New Data on Global Abortion Trends: Implications for U.S. Policy

Susan A. Cohen

A new report from the Guttmacher Institute highlights the urgency for increasing U.S. international family planning assistance and for the US to help mitigate the impact of unsafe abortion.

A new report from the Guttmacher Institute has major implications for U.S.
policy, highlighting the urgency for boosting U.S. international family
planning assistance and the need for the United States to be more engaged in
mitigating the impact of unsafe abortion.

report, published on October 13, shows positive global trends in increased
contraceptive use, lower unintended pregnancy rates and declining abortion
numbers, but also demonstrates that unsafe abortion remains a critical global
health challenge. According to “Abortion Worldwide: A
Decade of Uneven Progress
,” both the developed and the developing world saw
overall improvements on all three indicators. However, developed
regions saw the greatest progress, while improvement varied widely in the
developing world, with Africa lagging behind all other regions.

Increases in global contraceptive use have contributed to a
decrease in the number of unintended pregnancies and abortions, which declined from
45.5 million procedures in 1995 to 41.6 million in 2003. This decline in
worldwide abortion occurred alongside a global trend toward liberalizing
abortion laws, with 19 countries significantly reducing abortion restrictions
since 1997, and only 3 countries substantially increasing legal restrictions.

The report finds that while the incidence of abortion is
closely related to that of unintended pregnancy, it does not correlate with
abortion’s legal status. Indeed, abortion occurs at roughly equal rates in
regions where it is broadly legal and in regions where it is highly restricted.
The key difference is safety—illegal, clandestine abortions cause significant
harm to women, especially in developing countries. Unsafe abortion causes
70,000 deaths each year and 5 million women are treated for severe
complications resulting from unsafe abortion. Another 3 million women with
serious complications go untreated. 
In essence, the report provides new proof that the legality of abortion
has much more to do with the safety than the rate of abortion.

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Instead, the rate of abortions in a given country corresponds
mostly to the rate of unintended pregnancy, which in turn corresponds closely to
rates of contraceptive use.  Where
abortion remains severely restricted, it happens about as often as where it
isn’t—but it accounts for high rates of maternal death and disability and huge
costs to already strained health systems in developing countries.


report’s findings are an urgent call to action, and the United States is
well-positioned to be a leader in helping to prevent unintended pregnancies and
unsafe abortions worldwide. The Obama administration deserves praise for
reprioritizing international family planning assistance by rescinding
the anti-family planning Mexico City Policy
(also known as the Global Gag
Rule) and for restoring
U.S. funding to UNFPA
. The administration likewise deserves credit for making
unintended pregnancy prevention one of four pillars of its soon-to-be-released
Global Health Initiative. And the new administration and Congress already have
begun making up for lost time and have committed important increases in funding
for international family planning services despite the tough fiscal


But these positive steps are not enough. Deaths from unsafe abortion are utterly preventable
and there is much more the United States can do to avert death and suffering
among millions of women, their children and their families:

  • The
    U.S. Congress should increase foreign aid to international family planning programs
    beyond current proposed increases. U.S. advocates have called for U.S. family
    planning assistance to be doubled, to at least $1 billion annually. A recently
    released report
    by five former directors of the Population and Reproductive
    Health Program of the U.S. Agency for International Development (USAID) goes
    even further, recommending that funding for USAID’s population budget be set at
    $1.2 billion—and raised to $1.5 billion by fiscal year 2014.

  • Congress
    should also reexamine restrictive abortion policies. The 1973 Helms
    amendment bars the U.S. government from paying for safe abortion services
    overseas (much like the Hyde amendment does domestically). This
    restriction should be overturned because it is only exacerbating the
    problem of unsafe abortion and having no effect whatsoever on making
    abortion less likely. The United
    Kingdom’s Department for International Development’s position on unsafe
    shows just how far the United States is lagging behind other
    nations when it comes to supporting programs that make safe abortion and
    post-abortion care more accessible globally.

