, State Politics & Policy Quarterly, July 2014

“We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term.” Denial of Abortion Because of Provider Gestational Age Limits in the United States American Public Health Association August 2014

“I estimate an increase in the birthrate of 4% to 12% when abortion is restricted. In the absence of anti-abortion laws, fertility would have been 5% to 12% lower in the early twentieth century.” The Effect of Anti-Abortion Legislation on Nineteenth Century Fertility, Demography, June 2015

“Counties with no facility in 2014 but no change in distance to a facility between 2012 and 2014 had a 1.3% (95% CI, −1.5% to 4.0%) decline in abortions. When the change in distance was 100 miles or more, the number of abortions decreased 50.3% (95% CI, 48.0% to 52.7%).” Change in Distance to Nearest Facility and Abortion in Texas, 2012 to 2014 Journal of the American Medical Association, January 2017

“Increases in distance have significant effects for women initially living within 200 miles of a clinic. The largest effect is for those nearest to clinics for whom a 25-mile increase reduces abortion 10%.” How Far is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions National Bureau of Economic Research, May 2017

“This law caused an increase in viewing rates and a statistically significant but small increase in continuing pregnancy rates.” Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study PLoS One July 2017

“We estimate that over the past 25 years, parental involvement laws have resulted in half a million additional teen births.” Did Parental Involvement Laws Grow Teeth? The Effects of State Restrictions on Minors’ Access to Abortion, Institute for the Study of Labor, August 31, 2017 (See the SPL blog post about this specific paper here.)

“Trends in sexual behavior suggest that young women’s increased access to the birth control pill fueled the sexual revolution, but neither these trends nor difference-in-difference estimates support the view that this also led to substantial changes in family formation. Rather, the estimates robustly suggest that it was liberalized access to abortion that allowed large numbers of women to delay marriage and motherhood.” The Power of Abortion Policy: Reexamining the Effects of Young Women’s Access to Reproductive Control, Journal of Political Economy, November 2017

“Participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one…more participants who had considered abortion in Louisiana than Maryland reported a policy-related reason (primarily lack of funding for the abortion) as a reason (22% Louisiana, 2% Maryland, p < 0.001).” Consideration of and Reasons for Not Obtaining Abortion Among Women Entering Prenatal Care in Southern Louisiana and Baltimore, Maryland, Sexuality Research and Social Policy, October 2018

“Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14%.” Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion BMC Women’s Health, June 2019

“Greater exposure to ARs [abortion restrictions] was associated with increased risk of UIB [unintended birth].” Implications of Restrictive Abortion Laws on Unintended Births in the U.S.: A Cross-Sectional Multilevel Analysis APHA’s 2019 Annual Meeting and Expo, November 2019

“We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy….Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion.” Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions PLOS ONE January 2020

Further reading:

More evidence that abortion restrictions decrease abortion rates.

As a follow up to our previous post (Pro-life laws stop abortions. Here’s the evidence.) here in chronological order are more studies suggesting that abortion restrictions do decrease abortion—and not just legal abortion, but abortion in general. Note how many of the studies focus on how abortion policy affects birth rates rather than only the abortion rate itself.

“If all states observed the Hyde Amendment restrictions, many thousands of Medicaid-eligible women who would have obtained abortions under the 1977 funding policy would not receive them.” The impact of restricting Medicaid financing for abortion. Family Planning Perspectives, June 1980

“Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States.” Trends in rates of live births and abortions following state restrictions on public funding of abortion. Public Health Reports, December 1990

“The data show that 13% fewer had abortions in August through December than would have been expected on the basis of the number who had abortions in January through July.” The Effects of Mandatory Delay Laws on Abortion Patients and Providers, Family Planning Perspectives, October 1994

“A maximal estimate suggests that 22 percent of the abortions among low-income women that are publicly funded do not take place after funding is eliminated.” State Abortion Rates: The Impact of Policies, Providers, Politics, Demographics, and Economic Environment, Journal of Health Economics, October 1996.

“Access variables, including the restrictiveness of state laws regulating abortion, state funding of abortions for poor women and the availability of hospital abortions, affect abortion rates directly.” The role of access in explaining state abortion rates, Social Science & Medicine, April 1997

“The incidence of abortion is found to be lower in states where access to providers is reduced and state policies are restrictive.” The effects of economic conditions and access to reproductive health services on state abortion rates and birthrates. Family Planning Perspectives, April 1997

“The decline in geographic access to abortion providers during the 1980s accounted for a small but significant portion of the rise in the percentage of women heading families.” State abortion policy, geographic access to abortion providers and changing family formation. Family Planning Perspectives. December 1998.

“States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged.” Roe v. Wade and American fertility, American Journal of Public Health, February 1999

“The Texas parental notification law was associated with a decline in abortion rates among minors from 15 to 17 years of age.” Changes in Abortions and Births and the Texas Parental Notification Law, The New England Journal of Medicine, March 2006

“Our results indicate that much of the reduction in fertility at the time abortion was legalized was permanent in that women did not have more subsequent births as a result.” Abortion Legalization and Lifecycle Fertility, The Journal of Human Resources, 2007

“The empirical results find that increases in the price of an abortion and the enforcement of a Parental Involvement Law decrease the number of infants available for adoption in a state. States that do not fund Medicaid abortions do not have higher rates of infant relinquishment.” The effect of abortion costs on adoption in the USA, International Journal of Social Economics, 2008

“Overall, the results show that laws that increased minors’ access to abortion in the 1960s and 1970s had a larger impact on minors’ birthrates than laws that increased oral contraceptive access.” Fertility Effects of Abortion and Birth Control Pill Access for Minors, Demography, November 2008

“Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable.” Restrictions on Medicaid Funding for Abortions: A Literature Review, Guttmacher Institute, June 2009

“Robustness tests supported the association between access to abortion and decreased birthrates, while the relationship between access to the pill and birthrates received less support.” Abortion or Pill Access Is Associated with Lower Birthrates Among Minors, Perspectives on Sexual and Reproductive Health, March 2009

“Minors in states with mandatory waiting periods were more than two times as likely to report an unintended birth.” How Are Restrictive Abortion Statutes Associated With Unintended Teen Birth? Journal of Adolescent Health, August 2010

“A series of regressions on a comprehensive time series cross-sectional data set provides evidence that several types of state-level anti-abortion legislation result in statistically significant declines in both the abortion rate and the abortion ratio.” Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era, State Politics & Policy Quarterly, March 2011

“[If Roe v. Wade were overturned] abortion rates would fall by 14.9 percent nationally, resulting in at most, 178,800 additional births or 4.2 percent of the U.S. total in 2008. A ban in 17 states would result in a 6.0 percent decline in abortions and at most, 1.7 percent rise in births.” Back to the Future? Abortion Before & After Roe, National Bureau of Economic Research, August 2012

