Guttmacher Responds to Critics of Global Abortion Study

Susan A. Cohen

Some anti-choice activists have criticized the findings and policy recommendations of a recently released Guttmacher Institute study on global abortion trends. Susan Cohen responds to these critiques and debunks their misleading arguments.

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estimate that if the Hyde amendment were repealed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

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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.

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.

Read more of our coverage of the Democratic National Convention here.

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.

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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.

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

Texas Lawmaker’s ‘Coerced Abortion’ Campaign ‘Wildly Divorced From Reality’

Teddy Wilson

Anti-choice groups and lawmakers in Texas are charging that coerced abortion has reached epidemic levels, citing bogus research published by researchers who oppose legal abortion care.

A Texas GOP lawmaker has teamed up with an anti-choice organization to raise awareness about the supposed prevalence of forced or coerced abortion, which critics say is “wildly divorced from reality.”

Rep. Molly White (R-Belton) during a press conference at the state capitol on July 13 announced an effort to raise awareness among public officials and law enforcement that forced abortion is illegal in Texas.

White said in a statement that she is proud to work alongside The Justice Foundation (TJF), an anti-choice group, in its efforts to tell law enforcement officers about their role in intervening when a pregnant person is being forced to terminate a pregnancy. 

“Because the law against forced abortions in Texas is not well known, The Justice Foundation is offering free training to police departments and child protective service offices throughout the State on the subject of forced abortion,” White said.

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White was joined at the press conference by Allan Parker, the president of The Justice Foundation, a “Christian faith-based organization” that represents clients in lawsuits related to conservative political causes.

Parker told Rewire that by partnering with White and anti-choice crisis pregnancy centers (CPCs), TJF hopes to reach a wider audience.

“We will partner with anyone interested in stopping forced abortions,” Parker said. “That’s why we’re expanding it to police, social workers, and in the fall we’re going to do school counselors.”

White only has a few months remaining in office, after being defeated in a closely contested Republican primary election in March. She leaves office after serving one term in the state GOP-dominated legislature, but her short time there was marked by controversy.

During the Texas Muslim Capitol Day, she directed her staff to “ask representatives from the Muslim community to renounce Islamic terrorist groups and publicly announce allegiance to America and our laws.”

Heather Busby, executive director of NARAL Pro-Choice Texas, said in an email to Rewire that White’s education initiative overstates the prevalence of coerced abortion. “Molly White’s so-called ‘forced abortion’ campaign is yet another example that shows she is wildly divorced from reality,” Busby said.

There is limited data on the how often people are forced or coerced to end a pregnancy, but Parker alleges that the majority of those who have abortions may be forced or coerced.

‘Extremely common but hidden’

“I would say that they are extremely common but hidden,” Parker said. “I would would say coerced or forced abortion range from 25 percent to 60 percent. But, it’s a little hard be to accurate at this point with our data.”

Parker said that if “a very conservative 10 percent” of the about 60,000 abortions that occur per year in Texas were due to coercion, that would mean there are about 6,000 women per year in the state that are forced to have an abortion. Parker believes that percentage is much higher.

“I believe the number is closer to 50 percent, in my opinion,” Parker said. 

There were 54,902 abortions in Texas in 2014, according to recently released statistics from the Texas Department of State Health Services (DSHS). The state does not collect data on the reasons people seek abortion care. 

White and Parker referenced an oft cited study on coerced abortion pushed by the anti-choice movement.

“According to one published study, sixty-four percent of American women who had abortions felt forced or unduly pressured by someone else to have an unwanted abortion,” White said in a statement.

This statistic is found in a 2004 study about abortion and traumatic stress that was co-authored by David Reardon, Vincent Rue, and Priscilla Coleman, all of whom are among the handful of doctors and scientists whose research is often promoted by anti-choice activists.

The study was cited in a report by the Elliot Institute for Social Sciences Research, an anti-choice organization founded by Reardon. 

Other research suggests far fewer pregnant people are coerced into having an abortion.

Less than 2 percent of women surveyed in 1987 and 2004 reported that a partner or parent wanting them to abort was the most important reason they sought the abortion, according to a report by the Guttmacher Institute.

That same report found that 24 percent of women surveyed in 1987 and 14 percent surveyed in 2004 listed “husband or partner wants me to have an abortion” as one of the reasons that “contributed to their decision to have an abortion.” Eight percent in 1987 and 6 percent in 2004 listed “parents want me to have an abortion” as a contributing factor.

‘Flawed research’ and ‘misinformation’  

Busby said that White used “flawed research” to lobby for legislation aimed at preventing coerced abortions in Texas.

