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March 2013

An expert in population trends explains how the
ideology of birth control has ensnared demography.

The People Trap

Patrick Carroll

Modern ideology that prevails in governments and international organisations is pro-birth control. This is strong approval and priority in public funding for all forms of birth control, whether contraception or abortion or sterilization in developed and developing countries alike.

Demographic decline

But such policies have adverse effects. There is a demographic decline that is clearly apparent from published vital statistics and census reports in train with the high rates of abortion that have followed liberalisation of the law. The birth rate has fallen below the level require to replace the population. Fewer adults are married. Parenting has deteriorated and there is less family life when there are fewer children and more women work outside the home. Marriage rates decline as the rationale for marriage is lessened by available contraceptives. Divorce rates are high. More single parents face the demands of childcaring without the support of a spouse. Smaller families reduce the possibilities for caring within the family in old age. And there are more older people living alone.

Legal Abortion on a large scale with damaging effects

There was concern that women were suffering from “back street abortions” that led to maternal deaths. It was assumed that legally induced abortions, that were medically approved, would be safe. It was not recognised that all abortions affect women adversely. It was assumed that legally induced abortions would be similar in number to the illegal abortions that took place in the early 1960s. It was not anticipated that a liberalised law opening the door to abortion would open the floodgates to large numbers of abortions. Estimates vary as to the numbers of illegal abortions that took place in Great Britain in the 1960s. But we now have an official annual count that is not disputed for more than 200,000 abortions on resident women in Great Britain.

Birth control leads to overkill and contributes to the scale of modern abortion.

The large numbers of legally induced abortions with which we have now become familiar were not anticipated by the proponents of liberalisation of the abortion law, who were also enthusiasts for birth control. In the 1960s, the new contractive pills were acclaimed as providing the means for women to have the children they wanted to have so that every child would be a wanted child.

After more than 45 years experience of the operation of such laws in the UK and in other countries in conjunction with official promotion of birth control, we can report that abortion continues on a large scale, birth rates around the world have plunged and there is lacking the means to bring about a demographic recovery. And the evidence is accumulating as to how abortions harm women.

Abortion: a vice opposed to Christian marriage.

When abortion laws were liberalised, as in Great Britain with the 1967 Abortion Act, it was not anticipated that there would be such large numbers of legally induced abortions. How liberalised abortion laws have had such a large demographic impact becomes more understandable if the link between abortion and the decline of marriage is acknowledged.

The proponents of liberalisation of the law had assumed that, with newly available contraceptives, unplanned and unwanted pregnancies would be few in number. But after liberalisation, abortion numbers in England & Wales increased in the 1970s. And in the same epoch, the 1970s, there was a noticeable decline in marriage rates. Some young couples were choosing abortion as an alternative to marriage. And also in the same epoch the proportion of births outside marriage increased.

This early demographic change had further repercussions. Parity progression is less outside marriage. Single parents with one child are less well placed to care for second and further children than married parents with one child. There then followed in the 1980s a further increase in the abortion rate. This increase was in parous abortions, where single parents chose not to have more children.  Married and unmarried women were using contraceptives. Most of the women having abortions in recent years say they have been using contraceptives. The birth rate declined further below replacement level. Abortion continued to be rare among the married. The abortion rate among married women is much lower than among unmarried women but it is higher among divorced women. Often breakups among cohabiting couples were linked to abortions. There were also numerous abortions among separating and divorcing women. Divorce increased. The proportion of women unmarried, whether never married or divorced, increased further as abortion rates increased further.

The Swedish Model: Sex Education, Decline of Marriage, High Abortion Rates

Sweden has led the way in promotion of birth control and also provides a clear illustration of how this has impacted society. In Sweden the abortion rate is even higher than in England, which is not what sex education in Sweden was supposed to achieve. But it is consistent with the decline in marriage in Sweden. The proportion of births outside wedlock also continues to be higher in Sweden than in England. In Sweden it is now said and reported by demographers that marriage is associated with the birth of a second child to a couple. There seems to be an unwritten sub text to this: abortion is chosen by Swedish couples, not formally married, who do not want a second child.