“The empirical results add to the substantial body of peer-reviewed research which finds that public funding restrictions, parental involvement laws, and properly designed informed consent laws all reduce the incidence of abortion.” Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era – A Reassessment, State Politics & Policy Quarterly, July 2014

“We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term.” Denial of Abortion Because of Provider Gestational Age Limits in the United States American Public Health Association August 2014

“I estimate an increase in the birthrate of 4% to 12% when abortion is restricted. In the absence of anti-abortion laws, fertility would have been 5% to 12% lower in the early twentieth century.” The Effect of Anti-Abortion Legislation on Nineteenth Century Fertility, Demography, June 2015

“Counties with no facility in 2014 but no change in distance to a facility between 2012 and 2014 had a 1.3% (95% CI, −1.5% to 4.0%) decline in abortions. When the change in distance was 100 miles or more, the number of abortions decreased 50.3% (95% CI, 48.0% to 52.7%).” Change in Distance to Nearest Facility and Abortion in Texas, 2012 to 2014 Journal of the American Medical Association, January 2017

“Increases in distance have significant effects for women initially living within 200 miles of a clinic. The largest effect is for those nearest to clinics for whom a 25-mile increase reduces abortion 10%.” How Far is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions National Bureau of Economic Research, May 2017

“This law caused an increase in viewing rates and a statistically significant but small increase in continuing pregnancy rates.” Evaluating the impact of a mandatory pre-abortion ultrasound viewing law: A mixed methods study PLoS One July 2017

“We estimate that over the past 25 years, parental involvement laws have resulted in half a million additional teen births.” Did Parental Involvement Laws Grow Teeth? The Effects of State Restrictions on Minors’ Access to Abortion, Institute for the Study of Labor, August 31, 2017 (See the SPL blog post about this specific paper here.)

“Trends in sexual behavior suggest that young women’s increased access to the birth control pill fueled the sexual revolution, but neither these trends nor difference-in-difference estimates support the view that this also led to substantial changes in family formation. Rather, the estimates robustly suggest that it was liberalized access to abortion that allowed large numbers of women to delay marriage and motherhood.” The Power of Abortion Policy: Reexamining the Effects of Young Women’s Access to Reproductive Control, Journal of Political Economy, November 2017

“Participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one…more participants who had considered abortion in Louisiana than Maryland reported a policy-related reason (primarily lack of funding for the abortion) as a reason (22% Louisiana, 2% Maryland, p < 0.001).” Consideration of and Reasons for Not Obtaining Abortion Among Women Entering Prenatal Care in Southern Louisiana and Baltimore, Maryland, Sexuality Research and Social Policy, October 2018

“Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14%.” Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion BMC Women’s Health, June 2019

“Greater exposure to ARs [abortion restrictions] was associated with increased risk of UIB [unintended birth].” Implications of Restrictive Abortion Laws on Unintended Births in the U.S.: A Cross-Sectional Multilevel Analysis APHA’s 2019 Annual Meeting and Expo, November 2019

“We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy….Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion.” Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider – but do not have – abortions PLOS ONE January 2020

Further reading:

Pro-life laws prevent abortion primarily by preventing unplanned pregnancy.

Today’s guest post is by Conner Alford.

Women and their partners are generally forward-thinking and rational in their fertility behavior.

Within
our society’s broader debate on abortion, two particular pro-choice arguments
have occupied a great deal of attention among political activists and leaders
alike. The first and stronger of these arguments postulates that legal
restrictions make abortion more dangerous but that they do not make it any less
common. The underlying logic here is that pro-life policies simply replace safe,
legal terminations with an equal number of dangerous, illegal and self-induced
or ‘back-alley’ abortions (AGI 1999, 2009). In other words, if a woman is
pregnant and does not want to be, she will not consider the legality of her
actions or the risks to her own health when deciding whether or not to abort.
Any woman willing to get a safe, legal abortion is also willing to get an
unsafe, illegal one. When the former is harder to obtain, she will trade it in
for the latter. When the latter is no longer necessary because laws have been
liberalized, she will trade it for the former. This is the argument articulated
by the Alan Guttmacher Institute[1] (AGI) and its affiliated researchers
(Tietze 1973; Juarez et al 2005; Sedgh et al 2007b; Singh et al 2010).
The
second argument makes a somewhat contradictory claim. According to this
narrative, pro-life policies do in fact mitigate abortions. However, they only
do so by replacing those abortions with unwanted births. Women trade abortions
for babies. As a result, the story goes, these undesired offspring either wind
up in state custody or eventually wash out to become criminals (Levitt and
Donahue 2001). Either way, the conclusion that we are supposed to draw is that
pro-life policies are generally ill-advised. However, both of these arguments
are deeply inconsistent with the empirical record and based on a fundamental
misconception about the primary way in which abortion laws actually work and
operate.
First,
studies have shown that while legal restrictions on abortion do reduce the rate
at which it occurs, they do not necessarily
result in an increase in the birth rate (Trussel et al. 1980; Matthews et
al. 1997). Second, the claim that pro-life policies simply lead to an increase
in maternal deaths by driving pregnant women to seek unsafe abortions is
directly challenged by the empirical record. The lowest maternal mortality
rates (MMR) in Europe, for example, occur in Poland, Malta and Ireland—all of
which have extremely restrictive policies (Mundial 2010; Hogan et al. 2010).
Further, a plethora of systematic analyses examining countries from around the
world continuously challenge the idea that legal restrictions on abortion
increase MMRs or hospitalizations.[2]  This, then, undermines a key assumption in the
AGI narrative about illegal abortions. Third, it is important to note that
within the academic community the debate is, generally speaking, no longer
about whether legal restrictions
reduce abortions so much as how they
manage to do so. That pro-life policies mitigate abortion is a point that has
been repeatedly illustrated by literally dozens of independent, peer-reviewed
studies over the course of several decades.[3]
There
has, however, been some disagreement about the exact causal mechanism
responsible for this relationship. Herein we find the chief problem with the
two perspectives introduced at the beginning of this essay. Not only are their
key assertions inconsistent with the empirical record, their entire arguments
are fundamentally oblivious to recent academic insights on how abortion laws
actually operate. Traditionally, scholars have tended to assume that such
policies function to minimize abortions by acting on the posterior “…decision
of a woman who is pregnant not to have the child” (Medoff 1988, p. 354). In
other words, the law was presumed to affect a woman’s behavior only after she had already become
pregnant. The AGI and other pro-choice advocates have adopted this outdated
presupposition.
Since
the mid 1990s, however, the academic understanding has evolved in light of new
evidence. A substantial number of independent, peer reviewed studies have
consistently shown that legal restrictions on abortion work primarily by reducing the rate at which
unplanned pregnancies occur in the first place (Kane and Staiger
1996) and only secondarily by
influencing the behaviors of women who are already pregnant (Levine 2004a)! In
other words, pro-life policies address both the symptom and the cause! To be
more specific, research has shown that women and their partners are generally
forward-thinking and rational in their fertility behavior. They do not wait
until after a pregnancy has already occurred before deciding whether they
should take steps to preempt parenthood. As a result, pro-life policies actually
help to reduce the unplanned pregnancy rate by incentivizing couples to take
additional precautions prior to a
potential pregnancy rather than waiting to obtain an abortion after the
pregnancy has already occurred. Conversely, the opposite is also true. When
abortion is readily accessible, this very availability reduces the incentive to
avoid becoming pregnant by offering a sort of ‘insurance policy,’ should you or
your partner happen to do so. For example, studies have persistently shown that
more permissive policies are causally connected to an increase in unprotected
sex whereas more restrictive policies lead to an increase in contraceptive
usage (Levine 2004b; Medoff 2008a, b; Felkey and Lybecker 2011, 2014, 2015).
There is also some evidence to indicate that legally restricting abortion leads
to a change in the overall amount of sexual activity (Alford 2016).
Of
course, many readers are likely to find this logic somewhat counterintuitive or
even offensive. Despite this, it has been overwhelmingly
supported by the empirical record (Kane and Staiger 1996; Levine et al. 1996;
Levine 1999, 2002, 2003, 2004; Levine and Staiger 2004; McNabb 2007; Medoff 2008a,
b; Felkey and Lybecker 2011). It also helps to explain the previously puzzling
findings of several studies which suggested 
that abortion laws were able to reduce the number of abortions without
an increase in births (Trussel et al. 1980; Matthews et al. 1997) or harming
maternal health outcomes (see footnote 3). Furthermore, it is consistent with
previous findings that the legalization of abortion is associated with an
increase in the spread of sexually transmitted diseases whereas pro-life
policies have the opposite impact (Kick and Stratmann 2003; Klick and Neelsen
2012). Studies examining the impact of abortion policies on the number of
infants available for adoption have, similarly, supported the hypothesis (Gennetian
1999; Bitler and Zavodny 2002; Medoff 2008b).
In
conclusion then, it is important to understand that the primary interaction between pro-life policies and individual
fertility decisions happens before a
potential pregnancy. Men and women are generally rational, free and forward-thinking when it comes to their sex lives. They consider the risks and
potential costs of an unwanted pregnancy before making decisions about whether
to engage in sexual activity or to utilize contraception. When those costs are
subverted by liberalized abortion laws, this provides a sort of ‘insurance
policy,’ which encourages uninhibited sexual activity. When those costs are
reinforced by pro-life policies, however, the opposite occurs. Contraceptive
usage goes up and unplanned pregnancies go down. As a result, legal limitations
on abortion are capable of reducing abortion rates without actually impacting
the overall number of births. Where pro-life policies do lead to an increase in
births, this change is secondary and relatively modest as compared to the
decline in unplanned pregnancy. As a result of this, restrictions on abortion are
also able to operate without a concomitant risk of unsafe abortions. After all,
you cannot illegally terminate a pregnancy that never occurred. This helps to
explain why there does not seem to be any positive relationship between
legalized abortion and maternal health outcomes.[4] The arguments introduced
at the opening of this essay must, therefore, be dismissed in light of new
academic evidence and empirical data. The science simply does not support them.
It does, however, indicate that pro-life laws do not merely address abortion as a symptom but that they attack the
underlying cause of abortion—unplanned pregnancy—at its source.
 
