It's abortion again : "pro-life", "pro-choice" & contraception
Iain Dale has stirred up a hornet’s nest by highlighting the recently announced UK abortion figures under the headline “Abortion Figures Shame This Country!”
I infer from what he writes that Iain is of the disturbingly named “pro-life” persuasion. As always, however, he puts his considered views moderately:
In an ideal world there would be no abortion, but we do not live in that world and never will. Those of us who adopt a pro-life attitude must recognise that we cannot roll back the clock and shouldn't try to. We have to be pragmatic, but that does not stop us trying to understand why the abortion rate in this country is so much higher than in most others, and then doing something about it. The question is, what?It is hard to see even the most rabid member of the equally disturbingly named “pro-choice” persuasion taking offence at that statement but, of course, lots do. Read through the comments under Iain’s article. It is not possible even to mention the subject of abortion without the extremists from both sides started a pitched battle.
Dr Crippen, as I have argued many times before, is from the
..I really do not like abortions but on balance until we can come up with something better it seems to me it is a woman’s right to do with her body as she pleases and so reluctantly but nonetheless unequivocally I support her right to have an abortionschool of thought. Sorry if that is a bit wishy-washy.
I have just read a fascinating book (as above) entitled "What Roe v Wade should have said". Any one interested in abortion law - and the issues here apply just as much to the UK as they do to the USA - will be fascinated to read Roe v Wade being "re-heard" by eminent jurists of all political persuasions. The book is written by Jack Balkin who is an eminent Professor of Law in the USA, and who has his own website, Balkinization.
Iain Dale asks what we should do about the abortion rate but does not offer any answers. The answer is easy and obvious. Better sex education, starting in primary school. Sex education in schools must be compulsory; no right for parents to withdraw their children from it. And better and free availability of contraception and contraceptive advice for children of all ages.
How has the government fared on this?
Ann Weyman, Chief Exexutive fpa said:
"As this audit reveals, contraception is an ailing, fragmented and chronically underfunded public health service. The fact that some Primary Care Trusts (PCTs) found it acceptable to spend just 18 pence on each woman's contraception is simply beyond belief.Patricia Hewitt has thus “saved” a few pounds by reducing contraceptive services. She is unlikely to have saved her job.
"Since the audit was finished the situation has only got worse. Many PCTs used the Choosing Health[i] money allocated to contraception services for other purposes. Consequently more contraceptive clinics have closed and services have been cut. Clinics provide specialist training for doctors and nurses, so their closure will deeply affect services in the future as the number of trained staff shrinks.
"Investing in contraceptive services actually saves the NHS money. Research carried out for fpa by the University of Newcastle shows that investing in longer acting methods of contraception - the IUD, the IUS, injections and implants - would save the NHS £500 million over 15 years. Nevertheless the audit shows that 20% of PCTs have restricted women from having these methods.
"This audit should act as an alarm call to all PCTs to evaluate their strategic approach to reproductive health care," (Anne Weyman, fpa)
The strangest thing about the so called “pro-life” brigade is that they are usually as opposed to sex education and contraception for young people as they are to abortion.
Odd.
I wonder where Iain Dale stands on that one?
+++++++++++
A fascinating and, for the "pro-choice" believers, a challenging moral conundrum from The Difference Magazine
...at what point of maturity do embryos acquire the necessary "factors of form, function or behaviour" to merit their protection from needless destruction? At present, the creation and use of human embryos for research is not permitted beyond 14 days in vitro. In order to be consistent, should the time frame allowed for human embryo research be extended to 24 weeks to match that for abortions, should the time frame for abortions be reduced to 14 days to match that for in vitro experiments, or should some other compromise be reached?See Undignifying Research
33 Comments:
I agree that sex education needs to be at an earlier age (I taught it in secondary schools and by then it was too late) but I think the most effective place it can be taught is in the home. If I'm going to teach my children the most basic yet valuable things to survive in the world, a life tool like sex education is a must.