The Swedish model has been influential internationally with other countries adopting Swedish style sex education programmes. In Sweden there is intensive distribution of contraceptives – both to boys to prevent spread of sexually transmitted disease and to girls, to avert pregnancy. While teenage pregnancies are fewer and teenage abortions are fewer in Sweden than in England, in proportion to the size of the population, adult abortion rates in Sweden are higher than English. This difference is most marked at the mid-30s age range, which could correspond to more unstable relationships in Sweden between couples at that age of women.

Decline below replacement level

The decline in the birth rate was very obvious from the 1960s into the 1970s. But there was little concern. There had in contrast been much concern at the “Population Explosion”, which was considered to strain the resources of the world. While environmentalists were worried about some endangered species of animals, the birth rate of the human species was falling below the level required for replacement of the population.

Replacement level is a function of the gender ratio at birth and female mortality between birth and the age when women give birth. If there are 105 baby boys born for every 100 baby girls then the fertility rate, the TFR or TPFR, needs to be at least 2.05 for replacement. The Total Period Fertility Rate or TPFR is the sum of all the age specific fertility rates for each single year of age of women that are reported for a particular period. It corresponds to a notional family size that would be achieved if it were to remain constant. This is also often called a TFR as the period is usually assumed to be one year and birth rates are commonly quoted as for a calendar year. Only baby girls can be future mothers. But there is also a need to make some allowance for the possibility that some baby girls will not survive to the age when they are themselves capable of bearing children. The replacement level is calculated in modern conditions in Great Britain as 2.07, and the rule of thumb that replacement level is 2.1 is quite familiar and often quoted.

Higher replacement level when there is high mortality of girls or sex selective abortions

This TFR of 2.1 as the replacement level fits quite well to developed countries where there is comparatively low female mortality at the young ages. no female infanticide and no sex selective abortions.

But when there are more female foetuses that do not survive to become mothers the prospects for the replacement of the population are thereby further impaired and the TFR required to replace the population is rather more than 2.1.

There is heavy female mortality at the younger ages as in some parts of Africa where this rule of thumb replacement level 2.1 is too low to apply. And there are many sex selective abortions, in the major countries of Asia such as China and India, so that the gender ratio at birth changes and their replacement level is rather more than 2.1.

Exact data as to the gender ratio at birth tends to be lacking in the less developed countries.  Infant mortality and mortality among young girls is also not known with precision in such countries. Abortions tend to be unrecorded. In China a TFR of 1.55 is reported for 2010 which is 74% of the rule of thumb replacement level 2.1. But sex selective abortions are known to take place in China and there is a sex ratio at birth in China reported for 2007-09 of over 110 boys to 100 girls. This, with some allowance for the mortality of girls in China, suggests a replacement level TFR at around 2.15 for China in 2010.  The birth rate 1.55 is just 72% of this.

It can be seen from this cursory analysis that the fertility rate in China is further below replacement level than is usually assumed.

For India various web sites give TFRs for India in 2010 as 2.6 or 2.5, which is 19% more than 2.1. But in India, where there are also sex selective abortions and female infanticide, there is a gender ratio at birth of 120 boys to 100 girls reported for 2008, suggesting a replacement level of around 2.25 TFR. Such a replacement level is exceeded just 11% by a 2.5 TFR birth rate. The fertility rate in India continues to decline and is nearer to replacement level than is usually assumed.

Western complacency at low fertility: New concerns at immigration.

In Western countries, especially the English speaking countries, there has been complacency at a low birth rate. But there has been some disquiet at low birth rates even in countries like Scotland within the UK, and Australia, where immigration has traditionally been encouraged. 
Countries like the USA, Canada and Australia can always open their doors and admit more immigrants. While the cultural diversity brought by immigrants is seen in a positive light, there is increasing apprehension at the task of integrating large numbers of immigrants. When the immigrant community is large and the cultural differences of language, religion and lifestyle are more marked, there is more community tension.

