WHEN you live in Scot land, you get used to heading up unpalatable league tables. Whether it's heart attacks or drug and alcohol dependency, literacy or life expectancy, there we are right at the top, or bottom – whichever end is the embarrassing one.
Last week's statistics of shame involved abortions. While in most of the developed world the rate of terminations appears to be declining, Scotland is bucking the trend, recording an all-time high of 13,817 – a rate of 13.1 per 1,000 women aged betwe
en 15 and 24 – in 2008. Almost 3,500 of those involved teenagers, with 343 performed on under 16s. And more worryingly still, 3,770 involved women who had already had one or more termination. Although the rate itself is higher in England and Wales – 18.2 per 1,000 women between 15 and 24, its figures fell (by 1.6 per cent) last year as did those of the US, which, historically, has a high number of abortions.
No matter where you stand in the abortion debate, these figures represent the most appalling failure of policy. It is one thing to believe in a woman's right to choose, but something is going wrong if – almost 60 years after the contraceptive pill was made available on the NHS – so many Scottish women are still experiencing unwanted pregnancies.
As always, the opposing sides in the polarised abortion debate have been quick to blame each other. The Pro-Choice lobby claims what young people need is yet more sex education and accuse the Catholic Church of being obstructive. The Pro-Life lobby, meanwhile, insists it's a case of too much emphasis on sex and not enough on the virtues of abstinence.
To be fair, both have a point. In Holland – which has an abortion rate of around 8 per 1,000 women aged between 15 and 44 and is held up as a model of effective family planning – the use of contraceptives was already widespread before abortion became a political issue.
This was partly down to its own peculiar demographics: one of the most densely populated countries in the world in the 1960s, it was more conscious than most of the need to control its birth rate. But it was also due to its pioneering sexual health strategy and the fact that the declining influence of the Church on Dutch society made it easier to implement.
Studies suggest abortion rates start to decline when 80 per cent of the population is using effective contraception, so it's unsurprising that – Russia apart – they're higher in conservative and religious societies. In Scotland, the Healthy Respect initiative focuses not only on the biological aspects of reproduction but also on relationships and emotions.
Yet almost every newspaper story about sex education comes with the obligatory condemnatory quote from an Archbishop or Cardinal, while Catholic schools have an alternative programme, Called to Love, which promotes sex as something that should take place within marriage and does not cover contraception.
On the other hand, the number of repeat terminations does suggest the acceptance of promiscuity combined with what is, in all but name, abortion on demand may also be contributing to its prevalence. Certainly, it is difficult to avoid the conclusion that while in the sexually liberated Netherlands, abortion is acceptable only as a last resort, in Scotland some women view it as just an alternative method of contraception.
Inevitably, the complete picture is more complex than the views of those on either side of the abortion debate would suggest. A closer analysis of the figures shows that – like everything else that ails Scotland – the number of terminations is inextricably linked to poverty, with the overall rate twice as high in the most deprived areas of the country than in the least deprived. And when you think about it, that makes sense. Unwanted pregnancies are more likely to occur where people are living chaotic lives. They may be well-informed on contraception; they may understand the consequences of failing to use it, yet a trip to the family planning clinic may be as unrealisable as a trip to the library or dental surgery.
Allied to this is Scotland's love affair with alcohol. It doesn't matter whether you are a hardened addict or a weekend binger, taking drink or drugs may make you forget to take your contraceptive pill, or skew your judgment so the possibility of an unwanted pregnancy pales into insignificance alongside the prospect of instant gratification. One US study which compared comprehensive sex education programmes with abstinence-only ones found higher rates of unwanted pregnancies in the latter. But it went on to suggest that comprehensive sex education programmes might be more effective if they combined information on how to obtain and use contraception with social resistance skills: in other words, if they were to teach young people how to say 'No' to unprotected sex. Interestingly, on the rare occasions that adolescents have been asked their opinion, they have agreed sex education should focus less on anatomy and more on the art of negotiating within relationships.
In a sense, that's what the Netherlands has achieved. By combining a liberal attitude towards sex and sex education with a more traditional approach towards personal responsibility, it has created a generation of young people that knows that with every right comes a responsibility. If only we could find some way of encouraging Scots from deprived backgrounds to value themselves – and give them something to aspire to – maybe they too could learn to enjoy sex without any of the unwelcome results.
