Increase Access to Heathcare may decrease Abortion

[Deleted]

Increased Access to Health Care May Decrease Abortions
By Brian Fung





The number of abortions in Massachusetts has decreased despite predictions that health-care reform would have the opposite effect. Can the health insurance expansions part of Obamacare do the same nationally?
Kevin Lamarque/Reuters
President Clinton once famously remarked that abortion should be safe, legal, and rare. The unspoken challenge to him since then has always been, but how do we agree on a path that gets us there? As the controversy over Missouri Rep. Todd Akin continues to burn, it seems we won't have a resolution to our national abortion debate any time soon.

From Massachusetts, though, comes growing evidence that the quest for lower abortion rates may not be at a standstill -- and the key may be better insurance coverage. As the number of insured has gone up in Massachusetts, new state data show a corresponding decline in the number of abortions performed there since 2006.

Massachusetts, of course, is known nationally as the state that launched an ambitious project to insure almost all of its residents -- a proposal that helped give rise to President Obama's own health-care law. Census statistics reveal that in the three years before Governor Mitt Romney enacted the program in 2006, 10.7 percent of state residents lacked health insurance, on average. That three-year average was nearly halved after Romneycare took effect. From 2008 to 2010, Massachusetts boasted the best uninsured rate in the nation: just 5 percent, on average.

Meanwhile, as more people were benefiting from expanded coverage, the abortion rate was quietly coming down. Many states keep detailed records on all the legal abortions they perform, and Massachusetts is no different. According to data from the Department of Public Health and the U.S. Census Bureau, from 2006 to 2008 the annual abortion rate in Massachusetts fell from 3.8 per 1,000 state residents to 3.6 per 1,000. The findings, first reported in 2010 by Harvard rheumatologist Dr. Patrick Whelan, contradicted some forecasts that better coverage would simply drive up the abortion rate rather than bringing it down.

Not only were these predictions proven false in the first couple years of Romneycare -- they grew even more wrong with time. Whelan's study couldn't have predicted this, since it didn't have the data to hand, but the drop in abortion rates has accelerated even more in 2010 and 2011:



And that's just the statewide abortion rate. Drill down to specific demographics, and the improvements are in places even more pronounced. Among pregnant teens, for example, abortions fell by nearly 7.5 percent from 2006 to 2008. By 2011, they were down by more than 21 percent.

Now, for a quick reality check: it's possible that the decline in the abortion rate had nothing to do with Romneycare. In fact, Massachusetts has generally performed fewer abortions every year than the year before it going back to 1991. In the 17 years between then and 2008, Massachusetts' abortion rate fell by more than a third, indicating a long-term trend that may have as much to do with politics or culture as it might with Romney's health-care policy. Distinguishing cause from correlation here is next to impossible without writing a book about it.

That said, scientists think the latest drop in abortion rates is at least partly tied to a couple recent factors. According to Danielle Bessett, a sociologist at the University of Cincinnati who has studied small samples of low-income Massachusetts residents, patients who became eligible for state-subsidized insurance under Romneycare were "delighted" at the prospect of improved access to contraception. People no longer have to rely on condoms alone. Now they can get birth control pills or shots if they prefer. (Of course, conservatives argue that contraception does nothing to reduce abortions; rather than hash out that discussion here, I'll direct you to Conor Friedersdorf.)

Whelan, the Harvard specialist who pointed out the abortion pattern in 2010, thinks that better access to contraception -- and the concomitant decline of abortion -- is the byproduct of broader improvements in public health brought on by Romneycare.

"When women have more stable access to medical care, they're more likely to see doctors, they're more likely to have somebody inquiring about their sexual health," Whelan told me in a phone interview. "The fact that you have somebody who cares about you results in people being healthier, and that includes not getting pregnant if they don't want to be."

Massachusetts is just one state. Luckily, we're soon going to be able to replicate this experiment on a much larger scale, thanks to the Affordable Care Act. If expanded health insurance coverage can put a lid on abortion rates, then states like Texas, New Mexico, and Florida that lead the nation in terms of the rate of uninsured should also see some improvements in their abortion rates as health coverage grows. Keep your eyes peeled.

[aw]

This would depend on whether or not you view some birth control methods as abortifacients or not.

[Deleted]

Aug 24, 2012 10:55:11 GMT -5 aw said:

This would depend on whether or not you view some birth control methods as abortifacients or not.

No these numbers are based on health department reporting numbers and i'm pretty sure those are pretty specific about what is an abortion and what isn't.

[y4m]

Aren't unintended pregnancy rates down in general? I know they are among teenagers.

