Free contraception has prophylactic effect against abortions


I’m shocked. Are you shocked? I’m definitely shocked. Shocked is what I am. Find the crayon that most resembles “shocked”, and color me with it.

MotherJones posts about a new study that shows that when women have free access to contraceptives, there are fewer abortions. Meaning, people who don’t want or can’t have kids, for whatever reason, don’t have to use abortion as their last resort as often.

That’s according to a new study published on Thursday by researchers at Washington University in St. Louis. The project gave free birth control to more than 9,000 local women and girls, many of whom were poor or uninsured, and tracked them for two years. There were 6.3 births per 1,000 teenagers in the study group, compared to the 2010 national rate of 34 per 1,000. As for abortions, there were fewer than eight per 1,000 women in the study, compared with the almost 20 per 1,000 nationally.

“The impact of providing no-cost birth control was far greater than we expected,” Jeff Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis who co-authored the study, said in a statement.

Women’s health specialists say the study points to the potential impact of the Democrats’ health care reform bill, the Affordable Care Act, which mandates access to contraceptives without co-payments. The study’s authors say when this kind of program is deployed nationwide, more than 40 percent of the over 1 million abortions performed in the United States each year could be avoided.

Half (half!) of all pregnancies in this country are unwanted, way higher than in other developed countries, according to Scientific American. And about forty-three percent of those end in abortion. As the Associated Press reminds us, poor women are “far more likely to have an unplanned pregnancy than their wealthier counterparts.”

Which makes it completely self-evident: a large number of people are having kids they don’t want or can’t have for whatever reason, because they can’t afford or can’t get birth control. That there are fewer births overall when birth control is free, means the willingness to use them is there but the access (for whatever reason) is not. That means access to contraceptives is presently a privilege, and if we want to do our society any favours in reducing unnecessary abortion and unwanted children, we need to make access to contraceptives a right.

That abortions aren’t completely eliminated suggests to me that our birth control strategies aren’t completely bulletproof. Nor, I suspect, can they ever be. There will always be some uncontrollable variable in the equation. Reducing the number of abortions is its own good, and surely it’s something anyone should be able to get behind — whether Republican or Democrat, religious zealot or ardent atheist, feminist or woman-hater.

Okay, maybe not woman-haters, as they don’t seem to really give a shit about solving any problems except both bagging and bagging on bitches.

Also, no, human sexuality is not a controllable variable. You can’t solve this problem via the “panacea” of treating sex like it’s evil, you religious types. Besides — we all know that just makes it all the more likely unprotected sex will happen, so you’d be taking slap-shots at your own net.

Comments

  1. says

    Yes, posted it here even. My thoughts on it were complicated.

    IUDs are the method least likely to involve screwups by forgetting a pill, or screwups by pressure to and from a partner to wear/not wear a condom. They’re closer to foolproof, even where they fail very slightly more often than those other methods.

  2. Pteryxx says

    IUDs also can be concealed from a hostile partner and aren’t subject to sabotage; and only have to be paid for once in several years, so are resistant to financial crises. If I had to pick a favorite contraceptive method IUDs would be it. (I still wish for some sort of Sponsor an IUD! fundraiser…)

  3. phil zombi says

    That so many who would outlaw abortion also oppose contraception is particularly revealing. The debate is not really about abortions for them. If it were then free contraception for all would clearly reduce the need for abortions. But then all those slutty sluts would be free of the consequences(babies) of their slutty actions and that would obviously lead to chaos.

    As far as which method, I find the IUD to be pretty amazing.

    Also, nice hockey metaphor. Not such a lousy canuck, eh?

  4. Liberated Liberal says

    The major problem with this – it falls on deaf ears except for those of us who already understand the issue, as phil zombie pointed out.

    Those who oppose abortion also tend to oppose birth control.

    Those who oppose birth control oppose sex for anybody who isn’t willing to be pregnant and have 5 million children (and die for them if they have to).

    NFP-pushing Catholics are a whole other bag of bull#@%^ worms.

  5. Ysanne says

    In other news, the availability of clean drinking water leads to fewer people catching dirty water-related diseases.
    Weird, hunh?

