19

A recent study at the Washington University School of Medicine in St. Louis (see report here) concluded that provision of free long-acting contraception reduced the number of abortions in its recipients.

Even such an apparently simple result can be interpreted different ways given the deeply polarised nature of the debate about abortion and contraception in the USA. For example, according to this CBS report, the conservative view (as expressed by Jeanne Monahan of the conservative Family Research Council):

Additionally, one might conclude that the Obama administration's contraception mandate may ultimately cause more unplanned pregnancies since it mandates that all health plans cover contraceptives, including those that the study's authors claim are less effective

So I know that the whole contraception/abortion debate is particularly polarised in the USA, but is there an objective scientific view of the issue? Are there other studies we should look at? Does contraceptive provision reduce the incidence of abortion in the USA or elsewhere?

Chad
  • 9,099
  • 6
  • 49
  • 96
matt_black
  • 56,186
  • 16
  • 175
  • 373
  • 18
    Well, some people who oppose abortion would also oppose contraception because it isnt a desire to reduce fetal loss, it is a desire to control women. – Sam I Am Oct 15 '12 at 15:21
  • @SamIAm Possibly so, but the important thing is that, in a debate as polarised and as heated as this one, the evidence used in an answer has to be unimpeachable, unambiguous and objective. Let's hope skeptics.SE can live up to that. – matt_black Oct 15 '12 at 15:27
  • 3
    Also, I dont know what definition of "freely" you are using, but just because it is covered by insurance doesn't imply it is free. There is still copays, coinsurance, and deductibles to pay, depending on your insurance company and plan. Assuming you even have health insurance. These fees can be a major burden to students and the working poor. – Sam I Am Oct 15 '12 at 15:30
  • 8
    @matt_black, what I am saying is that even if contraception reduced abortion to zero, there will still be a very large group that still fiercely opposes it. This is because they don't oppose it because it doesn't work, they oppose it because a women being able to avoid pregnancy goes against "tradition", which is that *women are the property of men*. The better it works, the more they will oppose. The logic in your question is false for a large subset of abortion opposition. Like Oddthinking said, it is a false dilemma. – Sam I Am Oct 15 '12 at 15:39
  • 1
    @SamIAm The "broken" logic in my question was just an attempt to give some background about why the question is interesting. If it too distracting to the core issue it might be worth removing it. It isn't relevant to the actual question being asked. – matt_black Oct 15 '12 at 15:59
  • @chad I'm happy to accept edits if you think it would improve the question. I hoped to explain the context but I'm an outsider to the US debate and that alone means I won't do neutrality well. – matt_black Oct 15 '12 at 22:45
  • @Chad I made an attempt to depolarise the tone of the question. I'd value your feedback on whether I've done enough or advice on further improvements. – matt_black Oct 15 '12 at 23:27
  • @SamIAm baseless accusations. While no doubt true for some, it's not true for most that they just want to "control women". Might as well say that women want to control men by getting themselves banged up, then force the poor guys to marry them so they can financially ruin them and get a divorce when the cash runs out. – jwenting Oct 17 '12 at 03:42
  • @SamIAm I agree that those are baseless accusations, just like jwenting's hypothetical accusation is baseless. There are logical reasons to oppose both [contraception](http://www.catholic.com/tracts/birth-control) and [abortion](http://www.frc.org/brochure/the-best-pro-life-arguments-for-secular-audiences) that do not involve women being the property of men, even metaphorically. – Andres Riofrio Mar 13 '13 at 06:12
  • It's not just desire to control women. It's also desire to prevent women from picking the best and brightest and ensuring the dumbest people breed more. –  Oct 30 '13 at 18:18
  • @JimThio As with the previous "controlling women" accusation, your claim is baseless. Citation needed. – Reinstate Monica -- notmaynard Mar 25 '14 at 15:50
  • baseless? Everybody wants to control everybody else. It's how life works. Especially when resources are highly desirable such as hot babes. You should show me why they don't want to control women. – user4234 Mar 26 '14 at 03:27
  • Name any highly desirable objects that people don't try to control – user4234 Mar 26 '14 at 10:25
  • 2
    Saying it's about controlling women isn't really right. It's about controlling sex. In my experience the vast majority of "pro-life" individuals actually seek to punish the woman for sex they consider irresponsible. – Loren Pechtel Dec 17 '16 at 21:58

2 Answers2

25

The MEASURE Demographic and Health Surveys project published an analytical study on Recent Trends in Abortion and Contraception in 12 Countries in 2005, the 12 countries in the study being Armenia, Azerbaijan, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, Romania, Russia, Turkey, Turkmenistan, Ukraine, and Uzbekistan. From the Executive Summary of the study:

In a series of simulation models, the implications for further reductions in the prevalence of abortion are estimated. For example, if the women currently using modern methods of contraception were joined by those currently using traditional methods, abortion rates on average could be reduced by 23 percent; if women classified as having unmet need for family planning were also added to this group, abortion rates could be reduced by as much as 55 percent.

