More than 5,000 British women under the age of 20 had an abortion that was not their first last year, and nearly 33% of all UK terminations were not first-time procedures.
Female fertility peaks between ages 19 and 24: the reason we tend to see the most abortions (and pregnancies) in that group is because it is the most fertile group having the most sex. The UK teen pregnancy rate is the highest in western Europe – six times higher than the Netherlands, nearly three times higher than France and more than twice the rate in Germany. As was made clear by the alarmist headlines following the publication of those numbers, unwanted pregnancies are a big concern for the public.
But I don't get the concern about abortions, specifically. No matter what choices we make with it, pregnancy has the capacity to radically change our health and life. Pregnancy itself is a potentially dangerous health event: 40% of all pregnant women have some sort of health risk; 15% of these are potentially life-threatening. The maternal mortality rate in New York dropped 45% after abortion was legalised in the US. Safe, legal abortion isn't the main health issue we should focus on: unwanted pregnancy should be our deepest concern, no matter how a pregnancy ends.
What can be done to reduce the numbers? Provide better sex education and information about and access to contraception, which is what the UK has sound plans to do. The 2008-09 Opinions Survey Report shows only 57% of UK women aged between 16 and 19 using contraception, a lower rate than all other ages. Only 11% of young people in the Netherlands use no contraception: their rate of sexually transmitted infections and unwanted pregnancies is impressively low.
Women need access to comprehensive, unbiased information about all contraceptive methods, addressing all as viable while making clear the differences in effectiveness and proper use. They need that information at school, at home, in the media and from healthcare providers, including those providing care with pregnancy, whether it ends in abortion, miscarriage or birth. The youngest women use family planning services less than older ones, and are often scared to ask for them. It is vital to offer them these services without finger-wagging.
Young women nearly always ask for (or are routinely given by healthcare providers) the pill, but oral contraceptives are less effective for teenaged women than for older women. Awareness of emergency contraception should be increased and information should be provided during an abortion visit, with in-depth contraception consultations (women can often start reversible long-acting methods – an injection, implant or IUD – before they leave the clinic). Abortion providers should also ask about the dynamics of their patient's relationships. Intimate partner violence (IPV) rates are high and women in abusive, controlling relationships have high rates of unwanted pregnancies.
Poverty is also a huge factor in the number of unwanted pregnancies. It can result in a sense of reduced self, such as the idea (or reality) that motherhood is an attainable goal while other goals are not within reach. We must work hard to provide marginalised women with contraceptive information and support services.
Men need accurate information on contraception, too. A partner's refusal to use contraception or support women's use of contraception well is a problem, particularly for the youngest women. We need to make sure men know that two methods of contraception provide more protection than a single method, and have methods they can use themselves to exercise their reproductive rights. To be an effective sole or back-up method, condoms must be used correctly and consistently. We need to ensure boys and men understand that they are as responsible for their sexual choices, including prevention of unwanted pregnancy, as women. We don't do women or men any favours by accepting or enabling double standards to the contrary.
When we give young people the message that their sexuality is something shameful they need to fear or hide, they hear it. They become afraid and less inclined to ask questions or for help, to be honest about what they need and what's really going on with them. But most young people will – as they always have – have sexual relationships. The approaches to teen sexuality with the best outcomes accept this, rather than trying to deny or eradicate it.
Just like anything else, sexuality has a learning curve. We can't expect young people to magically be better at this than the rest of us are, especially without our help and support. Should we want them to be better, we can't keep doing the same things we know full well have always failed them.
