Family Planning and Safe, Legal Abortion Go Hand in Hand


See all our coverage of the 2012 Global Family Planning Summit here.

One in three women in the UK will have an abortion in her lifetime, most of whom will have been using contraception of some kind. Yet since as long ago as the late 1930s, there has been a split in the UK between those who insisted on promoting contraception on its own because they thought abortion was too controversial and would hold back acceptance of family planning, and those who insisted that the two go hand in hand. This split exists in many countries, not just the UK, and also within many organizations with a large membership in different countries, such as the International Planned Parenthood Federation (IPPF). It is reflected most recently in a comparison of the list of 600 groups and individuals who have endorsed the International Campaign for Women’s Right to Safe Abortion this year, and the 1300 that signed a letter circulated by the IPPF supporting the Family Planning Initiative – very different groups are on those lists. Yet all of them support the right to control fertility.

In 1994, the ICPD Programme of Action, a consensus document on the integration of sexual and reproductive health and rights, was only able to be passed if it included a “compromise” clause that called for abortion to be safe only if it was legal. This compromise was and remains a violation of public health principles and women’s human rights. ICPD failed to condemn the often 19th century, often colonial laws on abortion still in place in the criminal code in many countries. However, the Programme of Action did recognise that unsafe abortion was a major public health problem, one which to this day still affects some 22 million women every year, among whom 5 million end up in hospital with complications annually and tens of thousands die (WHO, Guttmacher). And young women, whom everyone wants to be  seen to be supporting these days, are in fact most at risk of unsafe abortion and also have the least access to contraception (Shah & Åhman, RHM, May 2012).

The answer is not to promote contraception in order to reduce unsafe abortion, as the FP Summit did. The answer is to promote contraception to reduce unwanted pregnancy and provide safe abortion to every woman who finds herself with an unwanted pregnancy. That is the way to make unsafe abortion history. Abortion will not go away unless men and women stop having sex with each other or everyone is sterilised. So forget it!

The growing number of countries in both the north and south, east and west, where there is 60 to 80 percent contraceptive prevalence proves that. Research shows that women and men take up contraception in large numbers if they feel they have the right to control their fertility and have access to the means to do so. There is a huge need for information, because every new generation of young women and men will know nothing about contraception or abortion unless they have access to this information. But there is no need for “demand creation,” a retrograde concept which implies lack of interest. The steadily falling fertility rate globally, falling since the 1970s, proves that, and in every country, abortion is in there, safe or unsafe, reducing the number of births. Forty-four million abortions globally and hundreds of millions of people using contraception and sterilisation prove the huge demand for the means of fertility control. “Unmet need” is more than just lack of knowledge or interest on the part of the women and men who aren’t using contraception, or using it erratically or unsuccessfully.

Women seek an abortion if they have an unwanted pregnancy, legal and safe or not, because it’s too late for contraception. There is no split between contraception and abortion from women’s perspective, they are two sides of the same coin. Even so, many of the biggest supporters of “family planning” refuse to support women’s need for safe, legal abortion. Even worse, they always talk about abortion in negative terms. They mention it along with STIs, as if it were a disease, or treat it as an annoying problem that they wish would go away, and consider it inferior to use of contraception. They even claim that use of contraception will (or should) make it go away. But this is about the realities of people’s sex lives and how sex happens, not just about well-thought-out, planned-in-advance decisions about family formation. Many pregnancies are started without any forethought at all, and all too often as one of the consequences of sexual pressure and coercion.

Campaigns for women’s right to safe, legal abortion have been going on for at least 100 years. Many of us involved in these campaigns are still seen as annoying by people who are supposed to be our colleagues. We’re told it’s sensitive, controversial, difficult, it can’t be put on the agenda, including in the FP Summit. At the same time, many of us who are fighting for abortion rights stopped supporting “family planning” years ago, because of what happened in the past, when coercive programmes put many people off “family planning” and gave it a bad name. Some family planning supporters have blamed ICPD for the neglect of family planning, because it placed family planning in a wider context. But as Gita Sen said at the Summit, ICPD in fact sought to rehabilitate family planning and restore its good name, while the barriers to safe abortion were left in place.