    Btw, regular IUDs are usually only suitable for women who have already had children. However, there is a class of IUD that is perfectly suitable for nulliparous women: They’re called “frameless” and basically consist of a few tiny cylindrical copper beads threaded onto a plastic string with a knot at the top, which gets stuck into the muscle at the top of the womb. (I’ve been wearing one for 6 years. It’s great.) In GB, they are commonly used for teenagers, particularly as a part of emergency contraception or follow-up prevention after terminating an unintended pregnancy. There’s also a hormonal variant. (Brand names: GyneFix and FibroPlant.)
    Guess where they are available: Europe and China; apparently also in Brazil. But not in the US (or Australia), even though plans to get the device approved there have been announced on the manufacturer’s web page since around 2005.

  6. Pteryxx says

    Btw, regular IUDs are usually only suitable for women who have already had children.

    I’ve been hearing that’s outdated information and current IUDs work just fine for younger or nulliparous women, as long as they’re properly sized or some such. One of my stashed articles just mentions it in passing:

    IUDs were once recommended only for women who were done having children, for fear of infertility from infections associated with the devices. But the guidelines were revised after better research showed these concerns to be groundless with currently marketed IUDs if proper precautions are taken when they are inserted.

    As a result, IUDs are increasingly popular among young, unmarried and childless women, many of whom sing its praises in online chat rooms like IUD Divas.

    And another use I’d forgotten:

    Not only is the IUD more than 99 percent effective in preventing pregnancy, but insertion of an IUD soon after a woman has unprotected intercourse is often effective as emergency contraception.

    http://well.blogs.nytimes.com/2012/02/27/americans-get-reacquainted-with-iuds/

  7. sheila says

    Contraceptives allow women to take charge of their own lives. That’s exactly what some people object to!

  8. says

    To promote the use of long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to a large cohort of participants in an effort to reduce unintended pregnancies in our region.

    Pointing out that this study is specific to long-term contraception rather than a daily hormone pill. Doesn’t change the point, of course, and I’ve been promoting this study to the “pro-lifers” I interact with as part of an ongoing campaign to demonstrate that there are options to minimizing abortions that don’t involve anti-women’s rights legislation.

  9. Ysanne says

    Pteryxx,
    IUDs (and what kind to use) in young nulliparous women seems to be a somewhat debated topic. I’ve heard it both ways from gynecologists, but I can’t tell how much of it is just personal preference/experience, how much evidence-based, and how much just a “we always did it that way” mindset.
    My gynecologist only does frameless IUDs for these women because she thinks that their cervix is not necessarily open/elastic/whatever enough to push a classic IUD through (and pull it out again — the frame is folded up during insertion, but unfolds into a kind of anchor shape once it’s in). Also, there’s a good chance of having less intra-uterine space, which is a factor for the most unpopular side effect, heavy and painful periods (it’s painful when the cramping uterus presses against the frame). Both of these issues simply don’t come up with the frameless models.

  10. ema says

    They’re closer to foolproof, even where they fail very slightly more often than those other methods.

    Not sure if by “they” you meant IUDs, but just in case: LARC* (IUD/Implant) is the top tier class in terms of effectiveness; pregnancy rates of less than 1% per year. The Pill and [female] sterilization are far less effective.

    Btw, regular IUDs are usually only suitable for women who have already had children.

    Pteryxx already addressed this misconception, but it bears repeating (from ACOG, emphasis mine):

    With top-tier effectiveness, high rates of satisfaction and continuation, and no need for daily adherence, LARC methods should be first-line recommendations for all women and adolescents….

    As to the frameless IUDs, we’ve been waiting form them now for what, about 10 years. And since, as a rule, we’re about a decade behind the UK and Europe as far as contraceptive method availability, they’re bound to pop up here any day now…not.

    *LARC = Long-acting reversible contraception

  11. Forbidden Snowflake says

    Reducing the number of abortions is its own good, and surely it’s something anyone should be able to get behind — whether Republican or Democrat, religious zealot or ardent atheist, feminist or woman-hater.

    Reducing the number of abortions isn’t its own good, reducing the number of unwanted pregnancies is. The study is very interesting regardless.

  12. says

    Reducing the number of abortions is its own good, and surely it’s something anyone should be able to get behind — whether Republican or Democrat, religious zealot or ardent atheist, feminist or woman-hater.

