Head's up on a new third rail: abortion vs. birth control

This is going to be a little bit heavier, and longer, than I usually get but it's important for the sex-positive community to get ahead of to keep the 'wingers from dictating the terms of the next phase of the abortion debate.

The topic is a new frame in abortion politics, and one that's gaining traction in progressive circles. The specific issue is the increasing number of abortions that are second and third abortions. Rather than wait for the 'wingers to begin beating us up over the issue I'd like to get in ahead of them and frame the debate in our own progressive, sex-positive terms. It's my fairly well informed opinion that abortions, and particularly subsequent abortions, represent a failure of education, policy, and, most particularly, birth control. I believe (passionately!) in your right to determine what happens in your bodies. The choice is, and should be, yours, and yours alone when and whether to bear children. Without that right the society I wish to live in as a citizen, a human, a partner, a father, and a man isn't tenable. It's your choice: end of discussion. I also feel, passionately, that controversies over abortion have almost completely degraded the far more important, and relevant, issue of the miserable state of birth control. And finally, I feel, passionately, that with contemporary availability, education, and investment in new birth control technology choice in North America in particular and the world in general is egregiously limited.

Here's the scoop, as articulated most recently by Garance Franke-Ruta in The New Republic and excerpted in her post on Tapped the blog of the progressive The American Prospect magazine.

According to the Guttmacher Institute, an abortion-rights organization respected for its data collection, close to half of the 1.3 million abortions performed in the United States each year are repeat abortions, up from just 12 percent in 1973. Most repeat abortions are, like Amy's, a woman's second, yet the number of third abortions is not insubstantial. In 2000, the Centers for Disease Control (CDC) reported that 18 percent of abortions were performed on women seeking at least their third pregnancy termination. In contrast, studies have shown that rape and incest victims, the most politically sympathetic and high-profile group of abortion-seekers, account for about 1 percent of abortions.

Despite its prevalence, repeat abortion is the least discussed or researched aspect of abortion in the United States. In the past year, liberals and Democrats have increasingly focused on preventing unwanted pregnancies as a means of preventing abortion. But they have yet to address the specific needs of women who have already had abortions, partly out of fear of affirming conservative stereotypes about why women abort or how they react to an abortion....

The sad fact is that, three decades after legalization, abortion is no longer mainly a tool women use to shape their own destinies, but rather a symptom of larger social problems that ought to be addressed by policymakers.

You should read her whole post on Tapped here or, better, see her original article (free registration required) here in The New Republic.

Got that? Since roughly the time abstinence-only education began rearing it's ugly head...

• Only 12% of abortions in the 1970s were repeat abortions
• Today over 50% are repeat abortions
• Today 18% are *third* abortions
• Rape and incest account for only 1% of abortions

Here are some other interesting tidbits I collected the last time I dug into this. They may be a little out of date and I'll be updating them as I gather new information. (I'm pretty confident any new figures will only be more depressing so I'll leap before I look.)

• When it comes to health-care policy at the national level, pro-choice groups like Planned Parenthood won't get behind birth control initiatives unless they include support for abortion as well
• When it comes to health-care policy at the national level, anti-choice groups like The Christian Coalition won't get behind birth control initiatives unless they exclude support for abortion
• Consequently legislators have generally failed to enact any meaningful policies at all
• Consequently medical researchers and curriculum developers have failed to produce any meaningful products at all (in America anyway)
• Consequently abortions resulting from birth control failure account for only 10% of all abortions
• Consequently abortions resulting from a *failure to use* birth control account for the remaining 90%
• Consequently aside from Iran, birth control technology and education in the United States is more primitive than in any other country

And, consequently, as Franke-Ruta points out, roughly half of all abortions today are second and third abortions.

Politics and society

The first question pro-choice advocates are going to say is (or ought to be, I'm pro-choice too) "So what? The right to choose is an absolute." I agree choice is, and ought to remain, an absolute right. I'll point out, however, that opposition to abortion is one of only three real legs the right-wing psychopaths who are presently imploding civil society have to stand on. (The other two legs being homophobia and, to a lesser extent, prayer in schools.)

