Rachel Held Evans (a self professed pro-life, woman of faith, Christian feminist) recently wrote a blog entitled “Privilege and the Pill.” She wished to express her opinion, “as a pro-life woman of faith who supports affordable access to birth control.” Denny Burke and Andrew Walker wrote a response here 1 addressing the political concerns which prompted her blog. However, there were many additional points in Mrs. Evan’s piece that needed to be addressed.
“Privilege and the Pill” was well written, level headed, and non-inflammatory. However, Mrs. Evans presented several sweeping statistics as though they were absolute fact, and altogether ignored a great deal of science. Below is an outline of her main points, each followed by a rebuttal citing overlooked information.
1. “Birth control should be an important topic to those of us who consider ourselves pro-life because the most effective way to curb the abortion rate in this country is to make birth control more affordable and accessible.”
Mrs. Evans links to a CBS news article entitled “Study: Free Birth Control Leads to Way Fewer Abortions.” The inclusion of “Way Fewer” in the title of the article gives us a clue as to the the level of serious scholarship we might expect from it. The article is reporting the findings of a 2 year study concluded in 2012 in St. Louis. The study reported that women in St. Louis were given free access to birth control, and the researchers saw the abortion rate drop in the same area. This study seems promising on the surface, but the methods for obtaining the “reduced abortion rates” in this study were sketchy at best. First of all, the study is an ecological study – which provides the weakest possible link of causation – and the study itself admits that, “there may be several factors that affect the rates of repeat abortion, such as the economic recession, federal changes in Title X funding for family planning, and Missouri state laws that limit access to abortion.” The women who participated in the study were self-selected, having heard about the study on the radio or word of mouth. The “control” was in a different state. The data collection method was not rigorous, nor was a complete record of the results published in the study itself.2
In contrast, there are multiple studies, using more rigorous methods, that show direct correlation between a rise of contraceptive use to a rise in abortion rates. A 2011 study published in the medical journal “Contraception,” followed over 2000 women for a period of 10 years. At the beginning of the study 49.1% of the women were using contraception. By the end of the study this number climbed to nearly 80%. Nevertheless, the national abortion rate nearly doubled in this same time frame.3
It is similarly telling that the Guttmacher institute, which was founded by Planned Parenthood as a research arm, reports that 54% of all “unwanted pregnancies” were achieved when contraception was being used.4
2. Birth Control is expensive. If a woman can’t afford birth control then they are more likely to abort because they can’t afford a baby either. If birth control is free, “unwanted pregnancies” will be reduced therefore abortion rates will drop.
As seen above, increased contraceptive use does not lower the abortion rate. A potential cause for this is that contraception use implies that any pregnancy achieved will be unwanted. However, when using contraception, a woman is engaging in the one activity that creates human life. Since no method of contraception if universally effective, statistically unwanted pregnancies will occur.
It is naive to claim that the cause of abortion is simply “unwanted pregnancies.” The current concept of an unwanted pregnancy is itself an ambiguous idea. One which has only grown more convoluted in recent years due to a shift in the culture which now views sex as being solely for pleasure and personal gratification, and which relegates pregnancy to a side effect of the sexual act. While pleasure is certainly an aspect of sexuality, biologically speaking, the primary purpose of sex is procreation. There is no other reason for it. To look at this another way J. Budziszewski, author for Touchstone Journal states,
Take the lungs, for example. When we say that their purpose is to oxygenate the blood, are we just making that up? Of course not. The purpose of oxygenation isn’t in the eye of the beholder; it’s in the design of the lungs themselves. There is no reason for us to have lungs apart from it.
Suppose a young man is more interested in using his lungs to get high by sniffing glue. What would you think of me if I said, “That’s interesting—I guess the purpose of my lungs is to oxygenate my blood, but the purpose of his lungs is to get high”? You’d think me a fool, and rightly so. The purpose of the lungs is built into the design of the lungs. He doesn’t change that purpose by sniffing glue; he only violates it.5
Mrs. Evans is quick (and correct) to strike down the idea that the only women taking advantage of free contraception are the Sandra Fluke’s of the world. Married women often use the pill to plan their family. While there is nothing morally or scientifically troublesome about planning one’s family or spacing children, there are a number of ethical and scientific concerns in using a Class 1 Carcinogen6 to do so.
