Last night, reports were published in the media about a study published in the Lancetwhich, it was claimed, contains data which shows that “criminalising abortion does not make it any less frequent”. If this provokes a sensation of déjà vu, it’s because we’ve been here before.
As I’ve had occasion to point out, the attempted argument that right-to-life protections do not, in fact, succeed in protecting unborn children from being destroyed, and indeed only causes deaths due to ‘unsafe’ abortions, is a hackneyed meme that has been popular both sides of the Atlantic. It’s not difficult to see why this should be the case. After all, why go through all the bother of attempting to morally justify the killing of innocent unborn children, when you can just argue that protections of the right to life of all human beings fail anyway? It seems to have the perceived virtue of sounding common-sensical, whilst requiring as little effort as possible.
Little wonder then, that studies which try (and seem) to support this apparent dialectical shortcut for abortion advocacy are promoted and spun with alacrity. As the Guardian summarised the new Lancet paper’s findings:
The abortion rate was similar regardless of the legal status of the procedure. It was 37 per 1,000 women in countries where it was prohibited altogether or only permitted to save the woman’s life and 34 where abortion was available on request.
The difference was in the matter of safety. No one knows how many clandestine, unsafe abortions are carried out, but it is known that between six million and nine million [sic] women are treated every year as a result of an unsafe abortion, which can end in death.
So, the claim here is that paper shows that right-to-life protections have ultimately no effect on the abortion rate (the number of abortions that occur), they only prevent abortion from being medically regulated and ‘safe’. Looking more closely however, we see it fails to do anything of the sort, but that it simply repeats the same error as past studies: it generalises so widely that it fails to make meaningful comparisons that would allow a real illustration of the efficacy of legal safeguards for unborn children, or the effects that these have on levels of deaths due to illegal abortions.
With regards to abortion rates, whilst there is relatively greater information about the levels of abortion in countries where the practice is legal and where there are more developed medical systems, where such systems are not so developed and where abortion is not legal, there is unsurprisingly little information to go on. Due to this, the authors of the Lancet study have to attempt to estimate abortion rates based on modelling, and various indicative statistics such as contraceptive failure rates. As the authors of the study themselves admit within it (pg. 8):
Our estimates have several limitations. Information about abortion incidence in the developing world is scarce. The quantity and precision of data in developing regions are reflected in the wide uncertainty intervals around estimates for these regions. Empirical evidence to inform and validate the estimated rates for subgroups of married women is also lacking, and research on abortion incidence in these subgroups is needed.
This is not hard data, then, but informed prediction. Even accepting the verisimilitude of such estimates, however, they fail to tell us anything truly meaningful about the effects of right-to-life safeguards on either abortion rates or illegal abortion deaths. The study itself argues:
When countries were grouped according to the grounds under which abortion was legal, we did not find evidence that abortion rates for 2010–14 were associated with the legal status of abortion (table 4). The rate was 37 abortions per 1000 women (34–51) where abortion is prohibited altogether or allowed only to save a woman’s life, and 34 (29–46) where it is available on request.
This is ‘table 4’ referred to in that text:
As we can see, there is a major flaw with the claim being made, and it is the same flaw of previous such attempts: it generalises absurdly, and fails to make more careful comparisons. The world is a diverse place, made up of countries that have very different societies, cultures, and economies. To group together all countries that have specific kinds of law regarding abortion, but regardless of the state of their medical system, levels of poverty, and other factors that would be relevant to the incidence of abortion and the level of maternal mortalities (including those due to illegal abortions) fails to control for these realities, and therefore tells us nothing.
It is meaningless to compare Sri Lanka with France, or Ethiopia with Norway. Rather, it is only when we compare countries that are relatively socio-economically and culturally similar, that we can properly try to control for important differences between them, and see the real difference that particular kinds of laws can make.
This is something the Lancet study never does. Rather than look at specific countries, it generalises in its estimates about abortion rates according to whole regions, without any concern for the diversity within them. This contributes little if anything to the debate. So, it still remains the case that to really begin to discern the effects of the right-to-life laws on either abortion rates or deaths due to illegal abortion, we need to engage in much more careful and specific studies and statistics.
