We’ve been getting a fair amount of feedback on Twitter and Facebook about our last blog, which compared our estimate of pre-repeal abortion numbers with the just-released official statistics from 2019. Based on this comparison, we said:
It’s clear that repeal of the 8th Amendment has lead to a large increase in the number of abortions: a year-on-year percentage increase of 38.4%, or roughly 1955 additional lives lost as a result of repeal of the 8th amendment (using 2018’s figures as a baseline). It looks like between five and six additional lives were lost every day last year as a result of repeal.
We also said that this pretty definitively proved wrong any idea that the 8th amendment wasn’t saving lives, or that repealing it wouldn’t lead directly to more abortions. We’d like to address some questions that that readers raised, particularly about our estimate of how many Irish abortions happened before repeal by way of illegally imported pills plus abortions obtained by Irish women who travelled to the UK.
In our last two stats posts we explained how we made all our estimates, and exhaustively linked to our sources, so we won’t waste time with objections along the lines of ‘you’re lying’ or ‘you’re making it up!’ (We invite readers with this sort of objection to tell us what precise claims we made were false.)
But, of course, it’s always possible that we made mistakes with the conclusions we drew, and we very much welcome sincere questions on this score. We’ll now address some of those questions, and then post a few more charts showing how conservative our estimate of the increase in abortion numbers was when you compare it to the estimates made by the Together for Yes campaign and Simon Harris, respectively.
The tl;dr is this: our estimate of abortion numbers pre-repeal was deliberately generous, and thus our estimate of the increase after repeal was conservative. We know that people aren’t inclined to trust numbers coming from people on the opposite side of the abortion debate, so where there were ambiguities we erred on the side of assuming there were more abortions before repeal, and thus a smaller rise after repeal: in other words, we made assumptions favourable to the pro-choice side’s claim that the 8th amendment made little to no difference to the number of abortions.
On this approach, we concluded that a generous upper bound of 5,086 abortions took place to women resident in Ireland in 2018. Official statistics from the UK and Irish government show that there were 7041 Irish abortions in 2019: 6666 in Ireland and 375 in the UK. That gives us a lower bound increase of 1995 abortions from 2018 to 2019: or an increase of 38.4%
This generous upper bound required judgement calls; any estimate of the 2018 abortions is just that – an estimate. We can never be absolutely certain about the precise number – but if you examine the figures, it’s possible to come up with an estimate that makes repeal look far worse in terms of increasing abortion, but it’s very hard to come up with one that makes it look like caused no change or only a small increase. (Skip to the table at the end to see a comparison of the estimates.)
1. What if Irish women who had abortions in Britain pre-repeal gave no address?
If this were true, then there would be Irish abortions that didn’t show up as such in the British statistics. The real number of Irish abortions pre-repeal would be higher, and the post-repeal increase correspondingly lower.
However, giving no address isn’t an option under British abortion regulations. Every abortion is categorised depending on whether the person getting it is a resident or non-resident. Non-residents are then broken down by country. There is no ‘no address given’ category. See the official figures from e.g. 1977, 2010, and 2018.
2. What if Irish women who had abortions in Britain pre-repeal gave a UK or other non-Irish address?
Unlike the last question, it’s at least possible that significant numbers of women provided a non-Irish address to British authorities. But it’s very unlikely.
The first thing that’s worth saying about this claim is that there is no positive evidence for it. There’s no research or even significant anecdotal evidence (that we are aware of) suggesting that significant numbers of women seeking abortions in the UK didn’t give an Irish address. It didn’t come up during the campaign to repeal the 8th, and pro-choice campaigners have never made it a major point.
Second, there doesn’t seem to be any significant motivating reason for people not to give their real address to British hospitals, clinics etc. The data provided is kept completely confidential: there is no prospect of it getting back to people’s friends or family: and providing a false Irish address would serve this purpose just as well as a UK one. Providing an Irish address doesn’t affect your ability to have an abortion in the UK: the same procedures are available regardless of nationality. And providing a UK address wouldn’t allow a person to get their abortion paid for by the NHS: you need to be registered with a UK GP long-term.
