Thanks Nick. I have come across quite a lot of abortion surveys in countries with restrictive laws. Here is one from Uganda: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002340#sec007 I agree entirely that the results are likely not to be very reliable, but I think that is the bigger problem; less so the lack of ethics approval.
Calum Miller
Karma: 52
“Long science comment incoming: I’ve had some time to go over the literature, and I find the passage below (which is the main secular argument against abortion presented) to be highly misleading.”
As I already explained in my comments above, the paragraph to which you refer was not the main argument against abortion, it was an extra peripheral consideration for a certain subgroup of readers. I do not understand why you seek to misrepresent my post even after I made this clarification.
“The mature brain cortex does not appear until week 24-ish, and according to this review paper , EEG results only produce reliable patterns synonymous with “wakefulness” at week 30, and at earlier dates the signal is often discontinuous. However, there is some research showing that cognition and experiences can occur without a fully formed cortex, so it should not be taken as the dividing line for certain.
(If you think I am cherry picking, these sources come from the first google scholar results for “fetal pain review”)”
Yes, Lee’s paper is well-known. But the wakefulness stuff is not really plausible—the RCOG dropped the argument completely from their recent review of the evidence, as Bellieni’s recent response points out (https://onlinelibrary.wiley.com/doi/10.1002/ejp.2109) - as Derbyshire pointed out elsewhere, there are a number of problems with this argument, including the fact that we just don’t really know much about the EEG sleep patterns even for newborns, let alone fetuses. We also have pretty clear ultrasonography from 23 weeks showing a fetus clearly crying in response to an anaesthetic injection—it is very implausible to me that this is done while asleep.
Regarding the rest: yes, the authors are somewhat cautious, though I’m pretty sure Bockmann now considers it likely the fetus can feel pain from 12 weeks, and I think is open to it being even earlier. The question is: is there any reason why the fetus wouldn’t feel pain at that point? You might say ‘because the cortex isn’t fully developed’. But as the authors point out, there is reason to doubt the necessity of the cortex for pain perception. The wakefulness argument doesn’t really work, for the reasons that Bellieni and Derbyshire describe.
“What the OP also didn’t mention was what the whole debate was mainly about: whether or not to use analgesia or anaesthesia when performing abortions. Even if an early fetus is capable of feeling pain, the use of these during the abortion may render the procedure painless.”
No, this isn’t what the debate is mainly about. I have made very clear in my comments I am also talking about early embryos/fetuses before pain capability, and that the arguments I describe briefly (and link to for more detail) apply to these.
These terms are pretty widely used and are the most widely accepted. Of course I don’t think ‘pro-choice’ is a good, neutral term—but they are a reasonable compromise for the sake of clarity, since everyone understands what they mean.
I don’t know what you mean here.
Yes, there is a lot we can do to tackle the root causes of abortion.
EA is supposed to consider how to improve the world as much as possible—that is what this post aims to do. The fact that it might lend credibility to a right-wing cause does not bother me, nor does the fact that the pro-animal posts here might lend credibility to a left-wing cause. I am struggling to understand what point you are trying to express, unless you are just assuming that anything that could benefit conservatives is evil. But that is just silly. Moreover, plenty of left-wing people (like myself) are opposed to abortion.
I explicitly stated at the start of that appendix that it was relevant for the 15% or so of EAs who are religious. It is relevant to them, and belongs there. If you don’t like, scroll past it.
At this point I fear you are not really engaging with (or even reading) the post. If you have specific criticisms, I’m happy to address them. If not, then I probably cannot help very much.
Here’s one example—I suggest it only needs to be in somewhere near the right ballpark to have a significant impact.
We don’t know how many legal abortions there are in India each year, because they don’t keep good statistics. But suppose the rate is similar to most other countries with legal abortion—this would be about 4 million abortions a year. If, as I suggest, prohibition of abortion prevents at least half of abortions, then for every year you delay the legalisation of abortion, that would be at least 2 million lives saved. Given how neglected the topic is politically in many countries like India (on the pro-life side, at least), I think you could have delayed the legalisation of abortion by at least a month with a team of 10 people working full time for, say, a year. That’s perhaps £100,000 - and would have saved ~170k lives.
