“Contraception Doesn’t Decrease Abortions” – Busted!

“Nations that have adopted contraception have not seen a drop in abortions,” fulminated a recent post in an anti-RH Facebook page. “That’s a patent lie.” This is such a common anti-choice trope, that anti-abortion activist Abby Johnson can repeat it without supporting data, and without fear of rebuttal.

Too bad the data doesn’t support their claims. More widespread contraceptive use correlates strongly with lower abortions. Diehard opponents of the pending Reproductive Health Bill will find this statement difficult to parse, much less accept: after all, aren’t abortions and contraceptives just two cogs in the same anti-life mechanism? Don’t abortion rates go up with rates of contraceptive use?

Actually, no – many studies show that abortion rates recede if decision makers are provided enough information and a wider range of contraceptive choices.

The states comprising the former Soviet Union are the perfect place to test this – a large population for whom “abortion was legal and widely available, whereas contraceptives were in limited supply” (Marston & Cleland). The data supports the conclusion that as more contraceptive methods were introduced, the rate of abortions began to drop precipitously.

From the RAND Corporation, Improvements in Contraception Are Reducing Historically High Abortion Rates in Russia: “The Russian record indicates that improved contraceptive access can help reduce high abortion rates. Continuing improvements in contraceptive knowledge and access can help Russian women lead more stable reproductive lives.”

Relationships Between Contraception and Abortion: A Review of the Evidence by Cicely Marston and John Cleland (published in International Family Planning Perspectives) finds that “increases in contraceptive prevalence and reductions in abortion appear to be related. Abortion rates in the republics examined have declined over the last decade, and there has been a simultaneous rise in use of modern contraceptive methods.”

Replacement of abortion by contraception in three Central Asian republics by Charles Westoff et al. also looks at incidence of abortion and contraception in Central Asia, and come to the same conclusion as Marston and Cleland.

There is ample evidence that abortion is declining and that contraceptive use is increasing in the Central Asian Republics of Kazakhstan, Uzbekistan, and the Kyrgyz Republic….

For many decades, abortion was the principal method of birth control in the former Soviet Union both because of the unavailability of modem contraceptive methods and because of negative attitudes on the part of the medical establishment, particularly regarding oral contraceptives. What is remarkable is how rapidly this substitution of contraception for abortion seems to be occurring, with major shifts apparent in the space of less than a decade.

The money quote is on page 8.

Another perspective that indicates an increase in contraceptive use in these populations is the recent sharp decline in the fertility rate itself. Since there is no evidence for an increase in age at marriage or age at sexual initiation or in the duration of postpartum insusceptibility or for any decrease in coital frequency, the only plausible explanation for the decline in fertility is the increased use of contraception. In theory, the decline could be caused by an increase in abortion, however, none of the evidence points in this direction. In fact, ail of the indicators point in the opposite direction.

The trend is not limited to former Soviet bloc countries. Recent Trends in Abortion Rates Worldwide by Stanley Henshaw et al. studied the incidence of legal induced abortions in 54 countries, based on official national data.

The study looked at 20 years of data, and concluded that the use of abortion is likely to fall rapidly when multiple contraceptive methods are widely available and effectively promoted and used. Belarus, Estonia, Kazakhstan and Latvia saw abortion rates decline by 28-47%, a similar pattern being seen in Bulgaria, Hungary and the Czech and Slovak Republics. Denmark, Finland, Italy and Japan have seen abortion rates drop by 40-50%.

Temporary Rise in Abortion Rates?

Some critics may note that some countries covered in the surveys quoted above experienced a temporary rise in both contraception and abortion rates – however, this is the exception that prove the rule.

Marston and Cleland acknowledge six countries where contraceptive usage and abortion incidence rise at the same time, but only temporarily: “Eventually, abortion should be replaced by contraception if levels of contraceptive prevalence continue to rise and fertility stabilizes,” say Marston and Cleland. “This pattern also seems to have occurred in Denmark (1970–1990), the Netherlands (1970–1995) and the United States (1965–1995)… In each country, the decline was accompanied by a continued rise in levels of contraceptive use, and the stabilization of fertility at a lower level than before.”

In Southeast Asia, Singapore saw “the same pattern of an initial rise in both abortion and contraceptive use” from 1970 to 1985, followed by a decline in abortion from 1985 onwards.

In situations where increased demand for fertility regulation combine with falling fertility levels, conclude Marston & Cleland, abortion may be resorted to temporarily, but as contraceptive use picks up and fertility levels stabilize, the incidence of abortion drops as well.

The data presented by Henshaw et al. found the same effect, but noted that increasing contraceptive use catches up eventually, decreasing the abortion rate. South Korea, Tunisia, and Turkey experienced a rise in both contraceptive and abortion rates at first, but are currently experiencing drops in abortion rates due to the greater use of contraceptives.

Image © Paige Foster / SXC.hu.