About 15 years ago I was active in my Catholic church on social issues. I served on AIDS care teams, a homeless shelter and issue advocacy. One thing I did was to start a petition drive at my church to support universal health care. It was an issue where Catholic views of charity coincided with my interest in social issues. Among the people in my committee, everyone supported the petition, but when we set up tables after church service, I was surprised about the hostility of reactions from some parishioners. Actually, I had drawn up a petition to reaffirm a set of core principles which I thought were uncontroversial and grounded in church teaching. Even so, I could at least respect the opinions of economists and business analysts who disagreed with the solutions or endorsed free market solutions (by the way, living in ex-communist states for 3 years made me skeptical of all government-run programs). I might disagree with the businessmen who endorsed a laissez faire health care system, but at least I could understand their point of view.
But these were not the kind of people who opposed my small petition. The ones who did were focused on one issue: abortion. They thought the Clinton health care plan would pay directly for abortions. I can’t remember the details of their argument; there was a grain of truth to their point (and something I had not considered). But it seemed like a minor side issue and one that would easily be addressed by including a clause about accommodating worker consciences. But judging from the opponents I talked to, you would think that the Clinton health plan were simply an elaborate ruse designed to increase the number of abortions in the country. Nobody was forcing them to sign my petition, but I would at least hope that people who did not would actually have substantive (rather than symbolic) disagreements. But those who brought up the abortion thing tended to have little knowledge about (or even interest in ) insurance rates or incentives; they simply applied a “purity test” to the health plan and found it deficient.
Abortion and pregnancy—two major American obsessions. The more people I talk to, the less I comprehend.
A few years later, I talked to a young woman from a communist country. She was single and independent; I mentioned how a mutual friend of ours (who was single) had become pregnant by accident. Our mutual friend was slightly irresponsible; certainly we didn’t think she would be a good parent. “Why doesn’t she have an abortion and be done with it?” my friend said to me. I was shocked because my friend was being perfectly serious. In communist countries, abortion was viewed as an acceptable form of birth control; there was no stigma attached to it, and certainly there was no Catholic church to voice its disapproval. I did not condemn my friend’s attitude because I knew they were shaped by the atheistic viewpoints of the country she was born in. It seemed heartless, but my friend was certainly not a heartless person.
A few years later, I talked to a married woman in her thirties, a committed Catholic. She was pregnant and had received disturbing test results about the health of her future baby. There was a very good chance that he might have a severe birth defect; she told me she was seriously considering having an abortion. Frankly, I was stunned. Even though I couldn’t conceive of a situation where I would opt for an abortion, the fact that this person (whom I generally respected) was considering it made me reexamine my own convictions. I didn’t condemn her choice, but at the same time, I made my opinions known to her. I also tried to make her aware of the medical help which would be available to her. As it turns out, the test was repeated, and the probability of birth defects was substantially reduced from before. The woman had the baby (a healthy boy), and everyone was happy.
In my thirties, I knew a lot of women who were obsessed with giving birth. Some were unmarried and wanted to get impregnated by any means necessary (including artificial insemination). Two married couples I knew were undergoing expensive fertility treatments …neither with success. It was sad; both would have made excellent parents; one couple already had a child and wanted a second; the other couple had to look into international adoption. On the other hand, they were throwing away valuable time and money on fertility treatments with marginal success rates. I understand the desire to raise children; but I couldn’t understand why these people didn’t channel their parenting energies elsewhere. It is a pity that some people resort to expensive procedures to have children and other people give away life so thoughtlessly. If only the interests of the people desperate for children and those who resort to abortions could be aligned.
A few months ago I had a vigorous debate with an upstanding Catholic about politics. My friend was a teacher and did not keep up with politics. She said she voted McCain because of his stance on abortion. I was floored by that. I spent the rest of the evening trying to argue with her.
