As more wobbly Dem congresscritters commit to supporting the health care package, I’m guardedly hopeful that Bart Stupak is about to consign himself to the dustbin of history.
Nonetheless.
I’ve got two “pro-life” reasons why wafflers like my own congresscritter, Charlie Wilson, need to vote yes and put themselves on the right side of history.
First, a study came out this week in the New England Journal of Medicine that demolished fears that universal coverage – even if paired with liberal access to abortion through insurance – will drive up the abortion rate. Dr. Patrick Whelan found that in Massachusetts, abortion actually declined after coverage was expanded to virtually all residents:
The national health care reform legislation that was recently passed by the Senate has been modeled, in many respects, on the Massachusetts reform law; both lack the “public option” that was included in the House bill, which was the focus of the Stupak–Pitts Amendment prohibiting federal subsidies for health plans that would pay for abortion. Therefore, I hypothesized that the early experience in Massachusetts might serve as a good model in which to examine whether a substantial expansion in health care coverage might result in an increased number of abortions.
The relevant part of the Massachusetts program is Commonwealth Care, which provides subsidized insurance to the self-employed, small businesses, and unemployed individuals with incomes below 300% of the federal poverty level. This quasi-public agency began coordinating care through five private participating health plans effective January 1, 2007. I sought to determine whether this increased availability of care has led to an increase in the number of abortions performed in Massachusetts.
The number of abortions in Massachusetts in 2006, the year before the new law was implemented, was 24,245, including 4024 among teenagers. I obtained data from the Massachusetts Department of Public Health for each of the two subsequent years. Some 158,000 people were enrolled in Commonwealth Care plans during the first year. The Urban Institute estimated that between the fall of 2006 and the fall of 2008, the proportion of adults with incomes below 300% of the poverty line who were uninsured fell from 24% to 8%; 63% of all newly insured adults were in either Commonwealth Care or the state Medicaid program.
In 2007, the first year of Commonwealth Care, the number of abortions fell to 24,128, and in 2008, it fell to 23,883 — a decline of 1.5% from the 2006 level (see graph). The number of abortions among teenagers in 2008 fell to 3726, a 7.4% decline from 2006. These decreases occurred during a period of rising birth rates, from 55.6 per 1000 women 15 to 44 years of age to 56.9 per 1000 in 2006 and 57.2 per 1000 in 2007 (the latest year for which data are available from the Massachusetts Department of Public Health), and an increase in overall population (in 2008, the Massachusetts population surpassed 6.5 million for the first time, and it was nearly 6.6 million in 2009, according to the Census Bureau). The abortion rate thus declined from 3.8 per 1000 population in 2006 to 3.6 per 1000 in 2008. Overall, since 2000, the number of abortions in Massachusetts has dropped by 12% (from 27,180 to 23,883) and by nearly 36% since 1991.2 The Massachusetts abortion rate has similarly dropped by a third, from 30 per 1000 women 15 to 44 years of age in 1991 to about 20 per 1000 in 2005, with most of the decrease occurring during the late 1990s.3
Or, to put it briefly, abortions declined both in absolute numbers and on a per-capita basis. The drop was steeper for teenagers.
Now, it’s possible that Massachusetts is simply mirroring national trends, where abortions have slowly declined in reason years (with, however, an upward blip nationally in 2006). But at the very least, it seems reasonable to conclude that in the biggest, best real-life laboratory we’ve got, access to abortion – which was a covered service for Medicaid recipients and the next-lowest income tier covered by Commonwealth care – did nothing to increase the number of abortions performed.
Whelan doesn’t speculate what other factors might be depressing the abortion rate, but I can think of two. First, there may be fewer unplanned pregnancies if Commonwealth Care is delivering family planning services and contraception to the neediest residents. Second, a woman confronting an unplanned pregnancy may be more likely to keep it if she knows she can count on good medical care for her child and herself. I don’t know enough about the details of the Massachusetts system to know if it really does provide decent reproductive health care, but this seems like a reasonable conjecture.
