Journal Offers Survey Results from 27 Nations

Why in the World Do Women Have Abortions?

By Randall K. O'Bannon, Ph.D., NRL-ETF Director of Education & Research

Why do women have abortions? Although abortion has been legal nationwide in the U.S. since 1973 and even earlier in other nations, not a lot is known about the reasons women in some of these other countries have abortions.

A report in the August 1998 issue of International Family Planning Perspectives1 examined the reasons women around the world have abortions. While the data are limited, they confirm what a survey of American abortion patients found in the late 1980s: that the vast majority are performed for social, not medical reasons.

Authors Akinrinola Bankole, Susheela Singh, and Taylor Haas analyzed data from 32 different studies gathered from 27 different countries conducted on six continents between 1967 and 1997. Because there was no uniform survey, sample size, sample composition, or methodology, studies from different countries don't always correlate and full aggregations of the data are impossible.2

One thing that is clear: most babies aren't being aborted because they have some disability or because their mothers are facing health problems, or even because of rape or incest. They die because someone believes their social or economic circumstances will be better if the baby is dead.

The authors are quite frank in calling for counselors and policymakers to develop a "greater appreciation of the roles that partners and other family members play" in the lives of women "at risk of unintended pregnancy."

Among women in those countries where reasons for abortion were surveyed, most cited by far a desire to postpone childbearing or to have no more children, the cost of a child, disruption to job or education, a relationship problem, or relative youth as the reason they had their abortions.3 Relatively few of those who were asked gave risk to maternal health or fetal health as the reason for their abortion. Only one country (the U.S.) asked about rape or incest, but few of those surveyed opted for the "other" category where such abortions would have been recorded.

Because few of the surveys listed every reason tracked by the authors, making direct comparisons is difficult. Cultural differences are also apparent from different distributions among reported factors.

Given such limitations, the authors give no summary totals of the surveys and it is difficult to identify any particular country's survey as authoritative or representative. Still, broader outlines are apparent, and distinctions between socio-economic reasons and what are sometimes classified as "medical" reasons are still discernable.

Surveys conducted in the U.S. and Thailand are illustrative. Researchers for the Alan Guttmacher Institute conducted a survey of 1,900 women in the U.S. in 1987 and 1988, the only known large-scale survey of American women's reasons for having abortions ever conducted by the abortion industry.4

A 1983-84 survey of 750 aborting women in Thailand asked roughly the same questions. Tallies of the primary reasons (as listed by the authors) that women gave for having abortions in both countries are shown in the chart.

Thailand U.S.

Wants to postpone childbearing 16.1% 25.5%

Wants no (more) children 36.3% 7.9%

Cannot afford a baby 18.5% 21.3%

Having a baby will disrupt 8.5% 10.8%

education or job

Has relationship problem or partner 3.3% 14.1%

does not want pregnancy

Too young: parent(s) or other(s) 2.7% 12.2%

object to pregnancy

Risk to maternal health 5.1% 2.8%

Risk to fetal health 5.1% 3.3%

Other 5.1% 2.1%

Even adding in the "other" category to the maternal and fetal health risks, the results show no more than 14.5% of Thai abortions being done for so-called "medical" reasons. According to this survey, more than 85% of abortions in Thailand are done for what can only be called social or economic reasons. For the U.S., the number is closer to 93%.

These figures were not unusual. In most surveys looked at by the authors, the percentage of women designating maternal or fetal health risks as the reason for their abortions ranged from 2.2% (Finland) to 15.9% (Turkey).5 Some surveys mentioned maternal risk but not fetal risk as a possible answer. However, in most cases those claiming a health risk to the mother as a motivating factor was less than 10%.6

While there were some countries reporting higher percentages who cited health risks, there are reasons to be suspicious of these higher figures.

For example, 20% in one Kenyan study considered by the authors cited some risk to maternal health as the main reason for their abortion.

But they were given few possible responses (they could not cite economic reasons or relationship issues) and the sample size was very small (only 20 women).7 Perhaps the biggest reason for the high figure is that abortion is generally illegal in Kenya, unless a mother's health is at risk.

Surveys of women in Bangladesh and India reported by Bankole, Singh, and Haas found 29.3% and 37.9%, respectively, who said that a risk to maternal health was the main reason for their abortions. Again, in both cases there is reason to believe these numbers may be inflated.

The figure for Bangladeshi women was drawn from just 53 women who were admitted to the hospital for abortion-related complications in 1995 and 1996, not a cross-section of aborting women in general. A larger study done in Bangladesh five years earlier allowed women to cite more than one reason for their abortion. Only 12% of women reported risk to maternal health as one of those reasons.

While the practice of abortion is widespread in India, the law is actually less permissive (at least on paper) than might be expected. According to the 1971 Medical Termination of Pregnancy Act, the only reasons for which a woman may be allowed to have an abortion are to preserve her health, to prevent the birth of child who would be deformed or diseased, or in "humanitarian" situations such as when the woman has been impregnated by a rapist, etc.

