Expert Commentary

Abortion services and modern contraceptives: Do women in Nepal use them interchangeably?

2016 study published in Demography that looks at whether women in Nepal use abortion and modern contraceptives interchangeably.

(Pixabay/public domain)

The issue: Some academics, policy makers and advocates hypothesize that contraceptives and abortion are considered substitutes. The theory goes: In a society with widely available, inexpensive contraception, women will not have as many abortions. Conversely, if contraception such as birth control pills, IUDs and condoms are difficult to obtain, women will have more abortions. If such a relationship does exist, there could be major consequences for population policy and foreign aid programs targeting women’s health.

An academic study worth reading: Population Policy: Abortion and Modern Contraception Are Substitutes,” published in Demography, July 2016.

Study summary: Grant Miller, director of the Stanford Center for International Development and an associate professor at the Stanford University School of Medicine, teamed up with Christine Valente, a lecturer in economics at the University of Bristol, to study whether women in Nepal use abortion and modern contraceptives interchangeably. For their research, they examined an unusual policy change adopted in Nepal in 2004. That year, abortion was legalized, but there was no significant change made to the supply of modern contraceptives.

To understand Nepalese women’s reproductive behavior, Miller and Valente studied data collected during four waves of the Nepalese Demographic and Health Surveys. The surveys were conducted in 1996 and 2001 – before the policy change – and then in 2006 and 2011 – after the change. The analysis involved a sample of 32,098 women.

Key findings of the study:

  • Each new legal abortion provider in a woman’s district of residence was associated with a 2.6 percent decrease in the likelihood of using modern contraception.
  • Each new legal abortion provider was associated with a 2.2 percent reduction in the odds of women undergoing sterilization. Centers have no effect on male sterilization, however.
  • The decrease in contraception use was driven primarily by decreased usage of reversible birth control methods such as injections. To a smaller extent, there was a decrease in the use of condoms and birth control pills.
  • The authors note that their estimates “provide evidence of true substitution between use of modern contraceptives and abortion.”

Helpful resources for reporters writing about this issue:

Related research:

  • A 2012 study from scholars at Washington University in St. Louis found a reduction in abortions and teen birth rates when women received free birth control as a part of the Contraceptive CHOICE Project.
  • A 2015 study published in Health Affairs found that the federal Affordable Care Act reduced out-of-pocket costs for multiple types of birth control.
  • A 2014 study by researchers from J.P. Morgan and Williams College found that early access to birth control can reduce the likelihood that a woman will live in poverty.


Keywords: birth control, family planning, fertility, abortion clinic, reproductive rights, pro-choice

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