Anecdotes about the consequences of the Mexico City Policy abound, although they take on a predictable slant depending on who you ask. However, there has been little systematic research on the issue. In our study, we combined data on nearly 750,000 women from the well-established Demographic and Health Surveys with data from the UN Population Division’s World Contraceptive Survey and the Organisation for Economic Co-operation and Development’s Credit Reporting System to examine the policy’s impact on reproductive health issues over a period of 20 years across Sub-Saharan Africa. Our analysis begins when the policy was inactive under Bill Clinton, examining changes when it was then re-introduced by George W. Bush and again rescinded by Barack Obama.
Specifically, we examined changes in contraceptive use, pregnancies, and abortion — and in particular, we isolated changes that vary systematically both with the sharp timing of the policy and with the relative importance of US foreign aid for family planning in each country. A strength of this approach is that it enabled us to separate the policy’s effect from other, confounding influences.
What we find is a stark, quantitative pattern that shows when the policy is in place, contraceptive use decreases by 13.5%, pregnancies increase by 12%, and importantly, abortions increase by 40% in countries most reliant on US funding compared to when the policy is inactive.
Abortion is difficult to measure, much less measure precisely because of the sensitivity surrounding it — and we carefully test different approaches — but the pattern is striking.
While it may at first seem surprising that the Mexico City Policy increases abortions, this pattern of results makes sense. Because many of these organizations are important providers of contraceptives and family planning across Africa, when the policy is active, the supply of these services falls — and the rest of what we find then flows from this: less contraceptive use, more pregnancies, and more abortion. Given that many abortions are performed under unsafe circumstances, our analysis likely underestimates the full harm of the policy.
Regardless of one’s political leaning or values, an increase in abortion seems to be an unintended consequence of the Mexico City Policy. There may be little agreement on alternatives to the policy, but not increasing abortion on a large scale, even unwittingly, could potentially be a common goal. And the data shows that the Mexico City Policy does not achieve that.