Is unsafe abortion economically burdensome?

“Abortion is cheaper for society than raising a child”

Is the world overpopulated?

What about the environment?

Is unsafe abortion economically burdensome?

Some abortion advocates claim that treating complications of unsafe abortion is very expensive, and hence argue that this is one reason to legalise abortion. There is something very sinister about very wealthy countries pressuring poor countries to make a decision of such profound importance on the basis of relatively minor economic considerations, but we will set that aside for now. The claim is that many women are treated in hospital from complications of unsafe abortion, costing the health system a lot of money. There are a huge number of problems with this claim:

1. Many of these complications – perhaps most – are, in fact, from miscarriage (see ‘How many abortions occur when abortion is illegal?’).
2. The argument assumes that illegal abortions stop when abortion is made legal. Not only do they not stop, in many cases they do not even decrease (and in some cases even increase) – see ‘Does legalising abortion prevent women dying from backstreet abortions?’
3. The argument assumes that legal abortions a) replace only illegal abortions, and do not increase independently; b) cost little in themselves and c) have few complications. But none of these are true. The total number of abortions dramatically increases (see ‘Do pro-life laws work?’); they cost a significant amount (abortion in the UK is estimated to spend £118 million a year on abortion alone, excluding complications); and a significant proportion of women require hospital care for complications (see my chapter on telemedicine).
4. There are many other economic costs of abortion. For example, increased preterm birth causes enormous hospital costs. Calhoun et al. estimated that the increase in preterm birth costs from abortion in the US came to over $1.2 billion a year in neonatal costs alone. Then there are ongoing costs from resulting disability such as cerebral palsy, a lifelong condition often requiring significant medical care.
5. Then there are the costs of depopulation: most Western countries, other than those with enormous immigration, have ageing populations which are causing huge financial problems for the health and social care system. Even in the UK where we have lots of immigration of working age people, we still have a deeply struggling healthcare system because we have too few workers to support the older population.
6. Abortion legalisation also causes a big increase in STD transmission; in the US this is estimated to cause $4 billion a year in healthcare costs. This will be higher in countries where HIV is more prevalent.
7. Abortion causes increases in suicide, alcohol and drug abuse, and family breakdown (see the questions on all of these), all of which have effects down multiple generations, and enormous healthcare, social and economic costs. Perhaps the most significant of these economically is family breakdown, which has been estimated to cost the US at least $112 billion each year through its impact on poverty, crime, education, and tax.
8. Abortion causes delayed childbearing and fertility gap (women having fewer children than they desire), leading to enormous increased (economic and physical) costs associated with IVF.

Again, a simplistic reading of the evidence suggests that laws protecting children and mothers cause some economic burdens. But these are far, far outstripped by the economic burdens of widespread legal abortion.

“Abortion is cheaper for society than raising a child”

A slightly different economic objection suggests that while abortion has costs, the costs for society of birthing and raising a child for 18 years are far greater. Where does this reasoning go wrong?

First, it goes wrong for the all the reasons described above. Second, it goes wrong because most women seeking abortion would never get pregnant in the first place, according to the empirical literature (see ‘Does restricting abortion lead to more unwanted births?’).

Third, it goes wrong because it is a bizarre way of counting the economic impact of an additional person. Why think that the economic impact of a child should be calculated by summing up all the costs of raising a child and then ignoring all the contributions that child will then make as an adult? That reasoning is utterly insane. Think about it this way. Which country would be more economically successful – a country with 5 people, or a country with 20 people? Obviously, the country with 20 people (other things being equal). People, on average, contribute more than they take, over the course of a lifetime. So although pregnancy and raising a child cost more than abortion in the short term (ignoring the huge economic impact on society as described above), they easily make up for that cost in terms of what the child produces when fully grown.

For all these reasons, the argument that abortion is cheaper than childbirth and childrearing fails.

Is the world overpopulated?

I will try to keep brief about this central question of demography, about which volumes and volumes have been written. Until the 1990s, population control was a huge component of abortion advocacy, mostly being pushed by extremely rich Western white men, and in large part wanting to preserve capitalism by a) keeping women in the workplace even if they wanted to be on maternity leave, and b) preventing large population increases in other parts of the world, which were seen as potential converts to communism and therefore needing to be limited. For much of the 20^th century, population control and abortion were also closely linked to eugenics, which was not held in as low esteem as it is today, being indeed very popular in ‘elite’ circles (naturally). For more on questions of overpopulation, I highly recommend leading environmentalist author Fred Pearce’s The Coming Population Crash, commended even by Paul Ehrlich, the forefather of modern overpopulation alarmism. Bricker and Ibbitson’s Empty Planet is also well worth consulting, and Angela Franks’ book on Margaret Sanger for a particularly in-depth look at the links between eugenics, population control and abortion.

