Guttmacher Responds to Critics of Global Abortion Study

Following the widely covered release of a new Guttmacher
Institute study on global abortion trends
—which found that increases in
contraceptive use have contributed to worldwide declines in the rates of both unintended
pregnancy and abortion—some anti-choice activists have criticized our findings
and policy
.  I’d like to take this opportunity to respond.

Abortion policy and abortion

An overarching finding
of our study is that the legal status of abortion is not highly correlated with
the extent to which abortions actually occur in a given country or region.  In fact, the study found that abortion
rates are about equal in countries where the procedure is broadly legal and
countries where it is highly restricted. Antiabortion activists attempt to challenge
this finding using the United States as an example. They point to recent Guttmacher
research showing that the Hyde amendment—which prohibits the use of federal
Medicaid funds to pay for abortions—deters some women from obtaining an abortion.
They also note that in the years immediately after abortion was legalized
nationwide in 1973, the U.S. abortion rate rose.

Those who claim that Medicaid funding restrictions have significantly
reduced the incidence of abortion in the United States are fundamentally
misreading the Guttmacher Institute’s study on the impact of the Hyde amendment.
Indeed, our study concluded that one in four of America’s poorest women who
would have an abortion if it were paid for by Medicaid instead continue the
pregnancy to term. However, that does not mean the Hyde amendment has reduced
abortions significantly, as some antiabortion activists have claimed, nor would
restoration of public funding have a substantial impact in reverse. We
estimate that if the Hyde amendment were repealed
, the annual number of
abortions nationwide would increase by approximately 33,000—increasing the U.S.
abortion rate by only 2.5 percent (there were a total of 1.21 million abortions in

Our study documents that the Hyde amendment leaves some of
the country’s poorest and most vulnerable women with no choice but to carry
unwanted pregnancies to term. It
also proves the larger point that large numbers of women will go to great
lengths to terminate an unwanted pregnancy. When denied Medicaid funding, three
out of four indigent women still manage to scrape together the funds for a procedure, not to
mention arrange for the transportation and child care they need and comply with state consent
and waiting period requirements (which likewise have not been shown to have any
significant impact on abortion rates), in order to obtain an abortion they feel
they need. This often comes at great expense to themselves and their families,
as money meant for rent, utilities or groceries is instead used for the

In developing countries, the stakes are much higher, as the
abortions women obtain are usually illegal or clandestine, posing terrible risks
to their lives and health. As our report notes, there are about 20 million
unsafe abortions annually, and 70,000 women die from unsafe, clandestine
procedures each year. Fully eight million suffer severe complications, only five
million of whom receive treatment for these complications.

More broadly, it’s important to note that the new Guttmacher
Institute study on global abortion trends does not claim that the legal status
of abortion has no effect.  Rather,
its conclusion is as follows: “The fact that the abortion rate in the less
developed world, where the procedure is legally restricted in many countries,
is quite similar to that in the more developed world, where abortion is largely
permitted on broad grounds in almost all countries, confirms the lack of an
inherent relationship between the prevalence of abortion and its legal status.
Abortion rates can be quite low in some countries where the procedure is legal
on broad grounds, and quite high in many countries where it is highly
restricted.  Restricting abortion
by law does not guarantee a low abortion rate, nor does permitting it on broad
grounds guarantee a high rate.” (The lack of a strong relationship between
abortion legality and incidence is also underscored by our finding that the
decline in worldwide abortion occurred alongside a global trend toward
liberalizing abortion laws. Nineteen countries have significantly reduced
restrictions in their abortion laws since 1997, while only three countries have
substantially increased legal restrictions.)

As for abortion trends in the United States post-nationwide
legalization in 1973, anti-choice activists tell only part of the story.  True, in the years immediately
following Roe v Wade, documented
abortions in the country increased—to a considerable extent, however, this was
a case of legal procedures replacing previous illegal procedures.  The official U.S. abortion rate peaked
at 29.3 per 1,000 women aged 15–44 in 1981, but—as the national rate of
unintended pregnancy declined with increased contraceptive use, especially
among unmarried womenthe abortion
rate also declined steadily to 19.4 abortions per 1,000 women of childbearing
age by 2005. The number of abortions declined as well, to a total of 1.2
million in 2005, 25 percent below the all-time high of 1.6 million abortions in 1990.

Change takes time

Critics of our report—as
the example above indicates—often cite selective time periods to make their
points about the impact of abortion legalization, focusing on short-term
outcomes (like the increase in the United States right after abortion was
legalized), but not mentioning long-term changes (like consistent decline in
the U.S. rate after 1980).

In fact, reducing unintended pregnancy and the need for
abortion takes time, and the time required for policy changes to have an impact
can vary widely from country to country. The bottom line, however, is that—notwithstanding
the legality and wide availability of abortion—where contraceptive services are
widely available and accessible, levels of contraceptive use will increase and
will be accompanied, over time, by falling abortion rates.

