The current U.S. abortion surveillance system yields reliable statistics on abortion incidence and patient characteristics, thanks to the joint efforts of state and federal governments and the Guttmacher Institute. Still, a new analysis in the Guttmacher Policy Review argues that this system should be strengthened in two key ways: First, the state and federal governments should collect data in a more complete and timely manner. Second, government abortion surveillance at the state and federal levels must be focused solely on collecting basic incidence and demographic data needed for legitimate public health purposes.
While very effective in informing public health policies and programs, the current U.S. abortion surveillance system is a patchwork. Most states report aggregate abortion data to the U.S. Centers for Disease Control and Prevention (CDC), but reporting from some of them is incomplete and California, Maryland and New Hampshire do not report to the CDC at all. The Guttmacher Institute, a nonprofit that funds its abortion surveillance work through private sources, supplements these government collection efforts through its own periodic census of abortion providers and survey of abortion patients.
"Ideally, all states would have robust abortion reporting systems to collect basic data on abortion incidence and patient characteristics, with the CDC then compiling and publishing national statistics," says Joerg Dreweke, author of the analysis. "Using voluntary surveys of providers and patients, private researchers could then build on the government-generated basic surveillance data to help answer other questions that—while too intrusive or unnecessary for the government to ask through mandatory abortion reporting—are important, like the reasons a patient is obtaining an abortion."
The analysis calls on the federal government to provide states with technical and financial assistance as needed to put in place more reliable abortion reporting systems. Dreweke also details how the current patchwork abortion surveillance system informs public health in myriad ways. For instance, CDC and Guttmacher researchers have noted that unintended pregnancies are rare among women who use the most effective contraceptive methods and that increasing access to and use of these methods could help reduce rates of unintended pregnancy and abortion.
However, the analysis warns that in a number of states, abortion reporting requirements have veered into political territory by requiring providers to report information that has no discernible public health purpose. For instance, nine states require providers to report whether state-mandated counseling was provided, and 13 states require providers to report whether state requirements for parental involvement were met.
"Opponents of abortion rights have long sought to restrict access to abortion care under the guise of advancing public health, and have in the process subverted important protections like informed consent and clinic safety regulations," says Dreweke. "The same is happening here. States should ensure compliance with their laws, but there is no justification for singling out abortion providers for special surveillance to achieve this end—or using a public health tool, abortion surveillance, to do so."
Dreweke points to Oklahoma as a particularly egregious example. A recurring theme in the state’s abortion reporting form—designed by abortion opponents in the state legislature—is an unwarranted undercurrent of suspicion that abortion providers are not following the law. Each time they complete the form, providers have to affirm on multiple occasions that they have complied with the state’s myriad abortion restrictions, like mandatory counseling, parental notice requirements and bans on "partial-birth" and sex-selective abortion. None of these questions serve a public health purpose.
The analysis cautions that in the current political climate, attempts to create a more robust government abortion surveillance system could well result in antiabortion policymakers in the states—and potentially even at the federal level—exploiting this issue in pursuit of their antiabortion agenda. Dreweke concludes that, while creating a more robust system is desirable, the United States already has a very good one that provides a large amount of information to ground reproductive health programs and policy in solid evidence.
Read the full article: "Abortion Reporting: Promoting Public Health, Not Politics," by Joerg Dreweke.