Congress Subverted on Family Planning

By Ruth K. Finkelstein

Many family planning supporters worked hard all summer to overcome the Reagan Administration's opposition to Title X, the national family planning program. Efforts were successful, and Congress reauthorized Title X as a categorical grant, appropriating $124 million for 1982. However, the Department of Health and Human Services did not concede defeat, but attempted to implement its opposition to Title X by means of an administrative solution.

This administrative solution included a new set of proposed regulations governing the Title X family planning program. These regulations state that family planning programs receiving federal funds:

1) Would be required to notify the parents of unemancipated teens within 10 days of pro-

viding them prescription drugs or devices used by women (birth control pills, IUD's, and diaphragms).

2) Could make exceptions to this rule only when the project director determines that parental notification would result in physical harm to the young woman.

3) Should define a teen's fee by her parent's income rather than her own resources. These regulations were published as Proposed Rules in the February 22, 1982 Federal Register. There is now a 60-day "public comment" period which closes April 23, 1982.

Planned Parenthood, a recipient of Title X funds, has a number of reasons for its opposition to the proposed parental notification regulations. First, they feel the proposed regulations violate the intent of Congress when it created the national family plan-

Abortion: The Public Record

by Jean Loria

According to a study published in Science, March 26, 1982, the increased availability of legal abortion in the U.S. has had a significant impact on public health. For those directly concerned--women of childbearing age-the legalization of abortion has dramatically decreased the number of deaths. In 1965, when abortion was illegal, 235 deaths were attributed to abortion as compared to 29 deaths in 1979. Likewise, there has been a decline in the number of women who were hospitalized with complications resulting from abortion. The greatest part of this decline coincided with the 1973 Supreme Court decision striking down state laws prohibiting abortion.

Several factors are pointed out as contributing to the improved safety of abortion methods. The most important factor is the widespread adoption of the vacuum aspiration technique (suction curettage) to replace the traditional scraping technique (sharp curettage). Other factors include better physician training and experience, improvements in anesthesia technique, better methods of dilation, reductions in the number of hysterectomies performed in conjunction with abortion, greater willingness to reevacuate a uterus if retained tissue is suspected, and physician familiarity with other abortion complications.

Women's response to the availability of legal abortion has further reduced morbidity and mortality. The more advanced the pregnancy, the greater the chance of complications after abortion. In 1970, nearly 25% of abortions were performed at 13 weeks or later. By 1978, this figure had declined to less than 10%, and more than 50% of abortions were done before 8 weeks. By seeking abortions at earlier gestational stages, women have directly impacted their own health.

Contrary to popular opinion, the data also suggests that the legalization of abortion did not result in a significant increase in the number of abortions performed nor in the use of abortion as a primary means of birth control. Estimates of illegal abortions in the U.S. in the 1960's range between 200,000 and 1,200,000 per year. This number has fallen to essentially zero, while the number of legal abortions steadily increased to around 1,500,000 in 1980. At the same time, studies show that there has been an increase in the use of contraception beyond that related to increased sexual activity.

Another trend in abortion cited in the report is the development of more convenient, low-cost outpatient health services. In 1980, 70% of abortions were performed in clinics, as compared to less than 40% in 1973. The legalization of abortion and subsequent development of clinic abortion services has reduced

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the cost of abortions by a substantial amount. In addition, for the "concerned taxpayer", the estimated 75% decrease in post-abortion complications has amounted to approximately a $20 million a year reduction in public expenditures. At least as important is the fact that as of 1980 virtually all abortion clinics offered pregnancy and contraceptive counseling as compared to only 60% of hospitals.

As one might suspect, marriage and childbearing patterns have changed as well in response to the advent of legal abortion. As early as 1970 marriage rates, especially in teenage women, began to decline in states where abortions were legal. Choice has affected not only the health of teenage women but their welfare with respect to avoiding marriages less stable than those of their contemporaries who postpone childbearing.

Moreover, carrying an unwanted pregnancy to term carries greater risk of death or surgery than if the woman chose to legally abort. Attitude also can affect postpartum infection and hemorrhage rates.

The decrease in deaths and complications after the legalization of abortion would also indicate that shady practices and incompetence are the exception. Investigative organizations, in cooperation with responsible abortion providers, have been conscientious in rooting out malpractice. The author points out that groups opposed to abortion have exaggerated the few cases as propaganda to restrict all abortion services.

Some preliminary reports have suggested that women who have had abortions increase their risks of future pregancy problems, such as miscarriage and premature infants, and the development of breast cancer. According to this report, the best available data is inadequate to ascertain the existence or magnitude of these risks.

Science is published by the American Association for the Advancement of Science, which will bring this article to the attention of the scientific community as well as policy-makers in health-related professions. Hopefully, this record will reach the mainstream media as well. Such a rational approach can only harm the anti-abortion forces.

Final Correction: The fact is that by the summer of 1981, Cleveland had a total of 1,068 construction apprentices, 39 of whom were women. The January 1982 issue WSW article "Coalition Contacts Sohio" incorrectly listed the total number of apprentices as 1,680. In our attempt to correct the original typo, we erred in our February-March 1982 erratum by stating the actual figure was 1,068 women apprentices. We wish it were true.

ning program and when it amended and reauthorized the program this summer. Title X was created to serve women who have trouble getting family planning services, specifically teenagers and low income women. When Congress reauthorized Title X in 1981, the original act was amended to "encourage family participation". The Conference Committee Report states, "The conferees believe that, while family involvement is not mandated, it is important that families participate in the activities authorized by this title as much as possible". The proposed regulations are mandating the involvement of parents, rather than encouraging it.

While Planned Parenthood believes family involvement in decision making is desirable, they fear that forcing this involvement will discourage teens from seeking family planning services. Unintended teen pregnancy is epidemic in this country: 1.2 million teenagers were pregnant in 1980. The family planning program is the only program which prevents teen pregnancies; an estimated 680,000 teen pregnancies were averted in 1980 alone.

In the Cleveland area, three-fourths of the teens remain unserved. A major problem in serving teens is their reluctance to come to a family planning clinic; teenagers have been sexually active for an average of nine months before coming to the clinic. A 1979/80 Alan Guttmacher Institute study showed that an important deterrent to teens visiting a clinic is fear their parents will find out. One-quarter of the teens stated they would not continue to attend the family planning clinic if their parents had to be notified; only 2 percent of these teens said they would stop having sex. It is clear that the proposed Title X regulations will discourage teenagers from seeking family planning services, and therefore will increase the incidence of teen pregnancy.

Furthermore, Planned Parenthood opposes requiring government involvement in the most intimate of family decisions and discussions. They feel the way to insure family-based decision making is to involve parents in their children's sexuality education from infancy. A note in the mail from a government agency cannot possibly create a relationship in families that takes years of discussion and interaction to accomplish.

These proposed regulations have not been written to improve the health of American families, but to impose upon the family planning program the moral agenda of a vocal minority intent upon eliminating reproductive rights. Therefore, Planned Parenthood has launched a campaign opposing the proposed regulations, speaking to other groups and organizations to urge them to write letters opposing the regulations. They are speaking on radio and on TV and writing to the newspaper. Planned Parenthood needs your help to make this effort work: write a letter to the editor or an "In My Opinion” message; write a letter to Marjory Mecklenburg at DHHS; suggest sympathetic organizations that would oppose the regulations.

Send your comments on the regulations to: Ms. Marjory Mecklenburg

Acting Deputy Assistant and

Secretary for Population Affairs Room 725H

U.S. Dept. of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201

Copies of your letter should go to Richard Schweiker, Secretary of the Department of Health and Human Services, President Ronald Reagan, Senators Glenn and Metzenbaum, and your Congressperson. If you can't make all those copies, send your letter to Planned Parenthood, which will make the copies and mail your letters for you.