Today’s supporters of family planning would like everyone to forget the coercive programmes of the past, which were target-based. But they may yet become target-based again because of “results-based financing.” So let’s not confuse opposition to coercive family planning policies with being anti-family planning. Yet, it is absolutely true that provision of contraception has been neglected in recent years – and yes, this neglect must stop. At the same time, neglect also characterises how women’s unmet need for safe abortion is treated. What needs to change is that both forms of unmet need should be taken into account – together – starting with donor and national government policies.

For example, although DFID’s development aid policy has long been to fund both family planning services and abortion services, in their roll-out of these policies, funding for family planning is (I am told) separated from funding for safe abortion. That is, it is managed by different people and in different programmes within DFID and in the recipient countries, and these different people may not work closely together or know what each other are doing. Yet DFID did not see a problem in agreeing to a family planning initiative in which funding for abortion is excluded. They fund abortions anyway, they say, so what’s the problem? The problem is that separating abortion from family planning at the programmatic level allows some countries to keep abortion legally restricted and not take responsibility for unsafe abortion.

Then there’s the United States, where support for family planning by USAID has been the highest in the world for many years now (but not in constant dollars), while safe abortion services are not funded by them at all. Since ICPD, however, the US has funded post-abortion care, which was invented at ICPD as a way to save women’s lives who had had an unsafe abortion. Unfortunately, the evidence that post-abortion care has in fact saved many women’s lives since ICPD is sparse and not compelling. Yes, the number of deaths from complications of unsafe abortion has fallen a lot, but this may be due to self-medication with misoprostol replacing life-threatening methods.

In fact, once ICPD was over, this so-called post-abortion care should have been rejected as unethical, because it allows harm to be done unchallenged and forces health care providers to clean up the mess without the support of the law. Under U.S. aid policy, even countries where abortion is legal who tried to use USAID funds for safe abortions as well as for contraception and sterilisation, in integrated programmes, had their “family planning” funding stopped. Research has now shown that this leads to higher rates of unwanted pregnancies and abortions in those very same countries, proving how illogical such a policy is/was. Will that evidence, published only recently, lead to a change in USAID policy? Unlikely. Too sensitive. And meanwhile, a violent and fanatical anti-abortion movement flourishes in the US, where some of the most punitive and misogynistic barriers to safe abortion are being implemented with near impunity, in one state after another.

The anti-abortion movement is also anti-family planning. For years, they were very circumspect about this as they feared, quite rightly, that it would lose them support. But the current Vatican has helped to bring anti-abortion opposition to both contraception and assisted conception out in the open again. This is evidenced in campaigns to ban emergency contraception and assert conscientious objection to providing contraceptives, e.g. by pharmacists. But still, many in the family planning movement do not support the right to safe abortion.

In light of the Family Planning Summit, it is a good time for abortion rights activists who have ignored family planning to link up with the family planning movement, and help to ensure that services have a rights-based approach. It is also a good time for all family planning colleagues to support the right to safe, legal abortion alongside the right to access contraception and sterilisation – and talk about abortion as a legitimate part of fertility control, a solution to unwanted pregnancy, a public health necessity for women, and a legitimate health care service. All of us should acknowledge the huge unmet need for safe, legal abortion services as well as for contraception and sterilisation services, and ensure that they are provided – and funded – together.

Many effective contraceptive methods, condoms, two types of emergency contraceptive pill and two very safe methods of early abortion – all on the WHO essential medicines list – can and should be provided at primary health care level. This includes medical abortion pills and manual vacuum aspiration for abortions up to 9 to 10 weeks. Some of these can even be provided during home visits by community-based health workers – the pill, condoms, injectables, emergency contraceptive pills and medical abortion pills for early abortions – as long as there are nurses, nurse-midwives or other mid-level providers who have been trained to do so. The evidence is there -– this is all safe and effective. Moreover, the legitimate sort of post-abortion care, i.e. the kind that happens after safe abortions, needs to include information about and provision of contraception, just as post-partum care ought to do. So, even programmatically and clinically, the integration of family planning and abortion makes more sense than ever.  

