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Michael Abrahams | Addressing abortion – Comprehensive sex education and contraception

Published:Tuesday | January 26, 2021 | 12:12 AM
Michael Abrahams
Michael Abrahams

The abortion debate is one that will likely never end. On one hand, those of us who are pro-choice insist that a woman has a right to make informed decisions about what happens to her body. On the other hand, anti-abortion proponents posit that abortion is the taking of a life, is morally wrong, and should not be allowed. However, while the debate rages, there is a discussion that we do not engage in enough, and that is the conversation about how to actually reduce the number of abortions being carried out.

Persons on both sides of this divide disagree on many things, but both would be comfortable seeing women being happy having less abortions without threats or coercion. However, in order for us to achieve a significant lowering of our abortion rates, we need to scrutinise the research, evidence and data concerning strategies that work, and those that do not.

An inconvenient truth is that contrary to what anti-abortion advocates would like to believe, restrictive abortion laws do not significantly lower abortion rates. According to a study published in The Lancet in 2016, the researchers “did not observe an association between the abortion rates for 2010–14 and the grounds under which abortion is legally allowed.” Indeed, the region with the highest abortion rates in the world is Latin America and the Caribbean, this despite the fact that this area has some of the most restrictive abortion laws in the world.

A comprehensive study published by the Guttmacher Institute in 2020 also found that unintended pregnancy rates are highest in countries that restrict abortion access and lowest in countries where abortion is broadly legal. The study also found that in countries that restrict abortion, the percentage of unintended pregnancies ending in abortion has increased during the past 30 years, from 36 per cent in 1990–1994 to 50 per cent in 2015–2019.

On the other hand, restrictive abortion laws, which are more common in developing countries, are associated with an increased risk of women having unsafe abortions and experiencing their complications. According to the World Health Organization, each year between 4.7 per cent and 13.2 per cent of maternal deaths can be attributed to unsafe abortions. Estimates from 2010 to 2014 showed that around 45 per cent of all abortions were unsafe, and almost all of these took place in developing countries. In contrast, only three per cent of abortions in Western nations are unsafe.


It is a no-brainer that if we want to lower abortion rates, and the complications that can arise form unsafe procedures, we need to lower the rates of unintended pregnancies. One effective way of doing this is to provide comprehensive sex education (CSE) in schools. This refers to age-appropriate sex education directed at empowering students with the knowledge, attitudes, skills and values to make appropriate and healthy choices in their sexual lives. This not only aims at reducing unplanned and unwanted pregnancies, but also lowers the risks of contracting sexually transmitted infections and rates of domestic and sexual violence. Educating and socialising children in this way, fosters the development of mindsets that lead to responsible sexual behaviour, a way of thinking that they will carry with them into adulthood.

Thanks to the Internet, we live in an era where children are exposed to graphic sexual content from an early age. If responsible, experienced and knowledgeable adults do not engage and guide them, their teachers will be porn sites and videos, and other children. Simply telling children to not have sex will not work, and the evidence and data prove it. The experiences of Texas and California in the USA are great examples. In 1990, Texas and California had similar teen birth rates: Texas’ rate was 75.3 per 1,000, while California’s was 70.6 per 1,000. California began a comprehensive sex education programme, while Texas continued with abstinence-only curriculum. The result? By 2011, Texas’ teen birth rate was 46.9 per 1,000 teen girls, while California’s fell to 28.7 per 1,000.

In addition, access to affordable, or even free contraceptives, especially long-acting ones such as IUCDs (intrauterine contraceptive devices) has been shown to significantly lower unplanned pregnancy and abortion rates.

Rather than insisting on punitive measures to reduce abortion rates, such as criminalising the procedure and demonising women who have abortions and the physicians who perform them, it would be more advantageous to focus on modifying the behaviours that place women at risk of having unplanned and unwanted pregnancies.

Based on the results of their study, The Guttmacher¬-Lancet Commission recommends that “a comprehensive package of essential sexual and reproductive health services, including contraception and safe abortion care, be included in national health systems”.

Likewise, the WHO has stated that “almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion, and timely care for complications”.

If we truly care about our women and their health, we must pay attention to and respect the data, and place it above our personal feelings, religious beliefs and opinions.

- Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Email feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or tweet @mikeyabrahams.