Abortion—A Major Political Issue

AbortionA Major Political Issue

On January 22, 1973, the Supreme Court legalized abortion, setting the stage for this politically sensitive issue to become a continuing topic of debate on the floor of Congress and in state legislatures. In general, state Democratic parties support a woman's right to choose abortion, and state Republican parties do not. (See Table 3.1.)

In 2004 the majority of states considered legislation that would place greater limits on a person's right to choose abortion. (See Figure 3.1.) People supporting such measures are sometimes described as being "antichoice." Likewise, those who oppose limitations on abortion rights are often described as "pro-choice." According to the NARAL Pro-Choice America Foundation in Who Decides? A State-by-State Review of Abortion and Reproductive Rights, in 2004 a total of 714 antiabortion measures were introduced among all the states, and twenty-nine were enacted; 422 pro-choice measures were introduced, and thirty were enacted. The antichoice legislative measures most frequently considered by states in 2004 were increased counseling (giving "pro-life" information to a woman seeking an abortion) and mandatory delay requirements, refusal to provide medical services, restrictions on young women's access to reproductive health services, targeted regulation of abortion providers, and abstinence-only education. (See Figure 3.2.)

Figure 3.3 shows the choice positions of state governments. In order to be considered either pro-choice or antichoice in this analysis, both the majority of the legislature and the governor of the state must hold that position. Figure 3.4 and Figure 3.5 separate the two. Figure 3.4 shows each governor's position on choice, while Figure 3.5 shows each state legislature's positions on choice.

State restrictions on abortion are varied and numerous. The most common restrictions in effect are parental notification or consent requirements for minors, state-sponsored counseling and waiting periods prior to receiving an abortion, and limitations on public funding ("State Facts about Abortion," New York: Alan Guttmacher Institute, 2003).

The Roe v. Wade decision was a catalyst for the right-to-life (or pro-life) movement, which had its beginnings in the late 1960s. Pro-life groups (called antiabortion or antichoice groups by their opponents) consider the Roe v. Wade decision to be government-sanctioned mass killing of the unborn. Following the landmark decision, antiabortion activists supported constitutional amendments to overturn the Roe v. Wade ruling, but none were passed. A constitutional amendment requires two-thirds approval of each house of Congress and ratification by three-quarters of the state legislatures. Antiabortion groups since have attempted to limit aspects of the Roe decision, not only by influencing the appointment of lower court and Supreme Court judges but also by restricting the rights to abortion conferred by the Roe v. Wade ruling. Pro-choice groups suggest that other antichoice legislative measuressuch as recognizing the embryo and fetus as a person for legal purposes, mandating a waiting period and counseling requirements, and restricting minors' access to abortionalso are attempts to chip away at the Roe v. Wade decision.

FEDERAL FUNDING AND ABORTION

The federal government established the Medicaid program in 1965 to pay for medical care for the nation's needy through a federal-state cost-sharing arrangement. During the presidential administration of Richard Nixon (196974), the Department of Health, Education, and Welfare (HEW, now the Department of Health and Human Services, or HHS) reimbursed states for abortions for poor women. Following the Roe v. Wade decision in 1973, HEW considered abortion a medical procedure funded by Medicaid.

TABLE 3.1
Positions of state Democratic and Republican parties on a woman's right to choose abortion, 2004
State Democrat Republican
Supports Opposes No position Unknown Supports Opposes No position Unknown
This party platform does not explicitly oppose a woman's right to choose, but it supports an Indiana law that states, "Childbirth is preferred, encouraged, and supported over abortion."
Notes:
Democratic Party
40 state Democratic Party platforms fully support a woman's right to choose.
8 state Democratic Party platforms do not take a position on a woman's right to choose: AL, AR, GA, IN, KS, NM, ND, SD.
Mississippi is the only state whose Democratic Party platform opposes a woman's right to choose.
Republican Party
44 state Republican Party platforms oppose a woman's right to choose.
2 state and the District of Columbia Republican party platforms do not take a position on a woman's right to choose: CT, MA.
Source: Adapted from "Political Findings: Political Party Platform Information," in Who Decides? The Status of Women's Reproductive Rights in the United States, 14th ed., NARAL Pro-Choice America & NARAL Pro-Choice America Foundation, January 2005, http://www.prochoiceamerica.org/yourstate/whodecides/trends/2005_key_findings.cfm#political (accessed September 20, 2005)
National X X
Alabama X X
Alaska X X
Arizona X X
Arkansas X X
California X X
Colorado X X
Connecticut X X
Delaware X X
District of Columbia X X
Florida X X
Georgia X X
Hawaii X X
Idaho X X
Illinois X X
Indiana X
Iowa X X
Kansas X X
Kentucky X X
Louisiana X X
Maine X X
Maryland X X
Massachusetts X X
Michigan X X
Minnesota X X
Mississippi X X
Missouri X X
Montana X X
Nebraska X X
Nevada X X
New Hampshire X X
New Jersey X X
New Mexico X X
New York X X
North Carolina X X
North Dakota X X
Ohio X X
Oklahoma X X
Oregon X X
Pennsylvania X X
Rhode Island X X
South Carolina X X
South Dakota X X
Tennessee X X
Texas X X
Utah X X
Vermont X X
Virginia X X
Washington X X
West Virginia X X
Wisconsin X X
Wyoming X X
Total 41 1 8 2 0 44 3 4

In 1974 abortion opponents in Congress attached a rider to the annual HEW appropriations (funding) bill. The rider forbade or restricted the use of federal funding for abortion, but it was overwhelmingly defeated.