Back in the real world however, especially in Britain, I don't see that changing soon, but recently I've been considering setting up workshops or something along those lines to help parents approach the subject with their children. Sometimes children aren't the only ones who need to be taught a few things :)
When I had my IUS fitted a few years ago, I was very lucky to have a PCT that funded it and had no trouble getting one as a woman with no previous pregnancies/births (and I wasn't in a relationship at the time). I do wonder when it comes to having it replaced, whether or not I'll have to pay privately. Give me 2 years and I'll get back to you.
I for one am "pro-life" but also in favour of compulsory, quality, early sex and relationships education and for those who don't then listen to the sex/relationship education quality and high availability contraception. It seems to me you can't both hope that abortion is the rare "last choice" and not empower people to take preventative action before they find themselves needing to make that choice.
One of the arguments attached to the Autism Omnibus is that it may encourage Big Pharma to abandon vaccination in the same way that it is ceased to develop contraception after various legal actions.
I gather that almost 1/3 abortions take place in the 40+ age group. A number of these women report that their contraceptive options pretty much dried up after the age of 35 and they were at the mercy of condom-and-normal-usage-related errors. The so-called 'natural' methods lose their dubious efficacy once a woman starts the dysregulated menstrual cycle of the peri-menopausal.
It is not just children who lack adequate contraceptive advice and provision.
In the Netherlands it seems that parents are forced to confront the issue precisely because children are being confronted with it in school lessons from age 5. We have a terribly knee-jerk reaction to this in this country. I mentioned it in another forum the other day and someone instantly replied "you want to teach five year olds how to give goodd head?" which is about the level of debate we are at. Of course not, but these Dutch five year olds were discussing relationships. We teach them history, landguage, maths, even "home economics", but not how they themselves work in a most basic way. Bonkers!
Just to add, when I taught sex ed, the headmistress of the school wanted to know what the material was and what we discussed - perfectly reasonable. We gave her our lesson plans and waited for a response.
She said it was fine, but wanted one thing taken out: we weren't allowed to tell them know where they could go for help if they needed it.
Jack coats: the knee-jerk hysteria is so frustrating. It's like you have to sit someone down and say very slowly, "No, your 5 year old won't be told how to put on a condom."
"The so-called 'natural' methods lose their dubious efficacy once a woman starts the dysregulated menstrual cycle of the peri-menopausal."
We often get older ladies falling pregnant believing they are going through the menopause. Some even visit their GPs and are told it's normal (one client of ours was told not to bother using contraception anymore). By the time they find out they are, they are often over 19 weeks gestation and require a late-term abortion.
Dr Crippen - THANK YOU for a really well written and interesting article - MORE LIKE THIS PLEASE!!!
My son is in reception class - he's 5 - he asked us recently 'what's does "sexy" mean?' My husband avoided an examplation and I struggled! Incidentally, we saw an excellent film on 'how babies are made' at Epcot in Orlando. My 5 yr old knows that it takes a 'sperm' and an 'egg' to make a baby, but not how the two meet!
Naughtymedic - how demoralising that you had to take the info about how to get help out - that's just plain stupid.
It was pretty demoralising, but not unusual apparently. My own sex ed at my old Catholic school was, "Here is how you do it. But don't do it." Which is what inspired me to work in schools.
It didn't make sense to not be able to tell them where they could go for help - that's part of the process in helping them to take responsibility for themselves. Maybe the Head was bound by certain regulations.
In the end, there was no point telling them what each method of contraception was like for instance, because half of the girls were on the pill already. Most questions I got were about suitable age-gaps (I was later told that some girls were seeing guys in their late teens/early 20s - they were 14) and the saddest question I got was at the end of the course, when a girl (holding her friends hand and looking ashen) was asking about second trimester terminations.
I think those lessons ended up teaching me more than it did them :(
Sex/Relationship education from primary school - yes.
Access to contraception - yes.
More high quality public heath education - yes.
One of the more worrying things I've come across recently is a study by Southampton University on reasons for second trimester abortions which shows that significant number of women are having abortions at that stage of pregnancy simple because they didn't realise they were pregnant until after 12 weeks gestation.
There is something very off in finding that a proportion of women are actually rather ignorant of the basic workings of their own body.
And let's make one amendment to current abortion law and get rid of the whole business of justifying elective abortions on mental health grounds.
