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U.S.: Healthcare Should Include Abortion Access, Women Say

NEW YORK, Mar 1 2010 (IPS) - Last fall, the push to reform healthcare in the United States was all but hijacked by one of the country’s most passionate recurring cultural debates.

On Nov. 7, 2009, Congressmen Bart Stupak, a liberal Democrat, and Joseph Pitts, a conservative Republican, sponsored a stipulation in the healthcare reform bill that would severely limit federal funding for abortions in a reformed healthcare system.

If Barack Obama’s comprehensive reform bill were passed, consumers would be able to buy discounted health insurance from an index of government-subsidised providers. But under the Stupak-Pitts amendment, an insurer could only be included on the index if its plans excluded abortions from its coverage.

The amendment passed, 240-194, and the debate over health care reform turned into a debate over abortion rights. Suddenly, a vote for reforming health care was also a vote for curtailing lower and middle-income access to abortions in the United States.

Wendy Chavkin, a professor at Columbia University’s Mailman School of Public Health, is a member of a group of academics that authored a position paper on the place of reproductive health in the healthcare reform process.

“The sweep of the Stupak Amendment took us by surprise,” she said. “We knew there would be opposition and efforts to put in anti-funding riders. But we were shocked by the scope of it and the fact that it got through.”

The Stupak amendment comes at a time when anti-abortion opinion has been on the rise in the U.S. A January Quinnipiac University poll found that 18 percent of citizens believe that abortion should be illegal in all cases; in 2005, only 12 percent believed this.

That same poll found that 34 percent of citizens take a moderately pro-abortion position, believing that the procedure should “usually” be legal. In 2004, 41 percent held this view.

Chavkin says that in countries with single-payer healthcare systems, abortions are always included in government-provided insurance plans.

“It’s considered healthcare,” she said, adding that the United States is the only country she can think of in which a healthcare procedure is excluded from coverage based on philosophical or religious disagreement rather than a shortage of personnel or resources.

“It’s unusual to single out a service and not fund it,” she says. “There are some places where the resources are limited and they debate whether or not to fund procedures because they’re so expensive. But it is a lengthy, deliberative and science-based process.”

Ironically, the public and legislative backlash against abortion rights comes at the same time Obama has increased U.S. aid for reproductive health abroad.

In 2009, his administration renewed U.S. funding for the U.N. Population Fund, from which the George W. Bush administration had withheld over 200 million dollars.

On the third day of his presidential term, Obama lifted the so-called “gag order”, a policy adopted by the Ronald Reagan administration in 1984 that banned federal aid for reproductive health work undertaken by international organisations performing abortions abroad, or simply providing any information about or referring women to abortion services.

Executive orders either banning or allowing such funding have been a veritable ritual during the first week of new party’s tenure in the White House.

This tug-of-war over the funding ban has had a devastating effect on reproductive health services abroad, says Jennifer Redner of the International Women’s Health Coalition. When the “gag rule” is reinforced, the U.S. goes from five to 10 years consistently funding organisations to giving them absolutely nothing.

“USAID has to defund organisations every 10 years,” says Redner. “And those are organisations like International Planned Parenthood that are the most equipped to be providing these health services.” She advocates a permanent congressional ban on the “gag rule”.

Such a measure would be timely. Right now, 13 percent of maternal deaths worldwide can be attributed to unsafe abortions, according to Redner. Even so, by 2008, international aid for reproductive health had reached worrying lows.

Despite the connection between reproductive health and broader public health issues in the developing world – such as infant and mother mortality and the transmission of epidemic diseases like AIDS – funding for reproductive health as a percentage of overall international health aid dropped from 30 percent in 1994 to 12.7 percent in 2008, according to the Lancet.

Meanwhile, there are an estimated 70,000 deaths a year due to unsafe abortions according to Ipas, an international women’s health NGO. An increased need for international support for family planning in the developing world coincided with the election of a decidedly pro-abortion U.S. president.

Yet a 1973 congressional prohibition on funding for abortions through federal foreign aid still limits how much the United States can contribute to reproductive health efforts abroad.

Prof. Chavkin notes that some organisations will curtail other, non-abortion services out of the fear that they could end up losing funding based on the appearance of their promoting or performing elective abortions.

Ipas Vice President Barbara Crane adds that this can have an extremely burdensome effect on federally funded organisations committed to performing abortions abroad.

“The fact there’s no guidance in the field means that it’s interpreted as a complete prohibition on anything: any information, services or references to abortion in U.S.-sponsored events or publications,” she says.

A group that does want to perform abortions needs a separate facility and staff that receive no federal funding, which Crane says is an unreasonable requirement in countries with already-low healthcare capacity.

Both Chavkin and a report from Ipas state that “millions” of women have died because of their limited access to safe abortions. But with the U.S. embroiled in a debate over whether its government should subsidise abortions here, it is unlikely that Congress will open up a debate on funding abortions in other countries.

“Policymakers are reluctant to go near the abortion issue internationally because it is so contentious domestically,” says Crane.

The Obama administration might be more open to funding reproductive health programmes abroad, even ones that perform abortions. But with the 1973 prohibition still in place, the debate in the U.S. itself could have the same effect on abortions in the developing world as it has had stateside.