Just a week or so after Democratic National Committee Chairwoman Rep. Debbie Wasserman Schultz (D-FL) blamed voters for being “complacent” about abortion, House Minority Leader Nancy Pelosi illustrated why, despite being the nominally pro-choice party, Democrats continuously fail to lead on the issue of reproductive health care.
Pelosi could not articulate a vigorous, unapologetic, and evidence-based response on abortion to questions posed in an interview this week by Roll Call‘s Melinda Henneberger. In fact, Pelosi expressed discomfort with using the word “abortion,” underscoring how deeply abortion stigma has permeated the discourse of even the female leader of the Democratic Party, one of the most powerful women in the United States.
It is more than clear that abortion will continue to be politicized through the 2016 election and beyond. But Democrats persist in stumbling when asked about it. So here are some facts that any politician claiming to be pro-choice—and otherwise charged with protecting the interests, rights, and health of the voters who put them in office—must master and assert without apology.
Access to safe abortion care is fundamentally a matter of public health. In countries where access to abortion is limited either by law or in practice, women face high rates of maternal mortality and morbidity. In other words, they die and are injured, sometimes permanently, at far higher rates than in countries or regions where access to safe abortion care is guaranteed. This was indeed the case in the United States before Roe v. Wade.
Sex. Abortion. Parenthood. Power.
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Today, according to conservative estimates, more than 300,000 women worldwide die each year from complications from pregnancy, childbirth, and unsafe abortion. That’s 830 women each and every day. These are women in their teens to their late 40s, who are most likely to be raising children and earning critical income for their families. Many times the number who die from unsafe abortion suffer long-term illness and disability instead.
In Uganda, for example, due to lack of access to contraception among other factors, more than four in ten births are unplanned, and women say they have far larger families than they want. In their struggle to have fewer children, they often resort to abortion. Abortion is, however, illegal in Uganda, and access to safe abortion is only available to the wealthy. Not surprisingly, Uganda has one of the world’s highest rates of maternal death, and estimates indicate that if rates of clandestine abortion continue, half of all women in Uganda will need treatment for complications of unsafe abortion at some point in their lives.
By contrast, as was the case for the United States, rates of maternal deaths and illnesses from unsafe abortion declined dramatically in both Nepal and in South Africa after those two countries legalized and increased access to abortion care.
The deaths of women should be reason enough to address the need for safe abortion, but families also suffer. When a mother dies, her children, especially those under 5, are more likely to suffer malnutrition, neglect, and death. As I first wrote more than 25 years ago, history has long shown that politically or religiously motivated laws will never eliminate abortion; they only make it more costly in terms of women’s health, and the health and well-being of their families. The fact of abortion as a public health issue should be the first talking point in any informed conversation led by pro-choice politicians.
Abortion is a matter of fundamental human rights. Every person on earth has the right to determine whether or not to become a parent, and when and with whom to have a child, although clearly too many people are as yet unable to exercise these rights.
Furthermore, the international community has long recognized the broader fundamental human rights of women. According to the 1993 Vienna Declaration on Human Rights:
The human rights of women and of the girl-child are an inalienable, integral and indivisible part of universal human rights. The full and equal participation of women in political, civil, economic, social and cultural life, at the national, regional and international levels, and the eradication of all forms of discrimination on grounds of sex are priority objectives of the international community.
Choice in childbearing, childbirth, and parenting are fundamental to women’s ability to make decisions about their participation in society, on their own terms. Women, however, cannot exercise these fundamental human rights without unfettered access to contraception and abortion. Yet too many governments, politicians, and religious leaders appear willing to abrogate access to these basic health interventions, ironically on the basis of a “pro-life” agenda—albeit one that ignores the value of women’s lives. Any politician who calls themselves pro-choice should understand the need to protect and promote the human rights of living, breathing women, and be able to articulate them.
Abortion is a fundamental economic issue. Access to both contraception and abortion play a major role in women’s economic lives. There have been innumerable academic studies carried out and policy papers written over the past several decades about the connections between access to abortion and women’s economic status throughout the world, and all of them come to the same conclusions: The ability to control reproduction is essential to women’s abilities to support themselves and their families, and is essential to long-term economic growth.
