Rachel Held Evans asks:

So yesterday I complained about feeling stuck in the middle between pro-life idealism and those progressive policies I think are most likely to actually curb the abortion rate. But today I’m thinking about practical solutions. There are a few I’ve been advocating and supporting for a long time, but I want to crowdsource a bit: What are some key initiatives (both domestically and globally) around which conservatives and liberals could rally that would address the underlying causes of abortion: poverty, expensive healthcare, expensive childcare, lack of access to contraception and comprehensive sex education, domestic violence, etc? If I find the time I’ll share the best in a blog post. Thanks for weighing in! (And let’s keep it positive and practical!)

I love talking about ways to address the underlying issues that lead to abortion. There’s so much that we can do to prevent abortions — IF, as an early feminist wrote in The Revolution, “We want prevention, not merely punishment.” My reply:

***

As other commenters have said, affordable and easy access to contraception is important. The less often people have to go pick up prescription refills, the better — there was a study in L.A. that showed that allowing low-income women to get twelve months’ worth of pills at a time decreased the odds of unintended pregnancy by 30%, and the odds of an abortion by 46%. Even better, IF a woman freely chooses them and can have them removed upon request, are long-acting reversible contraceptives like IUDs and implants that don’t require any action to be taken once they’re in. In general, humans are not great at taking a pill at the same time every day (not just contraceptives). LARCs also can’t be sabotaged by abusive partners.

Speaking of which, we also need to do more to stop rape, and to help women out of abusive relationships. Early research shows that counseling women who come to family planning clinics about reproductive coercion (asking about whether their partners hide their pills, threaten to hurt them or kick them out of the home if they use contraception, etc.) not only reduces unintended pregnancies among women in abusive relationships, it also increases the chance they’ll leave those relationships. Men who father children by rape must not be allowed to have custody or visitation. This is already the case in 35 or so states, but we need to finish the job.

Comprehensive and accurate sex ed, including instruction about how to be safe and responsible about sexual activity if one chooses to use drugs or alcohol.

School and workplace policies that are designed with the idea that workers are human beings who have lives outside of work, not just productivity machines. No more just-in-time scheduling. No more pregnancy discrimination. Paid maternity and paternity leave. Affordable child care.

Nobody should ever be in a position where they don’t feel like they can bear a child because they won’t be able to pay rent or feed their other kids. More power for workers would mean better wages, and a real social safety net (one that’s not premised on the false idea of recipients as moochers who need to be humiliated) would alleviate some of the financial fear that often leads to abortion. Better yet, a guaranteed basic income and/or a child allowance. It’s disgraceful that in a country as rich as ours, hundreds of thousands of abortions happen every year because mothers are afraid they can’t afford to give their children life.

***

The above comment was dashed off quickly, but I would also add perinatal hospice, so that abortion doesn’t seem like the only option for parents whose children are diagnosed in the womb with fatal conditions. Also, there needs to be community support for parents of children with disabilities. Asking them to go it alone, with all the added stress and expense and work that can be involved, overwhelms many parents. They can’t see themselves handling all that, especially if they also have other kids. They shouldn’t have to handle it without help.

And while it’s not a policy issue, in general we need to foster a sexual ethic that emphasizes care for the health and well-being of oneself, one’s partner, and for any child who might be conceived. Not just safe sex, but caring sex. Wise sex. Sex that acknowledges that we aren’t pleasure-seeking islands, but are connected to — and affect — our fellow human beings.

A lot of advocates for women’s health and for workers were pretty upset after Monday’s Burwell v. Hobby Lobby decision. The Lannisters even sent their regards. So of course, the Very Serious People arrived on the scene to tell us that it’s really no big deal and we shouldn’t get so worked up over it.

I don’t think so. Let’s look at some of the reasons people are saying that the holding was narrow and there probably won’t be any serious practical effects.

Claim: The ruling only applies to closely-held corporations.

True, but that doesn’t make it narrow. Over 90% of American companies are “closely-held corporations.” Those companies employ over 50% of American private sector workers. It’s true that most of them are unlikely to refuse to offer insurance that covers contraception (known hereafter as “standard insurance,” because by law that’s what it is), but that doesn’t mean the scope of the decision itself isn’t broad.