I mentioned to her Mario Cuomo’s speech at Notre Dame about how Catholic politicians could uphold abortion rights in government:
But not everyone in our society agrees with me and Matilda (Cuomo’s wife). And those who don’t — those who endorse legalized abortions — aren’t a ruthless, callous alliance of anti-Christians determined to overthrow our moral standards. In many cases, the proponents of legal abortion are the very people who have worked with Catholics to realize the goals of social justice set out by popes in encyclicals: the American Lutheran Church, the Central Conference of American Rabbis, the Presbyterian Church in the United States, B’nai B’rith Women, the Women of the Episcopal Church. And these are just a few of the religious organizations that don’t share the Catholic Church’s position on abortion.
Now, certainly, we should not be forced to mold Catholic morality to conform to disagreement by non-Catholics, however sincere they are, however severe their disagreement. Our bishops should be teachers, not pollsters. They should not change what we Catholics believe in order to ease our consciences or please our friends or protect the Church from criticism. But if the breadth and intensity and sincerity of opposition to Church teaching shouldn’t be allowed to shape our Catholic morality, it can’t help but determine our ability — our realistic, political ability — to translate our Catholic morality into civil law, a law not for the believers who don’t need it but for the disbelievers who reject it.
And it’s here, in our attempt to find a political answer to abortion — an answer beyond our private observance of Catholic morality — that we encounter controversy within and without the Church over how and in what degree to press the case that our morality should be everybody else’s morality. I repeat, there is no Church teaching that mandates the best political course for making our belief everyone’s rule, for spreading this part of our Catholicism. There is neither an encyclical nor a catechism that spells out a political strategy for achieving legislative goals. And so the Catholic trying to make moral and prudent judgments in the political realm must discern which, if any, of the actions one could take would be best.
I mentioned some of Kristof’s articles about how many Bush policies have led to an increase in abortions worldwide. (He later corrected his statement by saying that abortion rates fell much faster under the Clinton Administration than in the Bush administration). To Catholics, this may sound counterintuitive—until you remember that evangelicals and Catholics generally oppose “abstinence plus” sex education because they allegedly sanction premarital sex. Kristof writes:
The evidence is solid about how to reduce abortions: promote contraception and comprehensive sex education (rather than “abstinence only” programs). California has led the country in these areas, and as a result it cut teenage pregnancy rates by 39 percent over eight years.
Western Europe and Canada both emphasize sex education and family planning programs. The result is that American women are almost three times as likely to get abortions as women in Belgium or Germany. Or take Canada. Among women and girls aged 15 to 19, Americans are 38 percent more likely to get abortions than Canadians. And American teenagers, both boys and girls, are nearly 10 times as likely to catch gonorrhea.
Kristof made the point in a later article about how the Bush administration prohibited foreign aid to NGOs provided any form of contraceptives to the people it helped.
The Bush administration says it took this action because Marie Stopes International works with the U.N. Population Fund in China. President Bush has cut all financing for the population fund on the — false — basis that it supports China’s family-planning program.
It’s true that China’s one-child policy sometimes includes forced abortion, and when traveling in rural China, I still come across peasants whose homes have been knocked down as punishment for an unauthorized child. But the U.N. fund has been the most powerful force in moderating China’s policy, and a State Department team itself found no evidence of any U.N. involvement in the coercion.
“The irony and hypocrisy of it is that this is a bone to the self-described ‘pro-life’ movement, but it will result in deaths to women who just want to space their births,” said Dana Hovig, the chief executive of Marie Stopes International. The organization estimates that the result will be at least 157,000 additional unwanted pregnancies per year, leading to 62,000 additional abortions and 660 women dying in childbirth.
While I never would have had an abortion myself if I had had an unwanted pregnancy, I find that a lot of the “pro-life” people are really anti-sexuality. Some of the older “pro-life” women in particular, see pregnancy as a just punishment for non-marital sex. These same women are often very pro-war, so I think that the ultimate motivation for their “pro-life” stance is not pity for the fetuses but a basic authoritarianism. I can respect someone who is anti-abortion and who works to make abortion unnecessary, through advocacy of birth control and helping women who seek abortions for economic reasons, as well as someone who extends the “pro-life” ethos to include pacifism, opposition to capital punishment, and support for healthy, stable families. But I’m sorry, the types who are against abortion and contraception and sex education and every form of sexuality that isn’t conventional marriage–they’re warped and obsessive, especially the one-issue voters, who would probably vote for Kim Jong-il if he made a statement against abortion.
