This article was originally published in the Guardian.com and is reposted here in partnership with Scarleteen.com.

In 2008, over 5,000 UK women under the age of 20 had an abortion that was not their first. As was made clear by the alarmist headlines following the publication of those numbers, this is a big concern for the public.

A woman’s reproductive life often spans 30+ years. Around 1/2 of all
pregnancies in the US and UK are unplanned. Contraception isn’t used or
used properly. It fails sometimes even in perfect use. Female fertility
peaks between the ages of 19 and 24: the reason we tend to see the most
abortions (and pregnancies) in that group is because it is the most
fertile group having the most sex. (Piccinino, LJ, Mosher, WD.
Trends in contraceptive method use in the United States: 1982-1994.
1998. Family Planning Perspectives. Vol. 30(1): 4-10 & 6, Table 1)
The UK teen pregnancy rate is the highest in Western Europe: six times
higher than the Netherlands, nearly three times higher than France and
more than twice the rate in Germany.

In 2008, nearly 33% of all UK terminations were not first-time procedures.
Those under age 18 had 1,452 “repeat” terminations. Women 18-24 had 21,443
terminations that were a second or third; those 20-29, 16,734 repeats,
and for women over 30, 23,804. As it is in the US, the group with the
highest rate of repeats is women over 30. As it is in the states, half
those women are likely already mothers.

I don’t get the concern about abortions, specifically. No matter
what choices we make with it, pregnancy has the capacity to radically
change our health and life. Pregnancy itself is a potentially dangerous
health event: 40% of all pregnant women have some sort of health risk.
15 percent of those risks are potentially life-threatening. The rate of risk
and complication with delivery is 8-10 times higher (and higher still
for the youngest women) than for legal, first-trimester abortion. The
maternal mortality rate in New York state dropped 45 percent after abortion
was legalized in the U.S. Safe, legal abortion isn’t the health issue:
unintended pregnancy is.

We should all have women becoming unwantedly pregnant as our deepest concern, no matter how a pregnancy ends.

What most influences unplanned pregnancy? People shagging in ways
that matchmake sperm and egg, which most do and historically will have
done by the age of 19 or 20. Whether reliable contraception is used
correctly and consistently. Poverty is a huge factor, as is the sense
of reduced self that often results from poverty, like the sense or
reality that motherhood is an attainable goal while other goals are not
within reach. Rape and other sexual abuses and unhealthy relationships,
also whoppers.

What can be done? The UK plans to respond to this in exactly some of the ways I’d suggest. Lucky Brits! When I think the U.S. government should respond a certain way, they have an uncanny habit of doing the opposite.

Provide better sex education, information about and access to contraception: The 2008/2009 Opinions Survey Report
shows only 57 percent of UK women 16–19 using contraception, a lower rate than
all other ages. Only 11 percent of young people in the Netherlands don’t use
contraception: their rate of STIs and unwanted pregnancies is
impressively low. 11 percent vs. 43 percent: that’s major.

Women need access to comprehensive, unbiased information about all
contraceptive methods, addressing all as viable while making clear the
differences in effectiveness and proper use. Women need that
information at school, at home, in the media and from healthcare
providers, including those providing care with pregnancy, whether it
ends in abortion, miscarriage or birth. The youngest women use family
planning services less than older women, and are often scared to ask
for them. It’s vital they’re offered these services without
finger-wagging. Women need information about and access to
contraception before they need to use it, not after.

