Category Archives: Personal Autonomy

The Economics of “Social Policy”

There are economic consequences to most policy choices. That’s just as true of so-called “social” policies as it is of decisions to build roads or wage wars.

When religion is driving policy, economic repercussions tend to get ignored. So it was interesting to read Two Sides, Same Coin–a report by the University of California at San Francisco on the economics of abortion policy. Researchers followed women who were turned away–who wanted to terminate a pregnancy but were unable to do so. As the report noted,

Access to comprehensive reproductive health care, including abortion, is essential to women’s economic security. Yet many progressive politicians and advocates often ignore this important connection. This report delineates the many links between these topics—including that family planning increases women’s economic opportunity, lack of supports for pregnant and parenting women interferes with their economic stability, and there is an unfulfilled potential for reproductive health care to help create economic security—and the need to integrate both issues into any proactive policy agenda to achieve equality for women.

The Guardian recently noted the “costly choice” faced by pregnant American women:

For a country where politicians are rather eager to promote family values, America has few policies that make it easy to have children. On top of high health-care costs and limited employer benefits, the country has little in the way of affordable child-care. It is unsurprising, then, that three-quarters of women who choose to have an abortion say it is because they cannot afford to have a child. Some will argue that they can always put their child up for adoption. Others will add that marriage can be a fine antidote to poverty (45% of all women who seek abortion are unmarried). These are fair points. But perhaps instead of closing down abortion clinics, lawmakers might consider more ways to give these women better choices.

Perhaps the most widely-read economic analysis of abortion policy was the argument by the authors of Freakonomics,  

who concluded that legalization of abortion in the 1970s explained a substantial part of the crime decline in the 1990s. (Evidently, children born into households where they are wanted, and where the adults are financially and emotionally capable of raising them, commit fewer crimes.)

None of this is an argument for making moral choices on the basis of economic consequences. But opinions on the morality of abortion are hotly contested.

It’s interesting to note that people who believe that the moral position requires respect for personal autonomy and reproductive choice tend to give generously to organizations like Planned Parenthood. On the other hand, the lawmakers most willing to use government’s power to impose their personal moral/religious beliefs on women who may not share them have shown little interest in ensuring the well-being of children once they are born.

The economic consequences of that disinterest fall on the rest of us.

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Death, Taxes and Attacks on Planned Parenthood

Attacks on Planned Parenthood are as inescapable as death and taxes.

The most recent episode in this never-ending effort began with a doctored tape of an interview obtained under false pretenses . But let’s ignore the dishonesty. Let’s assume that medical employees of the organization were flip and “cold blooded” in their conversations about fetal tissue research—which is essentially the message the editing was intended to convey.

What facts would that change?

As the unedited tapes clearly show, and subsequent investigations confirm, Planned Parenthood isn’t selling fetal tissue or profiting from its use in medical research. Some affiliates, in states where the practice is legal, are assisting medical researchers by making such tissue available when the patient has authorized it, and being reimbursed for the costs incurred in that process.

The availability of embryonic stem cells and fetal tissue for research has led to cures for many diseases and saved many lives. As with stem cells, the choice is between using fetal tissue for lifesaving research or destroying it. Which of those options is truly “pro life”? Much the same moral calculus is involved when transplant surgeons harvest organs from people who’ve just died in order to prolong the lives of those with organ failures. (Most of us wouldn’t care to watch either grisly procedure.)

More to the point, most of Planned Parenthood’s services have absolutely nothing to do with abortion.

Planned Parenthood of Indiana & Kentucky treats 65,000 patients annually, the vast majority of whom are low-income women who would not otherwise get needed Pap tests, breast exams, STD testing and treatment, and birth control. A not-insignificant number are low-income men who come for testicular cancer exams.

The importance of the testing services provided by Planned Parenthood became painfully obvious when state funding cuts forced closure of Scott County’s Planned Parenthood, in southern Indiana, leaving the county without a testing facility. The resulting HIV epidemic is costing the state far more than it “saved” by closing the clinic—and that doesn’t take into account the likely increase in teen pregnancies or the negative health consequences for poor women unable to afford pap smears and other lifesaving services.

Proponents of defunding Planned Parenthood glibly assert that these services can be provided elsewhere. They can’t. Not only is there no other network or organization with the capacity to replace Planned Parenthood, there is no other organization willing to raise significant private funds—as Planned Parenthood does—to supplement inadequate government funding and ensure that women are not denied health care simply because they can’t pay for it.

