The Abortion Reduction Agenda: What Smells?


Working to reduce abortions, as a strategy
to find common ground between the pro-life and pro-choice communities,
has recently garnered much attention and debate. Will Saletan’s New York Times op-ed, This
is the way culture wars end
,
and Jodi Jacobson’s recent piece, Looking for Common
Ground on Abortion? You’re Standing On It
recently took up the proposition.
Proponents of this strategy, including Saletan, suggest that abortion reduction makes political
sense because it can bring together two historically polarized camps: those who
oppose abortion outright, and pro-choice advocates who (rightly) consider
abortion largely to result from the need to better prevent unintended
pregnancy. According to the abortion reduction proponents, public and
political support for contraception, comprehensive sex education and
other measures can be expanded if we work toward an ultimate goal of fewer abortions.  

Critics of the abortion reduction
paradigm (at least within the pro-choice community, including Jacobson), point out shortcomings
of this approach: the persistent focus on the fetus and abortion instead
of women and women’s health and autonomy, the anti-contraception agenda
of many in the anti-abortion community, and the fact that not all abortions
are the consequence of a failure to prevent unintended pregnancy but
instead result from unforeseeable, unpreventable circumstances often
relating to the pregnant woman’s health.  Also of concern to
critics of this approach is the promulgation of stigma inherent in a
strategy organized around abortion as the common enemy.  

Saletan proposes that abortion rates be adopted as a measure of our success
promoting contraception.  And, indeed, abortion reduction as a guiding principle for
women’s reproductive health policy has real world implications: if our goal is to reduce abortions, then a lower abortion rate should
be the measure.  So what smells? 

As researchers and advocates
we commend the attention to reproductive health, but wonder how we should
approach the proposed measure of lower abortion rates. Jacobson presents
a compelling argument for better sexuality education and ensuring access
to contraception as a way to ultimately reduce abortions. We wholeheartedly
support Jacobson’s call for improved access to prevention and share
her vision that this will ultimately result in a decline in abortion
rates, but before we see that decline we may very well see an increase
in abortion rates in this country, and that should hardly be regarded
as a failure. Here are a few reasons why. 

First, we are limited in our
understanding of what current abortion rates mean.  Does a low
abortion rate mean that women aren’t having unintended pregnancies?
Or is it because they can’t – or are too afraid or ashamed to – get
the abortion they would choose otherwise?  Common sense would suggest
that the current multitude of anti-abortion laws might indeed be preventing
some women from having abortions – this is, after all, their intent.
Examining state differences in abortion rates also provides some insight
into what "low" and "high" abortion rates might mean. 
In 2005, New York had the highest abortion rate (38.2 abortions/100,000
women 15-44) and Wyoming the lowest (.7).  What does this mean?
Do Wyomingites use contraception more consistently and effectively? Or, do they have difficulty
accessing abortion because there are only two providers in the entire
state (compared to New York’s 261)? It is impossible to view Wyoming’s
low rate as success without concern that women who need abortion care
can’t access it. 

Aiming for a reduction in abortion
also begs the question of what qualifies as a "good" abortion rate. 
What is our targeted goal?  30/100,000?  20? 10? 0? How will
we know that we have achieved a goal that reflects both success in preventing
unintended pregnancies but also access to a service that women die trying
to obtain?  

To use the abortion rate as a valid
indicator of success at preventing unintended pregnancy, we must first
ensure the accessibility of abortion.  We must remove onerous laws
and increase the availability of accessible services, and accept that
in doing so the abortion rate may first go up.  Whatever approach
is ultimately taken, ensuring women can access the care they need is
the only meaningful starting place. 

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  • invalid-0

    What smells is probably that Planned Parenthood makes a lot more money providing abortions than they do providing birth control.

    • invalid-0

      Nope, that’s BS. I’ve done a lot of work with Planned Parenthood and they make a ton of $ by providing all methods of birth control as well as STD treatment and prenatal care. I’m sick of idiots who think PP is just a big abortion mill. It isn’t. It does more good for women than any of you pontificating, self-righteous blowhards could ever hope to do.

