​A few years back, the executive director of a local pregnancy help center observed that more clients were not just “abortion-vulnerable,” that is, just thinking about abortion; instead, they were “abortion-determined.” They weren’t calling up with questions about pregnancy and abortion, but asking how much an abortion would cost. They had made up their minds. They were just shopping.
 
Now some of this could be the result of changing mores, new attitudes to sex and relationships, or a changing sense among these young women of how one has to act in “the real world.” A bigger part of the answer, however, is a change in the demographics: more of the women seeking an abortion are older. Let’s take a look at abortion numbers over the long term, to see the trend.

​The most striking change since 1973, perhaps, is how the percentage of young abortion patients has gone down: those under 20 years old (the yellow bars) dropped from 33% then, to 9% in 2019 – a 73% decline. Look at the difference, however, in percentage of patients who were over 24 from 36% to 63% (the blue bars). That’s an increase of 80%.
 
Put this data together with the decline in the rates of abortions per 1,000 women of child-bearing age over the same period, and it is clear: not only are younger women a smaller group of all those having abortions; they are a smaller group of all women their age. The following chart shows the pattern clearly: the trend lines showing the proportion of those women 15–19 and 20–24 who are having abortions go down (the orange and gray lines). The trend lines for abortions among women 25–29 and 30–34 rise slightly (the yellow and blue lines).

​Why are younger women having fewer abortions? The proportion of those using contraceptives has increased somewhat from 2010.[1] Adolescents, however, are also less sexually active than in the past. In 1991, 54% of high school students had had sex; in 2019 that number was 38.4.[2] Many observers have seen a decrease in sexual activity generally, though it is most observable in younger women. A variety of reasons are given to explain it.[3] The result, of course, is fewer pregnancies that lead either to birth or abortion. Is it possible that the morning-after pill (“Plan B”) has played a role here? This is unlikely, as the declining abortion ratios began well before the widespread availability of the morning-after pill, and continued at the same rate after its availability. The relatively sexually and contraceptively inexperienced young woman, if anything, would be less likely to resort to it than her older peer.
 
Women 15–24 gradually became a smaller proportion of all age groups having abortions. They also became a smaller group of all those their age who were pregnant. For those 15–19, those ratios per thousand births dropped over 50% from 1985 to 2007; for those 20–24, they dropped 29%. The decline for those 25–29 was 16%.[4]
 
Could it be that the cohort of women who were open to abortion years ago were just getting older and were still open to abortion, while younger women were less so? Changing practical attitudes to abortion may play a role, but the age trends are lasting much longer than the reproductive years of any given cohort. Something else is happening here.[5]
 
Abortion ratios are the best measurement of factors affecting the pregnancy decision. When the proportion of pregnant women choosing life goes up, one naturally looks for a cause. The most obvious cause of reduced abortion ratios across the country is the increase in pregnancy help centers and the advertising of them. Abortion numbers began falling in the mid-1980s, just as the number of pregnancy help centers began increasing sharply. The abortion numbers have continued to fall steadily to the present, as more centers go up and as advertising for those centers becomes more widespread.
 
Has pregnancy help had an outsized effect upon adolescents and younger women? It is almost certainly so. When they become pregnant, younger women are more likely to be unsure of whether they are. When they have confirmation that they are pregnant, they are more likely to be uncertain of their next step, or of what they really want. They are more likely to be ambivalent about abortion, and find decision-making challenging.
 
This is reflected in the fact that younger women have a lower proportion of early abortions than older women, and a higher proportion of later abortions. We can see this in the gestational ages at which most abortions are performed: 9 weeks or under. In the chart below, showing CDC data from 2019, notice that about 36% of women 15–19 had their abortions at 6 weeks or less. Of those women a little older, 20–24, 41% had abortions within the same period. If you follow the six-weeks-and-under line (blue) to the right, you see that the older a woman was, the more likely it was that she had an abortion early in pregnancy.

Between them, those 15–19-year-olds who had abortions at 9 weeks or less in 2019 had 74% of all abortions, and a slight majority of those had them between 7 and 9 weeks. What does the line for 7–9 weeks gestation (orange) show? It, too, shows that the older women were, the more likely it was that they had their abortions earlier in pregnancy. The same is shown by the line for 10–13 weeks gestation (gray) and, for the 15–19-year-olds versus the rest, the line for those 14–15 weeks (yellow).
 