“Since she filed her bogus coerced abortion bill—which did not pass—last year, she has repeatedly cited flawed research and now is partnering with the Justice Foundation, an organization known to disseminate misinformation and shameful materials to crisis pregnancy centers,” Busby said.  

White sponsored or co-sponsored dozens of bills during the 2015 legislative session, including several anti-choice bills. The bills she sponsored included proposals to increase requirements for abortion clinics, restrict minors’ access to abortion care, and ban health insurance coverage of abortion services.

White also sponsored HB 1648, which would have required a law enforcement officer to notify the Department of Family and Protective Services if they received information indicating that a person has coerced, forced, or attempted to coerce a pregnant minor to have or seek abortion care.

The bill was met by skepticism by both Republican lawmakers and anti-choice activists.

State affairs committee chairman Rep. Byron Cook (R-Corsicana) told White during a committee hearing the bill needed to be revised, reported the Texas Tribune.

“This committee has passed out a number of landmark pieces of legislation in this area, and the one thing I think we’ve learned is they have to be extremely well-crafted,” Cook said. “My suggestion is that you get some real legal folks to help engage on this, so if you can keep this moving forward you can potentially have the success others have had.”

‘Very small piece of the puzzle of a much larger problem’

White testified before the state affairs committee that there is a connection between women who are victims of domestic or sexual violence and women who are coerced to have an abortion. “Pregnant women are most frequently victims of domestic violence,” White said. “Their partners often threaten violence and abuse if the woman continues her pregnancy.”

There is research that suggests a connection between coerced abortion and domestic and sexual violence.

Dr. Elizabeth Miller, associate professor of pediatrics at the University of Pittsburgh, told the American Independent that coerced abortion cannot be removed from the discussion of reproductive coercion.

“Coerced abortion is a very small piece of the puzzle of a much larger problem, which is violence against women and the impact it has on her health,” Miller said. “To focus on the minutia of coerced abortion really takes away from the really broad problem of domestic violence.”

A 2010 study co-authored by Miller surveyed about 1,300 men and found that 33 percent reported having been involved in a pregnancy that ended in abortion; 8 percent reported having at one point sought to prevent a female partner from seeking abortion care; and 4 percent reported having “sought to compel” a female partner to seek an abortion.

Another study co-authored by Miller in 2010 found that among the 1,300 young women surveyed at reproductive health clinics in Northern California, about one in five said they had experienced pregnancy coercion; 15 percent of the survey respondents said they had experienced birth control sabotage.

‘Tactic to intimidate and coerce women into not choosing to have an abortion’

TJF’s so-called Center Against Forced Abortions claims to provide legal resources to pregnant people who are being forced or coerced into terminating a pregnancy. The website includes several documents available as “resources.”

One of the documents, a letter addressed to “father of your child in the womb,” states that that “you may not force, coerce, or unduly pressure the mother of your child in the womb to have an abortion,” and that you could face “criminal charge of fetal homicide.”

The letter states that any attempt to “force, unduly pressure, or coerce” a women to have an abortion could be subject to civil and criminal charges, including prosecution under the Federal Unborn Victims of Violence Act.

The document cites the 2007 case Lawrence v. State as an example of how one could be prosecuted under Texas law.

“What anti-choice activists are doing here is really egregious,” said Jessica Mason Pieklo, Rewire’s vice president of Law and the Courts. “They are using a case where a man intentionally shot his pregnant girlfriend and was charged with murder for both her death and the death of the fetus as an example of reproductive coercion. That’s not reproductive coercion. That is extreme domestic violence.”

“To use a horrific case of domestic violence that resulted in a woman’s murder as cover for yet another anti-abortion restriction is the very definition of callousness,” Mason Pieklo added.

Among the other resources that TJF provides is a document produced by Life Dynamics, a prominent anti-choice organization based in Denton, Texas.

Parker said a patient might go to a “pregnancy resource center,” fill out the document, and staff will “send that to all the abortionists in the area that they can find out about. Often that will stop an abortion. That’s about 98 percent successful, I would say.”

Reproductive rights advocates contend that the document is intended to mislead pregnant people into believing they have signed away their legal rights to abortion care.

Abortion providers around the country who are familiar with the document said it has been used for years to deceive and intimidate patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

Vicki Saporta, president and CEO of the National Abortion Federation, previously told Rewire that abortion providers from across the country have reported receiving the forms.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Busby said that the types of tactics used by TFJ and other anti-choice organizations are a form of coercion.

“Everyone deserves to make decisions about abortion free of coercion, including not being coerced by crisis pregnancy centers,” Busby said. “Anyone’s decision to have an abortion should be free of shame and stigma, which crisis pregnancy centers and groups like the Justice Foundation perpetuate.”

“Law enforcement would be well advised to seek their own legal advice, rather than rely on this so-called ‘training,” Busby said.