Third, it’s worth looking again at the 2019 abortion figures for England and Wales. Predictably, the number of abortions carried out on women providing an Irish address fell massively from 2018. But if a significant number of Irish women had been giving UK addresses, you’d expect the decrease to be reflected in the figures for English and Welsh abortions too. But abortion numbers in England and Wales increased substantially from 2018 (200,608) to 2019 (207,384 – the highest since the Abortion Act was introduced in 1967). That’s an increase of 6776. Now, there are a lot more UK abortions than Irish ones, so it’s possible that there was a big fall off in ‘Irish women giving a fake address’ that was just offset by a bigger increase in abortions in England and Wales generally. But again, there’s no reason to think that: nothing positively suggesting that is visible in the data.
In our previous blog we estimated that there had been an increase in the number of Irish abortions of 1955 from 2018 to 2019. In 2018 the number of women who had abortions in the UK and provided an Irish address was 2,879. So to make up the difference and argue that repeal hasn’t led to an increase in abortion numbers, you’d need another 1995 people travelling to the UK and falsely providing a non-Irish address: that would be more than 40% of the total number travelling. Nobody in the academic literature on abortion has ever suggested anything even vaguely close to this, nor was it ever a talking point in pro-choice campaigns. There’s a reason for that – it’s vanishingly unlikely.
So the idea that significant numbers of women falsely gave a UK address is conjecture, and it’s not very plausible conjecture. Did some Irish women falsify their addresses in the last fifty or so years? Probably. Is there any evidence to suggest that this was a significant number of people, the kind of number that would substantially alter our estimate of the pre-repeal abortion rate? No.
3. Did you account for all the abortion pills being taken by Irish women?
No, we didn’t: we missed a provider of abortion pills in our initial estimate – the Dutch organisation Women Help Women, which operated through an Irish affiliated organisation called Need Abortion Ireland. That’s our mistake, and so we’re going to update our initial estimate to account for them. That said, the generosity of our initial assumptions means that even missing Women Help Women still leaves our initial estimate overestimating the total number of abortions via imported pills.
First, the pills from Women Help Women. According to Need Abortion Ireland’s Facebook post of 5 January 2019:
Since April 2016 we have helped over 1000 people experiencing a crisis pregnancy to access information, support, financial help and services, which were illegal or largely inaccessible in Ireland.
That means that over a three year period Need Abortion Ireland provided something (‘information, support, financial help’ or abortion pill services via Women Help Women) to over 1000 women (presumably less than 1100). It’s unlikely that every one of these 1000+ both a. received pills, and b. actually used them (as we laid out in our blog on pre-repeal abortion statistics, the research suggests that at least 9.66% of women don’t take the pills they receive). But let’s do a generous estimate again and say 1000 of them received and took abortion pills. For simplicity’s sake let’s say that divides evenly into the three years, giving us 333 additional abortions via abortion pills in 2018.
This obviously increases the abortion number pre-repeal, but it doesn’t come anywhere close to accounting for the difference between Irish total abortion numbers post-repeal and pre-repeal. It only reduces it from 1955 additional abortions post-repeal to 1622.
However, the main point showing we could not possibly have underestimated the pre-repeal numbers of women taking abortion pills relates to how we treated the data from Women on Web. We used their number for abortion pills provided to women on the island of Ireland, including the North, but in our analysis we assumed that all of those pills went to the Republic. We did this as a way of erring strongly on the side of caution – but as you’ll see below, even if you add all the maximum number of pills that Women Help Women could have provided to Irish women through Need Abortion Ireland, correcting for the fact that Women on Web’s figure is for the whole island rather than the Republic causes the number of abortion pills provided to women in the Republic of Ireland to go down.
Let’s go through that in more detail.
As discussed extensively, by far the biggest provider of abortion pills is Women On Web. According to their own figures as provided to Aiken et. al, they went from providing 548 abortion pills to Irish women in 2010 to providing 1438 in 2015. In other words, their own data suggests that pill use increased year on year by 17% between 2010 and 2015.
As we said in our post on pre-repeal abortion rates, if that trend continued, it could be argued that in 2018, 2396 women ordered pills from Women on Web. So that’s the number we used in our estimate. But that’s for the whole island of Ireland, not just the Republic.
