Abstract : A review of evidence from the United States and Europe is presented to support the view that desired public health outcomes are best achieved with comprehensive family planning programs that include safe, legal abortion. Attention is also directed to the special needs of adolescents, who are at the highest risk for unwanted pregnancy. An international study of adolescents access to contraception in the US and Scandinavia concluded that the key factor required for reducing unintended pregnancy was contraceptive use among unmarried adolescents. The lowest rates of unintended pregnancy have been found in countries which provide access to contraceptive services for teenagers. Open discussion of sexuality and birth control in the Netherlands has ben linked with their low teenage birth and abortion rates. The approach emphasized early introduction to issues, that are reinforced throughout the life cycle. Privacy is afforded teenagers visiting family planning clinics. The higher rates in the US have been linked to the lack of openness about sexual matters and lack of access to services. In the US, those women aged <25 years account for 61% of abortions compared to only 40% in the Netherlands. In the US, between 1982 and 1988, contraceptive use increased among teenagers and sexual activity increased, yet the rate of pregnancy has remained constant. Additional features of unintended pregnancy are the high rates of failure of contraception: 26% for women aged <20 years versus 20% for all women. In the former Soviet Union, quality of abortion services has been highly variable, and, in 1988, 3.4 deaths per 100,000 abortions occurred in state hospitals. Poor quality of care has contributed to increased use of illegal Russian abortion providers. For example, 20% of all abortions of women without children were performed illegally in Russia. Women's health has been found to be improved when abortion services are included in accessible reproductive health services. Government objectives to improve the public health are best achieved through broad access to a full range of family planning methods.
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