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  • sarahsmiles

    There actually IS a split. It’s a pretty hefty one. I have no problem with using contraception. I’m completely non-religious, and I have no moral qualms with it for anyone. Sexual behavior between consenting adults is their own business. Using contraception is the responsible thing to do if a child is not a desired product of sexual intercourse, and it harms no one. I am currently sterilized, and I have used hormonal contraception in the past. However, I would NEVER, EVER take the life of one of my children in utero. To this woman, the split between using contraception to avoid brining a child into the world and killing a child that already exists in an abortion is immense, and far beyond traveling. My contraception has failed in the most dire of circumstances, but killing my resulting child was not and will never be an acceptable solution to such a failure, because killing others to solve our problems is not an acceptable solution for anyone.

  • prochoiceferret

    However, I would NEVER, EVER take the life of one of my children in utero.

     

    A lot of women who have abortions out of necessity used to think that way, too—oftentimes because they have children out of utero that they need to be there for.

     

    To this woman, the split between using contraception to avoid brining a child into the world and killing a child that already exists in an abortion is immense, and far beyond traveling.

     

    Probably because abortion is not, if you want to be accurate, “killing a child that already exists.” (That would be infanticide, if the child isn’t older than an infant.)

     

    My contraception has failed in the most dire of circumstances, but killing my resulting child was not and will never be an acceptable solution to such a failure, because killing others to solve our problems is not an acceptable solution for anyone.

     

    That is true, but then, that has nothing to do with abortion.

  • sarahsmiles

    A lot of women who have abortions out of necessity used to think that way, too—oftentimes because they have children out of utero that they need to be there for.

     

     

    Well, ending the life of one child because it facilitates the care of another hardly makes any sense, and definitely should not be considered a necessity.

     

     

    Probably because abortion is not, if you want to be accurate, “killing a child that already exists.” (That would be infanticide, if the child isn’t older than an infant.)

     

     

    Stating that abortion kills a child that already exists is perfectly accurate. Infanticide would ALSO fit into that category, but so too would abortion. When a woman is pregnant, her child exists in utero. That is where every child’s life begins. We don’t simply spring into being as infants all of a sudden. Our lives start well before that point. You’d acknowledge that if you had any interest whatsoever in being accurate yourself.

     

     

    That is true, but then, that has nothing to do with abortion.

     

     

    This has everything to do with abortion. As I was saying before, we don’t simply *POOF* into being as infants. The birth canal doesn’t build a child as they come out. They’re living and existing long before that point, and abortion kills them. Maybe if I hadn’t had college Biology before becoming pregnant myself for the first time, and perhaps if I wasn’t the oldest child from a large family who had watched my mother carry each of my siblings (gone to appointments with her, watched the doctor describe them on ultrasound as my siblings and saw how very much alive they were already at that stage of life) I might actually be ignorant enough to believe what you’re saying.

  • purplemistydez

    No you are ignorant.  A fetus is not a child.  No child I know is solely dependent of it’s mother and can not be removed from it.  A child can be cared by anyone.  A fetus is attached to only the woman.  That is quality no person has.

  • sarahsmiles

    A fetus is a child of his/her parents. A DNA test would indicate the familial relationship and parent/child bond shared between a fetal human being and his/her parents. The level of dependency a human being possesses has nothing to do with who or what that human being is. Is a neonate in the woods with only his/her mother there to breastfeed from less of a person than one born in a hospital who can be cared for by a team of nurses? Are people on respirators, or those requiring feeding tubes, are they not people? Because that is essentially the role that an umbilical cord plays for a gestating child.

  • purplemistydez

    Yeah a fetus has DNA of it’s parents.  So what?  That does not entitle it to any more rights than any actual persons have.  No.  It still does not change the fact that someone else can care for it if there were other people around.  A child would not cease to be alive if the mother places the child on the ground and walks away for a few minutes.  People on respirators can be moved to other locations and do not have to be directly connected to woman’s body to survive.  No person has to donate their body to allow another person to live. You’re ananlogy does not work.  A woman does not have to risk her life for someone on a respirator or feeding tube.

