Losing Ground on Abortion

Sharon L. Camp is President and CEO of the Guttmacher Institute.

The recent decision by the Food and Drug Administration to allow women 18 and older to buy the emergency contraceptive Plan B at pharmacies without a prescription is very welcome news. But Plan B alone will not be enough to overcome our nation's stalled progress in reducing unintended pregnancy and the need for abortion.

The latest data on abortion, published by the Guttmacher Institute in early August, should make no one happy – not the anti-abortion activists who have successfully lobbied for a raft of new abortion restrictions (and who opposed over-the-counter sales of Plan B) and not those of us who want to keep abortion safe, legal and available.

The new numbers strongly suggest that a decades-long decline in U.S. abortion rates is stalling out. In each year from 2000 to 2003, the abortion rate (the number of abortions per 1,000 women of childbearing age) barely budged. There is no reason to expect 2004, 2005 or 2006 will look any better. Indeed, they might look a good deal worse.

A decade ago, abortion rates were dropping significantly every year, as all groups of women benefited from improving contraceptive use. Today, abortion rates are declining only for better-off women. Rates for poor women are actually going up. This is very bad news, regardless of which side of the abortion divide you are on.

Given this latest evidence, anti-abortion activists may want to rethink their plan of action. Imagine what we could achieve if we could re-channel all the energy state and federal legislators now spend making it harder for women to get abortions into efforts to make it easier for them to avoid unwanted pregnancies in the first place?

The typical American woman who wants two children spends about five years of her life pregnant, post-partum or trying to get pregnant. But in order to avoid an unplanned pregnancy, she will need to use contraception correctly and consistently for 30 years. This is no mean feat in the American context, where contraceptives are relatively expensive (compared to other countries), increasing numbers of young women lack health insurance, and even those who have insurance may not have coverage for contraceptives.

Indeed, a surprising number of American women-17 million, according to new Guttmacher Institute estimates-need help to cover annual cost of prescription contraceptives and the medical services associated with them. This total grew by a million women between 2000 and 2004.

But in much of the country, public subsidies for family planning services failed to keep pace, with funding flat or declining in about half the states. Meanwhile, the cost to deliver such health care has gone through the roof. Many public health facilities can no longer afford to offer the most effective and easiest-to-use new contraceptive methods. Funding shortfall may be part of the reason why the number of sexually active women who are not using any birth control has gone up, especially among low-income women.

Publicly funded family planning services currently prevent an estimated 1.3 million unintended pregnancies each year. Without public funding for such services, the U.S. abortion rate would likely be 40% higher than it is. A good 10-year goal would be to reduce abortion another 40% by getting more resources to hard-strapped family planning clinics. Our country actually has a related goal: In 2000, we made it a national public health priority to reduce unintended pregnancy by 40%. But at the moment, we're making zero progress.

Instead, the disparity in unwanted pregnancy by income group has grown significantly. Unintended pregnancy has gone up 29% among poor women, and down 20% among better-off women. A poor woman is now four times as likely to have an unintended pregnancy, five times as likely to have an unintended birth and more than three times as likely to have an abortion as a woman living above 200% of the poverty level.

There are some easy ways to get things back on track, if our leaders would care to try. Many of them are revenue-neutral, meaning they cost nothing to implement or they pay for themselves quickly. The best examples are the 24 state Medicaid waivers that expand eligibility for family planning coverage to more low-income women. A recent Guttmacher study finds that making eligibility for contraceptive services the same as eligibility for Medicaid-covered pregnancy-related care would avert almost 500,000 unplanned pregnancies, 225,000 unplanned births and nearly 200,000 abortions a year, while also saving $1.5 billion in net state and federal expenditures.

Another good investment would be adequate funding for the categorical federal family planning program known as Title X. In inflation-adjusted dollars, funding for the program is just 40% of what it was in 1980.

We should also look for ways to make effective contraceptive use easier and less expensive for everyone. Following the example of Plan B, many experts think birth control pills and other newer hormonal methods should also be made available without a prescription. Regardless, we should try to remove unnecessary medical barriers that merely raise costs and inconvenience women. I believe conservatives call this deregulation.

Let's revisit contraceptive labeling. It's often outdated, inappropriately scary, confusing, incomprehensible or all of the above. Wouldn't it make better sense to have up-to-date, science-based labeling that most women could actually read?

We also need better public education programs – not just for teenagers, but for adults as well – education that stresses personal responsibility and that gives people medically accurate information on the safety and effectiveness of modern contraceptives, preferably before they start having sex.

We know how to make abortion rates start going down again. Let's stop wasting time and get on with the job.

Editor's note: this piece was adapted from Sharon Camp's op-ed in The Philadelphia Inquirer.

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