This has been seen in the USA where there is tension over Hispanic immigrants. And here in the UK and Europe we have large and rapidly increasing numbers of Moslem immigrants. The latest successive censuses in the UK in 2001 and 2011 show a steep increase in the numbers of Moslems here. The majority of schoolchildren in London are of immigrant decent. We are obviously dependent on immigrants to staff basic services.

In continental countries such as France and the formerly communist countries of Europe governments, have adopted pro-natalist policies designed to bring about a recovery of the birth rate. These had some limited success.

The French birth rate is quite high, similar to the UK at around 1.9, and nearer to replacement level than most European birth rates.  As in the UK there are immigrant groups that have a higher birth rate who have contributed to this revival in fertility.

What is peculiar to France is that their secular constitution prohibits questions on religion in the French census. It is not possible to say exactly what proportion of the French birth rate is Moslem. It is possible to speculate that the pro-natalist incentives to assist une famille nombreuse have accelerated the process of a Moslem takeover in France. But it is not known exactly how fast this process is proceeding.

Countries such as Czechoslovakia and the former East Germany did achieve a comparatively high birth rate nearer to replacement level than some western countries. There was an epoch in the 1980s when the East German birth rate was higher than the West German birth rate. These communist era pro-natalist measures included cash incentives for parents of children. There was one East German benefit that might be noted as having a particular interest here: Ehekredit – Marriage Credit. On marriage the prospective parents became entitled and when children were born the benefit could be claimed. Other incentives related to housing, so that a married couple with a child could expect priority in allocation of a dwelling. But when the Berlin wall came down these incentives for parents in East Germany lost their value and the East German birth rate collapsed in the territory of the former DDR to around 1 child TFR.

In the Soviet Union, in the communist era, it was found that the Moslem republics in Central Asia responded more to the pro-natalist incentives and their birth rates were higher than in Russia and the Ukraine, where the TFR remained below replacement.

It could be quite useful to us today to have measures to encourage couples to marry and to have children within marriage. But benefits along the lines of Ehekredit, which featured  in the old DDR – and indeed in Hitler’s Reich, are now discredited ideologically by the association with such unsavoury regimes.

Perhaps the most obvious, effective and revenue saving measure that could be taken to bring about a recovery in the birth rate would be to cut government expenditure on contraceptives that are now free on our NHS, in contrast to medicines to treat the sick that are subject to a prescription charge. But one leading demographer told me this would be a bad idea for eugenic reasons! The wrong people would have children…. Eugenic thinking still influences and is one component of this modern ideological trap.

Demographic Recovery: a remote prospect

While there is little prospect of any reversal of such public policies that favour birth control, there is lacking the means to bring about a demographic recovery. Birth control is promoted by governments in their educational institutions. Sex education in schools leads young people into habitual usage of contraceptives. Abortion is available and funded by national health insurance. The population is accustomed to rely on birth control. Sexual activity is less directed to reproduction.

For some time these patterns have been becoming more obvious and evident. But there is not yet much quantitative investigation of where these trends are likely to lead us. The adverse social impact is little studied. Deterioration in behaviour of young people exposed to sex education merits more study. There continues to be complacency, especially in the English speaking world, where the myth of overpopulation lives on, at the continuation of a birth rate below replacement level.

Sweden has the kind of lavish benefits to assist mothers that might be found in a pro-natalist country. There is access to publicly funded child care. In Sweden there were hopes that the birth rate was recovering to reach replacement level. In 1990 it seemed the TFR did reach around 2.1. But then there was a decline to below 1.6 in the late 1990s. Since then there has been some recovery. But the TFR in Sweden remains below 2 at around 1.9 in 2010. And from 2010 the number of live births was 115,641 and it dropped to 111,770 in 2011, a 3.3% decline as reported by Statistics Sweden. Notwithstanding the contribution of a sizable immigrant population that have a higher birth rate with TFR of over 2.2, Sweden is not recovering to reach replacement fertility in modern conditions. Again this can be better understood if the decline of marriage in Sweden is noted. Even in Sweden it is more difficult for single mothers to achieve parity progression and they are tempted to opt for abortion. It might be surmised that Sweden would now be achieving replacement level fertility if most Swedish women were married in the child bearing age groups and most Swedish children were born within wedlock

Forces driving modern population control

Various spirits or ideological forces are driving society in this direction.

