Indivisible of Lower Merion: Facts about Abortion and Contraception
What is an abortion?
An abortion is a medical procedure that ends a pregnancy.
Types of abortion:
A “medical abortion” is one that is brought about by taking medications that will end a pregnancy. In the U.S., medical abortions account for 45% of abortions before nine weeks’ gestation.
Aspiration (or suction) abortion is the most common type of “surgical abortion” (a somewhat misleading label in that no incision is made). Suction is used to empty the uterus; the procedure takes only a few minutes in a clinic to perform. This method is usually used until about 14-16 weeks after the last menstrual period.
Dilation and Evacuation (D&E) uses suction and medical tools to empty the uterus. D&E is used later in a pregnancy than aspiration abortion -- usually if it has been 16 weeks or longer since the last menstrual period.
Other methods are rarely used (approximately 1.4% of cases).
https://www.guttmacher.org/fact-sheet/induced-abortion-united-states
https://www.plannedparenthood.org/learn/abortion/in-clinic-abortion-procedures
Timing of abortions:
According to CDC data, in 2014, the majority (67.0%) of abortions in the U.S. were performed at or before 8 weeks’ gestation, and nearly all (91.5%) were performed at or before 13 weeks’ gestation. Few abortions were performed between 14 and 20 weeks’ gestation (7.2%); only 1.3% are performed at or beyond 21 weeks’ gestation. https://www.cdc.gov/mmwr/volumes/66/ss/ss6624a1.htm?s_cid=ss6624a1_w
In Pennsylvania in 2015, just 380 abortions (out of 31,818, or 1.2%) occurred after 20 weeks.
Safety:
A first-trimester abortion is one of the safest medical procedures for women in the United States. Fewer than 0.03% of women obtaining abortions experience a major complication that might need hospital care.
Abortions performed in the first trimester pose virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage), or birth defect, and little or no risk of preterm or low-birth-weight deliveries.
There is no association between abortion and breast cancer, and there is also no indication that abortion is a risk factor for other cancers.
For a woman who has an unplanned pregnancy, the risk of mental health problems is no greater if she has an abortion than if she carries the pregnancy to term.
The risks associated with abortion increase somewhat with the length of pregnancy.
https://www.guttmacher.org/fact-sheet/induced-abortion-united-states
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18010091
Pennsylvania restrictions on abortion:
Current Pennsylvania law contains many restrictions on abortion, including:
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A woman must receive state-directed counseling (“informed consent”) that includes information designed to discourage her from having an abortion, and then wait 24 hours before the procedure is provided.
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One parent of a minor must participate in the “informed consent” at least 24 hours before an abortion is provided. Without parental consent, a minor may receive an abortion if a judge determines that she is mature and capable of giving informed consent.
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An abortion may be performed after 23 weeks after the woman’s last menstrual period only if necessary to preserve the woman’s life or to prevent a "substantial and irreversible impairment of a major bodily function" of the pregnant woman.
Since 2012, Pennsylvania law has also required that all facilities that provide surgical abortions follow ambulatory surgical facilities regulations. The statute, Act 122, is widely considered to be a TRAP (Targeted Regulation of Abortion Providers) law; such laws impose medically unnecessary, expensive, and burdensome regulations on abortion providers with the goal of reducing access to abortion services.
In 2017, the Republican-controlled Pennsylvania legislature passed what would have been one of the most restrictive abortion laws in the country. The bill, which was vetoed by Governor Wolf, would have reduced the current 24-week cutoff for abortions to 20 weeks, with no exceptions for rape, incest, or severe fetal anomaly. It would also have made the safe and widely-used D&E method illegal; any doctor performing a D&E would have faced felony charges. (Language in the bill calls the D&E method “dismemberment abortion,” a non-medical and inaccurate term.)
Abortion Costs:
As a general matter, prices increase as time passes in gestation; by the second trimester these price increases happen every week. Thus, low-income patients often find themselves in the difficult situation of “chasing the fee.” The patient works to save enough money--and with the passage of time the price continues to increase, and she still can’t afford the procedure--getting later in the pregnancy.
Some providers have access to charitable funds that will help defray the costs of abortions for low-income women and teens.
Average prices of clinic-based abortion procedures in the Philadelphia area:
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First trimester abortion: $400-500.
