U.S. Gets a “C-” Reproductive Report Card

 According to the nonprofit Population Institute, The United States gets a grade of “C-” for its efforts to promote family planning and reproductive health. According to its “Report Card on Reproductive Health and Rights,” the country does a poor job of assisting its residents in obtaining essential family planning resources.

            The Report, released last year, gave nine states a grade of “F” while only 12 got a “B-” or better. Only Washington, Oregon, and California earned an “A”.

          What do all these letters mean? Reproductive health, as measured by the institute, is determined by four criteria, each broken down into sub-categories:

  • Effectiveness (30 percent):
  • Affordability (30 percent);
  • Prevention (20 percent);
  • Clinic access (20 percent).

          Effectiveness consists of teenage pregnancy rate and unintended pregnancies.

          Affordability consists of Medicaid availability for family planning, insurance that covers contraception, and funding for family planning clinics for low-income families.

          Prevention is broken down into two criteria: mandated school sex education and access to emergency contraception.

          The fourth criterion, clinic access, consists of abortion restrictions and protective legislation for clinic access. 

Color-coded map of states' grades

Population Institute Reproductive Health and Rights states map

         Title X (Title Ten) passed by Congress and approved by President Richard Nixon in 1970, provided low-income and uninsured individuals with access to family planning resources like birth control and preventive healthcare services. As a result, tens of millions of women who might not otherwise have had the option of limiting or spacing their pregnancies have been able to do so.

          “We’ve seen a lot of progress in the last four decades,” said Population Institute President Robert Walker in the report, “but we can’t take anything for granted.” Recent events, like legislation in Texas that restricts abortion clinics by requiring untenable operating requirements, concerns Walker. These
include such restrictions as requiring the clinic to be near a hospital or to have expensive budget-busting equipment in the clinic that would exceed any reasonable need for such facilities. “The U.S. still has an unacceptably high rate of unintended pregnancies, including teenage pregnancies, and yet family planning clinics in many areas are being forced to close, and schools in many states are using unproven, abstinence-only sex education curricula.”

          Fairness dictates we concede that some of the criteria employed in determining these grades are biased against those with religious beliefs that eschew abortion rights. But that still leaves a wide swath of heads-in-the-sand thinking in states that make it difficult to obtain abortions and are hostile to the availability of family planning. Among the most contemptible of these nexuses occurs when states like Texas attempt to close down Planned Parenthood locations because they provide abortions. The irony is that more than 95 percent of Planned Parenthood funding goes for services designed to help people avoid or plan pregnancies.

          According to Walker, the United States has a higher rate of teen pregnancy than most other developed countries. So while Texas (with a grade of D-) and New Jersey (C) have slashed state funding for family planning clinics serving low income uninsured folks, access to food stamps and unemployment insurance benefits are being hacked on the federal level as well. In other words, some families will grow larger while their ability to feed their most vulnerable members, the kids, will diminish.

          According to the Guttmacher Institute, in 2011 state legislators introduced about 1,100 reproductive health and rights-related provisions. Of those, 135 became law, tightening restrictions in 36 states.

          Let’s give this all some perspective. State legislatures dominated by conservatives tend to oppose the funding of family planning facilities, especially those that offer abortion or the so-called morning after pill. They also oppose generous contraception policies for teenage girls. These same legislatures frequently oppose health care reform, Medicaid and other benefits for those in the lower economic strata. Combine that with cutbacks in food stamps, and these states are whipping up a recipe for ipecac soup.

          Whether or not you believe that reduced population is a good thing, how can these anti-reproductive-health cohorts believe that their policies, or lack of them, are a good thing? Read more about these issues in our book, Enough of Us.

 

Should we Prevent Devastating Pregnancies? What’s Your Opinion?

            Adopting foster children can be an unending series of trials and tribulations. Maggie Jones’s “The Meaningful Life of a Supersize Family,” in the November 17, 2013 New York Times Magazine, makes the case in spades. The article profiles two families that have sacrificed the niceties of life in order to provide hearth and home for kids who most need it.  

            Misty and Jon already had four biological children. Even so, they discussed the adoption option and realized the $20,000 it would take to complete the process would overstretch their budget. But an ad on a Christian radio station about a new organization that was helping Christians to adopt foster kids helped change their minds. It opened the door for the Misty-Jon family (they didn’t want their last names used) to take in Denver County foster children, with the intention of adopting them. They were able to receive financial help including Medicaid and payment of therapy expenses.

            Their first foster children were brothers, Shon and Cory. They were told that the boys’ mother had dropped them off with a man who couldn’t care for them, and she never returned.

            Of the two, Shon had the worst time adjusting to his new family. He would lie in bed at night, head in hands, staring straight ahead until Misty left the room. He’d wake up in the same position in the morning “as if he were on guard all night.”