Eugenicists were prominent among the pioneers of birth control and modern disapproval of teenage pregnancies continues to reflect this strand of thinking. It is assumed that the girls who are pregnant are not the sort of women who should be having children.

Environmentalists see population growth as a factor in undesirable climate change and a threat to endangered animal species. It is assumed that fewer people would improve the prospects for the elephants and polar bears.

Neo-Malthusian economists see birth control as a key to economic advance. Rev Thomas Malthus was himself a conscientious Christian against all forms of artificial birth control. It is no longer true, as Malthus inferred, that limitation of resources determines population size. While obesity has emerged as a major problem in the developed world, the myth that overpopulation is straining the food resources of the world still prevails among policy makers. The modern neo-Malthusians have seized greedily on his principle, that fewer mouths can feed better, to favour birth control. And governments adhere to this advice by economists even when demographic decline in such countries as Germany and Japan today makes it difficult for these countries with their rapidly aged population to recover from recession. While younger consumers are more valuable for advertisers, who pay more to reach them, older consumers are less disposed to spend their money.
The demographic projections that show an ageing and shrinking population also predict less economic growth to be anticipated in future years. Even the most enthusiastic neo-Malthusians among economists use the same standard method to estimate the GNP: Gross National Product in Future Years. They first estimate the population and then apply an assumed economic production per year per head of this population. Demographic decline necessarily implies economic decline.

But here as in the rest of the English speaking world there is complacency, in the face of an ageing population. We have had an influx of immigrants that has masked the consequences of our fertility decline. While the government has pledged, when it was elected, to control this immigration, the implications for British demography if this aim is achieved, go unacknowledged.

For the world at large however there is no way of escaping or masking such a demographic decline. Net migration around the whole planet is necessarily zero!

When China and India need immigrants where are they to come from?

Abortion harms women

Independence feminists, as a modern article of faith, insist on a woman’s right to choose abortion. It is assumed that it is in the interest of women to have access to induced abortions and the health of women is best served with this. The leading politicians in all parties tend to make a statement that accords exactly with the promotional literature of the abortion providers: “I want abortion to be safe, legal and rare.” There are several modern myths in incorporated in this much emulated advertising slogan. And after 40 years of legally induced abortion, data has accumulated on computers around the world so that there is now available the means to refute them. National abortion statistics officially published by our own Department of Health and the Information and Statistics Division of the National Health in Scotland and in other countries where abortions are believed to be reported, enable us to demonstrate that legally induced abortion is not rare. Sex education and government funding for contraception does not lead to fewer abortions. And notwithstanding the neglect of medical research into the adverse impact of abortion, we can now demonstrate that legally induced abortion is not safe. The damage to society and to the health of women from large numbers of legally induced abortions is on a large scale.

Adverse impact on the health of women

Recent research using linkage of computer records has found that married women enjoy significantly better health than unmarried women. This research does not investigate the effects of induced abortion on women’s health. Study of abortion as a possible risk factor in women’s illnesses is not possible in Great Britain because records cannot be linked. But the better health of married women becomes more comprehensible if their low abortion rate is acknowledged.

The adverse impact on the health of women of legally induced abortion is particularly obscure here in the UK. Our Department of Health decided against recording NHS numbers on electronic records of abortions. We cannot easily discover what abortions are doing to the health of British women. In England this applies a fortiori as the name of the woman is not recorded on the computer record. The side effects of modern contraceptives are overlooked and underestimated.

There are indeed adverse consequences for the health of women from all these modern methods of birth control. An increased incidence of conditions known to be abortion sequelae is apparent from published health statistics. Post-abortion women have a higher incidence of depressive illnesses and are more likely to give birth to low weight and premature babies and may experience certain diseases of the immune system. NHS Prescription Statistics imply that more than a billion anti-depressive pills are prescribed annually, mostly to women. The proportion of live births that are of low weight and of premature births is high at over 5% in the UK.