After the Supreme Court ruling in Roe v. Wade, the number of abortions increased rapidly until, by 1976, according to the Centers for Disease Control and Prevention, almost one million abortions were being performed annually. An estimated three hundred thousand of these were federally funded. Abortion foes were angered by what they considered a mass slaughter being partially financed with tax dollars, and they responded by lobbying their senators and representatives to end this practice.

In 1976 then-freshman congressman Henry Hyde (R-IL) introduced an abortion rider to the HEW-Labor appropriations bill. Reflecting changing political attitudes in Congress, it passed. In fact, the 1976 rider, since known as the Hyde Amendment, has become the subject of an annual battle in Congress.

Representative Hyde originally proposed that no federal funding could be used for abortion. Following considerable debate, Congress settled on a compromise, which stated that none of the funds contained in the appropriations bill would be used to perform abortions except "where the life of the mother would be endangered if the fetus were carried to term." (This is a common sticking point for abortion legislationsuch as in the case of laws relating to partial-birth abortion.) The Departments of Labor and Health, Education, and Welfare Appropriations Act (PL 94-439), which included the abortion provision, became law in September 1976. However, because of legal challenges, it did not go into effect until almost a year later, in August 1977.

Almost immediately, the Hyde Amendment was challenged in the courts. The U.S. Supreme Court heard and ruled on public funding cases involving funding limitations both for therapeutic (medically necessary) and nontherapeutic (elective, or not medically necessary) abortions.

Funding Compromise

Over the years the language of the Hyde Amendment has changed occasionally. The conflict usually has involved the House demanding strict control over the use of federal monies for abortion and the generally more liberal Senate trying to modify House demands. In 1977 the House passed an amendment calling for Hyde's original proposal that no federal funds be used for any abortion, even one necessary to save the life of the mother. However, after lengthy debate and political maneuvering, the final compromise prohibited the use of federal funds to pay for abortions except:

  • For victims of rape or incest if the occurrence was reported promptly to the proper authorities
  • If justified to save the mother's life
  • In instances where two doctors determined that "severe and long-lasting physical health damage to the mother" may result

Congress began applying the Hyde Amendment to Medicare and Medicaid in 1988. Although Medicare is a medical insurance program for people over the age of sixty-five, it does provide for some disabled persons younger than sixty-five. Under the Hyde Amendment, all federally funded abortions for disabled women were banned except in cases of life endangerment, rape, or incest.

STATE FUNDING AND ABORTION

Medicaid is a federal assistance program for low-income people. Medicaid is implemented by the states, but with federal funds and federal guidelines. As of 2005, thirty-two states plus the District of Columbia allowed the funding of abortion under Medicaid in cases of life endangerment, rape, and incest. (See Table 3.2.) One state (South Dakota), in violation of federal law, provided Medicaid funding for abortion only if a woman's life was in danger. Seventeen states funded abortion in all or most circumstances, using state funds when Medicaid would not pay.

Abortion Funding and Managed Care

For the first time since the Roe v. Wade decision, the 1996 congressional elections resulted in a pro-life majority in both the House and the Senate. Pro-life lawmakers pointed out that, because states are increasingly contracting with managed-care organizations to provide Medicaid recipients with health services, the Hyde Amendment had to be revised. Representative Hyde sought to forbid health plans from offering abortion coverage when they contracted with states under Medicaid. He claimed that in cases where states used their own funds to pay for abortions beyond the federally mandated cases of rape, incest, and life endangerment, purchasing a health plan using a "co-mingling" of federal and state monies presented the possibility of an indirect federal abortion subsidy.

Hyde's proposed change met with great opposition from pro-choice Democrats. They protested that the new law would negatively affect privately insured women whose insurance companies contracted with the states. It also would affect Medicaid recipients in those states where abortions were subsidized. In the end the revised version passed with the provision that federal funds would not be used to purchase managed-care packages that included coverage of abortion. States that covered abortion with their own funds would be able to continue doing so under a separate program. In November 1997 President Clinton signed the FY (fiscal year) 1998 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (PL 105-78) with the abortion provision.

Abortion Funding and the State Children's Health Insurance Program

In August 1997 the Balanced Budget Act (PL 105-33) amended the Social Security Act (PL 89-97) by adding Title XXI (State Children's Health Insurance Program, or CHIP) to allocate funds to states to provide child health assistance to uninsured, low-income children who are not eligible for Medicaid. Under CHIP, state funds may be used for abortion only to save the life of the mother or if the pregnancy resulted from rape or incest.

How Much Do States Pay?

According to the Alan Guttmacher Institute (AGI), in 2001 about 14% of all abortions in the United States were paid for with public, mainly state, funds. About 74% of abortions were paid with personal funds, and the remaining 13% were paid for by private health insurance. Table 3.3 shows that, among the abortions paid for with public funds, state governments reported spending $72 million in 2001 to provide 168,518 abortion procedures. The federal government spent $233,000 for eighty-three abortion procedures. The eighteen states with nonrestrictive policies used their own funds to pay for most or all of the medically necessary abortions provided to Medicaid recipients. These funds accounted for well over 99% of the total expenditures and procedures paid for with public funds.