What would happen if we expanded the Massachusetts experiment nationwide? Well, the likelihood of an upward trend in abortions might be even slighter in more conservative states, where cultural attitudes discourage abortion. Those women might also be less likely to avail themselves of contraceptive services, so they’d benefit less from access to it. On balance, my gut feeling is that red states would continue to have more unplanned babies and shotgun weddings than blue states like Massachusetts, but their abortion rates will remain about the same. That’s just my instinct, and I could be wrong, but if Massachusetts women didn’t start aborting by the millions, do we seriously think the gals in Utah will?
The second “pro-life” argument I’d like our congresscritters to hear relates to our shameful maternal and infant mortality rates. Our ostensibly pro-life politicians are utterly silent on those two interlinked scandals. They shouldn’t be.
This week, Amnesty International released a lengthy, serious, well-documented study on maternal health in the U.S. (Go here for the link to the full, free report in pdf format.) At Mom’s Tinfoil Hat, Hilary writes:
It’s often asserted, including in this report, that infant and maternity mortality are key indicators in the health and social justice of a country.
I’d add that they ought to be key indicators for the seriousness of grandstanding “pro-life” politicians.
Take, for instance, the ranking of states according to maternal deaths. Maine comes out on top, with just 1.2 mothers dying per 100,000 live births. Vermont is second, at 2.6. You might object that these are small states with small populations, and that the number of women dying there is so small that figures may be deceptive. Could be. But then check out Massachusetts in third place with 2.7. Hmm, we’re starting to see a regional trend.
The District of Columbia rules the hall of shame with 34.9 maternal deaths per 100,000 live births, worse than Costa Rica. Georgia is second-worst with 20.5. (Figures are from pp. 104-5 of Amnesty’s report, Deadly Delivery: The Maternal Health Care Crisis in the USA.)
As Amnesty notes on its webpage:
During 2004 and 2005, more than 68,000 women nearly died in childbirth in the USA. Each year, 1.7 million women suffer a complication that has an adverse effect on their health.
This is not just a public health emergency – it is a human rights crisis. Women in the USA face a range of obstacles in obtaining the services they need. The health care system suffers from multiple failures: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight.
So why should Stupak care? After all, these are just a bunch of women – disproportionately poor women of color – who should’ve kept their legs shut, right, according to Stupakian logic? In his view, aren’t these just throw-away mothers?
Well, when mothers die, babies sometimes die with them. Hemorrhage, eclampsia, embolism – all can endanger the infant as well as the mother.
While babies can’t yet talk, I don’t think it’s a big leap to say that most prefer not to be half-orphaned at birth.
Most significantly for Stupak and his allies, however, is that obstetric care benefits babies and mothers alike. Where mothers survive, infants are more likely to survive and thrive. That’s true here in the U.S. as well as globally. We do worse than Cuba when it comes to keeping newborns alive.
And guess what? Health care reform has the potential for helping mothers and (potential) babies get the care they need.
So I’ll be waiting to hear from Stupak and the bishops on how, exactly, killing health care reform will help preserve mothers and babies – and how, precisely, they can call the resulting deaths and complications “pro-life.”
Patron cat of Kittywampus (1985-2001)
MassHealth covers contraceptives.
(I’m a Massachusetts resident and I work for an insurance company that offers both Medicare and Medicaid coverage)
And AWESOME POST!! Thank you for this incredibly valuable information.
Now, where’s the share-on-facebook link?? (oh yeah, WP doesn’t have one!)
Thanks for the info. It’s good to know contraceptives are covered. I’m guessing that the drop in abortions also means that they are actually being *delivered* to the people who need them.
I didn’t realize WordPress was behind other platforms on the Facebook thing. I’m irked by a few other features, but I migrated here from Blogger because it gave me more control over trolls, and that has been worth the other inconveniences.
