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Study: Fewer Abortions When Family Planning Services Available - 2001-10-02

As countries develop their birth rates decline. Researchers who conducted a study in Bangladesh say their findings show that during such a fertility transition, women who have access to good family planning have fewer abortions. Researchers say the findings support the argument for more funding for family planning services, a contentious issue in the United States.

Population experts have found that when a country's fertility rate declines, the use of both contraception and abortion goes up. But demographer Mizanur Rahman wonders why abortions should increase when contraception does, too. "This seems to be a kind of puzzle, because more and more women are using contraceptives to avoid unintended pregnancies," he says.

Mr. Rahman is with the Boston family planning support organization Pathfinder International. To learn why women make certain reproductive choices, he led a study in Bangladesh with the U.S. policy research firm The Rand Cooperation and the Dhaka office of the International Center for Diarrheal Disease Research.

They compared two areas in Bangladesh's rural Matlab region, one with high-quality family planning services, the other with poorer quality services. They found that women do not randomly choose between contraception and abortion.

As Mr. Rahman's team reports in the British journal The Lancet, women will generally avoid abortion if they are counseled on birth control. "We found that in the area where family planning services are better in terms of accessibility and quality, abortion didn't increase," he says. "It has remained more or less similar [at] 2.1-2.2 percent. On the other hand, in the comparison area, the abortion rate has increased from 2.2-6 percent."

Mr. Rahman says there is less reliance on abortion where family planning advice is good, because fewer unintended pregnancies occur. "I'm not surprised, but the apparent increase in abortion in various countries led some policy planners to believe that investment in family planning might lead to an increase in abortion," he says. "So we actually wanted to answer that question."

Mr. Rahman and other experts say millions of women around the world lack access to reproductive counseling and birth control. They advocate more investment in family planning to help reduce reliance on abortion, which is dangerous if performed improperly.

"Family planning is a remarkably inexpensive public health intervention, says Margaret Greene of the Washington non-governmental organization Population Action International. She says family planning has other advantages. "It contributes to reducing all kinds of health problems, in addition to maternal mortality rates," she says.

But Ms. Greene says the U.S. commitment to family planning is less than what it promised under the Clinton administration at the 1994 United Nations Conference on Population and Development in Cairo.

Early this year, President Bush reinstated a policy dropped by the Clinton administration of withholding U.S. government money for family planning groups that support abortion. Ms. Green argues that boosting U.S. assistance to family planning would be as effective an anti-abortion policy. "One of the problems in the American political scene is the confounding of family planning services with the provision of abortion," she says. "If we are interested in reducing abortion rates around the world, the best thing we can do is to support a broad range of family planning and related reproductive health services."

But some supporters of President Bush's anti-abortion policies think even family planning goes too far. American Life League spokesman Ed Szymkowiak says his organization follows Roman Catholic Church policy in opposing any birth control. "We would like to see all U.S. aid for family planning curtailed," he says. "God is sovereign over life and death, and if we do anything artificial, we are really doing something gravely wrong, because we are taking upon ourself something only God should be guiding."

But given trends in developing countries, the Bangladesh study suggests that doing nothing would encourage more abortion.