If the goal is to decrease abortions then we shouldn't be fighting contraception

If the goal is to decrease abortions then we shouldn't be fighting contraception
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As an OBGYN-in-training, I have only practiced medicine in the era of the Affordable Care Act (ACA). On a daily basis, I place IUDs in 20-year-olds, prescribe birth control pills to women nearing menopause to control their bleeding, or administer Depo-Provera to women with persistent ovarian cysts.

Despite occasional doubts that women have about the effects of hormones on one’s body, I am nearly always able to rationalize, through science, why these medications are both safe and necessary.

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The list of reasons I provide contraceptives is nearly as long as the number of patients I see daily. Because of the ACA’s “contraceptive mandate” I have essentially never had to worry whether the necessary medical care I was providing my patients would be covered by their insurance. In the same way that a primary care doctor prescribes insulin, I have been able to simply do my job while knowing my patients would be able to access the care they needed affordably.

 

The current move by the White House to slowly dismantle the ACA could have devastating consequences for preventive women’s health. No matter their political leaning, over 99 percent of sexually active women of reproductive age have used at least one contraceptive method at some point in their lives. The statistics are the same even for women who identify as Catholic or Protestant. Policy that diminishes access to contraception falls squarely at odds with the reality of women’s lives.

It is now well-established that improving access to contraception, especially highly effective contraception, decreases both unintended pregnancy rates and abortion rates.

The Contraceptive CHOICE study out of St. Louis found that when women are provided access to contraception free of cost and with adequate counseling, they overwhelmingly choose highly effective long-acting contraceptive (LARC) methods like the hormonal IUD, non-hormonal IUD, and subdermal implant compared with other methods. Impressively, they also observed that the overall rate of abortions in their cohort was less than 50 percent of the national rate. The teen population saw a 25 percent decline in abortion rates.

This observed decline in abortions is essentially in line with national statistics that show that from 2008 (prior to the ACA) to 2014, the proportion of abortion patients who were teens dropped 32 percent. In fact, in 2014 we saw the lowest rates of abortion since 1973, the year abortion was legalized in the US. Anti-abortion advocates argue that the decline has been secondary to increased abortion restrictions.

While it is true that there were hundreds of new restrictions imposed throughout the country during that time period, it is important to note that there was no change in the percentage of unintended pregnancies that resulted in abortion. In fact, the overall rate of unintended pregnancies declined by nearly 20 percent, as have overall rates of teen pregnancies.

So, what could have led to the historic low rate of abortions and the declining number of unintended pregnancies? There is no evidence to suggest that abstinence rates are changing. And while increased abortion restrictions have translated to decreasing rates of abortion in some states, it has not been consistently correlated in all states. What seems to be correlated across all age groups and regions is that the overall use of highly effective LARC has doubled from 6 percent to 12 percent. And we know that women who consistently use contraception account for only a small fraction (approximately 5 percent) of the women who report an unintended pregnancy.

It seems counterintuitive, then, that the same conservative groups that oppose abortion, also oppose contraception. In fact, in 2014, publicly funded family planning services helped prevent 2 million unintended pregnancies, which would have likely resulted in 700,000 abortions.

From a financial perspective, too, it is estimated that every dollar spent on helping women avoid pregnancies through contraception saved more than $7 in Medicaid expenditures that would go towards the cost of pregnancies and early childhood care. With these statistics, fiscal and pro-life conservatives, along with pro-choice liberals should all be rallying around the necessity of contraceptive coverage.  

Finally, given that a staggering 75 percent of women getting an abortion are poor or low income, actions that dismantle access to contraception will only create worsening health disparities and further disenfranchise women. Decreasing rates of unintended pregnancies is a shared and bipartisan goal. If we are truly serious about continuing the current trend of decreasing abortion rates in this country, we must be serious about provision of contraception as a basic preventative health care measure.

Namrata Mastey is an obstetrician/gynecologist at Brigham and Women’s Hospital and at Massachusetts General Hospital. The opinions expressed in this article are solely my own and do not reflect the views and opinions of Brigham and Women’s Hospital or Massachusetts General Hospital.