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A Roadmap to Defining and Winning the Real Abortion Debate: Prevention vs. Punishment

Lisa Littman suggests that the real abortion debate is about differing approaches to unintended pregnancy on the part of progressives and conservatives.

In this interesting and innovative essay, Lisa Littman suggests that the real abortion debate is about differing approaches to unintended pregnancy on the part of progressives and conservatives. Littman draws on George Lakoff’s formulation of the two worldviews that inform people’s perspectives of politics—the “Nurturant Parent” model and the “Strict Father” model—and argues that progressives, holding the former model, approach unintended pregnancy as something to be prevented, while conservatives, in line with the latter model, see the phenomenon as something to be punished. The two different value systems underlying the “Nurturant Parent” model and the “Strict Father” model, according to Littman, lead progressives, while supporting legal abortion, to support policies that would reduce abortion, while leading conservatives, while opposing legal abortion, to support policies that increase abortion.

-- Carole Joffe

The debate about abortion has been emotionally charged and divisive. Because we, as Progressives, have failed to define our values in this debate, we have allowed the Conservatives to oversimplify the debate into distracting sound bites and to put us on the defensive.

This debate is not about "choice" or "life". It is not even about being "anti-abortion" or "pro-abortion". This debate is how we approach the issue of unintended pregnancy: Prevention or Punishment. The Prevention Approach is about supporting policies that prevent unwanted pregnancies and decrease abortions while the Punishment Approach is about supporting policies that increase unintended pregnancies and increase abortions in order to punish people for having sex. The difference in approach reflects the difference in our values.

By defining the abortion debate terms of our values, we can show the difference between Prevention and Punishment values, policies, and goals. This will allow us to steer the discussion back to the relevant abortion question and allow us to have an honest debate. An honest debate is the kind that we can win. What follows is a discussion of the key issues in the abortion debate along with references to the supporting literature.

Define the Progressive and Conservative Values

George Lakoff, in Don't Think of an Elephant, describes two worldviews that inform people's perspectives of politics: the Nurturant Parent Model and the Strict Father Model. The Nurturant Parent Model, held by progressives, values Responsibility and Empathy. In this view, children are taught to be responsible decision makers through knowledge of the consequences of their actions. Children, with the active guidance of their parents and armed with honest answers, learn to make informed, responsible choices. Conservatives adhere to the Strict Father Model, valuing Obedience and Discipline. They believe that children need punishment to learn right from wrong. Understanding these two value systems illuminates differences in viewpoints of Progressives and Conservatives on the question of abortion.

Define the Prevention Policies

The Prevention Policies come from the Nurturant Parent Values of Empathy and Responsibility. The Nurturant Parent/Progressive views abortion as the result of an awful situation—a woman with an unintended pregnancy. Treating the woman as someone in need of empathy and taking responsibility to avoid this situation in the future leads Progressives to take a prevention approach and support policies such as: increasing funding and access to family-planning clinics, improving access to contraception and emergency contraception, supporting the use of sex-education and other programs that have been proven to be effective in lowering teen pregnancy, keeping abortion safe and legal.

Furthermore, Progressives also support social safety nets and community assets like prenatal care, health care, family leave, improved public schools, and aftercare programs which make it easier for women to raise their children in a healthy, supportive environment.

Define the Prevention Values

These prevention policies are consistent with Progressives' stated goals of decreasing unintended pregnancies, decreasing abortions, decreasing the risk of sexually transmitted diseases, protecting the health of women, and promoting environments in which women can choose to raise their children [1-18]. These policies also match the values in the Nurturant Parent worldview: Empathy to recognize that no woman wants to be pregnant when she doesn't have the means to raise a child; Empathy to understand that a woman will risk her life to defend her ability to care for the children she already has and will risk her life to delay pregnancy until she is in a position to provide for her children; Responsibility to prevent unintended pregnancies in the first place. Responsibility and Empathy motivate us to reduce human suffering.

On a personal level, we value that it is responsible to prevent pregnancies by using contraception. Woman use contraception to delay pregnancies until they are in position to provide for their children. Women use contraception to space their children to maximize the attention and resources that they can provide for each child.