With normal social or economic reasons officially "off the table," it is not surprising that large numbers of women (and their abortionists) would take advantage of the government's broad interpretation of the "maternal health" exception (including mental as well as physical factors) to classify their abortions this way.8

Only a few surveys allowed women to list risk to the baby's health as a separate reason. Among those that did, the percentages citing this as the primary motivation for their abortion were generally quite low. For example, this was the main reason given by just 1.6% of Finnish women and 3.1% of Czech women.

Figures were a little higher for Asian countries. While Malaysia reported 1.4%, percentages for South Korea, Taiwan, and Thailand ranged between 5.1% and 7.7%. The Indian government study from the late 1970s mentioned above reported the highest percentage - - 11.1% - - cited a risk to fetal health as the main reason for their abortion.

On three separate occasions, the authors of the International Family Planning Perspectives article9 comment that sex selection may account for the high percentages of women reporting fetal health risks in Asian countries. "In all four of these Asian and South Asian countries," the authors say in one place, "sex selection is believed to play a role in abortion, and in such instances, some women may report that 'fetal defect' was the main reason for their abortion." The implication is clear: the fetal health problem or "defect" precipitating the abortion is simply that the child the woman is carrying is found to be a girl, rather than a boy.

In a 1992 Australian study included by the authors 7% listed the possibility of "fetal defect" as one of several factors contributing to their abortions. The word "possibility" is important here.

Women in these studies are not necessarily reporting that a test or examination has identified a fetal anomaly in their baby. The authors correctly point out that in the 1987-88 U.S. study only about 1 in 12 of women who reported "fetal defect" as one of the reasons for their abortion had actually been advised by a physician that their baby might be "deformed" or "abnormal."

This suggests, the authors say, "that many women may be making this determination on their own." The authors also note that most women who have abortions do so before tests for such disabilities are conducted. Relatively few of the world's women even have access to such tests.

Difficult as it is to measure the precise impact of various social and economic factors on women's decisions to have abortions in surveys coming from widely different countries, cultures, study designs, time frames, and legal contexts, some broader implications of the analysis can be seen.

Despite the abortion lobby's insistence that abortion is a women's health issue, in no country do most women cite the health of the mother, the child, or even the expansive "other"10 category as the primary reason (or even as a contributing factors) behind their decision to abort. In every country studied by the authors, social or economic reasons were the driving factor in most women's abortion decisions. In most countries, socio-economic factors accounted for somewhere between 70% and 90%, and there are legitimate grounds for thinking that these are low estimates.

American pro-lifers have warned repeatedly that so-called "health exceptions" can easily become a back door to abortion on demand.

The evidence from the countries studied here lends credence to that claim. When "health" is legally interpreted to include both physical and mental factors, as the Supreme Court has in the United States, abortionists can and do utilize this excuse to cover nearly anything.

And the experience of Asian countries show how the "fetal health" or "fetal defect" exception can be expanded to mean the child is the "wrong" sex. In almost all instances the victims are female babies.

By and large, this analysis confirms what the 1987-88 American study revealed: that nearly all abortions are done for social or economic reasons, not for the woman's health and not to abort a child at physical risk.

Bankhole, Singh, and Haas's analysis can be found at www.agiusa.org/pubs/journals/2411798.html.

NOTES:

1. Akinrinola Bankole, Susheela Singh, and Taylor Haas, "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries," International Family Planning Perspectives, 24:3 (August 1998): pp. 117-27, 152.

2. Some surveys asked questions about concerns about maternal health while others didn't. Some let women list multiple possible reasons. Some were more open ended. Some were limited to married women only.

3.The authors of the analysis attempted to place survey answers in broad general categories, but wording in the surveys varied greatly from country to country and the fit was not always precise. One should not assume that women's answers from the original surveys are phrased exactly as they appear the IFFP article.

4. Aida Torres and Jacqueline Darroch Forrest, "Why Do Women Have Abortions?" Family Planning Perspectives, 20:4 (July/August 1988): pp. 169-76.

5. Others listing both, either as a separate or single category: Romania (4%), South Korea (14.8%), the Czech Republic (13.2%), and Taiwan (15%).

6. Zambia reported 3.4% citing maternal risk, Singapore 7.3% (1984) and 2% (1985), Colombia 8.8%, Mexico 8.3%.

7. The reference in the article is unclear as to whether these were reasons reported by the women themselves or recollections of nurses who treated them.

8. The pretense of compliance shown in the late 1970s when the survey was conducted may be considered unnecessary today. It may not be representative, but a 1990 study of 30 women in India found only 7% listing a health reason as one of several factors contributing to their abortion decision.

9. Akinrinola Bankole, Susheela Singh, and Taylor Haas, "Reasons Why Women Have Induced Abortions: Evidence from 27 Countries," International Family Planning Perspectives, 24:3 (August 1998): pp. 117-27, 152.

10. "Other" is the other category women might conceivably choose to indicate a health problem if the survey failed to list a risk to maternal or fetal health as a possible answer. However, this category is also a catch-all for situations of rape, incest, or any other possible reason a given survey failed to delineate (sometimes economic problems, relationship problems, or even educational or career interference were not presented as options on some of the cited surveys).