The Billings Ovulation Method is a highly researched method of fertility regulation. It is 100% natural, free from any side effects and boasts a 99.5% actual-use efficacy rate.7
3. “USAID: “Family planning could prevent up to 30 percent of the more than 287,000 maternal deaths that occur every year, by enabling women to delay their first pregnancy and space later pregnancies at the safest intervals. If all babies were born three years apart, the lives of 1.6 million children under the age of five would be saved each year.”
Mark Twain famously said, “There are 3 types of lies. Lies, damned lies and statistics.” One should never take statistics at face value, but should always ask, “Where did the figure come from? What methodology produced this statistic? Was the study thorough? Is the journal reputable?” and similar questions.
Preliminary research shows that the USAID does not offer any citation of studies or journals to back up their claim. Lets take this one subject at a time.
a. delayed maternal age = less maternal deaths.
A study published in the Bulletin of the World Health Organization found a lower risk of breast cancer in women whose first pregnancy was younger than the age of 18.8 Another study published in the Obstetrical and Gynecological survey concluded, “Increasing maternal age and nulliparody are associated with an increased risk of a poor pregnancy outcome.”9 A third study conducted by the Canadian Journal of Public Health cited delayed childbearing with these risks: conception difficulties (85.3%), multiple birth (24.0%), caesarean section (18.8%), preterm delivery (21.8%), and LBW (11.2%). Knowledge of specific developmental and health-related risks of suboptimal infant outcomes ranged between 18.0% and 46.5%.10
What precisely does USAID define as “delayed maternal age”, and where did they obtain the knowledge that delayed maternal age would translate into a specific number of fewer maternal deaths?
b. Spacing pregnancies = lower pregnancy mortality and lower infant mortality.
The WHO published a document11 reporting the findings of dozens of experts in conjunction with the USAID research and other meta-studies did find an increased maternal death rate with a birth to pregnancy rate of less than 6 months. However, it also states, “Evidence about relationships between birth spacing and child mortality was presented but the participants did not reach agreement on its interpretation.” The experts fell into two groups: those who considered 18 month spacing to be ideal and those who considered 27 month spacing to be ideal. Perhaps the USAID folks were siding with the 27 month spacing recommendation, but the 34 page document does not offer any clues as to how USAID calculated their statistic of 1.6 million children saved by this spacing formula. Conjectured statistics, as this one appears to be, are most often contrived for shock value rather than being based on any actual scientific data.
4. “When male politicians or pastors speak about women and contraception, they sometimes make generalizations that reflect a lack of experience.”
She is correct in saying that men do not understand a woman’s experience of pregnancy or reproductive issues. Several men have made headlines because of thoughtless or arrogant one-liners in this debate. This is unfortunate. However, one must remember that men are not the only ones discussing this issue. Women Speak for Themselves12 is an excellent example of women’s efforts to be heard in this debate. Even so, Ms. Evans attempts to support her plea of ignorant men by stating many half-truths when it comes to women’s health.
a. Married women are much more likely to be on the pill than non-married.
This is mostly true, but for the sake of accuracy, let’s define “much more likely.” Guttmacher Institute reported these statistics based on a CDC collection of data analysing women in the USA between 2006-2010. Percentages of “all women” who are using contraceptives are as follows: Married 77.4%, Never Married 44.2%. This does look like a large difference, but there are two categories which technically fall into the “not married” category that were ignored: Cohabiting 72.8% and Formerly married 63.9%. These numbers bring about a more complete picture of the data.