Both abortions and hormonal contraceptives are positive risk factors for female breast cancer. Cancer registrations of newly diagnosed malignant breast cancers among females show more than 50,000 cases annually in England & Wales. The cancer registries report this increased incidence but the government’s cancer epidemiologists explain it only in general terms of modern living, lower fertility and later childbearing.

Linking of records to determine exactly how many women diagnosed with breast cancer have previously had abortions or have previously used hormonal contraceptives is not possible in the UK. Likewise the remarkable social gradient of female breast cancer, whereby upper class women have more breast cancer but less of the other cancers than women in the lower socio-economic groups, is not officially explained. This trend also becomes more explicable if there is noted the cancer inducing effects of abortions among upwardly mobile women who have had abortions of their first pregnancy and the higher usage of  hormonal contraceptives among professional women that avail of educational and career opportunities.

Hormonal contraceptives and intra-uterine contraceptive devices (IUCDs) have other unwelcome side effects. Hormonal contraceptives bring risks of blood clotting and thrombosis. IUCDs bring risks of Ectopic Pregnancies. Pelvic infections are affecting more women in modern conditions. Sexually Transmitted Diseases have become more common over the same epoch since the advent of legally induced abortion and modern contraceptives. This era of supposedly safer sex has produced  continuing epidemics of Sexually Transmitted Diseases (STDs) that are also Pelvic Inflammatory Diseases(PIDs) such as Chlamydia and Gonorrhea, which add to the risk of Ectopic Pregnancies. More than 10,000 ectopic pregnancies are reported each year in England. The increase runs parallel in the UK to the use of IUCDs including modern drug-releasing fertility control systems.  It seems as though these means of contraception lead directly to Ectopic Pregnancies, and also indirectly when they facilitate the spread of infectious disease of this kind.

It is interesting that the dangers of HRT (Hormone Replacement Therapy) are now acknowledged so that doctors are more hesitant to prescribe it. The risk of breast cancer from HRT has become very evident. Yet the contraceptive pill, which is chemically similar to HRT and contains the same hormone(s), is still being prescribed with its attendant risk of breast cancer regarded as minimal. The contraceptive pill is however commonly prescribed with a higher dosage and for a more extended time period than HRT.

Morning after pills are now dispensed on a large scale, often by medical practices but increasingly with no medical supervision. Abuse is invited and the adverse impact on the health of women is yet to be measured. It was anticipated that this ready availability of the morning after pill would lead to fewer abortions at the abortion clinics. This has not happened. We have rather a further deterioration in behaviour. Findings by researchers in Scotland have shown that sex education and promotion of contraception does not improve the behaviour of young people.

Attempts to escape from the trap.

Where the necessity of bringing about a recovery in the birth rate is more acknowledged, the means of escaping from the demographic trap, with the ageing and shrinking of the human population now anticipated, also receive more attention. Likewise recognition of the adverse impact of abortion and contraception on the health of women would change the abortion debate.

But the same ideological forces that have led us into the trap also impede escape from the trap and discourage even attempts to look for the means of escape.

Economists provide a glib answer to the ageing of the population: We should simply work longer. They miss the lack of economic dynamism among the aged. Most of the men in the age range 60 to 65 are no longer economically active. Raising pensionable age to 67, which is now under way in the UK and elsewhere, will not bring more of these older men into the workforce. And of course similar considerations apply to women as to men in this matter. Rather the new law to raise retirement age and confer the right to work on longer, will further aggravate the unemployment of graduates. Often the more desirable posts which older people wish to retain by postponing their retirement are the kind of jobs to which the unemployed graduates aspire. And when older people continue to enjoy a good salary they are less likely to spend it as consumers than younger people, whereas young couples who are parents can especially be relied on to spend their salaries. The remedy prescribed by the economists to raise pension age is not leading us out of recession.

Economists seem attached to the neo-Malthusian principle that birth control is an important key to economic advance. There is also, consistent with this ideological stance, a disdain for the kind of pro-natalist incentives that have been applied in France and in the former communist countries of Europe, now discredited, to encourage more children.