  • sarahsmiles

    Yeah a fetus has DNA of it’s parents.  So what?

     

    So what? You’re the one that said a gestating human being was not a child. I submitted that a simple DNA test would prove otherwise. THAT is “So what”.

     

    That does not entitle it to any more rights than any actual persons have.

     

    And here you go and switch your argument from who/what the gestating child IS to what sort of rights they should have, and then inject the phrase “actual persons”, as if the gestating human being is not a person, which they very clearly are. They are members of the species homo sapiens sapiens and they are alive, which by definition makes them human beings, which in turn means they are persons. And they certainly are “actual”, or else pregnant women could just imagine themselves to be “unpregnant”, and it would be so, no abortion needed.

     

    As far as their deserved rights are concerned, they should have the same basic right to live that we all do.

     

    It still does not change the fact that someone else can care for it if there were other people around.

     

    And why should who must care for a child at any given time make killing them legal or illegal? If a family is utterly alone on a trip through the Canadian Tundra, and half way through the parents decide they no longer want to care for or parent their infant, should the fact that if they dump that child out on the road they would be dead in a very short time be justification for their doing so? Is the fact that there isn’t someone else around they can just hand that screaming baby over to justification for treating that child in such a way? How many additional people have to be available to care for an unwanted child before killing that child should be illegal?

     

    A child would not cease to be alive if the mother places the child on the ground and walks away for a few minutes.

     

    Depends on where you are, doesn’t it? It also depends on how old the child is, right? Infants are less able to maintain a consistent body temperature on their own than adults are. Does that mean an infant in certain parts of Alaska in winter is less of a person than an adult in Kansas in springtime? Why does level of development of a person/human being and their ability to sustain themselves make them more or less of a person/human being? How does that change their DNA sequence at all, since “person” and “human being” are just terms for homo sapiens sapiens?

     

    People on respirators can be moved to other locations and do not have to be directly connected to woman’s body to survive.

     

    Why does who/what they are connected to change the situation? And how does a mother’s natural method of providing nourishment for/sheltering her child when they are in the embryonic and fetal stages legitimize her opting to kill that child rather than continue to provide nourishment/shelter for her child? My youngest child refused bottles and would only breastfeed for almost the entirety of his first year post-birth. Does that mean that it would’ve been more legitimate for me to kill him than it would’ve been for my daughter who was weened happily at 6 months?

     

    No person has to donate their body to allow another person to live.

     

    True. And luckily, I’ve been through pregnancy and childbirth twice, so I know that even under these conditions, we do not have to donate our bodies so that our children live. We intake nourishment and oxygen they ALSO use, but they don’t steal our organs or blood. They make their own. Even while I was pregnant, MY body was MINE, and THEIR body was THEIRS.

    A woman does not have to risk her life for someone on a respirator or feeding tube.

     

    And 9 times out of 10, neither does any pregnant woman for her child. Not that we are even talking about situations like those. No other person I know who opposes abortion as I do would oppose an early induction to save a woman’s life if she were experiencing complications of a pregnancy. We are opposed to the legality of ELECTIVE abortion, though, and in those cases, no woman is risking her life. Not that I understand how that would be relevant…are these people on respirators and feeding tubes the minor children of women who have custody of them and are their legal guardians?

  • colleen

    We intake nourishment and oxygen they ALSO use, but they don’t steal our organs or blood. They make their own. Even while I was pregnant, MY body was MINE, and THEIR body was THEIRS.

    Is this degree of denial and cognitive dissonance painful?

  • sarahsmiles

    …do you think baseless accusations and insults are more substantial than an actual rebuttal?

  • colleen

    Right, because of course your ‘contributions’ haven’t been a constant stream of passive aggressive insults and sanctiminious bullshit. my bad.