Mrs. Evans clarifies the reason which most of these married women would be using contraception: to plan or space children. If this is the case, we should look to a second set of statistics provided by the CDC, “Women At Risk of an Unintended Pregnancy.” The numbers in this category are as follows: Married 92.5%, Never Married 82.6%, Cohabiting 90.2% and Formerly Married 87.8%. Not as big a difference as Mrs. Evans leads us to believe.13
b. The Pill is needed to treat a painful condition called Endometriosis.
Endometriosis is a condition in which the endometrium (lining of the uterus) grows out of control, and often outside the uterus into other areas of the abdomen. This causes painful cramps and frequent bleeding. The root cause of endometriosis is estrogen dominance. The birth control pill is often prescribed for this condition because it has been seen to reduce the thickness of the endometrium to an average of 1.1mm.14
These effects, however, are only present when the pill is being taken. As soon as a woman stops taking the pill, the symptoms return, and are often worse than they were before. Why? Because the pill does not “treat” endometriosis, it only masks the symptoms. While the pill provides the appearance of normalcy, it ignores the actual health concern. The pill simply does not effectively treat the “reproductive issues” for which it is so often prescribed.
c. Emergency contraception is valuable to those who are victims of rape and cannot cause an abortion.
The article Ms. Evans cited in Christianity Today, presents opposing points of view on the abortifacient nature of Plan-B. The author seems to emphasise the idea that Plan-B does not cause chemical abortions, yet the article closes by saying, “As a point of informed consent, it’s only honest to say it’s possible that this may have post-fertilization effects,… If that matters to you, this is not the contraceptive of choice.”
Before one can debate the abortifacient nature of emergency contraceptives (ECs), one must decide what it means for a product to be an abortifacient. Princeton University published a journal in April 2012 outlining research on the different types of emergency contraception, their mechanisms of action, health risks, etc. They make a careful distinction between the term abortifacient and the term “post-fertilization effect.” They found all types of ECs to have the potential to have “post-fertilization effects” but admitted that the research was inconclusive. They then went on to say that ECs did not have an effect on an “established pregnancy” which is defined as “after implantation takes place.”
A substantial meta-analysis published in Contraception in 200115 studied the different types of ECs finding that the mechanism of action depended heavily on the timing of ovulation, unprotected intercourse and the administration of the EC. In conclusion this analysis states,
“It is clear that EC appears to prevent ovulation in many cases but not so clear what the conditions are in terms of timing of treatment relative to the stage of follicular development. The criteria used to time treatment lacks this precision in practically all studies reviewed. Because ultrasound has not been used, the occurrence of ovulatory dysfunctions, such as luteinized unruptured follicle, has not been determined. Both logistic and ethical constraints prevent designing and performing experiments that can directly address what in fact happens to the crucial biologic entities -sperm, oo-cyte, zygote or preimplantation embryo- in the genital tract of women who receive EC in comparison to those who receive placebo.”
It is also important to understand that the week after Pill, Ella, while called an emergency contraceptive and covered by the HHS mandate, is actually in a different class of medications. Ella is a Selective Progesterone Receptor Modulator (SPRM). It does not interrupt a woman’s reproductive function by adding extra hormones, but rather it disrupts be body’s ability to appropriate the progesterone naturally present. As explained in Ella’s prescribing information16, this has the potential to inhibit ovulation but it the efficacy of the medication is also dependent on it’s ability to alter the endometrium making implantation difficult. Furthermore, without rapidly rising progesterone levels, an “established pregnancy” could also be affected. Another example of a medication classified as an SPRM is RU-486.
5. Mis-information on the Pill: I never heard objections to the pill growing up.
Beyond ECs, Ms Evans also states that regular contraception is also surrounded by misinformation. She states that she never heard anything bad about the Pill in her evangelical circles and only recently began hearing of the moral issue Christians have with contraception.