ABORTION SERVICES FOR MILITARY PERSONNEL

Before 1970 the armed forces of the United States did not have any official policy regarding the provision of abortion. Individual commanders had unwritten policies, which lower-rank personnel followed. Military medical facilities followed the laws in the states in which they were located, and it was up to individual physicians whether to offer abortion services.

According to "Abortion Services and Military Medical Facilities" (University of Maryland School of Law, Thurgood Marshall Law Library, http://www.law.umaryland.edu/marshall/crsreports, November 24, 2002), in 1970 the Department of Defense (DOD) issued an order that "military hospitals perform abortions when it is medically necessary or when the mental health of the mother is threatened." Military physicians, however, were not required to perform abortions.

After the 1973 Supreme Court decision in Roe v. Wade, the DOD funded abortions for women eligible for military health care. To perform an abortion, two physicians had to satisfy the above stipulation of "medical necessity" or "risk to mental health." In addition, the funding had to fall within the state regulations concerning abortions.

During the rest of the 1970s, varying abortion language was added to the DOD appropriations acts, with the exceptions ranging from saving the mother's life, rape, and incest, to severe, long-lasting physical damage to the mother. Women whose condition did not satisfy the law paid for their abortions at the military medical facilities.

By 1981 abortion was allowed only to save the life of the mother. In 1988 the DOD began banning all abortions at military medical facilities overseas, even if the woman was willing to pay for the procedure herself. In 1993, following his inauguration, President Clinton issued a memorandum to "permit abortion services to be provided [at U.S. military facilities], if paid for entirely with non-DOD funds" (quoted in "Abortion Services and Military Medical Facilities"). However, in 1996, after Republicans took control of Congress, the National Defense Authorization Act (PL 104-106) again banned the performance of abortions in U.S. military medical facilities except in cases of endangerment to the mother's life, rape, or incest.

At subsequent sessions of Congress, proposed amendments to PL 104-106, allowing privately paid abortions, were defeated. Currently, women in the U.S. armed forces wanting an abortion must return to the United States or have the procedure performed at a private overseas facility.

AVOIDING ABORTION: FUNDING THROUGH TITLE X FOR FAMILY PLANNING/CONTRACEPTION

In 1970, with broad bipartisan support, Congress enacted Title X of the Public Health Service Act (Family Planning Program, PL 91-572), which provides federal assistance to family planning clinics for contraception, infertility, and basic gynecologic services. The law specifically prohibits abortion as a method of family planning and forbids the use of any program monies to perform or advocate abortion. The program is intended to primarily benefit low-income women and adolescents. According to the AGI in "Fulfilling the Promise: Public

TABLE 3.2
Low-income women's access to abortion, 2005
State State prohibits low-income women's access to abortion except in Low-income women's access to abortion allowed State State prohibits low-income women's access to abortion except in Low-income women's access to abortion allowed
Life endangerment only Cases of life endangerment, rape, or incest Life endangerment, only Cases of life endangerment rape, or incest
This information is not conclusive as some states allow abortion in select other circumstances such as substantial and irreversible impairment of a major bodily function, medical emergency, and/or some cases of fetal anomaly.
Source: "Low-Income Women's Access to Abortion," in Who Decides? The Status of Women's Reproductive Rights in the United States, 14th ed., NARAL Pro-Choice America & NARAL Pro-Choice America Foundation, updated May 27, 2005, http://www.prochoiceamerica.org/yourstate/whodecides/maps/low_income.cfm (accessed September 20, 2005)
Alabama X Nebraska X
Alaska X Nevada X
Arizona X New Hampshire X
Arkansas X New Jersey X
California X New Mexico X
Colorado X New York X
Connecticut X North Carolina X
Delaware X North Dakota X
District of Columbia X Ohio X
Florida X Oklahoma X
Georgia X Oregon X
Hawaii X Pennsylvania X
Idaho X Rhode Island X
Illinois X South Carolina X
Indiana X South Dakota X
Iowa X Tennessee X
Kansas X Texas X
Kentucky X Utah X
Louisiana X Vermont X
Maine X Virginia X
Maryland X Washington X
Massachusetts X West Virginia X
Michigan X Wisconsin X
Minnesota X Wyoming X
Mississippi X Total 1 33 17
Missouri X
Montana X
TABLE 3.3
Public funding for abortion services, 2001
State Expenditures [in thousands] Number of abortions
Total Federal State Total Federal State
    U.S. total $72,707 $233 $72,473 168,601 83 168,518
Nonrestrictive policy
    Voluntary policy 32,722 0 32,722 51,852 0 51,852
      Hawaii nr 0 nr nr 0 nr
      Maryland 2,300 0 2,300 3,324 0 3,324
      New York 23,090 0 23,090 36,131 0 36,131
      Washington 7,332 0 7,332 12,397 0 12,397
    Court ordered policy 39,735 11 39,724 116,651 26 116,625
      Alaska 277 3 274 541 5 536
      California 27,183 0 27,183 84,381 0 84,381
      Connecticut u u u 3,913 5 3,908
      Idaho 27 5 22 39 5 34
      Illinois 6 0 6 u 0 u
      Indiana 0 0 0 0 0 0
      Massachusetts 2,391 0 2,391 5,874 0 5,874
      Minnesota 856 3 853 3,241 11 3,230
      Montana 100 0 100 u 0 u
      New Jersey 6,000 0 6,000 11,514 0 11,514
      New Mexico 451 0 451 1,265 0 1,265
      Oregon 1,930 0 1,930 4,371 0 4,371
      Vermont 181 0 181 469 0 469
      West Virginia 334 0 334 1,043 0 1,043
Restrictive policy
    Life, rape, incest 231 220 10 81 56 25
      Alabama 1 1 0 5 5 0
      Arizona 0 0 0 0 0 0
      Arkansas 0 0 0 0 0 0
      Colorado nr 0 nr nr 0 nr
      Delaware 0 0 0 0 0 0
      District of Columbia 0 0 0 0 0 0
      Florida nr 0 nr nr 0 nr
      Georgia 13 5 8 23 5 18
      Kansas u 0 u u 0 u
      Kentucky 13 13 0 8 8 0
      Louisiana 0 0 0 0 0 0
      Maine 3 3 nr u u nr
      Michigan 0 0 0 0 0 0
      Missouri 1 1 0 1 1 0
      Nebraska nr 0 nr nr 0 nr
      Nevada 0 0 0 0 0 0
      New Hampshire nr 0 nr nr 0 nr
      North Carolina 37 37 0 6 6 0
      North Dakota 2 2 0 1 1 0
      Ohio 42 42 0 6 6 0
      Oklahoma 0 0 0 0 0 0
      Pennsylvania 0 0 0 0 0 0
      Puerto Rico nr 0 nr nr 0 nr
      Rhode Island 2 0 2 7 0 7
      South Carolina 114 114 0 20 20 0
      Tennessee nr 0 nr nr 0 nr
      Texas 2 2 0 3 3 0
      Utah 0 0 0 0 0 0
      Wyoming 1 1 0 1 1 0

