​Chris Humphrey, Ph.D.
Executive Director of Vision for Life – Pittsburgh
Board Member, Heartbeat International

April 20, 2018; Revised June 15, 2018

​For more than 40 years, pro-life people from various walks of life have been taking different approaches to stopping legal abortion in the U.S. and abroad. The movement is strongly “entrepreneurial,” new ideas are explored, and new organizations spring into being. Some publicize the latest poll, which appears to show that “young people are more pro-life than ever,” and many hope that they have found the “silver bullet” that will take down the monster that is Big Abortion. In fact, we are winning at the ground level: fewer women are resorting to abortion every year. It’s worthwhile asking if there is any one thing that could be primarily responsible, so that we can set the right priorities in supporting pro-life work. This article, developed from a workshop given at Heartbeat International’s Annual Conference in Anaheim, California, in April 2018, addresses this larger question of the most likely cause for declining abortion numbers. It also presents an example of successful advertising for pregnancy medical centers in Pittsburgh, with recommendations for others engaged in pregnancy help.

​To measure our success in changing pregnant women’s minds about abortion, we look at abortion ratios, and not just abortion numbers. Pregnancy rates in general are declining, so abortion numbers would do so as well, in any case. Ratios measure the number of women who bear their children, rather than abort them.

The statistics from the last 30 years seem to show that Christian help to women seeking abortions is key: nothing else explains the decline in abortion ratios as well. To get to this conclusion, we’ll look at the data and possible alternative explanations for the decline.
​
Below is a chart, using abortion numbers from the Guttmacher Institute and birth numbers from the CDC, to show the ratios of abortions to live births from 1973 to 2014.

Joerg Dreweke of the Alan Guttmacher Institute, Planned Parenthood’s research affiliate, asserts that a decline in the numbers of unintended pregnancy is responsible for the drop in abortion numbers from 2008 to 2011.[2] Most abortions are performed on women who would report that they conceived unintentionally – “unintended pregnancies.” If, over the years, more women used contraceptives effectively, and more women used the more effective kind of contraceptives, the reasoning goes, then fewer women became pregnant unintentionally. Hence, fewer women would have resorted to abortion.

There are several counter-arguments to be made here. First, if more contraception, and more effective contraception, over the years meant fewer unintended pregnancies, then unintended births should have declined not just from 2008 to 2011, but over this longer period. That is not the case. The numbers of “unintended” births as a portion of all births have gone down and up slightly over the years, but have shown no long-term downward trend.[3]

Indeed, if the study is correct, it appears that unintended births increased over 7% from 1995 to 2010.
 
Could contraceptive use be the explanation for the drop in abortion ratios from 2008 to 2011? One simple observation is that the rate of decline for abortion ratios doesn’t change significantly from the mid-1980s to 2014, which may suggest that there is one major factor in the decline. As we have seen, it is unlikely to have been contraceptive use, as unintended births did not decline consistently. Let us consider Mr. Dreweke's claims in detail, however. He says that “overall use of any contraceptive method increased slightly among women at risk of unintended pregnancy, from 89% in 2008 to 90% in 2012,” and that “even such a seemingly small increase in contraceptive use can have a measurable impact on unintended pregnancy and abortion rates.”[5]  This is a 1% difference over four years. The failure rate for all contraceptives with “typical use” in this period was more than 10% (per year),[6] so the impact of an ostensible .25% average increase in use every year for four years on rates of unintended pregnancy would be negligible. Researchers say that around 40% of unintended pregnancies end in abortion, so there is simply no way that these insignificant changes in contraceptive use and methods explains a drop in abortion ratios between 5.9% (Guttmacher) and 10.2% (CDC).[7]
 
It may be true that “between 2002 and 2006–2008, the percentage of women who had ever used emergency contraception rose from 4% to 10% (5.2 million) . . . and the percentage who had ever used the contraceptive patch rose from 1% to 10% (5.3 million).”[8] These “Long-Acting Reversible Contraceptive” (LARC) forms of birth control are more effective at preventing pregnancy than other, more commonly used methods like the condom. Nonetheless, researchers note that “changes in contraceptive method choice and use have not decreased the overall proportion of pregnancies that are unintended between 1995 and 2008 . . . .”[9] As we have seen, abortion ratios have declined from 1982 or so on.

​There seems to be no correlation between rates of unintended births and pregnancies, and abortion ratios. Clearly the “harder,” more reliable data are abortion and birth numbers. While these are not precise – both the CDC and the Guttmacher Institute admit this – they are not subject to change, as are subjects’ recollections of their intentions, gathered in questionnaires months after aborting or giving birth.

The number of pregnancy help centers has increased constantly since the 1970s, with the biggest increase in centers happening in 1985. The cumulative total of new and relocated centers indicates a high rate of growth, year over year. These centers, offering free services, were started mostly by Christians who wanted to do something to help women who were choosing abortion. The movement has matured, and many centers provide not just pregnancy testing, emotional and material support, and options counseling, but STI testing and limited obstetrical ultrasounds. (Pregnancy medical centers have certified sonographers and nurses, as well as a physician as medical director.)
 
Currently (2018), there are about 2,750 pregnancy help centers in the U.S. OptionLine, the national helpline for abortion-vulnerable and abortion-determined women operated by Heartbeat International, connects women to these local centers. Staff at Heartbeat currently handle about a thousand phone calls, texts, chats and e-mails every day, 24 hours a day, 7 days a week. A similar umbrella organization, CareNet, also has a large group of centers affiliated with it, many of which are affiliated with Heartbeat.

​If contraception is not responsible for the long-term decline in abortion ratios, what of other pro-life activity? If contraception is not responsible for the long-term decline in abortion ratios, what of other pro-life activity? Perhaps changes to the law account for this, or perhaps pro-life protest, or education on prenatal development and abortion, have fostered a “culture of life” in which abortion is less appealing to more and more women.
 
