In February of this year, a large study was published that was immediately heralded by large pro-choice organizations such as the WHO, UNFPA, Guttmacher, and others for being the first of its kind and providing extremely valuable data for policy-making.
The study uses a statistical model to estimate both the unintended pregnancy rate and the abortion rate for 150 countries. The point of the study was to, “illuminate disparities in sexual and reproductive health and autonomy” and, “enable international comparison, and to inform country-level policy and programming.”
The authors discuss the robustness of their statistical model and estimates, as well as some interesting differences that were seen among countries within the same region, and the implications they could have on policymaking in these countries.
It sounds like a pretty useful publication, right?
For example, if country-level estimates for unintended pregnancy are known, and one country has a really high unintended pregnancy rate while a neighboring one has a much lower rate, the country with the higher rate could look to their neighbor with the lower rate and see what policies they have in place. And the same for abortion rates.
But let’s take a closer look and see how useful this information really is, and what the information is actually being pushed to be used for.
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Affiliations and funding sources
Of course, pro-choice organizations made such a big deal about this study — the authors work for pro-choice organizations and some of the funding sources are from pro-choice organizations and programs.
For example, the lead author, Dr. Bearak, and the next two listed authors are researchers at Guttmacher Institute. The next three authors work for the WHO, specifically for the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research. Only the final author listed has no overt ties to a pro-choice organization (they work at the University of Massachusetts Amherst); however, a look at her biography on ORCIID shows she collaborates with “various United Nations agencies” and the UN has made some very pro-choice statements.
The funding for the study comes from two pro-choice organizations and two country governments. The WHO (under the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research) and the Bill and Melinda Gates Foundation as listed, as well as government money from the UK and the Dutch Ministry of Foreign Affairs.
So we know the research is going to have a bias, and what the bias is likely going to be.
The findings
Keep in mind that all abortion rates and unintended pregnancy rates in this paper are estimates from a data model, and there are some problems there. The problem is that for many countries — over half, fact — the authors had to estimate abortions using the Abortion Complications Incidence Method (ACIM). While the method is logical, it is also highly flawed, as Dr. Calum Miller explains. This can give rise to extremely inaccurate estimations of abortion in countries without good abortion data.
But even with that caveat in place, many of the findings are not surprising. For example, “In general, unintended pregnancy rates are greatest among women who live in lower-income countries, and smallest among women who live in higher-income countries.” However, they found interesting exceptions where some higher-income countries had higher unintended pregnancy rates and lower unintended pregnancy rates in some upper-middle-income countries (like Albania)
Abortion rates, on the other hand, were a lot more all over the place — perhaps because so many countries had to have their abortion rates estimated using the ACIM. Unintended pregnancy rates were higher in sub-Saharan African countries and Latin American countries but the proportion of unintended pregnancies ending in abortion was lower. Many countries in Asia, though, had higher proportions of unintended pregnancies that ended in abortion than many other area in the world.
The implications (they see)
Countries with higher unintended pregnancy rates are seen as failures: “We found substantial differences in the unintended pregnancy rates estimated across countries, which suggests inequality between countries in the extent to which individuals have been able to achieve their reproductive goals.”
These authors view unintended pregnancy as something which should be prevented if at all possible and they see abortion as a good and necessary option to provide for women with unintended pregnancies.
They believe this information they have modeled concerning unintended pregnancy and abortion rates can be used to better allocate international resources for family planning services.
For example, in countries with high unintended pregnancy rates, perhaps funding for long-acting reversible contraceptives (LARCs) like IUDs could be given and programs to promote those in the various communities can be implemented. Or…perhaps increased access to abortion could be given in countries with higher rates of birth for unintended pregnancies.
The implications (I see)
The authors imply without outright saying it that they expect women who have unintended pregnancies to abort their child. In fact, they act surprised that abortions could follow intended pregnancies, saying, “we note that while unintended pregnancies are useful for contextualizing abortions, these may also occur following intended pregnancies…” as if the natural default for unintended pregnancies is abortion.
And then they act like the solution to lowering births from unintended pregnancies not just to offer more contraceptive options to lower unintended pregnancy rates, but also to make abortion more accessible so those pregnancies do not result in live births. However, they lump birth control and contraceptive access in with abortion so they can couch both in terms of “health services” and “autonomy”:
“For unintended pregnancy and abortion, country estimates have been needed to better inform resource allocations for policy and programming in supporting access to sexual and reproductive health services…Our findings illustrate inequality in reproductive autonomy.”
The other implication is that poor women (those in third-world or developing countries) especially need LARCs and abortion to be successful.
And yet another assumption is that “unintended” = “unwanted” and “poor” = “bad time to have a kid.” This is so incredibly condescending, to be honest.
What they don’t talk about are:
● Options that support women in carrying their unintended pregnancy to term, whether they choose to parent or place for adoption
● Options to support women who want to parent, such as higher-quality prenatal medical care, parenting education, workplace and education equality policies and laws, etc.
● Options to support mothers and families who add children to their lives, such as tax credits or tax relief, childcare options, time off/paid leave policies, etc.
● Removing barriers to carrying to term that women feel are pushing them towards choosing abortion for their unintended pregnancy.
● Counseling and informed concerning abortion procedures.
One thing I notice is that they are not necessarily interested in lowering the number of abortions or the abortion rate in any given country.
For example, for a country with a high unintended pregnancy rate and low abortion rate, the authors would likely not have anything positive to say! Instead, what they would likely say is
1. Abortion needs to be more accessible in that country (which would drive the abortion rate up) and
2. Unintended pregnancy rates need to be lowered, likely through distributing cheap or free LARCs.
But this may or may not lower abortion rates, especially if the same country that is implementing programs to distribute free contraception also loosens access to abortion, which would most certainly be what the WHO or the UN or the Bill and Melinda Gates Foundation would encourage.
Conclusion
This paper is written by authors who are biased and have staunchly pro-choice employers, funded by pro-choice organizations, and uses critically flawed data to make its conclusions.
The authors act like birth control and abortions are necessary for women to have equality around the world, and that the fewer unintended pregnancies, the better. The attitude these authors seem to have is that women should not be beholden to their own unique biology; instead, women’s fertility is something to be controlled, not understood and respected. Pregnancy is only to be planned or otherwise aborted, and children are only to be had under good economic circumstances.
It’s hard to take a paper seriously when the numbers they are reporting could be wildly wrong and the overall tone is so incredibly biased.
Women all over the world do deserve equality and do deserve to be able to pursue their goals and dreams just like men do. We should not need to suppress our fertility or kill our children in order to fully participate in society.
