Does freely available contraception cut the abortion rate?

Question

A recent study at the Washington University School of Medicine in St. Louis (see report here) concluded that provision of free long-acting contraception reduced the number of abortions in its recipients.

Even such an apparently simple result can be interpreted different ways given the deeply polarised nature of the debate about abortion and contraception in the USA. For example, according to this CBS report, the conservative view (as expressed by Jeanne Monahan of the conservative Family Research Council):

Additionally, one might conclude that the Obama administration's contraception mandate may ultimately cause more unplanned pregnancies since it mandates that all health plans cover contraceptives, including those that the study's authors claim are less effective

So I know that the whole contraception/abortion debate is particularly polarised in the USA, but is there an objective scientific view of the issue? Are there other studies we should look at? Does contraceptive provision reduce the incidence of abortion in the USA or elsewhere?

Answer 1

The MEASURE Demographic and Health Surveys project published an analytical study on Recent Trends in Abortion and Contraception in 12 Countries in 2005, the 12 countries in the study being Armenia, Azerbaijan, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, Romania, Russia, Turkey, Turkmenistan, Ukraine, and Uzbekistan. From the Executive Summary of the study:

In a series of simulation models, the implications for further reductions in the prevalence of abortion are estimated. For example, if the women currently using modern methods of contraception were joined by those currently using traditional methods, abortion rates on average could be reduced by 23 percent; if women classified as having unmet need for family planning were also added to this group, abortion rates could be reduced by as much as 55 percent.

The study found strong patterns of abortion declining with modern contraceptive prevalence rising in several countries:

...

In summary, 8 of the 12 countries show declines in abortion accompanied by increases in the prevalence of modern methods; one shows an increase in abortion with little change in prevalence (Azerbaijan); two show increases in abortion along with an increase in prevalence but with a substantial reduction in the ideal number of children (Turkmenistan) or a very low ideal number of children with increasing contraceptive failure rates (Ukraine); and one features no net change in abortion rates but with increasing contraceptive prevalence offset by increasing rates of contraceptive failure (Georgia).

Contraception in the Netherlands: the low abortion rate explained seems to strongly suggest that contraception is a major factor in the country's low abortion rates:

This article gives a review of the main factors that are related to the low abortion rate in the Netherlands. Attention is payed to figures on abortion and the use of contraceptive methods since the beginning of the 1960s up to the end of the 1980s. The strong acceptance of family planning was influenced by changing values regarding sexuality and the family, the transition from an agricultural to a modern industrial society, rapid economic growth, declining influence of the churches on daily life, introduction of modern mass media and the increased general educational level. The introduction of modern contraceptives (mainly the pill and contraceptive sterilization) was stimulated by a strong voluntary family planning movement, fear for overpopulation, a positive role of GPs, and the public health insurance system. A reduction of unwanted pregnancies has been accomplished through successful strategies for the prevention of teenage pregnancy (including sex education, open discussions on sexuality in mass media, educational campaigns and low barrier services) as well as through wide acceptance of sterilization. The Dutch experience with family planning shows the following characteristics: a strong wish to reduce reliance on abortion, ongoing sexual and contraceptive education related to the actual experiences of the target groups, and low barrier family planning services.

Unfortunately I don't have access to the full article.

The 1999 book From Abortion to Contraception: A Resource to Public Policies and Reproductive Behavior in Central and Eastern Europe from 1917 to the Present examines the "abortion culture" in USSR successor states, and theorizes that a key factor in high abortion rates was the limited availability, high cost and bad press of modern contraceptives.

Although I haven't got the slightest idea if freely available contraception will (significantly) cut the abortion rate in the US and I'm guessing that data from USSR successor states won't be enough to convince US conservatives, after giving a second read to the MEASURE DES study I'd say it's definitely worth a try.

Answer 2

Does contraceptive provision reduce the incidence of abortion in the USA or elsewhere?

Not necessarily.

1. Guttmacher's research shows contraceptive use may rise parallel to abortion rates. A cited example of this trend is the United States.

   Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant. The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly.

   The reason given for this trend is two fold. First, increased contraception usage indicates a decreased interest in having children. Second, a decreased interest in having children means that contraception failure is more likely to end in abortion. The combination of inexperience with using contraception and higher rates of contraception usage results in a much higher probability of contraception failure and an unwanted child.

   The advent of modern contraception is associated with a destabilization of high (or "fatalistic") fertility preferences. Thus, as contraceptive prevalence rises and fertility starts to fall, an increasing proportion of couples want no more children (or want an appreciable delay before the next child), and exposure to the risk of unintended pregnancy also increases as a result. In the early and middle phases of fertility transition, adoption and sustained use of effective methods of contraception by couples who wish to postpone or limit childbearing is still far from universal. Hence, the growing need for contraception may outstrip use itself; thus, the incidence of unintended and unwanted pregnancies rises, fueling increases in unwanted live births and induced abortion. In this scenario, contraceptive use and induced abortion may rise simultaneously.

   A graphic assembled from data collected from CDC and academic sources illustrates the connection between contraception legalization and reported abortions in the US. Griswold v. Connecticut legalized contraception in the US for married couples, and Eisenstadt v. Baird legalized for unmarried. After nationwide legalization of contraception the number of reported abortions increases dramatically. Abortion was not legalized nationally until 1973 with Roe v. Wade.

   Notably, national contraception legalization and abortion increase also precedes the state by state legalization that occurred before national legalization in Roe v. Wade. State legalizations are indicated by red lines. Abortion was legalized in CO, CA, OR and NC in 1967. HI, NY, AK, and legalized in 1970. DC in 1971. 13 states in total by 1972. This shows the abortion increase cannot be solely attributed to state by state abortion legalization, indicating contraception usage played a significant role in abortion increase, as stated by the Guttmacher report.

2. Some consider contraceptives abortifacients. For example see this pro life author arguing her position:

   The labeling of birth control pills, in their various forms, for years has included information similar to that given to me by my doctor, information that has caused strongly pro-life people, as I am, to consider the birth control pill—and the morning after pill, which operates on the same principles—to be, potentially, an abortifacient and, therefore, to be rejected within a pro-life philosophy.

   An example of contraception's abortifacient potential (prevention of implantation) can be found in the NIH's description of Plan B.

   It may also prevent fertilization of a released egg (joining of sperm and egg) or attachment of a fertilized egg to the uterus (implantation).

   The idea that pregnancy starts at conception is controversial. In order to make Plan B available over the counter after an FDA rejection, the American Medical Association passed resolution 443 in 2004 stating prevention of implantation does not terminate an established pregnancy, effectively redefining abortion to be post implantation in order to make Plan B easily available. Alternatively, the American Heritage Stedman's Medical Dictionary defines pregnancy as "the period from conception to birth".