An American blog by a relatively unknown author about the goals of the pro-life movement went viral recently, racking up around 100,000 hits in a mere two days.
The blog questioned the selective and inconsistent use of scientific information to promote the pro-life ideology and suggested the real agenda of the pro-life movement was the control of sexual behaviour. The motivation behind the objection to abortion, it said, seemed to be about forcing women to suffer the consequences of promiscuous sexual behaviour.
This is not a new idea. There is a long tradition of scholarship drawing attention to the possible motives of those who seek to constrain women’s sexual behaviour.
There have also been some spectacular recent instances of ideology masquerading as scientific evidence when politicians have attempted to weigh into debates about women’s access to abortion and contraception. United States Republican Todd Akin, for instance, declared that a woman would be unlikely to become pregnant as a result of a “legitimate rape” because “the female body has ways to try and shut the whole thing down”.
New Zealand’s Colin Craig claimed that research showed New Zealand women were the most promiscuous in the world and argued against the government subsidising long-acting reversible contraception for women on welfare benefits who “choose to sleep around”. The New Zealand government was also criticised for attempting to regulate women’s reproductive choices and “autonomy”.
It seems that in matters of sex, contraception and fertility control, you just can’t win!
There is no point in attempting to referee a clash between pro-life and pro-choice ideologies. Each side attempts to outdo the other in the battle for hearts and minds by hurling chunks of scientific evidence and declarations of violations of human rights in equal measure. Opinions that are based on deep-seated values and ideological positions are not swayed by appeals to logic, rational argument or science. Debate simply applies bellows to the already white-hot fire of emotions.
Let us take a step back and examine the issue of unintended pregnancy – an issue that may be just a little bit easier to discuss rationally than abortion.
What are the problematic aspects of an unintended pregnancy from a population health perspective? (Ignore for a moment the obvious conclusion that someone has been having sex - we’re trying to focus on broader health outcomes). Why don’t we ask a different question: why are intended pregnancies a good idea for public health?
The answer is that when someone plans a pregnancy (men should be involved in such planning too) they can do lots of things to boost the likely health outcomes for themselves and their child-to-be. They can have a pre-conception consultation with their doctor, eat more healthily, take folic acid, make sure their vaccinations are up to date and generally prepare their bodies for the task of producing healthy eggs and sperm, maintaining a pregnancy, delivering a baby and bringing up a child.
Emerging understanding about the importance of the fetal environment for the future health of the child as an adult suggests that there is a potentially significant benefit of planned pregnancies to population health and consequently to health-care budgets.
I’m not saying that unintended pregnancies can’t result in healthy babies – it’s just that if there’s a choice, you’d probably prefer to have a planned pregnancy.
The answer? More effective contraception
As the US blog author discusses, the best way to avoid an unintended pregnancy is to use effective contraception. In fact a recent paper published online in Obstetrics & Gynecology demonstrated the potential reduction in abortion rates, repeat abortions and teenage birth rates after a trial involving the promotion and provision of free long-acting reversible contraceptive methods.
Long-acting reversible contraceptive methods are not user-dependent and have a very low failure rate (less than 1%). Options include the implant and IUDs (copper and hormonal). More options are under development.
So, if we want to reduce the abortion and unintended pregnancy rate we should be promoting long-acting reversible methods of contraception. Clinical guidelines recommend this as best practice.
Both “sides” in the abortion debate have good reason to promote reductions in unintended pregnancy through effective contraception.
Even though many pro-life advocates also promote abstinence except within marriage, most people simply don’t do this. And only having unprotected sex within marriage still puts the couple at risk of an unintended pregnancy. Therefore, if the goal is to limit abortion rates, the promotion of contraception should be a key pro-life strategy.
For the pro-choice side, unintended pregnancy by definition is not a woman’s choice. Anything that increases a woman’s ability to control her own fertility enhances her choices.
Unfortunately, a recent analysis of Australian data from the Bettering Evaluation and Care of Health (BEACH) study found that a shift towards prescribing long-acting reversible methods of contraception, according to best practice guidelines, has not yet occurred in Australia. The authors suggest general practitioners may not be familiar with the newer methods of long-acting reversible contraception.
If women are to have easy access to the most effective methods of contraception, they need to be available at local health services.
Decisions about sex, whether and when to have children, use of contraception and abortion are made by individuals in the context of their complicated lives. We cannot make decisions about pregnancy for other people – that is their individual responsibility.
Rather, it is our collective responsibility to ensure that everyone has tools to prevent unintended pregnancy. Let’s start by increasing the availability of long-acting reversible methods of contraception.