So it appears that younger women are more uncertain and ambivalent regarding abortion than those a few years older. It is no surprise that more younger women who have an opportunity to find support, have increasingly turned away from abortion over the years than older women. It is also no surprise that, as abortion numbers have gone down, our success with younger women means that other, older clients seem more “abortion-determined” than ever.
 
Pregnancy help centers are staffed, in many cases, with older women who serve as advisors or mentors for women whose family situations make such mentors invaluable. These older women are effectively surrogate “moms,” taking the right amount of interest in the well-being of their clients, while respecting the freedom of these adult “children” to make their own decisions. These “moms” care, and inasmuch as their clients get to know them, their clients know that they care. It is this, and the information, practical advice, and moral and spiritual support that they provide, that has had the effects we see in my first two charts: younger women, women more ready to accept those falling into a “mom” role, are less likely to abort than those over 24.
 
The result, however, is that the women that pregnancy help centers have to reach are more and more “determined.” That is, they are more experienced, and less impulsive (something that both males and females face, as the brain matures in the twenties[6]). They are surer of themselves, and perhaps more cynical as a result of their experiences. About 60% are moms already, and over 40% have had one abortion or more before.
 
From about 2015 on, ratios of abortions to births for 15–19-year-olds began to climb again. The same was true for those 20–24, though the increase was smaller. Pregnancy help centers cannot ignore this group of pregnant young women, for whom they have done and can do so much, and despite the fact that this group has become smaller. Without ceasing to appeal to those under 25 (aiming at the high schools and colleges, and so forth), pregnancy help centers would do well to reach out to older women, who in many cases face more complicated situations than their younger peers. Despite the challenges, many still respond if they are given the opportunity.
 
 
Chris Humphrey, Ph.D.
Co-Founder, Vision for Life
www.visionforlifepgh.org

[1] “In terms of overall trends in contraceptive use between 2008 and 2014, there was no significant change in the proportion of women who used a method among either all women (60%) or those at risk of unintended pregnancy (90%)” (Megan L.Kavanaugh, Jenna Jerman, “Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014,” in Contraception, Volume 97, Issue 1, January 2018, pp. 14-21, https://www.sciencedirect.com/science/article/pii/S001078241730478X).
​
[2] Kate Julian, “Why Are Young People Having So Little Sex?” The Atlantic, December 2018 (https://www.theatlantic.com/magazine/archive/2018/12/the-sex-recession/573949/); CDC, Youth Risk Behavior Survey: Data Summary and Trends Report, 2009–2019, p. 12 (https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf).

[3] Julian, op. cit.

[4] Calculations were made using “Table 12 (page 1 of 2). Legal abortions and legal abortion ratios, by selected patient characteristics: United States, selected years 1973–2007,” from the 2011 CDC Abortion Surveillance Report (https://www.cdc.gov/nchs/data/hus/2011/012.pdf).

[5] I am indebted to my fellow Heartbeat International Board member Gary Thorne for this observation, and to Jor-El Godsey, President of Heartbeat, for helpful suggestions.

​[6] https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know
​

The PA Abortion Report for 2020 is not good news overall, but there’s good news for Allegheny County.  The bad news from Philly may be hiding the good effects of advertising, even there.
​
Abortions Down Again for Allegheny County Residents

At first glance, abortion statistics for Pennsylvania in 2020 are reasons for dismay: numbers are up. A close look at Allegheny County, however, shows that the number of abortions for residents actually dropped, while ratios remained the same. How is that possible? Birth numbers dropped, and abortion ratios are – wait for it – the ratios of abortions to births. So both abortions and births decreased proportionately in the County.

Philadelphia’s numbers were more discouraging at first glance. Both resident abortions and abortion ratios were up over the last few years, including 2020. On the surface, one might conclude that Vision for Life’s advertising was having no effect there. However, if one compares Philly not with Allegheny County, but with all the other counties, including neighboring counties, the picture is much brighter. It is quite likely that advertising pregnancy medical centers in Philadelphia County reduced the increase in abortion numbers and ratios of abortions to births.

First, the bad news: Abortion numbers for Pennsylvania residents were both up, for the third time since 2017.

​The ratio of abortions to births measures the proportion of women who choose life. That ratio was up again for PA women in 2020. That is, more PA women who were pregnant chose abortion that year. This was the pattern statewide since 2018.

​The good news, however, is that abortions to Allegheny County residents, after rising slightly in 2019, went down again in 2020, from 3,265 to 3,083.

​How can the numbers of abortions drop from the previous year, yet the abortion ratios remain the same? 2020 was “the year of the fear.” Birth numbers for Allegheny County residents dropped sharply.

