Health care increased, abortion rates declined

Jan. 22--The abortion rate in the U.S. has hit a historic low -- 14.6 abortions per 1,000 women aged 15 to 44 in 2014 -- a statistic many believe was reached though increased access to health care and contraception.

Since 2011, after the Affordable Care Act (also known as the ACA or Obamacare) was signed into law, the abortion rate has declined 14 percent in all regions of the U.S.

According to the Guttmacher Institute, West Virginia likewise experienced a 14 percent decline in its abortion rate -- down to six abortions per 1,000 women of reproductive age in 2014.

With the passage of the ACA, women could not be denied coverage or charged more just because of their gender. And as the uninsured rate declined, so did the rate of abortions.

According to U.S. Health and Human Services, the uninsured rate among women ages 18 to 64 decreased from 19.4 percent to 10.8 percent between 2010 and 2015. The number of abortions in 2013 and 2014 dropped below 1 million for the first time since 1975.

The uninsured rates for female West Virginians declined from 19 percent in 2013 to 6 percent in 2016, according to Enroll America. Roughly 2,020 abortions were provided in West Virginia in 2014, approximately 330 fewer than 2011.

Not all abortions that occurred in the state were provided to state residents, the authors of the study noted, and some West Virginians may have traveled outside the state for abortion services.

Sharon Lewis, executive director of Women's Health Center of West Virginia, , a nonprofit clinic located in Charleston, said she believes improved access to long-acting, reversible birth control has helped lower abortion rates.

She attributes improved access to the Title X Family Planning Program, a federal program providing health services and birth control on a sliding fee scale, and to the ACA -- both of which are at risk under the Trump administration.

"It's concerning to me," Lewis said.

Lewis touted the benefits of the ACA, even for women with private health insurance. The provisions allowed for women to have annual gynecological visits without a co-pay or deductible and access to birth control.

If the ACA is repealed or portions are eliminated, Lewis expects women's health will suffer.

"It's like a tax on women if that goes away," she said. "We need to promote the continuation of those benefits that enhance women's health."

Dr. Coy Flowers with Greenbrier Valley Medical Center said he's seen a number of patients who obtained health care through the ACA or Medicaid expansion, many of whom hadn't had a gynecological exam in seven years or more because they didn't have insurance.

He said preventive measures -- contraception and comprehensive education on sexual health -- are key factors in lowering the number of unwanted pregnancies that are terminated.

Lewis said repealing the ACA would be "a horrible mistake" -- she expects the country would see an increase in unintended pregnancies and a proliferation of sexually transmitted diseases if people no longer have access to primary health and reproductive health care.

"Other social problems will develop as a result of people having pregnancies they can't support financially and that they don't want," Lewis added.

At Women's Health Center of West Virginia, women can receive a full range of reproductive health services ranging from family planning and abortion to pregnancy support services.

Women's Health Center is the only abortion clinic currently operational in West Virginia. The Guttmacher Institute reported West Virginia had five abortion-providing facilities in 2014, two of which were clinics.

Rebecca Wind, Associate Director of Communications at Guttmacher, said the institute could not disclose any identifying information about the providers who participated in the survey due to confidentiality agreements.

The study said fewer abortion clinics does not necessarily translate to fewer abortions.

"The overwhelming majority of abortions -- 95 percent -- were performed in clinics, and there were 6 percent fewer clinics providing abortions in 2014 than in 2011," the report said.

Approximately 90 percent of all U.S. counties had no clinic that provided abortions in 2014, and 30 percent of women of reproductive age lived in those counties.

Roughly 98 percent of West Virginia counties in 2014 had no clinics that provided abortions -- 90 percent of West Virginia women lived in those counties.

"Women must continue to have access to abortions in a safe environment," Lewis said. " It is a component of women's health care. If it is not available in a safe environment, they will find a resource to do so whether it's safe or not. That's been proven throughout the history of this country."

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The authors of the Guttmacher Institute said in addition to greater access to contraception, another reason for the lower abortion rate could be restrictions passed at the state level over the past five years, which could have made it more difficult for women to obtain such services.

Restrictions could heighten, as President Donald Trump has promised to appoint a conservative Supreme Court justice to the vacant seat who will prioritize overturning Roe v. Wade, a Supreme Court decision legalizing abortion.

Four years after the 1973 decision, the Hyde Amendment was implemented to ban the use of federal funds to pay for abortion coverage, allowing only exceptions for pregnancies that endanger the life of the woman or that result from rape or incest.

Since the creation of the amendment, but it has been attached annually to congressional appropriations bills, according to the Kaiser Family Foundation (KFF).

The Washington Times reported Tuesday a congressional committee is working on a stricter version of the Hyde Amendment that would be written into law instead of being attached to appropriations bills. The new version would still block federal dollars from being used to pay for abortions, and would also prohibit abortions from being performed in federal facilities or by physicians in the employ of the federal government.

Some Democrats argue the legislation targets low-income women who rely on the government for health insurance (i.e. Medicaid).

The KFF said West Virginia is one of 16 states in which the state's Medicaid program permits the use of state funds (non-federal) to pay for abortion in circumstances outside of those allowed by the Hyde Amendment. In West Virginia, abortion coverage is not limited by private insurance or in the state's Marketplace; however, no Marketplace plan currently offers coverage.

Women who seek an abortion but do not have coverage for the services must pay out-of-pocket, according to KFF. Cost varies largely depending on the location, facility, timing and type of procedure. For reference, KFF said a clinic-based abortion at 10-weeks gestation is roughly $400 to $550. At 21 weeks, the cost rises to between $1,100 and $1,650.

Although West Virginia does not currently impose additional coverage restrictions on abortion, a representative with WV Free said legislation may be presented this year during the upcoming session to impose heightened restrictions.

West Virginia does currently require women to receive state-directed counseling designed to discourage them from having an abortion, and wait 24 hours before the procedure is provided. After 20 weeks post-fertilization, abortions are only allowed in West Virginia if the woman's life is endangered, her physical health is severely compromised or there is a severe fetal impairment.

Republicans in Congress also plan this year to end federal funding to Planned Parenthood, which provides health services such as mammograms, birth control, STD testing and treatment and abortion. The Washington Post reported Planned Parenthood receives about $500 million in federal grants and Medicaid reimbursements.

Lack of such services could potentially increase unintended pregnancies and increase the abortion rate.

Megan Donovan, Guttmacher senior policy manager, said restricting access isn't the answer.

"Empowering women to prevent unintended pregnancies and plan their families is both a human rights priority and smart public health policy."

The study, "Abortion Incidence and Service Availability in the United States, 2014," is available online at guttmacher.org.

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