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The 'A' Words — Abortion and AIDS: Let's Presume Good Faith

Ward Cates

October 20, 2013

Category: Health > Public Health

My career had been dominated by two "A" words — abortion and AIDS. Both are among the most polarizing issues of our time. For many persons on each side of the abortion topic, their view determines how they see the world, who they vote for, how they treat other humans, and how they approach life. In her 1985 book Abortion and the Politics of Motherhood, Kristen Luker found that the single biggest differentiator between those who were "pro life" and those who were "pro choice" was not their religion or politics, but rather their deterministic view of the world. Those opposed to abortion tended to see life through a fatalistic lens; pre-determined events happened, and humans needed to accept them and adapt. Those favoring "pro-choice" positions tended to see humans as in control of their destiny, able to intervene to optimize their personal outcomes.

Can the current gulf between these fundamental underlying differences be lessened? I hope so. We need a "common ground" approach that recognizes the heterogeneous values in a democracy. Such an approach begins by extending a presumption of good faith to others, and finding those similarities where kernels of agreement can begin. Thereafter, a vigorous debate over differing views can proceed without demonizing those who disagree.

Almost four decades ago, I went to CDC in Atlanta for a fellowship in epidemiology. The 1973 Roe v. Wade Supreme Court decision had just been rendered. My assignment serendipitously put me face-to-face with the topic of abortion. During the 1970s, our data helped clearly establish the public-health impact of legalizing abortion. Compared to the dangers of illegal abortion, legal abortion provided a safer alternative — it saved women's lives. But CDC's scientific evidence on abortion did not address the moral issues surrounding this topic. They remain — then and now — largely irreconcilable. In the highly emotional arena area of abortion, science is secondary to ideology.

In 1981, I turned to the emerging issue of opportunistic infections in gay men. HIV/AIDS was an emerging public health field that generated its own frequently polarizing forces. With HIV/AIDS, we had the "ABC" debates, where opposing sides argued for either the primacy of abstinence (A) or the primacy of condoms (C) as an HIV prevention approach. With careful nurturing and the presumption of good faith among key parties, we crafted a consensus statement emphasizing the full alphabet ("ABC…Z") of HIV prevention approaches. It was signed by 146 global leaders and published in Lancet, a prominent medical journal. So it is possible to lower the heat, even if positions can't be totally reconciled.

So as we search for common ground on abortion and other polarizing issues through the democratic process, we can begin by recognizing the well-meaning nature of those holding passionate convictions — however different from our own. Finding the areas of agreement on which to move forward becomes a goal. For example, offering effective contraception to sexually active persons prevents unintended pregnancies and the subsequent need for abortion. We have to try.