Contraception and abortion

Unborn baby

I saw this story a while back but only got around to posting about it now – a study has shown how abortion rates can apparently be more than halved.

Note: This post was edited twice on 27 December to include discussion of IUDs based on some comments, and a revised conclusion.

Medical study

The Washington University School of Medicine recently reported on a 4-year study involving almost ten thousand women considered at risk of unintended pregnancy. The women were given expert advice on the use of different contraceptive methods, then offered their chosen method free.

The study found that subsequently the women had abortions far less often than the national average, a reduction of 62-78%. The rate of abortions in teens was reduced even more.

Lessons learnt

The study report indicates that the commonly used contraceptive pill is not nearly as reliable as long-acting methods like intrauterine devices (IUDs) or implants, because the pill isn’t always taken according to the instructions. However relatively few women use the more reliable methods, often because of cost, and many women use no contraception at all. Teens, the less educated and poorer women are the most likely to fall pregnant unintentionally.

Since 90% of abortions are due to unintended pregnancies, improving the use of contraceptives by making advice and more effective methods freely available would lead to a significant drop in abortions.

A christian response

Since most christians consider abortion to be taking life, you might expect christians to support such a program. But the idea presents problems to some christians:

  1. Some christians oppose the use of contraceptives generally.
  2. Some christians oppose the provision of “socialised healthcare”.
  3. Other christians believe providing contraceptives to teens only encourages sexual irresponsibility.
  4. Some women are unhappy with the use of IUDs because they can cause an early abortion.

Are the objections valid?

Each of us will have our own view, but I only find one of the objections of any concern at all:

  1. I see no good reason for christians to oppose the use of contraception, and I imagine most christian couples in western countries use contraception. And I cannot see how the government should impose christian ethics on its citizens when both health and significant cost savings are at stake.
  2. I have read the arguments against the government provision of healthcare, and I believe they are less based on christian thinking than on an unwillingness to care for the poor. Democracies are government “by the people and for the people”, so if the people choose to have a health “safety net” for the disadvantaged, I see no good reason why this shouldn’t be provided, just as governments legitimately provide police protection, education, transport infrastructure and environmental protection.
  3. While governments have a role in health, they don’t have a legitimate role in legislating christian ethics for all citizens. The sexual morality of teens is a matter for them and their parents.
  4. According to the medical information, IUDs work primarily by preventing sperm reaching the egg to fertilise it, but if fertilisation does occur, they prevent the fertilised egg from attaching to the lining of the uterus. Thus they can cause what is effectively a very early-term abortion, but this is said to be not the normal case. In any case, the program doesn’t mandate the use of IUDs, and other methods can be used. On the less frequent occasions when an egg is fertilised, it is quite possible that a later abortion would have occurred anyway. Thus the use of IUDs can overall be considered to be an improvement, albeit with some negatives for some people.

Conclusion

My views on this have developed through the writing and re-writing of this post. Overall I conclude that extending this program is a no-brainer – we save money, promote health and reduce the number of abortions. But I can understand that some people will choose not to take up the opportunity, and some will find the use of IUDs problematic, but the free availability of medical advice and the pill or implants would still be a significant step forward.

Other news reports

Read other news reports on this by NBS News and Time.

Photo: Flickr Creative Commons

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20 thoughts on “Contraception and abortion

  1. EmilyClare says:

    I agree with you on all 3 counts – I think perhaps there’s a dangerous legalism at play here too (in Christian lobby/groups who oppose the promotion of good sexual health/awareness and contraception) – that is, follow Christian ethical standards or be damned! Why spend all that time harking on about how bad abortions are and not bother to address the reasons they are happening in the first place.

    God gives us freedom to be stewards of our bodies – and just on a side note I find it interesting on the biological side of things that God created women’s bodies and reproductive abilities in a complex way; that fertility only exists on a certain few days each month (that can be understood and tracked if educated to look for signs) and also that ovulation is suppressed when a woman’s body is severely malnourished (anorexic) or exclusively breastfeeding.

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  2. Tim says:

    On point number two in particular, I too have never understood why people in a democracy decry government funded health care. We fund education, don’t we? Roads too. Health care seems at least as important as those two to me.

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  3. ignorantianescia says:

    “But some christians would oppose the use of IUDs because they see their use as abortion rather than contraception.”

    Don’t IUDs mainly prevent fertilisation and only cause abortion in cases when fertilisation has occurred despite the IUD? I can understand their objection to it, but if they’d call it “abortion rather than contraception” then that is misleading. Unless they can demonstrate that abortion by IUDs occurs more often than contraception by IUDs.

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  4. EmilyClare says:

    From what I have read Ignorantianescia is right on IDU’s mainly preventing fertilisation and in rare cases abortion or failure for a fertilised egg to implant the uterus occurs – but so can the pill cause the same thing when not used correctly – if ovulation occurs, an egg may be fertilised but then is flushed out with the simulated hormonal “period”.

    Actually I am most in favour, personally, of natural family planning methods such as basal temperature charting and billings method because they can be learnt and followed by any woman in the world (without cost, so especially helpful in poor communities) and prompts women to really understand how their bodies work – naturally space children if they wish – and when used correctly the Billings method is claimed to be 98& effective almost as high as the pill! but without any side effects or increased risk of cancer and other unhelpful things. Obviously yes there are risks, but so it seems are their risk in all contraceptive methods – risk of unwanted pregnancies and risks of health complications!

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  5. unklee says:

    Hi Emily & IN,

    I am guilty of neglecting my research, I’m sorry. When I first wrote the post, I was only interested in the challenge for christians who oppose abortion, but also oppose freely available contraception. Then I remembered the objections to IUDs, so I hastily added some more, based on my memories of how things were 45 years ago when we went through thinking about these issues, and didn’t think to check the current situation.

    But IUDs are made of different materials now, and you are both right, the medical information says that contraception is the primary action, and preventing fertilised eggs from attaching to the wall of the uterus is said to be a secondary action. So they do sometimes cause abortions, but not nearly as often as they used to do.

    Thanks for the correction. I have altered the post yet again to reflect this information.

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  6. thoughtsfromanamericanwoman says:

    It is a complex issue. as a Christian woman I still believe abstinence is still the best form of birth control, but I am in a low minority on that thinking! But with the facts before us, educating young woman on their bodies is the best way especially with teens regardless how I feel morally. You are right their health and well being and the life of a child is important. I hate the argument no matter how true it is, that they will do it regardless, but I strongly believe it is best to prepare them as best as we can to stop abortion.. As an American, I do not even like the government in control of the emergency personnel, (our first responders, are great and we appreciate them) it is the government’s interference and not allowing them to do their job properly, I see this also with our military and now with doctors not able to do their job properly with all the new medical mandates. So why would I trust the government with my health? They need to balance the budget cut needless spending and provide a health care system that benefits everyone without corruption. Also as a Christian and a human being I feel it is our responsibility to care for those less fortunate and I feel many {both Christians and non Christians} fall way to short on that issue. That is my argument against government health care. And I will now step off my soap box!! 😉 But good post and I hope will generate lots of discussions and maybe just maybe someone will make a difference and we will see a decline in the abortion rates, better health for the poor and a fix to the medical issue. I do my small part, and if everyone does their small part imagine what a changed world we would live in. Blessings – Patty

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  7. unklee says:

    Thanks Patty, I think you have expressed the dilemmas very well.

    On government services and programs, I think we need to recognise that (1) people aren’t doing their part sufficiently, so if the Government doesn’t care for the disadvantaged, they won’t be properly cared for, and (2) there are somethings that governments can do better than individuals (as well as some things an individual can do better). But running a police force, controlling traffic, building hospitals, saving the environment, etc, often require concerted action on large scale that just won’t happen unless government does it. But of course, we still need individuals playing their part, cooperating with the government, caring for people, living in the right way, etc.

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  8. ignorantianescia says:

    About healthcare, I think governments can be relatively efficient at providing it compared to private companies. Based on OECD figures, the US spend a disproportionate amount on healthcare, 17% of their GPD went to healthcare in 2010, while among other developed countries (that already had universal healthcare, some for over a century, most of which have a smaller GDP per capita and many West-European countries have a more aged population as well) the highest share was 12% of the GDP (the Netherlands). The Netherlands have a relatively market-driven system as well, and it is slightly more expensive than other European healthcare systems and Canada’s public system and quite more expensive than the British NHS. The details of the system probably play a large role, but at first sight it seems that a government can provide more efficient care than markets.

    http://www.oecd.org/els/healthpoliciesanddata/oecdhealthdata2012-frequentlyrequesteddata.htm

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  9. unklee says:

    IN, as usual, your input has been very helpful, thanks. Those figures are very interesting. To compare, Australia’s healthcare costs in 2009/10 were 9.4% of GDP.

