Does Giving Women a Year's Supply of The Pill Reduce Abortions?

A reader asked me to take a look at this study (abstract here) and see if it reaches a valid set of conclusions. The study was conducted in California among ~80,000 women who receive birth control pills paid for by the state as part of a program for low income women. Previously, women in the program have received a 1 or 3 months supply of birth control at a time, and then have to go in to the clinic in order to receive a refill. In the study, a portion of these women were given a full year's supply instead of one or three months, and state medical records were then used to see if this resulted in a change in the rate of unplanned pregnancy and abortion among the women who received a full year supply of birth control.

Researchers observed a 30 percent reduction in the odds of pregnancy and a 46 percent decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one – or three-month supplies.

The researchers speculate that a larger supply of oral contraceptive pills may allow more consistent use, since women need to make fewer visits to a clinic or pharmacy for their next supply.

"Women need to have contraceptives on hand so that their use is as automatic as using safety devices in cars, " said Diana Greene Foster, PhD, lead author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. "Providing one cycle of oral contraceptives at a time is similar to asking people to visit a clinic or pharmacy to renew their seatbelts each month."
...
Oral contraceptive pills are the most commonly used method of reversible contraception in the United States, the team states. While highly effective when used correctly (three pregnancies per 1,000 women in the first year of use), approximately half of women regularly miss one or more pills per cycle, a practice associated with a much higher pregnancy rate (80 pregnancies per 1,000 women in the first year of use), according to the team. [source]

The details of that decrease are as follows:

Women who received a 1-year supply were less likely to have a pregnancy (1.2% compared with 3.3% of women getting three cycles of pills and 2.9% of women getting one cycle of pills). Dispensing a 1-year supply is associated with a 30% reduction in the odds of conceiving an unplanned pregnancy compared with dispensing just one or three packs (confidence interval [CI] 0.57–0.87) and a 46% reduction in the odds of an abortion (95% CI 0.32–0.93), controlling for age, race or ethnicity, and previous pill use.[source]

So, what should a Catholic pro-lifer make of this?

Well, there may or may not have been methodological issues with this study. I read several science news stories about it, but I can't get access to the full text, so I don't know for sure how they dealt with sample bias, etc. However, I have to admit, that from what I've read it makes sense to me that the study results are valid as far as they go. But they also give us a window into the contraceptive mentality which is at play in feeding into abortion in this culture.

The women in the study are receiving birth control so that they can have sex at will while not getting pregnant. Nevertheless, some percentage of them are getting pregnant (around 1% of those getting the year supply, around 3% of the rest) during any given year. The good news is that they are like the rest of California women in that in 80% of these cases, they are carrying these unexpected children to term. The bad news is that 20% of the time they choose an abortion instead.

But part of what's feeding this problem is not the quantity of birth control that's being given out at a time, but the sense in which people's actions are (for whatever reason) not fitting with their desires. One article on the study includes this telling quote:

“It's a cost-savings thing, but it's also a quality-of-care issue — and it's the right thing to do,” she says. “People don't stop having sex when their pills run out.”

So people are taking birth control pills in order to have sex while not getting pregnant, but if they run out of pills -- they don't stop having sex.

The study's proposed solution to this is "let's just make sure they always have lots of birth control on hand" and I suppose in the context of them taking birth control, I really don't have any strong feelings about whether they get a month's supply or a years supply at a time. But it seems to me that we're looking at the root of a much deeper issue when we hear someone conducting a study on this topic saying that people do not appear to stop having sex when they run out of birth control -- even if they know it's only the birth control that's keeping them from getting pregnant as a result of having sex.

All other things staying constant, if it's true (as the study appears to indicate) that some women on birth control are late in refilling their prescriptions and thus gap out for a few days, yet continue having sex as normal (or abstain during the couple days they don't have pills, but then go back to having sex as normal as soon as they start taking the pills again without realizing that the unexpected fertility might well come a week or two after the gap, not during it) then it's pretty logical that reducing the frequency with which women have the potential to experience that gap would reduce the number of unplanned pregnancies. And if we assume that the same percentage of unplanned pregnancies will always result in abortions, then necessarily reducing the number of unplanned pregnancies will reduce the number of abortions.

I think this does suggest that for those people who are in the business of dispensing birth control pills, it would be an obvious thing for them to dispense large prescriptions, and perhaps to look into some sort of automatic reminder or shipment in order to help women avoid these gaps. Women who are coming to them for birth control obviously don't want to get pregnant, and they will do a better job of fulfilling those women's wishes if they help them avoid those gaps.

I don't think we pro-lifers who have moral objections to birth control need to go out and become cheerleaders for the idea of handing out larger prescriptions of The Pill -- though in light of this study I think we shouldn't actively try to keep birth control dispensers from dispensing larger amounts at a time. The moral content of taking birth control is the same regardless of how much you pick up at a time and the larger prescription amounts seem to have, on the whole, positive results from everyone's point of view.

I think the role for us as pro-lifers is two fold:

First, either way, we believe that everyone will be better off if abortion is simply not on the table. (For those birth control enthusiasts, this might even result in some more conscientious pill taking.) This clearly makes no different in our fight to remove abortion from the set of legal medical options.

Second, our society is clearly both confused and dysfunctional when it comes to sex, if we have a lot of people who are taking birth control in order to avoid getting pregnant yet don't stop having sex if they run out of birth control. The birth control advocates who are the sources of this study are going to be no help in solving these problems, because their whole worldview is built around the idea that sex should be totally separate from reproduction. It is up to us to build the cultural understanding that sex results in new human life, and that even "protected" sex does some percentage of the time. If you are having sex, you had better be sure that it is with a person whom you are willing to have a child with -- even if you're taking measure to reduce the likelihood of that happening in any given year down to around 1%. One person out of a hundred is still a pretty significant group of people, and a number of years your chances of ending up with a child at some point only go up.