Pregnancy Help and Advertisers Need to Broaden Their Focus to Older Women
We have been very successful serving younger women. Now we need to reach out to their older peers.
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. 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. 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. 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%.
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.
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). 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
 “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).
 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).
 Julian, op. cit.
 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).
 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.
Someone has leaked a draft of the upcoming Supreme Court decision, Dobbs v. Jackson Women's Health Organization, apparently written in February, that had to do with state restrictions of abortion. If the final decision is not significantly revised, the Supreme Court will finally have overturned Roe v. Wade.
Pro-life people are ecstatic, and with good reason. The Court, we hear, will return the matter to the states' legislatures. The decision, then, may not change abortion practice that much: red states will tend to have few or no legal abortions, and blue states will likely have slightly more. It will lead to a significant, though not likely massive, reduction in abortion numbers, however, as many people will not cross state lines to get the abortions that were available at home. (The Texas "heartbeat law," which prevents abortions after a heartbeat can be detected, has reduced abortion numbers 50 - 60%, though some women have gone to neighboring states for abortions. While abortion drugs are readily available online, many women will not break the law. The President of Heartbeat International, an association of pregnancy help centers, has observed that some women in Texas have expressed gratitude that they didn't have the choice to abort -- which points to the pressures on women to do what they really don't want.)
Let's look further down the road: the Supreme Court is just putting off a decision that should apply to all the states, and not be left to them individually. (I think we can assume that Congress will not have the courage and fortitude to deal with the issue head on, though it should.)
While the Court may be politically attuned (or cautious), the inner logic of any moral prohibition of abortion demands a Court ruling, if you have any law, anywhere, protecting the child from the abortionist. If what is in the womb has the moral status of an appendix, then the law should back off and let medical professionals decide about abortion. If the moral status of that which is in the womb is unknown, but possibly that of a human being, the courts have an obligation to defend what may be a person, another one of us. (In short, those for permitting abortion have to show that that a pregnancy does not involve an individual human being. The hunter can't just shoot at anything that moves in the forest. He has to know that it's not another hunter.) Attempts to say when in pregnancy the state has "a compelling interest" to forbid abortion, on the grounds that the child should be protected at that stage, are in reality arbitrary: e.g., why 6 months (Roe), and not 5 months, or 4 months, when a life is on the line?
A legal person inside another legal person is a challenge to the imagination, especially early in pregnancy. It is also a challenge, admittedly, to the legal tradition, but it is perhaps an inevitable development, and the Equal Protection clause of the 14th Amendment will eventually apply, at least to the question of taking the child's life.
Compare our fight to the history of other issues before the Court, like race. From Wikipedia on the "equal protection clause": "The Equal Protection Clause is part of the first section of the Fourteenth Amendment to the United States Constitution. The clause, which took effect in 1868, provides 'nor shall any State ... deny to any person within its jurisdiction the equal protection of the laws.' . . .
"A primary motivation for this clause was to validate the equality provisions contained in the Civil Rights Act of 1866, which guaranteed that all citizens would have the guaranteed right to equal protection by law. As a whole, the Fourteenth Amendment marked a large shift in American constitutionalism, by applying substantially more constitutional restrictions against the states than had applied before the Civil War."
States surrendered their decision-making power as the Court saw the 14th Amendment entailing more uniform treatment of white and black peoples in more and more areas of life (accommodation, housing, education, etc. (https://historycollection.com/5-us-supreme-court-cases-defined-race/4/).
The Court, I submit, will eventually have to deal with the issue at the federal level; it can only be politics that holds it back at this point.
A good day. Let's hope and pray that the Court will stand firm.
Chris Humphrey, Ph.D.
The Good News, Obvious and Hidden, in the PA Health Department’s Abortion Report for 2020
A big wave on the beach, not the tide
There is no evidence yet of a statistical trend, and it is quite likely that 2019 is simply a bigger wave on the beach, and not the tide. Because the tide is definitely going out, as I will show below. The statistics for the rest of Pennsylvania indicate that this uptick is not local, but state-wide.
More than 1 out of 3 pregnancies ended in abortion in Philadelphia County
It is shocking to realize that in Philadelphia County, more than 1 out of 3 pregnancies ended in abortion in 2019 (562 abortions per 1,000 births). In Allegheny County, 1 out of 5 pregnancies ended in abortion. Before we began advertising, that ratio was about 1 out of 4.