  • invalid-0

    It is sad that you are concerned with money when we are talking about women’s reproductive rights! Birth control is a major factor, but what happens when it fails? Do you really believe that Planned Parenthood makes money on that! Sad and shameful!

  • invalid-0

    You did not mention the total size of the population in New York as compared to Wyoming. I am sure the population in NY is far greater than Wyoming. This propably accounts for the lesser abortions in Wyoming?

  • invalid-0

    You did not mention the total size of the population in New York as compared to Wyoming. I am sure the population in NY is far greater than Wyoming. This propably accounts for the lesser abortions in Wyoming?

  • invalid-0

    Planned Parenthood makes a lot more money providing abortions

    Cites please? Otherwise, I’m calling BS.

  • invalid-0

    This comment is illogical. First, Planned Parenthood is a not for profit organization; there is no incentive to do more costly procedures. Second, there are far more patients coming to PP for contraception than for abortion; if one could actually check the figures I’m sure the abortion part of their services is the less “lucrative.”

    • invalid-0

      Income is unrelated to profit. Nonprofits have income, meaning they take in money for services rendered. Too, many workers at nonprofits bring home a salary, which in a responsibly managed organization is dependent on showing a certain level of service provided. Your message implied that the workers and supporters of a nonprofit gained no benefit from providing services consistent with their organization, but their raison d’etre depends on it, and for those who bring home a salary, that too depends on providing consistent services.

  • invalid-0

    uh.. common sense maybe? If they provide a patient with condoms a few times a year the patient or her insurer (or medicaid) will almost certainly pay less than $100 for a year’s supply, but they’ve got to be getting at least $400 for each abortion. When I worked for a major health insurer from ’95-’00 they were getting at least $300 so it must be more now. Sure they provide birth control, but its when it fails that they really hit the jackpot.

  • invalid-0

    “Planned Parenthood is a not for profit organization”
    right, any bridges your selling too?

  • invalid-0

    Well quick, cmarie…get on the horn to the IRS with your evidence! Taxpayers are up in arms, you know.

  • invalid-0

    @ Anon:

    You did not mention the total size of the population in New York as compared to Wyoming. I am sure the population in NY is far greater than Wyoming. This propably accounts for the lesser abortions in Wyoming?

    No, it was a rate per 100,000 in population, so that has already been accounted for.

  • invalid-0

    Actually Planned Parenthood makes money on both.

    The abortion business posted over $1 billion in income in its last fiscal year report.

    On the birth control side, a former Planned Parenthood official filed a lawsuit against affiliates in California saying they overcharged the state hundreds of millions of dollars on birth control. P. Victor Gonzalez says the abortion business fired him because he raised concerns about the illegal practices.

    Gonzalez says his own internal audit estimates that Planned parenthood overcharged California taxpayers for purchasing birth control by at least $180 million.

    He was the vice president of finance and administration for Planned Parenthood of Los Angles and, according to a Los Angeles Times report, the overbilling began in the late 1990s.

    While other public health facilities and private facilities charged the state between $8 and $9 for a cycle of birth control pills, Planned Parenthood charged almost $12.

    The Planned Parenthood charge to the California government was several times more than it paid for the drugs originally.

    A California state audit found at least $5.2 million in overbilling in 2003 alone from just one of the nine California Planned Parenthood affiliates.

    Gonzalez’s attorney Jack Schuler told the Times that Medi-Cal officials first noticed the problems in 1997 and that Planned Parenthood received two separate letters at that time pointing out the problems.

    Gonzalez want’s the abortion business to be held accountable for firing him for doing his job and pointing out that it was breaking the law.

    “Contrary to their national reputation as a prominent charity organization and as a healthcare provider for reproductive services, there is probable cause to believe Planned Parenthood’s … California affiliates have systematically engaged in fraudulent overbilling against government funded programs,” the lawsuit says.