Now let’s come to the present day, a few days after the alleged controversy about Obama’s speech at Notre Dame. Several individuals and student groups launched a protest against Obama because he is “pro-abortion,” and Big Media, lapdogs to anything that smells of trivial controversy, gave them as much TV exposure as they wanted.
First, let’s be clear about a few things.
Despite the few visible protests, Obama’s politics is wildly popular among students at Notre Dame. For good reason; he took action to get out of Iraq, took initial steps to close Gitmo and fight global warming and access to health care. These are major accomplishments.
There really is no social campaign to promote the use of abortions as a birth control option. Maybe there never really was. Before the 1970s, there were a lot of poor and desperate women who resorted to dangerous methods to induce abortion (with often tragic results). Roe v. Wade allowed concerned organizations to help these desperate women. But a lot has changed since the 1970s. Smaller families, lots of single parent households and a falling fertility rate (although nowhere near as low as Europe). I think feminists recognize that the right to have an abortion is no longer critical to the feminist social movement (instead they focus on civil rights, anti-discrimination and better funding for social programs that help families). Take child care and maternity leave as examples. Those are vitally important for women raising children (regardless of whether the woman is single or married).
An article I once read said that people who have abortions are of two types. The first type is young, poor and irresponsible, perhaps even mentally ill. She is always living dangerously. The second type is a woman (single or married, but usually single) who is poor but otherwise a rational decision-maker. That second type is poor and often comes from a single-parent household and may have been abandoned or abused. This person is not opposed to motherhood per se, but views it as an impossible burden under the current circumstances. This second type probably wants to be a mother at some point, but just can’t imagine being able to raise a child in her current predicament. (This is a failure of imagination, not an intrinsic love of abortion).
According to this article (sorry, I couldn’t find it), the more serious problem was the first type (the irresponsible and mentally ill). They tended to have multiple abortions. They don’t care about social norms and they don’t think straight enough to use contraceptives reliably or to make sensible choices regarding relationships. The second type was your typical woman who had fallen into a bad situation. Maybe she is a teenager who made a mistake or a young working adult not on good terms with her family. She will probably make the decision alone and after much reflection…and even experience regret later on. The second type is likely to face this situation exactly once.
The widely respected Guttmacher Institute provides more detail about who gets abortion and why. Here’s its July 2008 report:
At least half of American women will experience an unintended pregnancy by age 45, and, at current rates, about one-third will have had an abortion
Women who have never married obtain two-thirds of all abortions.
The abortion rate among women living below the federal poverty level ($9,570 for a single woman with no children) is more than four times that of women above 300% of the poverty level (44 vs. 10 abortions per 1,000 women). This is partly because the rate of unintended pregnancies among poor women (below 100% of poverty) is nearly four times that of women above 200% of poverty* (112 vs. 29 per 1,000 women)
The reasons women give for having an abortion underscore their understanding of the responsibilities of parenthood and family life. Three-fourths of women cite concern for or responsibility to other individuals; three-fourths say they cannot afford a child; three-fourths say that having a baby would interfere with work, school or the ability to care for dependents; and half say they do not want to be a single parent or are having problems with their husband or partner.
So let’s analyze both types (the person who gets multiple abortions and the person who does only one time).
For the first type, making available effective and cheap contraception is the best solution (and also better access to drug treatment and mental health care).
For the second type, better access to health care and child care would be the best solution. This second type could definitely be persuaded to carry the child if she saw that getting childcare would not be a struggle.
