Health Care Inequality is Key in Abortion Rate Disparities

An op-ed in the Washington
Times muses about whether "abortion is more common in minority
communities because, similar to alcohol and tobacco, it is more aggressively
marketed there." A Wall Street Journal column promotes allegations
of racism on the part of "the abortion industry." Similar
accusations pervade the pro-life blogosphere. There’s even a Web site
called Black Genocide devoted entirely to the subject.  

Sadly, this hyperbole–and
all the energy supposedly directed toward helping African American women–both
misses the point and distracts from the real issue: the persistent health
by women, and men, in the African American community. 

As an African American woman,
a physician, and a reproductive health specialist, I see on a daily
basis the real-life consequences of unequal access to good health care. 

That’s why I strongly believe
that those professing concern for the well-being of African American
women have an obligation to put the issue of abortion in its proper
context, and to support evidence-based policies that would have a positive

Behind virtually every abortion
is an unintended pregnancy. African American women have higher abortion
rates than their white peers because they have much higher rates of
unintended pregnancy–three times higher than those of white women.
In other words, there is no need to resort to far-flung conspiracy theories
to explain the higher abortion rate among black women. 

But there’s more to the story.
Across the board, African Americans often have worse sexual and reproductive health
outcomes than people from other racial groups. For example, we experience
much higher rates of sexually transmitted infections. These disparate
rates reflect broader health disparities that can be seen in high rates
of diabetes, obesity, heart disease or cancer. 

The root causes are manifold:
a long history of discrimination; lack of access to high-quality, affordable
health care; too few educational and professional opportunities; unequal
access to safe, clean neighborhoods; and, for some African Americans,
a lingering mistrust of the medical community. 

There are no easy solutions
to these complex challenges. Innovative strategies to reduce entrenched
poverty, improve education, and broadly reform health care all will
have to be part of the longer-term approach. Yet, there are a number
of specific steps policymakers can take right now that could dramatically
improve the sexual and reproductive health of African Americans–and
Americans in general. 

Let’s start with the need for
better sexual health literacy. A 2006 study by the
Guttmacher Institute

shows that only one in three sexually experienced African American males
and fewer than half of African American females had received formal
instruction about birth control before they first had sex. (White teens
were only slightly better off.) That needs to change, and fast. 

Policymakers should heed the strong body of evidence showing that abstinence-only-until-marriage
programs are a waste of money. They should instead support comprehensive sex-education
, many
of which have shown success in delaying teens’ initiation of sex, reducing
their number of sexual partners, and increasing their use of condoms
and other contraceptives. 

We also need to redouble our
efforts to empower African American women to better plan their pregnancies:
to avoid pregnancies they don’t want and to achieve pregnancies they
do want when they want them. This goal is not only worthy in and of
itself, but its attainment will also lower the high rate of abortion
among African American women. 

Proven policies include boosting funding
for the federal Title X

family-planning program under which women and men across the country
can get subsidized contraceptive counseling and supplies as well as
STI (sexually transmitted infection) testing and treatment. Expanding Medicaid eligibility
for family-planning services

nationwide (a step 26 states-including Delaware and Pennsylvania,
but not New Jersey-have already taken) would likewise allow more people,
including many African Americans, to participate in these prevention-focused

Finally, Guttmacher Institute
research shows that the abortion decisions of many women (of all races)
are influenced primarily by their desire to be good
. Too many
women today are stretched so thin that they feel unable to take care
of their existing children, not to mention an additional child. Clearly,
policies that support working parents, especially at the lower end of
the income spectrum, are needed. Let’s make good on our pro-family rhetoric
by supporting paid sick leave for more parents, as well as subsidized
child care and affordable health insurance. 

My challenge to antiabortion
activists is to stop throwing around inflammatory terms like genocide
and instead channel their considerable energies and resources into supporting
policies that reduce the need for abortion. Let’s get serious about
helping women and their families, including women in the African American

This op-ed
was originally published
in the
Philadelphia Inquirer

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  • invalid-0

    …and how well it somehow really says it all so concisely (a talent I often envy)!

    One of my favorite things about working for the FWHC I do when not working for my own org is the level of awareness when it comes to women of color and low-income women, and the long history of that FWHC in that awareness.

    I really hope this piece gets seen, read and heard as widely as it should.

  • invalid-0


    If European American women are only marginally more educated than black women about chemical contraception and sexual habits, and European American women have significantly lower abortion rates than those of black women, then increasing sexual health literacy for black women through governmental promotion will only negligibly decrease aggregate abortion rates in black women. Hence, education must be ruled out as a contributing variable in your hypothesis, as it could not be a reason for the substantial incongruence between the respective groups of women because there is only a slight difference in education between the groups to begin with. I highly doubt that you mean to suggest that comprehension is a problem for one group, as it corresponds to the other group, and that the other group needs to double its education in order for it to terminate the disparity between the two. And I say terminate for a reason. Personnel responsibility and not governmental policies will enable blacks in America to break the now only proverbial chains that nonetheless prevent them for attaining the dream. Governmental policies actually enslave blacks in America by enabling them to think of themselves as victims fallaciously. My challenge to my adversaries in the pro-abortion camp is for you to admit that rhetoric and hyperbole is most assuredly used by us both. Fortunately, the methods are more easily employed when they are sustained by more of what constitutes truth. BTW: Black is not a dirty word. Be proud or call whites European Americans. How silly…


  • anna-clark

    Thank you, Dr. Gilliam, for such a clear and well-focused piece that ties so much together. Glad to see it here at RH Reality Check.


