Last year, my buddy (we’ll call him “Andy”) told me how his girlfriend (“Helen”) had a terrible weekend. Helen worked as an overnight nurse at a local hospital’s emergency room. In the early hours of Saturday morning, a young woman who had recently had an abortion came in, deathly sick, with septic shock.
It was determined that pieces of the fetus, not completely removed during the procedure, led to the sepsis. Later that day, another young woman came in who had just had an abortion, also with sepsis caused by fetal remains.
“Helen’s pretty shaken up,” Andy said. “She says both girls almost died.” I asked Andy about the two young women. Both were black, and about Helen’s age; both had their abortions at the local Planned Parenthood affiliate in St. Paul, Minnesota. I then explained to Andy that Planned Parenthood generally doesn’t use ultrasound when performing abortions—it costs too much and takes too much time, cutting down on margins.
Not using ultrasound is like operating with a blindfold. The abortionist can “feel around” for fetal tissue, but doesn’t want to feel around too much, as this would risk perforating the lining of the uterus. “That’s so sad, so messed up,” said Andy, who until then had been largely agnostic about abortion.
Planned Parenthood and its fellow abortion providers are no friends to black women, yet they are heavily subsidized by Congress. Rep. Gwen Moore recently argued the opposite in the Washington Post, that “Abortion clinics don’t ‘target’ the black community.” That’s plain false. Look at the facts, partisanship aside.
Watch for the Statistical Dodge
Moore begins by citing a commonly used Guttmacher Institute statistic (Guttmacher is Planned Parenthood’s research arm): “fewer than 1 in 10 abortion providers are in majority-black neighborhoods.”
This statistic is spurious. Because black Americans comprise only 12 percent of the U.S. population, relatively few areas in America are majority black. By neighborhood, Guttmacher means ZIP code. Only 2 to 4 percent of U.S. ZIP codes have a majority black population. Only 3 percent of counties have a majority black population.
Using Guttmacher’s own findings, however, almost 10 percent of America’s high-volume abortion clinics (performing more than 400 abortions per year) exist in those majority-black ZIP codes. Clinics in neighborhoods where non-whites are the majority, only around 15 percent of U.S. neighborhoods, make up 40 percent of all abortion clinics in the United States. This means that, even on Guttmacher’s own showing, abortion clinics are indeed disproportionately found where the local population is predominantly minorities.
Guttmacher’s misleading statistic on “black neighborhoods” was contrived to counter a statistic put out by a pro-life group. This group pointed out that 79 percent of Planned Parenthood’s surgical abortion facilities are located within a two-mile radius, or walking distance of, a black or Hispanic neighborhood (what the Census Bureau calls a tract), defined as either having a “minority population at or above 50 percent,” “minority populations at least 1.5 times higher than the average percentage of the surrounding county,” or “a minority population equal to or greater than the average national minority population: 12.6 percent African American or 16.3 percent Hispanic/Latino.”
The numbers don’t lie. Abortion clinics do disproportionately reside in minority neighborhoods. Planned Parenthood, especially, resides in urban, poor, and minority areas. This is no conspiracy. Rather, it makes business sense for Planned Parenthood to reside in urban areas with high concentrations of people, of which a high portion are poor.
Poverty Doesn’t Explain This
Moore says “[conservatives’] goal is to intimidate and inflict trauma while limiting the health care choices for pregnant women in need.” She goes on to blame poverty and the lack of proper contraceptive access for the stunningly high black abortion rate—abortions of black children make up almost 40 percent of total U.S. abortions each year, despite black Americans comprising only 12 percent of the population.
Poverty alone does not explain the high black abortion rate. There are almost twice as many poor whites as there are poor blacks in America, yet black women who live below the federal poverty line contribute to 14 percent of the nation’s abortions, while poor white women contribute to only 11.7 percent of the nation’s abortions.
