Unplanned Pregnancy and Abortion
in the U.S. and Canada:
What Can We Learn from Europe?
Rachael Phelps MD
Medical Director of Surgical Services
Planned Parenthood of the
Rochester/Syracuse Region
Median Age at First Sex
20
19
18
17
16
15
14
France
Sweden
U.K.
Canada
U.S.
Darroch, JE. Family Planning Perspectives 2001
Initiating Sex Early: < 14 y/o
16
14
12
10
France
Canada
U.S.
8
6
4
2
0
% Initiating sex before age 15
Darroch, JE. Family Planning Perspectives 2001
% With > 2 Partners in Past Year
60
50
40
France
Canada
U.S.
30
20
10
0
Women 18-19 y/o
Men 18-19 y/o
Darroch, JE. Family Planning Perspectives 2001
STD Rates among Teens 15-19
1200
per 100,000
1000
800
Netherlands
France
Canada
USA
600
400
200
0
Gonorrhea
Chlamydia
Panchaud et al.Family Planning Perspectives: 2000
% Using No Birth Control Method
30
25
20
France
U.S.
15
10
5
0
First Intercourse
Last Intercourse
Darroch, JE. Family Planning Perspectives 2001
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la
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s
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en
Re
Re
pu
b
Sw
Cz
ec
h
Sl
ov
ak
Ca
na
da
U.
K.
U.
S.
Pregnancy rates per 1000 age 15-19
90
80
70
60
50
40
30
20
10
0
Singh, S. 2000
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N
.K
Sp
ai
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Ita
ly
Fr
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y
et
he
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nd
s
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.
Fi
nl
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ep
ub
ep
ub
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R
ar
k
ed
en
U
en
m
Sl
ov
ak
C
D
.S
.
an
ad
a
Sw
C
U
Abortion rates per 1000 age 15-19
35
30
25
20
15
10
5
0
Singh, S. 2000
la
nd
ar
k
Sw
Ita
ly
ed
en
Sp
ai
n
Ne
th
er
la
nd
s
De
nm
Fi
nl
an
d
Fr
an
ce
an
y
pu
b
er
m
Re
Ca
na
da
Cz
ec
h
G
U.
S.
Re
pu
b
En
g
Sl
ov
ak
Birth rates per 1000 age 15-19
60
50
40
30
20
10
0
Singh, S. 2000
er
m
Fr
an
ce
Sl
ov
en
ia
Ne
th
er
la
nd
s
ar
k
an
y
ed
en
Ita
ly
Fi
nl
an
d
De
nm
G
pu
b
Sp
ai
n
Re
Sw
Cz
ec
h
Ca
na
da
U.
K.
U.
S.
Birth rates per 1000 age 15-19
60
50
40
30
20
10
0
Rwanda
Libya
Iraq
Georgia
Namibia
Morocco
Israel
Kazakhstan
Sudan
Tunisia
Jordan
Kyrgyzstan
Myanmar
Swaziland
Kuwait
Moldova
Sri Lanka
China
Lebanon
Tajikistan
Viet Nam
Korea
Saudi Arabia
Ukraine
Iran
Malaysia
Syria
Turkmenistan
Algeria
Philippines
Turkey
Trinidad&Tobago
Lesotho
Thailand
Armenia
Uzbekistan
Mauritius
Singapore
Azerbaijan
Bosnia
Egypt
Cambodia
Serbia
Croatia
Unintended Pregnancy Health Disparities

Overall unintended pregnancy rates have
plateaued in the U.S., but…

29% among poor women

20% among higher-income women
Alan Guttmacher Institute
What’s different about
Europe?
Why are we failing to prevent
unplanned pregnancy?
U.S. vs. The Netherlands
U.S. = Dramatization Netherlands = Normalization
Sex = Risk taking
Sex = Preparation
Love = Extraordinary Love = Normal
Battle of the sexes
Relationship between sexes
Sex = Secret
(from parents)
Sex = Negotiation
(with parents)
Schalet,A 2004
“The First Time”
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
U.S. Girls
U.S. Boys
Netherlands
Really wanted
Wish they had waited
Birth Control Use at First IC
70
60
50
40
U.S.
Netherlands
30
20
10
0
Hormonal BC
Dual Use
Schalet,A 2004
Poor Access to Health Care in U.S.