As much we might wish that this were so, there is little evidence that it is. Education may be maintaining a degree of pro-life sentiment, but there is no indication that it has affected abortion ratios. Attempts to inform and influence the general public on life issues, from the 1970s on, have not moved the needle on abortion: polls at least since 1975 show about 20–25 percent are pro-life, about 20–25 percent are pro-choice, and about 50 percent think contradictory things, and don’t want to think about it. So in a 1975 public opinion poll, 21% said abortion should be legal under all circumstances, 54% said it should be legal only under certain circumstances, and 22% said it should be illegal in all circumstances.[11]  Forty-one years later, in 2016, those numbers, if anything, had only gotten worse from the pro-life point of view: 29% said it should be legal in all circumstances, 50% said it should be legal in some circumstances, and 19% thought it should be illegal in all circumstances. Pollsters also found a deep ambivalence in the public as a whole: “Substantial numbers of people tell the pollsters that abortion is an act of murder. They also say that the decision to have an abortion should be a personal choice.”[12]
 
If pro-life educators and activists have not increased the proportion of those who hold pro-life views, we have no reason to assume that widespread exposure to ultrasound images of babies before birth (on fridge doors and the Internet, for example) has helped to reduce the numbers of those who resort to abortion. Again, the polls show virtually no change over the years, and instead a deep ambivalence about the morality and legality of abortion. Women, it seems, do not decide against abortion because they have been educated on prenatal development before they became pregnant.

The same thing can be said about pro-life protests or activism: it has had no effect on public opinion, and no discernible effect on abortion numbers. It is common among pro-life people to decry the failure of the media to report on the March for Life in Washington, D.C., and similar protests, but that disinterest, sad to say, reflects that of the majority of the country.

In an earlier version of this article, I argued that various state laws (72-hour waiting periods, informed consent requirements, parental involvement, and so forth) had no discernible effect on abortion numbers. In fact, it has been demonstrated widely and repeatedly that changes to the laws do affect abortion rates and ratios. The question is, How much?

Michael New of the Charlotte Lozier Institute recently published an article, “How the Legal Status of Abortion Impacts Abortion Rates,” which shows again that laws that restrict the grounds for abortion to varying degrees, or withhold funding for it, or otherwise regulate it, have reduced abortion numbers to one degree or another.[13] So, for example, he quotes a 2009 Guttmacher Institute literature review which finds that “‘a reasonable estimate is that a lack of funding [for abortions] influences a quarter of Medicaid eligible women to continue unwanted pregnancies.’” Similarly, he concludes from a statistical analysis of state data that Medicaid funding restrictions reduce the abortion ratio by 20.8 per 1,000 live births,[14] or 2.1 abortions per 100 live births.[17]

Laws requiring informed consent also have an effect. He writes that, “when an informed consent law takes effect, the regres­sion model predicts that the abor­tion ratio decreases by 10.34 abortions for every thousand live births.”[15] This is a reduction in the ratio of abortions to 100 live births of 1.0.

He notes, too, that “when a parental involvement law is enacted, the abortion rate [ratio] decreases by 16.37 abortions for every thou­sand live births,” or 1.6 per 100 live births.[16]
 
All of these reductions, as small as they may seem, would add up to a considerable number: 4.7 abortions per 100 live births. Other changes to the laws might increase that further still. Two things should be observed, however. First, the passing of a state law will have an initial, punctiliar effect on abortion ratios, but there is no reason to think that its effect would be continuous or cumulative: rates and ratios would fall, and remain where they were, all things being equal. The actual decline in abortion ratios, however, has been continuous from the early 1980s, and fairly uniform over this period. Second, the decline in abortion ratios has been much greater than 4.7: over 17 per 100 live births (1980– 2014).
 
Dr. New claims that “the results clearly indicate that value shifts [in public opinion] correlated with the pas­sage of legislation affect the incidence of abortion only marginally,” and that “this means that any outside factors that are correlated with the passage of pro-life legislation have only a marginal impact on the number of abortions that occur.” [17] He is surely correct in his assertion that changes to the laws do reduce abortion ratios and rates, and we are grateful for those who pursue these changes that protect the unborn and their mothers: lives are saved. The question then becomes, What of outside factors, perhaps not correlated temporally with the passage of legislation, such as increased numbers of pregnancy help centers? Could they have a major role in driving abortion numbers down over the longer term?

It is the large size of the decline in abortion numbers that leads Guttmacher Institute researchers to dismiss changes to the laws as factors. So Jones and Jerman write, “Between 2008 and 2011, some 24 states enacted 106 abortion restrictions. However, no strong evidence exists that these restrictions were the main factor behind the decline in abortion” (emphasis added).[18] In fact, in some cases abortion rates went up after new regulations were applied, and went down where there were none. Sixteen states had no new regulations, but their abortion rates went down anyway, while another ten without new regulations saw a larger-than-average decline.[19]

​The Guttmacher researchers explicitly “denied that the decline resulted from ‘new state abortion restrictions.’”[20]

It seems intuitive that if there were more abortion centers, there would be more abortions. This is implicit in the complaint that Planned Parenthood situates its centers near African-American communities. There is no demonstrable correlation between numbers of centers and abortion numbers, however. In a Guttmacher Institute-sponsored study, we read that “between 2008 and 2011, the number of clinics providing abortions declined by only 1%, and decreases in abortion incidence occurred in almost all states, including states that enacted multiple restrictions and states that enacted none.”[21] So “seven of the states that experienced the largest proportionate declines in clinics also experienced a larger than average decline in the abortion rate. However, the states with the two largest proportionate declines in clinic numbers – Missouri and Utah – experienced declines in the abortion rate that were comparable to the national average. And while Michigan had 33% fewer clinics in 2014 than in 2011, the state’s abortion rate increased slightly.”[22]  Again, “the number of clinics in Iowa rose (from 10 in 2008 to 17 in 2011, for a 70 percent increase), and yet, the abortion rate dropped from 11.3 per 1,000 women in 2008 to 9.7 in 2011 – a 14 percent decrease.”[23]  Though “the [U.S.] Northeast had more clinics providing abortion care in 2014 than in 2011, that region’s abortion rate declined 11%.”[24] Reducing the number of abortion clinics is a good thing, but we cannot assume that abortion ratios will be reduced thereby.