There is a depressing paucity of quality research in the UK into why women have abortions, much of the reason for which rests in the absurd practice of lumping all elective abortions under a spurious quasi-medical category devised forty years ago to placate opponents of legal abortions.
Its long past time we openly acknowledged that:
a) the vast majority of abortions are carried out for 'social reasons'
b) this in no way delegitimises the complex and difficult choices made by women in choosing to have an abortion or supports the view that such decision are somehow immoral, and
c) that the generic 'mental health' category actually gets in the way of research and prevents us from developing a full and properly evidenced understanding of why women choose to have an abortion, and therefore limits our ability to devise and develop public health/education programmes and public policy to meet both the real needs of women facing these difficult decisions and the wider objective of reducing the overall number of abortions.
Is the evidence that sex education works as good as the evidence that being fat kills you?
The answer is staring you in the face:
Girls are not to be educated, not allowed outside the family commune unless escorted by a male relation, and must wear hijab/q'tab/n'qab at all times. They must also always marry within the family.
!00% guaranteed no unwanted pregnancies.
May I invite the good doctor to declare where he stands on the related question raised by The Difference, arising from the Academy of Medical Sciences' definition of "human dignity" to defend research on hybrid and chimeric embryos? In order to be consistent, should the time frame allowed for human embryo research be extended to 24 weeks to match that for abortions, should the time frame for abortions be reduced to 14 days to match that for in vitro experiments, or should some other compromise be reached?
Dearime:
Yes - teenage pregnancy rates in the Netherlands are a quarter of those in UK and a tenth of those in the US.
I believe that sex education at an early age would help, but there also needs to be a change in attitude amongst young people. My daughter tells me that many of her friends, in their teens and early twenties have had abortions. These are generally necessary due to their irresponsible attitude, which tells them that its alright to go out and get drunk and sleep with guys they have just met. After all there is the morning after pill now - and if that doesn't work, it is easy to arrange an abortion.
I think that teenagers should be be educated about the effects of undergoing an abortion, both physical and psychological as part of their education about sex and relationships. But I don't know what we can do to change their self-destructive social behaviour.
J
My guess would be that it is this that would provoke objections:
"but that does not stop us trying to understand why the abortion rate in this country is so much higher than in most others, and then doing something about it."
It is implicit in the statement that abortion is inherently a bad thing, a position not everyone agrees with, and one that will continue to fuel the stigma associated with terminations.
incandenza says
"It is implicit in the statement that abortion is inherently a bad thing"
If it is not a bad thing, does this make it a good thing?
I'm not sure if there is much of a stigma associated with terminations but maybe if there were more of a stigma, this might reduce the number of unwanted pregnancies.
I have spoken at length to friends from the Netherlands about this very issue. An unplanned/unwanted pregnancy in teenagers there is frowned upon by guess who - other teenagers! They consider it to be "stupid", (not my words), especially when contraception is available.
Well, Unity, if the only difference between the Netherlands and the UK was sex education, that would be pretty conclusive. However...
Although I'm sympathetic to some of your points I think you're wrong. You say we need more sex education and contraception access but both of these have increased and yet the abortion rate has dramatically increased. I also do not see how sex education has any impact whatsoever because it's never more than a few hours a year at the very most. I'd rather scrap it to save costs and put that money into teaching sex education via more appropriate means (e.g. teen websites) rather than a classroom situation where everyone sits embarassed and giggling - never taking the subject seriously.
In any case, more concern should be given to the time limit of abortions. I am hugely uncomfortable with the fact that disabled babies can be aborted up to birth but abled body babies have a time limit of 24 weeks. Aren't we effectively saying that disabled babies are "not human" or "inferior"?
Yes, Dr Liberal, that is precisely the conclusion that the Academy of Medical Sciences appears to imply, as I tried to raise @12:23 and wrote about yesterday at The Difference.
The "typical" pro-life approach might run something like this:
1. If you have sex, you might get pregnant/make the girl pregnant.
2. It's especially hard work raising a child as a single parent.
3. Therefore keep your clothes on.
You can argue that you don't actually need more sex education than that.
