During his Administration, President Clinton said he wanted to make abortion “safe, legal, and rare.” The pointedly anti-choice Bush Administration, allied with far right members of Congress, religious and political groups spent eight long years fighting to make it illegal. Now, a new and more progressive Congress and Administration are working to repair the damage wrought by the war on sexual and reproductive health services while asserting it is time to put the “abortion wars” to rest.
But how will the warring sides make peace? And what is the peacemakers’ ultimate goal? To reduce unintended pregnancies, which in turn leads to fewer abortions while preserving a woman’s right to choose to terminate an unintended pregnancy should she be faced with one? Or to reduce the incidence of abortion by further stigmatizing it, by casting doubt over women’s moral choices and making it more difficult for a woman to obtain one through indirect means to convince her otherwise?
President Obama’s public position is that he:
“understands that abortion is a divisive issue, and respects those who disagree with him. [But] will make preserving women’s rights under Roe v. Wade a priority in his Administration”, and will oppose “any constitutional amendment to overturn the Supreme Court’s decision in that case.”
Meanwhile, ultra-right conservatives have not changed their position against a woman’s right to choose abortion. But they go further: They also oppose proven prevention measures such as birth control and comprehensive sexual health education, continue to question the medically bright line between contraception and abortion, and are campaigning at the state level to restrict access to services and to redefine fertilized eggs as people.
In between those two poles a wide range of political actors across the spectrum have begun to advocate for a new paradigm now often framed as seeking “common ground” on “abortion reduction.” Commentators like William Saletan of Slate.com writing in the New York Times and EJ Dionne in the Washington Post have pushed an “abortion reduction agenda.” Individuals and organizations representing various religious denominations — including those who support a woman’s right to choose abortion and others who oppose it — have joined the search for common ground on “abortion reduction.” White House advisors have begun using the term, and the President has created an Office of Faith-Based and Neighborhood Partnerships which lists among its key priorities
“supporting women and children, addressing teen pregnancy, reducing the need for abortion [and] encouraging responsible fatherhood.”
The head of the office, a young Pentecostal Minister named Josh Dubois, is holding meetings with faith leaders from both ultra-conservative and more progressive sides of the so-called culture wars in the search for common ground.
Getting beyond the political deadlock on abortion is important if for no other reason than that the political obstacles result in the denial to women of essential services. But the current public discourse on “abortion reduction” is vague, distracts us from sound policy approaches and suggests a worrisome practice of stigmatizing women who do choose abortion or trying to “convince” them to choose otherwise. It is a rubric based more on politics than on evidence. And, it’s also a solution in search of a problem.
Like those car keys you find you overlooked in the first place you searched after tearing the house apart, the “common ground” supported unequivocally by both a strong base of evidence and the vast majority of the American public is right under our feet, and points toward well-proven policies and interventions aimed at keeping abortion “safe and legal” and making unintended pregnancy “rarer.” Why is this different than “abortion reduction?” I’ll explain.
But first the evidence.
The number and rate of abortions is and has been declining for some time: All the talk about the need for “abortion reduction” implicitly suggests a crisis situation in which our country faces an increasing number of abortions. But many of the most vocal spokespeople on this issue have either failed to examine the actual trend lines or are misrepresenting them. On a recent segment of Hardball, for example, both the moderator Chris Matthews and his guest William Saletan perpetuated the myth of the need for “dramatic reduction” in the number of abortions. Matthews asked:
“How we can possibly find some common ground on the goal… of dramatically reducing the number of people who choose abortions in this country?”
Saletan later stated that a marker of success for Obama would be:
“If [he] can embark on an agenda of real abortion reduction,” and “actually achieve a reduction in the number after abortions.”
The fact is that both the number and the rate of abortions overall in the United States has been steadily declining since the 1980s. And there is no reason it won’t continue to do so under an Administration and a Congress committed to expanding access to birth control and evidence-based sexual health education. (See this excellent powerpoint on abortion trends in the United States by the Guttmacher Institute.)