​So abortions were down, but so were births, and the ratio of the first to the second remained the same. It is our contention that, without our advertising, abortion numbers and abortion ratios would have been up in Allegheny County, as they were in the rest of PA.
​
Compare the abortion ratios of Allegheny County residents to the residents of all other counties.

The abortion ratios for Allegheny County increased 8.1% from the low point of 2018 to 2020; in the rest of Pennsylvania the ratios from the low point of 2017 to 2020 increased 12.9%. Advertising makes a difference to demographics

What’s Happening in Philadelphia?

Mark Twain quoted British Prime Minister Benjamin Disraeli: “There are three kinds of lies: lies, damned lies, and statistics.” Anyone familiar with the use of statistics (especially in political controversy) can see why this quotation is remembered. Well, we do not want to use statistics to mislead you, so here’s the truth: the numbers for Philadelphia County, where we have been working since 2018, do not look good by comparison with Pittsburgh.

​As you can see, abortion numbers actually rose after we started advertising there. Abortion ratios for Philadelphia County also look disappointing.

​The increase in abortion ratios between 2018 and 2020 for Philadelphia County residents was 2.1%. If we go back to 2017 and compare the ratio of the earlier year with 2020, the increase was 8.5%.
​
Increases in abortion ratios can reflect an increase in the number of abortions, but they can also chiefly reflect, as we saw in Allegheny, a drop in birth numbers. Here are the birth numbers for Philadelphia.

The decline in birth numbers in Philadelphia County for 2017–2020 was not precipitous – 3.1%; this was less than the drop from 2012 to 2013 of 3.9%. The decline of previous years continued, however. From a comparison of abortion numbers and birth numbers over the years, we can conclude that the increase in abortion numbers in Philadelphia County played the larger role in the increase in abortion ratios than the decrease in births.

It appears, then, that our advertising was not having the effect we were looking for. There may be a few of reasons for this. For one, Philadelphia is a bigger “market” than Allegheny County, with 1.6 million people to Allegheny’s 1.2 million. Our ad spending in Philly was not commensurate with this difference in population. For another, the pregnancy medical centers in Philadelphia were not as prepared to handle abortion-determined women as were the centers in Pittsburgh. Finally, the year 2020 was an anomaly: in the midst of Covid fears, the centers in Pittsburgh remained open for business, while those in Philadelphia had restricted services.

Comparing Philadelphia to Other Counties Changes the Picture

Could our advertising have affected abortion numbers, despite the increase? Did it hold abortion numbers down? A comparison of Philadelphia’s numbers with those of the other counties (besides Philadelphia and Allegheny counties) suggests it did.

What do we find when we look outside Allegheny and Philadelphia counties? The number of births fell in these counties, 4.9% from 2017 to 2020, and 3.6% between 2018 to 2020. The drop in births in 2020 is sharp, if not unprecedented, and responsible for a big part of those years’ decreases.

​The really remarkable difference is the increase in abortion numbers and ratios in these other counties in 2020. Here are charts of the abortion numbers, followed by the ratios of abortions to births.

Abortion numbers and ratios increased sharply outside of the counties in which we advertise pregnancy medical centers, Allegheny and Philadelphia counties. From 2017 and 2018, to 2020, abortion ratios for counties other than Allegheny and Philadelphia rose from 135 to 158 per 1,000 births, or 17.0%. How does that compare with the abortion ratios for Philadelphia County?

In the chart below we see how the increases in abortion ratios of women in other counties compares with the increase in Philadelphia County, for the periods 2017 to 2020, and 2018 to 2020. (The low points in abortion ratios in the recent past vary from 2017 to 2018, hence the inclusion of both. The longer period, 2017 to 2020, is more significant, but our advertising in Philadelphia County began in earnest in 2018).

​The difference between the increase in Philadelphia County and its closest county neighbors (geographically, and in terms of abortion ratios) also suggests that advertising reduced the increase in abortion numbers and ratios there. The increase in the abortion ratios in Philadelphia County from 2017 to 2020 was greater than that in Allegheny County, but from 2018 to 2020, while our advertising was running, the increase in Philadelphia was smaller – by 6% (see the chart below).

