Unintended Pregnancy: Common Ground in the Abortion Debate

Screen Shot 2016-03-13 at 4.27.03 PMThis chart is a big deal because unintended pregnancy is a big deal.

The physical and emotional stress of unintended pregnancy is reason enough to desire its reduction. However, it’s also notable that unintended pregnancy is associated with inadequate prenatal care, smoking and drinking during pregnancy, and giving birth to premature or low birth-weight infants. Thus, by creating conditions in which a women can choose if and when she becomes pregnant, you can improve the health and well-being of both women and children.

Because of this, the National Survey of Family Growth has been a frequent cause for consternation among public health-minded folks as it has previously shown an unintended pregnancy rate that just wouldn’t budge. Results from 2001 allowed for some hope when there was a modest decline in the rate, but when 2008 results showed an increased rate of unintended pregnancy, those hopes were dashed.

Two weeks ago, the New England Journal of Medicine published the latest data on unintended pregnancy in the United States showing a 18% decline in the rate of unintended pregnancy between 2008 and 2011 to an all-time-low of 45 unintended pregnancies for every 1000 women between the ages of 15 and 44. This is still far too many unintended pregnancies, but it’s progress.

tThe report also contains lots of interesting information about the use of abortion in the United States. The percentage of unintended pregnancies that ended in abortion ticked up slightly from 40% to 42%. However, because the rate of unintended pregnancy dropped over this same time period the abortion rate actually decreased from 19.4 to 16.9 per 1000 women aged 15-44 between 2008 and 2011. 

I really can’t emphasize enough how important it is to recognize that one of the most effective tools we have for reducing the rate of abortion is to reduce the rate at which women need abortions by providing effective and affordable birth control to all women who desire it. In these times when political common ground is scarce, this strikes me as an area where people with different value systems can agree on a policy that would be a win for everyone.

Finally, the report also emphasizes a fact that I believe doesn’t get enough play which is that abortion is incredibly common amongst all types of women. Amongst Catholic women, 48% of unintended pregnancies end in abortion. Evangelical Christians, the religious group which utilizes abortion the least, still terminate 32% of their unintended pregnancies. Although people from these groups are often fighting to restrict access to abortion, there is a deep irony to the fact that this is a procedure that they themselves use at roughly the same frequency as the general population.

Even if it is ironic, it is not surprising. After all, abortion is a safe procedure which allows women to be in control of whether or when they raise a child. Of course women from all walks of life avail themselves of it.

Facts to take with you:

  1. 45% of all pregnancies are unintended
  2. 42% of unintended pregnancies end in abortion
  3. 21% of all pregnancies end in abortion
  4. 1 in 3 women will have an abortion at some point in their life

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Why do we pay more to treat illness than prevent it?

(The following has been cross-posted to the Leonard Davis Institute’s Health PolicySense blog)

David Asch, Mark Pauly, and Ralph Muller have a great piece in this month’s New England Journal of Medicine on how we as a society think about preventive versus cancer care. They observe that whenever preventive care strategies are studied, there is an obsessive concern with the return on investment of these strategies and that this same scrutiny is not applied to cancer care.

The entire article is well worth reading, but in summary their argument is that this difference occurs because:

  1. Cancer care is more profitable for healthcare providers than preventive care.
  2. There are more well-defined and evidence-based strategies for cancer treatment than for preventive care.
  3. Seeking reward for treating illness is a much stronger motivator than avoiding penalty for failing to prevent illness.

Continue reading “Why do we pay more to treat illness than prevent it?”

Early results from Mexico’s sugar tax

Mexico has one of the highest rates of soda consumption, overweight, and diabetes in the world. The average Mexican adult drinks 163 liters of soda. 72% of adult Mexicans are overweight, and 15% have diabetes.

In the fall of 2013, the Mexican federal government passed a 10% tax on sugar-sweetened drinks. The following year, purchases of these beverages decreased an average of 6% relative to the counter-factual (controlled for seasonal and pre-existing trends), indicating that this tax was an effective deterrent. Evaluating the public health benefits of this tax will require more time, but this is a promising early result.

While hard evidence for dietary interventions is difficult to gather, much of what we know already argues for a compelling public interest in curbing the consumption of refined sugar similar to the public interest in decreasing smoking or excessive alcohol consumption.

A tax on refined sugar with proceeds going to consumer-level fresh produce subsidies would be a great way for us to invest in a healthier future for ourselves.

“Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study”