    But, do the costs reflect the efficiency of the system, or the level of medical intervention? I would think both would be important. If so, then the high US costs may not indicate only the inefficiency of a private system, but a higher level of intervention and care compared to other countries, and perhaps the high cost of health-related litigation?

    Do you have any thoughts?

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  10. ignorantianescia says:

    Yes, I thought about those things as well, but I didn’t expect to be much data on the subject. It turns out I was wrong and there is a large body of research on comparing US health care with other OECD countries. In this long comment I’ll be going off figures given in this paper: http://content.healthaffairs.org/content/24/4/903.full

    Medical litigation in the US can’t explain the difference in cost. Spending on defense against malpractice litigation totalled an estimated $6.5 billion in 2001, that’s 0.46% of total health spending in 2001, while payments were less than 0.5% of total health spending. Such claims occur more often in the US than in other countries with a British legal system (50% more often than in Australia and Britain and 350% more often than Canada, all in proportion to the population), but as in Canda two-thirds of claims in not result in a pay out (in the UK 62% of claims result in payment) and payments are on average less (14% less than Canada, 36% less than the UK), except for comparisons to Australia (which paid less than the US). Neither can waiting lists in other countries account for the difference, because on average countries without waiting lists still spent a little more than half the US’ spending (PPP) on health care.

    According to this quote from the paper, the explanation can be found in higher prices paid for care in the US and higher American costs of living and incomes:

    Once again, the latest data from the Organization for Economic Cooperation and Development (OECD) show that the United States spends much more on health care than any other country. In 2002 the United States spent $5,267 per capita—$1,821 more than Switzerland, which had the second-highest per capita spending, and $3,074 more than the median OECD country.* The magnitude of this spending differential leads to the logical question: Why is U.S. health spending so much greater than that of other countries?

    In previous papers we have argued that the primary reason is that “it’s the prices, stupid.” We have shown that the United States pays much higher prices than other countries for pharmaceuticals, hospital stays, and physician visits.** This price differential continued in 2002. For example, the average cost of a hospital day in the United States in 2002 was $2,434, compared with $870 in Canada and even less in other OECD countries.*** The United States also pays much higher prices for physician services and pharmaceuticals.****

    Part of the difference can be explained by higher U.S. incomes and cost of living. However, even after adjusting for each country’s per capita gross domestic product (GDP), U.S. health spending is still $2,037 higher than the predicted value.***** In past papers we have also examined other possible causes, including population aging and administrative complexity. Neither of these factors explains a sizable portion of the higher levels of U.S. health spending.

    * Purchasing power parities (PPPs) were used to adjust for cost-of-living differences between countries.

    ** G.F. Anderson et al., “It’s the Prices, Stupid: Why the United States Is So Different from Other Countries,” Health Affairs 23, no. 3 (2003): 89–105.

    *** G.F. Anderson, P.S. Hussey, and J. Cylus, Multinational Comparisons of Health Systems Data, 2005, Commonwealth Fund Chartpack (New York: Commonwealth Fund, forthcoming).

    **** G.F. Anderson et al., “Doughnut Holes and Price Controls,” Health Affairs 21 July 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.396 (8 April 2005).

    ***** We calculated predicted U.S. health spending based on a simple regression of health spending per capita on GDP per capita for OECD countries (excluding the United States) in 2002.

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  11. unklee says:

    Thanks for that comprehensive review. I think the last question to be answered is why are the hospital, pharmaceuticals and physician costs so high in the US?

    I wondered whether it was because there was a higher level of healthcare. Wikipedia shows that the US is only 38th in the world in life expectancy, so either their healthcare is not better than other comparable countries, or they are living a less healthy lifestyle – both could be true. So we need to look further for a reason.

