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U.S. News and Commentary



Monday
Nov262012

CDC reports 784,507 abortions in 2009; public debate missing on ‘free’ birth control

Ultrasound image of fetus at four months. (Image: CDC; Jim Gathany)Will simply providing “free” birth control decrease abortions?

Abortion is often successfully used as a wedge issue by Democrats who target Republicans. Although both parties have abundant rhetoric supporting their opinions, there’s virtually no dialog exploring why women risk the prospect of an abortion for an unplanned pregnancy instead of using a legal method of birth control.

Evidenced by two new reports, this dialog is even more appropriate because today women in the U.S. have more means of preventing pregnancy than at any other point in history. In 2009, U.S. women had 784,507 abortions.

Recently an individual on Twitter posted a message in response to an article at a neoliberal website, claiming that the national abortion rate was “decreasing due to BC availability.”

If you look at the Centers for Disease Control surveillance report and at another report on a study cited by the CDC—some media are apparently confusing the two—it’s obvious that dialog still needs to occur. Even the CDC cautioned that cost is only “one barrier” to the “use of the most effective contraceptive methods.”

I responded to the Twitter message by telling the poster to talk to a social worker. I’ve talked to quite a few. One social worker told me it wasn’t unusual for her clients to use abortion as birth control—the women didn’t think twice about doing this even though contraceptives were available. Some unmarried women didn’t sign up for government medical care, she said, because they were concerned about having to report cash from their childrens' father(s).

The CDC did find that from 2000 to 2009, “[T]he total number, rate and ratio of reported abortions decreased 6 percent, 7 percent and 8 percent respectively.”

Not every state reports abortions to the CDC, by the way—California, New Hampshire and Maryland are among those who choose not to.

Among the more significant findings in the CDC report is the estimate that 18 percent of all pregnancies in the U.S. end in abortion. The CDC cautioned that “multiple factors” impact abortion, including “availability of abortion providers…state regulations…parental involvement laws…legal restrictions on abortion providers…[and]increasing acceptance of nonmarital childbearing…”

Changes in the economy and changing racial and ethnic sectors in the U.S. population also have an impact. CDC found, “Non-Hispanic white women had the lowest abortion rates…whereas non-Hispanic black women had the highest abortion rates…” Furthermore, most women seeking abortions are not married—85 percent.

Democrats in general believe that if contraception is covered by health insurance companies, abortions will decrease. The cost of the contraception is of course included in premiums, but no one brings that up. Smart people know there is no such thing as "free."

Moreover, the CDC report should raise questions about that simplistic approach [boldface added]:

Providing women and men with the knowledge and resources necessary to make decisions about their sexual behavior and use of contraception can help them avoid unintended pregnancies. However, efforts to improve contraceptive use and reduce the number of unintended pregnancies in the United States have been challenging. Findings from the National Survey of Family Growth (NSFG), the primary national source of data on unintended pregnancy in the United States, suggest that unintended pregnancy decreased during 1982–1995 in conjunction with an increase in contraceptive use among women at risk for unintended pregnancy (82–84).****** However, data from the 2002 and 2006–2010 NSFGs show that contraceptive use among women at risk for unintended pregnancy has decreased (84,85). Moreover, although use of the most effective forms of reversible contraception (i.e., intrauterine devices and hormonal implants, which are as effective as sterilization at preventing unintended pregnancy [86]) has increased (85,87), use of these methods in the United States remains among the lowest of any developed country (87), and no additional progress has been made toward reducing unintended pregnancy (41,42). Research has shown that providing no-cost contraception increases use of the most effective methods and can reduce abortion rates (88,89). Removing cost as one barrier to the use of the most effective contraceptive methods might therefore be an important way to reduce the number of unintended pregnancies and consequently the number of abortions that are performed in the United States.

One other underreported matter is noted in the report cited by the CDC. The American College of Obstetricians and Gynecologists published the study, Preventing Unintended Pregnancies by Providing No-Cost Contraception.

That study, the Contraceptive Choice Project, counseled women on risks and benefits of long term contraceptive methods and maintained communications with the women in the study. Participants were compensated with a modest gift card ($15 then $10 for each completed survey) and free contraception. Followup continued for up to 36 months.

We can immediately conclude that it isn't just free birth control that matters. The women in the study group not only received personal counseling and ongoing followup. The women in the study were willing to use birth control.

The Choice Project also noted:

Forty-five percent of participants reported a history of abortion. Almost sixty percent of participants reported five or more sexual partners in their lifetime and 28% reported a diagnosis of an STI in the past. Over 100 (4.8%) participants were positive for either C. trachomatis, N. gonorrhoeae, or trichomoniasis at their enrollment visit.

Contrary to media reports, there are no iron-clad conclusions. Even the Choice report is still ongoing:

“Our ultimate goal is to evaluate whether widespread use of LARC methods will result in a decrease in unintended pregnancies. We will assess this outcome by determining if rates of teen pregnancy and repeat abortions (proxy measures for unintended pregnancy) decrease in our region.

 In conclusion, by removing the financial barrier to all contraceptive methods, introducing LARC methods as a first-line contraceptive option, and addressing misperceptions regarding LARC methods, CHOICE has provided almost 1,700 of the first 2,500 participants with a long-acting reversible method of contraception.”

CNN summed all that up in 9 lines of content that suggested the “recession” and “contraception” reduced abortions. It’s not that simple, although it is a positive that an attempt at dialog is being made without the usual political posturing.

One federal judge writing about the ObamaCare Tax Bill before the Supreme Court reclassified the penalty as a tax claimed the government had the right to dictate to Americans the requirement to buy health insurance because of “cost-shifting.”

How much cost has been shifted across U.S. households because of decisions women make? Not just for abortions, but for those STIs that can impact health permanently. Has increased use of oral contraceptives and other non-barrier methods impacted STI risk?

Why, in an era when more birth control options and educational resources are available, do so many women resort to a procedure that was illegal for so long in so many states? Why are so many unmarried women resorting to abortion now that contraceptive availability has increased, especially compared to the boomer generation?

Why aren’t we talking about abortion and pregnancy in complex terms rather than confining debate to political jingoisms like “prochoice” and “prolife”?

The CDC report and the CHOICE study warrant more than a few lines of text and kneejerk conclusions to further a political agenda.

Of the 784,507 abortions reported to the CDC, 91.7 percent were performed at 13 weeks gestation or earlier, while 7 percent were performed at 14-20 weeks gestation.

(Commentary by Kay B. Day/Nov. 26, 2012)

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