Friday, July 20, 2018

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. 

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:
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:
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:
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).

No comments: