I. One In Four Viable Pregnancies in the US Leads to an Elective Abortion According to the Guttmacher Institute, almost one quarter of all viable pregnancies in the United States are electively terminated. In layman’s terms that means that women decide to get an abortion one time out of four when they become pregnant in the U.S.. How is this possible? Almost half of all pregnancies in the United States are unplanned and 40% of these are terminated.
http://www.guttmacher.org/pubs/fb_induced_abortion.htmlThis is not a legal problem. This is not a moral problem. This is not a job for the Church or for Sarah Palin. This is a public health crisis. The cost of contraception is low. Condoms and a spermicidal agent are cheap compared to an invasive procedure to end an unwanted pregnancy. They are cheap even compared to a chemical abortion, since no pregnancy test is required, no medical consultation is needed (both can be obtained over the counter), there is no risk of complications. Contraception does not force a couple to make the difficult decision to choose what they want to do about an unwanted pregnancy---a decision which could have psychological consequences in the future. And yet, according to the study above
46% of the women who sought abortions were not using contraception . A large percentage of those who were using birth control ( mostly condoms or the pill) were using them only sporadically.
There is another public health crisis hiding behind the abortion issue. Condoms also prevent a wide range of venereal diseases which can cause problems ranging from HIV infection (which causes AIDS) to impaired fertility ( from gonorrhea and Chlamydia which cause pelvic scarring) to cancer (viral infections that cause cervical cancer) to problem pregnancies (herpes). While the last two are not always prevented by condoms, their transmission is decreased. The complications of VD drain the nation’s health care resources as well as causing suffering for many men and women. The AIDS epidemic among women of color is just one example of a medical crisis that could be averted by the regular use of condoms. But, if men and women do not think to use birth control to prevent an unwanted pregnancy, how likely are they to use a condom to prevent the spread of venereal disease?
Now, if you are a dirt poor dirt farmers scratching out a living in Africa, you can be excused for not having the money to pay for condoms. However, this is not the case in the United States. Even those who live in poverty can go to Planned Parenthood and get free birth control---as every former college student knows. They hand out condoms like Halloween Trick or Treat candy. So, why don’t Americans bother to prevent unwanted pregnancies? Maybe it is because of the inadequacies of our public health system.
II. Abstinence Only Sex Education: One of the Most Dangerous U.S. Public Health Policies of the Decade Google “Abstinence only sex education versus comprehensive sex education” and you get almost two million hits. That number---the Google Value--- is a semi-official sign of significance, the way that the p-value is a sign of statistical significance. The higher the Google Value is, the more smoke is coming from that fire. Abstinence only sex ed----spending millions to tell kids in high school “Thou shalt not fuck”---is worse than a waste of time and money. It actually encourages unprotected sex.
Here is a very succinct document (single page) with a list of references:
http://www.advocatesforyouth.org/publications/factsheet/fssexcur.htm#referencesEach year, U.S. teens experience as many as 850,000 pregnancies, and youth under age 25 experience about 9.1 million sexually transmitted infections (STIs).<1,2> By age 18, 70 percent of U.S. females and 62 percent of U.S. males have initiated vaginal sex.<3> Comprehensive sex education is effective at assisting young people to make healthy decisions about sex and to adopt healthy sexual behaviors.<4,5,6,7> No abstinence-only-until-marriage program has been shown to help teens delay the initiation of sex or to protect themselves when they do initiate sex.<8,9,10,11> Yet, the U.S. government has spent over one billion dollars supporting abstinence-only-until-marriage programs.<12> Although the U.S. government ignores it, adolescents have a fundamental human right to accurate and comprehensive sexual health information.<8,11>
Other key points:
No highly effective sex education or HIV prevention education program is eligible for federal funding because mandates prohibit educating youth about the benefits of condoms and contraception.
snip
The American Academy of Pediatrics, American College of Obstetricians & Gynecologists, American Medical Association, American Public Health Association, Institute of Medicine, and Society for Adolescent Medicine, among others, support comprehensive sex education, including education about both abstinence and also contraception and condoms.
snip
According to Columbia University researchers, virginity pledge programs increase pledge-takers’ risk for STIs and pregnancy. The study concluded that 88 percent of pledge-takers initiated sex prior to marriage even though some delayed sex for a while. Rates of STIs among pledge-takers and non-pledgers were similar, even though pledge-takers initiated sex later. Pledge-takers were less likely to seek STI testing and less likely to use contraception when they did have sex.
That last study makes sense. If you have pledged that you will not “sin”, then you are not about to compound your “sin” by planning in advance to “sin” with the assistance of effective VD and pregnancy protection. Abstinence only sex ed teaches our youth that sex is a forbidden act that they must approach drunk (so that they can claim later that they did not know what they were doing) and free of condoms (ditto). In effect, it turns all sex into gay sex of fifty years ago, back in the days when "straight" guys would pretend that they were so drunk that they did not know what they were doing. Except that this forbidden sex can get you pregnant.
If I did not know better, I would say that the person who designed abstinence only sex education wanted America’s teenagers to have more unprotected sex and experience more unprotected pregnancies so that the abortion rate would begin to climb, just to give the religious right something to worry about. There has got to be a better way.
III. The Better Way: The Netherlands In this document from the late 1990s, the Guttmacher Institute compares legal and illegal abortion rates from around the world.
http://www.guttmacher.org/pubs/journals/25s3099.htmlThe whole article is worth reading. I am going to focus on just a small part of it. Notice that some of the countries in western Europe which have universal health care also have abortion rates which are much lower than that in the United States. There could be a variety of reasons for this. For instance, some of these are Catholic countries, so religion could be a factor in places like France and Italy (though note the high rates of illegal abortion in many Catholic South American countries where abortion is illegal).
