Doctor: Detroit abortion stats 'like some Third World country'
Karen Bouffard wrote this report for the Detroit News a 2013 National Health Journalism Fellow. Other stories in the series include:
Nearly one-third of all pregnancies in the city of Detroit end in abortion, a statistic public health officials blame on rising poverty and dwindling access to affordable contraception.
Of an estimated 18,360 pregnancies among Detroit residents in 2012, the most recent year for which data are available, 5,693 ended in abortion, or 31 percent.
During that same year, an estimated 160,219 pregnancies were reported in Michigan, with 22,699 abortions.
That translates into a Detroit abortion rate — the number of abortions by population, including women who weren’t pregnant that year — of 37.9 per 1,000 women aged 15-44. That’s up from 27.5 per 1,000 women in 2001.
It’s a staggering three times greater than Michigan’s statewide rate, which declined from 12.6 abortions per 1,000 women during child-bearing years, to 11 per 1,000, over the same period.
While the abortion rate has been climbing in Detroit, it’s been declining in Michigan and across the U.S. “We’re seeing a picture that looks more like some Third-World country than someplace in the United States,” said Dr. Susan Schooley, chairwoman of the Department of Family Medicine at Henry Ford Hospital.
National studies show a direct correlation between abortion and poverty. Legal abortion is considered a medically safe procedure with few complications. But problems that often underlie abortion, such as poverty and poor access to health care, are public health issues that need to be addressed if the rate is to be reduced, experts said.
Funding for family planning and contraceptives has decreased significantly in Michigan in recent years, from more than $5 million in 2006 to $692,300 in 2013, according to the state Department of Community Health. The number of clients receiving free family-planning assistance decreased by about 80,000 between 2006 and 2013.
“Both routine primary care and family planning-specific primary care are not available in Detroit,” Schooley said. “To the extent that a significant proportion of those (pregnancies) are unplanned, it leads to all these decision-making options of which abortion is one lousy choice.”
It’s another public health challenge for Detroit, which is the most dangerous city in America to be a child, according to a Detroit News study. Published in January, the study found that the death rate for children 18 and younger is higher in Detroit than in any U.S. city its size or larger. The highest number of deaths occur in the first year, most related to premature birth. Homicide is the second greatest cause of child deaths in the city.
“It made me sad,” said Penelope Allen, now 21, of an abortion she underwent at age 15. “I was still in school and I had to do what I had to do. I was a kid. People make mistakes.”
A foster child since the age of 4, Allen ran away from a group home at 15, and became pregnant. She returned to foster care until aging out of the system at 19. She now has a daughter, Patience, who’s almost 2.
“I’m doing better — I have a car, I have a job,” Allen said of her life today. “My daughter, it was her, she helped me get my life on track.”
The U.S. abortion rate in 2011, the latest year for which national data is available, was 17 per 1,000 women. That’s the lowest since the U.S. Supreme Court made abortion legal in all 50 states through it’s 1976 Roe Vs. Wade decision, according to a February study by the Washington, D.C.-based Guttmacher Institute, a pro-choice think tank.
Health professionals expect the Affordable Care Act to reduce abortions by providing greater access to birth control for low-income women, either through expanded Medicaid or low-cost health insurance.
Dr. Jay Berman, chief of gynecology at DMC Hutzel Hospital and division chief for gynecology at Wayne State University Medical School, said health reform will reduce cost barriers that have kept women, including many who have health insurance, from using long-acting reversible contraceptives — such as injections, intra-uterine devices (IUDs) and subdermal implants. These kinds ofcontraceptives, however, can be the most expensive option.
“Ultimately the (Affordable Care Act) is going to have an impact on the abortion rates,” Berman said. “We’re also promoting long-term reversible contraception, the implants in the woman’s arm, shots and IUDs, which are very suitable for a lot of these patients. There are three, five and 10-year IUDs that are available.”