  • prochoiceferret

    Well, ending the life of one child because it facilitates the care of another hardly makes any sense, and definitely should not be considered a necessity.

     

    No, but terminating a pregnancy because it facilitates the care of an existing child not only makes a lot of sense, a lot of women have made exactly that choice—and been grateful to have made it.

     

    Stating that abortion kills a child that already exists is perfectly accurate.

     

    No, because a fetus is not, in fact, a child. (Kind of how like how your abdomen is not, in fact, your “stomach.”) You can call it a “child” informally, and everyone will know what you’re talking about. But “child,” in proper usage, refers to a born person no more than a few years old.

     

    This has everything to do with abortion. As I was saying before, we don’t simply *POOF* into being as infants. The birth canal doesn’t build a child as they come out. They’re living and existing long before that point, and abortion kills them.

     

    Yes, we know that abortion kills (a.k.a. destroys, annihilates, makes go bye-bye) a fetus. That is not in dispute. If you are pregnant, and you don’t want to do this, then guess what? You don’t have to do it! Huzzah!

     

    Maybe if I hadn’t had college Biology before becoming pregnant myself for the first time, and perhaps if I wasn’t the oldest child from a large family who had watched my mother carry each of my siblings (gone to appointments with her, watched the doctor describe them on ultrasound as my siblings and saw how very much alive they were already at that stage of life) I might actually be ignorant enough to believe what you’re saying.

     

    Just goes to show that you can lead a horse to water, but you can’t make it use accurate terminology.

  • prochoiceferret

    The level of dependency a human being possesses has nothing to do with who or what that human being is.

     

    Well, it depends. Some people define themselves as moochers.

     

    But I’ll grant your point as far as abortion is concerned. Here’s a notion that’s going to blow your mind: Women have the right to terminate their pregnancies not because of what the fetus is or isn’t, but because the fetus (or whatever you want to call it) is making use of the woman’s body, and thus is reliant on the woman’s consent to taking sustenance from it. If the woman says no, that fetus is out of there.

  • jane-roberts

    From Jane. July 22 was the 10th anniversary of 34 Million Friends of the UNFPA which unfortunately does not engage in abortion but whose family planning programs prevent millions of them.

     

     

  • person-0

     

    “So what? You’re the one that said a gestating human being was not a child. I submitted that a simple DNA test would prove otherwise. THAT is “So what”.”

     

    You clearly don’t understand the scientific difference between genes and species classification. DNA has nothing to do with semantics or the common word usage. The scientific and medical terminology for in utero offspring is fetus. Your opinion of what does or doesn’t make a child is irrelevant. No one has disputed the fact that humans gestate human fetuses. What else would they be? A “person” is a subjective sociological construct that has no place in discussions of a medical nature. The opinions on what makes a person are varied and not agreed upon. Additionally, the semantic nitpicking is irrelevant since it doesn’t matter one way or the other in regards to abortion.  Whether you call it a child, fetus or person doesn’t change the fact that women own their bodies at all times and have paramount rights to them at all times.

    You can’t have your ridiculous arguments both ways. You create a completely fictional situation about infant abandonment in the tundra that has no basis is reality and compare it to the very real and well documented risks and harm that women endure during pregnancy and birth. You have zero evidence of the first but claim it as a valid argument while there is a plethora of evidence of the latter, but you claim it rarely happens and shouldn’t be a factor. Sorry, you can’t have it both ways. The FACT is that there is real risk for every single woman who gestates and only each individual’s acceptance of that risk is necessary. The risks are emotional, physical, financial and your opinion or anecdotal application of experience has no bearing on what other women deem acceptable for their own bodies and lives. There simply is no comparable situation to pregnancy and when you bring up such nonsense, it really shows your lack of basic understanding. Abortion is relevant to pregnancy only and how a woman’s autonomy and consent are affected. When you change the subject to unrelated fictional jibberish, you’ve clearly lost credibility.

    Women are under no obligation to you, their fetus or the government to continue an unwanted pregnancy. It’s too bad you don’t like it, but you enjoy the same autonomy even if you don’t understand it.