Claim: The ruling won’t have much effect because the affected employees will still get contraception coverage.

Well, they might. The HHS has created a system to accommodate religious non-profits who don’t want to offer standard insurance, and the Court said that for-profit corporations could be offered the same accommodation. It hasn’t yet been established that HHS has the legal authority to extend the compromise to for-profit corporations, though that does seem likely to happen. But there’s another problem. In Little Sisters of the Poor v. Burwell (formerly Sebelius), which is currently making its way through the Federal court system, a religious order is claiming the accommodation itself violates their rights because signing a form certifying that they won’t provide standard insurance means they’re directing the government to provide contraception coverage in their stead, and therefore cooperating with “evil.” It’s not impossible that the Court might say now that the government can provide contraception for Hobby Lobby employees, only to strike down the system they’re using to provide it later.

Claim: Hobby Lobby offers insurance that covers contraception; they were only asking not to cover “abortifacients.”

This is true in the case of Hobby Lobby itself. However, the decision applies to insurance coverage of all contraception. Basically, the Court used the concern over so-called “abortifacients” as cover to issue a broader ruling that will allow for-profit companies to deny all contraception coverage to their employees and their dependents.

In any event, the claim that the four methods in question are in fact abortifacient is highly contestable. I find it incredibly troubling that the Court felt no need to address the factual content of that claim.

Claim: The ruling only applies to contraception.

The majority said that people with religious opposition to vaccines, mental health screenings, or other services often covered under standard insurance might still have to cover them. At first, this seems to make the ruling more palatable; at least it affects fewer people and services than it otherwise might. But in fact, this is a problem precisely because the Court is singling out contraception as somehow unlike other medical services.

In any event, our decision in these cases is concerned solely with the contraceptive mandate. Our decision should not be understood to hold that an insurance coverage mandate must necessarily fall if it conflicts with an employer’s religious beliefs. Other coverage requirements, such as immunizations, may be supported by different interests (for example, the need to combat the spread of infectious diseases) and may involve different arguments about the least restrictive means of providing them. [page 46 of the majority opinion]

I’m not sure how the least restrictive means test would ever have a different result; after all, the government theoretically could step in and set up a program to cover any specific type of medical care. I think this comes down to “supported by different interests.”

Contraception is covered as part of standard insurance because the ability to plan and space pregnancies is good for women’s and children’s health. If the majority genuinely found that interest compelling, it would make no sense to argue that other coverage requirements might pass muster due to serving different (super-duper compelling?) interests. I don’t think they did, lip service to the contrary notwithstanding; there was not one mention in the opinion of the health benefits of family planning. It’s hard not to wonder whether the majority simply don’t think of contraception as “real medicine” like vaccines.

If HHS extends the religious nonprofit accommodation to cover closely-held corporations and if the court doesn’t strike down the accommodation, it may be that the practical effect of the decision is small. That’s the best-case scenario, and it’s certainly possible. No, SCOTUS didn’t ban birth control, and it’s not The Handmaid’s Tale. But it’s still a big deal.

Two recent news items highlight the need for better education about pregnancy and birth control. The first is a survey by the American College of Nurse-Midwives:

Despite the broad range of options available to women for birth control and family planning, a survey of more than 1200 US women between 18 and 45 released today by the American College of Nurse-Midwives (ACNM) shows that women do not feel knowledgeable about many of these options and have harmful misperceptions about their effectiveness. The survey also found that many women don’t feel they are able to have in-depth conversations with their health care providers to make well-informed decisions on birth control and family planning.

And what are the consequences of lack of knowledge and misperceptions?

We interviewed a sample of women obtaining abortions in the U.S. in 2008 (n=49) and explored their attitudes towards and beliefs about their risk of pregnancy. We found that most respondents perceived themselves to have a low likelihood of becoming pregnant at the time that the index pregnancy occurred. Respondents’ reasons for this perceived low likelihood fell into four categories: perceived invulnerability to pregnancy without contraceptive use, perceptions of subfecundity, self-described inattention to the possibility of conception and perceived protection from their current use of contraception (although the majority in this subgroup were using contraception inconsistently or incorrectly).