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By 14 weeks: $700.
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By 17 weeks: $1,300.
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By 24 weeks: $3,000.
Regarding relative costs, the cheapest option is almost always surgical with local anesthetic. Having sedation is more expensive, usually an additional $100. Sedation is optional until about 14 weeks, depending on the provider.
Medical abortions are not less expensive than other options.
The requirement of a hospital setting for a procedure increases its cost substantially. E.g., for a patient who is only 13 weeks pregnant, the price climbs to over $3,100.
For patients who must travel out of state for abortion care later in pregnancy, the price can exceed $8,000-10,000.
Source: Women’s Medical Fund http://womensmedicalfund.org/
Limits on insurance coverage for abortion:
Since 1977, the “Hyde Amendment” and related legislation have prohibited federal spending for abortion. Except for “physical” danger to the life of the mother, or rape or incest causing the pregnancy, abortion is not covered for any woman who relies on federal government-provided health care or insurance. This prohibition includes Medicaid and Medicare recipients, federal employees, and residents of the District of Columbia, as well as women in the military, federal prisons or immigration detention centers, the Peace Corps, and some Native American women.
https://en.wikipedia.org/wiki/Hyde_Amendment
In Pennsylvania, a health plan offered in the state’s health exchange under the Affordable Care Act can cover abortion only if the woman's life is endangered, or in cases of rape or incest, unless the insured individual purchases an optional rider at an additional cost. Insurance policies for public employees cover abortion only in cases of life endangerment, rape or incest. Public funding is available for abortion only in cases of life endangerment, rape or incest.
Pennsylvania state law does not prevent private health insurance policies from covering abortion, and many do.
https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-pennsylvania; https://www.guttmacher.org/state-policy/explore/restricting-insurance-coverage-abortion/
Other Arbitrary Federal Intervention:
Since March 2017, government officials at the Office of Refugee have attempted to block access to abortion services for undocumented, pregnant minors who have been detained in federal immigration custody.
http://www.latimes.com/politics/la-na-pol-abortion-migrant-20171218-story.html; https://www.nytimes.com/2018/03/31/us/abortion-immigrant-teens.html
[Add Title X proposed gag rule]
Contraception:
Contraception is vitally important for numerous reasons:
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it allows women to decide when, how many, and with whom they have children.
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it has important medical uses unrelated to birth control.
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it is a medical necessity for many women for whom pregnancy is contraindicated, including those with certain heart diseases, severe renal disease, and poorly controlled diabetes.
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Contraceptive use prevents abortions.
Access to birth control has been linked to better educational and professional gains for women, improved maternal and fetal health, and fewer unplanned pregnancies and abortions, as well as greater family well-being and reduced public spending.
https://www.guttmacher.org/sites/default/files/report_pdf/social-economic-benefits.pdf
Types of contraception:
Currently available contraception falls into five categories: hormonal, IUD/Implant, barrier, natural, and emergency. The top 5 forms of contraception by declining order are: the pill, tubal ligation (female sterilization), male condom, IUD, and vasectomy (male sterilization).
62% of women who are of reproductive age (15-44) use some form of contraception.
https://www.cdc.gov/nchs/fastats/contraceptive.htm;
See also: https://www.cdc.gov/nchs/data/nhsr/nhsr062.pdf
Costs of Various Forms of Contraception:
Particularly for women without health insurance, the cost of birth control can be prohibitive. And cost factors often lead patients to use less medically suitable methods. The approximate costs of the most popular methods (excluding the cost of health provider visits for screening and follow up) are:
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Birth control pills - $240 - $600/year
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IUD - $1,000 each (lasts up to 5 years)
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Implants - $800 each (lasts up to years)
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Depo-Provera Shot - $240/year
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NuvaRing - $1,000/year
https://nwhn.org/much-different-kinds-birth-control-cost-without-insurance/; https://pennstatehealthnews.org/2018/03/affordable-care-act-increases-use-of-more-effective-contraceptives/
Health Insurance Coverage for Contraception:
The Affordable Care Act specifically requires coverage for 18 methods of contraception used by women (including female sterilization), along with related counseling and services, and it requires that this coverage be provided without any out-of-pocket costs to the patient, such as copayments or deductibles.
