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?
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.