Before Roe vs. Wade, during the eighty or so years when abortions were for the most part illegal in the United States, hundreds of thousands of women in this country died from abortions performed under unsanitary conditions. During that time, abortions were banned, but that didn’t stop them from being performed, illegally and underground, sometimes with disastrous results. Emergency rooms saw a stream of mutilated women, victims of self-induced and back street abortions.
In 1973, the Supreme Courts Roe vs. Wade decision declared that the state laws against abortion were unconstitutional. In the next 20 years, after abortion was legalized by Roe vs. Wade, abortion-related maternal deaths in the U.S. dropped more than five-fold. Countless women were spared disabling, long-term health consequences from unsafe abortions.

History has repeatedly shown that women get abortions even when they are illegal, and even when they have to risk their lives to do so. It appears to me that making abortion illegal does not succeed in eliminating abortion, but pushes the practice underground, making what can be one of the safest of all surgical procedures highly dangerous, and only marginally reducing the number that occur.

One of the most extreme examples of what can happen when abortion is made into a criminal offense took place in Romania. For 14 years (ending in December of 1989), Romania under dictator Nicolae Ceausescu made abortions not only a criminal offense, but one punishable in some instances by death. No woman under 45 with fewer than five children could obtain a legal abortion under any circumstances. The effort to prohibit abortion was so massive that it involved a special arm of the secret police force, called the "Pregnancy Police," who administered monthly checkups to female workers and monitored pregnant women. Nevertheless, the country exceeded virtually all other European nations on rates of abortion and abortion-related maternal mortality. Some 3,000 women a year came to Bucharest Municipal Hospital after botched abortions, even though doing so subjected them to terrifying legal consequences. There is no telling how many women died without seeking medical aid, but conservative estimates are that more than 1,000 women died each year in Bucharest alone from bungled abortions.

That, of course, is not a fair comparison to our situation in the U.S. today. But I do believe that it is instructive that in Western Europe, by contrast, legalization of abortion coupled with public education efforts on planned parenthood has not only produced the worlds lowest abortion-related maternal mortality rates, but also reduced the number of abortions performed.

On the Swedish island of Gotland, for example, abortions were cut by 50 percent in three years by providing improved family planning services. That is a much greater reduction in abortions than has ever been achieved anywhere through illegalization. Another example is the Netherlands, where abortions are not only legal, but are paid for by the state. This nation, where contraceptives are widely available and comprehensive sex education is an accepted part of the school curriculum, enjoys one of the lowest rates of abortion in the world.

It seems clear that worldwide, the most abortions occur in those nations where there is limited access to contraceptives. In 1990, the Soviet Union was home to 70 million women of childbearing age, yet did not have a single factory producing modern contraceptives. At that time the average Soviet woman was terminating between five and seven pregnancies during her reproductive years. Researchers in Soviet health at Georgetown University in Washington, D.C. estimated that there were three abortions for every live birth.

When access to contraception for couples in Hungary was poor, the country had one of the highest abortion rates in the world – even though abortions were illegal. But when Hungary undertook a campaign to reduce the abortion rate by distributing condoms, birth control pills, and IUDs, and educating people about their use, the results were stunning. Even as abortion was being made legal, there was a substantial decline in the number performed.

The lesson seems to be that the most effective way to reduce the number of abortions is to provide couples with the means to understand their fertility and to prevent unwanted pregnancies. This is why I support birth control, family planning, education, and other means to improve the health and welfare of women and children. To my eyes the most effective way to reduce the number of abortions is to reduce the number of unwanted pregnancies.

Currently, a remarkably high percentage of all U.S. abortions – about a third of the total – are undergone by teenage girls. Our lack of education regarding family planning methods is one of the primary reasons that we now have one of the highest rates of unintended pregnancy among teenagers in the industrial world.

On his first working day in office,  U.S. President George W. Bush issued an executive order, known by its critics as the "global gag rule," that prohibits foreign family planning organizations from receiving U.S. government aid if they so much as mention abortion as an option for women with unwanted pregnancies. This prohibition, which applies even if no U.S. funding is being used for the activities in question, is seen by many in the international family planning community as an abhorrent restriction on free speech. The ostensible objective of the gag rule is to reduce the number of abortions, but by greatly undercutting the funding for the delivery of family planning services, it will probably have the opposite effect.

The international family planning programs losing their funding as a result of the gag rule have offered a wide range of services, from sex education to maternal health care and programs to stop the spread of sexually transmitted diseases such as AIDS. By preventing unwanted pregnancies, they have decreased the incidence of abortion. These are programs that have promoted education and contraception, not abortion, as instruments of family planning. In fact, the program of action adopted at the  Cairo International Conference on Population and Development emphatically condemns the use of abortion for family planning.

The International Conference on Population and Development also affirmed family planning as a fundamental human right: "All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so." I’m afraid that one consequence of the Bush administration’s invoking of the gag rule will be to deliver a serious setback to efforts to secure these rights for the people of the world.

The issue of abortion is of course highly controversial today, and intelligent people of goodwill may disagree about aspects of the situation. But I do believe that the most realistic and humane way to reduce abortions is not to be found in making them illegal, but by actively supporting family planning programs both domestically and abroad.