Bibliography
Alan Guttmacher
Institute (AGI). 1999. “Sharing Responsibility: Women, Society & Abortion
Worldwide.” New York.
__________. 2009.
Abortion
Worldwide: A Decade of Uneven Progress
.” New York.
Alford, Conner.
2016. “The Economics of Abortion: A Comparative Analysis of Mexico and the
United States.” Proquest
Dissertations
. Available at: https://search.proquest.com/openview/5e138d6c2e46744301e5f1706efbfa4c/1?pq-origsite=gscholar&cbl=18750&diss=y
Bitler, Marianne
and Madeline. Zavodny. 2002. “Did Abortion Legalization Reduce the Number
of Unwanted Children? Evidence from Adoptions.” Perspectives on Sexual and Reproductive Health. 34(1) 25-33.
Donohue III, John
J and Steven D. Levitt. “The Impact of Legalized Abortion on Crime.” The Quarterly
Journal of Economics
. 116(2): 379-420.
Felkey, Amanda J.
and Lybecker, Kristina M. 2011. “Variation in Pill Use: Do Abortion Laws
Matter?” International Journal of
Business and Social Science
. 2(16): 1-12.
_____. 2014.
“Utilization of Oral Contraception: The Impact of Direct and Indirect
Restrictions on Access to Abortion.” The
Social Science Journal
.  51: 44-56.
 _____. 2015. “The Role of Restrictive Abortion
Legislation in Explaining Variation in Oral Contraceptive Use.” Clinics in Mother and Child Health. 12(4):
1-10.
Gennetian, Lisa A.
1999.  “The Supply of Infants
relinquished for Adoption: Did Access to Abortion Make a Difference?” Economic Inquiry. 37(3): 412-431.
Gober, Patricia.
1994. “Why Abortion Rates Vary: A Geographical Examination of the Supply
of and Demand for Abortion Services in the United States in 1988.” Annals of the Association of American
Geographers
. 84: 230-250.
Guldi, Melanie.
2008. “Fertility Effects of Abortion and Birth Control Pill Access for
Minors.” Demography. 45(4):
817-827.
Haas-Wilson,
Deborah. 1993.”The Economic Impact of State Restrictions on Abortion:
Parental Consent and Notification Laws and Medicaid Funding Restrictions.”
Journal of Policy Analysis and Management.
12(3): 498-511.
Hansen, Susan B.
1980. “State Implementation of Supreme Court Decisions: Abortion Rates since
Roe v. Wade.” The Journal of Politics.
42: pp. 372-395.
Hogan MC, Foreman
KJ, Naghavi M, Ahn SY, Wang M, et al. 2010. “Maternal mortality for 181
countries, 1980-2008: a systematic analysis of progress towards Millennium
Development Goal 5.” Lancet
375(9726): 1609–1623.
Kane, Thomas J.
and Douglas Staiger. 1996. “Teen Motherhood and Abortion Access.” The
Quarterly Journal of Economics.
111(2): 467-506
Koch, Elard Miguel
Bravo, Sebastián Gatica, Juan F. Stecher, Paula Aracena, Sergio Valenzuela,
IvonneAhlers. 2012A. “Sobrestimacióndel Aborto Inducido en Colombia y otros Países
Latino Americanos. [Overestimation of induced abortion in Colombia and other
Latin American countries].” Ginecol
Obstet Mex
. 80(5): 360-372.
Koch, Elard, John
Thorp, Miguel Bravo, Sebastian Gatica, Camila X. Romero, Hernan Aguilera,
IvonneAhlers. 2012b. “Women’s Education Level, Maternal Health Facilities,
Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957
to 2007.” PLoS One. 7(5): 1-16.
Koch, Elard,
Calhoun, Paula. Aracena, Sebastian Gatica, and Miguel Bravo. 2014.
“Women’s education level, contraceptive use and maternal mortality
estimates.” Public Health,
128(4): 384-7.
Koch, Elard,
Monique Chireau, Fernando Pliego, Joseph Stanford, Sebastián Haddad, Byron
Calhoun, Paula Aracena, Miguel Bravo, SebastiánGatica, and John Thorp. 2015.
“Abortion legislation, maternal healthcare, fertility, female literacy,
sanitation, violence against women, and maternal deaths: a natural experiment
in 32 Mexican states.”BMJ. 5(2):
e006013–e006013.
Levine, Phillip
B., Amy B. Trainor, and David J. Zimmerman. 1996. “The effect of Medicaid
abortion funding restrictions on abortions, pregnancies and births.” Journal of 
Health Economics
. 15: 555-578.
Levine Phillip B.,
Douglas Staiger, Thomas J. Kane and David J. Zimmerman. 1999. “Roe v. Wade
and American Fertility.” American
Journal of Public Health
. 89(2): pp. 199-203.
Levine, Phillip B.
2002. The Impact of Social Policy and Economic Activity throughout the
Fertility Decision Tree.” in Risky Behavior among Youths: An Economic
Analysis
. E.D. Jonathan Gruber. National Bureau of Economic Research, pp.
167-218.
 _____. 2003. “Parental Involvement Laws and
Fertility Behavior.” Journal of Health
Economics
. 22(5): 861–878
_____. 2004a.
“Abortion Policy and the Economics of Fertility.” Society, 41(4): 79-85.
_____. 2004b. Sex
and Consequences: Abortion, Public Policy, and the Economics of Fertility
.
Princeton, N.J: Princeton University Press.
 Levine, Phillip B. and Douglas Staiger. 2004.
“Abortion Policy and Fertility Outcomes: The Eastern European
Experience.” Journal of Law and
Economics
. XLVII (April): 223-243.
Matthews, Stephens
David Ribar and Mark Wilhelm. 1997.”The Effects of Economic Conditions and
Access to Reproductive Health Services On State Abortion rates and
Birthrates.” Family Planning
Perspectives
. 29(2): 52-60.
McNabb, Leland.
2007. “Public Policies and Private Decisions: An Analysis of the Effects of
Abortion Restrictions on Minors’ Contraceptive Behavior.” Available at: https://econ.duke.edu/uploads/assets/dje/2006/McNabb.pdf
Medoff, H.
Marshall. 1988. “An Economic Analysis of the Demand for Abortion.” Economic Inquiry. 26: 353-359.
 _____. 2008a. “Abortion costs, sexual
behavior, and pregnancy rates.” The
Social Science Journal
. 45: 156-172
. _____. 2008b.
“The Effect of Abortion Costs on Adoption.”
International Journal of Social Economics
. 35(3): 188-201.
Mundial, Banco.
2010. “Trends in Maternal Mortality: 1990 to 2008.” Available at: http://www.bvcooperacion.pe/biblioteca/bitstream/123456789/7523/1/BVCI0006645.pdf
New, Michael.
2004. “Analyzing the Effects of State Legislation on the Incidence of
Abortion During the 1990s.”
_____. 2007.
“Analyzing the Effect of State Legislation on the Incidence of Abortion Among
Minors.”
_____. 2011.
“Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post Casey
Era”. State Politics & Policy
Quarterly
. 11: pp. 28-47.
_____. 2014.
“Analyzing the Impact of U.S. Antiabortion Legislation in the Post-Casey Era A
Reassessment.” State Politics &
Policy Quarterly
. 11: pp. 28-47.
Trussell, J., J.
Menken, B.L, Lindheimand B. Vaughan. 1980. “The impact of restricting Medicaid
financing for abortion.” Family Planning
Perspectives
12, 120-130.


