Fetal Positions: Understanding Cross-National Public All PostsOpinion about Abortion

Author: Amy Adamczyk
Publisher: Oxford Academic Press, 2025. 328 pages.
Reviewer: Brittany Hayes | Spring 2025

In Fetal Positions: Understanding Cross-National Public Opinion about Abortion, sociologist Amy Adamczyk delivers a timely and deeply analytical exploration of one of the most polarizing issues in contemporary society: abortion. Adamczyk leverages an analytical framework that integrates measurable trends with contextual depth well-situated in theories of cultural sociology, opportunity, social learning, and social control. By providing a global lens on a local debate, she attempts to answer the deceptively simple question: why do attitudes toward abortion vary so dramatically across the globe?

Adamczyk rigorously analyzes multi-level data from over 200,000 individuals across 88 countries to answer this question. Such a sample is not only massive, ensuring adequate power at both levels of analyses, but includes a range of nations across levels of economic development. Indeed, expanding the lens outside the Global North is a crucial step to understanding public opinion about abortion across the globe. Adamczyk meticulously demonstrates the reliability and validity of the measures she includes in analyses. Relying on predicted probabilities, Adamczyk sheds light on the substantive significance of the statistically significant quantitative findings.

Adamczyk then triangulates the patterns observed within the quantitative data with in-depth interviews with Chinese and American participants and a media content analysis of over 800 newspaper articles from 41 countries. By weaving together patterns observed within the numerical data and rich qualitative insight on processes gleaned through her interviews and the media content, Adamczyk highlights how both macro-level forces – like religion, democracy, and gender norms – and micro-level qualities – like gender, personal religious beliefs, and education – shape attitudes on abortion.

An essential first step is understanding why attitudes matter. Public opinion about abortion impacts how societies perceive women who get abortions, if women disclose that they had an abortion, and whether a safe abortion is even an option. All of these factors have an impact on women’s health and well-being, along with the stigma and shame associated with abortion. It also raises the question of whether policies reflect the behaviors of constituents. Indeed, attitudes do not always predict behavior, and one’s behavior does not always align with their attitudes. While abortion legislation appears to be liberalizing, suggesting greater support across the globe, some nations are not marching in that direction. Adamczyk considers the reasons why this may be the case.

The book is structured around six core themes. Each of these themes is explored in a dedicated chapter.

1. Religion: Adamczyk finds that religious importance at both the individual and country level is the strongest predictor of abortion disapproval. Demonstrating a religious contextual effect, living in a religious country, regardless of one’s own religious belief, matters regarding abortion disapproval! In one of the most interesting findings, individual religious affiliation does not seem to affect abortion disapproval. This is likely because of the proscriptions against abortion across all the world’s major religions. At the national level, Catholic-majority countries tend to exhibit higher levels of opposition to abortion, though this relationship is mediated by other factors such as education and economic development. While religion is a crucial and decisive link in understanding attitudes about abortion, these findings nevertheless highlight the complexity of this relationship.
2. Economic and Educational Development: Wealthier, more educated populations tend to be more supportive of abortion. The same is true of individual education, wealth, and support for abortion. Adamczyk, nevertheless, is again careful not to oversimplify this relationship. She notes that economic development, which can lead to normative ambiguity, boosts the role of individual-level factors, like religious importance.
3. Democracy, Laws, and Policy: Democratic nations tend to have more pro-abortion laws. Further, residents residing in democratic nations are also more likely to have supportive attitudes toward abortion. However, this is not universal. For example, Poland and the United States both have democratic systems but have made vastly different changes to their abortion policies than other democratic nations, like Ireland and Italy. The former have dramatically reduced access to abortion while the latter have liberalized their policies around abortion. In the following chapter, Adamczyk explores in-depth the role of social movements that may be at play in these nations.
4. Gender Equality and Social Movements: While at first glance there does not appear to be much difference between men and women and their support of abortion, Adamczyk demonstrates that religious importance moderates this association. Residents living in countries with higher levels of gender inequality are more likely to disapprove of abortion. Using the United States as a case example, Adamczyk unpacks the forces, including social movements, that led to major changes in women’s constitutional right to an abortion. That is, patriarchy and misogyny still matter in shaping attitudes toward abortion.
5. Cultural Values and Historical Legacies: In this section, Adamczyk considers competing influences on attitudes toward abortion, including the role of Communism, which was deeply entrenched within the Soviet Union. In a counterintuitive finding, given the Soviet Union’s history around abortion, whereby it was routinely used as a form of birth control, residents of former Soviet nations were less likely to approve of abortion. Adamczyk proposes novel explanations linked to the validity of the question wording and nationalism, aligning with arguments presented in Chapter 4. Adamczyk also examines the paradoxical finding that Confucian societies are more opposed to abortion once national religion importance is considered. Adamczyk considers different mechanisms for this association, including residents of Confucian nations’ focus on maintaining healthy bodies and the potential role of the one-child policy in shaping attitudes. Finally, she tests the robustness of findings from Chapters 1 – 4 with close to 30 additional country characteristics related to religion, economics, population, fertility, education, and health. None are significant in a cross-national context. This section highlights how state policy and cultural norms interact in complex ways while also acknowledging the reliability and validity of the public opinion measure on abortion.
6. Abortion Behavior and Attitudes: In contrast to prior chapters, this one shifts the lens to abortion behaviors, suggesting a disconnect between belief and behavior shaped by access, stigma, and legal frameworks. Counter to misconceptions, legislation on abortion, abortion disapproval, and religious importance are not associated with abortion behaviors. Instead, levels of development and gender equality are critical national factors for reducing unintended pregnancies. This finding reinforces the need to collect and analyze data outside the Global North. To do this, Adamczyk leverages a series of quantitative datasets to examine how personal characteristics shape abortion behavior. Across six developing nations (i.e., India, Albania, Cambodia, Cameroon, Cote d’Ivoire, and Indonesia), women who had at least one child, money, education, and lived in an urban area were more likely to have had an abortion (though there was variation by nation). Each of these personal characteristics may make an abortion seem more desirable. While the data from the developing nations cannot explore the pathway – unintended pregnancies – U.S.-based data showed more religious women had more conservative sex behaviors, lowering the odds of an unintended pregnancy and, consequently, the need for an abortion. It is nevertheless important to note that whether a woman already has a child “radically complicates” the abortion decision.

Through the presentation of the themes across the chapters, Adamczyk engages in a comparative case study of the United States and China. This is a deeply powerful thread throughout the book. Within the United States, abortion remains a divisive issue entangled with religion and politics. Yet, China has treated abortion as a largely settled issue, one not openly discussed in public. Adamczyk argues that China’s one-child policy was a significant factor in abortion approval. Despite the differences across these two nations, there are surprising similarities. Participants across both nations framed their views on abortion around morality, responsibility, and family.

Fetal Positions brings insight to the abortion debate, but on the global stage. It does so by leveraging one of the only data sources that can provide this cross-cultural analytic comparison on abortion approval and by integrating crucial perspectives. As a methodologically rich undertaking, Fetal Positions affirms the importance of mixed methods in sociological research centered on public health concerns that cut across cultures.

Brittany E. Hayes is an Associate Professor at the University of Cincinnati.