World Health Organization’s Study on Mexico City Policy Is Flawed

by Michael J. New

During his first days in office, President Donald Trump upheld a key promise to pro-life voters when he used an executive order to reinstate the Mexico City policy. This policy, first enacted by President Ronald Reagan in 1984, prevents overseas governmental organizations from performing or endorsing abortion as a method of family planning if they wish to receive federal funding from the United States. The policy was rescinded by Bill Clinton at the start of his presidency, reinstated by George W. Bush in January 2001 and rescinded again by Barack Obama in early 2009.

Unsurprisingly, this most recent reinstatement of the Mexico City policy has been controversial. Since Trump’s announcement, a World Health Organization (WHO) study from 2011 has been receiving a great deal of attention, as it purportedly found that, under the second Bush administration, the Mexico City policy significantly increased the incidence of abortion in sub-Saharan Africa. The study’s authors argue that this increase was due to the significant funding cuts made in programs that distribute contraceptives overseas. This WHO study has been cited uncritically by a number of mainstream media outlets including the New York Daily News, Slate, and The Atlantic.

In general, though, studies from the WHO should be viewed skeptically. The group has a well-known position in favor of legal abortion and expanding access to the procedure. What’s more, the study has a number of methodological shortcomings. The main flaw in the authors’ argument is the fact that contraception use in sub-Saharan Africa actually increased after the Mexico City policy took effect in 2001. According to the study itself, the percentage of women using modern contraceptives nearly doubled, shooting from 11.9 percent in 1994 to 18.9 percent in 2008. For this reason, it seems strange to argue that a lack of contraception was the culprit in the increased abortion numbers.

The authors also attempt to argue that the Mexico City policy had a larger impact on the African countries that were more dependent on U.S. funds for family planning. They split the countries in this dataset into two groups. In the first group, “high exposure” countries received per-capita family-planning assistance from the U.S. that was above the median amount. In the second, “low exposure” countries received per-capita family-planning assistance from the U.S. that was below the median. However, according to the study, contraceptive-use rates increased by similar levels in both “high exposure” and “low exposure” countries.

The study is also missing some data, which casts a shadow on its results. The study analyzes annual abortion data from 20 African countries between 1994 and 2008, a 15-year time span, meaning that the dataset should have 300 data points. But the data from nearly every African country are incomplete. In fact, 125 of the 300 data points — 42 percent – are missing. Furthermore, only one country (Kenya) provides a complete set of data for the entire 15-year time span. Finally, while five countries reported data in 1994, all 20 reported data in 2003. Because of these discrepancies, the increase in the incidence of abortion over time might simply be due to the fact that countries reported data more completely and correctly in recent years.

There are also legitimate concerns about the quality of the abortion data that the study analyzes. For instance, according to the data presented in the study, the number of abortions performed in Tanzania increased by a factor of nine between 1999 and 2004 then fell by 95 percent between 2004 and 2005. Such large reported fluctuations in the incidence of abortion do not inspire confidence in the quality and reliability of public-health data from many of these African countries.

In addition, substantial research shows that overseas contraception programs tend to be ineffective. A 2012 Policy Review study by Nicholas Eberstadt and Apoorva Shah examined fertility rates in over 40 Muslim countries and found a strong correlation between fertility rates and the number of children that women desired. The availability of contraceptives had only a marginal impact on fertility rates. Similarly, Lant Pritchett’s 1994 study of more than 60 less-developed countries found that national fertility rates are principally determined by the desire for children. Pritchett concluded that “contraceptive access or family planning effort more generally is not . . . a major factor in determining fertility differences.” Unfortunately, these studies typically receive scant attention from the mainstream media, perhaps because they fail to comport with many journalists’ beliefs about reproductive issues.

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