Monday, May 08, 2006

Contraception: The new abortion

Researchers using federal data have found two interesting trends that chart the relationship between abortion and contraceptives.

Between 1994 and 2001:

1. The rate of unplanned pregnancies rose by 30 percent among poor women. The abortion rate also rose.

2. The rate of unplanned pregnancies fell 20 percent among affluent women. The abortion rate also fell.

Asked what was driving the trends, the authors noted that some state and federal reproductive health programs have been cut or made more restrictive in recent years. State and federal programs have increasingly focused on abstinence rather than contraception, and some analysts have argued that the shift is leading to less use of contraceptives and more unintended pregnancies.


The authors said the growing disparities between richer and poorer women appeared to be the result of greater contraceptive use by the more affluent. The health statistics center, which is part of the Centers for Disease Control and Prevention, reported in 2004 that after decades of increasing contraceptive use, the trend stalled in the late 1990s and began to decline after that. The decline occurred almost entirely in poorer women.

Gee, imagine that. Reduced use of contraceptives leads to more abortions. Sounds like common sense, doesn't it? So why am I writing about it?

Because some people -- some relatively influential people -- disagree. Some Christian conservatives are starting to jump on the same bandwagon that Catholic groups have occupied for decades: life begins at fertilization, and anything that interferes with that is abortion. And they're willing to use laws and government regulations to force everybody to conform to their beliefs.

This weekend's New York Times Magazine had a cover story on the phenomenon. Some quotes:

"We see contraception and abortion as part of a mind-set that's worrisome in terms of respecting life. If you're trying to build a culture of life, then you have to start from the very beginning of life, from conception, and you have to include how we think and act with regard to sexuality and contraception." -- Edward R. Martin Jr., a lawyer for the public-interest firm Americans United for Life


Dr. Joseph B. Stanford, who was appointed by President Bush in 2002 to the F.D.A.'s Reproductive Health Drugs Advisory Committee despite (or perhaps because of) his opposition to contraception, [wrote in] a 1999 essay: "Sexual union in marriage ought to be a complete giving of each spouse to the other, and when fertility (or potential fertility) is deliberately excluded from that giving I am convinced that something valuable is lost. A husband will sometimes begin to see his wife as an object of sexual pleasure who should always be available for gratification."

Here's what happened during the FDA's consideration of Plan B, the "morning after" pill.

After the agency's advisory committees voted in favor of over-the-counter status for Plan B at the end of 2003, and after it was further approved at every level of the agency's professional staff, standard procedure would have been for the Center for Drug Evaluation and Research arm of the F.D.A. to approve the application.

But one member of the F.D.A.'s Reproductive Health Drugs Advisory Committee had reservations: Dr. W. David Hager, a Christian conservative whom President Bush appointed to lead the panel in 2002. (After an outcry from women's groups, who were upset at Dr. Hager's writing that he used Jesus as a model for how he treated women in his gynecology practice, he was shifted from chairman of the panel to ordinary member.) Dr. Hager said he feared that if Plan B were freely available, it would increase sexual promiscuity among teenagers.

F.D.A. staff members presented research showing that these fears were ungrounded: large-scale studies showed no increase in sexual activity when Plan B was available to them, and both the American Academy of Pediatrics and the Society for Adolescent Medicine endorsed the switch to over-the-counter status. Others argued that the concern was outside the agency's purview: that the F.D.A.'s mandate was specifically limited to safety and did not extend to matters like whether a product might lead to people having more sex.

Meanwhile a government report later found that Dr. Janet Woodcock, deputy commissioner for operations at the F.D.A., had also expressed a fear that making the drug available over the counter could lead to "extreme promiscuous behaviors such as the medication taking on an 'urban legend' status that would lead adolescents to form sex-based cults centered around the use of Plan B."

In May 2004, the F.D.A. rejected the finding of its scientific committees and denied the application, citing some of the reasons that Dr. Hager had expressed.

The drug's manufacturer reapplied two months later, this time for permission to sell it over the counter to women ages 16 and up, seemingly dealing with the issue of youth. Then, last August, Crawford made his announcement that the F.D.A. would delay its decision, a delay that could be indefinite.

Note the outsized influence of anti-contraceptive advisors at the FDA, and the FDA's reaction when the stated concern (use by adolescents) was addressed.

Why the opposition to Plan B? The stated reason is that it is an abortifacent, on the theory that at least occasionally it prevents the implantation of a fertilized egg.

But since Plan B is simply a higher dosage of regular birth-control hormones, the same arguments could be applied to the Pill. And IUDs. (And breastfeeding, BTW). And never mind that many of these same groups also oppose other forms of contraception, like condoms and diaphragms. Or that this represents a moving of the goalposts in the abortion debate.

