While rate of abortion declines, Title X gag rule will only increase need for abortion

Bulletin: A poll released Sept. 30 by Hart Research Associates shows that about two-thirds (62 percent) of voters nationally believe Medicaid should cover abortion as part of comprehensive reproductive health care. In some congressional districts, support for Medicaid coverage of abortion is stronger, with 7 in 10 voters favoring it. Congress passed the Hyde Amendment banning Medicaid coverage of abortion in 1976. This is a monumental shift in the struggle to overturn the ban, headed by young women of color, particularly All* Above All, and supported by the entire reproductive justice movement.

The Guttmacher Institute issued a report Sept. 18 that the rate of abortion in the U.S. declined 8 percent between 2014 and 2017. It’s now at an historic low since abortion was legalized in 1973. 

Despite abortion foes’ passage of hundreds of state restrictions during those years, the institute concluded that such laws were not the main reason for the decrease. Rather increased use of contraceptives accounted for the decrease, especially long-acting reversible birth control methods, free under the Affordable Care Act as essential preventive health care.

Guttmacher issued a statement in honor of Sept. 26, World Contraception Day, stating that the “vast number of unintended pregnancies, in both the U.S. and abroad, are among people who are either not using any contraception or are using it inconsistently.” However, it noted that 91 percent of U.S. women are dissatisfied with many methods of contraception, citing side effects and lack of sexual pleasure.

The institute stressed that “attempts to ‘reduce abortion’ through coercive restrictions are a direct violation of people’s dignity, bodily autonomy and reproductive freedom.”

Guttmacher reported a 25 percent increase in medication abortions, which accounted for 39 percent of all abortions under clinical supervision. The Food and Drug Administration approved the two-abortion-pill regimen in 2000. The first pill, mifepristone, blocks pregnancy-enabling hormones; the second, misoprostoil, causes uterine contractions. While the first pill is tightly controlled and only dispensed with a physician’s prescription, the second is sold over the counter in many countries, including Mexico. When both pills are taken during pregnancies up to 10 weeks, they are 98 percent effective. The second taken alone is 80 percent effective. 

Meanwhile, access to abortion varied based on regions and states. The number of clinics declined in the Midwest by 6 percent and in the South by 9 percent, while the number increased in the Northeast by 16 percent and the West by 9 percent. Some 89 percent of U.S. counties have no clinics that provide abortion services, imposing hardships for 38 percent of reproductive-age women (15-44) living there.

Guttmacher noted an increase in self-managed abortions, reported by nonhospital clinics — from 12 percent in 2014 to 18 percent in 2017. However, the authors concluded that it was “unlikely that an increase in self-managed abortion could account for most of the national decline in abortion incidence during this study period.”

A Sept. 20 New York Times article, ”Why America’s abortion rate might be higher than it appears” speculated that the decline in clinically supervised medical and surgical abortions is due to the “invisible” increase in self-managed care. “You can go online,” said Abigail R.A. Aiken, a professor at the University of Texas at Austin, “and you can fill out a form and you can get this safe and effective technology delivered to your home.”

Aid Access, a service set up by a Dutch doctor, offers online counseling by a doctor along with mail-order pills. The service reported 21,000 requests for self-induced abortions last year.  Plan C, which provides how-to information about self-managed medical abortions, reports about 40,000 visitors a month. Social media is spreading the word of how to protect privacy, lower costs and help prevent shame with self-managed care.

‘When contraception is limited, more unintended pregnancies’

The reactionary, racist, misogynous Trump-Pence administration aimed to reduce access to abortion by exercising state power over reproductive health care for 4 million low-income women and gender-oppressed people, predominantly people of color, youth, rural residents, immigrants, people with disabilities and survivors of domestic violence.

By significantly adulterating the rules for Title X of the Public Heath Services Act — passed in 1970 during the Nixon era — the revamped regulations, which went into effect on Aug. 19, do not allow providers enrolled in the Title X program to conduct abortions alongside their other services or to offer patients abortion referrals.

The primary target of what is popularly referred to as the “domestic gag rule” is Planned Parenthood, which has been the largest private provider of essential reproductive health services like contraception, testing for cancers, treating sexually transmitted infections and abortions. Planned Parenthood stood up to the Trump-Pence assault by opting out of Title X on Aug. 19.

As part of the administration’s reactionary agenda, it opened up participation in Title X to religious-based groups, which disapprove of most methods of birth control and do not offer comprehensive reproductive health care. The administration also promotes so-called “conscience clauses,” under the guise of religious freedom, so health care providers can deny certain services, such as pharmacists refusing to dispense emergency contraception. A Sept. 19 Rewire News article noted that “when contraception access is limited, there are more unintended pregnancies.”

Trump’s misnamed Department of Health and Human Services has increased funding for abstinence-only programs (now referred to as “sexual risk avoidance”) and only sanctions sexual expression in opposite-sex marriage. The DHHS defines methods of birth control by their failure rates and demonizes abortion as causing lifelong emotional and physical harm. However, the American Journal of Public Health reports that in conservative states abstinence-only education actually increased teen pregnancies.

Appeal court hears arguments on gag rule

Eleven judges in the Ninth Circuit Court of Appeals on Sept. 23 in San Francisco heard arguments requesting a preliminary injunction against the gag rule, brought by 23 states and a number of reproductive rights organizations, including Planned Parenthood and the American Civil Liberties Union’s Reproductive Freedom Project. 

The Sept. 24 Rewire News reported that government lawyers tried to downplay the consequences of the Title X changes. They argued that of all Title X grantees, only 18 have left the program, representing 20 percent of providers. However, Planned Parenthood, which refused to accept the new regulations, provides about 40 percent of all Title X’s services. 

Countering government arguments, Ruth Harlow, ACLU senior staff attorney in its RFP, stated that five states are no longer in the Title X program, and Title X funding has ended completely or has funding gaps in 28 states. More than 500 Title X service sites have closed. Harlow stressed that the consequences of the gag rule are still being revealed. Other lawyers for the plaintiffs focused on the harm the gag rule was causing, including higher fees and long delays in obtaining services.

In accordance with a 1991 Supreme Court ruling, agency decision making must be “reasoned and rational rather than arbitrary and capricious” based on the full administrative record. But even government lawyers had to concede that such a record did not exist at this time. A ruling is expected in several weeks.

Obviously, if the court rules in favor of a temporary injunction, that will go a long way to restoring reproductive health services to 4 million low-income people. But if it doesn’t, then those who support reproductive justice will need to raise holy hell.

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