Summary for 2020

Abortion ratios for Allegheny County residents fell from 2010 to 2013, and stayed relatively low and stable for years. The ratios dipped in 2017 and 2018, but rose to the same generally low level in 2019. Remarkably, those ratios remained stable in “the year of the fear,” 2020, because, though birth numbers fell, so did abortion numbers. Advertising continues to affect the thinking of abortion-vulnerable and abortion-determined women in Pittsburgh. The effects of advertising show up in demographics.

Abortion numbers and ratios for Philadelphia County rose overall in the period 2017 or 2018 to 2020, a gloomy picture indeed. When we compare the County to other Pennsylvania counties (that is, all other counties except Allegheny County), things look much better, however. Both Philadelphia County and Allegheny County saw half the increase in abortion ratios that the other counties had between their low points (either 2017 or 2018) and 2020. To put it another way, other counties in PA had double the increase in abortion ratios, compared to Allegheny and Philadelphia counties, from the latter counties’ low points to “the year of the fear,” 2020.

By comparison with Philadelphia County, from 2018 to 2020 the increase in abortion ratios in counties other than Allegheny County and Philadelphia County was almost 8.5% higher. Comparisons of Philadelphia County with its nearest neighbors reinforce the conclusion that Philadelphia’s increase in abortion numbers and ratios lagged that elsewhere.

No doubt, those who are well-versed in statistical methods could find more elegant ways to establish whether or not the small increase in abortion ratios in Philadelphia County from 2018 to 2020 was statistically significant, and, if significant, how much so. While the above comparisons do not let us quantify the likelihood that our efforts made a difference, they give us good reason to think that our advertising helped cap the increase in abortion numbers and ratios in Philadelphia County over this period. Our advertising, then, acted like a sea anchor, which (Wikipedia tells us) is deployed from a ship in a storm, and “provides hydrodynamic drag, thereby acting as a brake.”

What if Vision for Life had not been advertising in these periods? Would Allegheny County’s abortion numbers have been much higher? Almost certainly. Would Philadelphia’s ratios of abortions to birth have increased much more than they did? We can’t be as confident, but it is quite likely.
 
What Else Do We Learn from the PA Abortion Report That Is Helpful for Our Work?

In order to reach women thinking about abortion, especially with our under-two-minute video ads that run on Facebook, Instagram, and Facebook’s Audience Network, we need to know something about their situations. We learn a lot from sociological studies of abortion patients and their demographics, and also from the pregnancy medical centers, who have first-hand experience with women contemplating abortion. We also learn from the Pennsylvania Annual Abortion Reports, especially about things like race, age, number of previous children, and number of previous abortions. So from the 2020 PA Health Department’s Abortion Report, we learn that a majority of abortion patients are not scared teenagers, but women 25 years and older.

​This trend has been going on for some time.

Each multi-colored column in the chart above shows an age group over nine years (2012 to 2020). Within those columns, the colors apply to the particular years. As you can see above, within the muti-colored columns (Under 15, 1–17, 18–19, and 20–24), from the dark blue column on the left (2012) to the light green column on the right (2020), the trend is a decline in the numbers, except for the 20–24 group, which showed a slight increase in 2020. Among the older cohorts 30–34 and 35–39, the trend is an increase in the numbers of abortions, generally year after year. Among women 40 years old and above, the much smaller abortion numbers declined until 2018, and then rose slightly the next two years. So abortion patients are becoming older.
​
They are also more likely to be mothers of another child or of children.

Of the total number of abortions to residents in 2020, mothers of one or more children were the following percentages:
​
One previous birth – 26%
Two previous births – 21%
Three previous births – 10%
Four previous births or more – 6%
Mothers with no previous births were only 36% of the total.
 
Abortions to women who had no previous abortion had been in decline for years, until they started to rise in 2018. The same was generally true for women who had one or more previous abortion(s).

​Close to half of all abortions in 2020 were to women had had 1 or more abortion(s) – 47%.

​In summary, we are grateful that abortion numbers fell in Allegheny County in 2020, and that abortion ratios did not increase, as they did elsewhere. We are disappointed to see that we have not brought down abortion numbers and ratios in Philadelphia as we had hoped, but encouraged by the fact that numbers and ratios did not increase at the same rate as they did in the rest of the State, or at the rate of the surrounding counties with significant abortion numbers. We are persuaded that advertising is responsible for keeping abortion ratios down, and have expanded in 2022 to Cleveland, Ohio, whose abortion rate is close to that of Pittsburgh when we began there. Pray that God may bless our work, and that many more moms and babies are saved from abortion.

(This is an adaptation of the talk given by Co-Founder Chris Humphrey at the Fall 2021 Banquet, "They're Here Because You Care.")
 
