What the Contraceptive Choice Study Really Shows [Serge]

Update: Lydia McGrew has a more extensive and detailed analysis of this paper over at What's Wrong with the World.

News reports for the last couple weeks have been glowing about a new study that purports to lower abortion rates by offering contraception for free.  "Free contraception cuts abortion rates dramatically" is an example from NBC news.  This sounds promising, but as usual a closer look at this study tells a very different story.

The study itself is part of the Contraceptive Choice Project in St. Louis.  The preliminary results of the study can be found here, and a pdf presentation from the study's main author can be found here.  The claim is that this study has shown that increasing access to contraceptives by making them free shows a general decrease in the unplanned pregnancy and the abortion rates.   There are a number of reasons to indicate that the study does very little to support that claim.

First, it is important to look at the goals of the study.  According to the author the goal were "(1) To increase the acceptance and use of long-term reversible contraceptive (LARC) methods among women of childbearing age  and (2) To measure acceptability, satisfaction, side-effects, and rates of continuation across a variety of contraceptive methods, including long-term reversible methods."  It was not an attempt to study whether increased access to traditional contraceptives would increase their use and effectiveness, but an attempt to convince women to change the type of contraception that was used.  This is very important, and almost never mentioned in the news reports.

Second, the study group itself is very interesting.  Dr. Michael New has mentioned that there was no control group to compare the study group to.  However, even more important is the characteristics of the group itself.  Women who volunteered for the project were recruited mainly from Washington University and various abortion and family planning clinics.  In order to be involved in the program, the women had to be desiring contraception and be willing to change the type of contraception that they were presently using (if any).  66% of the women in the program had previously experienced an unintended pregnancy, and 40% of them had a previous abortion.  39% of the women had a history of an STD, and 6% presently had an STD.

Is it possible that this group, who were already seeking contraception and most have experienced an unintended pregnancy, may be more willing and motivated to change their contraceptive method for this study?  Data extrapolated from this group of women cannot be accurately applied to the public at large, yet that is exactly what the news media would have us believe.

Lastly, the goal of the study was to convince women to forgo traditional methods of contraception (mainly OCs) in favor of more effective, long-term methods.  These LARC methods were IUDs or implantable hormonal contraceptives.  Over 75% of the women in the study were convinced to change from traditional methods to longer acting methods, and this accounts for the majority of the success in preventing unplanned pregnancies.   The challenge that the researchers had, and one that they were highly successful in this group, was to convince women to change from a non-invasive method of contraception to an invasive one.  There is no reason to believe that women in the general public, and especially teens, would be willing to choose these more invasive methods over regular OCs.  Convincing a 15 year old that is looking for a pill to have a 4cm implant placed in her or have this contraption placed in her young uterus will not be easy.

Anyone who doesn't think this won't be a significant barrier hasn't been paying attention to the other side.  For years, family planning clinics have been looking to stop requiring pelvic exams for women who are seeking contraception.

Indeed, according to a consortium of health-care providers and researchers, called Oral Contraceptives Over-the-Counter Working Group (OC-OTC), the annual pelvic exam is still a major barrier to access to contraception for many American women.

So lets get this straight.  Having a doctor perform a pelvic examination (for the benefit of the woman) is a major barrier to contraception.  Yet this study would have us believe that upwards of 75% of women would allow not only examine her "ladyparts" (with apologies to the Obama campaign), but allow the placement of a hormonally saturated contraption in her uterus, knowing that it would also have to be removed by a doctor at a future date when a pregnancy is wanted.  Good luck with that.
Bottom line: in a carefully chosen group of women, who may be highly motivated to change their contraceptive methods and avoid another pregnancy, LARCs may help them avoid pregnancy.  However, extrapolating that data to apply to the public at large, and especially including tradition types of contraception is not supported.  This study reveals nothing to believe otherwise.

LTI Podcast #30 - Free Plan B in New York HIgh Schools [Serge]

We're back again!  Jay, Rich and Megan discuss the new policy in New York public schools that enables children as young as 14 to obtain emergency contraception as well as long term contraception in school without parental consent or notification.  Is this the best we can do to train and protect our children?

Direct link is 
http://traffic.libsyn.com/serge13102/LTI_Podcast_30.mp3

or you can subscribe via ITunes right here.  

What is meant by "Middle Ground?" [Megan]

“Abortion is a complex, painful issue that touches upon faith, gender, and class.”