  • Until
    such time as Congress is prepared to confront the Helms amendment ban on
    providing funding for safe abortion services in the world’s poorest
    countries, at the very least, the U.S. should work within the existing
    exceptions under Helms (in cases of rape, incest and danger to the
    mother’s life) to make safe abortion care available to women who meet
    these criteria (consistent with local law). The U.S. should also boost
    programs that aim to prevent the worst consequences of unsafe abortions,
    by helping to make post-abortion care more widely available to women
    suffering complications from clandestine procedures.

  • Lastly,
    the Obama administration should return the United States to its traditional
    role as a strong advocate for family planning at the international level. As
    part of this overall effort, the United States is recommitting itself to
    achieving reductions in maternal mortality and broader access to family
    planning services under the framework agreed during the 1994 International
    Conference on Population and Development in Cairo as well as under the
    millennium development goals.


are critical to the economic and social development of societies and to the realization
of U.S. international development priorities, as well as many, if not most, of
the Millennium Development Goals. It’s time for the U.S. to get serious about
addressing better access to contraception, unwanted pregnancy and unsafe
abortion as the key public health challenges they are.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

News Law and Policy

Three Crisis Pregnancy Centers Served for Breaking California Law

Nicole Knight Shine

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act.

The Los Angeles City Attorney is warning three area fake clinics, commonly known as crisis pregnancy centers (CPCs), that they’re breaking a new state reproductive disclosure law and could face fines of $500 if they don’t comply.

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act, advocates and the state Attorney General’s office indicate.

The office of City Attorney Mike Feuer served the notices on July 15 and July 18 to two unlicensed and one licensed clinic, a representative from the office told Rewire. The Los Angeles area facilities are Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

The law requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care, and for unlicensed centers to disclose that they are not medical facilities.

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“Our investigation revealed,” one of the letters from the city attorney warns, “that your facility failed to post the required onsite notice anywhere at your facility and that your facility failed to distribute the required notice either through a printed document or digitally.”

The centers have 30 days from the date of the letter to comply or face a $500 fine for an initial offense and $1,000 for subsequent violations.

“I think this is the first instance of a city attorney or any other authority enforcing the FACT Act, and we really admire City Attorney Mike Feuer for taking the lead,” Amy Everitt, state director of NARAL Pro-Choice California, told Rewire on Wednesday.

Feuer in May unveiled a campaign to crack down on violators, announcing that his office was “not going to wait” amid reports that some jurisdictions had chosen not to enforce the law while five separate court challenges brought by multiple fake clinics are pending.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before U.S. Court of Appeals for the Ninth Circuit.

In April, Rebecca Plevin of the local NPR affiliate KPCC found that six of eight area fake clinics were defying the FACT Act.

Although firm numbers are hard to come by, around 25 fake clinics, or CPCs, operate in Los Angeles County, according to estimates from a representative of NARAL Pro-Choice California. There are upwards of 1,200 CPCs across the country, according to their own accounting.

Last week, Rewire paid visits to the three violators: Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

Christie Kwan, a nurse manager at Pregnancy Counseling Center, declined to discuss the clinic’s noncompliance, but described their opposition to the state law as a “First Amendment concern.”

All three centers referred questions to their legal counsel, Alliance Defending Freedom (ADF), an Arizona-based nonprofit and frequent defender of discriminatory “religious liberty” laws.

Matt Bowman, senior counsel with ADF, said in an email to Rewire that forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs” and threatens their free speech rights.

“The First Amendment protects all Americans, including pro-life people, from being targeted by a government conspiring with pro-abortion activists,” Bowman said.

Rewire found that some clinics are following the law. Claris Health, which was contacted as part of Feuer’s enforcement campaign in May, includes the public notice with patient intake forms, where it’s translated into more than a dozen languages, CEO Talitha Phillips said in an email to Rewire.

Open Arms Pregnancy Center in the San Fernando Valley has posted the public notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

Even so, reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, a person who Googled “abortion clinic” might be directed to a fake clinic, or CPC.

Oakland last week became the second U.S. city to ban false advertising by facilities that city leaders described as “fronts for anti-abortion activists.” San Francisco passed a similar ordinance in 2011.