This past April, Andrew Koppelman became the latest in a long line of pro-choice commentators to scold the pro-life movement for not being more contraceptive-friendly.
He even took things a step further, saying that the policy positions of the religious right—namely the unwillingness of pro-lifers to support contraception funding—are actually promoting abortion. In his essay, Koppleman approvingly cites Naomi Cahn and June Carbone’s book Red Families vs. Blue Families, which argues for government policies that would make contraceptives more widely available.
In their book, Cahn and Carbone draw a distinction between a red family model, which emphasizes sexual restraint and early marriage, and a blue family model, which is more sexually permissive and contraceptive-friendly. Cahn and Carbone argue that the contraceptive-friendly blue family model offers a number of benefits. These include higher levels of education, low divorce rates, lower teen birth rates, and high incomes. These all may be worthwhile goals. However, one benefit that the blue family model clearly does not offer is lower abortion rates.
Cahn and Carbone are clear about this in their book. They report that the states with the lowest abortion rates tend to be red states in the Midwest, while states with the highest rates are blue states in the mid-Atlantic.[i] Their findings on abortion rates among minors are even starker. They observe that the “blue states in the Northeast and Mid-Atlantic regions have . . . higher use of abortion,” and go on to say that this set of states “discourages teen childbearing, with abortion as an established fallback.”[ii] Furthermore, according to the data presented in Blue Families vs. Red Families, pregnant teens in blue states are much more likely to obtain abortions than their counterparts in red states.[iii]
In my earlier response to Koppelman, I analyzed abortion rates from all fifty states, using data from both the Centers for Disease Control and the Alan Guttmacher Institute. This analysis provided additional evidence that red states have lower abortion rates than blue states. Since pro-lifers are primarily interested in lowering abortion rates, it is easy to see why the blue family model touted by Cahn and Carbone offers little appeal. Koppelman is simply wrong.
Furthermore, even though Koppelman, Cahn, and Carbone avidly promote greater support for contraceptives as a compromise, there is very little evidence to suggest that more government spending on contraceptives will do much to reduce abortion rates. As I stated in my response to Koppelman, nine years ago the Alan Guttmacher Institute surveyed 10,000 women who had abortions. Among those not using contraception at the time they conceived, a very small percentage cited cost or lack of availability as their reason for not using contraception. Only 12 percent said that they lacked access to contraceptives due to financial or other reasons.[iv] Given all the existing programs, it is by no means clear that more federal spending could increase the use of contraceptives among this subset of women.
In April, Koppelman, Cahn, and Carbone responded to my essay. Koppelman’s comments in particular left much to be desired. Instead of engaging my arguments or presenting actual data indicating that more government funding for contraceptives lowers abortion rates, Koppelman disregards my response. He states that this argument is “silly” and laments that it is “astoundingly stupid and tragic that this is what we are arguing about.”
To their credit, Carbone and Cahn actually make an argument, and note that improvements in contraceptives led to the 1990s abortion decline. There is actually a grain of truth to this. Abortion rates started to fall in the early 1990s for a host of reasons including improvements in contraceptives, a decline in sexual activity among minors[v], the passage of new pro-life legislation[vi], and reductions in the number of abortion providers.[vii] However, Carbone and Cahn overstate their case.
First, they claim that publicly funded family-planning services annually prevented two million unwanted pregnancies that would have resulted in over 800,000 abortions. This is misleading. Their figure comes from a Guttmacher Institute policy analysis which does not analyze any actual data on either funding for family-planning services or abortion rates.[viii] Instead, the Guttmacher analysis assumes that funding for family-planning clinics will automatically result in more clients, greater contraceptive use among clients, fewer unintended pregnancies, and fewer abortions. It fails to take into account that some people who obtain contraception from family-planning clinics would still be able to obtain contraception of a similar quality on their own. It also fails to acknowledge that easier access to contraception may increase the population of sexually active people and that people with access to more reliable forms of contraception may engage in sexual activity more often.