Also, apparently back in 2002, the BMJ (2002;324;7351) apparently published a set of studies showing that sex education does not appear to affect a whole host of behaviours.
http://www.thebody.com/content/world/art20389.html
I've seen other references (can't find the links offhand) that suggest that sex ed in the home works wonders, but no matter what you teach them in schools, they'll behave about the same.
So ending the slaughter of a children is rolling back the clock. Hmm... guess Wilburforce rolled back the clock too when he started fighting slavery.
For a very compelling reason to roll the clock back, watch the video on http://www.AbortionNO.org
Sex education in clas wound't be a snickering embaressing thing if it started earlier.
Our medical school had a sex-education type group that go in to schools. I think starting younger is better than the hardened young kids coming out with the horror stories i keep hearing.
I have nothing against abortion i think it can be a nessesary thing or as has been discussed useful when things are not easily planned (contraception had a failure rate so being careful isn't always enough).
Dr liberal, i think its fair that early pregnancies are 24 weeks where the decision is that the woman has no desire to have a baby full stop. But later abortions are allowed as the reason for abortion can only be determined later. I think this is more acceptable than either having disabled babies given away to the state or being cared for by parents who resent them.
Joey said "So ending the slaughter of a children is rolling back the clock."
Sorry Joey, you made a typing error there. I'm sure the word you needed was foetus.
I'm really glad there are blgos out there like this one to help catalyze the debate. We need an open forum to discuss these types of politically conflicting subjects. It's good to see people openly communicating here.
oops... blogs ;)
One can debate whether more earlier sex education per se helps, although I would say it can hardly make it worse. More information must be better.
As to the wider difference between (e.g.) the Netherlands or Germany and here, it comes down to the universal fuckwit culture that we abandon most of UK youth to at age 11 up, and the accompanying poor education. What fraction of the increase in terminations in the UK is in the higher socio-economic groups whose children get properly taught and who can expect to have "good prospects"? Not a lot, I would bet.
On a different issue, one of the less ideological problems with setting an earlier limit for terminations is the problem with getting all the pregnant women who need scans scanned quickly enough. What would you do if someone cannot get a scan until post 20 wks, the scan shows abnormalities and that then implies a late abortion?
I know what answer the frothing mad pro-lifers would give.
I suspect all the ritzy 4D scan technology that we have been seeing in the papers is widely available at your local private hospital to paying middle-class customers who want some nice pictures. Putting enough such machines in the NHS O&G Depts to make sure everyone gets scanned early for foetal anomalies is a different thing.
So if it is decided that the science now says the limit should be reduced, then there will have to be a major effort to stop people waiting for scans.
I didn't think most women had to wait for scans?
As far as i can see everyone is offered a scan at 16 weeks at least.
Alcohol causes pregnancies. Its the reason we have the highest rates of teenage mothers in Europe (i believe) and also why why have massive rises in birth rates in Sept (9months after xmas).
(Also from what is seen in maternity this is the the time with the highest number of single parents).
Education in all respects should help reduce unwanted pregnancies.
There are scans and scans, funny pseudonym. The more detailed the scan (which depends on time available and the equipment), and the more highly-trained and experienced the operator, the more can be seen. The current standard system is a fairly basic early-ish 2D scan (dating / booking scan, the one you mention, at 8-12 weeks), and then a more detailed 2D "anomaly scan" at 18-22 wks. At least, that was how it was when we were last going through the prenatal system. Would be interested to hear if things have changed much.
The question is really whether more detailed scanning for abnormalities could and even should be done earlier given more modern machines (e.g. w 3D/4D capability) / more ultrasonographers / more operator training / more funding.
I would love to hear from the ultrasonographers or obstetricians on what they think the answer is.
To give one example, last time I heard, measuring nuchal fold translucency, which is useful in looking for Down's, could be done but wasn't unless people paid for it.
Of course, the "cost-benefit" of fancier scanning technologies is a complex argument, but if the termination limits were going to be reduced it might need revisiting. A late anomaly scan at 22 wks doesn't leave much time until the current termination limit. And it seems self-evident that if terminations are going to be done, then the earlier in pregnancy it can happen the better.
