ARTICLES
June 2002 ARTICLES
Contents © 2002
by Jim Holman.
All rights reserved.
How Many Abortions in California?
The State Doesn't Want You to Know
By Bob McPhail
How many abortions are performed in California each year? The truth is, no one knows -- and California, unlike most states, is making almost no effort to find out. What abortion data it collects are not reliable. And as far as some of the biggest abortion providers are concerned, that's fine.
The California health code requires abortion providers to report the numbers, but this law is widely ignored. "Even though I believe reporting is required, no one is doing it," said Michael Quinn, chief of the state office for health information. "California does not actively collect abortion statistics."
The reason the state is stymied, said Quinn, is because of the "highly sensitive" and "highly political" nature of abortion. Even in the face of losing federal funds that encourage family planning and attempt to reduce teenage pregnancy, the health information office cannot get the information from abortion providers, said Quinn. Instead, state statisticians look outside California for help.
State officials enlist U.S. Centers for Disease Control and Prevention in Atlanta, according to Quinn. "Because federal dollars depend on the numbers, the CDC came out," he said. The federal health agency's last such survey of abortions in California was published three years ago, said Quinn.
Interviewers spent weeks phoning abortion providers in California, he said, "Some of the high-volume clinics were very reluctant," he said. "They don't want their addresses known; they don't want their numbers known."
The Centers for Disease Control estimates that in 1996 there were 280,180 legal abortions in California. According to the federal government, California was second only to New York in the ratio of abortions to live births in 1996. For every 1000 live births, there were 519 abortions. The ratio in New York was 580 abortions for every 1000 live births. The national average for the same year was 314 per 1000.
"The numbers are very large in California, and it's somewhat of an embarrassment," said Quinn. The reason state health officials find such abortion statistics embarrassing, he said, is because the numbers suggest programs directed at cutting illegitimate births and teenage pregnancies are not working. When the federal government reformed the welfare system in 1996, the law included a provision for an "illegitimacy bonus" of $20 million a year to states that could demonstrate a substantial decrease in the number of births by unmarried women. One measure used to determine whether a state qualifies for the bonus is whether the rate of abortion has been reduced.
The only other national organization that collects abortion statistics on a state-by-state basis is the Alan Guttmacher Institute, a pro-abortion think tank with offices in New York and Washington, D.C. A major sponsor of Guttmacher is Planned Parenthood. (The institute takes its name from a former president of the Planned Parenthood Federation of America.) The institute's annual report shows that Planned Parenthood provided it with more than $600,000 in grants in 2001.
Quinn said that state officials once tried to recruit the Guttmacher Institute to collect abortion statistics for California, but nothing came of the plan. Guttmacher conducts its national abortion surveys about once every five years, trying to measure how available abortion is to women. In its last survey, also conducted in 1996, the institute estimated there were 237,830 abortions in California -- 42,350 fewer than the federal government's estimate. At a national level, the discrepancy between the federal and Guttmacher numbers is greater, but usually the Guttmacher numbers are higher, not lower. "The CDC collects most of its information indirectly, mainly through reports from state health departments," the Guttmacher Institute explains in a briefing paper. "Reports for the states that collect information and the District of Columbia vary in completeness, with some lacking information on as many as 40-50 percent of the abortions that occur in the state. [The Guttmacher Institute], on the other hand, directly surveys all known providers of abortion services, which numbered 2,380 at last count. As a result, the number of abortions reported by [Guttmacher] is accepted as the more accurate and is somewhat higher than that reported by the CDC -- by 15 percent on average..."
Guttmacher's survey used mailed questionnaires followed up by phone calls to recalcitrant abortion providers. Even when dealing with sympathetic survey takers from the institute, some abortion providers refused to cooperate. "We sent up to four follow-up mailings," explained the institute in the preamble to its report on the 1996 statistics. "For facilities that did not respond to the mailings, we used health department data on the number of abortions from states that provide information on individual facilities. We contacted the remaining non-respondents by telephone and asked the number of abortions they had performed; some of the facilities hesitant to cooperate required up to 20 calls before we obtained information or a final refusal."
The Guttmacher Institute concedes that the national numbers are probably higher than those published in their report. "Most likely, some abortions go unreported to [Guttmacher] -- primarily office procedures performed by physicians for their own patients -- but this number is believed to be very small." And, with the advent of the abortion pill, says Guttmacher, "underreporting may become more prevalent."
