Barack Obama is combining good policy with a little bit of luck. The result is he may have started the process of virtually eliminating abortions in the US within the next ten years.
In 2008, the year before Barack Obama took office, there were 1,210,000 abortions in the US. In 2013, this number dropped to 984,000, a 23 percent fall. This is something we all ought to celebrate. It would be easy to stop here and give Obama credit for lowering the US abortion rate, but that wouldn’t be accurate and ignores many of the other dynamics taking place.
Abortions in the US have been dropping for decades. Yet, the rate of decrease is unmistakably accelerating. Also, the reasons for the decline are not well defined. Republicans want to take credit for the drop due to the 231 abortion restrictions passed in states from 2010 through 2014.
If the hundreds of Republican abortion restrictions had an impact on abortions, there would be an increase in the US birthrate in 2012 and 2013. This never happened. In fact the U.S. birthrate hit an all time low in 2013.
The most ultra-liberal intrusion in privacy and example of government interference in the doctor/patient relationship is in Wisconsin. Big government Republicans passed a bill requiring women wanting an abortion to sit through an ultrasound narration by their doctor pointing out body parts and such. Easily outsmarting the Republican legislators and their foolish governor, women come to their appointments with mp3 players, headphones and magazines. Although the law requires them to show up, it doesn’t require them to actually pay attention.
This Republican futility is even more evident when looking at spikes in abortion numbers in states like Louisiana and Michigan that are adjacent to Texas and Ohio that enacted the most onerous restrictions. These suggest that women are quite willing to travel to terminate an unwanted pregnancy. Data indicates that once a woman decides to get an abortion, it is a done deal. Travelling extra distances and incurring more costs are impediments that don’t affect women’s ultimate reproductive decision making. What all this means is that Republican efforts to make getting an abortion more difficult have little if any impact on the number of abortions.
What does make a difference in the number of abortions is reducing unintended pregnancies. The most practical way to do that is to make birth control more available and make sure women have access to the most effective birth control possible.
The most effective birth control are Long Acting Reversible Contraceptives (LARCs). They are 20 times less likely to fail than birth control pills or other methods of birth control. Unfortunately, they have a high upfront cost (often greater than $500) that prevents many women from using them. Solving this problem is the Affordable Care Act’s (ACA) free contraceptive mandate. The mandate is modelled after a Washington University in St. Louis study (Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstetrics & Gynecology. Online Oct. 4, 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000282/ that predicted providing birth control to women at no cost would cut abortion rates by 62 to 78 percent compared to the national rate.
However, the Affordable Care Act did not take effect until August 2012, so we can’t give that much credit for the reduction in abortions measured in 2013. There are other possible explanations for the recent dramatic drop in abortions.
Affluent women (who have the financial capability to purchase LARCs) have the largest percentage drop in the number of abortions (2000 to 2008). It may be that the Long Lasting Reversible Contraceptives are a factor in the 23 percent drop in abortions from 2008 to 2013.
If we take the Washington University study’s midpoint estimate of a 70 percent drop in abortions due to the free contraceptive mandate and bend some mathematical rules and add the 23 percent drop in abortions during the last six years, it becomes conceivable that in the next decade, abortion numbers could drop to the point where they are a political non issue. More important, we can dramatically reduce the heart wrenching decisions many women have to make.
We have the technology to virtually eliminate abortions. Barack Obama had the political leadership and courage to make this technology almost universally available to women in the US. The next president will need to make adjustments in Medicaid coverage so that low income women (who are the last segment of the population that still have rapidly increasing abortion numbers) have access to LARCs and knowledge of their advantages.
One shouldn’t expect immediate dramatic drops in abortion numbers as the ACA takes effect. With any new technology and government program, there is a learning curve. More realistic, if the annual number of abortions dropped from the 2008-2013 five percent range to 8 percent over the next nine years, total annual abortions at the end of the eight year period would be down about 90 percent from present levels. Obviously, a Democrat needs to win the next election for the ACA Birth Control Mandate to stay in place.
Summing up
President Obama’s policy of fighting to make the free birth control mandate part of Obamacare was an important victory for all of us. However, the impact is greater because of the lucky part of all this, the development of Long Acting Reversible Contraceptives. The combination of new technology and bold policy achieving a greater good is simply smart government.