Define the Punishment Policies

An alternative approach to abortion and unplanned pregnancies is favored by those adhering to the Strict Father or Conservative viewpoint. It includes cutting funding for family-planning clinics, decreasing access to contraception, withholding information about contraception and condoms, promoting unproven "abstinence-until-marriage" programs while opposing the programs that are effective in reducing teen pregnancy, and criminalizing abortion [5,6]. When the opportunity arose to safely eliminate the need for half of all the abortions that occur in this country by expanding the availability of emergency contraception [13,15,16], it was actively opposed by Conservative punishment proponents. This approach also includes opposing welfare, prenatal care, healthcare, family leave, aftercare and undermining public schools, essentially dismantling the programs intended to support women and families raising children.

To those with the Nurturant Parent view, this second approach makes absolutely no sense. Extensive worldwide research has studied the effects of these policies, and they consistently lead to negative consequences. Policies that increase barriers to contraceptive and condom use don't alter rates of sexual activity. However, individuals who are sexually active and do not use contraception or condoms have much higher rates of pregnancies, abortions, and STIs compared to those who use contraception and condoms [1-4,7,10-12,17,18]. Legal restrictions on abortion have very minimal impact on whether women will have abortions [10,11]. But, making abortion illegal makes it more likely that women will have illegal, unsafe abortions and subsequently more women will be injured and will die in the process [8,20,21]. Furthermore, undermining the social safety nets and community assets makes it harder for women to be able to continue pregnancies and raise children. Although the Conservative punishment proponents claim to be "anti-abortion", it appears as though the policies they support are specifically designed to increase the number of abortions and harmful effects for women and families.

Define the Punishment Values

To understand this seeming contradiction, it is helpful to take a closer look at the values underlying the Strict Father model. Their goal is not to decrease abortions, decrease unintended pregnancies, decrease sexually transmitted diseases, or protect the health and safety of women. The goal is to apply severe punishment to teach the lesson that any non-procreative sex is wrong. These measures make the punishment for having sex much more severe. If the punishment is less severe then women can "get away with" having sex. The increase in abortions, unintended pregnancies, and sexually transmitted infections are considered justifiable and acceptable losses in teaching this lesson.

Revealing the Punishment Goals

The vast majority of Americans harbor discomfort concerning the act of abortion. It is unlikely, however, that most believe that all women should be made to suffer when faced with an unintended pregnancy. I believe that if one were to pose the question: "Are you willing to deliberately increase the number of abortions, unintended pregnancies, and sexually transmitted diseases in this country in order to teach people the lesson that sex is wrong?" most people would answer no. In fact, many people would find this tactic to be inhumane, cruel and unethical.

How the Conservatives Sell the Punishment Approach

How can one possibly convince a person who truly believes that abortion is murder to support policies that increase the number of abortions? Among the "Pro-Life" leadership, there must be an understanding that honesty would make their policies unpopular. To build a large following, it would be necessary to distort the science and discredit the groups that promote accurate information. In this context, it is not surprising that numerous punishment groups are spreading falsehoods like: contraception is dangerous and increases abortions; sex education promotes sexual activity; abstinence-only programs are effective. These myths are blatantly and verifiably false [4-6,11], but they are repeated frequently enough to have won over a large segment of the U.S. population. Supporters of the punishment approach also continue to falsely assert that their goals are reducing abortions despite the evidence that their approach of increasing the risks of sex has never, in any democratic society, worked to decrease unintended pregnancies and abortions. To them, the unlikely end justifies the dishonest means.

Punishment and Prevention Policies: What Happens

Fortunately, there is a wealth of information about the effects of Prevention and Punishment policies from the experience of many countries including our own. We find in country after country that maximizing the use of effective contraception results in decreasing abortions over the long term [9-11]. When contraceptive needs are unmet, abortions increase [11]. Contrary to what proponents of the punishment approach use as justification for making abortion illegal, international experience shows that the legality of abortion is not correlated with the frequency of the procedure [8,10]. Many countries with the lowest abortion rates have the most liberal abortion laws while countries with the highest rates often have restrictive laws [8,10,19,21]. The Netherlands, which maximizes preventive measures and has liberal abortion laws, has one of the lowest abortion rates of any industrialized nation in the world [19,21]. Extensive international data also confirms that the legal status of abortion is correlated with safety [8,10,11,21]. When women experience unwanted pregnancies, they will turn to abortion whether it is legal or not [8,10,21]. The consequence of the illegality is that far more women die from the procedure and maternal mortality is greatly increased [8,11,20,21].

