Do women and men consider abortion as an alternative to contraception in the United States? An exploratory study

Abstract

The USA, a country with widespread access to the full range of modern methods of contraception, continues to have one of the highest abortion rates among developed countries. Forty-nine per cent of women reported ever experiencing an unintended pregnancy in 2001; 48% of these conceptions occurred during a month that contraception was used. We explored the extent to which people use contraception and abortion interchangeably to achieve their fertility goals via focus groups (n=4) and semi-structured in-depth interviews (IDIs) (n=18) with men and women between the ages of 18 and 35 in New York City in 2006. While there was a consensus that abortion cannot replace contraceptive use, poor couple communication, lack of planning, lack of acceptable contraceptive methods and the pleasures that people associate with having unprotected sex result in the perception that some individuals rely on abortion over contraception to prevent unintended births. Men and women both identified women as solely in charge of avoiding an unwanted pregnancy and resolving it should one occur. No one supported repeat abortions for themselves or others, and many respondents perceived multiple abortions to lead to infertility, which strengthens their position that substituting abortion for contraception is unacceptable.

Keywords:

• contraception
• abortion
• USA
• unintended pregnancy
• qualitative methods

Acknowledgements

This research was carried out in collaboration with the Contraception and Abortion Multi-Country Study Group (P.I.s Amy Tsui and John Casterline). The authors would like to thank the Gates Institute at Johns Hopkins University for funding this research. Lori Frohwirth, Ellen Smith, Tim Frasca and Lindsay Dauphinee provided research assistance on this project. The authors would also like to thank Ndola Prata and the International Seminar on Interrelationships between Contraception, Unintended Pregnancy and Induced Abortion, December 2008, for their helpful comments on an earlier draft of this article.

Notes

1. An unintended pregnancy carried to term is an unplanned birth.

2. Lower income was defined as below 200% of the poverty level and middle income was defined as at or above 200% of the poverty level, 100 % of the poverty level was equivalent to US$20,000 for a family of four at the time of the study, and 200% poverty is double this amount.