Consider the experiences of countries like South Korea and
Russia. South Korea experienced a dramatic decrease in desired family size
beginning in the 1960s. As women’s motivation for small families intensified,
abortion and contraceptive prevalence
rates rose.  Although it took a
number of years, the abortion rate eventually leveled off and then began to
fall, however, as contraceptive use continued to increase.

In contrast, Russia—which historically had some of the
world’s highest abortion rates— saw dramatic changes within a relatively short
period of time. Until the 1980s, it was not uncommon for a Russian woman
wanting only two children to have 10 or more abortions in her lifetime, because
modern contraceptives were essentially unavailable in the country. The
situation changed dramatically in the late 1980s, when foreign-made modern
contraceptives became widely available: Russia’s unintended pregnancy and abortion
rates decreased by half in less than one decade. (Similarly, as our new study
found, the decline in global abortion rates over the past decade was heavily
concentrated in Eastern Europe, where abortion is broadly legal but use of
modern contraceptives has increased dramatically.)

The Key Role of

Fundamentally, some
anti-choice activists simply cannot accept the fact that that increases in
contraceptive use contribute to declines in unintended pregnancy and abortion.  They persist in claiming that
contraception is ineffective and only leads to more unintended pregnancies and

The link between declining abortion incidence and increased
contraceptive use is well established (and well illustrated by many of the
above examples). Behind nearly every abortion is an unintended pregnancy, and it is clear that
the best way for a sexually active person to avoid unintended pregnancy is to
use contraception consistently and correctly.

A recent Guttmacher Institute analysis shows just how
important contraceptive use is for U.S. women. It found that the two-thirds of
U.S. women at risk of unintended pregnancy who use contraception consistently
and correctly account for only 5 percent of unintended pregnancies. In other words,
the one-third of women who use contraception intermittently or not at all
account for fully 95 percent of all unintended pregnancies. Other research indicates
that using any contraceptive method reduces a couple’s chances of having an
unintended pregnancy by 85 percent, and properly using the most effective methods
virtually eliminates that risk.

Of course, no contraceptive method is perfect, just as no
human being is perfect.  Unintended
pregnancy will never be reduced to zero, and accordingly, there will always be
a need for safe, legal abortion. But one thing is certain: Nonuse of
contraception, as anti-choice activists appear to advocate, is hardly an
answer.  It would only lead to
dramatic increases in both unintended pregnancy and abortion in the United
States and around the world.

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  • grayduck

    In my opinion, any proposals for additional spending or tax cuts at the federal level that are not accompanied by specific funding mechanisms should be discarded without further analysis or discussion.


  • caramel

    This is an interesting report and has provided relevent information that i have found difficult to access. However, I must, with all due respect, take issue with the titles being used for persons who are pro-abortion and persons who are against abortion. In the article persons who are against abortion are called "anti-choice." It is difficult to understand why anyone would be anti-choice. Choice is good. Choice gives us freedom. I like to choose what brand and flavor of ice cream I buy. "Anti-choice" smacks of dictatorship, loss of our freedoms, 1984. That is why it is being used here. Why don’t we call it as it is? A person who is pro-abortion is a proabortion activist, not a pro-choicer. A person who is against abortion is an antiabortion activist, a term which actually is used in the article. When terms such as anti-choice are used when describing the results of a scientific study it introduces a confounding factor – this is a biased report, based on what is presented here. Every researcher knows that he/she cannot conduct a study with pre-conceived ideas about what the study will show, must keep confounding factors to a minimum and should report the confounding factors.

  • jayn

    It’s ironic you complain about the use of the term ‘anti-choice’ while using the equally (or more) loaded term of pro-abortion.  I don’t think there’s anyone who thinks that woman should have abortions–however, studies such as this one are showing that if they want one, they’ll almost always find a way to get one, so pro-choicers want that option to at least be safe for them.  Anti-abortion activists want to remove that option from women, so the term anti-choice, while loaded, is often seen as at least correct (sometimes moreso that pro-life, considering that banning abortion mostly just means women find themselves taking more risks to end a pregnancy)


    Most if not all pro-choicers want to reduce the incidence of abortion–prevention of a bad situation is always better than figuring out how to deal with it after it happens, and if a woman is looking for an abortion, it’s safe to say she’s in a bad situation.  There’s no good way out of an unwanted pregnancy.  We just don’t see making abortion illegal as a legitimate means towards that end.

  • jodi-jacobson

    on reproductive and sexual health and rights with people from throughout the world, I have never once met a person who was "pro-abortion."