    Well, actually, the way this is worded I can’t get behind it, sorry Jason.
    What I can really get behind is reducing the demand for abortion by reducing the need for it, be it by contraception thus reducing unwanted pregnancies or by having actual support for women and children.
    But the way this sounds is as if abortions were something bad, you know, some necessary evil.
    It isn’t. Your standard run off the mill first trimester abortion is a safe medical procedure (not as safe as not getiing pregnant but way safer than carrying the pregnancy to term) and it isn’t as if there were another conscious being involved.
    Preventing unwanted pregnancies, that’s the goal I get behind.

  13. phil zombi says

    @13 I think it is important that we avoid stigmatizing abortion. That having been said; reducing the need for medical interventions, particularly surgical, is always a good thing. Abortion is a surgical procedure, albeit one with low risk. Thus reducing the overall number of abortions is a good thing. Not because abortion is scary and bad, but because surgery is a thing best avoided if possible.

  14. brucemartin says

    The key point to me is that 60% of abortions are caused by religion.
    As its the biggest source, those who oppose abortion should be fighting against religion.
    It’s simple math.

    This also means that atheist groups and planned parenthood are more effective at reducing abortions than is any religious group.

  15. No Light says

    IUDs and the Mirena IUS will work in anyone with a deep enough uterus.

    Ysanne – are you British? If so then it’s weird that you have a gyno or GP that still believes intrauterine contraception isn’t suitable for nullips. That’s a particularly American attitude! In fact, here in the UK we even have T-frame copper and silver IUDs that are especially for young teenagers or older people with shallow uterine cavities.

    I’m a nullip on my second Mirena. Insertion was fine and I’ve had no issues. The Mirena patient info leaflet states that anyone is a suitable candidate for Mirena, as long as they don’t have fibroids, certain cancers, or a very recent septic abortion.

    It used to be believed that people who’d never birthed. were at greater risk of device expulsion, but newer studies have ruled that out. The biggest risky factor for expulsion in nullips is having the device fitted by an inexperienced practitioner. It could be, in fact it’s likely, that your doc has had some bad experiences fitting framed devices. in nulliparous women, and as a result lacks confidence.

    It’s worrying that any practitioner is giving such outdated advice to patients, and hindering their choices. TBH I’m surprised the local family planning clinical supervisor for your PCT hasn’t picked up on it. They monitor fittings and pre-insertion appointments every two years or so, to ensure best practice is being followed.

    As to this research wow, who knew water was wet, eh? Sorry, I mean, that BC reduces the risk of unwanted pregnancy. It’s the reason that all contraception is free here in the UK. As a nation with socialised medicine, it’s in our best interests to ensure that money isn’t spent on providing free abortions or maternity care if it can be avoided.

    I hate to think how bad our unwanted pregnancy rates would be without free contraception. The figures are bad enough as it is!

    Although, having worked in sexual health, I can honestly say that a lot of pregnancies happen due to not using methods like the combined pill or mini-pills properly. If I had a quid for every time I’d heard something along the lines of “Well it’s not like I was wasting money by not using them right”, then I’d be sitting on a big, rattly piggy bank.

    Some people apparently think “no cost” = “no value”. The same thing is said to happen with antibiotic compliance in developing countries. Even a tiny token payment makes users more likely to comply with a treatment regimen, when compared with those who get the treatments for free. Maybe the NHS needs to charge a very small fee for pills/patches/rings/a bag of 200 condoms. A 50p charge for “recycling” or postage, maybe?

    And Americans – free LARCs, or even pills/patches/rings are a no-Brainer. Sure the slutty-sluts won’t be punished for their sex-having ways, but abortions will reduce, welfare rolls will shrink, more girls will graduate high school, child abuse and neglect offences will decrease, etc etc. Surely that can only be a good thing? I mean, the slutty-sluts can still get all manner of “social diseases” that you can use as a stick to beat them with!

  16. says

    phil zombi

    That having been said; reducing the need for medical interventions, particularly surgical, is always a good thing.

    Yes, reducing the need is a good thing. Reducing the amount of medical procedure X as such is not something good.
    “Medical abortion” reduces the amount of surgical abortions, it’s less invasive and less risky. Therefore it’s good. It doesn’t reduce the demand for abortions as such.
    Outlawing abortions reduces the number of abortions, but it’ not good.

    I fell really strongly about this because especially in women’s health this idea of “we need to reduce procedure X as it’s own goal” is particularly strong, like the push-back against c-sections and epidurals and plain “interventions” in childbirth.

