The Contraception Debate

A commenter named Carter challenged Brayton, asserting that such “sweeping  generalizations are not supported by what actually happened as birth control became widely available.”  Not surprising given the setting, Carter’s challenge attracted hostile attention.  In particular, Raging Bee wrote:

Carter: just like the rest of the religious right, you deny seeing evidence after it was waved in front of your face.  Do you really wish to deny that at least some women who don't want kids will use birth control in order to avoid having to get an abortion?  Every woman who makes this choice is, ipso facto, preventing abortions.  QED.  (That’s Latin for DUH.)

Mr. Bee’s comments are remarkably ironic.  He attacks Carter for denying the existence of evidence.  Yet he only offers an incomplete logical argument that ignores the complex effects that the widespread available of contraception has had on our society.  Accordingly, I responded:

I agree: “some women who don’t want kids will use birth control in order to avoid having an abortion.”  But that doesn’t get you to “DUH” on the question of whether “widespread availability of contraception absolutely reduces the number of abortions.”  Wouldn’t a sound analysis examine the other effects of the “widespread availability of contraception,” in particular the number of people who would have abstained from or delayed sexual intercourse absent easily available contraception?

While Raging Bee never responded, Ed Brayton did, leading to one more exchange between Ed and me.  If you read these exchanges, you will find that Mr. Brayton does not substantiate with evidence his claim that the “widespread availability of contraception absolutely reduces the number of abortions.”  Instead, he ultimately rests his argument on his own “values laden” “judgment.”  For someone writing at ScienceBlogs, it seems rather bold to admit that one’s public policy preferences (sometimes) are driven not by objective, verifiable facts but by values.   While I may not appreciate most of his conclusions, I do appreciate Ed’s candor. 

On the heels of the foregoing discussion, I read an essay by William Saletan in Sunday’s Washington Post, Where the Rubber Meets Roe.  Mr. Saletan advocates a position similar to Mr. Brayton’s, arguing, “To lower the abortion rate, we need more contraception.”  As part of his case, Mr. Saletan describes evidence of the type that I asked from Mr. Brayton, namely evidence concerning the overall effect of the availability of contraception on rates of abortion: 

[W]omen with family incomes below 200 percent of the poverty line . . . have higher rates of unintended pregnancy and more difficulty finding or affording contraception. Among these women, the percentage using contraception declined from 1995 to 2002. As predicted by contraception opponents, the rate of sexual activity also declined, though only slightly. Even better, from an antiabortion standpoint, when these women got pregnant unintentionally, the percentage who chose abortion fell.

Less contraception, less sex, more women choosing life. So, the abortion rate among these women went down, right? Wrong. The decline in contraception overwhelmed the decline in sexual activity, resulting in a higher rate of unintended pregnancy. And the increase in unintended pregnancy overwhelmed the increase in women choosing to have the baby, resulting in more abortions. From an antiabortion standpoint, trading contraception for “choosing life” was a net loss.

If this characterization of the evidence is true, contraception opponents must take notice.  (I am trying to locate Mr. Saletan’s primary sources.  If you are familiar with them, please leave references in the comments section below.)

At the same time, there is evidence to which contraception proponents, Mr. Saletan included, must respond.  He writes: 

[Contraception opponents] point out that birth control pills, like morning-after pills, can block implantation of an embryo.  But there’s no evidence that this has ever happened.  The chance is theoretical, and breastfeeding poses the same chance, so you’d have to stamp that out, too.

This dismissal of the abortifacient potential of birth control pills is much too casual.  A large number of medical studies demonstrate that the Pill “dramatically change[s]” the endometrium, the uterine lining in which fertilized eggs implant and develop.  “[M]ost of these studies conclude that the pill-induced endometrial changes render the endometrium hostile or unreceptive to implantation, at least some of the time” (The Growing Debate about the Abortifacient Effect of the Birth Control Pill and the Principle of the Double Effect).  Birth control pill opponents argue that its abortifacient potential “is so well-accepted in the medical world” that the FDA’s approved product information for the Pill says:

‘Although the primary mechanism of action is inhibition of ovulation, other alterations include changes in the cervical mucus, which increase the difficulty of sperm entry into the uterus and changes in the endometrium which reduce the likelihood of implantation.’  To proponents, this is an FDA admission of the potential abortifacient effect of the Pill.

While the medical evidence is in dispute, it cannot reasonably be argued that there is none.  The question before us is whether we will honestly deal with the evidence of the Pill’s abortifacient potential.