[1] The AGI is a pro-choice lobbying
organization and the semi-official research division of Planned Parenthood. Its
statement of purpose is to promote the liberalization of worldwide abortion
laws.
[2] Similarly, in South and Central
America, Koch et al (2014) finds no relationship between the restrictiveness of
state policies on abortion in Mexico and maternal mortality, while a time
series analysis of Chile failed to show any relationship between historical
changes in abortion policy and either maternal mortality or abortion related
hospitalizations (Koch et al. 2012a). Systematic analyses in Eastern Europe and
studies examining the impact of legalized abortion in Mexico City also
undermine the AGI narrative (Levine and Staiger 2004; Klick and Neelsen 2012; Koch
et al 2012b).
[3] Hansen 1980; Medoff 1988, 2008a,
2008b; Haas-Wilson 1993; Gober 1994; New 2004, 2007, 2011a, b; Guildi 2008;
Koch et al. 2012a, b, 2014…the list goes on. 
[4] 
In fact, some research indicates the opposite: that more liberal
abortion laws may actually lead to an increase in maternal mortality and
morbidity (Alford 2016). Although these findings have yet to be fully explained,
one possibility is that women who obtain abortions are able to become pregnant
again more quickly and/or are more likely to return to former levels of sexual
activity. As a result, this leads to an increase in the overall number of
pregnancies a woman experiences and therefore her overall risk of experiencing
a potentially life threatening complication. This may also help to explain why
countries with more restrictive abortion policies in both Latin America and
Europe tend to have maternal mortality rates that are lower than the regional average
(see above) and why the abortion mortality ratio decrease by almost 96%
subsequent to an abortion ban in Chile (Koch 2013).

Pro-life laws prevent abortion primarily by preventing unplanned pregnancy.

Today’s guest post is by Conner Alford.

Women and their partners are generally forward-thinking and rational in their fertility behavior.

