From abortion to contraception
Giuseppe Benagiano, Carlo Bastianelli, Manuela Farris
Department of Gynaecologic Sciences, Perinatology and Child care,
University “la Sapienza”, Rome, Italy
Voluntary abortion has been the source of bitter disagreement even among gynaecologists
and the ethical considerations brought forward in favour or against abortion are so
opposing that nothing one can say will ever create unanimity.
In spite of this reality, attempts should be made at establishing a minimum dialogue
because there is a sufficiently large portion of the international community which would
easily agree with the goal to minimize the need to recur to the voluntary termination of a
The best way to start such a dialogue is to explain why restrictive legislation might be good
to appease the conscience of policy makers and a part of the public, but definitely has
never deterred women from terminating a pregnancy when they felt strongly they could not
afford it, nor has it - per se - moved women to prevent unwanted pregnancies.
In addition, per se legalizing abortion does not entail a more widespread utilisation of the
procedure, and may - on the contrary - help decrease its incidence, provided
decriminalisation is linked to a series of other public health measures. The situation is
however very complex and, in Europe alone, there conflicting examples.
Notwithstanding this diversity, in most countries a law that forbids VTP does not cause a
decrease in the number of women who recur to the procedure, while it has two important
negative consequences. The first is an adverse effect on the reproductive health of
women: illegal abortions are often unsafe and the consequences can be an increased rate
of pregnancy-related morbidity higher secondary infertility and mortality among pregnant
women. The second is the very clear tendency that, because VTP is illegal, nothing is
done to actively reduce its incidence, or, rather, to reduce the reasons leading to the need
for terminating a pregnancy. Finally, decriminalisation makes it possible to evaluate the
true dimension of the problem and set in motion a process aimend at reducing it.
There is no question that contraception is the corner-stone of any fight to reduce abortion,
although the relationship between contraception and abortion is fairly complex. Data from
several industrialized countries indicate that where contraception is well established and
utilised by the vast majority of people and it is associated with a proper sex education, the
need to resort to an abortion has substantially decreased.
To successfully move from abortion to contraception, people's attitudes and behaviour
must be changed. This requires massive training and education programmes, as well as
the will of governments to educate potential users and remove medical obstacles to a wide
utilization. In addition, other obstacles, such as cost of contraceptives, should be removed,
especially in countries with no local production, where the need to purchase them with
hard currency makes them simply unaffordable. Education is the key to success because
a lack of knowledge about the real attributes of individual methods both within the
population and the providers, is at the basis of low prevalence. It is also necessary to fight
misconceptions about the safety of modern contraceptives.In this connection, more
research concerning sexual behaviour and knowledge, attitudes and practice of
contraception is needed in order to change the situation. Also, a proper training for
providers and educational programmes for consumers are badly in demand. Finally, the
possibility for potential users to choose among methods is another very important issue:
It must be stressed that ethical considerations influence the choice of strategies aimed at
decreasing the need to terminate a pregnancy. A good example is the possibility to recur
to emergency contraception. For those accepting the definition of pregnancy endorsed by
a WHO Scientific Group in 1992, emergency contraception - acting before nidation - does
not interrupt a pregnancy and therefore is a means to prevent voluntary abortion. The
problem is thae this definition establishes biological criteria, not moral norms.
In conclusion, we hope that the beginning of the third millennium will be remembered as
the time when a major effort will be made to decrease the need for VPT, protect human life
and ensure the continuation of its natural progression. Decreasing the need to terminate a
pregnancy is an achievable goal if we unite our forces rather than loose an opportunity by,
instead, underlining what divides us. We hope that the International community will begin
to work together, using as a common denominator the desire to reduce the need to recur
to voluntary pregnancy termination.