In Which I’m an Irrepressible Optimist About Obama, Birth Control, and Those Bishops
Over the last couple of weeks, many women’s health, feminist, and reproductive rights-oriented organizations have been running campaigns and articles urging people to contact the White House to preserve the no-cost coverage of birth control as part of the preventive services covered under the Affordable Care Act.
I understand why they’re worried.
The Roman Catholic Bishops met with the President, and one of them came away saying, “I left there feeling a bit more at peace about this issue than when I entered.” The big worry, and what people are supposedly hearing, is that Obama might back off on birth control coverage requirements, and that’s why the Bishops feel better now.
Obviously this would be a bad thing and would generally piss me off.
Now let’s take a few minutes for optimism:
The CDC released its 2008 abortion surveillance data. These reports are full of info on who has abortions at how many weeks of pregnancy and after how many previous live births, but I want to highlight this rather long Public Health Implications section of the Discussion. I’ve removed reference numbers, added some breaks for ease of reading, and bolded some key points (see the original):
According to the most recent national estimates, nearly one fifth of all pregnancies in the United States end in abortion. Multiple social, cultural, economic, and political factors are known to influence the incidence of abortion: the availability of abortion providers; the adoption of state regulations, such as mandatory waiting periods and parental involvement laws; increasing acceptance of nonmarital childbearing; shifts in the racial/ethnic composition of the U.S. population; and changes in the economy and the resulting impact on fertility preferences and access to health-care services, including contraception.
However, in spite of these multiple influences, efforts to reduce the incidence of abortion need to focus on preventing unintended pregnancy. Indeed, nearly all abortions are preceded by an unintended pregnancy, with most recent estimates suggesting that intended pregnancies account for <5% of all abortions, including those which presumably are performed for maternal medical indications and fetal abnormalities. Providing women with the knowledge and resources necessary to make decisions about their sexual behavior and use of contraception can help them avoid unintended pregnancies. However, efforts to reduce unintended pregnancy in the United States have been challenging. Findings from the National Survey of Family Growth (NSFG), the primary national source of data on unintended pregnancy in the United States, suggest that unintended pregnancy decreased during 1982–1995 in conjunction with an increase in contraceptive use among women at risk for unintended pregnancy. However, data from the 2002 and 2006–2008 NSFGs suggest that no additional improvements have occurred: contraceptive use among women at risk for unintended pregnancy has decreased; only small gains have been made in the use of the most effective forms of reversible contraception, such as intrauterine devices and hormonal implants; and no additional progress has been made toward reducing unintended pregnancy.
As part of the Patient Protection and Affordable Care Act, the U.S. Department Health and Human Services charged the Institute of Medicine with identifying which preventive services are important to women’s health and should be covered at no cost to patients. Following the Institute of Medicine’s recommendation, the full range of FDA-approved contraception methods, sterilization procedures, and patient education and counseling for women with reproductive capacity will be covered without cost sharing in new health plans beginning in August 2012. The removal of cost as one barrier to correct and consistent contraceptive use might contribute to a reduction in the number of unintended pregnancies and consequently the number of abortions that are performed in the United States.
What if this is the message the Bishops got, and they feel better not because the birth control coverage is going away, but because they were sold on an argument that the provision would reduce a stalled out abortion rate?
I have huge, huge problems with my argument here. Most of the folks currently advocating to keep no-cost contraception coverage are about a million times more politically connected than I am. They’re more likely to have inside information, and also more able to mobilize on delivering voters in response to either a birth control win or loss. I’ve read some stuff on the internet and thought about it, and decided not to be completely cynical in this one case. To be even more explicit: I’m in a position of knowing less than people I’m disagreeing with.
Also, the CDC report is attributed to a bunch of MPHs, people who in my experience tend to be very practical about public health in a way that gets read as “liberal.” They have their own opinions, and may have expressed them in this surveillance report with absolutely no input from the Administration. The 2007 abortion surveillance data was the subject to political scrutiny even before it was released, so there must be an awareness that this simple government report has become politicized and more widely known, but that doesn’t suggest there was any high-level coordination on it’s content.
And sure, the Bishops are against birth control. They’re against abortion, too, but also against birth control. A “let’s increase use of birth control” argument is a hard one to win with them, even though most women, including Catholics, do use birth control at some point. They’ve specifically campaigned against the birth control coverage provision.
I think it’s just *possible* that what made that Bishop come away feeling more at peace is a clear argument that increasing access to contraception has the effect of reducing abortions. I could see the case being made that, “Look, abortion is no longer declining. Contraception use is. These are women who would use birth control anyway, they don’t share your perspective, and this way we get them birth control instead of abortions.” And the Bishops were reasonable enough understand and agree to some mutually beneficial politically expedient course of action once the “we’re keeping birth control” announcement is made.
Okay, my supplies of optimism and willingness to make a possibly absurd argument have been exhausted for about the next two weeks. Later.