Far too many people don’t get factual education from their schools or adequate information from their doctors about how their own bodies work. The result is unintended pregnancy and, often, abortion.

Starting today, people in the U.S. who need health insurance can go to healthcare.gov to enroll in a plan through their states’ new exchanges.

There’s a lot for pro-lifers to love about health insurance reform. All plans offered on the exchanges must cover prenatal care, delivery, and care for mother and baby after birth. Prior to the Affordable Care Act, most individual insurance plans didn’t cover maternity care, and women who were already pregnant often couldn’t get insurance at all.

In addition to the reform of maternity care coverage, the ACA requires insurance plans to cover a number of preventive services with no cost-sharing. These include, but are definitely not limited to:

Having these vital preventive services available without a co-payment will help more women and children live healthy lives as well as making it easier for women to avoid unintended pregnancy and abortion.

* These are currently required to be covered for women but should be available without cost-sharing to everyone, in my opinion.

Imagine that you worked for somebody whose religion forbids drinking alcohol. Now, that doesn’t mean you couldn’t get a beer. The way it would work is that your boss would tell the bank where your checks are deposited that she’s anti-beer. You’d get your salary minus the amount you spend on beer, and then when you buy beer, you’d have to tell the store or bar to bill your bank. Then the bank would keep track of how much they’d spent on paying for your beer, and submit that information to the government to be reimbursed.

Imagine that around half the country supported this system — or thought even this Rube Goldberg arrangement wasn’t good enough, and still amounted to your employer being forced to buy you beer — and said if you didn’t want your boss deciding how you could spend your pay, you should just find a different job. You know, in an economy where unemployment has been above 7.5% for almost five years.

Sound reasonable? No? Well, that’s basically the situation that now exists with another form of employee compensation: the employee’s health insurance policy.

If it would be ridiculous for beer, why is it OK for family planning?

[I’d bookmarked the HHS announcement but hadn’t started drafting this post yet when two stories came out about workers who are forced to get their pay in the form of prepaid debit cards and get screwed by the cards’ high fees. A friend of mine pointed out that soon, it could become technologically feasible for companies to pay their employees with debit cards that can’t be used to buy certain things. And won’t that be a paradise of religious freedom?]

At the conference held for the 25th anniversary of Consistent Life (of which All Our Lives is a member group), Mary spoke with Elizabeth Palmberg about her views on how abortion relates to issues of reproductive justice faced by women, as well as to other forms of lifetaking. This interview is reprinted, with permission, from the Fall 2012 newsletter of Consistent Life.

When I was small, I had a strong intuition that all lives are sacred. And I heard about women’s liberation; I heard the feminists burned bras, and this and that and the other thing, but there was something about it that, inside, made me cheer. I was always kind of a free spirit. What I learned in college, at Bryn Mawr, was that if you’re for women’s rights, you have to be pro-choice— something about that just didn’t sit right with me. I didn’t know many people who felt the same way who would talk about it. I came from a very conservative background, and I came out of college feeling that some of my earlier moral and political intuitions were validated by feminism and progressive politics. But this issue of abortion—I just could not get away from the feeling that this is violence and it arises from injustice against women.

I wanted to do something about violence, but I felt very discontent with the pro-life movement as such. I became a social worker and worked in pregnancy care services. When I became too disabled to work a “normal” job, I went to being a writer and editor; one of my specializations is recovering lost history.

I’ve written on black history, Polish-American history. And I’ve done work on early feminists—even though the situation is different today, obviously, they have a very keen analysis, that still holds, why women have unintended pregnancies and abortions.

Two years ago Jennifer Roth and I co-founded a group called All Our Lives; we very consciously take a reproductive justice approach. Reproductive justice is a movement that arose from women of color, people with disabilities, people with a working-class perspective. Reproductive justice involves having not only the right to have a child but the social power to exercise that right, to raise the children we have in safety, and it also includes the right not to have a child.

