Do better family planning services reduce abortion in Bangladesh?

BACKGROUND: Fertility decline is often associated with an increase in contraception and abortion, but the causal relations are difficult to examine with non-experimental data. We aimed to assess the effects of family planning services on abortion rates in two similar areas.
METHODS: We examined trends in overall abortion rates and rates for intended and unintended pregnancies in two similar areas typical of rural Bangladesh. We analysed Matlab Demographic Surveillance System (DSS) data on pregnancy outcomes between 1979 and 1998 in these areas, matching them to survey data on fertility preferences, which enabled us to identify pregnancies as intended or unintended.
FINDINGS: Abortion rates were significantly lower in the area with better family planning services compared with the comparison area (1984-86, 2.2 vs 5.2; 1996-98, 2.3 vs 6.8). Abortion of unintended pregnancies is similar in both areas, but the higher levels of contraceptive use in the treatment area have led to lower levels of unintended pregnancy and abortion. The likelihood that an unintended pregnancy will be aborted has increased in both areas but the decrease in unintended pregnancies was sufficiently large in the treatment area to offset this increase. INTERPRETATIONS: Abortion may increase during the fertility transition in less-developed countries as the desire to limit family size increases unless there is widespread availability of quality family planning services.