Reducing the Abortion Rate

David Edelstein, reviewing Tony Kaye's abortion documentary, Lake of Fire:

I’m glad Nat Hentoff is in the movie. I remember the civil-liberties beacon from my days at the Village Voice, where he was shunned by most of the women on staff for his views on abortion. He’s a lefty atheist who also happens to believe that life begins when the sperm meets the egg—a view I find convincing. But the answer, as the movie’s pro-choice activists maintain, isn’t banning abortion but making birth control easier to obtain ...

Meanwhile, Will Saletan glosses the latest findings on this subject:

A study concludes that the global abortion rate is falling thanks to birth control. Data: 1) The rate fell 17 percent from 1995 to 2003. 2) The biggest drop was in the former Soviet bloc and "did coincide with substantial increases in contraceptive use in the region." 3) Previous studies found that "abortion incidence declines as contraceptive use increases." 4) Abortion bans don't correlate with low abortion rates. 5) Abortion bans do correlate with high rates of unsafe abortion. Authors' conclusion: If you want fewer abortions, don't ban them; provide more birth control and sex education. Liberal reaction: Bush is making things worse by censoring abortion counseling and pushing abstinence instead of condoms. Pro-life rebuttal: 1) The data are unreliable. 2) They're being spun by pro-choice "scientists." Human Nature's view: Reducing abortions through birth control is a no-brainer.

The difficulty isn't that the data are unreliable or the scientists dishonest; it's that - as Matt points out - these kind of cross-country comparisons don't actually tell you all that much about the landscape of abortion and contraception in the contemporary United States. We know that as poor countries get richer, better-educated, and so forth, contraception use goes up and abortion rates tend to go down; what we don't have is any evidence that increasing government funding for sex ed and birth control in a rich country like the United States, where contraception is already widely available, has an appreciable impact on the rate of unintended pregnancy, and thus abortion. Most of the evidence that I've seen suggests that it doesn't. Whereas we know that when abortion was legalized in America in the early 1970s, the abortion rate went up dramatically; we also know that Western Europe, which has lower abortion rates than the U.S., also has (somewhat) more restrictive abortion laws. Which suggests if you're serious about reducing the abortion rate in America (as opposed to taking the "more abortion is a good thing" line that Matt espouses), the Edelstein-Saletan answer is something of a cop-out; if some kind of restriction isn't on the table, you probably aren't going to get very far.

Comments

I asked this question at Megan's place: does anyone think that, regardless of the legality of abortions in this country, affluent Americans will face any real difficulty in getting abortions? Everyone knows about the back-alley abortion clinics in the pre-Roe days. But what they often fail to mention that those with the economic and social resources to do so had little trouble in getting an abortion at the time. There were the obvious remedies of going out of state or country; there was also the fact that it is extremely difficult to prevent doctors from performing short, generally easy and risk-free out patient procedures that can be performed quickly in a small, private facility. I don't find many people who honestly believe that the rich will have a difficult time procuring abortions if they want them and are willing to pay. So as always, since we're talking about the efficacy of criminalizing abortions here, I have to ask-- do you want to extend that ability to the poor, the ability to safely and legally terminate a pregnancy, or will that become yet another privilege reserved for the rich?

Posted by Freddie | October 17, 2007 4:06 PM

Freddie,

It's probably easier for the well off to purchase effective hit-man service when trying to get rid of spouses. Nontheless, I am inclined to outlaw contract murder despite the fact that this probably affects the ability of poor people to safely and without much legal jeopardy dispose of inconvenient people. I'm ok with things nobody should be doing being somewhat reserved for the rich.

The poor can't afford to bribe legislators, either, but I'm not in favor of making bribery ok even if that facillitates it for the poor, after all.

