Does Giving Women a Year’s Supply of The Pill Reduce Abortions?

A reader asked me to take a look at this study (abstract here) and see if it reaches a valid set of conclusions. The study was conducted in California among ~80,000 women who receive birth control pills paid for by the state as part of a program for low income women. Previously, women in the program have received a 1 or 3 months supply of birth control at a time, and then have to go in to the clinic in order to receive a refill. In the study, a portion of these women were given a full year’s supply instead of one or three months, and state medical records were then used to see if this resulted in a change in the rate of unplanned pregnancy and abortion among the women who received a full year supply of birth control.

Researchers observed a 30 percent reduction in the odds of pregnancy and a 46 percent decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one – or three-month supplies.

The researchers speculate that a larger supply of oral contraceptive pills may allow more consistent use, since women need to make fewer visits to a clinic or pharmacy for their next supply.

“Women need to have contraceptives on hand so that their use is as automatic as using safety devices in cars, ” said Diana Greene Foster, PhD, lead author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. “Providing one cycle of oral contraceptives at a time is similar to asking people to visit a clinic or pharmacy to renew their seatbelts each month.”

Oral contraceptive pills are the most commonly used method of reversible contraception in the United States, the team states. While highly effective when used correctly (three pregnancies per 1,000 women in the first year of use), approximately half of women regularly miss one or more pills per cycle, a practice associated with a much higher pregnancy rate (80 pregnancies per 1,000 women in the first year of use), according to the team. [source]

The details of that decrease are as follows:

Women who received a 1-year supply were less likely to have a pregnancy (1.2% compared with 3.3% of women getting three cycles of pills and 2.9% of women getting one cycle of pills). Dispensing a 1-year supply is associated with a 30% reduction in the odds of conceiving an unplanned pregnancy compared with dispensing just one or three packs (confidence interval [CI] 0.57–0.87) and a 46% reduction in the odds of an abortion (95% CI 0.32–0.93), controlling for age, race or ethnicity, and previous pill use.[source]

So, what should a Catholic pro-lifer make of this?

Well, there may or may not have been methodological issues with this study. I read several science news stories about it, but I can’t get access to the full text, so I don’t know for sure how they dealt with sample bias, etc. However, I have to admit, that from what I’ve read it makes sense to me that the study results are valid as far as they go. But they also give us a window into the contraceptive mentality which is at play in feeding into abortion in this culture.

The women in the study are receiving birth control so that they can have sex at will while not getting pregnant. Nevertheless, some percentage of them are getting pregnant (around 1% of those getting the year supply, around 3% of the rest) during any given year. The good news is that they are like the rest of California women in that in 80% of these cases, they are carrying these unexpected children to term. The bad news is that 20% of the time they choose an abortion instead.

But part of what’s feeding this problem is not the quantity of birth control that’s being given out at a time, but the sense in which people’s actions are (for whatever reason) not fitting with their desires. One article on the study includes this telling quote:

“It’s a cost-savings thing, but it’s also a quality-of-care issue — and it’s the right thing to do,” she says. “People don’t stop having sex when their pills run out.”

So people are taking birth control pills in order to have sex while not getting pregnant, but if they run out of pills — they don’t stop having sex.

The study’s proposed solution to this is “let’s just make sure they always have lots of birth control on hand” and I suppose in the context of them taking birth control, I really don’t have any strong feelings about whether they get a month’s supply or a years supply at a time. But it seems to me that we’re looking at the root of a much deeper issue when we hear someone conducting a study on this topic saying that people do not appear to stop having sex when they run out of birth control — even if they know it’s only the birth control that’s keeping them from getting pregnant as a result of having sex.

All other things staying constant, if it’s true (as the study appears to indicate) that some women on birth control are late in refilling their prescriptions and thus gap out for a few days, yet continue having sex as normal (or abstain during the couple days they don’t have pills, but then go back to having sex as normal as soon as they start taking the pills again without realizing that the unexpected fertility might well come a week or two after the gap, not during it) then it’s pretty logical that reducing the frequency with which women have the potential to experience that gap would reduce the number of unplanned pregnancies. And if we assume that the same percentage of unplanned pregnancies will always result in abortions, then necessarily reducing the number of unplanned pregnancies will reduce the number of abortions.

I think this does suggest that for those people who are in the business of dispensing birth control pills, it would be an obvious thing for them to dispense large prescriptions, and perhaps to look into some sort of automatic reminder or shipment in order to help women avoid these gaps. Women who are coming to them for birth control obviously don’t want to get pregnant, and they will do a better job of fulfilling those women’s wishes if they help them avoid those gaps.

