Though many will say United States has the best healthcare offered in the world, reproductive healthcare within the U.S, and reproductive rights for that matter, are far from perfect. But first, one question should be answered: what is reproductive health? The United Nations Population Fund states that, “Good sexual and reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system.” (UNFPA) For someone to have good sexual and reproductive health means that they have satisfying, safe sex, as well as the capability and choice in when or when not to reproduce. Robert Walker, the president for the Population Institute, reported on his organizations grading of reproductive rights in the U.S in an article published by the Huffington Post in 2015. Walker makes a telling statement of the of reproductive rights in just one line when he says, “Nineteen states received a failing grade [for reproductive rights] and the U.S. grade fell from a ‘C’ to a ‘D+.’” For being a leading world power, one might think that the U.S. would be better than this but in reality it is quite the contrary. In the United States, there are disparities in reproductive healthcare outcomes, some benefits from the current reproductive healthcare system, and biased actions are committed by the government against reproductive rights and healthcare, and given this: investing and expanding reproductive healthcare (and upholding reproductive rights) would not only improve the lives of women, but would at the same time save the U.S. government money.

Reproductive healthcare in the U.S. should be expanded because there are significant disparities in outcome among different groups of women in the United States. According to one study that investigated the determinants and disparities of young women’s reproductive health service use, “Younger women and undereducated, underinsured, and immigrant women had lower rates of service use … than older women and women of higher socioeconomic status” (Hall et al.). Another study, one specifically looking at disparities in abortion rates among different groups of women, found that women of lower-socioeconomic status (SES) and women of color are less likely to use contraception, less likely to use highly effective preventative methods, and more likely to discontinue methods than white women and women of higher-SES (Dehlendorf et al.). From these studies, it is evident that those less well off, and many of those who are of minority demographic status generally receive different, often worse, reproductive healthcare than those who are well off and those who are white. In regards to young women, rates of inadequate family planning and reproductive health outcomes in the United States disproportionately affect young women of socioeconomic disadvantage and demographic minority status, and are higher than even rates of those in developed countries. It is estimated that over 30% of reproductive women need reproductive care and do not receive it (Dehlendorf et al). Not to mention, between 2002 and 2006 to 2008 there was a significant decrease in reproductive health service use by young women which drastically opposes positive trends reported in years prior (Hall et al.). There are also disparities in rates of abortions between women in the U.S. In the United States, the abortion rate is much higher than the rate in most developed countries. There are significant disparities in abortion rates with women of color and low-income women experiencing higher rates of abortion than white women and those who are well off. In 2008, the abortion rate for non-Hispanic White women was 12 per 1000 reproductive-age women while it was 29 per 1000 Hispanic women, and 40 per 1000 non-Hispanic Black women (Hall et al.). These high rates in abortion among these groups of women could be lowered if access to contraceptive services and other reproductive services are improved. Though such disparities in the outcomes of reproductive health and family planning result from several social, political and economic contexts and conditions, access to quality reproductive healthcare undeniably impacts the overall quality of the reproductive healthcare system in America and the outcomes individuals experience.

Despite there being significant disparities in regards to reproductive healthcare, there are somethings that existing reproductive healthcare in the United States gets right. In the U.S. there is a nationwide network of health centers that provide publicly funded family planning services. Public funds, derived from both federal and state governments, have helped countless women to afford family planning services for the past thirty plus years. This safety-net serves nearly 7 million women annually, and helps women to avoid more than 2 million unplanned pregnancies. Because of this, 1 million plus unplanned births and 760,000 abortions are prevented ever year (Guttmacher). Continuing, this network of providers is a reliable source of affordable contraceptive services, and at the same time countless women are introduced to the healthcare system through these providers. Often enough, many rely on this network as their sole source for preventative healthcare. Such preventative care typically includes: “pelvic and breast exams, HIV and STI tests, and screenings for cancers, high blood pressure, and diabetes” (Guttmacher). Since 2000, a significant number of public sector clinics - which generally serve large portions of younger and more socially disadvantaged women - have closed (Hall et al.). Because of this, many of the women who needed reproductive healthcare the most were left without it. This network of health centers is comprised of family planning facilities and numerous organizations including the “infamous” Planned Parenthood organization. Though the organization often comes under fire for its abortion services, it does much good through the reproductive healthcare it provides. As Robert Walker writes, “Planned Parenthood health centers make up only 10 percent of publicly funded safety-net providers, but they serve 36 percent of the clients seeking contraceptive services” (Walker, 2015). To expand on the scope of Planned Parenthood’s (benevolent) reach: In at least 103 counties across the U.S. that have a Planned Parenthood center, the clinic serves all women in the area using the network for contraceptive services (Walker). Before further discussion on reproductive healthcare, it is important to know that as a result of the Hyde Amendment, the use of federal money (including funds from Medicaid) to pay for abortion is prohibited except in instances of rape and incest, or if the pregnancy endangers the woman’s life. Additionally, 33 states ban the use of funds barring cases in which federal funds are available. Still, even in cases where women should be eligible for federal funds, only a small portion of women are able to access such financial support (Dehlendorf et al.). This is just one case in which the government’s actions at best fall short, and at worst negatively impact reproductive rights and healthcare.