I still haven't seen evidence that unintended pregnancy due to lack of access to birth control is a major problem in this country.

[aw]

Aug 24, 2012 10:57:07 GMT -5 @septimus said:

Aug 24, 2012 10:55:11 GMT -5 aw said:

This would depend on whether or not you view some birth control methods as abortifacients or not.

No these numbers are based on health department reporting numbers and i'm pretty sure those are pretty specific about what is an abortion and what isn't.

OK. So the health department gets to define what an abortion is now. I see.

[soontobeka]

Aug 24, 2012 11:00:30 GMT -5 y4m said:

Aren't unintended pregnancy rates down in general? I know they are among teenagers.

I still haven't seen evidence that unintended pregnancy due to lack of access to birth control is a major problem in this country.

From 2011: At least 4 in 10 pregnancies in every state were unwanted or mistimed, according to the first-ever state-level analysis of unintended pregnancies.

According to the analysis released today, more than half of pregnancies in 29 states and the District of Columbia were unintended; 38% to 50% were unintended in the remaining states.

Using another measure that calculates frequency of unintended pregnancies, the analysis by the nonprofit Guttmacher Institute found the highest rates of unintended pregnancy were in the South, Southwest and in states with large urban populations. Highest was Mississippi with 69 per 1,000 women ages 15-44; lowest was New Hampshire, with 36 per 1,000.

"There are many, many reasons why people don't plan ahead, even when it's such a crucial decision," says Claire Brindis, director of the Bixby Center for Global Reproductive Health at the University of California-San Francisco, who was not involved in the analysis.

Brindis says difficulty in finding family-planning services and lack of access to birth control contribute to the high numbers of unintended pregnancies. There is "a very strong denial factor — (people think) 'this won't happen to me,'" she says.

www.usatoday.com/news/health/wellness/pregnancy/story/2011/05/40-of-pregnancies-across-USA-unplanned-study-finds/47316772/1

From the Guttmacher Unintended Pregnancy: Incidence and Outcomes
Among Young Adult Unmarried Women in the
United States, 2001 and 2008
Published April 2012


Given the high and increasing risk of unintended pregnancy
among women in their 20s, preventing unintended
pregnancy for this group continues to merit attention.
Efforts are underway to ensure that all women, and particularly
those who are most vulnerable, have access to
the full range of education and counseling services, along
with the most effective contraceptive methods available.

www.guttmacher.org/pubs/unintended-pregnancy-US-2001-2008.pdf

[mominatrix]

Aug 24, 2012 11:02:02 GMT -5 aw said:

Aug 24, 2012 10:57:07 GMT -5 @septimus said:

No these numbers are based on health department reporting numbers and i'm pretty sure those are pretty specific about what is an abortion and what isn't.

OK. So the health department gets to define what an abortion is now. I see.

Who do you think should? Your church? Mine?
IMHO, the Health Department is as good a neutral arbiter of that question as anybody else.

And...
If there was one, ONE, unintended pregnancy that didn't happen because somebody had a free condom, or free pills, that's good. That's the system doing its job.

I though it was a big "D'OH" that better / easier / cheaper access to BC = fewer abortions. It would strike me as news if that WASN'T the case.

And it may be anecdotal, but I'm pretty sure that I know a person or two who 'risked it' without BC, who ended up regretting it later.

[pixy0stix]

Aug 24, 2012 11:02:02 GMT -5 aw said:

Aug 24, 2012 10:57:07 GMT -5 @septimus said:

No these numbers are based on health department reporting numbers and i'm pretty sure those are pretty specific about what is an abortion and what isn't.

OK. So the health department gets to define what an abortion is now. I see.

Uh, yes. They have been able to determine what is considered, medically, an abortion.

Are you talking about birth control such as IUD or "the day after pill"?

[ttt]

Aug 24, 2012 11:02:02 GMT -5 aw said:

Aug 24, 2012 10:57:07 GMT -5 @septimus said:

No these numbers are based on health department reporting numbers and i'm pretty sure those are pretty specific about what is an abortion and what isn't.

OK. So the health department gets to define what an abortion is now. I see.

Why shouldn't they? I am confused by this.

[heyjude]

Well I define masturbation as abortion.

[aw]

I think the definition of abortion isn't as clear cut as this. Sure, the health department has their definition, but every individual probably defines it differently. For some, using BCPs causes abortion. So increased access means more abortions. For others, the morning after pill causes abortions. So increased access means more abortions.

I don't think church has anything to do with this. My point was simply that whether or not you feel access to birth control decreases abortions is going to depend on how you view birth control.