Within
our society’s broader debate on abortion, two particular pro-choice arguments
have occupied a great deal of attention among political activists and leaders
alike. The first and stronger of these arguments postulates that legal
restrictions make abortion more dangerous but that they do not make it any less
common. The underlying logic here is that pro-life policies simply replace safe,
legal terminations with an equal number of dangerous, illegal and self-induced
or ‘back-alley’ abortions (AGI 1999, 2009). In other words, if a woman is
pregnant and does not want to be, she will not consider the legality of her
actions or the risks to her own health when deciding whether or not to abort.
Any woman willing to get a safe, legal abortion is also willing to get an
unsafe, illegal one. When the former is harder to obtain, she will trade it in
for the latter. When the latter is no longer necessary because laws have been
liberalized, she will trade it for the former. This is the argument articulated
by the Alan Guttmacher Institute[1] (AGI) and its affiliated researchers
(Tietze 1973; Juarez et al 2005; Sedgh et al 2007b; Singh et al 2010).
The
second argument makes a somewhat contradictory claim. According to this
narrative, pro-life policies do in fact mitigate abortions. However, they only
do so by replacing those abortions with unwanted births. Women trade abortions
for babies. As a result, the story goes, these undesired offspring either wind
up in state custody or eventually wash out to become criminals (Levitt and
Donahue 2001). Either way, the conclusion that we are supposed to draw is that
pro-life policies are generally ill-advised. However, both of these arguments
are deeply inconsistent with the empirical record and based on a fundamental
misconception about the primary way in which abortion laws actually work and
operate.
First,
studies have shown that while legal restrictions on abortion do reduce the rate
at which it occurs, they do not necessarily
result in an increase in the birth rate (Trussel et al. 1980; Matthews et
al. 1997). Second, the claim that pro-life policies simply lead to an increase
in maternal deaths by driving pregnant women to seek unsafe abortions is
directly challenged by the empirical record. The lowest maternal mortality
rates (MMR) in Europe, for example, occur in Poland, Malta and Ireland—all of
which have extremely restrictive policies (Mundial 2010; Hogan et al. 2010).
Further, a plethora of systematic analyses examining countries from around the
world continuously challenge the idea that legal restrictions on abortion
increase MMRs or hospitalizations.[2]  This, then, undermines a key assumption in the
AGI narrative about illegal abortions. Third, it is important to note that
within the academic community the debate is, generally speaking, no longer
about whether legal restrictions
reduce abortions so much as how they
manage to do so. That pro-life policies mitigate abortion is a point that has
been repeatedly illustrated by literally dozens of independent, peer-reviewed
studies over the course of several decades.[3]
There
has, however, been some disagreement about the exact causal mechanism
responsible for this relationship. Herein we find the chief problem with the
two perspectives introduced at the beginning of this essay. Not only are their
key assertions inconsistent with the empirical record, their entire arguments
are fundamentally oblivious to recent academic insights on how abortion laws
actually operate. Traditionally, scholars have tended to assume that such
policies function to minimize abortions by acting on the posterior “…decision
of a woman who is pregnant not to have the child” (Medoff 1988, p. 354). In
other words, the law was presumed to affect a woman’s behavior only after she had already become
pregnant. The AGI and other pro-choice advocates have adopted this outdated
presupposition.
Since
the mid 1990s, however, the academic understanding has evolved in light of new
evidence. A substantial number of independent, peer reviewed studies have
consistently shown that legal restrictions on abortion work primarily by reducing the rate at which
unplanned pregnancies occur in the first place (Kane and Staiger
1996) and only secondarily by
influencing the behaviors of women who are already pregnant (Levine 2004a)! In
other words, pro-life policies address both the symptom and the cause! To be
more specific, research has shown that women and their partners are generally
forward-thinking and rational in their fertility behavior. They do not wait
until after a pregnancy has already occurred before deciding whether they
should take steps to preempt parenthood. As a result, pro-life policies actually
help to reduce the unplanned pregnancy rate by incentivizing couples to take
additional precautions prior to a
potential pregnancy rather than waiting to obtain an abortion after the
pregnancy has already occurred. Conversely, the opposite is also true. When
abortion is readily accessible, this very availability reduces the incentive to
avoid becoming pregnant by offering a sort of ‘insurance policy,’ should you or
your partner happen to do so. For example, studies have persistently shown that
more permissive policies are causally connected to an increase in unprotected
sex whereas more restrictive policies lead to an increase in contraceptive
usage (Levine 2004b; Medoff 2008a, b; Felkey and Lybecker 2011, 2014, 2015).
There is also some evidence to indicate that legally restricting abortion leads
to a change in the overall amount of sexual activity (Alford 2016).
Of
course, many readers are likely to find this logic somewhat counterintuitive or
even offensive. Despite this, it has been overwhelmingly
supported by the empirical record (Kane and Staiger 1996; Levine et al. 1996;
Levine 1999, 2002, 2003, 2004; Levine and Staiger 2004; McNabb 2007; Medoff 2008a,
b; Felkey and Lybecker 2011). It also helps to explain the previously puzzling
findings of several studies which suggested 
that abortion laws were able to reduce the number of abortions without
an increase in births (Trussel et al. 1980; Matthews et al. 1997) or harming
maternal health outcomes (see footnote 3). Furthermore, it is consistent with
previous findings that the legalization of abortion is associated with an
increase in the spread of sexually transmitted diseases whereas pro-life
policies have the opposite impact (Kick and Stratmann 2003; Klick and Neelsen
2012). Studies examining the impact of abortion policies on the number of
infants available for adoption have, similarly, supported the hypothesis (Gennetian
1999; Bitler and Zavodny 2002; Medoff 2008b).
In
conclusion then, it is important to understand that the primary interaction between pro-life policies and individual
fertility decisions happens before a
potential pregnancy. Men and women are generally rational, free and forward-thinking when it comes to their sex lives. They consider the risks and
potential costs of an unwanted pregnancy before making decisions about whether
to engage in sexual activity or to utilize contraception. When those costs are
subverted by liberalized abortion laws, this provides a sort of ‘insurance
policy,’ which encourages uninhibited sexual activity. When those costs are
reinforced by pro-life policies, however, the opposite occurs. Contraceptive
usage goes up and unplanned pregnancies go down. As a result, legal limitations
on abortion are capable of reducing abortion rates without actually impacting
the overall number of births. Where pro-life policies do lead to an increase in
births, this change is secondary and relatively modest as compared to the
decline in unplanned pregnancy. As a result of this, restrictions on abortion are
also able to operate without a concomitant risk of unsafe abortions. After all,
you cannot illegally terminate a pregnancy that never occurred. This helps to
explain why there does not seem to be any positive relationship between
legalized abortion and maternal health outcomes.[4] The arguments introduced
at the opening of this essay must, therefore, be dismissed in light of new
academic evidence and empirical data. The science simply does not support them.
It does, however, indicate that pro-life laws do not merely address abortion as a symptom but that they attack the
underlying cause of abortion—unplanned pregnancy—at its source.
 
