Reducing Abortion Rates Without Restricting Legal Access to Abortion: Evidence from Comparative Analysis of Relevant Policies and Demographic Indicators in 15 Post-Soviet Countries and Adaptive Agent-Based Modeling of Unintended Pregnancies

Abortion is a controversial topic internationally. Most current debates about abortion concern when, if at all, it should be legal. However, researchers have shown many times that after an abortion ban, maternal and infant mortalities rise significantly, as women who seek out abortions do so regardless of abortion legality. So, is it possible to reduce abortions in a population without delegalizing abortion and, if so, how? Why do some countries have higher abortion rates than others in the presence of the same law?This dissertation answers both questions. First, I present historical evidence in the first comprehensive comparative analysis of all 15 post-Soviet countries, which have very similar abortion laws originating from the Union of Soviet Socialist Republics (USSR). Second, I use those findings to build the first agent-based model (ABM) of unintended pregnancies in a hypothetical artificial population. USSR was the only country in the world to complete its demographic transition through abortion instead of modern contraception, and the Soviet government passed the first law in the world to allow abortion upon request in 1920. After the USSR dissolution in 1991, post-Soviet countries maintained very similar abortion laws, but had very different abortion rates for most years. Analysis of fertility data from post-Soviet countries shows that the prevalence of some specific contraceptive methods, namely the rhythm method (r = 0.82), oral pill (r = 0.56), and male condom (r = 0.51) are most strongly correlated with high abortion rates, and that sex education is a factor that reduces the rates in otherwise similar countries (p = 0.02). The ABM shows that even basic sex education results in fewer abortions than no sex education or abstinence-based sex education (p < 0.01). In scenarios without sex education, basic quality of post-abortion contraceptive counseling (PACC) is better than no PACC or low-quality PACC at reducing abortions (p < 0.01). Still, the higher the quality of sex education or PACC, the fewer abortions in the artificial population. The ABM is adaptive and policy makers can use it as a decision-support tool to make evidence-based policy decisions regarding abortion, and, potentially, other sociobiological phenomena with some adjustments to the code.