In the first part of this series, I described a new alliance formed between our national government and Planned Parenthood, effecting an unprecedented campaign against religious liberty in the United States—and threatening female wellbeing at the same time. Yesterday I considered three lines of response: that contraception isn’t the only way to plan a family, that contraception leads to sexual disillusionment, and that contraception weakens the marriage culture at the expense of the least well-off women. Today I enlarge upon the argument that less-privileged women will bear the brunt of large-scale, government-promoted contraceptive programs. I also consider two other arguments: that some contraception has problematic side effects for some women, and that contraception does not manufacture female happiness as its proponents suggest. I conclude by considering how religion contributes to several of the aspects of women’s flourishing that contraception was promised to—but failed to—promote.
Contraceptives Threaten Women’s Health
Although nonmarital births and abortions have increased coincident with large-scale, government-promoted contraception programs, there is an avenue, currently touted by supporters of such programs, that might lower these rates somewhat, and maybe for more than a few years: the use of “long-acting reversible contraceptives” (LARCs)—drugs and devices such as Depo Provera, Norplant, and IUDs. These contraceptives are injected or implanted. Some have to be surgically removed. Most women do not choose them. Maybe they don’t like the idea of the complicated insertion and removal techniques. Maybe the cost is too high. Maybe they don’t like years of hormones streaming into their systems. Or maybe they have heard one too many of the daily ads on their televisions and radios inviting them to join class action lawsuits against the makers of these types of contraceptives, initiated by women suffering strokes, cancer, or heart conditions.
But the bottom line for LARCs on a social scale? If more women used them, rates of pregnancies and abortions might decline, at least for a while, though almost surely not to the levels seen before the advent of widespread contraception programs. A study of 9,300 women in Missouri, many recruited by abortion clinics, and many poor and uninsured, showed how a project promoting the use of LARCs resulted in lower rates of unintended pregnancies and abortions over several years.
A closer look at the study reveals, however, that only 5 percent of the women and girls involved previously had chosen to use LARCs; the researchers conducting this study persuaded 75 percent of the women to start using them, and they visited their homes seven times over three years in order to ensure that they stayed with the program.
So perhaps the most important question the study raises is whether this path is the one that women, or our nation, want to take: strenuously promoting medically riskier, longer-term, hormonal contraception, most likely among poorer and minority populations. For it is inevitably the poorest who become the target of such efforts. Remember two decades ago when no fewer than seven states were considering offering Norplant (a surgically implanted hormonal contraceptive, lasting about five years) to women and girls, as a quid pro quo for minimum- or enhanced-welfare benefits? The vast majority of the targeted populations were African-American.
And remember that once these young women are temporarily sterilized, for three to ten years, the government, and likely the affected women and girls, are more than likely to fall into the trap of believing that all relevant consequences of sex are being managed. The psychological and spiritual fallout from sexual intimacies that lead nowhere will almost certainly be neglected. And these forms of contraception do nothing to prevent STDs.
It should prick our conscience that the less-advantaged seem inevitably to be targeted for reduction when large-scale contraceptive programs operate. The serious health-side effects of hormonal contraceptives, and their ties to higher rates of HIV transmission, should also challenge government support for LARCs as the answer to unwanted pregnancies and abortions. This is not to claim that all hormonal birth control is intrinsically dangerous, or that most women will suffer serious side effects. But it is to remember that it is well-known to the point of coverage in the New York Times that “taking a combination hormone birth control pill—which contains estrogen and a progestin hormone—can increase the risk of stroke and blood clots in the legs and lungs.”
Various forms of birth control pills and IUDs (the latter with and without hormonal elements), have been the subject of myriad class action lawsuits (over 11,300 claims, in the case of one company), which leading pharmaceutical corporations have paid hundreds of millions of dollars to settle. The World Health Organization continues to list some hormonal contraceptives as a group 1 carcinogen.
Further, a very recent study also suggested strongly that injectable LARCs may double the risk of contracting and transmitting HIV, to the point that even the World Health Organization is considering “re-evaluating … clinical recommendations on contraceptive use.”
Finally, common sense justifies wondering out loud why, fifty-two years after the launch of the birth control pill, no pharmaceutical company has seen fit to develop hormonal or other birth control products for men. In the words of Mother Jones magazine:
A male pill might have to be easier on the body than female contraceptives, too. Women have long complained of weight gain, moodiness, and other birth control side-effects, but despite that, 62% of US women of reproductive age use contraceptives. A recent clinical trial for a male contraceptive delivered via injection (similar to Depo-Provera for women) was ended early despite promising early results due to participants' complaints about side-effects such as depression, increased libido, and mood changes.