17 million women
are uninsured
 1/4 women report
delaying or forgoing
medical care
 1/5 could not afford
to fill a prescription
Poor Access to Health Care in U.S.
Women’s Health Insurance Coverage, 2006
Individual/
Private
6%

Other
Government
3%
PrivateJobBased,
Own Name
38%
Medicaid
10%
Uninsured
18%
Job based,
Dependent
25%
Over 17 million women are uninsured. This number has grown by 1.2
million since 2004, with half of the growth among low-income women.
17 million women
are uninsured
 1/4 women report
delaying or forgoing
medical care
 1/5 could not afford
to fill a prescription
International Patterns of IUD Use
% Contraceptive Users
30
25
20
US
Canada
Germany
Denmark
15
10
5
0
Spinelli et al. Am J Public Health 2000;90:1403
Abma et al. Vital Health Stat 23 1997;19:1
EC Without
a Prescription
France
1999
Sweden
Denmark
Portugal Belgium
Norway
U.K.
Finlan
d
2000
2001
2002
Canada
U.S.
2005
2006
Latvia Switzerland
Estonia Netherland
s
2003
2004
When Politics Trump Science: EC OTC







2001 CRR petition ignored
2003 Barr petition
5/2004 rejected by FDA
Canada OTC 4/05
8/2005 rejected by FDA
8/2005 Dr. Wood resigns
8/2006 approved 18 and
older only
When Politics Trump Science: EC OTC







2001 CRR petition
ignored
2003 Barr petition
5/2004 rejected by FDA
Canada OTC 4/05
8/2005 rejected by FDA
8/2005 Dr. Wood
resigns
8/2006 approved 18
and older only
$100 Million/Yr. for Abstinence Education
“the term ‘abstinence education’ means an
educational or motivational program which:”
“teaches that a mutually faithful monogamous
relationship in the context of marriage is the
expected standard of sexual activity;”
 “teaches that sexual activity outside the context
of marriage is likely to have harmful
psychological and physical side effects;”

U.S. Section 510(b) of Title V of the Social Security Act
Condom Misinformation
“In heterosexual sex, condoms fail to
prevent HIV approximately 31% of the
time.”
 “The popular claim that ‘condoms help
prevent the spread of STDs,’ is not
supported by the data.”
 “Pregnancy occurs 1/7 times that a couple
uses a condom.”

Conception Misinformation

“After conception, the tiny baby moves
down the fallopian tube toward the
mother’s uterus. About the sixth to tenth
day after conception, when the baby is no
bigger that this dot (.), the baby snuggles
into the soft nest in the lining of the
mother’s uterus.”
Fetal Development Misinformation

“At 43 days, electrical brain wave
patterns can be recorded, evidence that
mental activity is taking place. This new
life may thought of as a thinking person”
Abortion Misinformation
“Sterility: Studies show that 5-10% of
women will never again be pregnant after
having a legal abortion.”
 “premature birth, a major cause of mental
retardation, is increased following the
abortion of a first pregnancy”
 “following abortion, women are more
prone to suicide.”

Gender Bias
“Guys are able to focus better on one
activity at a time and may not connect
feelings with action. Girls access both
sides of the brain at once, so they often
experience feelings and emotions as
part of every situation.”
Gender Bias
“Just as a woman needs to feel a man’s
devotion to her, a man has a primary
need to feel a woman’s admiration. To
admire a man is to regard him with
wonder, delight and approval. A man
feels admired when his unique
characteristics and talents happily
amaze her.”
Gender Bias

“5 major needs of women: financial
support, family commitment, affection,
conversation, honesty and openness.”