Posted by The Marquis of Carabas | October 17, 2007 4:49 PM

Snarkiness aside -- if reducing abortion rates is the goal, and you're not someone who recognizes any _right_ to abortion, though you may greatly sympathize with individuals who do it (just as I have sympathized with a number of murderers over the years, where the wrongness is more clearly known to the person acting), it's hard to see what moral principle would compel one to be very concerned about where the reduction takes place. In other words, if you don't really have a problem with abortion, and despite all your hand-wringing really think it is something that should be available, then I don't see why you have much real interest in serious restrictions other than the blatantly cosmetic, in any case. And if you don't recognize abortion as a good, or a right, or a "privilege", then inequity in who has more trouble getting an abortion seems puzzling.

That's the way the world _is_. The poor almost always have a harder time escaping the consequences of choices or circumstances. When the means to escape consequences are morally undesirable, this becomes less problematic.

Posted by The Marquis of Carabas | October 17, 2007 5:04 PM

First of all, I find the idea that enforcability is irrelevent to a policy discussion about making something illegal truly bizarre. I never said it was the only consideration, or the most important consideration. But it is a major question when you seek to criminalize anything, and when you're talking about an issue that has such vast consequences in terms of family structure, poverty and social engineering, it is of particular relevance that the poor shoulder an unfair burden.

People are going to continue to get abortions if you criminalize abortion. It's just that the rich will get them safely, and the poor will not. So if your goal is to ensure that abortions remain safe for everyone, the policy fails; and if your goal is to eliminate abortions, the policy fails. See?

Posted by Freddie | October 18, 2007 9:50 AM

Freddie says "if your goal is to ensure that abortions remain safe for everyone, the policy fails; and if your goal is to eliminate abortions, the policy fails. See?"

No, I don't see. From the perspective of someone who comes down on the "eliminate abortions" side of the fence, it doesn't make sense to say that the failure of a legal ban to eliminate all abortions means that abortions should remain legal. Your argument concedes (or assumes) that there would be fewer abortions if abortion were made illegal - From a pro-life perspective, fewer victims of abortion is better (just as fewer assault victims or fewer robbery victims would be better, notwithstanding that the criminal law does not eliminate assault or robbery).

On a practical level, I also question your assumption that doctors would be able to operate underground abortion clinics for rich women with impunity. A sale of an illegal drug is a quick, private, and simple transaction, and use of illegal drugs can also be a simple and private activity. Yet the cops seem to find no shortage of dealers and users to bust, and many of these people go to prison. I suspect that in a setting where abortion was outlawed, and doctors could go to jail for performing one, there are not as many doctors as you think would volunteer to perform abortions and hope to avoid detection.

Posted by FW Dixon | October 18, 2007 2:13 PM

I'm sorry, I assume a rational agent is hearing my arguments. If someone is such a frothing zealot that basic issues of fairness, egalitarianism, safety and equality under the law become utterly unimportant, I'm afraid that they've passed the point where rational discourse has any value whatsoever.

As for your drug analogy, it's simply a laughably bad analogy. Drug dealers don't have the equivalent to legitimate businesses that utilize tools which have application to both legal procedures and abortion, nor do they have powerful ethical, social and legal institutions respecting their right to privacy.

Posted by Freddie | October 18, 2007 3:10 PM

Access to contraception (i.e. mandating inclusion in health care plans) is not the same as improving sex ed.

Posted by bob | October 18, 2007 3:29 PM

Freddie - I'd like to think I'm a "rational agent" and not a "frothing zealot," but I was responding to what I perceived to be your argument. I take it we would agree that rendering many abortions illegal would likely decrease the incidence of abortion. Your latest point seems to be that anyone who is not a "frothing zealot" will agree that the other values you identify will trump the benefits associated with reduced abortion. (Remember, I am writing this as someone who is pro-life - obviously, if I thought there was nothing wrong with abortion, I wouldn't say there were benefits to reducing it).