The population control narrative was sidelined in the 1990s, with a ‘women’s rights’ centred approach taking over around the time of the 1994 International Conference on Population and Development. This is why many in my generation grew up hearing a great deal about overpopulation (in the late 1990s and early 2000s), but less so in recent times. As climate change gains renewed political salience, the topic of ‘voluntary’ childlessness is now coming up with greater frequency. This brings us to a first point: the threat of overpopulation is a problem not only for pro-lifers, but also for people who believe in a so-called ‘woman’s right to choose’. After all, what if women, on average, want more than 2.1 children (replacement rate fertility level), as they do across most of Africa? It is surely their choice – regardless of how it might impact the climate. So this is a potential problem for both pro-lifers and pro-choicers. This is perhaps why so many womens’ rights groups have been so hostile towards population control enthusiasts for most of the 20^th century (see, for example, the heinous forced sterilisation campaigns across India in the 1980s, and Chinese and North Korean forced abortion policies continuing until recent times), despite their working in concert at times. It is also why their alliance had to be based on reducing women’s desire for children. Although population control is not at the forefront of debates on abortion today, population control still rears its head in development policy across the world to this day.

Additionally, recall the point I repeatedly make on questions about the impact of ‘additional unwanted people’: namely, that limiting abortion has only a minimal effect on birth rates, since it causes people to be more careful about becoming pregnant in the first place (see ‘Does restricting abortion lead to more unwanted pregnancies?’).

Beyond this, let me make a number of brief points.

First, overpopulation predictions have been wildly wrong throughout most of history. There are perhaps 3 key figures in the history of this debate: Thomas Malthus, who published his concerns about overpopulation in 1798, William Vogt, who published his Road to Survival in 1948, and Paul Ehrlich, who published his The Population Bomb in 1968. All have been proven spectacularly wrong on a wide variety of predictions – for example, that in a short space of time, that hundreds of millions would die of starvation. Vogt, for example, also happened to precede notorious eugenicist Alan Guttmacher (of Guttmacher Institute fame) as National Director of Planned Parenthood. He warned in 1948 that ‘Britain now finds itself literally on the verge of starvation… Unless we [America] are willing to place fifty million British feet beneath our dining-room table we may well see famine once more stalking the streets of London.’

In fact, poverty and malnutrition have dramatically fallen globally over the last few decades, despite an increase in population from 3.5 billion in 1968 to around 8 billion today. Although world population has doubled, food production did so long before. Pearce notes that in the last half-century, the world has added only 10% farmland but has more than doubled food production. It is now widely agreed that there is enough food for everyone in the world and that hunger is mainly due to political factors rather than lack of production. Moreover, we have the technology to feed far more still, with far less land than currently used. It has been estimated that if the average farmer around the world reached the average yield of an average American corn grower, 10 billion people (which, according to current projections will never be reached) could be fed with just half of today’s farmland. Part of the key problem with Malthusian predictions is, therefore, that they have assumed technology will increase far slower than population. In fact, the opposite is the case. Despite exponential increases in population, we are increasingly able to tackle the problems faced by the world’s poorest.

This leads to my second point, which is that the risk of overpopulation has been greatly exaggerated, and it is now pretty much universally agreed that the world’s population will peak in the next century before declining again. The most recent estimate from The Lancet was that it will peak as early as 2064 at 9.7 billion, then decline to 8.8 billion by the end of the century. The technological innovations likely to be developed in that time mean that the largest ever world population will easily be able to be fed, and will of course have other needs met far more easily by that time as well (for the environmental impact, see below).

The total fertility rate in most countries has rapidly declined, even in places one might instinctively consider to have huge overpopulation problems. India, for example, while deliberating over whether to introduce policies limiting families to two children, already has a fertility rate below replacement level (around 2.1), and it is continuing to fall. Some countries, like South Korea, have a fertility rate around 1, meaning that their population will halve every generation. It is worth noting that population growth is deceptive, since the population will continue to grow even for some time after the fertility level drops below replacement (partly due to increase in life expectancy).

Third, the benefits of population growth are substantial – both in economic terms and providing ideas to solve the problems of ‘overpopulation’: recall, for example, that without people, we never would have managed to increase crop yield by such a radical extent in the last century. The economic benefits are likewise significant: countries have typically had huge economic booms from high population growth rates, particularly in Asian economics in the 20^th century. The economic benefits may be even larger in future: as the global population begins to plateau and shrink, countries will likely need to compete for immigrants as workers, and those immigrants can earn significant amounts to send home.

