Giuseppe Benagiano


  • close

    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
    pregnancy (VTP).
    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.