Michael New of the Charlotte Lozier Institute and I are engaged in a discussion (here and here) on what has brought down abortion ratios from their heights in the early 1980s to 18.8 per hundred live births, a figure lower than that of 1973, the year of Roe v. Wade. ​Pace Michael, I am not “downplaying” the role of education and legislative reform in this: my intention is to kindle interest in what I think is driving down those rates, the proliferation of pregnancy help centers, and to encourage their support. Education and legislative reform have their place, and are no doubt making a contribution where they are found, but I am saying that we have no strong evidence that either are driving this decline. When we advertise pregnancy help, as we have done in Pittsburgh, we see the ratios fall farther – which inclines one to think that the key role of these centers has been overlooked in our focus on changing the laws.

​We need to be honest and realistic in assessing what is happening with abortion numbers. The decline of abortion ratios cited in my first Federalist article is gradual and continuous – the slight peaks and troughs are the “noise” of a steady “signal.” Is there a key factor, or a few key factors, that are continuous in operation from the beginning? In my first article I suggested that we may be seeing an ongoing psycho-social shift in the minds of generations of young, pregnant women regarding pregnancy, childbirth and abortion. This might be a shift which we cannot gauge, but whose effect is that fewer and fewer of them are seeking abortions. One factor in this shift might be personal knowledge of post-abortive women, a knowledge that disinclines a pregnant woman from following the path of someone she knows or hears about. This might have been a factor from the early 1970s on, so it can’t be discounted as not present throughout the period of this decline. Would it have increasing effects on abortion ratios, relative to their decline, however? That seems unlikely, but we simply don’t know. And so it goes with much of our speculation.

​

​Inasmuch as we do know about public opinion, we cannot say the same. Michael New claims that “Gallup data clearly indicates that since the mid-1990s, there has been both a long-term and durable increase in the percentage of Americans who identify as ‘pro-life.’” One of those new converts to the cause, of course, would be the President of Planned Parenthood, Dr. Leana Wen, who recently said that “being pro-choice is . . . being pro-family, . . . being pro-life.” It is somewhat encouraging to know that more people like to think of themselves as pro-life, but most of this can be dismissed as shallow self-regard: see the relatively level lines in the graph of the Gallup poll responses to the question, “Do you think abortions should be legal under any circumstances, legal only under certain circumstances or illegal in all circumstances?" There is simply no real trend here. (This criticism applies to New’s confidence in the educational impact of abortion regulations as well: there’s no evidence of an effect on public opinion. It is true that the laws have a measurable, punctiliar impact on abortion ratios. So in Pennsylvania, the abortion ratio dropped 12.3 percent the year after the Abortion Control Act was finally implemented in 1993. The laws, however, do not explain the continuing drop in abortion ratios, or the fact that abortion ratios had already fallen by over 27 percent from 1981 to 1993.)

What of his claim that the General Social Survey found “long-term gains in pro-life sentiment”? The opposite claim could be made, as one analyst found that “more people” in the 2014 GSS survey “support legal abortion for any reason, no matter why a woman wants it. About 35 percent held that view in the 1970s – but the number has risen to 45 percent in 2014.” What of his claim that young adults were the demographic most sympathetic toward legal abortion until 2000, when they became the most opposed? A close examination of these figures from the General Social Survey show that the change is very slight, and can’t be compared to the 48 percent reduction in abortions per 100 live births (1984–2015). In a Quinnipiac poll of 2017, the 18 to 35 age group was more in favor of abortion as legal in all cases than any other demographic group, by 3 percentage points.

​It is becoming common to observe that we really don’t have a solid grasp of what Americans think about abortion, nor of any trends. Pro-life education is important – how many of us would be pro-life without it? – but not because we can see that it’s changing public opinion as a whole. A local pregnancy medical center director told me that they still commonly hear women say, as they look at their unborn children on the ultrasound screen, “I had no idea.”