This quote was pulled from an opinion piece on the emphasis given the abortion issue at the Democratic National Convention. The piece is worth reading, but I want to address some ideas with regard to this particular statement.

This summarizes the collective thought about abortion from many who claim to stand on “middle ground.”

I recently attended an informal debate, the topic of which was:  “Is There Middle Ground On the Abortion Issue?” The outcome that day seemed to be a resounding “yes,” the reason being that both sides of the debate cared about the same things — families, women, caring for those in need, providing support and resources for women who face unwanted pregnancies, etc.

Both the statement above and the debate I attended address the psychological complexity surrounding the abortion issue, the complex and painful issues that bring women to the decision of whether or not to abort a pregnancy. I use “surrounding” because the issues they address are parallel to abortion. But unless “abortion” is defined broadly so as to include poverty, access to healthcare, lack of emotional support, church-and-state legislation, the overwhelming need for revolutionized sexual ethics, and other — albeit [very] important — issues, neither the statement nor the debate really focused on the issue at hand.

For the sake of clear thinking and decision making, we need to carefully consider the rhetoric and make some important distinctions. What is meant by the term “abortion”? What are the issues that touch the abortion issue? Are there limits out of which we must not step? What is the most human response?

Philosopher Christopher Kaczor defines abortion this way:  “Properly speaking, abortion is the intentional killing of a human fetus.”

His terms are carefully chosen and scientifically accurate. Working with this definition, either abortion is morally permissible, or it is not.

I suppose middle ground means the instances in which intentionally killing a human being might be up for consideration. Let’s look at some suggested instances from the “middle,” keeping in mind that I am addressing each one in an intellectual manner. My feelings are another matter, but I must check them by what I know to be true.

• Poverty — Though poverty is a travesty, and a result of a broken world, and though we should all have strong convictions about the need to bring an end to it, one cannot justify taking the life of an innocent human being to lessen the burden. I think that communities should work together to help those in need — including unborn children before and after birth; but just as I think a family cannot kill their 3-year-old to lessen the financial burden on the other family members, financial hardship does not justify abortion.

• Emotional support — Facing an unwanted pregnancy is, in many cases, terrifying. In some cases, it may be the most difficult thing a woman ever has, or ever will, face. Once a pregnancy begins, the “getting pregnant” cannot be undone. Where does a woman go from there? I agree that emotional support is much needed, and I think that communities should rally around women and families facing crisis pregnancies. I understand that so often, in our predominantly self-centered culture, this does not happen. But if a troubled woman cannot take the life of her toddler because she lacks emotional support, neither ought she be able to kill her unborn child.
   
• Church-and-state — Many claim that the pro-life view is grounded in “religion,” and so it has no place in discussions on matters of the State. If by religion, one is loosely referring to a metaphysical realm of unseen ideas, it may be true that the pro-life view is grounded there. But the pro-lifer’s claim that the unborn are deserving of a right to life is no more religious than claiming the unborn do not deserve such a right. Also, the claim that the unborn are human beings is not religious, but scientific. Science, not religion, tells us that from the very beginning, the unborn are living, distinct and whole human beings. Lastly, it is important to point out that the pro-life view is shared by individuals among a broad spectrum of “religious” views, and that all laws deal in morality, in setting parameters on what ought or ought not be allowed, which inevitably brings us back to metaphysics.

• Gender — The reality is that abortion is perceived as a “women’s rights issue.” Because I must operate according to what is, I keep this in mind when thinking, writing, and speaking. But even as I work in this reality, I work diligently toward replacing the wrong thinking with true ideas. The unborn are unquestionably human, which makes abortion a “human rights issue.” To perceive it as a women’s rights issue is to beg the question, “What is the unborn?” by assuming at the outset that the unborn — including unborn women — are not human beings deserving of rights.

• The need for a better sex ethic — I agree. Resoundingly. Just as I think that this issue, in particular, is one that undergirds the overwhelming number of elective abortions in our country and in others. But even as we work toward achieving this, there are new lives coming into existence all the time. Should we kill innocent human beings on the grounds that young people are lacking in sex education, access to or understanding about birth control, or in understanding sexual ethics? To improve upon those problems is a worthy endeavor, but to allow abortion-on-demand just because those problems exist is impermissible.