These solutions sound simple and obvious. In fact, they are very hard. Contraceptive coverage is somewhat high, but it varies widely across states (see the chart below). Some states mandate coverage for contraception; others do not.
Note: this chart was made in 2004; here’s a 2008 chart about coverage with larger employers (which does not break it down into states with mandates vs. no mandates).
For the second type, you need to demonstrate to this woman that taking care of the child will not be impossibly hard. One way to do this to provide a reliable source of health care and a reliable source of child care. Obviously, this gets us to the issue of the European welfare state, but actually this is a debate I’d love to have. Here are some statistics from the recent OECD report (as cited by Bernard Chazelle in the Tiny Revolution blog).
Here are the US rankings out of the 30 OECD countries (1 is best; 30 is worst — worst as in Somalia-like). The names of the countries even more Somalian than the US appear in parens.
Infant Deaths: 28 out of 30 (Mexico, Turkey).
Life Expectancy: 24 out of 30 (Mexico, Turkey, Hungary, Poland, Czech & Slovak Republics).
Health Expenditures: 1 out of 30.
Poverty Rates: 28 out of 30 (Mexico, Turkey).
Child Poverty: 27 out of 30 (Mexico, Turkey, Poland).
Income Inequality: 27 out of 30 (Mexico, Turkey, Portugal).
Obesity: 30 out of 30.
Incarceration: 30 out of 30.
Work Hours (ranked in ascending order): 30 out of 30.
Height (women): 25 out of 30 (Mexico, Turkey, Korea, Portugal, Japan).
Height (men): 24 out of 30 (Italy, Spain, Mexico, Portugal, Korea, Japan).
OECD countries: Turkey, Mexico, Poland, USA, Spain, Portugal, Ireland, Germany, Italy, Canada, New Zealand, Japan, Greece, Luxemburg, Australia, Netherlands, Slovakia, Korea, Czech Republic, UK, Belgium, Switzerland, Hungary, Iceland, France, Austria, Norway, Finland, Sweden, and Denmark.
What conclusions can be draw from this? Medical care for young American children is terrible! Child poverty rates for Americans is terrible! Parents work long hours, and that’s terrible! Health care spending is high, but the other statistics suggest that we are paying a lot and not getting much in return –that also is terrible! In other words, our crappy health care system is making it easy for the second type of woman to conclude that abortion is the only rational alternative. (note: see update at bottom).
Now I wish to talk partisan politics for a moment. Republicans, as a matter of core belief, oppose any kind of health care reform and show no signs of remorse at having a high percentage of uninsured Americans. Republicans, as a matter of core belief, oppose open discussion of contraception in schools (although to be fair, this is a political issue at the state – not the local level). In other words, Republicans say they oppose abortion, but they also oppose the very solutions that would reduce abortion here and worldwide.
Republicans treat the problem merely as a legality issue; all you have to do is forbid something, and it will be done. But you can’t coerce behavior. Prior generations have seen what happens when you try to. Perhaps historical analogies aren’t precise. For example, if abortions were banned in one state, they could be legal in another. Also, I suspect given the zeal of feminist organizations, if there were bans, underground networks would form which would provide abortion services much more safely than was done 50 years ago. Nonetheless, it’s a legitimate question to ask whether abortion services should be legal-and-monitored or whether they should be illegal-and-unmonitored.
Democrats treat the problem as a behavioural issue. How do you provide incentives for individuals never to be tempted to have an abortion? Interestingly, the Democratic point of view is more focused on policy questions rather than on legal ones. The problem with Republican Party solutions is that they do not involve sacrifices. It is amazingly easy for a pro-military, anti-health care reform and anti-sex Republican to adopt the anti-abortion stance. It is easy and painless; it requires no sacrifice or investment; it merely requires that you run around and tell people that they’re wrong.