Traditionally, even if just stemming from fringe or radical politicians, significant portions of the U.S. federal and state government have produced much legislation and communicated much rhetoric that is biased against women, and as a result has had a negative impact on reproductive rights and healthcare. Per Alicia Ely Yamin from her essay in the book Joseph M. Zuniga’s book Advancing the Human Right to Health, “Social constructions of women as animals and objects – as less than deserving of having full agency in their lives – are in no way limited to the global south.” To expand on this: between 2011 and 2012, almost 1000 legislative bills were proposed and sometimes passed in the United States Congress and state legislatures. Most of these bills were overreaching as they worked to eliminate contraception in health insurance systems, require vaginal ultrasounds prior to abortions, and even define rape or personhood (Zuniga et al, 286). One of the best examples of bias against women and their reproductive rights is Georgia state representative Terry England’s actions. England, on the floor of the Georgia state legislature, proposed making it illegal for women carrying stillborn fetuses to have the dead fetuses removed. In his argument, England analogized women to cows and pigs, ultimately portraying the situation as an unfortunate occurrence that affects human women like it does barnyard animals (Zuniga et al, 286). It need not be pointed out that women are anything but barnyard animals and so, deserve legislation that allows them to have control over their bodies and a say in their life.

Given this role that significant politicians and actors within the government play, it is no surprise that federal and state government have worked against reproductive healthcare and reproductive rights in recent years. As of recent, there have been political attacks on Planned Parenthood, which hinders access to contraception and other reproductive health services. In 2015, the U.S. House of Reps voted seven times to defund Planned Parenthood. Additionally, in 2015, the U.S. House Appropriations committee voted to eliminate all funding for Title X, a federal program that provides individuals with broad family planning and preventative health services (Walker). Without the Title X program, many family planning centers would be forced to close (Guttmacher). All the while programs such as Medicaid have been threatened with severe cuts. As for state governments: arbitrary and harassing abortion restrictions in Texas and other states resulted in the closures of dozens of family planning centers and limited legal access to abortion services. Finally, 21 states refused to expand Medicaid coverage under the Affordable Care Act (ACA), denying numerous poor women coverage for contraceptive services (Walker). If anything, reproductive healthcare and reproductive rights should not be taken away from American women. Instead healthcare should be expanded.

If the U.S. government were to expand funding of reproductive healthcare, or expand reproductive coverage and access, women across America would experience significant improvement in their lives. According to the Guttmacher Institute, contraception is a vital tool for planning families. Contraception, just one aspect of reproductive healthcare, allows women and their partners to space the births of their children and in turn, to better plan their families. Ensuring women have the choice in when or when not to bear children allows them to prepare financially for giving birth and for raising children. It’s common knowledge that children are expensive. The cost starts as early as the first pregnancy test kit, and from there, ramps up exponentially for prenatal care, birth, and beyond. Birthing and keeping and unplanned child is a financial burden that not many can afford. The ability to delay child bearing also helps women so that they can achieve other life goals first i.e. finishing school or getting a job (Guttmacher). Decreased educational and employment opportunity has the possibility to result in worse social and financial situations which can ultimately further widen divides present in the U.S. Additionally, access to contraception leads to healthier infants and mothers. If a mother is unaware that she is carrying and does not change her lifestyle - say for example, a lifestyle that includes smoking or drinking - she is going to end up with an unhealthy child and will perhaps endanger herself. Resulting negative health issues of the mother and her infant also have the possibility of worsening social, financial, and medical situations and thus widening social divides in America. Women who cannot afford medical services experience further financial burdens when it comes time to pay for services, which hurts their families and in turn, the economy. 

Although currently prohibited because of the Hyde Amendment, providing public coverage and funding for abortion and altogether improving access to abortion services – another component of reproductive healthcare – would improve women’s lives as well. Were abortions covered via public funds or by public insurance, it would greatly improve access to abortion and, in turn, enable women to acquire them sooner and in a safer manner (Dehlendorf et al.). If women who are seeking abortions must wait to acquire abortions due to an inability to pay for the service, it could put them in a situation where they develop medical complications during later gestational periods. In certain states, there exist policies which deny or limit increases in welfare benefits following the birth of additional children. Because of this, women may seek and obtain abortions because they know that they will not be able to afford to take care of another child with an understanding of their current financial situation and dependence on welfare. As suggested by research, an oft expressed reason for pursuing abortion services is the inability to afford a child or another child (Dehlendorf et al.). Aside from financial obstacles, women also face physical obstacles in acquiring abortions which if taken care of could improve women’s lives. In her journal article entitled Disparities in Abortion Rates: A Public Health Approach, Christine Dehlendorf et al write that “87% of all counties in the U.S. do not have access to an abortion provider, and 35% of women of reproductive age live in these areas” (Dehlendorf et al.). This means that those who require or seek abortions must travel farther to obtain them, possibly resulting in later use of services which results in even more complications. This especially makes it harder for younger women and women who do not have personal transport or cannot easily afford transport. 