Well where i am i think there is a detailed 16 week scan available if thought there is likely to be a problem.
Will find out the details on monday.
Ahem.
Think I've been talking slight balderdash since the 1967 Abortion Act says that:
"there is no time limit on abortion where two doctors agree...that the fetus is likely to be born with severe physical or mental abnormalities."
- although I am not sure what exactly counts as "severe" in this context.
It still seems to me that earlier scanning would be best, though - a termination must surely gets more traumatic as pregnancy progresses, so the earlier people can be scanned, and make the choices they have to, the better.
"Severe" has never been defined in law.
We were told in a recent lecture this was on purpose to maintain the ability of Doctors to decide what it meant.
Plus so that some things would not be seen to be "if you have this a termination is necessary"
Dr Crippen,
>
> As a (let's face it, I might as well admit it to myself) middle-aged
> man who used to participated heavily in the SCA (see
> http://www.sca.org/ for more info), I can assure you that most of the
> teenage girls I've seen honestly have no idea how their dress and
> behaviour can affect boys (and sadly, too many men who ought to know
> better). It is in that spirit that I think the advice you quoted in
> the comments to your recent post, "Girls just aren't turned on by
> man-boobs" is not unreasonable.
>
> I have seen, time after time, a teenage girl dress in very provocative
> clothing and flirting like mad, be surprised when what her courtiers
> perceived as a come-on was treated that way. I explicitly and
> forcefully do NOT claim "they asked for it" or "if she dressed like
> that she must've wanted it", let me be 100% clear about that. But I
> suspect if you recall your own teenage years, you'll recall it was
> quite easy to be aroused by an amusingly-shaped potato if the hormones
> were surging just right. Now, there is a decent percentage of girls
> who do that sort of thing explicitly and on purpose, but the vast
> majority of the teenage girls I've mentioned this to are honestly
> bewildered by the idea that exposing large quantities of skin and
> cuddling up to a boy by a campfire with singing and drinking going on
> all around them might result in the boy thinking she wanted to have
> sex with him.
>
> Sometime around 17 or 18, they generally clue in, but I have seen very
> physically-developed 15-year-olds being hit on by 25-30-year-old men
> who, in their defence, thought they were talking to someone in her
> early 20s, and the girls had no idea the men were trying to get in
> their pants. Perhaps they have all been consistently lying to me; I
> confess to a certain avuncular concern for their welfare that could
> make me more credulous to such claims than is perhaps strictly
> warranted. But I do not believe this is so; I have had woman after
> woman tell me that they had no idea how strong the sex drive is in
> men, and they wished someone had made it clear to them when they were
> younger. I had one even tell me that she was reassured so often by
> her parents and teachers that it was okay to have sex, that she never
> even considered until her twenties that it might be okay not to.
>
> That said, there is a sociological aspect to the SCA, at least in my
> area, that may make this not generally relevant, I should note: the
> SCA is often (though not always, or even necessarily primarily) a
> haven for misfits and social outcasts who share a common interest
> (namely, Dark Ages and medieval history, arts and crafts, and so
> forth), and teenagers are more likely than not to be in that category
> than, say, someone who's interested in learning the finer points of
> Italian court dancing. So it may be that the girls are simply social
> misfits, and "normal" girls would have clued in much earlier on as to
> what was going on.
>
> In conclusion, I think advice to teenage girls that it is okay to not
> have sex, and that gives them some clear signs to watch out for that a
> boy might be trying to talk them into it is actually fairly
> reasonable. And the advice itself is not particularly novel; it's the
> sort of thing a grandmother or aunt might have proffered in days past.
> It has been my experience that while some teenage girls are quite
> capable of handling themselves, thank you, most of them aren't (same
> goes to teenage boys, of course, but you didn't quote any advice to
> them), and most girls find it easy to miss signs that a boy would find
> trivial to notice from orbit. A little reminder to girls that "hey,
> pay attention before you get yourself into a situation you might not
> be able to easily extricate yourself from" shouldn't be treated with
> such dismissiveness and (as I perceive it) scorn.
>
> -=Eric
>
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