An important new report by the Kaiser Family Foundation documents persistent disparities between white women and women of color on a broad range of health indicators, including rates of diseases such as diabetes, heart disease, AIDS and cancer. The report also documents widespread disparities in access to health insurance and health screenings, and finds that there are “racial and ethnic disparities in health status and health care in every state in the nation, often disparities that are quite stark.” It finds, moreover, that “there is growing evidence that social factors (e.g., income, education, occupation, neighborhoods, and housing) are associated with health behaviors, access to health care, and health outcomes.”
The new report provides further strong evidence debunking claims by anti–abortion rights activists, who, ignoring all other contextual factors, have long argued that high abortion rates among minorities are the result of supposed aggressive marketing by abortion providers to minority communities. In truth, as the Guttmacher Institute has pointed out repeatedly, abortion rates among racial and ethnic minorities—especially blacks and Hispanics—are directly linked to their higher rates of unintended pregnancy, which in turn reflect pervasive health disparities more generally.
In an August 2008 opinion piece in the Philadelphia Inquirer, Guttmacher Institute Board Chair Melissa Gilliam said of the high unintended pregnancy and abortion rates among African Americans: “The root causes are manifold: a long history of discrimination; lack of access to high-quality, affordable health care; too few educational and professional opportunities; unequal access to safe, clean neighborhoods; and, for some African Americans, a lingering mistrust of the medical community.”
What can be done about entrenched disparities in women’s health? Kaiser calls it a “formidable challenge” that will “require an ongoing investment of resources from multiple sectors that go beyond coverage and include strengthening the health care delivery system, improving health education efforts, and expanding educational and economic opportunities for women.”
In the context of high abortion rates among women of color, Guttmacher has argued that the fundamental question policymakers should be asking is not why women of color have high abortion rates, but rather what can be done to help them have fewer unintended pregnancies and achieve better health outcomes more generally. Barriers to health care access, including financial and geographic hurdles, remain a significant issue. For instance, many women of color are unable to afford prescription birth control methods, such as the IUD, that are highly effective over extended time periods but have high up-front costs.
Beyond access to affordable contraceptives, however, other factors like dissatisfaction with the quality of services and the methods themselves may be at least as much an impediment to consistent and correct contraceptive use. There is increasing recognition that quality of care plays a major role in health-seeking behavior and health outcomes. Dissatisfaction with health care providers, a problem often made worse by cultural or linguistic barriers, can lead to frustration and poor follow-through on contraceptive use. Unstable life situations, in which consistent use of contraceptives is a lower priority than simply getting by, can also be a factor.
It’s a complex challenge, but one thing is clear: By continuing to label abortion providers as “racists” and refusing to support expanded access to contraceptive services anti–abortion rights activists are by no means part of the solution—to high rates of unintended pregnancy and abortion among racial and ethnic minorities or to persistent and tragic disparities in health care generally.
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