These recent attacks on Planned Parenthood are part and parcel of what has been called–aptly– a “war on women.” Over the past five years, state-level lawmakers have passed nearly 300 new restrictions on reproductive health access. A report from the Roosevelt Institute lays it out:

In the first quarter of 2015, lawmakers in 43 states introduced a total of 332 provisions to restrict abortion access, which is increasingly out of reach for women throughout the country. Republicans have voted more than 50 times to repeal the Affordable Care Act (ACA), which has dramatically improved women’s health coverage and access. In the fall of 2013, the party orchestrated a costly government shutdown motivated by their opposition to the ACA’s contraceptive mandate. And in June, House Republicans proposed eliminating funding for Title X, the federal family planning program.

When conservatives talk about “women’s health” funding, they aren’t talking about funding for abortion. Federal law already prohibits public dollars from being spent on abortion or abortion-related care. They’re talking about funding for family planning and other reproductive health services (pregnancy counseling, cancer screenings, STD treatment, etc.), which mainly comes through Medicaid and Title X, two programs that are consistently in conservative crosshairs.

So here’s the bottom line.

Genuinely pro-life people can oppose abortion and still support the other life-saving work done by Planned Parenthood—which is the only work being funded with tax dollars. Of course, if what they really oppose is women’s moral autonomy, as the efforts to restrict access to birth control strongly suggest, then the deaths of poor women denied access to critical medical care is just unavoidable collateral damage.

At the end of the day, there’s reality and there’s rhetoric. The reality is that women did not start getting abortions after Roe v. Wade. They just stopped dying from them.

Research confirms that the best way to reduce the number of abortions is by providing women with reliable birth control–and the best way to reduce deaths from abortion is by supporting high quality clinics like those operated by Planned Parenthood.

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Lying for “Life”

Another week, another attack on Planned Parenthood. It’s getting old.

Planned Parenthood provides basic medical services–reproductive health services–to women who cannot otherwise afford those services. We’re talking breast cancer screenings, pap smears and yes, contraception. Abortion amounts to 3% of the organization’s services.

Periodically, groups opposed to abortion, contraception and  (most of all) women’s moral autonomy, try to “set up” the organization. The AP reported about the most recent effort, which has drawn predictable outrage from the predictable suspects:

In last week’s video, Nucatola discusses how the group sometimes provides tissue from aborted fetuses for medical research…A nine-minute excerpt the center posted online shows Nucatola saying her organization charges $30 to $100 for such procedures. But in the full version lasting more than two hours, she repeatedly says those prices only cover the procedures’ costs, are not for profit and are only performed with the patient’s consent.

One of the most complete accounts of what seems to be a sustained, expensive and relatively sophisticated effort to invent misdeeds by Planned Parenthood was offered by the Daily Beast, and is worth quoting at length:

The videos appear to be part of a lengthy and expensive project that Daleiden, who is 26 and a relatively fresh face in the pro-life movement, could not have funded on his own.

Indeed, since the release of the first video, new details have emerged about the other individuals associated with the CMP’s undercover investigation—associations that go beyond Daleiden’s history with the anti-abortion group Live Action, which has also produced heavily edited sting videos in Planned Parenthood facilities.

A 2013 registration form obtained by The Nation last week revealed the names of Daleiden’s fellow board members at the CMP: Albin Rhomberg and Troy Newman.

Rhomberg has a long and strident history of anti-abortion activism—one California Planned Parenthood worker says that he once followed her “for an entire city block, barely 3 feet away, filming and shouting at me about my evil work with Planned Parenthood”—but it is Newman’s association with the CMP that has raised the most eyebrows.

Newman is the president of Operation Rescue, a pro-life organization that became the center of national media attention when George Tiller, a Kansas physician who provided late-term abortions, was assassinated by anti-abortion activist Scott Roeder in 2009 during worship services at Tiller’s church….

Further connections between Operation Rescue and the CMP investigation have emerged in conjunction with this latest video. In Operation Rescue’s announcement of the second video, the logo for the CMP’s Human Capital Project includes the phrase “In consultation with Operation Rescue.”

Let’s stipulate that people who kill abortion doctors are not “pro life.”

Let’s also stipulate that people who edit footage to make it appear that their targets have said things they never said and done things they haven’t done–fanatics whose sole mission is to destroy an organization that saves women’s lives– is not “pro life.”

And while we’re at it, let’s also concede that fetal tissue, when freely donated to medical research by fully informed patients, has long provided the promise of developing treatments for some of the cruelest diseases that afflict human beings–and that providing such donations in a manner consistent with law and medical ethics is “pro life.”