    Timothy, you pointed out what seems like dissonance between the generally poor sexuality education available to people of all races, and the higher percentage of African Americans who have abortions, and you conclude that "education must be ruled out as a contributing variable." 


    It’s not nearly so simple. As Dr. Gilliam describes, a lot of variables that exaggerate the negative impact of poor sex education–which people of color ARE more likely to receive–and that ultimately lead to the racial disparity among those who have abortions.


    The solution certainly is not to "rule out" comprehensive sex education. Of course we should have available more accurate and complete information about sexuality and reproductive health!


    But you’re right to imply that it’s not the only solution; it’s one vital piece of a multi-faceted response to our situation. Among those pieces, Dr. Gilliam recommends public policies that are supportive of parents, funding for Title X, expanded Medicaid, making health care equitable and accessible and safe, clean neighborhoods.


    I’d add that removing abortion from its place as a freakishly polarizing political weapon is another piece of the solution.

  • invalid-0


    Thank you, Dr. Gilliam, for this thought-provoking article.

    I wrote a post at my blog two weeks ago about abortion and I did not address this issue in the way that you have. I will link to your article so that my readers have a broader understanding of what is at stake.

    Continue to blow the trumpet!

    Peace, blessings and DUNAMIS!
    Minister L. Vazquez

  • marysia

    "My challenge to antiabortion activists is to stop throwing around inflammatory terms like genocide and instead channel their considerable energies and resources into supporting policies that reduce the need for abortion. Let’s get serious about helping women and their families, including women in the African American community."

    Some of us are already doing this, thank you very much.  I wish folks would stop assuming that if someone opposes abortion, they aren’t already working very hard to relieve its root causes.

    You are right, it doesn’t take an outlandish conspiracy theory to recognize & explain why African American & other lives of color are taken disproportionately through abortion–or, for that matter, HIV/AIDS infection, substance abuse, gun violence, and such. 

     But there is a grain of truth in those conspiracy theories and cries of genocide: these disproportionate  lifetakings are caused by human agency, by systematic inequalities that our collective power can set right–if enough members of this society learn to truly, in practice value black lives and other lives of color as much as white ones. 

    Also, it can really hurt to cry out and cry out for the equal value of people of color’s lives, only to be met with indifference or hostility or intractable incomprehension or perpetual "what are *you people* or *you n-word lovers* so upset about."  It can make even the strong and dedicated get a bit crazed and frantic.  I think that’s why the rhetoric escalates sometimes. 

    not to mention that the ghosts of history are still hanging around.  and they’re not always ghosts…for example, i have actually encountered white people who want medicaid to pay for abortions because they don’t want "all those black people going on welfare and eating up my precious tax dollars."

    At any rate, thank you for the analysis of why African Americans have a higher abortion rate and what can be done to address this problem. 

  • invalid-0

    Black women deserve to know the truth – and the truth is, Margaret Sanger, founder of Planned Parenthood, was a self-proclaimed racist and advocated for the abortion of black babies. Planned Parenthood has recently been caught agreeing to take donations earmarked to reduce numbers of blacks, and still you have the nerve to call these kinds of reports “hyperbole” and “far-flung conspiracy theories” while black children’s lives are being snuffed out left and right. You are doing a gross disservice to your race by suppressing the truth and letting people of color off the hook when it comes to being responsible for their own decisions and actions.

  • invalid-0

    I want to thank those who commented by reminding us of the the histotical foundations of the pro-abortion and contraceptives movement. I in no way commend Dr. Gilliam’s blog or other commentary of the same nature that has been strategically placed to rebuff the allegations of the NAACP and other black leaders that abortion is being aggressively promoted among poor black women. At first glance, their allegations do seem far fetched–right? Well at least to the predominanlty white matriarchal advocacy community that exhists in order to ensure that women have access to abortion first, access to contraceptive services second, and safe pregnancies last. Dr. Gilliam would have done her sisters a service by acknowledging the historical context of the Sanger movement, and even taking it a step back farther and acknowledging that even in slavery the sexual and reproductive health and rights of black women were compromised to the fullest extent. I have no doubt that this has remained in some way, shape, or form since they arrived on American soil. With the ugly history around the compromised sexual and reproductive health of black women in America, why the heck is it far fetched to think that their rights are not still being compromised?

  • invalid-0

    Thanks for laying out the facts. It’s one thing to talk about the disparities, but it’s something very different to highlight why. You are absolutely right when you talk about the lack of access to the economic and social supports to control their fertility and prevent unplanned pregnancies. Similarly, there are far too few social and economic supports to help women have healthy children. You do a great job of highlighting that the real work is eradicating all forms of reproductive oppression and achieve reproductive justice.