Because federal officials realized this likelihood, the Centers for Disease Control's "Standard Report of Induced Termination of Pregnancy" was changed in 1996 to add "medical" to the section that asks "Type of Termination Procedure." Other choices include suction curettage, dilation and evacuation, intra-uterine instillation, sharp curettage and hysterotomy/hysterectomy. The federal agency's system is supposed to work this way: an abortion provider sends the one-page report on each abortion performed to the appropriate state health agency; the health agency gathers information from other providers, then forwards its totals to the Centers for Disease Control in Atlanta, which then compiles its report from that data.
As of February 1, 2002, 44 states required abortion providers to submit such an annual statistical report. Four other states and the District of Columbia collect the data, though there is no state law requiring them to do so. Only California and Alaska did not collect information on abortions; but a bill introduced in April in the Alaska legislature would change that. If the bill passes, California would become the only state that does not collect abortion statistics.
Why California health officials ignore the law requiring them to collect abortion statistics is unclear. Quinn said there is not sufficient staffing to do it. Victoria Lin from Guttmacher gave this explanation: "California's reporting requirement was enacted in 1967 as part of a larger abortion law called the Therapeutic Abortion Act. According to David Alois of California Planned Parenthood, many of the major provisions of the law -- such as one that required a woman to go before a committee of doctors for approval for an abortion -- were struck down as unconstitutional by state courts in 1972. The reporting requirement itself remained intact, and the state actually used a sample method to collect the data a few times, but for reasons unknown, it simply stopped doing so in the early 1970s, and no one has challenged them on the stoppage."
The failure of California to collect accurate abortion statistics is perplexing given the insistence by federal health officials that accurate abortion numbers are a vital part of the total public health picture. "The surveillance of legal induced abortion is important for numerous reasons," wrote Lisa Koonin in an article posted on the website of the Centers for Disease Control. Koonin was the federal official who designed and oversaw their 1996 abortion count in California. "Surveillance is used to identify the characteristics of those who have abortions, in particular women at high risk of unintended pregnancy. Ongoing surveillance is essential to monitor trends in the number, ratio, and rate of abortions in this country." Among other things, federal health officials use abortion numbers -- in conjunction with other data -- to compute national pregnancy rates, ectopic pregnancy rates, and to calculate injuries and deaths to women attributable to abortion.
But among some abortion providers, the reporting requirements are seen as nothing more than an attempt to bury them in paperwork and to discourage abortions. They classify reporting the number of abortions they perform, and information like age and ethnicity of mother, as attempts to regulate abortion. Such laws are referred to in pro-abortion circles as "TRAP laws," which stands for "targeted regulation of abortion providers."
Contained as a footnote to a brief history of abortion in California on the website of Planned Parenthood Affiliates of California is the following: "Each year, a number of bills designed to create barriers or limit access to abortion services are introduced. Areas this legislation has covered include informed consent, abortion reporting, insurance coverage, student fees, pathology reports, fetal pain, fetal license plates, sex selection, fetal tissue research, late term abortions, etc. [emphasis added]."
Bits and pieces of abortion statistics are collected in California under other provisions of the law, but their reliability is suspect. Both the health and safety code and the California code of regulations require hospitals and clinics to submit a report each year. These annual "utilization reports" include a section on abortion. "We just take whatever they give us," said Jim Winter, an analyst with the state agency. "It's all self-reported." And how accurate are the data about abortion contained in their records? "It's plus or minus who knows," said Winter.
These state health statistics have been made available for inspection to some, but the agency will not provide them to the general public. "Every year the Alan Guttmacher Institute comes in and we give it to them," said Winter, but as a general rule, the abortion statistics are kept secret. "We do that because it makes a nice bombing list for those who want to go out and bomb abortion clinics," he said.
Another source of abortion statistics in California comes from the state department of health services, which collects information about abortions paid for by Medi-Cal. In a report published in December 2001, Medi-Cal officials admit that the statistics are not entirely reliable: "Abortions performed for enrollees in health care plans ... are included only as estimates."
Medi-Cal statisticians estimate the number of abortions paid for by the state through managed-care plans and add it to abortions directly billed as a Medi-Cal expense. "To estimate the calendar year total, add the estimated 29,415 abortions to the reported 45,794 abortions," explains the 2001 Medi-Cal report. "This yields an estimated total of 75,209 abortions for Medi-Cal beneficiaries in 2000."
The Medi-Cal total is another means of estimating the number of abortions in California for a given year. "Medi-Cal-funded abortions represent about one-third of all abortions in California," said Quinn. Using that formula, abortions performed in California in 2000 would be in the neighborhood of 225,627.
Since its 1996 estimate, which was published in 1999, the Centers for Disease Control has updated its abortion statistics for California. The latest federal figures, published in December 2000, estimate that 275,739 abortions were performed in California in 1997, which means that for every 1000 live births in California, there were 525 abortions.