Abortion is here to stay

Debating the abortion rate is futile - we need to focus on providing information and contraception

Recourse to abortion is a feature of all societies and is as old as humanity. Women have abortions regardless of the legal situation in their country. It’s clearly much safer for a woman to have an abortion in proper medical surroundings than as a clandestine procedure performed by untrained personnel. Younger generations need to be told and older generations reminded of the results of backstreet abortion: death and permanent injury from sepsis, mechanical trauma and chemical burns.

Globally there are about 42 million abortions annually, of which nearly a half are unsafe. 68,000 deaths occur annually from unsafe abortion, almost exclusively in the developing world.

It’s true that in the past, in countries like the former Soviet Union, because of almost complete lack of access to contraceptives women used abortion as a primary means of fertility control. This is not so nowadays in the West. But women clearly use abortion as an adjunct to contraception in the event of non-use, incorrect use, inconsistent use or failure of contraception. The most commonly used methods, the pill and condoms, have substantial failure rates in everyday use. This is why there is a current push from the National Institute for Health & Clinical Excellence for wider adoption of long-acting reversible methods (injections, implants and intrauterine devices).

Emergency contraception (pills or intrauterine devices administered after unprotected sex) have the potential to make inroads into the abortion rate. So far though, its use is not widespread enough to make any detectable difference.

An estimated 108 million married women in developing countries have an unmet need for contraception. So, there is potential here for reducing abortions in these countries. Availability of contraception in Eastern Europe has improved and abortion rates have fallen, but rates remains much higher than in the rest of Europe with more abortions than births.

Countries such as Belgium, Germany, the Netherlands and Switzerland have low abortion rates. High use of contraception and universal sex education almost certainly play an important part there. The specifics of their abortion laws and how they operate in practice will be relevant too. Abortion rates are determined by a complex range of factors including family size intentions, confidence in the safety of contraceptives, amount of sexual activity in adolescents and where the country concerned is in its demographic transition.

There has been a continuing decline of the abortion rate in the United States since it peaked in 1981, although it remains well above that of Western Europe. Increased use of contraception has contributed to this decline. Much of the decline took place in eight states in which efforts have been made to deliver good sex education, not the Bush administration’s abstinence-only approach. One suspects some of the decline is due to restrictive state laws causing delays or preventing some women altogether from having an abortion. These restrictions unfortunately have a disproportionate effect on the poor. And such a decline is not a unique trend - it may be part of a global decline which has been measured between 1995 and 2003.

In Britain the abortion rate has increased year on year since legalisation in 1968, but after 1998 this increase has been slower. There are signs that women’s desire to control their fertility is now being met by service availability.

Abortion is here to stay. There is little point debating whether our abortion rate is too high. What we should be concentrating on is making sure that women requesting abortion are supplied with evidence-guided information on which to base their decision. They should all be offered medical abortion: in this respect England and Wales are lagging behind Scotland. All women should be offered screening for infection. And all women should be offered contraception, including long-acting methods. Further research is needed on factors that detract from consistent use of contraception and from this possible effective interventions can be developed.

Dr Sam Rowlands is a freelance specialist in contraception and reproductive health and a Visiting Senior Lecturer at the University of Warwick.

Getty
Show Hide image

The New Times: Brexit, globalisation, the crisis in Labour and the future of the left

With essays by David Miliband, Paul Mason, John Harris, Lisa Nandy, Vince Cable and more.

Once again the “new times” are associated with the ascendancy of the right. The financial crash of 2007-2008 – and the Great Recession and sovereign debt crises that were a consequence of it – were meant to have marked the end of an era of runaway “turbocapitalism”. It never came close to happening. The crash was a crisis of capitalism but not the crisis of capitalism. As Lenin observed, there is “no such thing as an absolutely hopeless situation” for capitalism, and so we discovered again. Instead, the greatest burden of the period of fiscal retrenchment that followed the crash was carried by the poorest in society, those most directly affected by austerity, and this in turn has contributed to a deepening distrust of elites and a wider crisis of governance.

Where are we now and in which direction are we heading?

Some of the contributors to this special issue believe that we have reached the end of the “neoliberal” era. I am more sceptical. In any event, the end of neoliberalism, however you define it, will not lead to a social-democratic revival: it looks as if, in many Western countries, we are entering an age in which centre-left parties cannot form ruling majorities, having leaked support to nationalists, populists and more radical alternatives.

Certainly the British Labour Party, riven by a war between its parliamentary representatives and much of its membership, is in a critical condition. At the same time, Jeremy Corbyn’s leadership has inspired a remarkable re-engagement with left-wing politics, even as his party slumps in the polls. His own views may seem frozen in time, but hundreds of thousands of people, many of them young graduates, have responded to his anti-austerity rhetoric, his candour and his shambolic, unspun style.

The EU referendum, in which as much as one-third of Labour supporters voted for Brexit, exposed another chasm in Labour – this time between educated metropolitan liberals and the more socially conservative white working class on whose loyalty the party has long depended. This no longer looks like a viable election-winning coalition, especially after the collapse of Labour in Scotland and the concomitant rise of nationalism in England.

In Marxism Today’s “New Times” issue of October 1988, Stuart Hall wrote: “The left seems not just displaced by Thatcherism, but disabled, flattened, becalmed by the very prospect of change; afraid of rooting itself in ‘the new’ and unable to make the leap of imagination required to engage the future.” Something similar could be said of the left today as it confronts Brexit, the disunities within the United Kingdom, and, in Theresa May, a prime minister who has indicated that she might be prepared to break with the orthodoxies of the past three decades.

The Labour leadership contest between Corbyn and Owen Smith was largely an exercise in nostalgia, both candidates seeking to revive policies that defined an era of mass production and working-class solidarity when Labour was strong. On matters such as immigration, digital disruption, the new gig economy or the power of networks, they had little to say. They proposed a politics of opposition – against austerity, against grammar schools. But what were they for? Neither man seemed capable of embracing the “leading edge of change” or of making the imaginative leap necessary to engage the future.

So is there a politics of the left that will allow us to ride with the currents of these turbulent “new times” and thus shape rather than be flattened by them? Over the next 34 pages 18 writers, offering many perspectives, attempt to answer this and related questions as they analyse the forces shaping a world in which power is shifting to the East, wars rage unchecked in the Middle East, refugees drown en masse in the Mediterranean, technology is outstripping our capacity to understand it, and globalisation begins to fragment.

— Jason Cowley, Editor 

Tom Kibasi on what the left fails to see

Philip Collins on why it's time for Labour to end its crisis

John Harris on why Labour is losing its heartland

Lisa Nandy on how Labour has been halted and hollowed out

David Runciman on networks and the digital revolution

John Gray on why the right, not the left, has grasped the new times

Mariana Mazzucato on why it's time for progressives to rethink capitalism

Robert Ford on why the left must reckon with the anger of those left behind

Ros Wynne-Jones on the people who need a Labour government most

Gary Gerstle on Corbyn, Sanders and the populist surge

Nick Pearce on why the left is haunted by the ghosts of the 1930s

Paul Mason on why the left must be ready to cause a commotion

Neal Lawson on what the new, 21st-century left needs now

Charles Leadbeater explains why we are all existentialists now

John Bew mourns the lost left

Marc Stears on why democracy is a long, hard, slow business

Vince Cable on how a financial crisis empowered the right

David Miliband on why the left needs to move forward, not back

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times