Across the globe, most countries have moved towards more liberalized abortion laws. However, public opinion on abortion remains divided and dynamic. In Fetal Positions: Understanding Cross-National Public Opinion about Abortion, Amy Adamczyk thoroughly examines cross-national differences in public attitudes towards abortion and uncovers the primary drivers behind varying levels of liberalism across countries. This book fills a significant gap in the literature. Unlike prior studies that focus on single countries or small-scale comparisons, Adamczyk offers the first comprehensive global analysis of public opinions about abortion.

What distinguishes this book is not only its impressive scope but also its careful engagement with a wide range of evidence. Using a mixed-methods approach, Adamczyk draws on the fifth, sixth, and seventh waves of the World Values Survey (WVS)—covering 88 societies and 85% of the world’s population—to disentangle the macro-level forces shaping cross-national variation in abortion disapproval. National religiosity, economic and educational development, democracy, gender inequality, and communist legacies together explain 75% of these differences.

Cross-national surveys often face challenges because respondents interpret questions differently across countries due to language and contextual differences, making direct comparisons difficult. Rather than ignoring this issue, Adamczyk confronts it directly. The author considers linguistic and cultural variation as a potential explanation for some of the more surprising findings—particularly regarding abortion attitudes in China and former Soviet Union countries. To explore how specific historical and cultural contexts shape public attitudes, Adamczyk complements the cross-national analysis with in-depth case studies of China and the United States. By examining each country’s family-planning history, political regime, laws, policies, economic development, gender relations, and social movements, alongside 40 expert interviews, she clarifies how public opinion on abortion is formed in China and contrasts it with the United States, where public attitudes and abortion laws have increasingly diverged in recent years. Finally, Adamczyk analyses 800 newspaper articles from 41 countries to examine how democratic contexts shape media communication on abortion. Together, these diverse sources demonstrate the book’s robust multi-method design.

Adamczyk organizes the book around a set of counterintuitive findings that challenge widely held assumptions about abortion attitudes. One unexpected finding is that specific religions—Hinduism, Buddhism, Islam, Christianity, and Judaism—do not differ markedly in their disapproval of abortion, unlike their distinctive positions on other sex-related issues. Instead, both individual-level religiosity and the overall religious significance of a country exert a stronger influence on attitudes towards abortion than formal religious affiliation. Adamczyk convincingly demonstrates this “macro–micro link” by showing how national religious contexts shape individuals’ views regardless of their personal religious identities.

The comparison between China and the United States is particularly revealing. In China, the absence of a dominant organized religion and the legacy of the one-child policy mean that religion plays a far more limited role in shaping abortion attitudes. Chinese women tend to draw on the pragmatic and therapeutic aspects of religion to manage negative emotions related to abortion. In contrast, for American women, religion often amplifies guilt rather than alleviating it.

The book also highlights how national education levels and economic development moderate the relationship between personal religious beliefs and abortion attitudes. When examined independently, higher education and wealth at the individual or the country level unsurprisingly correlate with more liberal views on abortion. However, when personal religiosity is considered alongside these macro-level forces, Adamczyk supports the antiascetic hypothesis: gaps in abortion disapproval by levels of religious importance are considerably wider in highly educated and affluent countries than in less developed ones. She explains this by arguing that personal religious beliefs guide individuals’ abortion attitudes more strongly when broader societal norms are ambiguous or less clearly defined. Comparative analysis between China and the United States further demonstrates how economic pressures and policies shape the frameworks through which individuals interpret abortion.

Adamczyk is among the first to demonstrate a clear relationship between democracy and abortion attitudes. Statistical analysis shows that people in democratic nations are more supportive of abortion, suggesting that democratic ideals foster equality, citizen rights, and freedom. In analysing China, she finds another counterintuitive trend: unlike the neighbouring countries, Chinese people’s attitudes towards abortion have become drastically more conservative over time. She links this to shifting perceptions of the one-child policy and unique interpretations of survey questions in the Chinese context. Insights from her newspaper analysis underscore how the information environment shapes attitudes. Chinese media is heavily regulated, whereas Americans’ exposure to diverse perspectives is more subtly constrained by platform algorithms.

In the chapter on gender inequality, social movements, and race, Adamczyk examines how gender and racial dynamics shape public attitudes towards abortion. She traces the ways gender inequality informs sex-selective abortion, stigma, health concerns, and norms around unmarried childbirth in China, while also illuminating the tension between broad public support for abortion and recent legal restrictions in the United States. In the United States, she explores how pro-life and pro-choice movements intersect with gender inequality and, in some contexts, with white nationalist ideologies.

Adamczyk also analyses abortion-related histories in the Soviet Union and former and current communist countries. Despite high abortion rates in the Soviet Union, some former communist countries now express conservative attitudes. Adamczyk attributes this to alternative survey interpretations and persistent “Soviet habits.” Similarly, she finds that Confucian nations exhibit more opposition to abortion even after accounting for low levels of religious importance. Testing results based on WVS data do not suggest that these conservative attitudes are associated with Confucian values (e.g., obedience, family importance, and sexual morality). Adamczyk attributes this conservativeness to survey limitations, health concerns, and the extensive influence of China’s one-child policy, rather than Confucian values per se.

In the concluding chapters, Adamczyk shifts from attitudes towards behaviour, extending her comparative framework to cross-national abortion rates. This analysis yields several counterintuitive insights. She finds that neither abortion laws, public attitudes, nor national religiosity reliably predict national abortion rates. Likewise, highly religious societies do not exhibit substantially lower abortion rates than more secular ones. Drawing on US data, Adamczyk further demonstrates that religiosity reduces abortion risk primarily by lowering the likelihood of premarital sex and nonmarital pregnancy rather than directly discouraging abortion itself.

Overall, Fetal Positions represents a groundbreaking contribution to understanding how macro-level forces shape public opinion on abortion. While collecting reliable cross-country data on abortion remains challenging, this work demonstrates how creative use of multiple methods can make hard-to-reach questions accessible. Adamczyk’s comparative analysis of China and the United States is especially insightful, illustrating how contrasting histories, traditions, policies, religions, and cultures shape attitudes in ways that survey data alone cannot capture. While the expert analysis is thorough, the book suffers from a lack of non-expert perspectives. The findings, especially the counterintuitive findings I introduced above, would carry far more weight if they were balanced with, or tested against, the experiences and opinions of regular people. More broadly, the book provides a rich conceptual and empirical toolkit for scholars seeking to make sense of the politics of reproduction in a rapidly shifting global landscape. Its clear writing, thoughtful design, and creative use of diverse sources make it valuable not only to scholars but also to teachers, students, and anyone interested in the study of religion and public opinion.