    As Jayn notes, the issue is in fact one of protecting choices: the choice of each individual woman as to how, whether, when, and with whom to have a child.  This begins with effective knowledge about sex and reproduction (e.g. comprehensive sex ed), through knowledge of, access to and use of prevention measures such as contraception to access to safe abortion services should she need one when facing an unintended pregnancy she does not wish to or can not continue.


    Critics of this report and of data and evidence on abortion generally reject, as this response to recent criticisms underscore, even the role of contraception in reducing unintended pregnancy.  These same political actors object to comprehensive, evidence-based sex ed and to access to contraception, among other things, as well as to women’s access to safe, legal abortion services.  That is "anti-choice."  In such a situation, there is no choice. Given these actors seek regularly to eliminate access to all of the knowledge and services that improve sexual and reproductive health and promote the rights of individuals to make free and informed decisions, we consider them to be "anti-choice."


    The terms pro- and anti-abortion are meaningless as there is no one in the political realm who is "pro" abortion.  If you believe women are moral agents who can make effective decisions about their lives, you are pro-choice irrespective of what choice you might (freely) make given personal circumstances.  If you believe that women should have no choices other than to face unintended pregnancy and to bring any such pregnancy to term, you are in effect leaving them with no choice.

    Jodi Jacobson

  • douglasjohnson

    "In most countries, it is common after abortion is legalized for abortion rates to rise sharply for several years, then stabilize, just as we have seen in the United States."


    — Stanley K. Henshaw, Guttmacher Senior Research Associate (now Senior Fellow), June 16, 1994



    Douglas Johnson
    Legislative Director
    National Right to Life Committee
    Washington, D.C.

  • prochoicelady

    Actually Mr. Johnson,

    If you had read the article, you would find that even in countries where abortion is completely outlawed, abortions still occur and are very unsafe. And the number of abortions in countries where it is legal has declined thanks to better contraception and sex education. So please don’t use outdated quotes to try to justify restricting my choice.


    "Guttmacher estimated previously that the number of abortions worldwide fell from 45.5 million in 1995 to 41.6 million in 2003 — the latest year for which global figures were available.

    Despite this trend, the report said 40 percent of the world’s women live in countries with highly restrictive abortion laws, virtually all of them in the developing world. This category includes 92 percent of the women in Africa and 97 percent in Latin America, it said.

    The survey concluded that abortion occurs at roughly equal rates in countries where it is legal and where it is highly restricted. The key difference, according to the report, is the high rate of deaths and medical complications from unsafe clandestine abortions in the restrictive countries.

    ”Legal restrictions do not stop abortion from happening. They just make the procedure dangerous,” Camp said. ”Too many women are maimed or killed each year because they lack legal abortion access.”


  • jack-madison

    Mr. Johnson, Your comment ignores the evidence and employs exactly the kind of (non)argument that this blog post critiques. Did you even bother to read the extensive evidence that the author cites regarding abortion law, abortion rates and contraceptive availability/use?

  • hereswhatithink

    A few weeks ago, Rep. Barney Frank had a great comment that, with some people, arguing facts is as pointless as arguing with a dining room table. And so it is here. The very point Mr. Johnson makes has been decisively debunked above. Enough said.

  • sertelt

    Actual numbers reveal that contraception use doesn’t decease abortions. See Guttmacher Institute Claims Contraception Lowers Abortions, Data Shows Otherwise

    According to the London Daily Mail, teen pregnancy rates in England are now higher than they were in 1995 and pregnancies among girls under 16, below the age of sexual consent, are also at the highest level since 1998.

    That is despite the British government spending £300 million (that’s over $454 million for those of us in the United States) in an attempt to cut the number of teen pregnancies in half by promoting comprehensive sexual education.

    The British teen abortion rate, according to the newspaper, has also climbed steadily since 1999 when the government released its Teenage Pregnancy Strategy.

    That would be an aberration were it only an isolated case, but it is not.

    Last year, officials in Sweden reported that the number of abortions increased 17 percent in Sweden from 2000 to 2007 despite sales of the morning after pill increasing during the same time period.

    The morning after pill became a drug that could be sold over the counter in Sweden in 2001. In that time, sales of the drug tripled in the nation’s capital and doubled nationwide.

    Still, new national figures show 37,205 abortions in Sweden in 2007, up approximately 17 percent from the 30,980 done in 2000. In Stockholm, 10,259 abortions were done — a 6.9 percent increase in just one year from the 2006 figures.

    Meanwhile, last year the number of abortions in Scotland rose for the third straight year despite a heavy push for women to use the morning after pill.

    Abortions in Scotland rose four percent according to a report from the British National Health Service and now number 13,703. That increase came after NHS reported 13,081 abortions in 2006, up from 12,603 the previous year — an increase of nearly 3.8 percent.

    Not only is the increased promoting of the morning after pill resulting in more abortions, not less, the number of women having repeat abortions is increasing as well.

