An important new report by the
Kaiser Family Foundation
documents persistent disparities between white women and women of color
on a broad range of health indicators, including rates of diseases such
as diabetes, heart disease, AIDS and cancer. The report also documents
widespread disparities in access to health insurance and health screenings,
and finds that there are "racial and ethnic disparities in health
status and health care in every state in the nation, often disparities
that are quite stark." It finds, moreover, that "there is growing
evidence that social factors (e.g., income, education, occupation, neighborhoods,
and housing) are associated with health behaviors, access to health
care, and health outcomes."  

The new report provides further
strong evidence debunking claims by anti-abortion rights activists,
who, ignoring all other contextual factors, have long argued that high
abortion rates among minorities are the result of supposed aggressive
marketing by abortion providers to minority communities. In truth, as
the Guttmacher
Institute has pointed out repeatedly,
abortion rates among racial and ethnic minorities – especially blacks
and Hispanics – are directly linked to their higher rates of unintended
pregnancy, which in turn reflect pervasive health disparities more generally.  

In an August 2008 opinion
piece in the Philadelphia Inquirer, Guttmacher Institute Board chair
Melissa Gilliam said the of high unintended
pregnancy and abortion rates among African Americans: "The root causes
are manifold: a long history of discrimination; lack of access to high-quality,
affordable health care; too few educational and professional opportunities;
unequal access to safe, clean neighborhoods; and, for some African Americans,
a lingering mistrust of the medical community."  

What can be done about entrenched
disparities in women’s health? Kaiser calls it a "formidable challenge"
that will "require an ongoing investment of resources from multiple
sectors that go beyond coverage and include strengthening the health
care delivery system, improving health education efforts, and expanding
educational and economic opportunities for women."  

In the context of high abortion
rates among women of color, Guttmacher
has argued that
the fundamental question policymakers should be asking is not why women
of color have high abortion rates, but rather what can be done to help
them have fewer unintended pregnancies and achieve better health outcomes
more generally. Barriers to health care access, including financial
and geographic hurdles, remain a significant issue. For instance, many
women of color are unable to afford prescription birth control methods,
such as the IUD, that are highly effective over extended time periods
but have high up-front costs.  

Beyond access to affordable
contraceptives,
however, other factors like dissatisfaction
with the quality of services and the methods themselves may be at least as much an impediment
to consistent and correct contraceptive use. There is increasing recognition
that quality of care plays a major role in health-seeking behavior and
health outcomes.  Dissatisfaction with health care providers, a
problem often made worse by cultural or linguistic barriers, can lead
to frustration and poor follow-through on contraceptive use. Unstable
life situations, in which consistent use of contraceptives is a lower
priority than simply getting by, can also be a factor.  

It’s a complex challenge,
but one thing is clear: By continuing to label abortion providers as
"racists" and refusing to support expanded access to contraceptive
services anti-abortion rights activists are by no means part of the
solution – to high rates of unintended pregnancy and abortion among
racial and ethnic minorities or to persistent and tragic disparities
in health care generally.