A Pro-Both Agenda
In the case for pro-both I briefly described some of
the things that could be done to advance the pro-both objective of reducing
None of the programs described are new.
There have been generations of dedicated people devoting
their lives to working on these projects,
and in many cases they have made dramatic progress.
However, if America could put the energy
it has expended in the debate over the legality of abortion
behind these efforts, I believe that much more could be achieved.
This page presents some of my thoughts on the kinds of things that might make
sense in a pro-both agenda and discusses those issues from a pro-both
My objective in writing this is not to officially define exactly what should
be done, but only to point out enough possibilities to demonstrate that a
pro-both agenda really does have the potential to effectively address the
Many other possibilities surely exist.
Anything that advances both the causes of life and choice would
be a natural candidate for inclusion on a pro-both agenda.
The decision of what exactly should be done and how it should be done
should derive from scientific research and public debate, involving, I hope,
people with deeper personal experience with the issues than I have.
The question of who should implement the programs discussed here is
also left open.
If the nation wanted to illegalize abortion, the task of enforcing
such a ban would have to fall almost 100% on the federal, state, and
and the funding would have to come almost entirely from tax money.
In contrast, many parts of the pro-both agenda could be effectively
pursued by non-governmental organizations working at least partly with
In many cases, similar programs are already being implemented by such
The role of the government often might be to provide support,
coordination, and focus rather than to run programs directly.
Understanding the Problem
Before proposing solutions to a problem, it is always good to make sure
that you have a good understanding of the problem.
Although about one in three American women has an abortion during her
lifetime, few publically discuss their experiences,
so our impressions of the circumstances surrounding abortions tend
to be formed by stereotypes rather than knowledge.
An effective pro-both agenda would start with a solid understanding of
how people get into unwanted pregnancies.
We need to know both why these women don't want a baby and
why they ended up with one anyway,
and why abortion was chosen over other alternatives.
Some information about abortions already exists.
Most states collect some data on women having abortions, and the
US government's Center for Disease Control publishes an
Surveillance Report summarizing this information.
However this data is very limited, giving just age, race, location
and a few other facts.
This is not detailed enough to be of much use in policy making.
The Allan Guttacher Institute
has an agenda that looks pretty much identical to pro-both.
Though they have an institutional bias, their research appears to be
conducted with a high degree of professionalism and is widely quoted
by both pro-choice and pro-life authors.
Their In the Know
page gives a good overview of statistics about pregnancy, contraception,
and abortion that are relevant to the pro-both agenda.
They have published a number of detailed studies of women having
abortions in the US, the most recent studies covering
appearing in 2000-2001.
Collecting more detailed information about abortion and related subjects
should be a priority.
Limited studies conducted only every half decade or so do not give us the
fine-grained information we need.
When abortion rates change, we should have the data available to zero in
on the exact populations and time periods
where they have most increased or decreased
and identify the factors involved.
Funding for more research is needed, and
increasing reporting requirements on abortion clinics should be considered.
Assurances of the privacy and security of abortion patients and
physicians must be built into any such reporting system if wide compliance
is to be achieved.
Education is fundamental to reducing unwanted pregnancies and abortions.
As in any educational program, we must seek to impart both societal values
and factual knowledge.
The core values we want to teach in a pro-both educational agenda are
choice and responsibility.
Choice means that sex should always be a matter of consent.
Everyone has a right to say no.
Responsibility means that if you don't want children or aren't ready to have
then you have an obligation to ensure that you don't conceive any.
Personal freedom and personal responsibility are two sides of the same
They are the defining attributes of adulthood in our society
and all sex education programs need to emphasize them.
Factual knowledge is also vital.
Lack of accurate, practical knowledge about sex, fertility and birth
control in a key factor leading to many abortions,
even among people who are otherwise well educated.
Because people tend to be reticent about discussing these subjects,
important information does not always reach the people who need it,
and they are often reluctant to seek it out.
We must take action to ensure that this knowledge gets to the people who
In the last decade, substantial progress has been made in
improving in-school sex education, and this has been reflected in
reduced rates of teenage pregnancy and abortion.
More can be done, both in schools and in outreach to adults.
In schools, there have been two major types of programs implemented,
both not only emphasizing abstinence, but including practical training
on how to resist social pressure to have sex.
"Abstinence-plus" programs include detailed, practical information about
"Abstinence-only" programs believe
that giving students information about using birth control weakens
the abstinence message, so the only aspect of contraceptives that they
cover is their failure rates.
The pro-both agenda is aimed at reducing abortion by empowering men and
women to make their own choices and encouraging them to take responsibility.
Withholding information in hopes that ignorance will drive people to make
the choices we prefer obviously has no part in this.