Again, this is pretty speculative, but if it is anywhere near the right ballpark, then it looks pretty compelling in terms of cost-effectiveness.
There are lots of survey-based studies on abortion in countries where abortion is illegal—the problem is not so much getting it through an ethics board as the reliability of the results. You could alternatively measure using hospitalisations for incomplete abortion as a proxy—you won’t be able to identify the exact magnitude of the problem or the change since an unknown proportion of these are from miscarriages (some have tried to estimate the ‘natural’ miscarriage presentation rate, but I think these estimates are obviously unreliable), but you could see if there is a change and whether it is a big or small change, since the miscarriage rate should remain relatively constant. It would need a big enough sample size though.
Yes, Marston and Cleland’s paper is helpful, I think. But I think developing countries are generally most likely to have risk compensation, since they tend to be more conservative sexually and thus have more capacity for increased risky sex. The countries where abortion and contraception are inversely correlated tend to be those which have already been through a kind of sexual revolution, and were using abortion as birth control (i.e. generally the Soviet bloc in the latter 20th century). But neither of those are true in most developing countries today.
Thanks for this. I have had an (admittedly short) scout around, and would be grateful for a bit more direction if possible. Both Lafiya and FEM seem to take women reached and contraceptive prevalence as their primary measured outcome—but this doesn’t get us what we need, since contraceptive prevalence can have both positive and negative effects on the abortion rate (due to risk compensation). Do you know if either have an RCT where they measure pregnancies (or, even better, abortions) as an outcome? If so, do you know where I could find this?
Thank you for your comments. To try and respond:
Sure—but this is why I included the section on offsetting for women, wherein I noted that the empirical evidence just doesn’t support the idea that reducing abortion causes comparable harm to adults.
Perhaps, but there are many ideas EAs believe in which come across as prima facie implausible to some people—this is why I gave arguments (with links for more detail) to suppose that human embryos have similar moral value to adult humans—so it is difficult to respond without knowing exactly where you think those arguments go wrong. Could you elaborate please?
Perhaps—though this is only a somewhat peripheral and unnecessary part of my argument—most of which depends on the idea that they do indeed have some value. There will be some EAs who do hold views with pronatalist implications—this argument should be quite powerful for them. Other EAs don’t hold such views—that’s fine.
As I noted in the post, it is not neglected in the USA, though it is neglected in certain sectors, and is extremely neglected outside the USA (and to an extent Latin America).
Thanks again for your comments.
I haven’t, but I would be interested to read more. Is there a reason to suppose it is more effective than standard contraception/sex ed-promoting interventions?
When you are working with statistical trends, that can be true. But it is perfectly legitimate to highlight a single study with a very clear finding which is difficult to dispute—e.g. the existence of a certain kind of neuron. Moreover, the study we both cited was not a primary study, but was a review of sorts, from the world’s leading expert in this area—in turn, he cited multiple studies to develop his arguments. The systematic review you mention is, at the very least, outdated, and doesn’t really give any kind of convincing response to the arguments laid out in Derbyshire’s paper.
Put another way, I would take one well-argued paper over a million poorly argued papers. If a paper is well argued and cites relevant and convincing arguments/data, it really doesn’t matter if there are other papers which say the same thing or not. Unless another paper actually responds to those arguments and shows why they are bad—the conclusions remain perfectly valid. In short, I do not think there is any such general principle in science as ‘it is bad practice to cite a single study’ - that really depends on one’s purposes and one’s conclusions.
Hi, thank you for your comment. To try and respond:
I did try to be clear in distinguishing late abortions from all abortions—sorry if I did not explain myself very clearly! The large majority of the post—including all the arguments and references in the section on the ethics of abortion—refers to abortion in general, and is applicable to all abortions. So I do not think it is true that I used only late term abortions in my defence of fetal moral status. I only introduced late-term abortion in one short paragraph, where (I think) I made it clear that I was offering this as a separate argument even for those who were unpersuaded by the main post, and clarified the (reduced, but still large) scale of the problem for people who fall into that camp: “Even if one has no problem with early abortion, 10% of abortions are after 13 weeks’ gestation, at which point fetuses are fully formed, and likely conscious and able to feel pain.[9] This would amount to at least 3 million relatively late abortions each year globally – and potentially many more if abortion were to become more normalised and permitted around the world.”
