Abortion in the US: Agreeing to agree

What does Philadelphia doctor Kermit Gosnell’s conviction for murder and involuntary manslaughter mean for politics in the United States? It is hard to ignore the note of fatigue in media accounts. Predictably, Americans seem to want to escalate the same old, angry tug-of-war that has occupied them for the past 40 years on the same old, tired terms. But there is an opportunity to turn the rhetoric and thus transform the debate. 

Throughout this long battle, opponents have agreed on three substantial, important points. They share a common horror: fetid, careless facilities such as the Women’s Medical Society has been reported to be. They share a basic goal: reducing the number of abortions. And they champion a common means: cutting the rate of unplanned pregnancies. If pro-choice and pro-life advocates could join forces on this final point, the US abortion rate would plummet – without the reversal of Roe v Wade or repeal of a single state restriction. As a bonus, maternal and child welfare would increase. 

To be sure, the divide seems intractable. Most opponents of abortion who support the full dignity and rights of the unborn cannot accept legal abortion under any conditions. Most supporters of choice cannot accept any restrictions not clearly needed to protect women’s health. And both sides seem doomed to dissatisfaction with the confusing patchwork of regulations created by the Affordable Care Act (ACA) and state-by-state abortion laws. 

New restrictions

Unfortunately, recent battles have obscured the fact that the new restrictions, overlaid with the gaps in the ACA, could trap families in poverty and create a child welfare crisis without easing any of the problems that lead to unplanned pregnancy. Action is urgent. The connection between poverty, unintended pregnancy and access to abortion show why. 

A quick look at the new restrictions demonstrates their varying effects on women from different income groups. In the past few months, states such as Indiana, Alabama, North Dakota and Kansas have enacted provisions such as waiting periods, refusal of public funds for most abortions, and requirements that doctors administering abortions or providing prescriptions for drugs that cause medication-induced abortions have hospital admitting privileges. 

These laws probably will not be especially burdensome for women of means with insurance. According to the Guttmacher Institute, abortion rates among these women have been dropping in recent years. They will likely have access to free contraception under the employer health plan provisions of the ACA, making avoidance of unplanned pregnancy even easier. As they have in the past, women who do want to end pregnancies will be able to travel to other counties and even other states for safe abortions if there are no local providers. 

The situation is very different for poor women. For them, travelling to a distant clinic is onerous, but common: as of 2008, 87 percent of US counties had no abortion provider, and new state regulations will only boost this figure. Making a second trip for a mandatory pre-abortion counselling appointment and coming up with the cash to pay for a procedure that is no longer publicly funded are two further formidable barriers to terminating an unexpected pregnancy. 

Very poor women, not coincidentally, are the only group in the US among whom the abortion rate increased in the period between 2000 and 2008. The upshot is that the new restrictions will probably lower the abortion rate mainly for this group. And they will do so simply by making abortion unavailable to them. 

To make matters worse, the new restrictions are not accompanied by measures that help poor women raise the children to whom they give birth. This failure bodes ill for their welfare. Two years into a five-year longitudinal study, now being replicated on a larger scale, researchers found that poor women turned away for abortions were nearly twice as likely to be on public assistance a year later as women of similar income who had received them. They were also more than twice as likely to suffer domestic violence, a sign that they were less able to break away from abusive relationships. 

Universal contraception

Could it be that women who gave birth – having been turned away from clinics – are also more likely to experience additional unplanned pregnancies? In 2006, five times as many women below the federal poverty threshold had unintended pregnancies as women whose income equalled or topped 200 percent of the poverty line. 

This makes sense. The poorer a woman is, the more financially dependent is she on men and the less she may control whether, when and how she has sex. Quite simply, financial independence encourages sexual independence, which in turn discourages unplanned pregnancy and reduces the demand for abortion. 

Gaps in contraceptive coverage are also to blame. Unfortunately, the ACA does not eliminate these gaps for poor women. Few have employer-linked health coverage that would provide free contraception, and many do not live in states that plan to enact the Medicaid expansion. All told, adding Obamacare to new state abortion restrictions will do little to alleviate unintended pregnancy, unplanned childbirth, or abortion or to decrease maternal and child poverty. 

Both “pro-choicers” and “pro-lifers” should reconsider this unintended result: a restriction of choice and degradation of life that traps women and their children in nearly impossible situations. 

There is one easy way to relieve this problem – and with one stroke of the pen dismiss all the religious freedom lawsuits filed against the ACA. It is universal, free, federally-funded contraception. Simply put, fewer unplanned pregnancies mean reduced demand for abortion, which pleases both the pro-choice and the pro-life movements. Fewer unplanned pregnancies also mean fewer women and children on public assistance and more women in the workplace, which pleases fiscal conservatives. 

In short, universal contraception arrives at the goal – reducing abortion rates – by a route that increases procreative autonomy and raises quality of life, all without straining public funds. 

Pro-choice voters could heed the late choice advocate Beverly Wildung Harrison, who famously said that abortion is never a desirable means of exercising procreative choice. Pro-life advocates could chime in: unintended pregnancy is never a desirable means of honouring life. The nation could get behind one policy that definitely cuts abortion rates and promotes the lives of women and children: universal contraception. 

Cristina LH Traina is Professor of Religious Studies at Northwestern University, where she is a scholar of childhood ethics and Roman Catholic social ethics. She is part of the Northwestern Public Voices Fellowship of the OpEd Project.