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Defending Contraception

The controversy over the Obama administration’s proposals to include contraception in insurance coverage required by the new health care law has been portrayed as an issue of religious rights. And women’s rights. And reproductive rights. And political rights.

Instead, it ought to be viewed as a public health imperative.

The argument forwarded by the Catholic Church and its acolytes on the Republican campaign trail — that artificial birth control destroys the sanctity of sex and marriage — does not hold up to modern medical scrutiny. Nor does Rick Santorum’s definition of contraception as “a license to do things in a sexual realm that is counter to how things are supposed to be” quite fit into an America where 98% of all sexually experienced women use birth control at some point in their lives, including, no doubt, most Catholic women.

Opposition to birth control as a personal matter of faith, or as an expression of adherence to religious teaching, is legitimate and ought to be protected; whoever in America chooses to follow such dictates should be allowed to do so, of course. We’re not a nation with a one-child policy.

But with all we know about the public health benefits of preventing unplanned pregnancies, and we know a lot, this opposition ought not to shape public policy or the operation of publicly funded institutions. The proper use of birth control saves lives, prevents abortions, lowers the rate of teen pregnancies, improves the health of infants and mothers, and leads to happier, more stable marriages and less domestic violence. Why, it can even be included in a deficit-reduction package, since it demonstrably saves public dollars. All of these outcomes match neatly into what not too long ago was part of the conservative social agenda. Truly, it should be part of everyone’s agenda — everyone, that is, who is serious about improving society in general, and the lives of women and children in particular.

It may not be fashionable in some circles to compare the United States with Europe, but here the comparison is instructive. “Unintended pregnancy in the United States is higher than in other developed countries, and contraceptive use is lower,” wrote the Guttmacher Institute in congressional testimony submitted last year. “International comparisons also provide evidence that contraception use reduces women’s recourse to abortion.” For example, a 2010 study focusing on Georgia (the nation, not the state) found that increased use of contraception was a significant contributor to a drop in abortion rates between 1999 and 2005, explaining 54% of the decline.

The trends hold true in the United States. One Guttmacher study examined what happened when the proportion of unmarried women using contraceptives increased from 80% in 1982 to 86% in 2002 and found that the increase was accompanied by a dramatic drop in abortion rates: from 50 per 1,000 women in 1981 to 34 per 1,000 women in 2000.

If reducing abortion is such a serious goal, then wouldn’t the contraception option be an attractive choice, more attractive than the legal challenges and social bullying that are employed today?

There’s more. Guttmacher cites two studies that found that increased contraception use led to a decline in the risk of pregnancy among adolescents, another essential goal to improving public health. The proper use of birth control also helps women time and space their births; studies have found a causal link between such spacing and a reduced chance of a baby delivered before term and with the kind of low birth weight and small size that hinders health outcomes from the very first breath.

We know that children born of unintended pregnancies are less likely to be breastfed. Several studies in the United States, Europe and Japan also suggest an association between unintended pregnancy and subsequent child abuse. And Guttmacher cites evidence that marriages are more likely to dissolve after an unintended first birth than after an intended first birth, even when controlling for a range of socio-demographic variables.

But contraception is not cheap, as any woman on the birth control pill can attest. That is why insurance coverage is so essential. It also makes obvious financial sense: Every dollar invested by the government for contraception saves $3.74 in Medicaid expenditures for pregnancy-related care for births from unintended pregnancies, according to the Guttmacher report.

Really, one would have thought that the deficit hawks would be all over that.

So, let’s recap. If we were constructing a society that genuinely wanted to foster stable marriages, safe families and healthy infants, while reducing the rate of abortion and teen pregnancy and even, perhaps, the federal budget deficit, why on earth would we delegitimize the use of contraception, the one tested, legal way to achieve those goals? Why would we not require access to something that so demonstrably benefits individuals and society? No one is forced to insert an IUD or go on the pill, but fairness only dictates that poor and working women have the same opportunity to avail themselves of contraception as, oh, the wives of presidential candidates.

But maybe those wives are part of the 2% of women who don’t touch the stuff. As New York Times columnist Maureen Dowd so memorably wrote: “What’s wrong with the rhythm method anyway? That’s how I got here.”

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