Most Americans don’t care about abortion.  That may anger us, or sadden us, but, as they say, “It is what it is.”  In Allegheny County, however, thousands of babies are here because donors to Vision for Life care.
 
That care comes at the right time.  Abortion is THE human rights issue of our age. In all of human history, more human beings have been killed before birth than after.  Most of these have been killed in the last 50 years.  In America, however, we are winning on abortion.  Since the mid-1980s, abortion numbers have been falling at a consistent rate.  The ratios of abortions to births are actually lower in the last few years than they were in 1973 – the year of the infamous Roe v. Wade Supreme Court decision.
 
If you are a regular reader of our blog, or have read a few pages on our website, you will know that the biggest driver of this decline has been pregnancy help! Ratios of abortions to births are “inversely related” to pregnancy help centers: as pregnancy help center numbers rise, abortion ratios fall, from the mid-1980s to today.
 
We considered four other possible explanations as the main reason for the decline in abortion ratios: contraception (including abortifacients), restrictive state laws, fewer abortion centers, and public opinion becoming more pro-life because of activism and education.  See the series of six videos, and texts with data, on our website, for why none of these explains the decline.
 
Early on, we realized that trying to change public opinion in general was a mistake: we don’t have the resources.  The question then was, “If pregnancy help is the reason we’re winning, what can we do with what we have, to make the impact of the centers even bigger?”  A Charlotte Lozier Institute study confirmed what we thought: most young women had no knowledge of the centers.  Advertising could change that.  And it does!  Advertising pregnancy help is the most cost-effective thing we can do to reduce abortions in big cities in America now.
 
Our banquet theme was “They’re here because you care!” Who are the “they”? Our pregnancy medical center colleagues could tell you moving stories of individuals.  I want to answer the question, “How many are there?”
 
We estimate that roughly 9,600 fewer abortions were performed in Allegheny County, from 2012 to 2019, because of our advertising.  Incidentally, the abortionists would have lost much more than 4 million dollars.  (This is David versus Goliath, and we get to play the good role.)
 
Recently I looked more closely at the birth numbers in Allegheny County.  The birth numbers seemed a little low, in my analysis, and I realized that I hadn’t taken into consideration miscarriage, or those women, like students, leaving to have their babies at home.  That 9,600 number is still important: a woman who miscarried might be relieved, or grieve, or a bit of both, but she would not have an abortion on her conscience.
 
Here are the birth numbers from 1995 to 2019.

The 2019 PA Abortion Report is out. Abortions to residents of Pennsylvania increased from 28,240 to 28,796, or about 2%. In Allegheny County, there were 386 more abortions performed than the year before, an increase of 6.3%.
 
Vision for Life advertises in Allegheny County on Facebook to residents of the County. (Some of the abortions performed in Allegheny County would be on non-residents – people coming from surrounding counties and nearby states. They would not see our Facebook ads.) We also want to measure the effect of our advertising on all pregnant women considering abortion, so we don’t look at raw numbers so much: pregnancy rates have been going down, and we want to see what proportion of all pregnant women chose life. So we look instead at the ratios of abortions to births for residents of Allegheny County. Abortions to this group were up 8.6%, from 3,007 to 3,265.

When we compare abortions to residents in Allegheny County to those to residents in Philadelphia County, where 40% of Pennsylvania’s abortions are performed, we see that both saw an uptick in abortion ratios.

It is common for people to think that the average abortion patient is a teenager who made a mistake. There are, of course, some teenagers in that category, but most abortions are to adult women. The PA Abortion Report tells us that “more than 87 percent (27,221) of the abortions performed in Pennsylvania in 2019 were to unmarried women. The largest age group having abortions was 25–29, accounting for 9,529 (29.9 percent) of all 2019 abortions.” In fact, the trend over the last many years has been for younger women as a group to have fewer abortions, and older ones to have more.

What may surprise some is the high rate of multiple abortions. More than 1 out of 10 abortions is the woman’s fourth abortion, or more. Is abortion being used as a method of birth control here? Are there psychological problems that lead women to abort repeatedly?

From the time I (Chris Humphrey) became involved in pro-life work, back in the late 1970's, I have been concerned about making a difference, and not just a statement. We've had 46 years or so since Roe v. Wade to make a difference with our protests and education, and we've had very little success, if we're honest. It's true, we've seen great progress in state regulation of abortion, which frustrates some who want to see abortion banned outright. However, these state regulations have had, at most, a 5% effect on the ratios of abortions to live births.