Excellent post, and thanks for linking to me.
Unfortunately, Stupak doesn’t really mean “pro-life” when he says “pro-life”. Like most self identified “pro-life” types, he really means is pro controlling women’s bodies. Supporting legal abortion saves lives.
It would have been easy to decrease abortions with this legislation if Stupak wanted to – he could have sponsored an amendment that requires insurance companies to cover contraception. It also would have been easy to save mothers (and many of their baby’s) lives by supporting comparative effectiveness and quality control research in obstetrics, and funding to support evidence based maternity care. There’s more to healthy pregnancy and motherhood than simply a lack of an abortion.
Of course Stupak isn’t “pro-life” in a broad sense. He is anti-abortion, period. And his amendment and current antics are pure political grandstanding. As we’ve seen in the past few days, the bill is gaining support from many committed Catholics who oppose abortion (not just the Frances Kisslings of the church). These include the National Catholic Reporter, for one, and a large group of nuns in leadership positions. Most significantly, the Catholic Health Association backs the bill.
I assume Stupak is also anti-contraception. Since he’s kowtowing to the bishops, funding birth control is no doubt anathema. But even if that’s a given, it still ought to be a no-brainer that supporting this HCR bill will tend to reduce abortions, not increase them.
Yes, I can tell you speak German because “half-orphan” is such a literal translation of “Halbwaise”. I think this is the first time I’ve seen the concept in English.
As far at the substance of the post, it’s interesting, although I suspect that none of the questions are quite as easy as the true believers on either side of the debate think that they are.
Brinkmanship, I have to disagree. Not everything is 50/50, takes two to tango, both sides have extremists, so let’s call it a draw.
There are researched, evidence based ways to save lives, especially the lives of mothers and their children. Making abortion illegal is not one of them. This is not a “true believer” statement. Maternal mortality is not a political or religious extremist cause, and I really don’t appreciate being lumped in with people who demonstrate outside of clinics or try to get women’s rights taken away.
Maternal mortality rates are higher in California right now than they are in Bosnia, Vietnam or Kuwait. This isn’t a philosophical exercise about when life begins.
Oops! I wasn’t even thinking that about “half-orphan” but of course you’re right!
MomTFH, as both Sungold’s post and your response amply demonstrate, maternal mortality is a political cause.
Whether making abortion illegal saves lives is a point on which reasonable people can and clearly do disagree, and both sides cite copious amounts of evidence to support their respective views. Were that not the case, I do not think the questions would be as difficult and devisive as they are.
Given the inherent difficultly of the questions here, I would hope that people on each side could accept that those on the other side are operating in good faith, often based upon deeply held convictions, listen respectfully, and look for areas of common ground. I think Sungold’s post was an example of an effort to seek such common ground by describing a number of “pro-life” reasons to support healthcare reform.
On the other hand, I question whether characterizing people who protest outside of clinics as “trying to get women’s rights taken away” is similarly constructive. In my (admittedly limited) experience, very few people will be willing to reconsider their opposition to healthcare reform legislation after being attacked.
There’s only one way to run the numbers and find any doubt on whether legal abortion saves lives – and that’s to assume that the life of an embryo or early-stage fetus is morally equivalent to that of the woman carrying it.
I do think it’s important to seek common ground. This isn’t gonna work with Stupak or the bishops. It can work with a good many rank-and-file American Catholics and evangelical Christians, most of whom are indeed operating in good faith, in my opinion. It’s my experience that young people from those backgrounds who are exposed to all sides of the abortion issue often conclude that the are pro-life when it comes to their personal choices, but pro-choice with regard to keeping abortion legal. One reason for this is that they don’t want to see women imprisoned for abortion or dying of botched illegal procedures.
However, the maternal mortality resulting from abortion is still immense in those countries where it remains illegal today. That’s not up for dispute.
And I also see a vast distinction between the average “pro-life” person and those protesting outside clinics. The latter really do want to repeal Roe v. Wade.