Policy and U.S. Family Planning Clinics" (2000), each year more than four million women receive health care services at family planning clinics funded by Title X. These women are mainly young, poor, and uninsured, and most have never had a child. Of women using Title X-funded clinics, 71% are twenty years or older and 65% are white. Approximately 65% have incomes at or below the federal poverty level (which means they earn less than $15,020 per year for a family of three). It is estimated that these clinics are the only source of family planning services for more than 80% of the women they serve. Fewer than 5% of Title X fund recipients are abortion providers, according to the National Abortion Federation in "Abortion and Title X: What Health Care Providers Need to Know" (2003).

According to the AGI study "Fulfilling the Promise," Title X-supported clinics enable one million women each year to avoid unintended pregnancy and have helped prevent almost twenty million pregnancies over the last twenty years. Of these pregnancies, nine million would have ended in abortion, according to the report. Services are also available to men; about 2% of Title X clients are adult and adolescent males.

TABLE 3.3
Public funding for abortion services, 2001 [continued]
State Expenditures [in thousands] Number of abortions
Total Federal State Total Federal State
Notes: States with nonrestrictive policies use their own funds to pay for most or all medically necessarily abortions provided to Medicaid recipients; the policy may have been adopted either voluntarily or because of a court order. States with restrictive policies pay for abortions only in a few circumstances: when necessary to save the life of the woman or when the pregnancy is the result of rape or incest (which is federal policy); only to save the life of the woman (a violation of federal policy); or "broader than life, rape, incest" which means that states use their own funds to pay for abortions under additional rare circumstances such as in cases of fetal abnormality.
nr = no response or not available.
u = unknown.
Source: Adam Sonfield and Rachel Benson Gold, "Table 9. Reported Public Expenditures for Abortions (in 000s of dollars) and Number of Publicly Funded Abortions, by Funding Source, According to State and State Funding Policy (as of October 1, 2001), FY2001," in Public Funding for Contraceptive, Sterilization and Abortion Services, FY 19802001: National and State Tables and Figures, The Alan Guttmacher Institute (AGI), 2005, http://www.guttmacher.org/pubs/fpfunding/tables.pdf (accessed September 20, 2005)
    Life only 0 0 0 0 0 0
      Mississippi 0 0 0 0 0 0
      South Dakota 0 0 0 0 0 0
    Broader than life, rape, incest 19 2 16 17 1 16
      Iowa 17 2 15 9 1 8
      Virginia 2 0 2 2 0 2
      Wisconsin u 0 u 6 0 6

Guidelines instituted under the presidential administration of Jimmy Carter (197781) indicated that federally funded clinics could not advise a pregnant woman to have an abortion, and the clinic could not pay for the abortion should a woman choose to have one. However, the clinics "are to" inform her in a "nondirective" manner that her options include keeping the baby, giving the child up for adoption, or ending the pregnancy by having an abortion. In September 1986 the Reagan administration changed the wording in the guidelines from "are to"which implied a mandatory requirementto "may"which was subject to individual judgment. Should the woman want an abortion, the federally funded agency had to provide her with a list of abortion clinics that operated without federal funding.

Male Involvement in Family Planning

Since 1996 the Title X program has provided additional funds for an adolescent male initiative that employs male high school students as interns in the clinics. The students receive training in clinic operation and peer education, assistance in identifying possible careers in health and health-related occupations, and use of services in a family planning setting. The program also has awarded research grants to organizations that include social and educational services to males, enabling these organizations to evaluate the addition of reproductive health and family planning services to their existing program.

