World Population Awareness

Domestic Family Planning

August 01, 2015

Americans spend, per capita, $1.44 a year each - less than a tube of toothpaste on international population assistance.   October 2010, National Audubon Society doclink
More money is spent on cosmetic sales in the United States than is needed to provide prenatal and reproductive care for all the world's women. Dr. Arsenio Rodriguez speaking at Elon College   March 8, 2001, News & Record (Greensboro, NC) doclink
From the 1960s through the mid-1980s, U.S. funding, scientific expertise, and political leadership helped establish family-planning programs across the globe. Stabilizing population growth was deemed important to promote sustainable development, improve trade, mitigate illegal immigration, and ease potential conflicts.

But after Republicans gained control of Congress in 1994, a small group of antiabortion House members succeeded in slashing U.S. overseas family-planning funds by about one third to the current $385 million a year. U.N. Population Fund Executive Director Nafis Sadik believes the United States will resume its leadership role when congressional opponents come to realize that family planning will reduce the abortions they abhor.   October 11, 1999, US News and World Reports doclink

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Domestic Family Planning

Why an AIDS Fight Faces Delay; Democrats Seem Reluctant to Delete Abstinence-Funding Rule

May 21, 2007, Wall Street Journal

When Democrats took over Congress, liberal AIDS activists thought they would see the end to a requirement that the government pay to promote sexual abstinence. Activists say the conservative-backed rule diverts money from programs that promote condoms into abstinence efforts of dubious effectiveness. Meanwhile, proponents of abstinence say that Uganda shows abstinence works.

There are signs that Democratic leaders don't want to get into the fight.

Democrats are preparing a draft of their foreign-aid spending bill and appear reluctant to enact a measure that deletes the abstinence language. Democrats seem likely to push the issue off until later this year, when Congress will have to reauthorize the president's AIDS initiative. Behind the fight over spending is a debate over whether abstinence delay the onset of sexual activity among young people or draw funding away from more-effective approaches.

Supporters say that programs advocating sexual abstinence until marriage and sexual fidelity would get shortchanged. The opponents point to scientific evidence to back up their claim that the abstinence provision inhibits progress against HIV. A new study concludes that congressional provisions dictating how the administration must spend AIDS money tie the hands of health professionals on the ground.

Another study, found that abstinence-only programs in the U.S. have had no impact on the sexual behavior of young people.

If the Democrats fail to delete the abstinence provision, "they'd leave themselves open to the charge of being public-health frauds."

Before winning control of Congress, Democrats attacked the Republicans for failing to complete spending measures on time.

In an email, Bush said, "We'll certainly fight to maintain a balanced approach" in HIV-prevention grants, in other words, to support abstinence and fidelity programs in addition to condom promotion.

Health activists are pressing for repeal of a controversial measure which requires grant recipients to have written policies opposing prostitution. AIDS advocates thought their efforts to repeal the prostitution-pledge requirement, but Congress shows less appetite for taking on the prostitution issue than it does the abstinence issue. doclink

UK Withholds World Bank Donation

September 14, 2006, BBC News

The UK is withholding 50 million pledged to the World Bank in protest at conditions it attaches to aid.

Oxfam said it welcomed the move, adding that the World Bank's policy on aid was "disastrous."

The Bank has been demanding too strict conditions before giving aid to developing countries. It has for a long time insisted that the countries it lends to meet economic targets and has encouraged trade liberalization. World Bank chief Paul Wolfowitz has made it his mission to tackle corruption in poorer countries and his campaign has led to loans and contracts to countries like Chad, Congo, Ethiopia and Bangladesh being suspended.

Last year, the UK provided 1.3 billion to help poorer countries and promised to donate a further 50 million in 2007, provided it eased the strings attached to aid. doclink

Australia Allocates Funds to the Global Fund

June 7, 2005, UN News Centre

The Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis, initiated by Kofi Annan, has welcomed Australia's plan to allocate a further $US38.2 million over three years. The Fund called on other donor governments to follow, and to at least double their pledges for 2005 and beyond to help the fund respond to projected resource challenges. We will need $2.3 billion in 2005, $3.5 billion in 2006 and $3.6 billion in 2007, the foundation's Executive Director said. doclink