That is the main reason why I care not one bit about this so-called controversy regarding Obama’s abortion views. Saying that you’re opposed to abortion is easy; it requires absolutely no moral courage to express an opinion about something which requires no action. It reminds me of the College Republicans who strongly supported our invasion of Iraq yet were unwilling to serve in the military themselves. Having a child is not easy; it requires effort and commitment and sacrifice. I applaud people who do it (and regret never having had the chance to do it myself). Having a solution to the abortion problem is not easy either; it requires effort and commitment and sacrifice. Unfortunately, the anti-abortionists are unwilling to step up to the plate.
June 1 Update: I found this surprising but logically consistent rebuttal from Right to Life about Country Comparison statistics. Parts of the rebuttal is easy to dismiss (but parts seem valid). I’m glad to see Right to Lifers at least acknowledging the logical inconsistencies of refusing to support health care reform.
- WHO rankings give great weight to whether the evaluated health care system meets the organization’s ideological preferences. This is a bullshit answer—a groundless assertion. It is the job of Right to Life to demonstrate the validity of this assertion; they have not. Also, as I point out below, if single payer delivers better health care outcomes in other countries than in countries with private insurance systems, it seems reasonable to blame the system for the bad outcomes (even though it might not be relevant for a ranking of health outcomes).
- Life Expectancy. “If you correct for two causes of death not directly related to health care—homicides and automobile accidents—the U.S. actually rises to the top of the list for life expectancy.” I haven’t verified this yet, but let me make the partisan point that Republicans have consistently lobbied against gun control and mass transit. Still, this is an interesting subject worth pursuing in greater depth. Update: This point about removing two causes of death is a fanciful argument, making it delightfully easy to manipulate rankings. Also, amenable mortality analysis shows significant differences between countries directly as a result of their health care systems (not some statistic idiosyncrasies).
- Infant Mortality. the U.S. includes all deaths after “live birth” and defines births as live if newborns show any sign of life, regardless of prematurity. By contrast, Austria and Germany include only deaths of infants who weigh at least one pound at birth. In Belgium and France, the deaths of infants born after less than 26 weeks of pregnancy are not included. Moreover, many other countries do not reliably register babies who die soon after birth.This sounds like a valid criticism but I don’t have full access to OECD data. (Read a brief OECD analysis confirming the problems of cross-national comparisons of infant mortality data). See also this doctor’s restatement of the criticism. It wouldn’t surprise me if some attempt to standardize the data still shows disparities between US and other countries. For example, why do we have a lot of premies? Is it simply because our prenatal intervention is more developed? Or is it because expectant mothers are not in good health or at risk for many things? (For example, I read that fertility treatments result in a lot of premarital births). Could our health care for expectant mothers to blame?
- Specific Diseases. When you compare the outcomes for specific diseases, the U.S. clearly outperforms the rest of the world. Cancer is used as an example. This is an answer that begs for the cherry picking of data. First, about cancer specifically, I’d like to make sure that the uninsured are properly diagnosed and counted with respect to their specific cancer. Second, I’ve read in several places that the cancer success rates in the US may be the result of intervention in cancer cases where the cancer was unlikely to have an effect on mortality (like prostate cancer intervention). Second, outcomes of the general population (without segmentation for specific diseases) are easier to compare. See this discussion about the dangers of cross-country comparisons on Factcheck.org.
- Medical Innovation.Despite genuine problems of distribution and utilization of preventive care, overall, in comparison with other countries U.S. health care is faster, more effective, and more advanced. This is a big despite; if outcomes show us worse off, what does it matter that billionaires have the best possible treatment options? If the percentage of uninsured goes to 30-40%, you have people receiving emergency room treatment when it is too late and many going without treatment at all. The privatization of health care is a cherished Republican value; in fact, it is one of the core values which separates Republicans from Democrats.
June 2 Update #2. I don’t know enough about the details of late term abortions to have an opinion. But Kate Harding explains how in many cases late term abortions are used for hard cases where the mothers actually want their children. Many are cases where reasonable people might think an exception must be made.
September 14 Update. Factcheck’s Brooks Jackson did an extensive writeup about whether Obama health care reform will publicly fund abortions.