Marvin Olasky, editor of World magazine, published Abortion Rites: A Social History of Abortion in America in 1992.[25] By his calculations, which I have updated for our current population, if we had the rate of abortion of the 1860’s, we would have about 1.9 million abortions a year, instead of the 900,000 to 1 million or so that we have. In short, we have about half the abortion rate of the late-19th Century. Abortion numbers fell in the early decades of the 20th Century, before rising again in the 1950s and 1960s, and then leaping after the Roe v. Wade Supreme Court decision of 1973.
 
There were a number of factors that contained abortion in the late 19th and early 20th centuries, including the fact that journalists, medical men, and medical societies applied pressure on abortionists. (The churches, by and large, were not leaders in the struggle against abortion, though individual Christians and Christian organizations played many roles.)


In Olasky’s view, however, most important in the fall of abortion numbers was practical Christian help for women under pressure to abort. Late in the 19th Century there was a rapid proliferation of organizations to help women who were alone in American cities like New York. Furthermore, there were at least 20 organizations in New York that specifically provided unmarried pregnant women with lodging, help, and training. The largest, the House of the Good Shepherd, had room for 1,042 women. This was the story in every major city. Further, national organizations emerged: the Crittendon Homes, for example, helped a half-million unmarried women from 1883 to 1933. Pregnancy help organizations are the contemporary version of these centers. There are several organizations, such as Human Coalition, or Obria, that would like to become the Crittendon Homes of the 21st Century.

So what’s the difference between local pregnancy help centers and these maternity homes of the past? Social prominence! Everybody knew where those maternity homes were. The women lived there, and in most cases they worked there, and received training there, so people in the community for miles around knew about what was available.
 
Unlike the maternity homes of the past, pregnancy help centers are small and low-profile. The center (unless it is a maternity home) is more like a doctor’s office, and doesn’t have half the social prominence that these homes did. When I asked people at a fundraising dinner in 2016 if they knew where the local centers were, about half put their hands up. And this was at a pro-life event!

When we set our priorities for pro-life work, supporting and especially advertising pregnancy help centers should be at the top of the list. We have a theological mandate to do so: Jesus tells us that we should “let [our] light so shine before men that they may see [our] good works and give glory to [our] Father who is in heaven.” These centers are, beyond question, “good works”! A majority of Americans may not know which way is up when it comes to abortion, but they like people who help women choose life, and they like what they are doing. In a national 2014 poll, 92% of women said that pregnancy help centers were “very necessary” (70%) or “fairly necessary” (22%) in their communities, yet 54% did not know that there were such centers in their communities.[26]  Advertising is essential to make pregnancy help centers socially prominent.
 
We can’t prove that pregnancy help centers are the reason abortion ratios have gone down. (As they say, “correlation is not causation”). It might be possible to show causation by comparing abortion numbers, rates and ratios in states with more pregnancy help centers, to those with fewer, or to do the same analysis over time, seeking a correlation between abortion ratios and numbers of centers. Until this is done, the correlation between the increasing number of pregnancy help center and the decline of abortion ratios is at least very intriguing. How might pregnancy help centers have had this effect on abortion ratios? Some women choose life because they come to the centers, of course. Other women who never come to the centers, I suggest, choose life just because they know or learn that they are there: they feel under pressure to abort, but they know that they actually have a choice, that other women aren’t aborting. One way or another, they end up not aborting. The centers are there, and that little bit of leaven leavens the whole lump.

Vision for Life – Pittsburgh began advertising local pregnancy medical centers in early 2011. The year before in Allegheny County, the abortion ratio was 31.6 for every 100 live births. So, out of every 4 babies in the womb (excluding miscarriages), 3 were born; 1 was aborted. From 2011 to 2013, the ratios of abortions to live births declined to 25.3, a difference of over 6 percent. Since 2013, then, 4 out of 5 babies have been born. In other words, over the period 2011–2015, the ratios of abortions to live births went down across Pennsylvania, but they went down 20 percent in Allegheny County, versus 16 percent in the rest of Pennsylvania.

​I estimate that roughly 450 more children were born because of that difference (2011–2015). Birth numbers in Allegheny County made a modest 3.2% increase from 2010 to 2015.

Vision for Life began in early 2011 with a six-week, $90,000 TV ad campaign directed towards the general public, with some ads directed to abortion-vulnerable and abortion-determined women. Our partner for this was Virtue Media. We also ran ads for Women’s Choice Network on the interior of city buses and on bus shelters.

We realized that we wanted to reach women thinking about abortion, and so narrowed our focus to them, and to women who have had abortions and are in need of forgiveness and healing. We learned, too, that billboard advertising is great for donors – they like the ads – but much less effective in reaching women, for every dollar spent, than Internet advertising – Google Adwords, Facebook ads, and local search optimization.
 
We worked with Heroic Media to provide Google Adwords advertising for Choices Pregnancy Services. From September 2015 to January 2018, on average, each month we have gotten 414 “click-thru’s” to the Choices Pregnancy Services landing page for about $1,500, and generated 61 calls and e-mails; that is about $25 a contact.
 
From September 2014 on, we created three Facebook pages: one for women (“Pittsburgh Choices”), another for boyfriends (“Choose Together – Pittsburgh”), and one for experimentation, especially to our African-American audience (“Unexpected”). African-Americans are about 13% of the U.S. population, but black women are about 40% of Pennsylvania’s abortion patients, and 26% of the City of Pittsburgh is black.

Our goal at first was “brand lift,” as they call it: getting women (and men) to know about the “Pittsburgh Choices” centers in Pittsburgh. (Because we were working with two different organizations, we thought it better not to use their names.)