Europeans Unaware of Millennium Goals

February 28, 2005, InterPress Service

European citizens expect the E.U. to play a central role in development, but most are unaware what is being done. A survey reveals that 51% believe that Europe is "best placed" to play a central role, especially in Africa. More than three-quarters were unaware of the E.U. contributions, despite the fact that Europe is the leading donor. The E.U. and member states spend more than 30 billion euros (39 billion dollars) a year to developing countries and is committed to raising the total to 39 billion euros (51 billion dollars) by 2006. 88% of European citizens have never heard of the Millennium Development Goals (MDGs). A summit later this year will review progress and set the agenda for the next decade. Each EU country has agreed to contribute more than 0.7% of its gross national income (GNI) by 2015 to meet the United Nations target. A report found that only four EU member states -- Sweden, Luxembourg, the Netherlands and Denmark -- have met the 0.7% target. Some of the richest states such as Germany and Italy are doing little. 29% said the EU could help halve poverty and hunger by 2015. Only 5% were confident those goals would be met. Two in five citizens believed universal primary education and promotion of gender equality would be achieved, but only 7% said the EU would achieve those goals. European taxpayers have the right to know how their money is being spent, how we help the developing countries, how we are fighting against poverty and infectious diseases and what we are doing to promote good governance, democracy and fundamental rights. doclink

US House Panel Stops UN Family Planning Funds Again

July 9, 2004, Reuters

U.S. House of Representatives backed a $19.4 billion foreign aid bill but defeated a bid for a U.N. family planning agency (UNFPA) opposed by anti-abortion groups. This funding will help build maternity wards in Iraq, reduce the rate of maternal mortality in Afghanistan, and prevent HIV in Kenya. Lawmakers opposed to the amendment argued there was no way to track where the money went after arriving in U.N. coffers. The bill provides $2.2 billion to fight AIDS, and sets aside $2.2 billion for military assistance for Israel, $300 million for Pakistan and $66 million for Poland. The panel dealt a blow to Bush's plan to reward countries for economic and political reforms, halving the $2.5 billion he sought. Republican lawmakers say a spending squeeze this year has meant that the bill did not include enough money to fully fund Bush's Millennium Challenge Account. The bill also cut the U.S. contribution to the World Bank by $90 million from 2003. doclink

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Domestic Family Planning

Writing a letter to your lawmaker, letters to the editor, or even better, lobbying, are two of the more effective ways to influence policy makers in matters of funding for foreign family planning clinics, contraceptives with health insurance, and other important population and sustainability solutions. doclink

U.S.: State Facts About Unintended Pregnancy

December 19, 2012, Guttmacher Institute

There are 6.7 million pregnancies in the U.S. each year About half of these are unintended. Births resulting from unintended pregnancies have been linked to adverse maternal and child health outcomes and myriad social and economic challenges, including costs to the federal and state governments of $11 billion (2006).

The Guttmacher Institute has launched a new tool that gives the incidence and outcomes of unintended pregnancy in each state, including the proportion of all pregnancies that are unintended; the rates of unintended pregnancy; the proportions of unintended pregnancies that result in births and abortions; and the proportion of all births resulting from unintended pregnancy;

Also given is the public cost of unintended pregnancy in each state, and the impact in each state of publicly funded family planning services.

Adam Sonfield, senior public policy associate at Guttmacher, said of the fact sheets: "They are a comprehensive resource that documents the significant state-level benefits of investing in publicly funded family planning services, both in helping women avert unintended pregnancies, births and abortions, and generating considerable savings to the federal and state governments." doclink

Karen Gaia says: Sounds like a very useful tool for activists to use when having a conversation with their legislators.

Is your lawmaker -
  • For US foreign funding of family planning clinics ask if your lawmaker will co-sponsor a bill funding family planning
  • Against family planning -
    point out that many of his constituents are using family planning and wouldn't he want the same for the poor families in other countries.
  • Doesn't think overpopulation is a problem - Give him facts and figures about population and tell him about the worldwide impacts or point out the economic benefits of limiting family size. Explain that, while birth rates are falling, they are not falling fast enough, and the number of women of childbearing age is at an all-time high.
  • Against abortion - Check out the subject at and tell him that family planning prevents abortions.

Calling Your Lawmaker is Also Very Effective.

Members of Congress Telephone Directory
Members of the Senate Telephone Directory
If you contact your lawmaker via email, make sure you include your full name and mailing address so that they can verify that you are a constituent.
You may research the matter from the links above and from WOA's Funding Page, and then come up with a letter that you can send your legislator or notes from which you can talk when you go see your representative at her/his Washington DC office or at their local office. doclink

Advocate Toolkit

  • Thomas Legislative Information - Information on Legislators and Bills

  • Why Population Matters

  • Republicans for Environmental Protection

  • Comment on California Legislation

  • Sample letter asking for foreign aid funding for family planning ... send one like it to your representative!!!

