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Does the decline in abortion rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?

Written by Yvonne Hamby for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The latest Centers for Disease Control and Prevention (CDC) figures indicate not only the lowest current rate of abortion in the United States, but also the largest drop in the rate in 10 years. It will be difficult to determine the precise reason for this trend. As with most public health issues, but especially those that relate to sexual and reproductive health, there are myriad of potential explanations for the decline. The most important questions we need to ask now are: Does the decline in abortion rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?

Researchers have shared several theories behind the decline. Some believe the economic recession has affected reproductive decision-making. A Washington Post report suggests that women are making decisions to continue their pregnancy rather than terminating.

CDC says the decline is due to more effective contraception and increased access and use by women. A study from the journal Fertility and Sterility supports the CDC view with the finding that the use of long-acting contraceptives such as intrauterine devices had tripled between 2002 and 2009, with most of this increase happening within the last two years. These data suggest that our efforts in primary prevention are paying off, which is, to me, perhaps the most hopeful explanation.

It is interesting to note that trends in abortion rates match the current trends in teen pregnancy rates. The teen pregnancy rate and the teen birth rate have declined by more than 40 percent since the early nineties, according to The National Campaign to Prevent Teen and Unplanned Pregnancy. The decline, says National Campaign Chief Program Officer Bill Albert, is due to the "magic combination of less sex and more contraception."

There is a way to keep the trend going. Research tells us that information has a protective effect, and information plus the availability of contraception reduces teenage pregnancy, STDs, and abortions. The data leads to some inescapable conclusions: repressed sexual culture equals earlier sex, less ability to refuse sex, more unwanted pregnancies and thus more abortions. Effective sex education programs have been shown to decrease sexual activity and to increase contraceptive use among those already sexually active.

So young people need information, that much is clear. Who do they get it from? John Snow, Inc. has conducted two studies which explored issues and factors associated with choosing birth control methods and unintended pregnancy in two Colorado counties. Two key messages came out of these studies. The first is that young women (and men) want information about making healthy choices if they decide to become sexually active; and secondly their parents and health care providers are their most trusted sources of information. These results are similar to National Campaign findings.

Participants in the JSI study underscored the value of providers. Here is one participant's comment:

"I think doctors should spend more time talking about birth control. Even if it's just 15 minutes, like this is what it is, this is what it's going to do to you, this is what it may cause for you. Because for them, what's that? What's five minutes to them for a lifetime to someone else? That right there could change someone's life. They're getting paid good money, why don't they sit there for another 10 minutes? It's not going to hurt."

The information imparted during a contraceptive method visit is very important, as it enables women to choose and employ contraception with satisfaction and technical competence. A long-running quality improvement project with Title X Family Planning clinics found that a lack of information is a reason for discontinuing method use, and belief in rumors may be a deterrent to use altogether. The common response in this study was that women would like more information about the method that they are going to use so that they can make sure that it will fit into their lifestyle, among other considerations.

Reducing unintended pregnancies, particularly among adolescents, would improve educational and employment opportunities for women which would, in turn, contribute to improving the status of women, increasing family savings, reducing poverty and spurring economic growth. We have to end our taboo on open, honest conversations about sex because the stakes are too high.

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Comment Preferences

  •  I'd Think You'd Want to Break It Down Statewise (6+ / 0-)

    because in conservative states, abortion facilities can be nearly nonexistent for lower income women. We need to know how much the choice is being denied.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Dec 13, 2012 at 02:08:55 PM PST

    •  My thoughts exactly, Gooserock. (2+ / 0-)
      Recommended by:
      US Blues, Cassandra Waites

      We've seen a severe curtailment in the availability of abortion, so logically, that becomes concurrent with a lower abortion rate.  

      •  Agreed Gooserock and Bluedust (0+ / 0-)

        that it would be informative to look at the rates at a state level because when you look at the rates at their highest aggregate level (national) then nuances or disparities in the distribution can be hidden.  If you're interested in seeing those rates, you can go to

        http://www.statehealthfacts.org/...

        It is also important to note that obtaining the exact number of abortions performed has proven difficult as it has long been considered to be an underreported event.

        In the State of Colorado, for example, there has also historically been a lack of resources from a state level to enforce reporting requirement. Fortunately, due to increased resources over the past 5 years, reporting of abortions has been relatively stable. However, it has not yet been determined if the data is complete both in terms of specific providers (whose information is not captured) and in geographic distribution around the state.  Currently, providers are informed that reporting is required, but the process is passive in nature. Non-reporting may be due to a lack of resources from the providers to complete and submit reports, lack of education among providers regarding reporting requirements, and/or intangible barriers such as fear among providers of reprisal from the community.

    •  And cross-correlated with pregnancy stats (1+ / 0-)
      Recommended by:
      Cassandra Waites

      I'll bet those are higher in the red states.

      "Political ends as sad remains will die." - YES 'And You and I' ; -8.88, -9.54

      by US Blues on Thu Dec 13, 2012 at 02:43:20 PM PST

      [ Parent ]

  •  I'd like to believe that the decline in teen (5+ / 0-)

    pregnancy is related to better information. Maybe it's generational. The teens of today perhaps have parents who are young enough to be more open about discussing sex with their children---both girls and boys. I really hope that's what it is. I saw a program about 10 years ago which talked about how many teens were engaging in oral sex as opposed to intercourse. These young girls felt they were okay because they couldn't get pregnant, but they were indiscriminate about where and with whom they engaged. Many had STD's of the mouth, like herpes. I wish the studies you noted went further.

    •  Thank you for your response to my article. (0+ / 0-)

      I couldn't agree with you more.  Sadly, there are some young girls that aren't making the choice to be sexually active; it is being made for them.  There are some young women who don’t have the choice in being sexually active. In fact, a recent study by the American Academy of Pediatrics found that 20% of girls in the seventh through 12th grades had been “physically forced to have sexual intercourse against [their] will.”   “As many as one in four U.S. teenage girls have had a sexually transmitted disease (STD), many infected soon after their first sexual encounter”, a new government report shows. “Moreover, in the year after having their first sexual experience [often against their will] and with only one sex partner, 19.2 percent of the teens developed an STD”, Dr. Gottlieb’s group found.
      “To counter these problems, teens need to have early sex education”, Dr. Gottlieb from the CDC noted. "Adolescent girls need early access to comprehensive sex education, and barrier contraceptives,” Dr. Katz said. “This will not increase sexual activity, but it will attenuate the resultant harms.”   Parents should be and are in fact an important source of information. What I left out of this posting is that JSI has conducted two studies which explored issues and factors associated with choosing birth control methods and unintended pregnancy in two Colorado counties. Similar to what The National Campaign found, two key messages came out of these studies. The first is that young women (and men) want information about making healthy choices if they decide to become sexually active; and secondly their parents and health care providers are their most trusted sources of information. But in the same study, we found that participants’ parents’ attitudes about birth control and sexual activity were sometimes barriers for women using birth control. One woman described her experience as,

      “My dad doesn’t believe in birth control, because obviously it means you’re whoring around, and it just gives you the chance to whore around and not get pregnant. I wanted birth control when I was 13 in case I went to a party and something happened. But he said ‘No’.” [female participant]

      Another focus group participant said, “If you can get a birth control that your parents don’t know about, it’s free, and you can get it, get it! That’s why a lot of girls don’t go in to get birth control, because they are scared of their parents.” [female participant]

      We contributed to a recent article on sheknows.com, which advises parents on how to help protect their sexually-active daughters from unwanted pregnancy and STIs, emphasizes the above-all importance of open communication between parents and teens on the topics of sex and prevention.

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