The continuing debate over whether and how religious organizations should be forced to offer free contraceptives to their employees rests on a seemingly airtight premise: that greater access to contraceptives will lower rates of unintended pregnancy and abortion.
But that logic is flawed for at least two reasons. First, many common contraceptives cause abortions. Intrauterine devices, the pill, the patch and Plan B (the "morning after" pill) all sometimes prevent fertilized eggs from implanting in the uterine wall.
The Obama contraceptive mandate also covers Ella (the "week after" pill), which is chemically similar to the abortion drug RU-486 but in a smaller dose and may disrupt already implanted embryos, an early abortion by any definition.
Second, it's an open question whether greater availability of contraceptives will lead to fewer unintended pregnancies and thus to fewer abortions.
Contraceptives could hardly be more accessible than they already are. One of the main talking points of those defending the Obama mandate is that 99 percent of sexually active women (including 98 percent of Catholic women) have used contraceptives.
If those numbers are correct, they underscore not only the pervasiveness of contraceptive use, but also pervasiveness of access to contraceptives. Contraceptives aren't anywhere near as elusive as the Obama mandate's defenders would have us believe.
In a 2001 study, the Guttmacher Institute, a pro-abortion-rights organization that analyzes reproductive trends, surveyed 10,000 women who had had abortions. Of those who were not using contraception at the time they conceived, 2 percent said they did not know where to obtain contraception and 8 percent said they could not afford it.
Those numbers probably have decreased over the past decade. The government pays for insurance coverage of contraceptives for millions of its workers and for millions of low-income women through Medicaid, Title X and other programs. Ninety percent of employer-based health-insurance plans cover contraceptives, and most states require insurers that cover prescription drugs to cover contraceptives.
These facts help explain why, according to Guttmacher, among the 43 million sexually active women who do not want to become pregnant, 89 percent (including 93 percent of teenagers) are practicing contraception.
So can we assume that the more than 3 million annual unintended pregnancies and 1.2 million abortions come from the 11 percent of fertile, sexually active women who do not wish to conceive but do not use contraceptives? It's not that simple.
For one thing, all forms of birth control sometimes fail. According to Guttmacher, spermicides fail 28 percent of the time and the male condom 15 percent of the time. The diaphragm and cervical cap have a failure rate of 13 percent, while the pill fails 9 percent of the time. Implants and injectable contraceptives fail 2 percent to 4 percent of the time.
Also, studies have found that greater contraceptive access doesn't correlate with lower abortion rates. A 2011 study found that a 63 percent increase in contraceptive use over a decade among Spanish women was associated with a 108 percent increase in the abortion rate in Spain.
Dozens of studies have shown that increased access to "emergency contraception" (EC) had no statistically significant reduction in rates of unintended pregnancy or abortion. In a study of 2,000 women in San Francisco, the authors concluded, "We did not observe a difference in pregnancy rates in women with either pharmacy access or advance provision [of EC]. ... Previous studies also failed to show significant differences in pregnancy or abortion rates among women with advance provisions of EC."
David Paton, who has conducted four studies in Great Britain on the link between access to contraceptives among British youth and rates of unintended pregnancy and abortion, has written, "It is clear that providing more family planning clinics, far from having the effect of reducing conception rates, has actually led to an increase. ... The availability of the morning-after pill seems to be encouraging risky behavior. It appears that if people have access to family planning advice they think they automatically have a lower risk of pregnancy."
Just because people have access to contraceptives does not mean they'll always use them. One Guttmacher study found that 54 percent of women who had abortions had used a contraceptive method during the month they became pregnant. Another found that nearly half of women seeking to avoid pregnancy had periods of non-use of contraceptives (15 percent) or used their method inconsistently or incorrectly (27 percent).
The real reasons why many people use contraceptives inconsistently are more complicated than most policymakers are willing to admit. Many sexually active people are ambivalent about pregnancy. Guttmacher has found that nearly 1 in 4 women who were not trying to become pregnant said they would be very pleased if they found out they were pregnant. There is a big difference between an unintended pregnancy and an unwanted one.
Reproductive decisions are sometimes influenced by the availability of contraceptives. But they are also influenced by culture, faith, the ups and downs that are a natural part of sexual relationships and impulses buried deep in our psyches. In other words, they are influenced by factors well beyond the purview of a government mandate.
Daniel Allott is senior writer at American Values.
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