​We gradually built up “likes” for the page (we have over 1,400 for “Pittsburgh Choices”), which gives Facebook an idea of who is likely to respond to our ads. For a couple of years we “boosted” posts on the page (the simplest way to advertise in Facebook). We usually alternated black and white models in our monthly ads, but sometimes ran ads with black models back-to-back. Amy Scheuring came up with our slogan: “Don’t choose alone.” 

In 2017 we moved away from boosted photo ads, for a number of reasons. We found call numbers were falling; we learned that video was the way to go for engagement; and we wondered if our ad campaign was tired, that is, whether everyone who would notice “Don’t choose alone” had done so, and so they ignored it.

We moved from boosting posts to doing advertising through Facebook’s ad portal (“Manage Ads”). We began doing “carousel” ads on Facebook (several photos in sequence, which let us tell a story, for example, about going to a center, and getting the information and help needed), and eventually shifted to video.
 
We also changed our slogan to “Friends tell friends.” The ads are directed not to the woman facing an unintended pregnancy, but to her friends. About 40% of center clients are referred by friends. Facebook is a great venue for digitizing those referrals. Of course, women who have unintended pregnancies will see the ads, as will women who have had abortions. The implied audience, however, is invited to help other anxious women, something that most people are happy to do. Low-key, gentle, woman-centered, positive ads work.
 
There is currently a campaign by pro-choice activists to label pregnancy help centers “fake clinics.” Most women will not have heard of it, or of the “exposefakeclinics” website. While we can ignore the attacks and the false claims, it doesn’t hurt to encourage women to trust the centers by having the medical director appear in an ad (either a photo or a video). For this reason we ran an ad on Facebook in April 2018 for Choices Pregnancy Services featuring Dr. Rocco Adams, the Medical Director (https://youtu.be/3JaJAKzO-qI). 

Ad America’s work for Women’s Choice Network increased their 2017 client numbers over 2016’s by 45%.
 
The success of advertising in Pittsburgh has been demonstrated by repeated campaigns of harassment and deception by pro-choice activists over the past couple of years. In the most recent campaign, in March and April of 2018, activists have been phoning Women’s Choice Network to ask to speak to the doctor (who is not on site, and has no reason to be), and have given many one-star reviews on Google Places (without having visited the centers), claiming that they are not “full-service women’s health centers” because they don’t perform abortions. The extent of this opposition reflects their realization that they are losing the public relations battle: people think pregnancy help is a good thing, and more and more women are choosing life.

​When we think about how to spend our energy, time and money, fighting abortion in our country, we do well to set priorities according to demonstrable success. We have good reason to believe that pregnancy help has played a major role, perhaps the major role, in bringing abortion numbers and ratios down for the last 30 or 40 years. If so, it makes sense that it be the top priority for pro-life work. There is and will be no simple “silver bullet” – a new video, a new investigation of abortion crimes, a new ministry – that can demonstrate its devastating effects on the abortion industry in the short-term. There is, however, a long-term solution that, we believe, is even now saving more lives than anything else pro-life people are doing. With lower abortion ratios, it will become easier to overturn Roe v. Wade, and to pass pro-life legislation that restricts abortion practices, and finally to criminalize the abortionists’ killing of unborn children. Big abortion has powerful allies and a lot of money, but pregnancy help centers across America are standing up to Goliath. And, thank God, they are winning!

Advertise. I think that the quality of the ads is less important than their presence in the public sphere. Do simple videos with your phone, and “boost” them on your client Facebook page. Hire an ad agency like Ad America to get your organization into Internet search results. Get Heroic Media or a similar ministry to manage an Adwords campaign. You don’t have to spend thousands. Hundreds will do. Thousands are better, however: we spend about $40,000 a year on advertising. 

If possible, create a separate organization to advertise for your center, an organization with its own fundraising and budget. No matter what goes on with your expenses and fundraising, you want the advertising to continue, but it will be hard for your Board not to cut advertising if there’s any kind of financial squeeze. I’m convinced that, if your numbers go up, your supporters will rise to the challenge, if you present it clearly. People like helping women in need.

Ideally, find someone willing to lead this new group, and someone with church connections outside of the ones your organization has. You want to reach new donors. E.g., if your center is supported mostly by evangelicals, seek out Roman Catholic (or Orthodox) who are prominent in their pro-life commitments. You want people who don’t want just to make a statement, but to make a difference. They’re not always the same people. Let them create a new 501(c)(3), and collaborate with them on your advertising. Again, I’m happy to advise.

Whether you do your own advertising, or a separate groups does it, find ways to measure your results. We use state statistics on abortion and births. Use your center’s statistics, too. Donors and everyone else will be encouraged if you can show you are making a difference. Be transparent, even if you don’t see success.

We need to fear not failure, because you can always learn from failure, but the lack of initiative, the fear of failure. There are always nay-sayers who can see why something won’t work. Try things out over several months, and follow results closely. This is a long, slow battle.

The key thing here is not accuracy, but the display of a trend – downwards – which both organizations’ statistics show.

2. Joerg Dreweke, “New Clarity for the U.S. Abortion Debate: A Steep Drop in Unintended Pregnancy Is Driving Recent Abortion Declines,” Guttmacher Policy Review, Guttmacher Institute. Available online March 18, 2018, www.guttmacher.org/gpr/2016/03/new-clarity-us-abortion-debate-steep-drop-unintended-pregnancy-driving-recent-abortion, accessed April 17, 2018.

3. For a close examination of the question of the effect of contraception on unintended pregnancy and abortion rates, see the fact sheet, “Greater Access to Contraception Does Not Reduce Abortions,” on the website of the U.S. Conference of Catholic Bishops, http://www.usccb.org/issues-and-action/human-life-and-dignity/contraception/fact-sheets/greater-access-to-contraception-does-not-reduce-abortions.cfm, accessed May 21, 2018.