According to the Guttmacher Institute, the abortion rate in the US (the number of abortions per 1,000 women ages 15 to 44) has fallen from roughly 29 per 1,000 in 1979 to between 18 and 19 per 1,000 in 2005. The abortion rate among teenagers declined even more precipitously, from a plateau of about 43 per 1,000 between 1979 and 1989 to 20 per thousand in 2003. Similarly, the total number of abortions has fallen from just over 1.6 million per year in 1989 to 1.2 million in 2005 and continues to decline.
Poor women make up more than half of those having abortions. And the only group of women for whom the number of abortions has risen during this period were poor and low-income women (those living at less than twice the poverty level or less than $28,300 a year for a family of three) and women on Medicaid. A Guttmacher analysis concludes:
“Over time, women having abortions have become increasingly likely to be poor, nonwhite and unmarried, and already have one or more children.”
Today, abortion rates are highest among black and Hispanic women, and rose among Hispanic women over the past decade.
Poor women rely heavily on publicly funded contraceptive services, which prevent 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies, each year. These pregnancies would otherwise result in 860,000 unintended births, 810,000 abortions and 270,000 miscarriages. So real access to birth control—knowing about it, being able to afford it, having the time and social capital to get to a place you can obtain it (including taking time out from work and using public transportation and finding a pharmacist that won’t refuse to fill your prescription) are key factors in access. So too is a woman’s personal situation and whether she can safely advocate for her own right to use contraception. Taken together, all of these are critical to being able to prevent an unintended pregnancy and hence a potential abortion.
Not surprisingly, the groups experiencing the highest rates of unintended pregnancy have the least secure access to contraception. Of the 36.2 million women in the United States who expressed a need for birth control in 2006, 17.5 million were in need of publicly funded services and supplies, more than 71 percent of which were adults and the vast majority of which were already parents. Yet in 2006, only about half (54 percent) of those in need of publicly funded birth control actually had access to services provided by Medicaid, Title X and other sources of government funding.
Lack of access is of course not the only issue, but also is linked to and exacerbated by other factors such as poverty, and high rates of domestic violence and sexual coercion, which, according to Black Women’s Health.com are in turn tied to:
“[U]nemployment and underemployment, poor schools, inadequate vocational skills and training, bad housing, the influence and use of drugs, and the density of liquor stores in the inner city [all of which] contribute to the problem of domestic violence."
Research indicates that violence against women by intimate partners is highest during the reproductive years and contributes to unintended pregnancy (through marital and partner rape and inability to negotiate contraceptive use), sexually transmitted infections, and poor maternal outcomes, among other issues.
Yet instead of focusing first on access to contraceptives and health services, and the contributions of poverty and violence as core determinants in the number of unintended pregnancies among women in the U.S. or even on the conditions that affect women’s ability to access and use these methods, some prominent columnists have focused on “the morality of the left” and the morality of individual behavior and choices. Certainly, there are people – women and men – who have sex without giving protection (of pregnancy or infection) a second thought. The evidence suggests they are the exception, not the rule. In fact, I would argue that lack of access to contraceptives and the deliberate conflation of contraception with abortion, as well as the deterioration of sexual and reproductive health education in the United States all have kept the rate of unintended pregnancies and hence abortions higher than they would have been even today. However, the media often portray women as irresponsible, both directly and indirectly. Writing in the New York Times, for example, Saletan, stated that:
“[I]n this country, the principal cause of abortions isn’t that we can’t get birth control. It’s that we don’t use it.”
Is Saletan suggesting that poor women, among whom rates of unintended pregnancy and abortion are highest, have all the access to birth control they need? The evidence clearly indicates otherwise.
