The Agenda

A Peculiar Pro-Choice Compromise on Abortion

Jill Filipovic, a lawyer and columnist, calls for an abortion compromise in which access to abortion is restricted after the first twelve weeks of a pregnancy, unless the pregnancy threatens a woman’s health (including her mental health) or if fetal abormalities are identified, and in exchange abortion opponents will accept the abortion will be free (i.e., financed by the public sector, which is to say taxpayers) and widely accessible. Let’s leave aside, for now, whether abortion opponents will find this compromise very attractive, particularly in light of the fact that the limits on abortion she has in mind don’t seem very stringent. What I found particularly striking was Filipovic’s concluding passage:

As it stands, American women die in childbirth much more often than women in other countries with comparable economies. For every woman who dies, many more are disabled or injured. Every year, 1.7 million American women see their health compromised by pregnancy-related complications. The American way of giving birth is a moral failure and a human rights disaster. Infants, too, fare poorly here. And mothers and babies are sicker, and die more often, in conservative, pro-life strongholds. Women are better off giving birth, and babies are better off being born, in liberal, pro-choice states than in the supposedly pro-life ones. The factors that lower maternal and infant mortality are complex, but access to health care and family planning are two of the most crucial. Because I value the lives of women and children, I would be happy to call it quits on the abortion debates and cede current American abortion laws in favor of a more holistic reproductive health framework. 

If only those who call themselves pro-life were willing to do the same. 

Follow the link and you’ll find a telling indicator from Amnesty International:

The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 49 other countries, including Kuwait, Bulgaria, and South Korea.

Given that the U.S. spends “more than any other country on health care, and more on maternal health any other type of hospital care,” and that the Medicaid system is explicitly designed to protect the interests of low-income mothers, it is not obvious that the failure of “the American way of giving birth” reflects a lack of resources. The data on infant mortality is also ambiguous. Filipovic cites the following observation from Sarah Kliff of Wonkblog:

The Institute of Medicine is out with a sweeping look at how the American health care system stacks up against other industrialized countries. The big takeaway is similar to other research: While the United States spends more on health care, patient outcomes lag behind peer nations.

That’s especially true, it turns out, with infant morality. The infant mortality rate in the United States is more than twice that of countries like Japan and Sweden. 

But the U.S. infant mortality disadvantage relative to other affluent countries stems not from deaths in the first month of life (the neonatal period), when medical care is most salient. U.S. infants fare just as well as infants in peer countries during this period. The real differences arise later on, during the postneonatal period, when infants are brought home. And here we see striking differences between white and black infants, infants born to married mothers and unmarried mothers, and infants born to college-educated mothers and those born to non-college-educated mothers. To say that “babies are better off being born, in liberal, pro-choice states than in the supposedly pro-life ones” is to raise the question of whether this reflects demographic differences across states rather than differences in public social expenditures or commitment measured along some other dimension. There is more to say on this subject, but for now let’s just note that differences in child-rearing across different groups seem to play a big role. High infant mortality rates in the U.S. seem to have more to do with the transmission of cultural knowledge, or lack thereof, than with limited access to medical care. One can argue that the U.S. would benefit from home visitation programs that aim to teach mothers from disadvantaged backgrounds how to care for their children — yet it is easy to see why this might be a lightning rod in a society in which cultural sensitivity is no small matter.

Filipovic tells us that she is willing to “cede current American abortion laws in favor of a more holistic reproductive health framework” which would include taxpayer-financed abortion for any cause during the first twelve weeks of pregnancy, the period during which 88 percent of abortions currently take place. Because the vast majority of abortions already take place during the first trimester, it seems that the main difference between the abortion regime Filipovic favors and what we have now is that the barriers to abortion would be much lower. And keep in mind that Filipovic is presenting her grand bargain as a transparently reasonable proposal that the pro-life movement would be inhumane to oppose.

Reihan Salam is executive editor of National Review and a National Review Institute policy fellow.

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