  • A personal letter sent by mail is usually the most effective way to impact your lawmakers.
    Address your letter as follows:
    To a Senator: The Honorable (full name) United States Senate
    Washington, DC 20510
    To a Representative: The Honorable (full name) United States House of Representatives Washington, DC 20515

    Writing a letter to your lawmaker, letters to the editor, or even better, lobbying, are two of the more effective ways to influence policy makers in matters of funding for foreign family planning clinics, contraceptives with health insurance, and other important population and sustainability solutions. doclink

    Sample Letter to a Member of the US House of Representatives Supporting Title X

    I wish to appeal for your support for the maximum possible funding for Title X of the Public Health Service Act--Domestic Family Planning Assistance which pays for gynecological and contraceptive services for poor US women. President Clinton's FY2000 budget contains $240 million for the Title X family-planning grant program. (Congress approved $237 million for FY1999 and $215 million for FY1998.)

    Every public dollar spent for family planning services saves $4.40--over $3 in medical costs alone--that otherwise would be spent over the next two years to provide medical care, welfare benefits and other social services to pregnant women. Publicly funded family planning services prevent an average of 1.2 million unintended pregnancies each year, including 516,000 abortions (1995 data).

    Public support for family planning services for those who would be unable to afford them is a cost-effective way of reducing the public costs of problems like aid to families with dependent children, poverty, drugs, prison over-crowding, crowded classrooms and numerous other costs that taxpayers support. Yet, despite all these benefits, funding for Title X has fallen 72% during 1980-98 (corrected for inflation). As a result, fewer than 50% of women eligible for Title X services now receive these services.

    No Title X funding is used for abortions. In fact, Title X services significantly reduces the need for abortions by preventing unplanned pregnancies. (Nearly half of unintended pregnancies end in abor tion in the US.) About 60% of all pregnancies to US women are unplanned--about three million/year. But 76% of pregnancies to poor women are unplanned. In the US, the proportion of births that are unintended is as high as or higher than it is in 25 developing countries.

    About 33 million US women are considered to be at risk for unintended pregnancy; more than 16 million are low-income women needing subsidized contraceptive services (1995 data).

    Compared with other industrialized countries, US teenagers experience considerably higher rates of pregnancy, despite the fact that levels of adolescent sexual activity are about the same. The US teenage pregnancy rate is twice as high as in Eng land, France, Wales and Canada, and 9 times as high as in the Nether lands. One million US teenagers become pregnant every year, 85% unintentionally. Half of these pregnancies end in birth, a third in abortion, and the rest in miscarriage (1995 data). 73% of US teenagers who accidentally become pregnant are poor or low-income, even though overall only 38% of those aged 15-19 are poor or low-income. 54% of lower income teenagers who become pregnant choose to have an abortion (1995 data).

    Sincerely, ... doclink

    14 Steps to An Effective Visit with Your Legislator

    Population Connection

    1. Dress nicely but comfortably.
    2. Introduce yourself and where you are from (city, neighborhood, organizations, affiliation.) Make a connection to their district.
    3. Lead with an appreciation-Thanks for meeting with me. Thanks for your vote on XX.
    4. State clearly and concisely: your issue and your position on the issue;-What you want him/her to do?
    5. Stress how the issue will affect the member's district or state.
    6. Give the legislator a brief fact sheet.
    7. Mention other organizations, important individuals, government officials, &/or legislators that support your position.
    8. Be a good listener. Be ready to write down what happened immediately after the meeting.
    9. Answer questions, but if you don't know the answer tell them you will find out and get back to them.
    10. Ask a direct question to which the legislator can respond "YES" such as "Can we count on you to co-sponsor the bill?"
    11. Thank the legislator for his/her time and find out the names and titles of any aides working on the issue.
    12. Always follow up with a prompt thank you letter.
    13. When appropriate, report back to coalition groups, friends, the press and others about your meeting.

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    Domestic Family Planning

    Birth Control's Huge Impact on Life and the Economy (Infographic)

    December 5, 2014, Planned Parenthood Action Fund   By: Planned Parenthood Action

    Bloomberg Businessweek magazine just ranked the pill as the ninth most important invention that transformed the business sector in the past 85 years. Bloomberg's full ranking shows the magazine's take on the 85 most disruptive ideas that time -- ideas that changed the world.