  • invalid-0

    I am always frustrated with an overemphasis on quantitative results. Of course I realize that this is how policy is judged and formed (most of the time, clearly comprehensive sexuality education being an exception!), but these kinds of observations when focused purely on numbers are so far removed from the actual experiences of real women. What are women thinking, feeling, and saying about their reproductive health and well-being? I realize that this is difficult to capture and is often dismissed, but as someone who spent many hours in the procedure room, holding the hands of countless women during their abortions, I need to know that any approach around reproductive health tends to the needs of those individual women and their particular choices. A decline in abortion rates, as Zurek and Jackson note, does not correlate necessarily with a rise in quality health care or greater access to contraception.

  • therealistmom

    … can you think of any other surgeries that were performed for $300? Not very many. It costs more to have a tooth pulled. While an early-stage vacuum aspiration abortion is a simple procedure it is still surgical with all of the related expenses- having a doctor and nursing staff, sterilizing equipment, disposal, medications, possible anaesthesia, and I am sure plenty of things I as a layman wouldn’t know about as far as what is required for setup. Then take into account how many of the abortion procedures are supplied at sliding fee or otherwise not completely paid for by the patients. It wouldn’t surprise me in the least to find out that the organization actually takes a net LOSS on most abortions performed. Then there are all those pesky details like the fact that abortions account for something like 10% (taking a high percent, I believe it is considerably lower) of services rendered by PP (many locations don’t have abortion services at all) and that the focus of the organization is education and prevention of unwanted pregnancy as well as empowering people to make educated choices about sexuality and prevention of STI’s… OH and that whole nonprofit organization status. YOU might want to deny they are a NPO but the IRS tells a whole different story, and I doubt that ANY other charity in this country is under the microscope more than PP what with people’s political agendas.

  • invalid-0

    This article is about women and their needs — and that’s where the conversation should be. It doesn’t have to do with Planned Parenthood one way or another, but with women. PP is another red herring.

    As the article points out, abortion reduction does not address whether that serves women well. If abortion is reduced by making it impossible for women who want or need them to get one — whether making abortions impossible to access or providing no services for women without funds — then that is not a victory. “Abortion reduction” is a meaningless catch phrase of the day.

    This should be the question for common ground: what do women need and what can we do to help them?

  • invalid-0

    Taxpayers should be up in arms. What I’m saying is the wording itself is Orwellian. “Non Profit” just means you’ve identified yourself as meeting enough of a public need that you have tax exemptions. This goes for any church too. Technically, my (huge) insurance employer was also a non profit. No stockholders and most profits went back into the business, but that doesn’t mean for a minute that individuals didn’t make fabulous salaries. In fact we used to talk about how many people thought our “Non Profit” status involved some kind of altruistic purpose. This is hardly a charitible institution. I remember once taking a call from a woman who was going in for an abortion at PP the next day. They had convinced her she needed to bring a hard copy of her referral. I said “Well, its a covered benefit, you have a referral, its signed, you have no copayment and there is no question that they’ll get paid., but I can give you the referral number if you want”. But she said they wouldn’t see her without the actual referral so I faxed it to her. I later mentioned it to my (very pro choice) supervisor because the provider should have known a hard copy wasn’t necessary. She said “I know Planned Parenthood has always been very nasty about that. They’re so afraid they’re not going to get paid.” So tax exempt yes? Not paid or under paid? hardly.

  • jodi-jacobson

    I find this very misleading.

    I can’t go anywhere, to any doctor, pediatrician, internist, dentist or other medical provider no matter the type without lots of documentation, including my full insurance information. Depending on the type of insurance you have, you can not get any provider service–whatever it is—without a referral. And no provider, even our pediatrician, is not worried about getting repaid.

    This is frankly a frivolous example of a non-issue in regard to Planned Parenthood or any other provider. That is just the way the world works today. Period.