The study found strong patterns of abortion declining with modern contraceptive prevalence rising in several countries:

enter image description here enter image description here enter image description here

...

In summary, 8 of the 12 countries show declines in abortion accompanied by increases in the prevalence of modern methods; one shows an increase in abortion with little change in prevalence (Azerbaijan); two show increases in abortion along with an increase in prevalence but with a substantial reduction in the ideal number of children (Turkmenistan) or a very low ideal number of children with increasing contraceptive failure rates (Ukraine); and one features no net change in abortion rates but with increasing contraceptive prevalence offset by increasing rates of contraceptive failure (Georgia).

Contraception in the Netherlands: the low abortion rate explained seems to strongly suggest that contraception is a major factor in the country's low abortion rates:

This article gives a review of the main factors that are related to the low abortion rate in the Netherlands. Attention is payed to figures on abortion and the use of contraceptive methods since the beginning of the 1960s up to the end of the 1980s. The strong acceptance of family planning was influenced by changing values regarding sexuality and the family, the transition from an agricultural to a modern industrial society, rapid economic growth, declining influence of the churches on daily life, introduction of modern mass media and the increased general educational level. The introduction of modern contraceptives (mainly the pill and contraceptive sterilization) was stimulated by a strong voluntary family planning movement, fear for overpopulation, a positive role of GPs, and the public health insurance system. A reduction of unwanted pregnancies has been accomplished through successful strategies for the prevention of teenage pregnancy (including sex education, open discussions on sexuality in mass media, educational campaigns and low barrier services) as well as through wide acceptance of sterilization. The Dutch experience with family planning shows the following characteristics: a strong wish to reduce reliance on abortion, ongoing sexual and contraceptive education related to the actual experiences of the target groups, and low barrier family planning services.

Unfortunately I don't have access to the full article.

The 1999 book From Abortion to Contraception: A Resource to Public Policies and Reproductive Behavior in Central and Eastern Europe from 1917 to the Present examines the "abortion culture" in USSR successor states, and theorizes that a key factor in high abortion rates was the limited availability, high cost and bad press of modern contraceptives.

Although I haven't got the slightest idea if freely available contraception will (significantly) cut the abortion rate in the US and I'm guessing that data from USSR successor states won't be enough to convince US conservatives, after giving a second read to the MEASURE DES study I'd say it's definitely worth a try.

Community
  • 1
yannis
  • 1,029
  • 1
  • 11
  • 30
  • 1
    [This article](http://www.patheos.com/blogs/badcatholic/2012/11/does-contraception-reduce-the-abortion-rate.html) attempts to look at the the first study objectively and argues that studies like the first one, since they focus on previously Soviet states, can only conclude that "Contraception reduces abortion rates primarily in regions that already use abortion as a primary method of family planning, and thus already have extremely high abortion rates." It's from a Catholic, but reasonable people let arguments stand and fall on their own merit. – Andres Riofrio Mar 13 '13 at 06:02
  • 1
    That same article also quotes Victor Agadjanian [saying](http://business.highbeam.com/6081/article-1G1-92806337/abortion-culture-fading-former-soviet-union-views-abortion) saying that in the Soivet Union there was "little ideological or moral opposition to abortion." It "became the main form of birth control, available on request and free of charge." This could be another important factor in the high abortion rates. I have not read the 1999 book recommended by Yannis. – Andres Riofrio Mar 13 '13 at 06:06
-1

Does contraceptive provision reduce the incidence of abortion in the USA or elsewhere?

Not necessarily.

  1. Guttmacher's research shows contraceptive use may rise parallel to abortion rates. A cited example of this trend is the United States.

    Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant. The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly.

    The reason given for this trend is two fold. First, increased contraception usage indicates a decreased interest in having children. Second, a decreased interest in having children means that contraception failure is more likely to end in abortion. The combination of inexperience with using contraception and higher rates of contraception usage results in a much higher probability of contraception failure and an unwanted child.