If our goals are reducing abortions and reducing the number of women dying from pregnancy related causes, the data clearly show that prevention is effective, punishment is not.

How Do We Win the Debate?

  1. Frame the debate in terms of our values: Responsibility, Empathy, Honesty. Once we do this, we can cut through the rhetoric and talk about the facts.

  2. Hold the Conservatives and pro-punishment supporters accountable for their actions:

    At any mention of the "wrongness" of abortion or the "value of life," we need to respond with, "If you are opposed to abortion, you must help us reduce the number of abortions and unintended pregnancies by supporting the measures that are most effective in doing so. Instead of reducing abortions and pregnancies, your policies increase them. This must end.”

    At any mention of the word "safety," we need to respond with, "If your concern is the safety of women, you must make sure that abortion remains safe and legal. When countries make abortion illegal, the number of women who die of pregnancy related causes increases substantially."

    We value the health and safety of women and children. We value empathy and assume the responsibility to reduce suffering. That's why we support policies that reduce unintended pregnancies and abortions. This support includes making abortions rare and keeping abortion safe and legal.

    We value responsibility. It is responsible for a woman to delay having children until she feels she can provide adequately for her children. Being a good parent is a priority. It is responsible to delay or space out pregnancies to maximize one's ability to be a good parent.

  3. Know the facts and have them handy:

    The facts are that in societies where the fertility rates are stable, as contraception use goes up, abortions go down [9-11]. Comprehensive sex education does not cause people to become sexually active at earlier ages or increase sexual activity rates [5]. There is strong evidence that several programs that address sexual and nonsexual antecedents of teen pregnancy delay the onset of sexual activity, increase the use of contraception in sexually active teens, and have been shown to reduce teen pregnancy [5]. At this time, there is no credible evidence that abstinence-until-marriage programs delay sex or reduce teen pregnancy [6]. Contraception and legal abortion are significantly safer than continuing a pregnancy [4].

    We value honesty in communication. We value understanding the reality of situations as a necessity to solve problems. That's why we use valid, credible, substantiated evidence and facts in our discussions. We value autonomy and honesty, which is why we feel that women need to make informed decisions about their health, their family, and their future based on facts. Because we care for children, we want to make sure the people who have the biggest impact on the health and happiness of children, namely parents, are equipped with the most up to date and accurate information.

  4. Reveal the tricks the punishment proponents use to defend their myths.

    There are very specific and deliberate tricks used by punishment proponents to distort the science in order to defend myths. Often these tricks include a tiny kernel of truth that is taken out of context while large amounts of compelling and valid evidence are ignored in order to give an impression opposite of truth. Recognize the statements they make that are based on myths, point them out, explain the trick they are using, and show the real data. Increasing the public's scientific literacy will go a long way in preventing people from being susceptible to this type of manipulation.

    We value honesty. Our facts are straightforward and based on the best available evidence. The facts we use are supported and accepted by the individuals and groups who understand how to evaluate research based on objective standards. We don't find it acceptable that the punishment approach supporters rely on tricks to distort the science. Misusing or ignoring the best available data is irresponsible, dangerous and immoral.

  5. Ask the real question: prevention or punishment? The abortion debate is not about who chooses or when life begins. These arguments rarely reach the other sides. The true abortion debate question comes down to the following:

    Would you rather reduce unintended pregnancies, reduce abortions, and reduce sexually transmitted diseases while protecting the health of women and men, or do you want to deliberately increase unintended pregnancies, increase abortions, increase sexually transmitted diseases and harm the health of women and men in order to punish them for having sex?

