Wanting Abortion to be More Accessible Rather than More Rare or Less Needed
September/October
By Tracy Weitz, PhD, MPA
After four decades of fighting over abortion rights, we are all tired: advocates, the public, politicians, clinicians….everyone. We long for an end to the “abortion wars.” President Obama calls for finding “common ground” though a strategy of reducing the need for abortion. His approach builds from a sentiment articulated by President Clinton in 1992 that abortion should be “safe, legal and rare.” These sentiments are shared within the broader pro-choice arena. After George W. Bush’s election in 2001, the Guttmacher Institute (a reproductive health research organization known for studying the decline in the number of U.S. abortion providers) called on the new president to focus on making abortion “safe, legal, and rare.”1 And, in 2005, NARAL Prochoice America prioritized its work around a “prevention first campaign” to reduce the need for abortion.”2
What could be wrong about wanting abortion to be “rare” or seeking to “reduce the need for abortion?” These goals could be interpreted as efforts to make abortion unnecessary in a specific, individual woman’s life. But, in fact, they are less about women’s desire to avoid unintended pregnancy or abortion, and more focused on achieving a social compromise – one in which abortion remains legal but is less prevalent. Unfortunately, these strategies stigmatize not only women who seek abortion but also the clinicians who perform abortion, and threaten the health of women with the fewest resources and the least political power. This article describes the problems with efforts to make abortion more “rare” and to “reduce the need” for these services — henceforward abbreviated as the “rare/need” approach.
First and foremost, the desire to make abortion “rare” or “less needed” creates an immediate judgment about abortion. The terms suggest that abortion happens more often than it should. The rare/need approach creates the impression that women’s individual decision-making is somehow responsible for the nation’s violent and disruptive social conflict over abortion. If women just worked harder to prevent the need for abortion or women just took abortion more seriously, the arguments go, the general public wouldn’t be so opposed to abortion. The idea is that each woman’s individual behavior is responsible for the debate over abortion and, if she just acted differently, America would no longer be fighting over abortion. Such individualization of responsibility is harmful to women, since it both produces and reinforces the stigma that women experience when they seek an abortion.
Stigma is not neutral. According to experimental studies, stigma can create negative thoughts, emotions, and behaviors that adversely affect an individual’s social, psychological, and biological functioning. Societal stigma is particularly pernicious, because it leads to internalized stigma, by which an individual adopts negative societal beliefs and stereotypes about herself.3 In the abortion context, women understand their behavior to be stupid, irresponsible, immature, selfish, etc. and themselves as less adequate as social citizens.
Secondly, the rare/need goal is based on a presumption that abortion is not only something to be ashamed of, but also something intrinsically different from other health care procedures. As a result, increasing women’s access to abortion services is not included in the “rare/need” goal. Yet, the fact is, we need more abortion providers and better access to services, rather than less. In 2004, only 1,787 facilities provided abortion care and 86 percent of U.S. counties lacked an abortion provider.4 Reduced access to providers leads women who have the least resources to have later abortions (which are more expensive and medically risky) or to forgo an abortion altogether.5 The “rare/need” approach’s failure to address access issues similarly ignores the shortage of providers and the need for routine medical training in how to perform abortions. Currently, less than half of obstetrics and gynecology residency programs offer routine training in abortion care.6
The “rare/needs” approach’s central view that fewer abortions are a good thing hampers the ability to recognize the profoundly negative consequences of reduced access to services. In fact, the “rare/need” approach legitimizes legislative and political efforts to restrict abortion access because these efforts help decrease the number of abortions women are able to get. Since 1995, over 600 state laws have passed to restrict some aspect of abortion care, including waiting periods, funding restrictions, and restrictive facilities requirements.7. All of these laws have a disproportionate effect on women who have the least financial and social resources, and who find it hardest to access abortion services.
The third and final flaw in the “rare/need” approach is that it creates an expectation that the number of abortions can be reduced to an acceptably low number, at which point the country will feel more comfortable with the procedure. Unfortunately, actual numbers of procedures have little to do with on-going opposition to abortion rights. Over the last few decades, the overall number of abortions has continued to decline (from 1.6 million in 1990 to 1.2 million in 2005) even as the public debate over abortion has become more polarized.4 For example, one of the largest abortion fights in recent years was waged in South Dakota. In 2006, the state legislature banned abortion; the ban was narrowly reversed in two public referenda. Ironically, the year before the ban, only 790 women obtained abortions in South Dakota, suggesting that frequency of abortion services and controversy are not associated.8 Likewise, California’s significant decline in both teen pregnancy and abortion rates between 1996 and 2000 neither reduced nor eliminated fights over adolescent access to abortion.9 California experienced resource-intensive ballot initiative fights over parental consent in which voters rejected efforts to restrict minors’ rights in three consecutive election cycles: 2005, 2006, and 2008.
