A Pro-Both AgendaIn the case for pro-both I briefly described some of the things that could be done to advance the pro-both objective of reducing unwanted pregnancies. 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 perspective. 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 abortion problem. 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 local governments, 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 private funds. In many cases, similar programs are already being implemented by such organizations. The role of the government often might be to provide support, coordination, and focus rather than to run programs directly. Understanding the ProblemBefore 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 annual Abortion 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 abortion and contraceptive use 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. EducationEducation 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 children, then you have an obligation to ensure that you don't conceive any. Personal freedom and personal responsibility are two sides of the same coin. 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 need it. 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 contraceptives. "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 good choices. 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. Abstinence EducationAbstinence education, 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. Contraceptive EducationContraceptives 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:
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 communities. General Sex EducationThe 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 contraceptives.Non-School EducationThe 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. AccessPeople 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 problem.TechnologyIn 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. Parent SupportThe measures discussed so far are all targeted at reducing the number of abortions by helping people who don't want to have children avoid pregnancy. 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 Republican Representative Chris Smith, 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 welfare recipients. 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 working parents. AdoptionSince 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 that choice, 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 high. 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. ConclusionWe 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. |