Legal, safe, and rare?

Abstract

Your July 28 Editorial (p 291)1The LancetMaking abortion legal, safe, and rare.Lancet. 2007; 370: 291Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar follows the call of Bill Clinton to make abortion “legal, safe, and rare”. This is not a clarion call that my journal, which has been in the forefront of publishing on the need for safe, legal abortion, nor the international women's health movement, has ever supported. We campaign for abortion to be safe and legal, but we also recognise and accept that it will continue to be common.All the evidence shows that even when contraceptive prevalence is as high as it can go (eg, in the Netherlands and Australia, about 70% of women of reproductive age), abortion is less prevalent but not rare. Abortion could only become rare in a world in which contraceptives never failed, women and men having sex together never failed to use them, and sex between them was only ever preplanned and consensual. None of that is realistic, and there seems little point in calling for something that is totally unfeasible.The implication of “make abortion rare”, moreover, is that contraception is good but abortion is “bad”. If family planning is valid behaviour, then abortion is as valid when an unwanted pregnancy occurs. I believe Clinton bought into that phraseology because he wanted to appease the anti-abortion movement in the USA. What is The Lancet's reason?I declare that I have no conflict of interest. Your July 28 Editorial (p 291)1The LancetMaking abortion legal, safe, and rare.Lancet. 2007; 370: 291Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar follows the call of Bill Clinton to make abortion “legal, safe, and rare”. This is not a clarion call that my journal, which has been in the forefront of publishing on the need for safe, legal abortion, nor the international women's health movement, has ever supported. We campaign for abortion to be safe and legal, but we also recognise and accept that it will continue to be common. All the evidence shows that even when contraceptive prevalence is as high as it can go (eg, in the Netherlands and Australia, about 70% of women of reproductive age), abortion is less prevalent but not rare. Abortion could only become rare in a world in which contraceptives never failed, women and men having sex together never failed to use them, and sex between them was only ever preplanned and consensual. None of that is realistic, and there seems little point in calling for something that is totally unfeasible. The implication of “make abortion rare”, moreover, is that contraception is good but abortion is “bad”. If family planning is valid behaviour, then abortion is as valid when an unwanted pregnancy occurs. I believe Clinton bought into that phraseology because he wanted to appease the anti-abortion movement in the USA. What is The Lancet's reason? I declare that I have no conflict of interest.