Diana Blithe, a program director at the National Institute for Child Health and Human Development, says that “the reality is we could get a product out there very quickly if companies would aggressively take on the process of making it happen,” she said. But until consumers really ask for that product, or until marketing studies show it would really sell, US companies really have little to gain by developing a male contraceptive. Since condoms are widely available, protect against STDs, and have very few, if any, side effects, it may be a long wait.
An industry led by men, unwilling to produce birth control with side effects for men, but eager to do the same “for” women. All of this should raise a red flag, at the very least.
Contraception Doesn’t Make Women Happier
The most enthusiastic campaigns for expanded contraception access have the flavor that “our lives are not really about the next generation”; they are about our own adventures and preferences. This is not an outlook most people wish to be associated with. It’s almost certainly not the outlook adopted over time by the vast majority of adults who become parents. But promoting it has consequences for people’s willingness to have children. Thus, it is not an accident that most abortion patients are contraceptive users. It is not an accident that the St. Louis study described above—aimed at markedly increasing the use of longer-acting, more effective contraceptives—produced an abortion rate four times higher than the national average.
Putting adults’ interests above children’s interests is also not terribly good for women or for men. Books and studies keep reminding us that we are made for society, and that we are happiest when we have long-term stable love relationships in our lives. (See, for example, Loneliness: Human Nature and the Need for Social Connection and “Marital Status and Happiness: A 17-Nation Study.”)
An honest observer would have to wonder: could the shape of the new sex and marriage markets—which divorce sex from marriage and children, and result in more cohabitation, less marriage, and less stable marriage—be responsible for the data indicating a decline in women’s happiness over the last several decades? A decline in both absolute terms and relative to men?
Marriage and parenting are without doubt the “places” most likely to demand that we do what ultimately shapes and matures us into loving adults. Of course it is always possible to try building strong, generous, mutually giving communities among groups of friends or neighbors. In rare cases, this may happen. But it is no sure substitute for the interwoven goods of love, sex, children, and permanent commitment that marriage, open to children, provides on its average day. These are simply the facts—the facts confirmed by data in fields as various as sociology, demography, psychology, and economics.
Religion, Not Contraception, Advances Women’s Freedom
In challenging the widespread view that religion (Catholicism in particular) is bad for women, there is far more to say than one might first imagine. Quite a few of my arguments for maintaining religious institutional witness seem bold, but I contend that they still ring true to a large cohort of women—women of any faith or no faith. Women (and men), if they rightly understand their own nature, and the nature of happiness and freedom, still want to commit to relationships such as marriage, and want to parent. (This finding has been remarkably stable over time, according to polls of young women and men across America.) Sexual restraint is an important factor in achieving both of these goals. Further, women in particular prefer not to have sex outside the context of a committed relationship. Pumping hormones into female bodies for decades is scary. Birth control programs that “work” involve ratcheting up the use of these relatively scarier drugs or devices, and will almost inevitably target citizens with fewer social advantages. Men have refused to research or swallow male birth control for a reason.
We shouldn’t forget how ironic it is that the Planned Parenthood-federal government alliance has tried specifically to silence religious witness in their quest for women’s freedom. For women’s freedom, defined in the terms of the HHS mandate (achieving fewer unintended pregnancies and abortions) or in other terms (reducing poverty, increasing educational and employment opportunities, increasing access to marriage, and reducing divorce) is actually, empirically, better achieved when women and men practice the virtues and disciplines expressed in the Christian churches’ conscientious objection to the mandate. The Judeo-Christian scriptures provide the firmest possible foundation for a belief in the absolute equality of women and men: co-equal creation in the image of a divine God. Younger Catholic women, and many women of other Christian denominations, too, are far more attracted to Catholic teachings on contraception than outside commentators realize.
There is also evidence that women, on average, practice their faiths more than men do, and that, across nations, countries that give religious freedom more protection tend also to better respect women’s equality. (See, for example, Brian J. Grim’s article “God’s Economy: Religious Freedom & Socio-Economic Well-Being.”)
So why call it “women’s freedom” when religion—a source of support and conviction, not to mention healthy relationships for women—is shackled? At the very least, the religious voice, the entire religious project where sex and marriage and parenting are concerned, ought to be allowed to continue to shine its light. Religion’s thick and beautiful rationales for keeping in mind the links between sex and new life can help restore balance to our national discourse about sex and marriage and parenting. Not only women, but especially vulnerable women, and also society itself, would be better off if religious witness were allowed to live.
Helen Alvaré is associate professor at George Mason University School of Law and a senior fellow of the Witherspoon Institute.