In promoting choice, we have to have faith in people's ability to make
A CDC study
concluded that between 1995 and 2002 the percentage of teenagers
who were having sex dropped about 8 percentage points,
while the percentage using contraceptives climbed 18 percentage points.
This seems to clearly indicate that teenagers are, in fact, smart enough
to understand a message with two points:
don't have sex, but if you do, use contraceptives.
In any case, school should equip students with knowledge and skills that
will serve them lifelong, not just as teenagers,
and few people will choose abstinence as a lifelong strategy.
An effective pro-both education program cannot be based on any narrow
prescription that tells people in what stages of their lives sex is
appropriate and what birth control methods they should use.
Such prescriptions have the advantage of simplicity, and may serve
some people very well, but many will stray from any narrow path,
and if our educational efforts do not serve those people,
then it can not be effective in reducing abortion.
which not only encourages abstinence
but helps teach teens who want to
be abstinent how to resist pressure from others,
is now very common in American schools.
A 2002 CDC study found that
the great majority of teens now report having received formal
education on how to say no to sex before age 18 and two-thirds receive
such education before high school.
Sex education programs should never lose track of the idea that
the best way to avoid pregnancies and sexually transmitted diseases
is to choose not to have intercourse.
But there is still substantial room for improvement.
The same study found that, among teens who have had sex,
6% of males and 13% of females hadn't wanted it to happen,
while 31% of males and 52% of females had mixed feelings about it.
Clearly abstinence is a choice more teens would make, if they could.
Contraceptives are important for people who choose to have sex
but do not want children.
But they are frequently not used or used incorrectly.
Of American women who have abortions in 2000 and 2001:
- 46% used no contraceptives.
- 33% believed they were at low risk of pregnancy.
- 32% were concerned about contraceptives.
- 28% used male condoms.
- 49% used them inconsistently.
- 42% experienced condom breakage or slippage.
- 14% used the pill.
- 76% used them inconsistently.
Clearly, making good choices about sex and contraception
requires a lot of knowledge.
Lack of knowledge about contraceptives can leave people intimidated by the
range of options causing them not to use any,
or to choose options that don't work well for them.
It can lead to incorrect use of contraceptives.
Even among quite well-educated people, inadequate knowledge about sex and
contraceptives contributes to many unwanted pregnancies.
People are frequently reluctant to seek help.
Teenagers usually don't make their first visit to a family planning
clinic until many months after they become sexually active.
Their first visits are frequently triggered by pregnancy scares.
Effective contraceptive education has to be specific,
giving people not only general theoretical guidelines to birth control,
but specific information about how to obtain the help they need in their
General Sex Education
The high percentage of women who got pregnant at times when they thought
they were at a low risk of pregnancy suggests that many people still do
not have solid knowledge of the basics of sex and reproduction.
Natural family planning techniques could be used by most women to
identify their fertile periods with fairly good accuracy.
For some women, especially those in stable, supportive relationships,
simply avoiding sex during their fertile periods can be an effective,
safe, and inexpensive form of birth control.
For all men and women, accurate and practical knowledge of how
reproduction works is key to making good choices about sex and
The educational mission of the pro-both agenda cannot be accomplished
solely by sex-education classes in the schools.
Information must be available through many avenues, to people of all
ages in all walks of life.
Currently information is available to those who seek it out,
through doctor's offices and organizations like Planned Parenthood,
or on the Internet.
However at least some of these kinds of information need to be
actively broadcast to the wider population,
through media like television.
Broadcasting information about sex and contraception is the only way to
ensure that it really gets to all the people who need it.
There is a risk, of course,
of offending those who don't want to hear about it, and don't want their
children to hear about it.
But this is an important message, and we need to have the courage to
present it in public.
It doesn't have to be very explicit to be useful.
The core message should be that if you don't want children,
then you have a responsibility to either not have sex or
to use some effective birth control method.
It should reassure people that effective options exist,
and tell them where to seek assistance.
People not only need to know about contraceptive options,
they need to be able to obtain them.
Some birth control options can be fairly expensive, ranging from $180 per
year for Depo-Provera to $450 a year for Norplant.
Until recently most health insurance plans did not cover contraceptives.
When they did, however, cover Viagra, this set off a political controversy
that triggered a revolution in coverage of contraceptives.
At this point,
most employer-provided health insurance plans cover contraceptives,
but often only the older and more popular options are covered.
Subsidized contraceptives are also available from family planning clinics.
However many people, especially teenagers, still perceive significant
barriers to obtaining contraceptives.
Continued work to improve this would have a positive impact on the abortion
In our case for a pro-both agenda we imagined the
effects of a "perfect" contraceptive on the abortion rate.