I’m aware that Wikipedia has a certain perspective on fetal pain—as it does on many things! - but I think that the evidence shows that perspective to be false. I linked to a recent paper from the world’s leading researcher on this topic (Stuart Derbyshire) who used to hold something like the Wikipedia view, but who has now changed his mind because of evidence of thalamo-cortical precursors developing much earlier in pregnancy—around 12 weeks—than previously thought. Derbyshire himself is pro-choice. In addition, the papers I linked to challenge the necessity of the cortex for pain experience.
Thanks again for your comment. I hope this clarifies things!
Yes—I don’t want to speak for Ariel, but my sense is that we have pretty different perspectives on why abortion is bad. I have a fairly traditional pro-life position unrelated to population ethics or utilitarian considerations. I generally think children are a good thing for various reasons, but I’m not into maximising population for population ethics reasons or anything like that.
Even for LARCs I’m pretty sceptical that their promotion significantly reduces abortions except in exceptional circumstances (e.g. former soviet states where abortion was used as birth control). But I would support other interventions which, for example, hardcore pronatalists might well oppose (e.g. education encouraging delay of sexual debut, discouragement of multiple sexual partners, bans on surrogacy, etc.).
While those against abortion have many resources in the US, I don’t think that’s true in much of the rest of the world. Maybe some parts of Latin America would be another exception, but outside the US the anti-abortion movement is pretty severely underfunded. So I think there is a lot of room for improvement (from an anti-abortion perspective) there.
Regarding adoption, it seems to me that voluntary abortion reduction is not likely to increase the number of people placed for adoption by very much. Even with involuntary abortion denial, the best research we have seems to indicate that most women denied abortions go on to raise the child themselves rather than placing it for adoption. I would guess that this would be even more so if they are voluntarily choosing to continue the pregnancy. Most of these children have perfectly reasonable mental health outcomes. So it seems implausible that this would significantly counterbalance or outweigh the value of the extra lives preserved by voluntary abortion reduction interventions.
Thanks for your question, Ruth. I confess to being a sucker for the liberal democracy post-WW2 human rights deontological framework, according to which involuntary abortion reduction follows from a fairly simple premise: human embryos/foetuses are human beings. If so, then according to the standard human rights framework (specifically ICCPR Article 6) they have a right to life which must be protected in law—i.e. they cannot be killed.
I don’t see how a comparable case can be made for the interventions you mention. I know less than nothing about crypto so really couldn’t say anything at all about that. Regarding involuntary meat consumption reduction, I don’t think non-human animals have a right to life so consuming meat would not be wrong for the same reasons.
Whether meat consumption could reasonably/permissibly be involuntary reduced (I’m not sure why it would be specifically limited to poor countries) for other reasons depends on the facts of the case, I think. I certainly wouldn’t have an in principle/absolute objection to doing so if the case for doing so (either from climate concerns, animal suffering, or scarcity) were sufficiently strong. We rationed meat in the war and I don’t think that violated any sort of inviolable right to bodily autonomy, for example.
Thank you, Ariel. I was raised as a liberal Christian for whom pretty much anything broadly deemed progressive (including abortion) was permissible, but changed my convictions at medical school :-)
I don’t blame you for sticking to voluntary abortion reduction—I think it is a perfectly worthy topic of discussion in itself!
I will do my best to write something up after all. I’ve always found EA people to be more open-minded and thoughtful than most in philosophy, and I’ve been encouraged to see the thoughtful and cordial comments among even those who disagree here.