Let us consider the scheme of Christian History. We must guess that Mrs. Evans is referring to modern evangelicalism which emerged in the 1950’s. Evangelicalism as a whole began in the United States near the revolutionary war with the Methodists, but, John Wesley certainly did not have nice things to say about contraception. He was not alone. In fact, every single Christian denomination, and much of the secular world as well, denounced the use of contraception until 1930. All of the Protestant reformers spoke strongly against contraception. Sigmund Freud called the use of contraceptives a “perversion.” Mahatma Ghandi said it, “Put a premium on vice,” and said, “if artificial methods become the order of the day, nothing but moral degradation can be the result.” Theodore Roosevelt called contraception a “national sin.”17
For the first 1900 years of Christianity, contraception was universally denounced as immoral. It has only been a measly 80 years that we have collectively changed our minds. The shift began in 1930 at the Church of England’s 7th Lambeth Conference where they determined in Resolution 15 that “in those cases where there is such a clearly felt moral obligation to limit or avoid parenthood, and where there is a morally sound reason for avoiding complete abstinence, the Conference agrees that other methods [contraception] may be used, provided that this is done in the light of…Christian principles.” Adding that “The Conference records its strong condemnation of the use of any methods of conception control from motives of selfishness, luxury, or mere convenience.” By 1958 even those restrictions were removed. This decision fundamentally shifted the understanding of intercourse from a procreative act to a self-gratifying act. Over the course of the 20th century, one by one, most Christian denominations have followed suit. 1900 years of Christian teaching cannot be erased by 80 years of modern desires. While it is not surprising that Mrs. Evans has only recently heard of these objections, that fact speaks more to the compromises made by her own ecclesiastical tradition, than serves to identify the majority of Christian thought.
6. Mis-information on the Pill: i.e. the pill is an abortifacient
Also mentioned in Mrs. Evans’ section on misinformation is her interpretation of the mechanisms of contraception. She mentioned the first two mechanisms correctly, 1) prevention of ovulation, and 2) thickening a woman’s cervical mucus. When it comes to the 3rd mechanism – the thinning of the endometrium thereby interfering with implantation- she seems to think this is a hypothetical, remote possibility. I must point out the inconsistency of this view with her earlier assertion that the pill is essential to “treat” endometriosis.
As mentioned, the pill effectively reduces an painfully thick endometrium to an average of 1.1mm. Through IVF studies, we know that the endometrium must be 9mm thick to be hospitable for implantation. Scientifically speaking, it is quite obvious that the pill thins the endometrium thereby affecting implantation. But how often can this happen if the pill prevents ovulation in the first place? Again, let’s look to science.
Medical studies have shown that women ovulate up to 28.6% of the time when taking their prescriptions correctly.18 Doctors have reported even higher numbers among their patients using the pill, estimating breakthrough ovulations between 50-90% of the time. When an ovulation occurs the body has overcome the primary purpose of the pill. When a woman ovulates, her body naturally creates a discharge which breaks down any blockage in the cervix that the pill is supposed to have thickened, thus removing function #2. When ovulation occurs, the efficacy of the pill relies solely in function #3.
Mrs. Evans goes on to say that this doesn’t bother her much because it has been known that the body naturally rejects the implantation of fertilized eggs all the time. First of all, Dr. Walt Larimore asserts, “There is no proven method to measure the loss of the preembryo prior to implantation.”19
Secondly, the moral difference between a miscarriage and the use of an abortifacient rests on the issue of culpability. In the cause of the miscarriage, the pregnancy ends naturally, thus completing its biological course with no resulting culpability. However the use of an abortifacient directly causes the rejection of the zygote. The difference is as stark and well-defined as difference between natural death and murder.
Nevertheless, this assertion of the natural process of rejected zygotes and the intricacies of the reproductive system has lead Mrs. Evans to reconsider when life begins.
