by Philip Alcabes, Ph.D.
There hasn’t been much hope in the past few years that concord will calm America’s no-holds-barred struggle over abortion. But what if abortion were to become a rare event? There’s reason to hope that a new policy approach might make abortion a non-issue, or at least a less inflammatory one.
This week, the Associated Press reports on a study in St. Louis showing that when women have access to a variety of contraceptives at no cost, abortion rates fall dramatically. In the study of nine thousand women, many of them lacking health insurance, who were given contraceptives of their choice at no cost, only 0.4 to 0.8 percent had abortions per year – far less than the 2 percent per year that, according to the Guttmacher Institute, is the average for women aged 15-44 nationally.
Why does one study signal hope? Because the rules for women’s health services under the new Affordable Care Act (ACA) – the so-called Obamacare law – require that insurance companies cover contraceptive services for women at no out-of-pocket cost.
According to the US Health Resources and Services Administration, insurance plans, except for those sponsored by religious organizations, must cover:
“All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”
For roughly the past decade, there have been about 1.2 million induced abortions each year in the US. The percentage of women who need to end a pregnancy with abortion has not declined much during the decade, according to Guttmacher.
The St. Louis study suggests that widespread access to free contraception – which the ACA should help extend – might decrease the need for abortions dramatically.
There are caveats, of course. There’s the religious-insurance-plan exemption, which will allow contraception to remain financially out of the reach of some women. There’s the chance that opponents of women’s health within Congress could push through an amendment removing the free-contraceptive-access provision of the ACA.
And there’s the problem of correct use of contraceptives. In surveys of women seeking to terminate unwanted pregnancies in the early 2000s, a high percentage said they had used contraception during the month in which they became pregnant. That is, access to contraceptive methods doesn’t necessarily translate into effective use of those methods. Effective use of contraception has probably improved since the surveys were done – but it’s not clear by how much.
And, it’s possible that the struggle over abortion – embodying as it does a fundamental disagreement as to whether America’s search for justice should be based on deeply held beliefs about good and bad behavior, or on widely shared principles of individual rights – can’t be resolved even if abortion becomes a rare event.
Still, it’s worth wondering whether access to contraception, by dramatically reducing need for abortions, might just allow for the abortion fight to turn into an abortion conversation.
Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.