Many people who identify with reproductive justice take a pro-choice stand on abortion, but there are many of us who don’t. Loretta Ross, the head of SisterSong, a very influential reproductive justice organization, talks about “perfect choice.” If everyone had the means to do what they wanted to do reproductively and sexually, that would be the state of perfect choice. Some people believe that in that state there would still be abortions, and others of us think that it would be rare to nonexistent.

So that’s why we started All Our Lives, and we’ve had very interesting dialogues, mostly behind the scenes, with both pro-life and pro-choice people. One thing that we’re finding is a niche that nobody’s taken up is that a lot of scientific research now suggests that methods that were considered abortifacient really aren’t—there is so much resistance to hearing that perspective. We also have on our website a PowerPoint presentation called “Family Planning Freedom is Prolife.” It gives 10 reasons, many backed up with scientific studies. It addresses a lot of myths that both pro-life and pro-choice people have.

“As many as God sends us” is a family planning choice, and natural family planning is one, but the important thing is I don’t think “choice” is an empty word. Some people think it’s a cover for all abortion all the time, but I think it’s very real. You can’t just talk about choice in a vacuum; you have to talk about how it’s compromised by issues of race, gender, disability, class, sexual orientation. Environmental justice is one; a lot of women are losing their ability to conceive when they want to because of environmental toxins.

Believing that all life is sacred, that means women’s lives too, and that means we do have a right over our own bodies. Pro-lifers often interpret that as a selfish demand, but I [don’t.] I remember Muhammad Ali, when I was a little kid, boasting about how great he was; a lot of white people were saying, “God, this man has an ego!” But after living in a black community for a long time and having an interracial family, I realized that that’s not egotism—that’s saying, “I’m somebody, I have value.” That’s what women are saying when they say, “We have a right over our own bodies.”

Now with pregnancy, it’s a matter of two bodies, two lives. Our responsibility has two sides: one is responsibility for pregnant women and their children, and the other side is the responsibility to respect women’s right to prevent conception when they want to. That is a difficult thing to write in the pro-life movement. Some Catholics have objections; the other thing is the belief in something called the “contraceptive mentality,” that if your contraception fails, that you automatically have an abortion—that doesn’t explain millions of pregnancy outcomes. It certainly doesn’t explain why I had my daughter and why she had her son. I know lots of women who use contraception in the knowledge that it doesn’t always work as intended. But if it doesn’t work as intended, then you and your child have a right to everything that will help you both survive.

A lot of [the bridge-building we at All Our Lives have] done so far is behind the scenes. We find, in surprising places, opportunities to join with people who have a common concern. We have found pro-choice people who say, “I don’t agree with you on abortion, but I have respect for your perspective because it’s consistent, because you value women’s lives.” We found pro-lifers who say, “That’s exactly how I feel.” We share a lot of supporters with the Pro-Life Alliance of Gays and Lesbians. One very interesting thing is that women of color, even those who identify as pro-choice, really can relate to this perspective. There’s probably a lot of opportunity for common ground there.

We have a small board; most of us have disabilities. We’re all female; one of our board members is a woman and an independent ordained Catholic priest. We’re not anti-religious; we’re open to people of all faiths. I’m someone with Catholic and Protestant ancestry, and I also practice Buddhism, and Jen Roth is an atheist. We really try to bring in multiple perspectives, which can be difficult sometimes, but so far it’s worked out really well.

I was involved in Feminists for Life, I think, from 1986 until I resigned in 2007. I don’t quarrel with what they do—what they do is good—but I left specifically in protest of their inaction on pre-conception issues. [They] said [they] couldn’t come to a consensus because people disagree. I feel like we’ve worked out another approach. I kind of understand; Catholics in the United States, including my white ethnic ancestors, Polish and Irish, were targeted for eugenics, and that collective memory is still there. That legacy is one reason it’s hard to talk about birth control in the pro-life movement. But I think it needs to come more out in the open, it needs to heal.

As a multiply disabled person who depends on expensive medical care, I am really concerned about the threat euthanasia poses, especially to people on public assistance. I think disability rights folks—who are often not included in the debates, but we have had some impact—have gotten people to think about the fact [euthanasia often] isn’t a free choice; it can easily slide into coercion. As for the death penalty, I really think that’s tied into racism, it’s tied into poverty. I know a family with a member who was eventually exonerated, but he was on death row for something like 14 years. He was a young man, and he lost those years of his life. So that issue has a very human face to me. All these issues do.

