Losing Ground on Abortion

Sharon Camp

Sharon L. Camp is President and CEO of the Guttmacher Institute.
[img_assist|nid=1279|title=|desc=|link=none|align=left|width=86|height=100]The recent decision by the Food and Drug Administration to allow women 18 and older to buy the emergency contraceptive Plan B at pharmacies without a prescription is very welcome news. But Plan B alone will not be enough to overcome our nation's stalled progress in reducing unintended pregnancy and the need for abortion.

The latest data on abortion, published by the Guttmacher Institute in early August, should make no one happy - not the anti-abortion activists who have successfully lobbied for a raft of new abortion restrictions (and who opposed over-the-counter sales of Plan B) and not those of us who want to keep abortion safe, legal and available.

The new numbers strongly suggest that a decades-long decline in U.S. abortion rates is stalling out. In each year from 2000 to 2003, the abortion rate (the number of abortions per 1,000 women of childbearing age) barely budged. There is no reason to expect 2004, 2005 or 2006 will look any better. Indeed, they might look a good deal worse.

Sharon L. Camp is President and CEO of the Guttmacher Institute.

The recent decision by the Food and Drug Administration to allow women 18 and older to buy the emergency contraceptive Plan B at pharmacies without a prescription is very welcome news. But Plan B alone will not be enough to overcome our nation's stalled progress in reducing unintended pregnancy and the need for abortion.

The latest data on abortion, published by the Guttmacher Institute in early August, should make no one happy – not the anti-abortion activists who have successfully lobbied for a raft of new abortion restrictions (and who opposed over-the-counter sales of Plan B) and not those of us who want to keep abortion safe, legal and available.

The new numbers strongly suggest that a decades-long decline in U.S. abortion rates is stalling out. In each year from 2000 to 2003, the abortion rate (the number of abortions per 1,000 women of childbearing age) barely budged. There is no reason to expect 2004, 2005 or 2006 will look any better. Indeed, they might look a good deal worse.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

A decade ago, abortion rates were dropping significantly every year, as all groups of women benefited from improving contraceptive use. Today, abortion rates are declining only for better-off women. Rates for poor women are actually going up. This is very bad news, regardless of which side of the abortion divide you are on.

Given this latest evidence, anti-abortion activists may want to rethink their plan of action. Imagine what we could achieve if we could re-channel all the energy state and federal legislators now spend making it harder for women to get abortions into efforts to make it easier for them to avoid unwanted pregnancies in the first place?

The typical American woman who wants two children spends about five years of her life pregnant, post-partum or trying to get pregnant. But in order to avoid an unplanned pregnancy, she will need to use contraception correctly and consistently for 30 years. This is no mean feat in the American context, where contraceptives are relatively expensive (compared to other countries), increasing numbers of young women lack health insurance, and even those who have insurance may not have coverage for contraceptives.

Indeed, a surprising number of American women-17 million, according to new Guttmacher Institute estimates-need help to cover annual cost of prescription contraceptives and the medical services associated with them. This total grew by a million women between 2000 and 2004.

But in much of the country, public subsidies for family planning services failed to keep pace, with funding flat or declining in about half the states. Meanwhile, the cost to deliver such health care has gone through the roof. Many public health facilities can no longer afford to offer the most effective and easiest-to-use new contraceptive methods. Funding shortfall may be part of the reason why the number of sexually active women who are not using any birth control has gone up, especially among low-income women.

Publicly funded family planning services currently prevent an estimated 1.3 million unintended pregnancies each year. Without public funding for such services, the U.S. abortion rate would likely be 40% higher than it is. A good 10-year goal would be to reduce abortion another 40% by getting more resources to hard-strapped family planning clinics. Our country actually has a related goal: In 2000, we made it a national public health priority to reduce unintended pregnancy by 40%. But at the moment, we're making zero progress.

Instead, the disparity in unwanted pregnancy by income group has grown significantly. Unintended pregnancy has gone up 29% among poor women, and down 20% among better-off women. A poor woman is now four times as likely to have an unintended pregnancy, five times as likely to have an unintended birth and more than three times as likely to have an abortion as a woman living above 200% of the poverty level.

There are some easy ways to get things back on track, if our leaders would care to try. Many of them are revenue-neutral, meaning they cost nothing to implement or they pay for themselves quickly. The best examples are the 24 state Medicaid waivers that expand eligibility for family planning coverage to more low-income women. A recent Guttmacher study finds that making eligibility for contraceptive services the same as eligibility for Medicaid-covered pregnancy-related care would avert almost 500,000 unplanned pregnancies, 225,000 unplanned births and nearly 200,000 abortions a year, while also saving $1.5 billion in net state and federal expenditures.

Another good investment would be adequate funding for the categorical federal family planning program known as Title X. In inflation-adjusted dollars, funding for the program is just 40% of what it was in 1980.

We should also look for ways to make effective contraceptive use easier and less expensive for everyone. Following the example of Plan B, many experts think birth control pills and other newer hormonal methods should also be made available without a prescription. Regardless, we should try to remove unnecessary medical barriers that merely raise costs and inconvenience women. I believe conservatives call this deregulation.

Let's revisit contraceptive labeling. It's often outdated, inappropriately scary, confusing, incomprehensible or all of the above. Wouldn't it make better sense to have up-to-date, science-based labeling that most women could actually read?

We also need better public education programs – not just for teenagers, but for adults as well – education that stresses personal responsibility and that gives people medically accurate information on the safety and effectiveness of modern contraceptives, preferably before they start having sex.

We know how to make abortion rates start going down again. Let's stop wasting time and get on with the job.

Editor's note: this piece was adapted from Sharon Camp's op-ed in The Philadelphia Inquirer.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.