Many women won’t know about all options, how to use them properly,
or which methods will suit them best without thorough information that
puts an emphasis on them as individuals. For instance, young women
nearly always ask for (or are rotely given by healthcare providers) the
pill, but oral contraceptives are less effective for teen women than
for older women: some data shows a failure rate as high as 20 percent for
young women, with a risk of failure as much as 55 percent higher for those
under 20 as those older. (LM Dinerman et al, Archives of Pediatrics
and Adolescent Med, 149(9):967-72, Sept 1995. MD Hayward and J Yogi,
"Contraceptive Failure Rate in the US: Estimates from the 1982 National
Survey of Family Growth," Family Perspectives, Vol 18, No. 5, Sept/Oct
1986, p. 204; J Trussell, B Vaughan, Contraceptive Failure,
Method-Related Discontinuation And Resumption of Use: Results from the
1995 National Survey of Family Growth, Family Planning Perspectives,
1999, 31)

We must work hard to provide marginalized women contraceptive
information and overall support services: the poorest women, the
youngest women, women of color, refugee women, homeless women, abused
women. These women have a higher risk of unplanned pregnancy because
they are the least well-served and the least visible.

Assure thorough information is provided during an abortion visit:
Women who don’t want to become pregnant again should be offered an
in-depth contraception consult during their abortion visit. Women can
often start reversible long-acting methods – an injection, implant or
IUD – before they leave the clinic. Providers should make clear women
can easily become pregnant post-abortion and ask about the dynamics of
their sexual relationships. IPV rates in the UK are high: women in abusive, controlling relationships, particularly the youngest women, have higher rates of repeat unwanted pregnancies.

Talk about combining methods: Combining two forms of contraception
provides no less than 92 percent protection from pregnancy in typical use and
no less than 98 percent in perfect use. If we want to cut the rate of sexually
transmitted infections and unplanned pregnancy, we must make clear that
consistently backing up any method with condoms radically reduces both
STI and pregnancy risks.

Increase awareness about emergency contraception: Only 14 percent of
UK women 16-19 reported using emergency contraception in 2008. Less
than 1% of women knew it could be used up to 5 days after a risk; only
49 percent knew it could be used up to 72 hours. Six percent of UK women thought one
dose of EC could prevent pregnancy until the next menstrual period (it
can’t). Many young women do not know they can get emergency
contraception through the NHS, not just family planning clinics.

Men need accurate information on contraception, too. Partner
contraceptive non-cooperation is a problem, particularly for the
youngest women who are still working on their dump-that-chump-skills.
Beyond the impact abusive or careless partners have, even caring men
can inadvertently sabotage contraceptive efficacy or use. That Opinions
Survey Report included a study on male knowledge that makes clear men
need more contraceptive education. Only around 30 percent knew long-acting
contraceptives were more effective than other methods.

UK men reported they always used a condom only 3 percent of the time. To be
an effective sole or backup method, condoms must be used correctly and
consistently. Make sure men know that they also are entitled to prevent
pregnancies they do not want, and have methods they can use themselves
to exercise their reproductive rights.
We need to do a better job making sure boys and men understand they are
as responsible for their sexual choices, including prevention of
unwanted pregnancy, as women are. We don’t do women or men any favors
by accepting or enabling double-standards to the contrary.

Think (and talk) differently about teen sexuality: Most young
people will — as they always have — be sexual with partners. The
approaches to teen sexuality with the best outcomes accept this rather
than trying to deny or eradicate it.

When we give young people a message their sexuality is something
shameful they need to fear or hide, they hear it. They become afraid
and less inclined to ask questions or for help, to be honest about what
they need and what’s really going on with them. In the Netherlands
(last time, I promise): they don’t treat teen sexuality as we do in the
UK and the US. They don’t present young people’s sexual partnerships as
a terrifying if but as an acceptable when. When reared with a clear
cultural expectation they will seek out sexual partnership and an
equally clear expectation they will handle sexual partnership ably,
young people often will, in fact, do just that.

Just like anything else, all of sexuality has a learning curve. As
with, say, cooking, driving a car or writing pieces on huge topics in
less than 1,000 words, few begin their sex lives savants. We can’t
expect young people to magically be better at this than the rest of us,
especially without our help and support. Should we want them to be
better at it all than we were or are, we can’t keep doing the same
things we know full well have always failed them.