Abortion rates are down. Why? Family planning may be the key.
May 8, 2000 -- The year was 1986. It was before Planned Parenthood was the obvious first stop along the road to becoming sexually active, before high-school students were well versed in their contraceptive options -- at least in West Texas. College freshman Layla Carter, 18, (not her real name) started having sex during her first semester with a boy she'd met at a fraternity party. "We were both shy and inexperienced, and, even though it sounds crazy now, neither one of us brought up birth control," she recalls. "We only had sex about once a week, and he pulled out each time. I figured the chances of getting pregnant were pretty low." She figured wrong.
Three weeks after Layla was due for her period, the pregnancy test came back positive. "I was in a state of shock," she says. "I felt I had no choice but to have an abortion. I couldn't tell my parents, who would have made me have the baby, and the boy I was dating wasn't at all supportive."
With the help of a friend, Layla made an appointment at the only abortion clinic in town. "I look back on that experience and think, 'How could I have been so stupid to not use protection?' But then I try to remind myself that the culture back then was so different. AIDS was just beginning to be publicized, and safe sex wasn't a cool concept -- it was merely something embarrassing you hoped your parents wouldn't bring up at the dinner table."
Family Planning Up, Abortion Rates Down
Though teenagers still hope safe sex talk won't come up at the dinner table, times have changed since Layla came of age. A total of 1,184,758 legal induced abortions were reported to the Centers for Disease Control and Prevention (CDC) in 1997 (the most recent year for which statistics are available) -- a 3% drop from the previous year, according to a report released in January by the CDC. Twenty percent of the abortions were performed on women aged 19 and below; 32% on women between the ages of 20 and 24; and the majority, 48%, on women over the age of 25. In addition, the total number of abortions performed on women of all age groups in 1997 was the lowest since 1978, and the rate (number of abortions per 1,000 women of reproductive age) and ratio (number of abortions per 1,000 live births) were the lowest since 1975.
One big reason for the drop in the number of abortions, say experts, is that family planning is up. "These findings are encouraging," says Susan Tew, deputy director of communications at the Alan Guttmacher Institute, a reproductive health research organization. "It's not that fewer people are having sex. Instead, we are doing a better job of family planning in this country."
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Family planning tools include abstinence, contraception, and other methods, such as natural birth control (also called the rhythm method), says Lisa Koonin, lead author of the CDC report and chief of the CDC's reproductive health services division. "Any tools or behaviors a woman and her partner use to plan when they will become pregnant is defined as family planning," Koonin says. Increased access to these tools, she says, has also played a role in the drop in abortion rates.
Koonin points out, however, that a part of the declining abortion rate has absolutely nothing to do with safe sex practices and greater family planning, but is simply a function of an aging population. "The baby boomers are aging and becoming less fertile. As a result, there are fewer live births overall."
Another reason for the drop is that young people are not only gaining greater access to birth control, but they also have more choices than ever before. Beyond the condom and the pill lies a spectrum of female-controlled options, including injectable drugs, like Depo-Provera. "Depo is a very popular option with teens," says Tew. "One injection lasts three months, and a doctor's appointment every three months is easier for teens to adhere to than a daily pill."
Tew believes that an increased availability of emergency contraception has the potential to lower abortion rates even further. Emergency contraception includes the "morning-after" pill, which is taken within 72 hours after unprotected sex, or the insertion of a copper IUD (intrauterine device) to prevent an embryo from implanting up to five days after unprotected intercourse. But she repeats that "the reason why abortion numbers have dropped is primarily because couples are more successful at preventing unplanned pregnancy." Emergency contraception is simply that -- something used when the planned method may have failed -- or when there's been no planning at all.
The Role of AIDS and Other Factors
After having an abortion, Layla became involved in a safe sex campaign at the University of Texas at Austin, where she was a student, giving speeches on contraceptive options and the need for protection against HIV. "I didn't want what happened to me to happen to others," she says.
By increasing awareness about the spread of AIDS and other STDs, people like Layla are having an effect on sexual behavior. "According to the 1995 National Survey for Family Growth, condom use is up," Koonin says. "This has a lot to do with AIDS awareness."
And while Koonin believes that the drop in abortion rates is encouraging, she's not declaring victory yet. "There are still 1.2 million abortions each year in the United States. Any decline in that number is promising, but there's still a lot of work to be done in education, since most induced abortions are the result of unintended pregnancies. It's a public health issue, not a political one."
Tula Karras is an associate editor at WebMD.
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