​So why does public opinion matter, and why do we want to change it? It may be that we can’t help ourselves: if we were silent, we feel, “the very stones would cry out.” Perhaps we think that, if only the majority of those we know could see the moral horror that is abortion, they would not have abortions, and we could change the laws and “end abortion”? (This is what we really want, but we need to come back to earth here: we won’t “end abortion,” or “abolish abortion” as such, any more than we could end bank robbery, drunk driving, or spousal abuse, simply with laws. Similarly, instead of talking about “a culture of life,” it’s time that we ask, Where have people actually created this “culture”? Perhaps we can contribute to it.)
​
What if we can reduce abortion numbers without changing the public mind on abortion? What if we can so reduce abortion numbers – reduce the demand for abortion – that it becomes politically much easier to criminalize the work of abortionists and protect unborn children? (This, we can assume, would have a big impact on abortion numbers, though our success, again, would lack the eschatological completeness of the slogans.) A shift of attention to making pregnancy help better known would be a strategic move, not a denial of the importance of laws.

​
​Do the polls give us a clue as to why pregnancy help might be the reason for those dropping ratios? The American Enterprise Institute survey I cited in the earlier article points out that, over the years, “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.” Similarly, people (and not just politicians) will say that they are personally pro-life, but that they can’t impose their morality on others. Ramesh Ponnuru observed somewhere that whoever is perceived as imposing on the other side in the struggle over abortion, loses. We saw this in Pennsylvania with former Governor Tom Corbett, whose proposed bill requiring that a woman be offered the opportunity to see her unborn child on the ultrasound screen before her abortion was widely criticized for imposing on the woman, and withdrawn. We have seen it recently on the other side, as the courts have rejected laws that would have required pregnancy help centers to advertise abortion services as well.

Pregnancy help involves no such imposition: it is assumed that women at all times have a choice, and that many will choose life when they have the right information and support. Americans like pregnancy help. A 2014 national poll commissioned by the Charlotte Lozier Institute found that 92 percent of women (many of whom would be “pro-choice”) said that pregnancy help centers were “very necessary” (70 percent) or “fairly necessary” (22 percent) in their communities. This positive view of pregnancy help was confirmed for us by a young actress who helps us with advertising local pregnancy medical centers in Pittsburgh. S.K. is “pro-choice”: personally “pro-life,” but not willing to judge anyone else, she tells us. Nonetheless, she now knows that these centers are “the way to go” for abortion-vulnerable women.

If we’re looking for that actualized “culture of life” we hear about, we find it in these centers. In 2003, the national pregnancy helpline OptionLine took 35,000 calls from women in need. Like the number of pregnancy help centers themselves over the years, the calls have increased: in 2018, Heartbeat International reports, that number was over 400,000. Over one million visited OptionLine’s website last year.
​
Vision for Life – Pittsburgh, the non-profit of which I am the Executive Director, began advertising to abortion-minded women in late 2010. In the next few years, abortion ratios for residents of Allegheny County, Pennsylvania, fell sharply, and stood at roughly the same level before dipping again in 2017, the last year for which we have statistics, to 241 per 1,000 live births. From 2010 to 2017, abortion ratios declined 23.7 percent.

We don’t know for certain that the increase in pregnancy help centers lies behind the drop in abortion ratios, but if advertising local centers can have this kind of effect, it seems likely.

Michael New observes that this is a “rich area for future academic and policy research.” I would welcome the Charlotte Lozier Institute’s work on it. If they were to decline, however, perhaps others, or even a lone sociologist or statistician, would take on the task. I have the data on the increase in the number of centers, but I lack the competence with statistics for a proper assessment.
​
We continue to need public education, academic debate, legal engagement, lobbying, and even protest, whether these demonstrably affect abortion numbers or not. If it can be shown, however, that pregnancy help is driving abortion ratios lower, then we should direct greater resources to the increase of the number of these centers, and to making all of the centers better known in their communities through advertising. Statistics and broad trends are dry matters, but with them, and God’s help, we may be able to deliver many more mothers and babies from the scourge of abortion.

(I have offered the following article, a response to an article in National Review by Michael J. New of the Charlotte Lozier Institute, to National Review on January 24.)

Michael New’s January 19th article in National Review Online, “The Best Metrics of Pro-Life Progress,” rightly notes that abortion numbers are falling, which is encouraging for all of us who want to see the end of legal abortion in America. Before we celebrate, however, we should perhaps reconsider the best metric of success. If you measure the rates of abortion for every 1,000 women aged 14 to 44, as he does, the numbers drop significantly ­– more than 50 percent fewer in 2014 than in 1980. The problem with this, however, is that it does not take into account declining fertility in America. Raw birth numbers have been dropping for decades; one would expect abortion rates to fall as well. It’s more helpful, from a pro-life point of view, to know what proportion of all pregnant women choose abortion from year to year (excluding those who miscarry). If the ratios of abortions to live births go down, we know that more women are not seeking abortions, and we can look for possible reasons.