Bibliography
Alan Guttmacher
Institute (AGI). 1999. “Sharing Responsibility: Women, Society & Abortion
Worldwide.” New York.
__________. 2009.
Abortion
Worldwide: A Decade of Uneven Progress
.” New York.
Alford, Conner.
2016. “The Economics of Abortion: A Comparative Analysis of Mexico and the
United States.” Proquest
Dissertations
. Available at: https://search.proquest.com/openview/5e138d6c2e46744301e5f1706efbfa4c/1?pq-origsite=gscholar&cbl=18750&diss=y
Bitler, Marianne
and Madeline. Zavodny. 2002. “Did Abortion Legalization Reduce the Number
of Unwanted Children? Evidence from Adoptions.” Perspectives on Sexual and Reproductive Health. 34(1) 25-33.
Donohue III, John
J and Steven D. Levitt. “The Impact of Legalized Abortion on Crime.” The Quarterly
Journal of Economics
. 116(2): 379-420.
Felkey, Amanda J.
and Lybecker, Kristina M. 2011. “Variation in Pill Use: Do Abortion Laws
Matter?” International Journal of
Business and Social Science
. 2(16): 1-12.
_____. 2014.
“Utilization of Oral Contraception: The Impact of Direct and Indirect
Restrictions on Access to Abortion.” The
Social Science Journal
.  51: 44-56.
 _____. 2015. “The Role of Restrictive Abortion
Legislation in Explaining Variation in Oral Contraceptive Use.” Clinics in Mother and Child Health. 12(4):
1-10.
Gennetian, Lisa A.
1999.  “The Supply of Infants
relinquished for Adoption: Did Access to Abortion Make a Difference?” Economic Inquiry. 37(3): 412-431.
Gober, Patricia.
1994. “Why Abortion Rates Vary: A Geographical Examination of the Supply
of and Demand for Abortion Services in the United States in 1988.” Annals of the Association of American
Geographers
. 84: 230-250.
Guldi, Melanie.
2008. “Fertility Effects of Abortion and Birth Control Pill Access for
Minors.” Demography. 45(4):
817-827.
Haas-Wilson,
Deborah. 1993.”The Economic Impact of State Restrictions on Abortion:
Parental Consent and Notification Laws and Medicaid Funding Restrictions.”
Journal of Policy Analysis and Management.
12(3): 498-511.
Hansen, Susan B.
1980. “State Implementation of Supreme Court Decisions: Abortion Rates since
Roe v. Wade.” The Journal of Politics.
42: pp. 372-395.
Hogan MC, Foreman
KJ, Naghavi M, Ahn SY, Wang M, et al. 2010. “Maternal mortality for 181
countries, 1980-2008: a systematic analysis of progress towards Millennium
Development Goal 5.” Lancet
375(9726): 1609–1623.
Kane, Thomas J.
and Douglas Staiger. 1996. “Teen Motherhood and Abortion Access.” The
Quarterly Journal of Economics.
111(2): 467-506
Koch, Elard Miguel
Bravo, Sebastián Gatica, Juan F. Stecher, Paula Aracena, Sergio Valenzuela,
IvonneAhlers. 2012A. “Sobrestimacióndel Aborto Inducido en Colombia y otros Países
Latino Americanos. [Overestimation of induced abortion in Colombia and other
Latin American countries].” Ginecol
Obstet Mex
. 80(5): 360-372.
Koch, Elard, John
Thorp, Miguel Bravo, Sebastian Gatica, Camila X. Romero, Hernan Aguilera,
IvonneAhlers. 2012b. “Women’s Education Level, Maternal Health Facilities,
Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957
to 2007.” PLoS One. 7(5): 1-16.
Koch, Elard,
Calhoun, Paula. Aracena, Sebastian Gatica, and Miguel Bravo. 2014.
“Women’s education level, contraceptive use and maternal mortality
estimates.” Public Health,
128(4): 384-7.
Koch, Elard,
Monique Chireau, Fernando Pliego, Joseph Stanford, Sebastián Haddad, Byron
Calhoun, Paula Aracena, Miguel Bravo, SebastiánGatica, and John Thorp. 2015.
“Abortion legislation, maternal healthcare, fertility, female literacy,
sanitation, violence against women, and maternal deaths: a natural experiment
in 32 Mexican states.”BMJ. 5(2):
e006013–e006013.
Levine, Phillip
B., Amy B. Trainor, and David J. Zimmerman. 1996. “The effect of Medicaid
abortion funding restrictions on abortions, pregnancies and births.” Journal of 
Health Economics
. 15: 555-578.
Levine Phillip B.,
Douglas Staiger, Thomas J. Kane and David J. Zimmerman. 1999. “Roe v. Wade
and American Fertility.” American
Journal of Public Health
. 89(2): pp. 199-203.
Levine, Phillip B.
2002. The Impact of Social Policy and Economic Activity throughout the
Fertility Decision Tree.” in Risky Behavior among Youths: An Economic
Analysis
. E.D. Jonathan Gruber. National Bureau of Economic Research, pp.
167-218.
 _____. 2003. “Parental Involvement Laws and
Fertility Behavior.” Journal of Health
Economics
. 22(5): 861–878
_____. 2004a.
“Abortion Policy and the Economics of Fertility.” Society, 41(4): 79-85.
_____. 2004b. Sex
and Consequences: Abortion, Public Policy, and the Economics of Fertility
.
Princeton, N.J: Princeton University Press.
 Levine, Phillip B. and Douglas Staiger. 2004.
“Abortion Policy and Fertility Outcomes: The Eastern European
Experience.” Journal of Law and
Economics
. XLVII (April): 223-243.
Matthews, Stephens
David Ribar and Mark Wilhelm. 1997.”The Effects of Economic Conditions and
Access to Reproductive Health Services On State Abortion rates and
Birthrates.” Family Planning
Perspectives
. 29(2): 52-60.
McNabb, Leland.
2007. “Public Policies and Private Decisions: An Analysis of the Effects of
Abortion Restrictions on Minors’ Contraceptive Behavior.” Available at: https://econ.duke.edu/uploads/assets/dje/2006/McNabb.pdf
Medoff, H.
Marshall. 1988. “An Economic Analysis of the Demand for Abortion.” Economic Inquiry. 26: 353-359.
 _____. 2008a. “Abortion costs, sexual
behavior, and pregnancy rates.” The
Social Science Journal
. 45: 156-172
. _____. 2008b.
“The Effect of Abortion Costs on Adoption.”
International Journal of Social Economics
. 35(3): 188-201.
Mundial, Banco.
2010. “Trends in Maternal Mortality: 1990 to 2008.” Available at: http://www.bvcooperacion.pe/biblioteca/bitstream/123456789/7523/1/BVCI0006645.pdf
New, Michael.
2004. “Analyzing the Effects of State Legislation on the Incidence of
Abortion During the 1990s.”
_____. 2007.
“Analyzing the Effect of State Legislation on the Incidence of Abortion Among
Minors.”
_____. 2011.
“Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post Casey
Era”. State Politics & Policy
Quarterly
. 11: pp. 28-47.
_____. 2014.
“Analyzing the Impact of U.S. Antiabortion Legislation in the Post-Casey Era A
Reassessment.” State Politics &
Policy Quarterly
. 11: pp. 28-47.
Trussell, J., J.
Menken, B.L, Lindheimand B. Vaughan. 1980. “The impact of restricting Medicaid
financing for abortion.” Family Planning
Perspectives
12, 120-130.