[ttt]

Aug 24, 2012 11:15:13 GMT -5 aw said:

I think the definition of abortion isn't as clear cut as this. Sure, the health department has their definition, but every individual probably defines it differently. For some, using BCPs causes abortion. So increased access means more abortions. For others, the morning after pill causes abortions. So increased access means more abortions.

I don't think church has anything to do with this. My point was simply that whether or not you feel access to birth control decreases abortions is going to depend on how you view birth control.

Abortion is a medical term. That's like saying "every individual defines myocardial infarction differently."

[msmerymac]

Among pregnant teens, for example, abortions fell by nearly 7.5 percent from 2006 to 2008.

Is this necessarily a good thing? I mean, if the overall abortion rate among teens went down, that might be good. But if it's specifically among pregnant teens, doesn't that mean that a higher percentage are just choosing to give birth? Unless the overall teen pregnancy rate is down, and that relates to how the abortion rate among teens is down. Need more information.

[EllieArroway]

Individuals don't get to define words as they wish. They can, but that doesn't make them right. These are scientific words with actual definitions.

[EllieArroway]

I guess it makes sense that people who think they can redefine even basic words like "day" would assume that they can define any word as they wish.

[jillboston]

AW is right- the Republican party platform says (and has said for many many years) that life begins at conception. Therefore, as far as the Republican party is concerned Birth control pills, IUDs and the morning after pill are all considered abortion. I for one hope they broadcast this view far and wide.

[sandipluschris]

If I didn't think AW was serious - I'd be laughing.

Abortion can only be defined with the correct definition. You can't decide what abortion is no more than the religious right can. I had a D&E after a miscarriage two years ago. They called it (in my medical record) an abortion. Did I like it? No. Was it true? Yes. I can't argue that.

[lyssbobiss, Command, B613]

I would like to see the Health Department's statistics on abortion as it pertains to my definition, which is turning down your partner for sex.

[jillboston]

Aug 24, 2012 11:43:41 GMT -5 lyssbobiss, Command, B613 said:

I would like to see the Health Department's statistics on abortion as it pertains to my definition, which is turning down your partner for sex.

:Y:

[robin]

We need a little Elle Woods in here

[emmybean]

Can we get a list going of what words are ok to define emotionally while ignoring their medical or legal definitions, and what words aren't?

Just so everyone is on the same page.

[msmerymac]

I'd also say that RU-486 is an abortion - it's a medical abortion, v. surgical abortion (D&E or D&C). But that's about it. And it's NOT the same as the morning after pill.

[2vermont]

Aug 24, 2012 11:09:56 GMT -5 soontobeka said:

Aug 24, 2012 11:00:30 GMT -5 y4m said:

Aren't unintended pregnancy rates down in general? I know they are among teenagers.

I still haven't seen evidence that unintended pregnancy due to lack of access to birth control is a major problem in this country.

From 2011: At least 4 in 10 pregnancies in every state were unwanted or mistimed, according to the first-ever state-level analysis of unintended pregnancies.

According to the analysis released today, more than half of pregnancies in 29 states and the District of Columbia were unintended; 38% to 50% were unintended in the remaining states.

Using another measure that calculates frequency of unintended pregnancies, the analysis by the nonprofit Guttmacher Institute found the highest rates of unintended pregnancy were in the South, Southwest and in states with large urban populations. Highest was Mississippi with 69 per 1,000 women ages 15-44; lowest was New Hampshire, with 36 per 1,000.

"There are many, many reasons why people don't plan ahead, even when it's such a crucial decision," says Claire Brindis, director of the Bixby Center for Global Reproductive Health at the University of California-San Francisco, who was not involved in the analysis.

Brindis says difficulty in finding family-planning services and lack of access to birth control contribute to the high numbers of unintended pregnancies. There is "a very strong denial factor — (people think) 'this won't happen to me,'" she says.

www.usatoday.com/news/health/wellness/pregnancy/story/2011/05/40-of-pregnancies-across-USA-unplanned-study-finds/47316772/1

From the Guttmacher Unintended Pregnancy: Incidence and Outcomes
Among Young Adult Unmarried Women in the
United States, 2001 and 2008
Published April 2012


Given the high and increasing risk of unintended pregnancy
among women in their 20s, preventing unintended
pregnancy for this group continues to merit attention.
Efforts are underway to ensure that all women, and particularly
those who are most vulnerable, have access to
the full range of education and counseling services, along
with the most effective contraceptive methods available.

www.guttmacher.org/pubs/unintended-pregnancy-US-2001-2008.pdf

Wouldn't the bolded "denial" not change even if those folks had access to free contraception? It sounds like it's more about a choice not to use it.