Confidential Family Planning Services for Adolescents

Of the four million people receiving reproductive health and family planning services each year at family planning clinics funded by Title X, about one-third are younger than twenty years old. Although the law requires Title X clinics to encourage parental participation in teenage reproductive health decisions, they have to respect a teenager's wish not to involve his or her parents. Courts have recognized the importance of confidential services for teenagers. In Planned Parenthood Association of Utah v. Matheson (582 F. Supp. 1001, 1009 [D. Utah 1983]), a U.S. District Court prohibited a "blanket parental notification requirement" for minors seeking contraceptives. The court observed that adolescents who seek contraceptives are usually already sexually active. Therefore, these same adolescents would continue engaging in sexual activity even if they could not obtain contraceptives, thereby exposing themselves to "the health risks of early pregnancy and venereal disease" (quoted in "Government-Mandated Parental Involvement in Family Planning Services Threatens Young People's Health," NARAL Pro-Choice America Foundation, http://www.prochoiceamerica.org/facts/parental.cfm).

Funding for Private Family Planning Clinics

Besides providing monies to more than four thousand family planning clinics run by state and local governments, Title X also provides grants to private nonprofit groups that provide family planning services. In 1988 the HHS, acting on President Ronald Reagan's recommendation, issued regulations revising their interpretation of Section 1008, the longstanding statutory prohibition against using Title X funds to "promote abortion." The guidelines reaffirmed that Congress intended Title X funds "to be used only to support preventive family planning services."

The Reagan administration further prohibited counselors at federally funded clinics from discussing abortion as an alternative in an unintended pregnancy and from referring pregnant women to an abortion provider even if patients ask for such assistance and it is paid for with private funds. This prohibition against discussing abortion in Title X clinics became known as the "gag rule."

TITLE X CLINICS AND THE "GAG RULE." About thirty-six state health departments and seventy-eight national organizations opposed the gag rule because they said it violated the clinics' First Amendment right to free speech and infringed on the doctor-patient relationship. In May 1991 in Rust v. Sullivan (500 U.S. 173), the Supreme Court, voting 5-4, upheld the gag rule.

The American Medical Association (AMA) attacked the ruling, not only because it interfered with the doctor-patient relationship but because it exposed doctors to the risk of medical malpractice lawsuits for not informing a woman with a high-risk pregnancy of all her options. Pregnancy can be a risk to the health of a woman with diabetes, cancer, AIDS, hypertension, renal (kidney) disease, sickle cell anemia, malnutrition, or other serious illnesses. Some of these diseases particularly affect African-American women who, because of their greater rates of poverty, are more likely than white women to use federally funded clinics for health care.

Some federally funded clinics, including Planned Parenthood, chose, at the risk of having to close down, to turn down federal support rather than comply with the gag rule. The then-deputy assistant secretary of the HHS, William Archer, responded that if clinics would not comply, HHS simply would find other clinics to replace them. There were areas of the country, however, where there were no other existing health care providers ready to step in, leaving women who depended on subsidized health care with no source for prenatal care and contraceptive services.

In Congress those opposing Rust v. Sullivan fought to overturn the Title X gag rule by placing a rider blocking it on an appropriations bill for the HHS. In November 1991 when President George H. W. Bush received the appropriations bill, he vetoed it due to the rider.

Supporters of the bill tried to garner the two-thirds vote in Congress needed to overturn the presidential veto but failed. In August 1992 a federal appeals court ruled that the HHS could move forward with implementation of the regulations. On January 22, 1993, the twentieth anniversary of Roe v. Wade, newly elected President Bill Clinton repealed the gag rule.

The Adequacy of Title X Funding

Although the authorizing law (PL 91-572) for the Title X family planning program expired on September 30, 1985, annual appropriations legislation has continued its funding. During the years of the Reagan administration (198189) and the George H. W. Bush administration (198993), funding was less than it had been in prior years. Funding rose dramatically during the years of the Clinton administration (19932001). In Clinton's last year in office almost $254 million Title X funds were appropriated. Funding has also increased under the George W. Bush administration, which began in 2001. In 2003 $275 million was funded, and in 2005 $288 million was funded. (See Table 3.4.) Nevertheless, according to the National Family Planning and Reproductive Health Association (http://www.nfprha.org/pac/wac/index.asp?step=2=2956), if Title X funding kept up with inflation since fiscal year 1980, it would have be funded at more than $600 million in 2003.

ATTEMPTS TO "DEFUND" TITLE X. Each year antiabortion lawmakers try to "defund," or eliminate, federal monies from the Title X program. Although the law prohibits Title X funds from being used for abortion, opponents of Title X argue that organizations such as the Planned Parenthood Federation of America, which provide abortions, should not receive Title X funds. They believe clinic clients might think abortion is a method of family planning. In addition, critics feel that instead of preventing teen pregnancy by providing adolescents with contraceptives, more efforts should be made in encouraging abstinence before marriage. (Title X clinics do offer adolescents abstinence counseling and education.)

INTERNATIONAL U.S. AID FOR FAMILY PLANNING/CONTRACEPTION

The Foreign Assistance Act

In 1961 Congress passed the Foreign Assistance Act (FAA), which reorganized the U.S. foreign assistance programs and mandated the creation of an agency to administer themthe U.S. Agency for International Development (USAID). USAID offered direct support to the developing nations of the world.

