Prevention and Women's Reproductive Health: A Matter of Concern
Sable, Marjorie R., Galambos, Colleen M., Health and Social Work
The recent legislation on abortion in South Dakota and the subsequent copycat legislation proposed in nine other states (Alan Guttmacher Institute, 2006a) are a grim reminder of the continuing assault on women's reproductive health by state legislatures. The South Dakota law makes it a felony for physicians to perform abortions except to save the life of the mother. Amendments to make exceptions for cases of rape and incest were introduced for consideration; however, they were defeated. With the recent appointment changes to the Supreme Court, states may be viewing legislation such as the South Dakota law as an opportunity to overturn the landmark case of Roe v. Wade (which legalized abortion in the United States on a national level) and return abortion policy to the states.
Although this movement may reflect the sentiment of some states to control abortion policy, it is interesting to note that many states already determine abortion policy for poor women, who have been unable to obtain a Medicaid-funded abortion since the implementation of the Hyde Amendment in 1977. The Hyde Amendment (P.L. 94-439) prohibited the use of federal funding for abortion except in cases of life endangerment, rape, or incest. Thirty-two states follow that federal standard established with this amendment and provide Medicaid abortions only in these exceptional cases (Alan Guttmacher Institute, 2006b). South Dakota refuses to fund Medicaid abortions for rape and incest, which is a violation of the federal standards. Poor women, however, are most at risk of having an unintended pregnancy and obtaining an abortion. Half of all pregnancies in the United States are unintended, but the rate of unintended pregnancy varies by income. In 2001 women whose incomes placed them below the federal poverty level were four times as likely to experience an unintended pregnancy and three times as likely to have an abortion as women whose incomes placed them above 200 percent of the poverty level (Finer & Henshaw, 2006). Furthermore, the rate of unintended pregnancy was stable, at 49 percent, between 1994 and 2001, but it increased by 29 percent among women below the poverty level and increased by 26 percent for women between 100 percent and 200 percent of the poverty level. The abortion rate among U.S. women decreased during these years, as did the proportion of unintended pregnancies that resulted in abortion (Finer & Henshaw). Data from the National Center for Health Statistics (2005) reveal that unwanted births increased from 9 percent in 1995 to 14 percent in 2002. The data also show that women whose pregnancies are unintended are disproportionately young, unmarried, African American, and have low income. Ironically, the proportion of publicly funded family planning agencies receiving Medicaid funding--clinics that typically serve this population--fell from 91 percent to 81 percent between 1995 and 2003 (Lindberg, Frost, Sten, & Dailard, 2006).
Given the social, health, and economic consequences of unintended pregnancy (Brown & Eisenberg, 1995), it would seem logical to enact policies and implement programs targeting its reduction. The opposite seems to be occurring. Policies continue to be developed that deny the reality of human behavior and biological phenomenon. An example of such a policy is abstinence-only sex education, which sometimes provides incorrect information about the consequences of sexual behavior and abortion (U.S. House of Representatives, 2006). Some research findings on abstinence-only programs indicate that they may delay intercourse, but do not prevent intercourse and sexual behavior (Bruckner & Bearman, 2005; Jemmott, Jemmott, & Fong, 1998) or have no effect on sexual behavior (Texas Department of State Health Services, 2005). In addition, many school districts forbid the provision of positive information about contraception (Landy, Kaeser, & Richards, 1999), and two-thirds of the states have policies that would allow sex education in the schools only if the students obtain parental consent to participate in the program (Gold & Nash, 2001). …