The reality is more complicated, and troubling.
The reality is more complicated, and troubling.
T he recent announcement that the Supreme Court this March will hear an appeal in Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration — a case regarding the regulation of mifepristone, the most common chemical abortifacient — puts questions surrounding women’s health once more in the national spotlight. With the abortion pill under scrutiny, undoubtedly a chorus of voices will rise in favor of expanding “preventative” care: contraceptives. Liberals and conservatives alike argue that birth control reduces demand for abortion.
However, this is not always the case. Depending on the wider context, an increase in contraceptive use in a particular sample group can correlate to an increase of abortions. A 2003 study from the pro-abortion Guttmacher Institute chalks up the correlated increase of contraceptive use and abortions to the paradigm shift caused by the widespread introduction of contraceptives: With an influx of contraceptives, women begin to change their outlook on pregnancy itself. Contraceptives now present pregnancy as a choice rather than a fact. Is this pregnancy wanted or unwanted? If the latter, abortion suggests itself as the logical next step.
The Guttmacher study suggests that with the expansion of contraception access, “the incidence of unintended and unwanted pregnancies rises, fueling increases in unwanted live births and induced abortion. In this scenario, contraceptive use and induced abortion may rise simultaneously.” The 2003 study observed that the introduction of contraceptives within a group led to a decline in fertility rates. As fertility declined, abortions increased. As fertility plateaued, abortions decreased. In short, the influx of contraceptives within a group did not reduce the number of unwanted pregnancies. It made more pregnancies unwanted.
Further, according to a 2018 study also by the Guttmacher Institute, more than half of women who receive abortions reported using some method of contraception in the month they became pregnant. From the accompanying press release: “The methods most commonly used by abortion patients in 2014 were condoms (24 percent of patients) and the pill (13 percent). ‘Contraceptive methods are highly effective at preventing unintended pregnancies, but no method — and no user — is perfect,’ says Rachel Jones, author of the analysis.”
According to the National Abortion Federation, another pro-abortion group, “half of all women getting abortions report that contraception was used during the month they became pregnant. Some of these couples had used the method improperly; some had forgotten or neglected to use it on the particular occasion they conceived; and some had used a contraceptive that failed. No contraceptive method prevents pregnancy 100% of the time.”
So, at least half of the women pursuing abortions were using some kind of contraception. It seems so intuitive that an increase in contraceptive use should lead to a decrease in abortions. Even so, studies that show the opposite have often focused on the most effective method of birth control.
The studies that show the clearest link between a rise in contraceptive use and a subsequent decrease in abortions focus on IUDs, a form of contraception with a failure rate of less than 1 percent. Because IUDs are inserted within a woman’s body and last up to five years, they diminish the possibility of user error.
A 2012 study that gained political notoriety observed a stark, causal effect between an increase in contraceptive use and a decrease in abortions. The Washington University study focused on clinics in St. Louis that offered free contraceptives to 9,000 women “at risk for unintended pregnancy” over a three-year period. The women were counseled about the different methods of available birth control and informed about their effectiveness, risks, and benefits. The extremely low failure rate (less than 1 percent) of IUDs and implants compared with that (8 to 10 percent) of pills, patches, and other forms of shorter-acting birth control was emphasized. In total, about 75 percent of women in the study chose IUDs or implants.
From 2008 to 2010, annual abortion rates among study participants ranged from 4.4 to 7.5 per 1,000 women. This is a substantial drop (approximately 70 percent) compared with the standard rates in St. Louis city and county, which ranged from 13.4 to 17 per 1,000 women for the same years. So if every girl, on reaching puberty, was encouraged by the state to have an IUD inserted into her uterus, which could be removed only on her signing a legal document stating that she wants children — yes, that would certainly reduce the number of abortions nationwide. I believe I can speak for many when I say, I do not want to live in that America.
How did chemically altering a girl’s body become the ideal solution to avoiding unwanted pregnancies in the first place? While there are many positive effects of hormonal birth control for women — which, beyond the sphere of family planning, can include the reduction of severe menstrual pain — there are undoubtedly consequences, personal and social. The inconvenient truth is that contraceptives affirm the separation of sex and procreation, ultimately affirming the separation of sex and true intimacy. (I need not add here to the chorus of articles that investigate this reality, but I will recommend Christine Emba’s work on the subject.)
But with respect to pregnancy itself: In the same way that a woman cannot simply choose to become pregnant by force of will, she cannot independently choose not to become pregnant if sexually active. She can choose to use contraceptive methods that drastically decrease the likelihood of pregnancy, but even the most effective methods, including IUDs, do not vanquish its possibility. The biological structure of a woman’s body (or that of her male partner) would have to be surgically and permanently altered to ensure a 0.00 percent chance of pregnancy.
And so, the case for pregnancy as a choice falters — yes, the use of birth control is a personal choice, but that should not be conflated with the notion that pregnancy in itself is a personal choice. In every case, pregnancy is the result of preceding human choices.
“Just as there’s no such thing as sex without consequences, there’s no such thing as freedom without responsibility,” Hadley Heath Manning, vice president for policy at the Independent Women’s Forum and a sometimes-contributor to National Review, wrote in the New York Times. “Choices about sex — and birth control — are personal choices, and we are free to make choices, good and bad. But let’s strive for what’s good.”