The FAA contained few restrictions on how assistance was to be provided and contained only general guidelines on the kinds of factors to be taken into account prior to providing assistance. In 1973 Congress amended the FAA, forbidding the use of American foreign aid funding "to pay for the performance of abortions as a method of family planning or to motivate or coerce any person to practice abortions."

Thus, in 1984 the Reagan administration cut U.S. funding to the International Planned Parenthood Federation because it included abortion among the options recommended for controlling family size. In July 1985 the administration indicated that the United States would provide monies to organizations that advocated only "natural" or noncontraceptive methods of family planning.

The following year, the Reagan administration withheld $10 million in aid to the United Nations Fund for Population Activities (UNFPA). Now called the United Nations Population Fund, UNFPA was dedicated to limiting the world's population increase. The Reagan administration charged UNFPA with helping the government of the People's Republic of China to carry out forced abortions and sterilizations. The $10 million was roughly equal to the UNFPA's annual spending in the People's Republic of China. Funding for UNFPA has been debated in Congress every year since 1985.

TABLE 3.4
Funding for the Office of Family Planning, fiscal years 19712005
Fiscal year Total funds appropriated
Source: "Funding History FY 19712005," U.S. Department of Health and Human Services, Office of Population Affairs, Office of Family Planning, http://opa.osophs.dhhs.gov/titlex/ofp-funding-history.html (accessed September 20, 2005)
1971 $6,000,000
1972 61,815,000
1973 100,615,000
1974 100,615,000
1975 100,615,000
1976 100,615,000
1977 113,000,000
1978 135,000,000
1979 135,000,000
1980 162,000,000
1981 161,671,000
1982 124,176,000
1983 124,088,000
1984 140,000,000
1985 142,500,000
1986 136,372,000
1987 142,500,000
1988 139,663,000
1989 138,320,000
1990 139,135,000
1991 144,311,000
1992 149,585,000
1993 173,418,000
1994 180,918,000
1995 193,349,000
1996 192,592,000
1997 198,452,000
1998 203,452,000
1999 215,000,000
2000 238,885,000
2001 253,932,000
2002 265,000,000
2003 275,000,000
2004 280,000,000
2005 288,000,000

The Mexico City Policy/Global Gag Rule

At the United Nations population conference in Mexico City in 1984, President Reagan announced that the United States would no longer support private family planning groups overseas that, with their own funds, performed or promoted abortion. In June 1991 the Supreme Court upheld the policy by refusing to hear the case Planned Parenthood Federation of America v. Agency for International Development (cert. denied, 498 U.S. 933).

When the International Planned Parenthood Federation (IPPF) refused to implement the Reagan restriction on their affiliates in developing countries, the administration withdrew U.S. funds from the IPPF. The Reagan restriction, although never enacted into law, was enforced as an executive order for almost a decade. When President Clinton took office in 1993, he revoked the "Mexico City Policy" and restored the U.S. contribution to the UNFPA.

Many Americans agreed with this decision. A 1992 poll commissioned for the Population Crisis Committee (a nonprofit organization dedicated to providing international contraception and reproductive health care, later renamed Population Action International) found that 58% of Americans supported the use of U.S. funds for family planning in developing countries. About 65% said that family planning aid should not be denied to organizations that provided information about abortion, and 67% indicated that foreign aid should not be used to promote antiabortion policies internationally.

Since 1994, antiabortion advocates have introduced abortion-related clauses to a number of foreign aid measures. These lawmakers, led by Representative Christopher Smith (R-NJ), have sought to restrict U.S. aid to family planning groups that provide legal abortion services or advocate abortion rights in their countries. Pro-choice advocates liken this effort to the Mexico City Policy, calling it the "Global Gag Rule" because, they say, it limits free speech and the provision of abortion services.

For the first time, the Global Gag Rule was written into law for a year in the omnibus appropriations bill for FY 2000. In exchange for the release by Congress of $926 million in dues owed the United Nations, President Clinton agreed to restrictions on the $385 million appropriated for international family planning. Private organizations that performed or promoted abortion could not receive U.S. funds, as was the case under the Mexico City Policy.

On January 22, 2001, on the first business day of President George W. Bush's presidency and the twenty-eighth anniversary of Roe v. Wade, the new U.S. president issued a memorandum reinstating the Mexico City Policy, which had been rescinded since January 22, 1993. President Bush wrote in the memo, "It is my conviction that taxpayer funds should not be used to pay for abortions or advocate or actively promote abortion, either here or abroad. It is therefore my belief that the Mexico City Policy should be restored." He stated that he was reviving the rule in the belief that "it will make abortion more rare."

Although the reinstated Global Gag Rule is identical to that implemented two decades ago, the trend in abortion law worldwide has been toward making laws less strict. Since the Global Gag Rule was first implemented, twenty-six countries have made their abortion laws less strict, and five countries have tightened their laws. (See Table 3.5.) In 1999 41% of all women worldwide lived in countries where abortion is legal without restriction. Another 34% lived in countries where abortion is legal with restriction. (See Figure 3.6.) With the more recent implementation of the gag rule, the possibility of conflict arose because more countries that receive U.S. population assistance allowed abortions than during the past implementation. By June 2004, however, the 1999 percentages shown in Figure 3.6 remained relatively unchanged. See Table 8.1 in Chapter 8 for a comparison.

