Abortion and Fertility Control

During the period of demographic transition, abortion and contraception have been two of the main proxy determinants in fertility reduction. In most countries, the two methods coexist and occasionally play complementary roles. In some cases, the patterns observed suggest the probable transition from a higher to a lower abortion rate. Over time, contraceptive practices improve and reduce abortion rates, although they never entirely eliminate them (David and Pick de Weiss, 1992). The impact of abortion is particularly noticeable in countries with a low prevalence of contraceptive use (Singh and Sedgh, 1997). Conversely, the increase in contraceptive practice or the use of more effective methods leads to the reduction of abortion (Marston and Cleland, 2003).

According to Mundigo (1993), “insofar as the fertility transition advances and the incentive to reduce family size spreads, families will resort to abortion to terminate an unwanted pregnancy”. He also holds that the increase in the prevalence of contraceptive use is a determinant of abortion in the region since, despite the spread of family planning programs, it is a long way from achieving integral coverage for dealing with the population’s reproductive health needs. The same author considers there to be a severe lack of information on the correct use of appropriate contraceptive methods. Moreover, he adds, women that use natural methods know very little about their fertile period, which further reduces these methods’ effectiveness (Mundigo, 1993).

In Latin America, socioeconomic conditions, the rapid change in cultural patterns (which has led, among other things, to a smaller number of offspring), greater participation by the female population in extra-domestic activities, the separation of sexuality from procreation, and an increasingly widespread desire to achieve better living standards have led women to raise the increasing need to resort to contraceptive methods. However, in many cases, abortion continues to be an alternative for limiting, spacing and even postponing motherhood.

In recent years, family planning programs in countries such as Colombia, Brazil and Mexico have created a broad “contraceptive culture” that may have contributed to the reduction of the incidence of abortion. However, although family planning programs have spread in many countries, women often experience problems in using contraceptive methods effectively. For this very reason, discontinuity in their use continues to be high (Alan Guttmacher Institute, 1996).

In this respect, other authors point out that “studies undertaken in developed and developing countries show that when a woman is sufficiently motivated to control the size of her family, she resorts to abortion and other contraceptive methods: a woman that has used contraceptive methods is more likely to resort to abortion than those that have not used them, while those that have had an abortion, seek more effective forms of contraception. This pattern is observed, for example, in Colombia, where knowledge of contraceptive methods has been universalized. It is likely that the widespread use of contraceptives in all sectors of society reflects not only the availability of family planning services, but also a definite socio-cultural change. Unplanned, unwanted pregnancy is not accepted as it used to be. With safe abortion services, experienced personnel and reasonable costs, women have a means of controlling fertility when other contraceptive methods fail” (David and Pick de Weiss, 1992).

As Rayas points out (1998), the significance of abortion in each society is related to the differences that exist between them in aspects such as the origin of their laws and the conditions in which family planning (FP) programs are developed. In Puerto Rico, which has non-restrictive legislation on abortion, the prevalent use of contraceptives, together with widespread knowledge about them, explains the low incidence of abortion. This is also linked to the implementation of population control programs dating from 1927, in other words, long before such programs existed in the vast majority of countries in the region. In 1982, 69% of Puerto Rican women living with or married to their partners used some form of contraception, while a surprising 49% of women of reproductive age (15 to 49) had been sterilized. Women in Puerto Rico also have access to quality health services (Henshaw et al., 1999).

The situation is different in Cuba where, as Álvarez Vázquez and Martínez recall (2000), abortion has been legalized since 1979. This practice has been a de facto means of controlling fertility, due largely to the small supply of contraceptive methods, which is mainly the result of the economic embargo imposed by the United States. The array of contraceptive methods available on the island is limited and only sporadically available, IUDs are of poor quality and, for financial reasons, and many people are unable to afford these products. It is estimated that abortion is currently the second proxy determinant of fertility in this country (Álvarez, 2005).

Although the cases of Puerto Rico and Cuba are quite different, they show how access to safe contraceptive methods and quality abortion services is closely linked to the reduction of fertility levels. This access is also crucial for enabling women to decide freely and autonomously about their reproductive lives.

Transition in the use of abortion as the main method of fertility control is confirmed in a large-scale study by the Population Office of the United States Agency for International Development (USAID) covering Mexico, Colombia, Peru and Venezuela. According to this study, the practice of abortion is largely associated with the lack or ineffectiveness of contraceptives in these countries (USAID, 1997). Among the study’s main conclusions is the fact that abortion rates declined during the first 15 to 20 years after contraception use became the norm. Countries with modern, effective contraceptive methods had lower abortion rates than those where less reliable contraceptive methods were used. Abortion rates only decline when contraception is widely available and consistently used. Abortion rates and contraceptive use may increase simultaneously for short periods, until the desired family size is achieved. For example, the experience in some countries, such as Colombia, Mexico and Chile, showed that the number of abortions fell with an increase in the use of contraceptives and when the latter became widely available. Nevertheless, it is striking that 73% of women hospitalized in these countries for unsafe abortions, which were surely the product of unplanned or unwanted pregnancies, had not used contraceptives (USAID, 1997).

Another study conducted in Brazil, Colombia and Mexico shows that during the early stages of demographic transition, abortion probably played a key role in fertility reduction. Given the particularities of these nations, however, different patterns are observed in each country. Thus, in Colombia and Mexico, the incidence of abortions stabilized as contraceptive practice increased. Conversely, abortion continued to increase in Brazil until the early 1990s, despite the growing use of contraceptives. Singh and Sedgh (1997) state that the overall fertility rate in this South American country would have been approximately 13% higher that year if the abortion ratio had not increased.

Apropos of this, Oliveira (1994) states that abortion, together with surgical sterilization, was responsible for the reduction in the fertility of Brazilian women who began in the 1970s. On the basis of a study conducted in Sao Paulo in 1993, De Souza e Silva and González de Morell (2001) hold that the fertility decline was achieved through a process known as “perverse modernity.” This process included a sequential pattern of the inappropriate use of the Pill, which led to unwanted pregnancies and illegal abortions and eventually to definitive sterilizations, usually performed through unnecessary Cesareans. They therefore suggest that the inappropriate design and functioning of family planning programs has perpetuated the problem of abortions, since women that are highly motivated to control their number of offspring resort to both abortion and contraception.

In Mexico, the National Population Council states that while the overall fertility rate more than halved from 1976 to 1997 (from an average of 5.6 to 2.7 children per woman), the abortion rate was reduced to a twelfth of its original size (from 1.2 to 0.1) during this period. Thus, the reduction in the number of abortions has coincided with the rapid increase in family planning methods (Consejo Nacional de Población, 2000). This situation is associated with the effectiveness of family planning programs in this country.

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