Philadelphia Inquirer, October 26, 2006
OP ED: Use easy ways to reduce abortions
By Sharon L. Camp
The recent decision by the Food and Drug Administration to allow women 18 and older to buy the emergency contraceptive Plan B without a prescription is 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: A decades-long decline in the U.S. abortion rate 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 to 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.
Given this latest evidence, antiabortion activists may want to rethink their plan of action. Imagine what we could achieve if we could rechannel all of the energy that 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?
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 America, where contraceptives are relatively expensive (compared with the price in 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 our estimates - need help to cover the 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 of the states. Meanwhile, the cost to deliver such health care has gone through the roof.
At the same time, the disparity in unwanted pregnancy by income group has grown significantly: up 29 percent among poor women, and down 20 percent 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 percent of the poverty level.
There are some easy ways to get things back on track. Many of them cost nothing to implement or pay for themselves quickly.
The best examples are the 23 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 federal family planning program known as Title X. In inflation-adjusted dollars, funding for the program is just 40 percent of what it was in 1980.
We should also look for ways to make effective contraceptive use easier and less expensive. 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 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. Why not 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 - that stress personal responsibility, and give 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.
Contact Sharon L. Camp at scamp@guttmacher.org is president and CEO of the Guttmacher Institute in New York City, a policy research organization in the field of sexual and reproductive health (www.guttmacher.org).
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