U.S., World Abortion Practices Studied

A new survey of abortion laws and practices around the world has found that the United States differs in some important respects from other developed countries. The United States is the only Western industrialized country that bars payment for abortions for poor women at the national level, and it has a higher rate of unplanned, unwanted pregnancy than other Western countries. Also, the proportion of abortions obtained by American teen-agers is higher than in most other developed countries, even though Americans are less likely than teens in other countries to have abortions, a reflection of a teen-pregnancy rate that is much higher than the norm in the Western world.

“Induced Abortion: A World Review, 1986,” a fact book recently released by the Alan Guttmacher Institute, found that, in general, liberalization of abortion law is a worldwide trend. Four countries with populations of 1 million or more--Turkey, Spain, Taiwan and Portugal--have made laws less restrictive since 1983. (Notably, Spain, Portugal and Turkey liberalized laws despite strong religious opposition to abortion by the Catholic Church and in Moslem countries.) Only one country, Romania, has significantly reduced access to legal abortions in the last few years.

However, the survey found that millions of women in the world who choose abortion must obtain the procedure illegally. Worldwide, an estimated 40 to 60 million abortions are performed each year, of which about 33 million are legal.

In areas of the world where more than 1 billion people live, abortion is legal only to save the life of the mother. These include most fundamentalist Islamic countries and most of the countries in sub-Sahara Africa and Latin America.

Three-fourths of the world’s people live in countries where abortion is legal at least for health reasons, and half the world’s people live in areas where abortion is available on request.

“Whether it is legal or illegal, abortion is a common response to unwanted pregnancy throughout the world,” said Stanley K. Henshaw, deputy director of research for the institute and a co-author of the book. The survey found that women everywhere demand abortion as an option. Where laws are extremely restrictive, women seek illegal abortions or travel to other countries.

The law has less impact on women’s choices about abortion than other influences. The survey found that accessibility of birth control and abortion significantly affected the abortion rate in a number of countries. In Spain, where abortion is legal under a quite liberal law, it is almost unavailable because of a lack of abortion services. The same is true of many parts of India and even in parts of the United States.

In developed countries, the survey found, the abortion rate is high where use of contraception is low. For example, some European countries experienced increased abortion rates following publicity several years ago about possible harmful effects of oral contraceptives. In developing countries, however, an increase in contraceptive use may be accompanied by an increase in abortion, apparently due to periods in which women are motivated to control their fertility.

For women throughout the world, the likelihood of dying from childbearing is greater than the danger of abortion. In countries where abortion is legal, including the United States, the mortality rate associated with abortion is below one death per 100,000 abortions. However, as those who support legal abortion have argued, women will seek abortions regardless of the law and they will risk their health and lives with illegal abortions.

In Romania, after a restrictive law was applied in 1966, deaths due to illegal abortions increased seven-fold, the report said. Mortality due to abortions performed by non-medical people is relatively high in Latin American countries, and in some countries the researchers found as many as half of admissions to obstetrical units of hospitals were for complications from illegal abortion--as many women as were admitted for childbirth.

In the developed countries, abortions are most often sought by young and unmarried women, especially in the United States. In almost all of the Western countries, half or more of the women who obtain abortions are unmarried. In the U.S., the proportion is about 80%. Also, 27% of abortions in the United States are obtained by teen-agers, a proportion higher than almost all of Western Europe. Other studies conducted by the Guttmacher Institute, a nonprofit research and education corporation affiliated with Planned Parenthood, have found that superior sex education in Western Europe is the reason its teen pregnancy rate is far lower than that in America.

The researchers also found that when a country liberalizes its laws, the abortion rates rise for a number of years, then stabilize and decline, a trend that has occurred in the United States where abortion rates have declined slightly. Other countries have experienced much larger declines. The study cited Denmark, which in 1975 had the same abortion rate as the U.S., but between 1975 and 1984, its rate declined by 32%.

The American abortion rate is well under the worldwide rate. The world abortion rate, including illegal abortions, is estimated at between 37 and 55 abortions per 1,000 women aged 15 to 44. The U.S. rate is 27 per 1,000.

However, the U.S. rate is higher than any of its counterparts among Western nations. Henshaw explained the difference by saying: “The United States is basically in line with the rest of the world in terms of numbers of abortions and the availability of services, but its abortion rate is higher than those of other Western industrialized countries, a fact that primarily reflects high rates of unplanned pregnancy--more than half of all U.S. pregnancies are mistimed or unwanted.”