According to a new study, Delaware's abortion rate plummeted 37 percent in just three years, more than four times the national decline over the same period, and a bigger drop than in any other state. At the same time, and unlike many states in the country, Delaware increased access by growing the number of abortion-providing clinics by 33 percent.
Delaware ensured abortion is accessible and available, so why did abortions decline so dramatically? One big reason is increased access to contraception.
The vast majority of abortions in the United States are a result of an unplanned pregnancy, and nearly half of the 6 million pregnancies in the country each year are unplanned. Unplanned pregnancy is associated with a wide range of poorer health, social and economic outcomes. When I became governor in 2009, my home state of Delaware had the highest unplanned pregnancy rate in the country. My administration set out to change this—to reduce unplanned pregnancy by improving reproductive health care so that women are empowered to become pregnant only if and when they want to. In just three short years, our work in Delaware suggests that investing in reproductive health—specifically making multiple forms of birth control accessible and affordable to all—can not only lead to lower unplanned pregnancy rates, but lower abortion rates as well.
While reducing the number of abortions was not our objective, it is an expected outcome of increased access to contraception. When I first took office, Delaware had the highest abortion rate in the country, and just like the rest of the country, significant barriers to contraceptive access. Nearly half of unplanned pregnancies occur to women who are using birth control, but the method they are using doesn't work well for them. The other half occur to women who are not using birth control in the month they conceived—the reasons why can include cost, misinformation, mistrust and access.
In 2015, only 30 percent of community health centers nationwide provided same-day access to the full range of birth control, often due to a lack of training and the cost associated with the methods. Misinformation and poor patient counseling means that women are not asked about their pregnancy intentions as a standard screening question during appointments with their primary care doctors. Inconsistent and inequitable contraceptive care is one reason for higher rates of unplanned pregnancy, as we saw in Delaware.
We made a big bet in Delaware—that by increasing access to the full range of birth control methods at little or no cost, we could help women achieve their own goals of becoming pregnant only if and when they want to, improving downstream outcomes for individuals, children and families.
My administration partnered with the nonprofit organization Upstream USA to transform our health care system and fundamentally reshape contraceptive access for all. Upstream trained thousands of health care providers and staff at practices and hospitals across the state to offer the full range of methods in a single visit at low or no cost. By training providers to ask every woman of reproductive age if they plan to get pregnant in the next year as a standard question when they visit the doctor's office, patients are able to have a conversation with their provider about their goals, make their own decisions about their life plans and receive care that supports their choice. Surveys of patients tell us that they are in charge of choosing the methods they want, that they feel listened to and that they are making their own decisions about birth control. This is essential.
Delaware's progress is proof that there are encouraging, common sense steps that can happen in reproductive health care despite the unprecedented attacks on women's health at both the state and federal levels. As the Trump administration implements the Title X gag rule to stop providers who counsel on or offer abortion services from serving women for all their reproductive health care needs, many states are taking extraordinary measures to make it nearly impossible for people to access a safe and legal abortion. The country is erasing decades of progress in reproductive health in coercive ways, particularly for low income individuals and people of color.
Access to birth control isn't just a health care issue. Ensuring people are able to become pregnant only if and when they want to is one of the most powerful levers for expanding opportunity. Delaware is on the path to demonstrating that when states make birth control easily available at low or no cost through all doors of the health care system, it can reduce unplanned pregnancy rates, and abortion rates will also happen to decline. Upstream is now partnering with states across the country on the way to scaling its impact nationwide. This is the type of approach to health care that people across America want and expect from their elected officials.
Jack Markell served as governor of Delaware from 2009-17. He is a member of the Board of Directors for Upstream USA.
The views expressed in this article are the writer's own.
Uncommon Knowledge
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Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
