Michael Abrahams | Avoid pregnancy, avoid abortion

During the current uproar over abortion, I have noticed that there is little talk about how to prevent it. While in medical school, if I were asked in an examination to discuss the management of a disorder, my answer would be incomplete if I did not mention how the problem can be prevented. So, if the question concerns the management of cervical cancer, it would be remiss of me to say nothing about the Pap smear, a test that can detect early abnormal changes in the cervix, thereby guiding us to perform procedures to halt the process and avert the development of cancer. The saying “prevention is better than cure”is absolutely true.

Unfortunately, while we debate the abortion issue, and persons on both sides of the divide double down on their pro-choice and anti-abortion arguments, there is a necessary conversation that is, for the most part, absent. The dialogue I am referring to is the one addressing the root causes of situations leading to abortions and how to prevent them.

Abortions are sought after unplanned and unwanted pregnancies occur. Some unplanned pregnancies follow sexual assault or failed contraception methods, but the majority I see in my practice occur after unprotected sex. I offer an ultrasound service for patients being seen privately or at health centres and clinics and am currently conducting a survey on contraceptive practices. So far, after interviewing 88 consecutive pregnant women presenting themselves for ultrasound examinations, 68 (77%) revealed that their pregnancies were unplanned, and of those, 87% admitted that no contraceptive method, male or female, was used.

I am pro-choice regarding abortion, and strongly feel that women have a right to make informed decisions regarding what happens to and takes place inside their bodies. However, I must also be honest and admit that most abortions are the result of careless and irresponsible sexual behaviour.Abortion is not a pleasant process, and both immediate and long-term complications are possible. But it is more common than many realize. In another ongoing survey being conducted at my practice, 187 consecutive women were interviewed about their reproductive histories, and 70 (37%) admitted to having abortions. Of these, 18 have had more than one. In other words, of the women having abortions, 26% have had at least two.

In my opinion, much of our focus needs to be shifted from contentious arguments between pro-choice and anti-abortion advocates regarding who is right and who is wrong, to how we can prevent abortion in the first place.

Today, in 2019 in Jamaica, there really is little excuse for unplanned and unwanted pregnancies resulting from sex between two consenting persons above the age of consent. Unlike many countries, including the United States of America, Canada and England, the oral contraceptive pill is available over the counter at pharmacies in this country, and at health centres. A prescription is not needed. A woman can simply walk into a pharmacy and purchase a pack and be counselled by the pharmacist if necessary. Many different brands, containing various hormonal combinations and doses are available. The emergency or “morning after” pill is also available without prescription. Pharmacies also carry female condoms. There are also various injections, implants and intrauterine contraceptive devices (IUCDS) which are available, but these must be prescribed. Also, information regarding natural methods, for women with regular menstrual cycles, is freely available. Many women are aware of all these measures, do not wish to conceive, but take no precautions and still welcome unsheathed penises into their vaginas and semen into their uteri.

But it is not just about women. Men have a significant role to play in the causation of the unplanned and unwanted pregnancies which lead to abortion. What I find interesting in the abortion debate is that some of the loudest and most condemnatory anti-abortion voices belong to men, who for some reason, fail to call out other men for their role in contributing to the issue.

Let us face it, without penises, there would be no abortions. Men carry penises and will do irresponsible and cruel things. For example, there are men who:

- Rape women and girls

- Refuse to wear condoms

- Remove condoms during sexual intercourse, sometimes without telling their partners

- Do not report that the condoms burst or slip off during sex

- Deliberately bore holes in condoms

- Promise to withdraw before ejaculation, but ejaculate in the vagina anyway

- Initiate sex while their partners are asleep and unable to consent

- Forbid their partners from using contraception

- Coerce their partners into having abortions

This is just a partial list, but is clear that men contribute significantly to the issue of abortion. In addition, during courtship, it is usually men who do the pursuing and who initiate sex. Men tend to be physically stronger than women, and in relationships the male partner is usually older and more experienced. Also, more often than not, women rely on their male partners for financial support. So, it would be reasonable to assume that in the majority of heterosexual relationships, the balance of power rests comfortably in favour of the man. So, while many of us vociferously object to abortion, condemning women in the process, we hypocritically fail to acknowledge that we contribute significantly to the problem.

Abortion may be a women’s health and rights issue, but both sexes need to get their acts together and behave more responsibly.

- Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or tweet @mikeyabrahams.