Now, your competing values - "fairness, egalitarianism, and equality under the law" seems to be triple counting, in that they are different ways of saying the same thing. I'll get to those in a minute, but first, safety. First of all, in your scenario, the rich are able to get abortions from doctors who are running legitimate operations and doing abortions on the side - Given the advances in medical technology, particular with respect to treating infections, and given that we know have a generation of doctors with comparatively greater knowledge of abortion techniques, I suspect we could have a good number of these illicit abortions without a substantial increase in the danger to the women involved. However, assuming I grant some increased risk in the danger posed - That risk has to be weighed against the benefit of the decrease in abortions, with each abortion, after all, being fatal to the unborn child involved. (Again, you may think there is nothing wrong with aborting a fetus, but my assumption is that your argument was aimed at persuading people who did not already agree with you on the central issue at the core of the debate).

As to the other values, again, I note the question-begging nature of your approach - If the fetus/unborn child has moral worth, abortion is certainly "unequal treatment" in an egalitarian and legal sense - the fetus is not being given the same chance by its mother that the mother by definition received from hers. Even leaving aside this basic point, you can't claim that there would be no "equality under the law" - the legal restrictions would apply equally to everyone, and you're just upset that the rich would stand a better chance of successfully evading them - But that theory applies to all criminal prohibitions, and is generally not taken as reason to repeal existing criminal laws. (Marquis pointed this out earlier, and I don't think you offered a response).

This leaves general concerns of "egalitarianism" and "fairness" - Again, getting past the question-begging nature of this argument, it honestly doesn't seem to be a big deal. My preferred legal regime would be one in which abortions were heavily restricted, and doctors who broke the law could go to jail. I personally don't favor jailing women, because (a) I have "liberal" views on criminal law in general, and (b) I think the mindset of the average woman seeking an abortion is very different from the culpable mindset that we usually associate with other types of criminal behavior. I also would hope that in a post-Roe/restricted abortion regime, women would take seriously the option of adoption, and the government would support them in these effort. I also have no problem with widepread access to contribution, and I know of no credible legal scholar or political theorist who honestly believes that restricting abortion in the U.S. would inevitably lead to successful efforts to outlaw contraception (this is not to say that some folks might not try, just that there chances of political success would be virtually nil).

In the kind of regime I describe, which I think is the most plausible version of a post-Roe world in which abortion faced increased legal restrictions, I would not be greatly troubled by the fact that rich women might evade these restrictions. The truth is, I think that such actions would be rather contemptible, because the rich have less of an excuse for abortion than the poor - But the fact that rich people will often do bad things and have a better chance at getting away with them, while obnoxious, also seems to be somewhat inevitable, and thus is not a factor that plays a large role in my view of desirable social policy.

Now, just curious - Am I still a "frothing zealot," or am I just someone who disagrees with you on abortion?

Posted by FW Dixon | October 18, 2007 4:14 PM

Look, you addressed, or seemed to address, the question from the standpoint that reducing abortions was the one and only legitimate criteria for evaluating the success of the law. And I find that a little crazy, even if you generally want to reduce the number of abortions. I want to reduce the number of murders in this country. But my definition of the failure or success of that aim doesn't include only the rate at which murders decline, because I value the rights of the accused and due process, etc. There are other considerations that are important, even though I want to reduce the number of murders generally. And while enforceability, while not the sole matter of interest when evaluating the law, is an important consideration. And the degree to which the law is equitably applied to all citizens seems to me to be one of the most basic questions of justice. And if you're so opposed to abortion that you are willing to disregard those questions if it only results in some small decrease in the total number of abortions, yes, I think you're a zealot.

Posted by Freddie | October 18, 2007 8:10 PM

Whereas we know that when abortion was legalized in America in the early 1970s, the abortion rate went up dramatically;

What are your terms? If you're comparing legal abortions pre- and post-1970, then of course the rate would increase "dramatically." That's a tautology.

Or are you comparing all abortions, pre- and post-1970? I doubt it. That's the only meaningful comparison, but it inevitably robs you of your "dramatic[] increase."