“5 major needs of men: sexual
fulfillment, physical attractiveness,
domestic support…”
School Based Clinics in the U.S.
Alan Guttmacher Institute
Our restrictive reproductive
health policies set women up for
unplanned pregnancies and
abortions…
Then we punish them with
restrictive and demeaning laws.
2007 Abortion Rates Worldwide
45
Per 1,000
40
35
30
25
20
15
10
5
0
W.
N. Europe Oceania
Europe
S.
N.
Europe America
Asia
Africa
Latin E. Europe
America
Maternal Mortality per 100,000
400
357
350
300
250
200
150
100
50
0.6
0
Illegal abortion worlwide
Legal AB in U.S.
U.S. State Restrictions on Abortion
No Medicaid coverage for abortion
33
24 hour waiting periods
24
State mandated counseling
28
Parental consent or notification
35
The Guttmacher Institute
Biased State Directed Counseling

Government-produced pamphlets with photos
and detailed description of the fetus designed
to deter women from having and abortion
 Physicians are required to give medically
inaccurate information to patients:



Increased risk of breast cancer (3 states)
The ability of a fetus to feel pain (6 states)
Long-term mental health consequences for
women (3 states)
Center for Reproductive Rights
Parental Consent Laws
35 states require consent or notification
of parents
 4 states require 2 parents
 Opposed by ACOG, AMA, AAP, and
APHA because these laws threaten the
health of minors

Center for Reproductive Rights
Most Minors Involve Their Parents
61% of minors in states without a
consent law involved at least one parent
 The younger the teen, the more likely
she was to involve a parent
 Of teens who did not involve a parent,
most involved another trusted adult

Henshaw , S.K. Family Planning Perspectives. 1992
Laws Threaten Women’s Health

24 hour waiting periods
 Increase

2nd trimester abortions
Parental consent laws
 Increase
teen births
 Increase 2nd trimester abortions in teens
 Force teens to travel out state
Henshaw , S.K. Family Planning Perspectives. 1992
Partial Birth Abortion Ban Act
Bans a specific surgical technique that may
be the safest for some women
 No exception for the health of the woman
 No specifics regarding gestational age
 Found unconstitutional by 3 Federal courts
 Upheld as constitutional by Supreme Court
 Federal crime punishable with jail time and
civil liability

Center for Reproductive Rights
Congress and Justices Ignore the
Experts
American College of Obstetricians and Gynecologists
American Nurses Association
American Medical Women's Association
American Public Health Association
Association of Schools of Public Health
American College of Nurse Practitioners
Association of Reproductive Health Professionals
National Association of Nurse Practitioners in Reproductive Health
American Medical Student Association
California Medical Association
Rhode Island Medical Society
Physicians for Reproductive Choice and Health
Planned Parenthood Federation of America
National Asian Women's Health Organization
National Black Women's Health Project
National Latina Institute for Reproductive Health
National Women's Health Network
Association of Women Psychiatrists
What can we do?






National health insurance in U.S
IUD as first line contraception
EC in every woman’s medicine cabinet
School based clinics with contraception
Comprehensive sexuality education
Social marketing campaigns around responsible
sex positive messages
 Improved access to safe legal abortion
References:

ACLU Reproductive Freedom Act at
http://www.aclu.org
 Alan Guttmacher Institute at
http://www.agi-usa.org
 Center for Reproductive Rights at
http://www.reproductiverights.org
 UNFPA State of World Population 2004 at
http://www.unfpa.org
 The Henry J. Kaiser Family Foundation at
http://www.kff.org
 Advocates for Youth at
http://wwwadvocatesforyouth.org
References:

Texas state legislature
http://www.capitol.state.tx.us/tlo/78R/billtext/H
B00015F.HTM
 The Social Security Act Section 510
http://www.ssa.gov/OP_Home/ssact/title05/05
10.htm
 The Partial Birth Abortion Ban Act of 2003
http://thomas.loc.gov/cgibin/query/D?c108:1:./temp/ ~c108a2TMvQ: