Examining the argument that provision of contraception leads to increased abortion rates
(This is Part I of a two-part series. Read Part II: Abstinence versus contraceptive use: the effect on pregnancy rates)
One apparent paradox in the debate over public support of family planning is that groups that are against abortion are also often against contraception. Notwithstanding the objections of some religious institutions like the Catholic Church (though not necessarily its adherents) to any method of contraception, there are some moderate religious groups, politicians and academics that make the argument that contraceptive use actually causes abortions.
The New Yorker recently made fun of this viewpoint, lumping together “the view that global warming is a hoax, or that the budget can be balanced through spending cuts alone, or that contraception causes abortion, or that evolution is just another theory, on a par with the theory that the earth is six thousand years old.”
Because this presumption persists among some earnest people, and because it is routed in a basic misinterpretation of the data, it is worth examining in seriousness—and worth thoroughly refuting.
We are not addressing here the idea that contraceptives themselves act as abortifacients. For a review of the mechanisms of action of contraceptive methods, see Rivera et al. In this blog, we are examining the idea that using contraceptives leads women to need more, rather than fewer, abortions.
Misunderstanding on this issue is fueled by observations that increasing use of contraception often goes hand in hand with increased abortion rates when a country moves from high fertility to low fertility [1, 2]. This is a common pattern, but there is an explanation more plausible than increased contraceptive use causing increased abortion rates. When couples decide they want fewer children than they are biologically capable of producing, they use both methods of preventing birth—contraceptives and abortion—causing both contraceptive prevalence and abortion rates to rise. However, once effective contraceptives are widely available, abortion rates decline [3, 4].
The other reason that some people believe that contraceptive use causes abortion is the misconception that using contraceptives enables couples to have sex when they would otherwise abstain. Since contraceptives are not fail-proof, unintended pregnancies occur that would have been avoided if the couple refrained from intercourse, the argument goes.
There are four pieces of strong evidence that suggest that couples who desire to avoid pregnancy do not necessarily abstain from sex, even when they do not have contraceptives available:
- Nationally, data on abortion clients show that many women who do not want to become pregnant do not abstain. Among women seeking abortion in the United States, almost half (46%) were not using any contraception in the month they became pregnant.
- Women and men explicitly say that, in the absence of contraceptives, they would not abstain. In a large survey we conducted of family planning clients in California, half say they would have sex even if they had no contraceptives on hand. The high level of willingness to have unprotected sex found in this study is particularly remarkable since the study population had just received contraceptive counseling and was motivated enough to prevent pregnancy to have sought out family planning services.
- Among women with access to contraceptives, having a greater quantity of contraceptive supplies on hand reduces the abortion rate, as shown in our recent study of women in the California Family PACT program. This is evidence of a dose-response—the more contraceptives women receive, the fewer abortions they need. Women in the program who received a one-year supply of oral contraceptives had significantly lower odds of needing an abortion compared to women who were given just one month or three months’ supply at a time. When women have to return for resupply visits, some let their supplies run out, but they did not stop having sex. Had all 66,000 women in Family PACT who received just one or three packs of pills in January 2006 had a year’s worth of contraception on hand, over 1,000 pregnancies and 300 abortions might have been averted.
- When contraceptives are not available, couples still have sex and many turn to abortion to achieve their desired family size There are numerous international examples. In the Republic of Georgia, where desired family size is under two children per woman, and fewer than 20% of married women are using a modern method of contraception, abortion rates are very high—more than three abortions per woman, on average.
All evidence points to a lack of contraceptive use as the cause of unintended pregnancies that lead to abortion. Many couples do not stop having sex when there are no contraceptives available. It is true that contraceptives are not perfect and there is a risk of pregnancy even when using methods. Not having sex is the only fail-safe way to prevent pregnancy. But what level of abstinence would be required to achieve the same fertility reduction we see when people have sex but use contraception?
In the second part of this post, we will examine that question.
- Ahman, E.L. and I.H. Shah, Contraceptive use, fertility, and unsafe abortion in developing countries. Eur J Contracept Reprod Health Care, 2010. 15 Suppl 2: p. S77-82.
- Singh, S. and G. Sedgh, The Relationship of Abortion to Trends in Contraception and Fertility in Brazil, Colombia and Mexico. International Family Planning Perspectives, 1997. 23(1): p. 4-14.
- Marston, C. and J. Cleland, Relationships between contraception and abortion: a review of the evidence. Int Fam Plan Perspect, 2003. 29(1): p. 6-13.
- Bongaarts, J. and C.F. Westoff, The potential role of contraception in reducing abortion. Stud Fam Plann, 2000. 31(3): p. 193-202.
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