Health Care Inequality is Key in Abortion Rate Disparities

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Health Care Inequality is Key in Abortion Rate Disparities

Dr. Melissa Gilliam

Behind virtually every abortion is an unintended pregnancy. African American women have higher abortion rates than their white peers because they have much higher rates of unintended pregnancy -- three times higher than those of white women.

An op-ed in the Washington
Times muses about whether "abortion is more common in minority
communities because, similar to alcohol and tobacco, it is more aggressively
marketed there." A Wall Street Journal column promotes allegations
of racism on the part of "the abortion industry." Similar
accusations pervade the pro-life blogosphere. There’s even a Web site
called Black Genocide devoted entirely to the subject.  

Sadly, this hyperbole–and
all the energy supposedly directed toward helping African American women–both
misses the point and distracts from the real issue: the persistent health
by women, and men, in the African American community. 

As an African American woman,
a physician, and a reproductive health specialist, I see on a daily
basis the real-life consequences of unequal access to good health care. 

That’s why I strongly believe
that those professing concern for the well-being of African American
women have an obligation to put the issue of abortion in its proper
context, and to support evidence-based policies that would have a positive

Sex. Abortion. Parenthood. Power.

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Behind virtually every abortion
is an unintended pregnancy. African American women have higher abortion
rates than their white peers because they have much higher rates of
unintended pregnancy–three times higher than those of white women.
In other words, there is no need to resort to far-flung conspiracy theories
to explain the higher abortion rate among black women. 

But there’s more to the story.
Across the board, African Americans often have worse sexual and reproductive health
outcomes than people from other racial groups. For example, we experience
much higher rates of sexually transmitted infections. These disparate
rates reflect broader health disparities that can be seen in high rates
of diabetes, obesity, heart disease or cancer. 

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. 

There are no easy solutions
to these complex challenges. Innovative strategies to reduce entrenched
poverty, improve education, and broadly reform health care all will
have to be part of the longer-term approach. Yet, there are a number
of specific steps policymakers can take right now that could dramatically
improve the sexual and reproductive health of African Americans–and
Americans in general. 

Let’s start with the need for
better sexual health literacy. A 2006 study by the
Guttmacher Institute

shows that only one in three sexually experienced African American males
and fewer than half of African American females had received formal
instruction about birth control before they first had sex. (White teens
were only slightly better off.) That needs to change, and fast. 

Policymakers should heed the strong body of evidence showing that abstinence-only-until-marriage
programs are a waste of money. They should instead support comprehensive sex-education
, many
of which have shown success in delaying teens’ initiation of sex, reducing
their number of sexual partners, and increasing their use of condoms
and other contraceptives. 

We also need to redouble our
efforts to empower African American women to better plan their pregnancies:
to avoid pregnancies they don’t want and to achieve pregnancies they
do want when they want them. This goal is not only worthy in and of
itself, but its attainment will also lower the high rate of abortion
among African American women. 

Proven policies include boosting funding
for the federal Title X

family-planning program under which women and men across the country
can get subsidized contraceptive counseling and supplies as well as
STI (sexually transmitted infection) testing and treatment. Expanding Medicaid eligibility
for family-planning services

nationwide (a step 26 states-including Delaware and Pennsylvania,
but not New Jersey-have already taken) would likewise allow more people,
including many African Americans, to participate in these prevention-focused

Finally, Guttmacher Institute
research shows that the abortion decisions of many women (of all races)
are influenced primarily by their desire to be good
. Too many
women today are stretched so thin that they feel unable to take care
of their existing children, not to mention an additional child. Clearly,
policies that support working parents, especially at the lower end of
the income spectrum, are needed. Let’s make good on our pro-family rhetoric
by supporting paid sick leave for more parents, as well as subsidized
child care and affordable health insurance. 

My challenge to antiabortion
activists is to stop throwing around inflammatory terms like genocide
and instead channel their considerable energies and resources into supporting
policies that reduce the need for abortion. Let’s get serious about
helping women and their families, including women in the African American

This op-ed
was originally published
in the
Philadelphia Inquirer