War is very tied in. I know people who have gone into the military for very noble reasons: they want to serve their country, they know that some things are worth dying for. It’s unfortunate that they’re dying for such horrible reasons.

I see a parallel between that and a lot of women I know who’ve had abortions. They are not evil people; they are people trying, like all of us, to make the best of very bad situations. I know women who’ve had abortions who go to either the pro-life or the pro-choice movements, and I see good people in both groups. A lot of women feel they have to have an abortion because it preserves a relationship with a man, or with their parents. They are concerned about the situation they bring the child into. I just think it’s unfair that women are placed in that position to begin with, that the whole karmic burden is thrown on that woman and that child. We always talk about most of these issues in terms of individual rights, but what about collective responsibility? I think that’s where Americans really, really have gone wrong.

One of our board members just gave a talk on “Family Planning: Myth, Reality, and the Lifesaving Power of Choice” at the Call to Action Conference, a large gathering of progressive US Catholics. The detailed, amply referenced handout from the presentation is useful for family planning advocates of all faiths and none. Like the presentation itself, it covers the following points.

–Family Planning Freedom Is A Universal Human Right.
–Family Planning Freedom Saves Lives.
–Pregnancy Prevention Choice Is Not Violence Against the Already-Born.
–Pregnancy Prevention Choice Is Not Violence Against the Unborn.
–Natural Family Planning Is A Good Answer for Some, But Not All.
–What You Can Do to Advocate for Family Planning Freedom!

You can download it as a free .pdf here.

[Author’s note: this article was originally published in Life Matters Journal, Volume 2, Issue 1.]

The consistent life ethic is traditionally seen as a way to draw connections among issues that do not seem related at first glance, such as war, the death penalty, and abortion. However, the connections between forms of violence and injustice are sometimes more immediate. Recent research, including a study published in August 2012 by the Guttmacher Institute, has highlighted connections between intimate partner violence, poverty, and abortion.

Intimate partner violence and abortion

Multiple studies from countries around the world have established a link between intimate partner violence (sometimes also known as domestic violence) and unintended pregnancy and abortion.[i],[ii],[iii],[iv]

The increased abortion rate among women who have experienced intimate partner violence begins with an increased prevalence of unintended pregnancy. A health survey in Massachusetts found that 40% of women who reported being abused had experienced one or more unintended pregnancies in the past five years, compared to 8% of non-abused women.[v]

Women in abusive relationships who become pregnant face numerous pressures to abort. These include fear of being punished if their partner doesn’t welcome the pregnancy, fear that the child will be abused, and the belief that having a child will make it impossible to leave the abusive partner for good. Among women who had abortions in the United States in 2008, about 7% reported having been physically or sexually abused by their child’s father, compared with about 1% of women in the general population who report experiencing physical or sexual abuse in the previous 12 months.[vi]

Reproductive coercion

In 2010, University of California-Davis researcher Elizabeth Miller and colleagues conducted the largest study to date of a phenomenon Miller has termed reproductive coercion[vii]. Miller’s team surveyed women aged 16-29 seeking reproductive health services in five clinics in northern California. Of these women, 53% had ever been physically or sexually abused by a partner. Nineteen percent had experienced pregnancy coercion, defined as a male partner using emotional or physical pressure or threats to get a woman to agree to become pregnant. Fifteen percent had experienced birth control sabotage, in which their partner had deliberately interfered with their efforts to use birth control. Miller uses the umbrella term reproductive coercion to cover pregnancy coercion and birth control sabotage.

Reproductive coercion is often associated with intimate partner violence and may partly explain why intimate partner violence is associated with high rates of unintended pregnancy.