    Another possibility is that doctors and medical professionals are paid more in the US, making costs higher. Wikipedia shows that there is a greater gap between the rich and the poor in the US than in all other western democracies. So assuming the medical professionals and the pharmaceutical shareholders are towards the upper end of the wealth scale, that may partly explain things.

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  12. ignorantianescia says:

    For this answer, I base myself on this report: http://digitalcommons.ilr.cornell.edu/key_workplace/311/
    It disagrees on several points with the other paper, but overall it seems quite useful as it contains a lot of data and perceptive interpretations.

    Medical professionals are paid substantially more in the US than the OECD average, at least if they’re self-employed, but professionals in Australia and self-employed professionals in the Netherlands are paid even more. It does seem to be a factor making US healthcare more expensive, though. However, in the US professionals often end up with a higher debt, so they need relatively high wages to pay these debts.

    I don’t think the level of healthcare is higher, quality of service varies per, but it does not seem at all to be clearly superior (which is what you might expect for its higher costs). They don’t have waiting lists, but other countries without waiting lists still spend much less on healthcare than the US. And there are several disadvantages that the US system has in turn.

    Another issue seems to be that the US pay relatively much for medical drugs (the US spend a quite average proportion of their healthcare budget on pharmaceuticals, but as their healthcare expenses are disproportionally large they still spend relatively much on drugs). Now while the US generally pay less for generic drugs than other OECD countries (not true for Canada, as one example), they do overall pay more for patented drugs. This led some economists to state that on the short term the US pay more for medical drugs than other countries, but on the long term they pay less. That advantage is decreased, however, by the US’ tendency to use more patented drugs compared to other countries.

    Finally, administrative costs were relatively high for private healthcare insurance providers compared to public healthcare insurance providers in a case that compared American and Canadian private health insurers to Canadian public health insurance. I don’t know if that holds more generally, though. Public health insurance plans of course have disadvantages of their own.

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  13. ignorantianescia says:

    Note that the above post are items that I thought were important and not all are given prominence in the article. I recommend you to read the paper yourself or at to read the summary.

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  14. ignorantianescia says:

    Hey UnkleE, I just stumbled upon a news article that compared American healthcare with other Western healthcare systems. The quality of care is also discussed, but it’s a pointy subject and they don’t.

    http://www.vox.com/2014/6/24/5837832/is-america-better-than-europe-at-treating-cancer

    I think that the low access to care by poorer people in the United States makes it difficult to assess which one is better. But I would expect that lower diagnosis rates among the poorer segments of society would arbitrarily inflate the US’ good performance in diagnosis, but not the mortality rate.

    And they rightfully point to the higher rate of accident-and-gun-related deaths decreasing life expectancy. It would also decrease the disease-linked mortality rate, though this is not mentioned in the article.

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  15. unkleE says:

    Interesting article, and perhaps evidence of gross (though well-meaning) over-servicing in many parts of the medical system, perhaps due to fear of litigation. Nice to see Australia going pretty well. A bit of a surprise to see UK the best on almost all measures. Thanks.

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  16. ignorantianescia says:

    I’m not sure whether the problem is (fear of) litigation. American litigation is very anecdotal, but it isn’t an outlier compared to other countries. I think it’s the market mechanics (that influences many factors) and the focus on frivolous matters that it brings, like the appearance of hospitals.

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  17. ignorantianescia says:

    I’m going from part of a summary that comes from an earlier comment on this post:

    Medical litigation in the US can’t explain the difference in cost. Spending on defense against malpractice litigation totalled an estimated $6.5 billion in 2001, that’s 0.46% of total health spending in 2001, while payments were less than 0.5% of total health spending. Such claims occur more often in the US than in other countries with a British legal system (50% more often than in Australia and Britain and 350% more often than Canada, all in proportion to the population), but as in Canda two-thirds of claims in not result in a pay out (in the UK 62% of claims result in payment) and payments are on average less (14% less than Canada, 36% less than the UK), except for comparisons to Australia (which paid less than the US).

    It referred to this paper: http://content.healthaffairs.org/content/24/4/903.full

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  18. unkleE says:

    Ah, thanks, I see. I was referring to something slightly different – not the direct cost of litigation in the health sector, but the indirect cost in over-servicing caused by fear of litigation if something is missed. You may not need a scan, but we’ll get one anyway just so no-one can accuse me of negligence. I think think that must be a factor.

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