Right wingers, I might, add are keenly aware of the galvanizing (and fundraising) value of abortion politics. I happen to believe that if we can find progressive, sex-positive means to drastically reduce the need for abortions we can undermine on of their most effective supports.

I think the most progressive, sex-positive way to do it is to hammer, hammer, hammer away at the fact that better and more available birth control and birth-control education means up to 90% fewer abortions in general and almost no second or third abortions.

I think the most progressive, sex-positive way to frame this is to say that working birth control is the best way to stop abortion, and conversely that opposition to birth control is explicit support for abortion. I mean, it's possible -- though only remotely so -- that some people out there see abortion as a good in and of itself, and it's... possible... that these people see second and third abortions as laudable. If so I've yet to meet one and, more to the point, there are none in policy making positions. On the other hand I have heard anti-choice people on the right explicitly say they're opposed to birth control precisely because it would reduce abortions to a point where nobody cared anymore, and who explicitly say the number of abortions must remain high in order to keep abortion as a front-burner hot-button fund-raising, vote-getting issue.

I ought to add that abortion is a tremendous wedge issue that keeps otherwise progressive people in the conservative camp, and the spillover threatens to drive a wedge between non-conservatives. Last fall there was a (justifiable) spat between political strategists who (correctly) believe an uncompromising position alienates many voters and feminists who (also correctly) believe that such a compromise on abortion sells out women's rights. Reframing the argument as a pro-birth-control issue instead of an abortion waffle ought to be an excellent way to turn the tables first by healing the rift between ardent feminists and pragmatic Democrats, for instance, but also by driving a wedge between pragmatic suburban Republicans and the extremists who depend on them.

Women's health
Way back in the dark ages, when I used to volunteer for a latter-day underground railway helping to ferry pregnant fellow teenagers from southern Appalachia to the District of Columbia and New York where abortion was legal, we learned (in a church sex education class, no less) that

• Giving birth had more health risks than having an abortion
• Having an abortion had more health risks than using birth control and not getting pregnant in the first place

As far as I know that metric remains unchanged. More women continue to die from pregnancy-related complications than from abortion related ones, and more women die from abortion related complications than from birth-control related ones. Whatever one thinks of the health consequences of abortion, therefore, they must accept that birth control mitigates those consequences. This is important to remember when advocating birth control and while debating with those who are uncomfortable with abortion. It's also a helpful counterargument to the wingnut anti-condom, anti-hormone, anti-IUD, anti-Plan-B, and anti HPV-vaccine contentions that these methods are somehow more risky than no protection at all. They're not. Failing to use those methods increases the risks of pregnancy and thus the risks of abortion, pre-eclampsia, pregnancy-induced diabetes, ectopic pregnancies, gestational trophoblastic disease, maternal strokes, complications of caesarian section surgery, hemorrhage, embolism, infection, incomplete placental separation, and on and on and on.

Yes but...
Yes, but birth control doesn't always work!!! Lynn Gazis-Sax expressed her concern here. (I responded in comments there as well.) Yes, it's true. Contemporary birth control doesn't work extraordinarily well. That would be an issue if I was advocating for completely eliminating abortion (or completely eliminating unplanned pregnancies, not all of which are also unwanted) but I'm not. I'm suggesting only that compared to the half-assed and haphazard birth control policies we have today, even minimal efforts could reduce or eliminate abortion to effectively ignorable levels. Remember that barely 10% of abortions result from birth control failure compared to 90% that result from failure to use birth control.

