Why Banning Abortion is Terrible For Public Health

Dispelling myths and looking to science

Gideon M-K; Health Nerd

Abortion is in the news again, because in the United States a leaked Supreme Court document appears to show that the landmark Roe v Wade decision will be overturned shortly. This will almost certainly have the practical impact of making abortion illegal across a number of American states, and highly restricted in others.

As a man who does not have a uterus, there’s not all that much I can say about abortion on a personal level. It’s unlikely in the extreme that I will ever personally have to have one, and from an ethical standpoint all I can say is that it’s been more than a decade since I did a degree in bioethics and my opinion probably isn’t very useful there either.

However, there is one thing that I’m quite good at — fact-checking scientific questions online. So, here are some of the things bound to come up in the abortion debate, and why in general banning abortion is, from a scientific standpoint, not a very good idea.

Abortion Isn’t Bad For Your Health (unless you’re the one being aborted)

Now, I know this is a contentious topic, because many people will start to argue about the fetus vs the mother, but disregarding the ethics one thing is quite clear: modern abortions are really quite safe. Your risk of death from having an abortion is similar to that of having a tooth removed, or running a marathon.

While there are endless scare stories about breast cancer and depression, the evidence doesn’t really support the idea that abortion causes those issues either. Abortions are not without risk, but in general no more so than any other simple medical procedure you can get, especially medical abortions which are much more common these days than they once were.

Who Gets Abortions?

There is often a lot of misinformation when it comes to the characteristics of the people who choose to have abortions. The picture that is usually painted is of teenagers who accidentally fall pregnant, and merely need a helping hand to raise a child on their own.

In fact, this is untrue.

In most places, the average person to get an abortion already has at least one child, is married or in a long-term relationship, is between the ages of 25–35, and reports a religious belief. (It’s just that an unwanted pregnancy is inconvenient.) There are a few exceptions to this — in Nigeria, it’s mostly unmarried women who have abortions, for example — but in general it is a remarkably stable fact that most people getting abortions have already given birth at least once, and are much older than the misconceptions might suggest.

Abortion and Fertility Rates

The impact of abortion legalization and criminalization on fertility rates is quite complex. When we talk about fertility rates, there are several measures, but what we’re really referring to is how many babies are born in a certain year and region of the world.

The natural assumption is that legalizing abortion will cause fewer babies to be born — the idea being that people who would otherwise go on to have babies abort them as fetuses, and don’t fall pregnant again. And there have been studies looking at the fertility rate before and after the famous Roe vs Wade decision, which found that there was likely a decline in babies being born associated with the increased availability of abortions in the U.S.

However, even that is complex. A paper (un-named) that looked at abortion legalization in Mexico City found that, while there was a statistically significant decrease in babies being born across most maternal ages, the overall impact on the number of births was relatively small, arguing that “most legal abortions replaced clandestine abortion which would have occurred, anyway”. (Just as ILLEGAL murder, which is a crime, occurs anyway. Does that justify me taking your life if you’ve inconvenienced me?)

While it’s probably true to say that expanded abortion access has some impact on fertility rates, that impact is likely to be fairly modest. Indeed, while better abortion access appears to reduce the number of births in a given population by about 4%, this is completely overshadowed by the impact of contraceptive use which usually more than halves the birth rate in countries once introduced. (Unfounded opinion)

Abortion Bans Don’t Work (and neither do criminal laws against murder.) So, let’s just abandon the entire legal system because it doesn’t work anyway. Or does it?

This leads on to the next crucial issue, which is that we know from more evidence that banning abortions doesn’t meaningfully reduce the number of abortions. This is a well-demonstrated and robust finding that has been repeated in studies of the United States as well as other areas in the world.

There are a few reasons for this, but mostly it comes down to a simple fact: it is not actually hard to induce an abortion. What’s difficult, or at least more difficult, is inducing an abortion safely. You can ban safe abortions, but unsafe abortions will take place whether you want them to or not. (You can criminalize murder too, but it still takes place every day whether or not it’s legal. But it IS CRIMINAL and PUNISHABLE, if caught.)

