Conservatives and Contraceptives

By Rebecca Oas, Ph.D. | September 15, 2016

In recent years, there has been an increasing effort to convince the pro-life community to partner with family planning groups. This strategy has come to be closely associated with Melinda Gates, both because of the funding and influence she wields and because, in family planning circles, she is a definite outlier. By refusing to promote abortion, she has drawn the ire of many contraception advocates, and her continued refusal to back down on that issue does deserve credit. But should the pro-life community find common cause with the rest of her approach?

One faith-based group thinks we should: Hope Through Healing Hands (HTHH), which was founded by medical doctor and former U.S. senator Bill Frist, launched a partnership with the Gates Foundation in 2014 to promote maternal and child health through family planning.

Earlier this summer, HTHH published an article asking Should Contraceptives Play a Bigger Role in the Pro-Life Movement? To answer that question, there are three points that need to be considered: the moral and ethical issues that are implicated, the practical reasons why this is not already the case, and the flaws in the arguments for why it should be now.

One obvious reason why the pro-life movement has not wholeheartedly embraced contraception is the fact that much of the pro-life movement is not only Catholic, but motivated to be pro-life because of the teachings of the Church, which also condemns contraception. That’s not a trivial issue, and Eaton Dyer’s article refuses to meaningfully address it, apart from saying “even Pope Francis is shifting his stance on contraceptives in places affected by Zika,” as if that somehow reverses the entire position of the Church, not only for emergency situations, but for all other cases as well.

Eaton Dyer tosses out one other theory: “Usually, the line of thinking is that the promotion of contraceptives simultaneously promotes sexual activity outside the confines of marriage,” then tosses it aside by citing research that the majority of global abortions are obtained by married women (which doesn’t actually refute the straw-man argument, but no matter.)

The deeper philosophical and theological issues surrounding the meaning of the sexual act and its relation to the human person that undergird the Catholic position are not addressed at all, nor is the Biblical principle that children are a gift from God, not nuisances to be prohibited nor commodities to be demanded. This is frustrating, because one is left with the impression that Eaton Dyer thinks pro-lifers arrived at our anti-abortion stance by listening to public health arguments, and can be convinced to promote contraception through more of the same. Never mind the fact that the vast majority of family planning organizations also promote or perform abortions—for illustrative purposes, witness the hue and cry they raise every time the Mexico City Policy (which prohibits U.S. foreign aid funding from going to groups that advocate for abortion at all) goes into effect.

This leads into the second point: there is a long and important history of why the pro-life movement and the family planning movement have not joined forces, and that is the fact that the vast majority of family planning advocates also promote, or perform, abortions Notwithstanding Melinda Gates, who exactly do HTHH intend to partner with to promote contraceptives in developing countries? Who would be their allies? Gates has drawn criticism from pro-life organizations for teaming up with groups that actively promote abortion, even if she herself opts to stay silent on that issue.

Abortion and contraception have long been promoted by the same entities, for the same reasons, and using the same talking points. Here in the United States, we have a legal history that draws a clear, direct line from the legalization of contraception to the legalization of abortion. To pretend that these two things are not closely intertwined, both institutionally and ideologically, seems incredibly naïve.

But since HTHH is framing its position in terms of public health claims, let’s visit their “Just the Facts” page and examine some of the evidence they put forward:

“220 million women worldwide want access to HTSP [healthy timing and spacing of pregnancy] education and services but don’t have it.”

Not true. That’s the oft-cited “unmet need” figure I have written about many times before: see here and here. Bottom line: only about 5% of that 220 million women claim any lack of access, and nothing in that figure can be used as a measure of actual demand for any products or services.

“Less than 20% of women in Sub-Saharan Africa and barely a third of women in Asia use modern contraception.”

Unless they see that as a problem, why should we? Sub-Saharan Africa is known for both its high actual fertility and its high desired fertility. Again, nothing in that statistic implies that these women are seeking, unable to access, or planning to use contraceptives.

“Every year, complications from pregnancy and childbirth claim the lives of nearly 303,000 women and permanently disable many more, mostly in developing countries.

99% of these deaths are in developing countries, and 80% are preventable.

For every maternal death, at least 30 other women suffer serious illness or permanent debilitating injury.”