As these examples demonstrate, an approach that focuses on seeking to make abortion more rare and/or to reduce the need for abortion cannot achieve the broader goal of reducing societal conflict over abortion. Moreover, this approach has very real and negative consequences for women’s health and well-being that include reducing access to care, increasing stigma, and justifying onerous restrictions on abortion. Sadly, reduced access to care is experienced most acutely by women who have the least economic and political resources.
While providing a short-term relief for those seeking to avoid immediate conflict over abortion, the “rare/need” strategy does nothing to secure a consistent, on-going right to abortion that is grounded in real access and the ability to exercise that right. In fact, advocates should avoid these phrases, as their use has substantial and negative consequences for women. A more realistic approach to securing abortion rights requires a clear articulation that abortion is a common health care need for women and that significant efforts to increase access to abortion services are essential. Renewed efforts to eliminate public funding restrictions on abortion services (which were strengthened and expanded in the recently enacted health care reform legislation) are central to this effort, in order to ensure that women depending on governmental support of their health care have the same rights and access to care as do women who do not.
Tracy Weitz is the Director of the Advancing New Standards in Reproductive Health (ANSIRH) program at the Bixby Center for Global Reproductive Health at the University of California San Francisco. A medical sociologist, Dr. Weitz’s research focuses on abortion as a health care service. This article draws from a longer article on this subject to be published in the Journal of Women’s History, Fall 2010.
References:
1. Cohen SA. A Message to the President: Abortion Can Be Safe, Legal and Still Rare. Guttmacher Report on Public Policy 2001;4(1):1-2, 14.
2. NARAL Prochoice America. People, Politics, and Policy: Three Ways to Win with Prevention First. Report. Washington, DC: NARAL Prochoice America; 2008.
3. Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. Abortion and mental health: Evaluating the evidence. American Psychologist 2009;64(9):863-90; Robinson GE, Stotland NL, Russo NF, Lang JA, Occhiogrosso M. Is there an "abortion trauma syndrome"? Critiquing the evidence. Harvard Review of Psychiatry 2009;17(4):268-90.
4. Jones RK, Zolna MRS, Henshaw SK, Finer LB. Abortion in the United States: incidence and access to services, 2005. Perspectives in Sexual and Reproductive Health 2008;40(1):6-16
5. Strauss LT, Herndon J, Chang J, Parker WY, Bowens SV, Berg CJ. Abortion surveillance--United States, 2002. MMWR Surveill Summ 2005;54(7):1-31; Dennis A, Henshaw SK, Joyce TJ, Finer LB, Blanchard K. The Impact of Laws Requiring Parental Involvement for Abortion: A Literature Review. New York, NY: Guttmacher Institution; 2009 March; Henshaw SK, Joyce TJ, Dennis A, Finer LB, Blanchard K. Restrictions on Medicaid Funding for Abortions: A Literature Review. New York, NY: Guttmacher Institute; 2009.
6. Eastwood KL, Kacmar JE, Steinauer J, Weitzen S, Boardman LA. Abortion training in United States obstetrics and gynecology residency programs. Obstetrics and Gynecology 2006;108(2):303-8
7. Arons J. Abortion Bills by the Numbers: States Restrict Abortion Coverage by Passing Mini-Stupak Amendments. In. June 11 ed: Center for American Progress; 2010. p. http://www.americanprogress.org/issues/2010/06/abortion_by_the_numbers.html.
8. Guttmacher Institute. State Facts about Abortion: South Dakota. In. New York City, NY: Guttmacher Institute; 2008.
9. Bixby Center. Decline in Unintended Pregnancies in California: California State Senate and Assembly Districts. San Francisco, CA: The UCSF Bixby Center for Reproductive Health Research and Policy; 2007 June; Guttmacher Institute. U.S. Teenage Pregnancy Statistics National and State Trends and Trends by Race and Ethnicity. Report. New York City, NY: Guttmacher Institute; 2006 September.