Likewise, while Matthews talked incessantly on Hardball about those who “don’t use birth control” to prevent pregnancy, just a month earlier he compared the proposal in the original stimulus bill to provide states with waivers allowing them to greatly expand access to birth control under the Medicaid program to China’s coercive family planning policy:
"I don’t know. It sounds a little like China. […] I think everybody should have family planning and everybody believes in birth control as a right. I’m for — abortion is a right and all that. It’s all right. But why should the federal government have a policy of reducing the number of births?”
Actually, the point was to provide more women with access to affordable birth control to reduce unintended pregnancies, a proposal killed with the help of those like Matthews and others in the media who railed against it before he even knew what it was.
In the midst of this confusing and ill-informed cacophony of male voices pontificating on issues about which they appear to know little and understand less, and in a vaccum of media accountability, comes the “abortion reduction” debate.
What is an “abortion reduction” strategy? And what is the end goal? Half the number? No abortions? These are critical questions. Using “abortion reduction” as the framework puts us right back in the place of stigmatizing abortion, instead of creating the conditions in which fewer unintended pregnancies occur in the first place, which as the data clearly show will lead to reduced numbers of abortions overall. Moreover this framework suggests an unattainable goal that would require pressure and coercion. Reduction to what externally imposed and acceptable number? Abortion reduction implies the endpoint is to stop a woman facing unintended pregnancy from choosing an abortion–and leaves the door open to approaches that lead to the funding of crisis pregnancy centers (see Jessica Bearden’s excellent piece) and “adoption persuasion efforts” that actively seek to dissuade women from exercising their right to terminate a pregnancy in the moment. In fact, an approach that increases stigma and uses even slightly coercive and/or medically-inaccurate counseling of women facing unintended pregnancy will backfire, causing women determined to end a pregnancy to seek abortions later than they otherwise might.
The term "abortion reduction" also is informed by a moralistic attitude toward the right to choose an abortion that does not accurately reflect the individual reality of the vast majority of women. Not every woman who opts for fertility treatments has six kids at home and is seeking to bear octuplets and not every woman who has an abortion is someone at a loss to understand the moral dimensions of her choice. Yet “common-ground” proponents, including Saletan, question women’s moral agency in stating that the incidence of abortion is:
“a shortage of cultural and personal responsibility,” and that “for liberals, [the new agenda] means taking abortion seriously as an argument for contraception.”
After which he went on Hardball and agreed with Chris Matthews that, “birth control is the lesser evil." I did not know birth control was "evil," and I am pretty sure that the more than two-thirds of the 62 million women ages 15 to 44 now actively using birth control weren’t aware of this either. But by using this language unchallenged, these commentators feed misinformation and stigma and undermine rather than assist the end goal they claim to seek.
So how to reach common ground? It is right in front of us. It is a position strongly supported by evidence and well articulated in the original Democratic Party Platform, which asserted the Party’s Convention:
- Strong and unequivocal support for Roe v. Wade and a woman’s right to choose a safe and legal abortion, regardless of ability to pay;
- Opposition to any and all efforts to weaken or undermine that right.
- Strong support for access to comprehensive affordable family planning services and age-appropriate sex education programs that empower people to make informed choices and live healthy lives.
- Support for increased access to health care and education to help reduce the number of unintended pregnancies and thereby also reduce the need for abortions.
- Strong support for women seeking to have a child through efforts to increase access to and availability of programs for pre- and post-natal health care, parenting skills, income support, and caring adoption programs.
These efforts are further supported by those in other areas of the party platform seeking to address poverty, job creation, equity and reproductive justice.
This common ground position is supported both by the evidence as well as by the vast majority of Americans who endorsed this platform in electing Barack Obama President, and who, polls show, agree that the woman herself must make the ultimate decision whether or not to bear a child; agree that the government should fund family planning and related services to those in need; and fully support evidence-based comprehensive sexual and reproductive health education.
