But we at AAP challenge many of the assumptions behind abortion reduction and are not convinced it is the direction to take.   For example, as Dr. Jackson and I point out in our recent post on RH Reality Check, an abortion reduction agenda runs the risk of attributing causality where it doesn't exist and oversimplifying the reasons for  -- and hence the policy responses to -- abortion. 

As women and those working closely with women deeply understand, abortion is the result of multiple intersecting factors that combine uniquely for each woman around her need for and ability to access abortion care. These complexities are not beyond generalization, but demand a nuanced approach at the program and policy level.

AAP and many of our colleague organizations are working to better understand and respond to these complexities.  As part of our Rural Abortion Provider Initiative AAP is working with an Iowa-based sociologist to research the way women's communications with their primary care providers might impact access to abortion for rural women.  For our Least Access States Initiative, we commissioned a new, multi-issue framework for assessing and ranking the accessibility of abortion in twelve states - a framework that we are now applying to all fifty states in hopes that this will facilitate new and more effective approaches to abortion nationwide. 

Through the LASI project, now active in several states, we are taking an integrated, systems approach that addresses the multiple intersecting factors that contribute to abortion and abortion access: family, community, religion, health care, social services, economic opportunity, jobs and housing, and others.  We are engaging individuals and groups in each of these areas in discussions that include abortion and abortion access, and working with them to identify and implement program and policy solutions that are meaningful to women's lives.  In doing so, we can recognize and support women's desire to parent and to avoid unintended pregnancy without isolating and further stigmatizing abortion.  Instead, we can view abortion as an integrated part of the resources and supports that women need to fully and freely make decisions about their health, sexuality, and parenting. 

This multi-level, community driven approach may indeed inform different solutions than those that are being suggested by pundits and policy makers.  Sharing the perspective that comes from this approach is one of the unique contributions that AAP and others working at this level can and must make to the national dialogue that is taking shape.  Otherwise, women may find themselves again at the receiving end of an agenda - like one focused on reducing abortions - that sounds good on paper, but that at best solves only part of the problem and at worse further constricts access to the care and resources that women need.