When human life hangs in the balance, distinctions must be made. While I agree with the seriousness of the issues that make contact with the abortion issue, and while I think fruitful discussion can be had on how to improve the state of things with regard to those, none serve as justification for taking innocent lives.

On that issue — abortion as “the intentional killing of a human fetus” — there is no middle ground. Either it is morally permissible to unjustly take innocent human lives, or it isn't.

And while any progress that lessens the number of lives lost is good and deserving of support, it should be supported with the goal — to bring the killing to an end — in mind and in sight.

To protect the most fragile among us, even in the face of extreme difficulty and turmoil, is the most human response.

As we discuss weighty matters with one another may we do so winsomely and wisely; and with sharp awareness of exactly what it is we're discussing.

Pro-lifers on trial in the UK

See the lead BBC Southeast story on a court case against British pro-lifers Andrew Stephenson and Kathryn Attwood. Each was on trial for displaying graphic images of aborted fetuses outside of an abortion clinic in Brighton (last year). At the time of this video, Attwood's case was thrown out, while Stephenson awaits trial. Gregg Cunningham is serving as an expert witness in Stephenson's trial. This case has major implications for free speech in the UK.

Parts and Wholes Confusion in the NYTimes [Jay Watts]

In his opinion piece at The New York Times titled Men, Who Needs Them?, Boise State University professor of biology and criminal justice Greg Hampikian makes an egregious confusion of parts versus wholes in describing "your" biological history.  From his article:

Think about your own history. Your life as an egg actually started in your mother’s developing ovary, before she was born; you were wrapped in your mother’s fetal body as it developed within your grandmother.

After the two of you left Grandma’s womb, you enjoyed the protection of your mother’s prepubescent ovary. Then, sometime between 12 and 50 years after the two of you left your grandmother, you burst forth and were sucked by her fimbriae into the fallopian tube. You glided along the oviduct, surviving happily on the stored nutrients and genetic messages that Mom packed for you.

Then, at some point, your father spent a few minutes close by, but then left. A little while later, you encountered some very odd tiny cells that he had shed. They did not merge with you, or give you any cell membranes or nutrients — just an infinitesimally small packet of DNA, less than one-millionth of your mass.

So Dr. Hampikian is trying to stress how little the father is involved in the biological history of any given child in comparison to the mother.  The father's contribution is miniscule and to the extent that it is necessary it is only marginally so.  But in drawing out his narrative he is either intentionally or accidentally being very confusing.

You are not your mother's egg.  You did not begin to exist when her eggs were formed.  Her egg is a part of her body with a very specific reproductive purpose.  From Robert George and Christopher Tollefsen's Embryo:

Is either the sperm or oocyte... identical to Smith, the adult whose origins we wish to specify?  

The answer to all these questions is negative.  Sperm and egg cells are parts of the human organism... a part of a biological organism in the sense that concerns us here is some living subset of the cells that comprise the totality of the organism , the life of which subset is integrated into the life of the whole, and which performs some unified functional role within the life of the organism.

They point out that both the sperm and egg after being released to serve their reproductive function will quickly cease to exist if fertilization fails to occur.  Our ability to use scientific advancement to artificially preserve the life of the parts does not change their nature.  They are meant for a specific purpose within the organism they help comprise and once they serve that purpose or fail to serve that purpose they quickly cease to exist.

The zygote on the other hand is entirely different.  Quoting Keith L.Moore and T.V.N Persaud in The Developing Human, "Human development begins at fertilization when a male gamete or sperm (spermatozoan) unites with a female gamete or oocyte (ovum) to produce a single cell - a zygote.  This highly specialized, totipotent cell marked the beginning of each of us as a unique individual."

It is easy when telling the narrative of our worldview to hedge the story a bit to make our position seem more obviously true.  In Dr. Hampikian's desire to highlight an obvious truth, that women are more biologically invested in the reproductive process than men, he sails past telling the story into redefining the nature of our life.  We were never an egg that met up with some sperm after having sustained existence for years upon years.  Without both the sperm and the egg our story never begins at all.  I understand that this fact somewhat undermines the overall point Dr. Hampikian is trying to make, but it is a biological fact whether convenient or not.  

