Root Cause Analysis
Abortion is a contentious issue. While 77% of Americans are in favor of keeping abortion legal in at least some circumstances, few people would say they’d like to have one. Both those in favor of keeping it legal and those who would prefer that it was illegal can be quite vociferous and uncompromising. When an organization identifies a serious failure, they may use a tool called a Root Cause Analysis (RCA) to identify the cause(s) of the problem, identify appropriate solutions, and take necessary action. Society is a complex organization and abortion is, to many, a serious problem. Let’s undertake an RCA on abortion to see if we can come up with some societal solutions to this problem.
Phase 1. Define the Event
An elective abortion is a medical or surgical procedure to remove an ovum (called a fetus after 11 weeks) from the uterus.
It starts with biological drive, pleasure seeking, or a myriad of other psychosexual motivations that lead to sperm-in-vagina heterosexual intercourse during which a fertilized egg (an ovum) is, in our scenario, unintentionally created. To the two creators, the resultant pregnancy is ill-timed, unexpected, and/or unwelcome.
My understanding is that some people think that the voluntary removal of an ovum or a fetus ends the life of a potential human being and is close, or equivalent to, the voluntary killing of a child and therefore should be prohibited. They believe the action of abortion goes against the moral and religious standards of a modern society. Adoption is available for children who are born to people who cannot or do not choose to love or provide for their infant themselves.
My understanding is that some other people believe that there are times when the ramifications of childbearing and/or childrearing on the pregnant person may morally outweigh the importance of continuing a pregnancy to term. The ability at that particular point in time, to care for a child like a child deserves and requires, may be beyond the person’s capabilities or priorities. They believe the pregnant person should have the legal right to stop the development of the ovum or fetus in their uterus, which they do not equate with the killing of a living child.
Phase 2. Identify Contributing Factors
One out of every four US women will choose to have an abortion in their lifetime; it is one of the most common and one of the safest medical/surgical procedures. A complex of interrelated personal, social, economic, and health factors contribute to abortion decisions.
AGE: only 12% are teens, of whom 4% are minors; 60% in their 20s; 28% in their 30s and 40s
CONTRACEPTION: 51% were using a birth control method during the month they became pregnant
FAMILY SIZE: 59% already have at least one child. The needs of the current child(ren) are common considerations during decision-making about abortion.
INCOME: 75% poor or low income. People at higher income levels are better equipped to prevent pregnancy including better access to health care, birth control methods, and education.
RACE: 39% White, 28% Black, 25% Hispanic, 6% Asian/Pacific Islander, 3% Other. The proportional distribution of these demographics should be considered but it is obvious that women of all races and ethnicities choose, at times, to end their pregnancies.
RELIGION: 62% religiously affiliated. 17% mainline Protestant, 13% evangelical, 24% Catholic, 8% cited other religions and 34% had no religious affiliation. While we wouldn’t say that being religious causes abortion, belonging to a religion does not seem to prevent one.
Phase 3. Determine Root Cause:
The root cause of elective abortion is the failure (human or technological) to prevent the creation of an unwanted conception. Fair?
The root cause of abortion comprises two factors and one decision:
Factors: 1) the unintentional creation of a pregnancy and 2) the perception that the pregnancy is untimely or unwanted by the person within whose body it resides and
Decision: the pregnant person chooses option 3a) to remove the ovum or fetus from the uterus and end the pregnancy – rather than option 3b) to leave the ovum or fetus in the uterus and continue the pregnancy.
The RCA process has established the root cause of abortion and the contributing factors that facilitate abortion thereby identifying possible locations for prevention or intervention
Phase 4. Identify Solutions: (*Solutions below marked with an asterisk have been enacted or are on the Biden White House agenda.)
Solutions to Factor 1: Prevent the unintentional creation of an ovum.
Almost half of all US pregnancies are unintended, a rate significantly higher than other developed countries. Of these unintentional pregnancies, about 60% are mistimed, 40% are unwanted, and about half end in abortion.