Second, Carbone and Cahn’s claim that more consistent and effective contraception accounts for eighty-five percent of the drop in teen pregnancies is also questionable. Carbone and Cahn likely obtain this figure from a study that was authored by Santelli et al. in 2007.[ix] This study incorrectly assumes that minors use contraception as reliably as adults. There is plenty of reason to believe that minors—regardless of what kind of sex education they have—will be less consistent in their use of contraceptives. Since minor contraceptive use is less consistent—and less effective—there is a good chance that reductions in teen sexual activity played a larger role in the decline in teen pregnancies than Santelli and his co-authors conclude.
Finally, Carbone and Cahn attempt to support their argument about contraception by arguing that during the 1990s the rate of unintended pregnancies fell among college-educated women but increased among low-income women. However, arguing that these disparities are caused by differences in access to contraception seems a bit simplistic. For instance, the booming economy of the 1990s increased the economic costs of an unintended pregnancy more significantly for educated women, thus giving them a greater incentive to use contraceptives more often.
Furthermore, Carbone and Cahn fail to take into account that certain cultural and behavioral factors may be to blame for unmarried pregnancies among low-income women. In Unmarried Couples with Children, sociologists Kathryn Edin of Harvard and Paula England of Stanford conducted an intense study of 76 low-income couples from Milwaukee, Chicago, and New York who had just given birth. Some of these couples were married, but most were not. The fertility patterns of all of the women in the survey were carefully studied for 4 years.[x]
Edin and England found that only a very small percentage of these women wanted contraception, but were unable to afford it.[xi] Specifically, all of the women surveyed were asked whether they had been in a situation where they wanted birth control, but could not afford or find it. Tellingly, all said no.[xii] In fact, according to Eden and England “some laughed when we asked this question, pointing out how hard clinics and school in their communities push contraceptives.”[xiii]
Specifically, Edin and England found that pregnancies of unmarried women were often intended, or at least not specifically avoided. In particular, as relationships became more serious, contraceptive use tended to lapse. The authors found that the need of one or both partners to indicate trust is the reason for this. As such, the lack of consistent contraceptive use, but not lack of contraceptive availability, played a role in the pregnancy. As Edin and England put it, these parents were “not thinking” about pregnancy prevention. However, their lack of thought did not denote a desire to have a child. Overall, the evidence presented by Edin and England strongly indicates that greater access to contraceptives will do little to prevent unwanted pregnancies among low-income women.
As such, even though improvements in contraceptives may have played some role in the 1990s abortion decline, it does not follow that the government should increase funding for contraception. In particular, Carbone and Cahn fail to understand the argument I made in my original response to Koppelman’s essay. Attributing the following claim to me, Carbone and Cahn state that “the most frequently asserted half-truth making its way across the internet is that most women who have abortions did use some form of birth control, therefore ‘there is relatively little the government can do to increase contraceptive use among sexually active women.’”
However, that was not my argument at all. Again, my argument is that a number of studies indicate that only a small percentage of sexually active women who forgo contraceptive use do so because of either cost or availability. Considering the federal government already funds contraceptives for low-income women through the Title X program it is not clear that more funding for contraceptives would improve contraceptive use, result in fewer unwanted pregnancies, or reduce abortion rates. In my own research on state abortion trends, I have collected data on Title X grants by state and have found no correlation between Title X spending and state abortion rates.
Overall, there is precious little evidence that greater government funding for contraceptives will reduce abortion rates. Quite honestly, the hypocrisy here is astounding. Koppelman, Cahn, Carbone, and other opponents of abstinence-only education can always be relied upon to cite chapter and verse a number of studies that purportedly show that abstinence education is ineffective at reducing teen sexual behavior. However, they are unwilling to subject their own ideas to the same level of empirical scrutiny. Specifically, Koppelman, Cahn, and Carbone have yet to cite one peer-reviewed study from the United States which shows greater government spending on contraception results in lower abortion rates.
In fact, throughout their entire book Red Families vs. Blue Families, Cahn and Carbone only manage to cite one study that purportedly finds a negative correlation between contraceptive availability and abortion rates. This particular study is a 2003 Guttmacher Institute study that analyzed data from foreign countries.[xiv] Like many Guttmacher studies, however, the conclusions fail to fit the data.
