The Optimist

The Trojan Paradox

If religious conservatives want to put a stop to abortions, there's no better tool than making contraception a lot more available. And there's a world of good it'll do.

As a bunch of men on Capitol Hill discussed whether federally supported health-care programs should have to cover contraceptive services in the United States, a new study in the medical journal the Lancet was reporting that, globally, about one in five pregnancies worldwide ends in abortion. That's a disturbingly high statistic -- whichever side of the abortion rights debate you fall. But the awkward fact for those opposed to both abortion rights and supplying contraceptives is that global evidence suggests the most foolproof way to reduce the abortion rate is, in fact, to provide more widespread access to contraceptives.

The good news is that, according to U.N. data, the percentage of couples worldwide ages 15 to 49 using a modern method of contraception expanded from 41 percent in 1980 to 56 percent in 2009. The gray lining on that silver cloud, however, is that the rate of progress slowed considerably in the new millennium, to an annual growth rate of just 0.1 percent.

Of course, some of the 44 percent of couples who aren't using modern contraceptives are trying to have a baby. But hundreds of millions of women aren't using modern contraception because they don't have access to it or can't afford it. There are traditional, "free" methods of contraception -- the rhythm method or withdrawal, for example. But, beyond being considerably less reliable, they require the cooperation of male partners. A recent 10-country study by the World Health Organization suggests that between one in 10 and one-half of women in a relationship had suffered sexual abuse by their partners. And cross-country evidence in developing countries suggests men usually want more children than do their partners. Thus, it's naive in the extreme to assume women can always rely on their partner to cooperate in using traditional methods when it comes to avoiding pregnancy.

That's one reason why four-fifths of unintended pregnancies in the developing world occur among mothers who lack access to modern contraception, according to the Guttmacher Institute. And getting pregnant when you don't want to isn't just an inconvenience -- it can be a considerable physical danger in and of itself. Roughly 300,000 women worldwide die each year as a result of pregnancy and childbirth, with about 13 percent of those deaths due to unsafe abortions.

If you are a poor woman in a country where abortion is illegal, the options for dealing with an unwanted pregnancy are particularly grim. Take, for example, migrant Burmese women living on the Thai border. Attempts to end pregnancy usually start with self-medication; local remedies include a mix of redwood, black pepper, nutmeg, cloves, and sandalwood. When that doesn't work, the two most common approaches are a pummeling vigorous enough to pull off the placenta and cause uterine rupture or "stick abortions" -- which consists of putting a 4-inch twig into the uterus and leaving it there for days at a time. An illegal induced abortion, while considerably safer, costs about 10 times as much as these treatments. So it is perhaps not surprising that about half of pregnancy-related deaths in the region are due to botched abortions, the great majority of which are dangerous traditional approaches.

The Thai case illustrates another point -- make abortions illegal, and you just drive them underground, where they are more likely to be dangerous. In the United States, the number of abortion-related deaths per million live births fell by three-quarters between 1970 -- three years before Roe v. Wade -- and 1976. And after South Africa liberalized its abortion laws in 1997, abortion-related deaths fell dramatically. For those who fear that -- like drugs, say -- legalization would create a rampant culture wherein every woman would flock to her local clinic for an abortion on a whim, fear not: Abortion rates are actually a little higher in regions where the procedure is illegal than where abortion laws are comparatively liberal, according to the Lancet study.

Happily, the number of maternal deaths worldwide is down by one-third since 1980, despite a growing global population. One major factor behind that decline is that women are getting pregnant less often in the first place. Most of that change is due to parents wanting fewer kids as education spreads and child mortality rates decline, but one additional component is that, as a result of improved contraceptive access, fewer mothers are getting pregnant by accident. The percentage of women ages 15 to 44 who got pregnant unintentionally each year dropped from 7.9 percent to 6.9 percent between 1995 and 2008 across the developing world, according to the Guttmacher Institute.

Women who don't get pregnant unintentionally have much less need to turn to abortion as a possible solution to that problem. The former Soviet republic of Georgia had the highest rate of abortions in the world at the turn of the millennium -- an annual rate of one abortion for every five married women of childbearing age in 1999. But that rate declined 15 percent over the next six years as contraceptive prevalence increased by nearly a quarter, according to an analysis by researchers at the U.S. Centers for Disease Control and Prevention. Similarly, a 46 percent decline in abortions in Turkey between 1988 and 1998 was associated with more widespread use of modern contraceptives and more effective use of traditional methods. Again, research from a decade ago in areas of Matlab in Bangladesh where high-quality contraception services were available found that about one in 50 pregnancies ended in abortion. Compare that with a national average in Bangladesh of around one in 10.