What is amazing, however, has been the decline in abortion numbers -- rates and ratios to births, too -- since about 1984. There's little question, to my mind, that it's pregnancy help that has accomplished this. (See earlier articles.) The ratios are lower now than they were back in 1973. With first-time customers declining in number faster than "repeat customers," the abortion business is dying. Thank God.

The fact that our advertising has had a demonstrable effect on the abortion ratios in Allegheny County confirms that it is pregnancy help that has driven numbers lower everywhere. The pregnancy medical centers, and the women and men at Choices Pregnancy Services and Women's Choice Network, are the heroes of the story. Without the centers, we would have nothing to advertise. Just tell women not to have abortions? It's done all the time, but there's no reason to think that it changes many minds.

From the beginning of our work with Vision for Life, I have wanted to measure the effect of what we are doing. If we're making a difference, how do we know? Our best resources here are the State Health Department figures: the birth numbers and the abortion numbers.
​

Of course, we measure abortions. But how do we measure the effects of what we are doing in Allegheny County from just after Christmas in 2010 to 2018, the last year for which we have abortion numbers?

If abortion numbers are going down everywhere, it's clear that we can't just point to declining numbers in Allegheny County and say that our work caused that. We have to compare numbers with numbers. Our first concern is that pregnancy numbers are going down everywhere: if fewer women are getting pregnant, then of course abortion numbers will go down if the ratio of abortions to births remains the same. So we want to measure the ratio of abortions to births: if they are lower in Allegheny County after we have done our work, then we know roughly how effective advertising is. The ratios of abortions to live births fell 26% from 2010 to 2018 in Allegheny County, compared to 15% in the rest of PA, and 13% in Philadelphia County (where 40% of PA's abortions are performed).
​

The assumption of predictions of the future (even a "future" in the past, so to speak) based on past performance is that there have been no significant changes that would affect those predictions. We can't "control" for all the things happening around us, especially regarding an issue that is at once very personal, emotional, and controversial, with relational and socio-economic factors beyond our ken. Do women in one period view abortion more as a moral failure, and in another period more as a necessary wrong? Has a disillusionment with abortion affected recourse to it?

So perhaps a better gauge of the effect of advertising is to compare the rates of change in Allegheny County to those in all the other Pennsylvania counties. If there are social and cultural changes that affect abortion numbers generally, it is unreasonable to think that women in Allegheny County would be immune to them. So we can take the percentage change of abortion numbers in the rest of PA, and apply them to the numbers in Allegheny County, beginning with 2010 as the base year. Then we can subtract the actual numbers from these projections to get our number of saved lives. When we do, we find that there were about 9,600 fewer abortions in the 9 years from 2011 to 2019. That's over 1,000 fewer abortions every year. By the end of 2020, there would have been well over 10,000 fewer abortions.

It is striking that the number of lives saved is not that far from the 10,600 that Excel predicted. It is fewer in this prediction, because Excel could not take into consideration that abortion numbers were falling elsewhere in PA. Without advertising, numbers in Allegheny County would have fallen, presumably, about the same as elsewhere. The abortion ratio numbers we have, however, point to the same conclusion: numbers and ratios were falling in Pennsylvania as a whole in 2011-2019, but they fell significantly faster in Allegheny County, and stayed lower overall, because of the advertising.

Another way to measure success is to look at birth numbers. If there are fewer abortions in Allegheny County, you would expect birth numbers to go up, or at least not to fall as fast. In fact, birth numbers rose after we began our work, and settled in 2019 a little bit higher than they were in 2010. If we apply the same technique of projecting past performance on the 2011-2019 period, we see a phenomenal difference between those projections and the actual birth numbers -- an amazing 11,259!

The 5,079 births is lower than the projected 9,600 fewer abortions. Why? Wouldn't one fewer abortion in the County mean one more birth?

No. About half of the 6,000 abortions a year in Allegheny County are to non-residents. So the women who would have had abortions in Allegheny County, but didn't, were not all residents of Allegheny County. Some came from surrounding counties. Many would have been students, and would have gone home or elsewhere to have their children. So this chart is the least helpful in knowing how many unborn children were saved from abortion. Births as a whole, too, are less reliable as an indicator. Yet both birth projections point to the same result: thousands of lives have been saved by advertising pregnancy medical centers in Pittsburgh.

