Will Blocking Title X Funds for Planned Parenthood Increase Abortion?

It is rare that people on opposite sides of the abortion issue have a civil dialogue, although there are exceptions–such as a recent episode of The Argument podcast from the New York Times, in which Ross Douthat and Michele Goldberg debate abortion. I encourage readers to listen to this–simply to be reminded that civility exists.

My problem is not differing beliefs–I trust that nearly all those who work single-mindedly to end abortion are sincere in their belief that it is murder–it is rather that in order to punish abortion providers, particularly Planned Parenthood, anti-abortion advocates are willing to ignore the relationship between contraceptive access, unwanted pregnancy, and abortion. I am 66, and remember a famous quote, attributed to an unnamed U.S. major during the Vietnam War about the bombing of the village of Ben Tre in 1968: “It became necessary to destroy the town to save it.

USAF F-100 strike in South Vietnam during the Vietnam War (USAF Archives, public domain)

The recent move by the Trump administration to bar any organization that provides abortion services or referrals from receiving any Title X federal family planning funds would severely impact family planning providers, particularly Planned Parenthood, the largest recipient of these funds.

Anti-abortion organizations and their supporters in Congress have long sought to completely defund Planned Parenthood because the organization provides access to both contraception and abortion referrals and services. As written, the new rule would deny federal funds unless facilities that provide abortion are financially and physically separate from those that provide other family planning services, and would also prohibit any recipient of Title X funds from making a referral to an abortion provider. Current federal law already prohibits the direct use of federal funds to pay for abortion.

The new rule would require hundreds of Planned Parenthood clinics to either end providing family planning services entirely, or spend millions of dollars to provide entirely separate facilities for abortion services. Anti-abortion advocates, however, see space and staff sharing as a way of using federal funds to support abortion.

Anti-Abortion Protestors Outside a Planned Parenthood Clinic (photograph by Amy Wong, Wikimedia Commons)

A press release from the Susan B. Anthony list, for example, quoted their president, Marjorie Dannenfelser. “The Title X program was not intended to be a slush fund for abortion businesses like Planned Parenthood, which violently ends the lives of more than 332,000 unborn babies a year and receives almost $60 million a year in Title X taxpayer dollars.”

Planned Parenthood is the only comprehensive source of family planning services in many communities, with more than 600 clinics nationwide. The organization issued a press release, commenting that the new rule would disproportionately impact low-income and under-served women. Because the rule prohibits not only abortion, but referrals for abortion, it has been termed a “gag rule” by opponents. It has been opposed by most major medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists.

What happens if the rule prevails–or if Roe v. Wade is overturned, an increasingly likely prospect given the current makeup of the Supreme Court? An article by Michelle Oberman in the May 31, 2018 New York Times suggests that reducing access to legal, medically supervised abortion may ultimately be a Pyrrhic Victory for abortion opponents.

Oberman comments: “Whether we’re marching with coat-hanger posters or passing laws that outlaw the procedure earlier and earlier, we fight over abortion in the United States as if we know what will happen if it’s banned. But as we inch closer to potentially allowing states to recriminalize the procedure — with laws that ban abortions after six weeks, as in Iowa, and even seek to effectively ban the use of abortion-inducing drugs — we would do well to look past our southern border to consider what happens when abortion actually is illegal. It’s not the outcome anyone is looking for.”

In Latin America, where abortion has remained illegal, the advent of abortifacient drugs has resulted in widespread use of these drugs to abort without medical supervision, according to Oberman. Those who suffer complications are likely to end up in the emergency room, where physicians may be unable to distinguish drug-induced hemorrhaging from that accompanying natural miscarriage with potentially lethal consequences for these women. Because abortion is illegal, the emergency room may then become a crime scene.

Oberman goes into considerable detail (and has written a book on the subject). What is particularly interesting is her discussion of El Salvador’s experience enforcing its abortion ban. Public clinics, used by poor women, reported patients suspected of inducing abortions, but “not a single accusation against a woman originated from a private doctor or hospital,” writes Oberman. Doctors may suspect wealthier patients of inducing a miscarriage, but only poor patients, who cannot afford private care, are ever reported. Given that the only evidence against these women is a miscarriage, there have inevitably been wrongful convictions, with serious legal consequences.

There is, of course, one completely effective way to decrease abortions—prevent women from getting pregnant unintentionally. Research shows conclusively that better access to contraception leads to a decline in abortion. The Guttmacher Institute published a report in March 2016, highlighting the relationship. Among other things, the report cited evidence contradicting claims from the anti-abortion community that a decline in abortion resulted from more women carrying accidental pregnancies to term.

Similarly, research published in 2012 in the journal Obstetrics & Gynecology reported the striking finding that greater availability of free contraception following implementation of the Affordable Care Act (aka ObamaCare) spurred a drop in teen birth rates and halved the abortion rate for all participants. A discussion of the research appeared in Scientific American.

If there is one area of agreement among those who are pro-choice and those who are anti-abortion, it is a desire to decrease unintended pregnancies. We will never bridge the philosophical divide between those who sincerely believe life begins at conception and those who see life as involving consciousness or viability. It is sometimes said by those who are pro-choice that there is a “war on abortion”–and by those who are opposed that there is a “war on life.”

Pro-Choice, Anti-Abortion Protestor at the DNC in 1968 (photograph by Ava Lowery, Wikimedia Commons)

Back in 1758, essayist and biographer Samuel Johnson wrote: “Among the calamities of war may be jointly numbered the diminution of the love of truth, by the falsehoods which interest dictates and credulity encourages.” Those on both sides of the abortion debate need to acknowledge what we know about the results of making access to contraception and abortion more difficult.

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