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.
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.)
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.”