U.S. women have obtained nearly 53 million legal abortions since 1973. That is because self-described abortion foes ignore or oppose the most powerful strategies for making abortion obsolete. The antiabortion movement is dominated by religious fundamentalists whose determination to control sex—who has it, with whom, for what purpose—takes priority over their desire to reduce abortions. This focus has seriously interfered with eliminating the supply and demand for abortion services.
If the goal of the pro-life movement actually were to end abortion, both tactics and results would be radically different. Imagine a fictional person whose chief life goal is to reduce abortion by, say, 90 percent over the next 20 years. This person might devoutly believe that every fertilized egg has a soul and that fetal demise is a tragedy; or he/she might simply think that abortion is an expensive, invasive, emotionally complex medical procedure that should be made obsolete. Either way, this person believes that moving society beyond abortion is the most valuable cause to which he or she can devote a lifetime.
It might come as a surprise to the audience of today’s antiabortion theater—but our protagonist’s goal is attainable. Armed with just the information and technologies available today, someone genuinely committed to reducing abortion by 90 percent in 20 years could map out a plan to get there—and even make people’s lives better in the process.
Skeptical? Let me map it out. When someone gets serious about building an effective beyond-abortion campaign, the strategic plan will look something like this:
Serious beyond-abortion advocates will ensure that all Americans have the knowledge and means to prevent the kind of pregnancies that lead to abortion.
1. Since many parents had poor role models for birds and bees conversations, serious antiabortion activists will promote programs that help parents to overcome discomfort and create healthy, age-appropriate conversations about genitalia, sexual health, sexual pleasure, intimacy and reproduction.
Conversations between children and trusted adults delay the onset of sexual activity while increasing the percent of sexually active teens who protect themselves against unwanted pregnancy (and so the need for abortion). Therefore, serious antiabortion activists will help parents build trust and credibility on sexual matters. Despite the discomfort of aging traditionalists, who might prefer to avoid frank conversations about sex, serious antiabortion activists will keep their eye on their prize, which is fewer abortions.
2. Since preventing abortion is a higher priority for them than promoting chastity, serious antiabortion activists will promote open, honest conversations about sex within religious communities.
Approximately 85 percent of Christian youth have sex before marriage and the rate of abortion is as high among Christian believers as non-Christians, so beyond-abortion advocates will work diligently to ensure that Christian young people are equipped to manage their fertility and thus initiate pregnancy only when they are prepared to carry forward a new life.
Because beyond-abortion activists are single-mindedly intent on reducing abortion, they will take to heart the social science research showing that shaming—for example, through abstinence-only sermons, books and classes—drives down intimate conversations and preparations for safer sex while doing little to delay or reduce more impulsive sexual activity. They will recognize that guilt and shame about normal sexual urges can lead to denial, wishful thinking, church-avoidance and impulsive high-risk behaviors. They are also committed to helping young people understand and manage sexual desire and pleasure rather than simply trying to suppress those urges, which has been shown not to work. They will challenge old attitudes that treat youth contraception as “premeditated sin” or pregnancy as a punishment and will instead help young Christians to explore the spirit and purpose of ancient chastity laws. They will develop faith-compatible programs like Our Whole Lives, which was created by the Unitarian Church to integrate thoughtful, responsible family planning with other spiritual and moral wisdom.
3. Serious beyond-abortion advocates will treat the school system as part of the sexual education “village.”
To quote a research summary from Advocates for Youth: “Evaluations of comprehensive sex education programs show that these programs can help youth delay onset of sexual activity, reduce the frequency of sexual activity, reduce number of sexual partners, and increase condom and contraceptive use . . . teens who received comprehensive sex education were 50 percent less likely to experience pregnancy than those who received abstinence-only education.”
Recognizing that some families struggle with addiction, mental illness and other challenges that keep kids from getting excellent health information and care and recognizing that some children suffer unwanted sexual contact at home, serious antiabortion activists will support school efforts to fill knowledge gaps. They will invest in accountable, effective sexual health curricula demonstrated to delay sexual initiation and reduce risky sexual behavior (as measured by self-report, STIs, pregnancy and abortion). They will also lobby for age-appropriate education that starts long before youth become sexually active. When public dollars are limited, they will fund these materials and programs through charitable giving. Beyond-abortion advocates will insist that family planning be integrated into educational and career planning, not because this helps students attain their goals but because preventing surprise pregnancy prevents abortion.
4. Serious beyond-abortion activists will recognize that attempts to restore traditional gender roles and the traditional family formation sequence (education-marriage-sex-childbearing) have largely failed. They will also recognize that abortion prevention must adapt to a shifting pattern of pair bonding and family formation. Expanding beyond abstinence-till-marriage, they will deploy whatever tools are necessary to reduce the pregnancies that lead to abortion.
For over 20 years, advocates for child well-being promoted a return to traditional marriage as a means to ensure that parents get ready before getting pregnant. Lead advocate Isabel Sawhill (National Campaign to Prevent Teen and Unplanned Pregnancy, "Generation Unbound") concedes that the changes in family structure are likely irreversible and that new methods are needed to support well-timed pregnancy and family flourishing. To reduce abortions, serious antiabortion activists will adopt a pragmatic approach to intentional childbearing and family well-being, including community services for young families and access to better birth control.
5. Serious antiabortion activists will drive a technology revolution in contraception—from every-day and every-time birth control methods to long-acting contraceptives like IUDs and implants that radically reduce unintended pregnancy and abortion.