Most Americans are in the mushy middle when it comes to abortion. But among those who hew to a strongly position, only one side has conducted an organized campaign of intimidation that has accommodated arson and murder. I don’t hold ordinary pro-life citizens accountable for the acts of anti-abortion terrorists, but it’s untenable to say that both sides equally harbor “extremists.” That just ain’t so. And the other guys have the bombs and bullets to prove it.
Here is a link round up I did last year on blog for choice day about saving lives and access to safe abortion. I quote reputable, scientific sources like the Lancet, the WHO, and the Guttmacher Institute. This is not political opinion. I don’t see any evidence to the contrary, and I would be interested in what you see as copious evidence as to how restricting access to safe, legal, affordable abortion saves lives. Scientific sources, please.
This isn’t about “operating in good faith”. People who want to make abortion illegal, which I think fairly describes most people who demonstrate outside of abortion clinics, do want to take away rights of women, who in the United States today have access to legal abortion, at least in the 23% of counties that there is an abortion provider. Is that a stretch? I don’t see that as being an outrageous statement.
Who is being attacked? Early in the health care reform debate, there was a summit in which parties on both sides of the abortion debate agreed to keep everything at the status quo. There was no compromise necessary by Stupak to get so called “pro-life” politicians on board. The bill does not fund abortions. Stupak wanted to turn it into a debate about abortion, and he did. He wants to restrict aboriton more than the status quo.
Maternal mortality may be discussed in the political arena, but it is primarily an issue of public health. That’s why it’s in the Healthy People 2000 and 2010 goals put out by the Department of Health, and not in the Democratic or Republican political platforms. Just because you can argue about it in blog comments doesn’t make it merely a political issue. I would love for you to look in the face of the family of one of these two to three women a day who die in the United States and tell them people are just interested in this topic because of their political convictions.
This isn’t a rhetorical game to people who really do care about women’s lives. That’s the problem. I am getting a masters in public health and researching obstetrics interventions in an attempt to improve practices during labor and delivery. And frankly, I am furious to be compared to someone waving a sign with a disgusting photo on it outside a clinic where 98% of the clients are accessing contraception and STD treatment services.
Please see http://www.cccf.wordpress.com for another analysis on the subject of Dr. Patrick Whelan’s article in NEJM. Keep an open mind until the facts come in…probably five years from now. Thanks
I read your post and honestly, I’d be much more open to being convinced if your post had any links to its data. You don’t even link the Whelan study, much less the Guttmacher statement.
As for Massachusetts, if your prediction of skyrocketing abortion rates had any validity, even one year’s data ought to be enough to demonstrate that your prediction is coming true. Except it’s not.
Finally, the Hyde amendment is not going to be affected by the health care bill. Revoking it (or simply refusing to renew it) might well lead to some increase in abortions among the poorest women. But frankly, women who are desperate will often find a way to get an abortion, because raising a child is far more expensive than terminating a pregnancy. However, poor women often find themselves struggling to find the funds; if this weren’t the case, we’d see fewer second-trimester abortions, which would be preferable both medically and morally, in my judgment.
Thank you for reminding me to be more precise.
Dr. Whelan’s full NEJM article is found by googling (or other search engine) “Abortions Reduced in Massachussetts”.
Guttmacher, http://www.guttmacher.org, has references to several studies; one such is Guttmacher Policy Review “The Heart of the Matter: Public Funding for Poor Women in the United States”; winter 2007, vol 10, #1. (A typical summary from ‘one of the best studies’ according to Stanley Henshaw, Guttmacher senior fellow:- “One third of women who would have had an abortion if support were available, carried their pregnancies to term when the abortion fund was unavailable.”