But the economic benefits can probably best be seen by looking at what happens when a country is underpopulated, as most of Eastern Asia and Europe (and increasingly many other regions) are. Latvia, for example, had a population of 1,880,000 in 2020. But by 2050, 30 years later, it is estimated to fall to 1,250,000 – losing around a third of their population. Japan currently sits at 126 million (2021), but will fall to just 88 million by 2065.

But loss of population is not the only difficulty. Consider these graphs of Japan. As can be seen, with a traditional population structure in 1950, the proportion of elderly people was very small. By 2055, the proportion of elderly people is absolutely enormous, with an ever-decreasing working age population able to support them (see this piece on how isolation, financial pressure, and lack of support from children are leading contributors to suicide in Japan, which has the highest suicide rate in the world). As another example, in the UK, 1 million people are likely to have dementia by 2025. But this will double to two million in just 25 years, by 2050. Yet the working-age population will stay largely the same during that time – but having to support double the number of people with dementia, which already creates an enormous economic burden – not to mention the many more elderly people needing healthcare and social support, who will also grow in proportion. The UK is already struggling to pay for health and social care, and this is likely to get far, far worse as time goes on. For one more example, consider this stunning fact: in 1940, the US had 10 workers for every retiree. By contrast, by 2030 Japan expects to have just two workers supporting every retiree. Underpopulation is a crisis.

It is for these sorts of reasons that countries with particularly low fertility rates and low levels of immigration see underpopulation as a central national priority and even as an existential thread in some cases. Singapore’s government-run dating service is not a joke; it is a very serious attempt to respond to the crippling crises the country faces as a result of depopulation. Virtually every country facing these concerns has serious national policies to increase their birth rate, because they realise how serious the problems of depopulation are (and those mentioned here are just a few). The UK and US have gotten off relatively lightly so far only because of immigration, and perhaps this is why concerns about underpopulation are not widely known to Anglo-American audiences – but given global fertility trends this will likewise decrease over time, and the effects on unsustainable elderly care are already being felt.

In short, overpopulation is no longer a serious threat in a simplistic sense, as even the Bill and Melinda Gates Foundation (traditionally strong supporters of population control) appear to agree.

Given the human rights abuses which have been perpetrated in the name of concerns about overpopulation – whether forced sterilisation in India, forced abortion in China, or affluent countries deliberately leaving others to starve – we should be very cautious about accepting these concerns uncritically. I mentioned William Vogt earlier, who preceded Alan Guttmacher at Planned Parenthood. What was his solution to his alarmism about population?

“The modern medical profession… continues to believe it has a duty to keep alive as many people as possible. Through medical care and improved sanitation, they are responsible for more millions living more years in increasing misery. They set the stage for disaster… The greatest tragedy China could suffer at the present time would be a reduction in her death rate.” Vogt complained that “The British must largely bear the responsibility… for the present situation of India. Before the imposition of the Pax Britannica, India had an estimated population of less than 100 million people. It was held in check by disease, famine, and fighting. Within a remarkably short period the British checked the fighting and contributed considerably to making famines ineffectual… While economic and sanitary conditions were being “improved,” the Indians went their accustomed war, breeding with the irresponsibility of codfish… Her people are steeped in superstition, ignorance, poverty, and disease. Mother India is the victim of her own awful fecundity. In all the world there is probably no region of greater misery, and almost certainly none with less hope.”

Of course, Vogt laced his endorsement of sterilisation cash incentives with a good dose of eugenics: “Since such a bonus would appeal primarily to the world’s shiftless, it would probably have a favorable selective influence.” Remember, these (and other) openly eugenic sentiments came in the immediate wake of the Holocaust, and just 3 years before Planned Parenthood considered him the perfect person to lead their organisation. This is perhaps unsurprising given the words of Margaret Sanger, who founded it:

“Those vast, complex, interrelated organizations aiming to control and to diminish the spread of misery and destitution and all the menacing evils that spring out of this sinisterly fertile soil, are the surest sign that our civilization has bred, is breeding and perpetuating constantly increasing numbers of defectives, delinquents and dependents. My criticism, therefore, is not directed at the “failure” of philanthropy, but rather at its success.”

I will talk more about the links between the abortion, eugenics, and population control movements under ‘Are abortion providers linked to eugenics?’. For now, it is worth recalling the damage done, especially to women, in the name of population control throughout the 20^th century, before overly confident (and usually empirically false) claims about overpopulation.

Again, I highly recommend Fred Pearce’s The Coming Population Crash in particular.

What about the environment?