Based on the 2016 census of the Republic, and the 2011 census of the North, the population of the North is approximately 27% of the population of the island of Ireland (1). Assuming that demand for abortion pills per head of population doesn’t vary much between the Republic and the North, that would mean that women in the Republic account for approximately 1509 (63%) of the total abortion pills provided by Women on Web. That’s a decrease of 887 compared to our original estimate of pre-repeal abortion pill usage. Even when you add the Women Help Women/Need Abortion Ireland pills, you only get 1842 abortions by way of imported pills – still a lower figure than our initial estimate of 2396. (2)
Re-run our estimate with that figure, and you get a 2018 abortion figure of 4771. That means the post-repeal figure of 7041 (the 6666 legal Irish abortions plus 375 in the UK) represents an increase of 2270 abortions per year, or an increase of 47.6%: again, a greater increase than our initial estimate of 38%.
In chart form:
It’s possible that there are other providers of abortion pills besides Women on Web and Women Help Women. However, they are likely to be small organisations providing small numbers of pills, and won’t change the picture that much. The idea that there is another major provider out there of comparable size to Women on Web, which none of the major pro-choice organisations or campaigns have mentioned, is not credible.
We also made another generous assumption that lead us to likely overestimate the number of 2018 abortions: we ignored the 711 abortion (misoprostol) pills seized by Irish customs in 2018 . These seizures were very unlikely to have prevented 711 abortions (because Women on Web ship more pills than are necessary for the dose) but any attempt to factor in the seized pills would result in a further decrease in the estimated number of abortions in 2018. Again, in order to err on the side of caution, we mentioned customs seizures in our first blog, but did not include them in our estimates.
All the above means that when we make any reasonable adjustments for abortion pills, there has still been an increase of at least 38% in the number of abortions after repeal (or four to five additional abortions every day), and if you ease up on the generosity of some of our estimates even a bit that increase rapidly gets bigger. (See the table at the end for one such revised estimate).
4. Why don’t you use estimates from pro-choice campaigners and organisations?
For some of our figures, we have! As discussed above, our abortion pill estimates are taken from the abortion pill providers themselves. As discussed in the previous blogs, our figures for abortions in the UK and the Netherlands are drawn from government statistics.
What would happen to our estimates if instead of using official statistics and stats from providers, we used the figures widely cited by pro-choice organisations and campaigners during the repeal campaign? Actually, if we did that, pre-repeal numbers would look substantially smaller. In turn, that would make the increase in abortions post-repeal greater than our previous estimate (and as large as, or even larger than, our revised estimate from the last question).
We avoided this in our initial estimate because we wanted to err on the side of caution and use the highest numbers possible for pre-repeal abortions: higher numbers than major pro-choice organisations were willing to use themselves.
Together for Yes’s estimate of five women a day taking abortion pills
This estimate was thrown around a fair bit during the campaign. Together for Yes give it as an upper bound: their website has it that ‘2–5 women a day in Ireland risk accessing abortion care illegally by ordering abortion pills online’. Note that that’s women ordering pills, not necessarily taking them. ROSA also referred to the ‘five a day’ figure. If five women a day were taking abortion pills in 2018, that would be roughly 1825 abortions a year. This would give a total figure of 4754 Irish abortions in 2018. Using that figure, there would have been a 48% increase in the number of abortions after repeal, and an absolute increase of 2287 (almost exactly the same as the revised estimate in question 3).
In chart form:
Health Minister Simon Harris’s estimate: three women a day taking abortion pills
In December 2018, during the debates about the post-repeal abortion legislation, Health Minister Simon Harris told the Seanad that ‘We know that nine women travel and three women take the abortion pill every day’. Back in May of the same year, Harris told TheJournal.ie ‘that his department estimates around three women a day in Ireland take abortion pills’. That Journal article also has a very interesting quote from the Dr Rebecca Gomperts of Women on Web explaining why that number is so low.
When asked at a briefing last week about what explained the discrepancy in figures [between the ‘five women a day’ figure and Harris’s], [Dr Gomperts] said that women might request an abortion pill, but could decide at a later stage to continue with the pregnancy.
‘The fact that the option of getting an abortion is there for women, helps stop the panic and helps them make a decision’, she said.