TABLE 3.5
Countries changing their abortion laws since the initial imposition of the "Global Gag Rule," 19852004
Source: Compiled by Sandra Alters with data from The Alan Guttmacher Institute and the Center for Reproductive Rights for Thomson Gale
26 countries have liberalized their abortion laws since the initial imposition of the global gag rule
Albania (1991, 1996) Ghana (1985)
Algeria (1985) Greece (1986)
Belgium (1990) Guinea (2000)
Botswana (1991) Malaysia (1989)
Benin (2003) Mali (2002)
Bulgaria (1990) Mongolia (1989)
Burkina Faso (1996) Nepal (2002)
Cambodia (1997) Pakistan (1990)
Canada (1988) Romania (1989)
Chad (2002) Slovakia (1986)
Czech Republic (1986) South Africa (1996)
Ethiopia (2004) Spain (1985)
France (2001) Switzerland (2002)
Five countries have tightened their laws
El Salvador (1998) Russian Federation (2003)
Hungary (2000) United States (2003)
Poland (1997)

In September 2003 President Bush issued an executive order preventing the State Department from giving family planning grants to international groups that provide abortion-related counseling, effectively extending the Global Gag Rule, which previously applied only to the USAID. The new order exempts agencies in Africa and the Caribbean that would benefit from President Bush's five-year, $15 billion global AIDS initiative, however.

In April 2005 the U.S. Senate passed an amendment to the Foreign Affairs Authorization Act brought forward by Senators Barbara Boxer (D-CA) and Olympia Snowe (R-ME) that would repeal the Global Gag Rule. As of August 2005 no more action had been taken on the legislation.

WELFARE REFORM AND ABORTION

In 1995, as Congress worked to overhaul the nation's welfare system, the legislators were split on issues concerning teen pregnancy and abortion. Some believed that discontinuing federal cash assistance to the needy would help discourage out-of-wedlock childbearing. According to Lisa Kaeser's "Washington Memo" (Alan Guttmacher Institute, August 7, 1996), these members regarded out-of-wedlock births, especially among adolescents, as "both a central cause of welfare dependency and a direct result of the 'culture' it creates." Others feared that limiting welfare cash benefits would lead poor women to choose abortion.

In 1996 the sixty-year-old federal cash assistance program, Aid to Families with Dependent Children (AFDC), was eliminated, and President Clinton signed the new welfare reform law, the Personal Responsibility and Work Opportunity Reconciliation Act of 1998 (PL 104-193), which created the Temporary Assistance for Needy Families (TANF) program. TANF provides assistance and work opportunities to needy families by granting states the federal funds and wide flexibility to develop and implement their own welfare programs.

The new welfare reform law outlined specific provisions for reducing out-of-wedlock and teen pregnancies. Although it allowed states to spend a portion of their TANF funds on "prepregnancy family services," it prohibited funding of other medical services, such as abortions.

Although most out-of-wedlock births are to women not on welfare, Congress used the welfare reform law to stress the issue of illegitimacy. To encourage the states to develop effective solutions for reducing out-of-wedlock births, PL 104-193 provided for a performance incentive called "Bonus to Reward Decrease in Illegitimacy Ratio." Under the new law the federal government would award up to $100 million annually to a maximum of five states that reduced nonmarital births while decreasing their abortion rates below 1995 levels.

Table 3.6 shows the ranking of the states based on the decline in the percentage of nonmarital births. Table 3.6 shows that the District of Columbia and four states (New York, Maryland, New Hampshire, and Connecticut) had a reduction in their ratio of nonmarital births. The ratio also declined in American Samoaa decline that was larger than any of the state-specific declines. Table 3.6 does not show whether states decreased their abortion rates below 1995 levels.

UNBORN VICTIMS OF VIOLENCE ACT

Currently, thirty-two states have homicide laws that recognize unborn fetuses as victims at some point before birth. (See Figure 3.7.) On April 1, 2004, the federal Unborn Victims of Violence Act was enacted and covers unborn victims of federal and military crimes; it does not override existing state laws. The legislation states that anyone who causes the death or bodily injury of a fetus is "guilty of a separate offense" and that "the punishment for that separate offense is the same as the punishment provided under Federal law for that conduct had that injury or death occurred to the unborn child's mother." The law makes exceptions for legal medical procedures, including abortion, and acts on behalf of a pregnant woman. Opponents of the law, however, consider it a sneak attack on abortion rights because, in effect, it considers a fetus to be a person. They also state that pro-life groups are attempting to label the fetus as a person to change public perception about the nature of abortion.