In October 2017, the Trump administration released two new rules directed at the ACA’s contraception coverage provisions. Under these rules, any employer can claim religious or moral objections to deny its employees birth control coverage, including some types of preventative care and screening. At present the implementation of these rules has been blocked by a Pennsylvania federal court.
https://www.guttmacher.org/state-policy/explore/insurance-coverage-contraceptives; https://www.nytimes.com/2017/12/15/us/politics/obamacare-birth-control-trump.html
In short, the intended result of ACA coverage—that every insured woman can consult a doctor and make decisions about whether and how long to use one of the range of devices or medications that is safe, effective, and practical for her, with the cost shared among all who have insurance, like any other health coverage—is under attack. Claims of “religious liberty” -- on behalf of secular businesses –-threaten this standard by asserting the “liberty” to deny coverage to any business’s employees for this one medical need.
Guttmacher Institute: https://www.guttmacher.org/gpr/2017/01/what-stake-federal-contraceptive-coverage-guarantee
Non-Birth Control Uses of Contraception:
A majority of women who use oral contraception (58%) also use it to help with other medical issues. Moreover, almost three-quarters of a million women who have never had sex (33% of whom are teens aged 15-19) use birth control pills entirely for non-contraceptive purposes. Reasons that women use oral contraception, other than to avoid pregnancy, include:
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reducing cramps, pain, and bleeding (31%);
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regulating menstruation, which for some women may prevent migraines and other painful “side effects” (28%);
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treatment of acne (14%); and
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treatment of endometriosis (4%)
The pill can also mitigate or prevent symptoms associated with bone thinning; cysts in the breast and ovaries; Polycystic Ovarian Syndrome (which can lead to infertility); endometrial and ovarian cancers; serious infections in the ovaries, fallopian tubes, and uterus; iron deficiency; and premenstrual syndrome (PMS).
Intrauterine contraception (IUD) also has important non-contraceptive health benefits. IUDs can be used to treat menorrhagia (menstrual periods that are unusually heavy or prolonged) and anemia. They have also been used as part of hormone replacement therapy, as an alternative to a hysterectomy for women with bleeding problems, and as an add-on therapy with tamoxifen for breast cancer patients.
https://www.ncbi.nlm.nih.gov/pubmed/11832788
Access to contraception prevents abortions and saves taxpayer money:
About one half of all pregnancies in the United States are reported unplanned, and for women in their twenties this number goes up to 70%. Women who use birth control properly account for only 5% of unplanned pregnancies. By contrast, women who don’t use birth control account for 53% of unplanned pregnancies, and women who use birth control improperly or inconsistently account for 43% of unplanned pregnancies. 40-42% of unplanned pregnancies end in abortion – approximately 650,000 abortions annually.
Unplanned pregnancies cost federal and state taxpayers somewhere between $9.6 and $12.6 billion dollars per year if the expenses paid by Medicaid and CHIP are included with the actual cost of the birth.
Health consequences of illegal abortion:
Highly restrictive abortion laws are not associated with lower abortion rates. To the contrary, when countries that have highly restrictive abortion laws are grouped, including those where abortion is prohibited, abortion rates are 37 abortions per 1,000 women of childbearing age. In countries where abortion is available on demand, the rate is similar: 34 abortions per 1,000 women.
Legally available abortion also reduces the number of late term abortions. In 1970 (three years before Roe v. Wade legalized abortion throughout the U.S.), 25% of abortions took place at or after 13 weeks gestation. In 2014, 92% of abortions were performed within the first trimester, with the majority of performed under 8 weeks gestation. Just over 8% of abortions are performed after 13 weeks gestation period; only 1.3% of all abortions are late term (over 21 weeks gestation).
In countries where abortion is illegal, abortion is the leading cause of maternal mortality. The main causes of maternal deaths from unsafe abortions are hemorrhage, infection, sepsis, genital trauma, and necrotic bowel. And approximately one-fourth of women who survive unsafe abortions suffer long-term health complications.
https://www.ourbodiesourselves.org/health-info/impact-of-illegal-abortion/;
https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709326/
Read an account from two doctors who were early abortion practitioners here: (https://www.cosmopolitan.com/politics/a6964440/abortion-before-roe-v-wade/).