Contraception Access Could Prevent a Million Abortions in the US a Year
Thursday, February 23, 2012

You can oppose abortion.  You can oppose contraception.  But you cannot logically oppose both.

You don't have to be a gynecologist to understand that abortion's final common pathway is unintended pregnancy.  Preventing an unintended pregnancy makes abortion impossible.

Using 2008 data from the Guttmacher Institute, I came up with this admittedly speculative extrapolation.  Using retrospective data is always risky, but if I worked in an emergency room and noticed that the most severely injured car accident victims were not wearing their seat belts or intoxicated (or both), it would not be difficult to extrapolate what would happen if seat belt usage were universal and stricter drunk driving laws were followed.   In fact, the public health campaigns addressing these two issues were launched based on exactly those sorts of observations.  

In the same way, data about who gets an abortion can allow us to estimate what might happen if access to and use of contraception were improved.

Opponents of contraception are fond of pointing out that over half of those who seek an abortion were using contraception at the time of the conception.  Since contraception does not work perfectly, it must not work at all, right?  

Wrong.  54% of women who had an abortion used a contraceptive method the month prior to their unintended pregnancy.  The most common type of contraception was the condom or the pill.  But of these women, 76% of pill users and 49% of condom users admitted to not using the method consistently.  In fact, only 13% of pill users and 14% of condom users reported correct use.  

Since people have a tendency to over-report things that make them look good in the eyes of the surveyor, it's likely that this 13-14% "correct use" number is higher than reality.  

Besides, there are many ways someone deprived of rigorous education on contraception use might inadvertently misuse them.  A condom might be worn properly, for example, but how many people check the expiration date prior to use or avoid exposing a condom to excess pressure (as in a wallet in a back pocket) or heat (as in a car left in the sun)?   Did the condom also have a spermicidal lubricant or was it used in conjunction with spermicidal foam?  Did someone who was on an oral contraceptive forget to take it one day, then doubled the next, or simply dropped that pill from the cycle?  Studies of parents of children taking a 10-day course of antibiotics indicate 30% fail to give at least one dose by day 3, and that almost three-fourths fail to complete the full 10-day course, so the probability of a woman missing a dose of a regimen running over a much longer period is even higher.  

The bottom line is that the vast majority of those who have abortions were either not using contraception at all or using it inconsistently.  So what would happen if we improved these numbers (something the bishops are fighting fiercely to prevent)?   

Let's imagine a group of 100 women seeking abortions in 2008.  On average, 46 did not use any contraception whatsoever.   This is the low-lying fruit:  the biggest improvement would be to encourage all women who are sexually active but not ready to get pregnant to use contraception as religiously as they wear a seat belt.  Such a change in behavior would mean 46 more women would use contraception.

Admittedly, that would not prevent 46 abortions because - as the 13-14% of women obtaining an abortion who reported using contraception consistently reminds us - some unintended pregnancies can occur even with proper use.  

Note:  the fact that 13% of those taking who were on oral contraceptives and who got abortions in 2008 reported regular use does NOT indicate that the pill's failure rate is as high as 13%.  According to the CDC, oral contraceptives are 92-99% effective, meaning their "failure rate" is between 1-8% (probably closer to 1% if used properly and combined with other methods).  This is a classic Bayesian probability problem - the fact that you know the rate of exposure to proper use of oral contraceptives given an unintended pregnancy tells you nothing about the rate of unintended pregnancy given proper use of oral contraceptives.  

But let's assume for sake of argument that of the 46 additional women who now use contraception, 13% get pregnant anyway.  That still means 87% do not get pregnant, so even in this dismally unlucky scenario, contraception use has prevented 40 abortions (87% x 46).

Let's return to the other 54 women who already use contraception.  Of these, only 6 (about 13%) used it consistently and correctly.  That means 48 women in the contraception group are not using it consistently or correctly.  If we could - through an outreach and education campaign perhaps, or by eliminating financial barriers to filling their prescriptions or buying condoms - get that number up to 100%, even if we used the ridiculously high 13% failure rate, proper contraception use would prevent another 42 abortions (87% x 48).  

Adding the 40 abortions prevented by getting those who used no contraception to use it to the 42 abortions prevented by getting those who used contraception irregularly to use it regularly, even with the artificially high 13% failure rate of properly-used contraception, 82 total abortions of the original 100 would be prevented.  

Bottom line:  universal access to contraception, used properly, would reduce the abortion rate by 82%.  Extrapolated to national data, 82% of 1.21 million abortions in 2008 translates into 980,000 prevented abortions!  

So when Rick Santorum or Newt Gingrich say they are "pro-life", ask them why they are attacking policies that - in combination with other efforts, such as poverty reduction and universal access to healthcare - could easily prevent a million abortions a year.   If they really wanted to prevent the intentional loss of embryonic life why wouldn't they do whatever it took?  

            Yes, some who oppose contraception on theological grounds might sincerely believe that Jesus would prohibit the use of estrogen-progesterone pills or latex condoms, but since Jesus never said any such thing they cannot be sure.  Some rudimentary contraception existed in his time, but if it bothered Jesus, he never spoke against it, just as he never said a word about that other sexual litmus test of modern Christianity - homosexuality.   

What Jesus did teach was a variation of Rabbi Hillel's Golden Rule.  It's hard to imagine that when he said we should do unto others as we want them to do unto us that he would support preventing poor women in a wealthy nation from accessing technology that might break their cycle of poverty  compounded by unintended pregnancies leading to children born into a society that is appallingly indifferent to their post-natal existence.   It's hard to see how the man who saved a woman from being stoned to death for adultery would have wanted women today to be barred from an entire class of medicine because men they never met fear other women might use them to control the timing and number of her children.  

At any rate, it's unfair to claim to speak for Jesus or Yahweh or any entities, real or imagined, or are unable to speak for themselves, particularly when the 34,000 denominations of Christianity who all claim to be channeling the same spirit of Jesus disagree about what he actually meant.   Why not do as the Good Samaritan did, and not let the obtuse, abstract, legalistic religious ritual prevent us from doing the obvious good right in front of us.  If a man is bleeding to death in the road, help him.  If you have the means of preventing a million abortions a year, then for god's sake use it!.