New Study Finds Mexico City Policy Increased Abortion by 40 Percent

Researchers highlight major unintended consequences of reducing organizations' ability to support modern contraceptives

STANFORD – When the US Mexico City Policy was in effect, abortion rates in sub-Saharan Africa rose by 40% in countries more reliant on US aid, according to a new study released today by The Lancet Global Health. Reflecting an increased number of sub-Saharan countries analyzed, and a time period that spans over two decades, this 1995-2014 study reflects unprecedented evidence on the consequences of the Mexico City Policy. This analysis is the first to demonstrate that the Mexico City Policy (known by opponents as the Global Gag Rule) is followed by increased abortions, and likely unsafe abortions, but that this outcome is reversible with greater support for family planning organizations.

"Regardless of policymakers' beliefs about the ethics of abortion, the results of our analysis represent undesirable and unintended -- but reversible -- consequences of restricting federal funding for abortion," said Grant Miller, one of the authors of the study and non-resident fellow at the Center for Global Development and director of the Stanford King Center for International Development.

“The unintended consequences of increasing abortions may have to do with reducing organizations' ability to supply modern contraceptives,” Nina Brooks, PhD student at Stanford, adds. “Countries that perform or provide counseling on abortion are also key in providing other crucial methods of family planning.”

1. Curbing US assistance to family planning organizations, especially those that consider abortion as a method of family planning, increases abortion rates in sub-Saharan Africa. Abortion rates among women in countries highly exposed to the policy rose by 4.8 abortions per 10,000 woman-years.

2. The Mexico City Policy reduces contraceptive use and increases pregnancies as well. The study found a symmetric reduction in use of modern contraception (relative decrease of 13.5 percent) and increase in pregnancies (12 percent) when the policy was enacted.

3. The timing of the changes in abortion, contraception and pregnancies coincides with changes in the Mexico City Policy. Women in countries more vulnerable to the funding restrictions experienced a relative increase in abortions when the policy was enacted and a relative decrease when the policy was removed. One analysis estimates that a 10 percent decline in contraceptive use would lead to a 20-90 percent increase in abortions.

4. The effects of the Mexico City Policy may be reversible. The strength of this analysis lies not only in its span of many countries over two decades, but also in its analysis of both reinstatement and subsequent repeal -- finding that the timing of the changing rates of contraceptive use and abortion coincides with the changes in the policy.

“No matter your politics, cutting down on unsafe abortions is an important goal,” Miller said. “Frankly, because many abortions are performed under unsafe circumstances, our analysis likely underestimates the full consequences of the policy for women and their health.”

"The good news is, these changes are reversible," co-author Dr. Eran Bendavid, Professor of Medicine at Stanford University added. "Our analysis found that the policy's impacts reversed after the policy's repeal between 2009 and 2014."

You can read the full study at https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30267-0/fulltext.