1. Obstacles to Comprehensive Reproductive Health Care
Martin Donohoe

2. Worldwide, every minute
380 women become pregnant
190 women face unplanned or unwanted pregnancies
110 women experience pregnancy-related complications
40 women have unsafe abortions
1 woman dies

3. Abortion in the U.S. 3 million unintended pregnancies/yr By age 45
The average female will have had 1.4 unintended pregnancies
35% of US women will have had an induced abortion

4. Abortion in the U.S.
926,200 abortions in 2014 (rate down 50% compared to 1980)
Pre-Roe v Wade: between 700,000 and 830,000 women/yr underwent illegal abortions in the U.S. (many of them unsafe; deaths often attributed to other causes)

5. Abortion Worldwide 56 million/year Almost ½ unsafe
220,000 children orphaned each year by poorly performed abortions

6. Knowledge Barriers Misconceptions about Sex and Contraception
Common among adolescents and physicians
Discussions with parents/physicians limited / often too late

7. Educational Barriers
½ of states mandate (only 1/4 require comprehensive sex ed)
Supported by federal government spending
$90 million/yr vs $180 million/yr on comprehensive sex ed (2016)
Prohibits any discussion of contraceptives beyond failure rates
Presents worst case scenarios of abortions and STDs

8. Abstinence-Only Education
Attempts to instill guilt, fear, and shame
Stereotypes boys and girls; places responsibility for refusing sexual advances on women
Blurs science and religion
Does not decrease sexual activity, STD rates, teen pregnancies
Does not increase use of condoms and contraceptives

9. Comprehensive sex education programs
Delay onset of intercourse
Reduce the frequency of intercourse
Reduce numbers of sexual partners
Increase condom and contraceptive use
Reduce numbers of unwanted pregnancies
Supported by large majority of Americans

10. Availability of Contraception
Use of some form of contraception increasing (approximately 80%)
Male sperm counts also decreasing (50% over last 4 decades):
may have both short- and long-term consequences for our species
Infertility rates climbing
1/6 U.S. couples trying to conceive fail to do so over the course of 1 yr of unprotected sex

11. Availability of Contraception
Limited access to health care
Lack of insurance
School-based health centers (< ½ dispense, many require parental consent)
Expense (e.g., IUD post-delivery, OCPs)
Provider/pharmacist refusal (“conscience clauses”)
OCPs available OTC in 3 states, but in 106 countries worldwide (safe, does not increase sexual risk-taking behavior)

12. Christian Science Pharmacist Refuses To Fill Any Prescription

13. Availability of Contraception
Economic benefits of contraception:
More contraception → more education
1/3 of wage gains made by US women since 1960
$7.09 saved/ $1 spent by federal government

14. $1.43 cost savings for every $1 spent
Barriers to Abortion: Awareness/Availability of Emergency Contraception
Public awareness low
Available OTC, but some pharmacies do not stock/dispense (“conscience clauses”)
Cost: $25-$50
$1.43 cost savings for every $1 spent
Availability decreases abortion rate

15. Barriers to Abortion: Cost
Medical abortion (mifepristone/misoprostol or methotrexate) > ¼ of all U.S. abortions
Average cost $451
Surgical abortion
Cost: approximately $483 (1st trimester); $750 – $1,500 (2nd trimester)
¾ of patients pay out of pocket
Most insured patients reluctant to file due to confidentiality concerns

16. Barriers to Abortion: Coverage
Medicaid, Medicare, Tricare, Federal Employees Health Benefits Program allow abortion only to preserve the woman’s life or in cases of rape or incest
17 states allocate Medicaid funding to cover most abortions

17. Barriers to Abortion: Facility/Provider Availability
1800 facilities (2900 in 1982)
Only 14% of Ob/Gyns provide abortions
Over ½ of providers over age 50
89% of counties (38% of female population) have no abortion provider
30% of metropolitan areas have no provider

18. Barriers to Abortion: Harassment of Patients and Providers
Acts of violence and/or disruption at clinics in U.S. and Canada since 1977 include:
12 murders, 17 attempted murders, 41 bombings, 643 bomb threats, 175 arsons, 184 assaults, 100 acid attacks, 661 anthrax threats (487 since 9/11/2001)
21,715 clinic blockades/picketing incidents (2015)

19. Barriers to Abortion: Inflammatory Oratory
Former President GW Bush, declaring January 20, 2002 (20th anniversary of Roe v. Wade) “National Sanctity of Life Day,” likened abortion to terrorism:
“On September 11, we clearly saw that evil exists in this world, and that it does not value life. Now we are engaged in a fight against evil and tyranny to preserve and protect life.”

20. Barriers to Abortion: Inflammatory/Misogynistic Oratory
Virginia State Legislator Bob Marshall: “(W)hen you abort the first-born…nature takes its vengeance on the subsequent children.”
MO Congressman Todd Akin: “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down” (i.e., prevent pregnancy)

21. Barriers to Abortion: Inflammatory/Misogynistic Oratory
Former presidential candidate Rick Santorum: “Back in my days, they’d use Bayer aspirin for contraceptives. The gals put it between their knees, and it wasn’t that costly.”

