How to Decrease the Number of Abortions:

In 1971 President Richard Nixon declared a War on Drugs and he later created the Drug Enforcement Administration to co-ordinate the efforts of all other agencies.  Since then, billions of dollars have been spent and millions of drug users have been imprisoned. Although there was some early success decreasing the number of drug users, the overarching goal to end the international drug trade and use of illegal drugs in financing criminal enterprises has utterly failed.  In fact this has resulted in a dramatic increase in violence in many areas, often times contributing to the migrant crisis we have seen. In addition, we’ve seen dramatic racial and social discrepancies in enforcement and penalties.  Even though the rates of illicit drug use are nearly the same between black (10.5%) and white (9.5%) populations, African Americans are arrested at over 2.5 times the rate as Caucasians. We also see that adolescents and young adults with higher socioeconomic status are more likely to use alcohol and illicit drugs, although they are significantly less likely to be arrested or face jail time. So to summarize, much like prohibition of alcohol in the early part of the 20^th century, the War on Drugs has been only moderately successful at decreasing use, has been used to selectively target poor and minority members of society, and increased the violence in many parts of the world. But the good news is we are slowly beginning to realize there is another way to attack the issue of addiction; we can target the social factors that contribute to it. In addition to being better for the individuals, this method is more effective and less costly.

So, how does this relate to abortion? The fact is that there is no indication that overturning Roe

v Wade will lower the number of abortions.  We’re able to look at states that have posed more restrictions on abortion and see that it hasn’t limited the overall number.  We’re able to look at countries that have criminalized abortion and see that they have higher rates compared to countries where it is legal. In short, overturning Roe v Wade is ineffective if you want to actually reduce the number of abortions and there are much better ways to accomplish that goal.

An important thing to remember is that overturning Roe v Wade does not make abortion illegal in the United States; it enables each state to set its own laws.  The result is the Supreme Court ruling has almost no effect on people in the higher socioeconomic class.  You want an abortion?  Sure, just take a vacation to New York or California, stop in a clinic, and get one. Or, even if the US banned abortions, take a trip to Toronto or London and you’re set. The only thing that has changed for the upper class is they may have to schedule a vacation a little earlier.  For those struggling to make ends meet, however, it can be a vastly different story. Missing work, paying for a plane ticket or long car trip, perhaps finding childcare while you travel are all non-trivial tasks.  So, like the War on Drugs, this is going to adversely affect those of lower socioeconomic status much more, forcing them to deal with pregnancy (which can make it very hard to work as my wife Anne can attest to) while trying to make ends meet for their families. As a result, we have seen more illegal abortions performed in states which has pasted more restrictions and higher death rate to women because of it.

So, overturning Roe v Wade won’t work, what can be done to limit the number of abortions? Well, I’m glad you have asked; there is actually many steps than can be taken. The first is, unsurprisingly, increasing access and availability of birth control. (Related, this is why Thomas’s opinion is incredibly scary to some of us. His call to revisit court cases that made contraception legal further limits the options women can take) In 2007, a Contraceptive Choice Project provided over 9000 women with contraceptive counseling and the contraception of their choice for two to three years. The result was only 0.27 per 1000 women having unintended pregnancies as opposed to 4.55 for those who didn’t. In 2009 Colorado gave teens and low-income women free IUDs or other long-acting birth control and they saw the teen pregnancy rate drop by 40% and the abortion rate drop by 42%. Unfortunately, many of the long lasting, more effective methods like IUDs are more expensive, and therefore harder to get for low-income women.  Therefore, if we want to decrease abortions by as much as possible, we need to fund programs that make it easier and less costly for women to get long-acting birth control methods.

Pregnancy is sometimes hard, there were various complications in all of Anne’s pregnancies which caused her to miss work. These climaxed in Maggie being born prematurely as Anne’s uterus began to rupture.  After Maggie was born, the OB had a conversation with Anne that went something like this:
OB: “So, it would be very dangerous for you to become pregnant again and you probably wouldn’t be able to carry it to term.  Since we’re a Catholic Hospital I can’t recommend a more permanent form of birth control but…”

Anne: “My husband already had a vasectomy.”