And go down those ratios have. From the peak of 36.4 per 100 live births in 1984 they have fallen steadily to 18.8 in 2015, a drop of 48 percent (CDC data). The decline is profound and continuous. This rules out some explanations from the start. Dr. New rightly dispatches Planned Parenthood’s claim that increased use of contraception, and the right kind of contraception, is largely responsible for fewer unintended pregnancies, and thus for the decline in abortion numbers: rates of unintended pregnancy over the years don’t back it up.  His claim, however, that abortion numbers have fallen because of protective laws or changed hearts and minds needs closer examination. Academic research, he says, “shows that a variety of pro-life laws, including public-funding limits, parental-involvement laws, and properly designed informed-consent laws all reduce the incidence of abortion.” The question is, By how much? When we tally the reduction in abortion ratios that one would expect to see for these measures (which he has documented in his research), we get a total reduction in abortion ratios of 4.7 per 100 live births. The total reduction in abortion ratios from 1984 to 2015 was 17.6, however. (And this comparison assumes that these laws were all passed at some point in all of the CDC’s reporting states, which is not the case.) These laws save lives, and would save more lives if they were passed everywhere, but they are not driving the continuing drop in abortion ratios.

His second reason for the decline, changed hearts and minds, is intriguing, because it must be true in some sense, as women decide whether to abort or carry to term. If there is such a change, however, it is not reflected in public opinion polls. For years now, many have heralded polls ostensibly showing that the younger generation is more pro-life, or that more people consider themselves “pro-life.” Yet researchers from the American Enterprise Institute, who conduct an annual survey of previous polls on abortion, still report that there has been no significant shift in public opinion since the early 1970s. About 20 to 30 percent of the population are pro-choice, the same proportion are pro-life, and about half are in the middle. In May 2016, 29 percent of respondents to a Gallup poll said abortion should be legal in all circumstances, 50 percent said it should be legal in some circumstances, and 19 percent thought it should be illegal in all circumstances. “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.” (People may want to think of themselves as “pro-life,” but we can believe that there has been a true shift when a majority says that abortionists should go to jail.)

Perhaps, however, women who find themselves pregnant, and didn’t intend to be, are changing how they think of abortion and childbirth. There is ongoing discussion about “intention” among the technocrats who push “family planning” to women at risk of unintended pregnancy. They are challenged by the discovery that not all women plan these things or want to plan them. A woman who is taking some precautions not to become pregnant can actually be happy to find out that she is, especially if she is supported by her partner or those around her. (Those who focus on intention and planning seek to translate a woman’s imagined unhappiness with a future possible pregnancy into a plan for her fertility, that is, to make her over in their own image.) It may be that we are seeing the effects of fairly large-scale, social-psychological changes relating to pregnancy, abortion and childbirth, that we simply cannot discern.

In any case, Dr. New ends his list with “taking care of the material needs of pregnant women.” Here he is really on to something. In fact, the number of new pregnancy help centers has grown continuously while abortion ratios have declined. Heartbeat International, one umbrella organization for such centers, counted 23 new centers opening in 1973; by 2017 over 1,720 new centers had opened. (This is a partial count, as there are currently over 2,750 such centers. Some offer emotional, moral, spiritual, and practical help, some also provide limited obstetrical ultrasounds, and a smaller number are maternity homes.) The biggest one-year increase in centers recorded by Heartbeat was in 1985, the year after abortion ratios reached their peak, according to the CDC.

In a 1992 book, Abortion Rites: A Social History of Abortion in America, Marvin Olasky suggested that abortion rates in the latter half of the 19th Century (almost double ours, incidentally) declined largely because of Christian philanthropy, especially maternity homes. It is quite likely that we are seeing the same thing today with pregnancy help centers.

The key role of the centers has been confirmed here in Pittsburgh, where Vision for Life has been running modest ad campaigns for local centers since late 2010. Abortion ratios from 2000 to 2010 averaged 32.6 per 100 live births in Allegheny County. From 2011 to 2017, the last year for which we have the numbers, the average was 26.2, a 20 percent decrease. (Of course, abortion ratios are falling everywhere. The difference, however, between the two periods for all other Pennsylvania counties was only 7 percent.) The effect of advertising is not surprising: a Charlotte Lozier Institute study in 2014 found that 54 percent of women either did not know if there were centers in their communities, or thought that there weren’t any. When women know about the centers, more of them choose not to abort.

