Questions and Numbers in the Abortion Debate: There’s No Such Thing As A Free Pregnancy

Statistics from the Guttmacher Institute indicate that only 19.6 pregnancies per thousand  in the United States end in induced abortion procedures, a number that has declined from 29.3 per thousand in 1981.  Of these some 88% occur in the first 12 weeks.

If 88% of all induced pregnancy terminations take place within the first 12 weeks, why would states enact ultrasound testing? Further, why would a state enact a statute forbidding physicians from imparting information about potential pregnancy complications or about the results of pre-natal tests which show the likelihood of fetal abnormality?

What if the test showed evidence of anencephaly, a neural tube defect which usually happens in the first four weeks of a pregnancy?  Approximately 1 out of every 4,859 babies born in the U.S. are anencephalic, and will not survive very long after their birth. [CDC]  What if the ultrasound, demanded now by the state of Virginia, indicated that a fetus was thus fatally flawed, and would not survive for much longer than 24 hours?  The irony may be that in the case of the Virginia statute, the parents may well receive information which might cause them to seek termination of a pregnancy rather than “scaring” the woman into not seeking the termination.

What if the pre-natal testing indicated congenital, chromosomal, or genetic defects?  What if the parents were financially incapable of supporting a child with such severe defects?  One can demand that a fetus not be aborted for financial reasons, however such a demand requires a commitment on the other side of the equation, i.e. the community and state must provide services needed which the parents cannot afford.  Are the state legislatures willing to appropriate funding for a range of special services from institutional care facilities to home based medical providers to special education program funding?

The response in some instances, such as Arizona, is to put the government “between a woman and her doctor” and restrict what the physician can tell the family.  This is not a rational solution.

Frankly,  Kansas, which is considering draconian anti-abortion and contraception measures, enacted a state budget which proposed the exact opposite:

“Lawrence schools have about 11,000 students and 1,600 employees, with a monthly payroll of $4.5 million. The district trimmed its spending by laying off paraprofessionals who worked with special-education students, reducing the number of days teachers work and increasing the student-teacher ratio by one student, a move that may seem small but saved more than $1 million in one year.” (emphasis added)

Again in Kansas, a move to privatize the state’s Medicaid program, would leave programs for the developmentally delayed under the auspices of organizations which have no experience in related issues.

“The House Health and Human Services Committee is scheduled to hold hearings next week on a bill that would exempt long-term care services for the developmentally disabled from the managed care provisions in KanCare, Gov. Sam Brownback’s Medicaid reform plan.” [KHI]

The Democratic Party supported bill may not get much support in a Republican controlled legislature.  The situation in Virginia isn’t much different, the state legislature cut approximately $700 million from its budget for K-12 education, meaning that special education services will also feel the squeeze. [CBPP]  The 2012 Virginia budget cut $400 million from Medicaid funding. [ABC7] Those proposing the enaction of stringent restriction on abortion procedures, appear not to have thought ahead as to what state services will be required if all pregnancies — including those in which there is a strong chance of fetal abnormality — must be carried to full term.

Not to put to fine a point to it, but I am awaiting the day when the same people who rally for “Pro-Life” statutes attend hearings on Medicaid, state health services, and education with the same level of enthusiasm.

If the prevalence of abortion procedures has declined in the last three decades, as the chart clearly indicates, what is the role of contraceptive services in precluding abortions?  The science is clear:

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant. The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly. [Guttmacher]

Meaning:  In developed nations with relatively stable fertility levels, such as the United States, the availability of contraception resulted in fewer abortions.

What of the pregnancies which are not prevented or terminated?  We’ve still not developed a nationwide consensus on how to support infants with health issues.

The latest figures from the CDC indicate there are about 6,408,000 pregnancies in the United States every year. [CDCpdf] The CDC also reports that 8.2% of live births are complicated by Low Birth Weight, and another 12.2% of live births are Pre-Term. [CDC]  That means there are 338,715 low birth weight babies born each year, and another 503,941 infants born pre-term.

We know that smoking, age, genetics, and nutrition play a significant role in the low birth weight statistics.  From a Stanford University study we can add some additional information:

“Different ethnic groups show varying degrees of prenatal care utilization, with 76 percent of all women seeking prenatal care within the first trimester, and only 61 percent black and Hispanic women seeking prenatal care during the same time period. Underutilization of prenatal care is often attributed to poor socioeconomic statuses like inability to pay for prenatal care, a lack of knowledge in the importance of prenatal care, and inadequate location and availability of prenatal care providers.” (emphasis added)

Medicaid covers 51% of all babies delivered in Florida hospitals, but the state is looking at proposed program cuts ranging from $376 million to $720 million:  “Dr. Peter Dayton, who provides prenatal, obstetric and gynecological services for Medicaid patients through the Physicians to Women program, told the editorial board hundreds of pregnant women would be put at risk if Medicaid funds are slashed.”Five hundred women will be showing up in emergency rooms with no prenatal care if this program is not sustained,” Dayton said.” [TCPalm]

A 2011 editorial in Texas summed up the problem:

“Texas already runs one of the leanest Medicaid reimbursement programs – one so lean that it doesn’t cover the actual cost of treating Medicaid patients. Doctors already lose money on those patients; many simply can’t afford to accept them. And further cuts could mean that far more would have to stop accepting Medicaid.

The upshot? If pregnant women can’t find a doctor who’ll see them, they’re likely to skip prenatal care — and thus, more likely to suffer serious problems with their pregnancies or give birth to a premature baby. Those intensive-care outcomes aren’t just tragic; they’re far more expensive than prevention. And we taxpayers will end up paying for them.”

And so it goes.  Those demanding severe anti-abortion statutes, and those demanding restrictions on the availability of contraception, are all too often supporting politicians who also favor the restriction of public health services, and the parsimonious funding of education and family assistance programs.  IF we truly are a compassionate nation, in which we care deeply about healthy families, then we must also be a country in which we recognize that there is no such thing as a “Free Pregnancy.”

You Have My Condolences, but she was only your daughter?

It used to be really dangerous to be a woman.  It used to be even more dangerous to be a low-income woman.  The decrease in maternal mortality rates is a fairly modern thing, as the following graph of maternal mortality rates  illustrates:

The data on maternal mortality is complicated by the way statistics are collected and recorded, is the mortality the result of a complicated pregnancy (one in which the woman dies within 42 days of delivery)? Or, is it the result of a direct obstetric problem (omissions, or incorrect treatment)? Or, should the death be classified as an indirect obstetric death, one in which existing conditions or diseases were aggravated by the pregnancy? However the mortalities were classified, the results were the same.

Significant improvements in women’s health care since the 1930s have reduced the maternal mortality rates such that the topic doesn’t often appear in common discourse in developed nations.

One study published in the American Journal of Clinical Nutrition posited reasons for the decline in mortality rates:

“The sudden and dramatic decline in maternal mortality rates, which occurred after 1937, took place in all developed countries and eliminated the previously wide country-level differences in national mortality rates. The main factors that led to this decline seem to have been successive improvements in maternal care rather than higher standards of living. As a result of this decline in maternal mortality in developed countries, there is now no mortality for which there is a greater disparity between the developed and the developing world than the disparity in maternal mortality rates.” [Am.Jrnl Clinical Nutrition] (emphasis added)

Thus, it’s not just that we are “eating better,” the reduction in maternal mortality rates is connected to “successive improvements in maternal care.”  Cavalierly dismissing the inability to access general and maternal health care for women by saying, “There are other clinics…,” (yes, IF they are located in places where women need them, and IF they are affordable) or “Title X will cover the expenses…” (yes, if Title X funds are still available after all the Republican presidential candidates have promised to cut them), is an invitation to reverse the trends in those successive improvements which reduced maternal mortality rates in the first place.

