Contraception

Birth control policies and practices are controversial in the developed and the developing worlds. In developed countries, such as the United States, contraceptive methods fail frequently. Many of the types of contraceptives used commonly by Americans have well-documented rates of failure. One measure of the number of unwanted pregnancies is the rate of abortion, the surgical termination of pregnancy. Abortion and the controversial antigestation drug, RU 486 (Roussel-Uclaf), are not considered routine birth control methods in the United States. Although all individuals who receive abortions do not practice birth control, it is clear that many women do become pregnant when contraceptive methods fail.

Abortion rates typically are highest in countries where contraceptives are difficult to obtain. For example, in the Soviet Union in the early 1980s, when contraceptives were scarce, 181 abortions were performed annually for every 1,000 women aged 15 to 44; in 1990, 109 for every 1,000 women; and 1992, 98 per 1,000. In comparison, in the 1980s in selected western European countries, the rate did not exceed 20 per 1,000.

The abortion rate in the United States is typically higher than in many other developed countries. A 1995 survey showed the annual abortion rate was 20 per 1,000 women aged 15 to 44 (a total of 1,210,883 legal abortions), a decrease of 4.5% from 1994's rate of 28 per 1,000. The annual numbers have been decreasing since 1987, and 1995 was the lowest recorded since 1975. However, the rate in Great Britain in 1990 was less than half that of the U.S. at 13 per 1,000, and in the Netherlands, 5.6 per 1,000. A study of 20 western democracies found that countries with lower abortion rates tended to have contraceptive care accessible through primary care physicians.

Some experts believe that more access to contraceptive services would result in lower rates of accidental pregnancy and abortion. However, vigorous debate concerning programs to deliver contraceptives through school-based clinics and in other public settings have polarized the United States. Groups such as the Roman Catholic Church have opposed funding for greater accessibility of contraceptive services because they believe the use of any contraceptives is wrong.

Internationally, use of contraceptives has increased dramatically from the years 1960–1965, when 9% of married couples used contraceptives in the developing countries of Latin America, Asia, and Africa. By 1990, over 50% of couples in these countries used contraceptives.

China has taken an aggressive policy to limit population growth, which some experts have deemed coercive. Couples who agree to have one child and no more receive benefits ranging from increased income and better housing to better future employment and educational opportunities for the child. In addition, the Chinese must pay a fine to the government for each "extra" child.

Numerous problems exist which prevent the great demand for contraceptive services in developing countries from being met, due in part to the general difficulty of providing medical care to poor people. In addition, some services, such as sterilization, remain too expensive to offer to all those who could use them. Experts call for more money and creativity to be applied to the problem in order to avoid a massive population increase.