    Since Planned Parenthood founder Margaret Sanger coined the term "birth control" in 1914, contraception has truly revolutionized women's lives in the United States, and around the world. The timeline below starts that year and ends, 100 years later, in 2014 -- as 99 percent of sexually active women report using at least one form of birth control at some point in their lives.

    Follow the link in the headline to see the infographic where you can brush up on your birth control history, and see just how far we've come in 100 years.

    See The 85 Most Disruptive Ideas in Our History #9 The Pill

    Download the infographic as a PDF or as a hi-res PNG file doclink

    Affordability is Key to Access to Contraception

    June 14, 2015, Los Angeles Times

    Employers who provide prescription drug coverage were not compelled to cover prescription birth control before 2000. Since then the Affordable Care Act (ACA) enacted a mandate requiring insurers to cover birth control with no co-pay.

    The American College of Obstetricians and Gynecologists said in 2012 that oral contraceptives are safe enough to be available over the counter because they carry less medical risks than pregnancy and have fewer side effects than many medicines already available over the counter at grocery stores. New laws already enacted in a few states allow women to buy some oral contraceptives without a prescription. That would seem to improve access except where women must buy them without insurance.

    Senate Bill 1438, introduced by U.S. Sens. Kelly Ayotte (R-N.H.) and Cory Gardner (R-Colo.) would incentivize drug companies to apply for FDA permission to make their prescription contraceptives available over the counter by giving the drugs priority review and waiving the fee to apply. But the bill would also repeal the ACA's ban on using a flexible spending account for non-prescription medications. The problem is that ACA only requires insurers to cover prescription drugs, not over-the-counter medications. After having to pay nothing for contraceptives under ACA, many -- if not all -- women would have to pay out of pocket. If the FDA approves making oral contraceptives available over the counter, Congress should continue to require insurers to cover its cost.

    Opponents of the bill, including the Planned Parenthood Action Fund and the American Congress of Obstetricians and Gynecologists, have pointed out that affordability is necessary to make birth control truly accessible. Oral contraceptives can cost the uninsured as much as $600 a year. Furthermore, the bill would bar anyone younger than 18 from purchasing the pills over the counter (although they could still get them with a doctor's prescription).

    To resolve such problems, Senate Bill 1532, introduced by Sen. Patty Murray (D-Wash.) calls for complete insurance coverage of any oral contraceptive after it goes from prescription to over the counter, and it sets no age requirement for purchase. The Senate should enact this bill. If the FDA approves making oral contraceptives available over the counter, Congress should continue to require insurers to cover the cost. doclink

    The Family Planning Cuts That the Texas Legislature Forced Through Are Having Dire Consequences

    May 12, 2015, Think Progress   By: Tara Culp-ressler

    In the summer of 2013, a high-profile battle over a proposed package of abortion restrictions in Texas sparked huge protests, dominated national headlines, and spurred Wendy Davis to run for governor. But that was only the beginning.

    New abortion restrictions have forced at least half of the state's clinics to close their doors. These came on top of a growing health crisis impacting Texas' nearly 27 million residents that occurred after the GOP-controlled state legislature in 2011 slashed funding for family planning services by two-thirds and dismantled the state's network of family planning providers in an effort to exclude Planned Parenthood.

    A survey by the Texas Policy Evaluation Project -- based at the University of Texas at Austin -- reports that more than half of Texas women have faced at least one barrier to getting the reproductive health services they need. 76 women's health clinics have been forced to close, leaving low-income and rural women struggling to access basic preventative services like Pap smears, STD tests, and birth control consultations. Impoverished immigrant communities living in rural parts of the state have recently starting organizing in an effort to hold Texas officials accountable for what they say are human rights violations.

    Women in one of the largest states in the country are struggling to get to a clinic for their gender-based health needs. Respondents reported that they lacked childcare, lacked transportation, or had difficulty taking time off of work or school to make the trip.

    Texas is one of the GOP-controlled states that continues to refuse to accept Obamacare's optional Medicaid expansion, leaving more than one million people locked out of affordable health care coverage altogether. Since Texas has such a high population of uninsured residents and such stringent eligibility requirements for its Medicaid program in the absence of expansion, the Lone Star State is home to 25% of the people across the country who fall into this coverage gap.