Having a child or children is a major lifetime economic investment for anyone; the U.S. Department of Agriculture has estimated that it now costs more than $245,000 to raise a child in this country, not including the costs of college tuition. A study by the Economic Policy Institute shows that child care alone outpaces the cost of rent in 500 of 618 municipalities examined. Given these and other considerations, such as low wages and the cost of health insurance, transportation, food, clothing, and other necessities, unintended pregnancy can throw a family into economic crisis. Studies show that most women seeking abortion are already struggling financially, cannot afford an additional child, or want to continue their education to create a better future for themselves and their families.
The Turnaway Study, a multi-faceted research project on abortion conducted by researchers at the University of California, San Francisco’s Advancing New Standards in Reproductive Health program, examined the relationship between abortion, reproductive control, and poverty, among other things. As noted in a policy brief by the Reproductive Health Technologies Project about the economics of abortion and women’s lives, the Turnaway Study found that women denied an abortion in the United States had three times greater odds of ending up below the federal poverty line two years later than did women in similar economic circumstances who were able to obtain an abortion, adjusting for any previous differences between the two groups.
Smaller family size and educational attainment are among two of the most critical factors in the economic success of families and communities. Women and their partners know what it means to bring a child into the world and what it takes to raise children, and only they are equipped to make decisions about whether they have the financial and emotional means to make that commitment. Access to abortion is therefore fundamentally about personal and family economics. Abortion is about what women want for their future, and the future of any children now and later.
Access to abortion also has wider social and economic implications. According to the World Health Organization’s “Safe abortion care: the public health and human rights rationale:”
Safe abortion is cost saving. The cost to health systems of treating the complications of unsafe abortion is overwhelming, especially in poor countries. The overall average cost per case that governments incur is estimated (in 2006 US dollars) at US$ 114 for Africa and US$ 130 for Latin America. The economic costs of unsafe abortion to a country’s health system, however, go beyond the direct costs of providing post-abortion services. A recent study estimated an annual cost of US$ 23 million for treating minor complications from unsafe abortion at the primary health-care level; US$ 6 billion for treating post-abortion infertility; and US$ 200 million each year for the out-of-pocket expenses of individuals and households in sub-Saharan Africa for the treatment of post-abortion complications. In addition, US$ 930 million is the estimated annual expenditure by individuals and their societies for lost income from death or long-term disability due to chronic health consequences of unsafe abortion.
Unintended pregnancies also have other cost implications. Researchers at the Brookings Institute found that the United States spends $12 billion each year to cover medical care for women who experience unintended pregnancies and on infants who were conceived unintentionally.
In short, it is a fact that providing people with the means needed to make choices in childbearing is economically beneficial at all levels of society. In a country otherwise obsessed with individual economic choices, this should be a clear argument.
Abortion is an individual health issue. Yes, abortion is an individual health issue, related to but separate from its broader role in public health. Anyone who has had—or knows someone who has had—a difficult pregnancy, a miscarriage, an emergency c-section, a stillbirth, or any number of other complications is aware, pregnancy and childbirth can be wonderful and can be life-threatening, and the reality of either is a roll of the dice.
There are any number of contraindications for pregnancy that would result in the need for an abortion and any number of complications that can arise during a pregnancy, threatening the life or health of the pregnant person, the fetus, or both. The potential for very serious complications rises later in pregnancy, or after 20 weeks, the magic number alighted on by anti-choice zealots as somehow being a rational point after which abortion should be banned.
Any number of complications compromising the health of a pregnant person can occur, or fetal anomalies can be found, at or after 20 weeks of pregnancy, potentially causing even the most wanted pregnancy to go awry. Henneberger, now editor in chief at Roll Call, has frequently advocated for 20-week abortion bans, either not understanding or not caring that such a ban would dramatically limit access to medical care for untold numbers of women who face complications. Pelosi should have been able to more forcefully tell her why this is dangerous.
The United States is sliding backward on many fronts, including on access to contraception and abortion, two public health interventions for which the cost-benefit analyses are clear.
Politicians who claim to be pro-choice and raise money from citizens who support public health, human rights, and choice in childbearing must be able to articulate, embrace, and defend their positions. For too long, Democrats have come across as inept and apologetic when talking about abortion, even though the facts are clear and indisputable.
It’s time for this to stop.