abortion/reproduction

Opponents of abortion have long targeted the “demand side” of abortion by passing legislation aimed at dissuading patients from going through with an abortion. Examples of this type of restriction include parental consent/notification laws, waiting periods, and mandatory counseling. Research shows that targeting patients has had little impact on national abortion rates; they’ve been declining, but several factors are likely contributing to the decrease, including increased accessibility to contraceptives.

New approaches to restricting abortion have focused on the “supply side” of the abortion equation — that is, targeting the doctors and clinics that provide abortions. These regulations often require certain staffing and equipment requirements, resulting in clinics being shut down (often due to the expense of implementing the regulations). Reduced access to clinics often means that women have to travel further for an abortion — increasing costs (the procedure itself, travel, and accommodations), especially when a patient has to navigate waiting periods and counseling requirements.

Mississippi’s sole abortion clinic, for example, the focus of abortion opponents for many years, faced closure recently because of a law that changed licensing procedures. The law now requires all doctors performing abortions to have admitting privileges at local hospitals (difficult for the out-of-state doctors to acquire). The clinic was granted an extension to meet the requirements, though the law was allowed to stand.

So, does targeting the supply side of abortion work to reduce the procedure?

A recent article in the New England Journal of Medicine did a natural experiment to answer this question.  In 2004, Texas passed two new restrictions on abortion, one on each side. The “demand side” legislation required that women receive information about risks at least 24 hours before an abortion can be performed. The “supply side” legislation required that abortions after 16 weeks of gestation be performed in a hospital or an ambulatory surgical center instead of a clinic. At the time the law was passed, none of Texas’ non-hospital based clinics met the legal requirements, and very few abortions were performed in hospitals.

If the “demand side” legislation had an effect, the number of abortions would decrease at all levels of gestation. As Chart A illustrates, there was no change whatsoever in the number of abortions performed before 16 weeks — indicating that the demand side legislation had almost no impact.

If the supply-side legislation had an effect, the number of abortions provided after 16 weeks should have dropped.  In fact, Chart B shows that the number of later abortions performed dropped 88% after the legislation was implemented.

So, targeting the supply side reduced the number of abortions performed in Texas, but did the  women carry their baby to term?

No. Some of these women left the state to receive an abortion; in fact, the number of who received an out-of-state abortion more than quadrupled from 2003 to 2004. Accordingly, the average distance women had to travel to receive an abortion after 16 weeks increased from 33 miles in 2003 to 252 miles in 2004.

As has been noted on this site before, nations that have highly restrictive abortion laws do not have lower abortion rates; in fact, in those countries where abortion is illegal, many of those abortions are unsafe, resulting in high numbers of maternal deaths. Although targeting the supply-side of abortion might be appealing, it will probably not reduce the abortion rate nationwide. Instead, it likely places onerous restrictions on women with fewer resources, since they will be less able to meet the increased costs that result from having to travel for abortions.

Thanks to ­­­Jenna for the submission!

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Amanda M. Jungels is a PhD Candidate in the Department of Sociology at Georgia State University, focusing on sexuality, gender, and cognitive sociology. Her dissertation focuses on disclosures of private information at in-home sex toy parties. She is the current recipient of the Jacqueline Boles Teaching Fellowship, given to outstanding graduate student instructors.

The Fourth Estate has found that the vast majority of people quoted in news coverage of the 2012 election are men.  The media research group collected a sample of election-related news stories from print newspapers and TV broadcasts, finding that 13% of print sources were women (79% were men and 8% were organizations) and 16% of TV sources were women (81% were men and 3% were organizations).

Male dominance was true in all outlets, though Meet the Press and Time Warner stand out as the least disproportionate:

This might be old (though still frustrating) news, except for the fact that the pattern held for issues traditionally considered “women’s”: abortion, birth control, Planned Parenthood, and women’s rights (blue is men, pink is women, grey is organizations):

This asymmetry is found across media.  See also our posts on gender and book reviewing, gender and top billing at Paramount pictures, gender and top creatives for family movies, and women as news subjects.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Cross-posted at Montclair SocioBlog.

In case you wondered about what we in the U.S. pay for health care compared with those unfree unfortunates who suffer under various forms of socialized medicine, here are some graphs from 2009 showing the advantages of what is sometimes called “the best health care system in the world.”

The graphs are from the International Federation of Health Plans. I’ve selected only four — to show the relative costs* of

• an office visit
• a day in the hospital
• a common procedure (childbirth without complications)
• a widely used drug (Lipitor)

You can download all the charts here, but be warned: it gets boring. We’re number one in every chart, at least in this one category of how much we shell out.

Since we have the best health care in the world, this must mean that you get what you pay for. Our Lipitor must be four to ten times as good as the Lipitor that Canadians take.

Hat tip: Ezra Klein.

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*These amounts are what providers are paid by governments or other insurers, not what the patient pays, which in many Eurpean countries is essentially nothing. See the footnotes for the tables in the original document. Or look at the comments on this at Boing Boing, a discussion which is remarkably civil (do they monitor comments?).

Abortion is highly politicized in the U.S. (more so than in many other countries) and the fight between those who are in favor of and against available abortion occurs on two fronts.  One is familiar to just about everyone: the effort to overturn Roe v. Wade, the legislation Supreme Court decision that established the legality of abortion in 1973.

The second front, though, is less familiar.  It involves reducing the ease of access to legal abortion. Efforts to increase barriers to accessing legal abortion include passing laws that require minors to notify their parents of an abortion or get their consent, requiring mandatory counseling for abortion-seekers, instituting waiting periods, and discouraging medical schools from teaching abortion procedures.  Some of the issues of diminishing access are non-movement related; others are the direct result of pro-life activism.

I bring this up in order to focus on an additional barrier to access: a reduction in the number of clinics and hospitals that provide abortions.  The map below, based on data from the Guttmacher Institute and compiled by ANSIRH, shows how availability varies by state.  In the darkest states, up to 20% of women live in a county with no abortion provider; in the lightest states, between 81 and 100% percent do.

Living far from the nearest abortion provider is a problem especially for low-income women.  Such women are less likely to have an employer who will give her a day off to travel to the clinic, less likely to get a paid sick day, and less likely to be able to afford to lose even a single day’s wages.  She is also less likely to have a car, making it more difficult to get to a distant location, and less likely to have reliable day care for any existing children.  If the state requires in-person counseling and has a waiting period, it means that the woman must take two days off, travel to and from the clinic twice, and arrange for child care on multiple days.

Reduction in the availability of abortion does not necessarily reduce the number of abortions.  We recently posted global data showing that less liberal abortion laws actually correlate with higher rates of abortion.  The data below, also from Guttmacher, show that were abortion laws are less liberal (largely in developing countries), the rate of abortion is 34/1,000 women oer year, compared to 39/1,000 in developed countries (the difference may look significant here, but imagine how trivial it would look if the horizontal axis went all the way to it’s true maximum of 1,000):

Guttmacher explains that the relevant variable isn’t availability of abortion, but the unintended pregnancy rate (which is surprisingly high in the U.S.).

Barriers to accessing abortion, then, don’t lower the abortion rate.  They do, however, increase the likelihood that an abortion procedure will occur later in pregnancy and guarantee a greater logistic burden on the pregnant woman.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Cross-posted at Global Policy TV.

A great story at the New York Times, sent in by Katrin, reveals how the evolving science of marketing is creating its own set of challengers for advertisers.  Target, like many companies, tracks its customers purchases and uses the data to send packets of coupons tailored to individuals and households.  In this way, they tempt us into the store by offering us deals on things they know we want.

Target is also in the business of predicting what a person will want.  So the marketing company decided to try to use costumer shopping habits in order to predict pregnancy.  If they could start sending the woman baby-related before she started shopping for them in earnest, the company figured, she might end up always thinking of Target when she needed to spend money on the baby.

Using an algorithm that considered the purchasing patterns typical of newly pregnant women — e.g., prenatal vitamins, scent-free instead of scented lotion, a sudden uptick in the acquisition of cotton balls — they were able to make a pretty good guess as to whether a female customer was expecting.  Suddenly these women were getting coupons like this:

This caused two problems.

First was the father of the teenage girl who started getting coupons for diapers in the mail.  This led to an angry phone call to Target and, later, a chagrined apology by the stunned grandpa-to-be (story here).

The second was the reaction of the intended target, the expectant moms.  Some were pretty freaked out that Target knew they were pregnant!  It’s one thing, it turns out, for Target to know you like vanilla better than chocolate ice cream, or you fancy scented candles; it’s different, perhaps, to suddenly realize that it knows your you’re having a baby.  That could feel like a serious invasion of privacy.

So Target learned that the ability to predict our needs and desires comes with the need to do some psychological management as well. Accordingly, they began sneaking baby-related coupons into coupon books that also included other things.  So far, Target reports, these women are none the wiser… and thinking of Target as their one-stop baby shop.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

PBS has a gallery of images of oral contraceptives that provides a nice illustration of the way product design can be used as a form of behavior modification, while also needing to adapt to the way people actual use products — or forget to do so, the ever-present problem with the pill.

