Many conservatives believe the demise of abortion access in the wake of the Supreme Court overturning Roe v. Wade will bring a new dawn in which fewer abortions take place and more children are born. This promised new reality is likely to remain fantasy.
Why?
Because limiting legal abortion access does not result in fewer abortions.
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A better course of action, if reducing the number of abortions is the goal, is regulatory pragmatism—a flexible approach to the design and implementation of a regulatory system that avoids legal doctrine and dogma, while prioritizing effectiveness and durability.
Regulatory pragmatism adapts for context and on-the-ground realities, sets ideology aside, and focuses on the goal—sometimes even employing tactics that seem antithetical to that goal, simply because they work.
Take the current state of the battle over reproductive rights in the U.S.
Conservatives’ stated goal is “saving babies.” If serious about achieving that goal, it would make sense to look at a similar country that has significantly fewer abortions per person.
Canada is democratic, comparatively wealthy, and, in 2020, had a quarter fewer abortions per women than in the U.S. For women of typical childbearing age (15-44) Canada had 10.1 abortions per 1,000 women that year compared to 14.4 per 1,000 in the U.S.
Though it may seem counterintuitive, Canada did not achieve its lower abortion rate by banning abortion. Quite the opposite, in fact. Canada decriminalized the procedure in 1988. It is now legal, at all stages of pregnancy, and publicly funded. The most pressing concern is access to care, as most clinics are located near large population centers, and those living in rural Canada often have to travel significant distances to secure an abortion. But it is safe to say that very few Canadians who want abortions are denied them by their government.
Canada’s example suggests that completely free access to abortion does not cause high abortion rates. That means if the goal is to “save babies” and reduce abortions in the U.S., we need to take the broader context into account when considering how to regulate.
Canada consistently supports women and babies throughout their lives. Women have easy and inexpensive access to contraception. Should they choose pregnancy, they have good health care throughout the process, including prenatal care.
Maternal health is better and pregnancy is less dangerous in Canada. In 2018, the most recent year for which statistics are available, Canada’s maternal mortality rate was 8.82 per 100,000 live births. This stands in stark contrast to the same statistic in the U.S.—which was 17.4 in 2018 and then increased to a shocking 23.8 in 2020. Among high-income countries, the U.S. has the highest rate of maternal mortality—a rate that multiplies 2.5 to 3.5 times for Black women.
In Canada, biological and surrogate parents who have given birth receive 15 weeks of maternity leave, during which time they receive their regular pay and benefits. Afterward, all parents, biological or adoptive, can receive an additional 35 weeks of “parental benefits.” These provide for partial pay, with most receiving at least 55 percent of their average earnings. Either parent is eligible for this benefit and it can be split between the parents. Through the Canada Child Benefit, the government also helps eligible parents with child-care costs with a monthly tax-free payment.
The U.S., for its part, offers no guaranteed paid family leave, nor subsidized childcare, nor universal basic health care. And it has far more abortions than its neighbor to the North.
A system with almost unlimited abortion access, when combined with decent health care (including contraception), and good support for new parents, goes a long way towards creating ideal conditions for bringing babies into the world. Indeed, one might even call Canada’s policies more accurate examples of what pro-life should mean: policies that support the health and well being of pregnant people and their children.
But can such pragmatic regulatory policies work in the U.S.?
One Colorado program suggests that they can.
In 2008, the Colorado Department of Public Health and Environment launched a program to offer low-or no-cost long-acting reversible contraceptives to low-income women across the state. The results were astounding: Between 2009 and 2014, the teen abortion rate was nearly cut in half. In addition, teen birth rates were nearly cut in half, births to women without a high school education fell 38 percent, second and higher order births to teens were cut by 57 percent, and rapid repeat births declined by 12 percent among all women.
The decline in rapid repeat births is particularly important for the lives and health of low-income women and their children. Research shows that low-income women with shorter intervals between pregnancies have higher odds of precipitous labor, and infants whose birth was not spaced have higher odds of low birth weight, NICU admission and mortality. Medical research shows that spacing babies is critical to their survival.
With the demise of Roe, we have the opportunity to re-envision and redefine in the U.S. what it means to be pro-life.
Those who are “pro-choice” are rarely against saving babies and most will easily shift their support to a pragmatic strategy that preserves freedom and lowers abortion rates. Those on the right who are more traditionally “pro-life” will have to decide whether their anti-abortion stance is really about “saving babies” or about something else entirely. The evidence is clear and regulatory pragmatism suggests that we follow Canada’s lead.
The authors’ opinions are their own, and do not necessarily reflect those of the University of Notre Dame.
