The Abortion Reduction Agenda: What Smells?

Melanie Zurek and Courtney B. Jackson

To use abortion rates as a valid indicator of success at preventing unintended pregnancy, we must first ensure the accessibility of abortion.

Working to reduce abortions, as a strategy
to find common ground between the pro-life and pro-choice communities,
has recently garnered much attention and debate. Will Saletan’s New York Times op-ed, This
is the way culture wars end
and Jodi Jacobson’s recent piece, Looking for Common
Ground on Abortion? You’re Standing On It
recently took up the proposition.
Proponents of this strategy, including Saletan, suggest that abortion reduction makes political
sense because it can bring together two historically polarized camps: those who
oppose abortion outright, and pro-choice advocates who (rightly) consider
abortion largely to result from the need to better prevent unintended
pregnancy. According to the abortion reduction proponents, public and
political support for contraception, comprehensive sex education and
other measures can be expanded if we work toward an ultimate goal of fewer abortions.  

Critics of the abortion reduction
paradigm (at least within the pro-choice community, including Jacobson), point out shortcomings
of this approach: the persistent focus on the fetus and abortion instead
of women and women’s health and autonomy, the anti-contraception agenda
of many in the anti-abortion community, and the fact that not all abortions
are the consequence of a failure to prevent unintended pregnancy but
instead result from unforeseeable, unpreventable circumstances often
relating to the pregnant woman’s health.  Also of concern to
critics of this approach is the promulgation of stigma inherent in a
strategy organized around abortion as the common enemy.  

Saletan proposes that abortion rates be adopted as a measure of our success
promoting contraception.  And, indeed, abortion reduction as a guiding principle for
women’s reproductive health policy has real world implications: if our goal is to reduce abortions, then a lower abortion rate should
be the measure.  So what smells? 

As researchers and advocates
we commend the attention to reproductive health, but wonder how we should
approach the proposed measure of lower abortion rates. Jacobson presents
a compelling argument for better sexuality education and ensuring access
to contraception as a way to ultimately reduce abortions. We wholeheartedly
support Jacobson’s call for improved access to prevention and share
her vision that this will ultimately result in a decline in abortion
rates, but before we see that decline we may very well see an increase
in abortion rates in this country, and that should hardly be regarded
as a failure. Here are a few reasons why. 

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First, we are limited in our
understanding of what current abortion rates mean.  Does a low
abortion rate mean that women aren’t having unintended pregnancies?
Or is it because they can’t – or are too afraid or ashamed to – get
the abortion they would choose otherwise?  Common sense would suggest
that the current multitude of anti-abortion laws might indeed be preventing
some women from having abortions – this is, after all, their intent.
Examining state differences in abortion rates also provides some insight
into what "low" and "high" abortion rates might mean. 
In 2005, New York had the highest abortion rate (38.2 abortions/100,000
women 15-44) and Wyoming the lowest (.7).  What does this mean?
Do Wyomingites use contraception more consistently and effectively? Or, do they have difficulty
accessing abortion because there are only two providers in the entire
state (compared to New York’s 261)? It is impossible to view Wyoming’s
low rate as success without concern that women who need abortion care
can’t access it. 

Aiming for a reduction in abortion
also begs the question of what qualifies as a "good" abortion rate. 
What is our targeted goal?  30/100,000?  20? 10? 0? How will
we know that we have achieved a goal that reflects both success in preventing
unintended pregnancies but also access to a service that women die trying
to obtain?  

To use the abortion rate as a valid
indicator of success at preventing unintended pregnancy, we must first
ensure the accessibility of abortion.  We must remove onerous laws
and increase the availability of accessible services, and accept that
in doing so the abortion rate may first go up.  Whatever approach
is ultimately taken, ensuring women can access the care they need is
the only meaningful starting place. 

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Reproductive rights are a public health issue. That's a fact.

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