Abstract
ObjectiveThe relation between levels of contraceptive use and the incidence of induced abortion remains a topic of heated debate. Many of the contradictions are likely due to the fact that abortion is the end point of a process that starts with sexual activity, contraceptive use (or non-use), followed by unwanted pregnancy, a decision to terminate, and access to abortion. Trends in abortion rates reflect changes in each step of this process, and opposing trends may cancel each other out. This paper aims to investigate the roles played by the dissemination of contraception and the evolving norms of motherhood on changes in abortion rates.MethodsDrawing data from six national probability surveys that explored contraception and pregnancy wantedness in France from 1978 through 2010, we used multivariate linear regression to explore the associations between trends in contraceptive rates and trends in (i) abortion rates, (ii) unwanted pregnancy rates, (iii) and unwanted birth rates, and to determine which of these 3 associations was strongest.FindingsThe association between contraceptive rates and abortion rates over time was weaker than that between contraception rates and unwanted pregnancy rates (p = 0.003). Similarly, the association between contraceptive rates and unwanted birth rates over time was weaker than that between contraceptive rates and unwanted pregnancy rates (p = 0.000).
Highlights
An understanding of how abortion rates change over time is critical in guiding policies to improve sexual health
Abortion is the end point of a process that starts with sexual activity, followed by the use or non-use of contraception which in turn informs the risk of an unwanted pregnancy
To test if the association between trends in effective contraceptive prevalence rates and unwanted pregnancy rates was stronger than the association between effective contraceptive prevalence rates and abortion rates, we explored the association between trends in effective contraceptive prevalence rates and trends in (i) abortion rates, (ii) unwanted pregnancy rates, and (iii) unwanted birth rates and used a multivariate linear regression [17] with three dependent variables to determine which of these three associations was strongest (Table 4)
Summary
An understanding of how abortion rates change over time is critical in guiding policies to improve sexual health. Abortion is the end point of a process that starts with sexual activity, followed by the use or non-use of contraception which in turn informs the risk of an unwanted pregnancy. The process continues with the decision to terminate an unwanted pregnancy, and the need to access the health care system for the procedure (where abortion is legal). In this framework, trends in abortion rates reflect changes in each step of the process, with the possibility of opposing trends that statistically cancel each other out [7]
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