R. Veenhoven & B. Sondermeyer
Published in Dutch as ''Abortus''. Nisso Literature Study nr. 6, Netherlands Institute for Social-Sexuological Research (NISSO), Zeist, 1973, 358 pages

SUMMARY
Our first purpose in this study was to attempt an overview of the effects of liberalisation of legal abortion-policy. Secondly we tried to explain the backgrounds of the abortion-problem. We made an inventarisation of factors leading to unwanted pregnancies and we looked for an answer to the question why so many people are opposed to abortion. The following general conclusions can be formulated. For the specific details we refer to the paragraphs in the book.

• Following liberalisation of abortion policy a rise in the number of abortions is noted in all countries (1/ 3.1). The fewer the possibilities for adequate contraception in these countries the greater the number of abortions (1/ 3.2).
• Liberalisation is in most countries followed by a decline of the number of illegal abortions (2/ 4.1) , although the practice of illegal abortion seldom disappears totally. The more the abortion-aid is curtailed by abortion-boards, indicationsystems etc. the higher the relative frequency of illegally performed abortions (2/ 4.3).
• Where insufficient facilities are available for the effectualisation of a permissive law (for example shortage of specialised clinics and doctors) the relative frequency of illegal abortion remains high (2/ 4.2).
• Effects of liberalisation on (somatic) public health
  In countries which have had a liberal legislation towards abortion for a longer period the mortality due to abortion operations is low. Even lower than the maternal deaths in these countries (3/ 2.2). In countries with a restrictive law the average mortality of abortion is considerable higher (3/ 2.1) After liberalisation a gradual decline can be expected: a decline of the mortality due to legal as well as illegal abortion.
• Differences in mortality and morbidity of abortion between and within countries are caused by many factors, i.a.
  — method of abortion (3/ 1.3.1)
  — method of anaesthesia (3/ 1.3)
  — indicationsystem (3/ 1.3.2)
  — duration of pregnancy (3/ 1.3.1)
  — skill and practice of physician (3/ 1.3.3 / 1.3.1)
  -- permissivity of abortion-policy (3/ 1.3.2)
• At this moment the method known as suction- curettage without hospitalization seems to be the safest for the average abortion (3/ 1).

Effects of liberalisation on (mental) public health

• Unwanted children run a considerable higher risk for a premature death and deficient development than wanted children do (4/ 2.2). Because this concerns large numbers of people (in Holland in 1970 33.000 unwanted pregnancies) this phenomenon is an important factor in public mental health; as is most striking demonstrated in the deprived social classes. Liberalisation of abortion policy as such makes an important contribution to preventive mental health policy (4/ 2.3).
• As a rule abortion has a positive effect on the mental health of unwanted pregnant women. The therapeutic effect is greater as the wish of the woman for an abortion is more urgent (4/ 1.1). In some specific cases problems of assimilation can be demonstrated. These problems are the more frequent where the woman concerned is confronted with the rejection of her wish for abortion by her family, doctor and the wider social environment (4/ 1.2).

Effects of liberalisation on the birthrate

• Liberalisation exerts a diminishing effect on the birthrate. However liberalisation does not always result in a direct drop of the birthrate. The birthrate is determined by more factors than abortion- policy alone, and the influence of liberalisation of this policy is not always the same. The effect of liberalisation depends on the relative amount of unwanted pregnancies, the use of contraception and illegal abortion (5/).

Other effects of liberalisation

• In contradiction to popular belief liberalisation of abortion policy does not result in a greater immorality (6/ 1).
• Women who have had an abortion are not distinguished by more liberal sexual attitudes and behaviour; a rejecting attitude towards sexuality is more characteristic for them (9/ 1.5).
• No more does liberalisation result in a decline of conjugal fidelity, or in a dimishing respect for human life (6/ 4). Nor does liberalisation result in a lessened use of contraceptives. Such an effect can only be expected in countries where the availability of contraceptives is so imperfect that contraception cannot be a real alternative for abortion.

Problems of transition

• Liberalisation is usually accompanied by typical problems of transition. The problems center round quality of abortion-aid, and quantity. The latter arise where hospitals fail to intercept the wave of new applications and special abortion facilities are not available until the problems become evident. The quality of the aid is often not optimal because the doctors and nurses are very ambivalent and inexperienced towards abortion (7/ ).

Part II. Determinants of unwanted pregnancies

• The (un)wantedness of a pregnancy is first of all a question of motivations to procreation. With respect to this question, however, very little is known yet. It is not very clear why people want to have children or don’t (10/1) want to have them. We know something more about the factors which hinder people who do not want to have children to realize their wish.
• Failure of efforts to prevent pregnancy is more likely when the people concerned:
  — do not know what they really want (11/1.1)
  — have problems about their own sexual impulses and behavior (11/1.2, 11/1.3)
  — are not very mature (11/11.1)
  — are inexperienced in sexual affairs (11/1.4.2)
  — have a troublesome relation (11/2)
  — have been born in traditionally oriented and somewhat culturally backward groups (11/4)
• The present problem of unwanted pregnancy can be seen as a result of a delayed change-over to a new system of birth-control. In former days birth-control was mainly effected by abstinence: a smaller proportion of the population being married. As a result of social changes: i.a. the formation of the nuclear family, a change to birth-control by means of contraception proved to be necessary. However the values and structures which sustained the old system of abstinence have not changed so fast and have been a serious handicap for this change-over (11/ 4.2.b).

Part III. Constraints against liberalisation of the abortion policy.

• Current attitudes about abortion show great differences. It is likely that these differences will be less pronounced in the near future because the acceptance of a permissive policy grows larger and larger.The attitudes toward abortion are highly connected with attitudes towards sexuality and contraception (16/2.2, 16/2.3)
• It is known that these attitudes towards sexuality and contraception have been changed profoundly during the last century as a result of specific connected social changes in the field of i.a.:
  — the position of women society (16/3.1)
  — the position of the child (16/3.2)
  — the structure of the family (16/3.3)
  — the authority of the church (16/3.4)
  — the level of consumption (16/3.5)
  — the possibilities for upward social mobility (16/3.6)
• Negative attitudes towards abortion are most characteristic for those people who have stayed behind in these changes. Therefore people who take a restrictive position towards abortion are distinguished by
  — higher age (16/1.1)
  — low level of education (16/1.7.e)
  — lower social class (16/1.7.a)
  — traditionalistic orientation (16/2.5)
  — church-going (16/1.7.g)
  — a structure of personality unpropitious to the coping with radical cultural change.
• The attitude towards abortion is also influenced by the idea and attitudes people have about their own procreation (16/ 1.3); people who do not want more children being more permissive (16/1.3), and moreover by their confrontation with abortion people who know a friend or a member of their family to have had an abortion being less restrictive (16/ 1.5).
• As in public opinion there are remarkable differences in the group of doctors. Psychiatrists being far out more permissive than family doctors and family doctors more permissive than gynecologists. The causes of these differences can be located in differences in professional orientation; education, experience and the nature of contact with the patient: for example a gynaecologist is in his daily work not so often confronted with the long term effects of unwanted pregnancies as is the psychiatrist. (15/ ).