I don’t think we pro-lifers who have moral objections to birth control need to go out and become cheerleaders for the idea of handing out larger prescriptions of The Pill — though in light of this study I think we shouldn’t actively try to keep birth control dispensers from dispensing larger amounts at a time. The moral content of taking birth control is the same regardless of how much you pick up at a time and the larger prescription amounts seem to have, on the whole, positive results from everyone’s point of view.

I think the role for us as pro-lifers is two fold:

First, either way, we believe that everyone will be better off if abortion is simply not on the table. (For those birth control enthusiasts, this might even result in some more conscientious pill taking.) This clearly makes no different in our fight to remove abortion from the set of legal medical options.

Second, our society is clearly both confused and dysfunctional when it comes to sex, if we have a lot of people who are taking birth control in order to avoid getting pregnant yet don’t stop having sex if they run out of birth control. The birth control advocates who are the sources of this study are going to be no help in solving these problems, because their whole worldview is built around the idea that sex should be totally separate from reproduction. It is up to us to build the cultural understanding that sex results in new human life, and that even “protected” sex does some percentage of the time. If you are having sex, you had better be sure that it is with a person whom you are willing to have a child with — even if you’re taking measure to reduce the likelihood of that happening in any given year down to around 1%. One person out of a hundred is still a pretty significant group of people, and a number of years your chances of ending up with a child at some point only go up.

13 Responses to Does Giving Women a Year’s Supply of The Pill Reduce Abortions?

  • Hold on here.

    The study compared women who get a year of pills at once to women who get a few months of pills at a time.

    But you’re trying to answer the question of whether it’s better to give women a year of pills at once, or no pills at all.

    The data about the first question does not really shed light on the second question.

  • Abortion and artificial contraception are both intrinsic evils, so I don’t think this study changes anything.

  • Its hard to know if the study proves anything. I can only access the abstract and have minimal interest in reading the study (if there is desire, I can access via our library). Thus unable to comment on the methods of the study, data collection etc.

    Of interest is the note at the end of the abstract which notes that the Level of Evidence of the study is III.

    To put this in perspective, Level I is a randomized, controlled trial. II non-randomized , cohort studies etc. III is based on clinical experience, expert opinion or descriptive studies. I is the gold standard for clinical work, II okay and III pretty weak. Anyone basing practice changes on a level III evidence is going to be laughed at.

    I think that begins to put the study in perspective.

  • Bearing,

    Hold on here.

    The study compared women who get a year of pills at once to women who get a few months of pills at a time.

    But you’re trying to answer the question of whether it’s better to give women a year of pills at once, or no pills at all.

    Ummmm. Not sure if I got massively unclear while trying to type this up quickly or what, but no.

    I was basically asked, “Can you debunk this, or else what should we pro-lifers make of this,” to which the one sentence version of my reply would be, “It looks to me like it’s probably accurate as far as it goes, so from the point of view of agencies already giving out birth control perhaps they should give out more at a time, but I think the pro-life contribution here would be to work to ban abortion and to make people aware of the connection between sex and babies — not to become cheerleaders for one year prescriptions.”

    Phillip,

    To put this in perspective, Level I is a randomized, controlled trial. II non-randomized , cohort studies etc. III is based on clinical experience, expert opinion or descriptive studies. I is the gold standard for clinical work, II okay and III pretty weak. Anyone basing practice changes on a level III evidence is going to be laughed at.

    Thanks, that helps a lot.

  • Kyle Kanos is absolutely correct.

    Truly, only the dead have seen the end of abortion in this country.

  • Ah, but it only reduces the abortions we “know” about. The pill is strongly suspected of being an abortafacient–preventing an embryo (not fertilised egg) of implanting in the uterus. While a one year supply of the Pill may reduce surgical abortions, we don’t know if it reduces the number of deaths of embryos whose existence is hidden to us because modern day pregnancy tests are not yet sensitive enough to detect them. Only God knows. (And do we want to irritate more than He probably already is?)

    We also need to remember that “pro-life” is not simply “anti-abortion,” and no, I am not talking about the seamless garment issue so many Pro-lifers do not appreciate. It is in having children. As I recall, Europe has fewer abortions than the US, but it also has a much lower birth rate. Some countries are already on the down hill slide. Euthanasia of the elderly and very sick is right at the doorstep. In some countries, it is a reality. There are not enough young people to go around.

