[Editor's Note: This article was originally published one year ago in the May 2011 issue of Catholic World Report.]
New York City is the abortion capital of
America. More than 40 percent of pregnancies in New York City end in abortion
(excluding miscarriages), nearly twice the national rate. The abortion rate
among the city’s black residents is a jaw-dropping 60 percent. In 2009, New
York City saw more than 87,000 abortionsone roughly every six minutes.
Not surprisingly, New York City also has one of
the country’s most pro-abortion political establishments. When the New York
Post interviewed the City Council’s 51 members in 2010 about the city’s
abortion rate, only five would
allow that it was too high. One council aide even fretted that a lower abortion
rate might bankrupt the city.
Asked to comment on how her city could best
lower its rates of unintended pregnancy and abortion, Council Speaker Christine
Quinn told the Post, “We can reduce the number of unintended
pregnancies…by expanding access to contraceptives and increasing sex
A similar analysis was offered in 2008 by
Deborah Kaplan, deputy commissioner of New York City’s Department of Health and
Mental Hygiene. Responding to questions about the city’s high abortion rate,
she told Crain’s business journal, “To me, the problem is access. If we
improved access to contraceptives, there would be a reduction in abortion.”
Quinn and Kaplan were echoing the conventional
wisdom about the relationships between contraception, unintended pregnancy, and
abortion. The theory holds that since most abortions are the result of
unintended pregnancies, efforts to reduce unintended pregnancies will reduce
the number of abortions. And since contraceptives can reduce the number of
unintended pregnancies, expanding access to contraceptives will lower the
But that logic has not worked very well in
practice. If New York City is the abortion capital of America, it is also the
contraceptive capital of America. Free or low-cost birth control is available
through dozens of publicly-funded programs at more than 200 places throughout New
York state, most of them in New York City and its suburbs.
The city’s health department distributes a
pocket-size guide showing teenagers where they can get low-cost or free
contraception, information that is also available on the city’s 311 phone and
Internet hotlines. New York City hands out three million free condoms every
month at thousands of venues. The
city even has its own brand of condoms, NYC Condoms.
In February, the city introduced the world’s
first condom app to help New Yorkers with smartphones find a condom when they
need one. “We want New York City to
be the safest city in the world to have sex,” announced Dr. Monica Sweeney, the
city’s assistant health commissioner, during the Valentine’s Day launch.
The new campaign was unveiled a month after
health department statistics revealed a 2009 abortion rate of 41 percent. At a
January news conference to discuss the new statistics, Timothy M. Dolan, the
Catholic archbishop of New York, was the first to raise the contraception
“My word, what have we done the last 30 years?”
he told reporters. “There’s candy bowls on people’s desks with condoms, they’re
dropping them from airplanes, yet nothing seems to improve, so they’ve been on
the wrong track here.”
moral theologians and others have long maintained that by changing the
way people think about sex and pregnancy, contraceptives don’t merely fail to
lower rates of unintended pregnancy and abortion. They may in fact increase
Many policymakers take the opposite view,
arguing that insufficient access to contraception is the main obstacle to
lowering rates of unintended pregnancy and abortion. In recent debates over
public funding for Planned Parenthood, the country’s largest abortion provider,
the organization claimed that without taxpayer funding of its contraceptive
services the number of abortions would grow by a half million a year.
This view is the basis for widespread promotion
of sex education in schools, public funding of contraception, and the movement
to “de-medicalize” contraceptives that require a prescription, including oral
contraceptives, to make them easier to obtain.
But growing evidence suggests that the “more
contraceptives, fewer abortions” theory is flawed. A January 2011 study
published in the medical journal Contraception found that a 63 percent
increase in contraceptive use over 10 years among Spanish women corresponded
with a 108 percent increase in the abortion rate in Spain.
At the heart of the issue are complicated
questions such as: How has access to contraception and abortion altered the way
people think about sex and pregnancy? And in what ways has the availability of
abortion changed the way people think about and use contraception?
The most common methods of contraception are
barrier methods such as condoms and diaphragms, hormonal contraceptives such as
the pill, the patch, and intrauterine
devices (IUDs), as well as spermicides and sterilization.
Nearly 40 percent of the most common
contraceptives are abortifacients. These include IUDs, the pill, the patch, and
emergency contraception. All act to prevent implantation onto the uterine wall
of some fertilized eggs, distinct human beings. Contraceptives are widely and
cheaply available throughout the United States. The government has subsidized
contraceptives for low-income women for more than 50 years, through programs
such as Medicaid and Title X.
Millions of government employees receive
insurance coverage for contraceptives. Nine in 10 employer-based insurance
plans cover a full range of prescription contraceptives. Twenty-seven states
have laws requiring insurers that cover prescription drugs to provide coverage
for most contraceptive drugs and devices.
The health care reform law enacted in 2010
mandates that insurance companies cover a variety of preventive services at no
out-of-pocket cost. Depending on how the Department of Health and Human
Services ends up defining “preventive services,” coverage may include
prescription contraceptives. Guidelines are expected to be issued by August.
Most American women use contraceptives.
According to the Centers for Disease Control and Prevention (CDC), 98 percent
of all women who have ever had sexual intercourse have used at least one method
of contraception. Eighty-nine percent of the 42 million fertile, sexually
active American women who say they do not want to become pregnant are practicing
Among sexually active Americans who do not use
contraception, only a small percentage fails to do so because of lack of access
to contraceptives. In a 2001 study, the Guttmacher Institute (GI), a public
policy organization that analyzes reproductive trends, surveyed 10,000 women
who had abortions. Of those who were not using contraception at the time they
conceived, 2 percent said they did not know where to obtain contraception, and 8
percent said they could not afford it.
