By Melanie Zurek and Courtney B. Jackson
March 23, 2009
Working to reduce abortions, as a strategy to find common ground between the pro-life and pro-choice communities, has recently garnered much attention and debate. Will Saletan's New York Times op-ed, This is the way culture wars end, and Jodi Jacobson's recent piece, Looking for Common Ground on Abortion? You're Standing On It recently took up the proposition. Proponents of this strategy, including Saletan, suggest that abortion reduction makes political sense because it can bring together two historically polarized camps: those who oppose abortion outright, and pro-choice advocates who (rightly) consider abortion largely to result from the need to better prevent unintended pregnancy. According to the abortion reduction proponents, public and political support for contraception, comprehensive sex education and other measures can be expanded if we work toward an ultimate goal of fewer abortions.
Critics of the abortion reduction paradigm (at least within the pro-choice community, including Jacobson), point out shortcomings of this approach: the persistent focus on the fetus and abortion instead of women and women's health and autonomy, the anti-contraception agenda of many in the anti-abortion community, and the fact that not all abortions are the consequence of a failure to prevent unintended pregnancy but instead result from unforeseeable, unpreventable circumstances often relating to the pregnant woman's health. Also of concern to critics of this approach is the promulgation of stigma inherent in a strategy organized around abortion as the common enemy.
Saletan proposes that abortion rates be adopted as a measure of our success promoting contraception. And, indeed, abortion reduction as a guiding principle for women's reproductive health policy has real world implications: if our goal is to reduce abortions, then a lower abortion rate should be the measure. So what smells?
As researchers and advocates we commend the attention to reproductive health, but wonder how we should approach the proposed measure of lower abortion rates. Jacobson presents a compelling argument for better sexuality education and ensuring access to contraception as a way to ultimately reduce abortions. We wholeheartedly support Jacobson's call for improved access to prevention and share her vision that this will ultimately result in a decline in abortion rates, but before we see that decline we may very well see an increase in abortion rates in this country, and that should hardly be regarded as a failure. Here are a few reasons why.
First, we are limited in our understanding of what current abortion rates mean. Does a low abortion rate mean that women aren't having unintended pregnancies? Or is it because they can't - or are too afraid or ashamed to - get the abortion they would choose otherwise? Common sense would suggest that the current multitude of anti-abortion laws might indeed be preventing some women from having abortions - this is, after all, their intent. Examining state differences in abortion rates also provides some insight into what "low" and "high" abortion rates might mean. In 2005, New York had the highest abortion rate (38.2 abortions/100,000 women 15-44) and Wyoming the lowest (.7). What does this mean? Do Wyomingites use contraception more consistently and effectively? Or, do they have difficulty accessing abortion because there are only two providers in the entire state (compared to New York's 261)? It is impossible to view Wyoming's low rate as success without concern that women who need abortion care can't access it.
Aiming for a reduction in abortion also begs the question of what qualifies as a "good" abortion rate. What is our targeted goal? 30/100,000? 20? 10? 0? How will we know that we have achieved a goal that reflects both success in preventing unintended pregnancies but also access to a service that women die trying to obtain?
To use the abortion rate as a valid indicator of success at preventing unintended pregnancy, we must first ensure the accessibility of abortion. We must remove onerous laws and increase the availability of accessible services, and accept that in doing so the abortion rate may first go up. Whatever approach is ultimately taken, ensuring women can access the care they need is the only meaningful starting place.