[jillboston]

Aug 24, 2012 11:27:54 GMT -5 @majorwife said:

i think you have to recognize, aw, that the vast majority of people don't view anything as abortion other than an actual D&C, D&E abortion. If you ask 100 people on the street what an abortion is I bet a good 90 or so would say something in line with the medical definition of abortion or killing a baby from inside your uterus.

I don't think you would find many that would include birth control - pills, IUD, condoms, the morning after pill - as abortion.

This reminds of the VP debate lo those many years ago (I am an old hag) - when Dan Quayle was asked what he would do if is daughter was raped and got pregnant (since he was against abortion) . He said she could get a D&C. Akin's not the first Republican to know shit from Shine ola about women's bodies.

[heyjude]

Aug 24, 2012 11:43:41 GMT -5 lyssbobiss, Command, B613 said:

I would like to see the Health Department's statistics on abortion as it pertains to my definition, which is turning down your partner for sex.

Yes!

[ttt]

Aug 24, 2012 11:50:54 GMT -5 2vermont said:

Aug 24, 2012 11:09:56 GMT -5 soontobeka said:

From 2011: At least 4 in 10 pregnancies in every state were unwanted or mistimed, according to the first-ever state-level analysis of unintended pregnancies.

According to the analysis released today, more than half of pregnancies in 29 states and the District of Columbia were unintended; 38% to 50% were unintended in the remaining states.

Using another measure that calculates frequency of unintended pregnancies, the analysis by the nonprofit Guttmacher Institute found the highest rates of unintended pregnancy were in the South, Southwest and in states with large urban populations. Highest was Mississippi with 69 per 1,000 women ages 15-44; lowest was New Hampshire, with 36 per 1,000.

"There are many, many reasons why people don't plan ahead, even when it's such a crucial decision," says Claire Brindis, director of the Bixby Center for Global Reproductive Health at the University of California-San Francisco, who was not involved in the analysis.

Brindis says difficulty in finding family-planning services and lack of access to birth control contribute to the high numbers of unintended pregnancies. There is "a very strong denial factor — (people think) 'this won't happen to me,'" she says.

www.usatoday.com/news/health/wellness/pregnancy/story/2011/05/40-of-pregnancies-across-USA-unplanned-study-finds/47316772/1

From the Guttmacher Unintended Pregnancy: Incidence and Outcomes
Among Young Adult Unmarried Women in the
United States, 2001 and 2008
Published April 2012


Given the high and increasing risk of unintended pregnancy
among women in their 20s, preventing unintended
pregnancy for this group continues to merit attention.
Efforts are underway to ensure that all women, and particularly
those who are most vulnerable, have access to
the full range of education and counseling services, along
with the most effective contraceptive methods available.

www.guttmacher.org/pubs/unintended-pregnancy-US-2001-2008.pdf

Wouldn't the bolded "denial" not change even if those folks had access to free contraception? It sounds like it's more about a choice not to use it.

Sure - I think you're always going to have people who are just plain stupid or in denial even if someone hand delivers their free contraception to them daily. You won't ever 100% eliminate all unintended pregnancies. But you can reduce them to only those who refuse to use contraception.

[heyjude]

I think the appropriate definition for abortion is a woman turning down any man for sexy time during the fertiles.

[2vermont]

Now, for a quick reality check: it's possible that the decline in the abortion rate had nothing to do with Romneycare. In fact, Massachusetts has generally performed fewer abortions every year than the year before it going back to 1991. In the 17 years between then and 2008, Massachusetts' abortion rate fell by more than a third, indicating a long-term trend that may have as much to do with politics or culture as it might with Romney's health-care policy. Distinguishing cause from correlation here is next to impossible without writing a book about it.

I suspect that there is some connection with Romneycare, but if there was that huge of a decline already happening, I'm inclined to think it wasn't that big of a connection.

[cattledogkisses]

Please explain to me how BCPs = abortion. BCPs work by preventing ovulation, no ovulation means no egg to fertilize. So I'm failing to see how even people who believe that a fertilized egg is a person could argue that BCPs are equivalent to an abortion. ^o)

[mominatrix]

Aug 24, 2012 12:09:57 GMT -5 cattledogkisses said:

Please explain to me how BCPs = abortion. BCPs work by preventing ovulation, no ovulation means no egg to fertilize. So I'm failing to see how even people who believe that a fertilized egg is a person could argue that BCPs are equivalent to an abortion.

It doesn't matter what the science is... it matters what you believe. So, if I believe that BCP's = abortion, that means you have to count it as such.

...no word yet on the "every sperm is sacred" count of how many abortions, annually, are caused by masturbation.