Contraception in The Netherlands: the low abortion rate explained

Abstract

This article gives a review of the main factors that are related to the low abortion rate in the Netherlands. Attention is payed to figures on abortion and the use of contraceptive methods since the beginning of the 1960s up to the end of the 1980s. The strong acceptance of family planning was influenced by changing values regarding sexuality and the family, the transition from an agricultural to a modern industrial society, rapid economic growth, declining influence of the churches on daily life, introduction of modern mass media and the increased general educational level. The introduction of modern contraceptives (mainly the pill and contraceptive sterilization) was stimulated by a strong voluntary family planning movement, fear for overpopulation, a positive role of GPs, and the public health insurance system. A reduction of unwanted pregnancies has been accomplished through successful strategies for the prevention of teenage pregnancy (including sex education, open discussions on sexuality in mass media, educational campaigns and low barrier services) as well as through wide acceptance of sterilization. The Dutch experience with family planning shows the following characteristics: a strong wish to reduce reliance on abortion, ongoing sexual and contraceptive education related to the actual experiences of the target groups, and low barrier family planning services.

PIP: People in the Netherlands consider unplanned pregnancy to be a large problem that society and decision-makers should and do seriously address. The abortion rate fluctuates between 5 to 7/1000 women of reproductive age, the lowest abortion rate in the world. Between 1965 and 1975, a shift from a largely agricultural society to an industrial society, rapid economic growth and the establishment of a welfare state, a reduced influence of the church in public and personal life, introduction of mass media, and a rapid increase in the educational level of both men and women brought about a rapid change in traditional values and family relations in the Netherlands. These changes and the introduction of modern contraception effected a breakthrough in family planning and sexual morality. Factors facilitating the rapid transition to a contraceptive society in the Netherlands were a voluntary family planning movement, fear of overpopulation, role of general practitioners in providing family planning services, and inclusion of family planning in the national public health insurance system. Acceptance of contraception preceded liberalization of abortion. Society accepts abortion as only a last resort. The sexual sterilization rate is higher than that in other European countries (25% vs. 0-23%). Special family planning programs in the Netherlands target groups at risk of unwanted pregnancy, particularly teenage pregnancy. Almost all secondary schools and about 50% of primary schools address sexuality and contraception. Sex education has largely been integrated in general health education programs. The mass media address adolescent sexuality and preventive behavior. Very large scale, nonmoralistic, public education campaigns that are positive towards teenage sexual behavior appear to be successful. Teens have wide access to contraceptive services through general practitioners who maintain confidentiality and do not require a vaginal exam and through subsidized family planning clinics.