Guttmacher study of “disruptive life events” and abortion

In August 2012, the Guttmacher Institute published a study in the Journal of Family Planning and Reproductive Health Care about the circumstances under which women have abortions. The researchers surveyed 9493 women who had abortions, and found that most had experienced at least one “disruptive life event” in the last year, such as unemployment, divorce or separation from a partner, getting behind on the rent or mortgage, moving two or more times, or having a baby.[viii]

The women in the study who were living in poverty experienced more disruptive life events – and hence, more abortions – than the women who were making greater than poverty incomes. Women living in poverty were also more likely to report having been physically or sexually abused by their partners.

In addition to the quantitative survey, researchers conducted in-depth interviews with 49 women. Nearly half of these women said that disruptive events interfered with their ability to use contraception consistently. Women reported losing health insurance and having trouble affording prescription contraception and getting to doctor’s appointments. Consistent use, not simply any use of contraception, is key to preventing unintended pregnancy. Poverty and disruptive life events appeared to make consistent use more difficult.

There were no questions on the quantitative survey about reproductive coercion, but six of the 49 women interviewed in-depth reported experiencing it.

Conclusions

Intimate partner violence and poverty both make it more difficult for women to avoid unintended pregnancy and to carry to term if they become pregnant.

For pro-life advocates who are working to reduce the demand for abortion, these data suggest two courses of action. The first is working to end poverty and abuse themselves, and ensuring a strong social safety net to buffer against the effects of disruptive life events. Second, it is also important to ensure that women currently experiencing poverty and abuse have the information and health care access they need to prevent unintended pregnancy, as well as social and material support if they do conceive.

Mitigating the effects of injustice and working to end the injustice itself are not mutually exclusive approaches. As one example, Elizabeth Miller and colleagues reported in 2011 on a pilot program that tested a new harm reduction intervention for women experiencing abuse or reproductive coercion.[ix] Their intervention enhanced standard intimate partner violence counseling with information on reproductive coercion and strategies for minimizing the risk of unintended pregnancy by using birth control methods that were concealable or hard to tamper with. The enhanced intervention both reduced the incidence of reproductive coercion and increased the likelihood that women would leave abusive male partners.

Protecting lives that are threatened by poverty and intimate partner violence also turns out to be a way to protect lives that are threatened by abortion.

 


[i] Christina C. Pallitto, Claudia García-Moreno, Henrica A.F.M. Jansen, Lori Heise, Mary Ellsberg, Charlotte Watts, on behalf of the WHO Multi-Country Study on Women’s Health and Intimate partner Violence, Intimate partner violence, abortion, and unintended pregnancy: Results from the WHO Multi-country Study on Women’s Health and Intimate partner Violence, Int J Gynecol Obstet 2012. Published online in advance of print September 6, 2012. Available at: http://dx.doi.org/10.1016/j.ijgo.2012.07.003. Accessed September 17, 2012.

[ii] Lockart I, Ryder N, McNulty AM. Prevalence and associations of recent physical intimate partner violence among women attending an Australian sexual health clinic. Sex Transm Infect 2011; 87(2): 174-176.

[iii] Alio AP, Salihu HM, Nana PN, Clayton HB, Mbah AK, Marty PJ. Association between intimate partner violence and induced abortion in Cameroon. Int J Gynecol Obstet 2011; 112(2): 83–87.

[iv] Fanslow J, Silva M, Whitehead A, Robinson E. Pregnancy outcomes and intimate partner violence in New Zealand. Aust N Z J Obstet Gynaecol 2008; 48(4): 391–397.

[v] Futures Without Violence. The Facts on Reproductive Health and Partner Abuse. Available at: http://www.knowmoresaymore.org/wp-content/uploads/2008/07/The-Facts-on-Reproductive-Health-and-Partner-Abuse.pdf. Accessed September 17, 2012.

[vi] Jones RK, Moore AM, Frohwirth LF. Perceptions of male knowledge and support among U.S. women obtaining abortions. Women Health Iss 2011; 21(2):117-23.

[vii] Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, Schoenwald P, Silverman JG. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception 2010; 81(4):316-22.

[viii] Jones RK, Frohwirth L, Moore AM. More than poverty: disruptive events among women having abortions in the USA. J Fam Plann Reprod Health Care 2012; published online in advance of print August 20, 2012. Available at: http://dx.doi.org/10.1136/jfprhc-2012-100311. Accessed September 17, 2012.