            Eight months later, as the adoption process was inching along, a caseworker informed Misty and Jon that Corey and Shon’s mother had just given birth to twins, a boy and a girl. They were dangerously premature at 24 weeks old. Each infant weighed one pound, and the county was asking for foster parents to

Premature ababy and mother.

10-week premature baby being held by her mother (this is not drug-related). Photo courtesy Polihale, Wikimedia Commons

cuddle the babies in the hospital. The boy died days before Misty and Jon’s first “holding” hospital visit, but his sister Olivia survived. Having severe heart problems, she was hooked up to a ventilator. After six months of driving 45 minutes every other night to the hospital to hold Olivia, Misty brought the little girl home, with a tracheostomy tube to help her breathe, a feeding tube, and full-time nursing care paid for by Medicaid.

            Another girl, Raena, was supposed to be a short-term placement. Her mother was on track to regain custody of the four-month-old, who weighed only 11 pounds. A relative’s boyfriend had shaken the child and thrown her into a bassinet, which resulted in two permanent brain injuries. When Raena’s mother lost her parental rights due to drug problems, Misty and Jon, who were caring for this special-needs child, “eagerly” began the adoption process.

            Maureen and her husband Christian heard the same religious radio ad as had Misty and Jon. They also had four birth children, and believed they had a calling to adopt foster children. The result was they adopted two boys. David and Ernesto’s birthmother was 16 when she had David. Thirteen months later, she gave birth to Ernesto, even though she tested positive for methamphetamine. Ernesto struggled with sensory issues: In one instance, he wrapped his torso in duct tape and in another, covered his head in Vaseline. He had screaming fits, hit his adoptive mother, and “grabbed her hair with both hands so that she couldn’t move.” Maureen rightly suspected that he had been exposed to drugs in utero.

             These stories lead us to ask the big question: Is it time to consider laws that prohibit unfit parents (drug addicts and child abusers) from repeating their traumatic, inhumane, and costly mistakes?  Progeny from parents who have no capacity to “think twice before making children,” frequently suffer sad and dysfunctional lives. The families who take in and take care of these children suffer too, both financially and emotionally. Society suffers by paying for services to dysfunctional parents and the children they sire. Citizens witness the cruelty to these offspring with horror, unable to stop the injustice. Why do our laws allow it? Can lawmakers and voters set boundaries that will actually save the yet unborn from a terrible fate?

          What do you think? We’d love to start some dialogue in this topic.

Lone Star State Deserves Another Star . . . for Mindless Abortion Policy

           The Texas legislature recently passed, and Governor Rick Perry signed into law, a bill that not only closes most of the state’s abortion clinics, it will also increase the number of babies born with serious birth defects. We have often pondered how a state with six of the 20 most populous cities in the country can be so regressive in its thinking.

Texas Governor Rick Perry

Texas Governor Rick Perry signed the anti-abortion bill

           On July 11, 2013, Darshak Sanghavi, a pediatric cardiologist, posted a column on Slate.com in which he answers the question, “Who Has an Abortion After 20 Weeks?” In a nutshell, here is how he answers the question: “Comprehensive fetal testing … (is) typically performed just before 20 weeks of gestation. Such scans are critical for uncovering major birth defects.” These defects include severe brain malformations, heart defects, missing organs and limbs, and other serious imperfections.

          Therefore, by virtually abolishing the abortion option at 20 weeks of pregnancy, Texas has almost guaranteed that mothers with fetuses that have traumatic defects, and who cannot afford to seek abortions in other states, are considerably more likely to need various forms of public assistance in order to care for their newborns. State taxpayers, in many cases, will have to bear the burden of care, particularly in light of Texas’s rejection of Medicaid expansion under the Affordable Care Act (Obamacare).

          So while those with money can hop a flight to, say, New Mexico or Colorado, to terminate a 20-week-plus pregnancy, those without the cash … you get the idea.

          But wait – there’s more. Less reliable tests are available at earlier than 20 weeks. There’s just one drawback: they are less reliable. So let’s say a doctor tells the expectant parents that their baby may be suffering from anencephaly (in which a major part of the brain is missing), but that it’s too soon to tell for sure. The parents are now in the position of deciding whether to gamble on a healthy baby or, alternatively, to abort the fetus because they cannot emotionally and financially afford to cope with a severely disabled child. If they opt for the latter, they may be aborting a perfectly healthy fetus.

          Is this what Texas lawmakers were intending? Our guess is they either gave it little (or no) thought, or they were more concerned with mollifying the folks who might vote for them.