* Illegal abortions are, by definition, nearly impossible to quantify.

* Let's say you have two choices: 1) Take on, against your will, a tremendous responsibility that determines the course of your life for the next 18 years, minimum; 2) Undergo an illegal operation--assuming you can find anyone willing to perform it--that has a non-trivial chance of killing you, and an even less trivial chance of injuring or infecting you in a non-fatal way. While you're weighing your options, you're offered choice 3) A legal operation that's vanishingly unlikely to cause internal infections, much less kill you.

Are you surprised that many people prefer the third choice?

we also know that Western Europe, which has lower abortion rates than the U.S., also has (somewhat) more restrictive abortion laws.

They also have (somewhat) more generous social support for single mothers, and families in general.

Really, Ross, are you even trying?

Posted by dogrose | October 18, 2007 10:45 PM

I'd argue more with Freddie here, but I prefer rational listeners, too.

Look, the problem is that _in this context_ egalitarian outcomes don't really seem to be very interesting. If you don't grant any legitimacy to the goal of seeking an abortion, it is hard to see how you would see it as unjust that it is harder for others. "Equality before the law"?? The law would apply to everyone, but be easier for some to circumvent. This is true of _all laws that I can imagine_. You're the one appealing to a rather extreme version of the leftish fetishization of equality as some kind of trump card against anti-abortion laws. But even ignoring abortion, it's hard to see why anyone would worry too much about a law being practically harder to enforce on some people if that law is inherently just in what it outlaws. You don't have any problems with abortion, I suspect, and so are very interested in this red herring. But given pro-life premises, it's hard to see why it's much more than a fairly low-grade pragmatic concern ("gee, it would be nice to enforce this law better on the wealthy, too, since they are the ones most likely to be having abortions for more morally repulsive reasons").

Posted by The Marquis of Carabas | October 19, 2007 12:52 PM

It's not a red herring, it is one of most basic, foundational notions of Western jurisprudence and basic justice: the law should apply equally to everyone. I know that, as conservatives are wont to do, you're trying so hard-- so, so hard-- to push my argument into some sort PC plea. But it isn't. It's a question of the most elementary notions of justice. Now, please, answer this question: is the idea that the law should be applied equitably to everyone one of the basic tenets of justice and Western law? Yes or no?

I'd like to see you seriously confront my point, which you have completely ignored so far, the fact that in your zeal to stop abortions you have now asserted that both enforceability and egalitarianism are pointless irrelevancies. You're dismissing some rather simple notions of law and justice in your vain (yes, utterly vain) quest to end abortions. There were abortions before Roe, there will be abortions after a repeal of Roe, and you won't ever seriously reduce their number.

How's that for the real world, Mr. Pragmatics?

Posted by Freddie | October 19, 2007 2:05 PM

But this law would be "applied equally to everyone" -- you're trying to make "the effects of, and ability to duck, a law will be egalitarian" a core principle of Western law and jurisprudence. That's a nonsense on stilts.

I think your version of egalitarianism, actually, IS NOT a core Western judicial principle, but a rather absurd invention of recent history. Enforceability isn't a red herring, it's a practical concern. Egalitarianism (of the type you endorse) is a principle I have no particular use for, so I don't really see why I'd give much thought to how to apply it here.

I think that it's fairly clear that legal restrictions would reduce the number of abortions. Would abortion vanish? Hardly. We've had laws against murder and theft for as as long as we've had laws, and these are with us always.

What's your serious argument that a more restrictionist law wouldn't result in fewer abortions? Hand waving? The moral imperative of terminating fetuses? Some evidence (I'd like to see it) that legality doesn't influence people's decisions and the social environment of a course of action?

As I said, I prefer rational actors, not agitated grad students with an axe to grind and a grief that it isn't someone else's axe.