4. From Table 1 in William D. Mosher, Ph.D.; Jo Jones, Ph.D.; and Joyce C. Abma, Ph.D., “Intended and Unintended Births in the United States: 1982–2010,” National Health Statistics Reports, 55, July 24, 2012, www.cdc.gov/nchs/data/nhsr/nhsr055.pdf, accessed March 2018.​

5. Joerg Dreweke, op. cit.

6. “The likelihood of failure for any method use declined from 14.9% to 10.3% during this period [from 1995 to 2006–2010]” (Guttmacher Institute, “Failure Rates for the Most Common Contraceptive Methods Have Improved,” February 24, 2017, www.guttmacher.org/news-release/2017/failure-rates-most-common-contraceptive-methods-have-improved, accessed April 18, 2018).

7. The abortion ratios declined from 23.4 per 100 births to 21.0 (CDC), or from 28.5 to 26.8 (Guttmacher/CDC, author’s calculation – see footnote 1, above), from 2008 to 2012.
​
8. William D. Mosher, Ph.D., and Jo Jones, Ph.D., “Use of Contraception in the United States: 1982–2008,” Centers for Disease Control and Prevention, National Center for Health Statistics, www.cdc.gov/nchs/data/series/sr_23/sr23_029.pdf, p. 15.

9. Jo Jones, Ph.D.; William Mosher, Ph.D.; and Kimberly Daniels, Ph.D., “Current Contraceptive Use in the United States, 2006–2010, and Changes in Patterns of Use Since 1995,” National Health Statistics Reports, No. 60, October 18, 2012, www.cdc.gov/nchs/data/nhsr/nhsr060.pdf, p. 11. A more recent, short-term study found that “the rate of unintended pregnancy among women and girls 15 to 44 years of age declined by 18%, from 54 per 1000 in 2008 to 45 per 1000 in 2011,” and that “the percentage of unintended pregnancies that ended in abortion remained stable during the period studied (40% in 2008 and 42% in 2011)” (Lawrence B. Finer, Ph.D., and Mia R. Zolna, M.P.H., “Declines in Unintended Pregnancy in the United States, 2008–2011,” New England Journal of Medicine, March 3, 2016, http://www.nejm.org/doi/full/10.1056/NEJMsa1506575, accessed April 18, 2018). Even if their assessment is correct, and that is debatable, the time-frame is very short; abortion ratios were declining for decades before this period.

​10. The annual numbers of openings of new pregnancy help centers were provided to the author by Jor-El Godsey, President of Heartbeat International, in March of 2018. The figures were aggregated in 2014. The author is responsible for the chart above. The graph does not indicate the number of centers in existence, as some proportion, perhaps 1 in 20, may have closed each year. The growth is impressive, in any case.

11. “Attitudes About Abortion,” compiled by Karlyn Bowman and Heather Sims, AEI Public Opinion Studies, January 2017, www.aei.org/wp-content/uploads/2017/01/ABORTION.pdf, accessed April 19, 2018.​

12.​ Ibid., p. 3.

13. Charlotte Lozier Institute, May 23, 2018, https://lozierinstitute.org/how-the-legal-status-of-abortion-impacts-abortion-rates/, accessed June 12, 2018.

14. “Analyzing the Effect of Anti-Abortion U.S. State Legislation in the Post-Casey Era,” State Politics and Policy Quarterly, 2011, 11(1), p. 37, http://www.lifetechconference.org/slides/2012/New_2012_Handout_2.pdf, accessed June 12, 2018.

15. “Using Natural Experiments to Analyze the Impact of State Legislation on the Incidence of Abortion,” Catholic Social Science Review, 2009, 14: pp. 339–362, https://www.heritage.org/marriage-and-family/report/using-natural-experiments-analyze-the-impact-state-legislation-the; accessed June 12, 2018.

16. Ibid.

17. Using figures from the CDC Abortion Surveillance reports for those years.

18. New, “Using Natural Experiments to Analyze the Impact of State Legislation on the Incidence of Abortion."

19. Jones and Jerman, op. cit. The qualifier, “no strong evidence,” invites the query, “How strong is the evidence?”

​20. See the chart from the Guttmacher Institute, in the text below, for the years 2011 to 2014.

21. Brenda Zurita, “Abortion on the wane: Pro-life laws, abstinence education making a difference,” Washington Times, February 3, 2014, www.washingtontimes.com/news/2014/feb/3/zurita-abortion-on-the-wane, accessed April 17, 2018.

​22. Jones and Jerman, op. cit., p. 17.

23. Ibid., pp. 22–23.

24. Ibid.

25. Jones and Jerman, op. cit., pp. 24.

26. Wheaton, Ill.: Crossway Books.

27. Charlotte Lozier Institute, 2014. 

​

 There's a campaign on right now to discredit pregnancy medical centers, especially Women's Choice Network here in Pittsburgh. Why? Because the other side knows that fewer women are getting abortions because these centers are there. And there are a lot of bad consciences regarding abortion out there: the implication of our ads is that women really have a choice, and in their heart of hearts, our adversaries know that it's not just a practical choice, but a moral one. A woman who has had an abortion can either attempt to justify it, or repent of it, and seek and find the forgiveness of God. We pray that our adversaries with a personal stake in this disagreement will do the latter.

Later this month (April 2018) I hope to do a video with a Medical Director from Women's Choice, not to address the false and malicious claims of the pro-abortion crowd, but just to reassure women that they get trustworthy information on pregnancy and abortion, from people who want to help them. Dr. Rocco Adams, whom I have known personally for years, is the Medical Director for Choices Pregnancy Services, in Coraopolis (but with mobile units travelling throughout our area). He speaks to women in this month's Facebook ad, assuring them that they and their friends can trust the people at Choices.
​

The explosion in numbers of Pregnancy Help Centers in the mid-1980s across America is likely the biggest factor in the reduction of abortion ratios since the early 1990s.

As you may know, Planned Parenthood is now pushing the argument that their contraceptive work has actually reduced unintended pregnancies in the very short term (2008-2011, and onward), and so has reduced the number of abortions. (They may offer rewards to employees who generate more abortions, but they know what sells in the political sphere.)