          According to Dr. Sanghavi, approximately one-third of all women in the United States will have an abortion by age 45. One reason is that about half of all pregnancies are unintended, to no small degree because birth control is not foolproof – 5 percent of women on the pill get pregnant each year.

          Every year “in Texas, about 85,000 women have an abortion,” explains Sanghavi, “of which only about 1,000 are performed after 20 weeks of gestation.” That’s a little over 1 percent.

          Of the 400,000 babies who are born, “16,000 have a birth defect of some type. Of these, about 700 have major brain defects, 600 have major chromosomal disorders, and the rest have any number of other birth defects.”

          In the first chapter of our book Enough of Us, we discuss at some length the possibility that pregnancies will end disappointingly, if not in total disaster. It seems to us the lawmakers of Texas are determined to increase the odds of such unfortunate outcomes.

          As the good doctor concludes in his essay:Pain Capable  Unborn Child Protection Act

          “In the end, restriction on late mid-term abortions may seem motivated by concerns about a healthy fetus; after all, the Texas bill was called the ‘Pain-Capable Unborn Child Protection Act.’ But a closer look strongly suggests that no matter what the legislators do, some fetuses and families will still be faced with a great deal of misery.”

          Many Texas politicians decry the intrusion of big government into our everyday lives. They may or may not have valid points to make. But this? These lawmakers are telling a significant minority of would-be parents to take a guess, decide whether to abort or not, and hope for the best. If not, they may be stuck with a decision that will mean disaster to both parent and child. Now, that’s big government intrusion.

Oppose Abortion and Oppose Subsidized Contraception? It’s a Recipe for Disaster

Across America the righteous right seems to have no shortage of barriers in its arsenal that are designed to make it difficult, if not impossible, for women to obtain safe, legal abortions. When these very same folks also oppose government-sponsored or insurance-sponsored family planning (read: contraception) they fall into the category of biological Luddites.

As part of a study published last October 4 in Obstetrics and Gynecology, researchers at the Washington University School of Medicine in St. Louis gave more than 9,000 women and teenage girls free contraceptives.  Participants were 14-45 years of age, at risk for unintended pregnancy, and willing to start a new contraceptive method.

The number of accidental pregnancies fell to between 62 and 78 percent below the national average. Teens are at particularly high risk for unintended pregnancies and, therefore, abortions. The study concluded that free contraception could reduce the number of abortions in the United States by a whopping two-thirds.

When we hear the likes of former senator and would-be presidential candidate Rick Santorum as well as Catholic contraceptive naysayers, decry the idea of government involvement in the contraceptive “business,” it leaves us scratching our heads. We have no argument with the church instructing its adherents about how to deal with their own genitalia. That’s their business. But when you comprehend the realities of unwanted pregnancy, it seems to us that an ounce of prevention is worth a pound of cure; the “cure” in this case being abortion.

The research found that providing free, reliable birth control to women could prevent between 41 percent and 71 percent of abortions in the United States.

Three-quarters of the women in the study elected to use long-acting contraceptive methods like intrauterine devices (IUDs) or implants, which have lower failure rates than birth control pills. In the United States, IUDs and implants have initial costs in excess of $800 that sometimes aren’t covered by health insurance, making these methods unaffordable for many women. We can only guess that the insurers don’t want to fork over more than 800 bucks for each fertile female client when the insureds might be able to provide their own individual-use contraception.

IUDs

Copper (l) and hormonal intrauterine devices

According to lead author Professor Jeff Peipert, MD, “The impact of providing no-cost birth control was far greater than we expected in terms of unintended pregnancies. …We think improving access to birth control, particularly IUDs and implants, coupled with education on the most effective methods has the potential to significantly decrease the number of unintended pregnancies and abortions in this country.”

Health-care professionals insert IUDs and implants, which are effective for five to 10 years, and 3 years, respectively. They provide superior effectiveness over short-term methods. But only a small percentage of U.S. women using contraception choose long-term implanted methods for a variety of reasons, including expense and fear of implanting devices into their bodies. “Unintended pregnancy remains a major health problem in the United States, with higher proportions among teenagers and women with less education and lower economic status,” Peipert says. “The results of this study demonstrate that we can reduce the rate of unintended pregnancy and this is key to reducing abortions in this country.”

As for those who cannot see the forest for the trees, doesn’t it make more sense for state and federal governments to provide contraception, and to require insurance companies to do so for those low-income folks who are lucky enough to have coverage, than for the government to pick up the tab for pre- and post-natal medical care of mother and child?

In addition, we wonder what other burdens—like education, housing, child support services, and healthcare—such families, especially single-parent households, will impose on society. We say that regardless of the immediate financial costs, Enough of Us already inhabit this planet. So let’s cough up the 800 bucks every three or five or 10 years and save ourselves all the other potential costs.