    As Kyle Kano noted, contraception is intrinsically evil. Ultimately, not sure this study matters whether valid or not.

  • KJLarsen,

    Agree. But if pro-aborts start pointing to this study, then we are able to point out the design flaws and undermine their argument. We must be able to engage the world on its terms including all valid knowledge.

  • Kyle Kanos,

    Certainly, I agree that using birth control is a major sin — I would never advise someone to do so. Indeed, I would tell everyone not to do so. However, if a doctor is prescribing birth control, and a patient is taking it, it sounds to me like (if the results of this study actually proved out — it sounds like all that exists right now is an observed correlation) it might, overall, be better if the doctor prescribed a large run of The Pill rather than a small one.

    I would certainly consider it to be sinful to be using birth control, but if someone is going to commit that sin I would be at least somewhat inclined to think that it is better to use it right than not.

    I’m a bit divided on this because clearly, although the contraceptive failures resulting from people taking the pill inconsistently when their prescriptions gap out result in a number of abortions, they result in significantly more lives that are in fact embraced and spared. According to the study, 300 abortions might have been avoided if the pill had been used consistently by the members of the study — but then, so would have 1300 live births.

    So I’m not really sure what our reaction, as Catholics should be to that other than that we continue to:

    a) oppose sex outside of marriage and the use of contraception and
    b) oppose abortion

    KJLarsen,

    My understanding from what I’ve read on the topic is that it’s fairly rare for the standard methods of oral contraception (as opposed to the strictly abortafacient “Plan B” kind of stuff) to allow an egg to be fertilized but then prevent it from implanting. It does happen, and it’s one of the many reasons to morally object to The Pill, but from what I’ve read it’s the sort of thing that would happen perhaps once every few years (if even that often) assuming that a woman is using the pill consistently and having sex quite regularly. So it seems to me that it’s virtually impossible that in this particular situation there are enough unrecorded abortions being performed by the pill to make up for the number that are resulting form inconsistent use of the pill.

    Obviously, that does not mean that we as Catholics should advocate that people use the pill — that’s a mortal sin and I would never recommend it. I just wanted to try to address the study as honestly as possible, and I think that means admitting that it is probably the case, if the study is in fact statistically valid, that dispensing a year of birth control at a time does result in fewer abortions (though also many more live births!) than dispensing 1-3 months at a time.

    Certainly, that doesn’t make the pill good. Lots of heinous things would reduce the number of abortions that a given group of women had. (For instance, if California had forcibly sterilized all 80,000 women, they would have had exactly zero abortions, but that certainly wouldn’t have made the action of sterilizing them right or desirable.)

  • I can’t support the use of birth control pills, but knowing they are dispensed and used – often times month over month for years or decades, I have a hard time accepting the practice of requiring someone to return the doctor monthly or quarterly to get a refill. It’s not like a doctor ever says, “well hey, you’ve been on these for six months I better wean you off now.” He simply scribbles out a new script, collects his $50, and sends on her on the way to the pharmacy. How much more expensive is health care than it should be because doctors and the FDA perpetuate this racket?

  • Abortions from the Pill? Funny, I heard the opposite. I think it was Chris Kahlenborn (sp?) MD that wrote that he calculated 10 million per year. I would have to do some digging to find that one though.

    I do agree that refuting the study is important. Alas, I only know of very few pro-lifers who think contraception is evil.

  • What this study doesn’t do is suggest how much of an impact giving out larger quantities of contraceptives will have on the overall abortion rate. According to Guttmacher, only a little over 5% of women procuring abortions report that they lack access to contraceptives for financial or other reasons. So achieving a significant reduction in abortions while continuing to promote contraceptives will require not just providing them, but changing people’s behavior (which can include using contraceptives at all, using them more consistently or correctly, using multiple instead of single methods, avoiding sex when they’re fertile if not using a contraceptive, etc.) Aside from the fact that every time I’ve ever suggested that people change their behavior regarding sex I’ve been summarily execrated, I’m not aware of any study that has shown that people who already have access to contraceptives can be made to change their behavior enough to have a meaningful effect on the overall abortion rate. And you also can’t ignore the fact that over 7% of those procuring abortions report using contraceptives perfectly, for whom decreasing the abortion rate lies along a different path altogether.

  • If you want to email me, I can send you a copy of the full article for a more thorough reading.

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