Berman noted that legal abortion is a safe procedure. He said the general consensus among physicians is that abortions — even multiple abortions — do not lead to premature birth or other complications with future pregnancies.
“We certainly would like to reduce that number,” Berman said. “There’s physical stress, but there is psychological stress as well. (Unplanned pregnancy) has an effect on plans for education, for work. Women don’t take these choices very lightly. It certainly has an emotional and psychological (effect).”
Abortion rate peaked in '08
It’s impossible to compare Detroit’s abortion rate to that of other cities, because mandatory reporting of abortions is not required in all states, as it is in Michigan. But abortion rates tend to be higher in poor urban centers such as Detroit, experts said. The city’s abortion rate peaked in 2008, coinciding with the worst year of the recession and increasing cutbacks in social safety net programs. Infant mortality and child homicides peaked the same year, according to a Detroit News study.
“We do have an association nationally with higher rates of abortion among low-income women; the rate drops off as women have higher incomes,” said Marianne Udow-Phillips, director of the University of Michigan’s Center for Healthcare Research and Transformation.
Udow-Phillips noted a 2008 study by the Guttmacher Institute, in which researchers found that 42 percent of 9,493 women who had abortions had incomes at 100 percent of the federal poverty level or below. In Detroit, 42 percent of women have incomes below the poverty line, compared with 17.3 percent statewide.
“Why are abortions not reducing in Detroit when they are statewide? It could be evidence that women aren’t getting contraception when they need it,” said Udow-Phillips when asked if the high number of abortions in Detroit is a concern.
Loretta Davis, president and CEO of Detroit’s Institute for Population Health, which administers health services for the city of Detroit including family planning programs, said the increasing abortion rate represents a “public health failure.”
“Somehow, we need to be able to get to these women and girls and reach them in such a way that they are able to make a healthy decision around their sexuality and choose a method of birth control that will work for them,” Davis said.
Abortion debate continues
The debate over abortion and contraception has become so contentious that several individuals and institutions declined to comment for this story. Among them were Michigan State University and the University of Michigan, which both have medical schools. The state Department of Community Health declined to comment on the issue, as did Detroit’s Department of Health and Wellness Promotion.
Daniela Scholl, spokeswoman for St. John Providence Health System, sent a statement saying “St. John Providence Health System operates in accordance with the Ethical and Religious Directives for Catholic Health Care Services and therefore does not promote or condone contraceptive practices.”
Bill Albert, chief program officer for the non-partisan National Campaign to Prevent Teen and Unplanned Pregnancy, said the tenor of conversation has changed since 1970, when the Title X Family Planning program was signed into law by President Richard Nixon.
“What has been striking has been the ... conflation of contraception with abortion,” Albert said. “State and national policy makers, some of them, use these words interchangeably.”
According to Albert, some of the most successful public campaigns to reduce unplanned pregnancies combine messages about abstinence with education on contraception.
Detroit Public Schools spokeswoman Jennifer Mrozowski said the district has an abstinence-based sexuality curriculum that is “age, sequentially and developmentally appropriate for all students grades K-12 including special education.”
But Davis, of the Institute for Population Health, said sex-education can’t be left to schools. She called for a cool-headed community discussion of the issues surrounding contraception and abortion.
“We really have to come together as a community and look at it from the science of it all,” Davis said. “We need highly effective and safe birth control for these people who are not ready to become parents.”
In 2012, the most recent year for data from the Michigan Department of Community Health:
■86.3 percent of abortions were at 12 weeks gestation or fewer
■13.5 percent of the women were younger than 20; the greatest proportion, 35.8 percent, were aged 20-24
■89.4 percent of women who had abortions were unmarried
■58 percent had at least one child already
■25.3 percent had one or more previous abortions
■Self-pay was the source of payment for 95.4 percent of abortions reported
Source: Michigan Department of Community Health
Photo Credit: Max Ortiz
This story was originally published in The Detroit News.