[ix] Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, Schoenwald P, Silverman JG. A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion. Contraception 2011; 83(3):274-80.

 

Yesterday, the New Evangelical Partnership held an event at the National Press Club to unveil a statement called “A Call to Christian Common Ground on Family Planning, and Maternal, and Children’s Health.

The statement makes three main points:

  1. Family planning strengthens families and creates more stable and healthy communities worldwide.
  2. Family planning protects the health of women and children.
  3. Family planning reduces abortion.

We agree wholeheartedly, of course, and are pleased to have the New Evangelical Partnership as part of the movement for family planning freedom.

You can watch the whole event on YouTube. I recommend at least watching Rev. Jennifer Crumpton’s presentation of the NEP statement, starting at about 8:15 in, Dr. Mark Hathaway’s talk at 19:00 about the medical benefits of family planning for women and children, and Katherine Marshall’s talk at 28:10 about the international context of family planning.


Speakers at the NEP event referred more than once to a study recently conducted by Washington University in St. Louis. The project provided women and teens at high risk of unintended pregnancy with the contraceptive method of their own choice at no cost. The results were dramatic. The abortion rate fell to 6 per 1,000 women, compared with a national average of 20 per 1,000 women. The teen birth rate from to 6.3 per 1,000, compared with 34.1 per 1,000 nationwide.

Imagine the impact of cutting the abortion rate in the U.S. by almost two thirds.

As the Agence France write-up of the study noted: “If the same results were replicated across the United States, free birth control could prevent 1,060,370 unplanned pregnancies and 873,250 abortions a year.”

Yes, that’s a big “if.” [Edited to add: as the researchers pointed out, the sample of women who participated in this study is not generalizable to the total population of women of reproductive age in the United States. That said, they likely bear a great deal of similarity to the population of women at the highest risk for unintended pregnancy and abortion.] And of course, there are important caveats. Women’s consent must be free and fully informed. Women must never be coerced into using long-acting contraception because other people think it would be better for them not to reproduce. It must always, always be the woman’s choice to use contraception. In addition, protection against HIV or other STDs is vital, and the forms of contraception chosen by most women in the study did not provide that protection.

But imagine it. Imagine 873,250 fewer unborn human beings destroyed every year. Imagine 873,250 fewer women going through abortions. Imagine 1,060,370 fewer women having to experience unplanned pregnancy, and instead being able to bear children at a time when their age, health, and life situation are better suited for motherhood — or being free to choose a different life path than motherhood.


Earlier this month, a Republican-appointed federal judge in the United States District Court for the Eastern District of Missouri rejected a lawsuit brought against the U.S. Department of Health and Human Services by an employer in a secular industry (mining, metals, & ceramics) who, due to his own religious beliefs, doesn’t want to provide his employees with insurance that covers contraception.

Judge Carol Jackson noted that employers already pay their employees a form of compensation that could be used to purchase contraception: their salaries. This is an argument I’ve made in the past. The full ruling is online here.

The burden of which plaintiffs complain is that funds, which plaintiffs will contribute to a group health plan, might, after a series of independent decisions by health care providers and patients covered by OIH’s plan, subsidize someone else’s participation in an activity that is condemned by plaintiffs’ religion. This Court rejects the proposition that requiring indirect financial support of a practice, from which plaintiff himself abstains according to his religious principles, constitutes a substantial burden on plaintiff’s religious exercise.

RFRA is a shield, not a sword. It protects individuals from substantial burdens on religious exercise that occur when the government coerces action one’s religion forbids, or forbids action one’s religion requires; it is not a means to force one’s religious practices upon others. RFRA does not protect against the slight burden on religious exercise that arises when one’s money circuitously flows to support the conduct of other free-exercise-wielding individuals who hold religious beliefs that differ from one’s own…

Just as in Mead, plaintiffs must contribute to a health care plan which does not align with their religious beliefs. In this case, however, the burden on plaintiffs is even more remote; the health care plan will offend plaintiffs’ religious beliefs only if an OIH employee (or covered family member) makes an independent decision to use the plan to cover counseling related to or the purchase of contraceptives. Already, OIH and Frank O’Brien pay salaries to their employees—money the employees may use to purchase contraceptives or to contribute to a religious organization. [emphasis added] By comparison,the contribution to a health care plan has no more than a de minimus impact on the plaintiff’s religious beliefs than paying salaries and other benefits to employees.