Facts, of course, are irrelevant to politicians willing to seize on any ammunition–no matter how dishonest or contrived. As the New York Times editorialized,

A hidden-camera video released last week purported to show that Planned Parenthood illegally sells tissue from aborted fetuses. It shows nothing of the sort. But it is the latest in a series of unrelenting attacks on Planned Parenthood, which offers health care services to millions of people every year. The politicians howling to defund Planned Parenthood care nothing about the truth here, being perfectly willing to undermine women’s reproductive rights any way they can.

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Poverty and Contraception

The New York Times began a recent article as follows:

Over the past six years, Colorado has conducted one of the largest experiments with long-acting birth control. If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years, state officials asked, would those women choose them?

They did in a big way, and the results were startling. The birthrate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school.

Isabel Sawhill, an economist at the Brookings Institution has argued in her 2014 book, “Generation Unbound: Drifting Into Sex and Parenthood Without Marriage,” that single parenthood is a principal driver of inequality, and that long-acting birth control is a powerful tool to prevent it.

The program in Colorado was originally funded by a grant from the Susan Buffett Foundation, but as I have previously noted, that grant has now run out.

The state’s health department has estimated that every dollar spent on the long-acting birth control initiative saved $5.85 for the state’s Medicaid program, which covers more than three-quarters of teenage pregnancies and births. Enrollment in the federal nutrition program for women with young children also declined by nearly a quarter between 2010 and 2013.

It works. It saves tax dollars, and it saves young women’s futures.

So of course, the Colorado legislature has declined to fund the program. The only hope for continuation of the program is the Affordable Care Act–aka Obamacare.

As I said in my previous post, if these lawmakers were really “pro-life,” they would support programs that substantially and demonstrably reduce the incidence of abortion.

If.

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Speaking of Abortion..

Yesterday’s blog ended with a question about the motives of the anti-abortion culture warriors. Although there are obviously many sincere people who have moral or religious objections to reproductive choice, the punitive measures advanced by many others (together with their utter lack of concern about what happens to the babies so “saved” once they are born) raises legitimate questions about their real agenda.

I’m not much for conspiracy theories; I tend to agree with a colleague from my days in city government who often remarked that incompetence explains so much more than conspiracies. But in this case, it’s hard to avoid the conclusion that a fair number of the men who have staked out anti-abortion positions (and yes, they’re disproportionately male) aren’t as opposed to abortion as they are to women’s full equality. (Keep ’em barefoot and pregnant, like God intended…).

After all, if you are truly anti-abortion, you’d support programs that reduce the need for and incidence of abortion.

The New York Times recently reported on the GOP’s war on contraception and Planned Parenthood:

One would imagine that congressional Republicans, almost all of whom are on record as adamantly opposing abortion, would be eager to fund programs that help reduce the number of unwanted pregnancies.

That would be the common sense approach, anyway.

And yet since they took over the House in 2011, Republicans have been trying to obliterate the highly effective federal family-planning program known as Title X, which gives millions of lower-income and rural women access to contraception, counseling, lifesaving cancer screenings, and treatment for sexually transmitted diseases.

A House subcommittee on Labor, Health and Human Services has proposed to eliminate all Title X funding — about $300 million — from a 2016 spending bill.

The bill would also slash funding by up to 90 percent for sex education, specifically President Obama’s teen-pregnancy prevention initiative. The only winner was abstinence-only education, whose funding the subcommittee voted to double, despite the fact that it has basically no effect on abstinence and has been associated with higher rates of teen pregnancy.

Federal law prohibits the use of any federal dollars for abortion or abortion-related services, and has for many years. That inconvenient fact hasn’t prevented the “pro-life” posers from insisting that their efforts to eviscerate reproductive health programs serving poor women–programs that save the lives of many of those women–are “pro life.” Of course, they aren’t “pro” anything. They are anti-woman–and fiscally irresponsible.

What Title X grants actually do is help prevent unwanted pregnancies — more than one million in 2012, which translates to about 363,000 abortions avoided. According to the Guttmacher Institute, a research organization, every public dollar spent on family planning services saved about $7 in costs related to pregnancy, birth and infant care, as well as sexually transmitted diseases and cervical cancer. So the proposal to slash the program’s funding is not just inhumane, it’s also fiscally dumb.

A genuine opposition to abortion would require support for family planning programs that reduce abortions. A genuine concern for “life” would include concern for the lives of poor women. A genuine commitment to fiscal conservatism would mandate support for programs that demonstrably save tax dollars.

The operative word is “genuine.”

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