Gibson: End of the road for Roe?

Guest writer Scott Gibson returned to his childhood home 30 years ago to practice medicine. A board-certified internist, he served on the McMinnville School Board from 2011 to 2017, when he and his wife, Melody, moved to the outskirts of Amity to open the Bella Collina B&B. In addition to medicine and science, he counts history, economics and writing among his interests.

With the conservative shift of the Supreme Court during the last administration, most watchers expect that the landmark Roe v. Wade decision to soon be sharply limited, if not overturned entirely. If that happens, 26 states appear to be ready to largely outlaw abortion.

It’s a change long sought by many Republicans and dreaded by most Democrats. So how are Democrats poised to respond?

For the moment, it appears that they’ll look for ways to reinstate abortion rights. But that’s a dubious prospect that would, in my view, most likely prove a misguided use of political effort.

Before we get to that, though, let’s take a look at the state of abortion in the United States today.

The first thing to note is that abortion has been ebbing in the U.S. for years.

According to the federal Centers for Disease Control and Prevention, the rate per 1,000 women in the child-bearing 15-44 age range dropped from 16.1% to 11.4% between 2006 and 2019. That represents an overall decline of almost 30%.

The rate of unintended pregnancies is also declining, falling from 51% of all pregnancies in 2008 to 31% in 2019.

It remains remarkable, in this age of effective and easily obtained contraceptives, that almost a third of pregnancies are unplanned. But we are making substantial progress.

Another piece of good news is a sharp drop in teen pregnancies. Between 1983 and 2018, the pregnancy rate in the under-18 age group fell from 5% to just over 1%.

Looking at who is getting pregnant unexpectedly is enlightening.

According to the CDC, unintended pregnancy correlates most strongly with unmarried cohabitation, lower levels of age, income and education, and African American women because they are overrepresented in those categories. Not surprisingly, it is also more prevalent among the addicted and homeless.

Sadly, that suggests unwanted children continue to come most often to the women least prepared financially, socially and educationally to bear the burden of parenting.

What has brought the drop in abortions and unintended pregnancies? Most researchers credit the growing acceptance of long-acting reversible contraceptives, or LARCs, for the decline.

LARCs come mainly in two types — intrauterine devices known as IUDs and implantable hormone-release systems commonly referred to as implants.

Both of these are exclusively available for women. Male biology has so far confounded efforts for a reversible long-acting contraceptive for men.

LARCs have proven spectacularly successful. In a Colorado study comparing oral contraceptives to LARCs, the only woman in the LARC arm of the study to get pregnant intentionally had her contraceptive removed.

That has fostered efforts across the country to encourage their use. As a result, it rose from 4% in 2007 to 18% in 2016, according to the Guttmacher Institute. And that has proven a prime mover in the sharp declines in unintended pregnancy and abortion. 

The Affordable Care Act also seems to have helped bring down the rate of abortion, a remarkable feat that had evaded prior Republican administrations. By requiring all health insurance plans to cover contraceptive costs without copays or patient out-of-pocket costs, the number of women using contraceptives rose and abortions declined.

Today’s news, however, is about the restriction of abortions.

Texas has instituted a de facto ban on abortions as soon as six weeks after conception, before many women even know they are pregnant.

The Supreme Court has declined to place a stay on the law before deciding on its constitutionality. As a result, pregnant women are seeking out-of-state abortions in record numbers.

Obtaining out-of-state care can be exceedingly expensive, involving travel and lodging costs added onto the cost of the abortion itself. Sometimes the bill runs into the thousands of dollars.

In response, there are now 80 funds assisting pregnant women in accessing abortion care. So if Roe is overturned, arranging out-of-state abortion services will likely become a booming field.

Given these realities, what should lawmakers do — especially Democratic legislators, who tend to express the most distress for the plight of women coping with unintended pregnancies?

Investing all efforts in restoring abortion rights is unlikely to be a winning strategy for years to come. You can’t fundraise your way to a quick change in Supreme Court justices.

That makes preventing unwanted pregnancies the best option. Lawmakers should establish public health programs to assure that every pregnancy is a cause for celebration, not despair.

Ideally, this could be a bipartisan effort, but I fear that Republican legislators will pass abortion bans, declare victory and turn out the lights. In that event, the job of preventing unwanted pregnancies will devolve to the Democrats.

Nonprofits will play a big role in making an all-out push to be sure that currently underserved groups get information and funding for effective birth control. This won’t be easy or cheap, but it works and it’s needed. And paying for an IUD is far more cost effective than flying a pregnant woman from Corpus Christi to Denver for an abortion.

What we don’t need now is continued use of abortion to rev up each side’s political base.

For decades, Republicans have been driven to outlaw abortions. A Supreme Court decision to allow that could shift the political energy to the Democrats. But if the abortion debate remains little more than a matter of political rugby, we all lose.

Democrats should champion a campaign to make every child a wanted child.

Abortions are an intervention that represent a failure of prevention. We need to make all pregnancies a matter of choice, not accident.

We have the tools. With sufficient effort, we could make unwanted pregnancies so uncommon the need for abortions would shrink dramatically — a win for Republicans and Democrats, women and families.

Democrats need to quit talking as if abortion is the only choice women have. Abortion should be legal, yes, but women should be empowered to have the pregnancies they want, not the pregnancies that happen to them.

Abortion will likely soon be banned in many states. That will be the reality.

But unwanted pregnancies don’t have to be. Let’s close abortion clinics not by outlawing them, but making them unneeded.