Posted by The Marquis of Carabas | October 19, 2007 2:41 PM

There were abortions before Roe, there will be abortions after a repeal of Roe,

This much I can agree with. Of course there were. Who on earth imagines otherwise? Some reduction in numbers and the attachment (in some places) of legal consequences to doctors performing abortions is about all that can be hoped for here, naturally.

Since welfare policies don't totally eliminate poverty and hunger, I suppose we should abandon as quixotic all vain (yes utterly vain!) attempts to provide assistance to the destitute.

Posted by The Marquis of Carabas | October 19, 2007 2:43 PM

it is one of most basic, foundational notions of Western jurisprudence and basic justice: the law should apply equally to everyone.

Yes. But as it's already been explained to you, the question isn't merely whether the law "applies." But to continue playing your little game: Isn't it one of the most basic, foundation notions of Western jurisprudence and basic justice that once it's been shown that a law is capable of evasion by even one person, that law must be repealed? Yes or no?

I'd like to see you seriously confront the point, which you have completely ignored so far, the fact that in your zeal to stop murder, rape and robbery you have now asserted that both enforceability and egalitarianism are pointless irrelevancies. You're dismissing some rather simple notions of law and justice in your vain (yes, utterly vain) quest to end murder, rape and robbery. There were murders, rape and robbery before such conduct was criminalized and you won't ever seriously reduce their numbers.

Posted by The Raving Atheist | October 19, 2007 3:12 PM

"Enforceability isn't a red herring, it's a practical concern.

Except that here you're using "enforceability" as a red-herring substitute for the real practical concern: whether the overall social benefits of an abortion ban outweigh the social costs. Any law that can be easily circumvented by border crossing will be of greatly reduced benefit and the costs will fall disproportionally on the poor. Any law that bans a service without reducing demand will generate a black market. In this case, the black market will result in death and serious injury. The full spectrum of costs and benefits need to be considered, not merely the raw number of abortions performed within the borders of the US (which will assuredly decrease.)

"But even ignoring abortion, it's hard to see why anyone would worry too much about a law being practically harder to enforce on some people if that law is inherently just in what it outlaws."

This is one of the fundamental divides that liberal/conservative social arguments tend to boil down to. Cultural conservatives tend to judge laws by the principles they uphold rather than the effects they engender. They believe that if some action is detrimental to society it ought to be illegal, or at least strongly discouraged. Great concern is expressed about the "message" that it sends for said action to be permitted. Concern about the message ultimately outweighs a practical accounting of outcomes.

It seems to me that someone who wants to reduce the overall number of abortions should be willing to consider any and all steps that could be taken to achieve this goal, and would not want the effects of this reduction to involve widespread lawlessness, more injuries and deaths among young women, and a higher percentage of children growing up in poverty. They would not simply reduce the issue to a question of whether or not the action is illegal and bad people are punished. And whether or not they support an outright ban on abortion, they would all certainly promote and subsidize the use of birth control.

That's not what's going on here. And while it's unfair to claim that the anti-abortion movement is primarily motivated by a desire to restrain female sexuality, it's hard not to draw the conclusion that this secondary motivation prevents them from taking straightforward steps to achieve their goal.

Posted by LaFollette Progressive | October 19, 2007 4:13 PM

LaFollette,

Ok, you're a more reasonable guy generally than Freddie. But as I've argued on here before (maybe even with you), it is really hard to see how _in America_ (maybe some other place it's true!) a lack of support for or lack of access to, birth control is a real factor in the number of unwanted pregnancies. I just haven't seen any serious evidence that pro-birth-control sex ed makes much difference (or that abstinence-only sex ed makes much difference), or condom distribution, or anything of the sort. Maybe I'm missing something, but the hard data just seems to be absent. Given that absence, this constant recurrence to "why do you go about trying to ban this kind of murder? why not do X instead?" seems to me to be a tactic, rather than a serious argument. But it's probably in good faith, based on an (unsupported) notion that somehow, lack of birth control options or availability, or pressure from the social right against birth control is a serious factor in the pregnancy biz.