OB: “Oh thank God!”

Even though we had insurance through Anne’s work, Catholic hospitals and Catholic insurance make it harder for women to avoid pregnancy. For instance, that vasectomy I got had to be paid for out of pocket and my primary care doctor refused to give a referral for it, so I needed to come up with a work around. I find it alternating amusing/frustrating that while the vast majority of Catholics support birth control, the group of celibate men decide it shouldn’t be allowed. In fact, back in 1966 the Pontifical Commission on Birth Control overwhelmingly recommended the Catholic Church accept it; however, Pope VI declared it morally wrong in 1968. Since then, that has been the official Catholic view and while it might not be as big a deal, it contributes to limiting the access of birth control and increasing abortions; so, Pope Francis, it you’re reading this, you know what to do.

Like I said above, pregnancy is hard, and Anne had to miss work with various issues during each of her pregnancies. If we want to limit abortions, we need to make sure that every woman has access to good prenatal care.  That means that companies need to be required to allow workers to take time to have doctors’ appointments.  That means prenatal care needs to be free for all who need it. This means we need to fix inequities in medical treatment and give low income and Black moms-to-be access to care since they have increased risk of preeclampsia, eclampsia, and embolisms and a three times higher death rate due to pregnancy. Much like food deserts, there are maternity care deserts that exist, that make pregnancy harder on those who can least afford it. Undoing this would make pregnancy easier and decrease the number of abortions.

Related to contraception is comprehensive, evidence-based sex education.  After all, using birth control depends not only on access to said birth control but knowing about it and how to use it.  We see that states with abstinence-only sex education have a higher rate of teen pregnancy.  In addition, after California introduced comprehensive sex education, they saw the number of abortions in teens drop from 76 per 1000 in 1988 to 26 per 1000 in 2005.  In spite of this, only 7 of the 50 states require that information in sex education classes be medically accurate.  This has affects that go well beyond abortion as we see an increase in STIs and reports of sexual assault in areas without comprehensive sex education. We may like to think that we, as parents, are best equipped to discuss sex with our kids and it’s never wrong having a conversation (or better yet, ongoing, multiple conversations) with them. But we see that this is done in far too few cases so we need to create a place where accurate, honest information can be obtained.

Of course, the expense and stress of having a kid doesn’t end after birth; I know I was scared shitless when we first brought Isaac home even though we had a good social support network. Millions of women suffer from post partem depression and millions more suffer other medical issues. Yet, there is no paid maternity or paternity leave in the US, so many times parents will be forced back to work while they are still reeling from having their life upended (often upended in a good way, but babies wreak havoc on your life, and you can’t just go back to the way things were).  About 10% of new mothers report not being able to go to their first postnatal appointment because of work or finances.  Affordable day care is had to find and there are often long waiting lists.  For women seeking abortion, the cost of pregnancy and having a child is the most common reason given, so if we want to decrease the number of abortions, we need to tackle that.

I’ll be honest, I’m not a big fan of abortions; my reasoning is close to that which Ann Druyan and Carl Sagan laid out in their article “Abortion: Is it Possible to Be Both Pro-Life and Pro-Choice?”, but there is enough uncertainty and gray area that I pause.  If I woke up tomorrow and somehow, magically no woman felt she needed to choose to have an abortion, I would be happy.  In this way, I would qualify as “pro-life”, but as a friend of mine said, “There are two types of pro-life people. There are those who view children as a gift: one that needs to be taken care of and we need to provide them and their families everything we can to make sure they succeed.  Then there are those who view children as a punishment: a punishment for irresponsible choices so any problems or issues they have with supporting the child are deserved.” For those in the first group, you’ll find many in the pro-choice camp that are happy to work with you to decrease the number of abortions and decrease them in a way that is much more effective than overturning Roe v Wade. For those in the second group, well it’s probably good if you cut ties with me now.