This much is true: In the United States, the abortion rate for black women is almost five times that for white women. Antiabortion activists, including some African-American pastors, have been waging a campaign around this fact, falsely asserting that the disparity is the result of aggressive marketing by abortion providers to minority communities.
Black women are not alone in having disproportionately high unintended pregnancy and abortion rates. The abortion rate among Hispanic women, for example, although not as high as the rate among black women, is double the rate among whites. Hispanics also have a higher level of unintended pregnancy than white women. Black women's unintended pregnancy rates are the highest of all. These higher unintended pregnancy rates reflect the particular difficulties that many women in minority communities face in accessing high-quality contraceptive services and in using their chosen method of birth control consistently and effectively over long periods of time. Moreover, these realities must be seen in a larger context in which significant racial and ethnic disparities persist for a wide range of health outcomes, from diabetes to heart disease to breast and cervical cancer to sexually transmitted infections (STI), including HIV.
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The abortion rates among women in minority communities have followed the overall downward trend over the three decades of legal abortion. At the same time, however, black women consistently have had the highest abortion rates, followed by Hispanic women (see chart). This holds true even when controlling for income: At every income level, black women have higher abortion rates than whites or Hispanics, except for women below the poverty line, where Hispanic women have slightly higher rates than black women.
Whether an at-risk woman practices contraception, however, does not in itself tell the whole story. For an individual woman who is attempting to avoid a pregnancy, the particular method she chooses and the way she uses it over time also matter. In fact, all of the major contraceptive methods are extremely effective if used "perfectly." In actual practice, however, there are significant variations in a method's effectiveness in "typical use" (i.e., for the average person who may not always use the method correctly or consistently). The IUD has a very low failure rate because it is long-acting and requires little intervention by the user. Coitus-related methods such as condoms are at the other end of the typical-use effectiveness scale, because they depend on proper use at every act of intercourse. The pill, which is not coitus-related but must be taken every day, is usually more effective than the condom, but less effective than an IUD (see table). Factoring together the method choices and the real-life challenges to effective use over long periods of time, women of color as well as those who are young, unmarried or poor have a lower level of contraceptive protection than their counterparts.
Fundamentally, the question at hand is less why women of color have higher abortion rates than white women than it is what can be done to help them have fewer unintended pregnancies. Obviously, facilitating better access to contraceptive services is key. Beyond access, however, dissatisfaction with the quality of services and the methods themselves may be as much or sometimes more of an impediment to effective use of contraceptives.
Beyond geographic and financial access, life events such as relationship changes, moving or personal crises can have a direct impact on method continuation. Such events are more common for low-income and minority women than for others, and may contribute to unstable life situations where consistent use of contraceptives is lower priority than simply getting by. In addition, a woman's frustration with a birth control method can result in her skipping pills or not using condoms every time. 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. Cultural and linguistic barriers also can contribute to difficulties in method continuation.
These themes resonate beyond the domains of contraceptive use, unintended pregnancy and abortion. Indeed, they probably underlie many of the stark racial and ethnic disparities that exist across a broad range of health indicators. For example, the Centers for Disease Control and Prevention presented data in March 2008 indicating that black teens were more than twice as likely as their white or Mexican-American counterparts to have one or more of the four STIs studied (chlamydia, trichomoniasis, genital herpes and human papillomavirus), independent of income and number of sexual partners. Reported cases of syphilis are triple the rate for Hispanics than for whites, according to the American Social Health Association. According to the Department of Health and Human Services Office of Minority Health, the AIDS case rate for African-American men is more than eight times that for whites; the rate for Latinos is more than three times that for whites. Hispanic women are more than twice as likely as whites to be diagnosed with cervical cancer; black women are less likely to be diagnosed with breast cancer than white women, but 30% more likely to die from it.
Beyond sexual and reproductive health, African-Americans and Hispanics bear a greater disease burden than whites across a range of important health indicators. Blacks, for example, are almost twice as likely as whites to have diabetes. New cases of colorectal, pancreatic and lung cancer occur more often in African-American women than in any other group. There is a higher incidence of stomach and liver cancer among Hispanics, male and female, than among whites and a higher mortality rate from these cancers as well.
Ironically, treating all patients the same, regardless of race or ethnicity, may not be the answer to the problem of health disparities. Harvard Medical School professor Thomas Sequist published the results of his research in a June 2008 issue of the Archives of Internal Medicine in which he and his colleagues found that a physician's failure to match a treatment regimen with a patient's cultural norms could contribute significantly to the poor compliance and worse health outcomes manifest in minority communities. "It isn't that providers are doing different things for different patients," he explained to the New York Times. "It's that we're doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren't being met."
Perhaps all that is certain about racial and ethnic health disparities is that there are too many, they are too great and the reasons for and solutions to them are complex. Narrowing the gaps in access, quality and health outcomes is essential and a priority in the public health community. It is also a priority among key members of Congress, led by Rep. Hilda L. Solis (D-CA), chair of the Congressional Hispanic Caucus Task Force on Health and the Environment, along with Del. Donna M. Christensen (D-VI), chair of the Congressional Black Caucus Braintrust, and Del. Madeleine Z. Bordallo (D-GU), chair of the health care task force of the Congressional Asian Pacific American Caucus. Under Solis' leadership, these three caucuses have been advocating for passage of the Health Equity and Accountability Act of 2007, legislation designed to address some of the known impediments to quality health care, including some aspects of reproductive health care, for minority populations.
Perhaps it is because they are more acutely aware of the larger societal issues surrounding health disparities, members of the Black, Hispanic and Asian Pacific American caucuses in Congress, overwhelmingly, are strong and reliable advocates of reproductive heath and rights, including abortion rights. So, too, is an array of organizations representing women of color, including African American Women Evolving (AAWE), the National Asian Pacific American Women's Forum, the National Latina Institute for Reproductive Health and Sistersong, among others.
This article was made possible by a grant from the Robert Sterling Clark Foundation. The conclusions and opinions expressed in this article, however, are those of the author and the Guttmacher Institute.
While at a local pub, I noticed a lady with a cell phone camera taking covert pictures of me without my expressed permission. I asked the lady to stop and to give me a copy of any and all pictures of me and to destroy all copies in her phone's memory. I asked twice on two different occasions and so far have been denied. What, if anything, can I do to obtain the unwanted pictures?
If it was "covert" how can you know she was taking your photo and not a photo of something or someone around you ( or the room in general ) ? Phones typically don't have much zoom capability so unless she pointed at you close up, it probably wasn't you she was photographing and if she did that it wasn't covert.
It's unrealistic to expect to sit in a bar or restaurant ( or stand in public ) and not be photographed either by accident or design. It's such a normal thing to see people holding up phones and taking photos and video now that it's become utterly pointless for anyone to try it in secret.
Asking for a copy would, unless I'm mistaken, make her a legitimate photographer of an image and entitled to keep one for herself. So getting a copy would be counter-productive. Either you don't want to be photographed or you're happy to be photographed - you can't have it both ways.
In your own home you'd be on safer ground legally. But in many countries it's perfectly legal to photograph someone in their own home once the photographer is not there (with a long focal length). In general your right to privacy is governed by how privately you are acting. Doing something in a pub is not somewhere you can easily claim a right to privacy. 152ee80cbc
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