  17. Ma Nonny says

    As a participant in the cited study (I don’t mind outing myself since I no longer live in the area where the study was done), I can address a couple things.

    “Btw, regular IUDs are usually only suitable for women who have already had children.”

    This is actually what I was told by the study doctors too – something about the shape of the uterus not being right. I specifically went into the study wanting something long-term but was given a monthly BC method instead. I found out later that they started offering implants (under the skin) and was kind of pissed I was never given the option. I think part of the issue was that I was a very early partcipant (like, one of the 1st 100), so they hadn’t figured out everything yet for how it would all run.

    “Pointing out that this study is specific to long-term contraception rather than a daily hormone pill. Doesn’t change the point, of course, and I’ve been promoting this study to the “pro-lifers” I interact with as part of an ongoing campaign to demonstrate that there are options to minimizing abortions that don’t involve anti-women’s rights legislation.”

    The study only became about promoting the long-term methods later. Like I said, I was even turned down for a long-term method myself. If you chose a short-term method, you were just as much a part of the study.

    I went to a talk by the study doctor after my time in the project ended, and he mentioned that they were going to reduce the number of monthly BC options offered and start promoting long-term methods for the 2nd 5000 women they wanted to recruit. At the time, they were presenting some data about short-term method users vs. long-term method users (and how long-term is more effective), so the study was also comparing the 2 methods to each other. I didn’t look at the actual published paper that just came out, but if comparing short- vs long-term BC is not in there, I bet it will be in a follow-up paper later.

  18. says

    I dunno, the argument that saying reducing the need for a medical procedure is its own good stigmatizes the procedure is iffy with me. I get it — you don’t want to say that any instance of the procedure is unfortunate. It’s not unfortunate. Abortions should be legal, safe, and done entirely at the woman’s discretion for any reason without any third-party scrutiny or “oversight”.

    If it comes to that, those procedures are not unproblematic. They carry (some, mild) risks. They are expensive, compared to the contraceptives. They are not always convenient. They are a backup plan, not a first resort. They absolutely have their place, though, anytime an unwanted pregnancy unfortunately happens despite best efforts. When I say “reducing abortions is its own good”, it’s because I’d rather those unwanted pregnancies are stopped at the first step, contraception.

    My wife is looking into IUDs, and her gynecologist has suggested that yes, most of the information about discomfort is old information, coming from the days when IUDs were copper.

  19. ema says

    Outlawing abortions reduces the number of abortions, but it’ not good.

    Sure, it reduces the number of safe/legal abortions with little to no effect on incidence. Brilliant, no?

    As to reducing the need, not the procedure, you couldn’t be more right. I still remember when the C/S rate was in the 20s and then, poof!, comes the “directive” to reduce it to low teens. Ha! (rather than decreasing it’s now in the 30s)

  20. says

    Jason
    That’s why I said I disagree with your wording.
    Reducing the need for abortions: Yes, good.
    Reducing abortions themselves: not a good of it’s own.

    Abortions are the airbag that gets triggered* by the car accident:
    They bruise your nose, they’re expensive, they can kill you in a freak accident.
    Slamming you head into your airbag is much worse than getting to work without an accident.
    Reducing the number of accidents that trigger airbags: good!
    Just reducing the number of airbags triggered: what?
    If somebody introduced a new traffic-safety concept to you as “a means to reduce the amount of triggered airbags” you’d ask them to get their priorities right.
    Dunno how often you argued with pro-lifers, but I know them. They will take such a wording and turn it into “you think abortions are bad. It’s the bad old “safe, legal and rare” slogan.
    We need to reduce the number of unwanted pregnancies. Full Stop.
    That this reduces the number of abortions is a nice side-effect

    *do you say that? No idea, I’m too lazy to look it up right now.

  21. says

    Complete agreement, Giliell. It’s apparent I haven’t argued with enough pro-lifers to see that trap. And your airbag analogy does tell me where my priorities are backward. I’ve evidently fallen into their frame — where they’re screaming about airbags being murder and evil and horrid, and that they should be banned and nobody will ever have to suffer from hitting one. They neglect that it takes an accident and that the airbag is a safety feature of last resort to prevent worse consequences.

