07 Dec

The Dutch Paradox: Unintended Pregnancy and Induced Abortion in the Netherlands 1954-2002


The Dutch Paradox of abortion entails the observation that in the Netherlands induced abortion is legal, safe, available, and free, but also extremely rare compared to other countries. A new publication in the European Sociological Review, authored by Mark Levels (corresponding author), Ariana Need, Rense Nieuwenhuis (that’s me), Roderick Sluiter, and Wout Ultee, examines the effect of both individual and societal effects on women’s decision process leading to an abortion. The article is available as advance access (limited to institutional access). Findings suggest, as quoted from the summary: “that the legalization, availability, and insurance of contraceptive pills helped to prevent abortions, because these measures effectively reduced the demand for abortion“.

A key innovation in this article, I think, is the theoretical and methodological focus on individual women, allowing to model the subsequent decisions that lead to an abortion. The life-courses of 3,793 Dutch women were analyzed, in which factors leading to an unintended pregnancy, and factors leading to a woman having an unintended pregnancy terminated are analyzed sequentially. This approach proved very elucidative. For instance, it has previously been observed that higher educated women are less likely to have an abortion. Our study shows the process leading to this observation: higher educated women are less likely to experience an unintended pregnancy, but when they do higher educated women do not differ from lower educated women in their likelihood of having an abortion.

This study tentatively concludes that the Dutch Paradox cannot be explained by the demographic composition of the Netherlands. For instance, while findings indicate that single women are more likely to have an abortion, Dutch women are more likely to be single than women in countries with higher abortion ratios. Similarly, still being in school increases the likelihood of a woman having an abortion, but Dutch women are in school (compulsory) longer than women in other countries.

In addition, women’s decisions regarding abortion were found to be influenced by societal characteristics. Liberal abortion laws and high availability of clinics increase women’s likelihood to terminate an unintended abortion. However, this cannot explain why Dutch abortion rates are so low. Legal sale of contraceptives, availability of the contraceptive pill and health care insurance of the pill increased women’s control over their fertility, all leading to a lower likelihood of a woman experiencing a pregnancy. Key understanding of low abortion rates, however, most likely resides in legality of contraceptives: when contraceptive sales were legal, women were less likely to experience a pregnancy, and less likely to experience their pregnancy as unintended.

Levels, M., Need, A., Nieuwenhuis, R., Sluiter, R., & Ultee, W. (2010). Unintended Pregnancy and Induced Abortion in the Netherlands 1954-2002 European Sociological Review DOI: 10.1093/esr/jcq065

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