'Tis the season to be finger wagging at women about the perils of parties and promiscuity. While it's true that the first couple of months of the new year are a busy time for bpas, this more to do with the fact that fewer appointments are made over Christmas and the New Year-with a resulting backlog - than a wave of unplanned pregnancies caused by binge-induced recklessness.
The idea that it's "irresponsibility" which drives unplanned pregnancy - whatever the season - is misplaced. A recently conducted audit of all women contacting bpas for advice in 2011 found nearly two thirds were using contraception, including condoms, pills, patches and coils, when they became pregnant. Were the remainder - those who either admitted to using none or didn't give an answer - their more reckless contemporaries? Well maybe, and most people have taken chances at some point in the heat of the moment which they regret the next day.
Yet when you drill down into the reasons why women don't use contraception the picture is often more complex. In an age where infertility and IVF dominate the headlines, some women - both younger and older - significantly underestimate their ability to get pregnant, or believe they are infertile because of a diagnosis of polycystic ovary syndrome (PCOS) or an episode of Chlamydia, for example. We see women who have become pregnant not long after giving birth, not realising how quickly fertility returned, or after misinformation about the protection breastfeeding provides against pregnancy. Sadly we also see women who simply haven't been able to negotiate contraceptive use with a reluctant partner, as well as women for whom a much wanted pregnancy is no longer possible after a dramatic change in personal circumstances.
As it happens, we would never distinguish between the woman who has become pregnant when all thought of contraception has gone out of the window in the heat of the moment, and the woman whose LARC has let her down. Moreover, we do not distinguish between the woman who is visiting us for the first time, and she who is returning. Figures on "repeat abortion" are often pointed to as evidence that women are using terminations as a form of contraception, without any analysis or definition or what that means. No unwanted pregnancy is a carbon copy of the last but the term "repeat abortion" (with it's almost criminal connotations - think repeat offender) very much implies that these are back-to-back, identical events. "Repeat abortion" can be used to cover the most dissimilar of experiences: the woman who has an unplanned pregnancy when she forgets her pill at 21 and a "repeat" procedure at 40 after a serious problem is picked up with a much wanted pregnancy. "Repeat" is very unlikely to have much resonance for her.
But we also need to bear in mind how women's lives and expectations of motherhood have changed, and the impact that may have on the number of women undergoing more than one abortion. At 30, the UK now has the oldest average age of first time motherhood in the developed world. Many women strive to have achieved a certain level of security - in their job, finances and partnership - before taking on the significant responsibility of parenthood. But this does mean that many women are spending their 20s - the time when they are most fertile - not wanting to be pregnant. This combination of delaying motherhood, high fertility, and what we know about contraceptive failure rates (and our failure to always use it effectively) means it really isn't that surprising that the proportion of women having an abortion in their twenties who have already had one has increased.
It's estimated that about half of pregnancies in this country are unplanned - many of which will be greeted with joy and carried to term, while others will end in abortion. For one woman experiencing an unplanned pregnancy, an unstable job market and poor career prospects may make it the right moment to start a family - for another the same uncertain environment will make her certain that now is not the time for a baby. Unplanned pregnancy is not a marker of irresponsibility - it's a fact of life. The responsible thing for the rest of us to do is to ensure women have the space and support to make the decision about that pregnancy that is right for her.
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