Long-acting contraceptives are the most dramatically effective means to date of reducing demand for abortion. A St. Louis program that offered top-tier, long-acting contraceptives to 9,000 women and youth dropped unwanted pregnancy and abortion to less than half the local average. A Colorado program that provided long-acting contraceptives to sexually active teens reduced teen pregnancy and abortion by 40 and 35 percent respectively. Serious antiabortion activists will challenge the false perception that these methods work to end rather than prevent pregnancy and instead promote the science-based awareness that these methods are true contraceptives with bonus health benefits. They will work to reform liability practices that undermine development and distribution of better birth control.
6. Serious antiabortion activists will ensure that young and poor women in marginalized communities have access to excellent reproductive health services free of charge, since these are the youth and women with the highest rates of unplanned pregnancy.
While unsought pregnancy and abortion are declining for middle- and upper-middle-income families, they are on the increase among those least able to absorb the impact of another child. But making excellent contraception available to teens at no cost can drop the abortion rate by three-quarters. As is, Title X family planning services prevent 2.2 million unplanned pregnancies yearly, without which the abortion rate would be two-thirds higher.
Drawing on tested models like A Step Ahead in Memphis, serious antiabortion activists will create programs that recognize the complexity and financial challenges of life in poor communities. These programs will provide rapid response, single-visit services and they will systematically eliminate financial barriers to better birth control. They will address anxiety (and contraceptive avoidance) that is due to forced sterilizations and other bad history and ensure that women are freely able to choose and switch contraceptive methods, as well as have them removed as desired.
7. Serious antiabortion activists will insist that medical practices be updated so that family planning becomes a routine part of adolescent medicine, family practice, prenatal care, and hospital labor and delivery services.
Women and men are most likely to engage in effective pregnancy prevention when primary care providers and other doctors routinely assess family plans and fertility management as a part of all medical care. Serious antiabortion activists will promote innovative and effective programs that treat pregnancy intentions like one more vital sign for both healthy and chronically ill patients. They will ensure that continuing education programs teach doctors how (and why) to include family planning conversations in prenatal care and birthing services. They will monitor hospitals and other care systems to ensure that the best fertility management options are available on patient request.
8. As both unintended pregnancy and abortion decline, serious antiabortion activists will ensure that any woman who does end up with a surprise pregnancy will never be driven by financial or educational or career concerns to terminate that pregnancy.
Forty percent of women seeking abortions cite financial concerns as a factor in their decision to end a pregnancy. Serious antiabortion activists will tackle structural barriers to broad family prosperity including policies that create income inequality and cause families to fall out of the middle class. They champion family-friendly workplace norms and public policies including maternity leave, paid family leave, affordable childcare, and mom-friendly education alternatives for youth and women who decide to carry forward a surprise pregnancy.
9. Serious antiabortion advocates will work to minimize maternal health problems and fetal anomalies by promoting pre-conception care and prenatal care and by ensuring that fertility management is integrated into care for chronic conditions such as diabetes and HIV.
Only a small percent of abortion is triggered by threats to maternal health and life, or by fetal anomalies, but serious antiabortion activists will work to prevent these difficult situations. They will raise awareness that preconception care can prevent some fetal anomalies and maternal health risks and they will make sure that medically compromised women receive integrated care so that high-risk pregnancies occur only when a woman or couple actively wants a baby.
10. With an eye to the future, serious antiabortion activists will aggregate $200 million in philanthropic dollars, public research funds and investment capital to develop better birth control for men and take it to market.
A man is involved in every pregnancy and men are involved in many abortion decisions, but today male contraceptives lag behind female contraceptives by almost a century. As of 2015, the best reversible method for women has an annual pregnancy rate of 1 in 2,000, while the best for men (the condom) has a 1 in 6 annual pregnancy rate. Serious antiabortion activists will recognize that giving men better means to manage their fertility will result in fewer surprise pregnancies and fewer abortions.
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Forty years after Roe v. Wade, the pro-life movement is a radical failure by the very metrics that abortion foes cite to inspire their base—or would be if the goal were actually to eliminate abortion. Unintended pregnancy and abortion are in decline, thanks to a number of cultural and economic factors and better birth control. But American care providers still serve over a million women seeking abortions annually and more than 900,000 of these women terminate a pregnancy.
Self-described abortion foes in Congress pass copycat TRAP laws (targeted restrictions of abortion providers) that drive up the price of abortion care. Other self-proclaimed abortion foes have launched a multi-year “yuck factor” media campaign aimed at triggering moral and physical disgust. Still others harry women and care providers, forcing them to walk gantlets of posters and prayers at clinic entrances or stalking and doxing them online. Indeed, self-proclaimed foes have so stigmatized abortion care that most of us have no idea which third of our female friends have terminated ill-conceived pregnancies.
But, if a half century of evidence from around the globe is to be believed, no amount of shaming or harassing women, nurses and doctors—however well-organized and sustained—will produce anything close to a 90 percent reduction in abortion. Nor will another 800 restrictive laws like those passed in the last 20 years, even if they criminalize women and providers. Such approaches may force some women to carry forward unwanted pregnancies, but their effect is limited by the power of human desperation. Extreme restrictions and stigma in Eastern Europe filled orphanages with unwanted babies but also filled backrooms with bleeding women. In pre-Roe America, compassionate clergy became weary of burying dead parishioners and helped to create an underground railroad to safe abortion. Around the globe, 22 million women each year undergo a back-alley abortion rather than carry yet another unwanted pregnancy to term and over 20,000 pay with their lives. More restrictions, more disgust, more stigma—these may feel righteous to some, but at best they produce an impasse that destroys dreams and hopes and even lives and that satisfies no one.
By contrast, we know what it would take to make most abortion simply go away. Ironically, the upstream solution lies in the common ground between those who oppose abortion care and those who support it—the value we all place on empowering young people to flourish, and parents to love and care for their children. The only question is whether an antiabortion movement will emerge that takes this challenge seriously.