Our calculations for abortion numbers do not take into consideration the proportion of early pregnancies that would end in miscarriage if abortion were declined. There are no sure numbers here, as most early miscarriages do not involve a trip to the doctor. I have heard that between 17% and 32% of pregnancies end in miscarriage. So the number of births would likely have been smaller than our predictions using the abortion numbers.

Miscarriage is a tragedy, felt to varying degrees as such, often depending on the age of the child in utero​ or on the temperament of the woman. It is still important that a woman who miscarried did not have an abortion instead, because she knows that at least she did not participate in the killing of her child.

Pro-choice advocates imply that state abortion restrictions are a main reason that abortion numbers have fallen across the country. Ohio is a good example: Elizabeth Nash of the Guttmacher Institute notes that “Ohio is a testing ground for abortion restrictions.” So in 2019, Ohio passed a law prohibiting abortion once the baby’s heartbeat could be detected, unless it were to save the mother’s life or a major bodily function were threatened. The human heart begins to beat about 16 days after conception, but the heartbeat is usually detectable only sometime between six and eight weeks of gestation. Planned Parenthood and others sued, and the heartbeat law is in legal limbo until the lawsuit is resolved. Other laws are in force, however, including informed consent (the woman has to be told in person what the medical procedure entails, at least 24 hours before the abortion); a 24-hour waiting period; parental consent in the case of minors; and the limiting of public funding to those whose lives are at risk, or who conceived as a result of rape or incest. These and similar restrictions, it is implied, explain why Ohio’s abortion numbers are down from 34,128 in 2005 to 20,425 in 2018, or 40%.

The Guttmacher Institute, formerly the research wing of Planned Parenthood, and its many fellow-travelers tell us that these state laws limit abortion “access,” that is, they make it more difficult for women to get the abortions they want. The chief reason for lack of access, we are to assume, is the decline in the number of clinics near women who need them. On the Institute’s web page for Ohio, it presents its information tellingly under the headings: “Abortion Incidence,” “Where Patients Obtain Abortions,” and “Restrictions on Abortion.” We are to note that, in 2017, 89% of U.S. counties had no abortion clinics, though 38% of America’s reproductive-age women lived there. As a result, women wanting abortions would have to travel to get them.

​One of the articles cited on the Ohio page changes the picture, however. “Abortion Incidence and Service Availability in the United States, 2017,” presents the same implicit argument – fewer abortion centers must mean hardship for women, and thus fewer abortions – but then admits that the number of centers is not a factor in declining abortion rates. “Although the number of state abortion restrictions continued to increase in the Midwest and South between 2014 and 2017, these restrictive policies do not appear to have been the primary driver of declining abortion rates. There was also no consistent relationship between increases or decreases in clinic numbers and changes in state abortion rates” (emphasis added). So Delaware, for example, had more abortion centers in 2017 than in 2014, but its abortion rate dropped 37% anyway. “States considered to be supportive of abortion rights in 2017 – including large states such as California and New York – accounted for 43% of all U.S. abortions in that year but 55% of the decline [in abortion rates] since 2014.” “Abortion rates declined in all 10 states that had more clinic facilities in 2017 than they did in 2014 . . . . Half of these states had not enacted any abortion restrictions during the study period.” It is to their credit that the authors of the study looked at the evidence and reported this observation, as inconsistent as it is with the mantra of reduced-access-means-fewer-women-get- abortions.

Many on the pro-life side would be inclined to discount the claim that the restrictions aren’t driving the drop: “See, the pro-abortion crowd just wants to discourage pro-life political activity, because it’s working.” Is it? Yes, the laws have their measurable effects on abortion numbers, as political scientist Michael New has shown repeatedly, though altogether these would be less than 5%. Moreover, the effect of a change in the law would be a one-time decrease in abortion numbers. There is no reason to think that, say, the new requirement of a 72-hour waiting period would have an increasing or cumulative effect on the ratios of abortions to live births in following years. As good as all these laws are, from the pro-life perspective, the Guttmacher researchers are right: the restrictive laws are not the primary driver of declining abortion rates and ratios.

The problem with the “lack of access” claim is that the abortion-on-demand crowd are only looking at the supply side of the supply-and-demand relation: those state legislatures, they think, are dominated by men who want to dominate women, and are gradually cutting off the supply. (In reality, those legislatures usually have a share of women legislators, a large portion of whom are pro-life.) Ratios of abortions to live births have been dropping continuously for decades across the country – 49% from 1984 to 2016 – independently of changes to the law or the numbers of clinics. What if the decrease in clinic numbers and abortions reflects a decline in demand for abortion? What if the decline in the number of abortion clinics reflects market forces, and not government intervention? Jonah Goldberg makes a similar point about assumptions with the current coronavirus: to explain the less-than-catastrophic number of new cases and deaths, compared to earlier predictions, people either argue that the government overstated the likely cases and deaths, or that it was government action that “flattened the curve.” He argues for an alternative: when given accurate information in a timely way, people themselves act in a way that has better consequences for everybody.