What else do we learn from the report?
Abortion patients are getting older
The increase in abortions is entirely more abortions to women over 24
The increase in abortions in Pennsylvania in 2019 is entirely because of more abortions to women over 24. This has implications for anybody working in pregnancy help.
Fewer women without children are having abortions
While 2019 breaks with the trend, the abortion trend for women who have had no previous child, or have had one child only, is downwards. There is a slight increase, however, in the number of abortions to women who have had 3 or 4 children or more. This suggests that anxiety over finances and accommodation may be making abortion appealing to them.
High rate of multiple abortions
“First abortions” are a slight majority of all abortions again in 2019, at 52.6% of all abortions. “Repeat abortions” are almost half of all abortions.
The death knell of the abortion industry
It is clear, however, that the trend with all abortions is downward. While 2019 is an outlier, the number of first abortions is actually declining faster than repeat abortions. This is the death knell of the abortion industry.
In Allegheny County the birth rate was positive or stable
The bottom line is that, though abortion ratios in Allegheny County and Philadelphia County ticked upwards, in Allegheny County the birth rate was positive or stable over the period.
Letting them know that they have a choice
This is good news. It shows that advertising for pregnancy help directs more women to pregnancy medical centers where they can see their unborn children on the ultrasound machine. About 80% of those who do, choose life. Advertising reaches tens of thousands more each month, letting them know that they have a choice, that abortion is not the only solution. The results are big enough to show up in birth numbers. We estimate that about 8,400 more children were born between 2010 and 2018 than would have been if we had not advertised the centers.
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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.
What do we measure?
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).
Translating predictions into Approximate numbers of lives Saved
To do this we again need numbers to compare: actual numbers, and predicted numbers. The predicted numbers are approximations, representing a possible mathematical center in a range of possibilities. There are two basic ways of making these comparisons, that I can see. One looks at past trends over the years (determined mathematically by Microsoft Excel), and extrapolates these into the period in which we were working, and then compares those numbers with the actual numbers. There is an assumption made, here: the period 2011 to 2019, and especially the period 2011-2013, when numbers fell sharply, was basically similar to the previous 25 years. There were no new developments in pro-life work, or changes in sexual mores, or availability of abortion, or of pregnancy help, and so forth. Another assumption is that the deviation from the norm of abortion numbers for the period will not be extreme. Here's what we get when we chart the numbers. As you can see, Excel predicts that by 2019 there were about 10,600 fewer abortions, based on the trend of the previous 25 years. By this point in 2021, we can be assume by the same analysis that there have been well over that.
But what if there were changes outside allegheny county?
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.
The Numbers all point to the same conclusion
Birth Numbers point the same way, too
So we want to see what Allegheny County's birth numbers would have been if they had changed at the same rate as the rest of PA, and then compare that to the actual numbers. It's still impressive.
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.
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.
What do we conclude?
Advertising pregnancy medical centers is the way forward in reducing abortion numbers everywhere.
What we spend is small compared to the budgets of the large and well-run pregnancy medical centers. The effect of advertising, however, is much greater than one would expect from the money spent. God has opened doors for us, and provided people to help when we needed them, and provided the funds needed to save lives, and we have done our part. The results have been very encouraging, and we thank God. There are thousands more children out there who wouldn't have been, if we had not advertised the centers. We calculate that it cost us, in total, $ 42 to save a life using advertising.
a personal note . . .
Fewer Women Wanting Them, Not Less “Access,” Is Driving the Decline
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.
State Restrictions aren't driving the decline
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.
Focusing on Supply; Ignoring DemanD
contraception isn't the driver
So why is abortion dying in america?
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.
How long till no demand for abortion?
Chris Humphrey has been involved in pro-life activity of one kind or another since the late 1970s, when he first looked at the subject of abortion in seminary in Canada. He has an undergraduate degree in English (University of Toronto), and M.A. and Ph.D. degrees in religious studies (McGill). He has had a varied career as a pastor, chaplain in a psychiatric hospital, editor of academic and instructional publications, semi-professional photographer, and home renovator. He is a husband of over 45 years to Edith (a Professor of New Testament), father to three girls, and grandfather to seventeen grandchildren. He lives and works in the Stanton Heights neighborhood of Pittsburgh.