22. Hypocrisy
Former Rep Time Murphy (R, PN): Supported bill making it a crime to harm a fetus during another crime; allegedly urged his mistress to have an abortion
Current Rep Scott DesJairlais, MD (R, TN): Anti-choice legislator; fined by TN Medical Board for sexual relationships with 2 patients, urged (now ex-) wife to have 2 abortions, encouraged mistress to have abortion

23. Barriers to Abortion: Scare Tactics, Misinformation, and Pseudoscience
“Relying on condoms is like betting on your own death...They [the WHO] are wrong about that [condoms are a highly efficient means of preventing the spread of HIV]”
Cardinal Alfonso Lopez Trujillo (Vatican spokesperson on family affairs)

24. Starving Third World Masses Warned Against Evils of Contraception

25. Barriers to Abortion: Legal
Viability: Roe v Wade (1973): 24 weeks
: States enacted 1,074 abortion restrictions (more in last 5 yrs than in any other 5 yr period)

26. Barriers to Abortion: Legal
Mandated waiting periods
Spousal Notification Laws
Parental Consent and Notification Laws for Teen Abortions
Targeted Regulation of Abortion Providers (TRAP) Laws
Refusal clauses

27. Barriers to Abortion: Biased Counseling Laws
Often deceptively labeled “Mandated Informed Consent” or “Women’s Right to Know” Laws
Scare tactics:
Women read a lengthy list of possible but very rare complications from abortion (but not list of benefits of abortion)
Many require providers to state, falsely, that abortion can cause breast cancer and “post-abortion syndrome”

28. Barriers to Abortion: Publicly-Funded “Crisis Pregnancy Centers”
Over 4500 nationwide, some receive state funding
Outnumber abortion clinics
Listed in phone book under “pregnancy services” or “abortion services”

29. Barriers to Abortion: State Laws
Laws requiring pre-termination ultrasound
Unnecessary
Rape when transvaginal (trans-abdominal US does not capture images prior to 10 weeks)
Patients often required to bear cost
“Informed Consent” laws
“Fetal Personhood” laws
“Human Heartbeat” laws

30. Barriers to Abortion: State Laws
“Unborn Victims of Violence” laws
“Fetal Homicide Laws”
“Partial Birth Abortion” Ban
“Teen Endangerment Act”
Unborn Child Pain Awareness Act
“Fetal Pain Counseling” requirements

31. Facts re Abortion
One of the safest and most common medical procedures available
Risk of death from legal abortion less than that from a shot of penicillin
40 times safer than a colonoscopy
10-30 times more dangerous to carry a fetus to term than to undergo a legal abortion

32. Facts re Abortion Unintended pregnancy associated with:
Reduced prenatal care
Lower breast feeding rates
Poor maternal and neonatal outcomes

33. Facts re Abortion (Turnaway Study)
Women denied abortions:
Experience resentment and distrust
Less employment
More poverty/government assistance
More anxiety/depression
Doubled risk domestic violence (not due to getting into new abusive relationships, but because abortions allowed them to get out of abusive relationships more easily)
Their children may face social and occupational deficiencies

34. Barriers to Abortion: Politics
Political appointments to government scientific organizations/committees based on ideology, not knowledge and experience

35. Barriers to Abortion: GW Bush Political Appointments
FDA Advisory Board appointee and Ob/Gyn David Hager
Author of “As Jesus Cared for Women”
Advocated Scripture reading and prayer for PMS and reportedly refused to provide contraceptives to unmarried women
Accused by wife of “serial anal rape”

36. Barriers to Abortion: GW Bush Political Appointments
FDA Representative Dr. Janet Woodcock:
Selling Plan B OTC would transform it into an “urban legend” that would tempt adolescents to create “sex-based cults”

37. Christian Right Lobbies to Overturn Second Law of Thermodynamics

38. Trump Administration
Trump: narcissistic, sociopathic, misogynistic, admitted sex offender/sexual predator
Pence: passed law banning abortion on grounds of fetal anomaly (including Down’s) and requiring fetal US before termination when governor of Indiana (stayed by courts)

39. Trump Administration
Signed resolution allowing states to restrict how federal funds for contraception and reproductive health are spent
Republican House calling for defunding Planned Parenthood
Administration rule will greatly expand the number of employers and insurers that could qualify for exemptions from the mandate by claiming a moral or religious objection, including for-profit, publicly traded corporations

40. Trump Administration Reinstated and renamed/expanded global gag rule
“Protecting Life in Global Health Assistance”
Requires every global health organization that accepts US funding to pledge it will not carry out abortions anywhere in the world (even with its own money), discuss abortion, or lobby governments to liberalize abortion policy
Almost $9 billion funding hangs in balance (including State Dept, USAID, and Defense Dept aid) covering maternal and child health care, HIV, etc.
IPPF will lose $100 million, since it will not abide by the rule

41. Trump Administration Cut off funding for UN Population Fund
US gave $69 million in core funds for its humanitarian work in 2016
Proposal to cut all overseas family planning aid
$600 million dollars in 2016

42. Trump Administration
Office of Adolescent Health’s Teen Pregnancy Prevention Program halted
2018 budget asks for massive increase from $90 million/yr to $277 million/yr for abstinence-only education

43. Trump Administration
Nominations of anti-choice judges (possibly including more Supreme Court nominations)
?Roe v Wade at risk
If overturned, 19 states have laws that could be used immediately to restrict the legal status of abortion; right to abortion would be at risk in 33 states
A step backwards: Democratic Party will support candidates who are anti-choice (2017)

44. Conclusions
Restrictions on access to reproductive health services remain widespread
Vigilance and legislative efforts at federal and state level and in the courts necessary to preserve and protect women’s right to choose

45. Conclusions
Provision of full reproductive health care to women worldwide:
Just
Would improve the lives of women and children
Cost-saving

46. Conclusions
Amount of money needed each year ( in addition to current expenditures) to provide reproductive health care for all women in developing countries = $12 billion = Amount of money spent annually on perfumes in Europe and the U.S.

47. Creating Change Comprehensive sex education
Fully-funded access to all forms of contraception and to pregnancy termination upon request up to viability
Improved education and training of students, trainees, and providers
More public health educators; public education campaigns; bringing contraception and abortion “out of the closet”
Increased activism/protests

48. Contact Information
Public Health and Social Justice Website
Further Information: Guttmacher Institute: