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How should we respond to abortion statistics?

People worry about numbers because they worry about abortion. Flickr/Artnoose

Each year the release of the Abortion Statistics for England and Wales gives an interesting snapshot of how Britain fits into wider international struggles over reproductive justice and abortion rights.

In Ireland, the government finally passed legislation recognising a woman’s right to life-saving abortion, 21 years after the Supreme Court called for action. In Texas, Wendy Davis’s attempt to halt more restrictive abortion legislation ended in an 11-hour filibuster, though this ultimately proved unsuccessful.

In England and Wales, the consensus is generally in favour of access to abortion, but the policy debate tends to contest particular kinds of abortion. For example, a parliamentary inquiry recently recommended that abortion for a foetal abnormality be reviewed. Currently, abortion is allowed throughout pregnancy if there is a risk that the child will be disabled. In other circumstances, such as a risk to the woman’s physical or mental health, the legal limit is 24 weeks.

Each year, the statistics are scrutinised as the debate rages over whether some abortions are worse than others.

Facts and figures

By counting abortions and documenting details such as how a pregnancy is terminated, the woman’s age, how far along the pregnancy is and the grounds for termination, the abortion statistics generate important factual information about the abortion-using population.

But the numbers quickly get caught up in claims about the merits of particular abortion trends. Last year there were 185,122 abortions in England and Wales. Some commentators have focused on the 2.5% reduction in the overall number and on the decrease in the number of teenagers involved.

Other have expressed concern over the apparent rise in so-called “repeat abortions”: 37% of women who ended a pregnancy in 2012 had had a previous abortion. But the statistics also show that 52% were already mothers. So should we be concerned about women having more than one abortion?

Word association

We’re still using language that associates women’s body choices with criminality. Flickr/Inrepose

“Repeat abortion” is itself a debated term. For a start, using language that associates abortions with criminality through an implied connection between “repeat abortion” and “repeat offence” suggests a cause for concern.

But this language is counter-productive, which is why reproductive health advocates reject the term. It doesn’t make the case as to why more than one abortion should be a public health concern.

Interestingly, the criminal characterisation of abortion goes against the dominant trend of medicalisation and decriminalisation in practice.

This criminal association ought to be rejected for all the reasons criminalisation of abortion ought to be rejected. It’s a disproportionate response to any defensible concern for foetal protection. It produces more harm than good since women will find a way to end their unwanted pregnancies, and will do so unsafely and at greater personal cost.

Reducing harm

One reason why people worry about recurring abortion is simply because they worry about abortion. While there may be regrettable individual instances of women being harmed by abortion because it was the wrong decision for them, the general evidence is that safe abortion reduces harm to women’s health and well-being.

Some argue that abortion is harmful to the embryo or foetus. But if we take the view that living beings require sentience before they can be harmed, then current legal limits are appropriate. The Royal College of Obstetricians and Gynaecologists concluded that foetuses may not be sentient all through pregnancy and cannot be sentient before the 24th week of gestation.

A rise in the number of re-occurring abortions should not be a public health concern if the abortion itself is unharmful and justifiable. Health governance should focus on reducing the conditions that make some abortions harmful, rather than assume that all re-occuring abortions are harmful. And reproductive decisions which can harm you are still decisions that adults have a moral right to make.

Separate consideration

Abortions that are characterised as “repeat” may not actually be repeats in any meaningful sense. Imagine that at 35, a woman finds herself ending a wanted 16-week pregnancy on discovery of a foetal congenital abnormality. When she was 20 she had a termination of a nine-week pregnancy because distress threatened her mental health. Her second experience is not a “repeat” of the first.

And over a woman’s 30-year reproductive lifespan, very few terminations will be “repeats” in this sense, as reasons and circumstances will vary.

Abortion as healthcare

A recurrence of abortion could be a public health concern if it means that a woman’s healthcare needs were unmet in some way. More than one abortion in a reproductive lifespan could be a sign of failed contraceptive methods. But the solution here is to improve access to contraceptive care.

Another factor is that with the “abortion pill”, also known as early medical abortion (EMA), the boundary between abortion and contraception is less clear cut.

In England and Wales in 2012, 77% of abortions occurred at less than 10 weeks gestation, and 48% of abortions were medical abortions.

Early medical abortion through a pill is safe and used early. PA/Julien Behal

It’s clear that women are taking drugs to interrupt their pregnancies - under medical guidance - in the first few weeks of pregnancy. EMA may seem more like contraception because it’s medication and because it works so close to conception.

The good health record of EMA means that there is now less reason for concern when women choose this kind of abortion over contraception as their reproductive health care. Abortion may also be preferable to contraception for some women if there are other contraception-related factors that may harm her health and well-being.

Counting abortion and abortion details is incredibly useful as it generates data that challenges stereotypes and helps improve reproductive healthcare. The number of a particular kind of abortion is just that, a number. We need to know a lot more about the reasons, circumstances and effects of each abortion experience before we can conclusively argue a cause for concern.

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