    Many immigrant women in Texas report that they're not receiving culturally competent care and therefore struggle to build trust with their doctors. Other issues are that they can't pay for the services they need or have issues getting their clinic visits covered, as well as having to look for new doctors.

    After the state's health department projected a sharp rise in unintended births as a direct result of the budget cuts, Texas lawmakers have attempted to take some steps to restore the funding for family planning services. But it will take years for Texas to truly recover from the damage wrought by the deep cuts to its family planning network.

    Meanwhile, legislators show no signs of slowing down the ongoing assault against reproductive health access, for example, slashing cancer screenings for low-income women and banning insurance plans from offering any type of coverage for abortion services. doclink

    Pro-Lifers Change Their Minds When Abortion Gets Personal

    May 19, 2015, Cut   By: Alex Ronan

    Tennessee representative Scott DesJarlais opposes abortion, has run repeatedly as a pro-life candidate, and routinely votes in favor of restricting reproductive rights. In early May DesJarlais voted in favor of the 20-week abortion ban. Yet in 2012 a tape surfaced of a conversation DesJarlais had recorded between himself and his mistress back in 2000 where he pressured her to get an abortion. This raised a scandal which coincided with his reelection campaign. DesJarlais denied that there was a pregnancy.

    A divorce trial transcript from 2001 demonstrated that DesJarlais had also supported his ex-wife's decision to get two abortions before their marriage. The first was a "therapeutic" abortion because she was on medication that could cause birth defects and retardation. The second was because "things were not going well between us" and the abortion was a "mutual decision."

    Polls have shown repeatedly the same sort of dynamic, where people who identify as pro-life support abortion when it's discussed as an individual decision rather than an abstract judgment between right and wrong. When Jon Pennington interviewed people while working on his Ph.D. on the pro-life movement: a woman he interviewed said, "Most pro-life women oppose abortion with four exceptions: rape, incest, the life of the mother, and me." doclink

    Report Ranks U.S. Last Among Developed Countries for Maternal Health

    May 7, 2015

    An annual report by Save the Children provides a global ranking of the best and worst countries for maternal health and other motherhood-related measures, Time magazine reports. In addition to maternal health, the report considers economics, education, children's well-being, and women's political status.

    Averaging all measures, the U.S. ranked as the 33rd best country for mothers out of 179 surveyed countries, down from 31st the previous year (2014). But on maternal health the U.S. ranked 61st. One per 1,800 U.S. women experience a pregnancy-related death, 10 times the rates for Austria, Belarus and Poland. What's more, U.S. infant mortality (death of baby within the first year) is 6.1 per 1,000 live births. (compare to 2.13 in Japan). Washington, D.C. had the highest infant mortality rate among the 25 surveyed capitals of high-income nations, and some U.S. cities -- including Cleveland and Detroit -- had even higher rates. Time magazine correlated high infant mortality with premature births, inadequate prenatal care, low incomes, education, race, age and marital status. doclink

    It's Still Pretty Hard for Women to Get Free Birth Control

    March 19, 2015   By: Emily Cohn

    Until recently Emily Cohn got free birth control - a tangible effect of the Affordable Care Act (AFC or Obamacare). But when her CVS pharmacist charged her $20 for a 28-day supply, she said, "I understand Obamacare. I shouldn't be getting charged for birth control." What troubled her most wasn't paying $20 for some pills. She could afford it, but she could not understand the change. Her CVS pharmacists didn't know why she was being charged, and the customer service rep at her employer's benefit manager couldn't clarify it either, so she consulted a lawyer. That is a privilege she has as a journalist writing a story for a widely read publication.

    "You're supposed to be getting birth control without cost-sharing," or copays, said Mara Gandal-Powers, a counsel for health and reproductive rights at the National Women's Law Center. Under AFC, all insurance plans cover the full cost of recommended preventive medical services, like screenings for certain types of cancer and immunizations. The law identified contraception as one of these preventative services, and it intended that all FDA-approved forms of contraception be covered free. The financial benefits are obvious: In 2013, women saved nearly $500 million on out-of-pocket-costs for birth control. As of last spring, 67% of insured women paid nothing for the birth control pill, up from 15% before health care reform took effect.