So what we need now is pretty simple: The kind of leadership and straight talk based on the evidence and on the moral bedrock for women’s choices that only President Obama himself can now provide. Given the hard evidence, and in the interest of reducing unintended pregnancies, the Obama Administration and Congress needs, at a minimum, to do the following:
- Underscore that the United States is a pluralistic society in which people of many faiths are free to hold different views on and to personally practice their own beliefs in regard to birth control and abortion, but that the government’s moral, ethical and policy positions are based on evidence and on human rights.
- Reiterate the evidence and support for the full range of efforts originally outlined in the party platform and start to put a coordinated plan into action. Women need access to basic reproductive health care from trusted and experienced sources. As such, it is also critical that the President and the Administration make clear exactly what role the Office of Faith-Based Initiatives is playing in shaping a public health policy that clearly requires the leadership of the Departments of Health and Human Services and Education among others. The President must also make clear what types of grants will and will not be funded through faith-based groups seeking to provide pregnancy-related services and to refuse to fund so-called "crisis-pregnancy centers" or abstinence-only-until-marriage programs.
- Assert publicly that federal policy will adhere to widely accepted medical definitions of pregnancy beginning after implantation, and that for the purposes of federal funding all hormonal methods of birth control including emergency contraception will be contained in the definition of “contraception.” This statement from the Administration is critical to stemming the stream of misinformation and confusion around methods that, like emergency contraception, will help dramatically reduce unintended pregnancies.
- Pledge to quickly close the gaps in access to basic reproductive and sexual health care according to income, race, and ethnicity, and to address the broader issues of poverty and inequity inherent in the reproductive justice agenda.
- De-stigmatize sex and refrain from talking about the issue as “only within marriage." Consensual sex between two mature individuals is normal, healthy and commonplace. We need to ensure that “sex positive” approaches to rights and responsibility are the foundation of our strategy to ensure people act wisely when engaging in sexual activity. President Obama can do this.
- Reaffirm unequivocally that women are moral agents making their own decisions with respect to childbearing, birth control and abortion in conjunction with their families and their faiths. The Institute for Sexual Morality, Justice and Healing puts it eloquently in stating that:
"Abortion is always a serious moral decision. It can uphold and protect the life, health, and future of the woman, her partner, and the family. We affirm women as moral agents who have the capacity, right and responsibility to make the decision as to whether or not abortion is justified in their specific circumstances. That decision is best made when it includes a well- informed conscience, serious reflection, insights from her faith and values, and consultation with a caring partner, family members, and spiritual counselor. Men have a moral obligation to acknowledge and support women’s decision-making."
- And yes, talk to men about responsibility, but not just as fathers. The Administration must focus on ensuring men see themselves as equal partners with women in sex, reproduction, and childrearing. For everyone woman experiencing an unintended pregnancy, there is a man who did not use a condom. It is not only “after” conception that men should become involved.
- Finally, Congress and the Administration must push for quick passage of key legislation that expands choices and ensures access to comprehensive sexual and reproductive health legislation, as well as ensuring expansion of Medicaid eligility for birth control, full funding of Title X and other programs, and deliberate inclusion within health care reform of reproductive and sexual health services.
These are among the first most important steps the President and the Administration can take not only to more effectively address unintended pregnancies in the United States, and ultimately the number of abortions, but also reduce the rate of sexually transmitted infections and other adverse outcomes resulting from lack of sexual and reproductive health education and services. Will they make everyone happy? No. Let’s face it: there is no real common ground with those who decry abortion but undermine access to contraception and seek to limit women’s choices at every step. But by taking these steps while also increasing individual and family wellbeing we will dramatically reduce unintended pregnancies and by extension abortions, and achieve all the gains we seek while protecting women’s rights.
The numbers and rates of abortions are declining. These rates will continue to decline if we focus on securing women’s rights, closing the gap in access to services, providing universal sexual and reproductive health education based on evidence, engaging women and men as moral actors in their choices, and removing the social and political barriers to essential services.
That’s not only common ground, it’s solid ground and proven ground.