The Power of Denominators: Planned Parenthood Edition

Content note: Big contentious political issues ahead. Proceed with care. As with most of my posts, the intent here is not to take a stance on a political issue, but rather to discuss the ways numbers are used to talk about them.

Last week I got tagged in a rather interesting Facebook discussion about abortion and Planned Parenthood. It centered around this video from the group LiveAction, that focused on debunking the “abortion is only 3% of what Planned Parenthood does”.

What stuck out to me about this video (and the associated Slate and Washington Post articles it referenced) is that despite the contentious issue being addressed, this is fundamentally a debate about denominators. No one seems to question the numerator here….Planned Parenthood readily states that they performed 323,999 abortions in fiscal year 2014-2015. What’s up for debate is what you divide that by to get an accurate picture of their business, and what questions those denominator choices answer.  There are a couple of options here:

  1. Number of billed procedures or “discrete clinical interactions” Every year, Planned Parenthood provides 10.6 million different types of services in it’s clinics. This is the denominator used to get the 3% figure. As the video above (and the Slate and Washington Post article) point out, a pregnancy test, abortion, STI screening and follow up contraception prescription would count as 4 separate line items, despite not being even remotely equal in time, cost, or overall impact. What this number does answer is “what does Planned Parenthood do other than abortion?”.
  2. Pregnancy services provided The Washington Post article that investigated the 3% claim also investigated the claim by the Susan B Anthony foundation that 94% of “pregnancy services provided by Planned Parenthood” were abortions. To get this number, they took the number of services offered exclusively to pregnant women: abortions, prenatal services and adoption referrals. Those last two categories total a little over 20,000/year, so you end up with a denominator of 344,000 or so. This gets you to 94%. This number answers the question “what does Planned Parenthood do exclusively for women who present at the clinic already pregnant?”. I keep repeating exclusively because there’s no way of seperating out pregnancy tests or STI screenings for pregnant vs non-pregnant women.
  3. Amount of revenue Another way of calculating the percent of a business is calculating the percent of revenue derived from that one service. The Washington Post attempts to crunch these numbers based on published rates, and comes up with something in the 15-37% range. Since Planned Parenthood does not actually publish this data, there are a lot of assumptions built in. Essentially though, this is the number of procedures times the approximate cost per procedure divided by total PP revenues. The approximations are difficult to make mostly because costs vary and Planned Parenthood tends to have a sliding scale for those who can’t afford the full cost. This number is probably closer to what most people think of as “percent of business”.
  4. Number of abortions in the country I’ll come back to this one later, but The Blaze article notes that if you use the denominator of “total abortions performed in the USA” you find the Planned Parenthood performs a little over 30% of abortions. This answers the question “what percentage of abortions are actually performed at Planned Parenthood”.
  5. Number of patients In the LiveAction video, it is noted that Planned Parenthood saw about 2.7 million patients. This means about 1 out of every 8 patients seen by Planned Parenthood in a year got an abortion in that year. This is a stat to be careful with because people can have multiple visits, so this does not answer the question “what are the chances a person walking in to a Planned Parenthood clinic is there to have an abortion”, but rather “what percent of all patients had an abortion in a given year”. It should be noted that the assumption here is that no one got more than one abortion in a year. That is probably mostly, but not entirely, true.
  6. Number of total clinic visits Finally we get to the number of overall visits. This number is given at 4.6 million, and for my money is probably the most accurate representation of “what percent of their business is abortion”. This comes out to about 7% of visits per year, but if you count follow up visits (which may or may not occur), it could be up to 14%. This answers the question “what are the chances that a person walking in to Planned Parenthood is there to have an abortion”.

Some quick notes on this data: all of this was from other sources, I didn’t crunch any numbers myself. Since the original Blaze article didn’t quibble with any of Planned Parenthood’s published data, I took it as is. I also switched back and forth a few times between the 2013 data and 2014 data, so some numbers may be slightly off.

So overall, what do I think? Well, as you can see, denominators matter. For a less contentious issue, parsing this data would be purely a matter of intellectual debate, and no one would really care that much. When it comes to something like abortion however, the stakes are raised. Changing the denominator you use is inherently a political statement, as you change the ability of your data to answer a particular question.

Interestingly, I don’t think any of this data answers the real question. To me, the crux of the issue is something along the lines of “why is Planned Parenthood so important”? This is not answered by any of the above data. While they certainly perform a lot of abortions, they don’t perform the majority of them. So why all the focus on their business model?

Basically I think it comes down to political organization. I couldn’t find good data on where the other 2/3rds of abortions are performed, but my guess is they are probably independent doctors or clinics that have nowhere near the organizational or advocacy power of Planned Parenthood. Even if Planned Parenthood doesn’t perform those abortions, I think both sides probably agree they make it easier for the groups that do the procedures to continue their practices. By drawing the political fire and filing the lawsuit challenges themselves, Planned Parenthood ends up with an impact that is felt by everyone but would be nearly impossible to quantify in numbers. Additionally, many Planned Parenthood clinics are intentionally built in areas without easy access to other similar services. How much of this business would be picked up by other doctors/clinics/hospitals if Planned Parenthood closed is debatable. Whether or not that’s a good thing depends almost entirely on your pre-existing political beliefs.

As much as I love numbers, it’s important to remember the limits of data.   Any time someone rattles off a statistics, a helpful first question is “does that answer the question we’re really asking?”. Not all important issues can be quantified, and not all statistics hit the heart of the issue. Most important, very few people have ever (or should ever) change a profound moral conviction because of a denominator choice. In the immortal words of Andrew Lang:  “try not to use statistics as a drunken man uses lamp-posts, for support rather than for illumination”.