    But, according to Express Scripts, the pharmacy benefit manager for The Huffington Post's parent company, AOL, insurance plans can use "reasonable medical management techniques" to encourage customers to get care at a lower cost, Gandal-Powers said. So "The pharmacy plan provided by your employer can offer 100% coverage for contraceptive medications only when the plan's home delivery pharmacy fills them," said the Express Scripts spokeswoman. A rule change that took effect in January, so free pills must now come via mail from Express Scripts. They defended the process by saying, "Studies show that patients who use Express Scripts' home delivery pharmacy for chronic medications have greater adherence to their medication, which is crucial for the effectiveness of contraceptive medications. For these reasons, your plan has decided to require the dispensing of contraceptive medications via home delivery."

    For Cohn, this required a new prescription from my doctor for three packs at a time and setting up a mail delivery with Express Scripts. For thousands of other women, it will be more of a hassle. Some women don't want to have birth control delivered because they don't want those they live with to know they're using contraception, and some can't get packages delivered without the risk of theft, Gandal-Powers noted. This group could include minors living with their parents, or women who are in abusive relationships.

    Many of Cohn's colleagues had not figured this out. They told her they have always paid at least $20 a month for birth control, even though they should be getting it totally free. One woman who said she picks up a bunch of prescriptions at once admitted to not even noticing which ones she was paying for and which ones she wasn't. Another who did switch was frustrated that mail order was now the only choice. A third was planning to switch to an intrauterine device, or IUD, so "I won't have to worry about it for five years."

    Gandal-Powers offered some steps these for women who are still paying for birth control:

    1. Make sure this part of the law actually applies to your insurance plan. As of last fall, Obamacare hadn't kicked in yet for one in four people on employer-based plans. These "grandfathered" plans must eventually follow the law, but until then, they can still charge for birth control.

    2. Ask your insurance company why you're still getting charged. If you think shouldn't be getting charged, there is an appeals process.

    3. If you get your insurance through work, ask your employer's HR department about your problem, Gandal-Powers suggested. "They have a lot of power," she said.

    Free birth control for all women was a lofty promise, but women must still do a lot of work to ensure they get the rights they are guaranteed under the law. doclink

    U.S.: Unintended Pregnancies Cost Federal and State Governments $21 Billion in 2010

    February 27, 2015, Guttmacher Institute   By: Adam Sonfield and Kathryn Kost.

    A study "Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010," showed that U.S. government expenditures on births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21 billion in 2010. In 19 states, public expenditures related to unintended pregnancies exceeded $400 million in 2010. Texas spent the most ($2.9 billion), followed by California ($1.8 billion), New York ($1.5 billion) and Florida ($1.3 billion); those four states are also the nation's most populous.

    51% of the four million births in the United States in 2010 were publicly funded, including 68% of unplanned births and 38% of planned births.

    Prior research has shown that investing in publicly funded family planning services enables women to avoid unwanted pregnancies and space wanted ones, which is good not only for women and families, but also for society as a whole. In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 would have been 75% higher.

    Adam Sonfield, one of the authors, said. "Reducing public expenditures related to unintended pregnancies requires substantial new public investments in family planning services." ... "That would mean strengthening existing programs, such as the Title X family planning program, as well as working to ensure that the Affordable Care Act achieves its full potential to bolster Medicaid and other safety-net programs. We know we can prevent unintended pregnancies and the related costs. There are public programs in place that do it already, but as these data show, there is significantly more progress to be made." doclink

    U.S.: Is Inequality Killing US Mothers?

    January 16, 2015,   By: Andrea Flynn

    It is no surprise that maternal mortality rates (MMRs) have risen in tandem with poverty rates. Women living in the lowest-income areas in the United States are twice as likely to suffer maternal death, and states with high rates of poverty have MMRs 77% higher than states with fewer residents living below the federal poverty level. Black women are three to four times as likely to die from pregnancy-related causes as white women, and in some U.S. cities the MMR among Black women is higher than in some sub-Saharan African countries.

    In terms of economic inequality it might as well be 1929, the last time the United States experienced such an extraordinary gulf between the rich and everyone else. Today 30% of Blacks, 25% of Hispanics (compared to only 10% of whites) live in poverty, and in certain states those percentages are even higher. Since 2008, the net worth of the poorest Americans has decreased and stagnant wages and increased debt has driven more middle class families into poverty. Meanwhile, the wealthiest Americans have enjoyed remarkable gains in wealth and income.

    The Affordable Care Act is providing much-needed health coverage to many poor women for whom it was previously out of reach and if fully implemented could certainly help stem maternal deaths. But nearly 60% of uninsured Black Americans who should qualify for Medicaid live in states that are not participating in Medicaid expansion. doclink

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