    The advent of modern contraception is associated with a destabilization of high (or "fatalistic") fertility preferences. Thus, as contraceptive prevalence rises and fertility starts to fall, an increasing proportion of couples want no more children (or want an appreciable delay before the next child), and exposure to the risk of unintended pregnancy also increases as a result. In the early and middle phases of fertility transition, adoption and sustained use of effective methods of contraception by couples who wish to postpone or limit childbearing is still far from universal. Hence, the growing need for contraception may outstrip use itself; thus, 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.

    A graphic assembled from data collected from CDC and academic sources illustrates the connection between contraception legalization and reported abortions in the US. Griswold v. Connecticut legalized contraception in the US for married couples, and Eisenstadt v. Baird legalized for unmarried. After nationwide legalization of contraception the number of reported abortions increases dramatically. Abortion was not legalized nationally until 1973 with Roe v. Wade.

    Notably, national contraception legalization and abortion increase also precedes the state by state legalization that occurred before national legalization in Roe v. Wade. State legalizations are indicated by red lines. Abortion was legalized in CO, CA, OR and NC in 1967. HI, NY, AK, and legalized in 1970. DC in 1971. 13 states in total by 1972. This shows the abortion increase cannot be solely attributed to state by state abortion legalization, indicating contraception usage played a significant role in abortion increase, as stated by the Guttmacher report.

Contraception and abortion legalization compared to reported abortion rates.

  1. Some consider contraceptives abortifacients. For example see this pro life author arguing her position:

    The labeling of birth control pills, in their various forms, for years has included information similar to that given to me by my doctor, information that has caused strongly pro-life people, as I am, to consider the birth control pill—and the morning after pill, which operates on the same principles—to be, potentially, an abortifacient and, therefore, to be rejected within a pro-life philosophy.

    An example of contraception's abortifacient potential (prevention of implantation) can be found in the NIH's description of Plan B.

    It may also prevent fertilization of a released egg (joining of sperm and egg) or attachment of a fertilized egg to the uterus (implantation).

    The idea that pregnancy starts at conception is controversial. In order to make Plan B available over the counter after an FDA rejection, the American Medical Association passed resolution 443 in 2004 stating prevention of implantation does not terminate an established pregnancy, effectively redefining abortion to be post implantation in order to make Plan B easily available. Alternatively, the American Heritage Stedman's Medical Dictionary defines pregnancy as "the period from conception to birth".