Despite the pervasiveness of contraception,
nearly half of pregnancies among American women are unintended, and four in 10
of those end in abortion, according to GI and the CDC. Part of the problem is
contraceptive failureall methods sometimes fail to prevent pregnancy.
But a more significant problem is that most
sexually active people who use contraception use it inconsistently. According
to a GI study, a majority of women (54 percent) who had abortions used a
contraceptive method (usually a condom or the pill) during the month they
became pregnant. Another GI analysis found that nearly half of women seeking to
avoid pregnancy had periods of nonuse of birth control (15 percent) or used
their method inconsistently or incorrectly (27 percent).
Erratic contraceptive use is often rooted in
ambivalence about pregnancy. Another GI study found that nearly one in four
women who were not trying to become pregnant said they would be very pleased if
they found out they were pregnant.
Such ambivalence baffles many policymakers. To
understand this phenomenon, it helps to try to understand the circumstances in
which women who have unintended pregnancies make reproductive decisions.
Although all types of women experience unintended pregnancies, a
disproportionate number are young and poor. Many already have at least one
child and are in unstable relationships with their sexual partners.
For many women at high risk of unintended
pregnancy, feelings about pregnancy change oftenjust as often as their
feelings about the long-term prospects of the relationships they are in. And
when people are uncertain about whether or not they want to become pregnant,
they can be erratic about contraceptive use. Ambivalence about pregnancy makes
it more likely that sexually active people will leave the condom in a wallet or
neglect to refill an oral contraceptive prescription.
As Rachel Jones, a GI senior research associate,
put it to the New York Times, “[T]he high rate of unwed pregnancy and
abortion among poor women is a sign of ambivalence. They are torn between the
desire to have a baby and the realization that it would be hard to bring up a
child as a single mother.”
Reproductive decision-making is complicated
further by the availability of induced abortion. Statistics suggest that though
it is marketed as a method of birth control used only when other measures fail,
abortion has become a method of birth control used in place of other measures.
Few people would admit to using abortion as
birth control, but the evidence is in the data. After Roe v. Wade, the US
Supreme Court’s 1973 decision legalizing abortion nationally, pregnancies grew
by 30 percent even as births decreased by 6 percent. After Roe, which
suddenly made abortion much easier to obtain, many Americans began using
contraceptives less consistently.
The results are seen in the number of women who
have multiple abortions. Consider that of the more than 1.3 million women who
obtained abortions in 2001, about half (650,000 women) had had at least one
previous abortion. About a quarter (325,000 women) had obtained at least two
previous abortions. And roughly 15 percent (195,000 women) had already obtained
at least three abortions.
Those numbers haven’t changed all that much. Of
the 1.21 million abortions performed in 2008, half were performed on women who
had already had at least one abortion. These disturbing statistics highlight
the moral hazard of abortion. The wide availability of abortion
diminishes the expected cost of sexual intercourse, because the pregnancy can
be aborted in the event of unwanted conception, thus avoiding many of the costs
associated with unwanted pregnancy.
So, by giving men and women a relatively safe
and inexpensive way to eliminate the unintended outcome of risky sexual
behavior, liberal abortion laws encourage more and riskier sexual behavior. In
other words, the wide availability of abortion discourages people from using
Abortion’s effect on contraceptive use doesn’t
only influence rates of unintended pregnancy. It also affects exposure to
sexually transmitted diseases. A 2006 paper by Jonathan Klick and Thomas
Stratmann in the Journal of Legal Studies found that by lowering the
cost of sexual activity, legalized abortion leads individuals to engage in more
sex and to use condoms less often, causing an increase in sexually transmitted
The authors found that, all else being equal,
abortion legalization led to an increase in gonorrhea and syphilis rates
potentially by as much as 25 percent. The authors concluded, “[O]ur results
attributed a large increase in gonorrhea and syphilis rates to changing sexual
behavior, which was induced by abortion law changes.”
All of this was foreseen. In the 1930 encyclical
Casti Connubii, Pope Pius XI condemned contraception as a violation of
the natural law. In the 1968 encyclical Humanae Vitae, Pope Paul VI famously predicted
that if the Church’s teaching on sexuality and artificial birth control were
ignored, it would “lead to conjugal infidelity and the general lowering of
morality” and give man the idea that he has unlimited “domination over his own
body and its functions.”
Humanae Vitae was published three years
after the US Supreme Court decision in Griswold v.
Connecticut, which legalized contraception for married people, and
five years after the pill arrived on the American market. Even those not sympathetic to the Church’s
view of sexuality have made the connection. In 1979, Malcolm Potts, former medical
director of the International Planned Parenthood Federation, predicted, “as
people turn to contraception, there will be a rise, not a fall, in the abortion
A couple that uses contraception establishes a
“contraceptive mindset,” so that even if a child is conceived that child is
unintended and thus unwelcome. The US Supreme Court came close to acknowledging
this idea in its 1992 decision upholding the right to abortion. In Planned
Parenthood v. Casey, the court stated, “In some critical respects abortion
is of the same character as the decision to use contraception. For two decades
of economic and social developments, people have organized intimate
relationships and made choices that define their views of themselves and their
places in society in reliance on the availability of abortion in the event that
contraception should fail.”
Further research is needed to determine the
precise relationship between contraception and abortion. GI estimates that of
the 6.4 million pregnancies that take place each year in the US, nearly
half3.1 millionare unintended, and 1.3 million of them end in abortion.
Millions of lives (not to mention billions of dollars) are at stake.
But policymakers and activists do a profound injustice
when they argue that lowering rates of unintended pregnancy and abortion is
simply a matter of improving access to contraceptives and ensuring all children
are taught how to use them. In many cases, those policies are making matters