‘What is also interesting is that the data shows quite a lot of women decide not to get an abortion, because actually for them it was such a relief that they had the medicine they could start to really think about whether they wanted to have an abortion or not.’
Women on Web can’t say that a woman has had an abortion just because the pills were sent out.
If Harris is right, then even five abortions via imported pills per day could be an overestimate. If we use the Department of Health’s estimate of three per day, that gives us a 2018 figure of 1096 abortions with imported pills, a total of 4024 Irish abortions, and thus an absolute increase of 3017 from 2018 to 2019: a massive 75% increase in the number of abortions.
There has been a large increase in abortion post-repeal
So what can we conclude? There’s little to no reason to think that substantial numbers of Irish women are invisible in the data because they are giving false UK addresses. Our pre-repeal abortion pill estimates were deliberately very generous: much more generous than estimates made by Together for Yes and Simon Harris’s Department of Health. Based on the evidence we have, there’s no reason to think that large numbers of abortion pills weren’t being accounted for.
To be clear: our last blog’s estimate of the rise in abortions post-repeal (1995, or 38%) was and is a conservative estimate. Every time we had to assume or extrapolate, we tried to choose a reasonable figure that would be more favourable to the claims the pro-choice side makes, and less favourable to the claims the pro-life side makes.
If Together for Yes or Simon Harris were right (and they may well have been) the increase would be even greater: either a 48% or a 75% increase, respectively. If we suspend just one of our generous assumptions (that all the pills delivered by Women on Web went to women in the Republic and none went to Northern Ireland), then we land upon an increase of 48% as well.
Comparing all the different estimates:
2019 total Irish abortion numbers: 7041 (6666 performed legally in Ireland + 375 performed in the UK)
Note also that we still have ignored customs seizures in all the above estimates. Including them would decrease the pre-repeal abortions even further.
This won’t be the last word on the debate about pre-repeal abortion numbers. But we hope at this point that we have shown that the post-repeal increase is very real. At the very least, we hope that people will engage with our estimates in detail; if they disagree with any of the assumptions or methods we used to arrive at them, they ill explain why and make a case for their own.
It’s one thing to acknowledge that we don’t have great data and that estimates are not precise figures. And there’s nothing wrong with making specific criticisms of any one estimate for pre-repeal abortion figures and proposing an alternative.
But to throw up your hands and say ‘we can never really know, and so the only guide we have to the pre-repeal number of Irish abortions is the post-repeal one’ is selective extreme skepticism. We could just as easily do the same thing to favour the pro-life side: who knows whether all abortions in Ireland are currently being reported? Who knows whether the estimated figure for how many women actually take the abortion pills delivered to them is accurate?
But what we’ve done is use the best data we can find, and if in doubt to skew it towards a result that makes our case look weaker. And going about it this way, we still found that it’s possible to make well-grounded, reasonable estimates of the pre-repeal abortion numbers in Ireland. Even using our very generous estimates of the numbers of abortion pills taken, that still reveals a substantial increase in abortion post-repeal. Nearly two thousand a year. A thirty-eight per cent increase. That’s four to five additional abortions per day compared to just one year ago. If you use the Together for Yes estimate or Simon Harris’s one, the increase is even higher.
What is undeniable is that more than nineteen women per day got an abortion in 2019. This is a fact, verifiable from data from the Irish and British governments. It is also a fact that this figure is far greater than the number of abortions per day up to and including 2018 – which was consistently said to be eleven to twelve women per day.
By all means, let’s have a conversation about what that increase means, and what to do about it. But that there has been a large increase in abortion numbers now looks very hard to dispute.
The Minimise Project
(1) The NI population figures are more out-of-date than the Republic ones: official government population estimates from 2019 suggest that the North’s population has increased by almost another hundred thousand since 2011. This means that using the 2011 figures will tend to suggest that more women from the Republic ordered pills than actually did, so this is still a generous estimate, but we figured we’d stick to the census figures. If you went based on more recent estimates it would further decrease the number of pre-repeal abortions and the rise in abortions post-repeal would be even larger.)
(2) For what it’s worth, it’s not even clear from Need Abortion Ireland whether their figure of ‘over 1000’ refers just to women from the Republic or to women from throughout the island of Ireland.