December 6, 2019

Safe, Legal, and Timely

Guest Opinion
By Tom Gutowski | July 20, 2019

Despite current divisiveness on the abortion issue, most Americans are somewhere in the middle: They think abortion should be legal but would like there to be less of it, especially after the first trimester. That’s actually been the trend for a while now. Abortion rates are at their lowest level since Roe v Wade.Teenage pregnancy, birth, and abortion rates have all been dropping since the 1990s. Today, 91 percent of abortions occur within the first trimester. About 1.3 percent take place after 20 weeks.
It’s possible to further reduce both the number of abortions and the percentage occurring later in pregnancy — in line with the preference of a majority of Americans — without denying women the right to control their own bodies, and without shaming them when they choose to exercise that right.
The number of unwanted pregnancies could be reduced through a combination of easier access to effective contraception (not just condoms) with comprehensive, medically accurate sex education. Improved access to birth control is one of the reasons for the continuing decline in the teenage pregnancy rate. But real sex education — not just the “abstinence only” approach — is needed as well. To be effective, it should include information about human reproduction, sexually transmitted diseases, contraception (including abstinence), pregnancy, and childbirth, along with instruction in healthy relationships, affirmative consent, and the necessity of bothparties taking responsibility for their actions. It’s self-defeating to decry the use of abortion as birth control if we simultaneously impede access to accurate information and effective contraception.
If young people learn about the risks and responsibilities associated with sex, some will delay having it, and some won’t. But whatever the timing, when they do have sex, it’s better if they know how to stay safe, have given some thought to the potential longer term consequences,  and have access to effective contraception.
We can increase the likelihood that women will choose to carry unplanned pregnancies to term by providing free prenatal care. We already do this through Medicaid and through publicly funded clinics. However, funding is inadequate, and 14 states have not adopted Medicaid expansion. And if the Affordable Care Act is overturned, millions would lose health insurance, private insurance companies could again treat pregnancy as a pre-existing condition, and Medicaid expansion would be rolled back.
Many abortions occur for financial reasons. Anything that makes it easier to feed, clothe, and shelter a family, such as free or subsidized day care, would help. So does anything that provides healthcare to those who would otherwise do without. Again, undoing the ACA without a viable alternative in place would be a step backward.
Parental leave policies also could be improved. The United States is the only wealthy nation that has no federal law mandating paid maternity leave. The Family Medical Leave Act grants twelve weeks of unpaidleave, but 40 percent of women don’t qualify for it under the law, and 25 percent of new mothers go back to work within two weeks.
More support from pregnancy through the early stages of child raising might reduce the number of abortions. It would also result in healthier and happier mothers and babies, and it might lower our very high infant and maternal mortality rates, both of which are worse than in other developed countries.
Finally, anything that facilitates adoption helps by giving expectant mothers another alternative.
To decrease the number of abortions after the first trimester, we should look at the obstacles to timely access to abortion services that have been put in place over the years. These include lengthy waiting periods, mandatory counseling, unnecessary and sometimes highly invasive tests, gag rules, laws forbidding insurance companies from including abortion services in standard coverage, laws that needlessly force safe clinics to close, and — the one that would be most difficult to repeal because of religious objections — the Hyde Amendment, which outlaws the use of federal funds for abortion in most cases. Reasons frequently cited for delaying an abortion include having to save up money, lack of insurance coverage, non-availability of a clinic, and lack of knowledge of the options. To some extent these are all “man-made” obstacles.
Late-term abortions will never go away entirely. There will continue to be situations where the pregnancy is a danger to the mother’s life (e.g. heart failure, severe preeclampsia, severe infection) or where the fetus has catastrophic abnormalities (such as anencephaly, which is non-development of the brain) that make survival outside the womb impossible. Often these problems aren’t even diagnosed until the second trimester. But the scenario that President Trump describes — a mother gives birth and then discusses with the doctor whether to execute the baby — is spurious. That’s infanticide, not abortion, and it’s illegal. What doctors and mothers do discuss when a non-viable fetus is born alive is what kind of life support or comfort care to provide to a dying infant. Each of these situations is heartbreaking and medically complex. It’s hard to think of circumstances where it’s less appropriate to insert a government bureaucrat between a woman and her doctor.
We can reduce the number of abortions and decrease the number occurring after the first trimester without intruding on others’ grief or making their most private decisions for them.
Tom Gutowski earned degrees in economics and history before entering the insurance industry, from which he retired a few years ago.


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