(Incident​ally, this is a fundamentally dishonest infographic, as they know that only one-half of unintended pregnancies end in abortion, so the increase in abortions, if the initial claim were true to begin with, would be about 7 to 8% more -- not 15%.)

To make their case, they have to run down what many fine people -- like those at #ChoicesPregnancyServices and #WomensChoiceNetwork -- are doing in the pregnancy help centers. So, one Guttmacher piece says, "Antiabortion activists routinely fail to acknowledge that abortion declines can result from fewer unintended pregnancies, and instead pretend that any decline in the number of abortions is the result of women opting, or being compelled, to give birth rather than have an abortion. These activists often seize on declines in the abortion ratio—the proportion of all pregnancies ending in abortion—to showcase the supposed impact of their efforts."

The problem for Planned Parenthood is that the decline in abortion ratios is long-term, and can't be explained by changes in contraceptive media or rates of contraceptive usage. The conclusion of the most recent annual report on abortion from the CDC does not put much stock in the notion that Long-Acting Reversible Contraceptives -- LARCs -- can be credited with the recent decline in abortion ratios. A big increase in the use of the relatively effective LARCs, if there were one, might make PP's case statistically for the recent past -- but the increase would be short-term, while the decline in abortion ratios precedes it by decades.

While, for example, “between 2002 and 2006–2008, the percentage of women who had ever used emergency contraception rose from 4% to 10% (5.2 million)" and "the percentage who had ever used the contraceptive patch rose from 1% to 10% (5.3 million),” (1) “changes in contraceptive method choice and use have not decreased the overall proportion of pregnancies that are unintended between 1995 and 2008 . . ." (2). If unintended pregnancies remained more or less stable, while the ratios of abortions to live births went down, then more women whose pregnancies were unintended must have been choosing life.

Through it all, the ratios went down. Here's the updated graph showing the long-term and short-term pictures.

These bars represent new centers, not just the total of existing ones. The effect of these centers on their communities likely grew over time, after an initial lag. While changes in contraception may be having some impact on unintended pregnancies in the last few years, and indirectly on abortion ratios, the biggest influence over time, and even now, is likely these centers -- and even on women who wouldn't go to one, but just know that they're there.

The Pennsylvania Department of Health released the 2016 Abortion Report just after New Years, 2018, and it is encouraging in every way for people who are troubled by the enormous numbers of abortions performed in the State. It is somewhat troubling for us as an organization devoted to advertising pregnancy medical centers in Allegheny County and the region, for reasons which I will explore below. In any case, we are learning things that will help us keep driving down the numbers of abortions performed in the County.

First, the good news. Here's a chart that shows that the annual numbers of abortions in PA are falling. We thank God! Further, the ratios of abortions to live births continues to fall. What does this mean? The proportion of pregnancies that are "intended" (or, perhaps, welcomed, would be the better adjective) is relatively stable, we are told. Women who abort come almost entirely from the "unintended" category. If the proportion of women who have unintended pregnancies has not changed significantly over the years, then more women with unintended pregnancies are choosing life.
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There is also the possibility that the use of so-called emergency contraception (ella, Plan B) has reduced unintended pregnancies, and thus, abortions. (There is still some dispute about whether these drugs prevent ovulation or interfere with the implantation of newly conceived human beings.) While we may be unsure about how these drugs work in every instance, we know that fewer women are having later surgical and chemical (so-called "medical") abortions.

What about Pittsburgh and Allegheny County? Here we see that abortion numbers, having dropped from 2008 to 2013, seem to have hit a "floor."​

The same is true if we look at the ratios of abortions to 1,000 live births.

So, if Allegheny County's abortion numbers and ratios don't seem to be going down, what do we do next? Well, we note that the gap is large between the total number of abortions performed in Allegheny County, and the number of abortions performed on residents​.

Some, and perhaps all, of the difference is made up of women coming from surrounding counties. In the following chart we divide these counties into two groups, the "First Tier," which includes the closest, and the "Second Tier," which are those farther afield. (These groups were distinct viewing areas in our original television advertising.) The graph below "stacks" the statistics on top of one another. You can see that the farther you get from Pittsburgh, the fewer the abortions (and the fewer the births).

Do the official statistics from these surrounding counties make up the difference between Allegheny County residents and all of the abortions performed here? No. When we add the total number of abortions performed in Allegheny County to the stacked statistics above, we see this.

The chart might lead us to think that a large number of women are coming from beyond the "Second Tier" counties. This, I think, is unlikely. Another possibility is that these women are coming from colleges in the Pittsburgh area, and are not giving their PA counties as their residences. So, for example, State College has 47,000 students, yet Centre County residents officially had only 139 abortions in 2016. Yet, officially too, only 1,667 abortions were performed in all of PA on women from other countries or states that year. These things just don't add up. (It is possible that the residencies are not being recorded properly for one reason or another, which brings into question the accuracy of all of the residency reports.)

In any case, "the fields are white unto harvest" outside of Allegheny County, too. We have begun advertising work with Alpha-Omega in Slippery Rock and New Castle. There are many schools and colleges in their area, and we look forward to seeing the results. There are other centers outside Pittsburgh, too, that are similarly situated. We look forward to breaking new ground, and, with God's help, reducing abortion numbers and ratios in Southwestern PA in the year ahead.

Chris Humphrey, Executive Director
​Vision for Life - Pittsburgh

We are told that users of Facebook give more attention to video ads than to regular photo ads. We have experimented with some variations on photo ads, boosted from our Facebook pages "Pittsburgh Choices," "Choose Together - Pittsburgh," and "Unexpected," using Facebook's "carousel" ad option, and, as I recall, the results in terms of numbers of click-thru's to websites, was positive. Now we are trying our hand at video.

Personally, as a photographer, I much prefer the still image, but as an advertiser, I see the value in video. It's also a lot of fun getting a team together and going out and shooting. The work afterwards in post-processing takes a lot of time -- more than one expects. Telling a story, however, is an enjoyable, creative challenge. Here's a sample, the version for Women's Choice Network.