[1] The AGI is a pro-choice lobbying
organization and the semi-official research division of Planned Parenthood. Its
statement of purpose is to promote the liberalization of worldwide abortion
laws.
[2] Similarly, in South and Central
America, Koch et al (2014) finds no relationship between the restrictiveness of
state policies on abortion in Mexico and maternal mortality, while a time
series analysis of Chile failed to show any relationship between historical
changes in abortion policy and either maternal mortality or abortion related
hospitalizations (Koch et al. 2012a). Systematic analyses in Eastern Europe and
studies examining the impact of legalized abortion in Mexico City also
undermine the AGI narrative (Levine and Staiger 2004; Klick and Neelsen 2012; Koch
et al 2012b).
[3] Hansen 1980; Medoff 1988, 2008a,
2008b; Haas-Wilson 1993; Gober 1994; New 2004, 2007, 2011a, b; Guildi 2008;
Koch et al. 2012a, b, 2014…the list goes on. 
[4] 
In fact, some research indicates the opposite: that more liberal
abortion laws may actually lead to an increase in maternal mortality and
morbidity (Alford 2016). Although these findings have yet to be fully explained,
one possibility is that women who obtain abortions are able to become pregnant
again more quickly and/or are more likely to return to former levels of sexual
activity. As a result, this leads to an increase in the overall number of
pregnancies a woman experiences and therefore her overall risk of experiencing
a potentially life threatening complication. This may also help to explain why
countries with more restrictive abortion policies in both Latin America and
Europe tend to have maternal mortality rates that are lower than the regional average
(see above) and why the abortion mortality ratio decrease by almost 96%
subsequent to an abortion ban in Chile (Koch 2013).

Which decreases abortion rates more: contraception access or abortion restrictions?

Pro-choicers frequently claim that making abortion illegal won’t decrease the number of abortions; it will only decrease the number of safe, legal abortions. They suggest that there is no practical use to restricting abortion legally and that if pro-lifers really cared about decreasing abortion rates, they would focus on decreasing unplanned pregnancies (through better access to contraception, better sex education, etc.)

So pro-choicers claim.

But there’s a lot of research to show that abortion law affects abortion rates–and not just legal abortion rates, but total abortion rates. Studies often measure the changes in fertility in areas where abortion access recently changed. Secular Pro-Life has compiled a list of such studies if you’re interested.

I’ve now had a few conversations where I point out this reality, and the pro-choice person’s response is to claim that even if abortion restrictions have some nonzero effect on abortion rates, that effect is dwarfed by the decrease in abortions thanks to contraception access. It’s easy for me to believe that both more access to contraception and less access to abortion will decrease abortion rates, and personally I’m for taking both approaches. But the claim that the effect of contraception access trounces the effect of abortion access sounds like just a slightly watered down version of the false claim that abortion access doesn’t affect abortion rates at all. That is, it’s an ad hoc, ill-founded claim to justify our country’s incredibly liberal abortion laws, but the evidence (at least what I’ve seen so far) doesn’t bear it out.

For example, in late 2017 the Daily Mail published “Abortion rate plummets to an historic low, CDC figures reveal.” Specifically the article claims

While the drop mirrors the closure of abortion clinics nationwide, experts say the figure is likely down to more effective use of contraception and the falling pregnancy rate.

The article references this CDC report, which has found a net decrease in the abortion rate (number of abortions per 1,000 women age 15-44) of 22% (from 15.6 to 12.1). This is great news, but it’s not clear from the CDC report the extent to which different factors contributed to the decrease. The CDC authors explain

One factor that might have contributed to this decrease is the increase that occurred during the same period in the use of the most effective forms of reversible contraception, specifically intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy (102–105). Although use of intrauterine devices and implants has increased in recent years, use of these methods remains low in comparison with use of oral contraceptives and condoms, both of which are less effective at preventing pregnancy (102,104).

So contraception likely played a role, but the CDC can’t quantify it, and they still find that the most effective forms of contraception are not used much compared to the less effective forms. They certainly aren’t asserting that the entire 22% decrease is due solely to contraception access, and their report doesn’t attempt to compare the effects of contraception access to the effects of abortion access. 

There are studies that looked at both factors. For example, this Guttmacher report found that between access to the Pill and access to abortion, abortion was associated with a birth rate decrease twice that for the pill.

Among white minors, having had access to the pill was associated with a 9% drop in the overall birthrate and an 8% drop in the rate of nonmarital first births. In this same group, access to an abortion was correlated with a 17% decline in the nonmarital birthrate and a 16% decline in the rate of nonmarital first births.

Another study found that, for women under age 19, “liberalized abortion policy predicts a 34 percent decline in motherhood” whereas “the results do not provide evidence that pill policies had a substantial effect.” The author explains

The birth control pill’s effects on family formation are theoretically ambiguous: The pill was a technological innovation in contraception, but with a failure rate of about 9 percent in the first year of typical use (Trussell, 2004), it still provides an imperfect means of preventing pregnancy. Trends in sexual behavior suggest that any reductions in unintended pregnancies among teens due to safer, pill-protected sex were offset by large increases in sexual activity. Difference-in-difference estimates also provide little evidence to support the view that pill policies had a substantial influence on age at first birth and marriage. Results in Goldin and Katz (2002) and Bailey (2006, 2009) that suggest otherwise are not robust to reasonable perturbations of the authors’ research designs including addressing discrepancies in the legal codings, choosing alternative data sets, and/or adjusting sample selection procedures. Rather, the results robustly point to policies governing abortion, a second, less lauded but more certain means of preventing unwanted births, as the driving force behind delayed family formation in the 1970s. [Emphasiss added]

This study is not a perfect comparison to claims about more modern contraception. The idea is that the most effective forms of contraception (e.g. IUDs instead of the Pill) do a better job of decreasing unintended pregnancy rates because even if users increase their sexual activity as a result, the increase in risk-taking behavior does not offset the decrease in risk these more effective contraceptive methods provide.

Note also that research suggests when abortion is legalized the abortion rate increases more than the birth rate decreases. See Footnote 8 of this report, p8 of the PDF, which explains in part:

Note, however, that the decline in births is far less than the number of abortions, suggesting that the number of conceptions increased substantially –and example of insurance leading to moral hazard. The insurance that abortion provides against unwanted pregnancy induces more sexual conduct or diminished protections against pregnancy in a way that substantially increases the number of pregnancies. [Emphasis added]

People are less cautious about avoiding pregnancy when they know they can get abortions as a back up option. This idea is further substantiated by a study published in the June 2015 edition Perspectives on Sexual and Reproductive Health which concluded:

Women who lived in a state where abortion access was low were more likely than women living in a state with greater access to use highly effective contraceptives rather than no method (relative risk ratio, 1.4). Similarly, women in states characterized by high abortion hostility (i.e., states with four or more types of restrictive policies in place) were more likely to use highly effective methods than were women in states with less hostility (1.3).

