Abstract
Few issues generate as much global debate as abortion. In some countries, it dominates politics, mobilizes activists, and fills court dockets. In others, it scarcely registers as a public concern, treated instead as a private health matter or a settled issue. Amy Adamczyk’s Fetal Positions: Understanding Cross-National Public Opinion about Abortion sets out to explain these differences. Why do abortion attitudes vary so widely across the globe? What explains why some nations relax restrictions while others remain firmly restrictive?
Her answer is ambitious yet straightforward: abortion attitudes are not random but patterned. They are shaped by religion, development, democracy, communism, history, and gender inequality. Remarkably, this book is the first large-scale attempt to make sense of abortion attitudes across dozens of societies—filling an important gap in the literature. Fetal Positions makes a major contribution through survey data, case studies from the United States and China, and a media analysis spanning more than 40 countries.
Adamczyk’s goal is to explain broad patterns in abortion attitudes across the globe. She argues that public opinion is shaped by enduring religious, cultural, and political structures, not simply individual preferences. To build this case, she employs an explanatory sequential design, starting with large-scale survey analyses, followed by qualitative case studies, and concluding with an analysis of media discourse.
The backbone of the book comes from data from the World Values Survey (WVS), which, since 1981, has gathered responses from more than 200,000 people in 88 societies, covering about 85 percent of the world’s population. It is supplemented by 40 expert interviews in the United States and China. The book also draws on an ambitious media analysis of 810 hand-coded English-language newspaper articles published in 2018 across 80 outlets in 41 countries. Together, Adamczyk’s triangulation of surveys, interviews, and media connects individual attitudes to broader institutional contexts and shows how abortion is framed, contested, or ignored across societies.
The scope is remarkable and is organized around the major factors shaping abortion attitudes. Chapter One looks at religion, Chapter Two at economic and educational development, Chapter Three at governments, Chapter Four at gender inequality and racial and ethnic differences, Chapter Five at more than 30 other macro-level factors; and Chapter Six shifts the focus from attitudes to abortion decisions.
Across 88 societies, Adamczyk shows that the importance attached to organized religion is the strongest predictor of abortion disapproval. Gender inequality is nearly as influential, shaping both attitudes and legality. Strikingly, neither legislation, disapproval, nor religiosity predicts actual abortion rates. Instead, rates reflect the prevalence of unintended pregnancies, themselves driven by development and gender inequality. This finding is especially relevant in the United States after Dobbs v. Jackson, where restrictive laws in some states are proliferating in an effort to reduce the number of abortions. Adamczyk shows that such laws are unlikely to achieve that aim.
The interviews highlight how abortion is politicized in the United States but treated more pragmatically in China, though stigma, inequality, and policy matter in both contexts. The media analysis shows that democratic societies frame abortion through a wider range of lenses—gender equality, rights, religion, morality—while coverage in less democratic contexts is narrower. Together, these findings situate individual attitudes within broader cultural narratives and institutional environments.
Despite its breadth, Fetal Positions combines methodological rigor with accessibility. The book triangulates across diverse data sources, connects macro structures to micro attitudes, and offers a longitudinal view of change—all presented in an impressively clear and well-organized style. Adamczyk avoids jargon and explains her statistical analyses and findings clearly. I appreciated her decision to use marginal effects plots, scatterplots, and line graphs in the main text rather than dense regression tables. These make it easy to see patterns across countries and over time. The statistical methods are rigorous—using multilevel mixed models and accounting for both individual- and country-level variables—but the presentation is rarely overwhelming. The book is also well grounded in established theoretical frameworks and empirical testing. The integration of qualitative data—interviews and newspaper analyses—strengthens the arguments by situating statistical patterns in real-world contexts.
There are, of course, limitations. The WVS question on abortion—asking whether it is “justified” on a ten-point scale—restricts analysis to moral judgment and cannot capture views on legality, context, or timing-specific circumstances. Self-report surveys are also shaped by political climates, and measuring religiosity consistently across cultures is difficult. The case study selection for the interviews and media analysis is narrow. Many of these constraints stem from the available data rather than the author’s choices, and Adamczyk is transparent about them. The consistency of her findings across multiple methods makes them persuasive, nonetheless.
The book makes a clear contribution by showing that abortion attitudes follow systematic patterns shaped by religion, politics, and gender inequality, rather than being merely the sum of individual beliefs. For scholars of religion, the global evidence that religiosity predicts disapproval is especially compelling. For gender scholars, the strong association between gender inequality and abortion attitudes shows how inequality shapes reproductive politics. For political scientists and health researchers, the finding that laws do not predict abortion rates upends assumptions about how policy affects behavior.
The book also provides a powerful perspective on change over time. Abortion laws have generally become more liberal, but the process has been uneven and nonlinear. Adamczyk situates these shifts in relation to religion, development, and inequality, explaining why abortion remains contested even in wealthy, educated nations like the United States.
The timeliness of the book cannot be overstated. In the United States, debates have intensified since Dobbs v. Jackson, as the decision has sharpened polarization and spurred legislative changes and a wave of state-level ballot initiatives. Adamczyk’s global perspective reminds us how unusual the United States is in its polarization. China provides a striking contrast, where abortion has been treated largely as a policy regulation rather than a moral battle. Latin America and Europe illustrate how declines in religiosity and changes in gender norms can produce rapid shifts in both attitudes and law.
Fetal Positions will be valuable in the classroom as well as for research. Its accessible writing and comparative evidence make it an excellent fit for advanced undergraduate and graduate seminars in sociology of religion, gender, and politics. At the same time, the book underscores the need for future cross-national surveys that can capture more nuanced questions across dimensions. In this sense, Adamczyk offers both a foundational analysis and an invitation for further research.
Fetal Positions is a landmark contribution to the study of abortion, public opinion, and cross-national comparison. Adamczyk tackles an ambitious project with clarity, rigor, and unusual breadth. While the measures available in cross-national surveys are imperfect, and the case studies cannot capture all the global variation, the book succeeds in showing that abortion attitudes are not random but are structured outcomes of histories, institutions, and inequalities.
At a moment when abortion dominates headlines in some countries and is scarcely discussed in others, Fetal Positions provides a timely reminder: understanding abortion requires a global lens. Where people stand on the issue depends not only on personal conviction but also on the cultural and political worlds in which those convictions are formed.