Zara Ahmed Abortion rates don't drop when the procedure is outlawed. But it does make it more dangerous.

Though abortion restrictions are incredibly harmful and coercive in the U.S., they aren't a primary driver in the national decline in pregnancy terminations.
The data is clear: Abortion bans are ineffective, harmful and dangerous.
The data is clear: Abortion bans are ineffective, harmful and dangerous.Elise Wrabetz / NBC News; AFP - Getty Images; Reuters
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By Zara Ahmed, associate director of federal issues for the Guttmacher Institute

Anti-abortion advocates working to criminalize abortion in the United States and abroad will always be stymied by a crucial fact: People everywhere want, need and find ways to get abortions.

I observed this firsthand while working as a public health adviser in Asia, Africa and Latin America, and now new research from the Guttmacher Institute demonstrates just how misguided and dangerous it is to try to limit abortion access. The data shows that abortion rates are roughly the same in countries where abortion is broadly legal and in countries where it isn't. And abortion rates are actually four times higher in low-income countries where abortion is prohibited than in high-income countries where it is broadly legal.

Abortion rates are actually four times higher in low-income countries where abortion is prohibited than in high-income countries where it is broadly legal.

That is part of the reason we must do more to ensure that people around the world don't have to contend with unintended pregnancies and unsafe abortions. For nearly 50 years, the Helms Amendment has essentially banned using federal funds to support abortion services abroad. As a direct consequence, tens of thousands of women around the world have died of unsafe abortions, even though they may have lived within sight of a U.S.-supported health clinic.

Members of Congress are now taking action to permanently repeal the Helms Amendment and allow the provision of a full package of sexual and reproductive health services. The introduction of the Abortion is Health Care Everywhere Act of 2020 on Wednesday by Rep. Jan Schakowsky of Illinois — with co-sponsorship from fellow Democratic Reps. Diana DeGette of Colorado, Nita Lowey of New York, Ayanna Pressley of Massachusetts and Barbara Lee, Jackie Speier and Norma Torres of California — is a milestone in the journey toward a more equitable world.

This landmark legislation would rescind the Helms Amendment and allow U.S. funding to be used to provide comprehensive reproductive health care abroad, including safe abortion services. This change is needed urgently because the demand for abortion services is only growing: Where abortion is legally restricted, the proportion of unintended pregnancies ending in abortion has increased by 39 percent over the past 30 years. The data is clear: Abortion bans are ineffective, harmful and dangerous.

According to data published in The Lancet Global Health by my colleagues at the Guttmacher Institute, an organization that supports abortion rights, every year there are roughly 121 million unintended pregnancies around the world; of these, 73.3 million, or 61 percent, end in abortion. To determine these numbers, our researchers developed a statistical model that simultaneously estimated incidence of unintended pregnancy and abortion. They used thousands of data points on pregnancy intentions and abortion compiled from country-based surveys, official statistics and published studies.

When performed by a trained provider using a method recommended by the World Health Organization, abortion is an overwhelmingly safe medical procedure. Unfortunately, almost half of all abortions — 35 million — take place in unsafe conditions, resulting in an estimated 23,000 preventable pregnancy-related deaths every year.

Beyond this avoidable loss of life, the social and economic consequences for women, their families and communities are often severe. Women who pursue abortions where they aren't legal may suffer discrimination by health providers, be stigmatized or harassed by their communities or face violence by their partners. And these actions have ripple effects on their children and broader families.

Countries with restrictive abortion laws also often lack access to contraception. The result is that low-income nations where abortion is restricted have more than three times the unintended pregnancy rate as high-income countries where abortion is legal. The tragic paradox is that abortion services are most needed where they are least legally available.

Specifically, more than 218 million women of reproductive age in low- and middle-income countries who want to avoid pregnancies aren't using modern forms of contraception, and in the lowest-income countries, nearly half (46 percent) of women who don't want to become pregnant don't use modern forms of contraception or are using traditional methods (like periodic abstinence or withdrawal), putting them at high risk of unintended pregnancies.

And even though abortion restrictions are incredibly harmful and coercive in the United States, they aren't a primary driver in the national decline of abortion rates. According to the most recent national data, the United States now has the lowest abortion rate since Roe v. Wade. But data shows that births have dropped, too, indicating that fewer people are getting pregnant in the United States in the first place.

In fact, according to Guttmacher data, 57 percent of the U.S. decline in the number of abortions from 2011 to 2017 happened in the 18 states, along with Washington, D.C., that did not enact any new abortion restrictions during those years.

The tragic paradox is that abortion services are most needed where they are least legally available.

No matter where in the world they are in place, abortion restrictions are punitive and coercive by design, and they harass, block and punish people trying to get abortion care, disproportionately weighing on people who already face systemic barriers to care. Beyond that, abortion bans are a violation of human rights. Every person should have the ability to decide whether, when and by what means to have a child or children, and how many to have.

As someone who spent years overseas working to expand access to health care, I know that repealing the Helms Amendment is the right thing to do and that it would contribute to improving the health and well-being of millions. This is also what the American people want, what public health institutions recommend and what basic human kindness and fairness demand.