This research also suggests that teasing out the effects of abortion access compared to contraception use may prove challenging, since the two appear to be inversely correlated.

So with that brief overview of just a few studies, so far these are the conclusions I’m drawing:

  1. Abortion restrictions decrease abortion rates (and likely also unintended pregnancy rates).
  2. Access to the most effective forms of contraception decrease abortion rates.
  3. Abortion restrictions probably decrease abortion rates more than access to less effective contraception (e.g. the Pill) does, and
  4. It’s unclear whether abortion restrictions or access to the most effective forms of contraception (e.g. IUDs) decrease abortion rates more.

I’m open to other suggestions or studies if you have them.

[This article is reposted with permission from Difficult Run.]

Which decreases abortion rates more: contraception access or abortion restrictions?

Pro-choicers frequently claim that making abortion illegal won’t decrease the number of abortions; it will only decrease the number of safe, legal abortions. They suggest that there is no practical use to restricting abortion legally and that if pro-lifers really cared about decreasing abortion rates, they would focus on decreasing unplanned pregnancies (through better access to contraception, better sex education, etc.)

So pro-choicers claim.

But there’s a lot of research to show that abortion law affects abortion rates–and not just legal abortion rates, but total abortion rates. Studies often measure the changes in fertility in areas where abortion access recently changed. Secular Pro-Life has compiled a list of such studies if you’re interested.

I’ve now had a few conversations where I point out this reality, and the pro-choice person’s response is to claim that even if abortion restrictions have some nonzero effect on abortion rates, that effect is dwarfed by the decrease in abortions thanks to contraception access. It’s easy for me to believe that both more access to contraception and less access to abortion will decrease abortion rates, and personally I’m for taking both approaches. But the claim that the effect of contraception access trounces the effect of abortion access sounds like just a slightly watered down version of the false claim that abortion access doesn’t affect abortion rates at all. That is, it’s an ad hoc, ill-founded claim to justify our country’s incredibly liberal abortion laws, but the evidence (at least what I’ve seen so far) doesn’t bear it out.

For example, in late 2017 the Daily Mail published “Abortion rate plummets to an historic low, CDC figures reveal.” Specifically the article claims

While the drop mirrors the closure of abortion clinics nationwide, experts say the figure is likely down to more effective use of contraception and the falling pregnancy rate.

The article references this CDC report, which has found a net decrease in the abortion rate (number of abortions per 1,000 women age 15-44) of 22% (from 15.6 to 12.1). This is great news, but it’s not clear from the CDC report the extent to which different factors contributed to the decrease. The CDC authors explain

One factor that might have contributed to this decrease is the increase that occurred during the same period in the use of the most effective forms of reversible contraception, specifically intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy (102–105). Although use of intrauterine devices and implants has increased in recent years, use of these methods remains low in comparison with use of oral contraceptives and condoms, both of which are less effective at preventing pregnancy (102,104).

So contraception likely played a role, but the CDC can’t quantify it, and they still find that the most effective forms of contraception are not used much compared to the less effective forms. They certainly aren’t asserting that the entire 22% decrease is due solely to contraception access, and their report doesn’t attempt to compare the effects of contraception access to the effects of abortion access. 

There are studies that looked at both factors. For example, this Guttmacher report found that between access to the Pill and access to abortion, abortion was associated with a birth rate decrease twice that for the pill.

Among white minors, having had access to the pill was associated with a 9% drop in the overall birthrate and an 8% drop in the rate of nonmarital first births. In this same group, access to an abortion was correlated with a 17% decline in the nonmarital birthrate and a 16% decline in the rate of nonmarital first births.

Another study found that, for women under age 19, “liberalized abortion policy predicts a 34 percent decline in motherhood” whereas “the results do not provide evidence that pill policies had a substantial effect.” The author explains

The birth control pill’s effects on family formation are theoretically ambiguous: The pill was a technological innovation in contraception, but with a failure rate of about 9 percent in the first year of typical use (Trussell, 2004), it still provides an imperfect means of preventing pregnancy. Trends in sexual behavior suggest that any reductions in unintended pregnancies among teens due to safer, pill-protected sex were offset by large increases in sexual activity. Difference-in-difference estimates also provide little evidence to support the view that pill policies had a substantial influence on age at first birth and marriage. Results in Goldin and Katz (2002) and Bailey (2006, 2009) that suggest otherwise are not robust to reasonable perturbations of the authors’ research designs including addressing discrepancies in the legal codings, choosing alternative data sets, and/or adjusting sample selection procedures. Rather, the results robustly point to policies governing abortion, a second, less lauded but more certain means of preventing unwanted births, as the driving force behind delayed family formation in the 1970s. [Emphasiss added]

This study is not a perfect comparison to claims about more modern contraception. The idea is that the most effective forms of contraception (e.g. IUDs instead of the Pill) do a better job of decreasing unintended pregnancy rates because even if users increase their sexual activity as a result, the increase in risk-taking behavior does not offset the decrease in risk these more effective contraceptive methods provide.

Note also that research suggests when abortion is legalized the abortion rate increases more than the birth rate decreases. See Footnote 8 of this report, p8 of the PDF, which explains in part:

Note, however, that the decline in births is far less than the number of abortions, suggesting that the number of conceptions increased substantially –and example of insurance leading to moral hazard. The insurance that abortion provides against unwanted pregnancy induces more sexual conduct or diminished protections against pregnancy in a way that substantially increases the number of pregnancies. [Emphasis added]

People are less cautious about avoiding pregnancy when they know they can get abortions as a back up option. This idea is further substantiated by a study published in the June 2015 edition Perspectives on Sexual and Reproductive Health which concluded:

Women who lived in a state where abortion access was low were more likely than women living in a state with greater access to use highly effective contraceptives rather than no method (relative risk ratio, 1.4). Similarly, women in states characterized by high abortion hostility (i.e., states with four or more types of restrictive policies in place) were more likely to use highly effective methods than were women in states with less hostility (1.3).

This research also suggests that teasing out the effects of abortion access compared to contraception use may prove challenging, since the two appear to be inversely correlated.

So with that brief overview of just a few studies, so far these are the conclusions I’m drawing:

  1. Abortion restrictions decrease abortion rates (and likely also unintended pregnancy rates).
  2. Access to the most effective forms of contraception decrease abortion rates.
  3. Abortion restrictions probably decrease abortion rates more than access to less effective contraception (e.g. the Pill) does, and
  4. It’s unclear whether abortion restrictions or access to the most effective forms of contraception (e.g. IUDs) decrease abortion rates more.

I’m open to other suggestions or studies if you have them.

[This article is reposted with permission from Difficult Run.]