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 (UNFPA). 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. Though the United States reproductive healthcare system has a solid foundation, there are significant disparities in reproductive health outcomes among different groups of women, and reproductive rights along with reproductive healthcare are quite often put on the chopping block by federal and state governments; 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.

As it stands now, the U.S. has a strong framework for reproductive healthcare which successfully benefits millions of women, thus supporting the case for the expansion and greater coverage of reproductive healthcare. 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 (Guttmacher). This safety-net provides services for 6.7 million women annually, and helps women to prevent more than 2 million unplanned pregnancies per year (Guttmacher). Because of this, 1 million plus unplanned births and 760,000 abortions are prevented (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 singular source of 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). Without these services, not only would many women’s wellbeing be threatened, but so would their lives.

The network of health centers, which is the foundation of reproductive healthcare in America, is comprised of family planning facilities and numerous organizations including the Planned Parenthood organization. Though the organization often comes under fire for its abortion services and for the $540.6 million it receives from the federal government, it does much good through the reproductive healthcare it provides (The National Review). 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 Planned Parenthood and 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 (Kurtzleben). So, planned parenthood does not provide abortions with federal funds. Additionally, 33 states ban the use of funds barring cases in which federal funds are available. Still, even in cases of abortion in which 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 instance in which the government’s actions at best fall short, and at worst negatively impact reproductive rights and healthcare.

Although the United States’ reproductive healthcare system has a good foundation through the existing network of reproductive healthcare providers, reproductive healthcare in the U.S. should be expanded because there are still significant disparities in reproductive health outcomes among different groups of women, especially among women of minority demographic status and among low income women. One study that specifically looked 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.). This is just one example of the poor and inadequate reproductive health outcomes. There are also 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. 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. 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. 

Disparities in reproductive health outcomes also exist between young women and older women, which further evidences the case to expand funding for and coverage of reproductive healthcare in America. 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.). Continuing, 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 (Hall et al.). To expand on this, it is estimated that at least 30% of reproductive age women need publicly funded family planning and do not receive it (Dehlendorf et al). The reproductive age for women is generally defined as the ages 12 through 49 (The Free Dictionary). As of 2013, there were approximately 74.7 million women of the ages 15 through 49 (Population Reference Bureau). Simple math shows that at least 22.4 million women in the United States need family planning and do not receive these services. Additionally, 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.). This is paralleled by a significant decline in the number of public sector clinics, which just so happens to serve large portions of younger women (Hall et al.). This lack of access and the reduction in public sector clinics comes as a significant shock given that the United States is often touted as the wealthiest and most powerful nation in the world. 

Rather than trying to remedy the situation and solve these disparities in reproductive health, in the past decade state and federal governments have instead produced legislation that has increasingly limited women’s reproductive rights as well as their access to reproductive healthcare. Per Alicia Ely Yamin in her essay in 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 about women’s rights were proposed and sometimes passed in the United States Congress and state legislatures (Zuniga et al, 286). Most of these bills were overreaching as they worked to eliminate contraception in health insurance systems, require vaginal ultrasounds prior to abortions, and even defined rape or personhood (Zuniga et al, 286). One of the best examples of bias against women and their reproductive rights in a state legislature is Georgia state representative Terry England’s actions. England, on the floor of the Georgia state legislature, proposed making it illegal for women who are 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.

Federal and state governments have not only attempted to limit reproductive rights through legislation, but have also attempted to cut funding for reproductive healthcare on numerous fronts, and in some cases, have succeeded.  As of late, there have been countless political attacks on Planned Parenthood, which hindered access to contraception and other reproductive health services. For example, in just one year (2015) the U.S. House of Representatives voted seven times to defund Planned Parenthood, and the U.S. House Appropriations committee moved to eliminate complete funding for the Title X program (Walker). The Title X program is a federal program that provides individuals with family planning and preventative health services (Walker). Without  this program, many family planning centers would be forced to close (Guttmacher). All the while public health insurance programs such as Medicaid have been threatened with severe cuts (Walker). 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 (Walker). Finally, 21 states opposed the federal government and refused to expand Medicaid coverage under the Affordable Care Act (ACA) (Walker). Medicaid, like the Title X program, provides numerous poor women coverage for contraceptive services and similar reproductive healthcare needs (Walker). If anything, reproductive healthcare and reproductive rights should not be taken away from American women. In contrast to what federal and state governments have recently done, healthcare should instead be expanded.

If the U.S. government were to expand coverage and access to reproductive healthcare, 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 (Guttmacher). 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. The 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 (Guttmacher). 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. 

Providing public coverage and funding for abortion and altogether improving access to abortion services – another component of reproductive healthcare – would also improve women’s lives. Were abortions covered via public funds or by public insurance, it would greatly improve access to abortions 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 may 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 (Dehlendorf et al). 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 can result 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. If abortions are publicly funded and at the same time access to contraception is increased, rates of abortion will go down and those who need abortions will be able to acquire them.

If America’s reproductive healthcare system is greatly expanded and improved through increased public funding, the U.S. government would save money in the long run. Estimates show that nearly $21 billion is spent annually on unintended pregnancies (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. Continuing, the government’s “Investments in contraception, family visits and STD testing save taxpayers $15.8 billion” per year and expanding services could “cut the cost of unintended pregnancies by an additional $15 billion” (Ingraham). This large cost primarily manifests in welfare programs such as Medicaid for low income women who need assistance. 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 amounts to more than five times return on investment for the government (Guttmacher). In 2010, 68 percent of the 1.5 million unplanned births were covered by Medicaid and public insurance programs (Ingraham).  This may not sound like much, but the average cost of a publicly funded birth is expensive. Prenatal care, labor and delivery, postpartum care and the first year of infant care amounts to $12,700 (Ingraham). From there, care through the fifth year of a child’s life costs an additional $7,947. This totals to $20,716 for one publicly funded birth (Ingraham). What this paper is advocating for is not increasing spending just for the sake of increasing spending, but rather because it would be smart spending that would save the government money. If the government can expand funding for and coverage of reproductive healthcare and ultimately preemptively act to reduce unintended pregnancies, it will spend less providing for those who need assistance.

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 (Hall et al.). 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 experience sex 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). When 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 (Walker). Nearly 50% of pregnancies in the U.S. are unintended, and thus limiting access to sex education, as well as fundamental components of reproductive healthcare such as contraceptive services, will only increase the rate of unintended pregnancies. In turn, there will be a rise in the demand for abortions (Walker). 

Given that the U.S. reproductive healthcare system, while providing some benefits, yields significant disparities in reproductive health outcomes, and like reproductive rights, is constantly threatened by federal and state legislatures: 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 this would save the government billions of dollars in potential costs. But for those governing does that even matter? Will the current administration choose religious ideals and budget cuts over actions that will benefit the American people? Only time will tell.