In fact, it's not at all surprising that abortion rates have been declining as contraceptive access has increased worldwide. The Lancet study suggests that there were 35 abortions per 1,000 women of childbearing age in 1995. That dropped to 29 per 1,000 in 2003. Since then, limited progress in rolling out modern contraceptives has been reflected in a slower decline in the number of abortions, which stood at 28 per 1,000 in 2008. Worse, unsafe abortions have been declining at a slower rate than safe procedures, because those countries left without widespread access to contraceptives are increasingly the poorest, while many of these same countries have outlawed elective abortion.

Nonetheless, the global evidence is clear: If you want to reduce the number of abortions, making them illegal won't work. Making modern contraceptives widely available is far more effective. And, as a not insignificant side effect, this is also a strategy that puts women more firmly in charge of their own bodies and health, saving tens of thousands from death and millions from illness each year.

For those concerned men on Capitol Hill last week, support for contraceptives may be a bitter pill to swallow. But if they really want to cut down on the practice of abortion, modern contraceptives play a vital role. And they should look on the bright side -- they aren't the ones who actually have to do the swallowing. Yet.

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The Optimist

There Will Not Be Blood

Across the world, crime is down -- and in a big way. Are violent movies to thank for less real blood and gore?

For all the grim news about the economy and jobs over the last few years, one indicator of the quality of life in the United States has stubbornly continued to improve. The latest Federal Bureau of Investigation data suggests crime rates went on falling through the first half of 2011, recession be damned. In 1991, the overall national violent crime rate reported by the FBI was 758 cases per 100,000 inhabitants; by 2010, that had dropped to 404 per 100,000. The murder and "nonnegligent homicide" rate dropped by more than half over the same period. You wouldn't know it from watching television -- beyond the continuing conviction that "if it bleeds it leads" on local news, the number of violent acts on prime-time TV shows climbs ever-upward. But that rise in fake violence may have played some role in the real-life trend heading squarely the other way.

The United States isn't alone in a trend towards people just getting along better -- it's a global phenomenon. In 2001, homicide killed more than twice the number of people worldwide who died in wars (an estimated 557,000 people versus total war deaths of around 208,000). But just as in the United States, violent crime rates have been falling across a large part of the planet. The data is patchy, but in 2002, about 332,000 homicides from 94 countries around the globe were reported to the United Nations. By 2008, that had dropped to 289,000. And between those years, the homicide rate fell in 68 reporting countries and increased in only 26.

Look at the really long-term picture and violent crime rates are way down. Institute of Criminology professor Manuel Eisner reaches all the way back to the 13th century to report that typical homicide rates in Europe dropped from about 32 per 100,000 people in the Middle Ages down to 1.4 per 100,000 in the 20th century. (Sadly, of course, for all of their decline, U.S. rates are still more than three times that -- a rate above what Eisner suggests is the Western average for the 1700s.)

The global picture of the last few years, along with the historical picture covering the West over the last 800 years, both suggest that there isn't just a constant proportion of bad people out there who will commit a crime unless you lock them up before they do it. And there's a lot more evidence that whatever is behind declining violence it isn't the number behind bars -- or, indeed, the length of sentencing or the number of cops on the street.

It is true that a Pew Center report suggests that as U.S. crime rates were declining, the national prison population increased from 585,000 to 1.6 million between 1987 and 2007. But the rest of the world hasn't followed the United States down the path towards mass incarceration, and yet has still seen declining violence. The U.N. crime trends survey suggests that homicides fell in Britain by 29 percent between 2003 and 2008 alone, for example. And yet the incarceration rate in Britain was one-fifth as high as the United States, according to the Pew report. Again, within the United States, one of the places with the most dramatic drops in violent crime is New York City -- the homicide rate is 80 percent down from 1990. But while the rest of the country was locking up ever more people, New York City's incarceration rate fell by 28 percent over the last two decades.