And once again, despite the claims in this and similar lawsuits that the HHS mandate forces them to cover abortifacients, the belief that emergency contraception is abortifacient has not been borne out by the evidence. I’m going to keep repeating that until new evidence comes to light or people stop making this claim, so get used to it.

In countries where there is a vocal, well-funded minority against contraception, stereotypes against women who use it abound.

In the United States, for example, women who use contraceptives–the overwhelming majority of women, by the way–have been derided as feckless, irresponsible, selfish, monstrously unnatural, man-hating, child-hating sluts who want to live parasitically off hard-working, moral-paragon taxpayers, and who automatically have abortions without a thought if they become unintentionally pregnant. Women who do not use contraceptives, on the other hand, are praised as spiritually superior, virtuous, man-loving, child-loving, fruitful Good Girls who know their ordained place in G*d’s Order of Things.

What a different, and much more flattering, much more accurate picture emerges from a new Guttmacher Institute study, Reasons for Contraception: Perspectives of US Women Seeking Care at Specialized Family Planning Clinics, which is forthcoming in the journal Contraception.

From a release about the study:

“Women value the ability to plan their childbearing, and view doing so as critical to being able to achieve their life goals,” says study author Laura Lindberg. “They need continued access to a wide range of contraceptives so they can plan their families and determine when they are ready to have children.”

Few studies in the United States have asked women directly why they use contraception and what benefits they expect or have achieved from its use. To fill this gap, the authors surveyed 2,094 women receiving services at 22 family planning clinics nationwide.

The majority of participants reported that contraception has had a significant impact on their lives, allowing them to take better care of themselves or their families (63%), support themselves financially (56%), complete their education (51%), or keep or get a job (50%).

When asked why they are seeking contraceptive services now, women expressed concerns about the consequences of an unintended pregnancy on their families’ and their own lives. The single most frequently cited reason for using contraception was that women could not afford to take care of a baby at that time (65%). Nearly one in four women reported that they or their partners were unemployed, which was a very important reason for their contraceptive use. Among women with children, nearly all reported that their desire to care for their current children was a reason for contraceptive use.

Many women reported interrelated reasons for using contraception, suggesting that the complexities of women’s lives influence their decision to use contraception and their choice of method. Other reasons for using contraception, reported by a majority of respondents, include not being ready to have children (63%), feeling that using birth control gives them better control over their lives (60%) and wanting to wait until their lives are more stable to have a baby (60%).

The release also includes this commentary.

“Notably, the reasons women give for using contraception are similar to the reasons they give for seeking an abortion,” according to Lawrence B. Finer, author of a previous Guttmacher study on that topic. “This means we should see access to abortion in the broader context of women’s lives and their efforts to avoid unplanned childbearing, in light of its potential consequences for them and their families.”

What does this study mean from an All Our Lives sort of perspective? For one, it fits well with what we already know experientially about the critical reasons why women need and want access to the full range of pregnancy prevention methods. Reasons that have nothing to do with the abovementioned belittling stereotypes.

For another, any serious effort to reduce unintended pregnancies and abortions must include expanded access to the full range of methods and understanding and alleviation of any problems that might hinder their effectiveness.

We do not advocate this course because we equate contraception with abortion, let alone believe the hype about some foreordained, inevitable “contraceptive mentality.” We advocate it because it works best in the real world, honors most women’s preferences to avert rather than interrupt unintended pregnancies, and does not involve the taking of prenatal lives. In other words, it evinces the most respect for human beings and universal human rights.

For yet another–the study findings call into question the sharp division between women who use contraception and those who do not. All Our Lives has long questioned this as just another brutal variant on the sundering of womankind into Madonnas and Whores. We assert the right of all women to use/not use any particular method of pregnancy prevention in accordance with their own preferences, values, and circumstances.

Thanks, Cristina Page, for bringing the Guttmacher study to our attention.