Initially , the pill came in bottles, like other prescriptions:

Notice the bottle contains 100 pills; there was no effort to package it into quantities for a single month. Women were supposed to take 20 pills in a row, then none during their period. It was up to them to keep track of everything and remember when it was time to start taking the pills again.

In 1962, an engineer created a prototype of a dispenser pack, designed to hold exactly a month’s worth of pills and help women remember to take them correctly:

The first contraceptive in a pack of this type, Dialpak, appeared the next year; oral contraceptives packaging has been designed to help women remember to take them accurately ever since. This became a major selling point, with Dialpak 21 even offering a small calendar you could attach to a special watch band so you could more easily keep track of whether you’d taken the pill:

In 1965, Eli Lilly introduced a new packaging design, with differently-colored pills arranged in a sequence; however, it didn’t label the days of the week, so it didn’t help women figure out if they’d remembered to take their pill on any given day:

Norinyl came in a package that took the sequential design but added several features that enhanced compliance. An extra pill was added, so that pills with active ingredients were taken for 21 days, not 20. Then a row of placebo pills were added so that women took a pill every day of the month, so they were less likely to forget to start a new pack:

When we think about the emergence and success of the pill, we tend to focus on the product itself. But the packaging tells an interesting story on its own. The pharmacological effectiveness of oral contraceptives meant little if women forgot to take them reliably. The design of the packaging helped play a crucial role, increasing users’ ability to follow the prescribed schedule.

Today, there’s an entire trade organization, the Healthcare Compliance Packaging Council, dedicated to promoting attention to the design of packaging as an important element in all areas of healthcare. The pill was the first prescription drug sold in a so-called “compliance pack,” serving as an example of the potential effectiveness of packaging design as a way to encourage patients’ conformity to prescribed medication regimens.

Cross-posted at Ms.

Andrew S. let us know that The Lancet has just released a study on global trends in abortion, focusing on overall rates, access to safe vs. unsafe abortions, and how the legal status of abortion impacts abortion rates. The results shed some interesting light on the effects of efforts to reduce abortion by outlawing or restricting access to it. Looking at data from 1995 to 2008, the authors found that abortion rates were actually lower in areas of the world with less restrictive abortion laws:

[Via ThinkProgress.]

The Guttmacher Institute provides a full summary of the article. Not surprisingly, the more restrictive abortion laws are, the higher the proportion of unsafe abortions (with Eastern Europe being a significant outlier, with the highest global abortion rates). About half of all abortions are unsafe, leading to the deaths of roughly 47,000 women each year, or 13% of all global maternal deaths — almost entirely in developing nations, where restrictive abortion laws are more common and  access to contraception and medical care are generally lower.

UPDATE: A couple of commenters pointed out that I was sloppy with my wording, and it seems like I’m making a direct causal argument (i.e., fewer restrictions leads to fewer abortions). The situation is more complicated than that; the very fact that some nations have more restrictions than others likely reflects a variety of issues that themselves influence the abortion rate, so that while there might be *some* causation, it’s also probable that laws on abortion and abortion rates are both influenced by other variables. I don’t think that getting rid of all restrictive laws in, say, Southeastern Asia, without making any other change at all, would necessarily lead to a dramatic shift in abortion rates. That said, what I find more interesting is the opposite proposition: the idea that imposing restrictions on abortion will automatically reduce abortion rates, which doesn’t seem true, at least on a global level.

If you’re looking for basic global demographic information, World Health Rankings provides a great overview, using World Health Organization, World Bank, UNESCO, and other data. The website allows you to select a country, then provides a detailed breakdown of many demographic details, such as population pyramids (you can select different years in the past, or look at predictions for the future), leading causes of death, etc. Here’s the 2010 population pyramid for the U.S.:

You can also easily access all the age pyramids here. The 2020 projections for Brazil show the changing demographics due to the dramatic decrease in the fertility rate, which Lisa posted about this weekend:

There’s an interactive map of the top 15 causes of death in the U.S., allowing you to look at variations by county. Here’s the map of deaths due to heart disease, with Clark County, Nevada, highlighted:

You can also look at life expectancy for different nations for every decade between 1960 and 20101, a “real-time” clock that tracks global deaths (you can look at how many have died in the last year or month, or you can click “now” and reset the clock and watch as the clock estimate how many people die of various causes of death worldwide), and maps showing the prevalence of various causes of death around the world. Lots of neat representations of rather depressing information.

Also, as I wrote this post I realized that now every time I see a population pyramid of the U.S., Community‘s song “Baby Boomer Santa” is going to play through my head.