The fact that women are dying in childbirth in developing countries at much higher rates than in developed countries is an primarily a development issue, and an equity issue. We know how to make birth relatively safe, the hard part is ensuring that the things we rely on in countries like the U.S. are also present elsewhere. These are not quick fixes, nor Band-Aid solutions: electricity, sanitation, hospitals, skilled health workers, emergency obstetric care, good transportation infrastructure, and the best modern equipment and medicines.  Fortunately, groups like HTHH are busily working on these issues alongside other development actors.

“Girls younger than 15 are five times more likely to die from complications during pregnancy or childbirth than women in their 20’s.

Pregnancy is among the leading causes of death for girls aged 15 to 19.”

Lest we forget, this is a list of facts intended to convince pro-lifers to promote contraceptives. If girls under 15 are at risk of pregnancy, there are far bigger issues to tackle than putting them on the pill or inserting IUDs. And it’s worth bearing in mind that in developing countries, the vast majority of births among girls aged 15-19 occur within marriage. Furthermore, mortality rates are low among adolescents compared to other age groups, for perspective, the World Health Organization announced in 2014 that the leading cause of death for girls aged 15-19 was suicide.

“Women with five or more children are 1.5 to three times more likely to die from pregnancy complications.”

That one just makes me tired: 1.5 to three times more likely to die than whom? You can’t make a comparison without two things to compare. It appears that the remainder of that talking point should involve women with two or three children. However, the origins of that statistic are in the early-to-mid 1980s, which begs the question of whether it’s been updated or reassessed since then. But again, there’s nothing in that statement to suggest that the woman with five or more children didn’t want to have a large family in the first place. It’s not for us to stand over the bed of a woman dying in childbirth and chide her for not having used a condom, regardless of the size of her family.

Skipping ahead a bit:

“For women who seek abortion, 67,000 will die because of abortion-related injuries and millions more suffer complications and long-term injuries.”

That figure dates from 2003, and the link oddly goes to the WHO’s African regional website. Had they linked to the main WHO website, they would know that, as of 2008, the figure of deaths due to “unsafe” abortion was down to 47,000 and has likely dropped further since then. (It’s also worth noting that there are countries with very strong pro-life laws and very low maternal death rates by all causes, including abortion-related complications, thanks to good healthcare infrastructure.)

“Abortion-related injuries account for 13% of maternal deaths worldwide each year.”

Nope. World Health Organization (per Lancet) puts it at 7.9% as of 2014. Funny how slow some advocacy groups are to update their fact sheets…

There’s more here, including a selection of references to “helpful Bible verses” which I’m guessing do not include any mention of “modern contraceptives,” “healthy timing and spacing of births,” or “Onan.”

One more:

“If 120 million women get access to HTSP resources, 200,000 fewer women and girls will die in childbirth by 2020.

“If 120 million women get access to family planning resources, 3 million fewer babies will die in their first year of life by the year 2020.”

Conveniently, that 120 million number coincides with the target of Melinda Gates’ FP2020 initiative: notice how those figures cleverly equate access with use, implying that a) the women involved currently do not have access to “HTSP resources,” and b) if such resources should become available, they would immediately start using them. And if our best plan for reducing infant deaths is reducing their conception in the first place, I think that should make us all a bit cynical, as I’ve written about here and here.

Plenty of conservatives have made family planning their advocacy issue. Republican administrations in the U.S. have been among the biggest funders of family planning abroad. If HTHH wants to advocate for family planning, they are free to do so, although I admit to being curious how much that work will require them to partner directly with abortion-promoting organizations, and how they square that with their pro-life stance. But no matter how high the contraceptive prevalence level is in a given country, and no matter how rare teenage pregnancy becomes, there will inevitably be those tough cases: the contraceptive failure, the unintended, unexpected, maybe even traumatic moment that results in a crisis pregnancy. And it is for such moments that the pro-life community exists: to provide hope and resources for both mother and child to not only survive but thrive and reach their potential.

Making abortion rare in terms of numbers is a public health goal; eradicating the evil that is abortion is a pro-life goal. Ending deaths due to “unsafe” abortion is a public health goal; giving pregnant women hope that a positive future exists for both them and their children, so that they would not resort to abortion in the first place, is a pro-life goal. HTHH is doing important public health work, from a faith-based perspective: kudos to them for that. But speaking as one pro-lifer, if finding common cause with family planning groups means turning a blind eye to their support for abortion—and uncritically accepting a litany of easily refutable statistics—I remain unconvinced.

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