Should have mentioned earlier that in terms of tractability, Hungary might offer the most interesting case study: abortion has not been restricted significantly there at all, but they have reduced the abortion rate from 90,000 in 1990 to just over 20,000 today. This resulted from quite a costly set of pro-family policies which have been widely lauded in pro-family circles, but it is possible that other factors contributed as well (as a nuance to my earlier post, there is good evidence that contraception reduced abortion rates specifically in ex-Soviet countries, probably because sexual behaviour had already changed but abortion had been legalised and was being used as birth control—so contraception substituted more equivalently for it). Hungary abortion numbers: https://www.ksh.hu/stadat_files/nep/hu/nep0013.html
Thank you for a very thoughtful comment. I did just want to add that there are some who do place the possibility of fetal pain earlier—namely, if the cortex is not in fact necessary for conscious experience or pain (https://journals.sagepub.com/doi/full/10.1177/00243639211059245). I realise this is a minority view, but I do think it has some things to commend it (e.g. experiences of pain in those with anencephaly/hydranencephaly).
It’s probably worth noting as well that the sheer number of abortions makes even small percentages significant—if only 10% of abortions take place after 12 weeks, that is still 5-7 million or so a year, so plausibly still worth addressing from an EA perspective.
(DOI: I don’t take a view of moral status that relies on conscious experiences so would be opposed to abortion even before that)
Thank you Lin for your thoughtful comment. I gave some further thoughts to Matt above, and it felt rude to copy and paste that comment again here. But if you have a particular hesitation which I haven’t addressed to Matt above please do let me know and I’ll do my best to come back to you on it.
Thanks, Matt. Sorry I was heading out earlier so didn’t have time to elaborate as much as I would have liked. When I say unmet need for contraception (UMC) is low, I meant proportionally—by 2010 it was just over 10%, and I would guess is significantly lower still now. Of course, 10% globally is still a lot of people, but these are presumably the hardest people to reach and it is not clear how cost-effective doing so would be—moreover, it seems clear that even if we did manage to reach those 10%, the abortion rate would hardly decline by that much—so it is a pretty limited strategy for reducing abortions, if it is effective at all.
Regarding the second paper, table 5 indicates that only 8% of women with UMC globally lacked access (including because of cost). Table 3 in the third paper shows similar. So it still seems that only a very small proportion of women globally—perhaps 1% in 2010 - have a UMC because of lack of access to contraception.There probably are interventions which could increase contraceptive uptake—but I don’t think they are by any means simple, and they are not generally solving lack of access per se. The access is there, even if the relevant education or empowerment of women is not. As indicated in the rest of my previous post, even if this were solved, it is still not clear to me that it would reduce abortions, given the counterbalancing effects contraception promotion has on sexual behaviour and desired family size. It seems particularly doubtful that it would reduce abortions by a large amount.
You are right that as education increases, desired family size generally falls, and contraception demand will grow. But I don’t see that there is a significant risk of contraception supply failing anytime soon. Even under the Mexico City Policy, which was widely held to significantly impede access to contraception, contraceptive use in the affected countries (turquoise—unaffected countries in orange) rapidly increased:
This, I suppose, is relevant to the EA discourse on neglectedness—with the emphasis on contraception in international development circles, it seems unlikely that slightly trimmed down support for it is going to significantly impede it or significantly increase abortion rates. But I confess I am only really on the peripheries of EA so I might be outdated with the neglectedness stuff.
Highlighting the passage is perfectly fine—I wrote it, and it is part of the post. What is not fine is continually suggesting that it is the primary argument I have given for abortion being wrong, when that is manifestly not the case, and I have made that explicit. I’m happy to respond to criticisms of that particular point—but not for people to misrepresent my post by pretending that it is the main argument given, especially when I have clarified that it is not.
Yes, I am familiar with the evidence. If I had deliberately misrepresented any of the papers I cited, then again, you would be right. But you have failed to show that. Bockmann does think the fetus is likely conscious and able to feel pain by that point, even if they phrased it more hesitantly in the paper, presumably because it is difficult to be certain. Of course, we can never be certain—but they have shown that the main arguments for placing fetal consciousness later in pregnancy fail. I see no good reason to suppose it is later than 12 weeks.
Again, no, I did not ‘just state’ that we should ‘assume’ 4 week old fetuses have full human rights. I said, for example, “Denial of fetal personhood typically leads to implausible conclusions regarding how we may treat infants and severely disabled humans, and arguably to a denial of human equality even among non-disabled adults.” These arguments apply to all embryos/fetuses, regardless of whether they can feel pain, and more detail is available in the references linked.