We can’t prove (yet) that pregnancy help is the main thing driving the drop in abortion numbers in the U.S., but it is certainly the chief candidate for study. One thing we can assume: increased advertising for local centers will bring those declining numbers down further.
​
Chris Humphrey, Ph.D.
Executive Director, Vision for Life - Pittsburgh

​Black women had 43% of abortions performed in PA, something that should exercise the hearts and minds of anyone who cares about the black community. As they are about 13% of the population, they are over-represented by two times in the abortion statistics. If black lives matter, then this has to change. Black pastors need to step up, and reassure women that God can and will forgive sexual sin -- the child is His good, natural gift -- and that He gives us sexual boundaries because He loves us.

88% of women who aborted in Pennsylvania in 2017 were unmarried. We know apart from the Report that women who cohabit are most at risk of abortion.

Over 61% of women who aborted had one or more previous live births. In other words, moms with one child or more were more likely than women with no children to have an abortion. It’s very likely that finances and the state of their relationships played a big part in these decisions.
​

​Repeat abortions (a woman’s second, third, fourth or more) accounted for over 47% of the total abortions to residents.

Chris Humphrey
Executive Director

Abortion numbers are falling everywhere across the country, including Pennsylvania. What impact is our pro-life advertising in Allegheny County having on those numbers?

In previous calculations of how many lives have been saved since Vision for Life - Pittsburgh began advertising in 2011, I have used the actual Allegheny County numbers for the year before, instead of the projected ones if there had been no advertising (using the percentage reduction of the rest of the State.)

If I have lost you already, don’t give up.* The bottom line is, I estimate the total number of lives saved from 2011 to 2016 to be over 3,500!

Now, this is a general number, and hardly precise. And, “correlation is not causation.” Still, the gap between the two lines strongly suggests that advertising is making the difference, and reaching the abortion vulnerable.

Birth numbers in the rest of PA declined 2.6% from 2010 to 2016, but increased in Allegheny County by 2.6% (a difference of 5.2%).

Thank God that, through our efforts and those of the pregnancy medical centers, so many more women are choosing life for their babies!

Feel free to share this encouraging news!


* Here’s how I calculated the figures. We have actual, annual abortion numbers for all the counties, including Allegheny. What I needed were the projected numbers of abortions if Allegheny County’s reduction in abortions were the average of all the other counties’. So, for example, in 2012 there were 6,909 abortions, which was 11.6% fewer than 2011’s 7,820. The reduction in abortion numbers for all the other counties, however, was only 1.4%. If we used abortion numbers from the year before we advertised, 2010, as the baseline for all subsequent calculations, the expected number of abortions in 2012 in Allegheny County would have been 7,587 (1.4% fewer than the projected 2011 number, which was 7,697). So the difference between the projected 2012 figure of 7,587, and the actual number, 6,909, was 678. Here’s a chart showing the difference between actual and projected abortion numbers for the years 2011 to 2016.

​Now some of the differences between projected and actual numbers may be due to other factors peculiar to Allegheny County, and some of the difference may be normal statistical variance between any one county and the rest (though it would vary up as well as down over the years). Say we’re out by 500, or even 800, for some reason -- this still leaves us with a very high number.

Chris Humphrey
​Executive Director

Pennsylvania's abortion numbers have been going down for years, and that's encouraging: fewer women doing harm to themselves (at least morally and spiritually) and fewer unborn children killed. The news is even better, however. PA started to record repeat abortions in 2008: the number of previous abortions a woman had when we she went for the current one: none, 1, 2, 3, and 4 or more. The results are below.

Note that first abortion numbers are going down faster than repeat abortion numbers. The reduction of first abortions from 2008 to 2016 was 23%; the reduction for repeat abortions was less than 18%. What does that mean? If it continues, it's the death spiral for the abortion business: as the number of women having their first abortion declines, the pool of those who might have their second, third, fourth, and so on, will get smaller still. If it were any other big business, they would see the handwriting on the wall. Fewer women are trusting that abortion is going to solve their problems, and there's no reason to think the trend will stop.

(Incidentally, it's not contraceptives that is reducing abortion demand; see my previous blog post on the possible explanations.)

​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.