Posted by The Marquis of Carabas | October 19, 2007 6:11 PM

I see Marquis did a good job of picking up the ball and dealing with Freddie in my absence. I'll echo the points that (a) outlawing most abortions would likely result in a substantial decrease in the number of abortions, particularly the mid-to-late term abortions that are the most morally problematic; and (b) it doesn't seem like a lack of access to sex-ed and condoms can realistically be blamed for the high number of abortions in our country, particularly among the young, single, upwardly mobile demographic that seems to speak out most forcefully in support of abortion rights.

Other points worth considering - (1) the argument that outlawing abortions would not substanially decrease the # of abortions is in tension with the common assertion that outlawing abortion would be bad because it would force women to carry unwanted pregnancies to term; (2) This is an issue where the "signal" a law sends matters a lot - the current abortion on demand regime essentially severs biological personhood from legal personhood, and that creates all sorts of slippery slope problems in other areas, particularly in connection with infanticide, euthanasia, and eugenics. Imposing legal restrictions on abortion would help draw bright legal lines that could check the slipperly slope, even if the # of abortions remained relatively stable after being forced underground; (3) Roe and Casey currently prohibit nearly any meaningful restrictions on abortion,even in the second and third trimester - This puts us out of step with the rest of the Western world, where far greater restrictions are permitted; (4) I don't support a Constitutional amendment banning abortion - I just want Roe overturned so we have a fair chance to make our case on a state by state basis.

Posted by FW Dixon | October 19, 2007 11:24 PM

The Marquis of Carabas:

I just haven't seen any serious evidence that pro-birth-control sex ed makes much difference

Do you mean "if there is evidence that contraceptives reduce abortions then it would be a good idea to promote sex ed"?

If there is no empirical data, then the response should be to get the data, no? Personally, I tend to buy Saletan's argument on the simple grounds that abortion is a very unpleasant method of birth control, so why would anyone choose it over a pill.

Perhaps the analogy here should be with 401k's -- people (even white collar workers) tend to undersave, essentially throwing away the matching money. This leads to all kinds of unpleasant outcomes. However, when 401k's are made opt-out instead of opt-in, the rate of participation goes way up. I would venture a guess that rational judgment skills of middle-aged white collar professionals are better than those of teenage girls -- and still they make the stupid choice! So perhaps if contraceptives were aggressively being made available ("default option") then the rate of the stupid choice would go dramatically down.

(I think I just came up with an argument I haven't heard before. Heh.)

Posted by bubba ho-tep | October 20, 2007 11:06 AM

But what do you mean by "aggressively being made available"? If you mean actually providing them to every single kid whether they want them or not, that seems to infringe on personal freedom in a way that is quite extraordinary, and would cause me to withdraw any kids I had in public schools (not that I have any there now, for other reasons). If you mean less than that -- for instance, talking up contraception and making it a cheap and widely available commodity, I think we're already there. I mean, is it really your claim (sans empirical evidence) that bad judgment comes because, say, every boy isn't walking around actually wearing a condom, from the age of puberty? If memory serves, some weak evidence suggests that contraception is even _present_ (boy with a condom in his wallet) in a number of contraception-less teen encounters as it is.

Posted by The Marquis of Carabas | October 23, 2007 12:52 PM

If there is no empirical data, then the response should be to get the data, no?

There is data, right? At least some? Didn't Ross himself post here a few of the studies showing that not only did abstinence-only sex ed in the US not do very well, but that sex education in general, pro-contraception or whatever, just didn't have all that much effect on behavior. I may be mis-remembering that data, which I've seen elsewhere, too, but that seemed to be the most obvious conclusion, though the studies were far from iron-clad science.

Posted by The Marquis of Carabas | October 23, 2007 12:55 PM