Community
  • 1
yters
  • 257
  • 1
  • 6
  • 5
    "Abortion is ending a pregnancy, and pregnancy starts at conception" Is this a cultural or law based claim? Can you add the source for it? – TsSkTo Dec 16 '16 at 19:07
  • 5
    @TsSkTo, it's a misunderstanding of the WebMD page. For historical reasons, doctors measure the progression of a pregnancy in terms of "weeks since the end of the last monthly period". Under this measurement, conception typically takes place during "the second week of pregnancy". – Mark Dec 17 '16 at 00:50
  • 4
    I suggest you look at that Guttmacher data again--a more careful examination will show that "cause" is not the right word to use here. Rather, there are other factors at work. That US data includes the period in which abortion became legal. You think that might have something to do with it?? – Loren Pechtel Dec 17 '16 at 22:03
  • 1
    @LorenPechtel it is difficult to disentangle, as that is the period when contraception also became legal. Contraception became legalized nationwide prior to Roe v. Wade, so it precedes abortion's legality to some extent while coinciding with the dramatic increase in recorded abortion. The abortion increase also precedes Roe v. Wade. Overall, the main point is the answer to the question is not a clearcut yes. – yters Dec 18 '16 at 01:04
  • 3
    Yeah, the data is difficult to disentangle. That's why I am objecting to your statement that it can increase rates--you are claiming to have disentangled the data, or else you are mixing up correlation with causation. – Loren Pechtel Dec 18 '16 at 01:08
  • @LorenPechtel changed causation to correlation. How can someone show that contraceptives cause lower abortion rates? – yters Dec 18 '16 at 01:43
  • 3
    -1; you 1) misrepresent the result of that study ("Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant") 2) you make a separate claim that is not backed up by modern sources ([plan b does not cause an abortion](http://www.christianitytoday.com/ct/2013/may/does-plan-b-cause-abortion.html)) and 3) just seems like an anti-abortion, anti-contraception, and anti-PP rant that is only tangibly related to the question and does not cite sources – tim Dec 18 '16 at 10:59
  • @tim thanks, that is an interesting find. I did not know the latest research on plan B, I will look into it further and change the answer accordingly. The point regarding PP is showing how reducing fertility does not necessarily mean reduction in abortion. PP is used as an indication of what happens to the child when contraception does not work as planned. – yters Dec 18 '16 at 19:20
  • 1
    @yters When you have one data point with an obvious other possible factor you can't draw any conclusions. When you have many data points without any apparent other factors then you can think of conclusions. – Loren Pechtel Dec 18 '16 at 22:23
  • @LorenPechtel Exactly. That is my thinking too, and why I don't believe one can categorically say contraception lowers abortion rates. I list the 3 reasons why such thinking is problematic. – yters Dec 19 '16 at 15:16
  • @tim, I've looked into Plan B a bit further. NIH website still says it can prevent implantation, see the Other Information section. Once they change their official stance I'll feel better about changing this answer. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6a4be337-433c-4906-9f2b-768708dcb9ef – yters Dec 19 '16 at 15:19
  • 3
    "pregnancy starts at or before conception"... BEFORE? Sorry, but unless you're counting the virgin birth there is no reasonable definition that says a pregnancy has started before the egg has been fertilised. Do you think a period qualifies as a miscarriage? – GordonM Dec 19 '16 at 16:41
  • @GordonM this citation is in response to TsSkTo's request that I back up the claim that pregnancy starts at conception. I agree it is absurd to say pregnancy starts before conception, but that is the official standard that was asked for. – yters Dec 19 '16 at 19:34
  • 5
    @yters That's for book-keeping purposes and for making an estimated delivery date. It does not mean you're pregnant the instant your final period before conception begins. At best you've badly misunderstood your own source, at worst you're deliberately twisting it for your own purposes. – GordonM Dec 19 '16 at 20:43
  • 2
    @yters That's why you look for situations where other things are as constant as possible. You're trying to cherry-pick cases that aren't representative. – Loren Pechtel Dec 20 '16 at 04:29
  • @yters i've tried to salvage your answer. Point 1 unintentionally misrepresented the research it linked (a parallel rise is not necessarily a correlation, also there is clearly some context that was missing); Point 2 presented a philosophical position as fact, whereas it is not. However, it is fair to present the fact that such a position exists. I believe I provided a good, reasoned example of it, feel free to review it; finally Point 3 was a theoretical part which we simply do not allow. Hope this helps, if not please present your own best version: the old version would be deleted though. – Sklivvz Dec 22 '16 at 23:06
  • @Sklivvz thanks for the edits. I've re-added the NIH citation for Plan B. It is evidence for the author's claim, and is from an official source, showing the claim is not merely opinion. The third point you deleted is supported by the Guttmacher study: "as contraceptive prevalence rises and fertility starts to fall, an increasing proportion of couples want no more children (or want an appreciable delay before the next child), and exposure to the risk of unintended pregnancy also increases as a result." I will reword point 1 accordingly, as your rewording also omits important context. – yters Jan 02 '17 at 16:09
  • 2
    @yters please be careful, the answer is barely acceptable as is, and your edits are not making it better. For example, the link you just added does not prove what you say it does. It explains how the pill works -- whether that is abortion or not is entirely opinion. – Sklivvz Jan 02 '17 at 16:11
  • @Sklivvz the Atlantic author claims contraception is abortion when it prevents implantation. The link I provide substantiates that some contraceptives (Plan B) prevent implantation. This is entirely in line with the Atlantic article. I will clarify this point, but otherwise I do not understand the problem. – yters Jan 02 '17 at 16:52
  • 1
    The Atlantic author is not a valid source on whether contraception is factually abortion. I've left them in merely to show that there are different moral positions, not that any particular moral position is valid or science-based. Whether pills prevent implantation is a red herring. The only important point is that some people consider the effect of the pill the same as abortion - not that this is scientific. We are simply describing what some people consider abortion, and for that the Atlantic article is sufficient. – Sklivvz Jan 02 '17 at 17:01
  • @Sklivvz Thanks, I understand your reasoning. The question asks for an objective scientific view of the matter. That is why I included objective scientific definitions and evidence in my original answer to substantiate the claim that preventing implantation counts as abortion. Since it seems an author's moral position counts as the requested evidence, I'll remove the citation. If the answer is contested due to not having objective evidence I'll add the original sources again. – yters Jan 02 '17 at 17:50
  • @Sklivvz This question has become the subject of another question due to the NIH cite. I am re-adding it for that reason. http://skeptics.stackexchange.com/questions/36535/does-plan-b-levonorgestrel-prevent-implantation-of-fertilized-eggs – yters Jan 02 '17 at 17:54