    NHS reports more than a quarter of women, 26.3 percent, who had an abortion in Scotland last year had at least one prior abortion before that. That’s 3,600 women who had one or more abortions prior, according to the government’s statistics.

    Finally, a report from Planned Parenthood of Western Washington shows abortions are on the rise in Washington state even though it participated in Washington state’s Take Charge pilot program.

    Take Charge is a Medicaid section 1115 Waiver program initiated in 2001 to provide free contraceptives to low-income women not already covered under Medicaid. It was originally funded for five years in 2001, then extended for three more years, and comes up for renewal in 2009.

    Yet the PPWW annual report indicates abortions rose 16 percent from 7,790 in 2006 to 9,059 in 2007.

    The report found the abortion increase occurred despite sales of over 106,000 emergency contraception kits to Planned Parenthood customers.

    More on these false numbrs at Guttmacher Institute Study Casts Doubt on Contraception Use Reducing Abortions

  • hereswhatithink

    Very weak. You cherry pick studies on subgroups of women (like teens) or on only one method of contraception (like emergency contraception) in a couple of random countries and then make sweeping statements about all women and all methods of contraception. And, of course, you completely ignore all the evidence cited in the blog post.  

  • crowepps

    I don’t suppose that it occurred to you for a second that the reason “abortion rates rise for several years” is that they are moving from the illegal column where they are secret and uncounted into the legal column where statistics are kept, but that’s certainly the likely explanation, just as the numbers for anything else from diseases to crimes show an ‘increase’ (or possibly decrease) when those dealing with them are required to gather the numbers and make actual reports so that the central agency can replace estimates with statistics.

  • ahunt

    Just so we are clear, Sertelt…are you objecting to the failure of women to use contraception, or the use of contraception itself?

  • crowepps

    Your bias arises from the fact that you are incorrectly assuming that there are only two possible categories. Actually there are four major and many more minor ones, a NONinclusive list of which include people whose position is:


    No abortion for any reason whatsoever for anybody at all no matter what the circumstances with criminal penalties for everyone involved in any way.


    Legal abortion only for specific reasons like life of the woman or nonviable fetus but with the decision made by someone else (like a panel of doctors)


    Legal abortion for more reasons like incest or rape with evidence independent of the girl/woman’s own testimony on the assumption that the girl/woman will make a false report to obtain an abortion by ‘trickery’.


    Choice involves various combinations of ‘let the people involved make their own decisions even though it’s not what I might do in the situation’ including:


    Legal abortions for the reasons above and for ‘mental health’ with the woman being the final decisionmaker on the assumption that she is the person must likely to know the true facts of her situation but with a few more restrictions than presently, or what we actually have today – legal abortions for a variety of reasons including abortion in the first trimester for ‘not wanting to be pregnant’ with increasing restrictions as the fetus develops.


    There are many ProChoice people who would not personally choose to have an abortion, who perhaps even find abortion abhorrent, but who respect the right of others to disagree with them and to choose differently. The concern of these ProChoice people is saving women’s lives by avoiding illegal abortions.


    Then are those who would not mandate but who would ENCOURAGE and PROMOTE women getting abortions for various reasons like economic realities. I suppose they could be called ‘proabortion’.


    Then we can move further out of the realm of choice and back into no-choice: compulsion, mandates and requirements by those with pro-abortion views, so fringe that they’re not often heard at all in the USA. These people are no more representative of the larger ProChoice movement than the ‘no abortion for any reason – let the women die’ fringe of ProLife.


    These include people who believe the government should be able to REQUIRE women to get an abortion if the fetus is nonviable (‘be sensible’ in order to cut total medical expenses), those who would REQUIRE abortion if the fetus will be grossly handicapped (to eliminate their ‘drain’ on society), those who would REQUIRE abortion if the fetus is even mildly handicapped or will inherit certain genetic conditions potentially requiring society to provide support or potentially putting society at risk (infamous to us all under the name eugenics).


    And last there is the tiny fringe of zero population/reduce population advocates that believe nobody should be allowed to have more than two children/one child, that the people who want to be parents should have to prove their capability and be licensed by the government to do so, and that people who are ‘unfit’ or who have already reproduced once or twice should be REQUIRED to submit to sterilization. The most extreme believe that ‘excess’ or ‘unlicensed’ children should be euthanized.

  • jane-roberts

    Jane Roberts   By joining our 34 Million Friends of the United Nations Population Fund which offers the family planning that we all practice, AND with as little as one dollar, you can actually help prevent the terrible suffering that results from this scourge of unsafe abortion.  At the core, restriction of legal safe abortion is a kind of misogyny which results from gender inequality. If law making bodies all over the world were equally divided between men and women, things would change dramatically. The number one change might be that contraception might be universally available as promised in human rights documents.