What about harsh punishment? Statistics from MIT psychologist Stephen Pinker's new book on global trends in violence show the United States used to execute more than 100 times the amount of people in the 1600s as it does today -- and yet violence rates then were far higher than today. Think Clint Eastwood's western, The Good, the Bad and the Ugly: Despite all of the authorized hangings, there was still a lot of unofficial shooting. More broadly, the number of countries using the death penalty has declined worldwide -- along with violent crime rates.

In a survey asking "What Do Economists Know About Crime" for the National Bureau of Economic Research (NBER), Angela Dills, Jeffrey Miron, and Garrett Summers conclude "economists know little." They suggest that it isn't just incarceration or the death penalty -- any link between lower crime and the number of police, higher arrest rates, and the stock of guns (whether more or less of them) is weak. Studies from Latin America have echoed that longer sentences are not linked to lower crime rates -- although a higher probability of being caught may be related to less violence in the region.

At the same time, for those convinced that crime is a product of poverty and inequality, the recent trends for New York and the nation as a whole also pose a challenge: For all the growing estates of the plutocrats in Wall Street, neither growing inequality nor rising unemployment has reversed the downward path of crime. Similarly, Latin American evidence suggests that while rising inequality might be linked to increased violence in the region, average incomes are not -- richer countries are no safer than poorer ones, all else equal.

What about drugs, then? Interestingly, the NBER survey notes that drug enforcement might increase crime. The authors suggest that "If government forces a market underground, participants substitute violence for other dispute-resolution mechanisms," -- i.e., if they can't go to court to settle their dispute over who gets which street corner, rival drug gangs will shoot each other instead.

New York's experience suggests that it is possible to reduce the violence associated with drugs by taking those disputes off of the street. Franklin Zimring, a law professor at the University of California, Berkeley, suggests that one important factor behind the decline in homicide in New York was shutting down open-air drug markets. It didn't slow sales, but it did eliminate 90 percent of drug-related killings over turf conflicts. Echoing the recent pattern in New York City, Eisner suggests that the long-term historical decline in Western homicide rates as a whole is associated with "a drop in male-to-male conflicts in public space."

Over the sweep of centuries, Eisner suggests that cultural change -- from "knightly warrior societies" to "pacified court societies" -- is an important factor. So are we just getting more civilized, then? Indeed, the decline in violence coincides with global evidence of converging attitudes towards greater toleration. For example, the proportion of people worldwide who say they wouldn't want to have a neighbor of a different religion dropped from 67 percent to 48 percent between the early 1990s and the mid-2000s. Turn on the television and you'd be sure to think that political dialogue is getting more rancid by day. And it might be, but people's attitudes are actually becoming more pacific and tolerant.

Cultural factors are important, then. But before you rush to deride the Federal Communications Commission and the Supreme Court for their lackadaisical attitude to violence on television, note that the trend towards more -- and more graphic -- violence on TV doesn't quite sync with the pattern of crime rates. A culture of violence and violence in popular culture are two very different things. In fact, one more element of cultural change that may behind declining violence is the substitution of fantasy violence for the real thing. French historian Robert Muchembeld argues in his book, History of Violence, that crime fiction and novels about war have given young men a way to indulge in violent fantasies without actually going out and stabbing someone. Or, over the last few years, they could stab someone playing Grand Theft Auto rather than stab someone while actually committing grand theft auto. This is the blood-and-gore version of the argument that that more pornography leads to lower sexual violence.

There might be something to it. While exposing kids to the latest cadaver on CSI -- or to Jack Bauer's lessons in successful torture on 24 -- is probably a bad idea, watching an action movie might in fact reduce violence among adults. A recent study in the Quarterly Journal of Economics suggests that violent crime rates actually dropped when a blood-splattered blockbuster was in the cinema in the United States. The authors Gordon Dahl and Stefano DellaVigna looked at data from 1995 to 2004 and concluded that violent movies deter almost 1,000 assaults on an average weekend in the United States.

Perhaps humanity will never completely abandon its lust for blood. But it appears that lust can in fact be sated using fake blood wielded by Hollywood special-effects technicians. And outside the theater, people respond to behavioral cues -- if their friends don't stab people to win an argument, they are less likely to do it themselves. They also respond to institutional cues -- if they can use the courts to settle a dispute or address a wrong, they're less likely to resort to blood feuds. All of which suggests the hope that, in years to come, there will be a lot more deaths on TV and movie screens than in the real world.

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