LLOYD MILLER
DaShaya Craig is a 29-year-old Chicago mother of three who has had three abortions.
The first time, she had stopped taking birth control pills because they made her sick, and her boyfriend didn’t always use condoms.
The second time, she’d been wearing a patch, which she later learned is less effective if the user weighs more than 198 pounds. Her patch also had a tendency to fall off.
She had her third abortion after she stopped using birth control “because I had tried them all”–the pill, the patch, shots–and they either made her sick, didn’t work or, in the case of the injections, caused highly unpleasant side effects.
Although concerns over the economy have pushed the debate over abortion to the back burner, whether President Barack Obama lives up to his campaign promise to do everything possible to reduce the unintended pregnancies that make women consider having abortions seems even more crucial now, given some recent statistics.
A report released this past fall by the Guttmacher Institute, a research group that supports abortion rights, found that African-American women have abortions at a rate five times that of non-Hispanic white women and three times that of Hispanic women. While abortion rates have been declining for all women, nonwhite women have had a higher rate of abortions since the procedure was legalized in the 1970s. But the disparity between white and nonwhite women began widening in the 1980s.
The statistics appear to defy the strong antiabortion messages that have been emanating from the black community for years. Black churches teach that abortion is a sin, tantamount to murder, and that a woman who gets pregnant has a moral responsibility to bear any child that results from unprotected sex. A more political message that has been kicking around since the civil rights movement of the 1960s argues that abortion is genocide and that for a black woman to have one only plays into the hands of a larger racial conspiracy to reduce the black population.
That black women seem to be disregarding these messages shows that they consider abortion to be a personal decision and that, like many Catholic women, they are refusing to let anyone else make such an important decision for them. What’s obvious is that until there’s more equity in medical care and contraceptive services, as well as more financial and emotional support for black women, they will continue to have abortions at a high rate.
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Former Surgeon General Joycelyn Elders, who became controversial for speaking frankly about such issues, thinks the country should stop obsessing about abortion, stop trying to legislate morals and instead focus on promoting sexual health and preventing unplanned pregnancies. “There’s never been a woman who needed an abortion who was not already pregnant,” she says, framing the issue in simple terms.
“Sometimes we think black women are struggling with this whole [abortion] issue, but maybe not for the reasons we think they are,” says Gaylon Alcaraz, executive director of the Chicago Abortion Fund, a private group that pays for abortions for women who can’t afford them. Last year 72.6 percent of her clients were black, 6 percent were Hispanic and 14.9 percent were white.
The lack of healthcare, job security and stable partners, and the desire not to increase the burden on their families all contribute to black women’s decisions to have abortions, even though they might otherwise want to have the child. And a lot of them get pregnant while taking some form of birth control, Alcaraz says.
According to the Guttmacher Institute, African-American women have three times the rate of unintended pregnancies of white women. Fifteen percent of black women who are at risk of unintended pregnancies–who are sexually active, fertile and don’t wish to become pregnant–don’t use contraception, compared with 9 percent of white women; and when they do, the contraceptive failure rate is twice as high.
Interviews with advocates for black women’s health and with black women who have had abortions reveal that many black women struggle to find an appropriate method of contraception and to use it successfully.
When I asked DaShaya Craig, for example, if anyone had ever recommended that she try an IUD–a highly effective form of birth control that has relatively few side effects and lasts for years once inserted–she said she didn’t know anyone who had one.
“It’s an issue of education,” she said. “A lot of black women don’t have health insurance, and they’re on Medicaid. They may go to a gynecologist but see a different one every time. They don’t have a person to ask about the different methods. From my experience using a Medicaid card and going to a hospital clinic, every time I went, there would be somebody different.”
Alcaraz says many of the women who have come to her organization for help with abortions experienced similar frustrations with reproductive services. They described being poorly informed about how to use birth control pills, getting pregnant even when they took them (presumably because they took them improperly), experiencing bad side effects from birth control injections (which Alcaraz says are often prescribed to clients at public health clinics) and, in some cases, feeling an emotional resistance to using any of the methods available.
In 2007, 18 percent of black women were uninsured, according to US Census data, compared with 12.9 percent of white women, and given the current economic downturn those numbers may be higher now. Practically every one of the eleven black women I spoke to–seven of whom are advocates for black women’s reproductive healthcare, and seven of whom have had abortions–cited additional barriers to black women’s receiving adequate family planning services, including the need to travel long distances to get to public health clinics; the long wait to see a doctor when they have competing job and childcare responsibilities; and the lack of regular gynecologists to monitor their contraceptive choices and needs.
I’m convinced that in addition to having less insurance and receiving fewer consistent reproductive services than other women, another factor contributes to the high rate of unintended pregnancies among black women: the relentless message from black churches that says extramarital sex is sinful, and the refusal to encourage couples to plan their sexual lives carefully.
“There’s a taboo within the black community, especially within the religious community, regarding talking about healthy sex and sexuality,” says Loretta Ross, national coordinator of Sistersong, an association of reproductive health organizations for women of color. She describes “a perfect storm of lack of contraceptive information, lack of safe spaces to talk about sexual activity and a lot of unwanted pregnancies.”
The available research on abstinence-only education for teenagers has shown it has no impact on preventing young people from having sex, and that it has a discouraging effect on contraceptive use when they do. According to a 2006 Guttmacher study, premarital sex is nearly universal among Americans. But people are less likely to plan for behavior they’ve been taught is wrong. Black religious and other leaders need to create a role that empowers couples to be thoughtful in managing their sexual lives instead of instilling guilt about sex. One black women’s health advocate suggests using beauty shops–a mainstay in the lives of many black women–as places to disseminate information and dispel myths about sex and contraception.
In a statement issued on the thirty-sixth anniversary of the Roe v. Wade decision, in January, President Obama renewed his campaign promise to support abortion rights, but also to work to find ways to expand access to affordable contraception, accurate health information and preventive services.
In his proposed budget, the president asked Congress to approve the Medicaid Family Planning Option, which would allow states to increase the number of low-income women eligible for family planning services under Medicaid without the burdensome Medicaid waiver process. The measure was struck from the president’s economic stimulus package when Republicans threatened to hold up the bill. But Congress should make sure it’s part of the budget. According to the Planned Parenthood Federation of America, it would provide coverage to 2.3 million women by 2014.
The Obama administration also needs to improve family planning services at public clinics so that doctors are not prescribing the patch to women who are clearly over the weight limit, pushing injectable contraception when the results are often dreadful and prescribing pill dosages that make women sick. The government also needs to stop spending millions on abstinence-only programs, which have proved ineffective, and to fund serious school-based sex education that focuses not only on biology lessons but on teaching young people how to manage relationships.
Obama’s nomination of Kathleen Sebelius as secretary of Health and Human Services is encouraging because of her efforts to expand health coverage in her native Kansas.
Whatever the administration does to expand medical coverage to more Americans will help women who don’t receive medical insurance through their employers, who are out of work and who aren’t poor enough to quality for Medicaid.
Even if we accomplish all of the above, however, there will still be unintended pregnancies. And as long as black women, for a host of reasons, feel unable to care for additional children in their current circumstances, they will continue to see abortion as an alternative.