As I argued before:
Whilst many of the countries that have permissive abortion laws are in richer areas such as Europe or North America, countries that have greater protections for the right to life of unborn children are located in places like Latin America or Asia that have higher rates and incidences of the sorts of social problems that lead to a higher perceived need for abortion. Yet when we compare countries that are similar – that is, countries or parts of countries that are socially and economically similar and in the same region, we find a different picture is painted.
Let’s start with illegal abortions. Deaths due to this are recorded by the reported incidence of ‘maternal mortalities’. These figures are published annually by the World Health Organisation (WHO), and can be found here (go to ‘Annex 19. Trends in estimates of maternal mortality ratio (maternal deaths per 100,000 live births), by country, 1990–2015’, pp. 92-98). If we compare the relatively lower maternal mortality rate (MMR) of 30 deaths per 100,000 in Sri Lanka (which has profound restrictions on abortion), compared with the 258 deaths per 100,000 births in Nepal (which has a de facto permissive abortion system), we seem to see a fairer comparison of countries with different abortion laws.
We see a similar situation when we compare Guyana to Chile. Guyana significantly liberalised its laws in the mid-1990s precisely citing concern over maternal deaths, and has now a higher rate of 229 maternal deaths per 100,000 births. Chile meanwhile, has uncompromising protections for the unborn child in its constitution, and has one of the lowest rates of maternal mortality, having seen its MMR decline from 275 maternal deaths per 100,000 live births in 1960 to 22 in 2015, possibly the largest reduction in any Latin country.
As for abortion rates, this is more difficult to ascertain from country to country by sheer definition: when abortion is illegal its incidence is harder to track as with any illegal activity. There is profound evidence, however, of the efficacy of right-to-life laws in reducing the incidence of abortion in jurisdictions that pass such legislation.
In the U.S., a 2014 study published in the State Politics & Policy Quarterly has showed that right-to-life protections at the state level have practically succeeded. The study was a meta-analysis of research based on data from the pro-abortion Guttmacher Institute and the U.S. Centres for Disease Control and Prevention from nearly all 50 states for every year from 1985 to 2005. It found that public funding restrictions, parental involvement laws (which mandate that parents be notified when their child tries to access abortion, and require their consent), informed consent laws (which mandate women be informed in various ways about abortion prior to being allowed to go through with the procedure), and laws that limited abortion by other means, all reduced the incidence of abortion.
When public money for abortion was not available, abortion rates were reduced by 10-15%. Parental involvement laws led to a statistically significant decline ranging from 13%-42% in the abortion rate for under-18s, with most declines being between 15%-20%. Informed consent laws that specifically required women to have the chance to view colour photos of fetal development that reduced the abortion rate by 3%-7%, whilst those that required in-person counselling the day before the procedure saw a fall of 7-12%.
One study that the meta-analysis looked at found that a law in the state of Texas which requires all abortions at or after 16 weeks of gestation to be performed in either a hospital or premises designated as ‘ambulatory surgical centres’ led to a reduction in the abortion rate by an astonishing 88%.
Additionally, two studies looked at by the meta-analysis found that when abortion was prohibited its incidence fell, and conversely when legalised, its incidence rose. One of these studies analysed changes in abortion policy in Eastern Europe after the fall of communism, and found that abortion restrictions reduced abortion rates by about 25%. The other study found that in 1971 and 1972, after the state of New York legalised abortion in 1970, abortion rates were significantly higher not only in that state but also in surrounding states.
This latter figure confirms what we know from our own experience in the UK. Since the Abortion Act 1967 passed, the abortion rate has gone up profoundly, compared to what it was estimated to have been in the 1960s (even if you use the higher rate historically estimated by the abortion lobby of 100,000 abortions prior to legalisation).
Like bad gifts, some errors are never properly junked even after they are debunked. They just keep on getting repackaged and sold again. In defending the very enterprise of the campaign for the right to life of unborn children, those who advocate for human dignity have to be willing and able to refute the abortion lobby’s falsehoods, even ad nauseam, until they are put to bed once and for all.