So perfect a contraceptive is probably not a practical possibility,
but surely it should be possible
to develop new contraceptive methods that work better for people.
Some unwanted pregnancies occur because of contraceptive failure, so
more reliable contraceptives would reduce the abortion rate.
Many people don't use contraceptives because of issues of convenience or
concerns over safety, so improvements on these fronts would also be
reflected in a lower abortion rate.
Unfortunately, progress in the development of contraceptives has been
slow in recent decades.
Contraceptive research is a risky proposition for companies.
The development cost is high, testing is difficult and expensive,
there is no certainty of earning FDA approval,
and there is a significant risk of lawsuits once the product is released.
These factors have made pharmaceutical corporations reluctant to
invest in contraceptive research, leaving it mostly in the hands of non-profit
organizations supported by limited government funding and private donors.
It would be counterproductive to relax safety requirements, but
the development of better contraceptives could be sped up by increasing
funding to non-profit research groups, or providing financial incentives
to pharmaceutical corporations to offset development costs.
An example of one of the many promising areas for development
is male contraceptives.
Currently, male contraceptives are limited to condoms and vasectomies.
There have been trials of a couple contraceptive drugs for men, but none
proved safe or effective. However, there is no reason to believe that
better male contraceptives, ranging from drugs to more easily reversible
alternatives to vasectomies cannot be found. There are a number of
promising research directions that could be much more energetically pursued.
Men tend to be less directly involved in abortion decisions than women,
but certainly if the father of the baby does not want it, the chances
that the mother will choose an abortion are increased. If men who didn't
want babies used contraceptives, the reduction in the number of abortions
would be significant.
Even if new contraceptives turn out to have imperfections,
increasing the range of contraceptive options available to couples
increases the number of couples who will find an option that works for them.
Different people, in different cultures
and different stages of life have different needs for contraceptives,
it is important that we have a wide range of different
contraceptive options available.
The measures discussed so far are all targeted at reducing the number
of abortions by helping people who don't want to have children avoid
But many of these people do, in fact, want a child, but do not believe
that they can raise one in their current situation.
So another effective approach to reducing abortion is to pursue programs
that would change these circumstances in ways that would encourage people
to choose life over abortion.
Many women who would like a child, nevertheless choose to have abortions
simply because they can not afford to care properly for it.
This was clearly demonstrated when state caps on welfare payments to
mothers resulted in an increase in the abortion rates,
sparking many conservatives, including
to come out in opposition to such measures.
There does seem to be reason to believe that measures like increasing
welfare support for children or increasing the minimum wage may
have the side effect of reducing the number of abortions.
Most women having abortions for financial reasons, however,
are not poor or welfare recipients.
Some working women may choose an abortion because they believe that to
raise a child they would have to give up their jobs and, perhaps, become
Fairly well-to-do parents may feel that they can manage to send the
children they have to college, but couldn't if they had one more child.
Addressing problems like these suggests a whole range of efforts to
support families possibly including larger tax breaks for families,
more affordable day care options, and more affordable college options.
It would also help for workplaces to be more accommodating to
Since the programs above will never completely
eliminate unwanted pregnancies,
it will always be important to make the option
of offering infants for adoption as attractive as possible.
If we could find policies to encourage adoption,
then this would certainly have a beneficial effect on the abortion rate.
However, this is one area where it is not obvious that
practical and effective policy alternatives exist.
Many mothers are reluctant to undertake the risk and
discomfort of carrying a baby for nine months only to give it away.
It is tempting to offer some material compensation for women who do make
but any such reward could tempt people to
give up a child they otherwise would have kept,
or even deliberately conceive a child so they can offer it for adoption.
Any incentives we offered would have to be quite modest,
like subsidizing pregnancy-related health-care and legal costs
(which is already frequently done by the adopting parents).
It's hard to see such mild incentives having a
very significant impact on the abortion rate,
but they might be worth considering.
Currently, there are already many children
available for adoption who have not been adopted.
A general decrease in the number of unwanted pregnancies would probably
lead to an overall decrease in the number of children offered for adoption.
If there were more qualified people eagerly waiting to adopt,
that might encourage more people to choose adoption over abortion.
Perhaps policies that encourage people to adopt would further help.
But again, the impact on the abortion rate would probably not be awfully
In any case, there is already good demand for healthy infants.
So, at this point, it is not clear to me that we can impact abortion very much
through adoption policy,
but it is certainly a subject that should be studied carefully.
We have suggested a large number of possible pro-both methods for
reducing the abortion rate.
Clearly none of them, by itself, is likely to be a complete solution,
but taken together it is clear that dramatic decreases in the abortion
rate could be achieved, without infringing on the privacy or freedom
of individual Americans.