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Some Women Have More Than One Abortion - Why We Should Listen to Them, Not Blame Them

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I spoke with a young woman last week willing to share her remarkable story of growing up, of fertility, motherhood and abortion.

It was a story of misconceptions and missed opportunities to help her, made remarkable not because it was rare, but because women seldom feel able to talk about their experiences of abortion.

We all know why: despite the fact that one in three of us will have an abortion, talking about it risks bringing down the judgement of others on our heads, so few of us do.

Yet without hearing the voices of women who have experienced unwanted pregnancy, how can we properly understand the myriad reasons why it happens and better still, how to prevent it?

Research published this week by Marie Stopes UK points to the quarter of young women who have had one abortion who will go on to have a subsequent abortion. Here, surely, we should do far, far better?

The women who took part in Marie Stopes' study were very keen to avoid further unwanted pregnancy. Almost nine out of 10 went immediately onto contraception after abortion, and yet within two years, a quarter of them were seeking abortion once more. Why?

Well, here's the thing: The research showed there is no particular demographic risk factor for having more than one abortion - it can happen to any of us. What these women had in common was bad luck. Of those who were using contraception (more than half of them), it was more often the shorter term methods that failed them.

Put bluntly, there is a walloping hole where support for women to choose and use contraception should be despite the best efforts of some NHS services or charities to plug it.

Women have roughly three decades of fertile years to try to navigate without mishap - a tough task for anyone.

Girls and boys enter puberty ill prepared by parents or schools, and then turn to peers in the playground or the internet for advice. And we wonder why our rates of sexually transmitted infections and unwanted pregnancy are among the highest in Europe.

On our side is the fact that there are now more methods of preventing pregnancy than ever before, with new long-acting contraception available freely, in theory at least, on the NHS. In reality, lack of training for staff means that many women struggle to get hold of anything other than the pill.

Staff in abortion clinics can make sure women leave with contraception, but they can't follow them up to check everything's ok because of the way services are commissioned. So some women give up on the more reliable, longer-acting methods because of side-effects which can be managed.

It's hugely frustrating for those working in abortion clinics to see women coming back through their doors when they know they could have played a key role in helping them avoid another unwanted pregnancy.

There has been success in bringing down rates of teen pregnancy, thanks to huge efforts from campaigners, policy makers, service providers, researchers and educators.

Yet the one thing we lack, that we still don't have and that would make all the difference, is high quality relationships and sex education on our national curriculum.

It's beyond frustrating that no government has yet taken such a simple step to secure the future health and wellbeing of our young people.

But back to the young woman whose story I heard last week - let's call her Sarah. Her story paints a reality which is frustratingly familiar.

There were several moments in her journey when someone could have supported her better, talked about contraception, found the right method for her lifestyle and life-stage, and helped her avoid pregnancy.

No one did, until she came for her second abortion and was told about and fitted with a long-acting method of contraception she's had happily in place for the past year.

Sarah told me about the GP who cheerfully pinpointed a bout of sickness and diarrhoea as being the likely cause of her pill failing. "It might have been nice if he'd mentioned this as a risk when I saw him at the time" she said.

She told me about her first abortion at just 16 where the clinic staff barely spoke to her at all, let alone about how to prevent further pregnancies.

And she talked about her baby, just 12 weeks old when she fell pregnant again, and how she knows she made the right decision to focus on him rather than bring a sibling into the family. He's still so young, and actually, so is she.

Now, I know that times are tough, and we're not awash with cash to lavish on every service that would like more to spend. But get this: every pound spent on contraception saves the NHS £12.50.

Furthermore, NICE estimates that NHS England could save more than £100 million a year by improving access to the more reliable long acting contraceptive methods like the IUD and IUS.

The numbers of women seeking abortions each year is falling slowly and teen pregnancy rates have dropped by a quarter in the last decade. But my goodness, we could do better.

We should make sure every young person leaves school knowing how to enjoy respectful and healthy relationships, and we should bridge the gap between abortion, contraception and sexual health services so they can have ongoing relationships with women.

And we should stop blaming women for having abortions and start learning instead from women like Sarah and the thousands like her who need better services and support to manage fertility.

Get it right, and the abortion rate will plummet.

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