For instance, according to the study, a number of countries, including the United States, Cuba, Denmark, Netherlands, Singapore, and South Korea saw simultaneous increases in both contraceptive use and abortion rates. Now it is true that the abortion rates in some of these countries declined in the long term. However, in many of these countries—including, again, the United States—the abortion rate remained higher than it was before contraception was widely available. This particular Guttmacher study fails to consider how the availability of contraception affects sexual behavior and how a more permissive sexual culture will result in a higher incidence of abortion.[xv]
Overall, considering the weakness of their empirical argument, any “compromise” that would involve greater government funding for contraceptives seems like a bad deal for the pro-life movement. At the end of the day conservatives are not scared of contraception. Most of us realize that contraceptives are here to stay. Most of us also respect the rights of others to make the contraceptive choices they feel are appropriate. However, we are rightly concerned about proposals to have the government fund and distribute contraceptives.
Easier access to contraceptives might encourage even more sexual activity among unmarried people. This is especially the case if contraceptives are made available to populations which include a high percentage of sexually inactive people, such as young teens. After all, government programs send powerful messages about the types of behavior that are acceptable and appropriate.
Indeed, what we are rightly scared of is a more sexualized, more promiscuous culture. We know that a promiscuous culture is never going to support significant restrictions on abortion, regardless of the availability of contraceptives. No contraceptive is one-hundred percent effective and when contraceptives fail in a sexualized culture, there will be significant demand for legal abortion. The high rates of abortion in blue states are evidence of this.
Creating a more chaste culture will pose a substantial challenge for the pro-life movement.
Public policy is a rather clumsy tool for changing sexual activity in a positive way, and getting people to change their sexual behavior will doubtless be difficult. Pro-lifers need to realize this. At the same time, Koppelman, Carbone, and Cahn need to realize that a contraceptive culture and a chaste culture are mutually exclusive, and public policy can do much to change sexual activity in a negative way. As such, the pro-life movement is never going to embrace contraception. Simply put, most of us feel that any potential benefits from greater contraceptive use are dwarfed by the benefits that would accrue from a more chaste culture.
Pro-lifers may discover that advocating for sexual restraint is more difficult than advocating for the unborn. However, this is a battle that pro-lifers must continue to engage in if we are to succeed in our goal of providing legal protection to all unborn children.
[i] Cahn, Naomi and June Carbone. 2010 Red Families vs. Blue Families. Oxford University Press. Oxford. pp 27-28
[ii] Ibid., p.24
[iii] Ibid., pp. 22-23
[iv] Jones, Rachel, Jacqueline Darroch, and Stanley K. Henshaw. 2002. “Contraceptive Use Among U.S. Women Having Abortions 2000-2001.” Perspectives on Sexual and Reproductive Health 34(6): 294-303.
[v] Centers for Disease Control and Prevention. 2002. “Trends in Sexual Risk Behaviors Among High School Students – United States 1991-2001.” Morbidity and Mortality Weekly Report. September 27, 2002, Volume 51: 856-859.
[vi] New, Michael J. 2010. “The Effect of Pro-Life Legislation on the Incidence of Abortion Among Minors.” Catholic Social Science Review 12: 185-215.
[vii] New, Michael J. Forthcoming. “Analyzing the Effect of State Level Anti-Abortion Legislation in the Post Casey Era.” State Politics and Policy Quarterly.
[viii] Gold, Rachel Benson, Adam Sonfield, Cory Richards, and Jennifer Frost. 2009. Next Steps for America’s Family Planning Program. The Alan Guttmacher Institute. For a more detailed description of the Metholdogy see Jennifer Frost, Lawrence Finer, and Athena Tapales. 2008. “The Impact of Publicly Funded Family Planning Clinic Services on Unintended Pregnancies and Government Cost Savings. Journal of Health Care for the Poor and Underserved. 19(3):777-795.
[ix] Santelli, John, Laura D. Lindberg, Lawrence Finer, and Susheela Singh. 2007. “Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use.” American Journal of Public Health 97(1): 150-156.
[x] Edin, Kathryn and Paula England. 2009. Unmarried Couples with Children. Russell Sage Foundation. New York. pp 5-6
[xi] Ibid., p. 32
[xii] Ibid., p. 48
[xiv] Martson Cicely, and John Cleland. 2003. “Relationships Between Contraception and Abortion: A Review of the Evidence.” International Family Planning Perspectives. 6-13.