Taboos: Face it - abortion is now a fact of life

A high abortion rate is a symptom of a society in which women want to combine a sex life with ambition, suggests Ann Furedi

Nobody is entirely sure why the number of abortions continues to rise. It is not simply a matter of demography. Throughout the 1980s increased numbers of abortions were largely due to an increased number of fertile women in the population, as the 1960s baby boom generation reached reproductive age. From 1990 to 1995 the rate of abortions slowly but surely fell, and when in 1996 the trend was reversed and the abortion rate shot up, there seemed to be an obvious explanation.

In October 1995, the safety of the contraceptive pill was questioned in a manner that led to one of the biggest-ever health panics. In response to government-sponsored health warnings about the risk of thrombosis, tens of thousands of women needlessly abandoned their preferred method of contraceptive. It was no surprise that thousands of unplanned, unintended pregnancies resulted - and it was no surprise that many of these ended in abortion. Previous contraceptive scares had had similar effects. But what was surprising was the abortion rate failed to go down again afterwards. In the case of previous scares, the abortion rate had risen and then gradually returned to the status quo ante as women drifted back to the pill. The shared assumption that this would happen again has turned out to be false.

It may be that the 1995 pill scare has had a more durable effect than have those in the past. Brook Advisory Centres, a network of teenage sex centres, report that their clients are still reluctant to believe that the pill is as safe as it is effective. Articles in women's magazines are more likely to question the need for what they perceive to be high-tech hormones, than to celebrate their advantages over less effective, less convenient methods of birth control. But it seems likely that there are other factors at play, and it may well be time for advocates of fertility control to stop wringing their hands about increased numbers of abortions and face the fact that abortion has become acceptable and necessary.

It is time everybody accepted that abortion has a place in fertility regulation. It is a method of family planning, if by that we mean that abortion is used by women to control whether or when they have children. Women may not intend to rely on abortion as a means of family planning, but in reality that is often the way it works out and the elevated rate of abortions may reflect that.

Women today expect to have control over their fertility and are expected to control their fertility. The desire to regulate when, or if, we have children is not a radical issue any more. The need for 'family planning' is universally accepted, even among the most conservative thinkers.

Women cannot manage their fertility by means of contraception alone. Contraception fails, and couples fail to use it effectively. A recent survey of more than 2000 women requesting abortion at clinics run by the British Pregnancy Advisory Service (BPAS), Britain's largest abortion provider, found that almost 60 percent claimed to have been using contraception at the time they became pregnant; nearly 20 percent said they were on the pill. Such findings are comparable to several other smaller studies published during the past decade.

The number of women who claim they experienced a split or slipped condom, or missed just a couple of pills, is undoubtedly inflated. Unprotected sex is a no-no and some women may falsely claim to have used contraception, believing that they will be treated more sympathetically if people think they did everything possible to prevent the pregnancy. But even so, it is clear that contraceptives let couples down. Whether the pregnancy occurred because the condom split or because the couple failed to get it out of the packet is of less importance to a woman needing an abortion than it is to family-planning professionals. The simple truth is that the tens of thousands of women who seek abortion each year are not ignorant of contraception. The majority have tried to use it and, indeed, may have used it and become pregnant regardless.

Whatever misgivings they might express, women's need for abortion is implicitly understood by policymakers and legislators - that is why abortion is provided at NHS hospitals throughout the country. Attitudes to abortion exist as part of a web of other ideas that interface with contemporary social values on issues such as poverty, perceptions of women's role in society, the value of parenting, and even global issues such as the environment and overpopulation. There is a general acceptance throughout most Western societies that women should expect, and be expected, to make a broader contribution to society than solely devoting their life to bearing and caring for the next generation. Motherhood is still regarded as 'natural' at some time in a woman's life, but most people assume that motherhood will be an interval sandwiched on both sides by an income-generating job if not a career. Girls from appropriate (middle class) backgrounds are expected to progress to a university education.

Society currently places a high premium on planned parenthood. There is a strong belief that children should be wanted, and that parents should be able to support them and be willing to make sacrifices for them. Growing social concern about 'unfit' or 'problem' parents does not easily coexist with a disposition to force people to bear children they do not want and, by their own admission, cannot care for. This ethos creates a framework whereby abortion can in some circumstances be perceived as a 'responsible choice', even by social conservatives who would disapprove of abortion in principle.

In almost all developed countries, the laws which regulate abortion allow women to end unwanted pregnancies in early pregnancy, usually restricting the criteria after 10 or 12 weeks. In the USA, Roe v Wade protected a woman's right to decide whether to terminate her pregnancy in the first trimester, deeming it to be a part of her constitutional right to privacy. Countries as diverse as Turkey, France, Norway and Austria also allow abortion on request in early pregnancy. Although British law does not allow abortion on request at any time in pregnancy, it is considered acceptable and appropriate for doctors to refer women for an abortion, on the grounds that it would be damaging to their mental health if they were denied it.

Surveys of public opinion suggest widespread tolerance of legal abortion. A national opinion poll carried out two years ago by MORI, Britain's main polling agency, found that 64 percent of those asked agreed with the statement: 'abortion should be legally available to all who want it.' Twenty-five percent disagreed. The remainder neither agreed nor disagreed, or said they did not know. The proportion of those who agreed had increased by 10 percent since 1980. Birth Control Trust, for whom the poll was commissioned, suggested that this demonstrated a growing acceptance of legal abortion, and a widespread belief that the law should not be used to prevent women ending pregnancies.

Women today are at particular risk of unplanned pregnancy. Sex is an accepted part of an adult relationship for which we do not expect to suffer unwanted consequences. And pregnancy is seen by an increasing number of women as an unwanted consequence to which they are not prepared to adapt. The fact that more women now delay starting a family until they are in their thirties, and that many are deciding to opt out of parenthood altogether, suggests increased numbers of sexually active women who do not want a child. Is it any wonder then that the number of abortions remains relatively high?

The abortion rate may not be a sign of the failure of sex education and family-planning programmes. It may be a symptom of a society where women wish to combine a sex life with ambition. It may be that an increasing number of women are unprepared to allow an unplanned pregnancy to dictate their lives. It may be that policymakers should stop using the abortion rate as an indicator of a problem. Of course it is preferable for unwanted pregnancies to be prevented rather than ended. Abortion is safe, but contraception is safer and more convenient. It may be time to understand that, for women, abortion is an essential method of family planning and accept it as such.

Ann Furedi is director of communications for BPAS
BPAS abortion action line
Phone 08457 30 40 30 for an appointment

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