TABLE 3.6
Percentage of births to unmarried women, by state and territory, 19992000 and 200102
State Percent unmarried 20012002 Percent unmarried 19992000 Percent change in percent unmarried, 19992000 to 20012002 State Rank order of states by largest decline in percent unmarried, 19992000 to 20012002
Rank State Percent change
Note: Calculations for all states and territories were done on the basis of data files provided by each state to the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), which has tabulated the entire national birth file by mother's place of residence.
aExcludes data for the territories.
bData not available.
Source: "Percent of Births to Unmarried Women, 19992000 Average and 20012002 Average, and Percent Change in the Percent of Births to Unmarried Women, 19992000 to 20012002, and Rank Order of States with Respect to Their Change (in order of largest decline to largest increase) and Rank Order of Territories (ranked separately from States)," Centers for Disease Control and Prevention, National Center for Health Statistics, http://www.cdc.gov/nchs/data/welfare/bonint04.pdf (accessed September 20, 2005)
United Statesa 33.739% 33.120% 1.869% United Statesa United Statesa 1.869%
Alabama 34.577% 33.797% 2.308% Alabama 1 District of Columbia -6.680%
Alaska 33.399% 33.086% 0.946% Alaska 2 New York -2.359%
Arizona 39.940% 39.021% 2.355% Arizona 3 Maryland -0.334%
Arkansas 36.629% 35.460% 3.297% Arkansas 4 New Hampshire -0.331%
California 32.867% 32.788% 0.241% California 5 Connecticut -0.062%
Colorado 25.883% 25.224% 2.613% Colorado California 0.241%
Connecticut 29.116% 29.134% -0.062% Connecticut Massachusetts 0.818%
Delaware 40.272% 38.385% 4.916% Delaware Alaska 0.946%
District of Columbia 56.946% 61.022% -6.680% District of Columbia Illinois 0.982%
Florida 39.153% 37.864% 3.404% Florida Oregon 1.266%
Georgia 37.566% 36.777% 2.145% Georgia Mississippi 1.615%
Hawaii 33.292% 32.528% 2.349% Hawaii Virginia 1.647%
Idaho 21.969% 21.606% 1.680% Idaho Idaho 1.680%
Illinois 34.643% 34.306% 0.982% Illinois Utah 1.754%
Indiana 35.913% 34.565% 3.900% Indiana New Jersey 1.782%
Iowa 29.059% 27.750% 4.717% Iowa Missouri 1.889%
Kansas 30.502% 28.803% 5.899% Kansas North Dakota 1.986%
Kentucky 32.443% 30.713% 5.633% Kentucky South Carolina 2.017%
Louisiana 46.662% 45.240% 3.143% Louisiana Georgia 2.145%
Maine 32.169% 31.162% 3.231% Maine Alabama 2.308%
Maryland 34.617% 34.733% -0.334% Maryland Washington 2.335%
Massachusetts 26.750% 26.533% 0.818% Massachusetts Hawaii 2.349%
Michigan 34.210% 33.190% 3.073% Michigan Arizona 2.355%
Minnesota 26.883% 25.853% 3.984% Minnesota Rhode Island 2.388%
Mississippi 46.700% 45.958% 1.615% Mississippi Wisconsin 2.424%
Missouri 34.997% 34.348% 1.889% Missouri Pennsylvania 2.462%
Montana 32.095% 30.402% 5.569% Montana Ohio 2.598%
Nebraska 28.144% 26.513% 6.152% Nebraska Colorado 2.613%
Nevada 37.312% 36.045% 3.515% Nevada Texas 2.679%
New Hampshire 24.359% 24.440% -0.331% New Hampshire New Mexico 2.761%
New Jersey 29.249% 28.737% 1.782% New Jersey Michigan 3.073%
New Mexico 46.595% 45.343% 2.761% New Mexico West Virginia 3.094%
New York 35.728% 36.591% -2.359% New York Louisiana 3.143%
North Carolina 34.467% 33.289% 3.539% North Carolina Maine 3.231%
North Dakota 28.448% 27.894% 1.986% North Dakota Arkansas 3.297%
Ohio 35.271% 34.378% 2.598% Ohio Florida 3.404%
Oklahoma 35.813% 33.713% 6.229% Oklahoma Nevada 3.515%
Oregon 30.647% 30.264% 1.266% Oregon North Carolina 3.539%
Pennsylvania 33.625% 32.817% 2.462% Pennsylvania Wyoming 3.773%
Rhode Island 35.721% 34.888% 2.388% Rhode Island Tennessee 3.854%
South Carolina 40.216% 39.421% 2.017% South Carolina Indiana 3.900%
South Dakota 34.276% 32.632% 5.038% South Dakota Minnesota 3.984%
Tennessee 35.947% 34.613% 3.854% Tennessee Iowa 4.717%
Texas 31.730% 30.902% 2.679% Texas Delaware 4.916%
Utah 17.286% 16.988% 1.754% Utah South Dakota 5.038%
Vermont 31.428% 28.530% 10.158% Vermont Montana 5.569%
Virginia 30.300% 29.809% 1.647% Virginia Kentucky 5.633%
Washington 28.790% 28.133% 2.335% Washington Kansas 5.899%
West Virginia 32.691% 31.710% 3.094% West Virginia Nebraska 6.152%
Wisconsin 29.962% 29.253% 2.424% Wisconsin Oklahoma 6.229%
Wyoming 30.004% 28.913% 3.773% Wyoming Vermont 10.158%
Puerto Rico 51.497% 48.921% 5.266% Puerto Rico American Samoa -14.973%
Virgin Islands 67.030% 66.893% 0.205% Virgin Islands Virgin Islands 0.205%
Guam 55.534% 55.349% 0.334% Guam Guam 0.334%
American Samoa 30.165% 35.477% -14.973% American Samoa Puerto Rico 5.266%
Northern Marianas 58.269% b b Northern Marianas Northern Marianas b

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