I will leave it others to address the idea that men are not necessary after conception.  It is not a tall hill to climb as you have the support of mountains of evidence that intact traditional families contribute to the well being of children in numerous and often surprising ways.  It is enough that in order to minimize the impact of men in sexual reproduction he felt it necessary to reduce us all to components of our mother's reproductive system and - in doing that - blurred the lines between parts of human beings and the whole distinct living human beings we all are.

Responding to the Rape Exception Question [Megan]

The "exception in cases of rape" question to the abortion issue is one that has put many pro-life candidates running for public office on the hot seat. Of all of the questions we at LTI answer in classrooms, it is among the toughest. It shoots straight for the intersection between knowing what's true, and the gut reaction to what's right in front of you — the intellectual and the emotional.

You have to answer both. And it helps to assume that the person you're speaking with — or others in the room — have had a brush with this issue either directly or indirectly. It is very likely the case.

To give only an intellectual response is to seemingly ignore the very real emotions surrounding something as hideous and tragic as rape — a reality that can only be truly understood by someone who has experienced it. It is true that I have not. My heart bleeds for any who have.

But even in grief, the deepest grief, we can know what is right. Though this is among the toughest issues psychologically — which should not be ignored — it is morally simple.

Morally, it's Case for Life 101:  What is the unborn? Science tells us the unborn are living, distinct, and whole human beings from the very beginning. Philosophy tells us their value lies in the human nature they share with the rest of us. And in a civil society, we cannot kill others because they remind us of something traumatic.

"I don't like that answer," I tell students. Because when confronted with a victim of rape, my unchecked gut reaction is overwhelming sympathy for the person I see in front of me.

But my dislike doesn't make the truth untrue. Just as my dislike it doesn't make the world unbroken. Rape is horrible and once committed, cannot be undone. What comes next? If the unborn are human beings, the answer cannot be to kill the unborn.

I stand with the truth.

Though it is a parallel issue, I think it is important to address a community's duty to come alongside the victim of such a travesty, as well as the victim's family, and walk with them through the difficult months and years ahead. Rallying around those in need is the most human response. To "bear one another's burdens," as Paul writes in Galatians.

I include my thoughts on this in anticipation of the remark :  "You care nothing for the woman! Only for the unborn." In the past, I have been caught off guard by this heated accusation. I was discussing the humanity and value of the unborn (thoughts and ideas) — my accusers had no knowledge of my feelings on that or any other matter! Had they asked, I would have gladly shared them, from which point they could not have accused me of not caring.

In fact, I care enough to keep talking about it, even when it's hard. If Christianity is true, and I believe it is, then the only real healing anyone can find from the worst pain inflicted by a broken world is in Jesus.

Staying on point [Megan]

In the firestorm following comments made by Rep. Todd Akin, Republican nominee for the Missouri Senate, the blast has been directed at Akin's character in light of a blundered interview more than at his ideas. As a result, the pro-life view he stands for is under fire as well. While I know little about Akin's character — which is important to consider given his position — I can address what he said.

Akin, when asked about exceptions to his pro-life stance in cases of rape, claimed that in cases of "legitimate rape," a woman's physiological reactions work to prevent fertilization from taking place — a kind of shut-down mechanism — and that cases of pregnancies resulting from rape are rare. (Scan an article and see a video clip of the interview here.)

His off-the-cuff remarks were unsubstantiated, and unwise. Even if he believed them to be true, they weren't necessary to make his case (He later claimed that he "misspoke" during the interview.). There are many things — good things — that can be said to bolster the case for life, but the issue of rape is hard-hitting and the answerer must zero in on the central question:  "What is the unborn?"

Akin's remarks that followed were more on point — he said that while punishment was needed as a consequence to rape, that punishment should fall on the rapist and not on the innocent child (paraphrased) — and had he just gone with those thoughts minus the other, he might still be under fire, but it would be for consistency in his pro-life stance. Earlier in the same interview, he actually answered the issue of ectopic pregnancies fairly well.

We live in a culture in which stereotyping is knee-jerk. The pro-choice crowd has, at least in the media, used this mishap to make Akin a poster-child for pro-lifers. The name-calling has extended from Akin to those who share his beliefs on the abortion issue. This is unfortunate, and is just as much a failure to stay on point as Akin's unhelpful aside was.

While labels have their place and can be helpful in dialogue, to paint with such a broad brush reveals a serious lack of careful thinking.

What we say, with or without thinking, matters. I challenge those on both sides of the debate to be more diplomatic, especially with what's at stake.