Not only would the expansion and greater coverage of reproductive healthcare improve the lives of women, but at the same time it would be an investment that would save the United States government money in the long run. It is estimated that unintended pregnancies cost taxpayers 21 billion dollars annually (Ingraham). Though outside of an ideal world it is unlikely that all unintended pregnancies could be prevented, it is undeniable that there is room for vast improvement in the rate of unintended pregnancies in America. Many low-income women may rely on government welfare programs such as Medicaid and so helping prevent unintended births saves money. According to the Guttmacher Institute, for every dollar invested into family planning services, $5.68 are saved in potential Medicaid costs for low-income women. That is more than five times return on investment. In 2010, there were 1.5 million unplanned births, 68 percent of which were covered by Medicaid and other public insurance programs. For an average, publicly funded birth: prenatal care, labor and delivery, postpartum care, and the first twelve months of infant care amounts to $12,770. From there, care from the first through the fifth year of child’s life costs an additional $7,947. In total, the public cost per birth is $20,716 (Ingraham). What this paper is advocating for is not increasing spending just for the sake of spending, but rather because it would be smart spending. For example, the government’s (as of 2015) “investments in contraception, family visits, and STD testing save taxpayers $15.8 billion” per year and expanding family services “could cut the cost of unintended pregnancies by an additional $15 billion” (Ingraham). 

In response to the argument presented in this article, many would make the claim that abstinence based education - not sex education, or contraceptive services and other aspects of reproductive healthcare - is the way best way to reduce unintended pregnancies.  Abstinence is the principal that men and women should abstain from sex until marriage.  Both abstinence based strategies and abstinence based education are non-solutions to the issue of unintended pregnancy. Contrary to what proponents of abstinence centered strategies might believe, such strategies are unsuccessful and ineffective at improving reproductive and sexual health outcomes. Although abstinence strategies delay first acts of sexual intercourse, they ultimately do not deter risky sexual activity i.e. not using contraception, condoms, and other preventative methods (Hall et al.). This makes sense as if one is taught to avoid sex altogether, they are kept in the dark because they are not taught to learn how to be safe. For those who will have sex no matter what, as such is human nature, they may fare worse or at least earlier. According to Robert Walker of the Population Institute, “Sex education programs have made a significant contribution to the historic decline in the nation’s teen pregnancy rate” (Walker). Compared to other industrialized countries, the United States’ teen pregnancy rate is significantly high and could very well be higher if federal and state support for sex education programs is cut. About half of all pregnancies in the U.S. are unintended, and thus limiting access to sex education, and fundamental parts of reproductive healthcare such as contraceptive services can only increase the rate of unintended pregnancies, therefore raising the demand for abortions (Walker). 

Other opposition arises specifically in regards to the Planned Parenthood organization, an organization that is often brought up in the news as Republican congressmen threaten to “defund” it. Planned Parenthood is a family planning center that provides reproductive healthcare and offers services such as STI/STD testing and treatment, cancer screening and prevention, contraception, and abortion services, and specializes in these areas. One area in which Planned Parenthood receives much criticism is that it receives 540.6 million dollars in state and federal funding (The National Review). This funding is derived from Medicaid, Title X, and several other state and federal programs so it is unlikely to believe that all such funding could be done away with in one fell swoop. Even if federal funding were to be cut, states would still be able to spend as they please (Kurtzleben). Still, Planned Parenthood serves a large portion of women seeking reproductive healthcare and other preventative care services, and limiting or taking away these services would have dire consequences on their lives. Another common point of criticism of Planned Parenthood is that such centers could be replaced with “Community health centers,” which serve a similar function but do not provide abortion services (The National Review). It is important to note that abortions are just 3% of Planned Parenthood’s performed services (Kurtzleben). The main difference between the two, though, is that Planned Parenthood specialize in reproductive healthcare, whereas community health centers provide more generalized care. Ultimately, reducing the number of Planned Parenthood clinics for the sake of limiting abortions would make it harder for women who decidedly seek abortions to acquire services, and additionally harder for those that rely on Planned Parenthood for other services. Though one can eliminate or diminish abortion providers, the demand for abortions will remain so long as the root cause remains: unintended pregnancies.

Given today’s situation – significant disparities in reproductive health outcomes albeit the current system having some benefits, in addition to the legislation being produced, rhetoric being communicated, and actions committed by the government that all are biased against reproductive rights and reproductive healthcare – reproductive healthcare has room for improvement and should be expanded because it would improve women’s lives and save the government money. Key components of reproductive healthcare such as contraception enables women to have more control over their social and financial lives, and abortion which, if publicly funded, would reduce financial burdens for women and make necessary abortions easier. Ultimately these would save the government billions of dollars in potential costs. But for those governing does it even matter? Will the current administration choose religious ideals and budget cuts over actions that will benefit the people? Only time will tell.
