文章基本信息

标题：Disparities in Abortion Rates: A Public Health Approach
本地全文：下载
作者：Christine Dehlendorf ; Lisa H. Harris ; Tracy A. Weitz 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：10
页码：1772-1779
DOI：10.2105/AJPH.2013.301339
语种：English
出版社：American Public Health Association
摘要：Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them. The abortion rate in the United States is higher than that in most other developed countries. 1 Although this fact alone requires attention, looking deeper within these statistics reveals an additional area of concern: similar to many health outcomes in the United States, there are substantial disparities in abortion rates in the United States, with low-income women and women of color having higher rates than affluent and White women. In 2008, the abortion rate for non-Hispanic White women was 12 abortions per 1000 reproductive-age women, compared with 29 per 1000 for Hispanic women, and 40 per 1000 for non-Hispanic Black women. 2 Disparities in abortion rates also exist by socioeconomic status (SES), with women with incomes less than 100% of the federal poverty level (FPL) having an abortion rate of 52 abortions per 1000 reproductive-age women, compared with a rate of 9 per 1000 among those with incomes greater than 200% FPL. In analyses assessing both income and race/ethnicity, both are independently associated with abortion rates. 2 In the past several years, the differences in rates of abortion have received increasing political attention, with those opposed to abortion rights citing differences in abortion rates as evidence of the diabolical nature of the “abortion industry.” Abortion rights opponents point to racial/ethnic differences in abortion rates as evidence of racism and coercion among those who support the right to obtain abortions. 3,4 Not only do these messages explicitly blame those providing abortion for targeting communities of color, they also assign guilt to women of color who decide to have abortions by implying that they are falling victim to a racist conspiracy. Differences in abortion rates by income are also seen as evidence of exploitation by abortion providers, who are claimed to be aggressively profiting from public funding of abortion for low-income women. 5 Although there is no evidence of racial targeting 6 or routine profiteering by abortion providers, from the perspective of those who espouse these views, the problem of disparities in abortion rates can only be solved by limiting access to and utilization of abortion services. Motivated by a concern that this politicized perspective on disparities in abortion rates fails to consider their actual underlying causes, and thus will not ultimately lead to meaningful policy or programmatic outcomes, we review what is known about the origins of disparities in abortion rates by both race/ethnicity and SES. We discuss what can be done to address the root causes of these disparities in abortion, as well as to minimize their negative effects. By moving beyond a focus on abortion rates in isolation, we hope to shift the focus from abortion alone to the overarching issue of how to improve all women’s health outcomes, as well as women’s ability to make decisions about their reproductive health and life trajectories. Although we focus on issues related to Black, Hispanic, and low-SES women, as these are the groups for which data on abortion rates are available, we note that many of the issues discussed are likely also relevant to other disadvantaged racial/ethnic groups such as American Indians, Alaska Natives, Asians, and Pacific Islanders. In discussing these issues, it is essential to consider that abortion is not in and of itself an adverse outcome. Although popular discourse often focuses on making abortion “rare,” this does not allow for the reality that, for a woman with an unintended pregnancy who desires an abortion, being able to obtain this procedure in a timely and safe manner is in fact a desirable outcome. In addition, the framing of abortion as something that needs to be rare may actually contribute to the ongoing stigmatization of abortion and of women who seek it, which in turn can lead to delayed or unsafe abortion. 7,8 However, as it is desirable to avoid an unintended pregnancy that leads to abortion in the first place, we suggest that it is constructive to address disparities in abortion rates that result from structural social inequalities—especially racism and poverty—without seeing abortion as a bad outcome once an unintended pregnancy has occurred. When such an approach is taken, the focus shifts from the overall number of abortions to helping women achieve their personal fertility desires.