    Jodi Jacobson

  • invalid-0

    Well, we had hundreds of providers and thousands of members. Everyone needed referrals for almost anything and this woman had a valid one so there shouldn’t have been a problem, but Planned Parenthood and only Planned Parenthood dumped the entire responsibility on the patient and made her dig up her own original referral and bring it in. I have a better story though. This was a smaller “women’s clinic” where I’m sure everyone flattered themselves that they were saving the world. I received a call from an emergency Dr. A college student had been sexually assaulted a thousand miles from home and had seen him. He was referring her to this clinic the next day but they were giving her trouble and wanted her to pay for everything up front. I called them. I verified she was covered for this out of area visit. I told them I had written out a referral and would give them the number and they could bill us and we would pay them, but it made no difference. Nothing would make them see her unless she paid up front. No sympathy for this kid with no credit card and no money to speak of. That was the only time I had an out of area provider refuse to accept our guarentee to pay and make the member to it.

  • invalid-0

    Pro-choicers who support this “abortion reduction” schtick want to lessen abortion by empowering women and girls’ education about contraception, their sexuality, undoing rape culture and making it easier for women to have access to contraception. That’s all well and good, but they miss one salient point. Antis just want to make abortion, contraception and sex education impossible to obtain. That’s a big difference. There isn’t any “common ground” because the fundies running the pro-fetus movement are quite happy to lie to get what they want, and they will not be happy until everybody is living their way and every fertile female is held captive by her reproductive system. If we’re all too busy with forced breeding we won’t be competing in the world and will be at the very bottom of the pile again. All good and godly, huh? I don’t know how women can support this. You must be deluded.

    • http://hi-architecture.blogspot.com/ invalid-0

      You understand, the man can have a vote concerning the child in marriage (though it is that slippery slope because it is not clear how this vote will be shown – for abortions? Against abortions? Whether the man that the woman has made abortion can demand?

  • invalid-0

    As someone who has had an abortion and now councils women who have had abortions – I see the emotional toll this “procedure” takes on them. It is not an easy “choice”. Most women do not associate their emotional issues with a past abortion until many years later. I spent 25 years numbing myself with drugs and alcohol and living in fear that my children would be taken to pay for the life I took. I realize that not everyone reacts this way, but many do – and out of shame, they do not speak about it. I get so tired of this debate being all about women’s right to choose. All three options available to women with unplanned pregnancies are HARD and carry life-long consequenses. Contraception is not a silver bullet – I can’t tell you how many of my clients were using it when they became pregnant, or just “forgot” in the heat of the moment (I was on the pill). PP’s own research (Gutmacher) shows the ineffectiveness of contraception. What we need is education first, and support (affordable health care) for women who really want to carry an unplanned pregnancy. In my experience, most women choose abortion because of a lack of financial or emotional support.

    • invalid-0

      Please don’t try to speak for “most women” just because you have mental issues about abortion. It’s just embarrassing. And “most women” who get abortions don’t want to be pregnant or give birth. “Support” has nothing to do with it. A lot of us just DON’T WANT BABIES.

      • invalid-0

        A lot of us just DON’T WANT BABIES.

        Well then don’t have sex if you’re single or have a TUBAL LIGATION or HYSTERECTOMY if you’re married!!!

        DON’T KILL BABIES!

        What crime did your own children commit to deserve such torture and death??? They don’t have to pay for your own mistakes. You can’t make a wrong right by committing another wrong. The fact that we have to explain to you morally bankrupt abortion advocates why ABORTION IS WRONG is JUST EMBARRASSING and APPALLING!

  • jodi-jacobson

    love to make these sweeping statements about how “women” feel. Your experiences are your own. The experiences of others are their own. Everyone has their own experiences. There is no evidence that abortion takes an “emotional toll” on women across the board. Some women may have emotions about their abortions, regret, or other feelings, and these are legitimate. Others have no regrets whatsoever and that too is legitimate. This has nothing at all to do with the availability of the choices open to women when faced with an unintended pregnancy. Your comment about the “ineffectiveness” of contraception alone belies a bias that is based on belief, not evidence.

    Personal experiences and feelings in regard to an abortion are relevant to the person in question. Let’s stop generalizing our personal experiences to the population. It just does not hold water.