The story sums up the underlying issue nicely:

The conservative [viewpoint is] that giving even more government backing to emergency contraception and other escape hatches from unwanted pregnancy will lead to a new wave of sexual promiscuity. An editorial in the conservative magazine Human Events characterized the effect of such legislation as "enabling more low-income women to have consequence-free sex."

And that is relevant how?

Does effective contraception reduce the risk of pregnancy, and thus reduce a barrier to sex? Undoubtedly. But that's a personal choice, and nobody else's business. It's something to be addressed by education and persuasion, not legislation and regulation.

I have no problem with people believing that contraception is against their beliefs. I have no problem with people trying to persuade others to feel the same. But I have a big problem with using the regulatory process to try to impose those beliefs on others. If you don't want to use contraceptives, don't; but don't try to get them legally restricted so that others can't use them, either.

I also find this argument unpersuasive:

Rector says that abstinence programs can't properly be combined with other elements in a comprehensive sex education program because the message is lost when a teacher says: "One option you might want to consider is abstaining. Now let's talk about diaphragms."

If you can't make the case for abstinence compelling in context, then it's a weak argument. It's almost a "victimology" response to argue that information on contraception must be muzzled in order for abstinence education to be effective.

True, it may be a matter of emphasis. But I doubt most sex ed classes throw abstinence away as a one-liner. And if they do, the answer is to provide curricular guidelines. Spend time emphasizing the advantages of abstinence. Discuss the risks and downsides, from pregnancy to STD to social and mental impacts. Then say "If despite all that you're going to have sex, here's what you can do to reduce but not eliminate some of the risks."

And never mind that study after study has found abstinence-only programs to be ineffective.

The good news is that the people cited in this article still represent a minority view. The article mentions that 98% of sexually-active women have used some form of birth control. It also notes this, about sex ed:

A poll released in 2004 by National Public Radio, the Kaiser Family Foundation and Harvard's Kennedy School of Government found, for example, that 95 percent of parents think that schools should encourage teenagers to wait until they are older to have sex, and also that 94 percent think that kids should learn about birth control in school.

Exactly as I outlined above.

And a final statistical note:

Countries in which abortion is legal and contraception is widely available tend to rank among the lowest in rate of abortion, while those that outlaw abortion — notably in Central and South America and Africa — have rates that are among the highest. According to Stanley K. Henshaw of the Guttmacher Institute, recent drops in abortion rates in Eastern Europe are due to improved access to contraceptives. The U.S. falls somewhere in the middle in rate of abortion: at 21 per 1,000 women of reproductive age, it is roughly on par with Nigeria (25), much better than Peru (56) but far worse than the Netherlands (9).

I repeat: feel free to be personally against contraceptive use. But don't use the levers of government to force everyone else to conform to your beliefs.

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Anonymous Joel said...

I cannot tell you how spot on you are with this.

Abortion was the initial wedge to take the Republican Party from the small government party, to the "in your bedroom with you" one, with over reaching legislation on one's life.

It's time for the Republican core to stand up to these people. The Democrats can easily use it as the wedge needed these days in politics too. As for a "third way" option, look out for this one from disaffected Republicans fed up with the unjustified influence of the christian right.

5/08/2006 8:43 PM  
Anonymous david said...

My sister, over at Ambivablog, has lumped us together in seeming "incredulous" at the legislation.

I don't think either of us is "incredulous." I also think I don't belong in your league. A very thoughtful post.

5/09/2006 5:34 AM  
Blogger Rudi's Thoughts said...

I can never vote for a Repub who courts the RaptureReady bible nuts. It looks like McCain is selling his soul for a few votes. These same nuts are against a HPV vaccine because it might facilitate sex outside of marriage. Better dead than having sex outside of procreation. Intelligent Design not, Gods work in creating these wingnuts!!

5/09/2006 2:10 PM  
Blogger Sean Aqui said...

I'm just amazed at the willingness of some people to follow a principle off of a cliff. Let's ban birth control on principle -- even if that leads to more teen pregnancy and abortion.

Joel: It points up the philosophical chasm between political conservatives and social conservatives, since the latter are willing to trample over the whole "limited government" idea as they attempt to impose their moral values on everyone. That conflict, it seems to me, is coming to a head. And not a moment too soon.

I predicted several years back that the Christian right, once it got a taste of success, would overreach just as it did in 1992. They haven't let me down. And I trust that their influence will implode again, as it did in 1992 -- as long as people keep pointing them out.

David: I am kind of incredulous, actually. Not surprised, exactly, but amazed that they would come right out and say it.

5/11/2006 2:01 PM  

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