Furthermore, to say that current birth control technology is as good as we can get is... ok, words fail me. Let's consider some options though:

• First of all, when we talk about "birth control failure" we're talking about variations on the rhythm method. Rather than debate whether that even counts, how about pushing research to make a test for detecting fertility as inexpensive and reliable as a grocery store pregnancy tests are now? That would dramatically improve the relatively questionable reliability of rhythm, mucous, and temperature-based methods and would certainly help with the recently noticed problem of variable ovarian follicle development.
• How about improving vasectomy technology so that, for instance, injecting a plug that dissolves after a year or two is no more painful than a visit to a waxing salon? (If she can stand getting a Brazilian he ought to be able to stand getting a plug.)
• How about vastly more research into contraception for men? I was happy to get my vasectomy back in 1976 or so but only because there wasn't anything else available. (It's risible that condoms remain the only contraceptive alternative for men.)
• How about an inexpensive kit for detecting live sperm in similar to pregnancy kits to work in conjunction with various male contraceptives under development? Few men would object to their partners producing a little pre-ejaculate for testing and it would be a logical hedge against the possibility that one's partner only claimed he was infertile.
• How about a little research into more targeted approaches to inhibiting ovulation than (relatively) massive injections or ingestions of whole-body hormones?

None of these, or any number of other avenues I've overlooked, would take longer or cost more to develop and promote than the next me-too version of a premature climax inhibitor for women(?!?) but there has to be a positive infrastructure for them to sell into or nobody will bother.

Fallback
Taking this position is also a strong hedge against the very real possibility that the current administration will finally succeed in packing the courts with anti-choice, pro-forced-pregnancy, women-hating, sex-hating psychopathic activist judges like Antonin Scalia, Samuel Alito, and others of their ilk who will finally redefine abortion as murder. Should that happen we'd better be there with very strong, very well-developed birth-control initiatives or risk sliding back into the middle ages.

The Bottom Line
My goal here is *not* to pontificate or pundificate. It's to propose way out of a decades-long deadlock over what Franke-Ruta, others like her, and I see as "a symptom of larger social problems that ought to be addressed by policymakers." This post isn't a final word on anything. Given my very limited skills and knowledge I think it's barely a beginning. I would prefer that better minds be involved. Fortunately better minds shouldn't be hard to find. I do hope, though, that at the end of the debate at least one of the following points (in no particular order) becomes the conventional wisdom. Not because I thought of them (none are unique to me) but because we'd all be better off than if we don't.

• Reframe the abortion debate as a birth control debate because a) it's sex-positive, b) progressive, and c) a majority of Americans would support it.
• Push abortion as a failure of birth control not a failure of self control
• National policy should be to reduce unwanted pregnancy, not to reduce abortions. Birth control is the best way to reduce unwanted pregnancy
• Keeping the focus on abortion is hugely attractive to social conservatives. Reducing the number of abortions without limiting women's choice undercuts the appeal of social conservatives.
• Birth control is safer than pregnancy or abortion
• Contraceptive research shouldn't be confined to women, though since men wouldn't be the ones who wound up pregnant, methods of verification should probably be developed in conjunction with male contraceptives.
• If or when the troglodytes finally gain enough clout to outlaw abortion we need to have something in place to reduce our dependence on abortion.
• Discard the Clinton's "keep abortion safe, legal, and rare" for the more sex-positive "make abortion safe, legal, and rarely needed."
• Inadequate access to reliable birth control limits our choices as surely as social conservatives would eliminate our choices
• The right of women to choose an abortion is, and should always remain, absolute and absolutely her choice and nothing in this post should be construed as meaning otherwise. I hope the differences between "rare" and "rarely needed" make that perfectly clear.

If you've made it this far I appreciate your patience. I'm not used to writing five-page essays as a single draft and, considering the third-rail-like qualities of the subject I'm probably insane for posting it as a first draft. I welcome any and all constructive criticism (and corrections of typos) and will do my best to incorporate them, giving credit where due. Eeek! I'm going to push the post button.

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Update: I ought to mention that ema of The well-timed period has a great deal of information mainly on contraceptives for women. If you know of other good resources, particularly regarding contraception policy (rather than contraceptive technology) please let me know via email or in comments and I'll append them here.