EDITORIALS

2.

3. 4.

5.

ventive implications of an advocacy approach. Am. J. Public Health 67:612-615, 1977. Kempe, C. H. and Helfer, R. E. Helping the Battered Child and His Family, Philadelphia, PA: J. B. Lippincott Co. 1972. Cohen, N. E., Ed. Social Work and Social Problems, New York: National Association of Social Workers, Inc., 1964. Polansky, N. A., Hally, C., and Polansky, N. F. Profile of Neglect. A Survey of the State of Knowledge of Child Neglect. DHEW, (SRS) 75-23037, 1975. Dohrenwend, B. S., and Dohrenwend, B. P., Eds. Stressful

Life Events: Their Nature and Effects, New York: John Wiley & Sons, 1974. 6. Haggerty, R. J., Roghmann, K. J., and Pless, I. B. Child Health and the Community, New York: John Wiley & Sons, 1975. 7. Gelles, R. J.,"Violence toward Children in the United States," paper presented at the American Association for the Advancement of Science Annual Meeting, Denver, CO, 1977. (To be included in a forthcoming book by Murray A. Straus, Richard J. Gelles, and Suzanne K. Steinmetz, Violence in the American Family.)

Abortions and Public Policy The feelings unleashed following the United States Supreme Court's sanction of abortions in 1973 have spanned a breadth of controversy equaled by few issues in our times. Legal, medical, ethical, religious and political-almost every branch of the human endeavor is impelled to respond. Within a given field the opinions voiced may possess common terms of reference, but their verdicts are divergent. One may hazard the guess that they reflect individual human experience rather than immutability. The derivation of the word abortion is from a language root that signifies the disappearance of sun and moon, primitive symbols of life on earth. It would be a mistake to underestimate the depth of the emotions involved in the controversy around it, or to override one side or the other with the rhetoric of advocacy. One extreme hides the gas chambers efficiently disposing of cripples and Jews. The other masks the self-righteous denial of a health service to those who desire it. In this charged atmosphere, factual information which can shed light on public policy is rare. The Journal publishes two studies which supply such information in its current issue.1, 2 Analyzing data from President Jimmy Carter's home state, Shelton addresses himself to the provocative question of whether abortion or contraception has lowered the fertility of girls 14 years or less of age. In 1972 a Georgian law allowed minors to obtain contraceptive advice without parental consent. However, the fertility rate of Georgian teenagers under age 15, which had begun to rise in 1967, continued to do so through 1973. It declined slightly in 1974 for the first time in 6 years. In 1975 the decline was quite sharp. It was greatest among whites and residents of Central Atlanta. Shelton traces this recent decline to the delivery of abortion services rather than contraceptive services, basing his case on the timing of the decline and on differences in geographic accessibility and the reported utilization of abortion and contraceptive services. It is of some interest that no racial differential in the utilization of abortion services exists for older women in Georgia. In the late 1960s comprehensive service programs of prenatal, maternity, and newborn care for school-age moth604

ers were developed in many urban communities. New Haven, Connecticut was the site of one of the oldest and best known. Serving high school students 17 years or under, the Yale program included a heavy increment of counseling and education encouraging the use of contraception. In a followup of a group of 180 adolescents served by this program 6-8 years after their babies were born, Jekel, Tyler and Klerman found, somewhat to their surprise, that over one-third of them had used legal abortion to terminate some 80 subsequent pregnancies; an additional 16 young women had sought and received surgical sterilization. The abortion experience after the first pregnancy of the 180 teenage mothers served by this special program was not significantly different from comparable groups of teenage mothers who had not been served by the program. The figures reported by Jekel and his colleagues almost certainly understate the situation since they are based on a review of medical records at the Yale-New Haven Hospital and thus do not include abortions or sterilizations performed elsewhere. Both of these studies, it should be noted, reflect the fact that applying a little imagination to the extraction of data from routine records and statistical reporting systems, canif one understands the limitations of the data-yield useful and important information. This simple but often neglected area of research has been commented upon before in these pages .3 In 1975 there were 12,642 births to young women under the age of 15 in the United States, about the same number as in 1974.4' 5 Few of us would be bold enough to maintain that many children in today's world can function as mothers at the age of 13 or 14, or that the children of such children can be nourished by the social milieu into which they are born or accommodated by an already overloaded adoption process, if it were to be chosen. Few of us, including the authors of these two papers, would maintain that the taking of life after its conception is preferable to avoidance or prevention of conception in situations inimical to life. The evidence from these two studies, however, indicates that we do not understand enough about human behavior or that we have not matured enough as a society to apply what we know to be able AJPH July, 1977, Vol. 67, No. 7

EDITORIALS

to opt for the more desirable alternative. Once society has reached the state where all pregnancies are planned and wanted, when children are born to parents mature enough to care for them, then abortion services as they now exist may well become obsolete. Clearly we must strive to attain such an end by social reform as well as educational and service programs. Until that time, however, access to abortion services for those women who desire them would appear to be in the best interests of society at large.

ALFRED YANKAUER, MD, MPH

REFERENCES 1. Shelton, J. D. Very young adolescent women in Georgia: Has abortion or contraception lowered their fertility? Am. J. Public Health 67:616-620, 1977. 2. Jekel, J. F., Tyler, N. C., and Klerman, L. V. Induced abortion and sterilization among women who became mothers as adolescents. Am. J. Public Health 67:621-625, 1977. 3. Erhardt, C. L. Editorial: The underutilization of vital statistics. Am. J. Public Health 67:325-326, 1977. 4. Monthly Vital Statistics Report, National Center for Health Statistics Vol. 25, No. 10, Supplement, Dec. 30, 1976. 5. Monthly Vital Statistics Report, National Center for Health Statistics Vol. 24, No. 11, Supplement, Feb. 13, 1976.

ERRATUM The Journal regrets the misspelling of an author's name in the references following the editorial "Facing Challenges in Service-Related Research in Aging," in the April issue of the Journal, p. 329. The reference, including updated information, should read as follows: 7. Solon, J. A. Alternative models of physician leadership in long-term care facilities. In W. Reichel (Ed.), Clinical Aspects of Aging. A monograph of the American Geriatrics Society. Williams and Wilkins Co., Baltimore, in press, January 1978.

AJPH July, 1977, Vol. 67, No. 7

605

Abortions and public policy.

EDITORIALS 2. 3. 4. 5. ventive implications of an advocacy approach. Am. J. Public Health 67:612-615, 1977. Kempe, C. H. and Helfer, R. E. Helping...
256KB Sizes 0 Downloads 0 Views