Traditionally, overpopulation concerns have centred around food production. Classical population control fell into the (nevertheless very active) background in the 1990s, allowing abortion to become a ‘women’s issue’ rather than a demographic issue, partly in recognition of the atrocities perpetrated in the name of population control. But concerns about population have resurged in recent years in response to environmental concerns.

I hope my pro-life readers will forgive me for saying that I do not think pro-lifers have often given very substantive responses to these concerns. I think that climate change is real, and as far as I can tell (according to the subgroup of experts who I consider trustworthy and not politically motivated), significantly exacerbated by human consumption. This already causes a significant number of deaths globally, and will cause many more in future. Humans have a duty to steward the planet well, and especially insofar as the planet is important for nourishing humans and being inhabited by them, because humans are especially valuable.

Given this, how do we respond to the obvious suggestion that more people equals more carbon emissions, for example?

Well, some of the responses from the last question are again relevant: restrictions on abortion only lead to population increases if they are complete restrictions, and even then the effect size is small and temporary. And recall that these questions are equally challenging for those who think that having children is simply a matter of women’s choice: if women wanted large numbers of children, then they should presumably be allowed to have them regardless of the climate. So there are no easy answers here. Finally, recall everything said about the empirical population trends: that in fact, the world is quickly heading towards a population peak already.

There is more that could be said about the environmental concerns specifically, however. First, I can hardly improve upon this summary by leading climate ethicist (and advocate) Dominic Roser, where he offers a number of reasons (on which I elaborate slightly) why things are not so simple, including (but not limited to):

1. Emissions per capita are likely to drastically decline over the next few decades, making the impact of having children far smaller, a fortiori for more distant descendants. Since the impact of a child is often calculated in part on the basis of the emissions of one’s descendants, this becomes highly relevant.
2. There are, of course, enormous benefits to children, not merely costs. This is true both in general and with respect to the climate. Climate-conscious parents are more likely to have climate-conscious children. Climate-conscious children are likely to do net positive with respect to the environment.
3. Another benefit of children is that they come up with the solutions. The same booming population which caused concerns about overpopulation is the same large population which facilitated the green revolution, massively increasing food production in the 20^th century far beyond population increases. Children cause problems; but they often provide solutions at faster rates. Innovation comes from people. With fewer people, there will be less innovation. And innovation is desperately needed to solve (and ideally reverse) climate change. As Bryan Caplan puts it, population does not cause poverty, it causes prosperity. He notes that in the last 2 centuries, the population and quality of life both skyrocketed. This is because people = ideas: ‘The human imagination is the ultimate resource’. This is why despite finite resources, and huge increases in population, average commodity prices have steadily decreased for the last 150 years, adjusting for inflation. Air and water quality have likewise improved substantially in recent decades. The best solution to climate change is not gradually dying out with horrendous underpopulation problems. It is innovation. And innovation needs people.
4. Offsetting is possible: it has been estimated that you could offset the emissions from having a child with merely $160 a year, which is trivial in comparison to the other costs of raising a child – and this is based on US emissions, which are very high per capita in comparison to many other Western countries.
5. Crucially, the aim is to reach net-zero carbon emissions. If this is possible, then more people will not lead to more carbon emissions. 20 billion multiplied by zero is still zero. What is therefore necessary is to focus our attention on cleaner technology, which will have a far bigger impact than having fewer children. We may – and indeed hope to – arrive at a situation where each additional person makes no difference to carbon emissions. (You may worry that if we are carbon-neutral only by offsetting emissions, then more people equals more work required to offset emissions, and this may be unsustainable. But given that our global population is only expected to increase by another ~20% before falling, that the costs of offsetting are relatively small, and are likely to get far smaller with new technology, this does not seem like a huge challenge). Relatedly, even the researcher responsible for the most widely cited paper on avoiding children for climate reasons pointed out that the timeframe over which children make a difference is virtually irrelevant to the climate crisis.

Roser notes that there are also serious problems with overpopulation rhetoric and policy which need to be balanced: for example, the fact that it has frequently been used as a vehicle of racist population suppression. People in the West have consumption per capita far higher (by orders of magnitude) than those in many developing countries – and yet population suppression has been targeted very clearly towards people in developing countries. There are, of course, a variety of other concerns regarding women’s rights, coercion, and so on.

Obviously there are a variety of other environmental concerns which I cannot address in detail here (yet). But I hope that this general framework for carbon emissions (and the previous discussions about food production) shows that limiting population is not necessarily the solution to overconsumption – healthy and sustainable consumption is. Moreover, the world population is already set to peak, and abortion bans barely raise the population in any case. For all these reasons and others, it can be (and often is) widely agreed by environmentalists and sceptics alike that abortion access is not needed to solve environmental concerns, very serious though they are.