Philip Darney

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    Giving women choices in reproductive health

    Philip Darney University of California San Francisco, San Francisco, CA, USA - darneyp@obgyn.ucsf.edu

    The world's health, prosperity and peace are determined by the choices women have for their own reproductive health. Women nurture children and families and do most of the world's work. Women's unpaid work alone accounts for a third of world GDP and the fate of her family depends on a woman's health: the death of a woman increases the risk of her children's death ten times. Since pregnancy and delivery are by far the most hazardous experiences women have, choice about beginning or completing pregnancies is imperative. The Global Health Policy Summit of 2012 identified two interventions as the most cost effective in preventing women's deaths during their reproductive years: access to contraceptives and to safe abortion. These two reproductive choices have a dramatic effect because half of the pregnancies that lead to maternal mortality and reproductive injury are unintended. These unintended pregnancies also result in high rates of premature birth - the most important cause of neonatal death and injury. In places where women do not have access to the highly effective contraceptives they want or where they are denied the choice of safe abortion when they become pregnant unintentionally, maternal and neonatal mortality rates are high and societies are poor and chaotic. The cost of making these choices available to women is trivial - 0.1% of GDP in countries that succeeded in substantially reducing maternal mortality - but the costs of denying them are huge in health and economic losses and personal happiness.

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    FC20

    Why have abortions decreased in the USA?

    Philip Darney
    University of California, San Francisco, USA

    Background: The rate and number of abortions in the USA increased rapidly after legalisation in 1973 to nearly 1.5 million by 1990.  But by 2009 the total was less than 1 million.  What accounted for a 50% decline in less than 20 years?  Those opposed to abortion rights argue that various restrictive laws in more than half the states have encouraged women to give birth rather than abort.   Advocates of family planning assert that increased use of effective contraceptives has decreased the need for abortion in the USA.
    Methods: State and US National data are reviewed in light of legislative changes to examine the relationships among contraceptive prevalence, method mix, age specific fertility, employment, unintended pregnancy and abortion rates.  Specific states, eg, California and Texas, are compared and contrasted.
    Results: Several factors explain the steep decrease in abortion rates and numbers in the USA, but legislative restrictions and declining numbers of providers account for only a small proportion of state-specific variance.  Changes in age-specific fertility rates, particularly a rapid decline in teen pregnancies, increased use of more effective contraceptives and rising employment rates among women provide, along with other demographic factors, powerful explanations for fewer abortions.
    Implications: Fewer abortions require fewer providers which could further decrease access to family planning for poor women living in medically underserved areas.  Less access in already impoverished regions, where restrictive abortion laws are most likely, increases teen and premature births, poverty rates and local health care costs leading to a cycle of declining reproductive health services and increasing poverty and social disruption.