A Universal Win

Universal Health Care Means Less Abortion and More Choice

A new report in The New England Journal of Medicine reveals that the abortion rate declined in the first two years after Massachusetts implemented health care reform, writes Jess Arons.

A woman visits with her midwife while her son looks on in Free Union, Virginia. (AP/Andrew Shurtleff)
A woman visits with her midwife while her son looks on in Free Union, Virginia. (AP/Andrew Shurtleff)

No more speculation. Now we know—universal health care coverage leads to a reduction in the abortion rate, confirming what many have long suspected but have never before been able to prove in the United States. A report released this week in the New England Journal of Medicine reveals that the abortion rate declined in the first two years after Massachusetts implemented health care reform.

According to the study, the insurance rate was 86 percent prior to Massachusetts’ health coverage expansion in 2006. By 2008, 94 percent of people had insurance. During that same time, the number of abortions declined 1.5 percent overall and by a whopping 7.4 percent among teenagers. Yet, nationally, the steady decline in the abortion rate had been stagnating and actually increased by 3.2 percent from 2005 to 2006 (the most recent data available) while the rate for teenagers rose 1 percent.

Another interesting fact: The birth rate increased in Massachusetts in 2007, the last year for which data are available. This decrease in abortion and increase in births occurred even though the state’s Medicaid program provides full coverage for abortion for its poorest residents and even though the private plans that insure people in the next income bracket also cover abortion.

Given that the poorest women are more than four times as likely to have an abortion as the most affluent women, this development offers especially striking evidence that, contrary to popular belief, covering abortion neither encourages nor increases its usage.

The study concludes that the increased availability of affordable health care is a key driving force behind these trends. Abortion rates are a result of complex social determinants, and no single factor will likely ever be enough on its own to tip the balance. But it seems almost too obvious to state that a woman who would like to have a baby would be reassured by the knowledge that she and her child will have access to health care whenever they need it, not to mention the economic burden that affordable coverage alleviates.

Moreover, providing coverage removes the very real financial barriers that prevent many women from seeing a health provider and obtaining routine health care, including reproductive care. With coverage, women can access contraception to prevent unwanted pregnancies as well as receive the care they need to have healthy, wanted pregnancies. Indeed, the single most important factor in achieving a healthy pregnancy is the health of the woman before she becomes pregnant. Simply put, overall health care is a vital ingredient in achieving positive reproductive health outcomes.

International data have provided similar evidence for decades—countries with a strong health care infrastructure have a low abortion rate, while countries with poor health care access have high abortion rates, regardless of whether abortion is legal or criminalized. In fact, the Washington Post reported earlier this week that the United States continues to have the highest abortion rate in the industrialized world in part because we do not have universal health care. But now, with this latest study, even skeptics who may point to cultural or other differences can look within our own borders and find the same results.

This is good news for everyone, including supporters and opponents of abortion rights alike. With universal coverage, those who call themselves pro-life will see the abortion rate go down, while those who call themselves pro-choice will know that women’s pregnancy decisions will come more from their heart than their circumstances.

It is the height of irony, then, that one of the biggest sticking points in the health care debate has been abortion, when we now have such compelling evidence that universal health care can reduce the abortion rate. As an organization representing 59,000 Roman Catholic nuns recently stated, the pending health reform bill "is the REAL pro-life stance, and we as Catholics are all for it."

We may have waded so deep into the realm of politics that facts have little bearing at this point. But for politicians concerned about abortion, the best thing they can do is vote for comprehensive health reform.

Jessica Arons is the Director of the Women’s Health and Rights Program at the Center for American Progress.

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Jessica Arons

Director, Women\'s Health & Rights Program