How To Reduce the Abortion Rate

Let’s start with a basic premise: Abortions are undesirable.

I’m not saying that abortion is never the best choice of a bad set of choices. In cases of incest, rape, and in cases where the health of the mother is at risk or the child is unviable, abortion may well be the best choice.

But, it gets more complicated than that. It’s almost impossible to define the terms “health of the mother is at risk” and “child is unviable”. Different doctors will occasionally have different opinions. And, my list in the last paragraph is likely incomplete. It’s likely impossible to anticipate every possible set of circumstances.

All I can say conclusively is that abortions are sometimes the right choice, and that somebody needs to make a decision.

Time is of the essence here. If an abortion is the right action, most people would agree that the earlier it happens, the better. That means our “somebody” needs to be able to make an well informed and unimpeachable decision. There is no room for appeal.

Who should our “somebody” be? Should it be someone well positioned to balance the interests of the child and the interests of the mother? Should it be someone who is well versed in the facts of the situation, the emotions of the situation, and who has spoken with every healthcare professional involved? Is there anyone better qualified than the mother herself? I think not.

Clearly, as much as I dislike abortion, I’m pro-choice.

So, how do we reduce the abortion rate without regulating access to abortions? If we can’t reasonably regulate the supply of abortions, we need to reduce the demand for them. To do that, we need to look at where the demand comes from.

The need for an abortion comes from many root causes. Let’s look at those that come to mind and think about how we can provide alternatives.

Rape and incest are both criminal acts. The woman is usually a victim, not a perpetrator. So our focus needs to be on reducing the incidence of these crimes. That’s a long and complicated subject which is better covered in a dedicated article. Suffice to say, there’s an education component (specifically around consent), a legal component (deterring crime and preventing recidivism), and a social component (supporting victims and ensuring their safe access to law enforcement).

Another important reason for abortions is the health of the mother. In the last century, the maternal mortality rate has fallen from around 700 to approximately 20 deaths per 100,000. (Those numbers have actually been trending up for the last thirty years after bottoming out at around seven.) When women receive adequate healthcare, risky pregnancies can be identified and the risks can be controlled. In some cases, the pregnancy must be aborted but with better healthcare the abortion rate should go down.

Similarly, some pregnancies may be aborted due to concerns about the health of the child. Admittedly, little is known about the relationship between a woman’s health and congenital defects on the part of the child, but there is a strong correlation between maternal health and infant mortality rates. So, if we want to reduce the rate of abortion, improving access to healthcare (especially, but not exclusively maternity healthcare) would seem to be helpful.

There is a lot of room to improve access to maternal healthcare. According to the March of Dimes Maternity Care Desert Report (2020), there are 1,095 counties in the United States without a hospital offering obstetric care, birthing center, or even a practicing obstetric provider (either an OB/GYN or a Certified Nurse Midwife). Within these counties there are about 150,000 babies born each year. These counties also have lower median incomes and higher poverty rates than average.

Interestingly, according to the Commonwealth Fund, between 2018 and 2020 the 26 states with the most restrictive abortion policies had a 51% greater maternal mortality rate and a 29% greater infant and perinatal mortality rate than the 25 least restrictive states plus the District of Columbia. While correlation does not equal causation, it’s interesting to note that in the 26 more restrictive states about 39% of counties are “Maternity Care Deserts” whereas only 25.2% of counties in the less restrictive states fall under the definition.

Another common reason for abortion is a pregnancy that is unwanted. There are several approaches to preventing unwanted pregnancies, converting pregnancies to wanted pregnancies, and providing reasonable alternatives to abortions.

Maslow’s Hierarchy places sex alongside food, breathing and sleep in the needs category. Expecting people to abstain from sex is unreasonable. Fortunately, we live in an age where there are multiple options for contraception. Of course, we need to ensure that appropriate and redundant contraception is available to everyone (including those without health insurance and those who are facing economic challenges).

In the real world, no contraception is perfect. Even vasectomies have been seen to spontaneously reverse resulting in unwanted pregnancies. And having a child can lead to a substantial drop in income as parents redirect effort from work to caring for the child. (Single parents fare worse than parents with partners.) Add to that the high costs of daycare, and the first five years of the child’s life can bring significant economic challenges. Policies that reduce these economic challenges can convert an unwanted pregnancy into a wanted pregnancy.

If a child is still unwanted by the birth mother, it’s very likely that there are adoptive parents who would want the child. By streamlining adoption laws and ensuring that mothers have access to maternal healthcare, giving a child up for adoption becomes a viable alternative to abortion.

In short, we have the ability to reduce the abortion rate without the need to deny access to anyone. And the act of denying access is both impractical and dangerous. Finally, it is counter to the very ideals of freedom.