  • invalid-0

    http://www.guttmacher.org/pubs/fb_contr_use.html – This is the report I spoke of in my earlier post. It’s a real shame when we forget that there are real human beings behind the statistics. But I guess that just does not hold water in the political arena.

  • invalid-0

    I’ve copied and pasted the link and even tried typing it in myself, but each time I just get a blank page.

  • invalid-0

    The link’s working for me, at least in Firefox.

    • invalid-0

      I’ve used both IE and Firefox and still get nothing but a blank page when I use that link.

  • progo35

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

    As a person who was born as a result of an unplanned pregnancy, I think that the pro choice community needs to look beyond the idea of this contention as an existential hang up. Abortion being legal doesn’t mean that it should be frequent or encouraged, or any mention of the fetus obliterated. It is there, and it is a factor in any woman’s decision. It is not wrong for people on both sides of the aisle to aim at reducing abortion by providing resources, communicating the nature of the fetus, and encouraging reasonable safeguards for all involved, including parental consent laws, limits on late term abortion, etc.

    • invalid-0

      As another person who is the result of an unplanned pregnancy, I feel there is a huge difference between reducing the number of abortions as an end in itself and reducing the need for abortions. Most pro-choice people are quite happy to do whatever we can to reduce the need for abortions, by advocating for more and better access to sex education, contraception, support for pregnant women and families, etc. But none of that is foolproof and there will always be some women who need/want an abortion, no matter how much education and support you give them. I know that if I were to become pregnant again (I already have two very much loved and wanted children) I would have an abortion as soon as humanely possible. Because I don’t ever want to be pregnant again, I don’t ever want to give birth again, and I certainly don’t want to raise more children.

  • invalid-0

    Stop the “women and their needs” and “women’s reproductive health” and “empowering people” and “educated choices” crap. If you or Planned Parenthood or NARAL really cared about women, you wouldn’t be continuing this deception on abortion and birth control!!!

    Planned Parenthood is founded on deception and lies. “We don’t want the public to know….” NARAL is founded on deception and lies. “Repeating the big lie often enough convinces the public.” Abortion is founded on deception and lies. “The fetus is not a baby.” NOTHING BUT CRAP! You’ve been selling crap to the public from DAY 1.

    Real people are dying, real women are hurting, real people are losing jobs and all you’re concerned abt is keeping your taxpayer $$$$$$$$$$$$$$$ and millions of profits!!!!

    Crap is still crap no matter whatever nice packaging you put it in. Now THAT SMELLS!!!

  • emma

    What are you on about, Angel? I sure as hell don’t get any income from anyone having abortions or using contraception. You’re not making sense.

  • invalid-0

    Stop the “women and their needs” and “women’s reproductive health” and “empowering people” and “educated choices” crap. If you or Planned Parenthood or NARAL really cared about women, you wouldn’t be continuing this deception on abortion and birth control!!!

    So if we/PP/NARAL really cared about women… we would not give them the means to have sex without becoming pregnant? Force them to carry unwanted pregnancies to term?

    You sure have a funny way of “caring” for women….

  • colleen

    Real people are dying, real women are hurting, real people are losing
    jobs and all you’re concerned abt is keeping your taxpayer
    $$$$$$$$$$$$$$$ and millions of profits!!!!

    You appear to have confused Planned Parenthood and NARAL with  Concerned Women for American and The Independent Women’s Forum.   Hope this helps.

  • mellankelly1

    Well then don’t have sex if you’re single or have a TUBAL LIGATION or HYSTERECTOMY if you’re married!!!

    Why not have tubal ligation if you’re single and don’t have sex if you’re married? That should work just as well.

     

    Your emotional outburst aside, your personal opinions about choosing to gestate or terminate a pregnancy do not alter whether either choice is moral. It would be every bit as immoral to force a woman to terminate her pregnancy as it would be to force her to gestate her pregnancy. Hurting women (even if they happen disagree with your personal beliefs) is "wrong, embarrassing, appalling" and immoral.