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Scott Gibson: Making every baby wanted

Can Stock photo##
Can Stock photo##

In an age when political positions are staked out with razor wire, it is unusual to find solutions to social problems that can bridge political divides. We may, however, be on the cusp of a radical change that has the capacity to shrink one of our most contentious political problems — abortion. The hero of this story is, once again, technology — if we choose to use it.

Unintended pregnancies remain a serious problem in the United States. About half of all pregnancies in the country are not planned, and this leads to the distressing result of 1.2 million abortions per year. The American teen pregnancy rate is seven times that of Switzerland. Clearly, we are doing something very wrong.

Guest Writer

Guest writer Scott Gibson M.D. has practiced medicine in McMinnville, his hometown, since 1989. He is interested in a diverse and seemingly random variety of topics, but his major non-medical interests are photography and writing. He and his wife, Melody, have three children and two grandchildren, hoping for more.

Unwanted pregnancies can have deep and lasting adverse consequences for people of any age, but for young women in particular. Young women who have unplanned births often have their education interrupted or halted, limiting their ability to be financially independent and reach their full potential. Often this leads to a perpetuation of poverty, as poor women have four times as many unintended pregnancies as wealthier women. Unplanned pregnancies put a burden on women, their families and society.

The risk factors that increase the likelihood of unplanned pregnancies are familiar: poverty, low educational attainment, ethnic minority status and unmarried cohabitation. In an age of easy access to contraceptives, it would seem that pregnancy avoidance would be the norm, even in these risk categories. So what is going wrong?

The Centers for Disease Control (CDC) wanted to know why so many women were getting pregnant needlessly. They performed a survey to determine why women thought they had unexpectedly gotten pregnant. Here are some of the revealing answers:

* The most common answer, at 36 percent, was that they did not think they could get pregnant.

* Another 23 percent said they “didn’t really mind” if they got pregnant.

* More concerning were 17 percent who “didn’t expect to have sex.”

* The ones that bother me the most were the 8 percent who said their male partner didn’t want to use protection and the 5 percent whose male partner didn’t want her to use protection.

This revealing survey shows that we as a society are not doing enough to educate and empower young women, especially those in high risk groups, about how to protect themselves from unwanted pregnancy. Some facts bear this out: Forty-four percent of young U.S. women agreed with the statement: “It doesn’t matter whether you use birth control or not; when it is your time to get pregnant it will happen.” Two out of three knew little or nothing about intrauterine devices (IUDs); one in four did not know where they implemented.

Part of the reason that so many women are fatalistic about pregnancy or are surprised when they get pregnant is that the most commonly used contraceptives are flawed. About half of unintended pregnancies are due to contraceptive failure, including improper use. Skip a single pill and you could become pregnant. Relying on condoms is a common path to parenthood.

What we need are contraceptives that women do not have to remember to take, that are highly effective, and have few side effects. Fortunately, we have them. They are called LARCs, long-acting reversible contraceptives. They are available in two types--IUDs and implantable hormones, which are placed under the skin in a simple office procedure and can be easily removed any time. Both are for women only, but women have always had to carry the burden of birth control.

How much better are LARCs? Much, much, much better. One study showed that at two years, usual contraceptive users had an 8 percent pregnancy rate, versus less than 0.5 percent for LARCs. In another study, the only woman who got pregnant in the LARC arm of the study decided to have the contraceptive device removed. One researcher declared that LARCs create “virtual infertility.”

But what about those at greatest risk: the poor, minority, young women? Two studies have addressed this question of what can happen if LARCs are provided free of charge and women are educated about them. In a three year study in St. Louis, abortions dropped to one-fourth the previous rate. Among the group most at risk in this study, poor black teen women, the rate of pregnancy dropped by a factor of eight.

In a Colorado study, teen births fell by 26 percent and abortions by 34 percent. The state saved $6 for each dollar spent on the program, not counting the gains to women who finished their education. Clearly, these programs work, and they are exceptionally cost effective.

Educating people about the dangers of cigarettes took decades, but we have dropped the smoking rate to a fraction of what it was in the 1960s. By promoting LARCs as a public health issue, we can do the same with unintended pregnancies, and in the process slash the number of abortions. This would be an outcome that activists on the left and the right could applaud.

Every pregnancy should be a cause for celebration. Every child should be wanted even before conception. We should quit making the legality of abortion our battleground. Instead, we should join forces to make unwanted pregnancies so rare that abortions drop from the political radar.

The country has a host of problems that have no cheap or easy fixes, but stopping unwanted pregnancies is not one of them. This is something we can do, if we find the strength to focus on solutions instead of reveling in political warfare. It’s time to work together, empower women, and put the abortion furor in the rear-view mirror.

Comments

Mudstump

I really enjoyed reading your article Dr. Gibson. We should work to make effective contraception affordable and readily available. Unfortunately, we have certain extremists who work instead to promote abstinence only education and to make contraception harder to get. Education and the availability of contraceptives is crucial to reducing the number of abortions. Many of us who are pro-choice support reducing the need for the procedure. Abortion should be safe, legal and rare....as they say. Thanks

Lulu

I believe all contraceptive devices should be free for everyone.

Scott Gibson

I appreciate the comments. Sadly, it seems that the Republicans are dead set on working to make abortions illegal and then they think their job is done. Democrats work to keep abortions legal, but have not been very pro-active in assuring that the very best forms of contraceptives are available to any woman that wants them, and assuring that young women have a full understanding of which are the best choices. Clearly, the abstinence only crowd is hindering the spread of much needed information. It would be good if both sides could join together to make unwanted pregnancies rare.

Joel2828

Any chance you could get this off the front page of your web site? Three days in a row of seeing it is about all that I can handle. Thanks.

Reporter Starla Pointer

We change the lineup of stories several times a day. No story remains in the top spot for three days in a row.

Joel2828

Thanks Starla. Must just have been a coincidence that it was there every time I opened the web site.
I almost took Dr Gibson's bait several times but thankfully, each time, I was able to muster the self control to delete my scathing comments right before hitting the "post comment" button.

Mudstump

I hope this article stays up and available for a long time. Dr. Gibson has provided important information for the general public. It should be required reading for every high school student.

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