Scientific studies on unsafe abortions have found methods such as inserting sticks, knives, knitting needles, and other sharp objects into the uterus; drinking bleach or other common chemical substances; jumping off roofs, down stairs, or hills; and a myriad of traditional methods including everything from herbal teas to ingesting animal dung — these methods are essentially impossible to regulate.

The thing is, you can ban methods that allow for safe abortions to take place, limit the supply of drugs and surgical options that lower the risk, but ultimately abortions can be caused by any number of common, easily available substances. They may be very dangerous, but surveys of women in areas where safe abortions aren’t available show that people are willing to take these measures when they are desperate. Moreover, rates of abortion tend to be much higher in places that criminalize the act, showing that even the threat of prison is not enough to prevent people taking matters into their own hands. I’s like to see a valid reference for this “opinion”. I don’t believe it.

Banning Abortion Probably Kills Women

Leading on from this, we have another finding: banning abortion likely causes more maternal deaths. This is probably not surprising at this point — we know that reduced abortion access does not substantially reduce the number of abortions, and that illegal abortion methods are often very unsafe, so the logical conclusion is that more unsafe abortions means more maternal deaths.

There is more evidence that this is the case. One example from the U.S. is a paper that looked at the impact of abortion restrictions put in place over the last two decades and the maternal mortality rate. The authors found that additional restrictions on abortion were associated with more deaths, whereby very restrictive states saw a rise of about 15 extra maternal deaths per million live births, compared to states with no restrictions on abortion.

Other research has supported this finding — for example, this ecological study found that countries which relaxed abortion laws saw much bigger declines in maternal mortality. Similarly, states that decreased their number of abortion providers in the United States saw an increase in maternal mortality in another piece of research on the topic.

However, while we know that fewer restrictions on abortion and better access to safe abortion services are associated with a lower maternal mortality, it’s a fairly complex field. It’s possible that the impact is mostly from the other services that these clinics offer, although there does seem to be a pretty solid link between abortion bans and increasing maternal deaths.

The Best Way To Prevent Abortion Is Contraception

There are many uncertainties in the literature about abortion, but this last point is a well-demonstrated fact: if you want to prevent abortions, the best method to do so is by increasing contraceptive use.

This fact has been proven many times.

For example, a study showed that when the United States implemented the Mexico City Policy, also known as the Global Gag rule, which prevents international funding going to clinics that provide abortion services, abortion rates in those areas actually went up. The reason for this is likely because those clinics provided contraceptive services, and when they were shut, contraceptive use dropped dramatically. This caused more unwanted pregnancies, which caused an increase in the abortion rate.

We can also see the incredibly close relationship in studies of married couples. A 2004 review of couples in Shanghai resulted in the impressive graph below, showing that the rate of unintended pregnancy fell to almost nothing once most couples were protected by an IUD. The study also found that 98% of couples who had an unintended pregnancy after already having one child opted for abortion, although this was probably affected by the government policy at the time.

Indeed, paper after paper shows this simple finding across nations — the strongest association with abortion rates is contraceptive use. When you increase the proportion of people who have easy access to effective, modern contraceptives, the number of abortions falls dramatically.

Bottom Line

Whenever I write these articles, I realize you can never say everything in one piece. There is a huge plethora of evidence and literature out there looking at abortions, why they happen, and the effect that banning safe abortions have on the population.

However, there are some things we can be reasonably certain about — even without more extensive research. An evidence-based abortion strategy would include free, easy contraceptive access to reduce the rate, effective sex education to ensure that these options were used when needed, as well as support and counselling for people who have unintended pregnancies. This strategy would also include legalized, easily-available safe abortions, because the evidence shows that banning safe abortions doesn’t decrease the rate of abortions much overall, but it does drive a lot of people to unsafe and horrifying options such as sticking bicycle spokes into their vagina.

As I said right at the start, I’m not an ethicist, and I’m not here to debate the ethics of restricting abortion access. However, from a scientific standpoint, I can plainly see — and answer — whether banning safe abortions is a good idea for public health. And, based on the evidence, the answer is clearly no. Based on the evidence, banning abortions is likely to kill women, and will have very little impact on the number of abortions that take place. If you truly want fewer abortions to happen, preventing unintended pregnancies with contraception is a much more effective solution.