The country I find most intriguing is the Netherlands with an abortion rate of 6.5.
If effective contraceptive use is widespread, abortion rates can be very low even in countries where fertility is low and where the rate of sexual activity among unmarried women is high. The lowest documented abortion rates are in Belgium and the Netherlands, countries that rely on contraception to maintain low fertility. In both countries, abortion services are provided without charge to the woman, and abortion is legal under broad conditions.
People in the Netherlands are not Bible thumpers. They are just as sexually liberated as we are here in the U.S. And yet, they are motivated to use birth control—even though they know they could get a free abortion if they decided not to bother. What gives?
http://www.ncbi.nlm.nih.gov/pubmed/7971545 Special family planning programs in the Netherlands target groups at risk of unwanted pregnancy, particularly teenage pregnancy. Almost all secondary schools and about 50% of primary schools address sexuality and contraception. Sex education has largely been integrated in general health education programs. The mass media address adolescent sexuality and preventive behavior. Very large scale, nonmoralistic, public education campaigns that are positive towards teenage sexual behavior appear to be successful. Teens have wide access to contraceptive services through general practitioners who maintain confidentiality and do not require a vaginal exam and through subsidized family planning clinics.
IV. Sane Public Health Policy Forget the religious right. It exploits the abortion issue as a way to oppress women. The members of the anti-abortion movement have no interest in reducing the number of unwanted pregnancies or cutting down on the number of abortions performed. All they want to do is change the legal abortions to illegal abortions----see the Guttmacher article about world abortion statistics to see how universal the procedure is---which will allow them to criminalize the reproductive lives of women. Evidence of this can be seen in their attacks on contraception (which would reduce the number of unplanned pregnancies and thereby reduce the number of abortions). I have a strong suspicion that Right to Life attracts people who have a grudge against their mothers.
Forget the Republican Party. It loves high abortion rates, which keep the religious right and Right-to-Life voting for the Republican Party. The GOP will enact public health policies (like abstinence only sex ed) that increase teen pregnancy and abortion rates so that they can increase their voting base. They will strip funding from agencies that provide contraceptive services, so that more women will seek abortions for the same reasons. Every abortion that is performed in the United States means more votes for a Republican candidate.
Forget the Catholic Church. Any group that objects to birth control is trying to increase its own membership----and it does not give a damn what the consequences are to the families which can not support huge numbers of children. If you feel sorry for the Catholic Church, go to Rome and see the Vatican Treasures. The Pope won’t go broke if he has a few less Catholics to give him money.
It is up to Democrats to enact some sane public health policies. First, we need
universal health care. Everyone, including teenagers, needs access to a medical provider who can advise about pregnancy and STD and prescribe contraception. Such services need to be available without parental consent, as they are in Texas (the reddest of red states) in order to encourage teenagers to seek them out.
Second, we need to copy the Netherlands and begin a
two pronged health education program. One arm will be a
school based comprehensive sex education class that starts in late elementary school since some girls get pregnant as early at ten. Forget abstinence. Instead, empower teens to
say no if that is what they want but give them the tools to
say yes safely if that is what they choose instead. Surveys show that parents want their kids to be taught about contraception (see the document linked in part II) The other arm should be a
social marketing program designed to counter balance the distorted vision of sexuality which is shown on television and in the movies. Teens and young adults need to be shown positive images of sexuality in which birth control and condoms have a place----rather than always seeing images of impulsive sex that leads to unintended pregnancy that leads to story book happy endings that never happen in real life. Pregnancies and weddings are great plot developments for soap operas but not so great in real life when you are in high school and planning for college.
Finally,
we need to tackle the public health problem which is at the root of this and so many of our medical ills----wealth disparity. Since the 1970s, the United States has gone from having a not so bad wealth disparity for an industrialized nation to having one of the worst. Income disparity is associated with a variety of medical problems including depression, suicide, family violence, drug abuse, alcohol abuse as well as early death from all causes including preventable chronic diseases. People who live in poverty in a land of plenty have an unusually high burden of stress and resentment which affects their health and their attitude towards disease prevention. In addition, societies which tolerate and promote wealth disparity tend to offer fewer services towards the poor, compounding their medical problems.
http://multinationalmonitor.org/mm2003/03may/may03interviewswolff.html Typically when countries are more equal, educational achievement and benefits are more equally distributed in the country. In a country like the United States, there are still huge disparities in resources going to education, so quality of schooling and schooling performance are unequal. If you have a society with large concentrations of poor families, average school achievement is usually a lot lower than where you have a much more homogenous middle class population, as you find in most Western European countries. So schooling suffers in this country, and, as a result, you get a labor force that is less well educated on average than in a country like the Netherlands, Germany or even France. So the high level of inequality results in less human capital being developed in this country, which ultimately affects economic performance.
In a place like the Netherlands, income disparity is not tolerated as it is in the United States. See this poll in which 2/3 of respondents wanted to see differences in income between citizens reduced.
http://www.cbs.nl/en-GB/menu/themas/overheid-politiek/publicaties/artikelen/archief/2007/2007-2292-wm.htmWhen you are not taught from a young age to expect nothing but hard knocks from life, it makes more sense to plan for your future with preventive health measures----like birth control and STD prevention. Especially if your country has an adequately funded public education system to teach you about these things and if there is equal access to health care for all.
V. In Conclusion... Any group that thinks that they will decrease the rate of abortions in the US by passing a law or putting a new Justice on the Supreme Court, is being lead by a fool or a charlatan. As the Guttmacher document about world wide abortion rates shows, countries which make abortion illegal simply make more illegal abortions. If decreasing the total number of abortions each year in the United States is your goal, you will have to work hard and change a lot of things about this country.
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