Massachusetts and 16 other states already with state medicaid funding of abortions will not “skyrocket” necessarily; they already have increased (as I think I wrote); and other major states like California and New York. California, incidentally, has 11% of the U.S. population yet performs 23% of the nation’s abortions (as last reported to the CDC, according to CDC Abortions Surveillance United States, 2005 : ref http://www.cdc.gov page 7 of 60, under Discussion: “California performed greater than 23%of the U.S. total in 1997 – the lack of data since then – from California – largely explains the majority of the 28% decrease from the annual number of abortions reported.”)
It’s primarily the other 33 states that do not now have or want state medicaid funding of abortions, that may see their states’ legal abortion numbers go up 35%, which would take their annual total from 670,000 abortions to over 900,000 per annum.
Add to that other categories cited by Guttmacher (military active and veteran women, women in federal prisons, Alaskan Natives and American Indians, women in the federal workforce etc.) that would be subsidized by federal funding, increasing abortions as per above rationale, would add another 50 to 100,000 per year.
Coupled to the (already inflated) 550,000 annual abortions performed by the 17 state-medicaid-funding states, raises the nation’s total abortions from the current estimated 1.25 million per annum to circa 1.5 million.
My point at the outset, however, was to postulate that Dr. Whelan’s contention that ‘abortions in the nation would be REDUCED with universal federal funding’ simply makes little sense. Perhaps the professors at Harvard Med School can defend their thesis better.
Sungold,
I have been thinking about your statement, “There’s only one way to run the numbers and find any doubt on whether legal abortion saves lives – and that’s to assume that the life of an embryo or early-stage fetus is morally equivalent to that of the woman carrying it.”
That equivalence is precisely the basis for the moral objection that many pro-life individuals have to abortion. In this view, because the fetus is a person, each abortion is a homicide.
I think pro-choice advocates make a huge error by dismissing this view as “absurd”. Even if this is not a view that pro-choice individuals can embrace, it’s one that needs to be taken seriously and accorded more respect than the mere dismissal allows — particularly if pro-choice groups want evangelical Christians and Catholics to join them in a search for common good on issues like healthcare reform.
Taking this view seriously, I think a conclusion that follows is that, in the view of many sincere pro-lifers, abortion clinics are engaged in homicide and killing people (yes, people, not just fetuses) even though no guns or bombs are involved. That doesn’t justify the actions by the lunatic fringe of the pro-life movement in murdering doctors and blowing up clinics. But it goes a long way towards explaining why people who otherwise aren’t very politically inclined can become single-issue voters over abortion, and why they might choose to give up their leisure time to exercise their first amendment rights by protesting abortion clinics.
While I respect the first amendment (and generally also the lawful exercise of first amendment rights, even by those I happen to disagree with), I wonder if helping poor women wouldn’t be more effective? The pro-lifers I have come to respect a great deal are those who roll up their sleeves and provide the kinds of practical help to poor women that makes it both more attractive to have a baby than to terminate a pregnancy and ensures after-care and quality of life for mother and child.
Among the shrillest voices on both sides of the abortion debate, I have seen remarkably little true service to poor women and their children.
Of course provision of material and practical aid is something we can all respect, as long as it’s not accompanied by coercion.
But most people who have moral qualms about abortion do not consider it the equivalent of homicide. I don’t have to characterize the equation of abortion with homicide as “absurd” to dismiss it. I merely have to point out that most Americans (roughly 75-80%) support the right to abortion in cases of rape or incest. Someone who truly believes that abortion is homicide could not make such an exception. It would be logically inconsistent.
And actually, if you believe abortion is murder, then a moral case can indeed be made for blowing up clinics and killing providers – the same case that can be made for a hypothetical assassin killing Hitler before he managed to implement genocide. However, most pro-life Americans don’t condone clinic violence, which again signals that they don’t truly view abortion as a second Holocaust. And thank goodness for that.
Getting back to Stupak, I’m not at all convinced that he and other grandstanders are even sincerely committed to repealing Roe v. Wade. The abortion issue would lose its political resonance for the right-wing base if they actually won.