The Abortion Debate in Context

Discussing Taxpayer funding, prevention, and Plan Parenthood

Conservative leaning states, emboldened by the election of President Trump and his appointment of Supreme Court Justices Neil Gorsuch and Brett Cavanaugh, are quickly passing limitations on abortion, ensuring it will be a major bridge to cross as the nation begins traveling down the road to the 2020 election. As its opponents view it as murder, and its supporters view it as a civil right, abortion will always be a policy arena dominated by rhetoric and emotion.

But even emotional debate needs to be framed in fact.

Planned Parenthood sits at the forefront of the debate, in large part because they receive federal funding, and they provide abortions. These two facts are often used by opponents of abortion to argue for defunding of Planned Parenthood. As debate about this possibility continues, here are a few things to consider.

Planned Parenthood does receive funding under the Title X Family Planning Grant, but they are not the only recipient. Funding also goes to other organizations, and community health centers to provide family planning care.

Federal Law, known as the Hyde Amendment, prevents Title X funding from being used to provide abortions. However, this does not prevent any taxpayer funding from paying for abortions. Title X restricts federal grant funding to services other than abortion, but Title X is not the only federal funding for medical services. Government funded Medicaid and Medicare plans are allowed to cover abortion under the circumstances of rape, incest, or medical threat to the mother. As the Affordable Care Act was implemented, it too applied the Hyde amendment to subsidized health insurance plans of the ACA marketplace exchanges—sometimes called Obamacare plans. The best data available suggests about 15 percent of abortions were paid for by Medicaid, though Medicaid did not cover the entire cost.

Planned Parenthood is often understood to be the largest abortion provider in the US. Eliminating their Title X funding would severely limit their effectiveness. Opponents of Planned Parenthood interpret the goal of the organization to be providing abortions, which is why they want to limit the effectiveness. To justify this a statistic is often cited that 97 percent of Maternity services at Planned Parenthood are Abortion services.

Planned Parenthood supporters argue that, while abortion is one service provided, it is a small portion, and in no way the goal of the organization. Leana Wen, the new director of Planned Parenthood, focuses her role on non abortion services. They counter with the statistic that only 3 percent of services are abortion.

So who is telling the truth?

They both are.

The difference here is the definition of maternity services. Planned Parenthood focuses most of their services—96 percent— on pre-pregnancy efforts. Once a woman becomes pregnant however, most of the services—97 percent— provided are abortions. The best way to put it is that abortions take up a large part of a small subsection of Planned Parenthood’s services.

In these two charts, abortion services are in red, other services in various shades of blue. As can be seen from the first chart, a small total of the services are abortion. But, of all maternal services, which make up a tiny sliver of total services, abortion is nearly the only service. In their latest annual report, Planned Parenthood listed provision of 332,757 abortions. They also assert they refer far more patients to OB/GYN care then the provided abortions, but do not keep or report data on this claim—keeping data on medical referrals is not a universal practice.

Currently, the Trump administration is trying to limit Title X grant funding to only those family service providers who refuse to provide abortion. Under this change, any organization providing abortion services—even if paid for entirely out of the patient’s pocket—could not receive federal funding. This is largely seen as an affront against Planned Parenthood.

But abortions occur outside of Planned Parenthood too. This is where the debate should focus for one main reason: banning abortions likely does not prevent abortions, and may lead to more overall deaths. The logic here is the same logic conservatives us on gun bans—it does not get rid of guns, only guns owned by safe people. A real life scenario can be used to illustrate this. Abortion services are banned, so many family planning centers close. Access to pre-pregnancy treatment such as birth control is limited, so a woman becomes pregnant. She absolutely does not want to become a Mother, but she has nowhere to go to talk about her options—places where she could be referred to adoption services, or prenatal care and other resources to help young, scared potential mothers. Because she is not aware of all her options, she feels abortion is her only choice. She seeks out an illegal abortion from an untrained practitioner who does not perform the abortion in a safe manner. This potential mother dies from complications.

This is a reality for all too many women where abortion is illegal. The best estimates show this to be the case for more than 60 women every day. Republican Presidents in the last several decades have enforced the Mexico City Policy, commonly known as the gag order, that prevents federal funding from going to international organizations where abortion is one option—those similar to Planned Parenthood. Without these resources, unsafe abortions increase. The data seem to increasingly suggest that we can choose to ban abortion, or we can choose to reduce the number of abortions, but doing both might not be possible. This is not so say one is a better option then the other; it is perfectly reasonable for one person to prefer their government make a moral stance on banning abortions, while another prefer to have a smaller loss of human life by allowing abortions. But the numbers suggest we have to choose on or the other.

Taken from Colorado Department of Public Health and Environment, ‘Taking the Unintended Out of Pregnancy: Colorado’s Success with Long-Acting Reversible Contraception.’ https://www.colorado.gov/cdphe/cfpi-report

The unquestionably easiest way to prevent abortion is to provide easy access to birth control: if those who do not want a baby do not become pregnant, they do not have an abortion. Colorado increased contraceptive access and saw huge drops in abortion rates, especially among teens. Colorado also saved nearly $70 million in taxpayer funds by providing the cheap contraceptive treatment, rather than the expensive pregnancy care. Across the US, a dollar spent on contraceptives via Medicaid saves the taxpayers almost six that would be spent on pregnancy.

Many conservatives are uncomfortable with access to contraceptives, arguing it provides consequence free sex and immorality. Foster Friess, the GOP megadonor, argued the best contraception is an aspirin held between a woman’s knees. But as we have seen from the hundreds of Southern Baptist ministers accused of assault, and President Trump’s numerous extramarital affairs, people are never going to just stop having sex.