  22. says

    ema
    well, i guess it would reduce it in some cases.
    Right now, if I became pregnant I’d get an abortion. I have two kids, my family is complete, we’re on a bumpy road but I believe towards a better future for the four of us. A third kid would throw us back for years.
    Well, I’m in Germany, I can’t get a legal abortion, but one that’s not prosecuted. So, yeah, gimme one.
    Now, if I risked ending up dead or in prison with a rather good chance, a third kid would be preferable (actually a trip to the Netherlands would be, but let’s just pretend it wasn’t an option)

    Jason
    They’re a weasely lot, the whole of them.
    Their current tactic isn’t even to scream about “murder” so much, but to actually frame it in terms of women’s health and safety, like all those restrictions claiming to give women information and making it safe like putting impossible restrictions onto abortion clinics and providers.

  23. Nepenthe says

    If punishing the slutty-sluts for having the sexy-sex is the main concern perhaps we can make birth control often have wicked uncomfortable side effects… oh wait.

    What was the problem here again?

    Re airbags:
    The forced birth solution is like trying to reduce car accidents by mounting six inch spikes on steering wheels. (That’s either Paul Krugman or Nicholas Kristof’s originally.)

  24. Ysanne says

    No Light,
    I’m German (and now live in Oz).
    My gyno is, hm, let’s call it “outspoken”. :-) Especially when it comes to what she thinks is best for her patients’ health and how this relates to device manufacturers’ claims. She uses both kinds of IUD, and is one of the leading providers of IUD insertion training in Germany. Since she also seems to be quite up-to-date on research journals, and is one of the most dedicated doctors I’ve ever met, I trust her judgement when she says that in her experience generally women with a firm cervix and a small uterus do way better with a frameless than a framed IUD, especially when it’s a non-hormonal one. (That would include the typical nulliparous woman in her 20s and specifically me: I experienced annoying side-effects from all variants hormonal BC that I tried, and the insertion-check ultrasound also showed small fibroids.)

  25. phil zombi says

    @14 “But the way this sounds is as if abortions were something bad, you know, some necessary evil.”

    This I agree with: rhetorically the “safe, legal, and rare” narrative is a loser from the start.

    @18 “Outlawing abortions reduces the number of abortions, but it’s not good.”

    Reducing the need for abortions reduces the number of abortions. They are functionally the same. Outlawing abortions does not reduce the number of abortions. They become more difficult to obtain and much more dangerous.

    FWIW Giliell, Approved Straight Chorus I think that we are mostly in agreement. Preventing unwanted pregnancies is a goal we should all be able to get behind.

  26. says

    oH, another thing about the health risks:
    There seems to be an itsy-bitsy-teenie-tiny number of middle-class women with ample access to contraceptives who don’t bother much and as a result have multiple abortions throughout their lives.
    Now, if you start from the point that an abortion in itself isn’t anything “bad”, then all that you have is some women deciding to run an additional health-care risk. But so doe people getting plastic surgery, tatoos and piercings. And nobody feels the need to police that behaviour and campaigns that we need to bring the number of Prince Alberts down.

  27. ButchKitties says

    I’m a nulliparous woman, and I’ve had a Mirena IUD for 2.5 years. The main concern was whether or not my uterus would be big enough to accommodate the IUD, but the doc did a sounding before the insertion and confirmed that it was. I haven’t had any problems with mine.

  28. sawells says

    Isn’t it unsurprising that the abortion rate does not drop to zero when contraception is available?Sometimes there are medical reasons for not continuing a pregnancy (risk to mother’s life/health ; serious fetal developmental defect) when the pregnancy was intentional.

  29. Daniel M. says

    It’s also good at population control – we’ll soon be extinct. I’m back mofos!

    Good to see you, haven’t read the blog in a while.

  30. says

    Good to see you Daniel! Hope you & family have been well.

    It’s also good at population control – we’ll soon be extinct.

    Please tell me you aren’t being remotely serious with the word “extinct.”

  31. Mark Baker says

    This study was widely doctored. Changes in laws that made procuring an abortion more difficult, and resulted in the closing of several murder clinics, resulted in the drop in abortions across the state. Birth Control had nothing to do with it.

  32. says

    And your proof of this assertion is…? I can’t comment on assertions like this without at least something resembling evidence.

    I suppose I could comment on your “murder clinic” assertion. But it just proves you’re a motivated reasoner more than anything.

  33. Rodney Nelson says

    murder clinics

    We know where Mark Baker stands on abortion. Considering his denial of the efficacy of contraception in reducing abortion, I think I know his position on that as well.

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