Over at the main page, both Mike and Will have been discussing abortion rates and the impact of various factors on the different rates from state to state. They have already presented plenty of data, and I have no numbers to throw into the mix. For the negligible number of you who read this blog but not the main page, I recommend both posts, which are thoughtful and thorough.
I do, however, think it’s important to make sure we’re asking the right question. Mike, jumping off from a column by Ross Douthat, questions the connection between easy access to contraception and legal abortion and a reduction in abortion rates overall. I agree that this connection is often made as an argument for the former, and certain data make that argument more challenging. But as Will points out, it’s difficult to pin down exactly why some areas have higher abortion rates than others, even in areas where the various influencing factors would seem similar.
Personally, I’ve been all over the map with regard to the abortion question, both literally and figuratively. I was raised in a very, very conservative evangelical church in the Midwest, where a great deal of emphasis was placed on abstinence from sex until marriage, period. It was the central message of my adolescence, followed closely by exhortations to be aware of the works of Satan in popular culture (an utterly sincere, unironic concern). Over time, three members of the youth group went on to get pregnant/get someone pregnant out of wedlock, including both of the minister’s daughters. And despite the injunctions to refrain from sexual activity, I was well-aware of how ardently it was pursued by other members of the group.
By the time I started my fellowship in adolescent medicine in New York City, I had swung all the way to the other end of the spectrum. For three years I worked at a large, well-funded adolescent health center that was straight from the most fevered dreams of my youth minister. We dispensed contraceptives free of charge to all who asked for it. We had a battalion of health educators to teach or review the correct use of methods both barrier and hormonal in detail. And still there were girls who came in for abortion number two or three. It was immensely frustrating.
Having seen the various failures (and yes, I consider serial abortions a particular kind of failure) of both approaches, I am wary of any kind of absolute prescription. I chafe at both the moralistic strictures of the Santorum set and the almost celebratory attitudes regarding abortion of their adversaries. (Having attended this event, I do not think that is a mischaracterization.) But when faced with a choice between more freedom and less, I am generally inclined to give people more.
If the goal of providing contraception is to lower abortion rates overall, then it will be inadequate. If, however, the goal is to give the women who use it the option of having sex with a much lower risk of unintended pregnancy on their own terms, then it is worthwhile to provide it. Bluntly, women should have the same access to minimally-risky sex that men do. That is justification enough. Yes, many adolescent girls and women will use it incorrectly or not at all. I fail to see why that should limit access for those thousands of women who would use it correctly, teenagers included.
As for abortion, it remains a thorny question. If I were to be fully honest, I would admit that both my stridently anti-abortion and pro-choice phases were largely informed by the social attitudes of my peers. Sitting here now, the best way to describe my feelings about abortion is that I think it is tragic. Always. That is not to say that I think it is always wrong, but it is always grave and sad, even if it is not always treated as such. But for women who are pregnant and don’t wish to be, I do not see an option. One thing that I passionately wish were different, particularly as the adoptive parent of a son I adore, is that there is barely any mention at all of adoption in many (most?) adolescent health centers. (I would be thrilled to be wrong about this, so anyone is free to enlighten me if this perception is incorrect or incomplete.) However, it is preferable that women who do not wish to be pregnant have access to safe, legal abortion than seek recourse through dangerous back-alley procedures. Those outcomes are no less tragic, and are frequently more so. After meeting so many young women who recognized their own unreadiness to parent a child and who were unwilling to carry a child to term, I fear what would happen to them if they did not have access to legal abortions.
It is a question that, to me, has no good answer. But the pro-choice position seems the least bad answer to me now, after all these years and all the places I’ve been. I wish no woman ever sought an abortion, but I am unwilling to tell those who seek them that they cannot do so. This untidy position lacks the comforting clarity of the extremes I have previously inhabited, but I’m afraid it’s the best I can do.