Abortion Down, Contraception Up: Recipe for Health Reform?

A new report shows that abortions have dropped worldwide because of increased use of contraception.

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Global abortion rates are down—from an estimated 45.5 million in 1995 to 41.6 million in 2003, according to a report issued Tuesday by the Guttmacher Institute, a nonprofit research center that supports abortion rights. A key reason for that drop, the report said, was that the proportion of married women using contraception worldwide increased from 54 percent in 1990 to 63 percent in 2003 as pregnancy prevention methods became more available and socially acceptable.

That's the good news.

The bad news is that unsafe abortions kill 70,000 women a year, mostly in poorer countries with strict antiabortion laws. African countries, where only 28 percent of married women use contraception, have some of the highest rates of unsafe abortions. Most of these are performed by women themselves or by untrained traditional healers. The report included the story of a Nigerian woman who first tried to induce an abortion by drinking an herbal concoction, then consulted a healer who inserted leaves in her vagina, causing internal injuries. It's reminiscent of the wire-hanger attempts to terminate pregnancy in this country before abortion was legalized nationwide in 1973.

The Guttmacher report also found that total abortions occurred at "roughly equal rates" in countries where they are legal and where they are highly restricted, which means that laws outlawing abortion are serving only to drive women to have the procedure in riskier places and with riskier methods. But at a news conference in London, Guttmacher president Sharon Camp cited the Netherlands as an example for all other countries to follow. It has the lowest abortion rate in the world: about 1 percent of women have had an abortion in the past year compared with a worldwide average of about 3 percent.

The Dutch? With their legalized prostitution and ultraliberal abortion laws? How can that be? I did a little research and found out that the Netherlands has not only the lowest abortion rate but the lowest rate of teen pregnancy. In fact, the country has held this distinction for decades. Researchers credit strategies like sex education in schools, discussion of sexuality in the mass media, and easy access to contraception. One study pointed out that "acceptance of contraception preceded liberalization of abortion" and that Dutch citizens accept "abortion only as a last resort."

Also a biggie: inclusion of family planning services as part of the Dutch medical system. Hmm. Full coverage for birth control pills, IUDs, and vasectomies? Sounds like a must in our healthcare reform bill. In fact, I'm wondering if all of the raging arguments concerning abortion coverage in health reform aren't a little misguided. Perhaps pro-choice and antiabortion activists should unite to wage a push for comprehensive family planning services. After all, both groups say they want to lower the rate of abortions, and research suggests those programs, rather than restrictive laws, are the way to achieve that goal.

This poll is now closed, but the debate continues in the comments section.

Do you think contraception coverage should be included in health reform?

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