Poverty also fails to explain the lack of birth-control access among poor black American women. In the 1990s, even though Title X funding steadily increased and the poverty rate fell, the number of unintended pregnancies poor minority women had began to skyrocket. That trend persists until the present. According to the American Prospect, while the average abortion patient used to be “[a] middle-class, white high-school or college student with no children whose bright future could be derailed by motherhood,” today she is more likely to be “a twenty something single mother of color,” because an unexplained “[l]oss of [birth control] access for poorer [minority] women” occurred in the first half of that decade.
What then, can explain the high black abortion rate? Moore decries the lack of birth control access among poor black women even while Planned Parenthood gets millions every year from the public purse to provide contraception to low-income women. Are these women served well? Guttmacher reports that “minority women, women who are poor, and women with little education are more likely than women overall to report dissatisfaction with either their contraceptive method or provider.” Isn’t Planned Parenthood their main contraception provider?
Blame Planned Parenthood for Its Clients’ Poor Access
As I’ve extensively outlined in the past, Planned Parenthood is to blame for the high black abortion rate. Because black Americans are disproportionately poor, black women of childbearing age disproportionately rely on Medicaid, or are uninsured. Black Americans also disproportionately reside in urban areas.
Planned Parenthood is also largely urban-focused, mostly due to Planned Parenthood v. Casey, and Title X. Title X essentially pays Planned Parenthood to locate next to poor populations. Planned Parenthood v. Casey, which allowed states to regulate abortion providers, brought higher fixed costs, increasing the appeal of urban areas to leverage economies of scale through higher abortion volumes. Planned Parenthood gained immense market share after Casey was decided in 1992, due to competitors’ retrenchment in the face of the regulatory onslaught, and this strengthened monopolistic power corresponds with the loss of birth-control access that occurred among poor women during this time.
Next, women in urban areas who are uninsured or receive Medicaid (who are also disproportionately black) find few choices outside the local Planned Parenthood affiliate. Medicaid grossly under-compensates providers who don’t also receive Title X funds (of which Planned Parenthood is the largest recipient), and Title X providers offer the only avenue for uninsured women to receive women’s health care.
Rather than empowering women, this system accomplishes the opposite, namely through lack of choice. According to a Guttmacher study, 6 in 10 women who visited a “specialty contraceptive clinic” (a Title X grantee) considered the clinic their “usual source of medical care,” while 4 in 10 women surveyed considered the clinic their “only source of health care.” Because this study only looked at clinics in areas with multiple Title X grantees, many women frequenting Planned Parenthood experience an even greater lack of choice.
Due to this lack of competition, Planned Parenthood is free to undersupply its low-margin or loss-making product, contraception, to steer customers towards abortion, its high-margin product. A similar situation was seen in post-Soviet Romania, where doctors were heavily compensated for abortion relative to birth control. I estimated that between 30 and 50 percent of Planned Parenthood’s $91 million in profit during its last reported fiscal year comes from abortion. Planned Parenthood is like the Veterans Administration, only Planned Parenthood is actually efficient at abortions, a cash business with high profit margins.
Poor Black Women Suffer to Protect Democrats
To Moore and members of the Congressional Black Caucus, along with the rest of the Democrat Party: I understand you are for “choice,” but how long can you put your party’s interests above the interests of poor, black women? Many of these women directly support you, through volunteering, donating, and voting. Will they never find out what is being done? Will the light of day never shine through?
Congress could act now to end the high black abortion rate. Foster competition: Give every poor woman a “women’s health insurance” card they are free to use at any OB-GYN in the nation. Pay for this with the Title X funds currently allocated to Planned Parenthood. Lawmakers should agree that this insurance can’t be used for abortion—that’s already the status quo with Title X. Republicans would surely increase funding for women’s health care under such a program.
Don’t worry: if Planned Parenthood is so great, it will still be around. Let it compete with other OB-GYNs for the funds, and let the women who use these services decide who gets the money.
Black lives matter. And the lives of black babies matter, too. Let’s act to protect them now.
An earlier version of this article incorrectly stated that black women comprise 12 percent of the U.S. population. Black men and women together comprise that 12 percent. We regret the error.