The Abortion Debate in the World Arena (review)

Andrzej Kulczycki. The Abortion Debate in the World Arena. New York: Routledge, 1999. 246 pp. $80.00 cloth; $24.99 paper.

Policy debates about abortion are no longer confined to Western liberal democracies; they have spilled over to the developing world and to the postcommunist societies of East Central Europe. By designating three countries (Kenya, Mexico, and Poland) as regional bellwethers, this study analyzes how and why abortion has become more politicized globally. It also firmly establishes abortion as a health concern of the highest magnitude.

The most often-cited global estimate of the number of induced abortions is 45 to 50 million. Another way of looking at this phenomenon is that an estimated one in four pregnancies worldwide ends in abortion. Such high numbers "reflect the unmet need for family planning and the common recourse to abortion in the absence of contraception or in the event of contraceptive failure" (3). Under medically safe conditions, induced abortions-particularly those performed in the first trimester--carry little risk to a woman's health and future fertility. However, the complications resulting from unsafe abortions cause approximately 585,000 maternal deaths annually, "99 percent of them in developing countries" (9). Where abortions are illegal, unsafe procedures are far more likely. About a quarter of the world's population resides in "countries where abortion is illegal under any circumstances or authorized only to save the life of a pregnant woman" (13).

With abortion illegal in Kenya, Mexico, and Poland, these countries presented a "difficult environment for conducting research on a phenomenon that remains unlawful and stigmatized" (174). Nevertheless, Andrzej Kulczycki successfully articulates the way the abortion issue is debated in each. His approach is thorough. First, he presents the demographic and public health aspects of abortion for each country. This task alone required an enormous effort and an amalgam of sources, including official statistics (available only for Poland), hospital admissions data, and other fertility indicators. It also demanded an understanding of the illegal and largely undocumented abortion system within each country.

Kulczycki's second task was to examine how the policy-making process in each country treats this volatile issue. In so doing, he looks at whether the policy-making process actually considers the issue, and if
so, whether demographic and health data inform the debate. This task required a thorough understanding not only of the political institutions in each country but also of how they have recently changed. This was no easy feat; since the late 1980s, Kenya, Mexico, and Poland each have had turbulent political environments.

His third task of this book was to examine the views, strategies, and relative influence of different interest groups in shaping each country's abortion debate and policy. In order to understand the political, religious, and other factors that affected policy making, Kulczycki conducted 162 two-hour interviews with elites in different organizational categories (e.g., high-level officials, academics, activists). These interviews revealed the power of the Catholic Church, "an old hand at politics" (22) and arguably "the most highly organized religious group and one of the most influential social institutions in the world" (19). Kulczycki also presented findings on the relative influence of women's groups, the medical profession, and individual politicians. These extensive interviews allowed him to assess the process by which abortion has entered the public domain and the likelihood of change in the near future.

Kulczycki finds that the mix of demography, policy making, and interest groups varies among the three countries. In Kenya, the incidence of abortion is increasing--its abortion rate is similar to that in the United States--but the Kenyan abortion fatality rate is more than fifteen hundred times higher than that in the United States. However, abortion has not yet reached agenda status in Kenyan policy making. Among the stakeholders, there is widespread confusion and conflict about how abortion policy should evolve. Women's groups are not cohesive...