Step 1-Facilitate contraception
A little more than half of unintended pregnancies result from non-use of contraception, about 43% from inconsistent or incorrect use, and only 5% from contraceptive failure. Unintended pregnancies are reduced by providing free contraceptives, by using the most effective contraceptive methods, and by emergency contraception. Mandating insurance coverage of birth control can cut abortion rates by 62% to 78% compared to the national rate. Oral contraceptives meet all the FDA requirements for over-the-counter sales so move them into drug stores (they are OTC in over 100 other countries). Fund research studies on more highly effective, affordable, and easy-to-use birth control methods for men and women. Children whose mothers had access to birth control have higher family incomes and college completion rates. Therefore the Affordable Care Act’s contraception coverage mandate* should be enforced.
Step 2-Restore Title X
Recent Title X changes* reduced clinical capacity of reproductive health clinics by 46%, negatively affecting 1.6 million family planning patients. Restore the program to pre-2019 standards,* rescind the global and the domestic gag rule,* and improve funding to increase capacity and provide comprehensive high quality reproductive health care to those in need.
Step 3-Teach comprehensive sex education
Sex education is only mandated in 25 US states, only 13 states mandate that the information provided is medically accurate. In 19 states contraception information must be included, while 25 mandate that abstinence be stressed. Yet studies show that teens who receive comprehensive sex education are significantly less likely to become pregnant.
Solutions to Factor 2: Prevent the pregnancy from being considered untimely or unwanted. Consider the contributory factors.
Step 4-Make raising a child more affordable
73% of women undergoing an abortion said that being unable to afford a baby at that time was a reason for the abortion. That number rose to 81% for women living below the federal poverty line. And while the abortion rate for American women declined by 8% between 2000 and 2008, among poor American women it increased by 18%.
- Raise the minimum wage to $15.* Pass equal pay for equal work legislation.* Guarantee paid sick leave* and unemployment insurance.* Two-thirds of minimum-wage workers are women, which leaves many working women living below the poverty level.
- Support paid family and medical leave; more expansive family leave laws are associated with lower abortion rates.
- Provide child tax credits;* a $1000 increase in the maximum credit has been associated with a 7.6% decrease in the overall abortion rate.
- Subsidize child care for working parents*(83% of parents of kids under age 5 called finding quality affordable child care a serious problem), universal pre-school,* pre- and after school programs, children’s meals in schools and throughout the summer,* and continue nutrition assistance programs,* and free community college and trade certificate programs.* Some studies find that any kind of provision of government benefits — welfare, child care — has an impact on lowering the abortion rate.
Step 5-Keep moms and dads healthy
Ensure health care coverage* for all family members (including mental health and addiction services that are available, accessible, and affordable) so people can conceive, deliver, nourish, and raise healthy children from conception to college/trade school graduation.
Step 6-Ensure mothers survive pregnancy
Of all the high-income countries in the world, the US has the highest rate of mothers dying due to pregnancy and childbirth. And for every white woman who dies due to pregnancy-related causes, 14 Black women die. Forced continuation of a pregnancy can be life-threatening, especially for Black women. Pregnancy is much more hazardous to a woman’s health than abortion. Make decreasing maternal mortality* a priority health care issue.
Solutions to Decisions 3a and 3b: Help the pregnant person choose the option that best fits their values, circumstances, and future plans.
Step 7-Non-judgmental pregnancy options counseling
In the face of an unexpected pregnancy, nonjudgmental options counseling should be available to all pregnant people who need it. Objectives are to 1) aid the person to make a decision about the unwanted pregnancy, 2) help the person implement their decision, and 3) assist the person to control future fertility. Pregnancy options counseling does not—and should not—involve advocacy of any one option. Rather, counselors should assist and support all women in exploring all options so they can make their own, fully informed reproductive health choices free from coercion. Among women who seek an abortion but are denied it, more than 90% choose to keep and raise the child rather than place it for adoption. Women have reported that giving up their babies is more traumatic, emotionally painful, and morally unconscionable than having an abortion. Adoption, at this time, is not a viable option for most women confronting an ill-timed or unwanted pregnancy.