What could be responsible for dropping demand? Guttmacher and its supporters would say that it is contraception. Fewer women need abortions because of better contraceptives (the long-acting kind), better contraceptive practices, or more widespread use of contraceptives. The evidence, however, doesn’t back this up. If it were so, better contraception would mean that fewer pregnancies would be unexpected or unintended. Researchers, however, found that “changes in contraceptive method choice and use have not decreased the overall proportion of pregnancies that are unintended between 1995 and 2008” (emphasis in the original). In fact, the proportion of these unexpected pregnancies went up 1%, from 48 to 49%. Here, the ratios of abortions to live births are a good measure of demand: while abortion rates (abortions per 1,000 women 15-44) would fall if pregnancy rates fell, the ratios tell us what proportion of pregnant women chose abortion rather than birth. According to the CDC reports, over the same thirteen-year period in the study described above, the ratios of abortions to live births dropped from 31.1 to 23.1 per 100 live births, or 26%. While there are other studies which seem to show a drop in unexpected pregnancies or births, or a certain volatility, so speak, there is no long-term trend in either that parallels the decrease in ratios of abortions to live births. While social-scientific surveys of women’s intentions and the statistics of abortions both have their problems, the latter, at least in terms of establishing a trend, are more trustworthy. Contraceptive use, then, is not driving down the numbers either.

So is there a candidate for the main driver of falling abortion ratios? Drum roll, please . . . . The increase in pregnancy help centers across America, now over 2,750, is the only candidate that lines up in terms of timing and trajectory. The number of centers increased sharply from 1982 to 1986, and continued upward to the present. In his horribly titled Abortion Rites: A Social History of Abortion in America, Marvin Olasky argued that it was mainly pregnancy help (in the form of maternity homes in that day) that reduced the very high abortion rates of the late-19th Century. We are seeing the same thing today.

The pro-choice side knows very well that pregnancy help centers are having an effect on abortion, and some activists have attempted to defame the centers as deceptive, oppressive of women in their religiosity, and unscientific in their information. (In fact, it is the representatives for abortionists who obscure the early development of the child in the womb with terms like “a clump of cells,” or “a blob of tissue.” For an answer to the pro-choice criticisms of the centers, see Heartbeat International’s pregnancycentertruth.com. I am on the Board of Heartbeat.) Abortion is big business, and business is down. The reality is that most women do not want abortions. This is what women who come to pregnancy help centers say themselves. (They come to the centers “abortion-vulnerable” or “abortion-determined,” in the centers’ terminology.) For many, abortion appears to be a necessary evil, to be gotten through numbly, with as little thought and reflection as possible. The centers help them do what they admit they really wanted: to bear their children. Pregnancy medical centers have very high customer-satisfaction ratings. Hundreds of thousands, are deeply grateful for the help they have received at these centers, and their endorsements are simply unanswerable. While technically it may not be true that “no one ever says ‘Thank You’ to an abortionist,” the number would be minuscule by comparison.

If these centers are the main driver for dropping abortion ratios, then advertising the centers should drive ratios even further down. This, in fact, is what we have found in Pittsburgh (Allegheny County). From 2010 to 2018, non-profit Vision for Life advertised two local pregnancy medical center organizations, with five centers and two mobile units between them. Abortion ratios for residents dropped sharply in the first two years, remained relatively stable for several years more, and then dropped again in 2018. The decline overall was 26%. The ratios are the lowest they’ve been since the State began recording them in 1995, and likely the lowest in a half-century. There is no reason to think that ratios would not fall further with more advertising.

​Abortion is dying in America. The abortion industry is consolidating. Abortion is less available in many counties because the demand is just not great enough to sustain a business. In Pennsylvania, the numbers of “repeat” abortions (a woman’s second, third, or more, and about half of all abortions) have been decreasing for years, but first-time abortions have been falling faster. Without more first-time customers, a business is on the way out. The state is probably representative of the country here. The questions then becomes, How low can the U.S. numbers go? How soon will “abortion on demand” become “abortion: no demand”?