You can see the video for Choices Pregnancy Services on Youtube at ​https://youtu.be/QZYqTEcQPdk

We have enough raw footage for another two months, and it takes about a week to prepare one 45-second video. The ads are directed to the friends of abortion-vulnerable women in Allegheny County and parts of Beaver County, reasoning that increasing knowledge of the existence of the centers among the 18-28 demographic increases the likelihood that women will tell their friends that the centers exist, if and when they learn of friends' pregnancies. And of course pregnant women thinking about abortion will see it, too.

The ads went up on Monday, December 4, and have been seen by about 4,900 women. 77 of them have clicked on the links to the center's websites, and 95 have watched at least half the video. This is a pretty response, I think, for the two days the ads have been up. We'll see at the end of the month what the totals are.
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For quite some time we have been told that half or more of those getting abortions were poor women, beneath the Federal Poverty Level. It seems that this is not the case. In the online article, "Sex, Contraception, or Abortion: Explaining Class Gaps in Unintended Childbearing," published by the Center on Children and Families at the Brookings Institution, Richard Reeves and Joanna Venator show that women below the Federal Poverty Level (FPL) who conceive unintentionally tend overall to keep their children. Wealthy women do not, but nor do those who are at 200 to 300% of the FPL. Check out the table below.

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​While there were more of these poor women, the great majority - 78% - carried their children to term. Sadly, 9% aborted. Not surprisingly, those at 400+ of the FPL, the wealthy, conceived less frequently, but, if they conceived, they aborted much more frequently: they were 32% of pregnant women who got an abortion, and only 52% carried to term. (The difference between those who aborted and those who carried to term - 16% - must reflect miscarriages.)

​Who are these women? Here's a chart of the Federal Poverty Guidelines for 2017, which should correspond roughly to the FPL for the original study in 2013. These figures reflect total household income.

It is not poverty, per se, which inclines women to abort, but the complications to life -- work, the rearing of other children -- that another child represents. Likely in many cases, the woman is working. This fits with what many women report when asked about why they are seeking an abortion: they have obligations to others that are made more difficult by the addition of another child. Perhaps the loss of a job seems critical. Oddly, those with less money -- 100 - 200% of the FPL -- carry their children to term 75% of the time. And then those in the bracket above -- 300 - 400% of the FPL -- are more able as a group to handle the challenges, and so 86% carry to term. There's something about this group in the middle, among whom less than half carry to term.

​What does this tell us? For one thing, generally speaking, it is not poverty that leads women to abort. The group that resorts to abortion is not poor. So any sentimentality about grinding poverty is off-base, and any attempt to "solve" the problem of abortion by throwing money at it is not going to help.

We don't know how many from this group are coming to pregnancy help centers. If they are, then staff at these centers have their work cut out for them. The commonest problem may be one of morale. Those in this group will not starve if another child is born, but they may have to make sacrifices that they find overwhelming. Their work and family arrangements may have to change in ways that they find drastic. (We know that about 60% of abortion patients have one child or more already.) They may feel that they will be falling behind financially with another child. Issues of morale are best addressed by the truths of faith: staff at the centers can remind these women that God cares for them, for their families, for their situations. It is true, and it may be crucial.

"Are not five sparrows sold for two pennies? And not one of them is forgotten before God. Why, even the hairs of your head are all numbered. Fear not; you are of more value than many sparrows" (Luke 12:6-7).

​God knows our future, and He has it in His hands. Our material situation may change, but the gift of another child, understood properly, is so much more significant to our lives than any material or social challenge we may face.

Vision for Life - Pittsburgh has been running Facebook ad campaigns for three years now. For most of that period, we were generating, on average, 11 calls a month to pregnancy medical centers -- not bad, when you consider that this was not an audience seeking abortions or pregnancy help.

​The numbers began to drop last Spring, however, and I was looking at possible reasons why. ​The most obvious reason was that every young woman on Facebook had seen the ads -- "Don't choose alone" -- and the campaign was simply tired, faded. I read that videos and combined video/slideshow posts were actually much more successful in reaching and engaging viewers, so we have tried our hand at it. When I say "we," I mean a team of volunteers -- Carley Adams, Cassandra Adams, David Adams, David Bodin, Emily Bonessi, Katie Breckenridge, and myself. We have produced two videos. You can see the first video on YouTube.

Here's a graph showing the response so far: over 7,500 have seen the video, and there were 103 unique "link clicks," that is, 103 viewers "clicked through" to the Women's Choice Network website. That's more than 100 young people (70% women), who now know about a pregnancy medical center organization with offices in Oakland, Wexford, Monroeville and the North Side.

About 40% of clients at pregnancy help centers come by word-of-mouth advertising. Jake Barr of iRapture and I are talking regularly about using Facebook to encourage friends to tell friends about local pregnancy medical centers -- in my case, Choices Pregnancy Services and Women's Choice Network. The hope is that people who like our Facebook pages ("Pittsburgh Choices," "Unexpected"), and people who are like those people, will be willing to say something if a friend says that she's pregnant, and she's thinking about abortion. This is a different audience than the pregnant woman herself, but I think it says all the right things to any woman in this age bracket.

​We know that many women feel coerced or forced into abortion -- that they "have no choice." Ironically, it is Planned Parenthood and other abortion industry members that do their best to narrow choices down to abortion: they make money that way, and, no doubt for some counselors/sales people, it is part of justifying their own abortions, or their complicity in the killing. It is the pregnancy medical centers that truthfully describe all the options: raising a child oneself, placing a child for adoption, or aborting the child. Many women feel that they can't manage their situations with another child; often, it is not a matter of serious hardship, but of morale -- everyone around her is telling her to "get rid of it." A woman can be surprised to find out, for example, that she can continue to go to school and have a baby. "Coercion" can be subtle or unmistakable: the leading cause of death for pregnant women is murder. A woman's psychological state in a time of crisis is also a big factor in the question of coercion.

An article on coerced abortion gives us a sense of what women are going through. "The problem of women feeling pressured into unwanted abortions is . . . acute in light of research into the risk of defective decision making in crisis situations.