    That's the real debate. Every discussion on abortion needs to be about this question. Understanding the values, policies and goals of both sides will allow people to support the policies consistent with their goals. Prevention policies result in fewer pregnancies, fewer abortions, and fewer women dying. Punishment policies result in higher pregnancy rates, higher abortion rates, and more women dying. Those who take the side of increasing risk to accentuate punishments will have to defend their views. And that's an abortion debate worth having. It's the abortion debate. It's definitely an abortion debate we can win.

Dr. Lisa Littman is a board certified Obstetrician/Gynecologist from New Jersey. She works primarily in family planning.

Copyright © 2005 Lisa Littman, MD

Sources

  1. Kahn, JG et al. Pregnancies Averted Among U.S. Teenagers by the Use of Contraceptives, Family Planning Perspectives (1999), 31(1):29-34.
  2. Foster, DG et al. Expanded State-Funded Family Planning Services: Estimating Pregnancies Averted by the Family PACT Program in California, 1997-1998, American Journal of Public Health (2004), 94:1341-1346.
  3. Trussell, J. Contraceptive Failure in the United States, Contraception (2004), 70:89-96.
  4. Hacker, RA et al. The Essentials of Contraception: Efficacy, Safety, and Personal Considerations, Contraceptive Technology, 18th rev. ed. Chapter 9.
  5. Kirby, D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington (DC): National Campaign to Prevent Teen Pregnancy (2001).
  6. Kirby, D. Do Abstinence-Only Programs Delay the Initiation of Sex Among Young People and Reduce Teen Pregnancy?, Washington (DC): National Campaign to Prevent Teen Pregnancy (2002).
  7. Darroch, JE. Singh, S et al. Differences in Teenage Pregnancy Rates Among Five Developed Countries: The Roles of Sexual Activity and Contraceptive use, Family Planning Perspectives (2001), 33(6): 244-250 & 281.
  8. Dailard, C. Abortion in Context: United States and Worldwide, Issues in Brief (1999 series), Number 1, Alan Guttmacher Institute.
  9. Henshaw, SK et al. Recent Trends in Abortion Rates Worldwide, International Family Planning Perspectives (1999), 25(1): 44-48.
  10. Deschner, A. and Cohen, S.A., Contraceptive Use is Key to Reducing Abortion Worldwide, The Guttmacher Report in Public Policy (October 2003).
  11. Marston, C., Cleland, J. Relationships Between Contraception and Abortion: A Review of the Evidence, International Family Planning Perspectives (March 2003), 29 (1).
  12. Bongaarts, J., Westoff, C.F., The Potential Role of Contraception in Reducing Abortion, Studies in Family Planning (September 2000) 31(3):193-202.
  13. Grimes, D.A., et al. Emergency Contraception Over-the-Counter: The Medical and Legal Imperatives, Obstetrics and Gynecology (2001) 98:151-5.
  14. Trussell, J., Ellertson, C., Stewart, F., Raymond, E.G., Shochet, T. The Role of Emergency Contraception, American Journal of Obstetrics and Gynecology (April 2004) 190 (4 Suppl): S30-8.
  15. Trussell, J., Stewart, F. et al. Emergency Contraception: A Simple Proposal to Reduce Unintended Pregnancies, Family Planning Perspectives (Nov/Dec 1992), 24(6).
  16. Camp, S.L., Wilkerson, D.S., Raine, T.R. The Benefits and Risks of Over-the-Counter Availability of Levonorgestrel Emergency Contraception, Contraception (2003) 68:309-317.
  17. Cates, W. The NIH Report on Condoms: The Glass is 90% Full. Family Planning Perspectives (Sept/Oct 2001), 33(5).
  18. Contraception in the US: Current Use and Continuing Challenges, Alan Guttmacher Institute (May 2004).
  19. David, H.P., Rademakers, J. Lessons from the Dutch Abortion Experience, Studies in Family Planning (Nov-Dec 1996), 27(6): 341-3.
  20. Stephanson, P. et al. Commentary: The Public Health Consequences of Restricted Induced Abortion—Lessons from Romania, American Journal of Public Health (October 1992), 82(10):1328-1331.
  21. World Health Organization, Division of Reproductive Health, World Health Day, Safe Motherhood, Address Unsafe Abortion (April 1998) WHD 98.10.

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