Making contraception cheaper does not reduce a country’s abortion rate

You would think that there would be a correlation between the affordability of contraception and the abortion rate of a country. That is to say, the cheaper contraception is, the lower the rate of abortion should be. Not so, a new study from the Nordic countries suggests.

The aim of the study, which was published on the journal of the Nordic Federation of Societies of Obstetrics and Gynaecology, is to describe and compare contraceptive use, fertility, birth, and abortion rates in Denmark, Finland, Iceland, Norway, and Sweden.

In the European context, the Nordic countries are among those with the highest user rates of hormonal methods (like ‘the Pill’) and intrauterine devices and the overall use of contraception has remained relatively stable in recent years.  From roughly 1975 until the mid-1990s the abortion rate declined from a high in Denmark and in Finland, increased in Iceland and remained stable in Sweden and Norway.

“There was no clear correlation between the contraceptive user rates and abortion rates”, over this period, the study concludes.

For example, Sweden has a somewhat higher abortion rate than Denmark even though various Swedish counties subsidise contraception and Denmark does not. If making contraception more affordable reduces the abortion rate, then Sweden should have a lower abortion rate than Denmark. (In Sweden about one in four pregnancies ends in abortion. In Denmark the rate is about one in five).

This seems to be confirmed by the findings of another study, published in 2014 in the BioMed Central Public Health journal, on the reimbursement of hormonal contraceptive and the frequency of induced abortion among teenagers in Sweden.

The study found that no correlation can be found between the cost of hormonal contraceptives and the rates of abortion.

As mentioned, in Sweden the provision of family planning centres are decided by each county separately. So, there are differences in the amount of reimbursement of contraceptives between counties. The study tested the hypothesis that costs for contraceptives are a deciding factor and have an impact on the abortion rates.

Here is the result: “No clear connection is found in this paper between actual sales of hormonal contraceptives, induced abortion or the relation between different counties with different amount of reimbursement among young women 15-19 years. Our study suggests that in a modern welfare society there is neither a straight agreement between induced abortion and the amount of prescribed and dispensed hormonal contraceptives, nor reimbursement and rates of induced abortion, not only in Sweden, but also, in comparison with other Nordic countries.”

In the county of Stockholm, for instance, a fall in dispensed hormonal contraceptives was not paralleled to a rise in the numbers of abortion. (Something similar was recently noted in the UK, where the expenditure cuts in the programmes to reduce rates of teen pregnancies was found to be associated with reductions, rather than increases, of those rates).

The study also noted that Finland has no reimbursement at all for hormonal contraceptives and from 2004 has had a steady drop in the number of induced abortions.

It concluded that abortion rates among teenagers are multifactorial, they don’t depend much on the availability and cost of contraception but rather on “attitudes, education, religion, tradition or cultural differences”.