"Experts on crisis counseling have found that those who are in a state of crisis are increasingly vulnerable to outside influences and have less trust in their own opinions and abilities to make the right decision. Such 'heightened psychological accessibility'[5]can lead to a situation where parents, counselors, or others in authority can have enormous influence over a woman’s decision. 'A relatively minor force, acting for a relatively short time, can switch the whole balance from one side or to the other—to the side of mental health or to the side of ill health.'[6] Persons in crisis 'are less in touch with reality . . . and more vulnerable to change than they are in non-crisis periods.'[7] They often experience feelings of tiredness, lethargy, hopelessness, inadequacy, confusion, anxiety, and disorganization. Thus, they are more likely to stand back and let other people make their decisions for them, instead of protecting themselves from decisions that may not be in their best interests.

"A person who is upset and trapped in a crisis wants to reestablish stability, and is therefore very susceptible to any influence from others who claim to be able to solve the crisis, especially those who have status or authority.[8] Thus, with a minimal effort on the part of a mental health professional, family member, minister, or male partner, an enormous amount of leverage may be exerted upon a woman who is in a crisis situation.[9] This can be a dangerous situation for a woman who doesn’t really want an abortion but has others around her who push for it.

. . . 

​"What women experience as 'pressure' to abort may involve indirect but significant pressure such as withholding love, approval and personal or practical support from the woman unless she agrees to an abortion. Or it may be overt, as in abuse or an outright threat to abandon or expel the woman from her home if she does not abort her child. In many cases, the pressure is applied intentionally by others. In other cases, the “pressure” is not intended, but simply perceived by the woman. For instance, if her boyfriend exhibits an unenthusiastic response to the news that she is pregnant, she may see this as his way of telling her that he will not help to support her or their child."

​The videos we have made may resonate with a well-to-do, educated audience. This is not the group who are having most of the abortions: abortion patients are more often poor, and disproportionately black. They are more likely to feel explicitly pressured to have an abortion. We will be looking to see if we can't produce materials that appeal to this audience as well.​ It will be a challenge to find the right actors, and the right scripts, and to keep the material upbeat enough that it will encourage women to call the pregnancy medical centers, and get past the Facebook censors (who really just care that people enjoy Facebook). Pray for our success, please.

How should Christians respond to Christian women who get pregnant outside of marriage?

​The question no doubt sounds quaint to those who are not Christian, but it's a live issue for those who are. And it's important for those who care about abortion: Amy Scheuring of Women's Choice Network told me about a 2015 survey by CareNet that found that 70% of those who were having abortions were Christians, and 43% were attending church at least once a month at the time of their abortions.

​There is little question that shame is a big driver of abortion. It is an even bigger motivator among people who go to church. So it seems that the best thing you could do to reduce abortions among Christians would be to tell them that there is no shame in having a baby. This was the common pro-life response to Maddi Runkles, the 18-year-old President of the Student Council and officer in the prestigious Key Club at her Christian high school, Heritage Academy. The student with a 4.0 GPA would be seven months pregnant when she walked across the platform to receive her diploma, and the school wasn't having it. Heritage requires its students to sign a pledge to avoid things like alcohol, tobacco, and illegal drugs, and to abstain from sex. “When Maddi chose to breach that Bible standard, a discipline plan had to be established,” Principal Dave Hobbs said. So Maddi had a two-day suspension and was not permitted to receive her diploma publicly. (The young man involved was not a student, and so faced no public consequences, to my knowledge.)
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“'The school has shown students that it would be easier to choose abortion than to choose life,' said Kristan Hawkins, executive director of Students for Life of America. 'Because she chose to carry her child and courageously made that decision, she’s been punished this entire semester for being pregnant, and that’s just wrong.'"

​Ms. Hawkins is probably right, but we can see it from the school's point of view, too: this was not the story of "the woman taken in adultery" (John 8:1-11), who would have been stoned if her accusers had followed the Law of Moses rigorously. (The trap that His adversaries thought they were setting for Jesus was this: on the one hand, He could be accused of ignoring the Torah, the Jewish Law on adultery, if He didn't agree with her stoning, and, on the other hand, if He agreed, He would be going against the Roman law, as only they had the right to put anyone to death.  Jesus avoids His adversaries' trap entirely by throwing the question back at them: "Let him who is without sin, cast the first stone.") So where does this leave us? We are all sinners, it is true, but the school wasn't going to stone Maddi, and it had to maintain discipline. If it ignored its own rules, everyone would see that the administration wasn't serious about abstinence as the goal.

​Pre-marital sex is a common phenomenon, in permissive and in rigorous times. In Abortion Rites: A Social History of Abortion in America, Marvin Olasky estimates that about 30% of American colonial marriages were "shot-gun," that is, the young woman was pregnant and the bride's family forced the issue.) We must recognize the realities here: the God-given drive for sex is a good thing, but it can find its full expression only properly in marriage. Many of us will fail, but that is no reason to abandon the goal, for those who have "fallen" and those who have not. If discipline is necessary, it is still true that none of us is without sin: shame attaches to public things, but the most offensive things to God may be hidden in our hearts. There is no ground for us to pass judgment on others. And women today who don't succumb to shame and abort their babies are oftentimes the courageous and honorable ones.

​We (Christians, churches) need to say loud and clear that a baby is no reason for shame. We can and should control our sexual behavior; that's the goal. If the discipline of those who fail is necessary for the sake of other young women and men, then let it be as discreet as possible, and only as obvious as necessary. (Remember Joseph, who, when he learned that Mary was pregnant, "not willing to make her a public example, resolved to put her away privately.") We Christians need to say publicly that, if any of us fails to be chaste, he or she can repent; there is forgiveness, and we can start again.

The mock-ups for ads here make similar points, as simply as we can in a few words, without sacrificing our Christian sexual ethic, our humility as sinners too, or our deep desire that women love the children they carry, no matter the situations in which they are conceived.