The beginning of life is a measurable, scientific question. It is not influenced by a bodies acceptance or rejection of a fertilized egg nor is it impacted by the intricacies of a woman’s reproductive system. Maureen L. Condic, in looking at this very issue says,
“Based on universally accepted, scientific criteria, a new cell, the human zygote, comes into existence at the moment of sperm-egg fusion… [it] Immediately initiates a complex sequence of events that establish the molecular conditions required for continued embryonic development. The behavior of the zygote is radically unlike that of either sperm or egg separately and is characteristic of a human organism. Thus, the scientific evidence supports the conclusion that a zygote is a human organism and that the life of a new human being commences at a scientifically well defined ‘moment of conception.’”20
If one rejects the objective criteria of conception as the beginning of life, one is left with only subjective criteria. If life does not begin at the moment of sperm-egg fusion, relativistic thought necessarily consumes the debate. No other moment has such concrete indicators. There is left no moral high-ground, no scientific definitions, all that remains are the arbitrary whims of desire.
7. “Let’s talk about contraception…Let’s avoid making generalizations about the millions of women and families who say they would benefit from affordable, accessible contraception.”
Lastly, much of Mrs. Evans article was precipitated by the vocal backlash against the government’s HHS mandate. She incorrectly attributes motives to those who oppose this mandate. For those who have examined the dangerous precedents set by this mandate, it is clear that the furor is not about contraception at all. Rather it directly involves the Government’s overreach in requiring the purchase of a product that an individual or employer considers to be immoral. These visceral reactions are not a form of judgement on those who choose to use contraception, rather they are a response to being compelled to participate directly in what we consider to be immoral, and prevented from the “free exercise of religion.” If the government sets this precedent, then none of the rights guaranteed by the constitution have any validity or security in the future.
I am grateful that Mrs. Evans has taken the time to civilly address an emotionally charged topic. I hope that by her discussing this issue, others will take the time to examine all the facts, scrutinize the research, and take an honest look at history. Our culture is addicted the soundbite, the blog-post, and the misleading statistic; only through mature and thorough examination can we come to a comprehensive understanding of the complex moral and scientific issues which we now face.
- http://www.firstthings.com/blogs/firstthoughts/2014/01/equivocation-and-contraception-a-response-a-response-to-rachel-held-evans ↩
- Cara. Free as a LARC. http://www.1flesh.org/choicestudy. Oct 6, 2012. ↩
- José Luis Dueñas et al. Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997–2007. Contraception. Volume 83, Issue 1, pp82-87. Department of Obstetrics and Gynecology, Hospital Universitario Virgen Macarena, Sevilla, Spain. January 2011 ↩
- http://www.guttmacher.org/pubs/fb_contr_use.html ↩
- Budziszewski, J. Designed for Sex: What We Lose When We Forget What Sex Is For. http://www.touchstonemag.com/archives/article.php?id=18-06-022-f#ixzz26m8Yxri ↩
- http://www.cancer.org/cancer/cancercauses/othercarcinogens/generalinformationaboutcarcinogens/known-and-probable-human-carcinogens ↩
- Jiangsu Family Health Institute, China (1997) ↩
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427645/ ↩
- http://journals.lww.com/obgynsurvey/Citation/1993/02000/Delayed_Childbearing_and_Risk_of_Adverse_Perinatal.5.aspx ↩
- http://www.ncbi.nlm.nih.gov/pubmed/16967756 ↩
- http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf ↩
- http://womenspeakforthemselves.com/ ↩
- http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf ↩
- McCarthy S, Tauber C, Gore J. Female pelvic anatomy: MR assessment of variations during the menstrual cycle and with use of oral contraceptives.Radiology. 1986;160:119-123 ↩
- http://www.ncbi.nlm.nih.gov/pubmed/11368982 ↩
- http://pi.actavis.com/data_stream.asp?product_group=1699&p=pi&language=E ↩
- Love Undefiled. Roosevelt, Freud and Gandhi on Contraception. April 5, 2010. ↩
- Pierson, Roger et al. Ortho Evra versus oral contraceptives: follicular development and ovulation in normal cycles and after an intentional dosing error. Fertility and Sterility. Volume 80, Issue 1, July 2003 ↩
- http://www.polycarp.org/larimore_stanford.htm ↩
- http://bdfund.org/wordpress/wp-content/uploads/2012/06/wi_whitepaper_life_print.pdf ↩