In Germany there has been some concern at the low birth rate. After German reunification the very low birth rate in the German districts of the former East Germany became apparent after the low birth rate in former West Germany had been noted since the 1980s. Special housing incentives for parents who are owner-occupiers were introduced via the tax system. A child allowance of €7,000 per child per annum is given in German income tax. These measures are expensive but their effect has been limited in bringing about a recovery in the German birth rate, which has remained at around TFR 1.4, one third below replacement level, for 40 years. Successive cohorts of young women entering the child bearing age groups are smaller so there are immer weniger/ ever fewer children each year. 663,000 children (TFR 1.36) were born in 2011, 15,000 fewer that in 2010. Mrs Merkel, herself divorced and childless, cannot claim success on this score.

In Russia likewise there is a history of low birth rates persisting, notwithstanding pro-natalist incentives to encourage children. It seems there is now more direct action to discourage abortions and require more in payments for abortions.

But in the supposedly Catholic countries of continental Europe such as Italy and Spain there is an even lower birth rate and less has been done to restore fertility. There is a contrast with the UK and Scandinavian countries that have more experience of women combining work outside the home with child-caring.

In the Republic of Ireland and Northern Ireland restrictive abortion laws have helped to maintain the birth rate at near to replacement level.

In America there are cultural and ideological distinctives, manifest in a disdain for “Big Government” and “Socialised Medicine”. There is less promotion by the government of contraception within the USA than in Europe. Birth rates and abortion rates in the USA are both high in comparison with Europe. While there is not the generous allowance for children in the tax system  found in France and Germany there is deduction of mortgage interest which assists families with children. The American  birth rate with TFR 2.06 in 2010 and 2011 and estimated again for 2012 continues to be much closer to replacement than European rates. When the American birth rate is so near to replacement level there is complacency. Americans and American-trained  economists, neo-Malthusian in outlook, tend to be influential in international organisations so that developing countries in receipt of aid are not in a position to reverse birth control polices.

Australians have viewed their low birth rate (TFR 1.73 in 2001 was a low point) with some concern, though it is comparatively high compared with Europe. Substantial cash payments for new mothers were announced with some fanfare. And since 2005 when the TFR was 1.8, there has been a noticeable increase in the Australian birth rate to nearly TFR 2 (1.96) in 2008. But since then it has declined again to 1.89 in 2010 and 1.88 in 2011.  66% of these were to married parents in 2011. It seems as though the response to such incentives tends to tail off as society develops to make child caring less attractive. Incentives alone have not sufficed to raise the Australian birth rate to reach replacement level.

As noted, ideology also impedes studies of the health sequelae of abortion. In the UK the NHS number is recorded on the computer record for NHS operations, but not for abortions. While in Sweden the personal number is not recorded on the electronic record of an abortion, ostensibly for similar reasons of privacy and confidentiality. There was a time when Swedish women went to Poland for abortions. Use of register data is however possible in other Scandinavian countries such as Denmark and Finland to enable linking of abortion records to other health records such as breast cancer diagnosis. In these countries it is quite feasible to discover how much higher among women who have experienced legally induced abortion is the incidence of breast cancer. But this research is not being done. Use of anti-depressants among women who have had abortions could also be investigated using Danish and Finnish register data. Again this research is still awaited. It seems there is an official perception that such research is a threat to a woman’s right to access abortion and it is blocked by the controlling committees.

Summary conclusion

Continuing failure to address effectively the demographic decline has consequences now becoming very evident. Worldwide the economy has limited potential for further growth and recession or near recession is the norm. The more prosperous countries in Europe, America and Asia are faced with either a takeover by immigrants, as in Western Europe, or an actual decline in the population, as in Japan and Russia. The social effects in terms of the decline of marriage and deterioration of parenting are manifest in the numbers of young people in prison.

The health of women who use contraceptives and have abortions continues to be impaired. Failure to investigate adequately the adverse effects of abortion and contraception on the health of women leaves unexplained the modern breast cancer epidemic. There are many women who have had abortions now taking anti-depressants but it is not known what this will do to their health long term.


The author is an actuary and statistician who has written on pension provision, fertility and breast cancer epidemiology. His reports on the impact of abortion on society are available at PAPRI.




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