Black Bordered Invitations

The Republicans at the state and federal level are doing their best to insure that the maternal mortality trend reduction is reversed.  Some samples:

“The Arizona Senate has approved a bill that would shield doctors and others from so-called “wrongful birth” lawsuits. Those are lawsuits that can arise if physicians don’t inform pregnant women of prenatal problems that could lead to the decision to have an abortion. The Senate’s 20-9 vote Tuesday sends the bill to the state House.” [AZCapTimes]

What’s wrong with this picture?  Are Arizona Republicans saying that if there is a condition or disease present during a pregnancy which could result in an “indirect obstetric death” it is allowable for a physician to withhold the information in order to avoid a possible decision to terminate the pregnancy?  And, the grieving husband will have no recourse to the courts if an obstetrician fails to tell the family a pregnancy could be fatal?

Is a physician supposed to ignore the potential complications related to hypertension and heart disease, or pituitary or adrenal gland problems which could be fatal, all in the interest of encouraging the family to carry the pregnancy to term?  What happened to “first, do no harm?”

Then there was New Hampshire 2011:

“In June, the state of New Hampshire exercised its right to decline renewal of a $1.8 million contract with Planned Parenthood of New England, which operates clinics – including those where abortions are performed – in the state,” the leader of the pro-life political group said. “It is well within the purview of the New Hampshire state government to decide not to continue to subsidize America’s abortion giant with taxpayer dollars.” [LifeNews]

The fact that only 3% of Planned Parenthood’s total services involve abortion procedures seems to have escaped them. [PP]  This would be the state in which approximately 64,500 women of child bearing age and who have maximum incomes of 250% poverty line level need help obtaining contraceptive medication.  This would also be the state in which the abortion rate was well below the national average.  And, this would also be the state in which unintended pregnancies cost the state and federal government about $27 million. [Guttmacher]

Deep in the heartlessness of Texas. Governor Rick “I can’t remember the third thing” Perry suddenly remembered that if he refused federal funding for women’s health services there was going to be a major hole in money for those “successive improvements in maternal care.”

“The health program provides care to about 130,000 low-income women statewide. It had been expected to close next week, when Texas begins enforcing a law passed last summer that bars state funding from clinics affiliated with abortion providers. The Obama administration has said it will stop funding the program because federal law requires women to be able to choose any qualified clinic. Perry spokeswoman Catherine Frazier countered that Texas has the right under federal law to determine qualified providers in the program.” [WaPo]

That’s a Texas Tall Order to fill a $40 million program without the usual 90% coming from the federal government.  It’s going to be a taller order since low income women tend to use Planned Parenthood Clinics as a source of health services (cancer screenings, contraception, etc.)  The “They Can Just Go Somewhere Else” argument falls apart quickly when we look at where women in Texas go to find affordable contraceptive prescriptions.

So, according to the Guttmacher Institute 78,490 women in Texas needed help from Planned Parenthood for contraceptive services, and now the Governor believes the state can “fund the gap?”  Did the Governor miss the part wherein if the services graphed above were NOT available Texas’s teen pregnancy rate would be 13% higher than it is now? [Guttmacher] It may well take more than a ten gallon hat to fill this void in women’s health care services in the Lone Star State, or “Ladies don’t let your daughters grow up and marry Cowboys…”  It will be hazardous to their health.

Just Peachy!  Female members of the Georgia Legislature walked out in protest.

“The Senate voted, 33 to 18, to prohibit state employees from using their state health benefits to pay for abortions.

And the Senate decided, by a vote of 38 to 15, that employees of private religious institutions have no right to demand that their insurance policies pay for contraceptives, as the Obama Administration wants to require.” [WXIA, C&L]

A statute enacted in 1999 requiring coverage for contraception hadn’t been controversial in the Peach State until now.   So, imagine a female employee of the state of Georgia faced with a pregnancy that could cost her very life, and note that according to this legislation  she cannot use state health benefits to terminate the pregnancy?  Additionally, even if the federal government requires that the insurance corporation which underwrites the health benefits cover contraception, a female state employee in Georgia can’t even ask for it? This carries “Let ‘em die” to an entirely new depth.

At some point the Kipling Men who are promoting these, and other, egregious plans to reverse the improvements in women’s health made since the Depression Era, are going to electorally discover the truth in Kipling’s poem:

Man’s timid heart is bursting with the things he must not say,
For the Woman that God gave him isn’t his to give away;
But when hunter meets with husband, each confirms the others tale -
The female of the species is more deadly than the male.