Other solutions that prevent abortions
A-Impose legal obstacles to accessing abortion
It is difficult to assess the impact that anti-abortion regulations have had on the overall abortion rate because so many variables may concurrently affect that outcome (i.e., sex education classes, clinic access, cost of contraceptives, employment rates, etc.). One study that controlled for those factors found that requiring clinics to be outfitted to ambulatory surgical center requirements reduced the abortion rate by 1.25 abortions per 1000 women and that laws requiring that abortion providers have hospital admitting privileges increased the abortion rate by .57 abortions per 1000 women. Another study found that a state with a highly restrictive policy climate, when compared with a less restrictive one, was associated with a significantly lower abortion rate by 0.48 abortions per 1000 women. Such restrictions often cause delays in the timing of abortions. Every additional one week of pregnancy increases the risks of the abortion procedure. The obstacles and their risks fall hardest, of course, on young people, poor people, and people of color. While blocking access does potentially reduce abortion rates, there may be unintended consequences. Unwanted pregnancies carried to birth, especially among mothers who sought but were denied an abortion, have been associated with adverse prenatal outcomes (delayed prenatal care, low birthweight, preterm birth) and higher rates of substandard parenting, child neglect, and child abuse. Women who were refused abortions are nearly four times as likely to live below the federal poverty line four years later as women who had abortions.
According to the World Health Organization findings, the legality of abortion across the world affects the number of safe abortions women are having but has little to no effect on how many abortions occur every year. In another study, the abortion rate in high-income countries with restrictive laws was higher than that of high-income countries where abortion is broadly legal. Researchers found no evidence that abortion rates were lower in settings where abortion was restricted. In the US, abortion law is regulated by the states. Anticipating decisions from a more conservative supreme court, individual states have passed or are considering laws or constitutional changes to either outlaw or protect abortion that will result in a mish-mash of resources dependent on geography.
Phase 5. Implement the Solutions
Solutions #1 through #7 are people-positive pro-women family-forward efforts with demonstrable success in lowering rates of abortion while improving the lives of pregnant people and their children. Bipartisan support for these measures would ensure their passage and result in a significant reduction in the yearly number of abortions performed in the US – that’s a goal of both the Republican and the Democratic parties, isn’t it? Solutions A and B, though they may decrease a number of abortions, are disproportionately detrimental to young women, poor women, and women of color and have not been shown to decrease the rate of abortion while simultaneously improving the life of the mothers and babies who are the concern at the core of the abortion debate, aren’t they? Forced continuation of an unwanted pregnancy can be life-threatening, especially for Black women. Unnecessary obstacles to a woman seeking an abortion are cruel.
Phase 6. Verify Effectiveness
Ensure that studies to evaluate the effects of each enacted prevention or intervention are designed, adequately funded, and conducted at periodic intervals by a qualified and impartial group of experts. This ongoing evaluation serves to identify what’s working, what doesn’t seem to be having much impact, and what modifications can be made to be even more effective. RCAs on individual solutions can be insightful.
The results of this Root Cause Analysis demonstrate that practical solutions have been identified that can reduce the number of unintended and unwanted pregnancies while simultaneously improving life for mothers, expectant mothers, and children. A substantial uptake of these solutions, many of which are on the Biden agenda, could result in considerably fewer unwanted pregnancies, making abortion a much more rare occurrence. A significant decline in the US abortion rate would represent improvements in the quality and affordability of reproductive health services. It would be a victory for both sides of the abortion debate and could serve to dampen the currently divisive and aggressive abortion debate, leaving time and energy to focus on improving other important social, economic, and political concerns.
References are available from the author upon request. (www.kristineshieldsauthor.com)