Selling Rubbers

Science, technology, and life.
Feb. 27 2009 11:48 AM

Selling Rubbers

 

Ross Douthat is such a sensible and honest guy , I really ought to be able to sell him on the idea that contraception can significantly lower the abortion rate.

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

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I pontificate ; he demurs . I throw data ; he remains unconvinced . I feel like a shingle salesman standing in the rain at the front door of a house that has holes in its roof and 2 inches of water inside. The owner's standing there, listening, his arms folded. How am I not making this sale?

Ross and his Atlantic colleague, Megan McArdle , have persuasively challenged what I used to believe: that birth-control availability was the key to reducing abortions. Three years ago, in a careful analysis , McArdle made a case that "the monetary cost of contraception is, at best, a small contributing factor to unwanted pregnancy in this country." A friend who works in reproductive health has impressed a similar lesson on me from her own research: Use, not access, is the missing ingredient.

The data back her up . So, last Sunday, I conceded the point :

Eight years ago, the Alan Guttmacher Institute surveyed over 10,000 American women who had abortions. Nearly half said they hadn't used birth control in the month they conceived. When asked why not, 8 percent cited financial problems, and 2 percent said they didn't know where to get it. By comparison, 28 percent said they had thought they wouldn't get pregnant, 26 percent said they hadn't expected to have sex and 23 percent said they had never thought about using birth control, had never gotten around to it or had stopped using it. Ten percent said their partners had objected to it. Three percent said they had thought it would make sex less fun.

This isn't a shortage of pills or condoms. It's a shortage of cultural and personal responsibility. It's a failure to teach, understand, admit or care that unprotected sex can lead to the creation—and the subsequent killing, through abortion—of a developing human being.

Ross listened thoughtfully, as he always does. But he didn't budge :

I remain unconvinced that [Saletan's] preferred method for such reductions—a dramatic new push, whether political or cultural, to expand the use of contraception in the United States—would produce anything like the results that he envisions. Consider, for instance, the idea that the government should dramatically expand eligibility for free contraception through Medicaid. ... [T]he universalization of this program, according to its supporters , might reduce the national abortion rate by somewhere between 1 and 2 percent. That's not nothing, obviously, but it's not a whole lot ...

Whoa, there. That's the old debate: access. What I'm talking about now is the other part of the equation: use. Access is important, but pills and condoms don't work unless people use them.

There's nothing fancy about this idea. I don't have a brilliant program in mind. All I have is process of elimination: If most people in this country, including me, aren't willing to ban abortions (check), and if you can't stop people from having sex (check), and if contraception is the only other way to prevent pregnancy (check), and if providing access to contraception hasn't solved the problem (check), then the remaining factor is human failure to use the contraception. Target that problem. I don't care whether it's through the federal government, states, clinics, schools, churches, or Conan O'Brien. All that matters is sending a forceful message that if you're not prepared to become a parent, you must either avoid vaginal intercourse or use birth control religiously.

If sex-ed programs aren't getting this message across, come up with better sex-ed programs. Or go through churches, doctors, parents, Facebook, Webkinz—whatever. Keep trying until you find something that works.

On this point, I should mention an equally sincere critique from the other side. One of my proposals for getting the message across was that "reproductive-health counselors must speak bluntly to women who are having unprotected sex." (I recommended the same message for men.) Jodi Jacobson, a longtime pro-choice activist and editor at RH Reality Check , says counselors are already doing this :

[W]omen's rights advocates and reproductive health providers have always put these two issues together.  It's called "prevention" and it is the core of reproductive health services that include efforts to prevent unintended pregnancies, prevent infections, assist people who wish to get pregnant, offer pre-natal and maternal care, and much more.

What exactly does Mr. Saletan think reproductive health counselors do, but guide people toward protected sex, help them find the methods they need and which will work best for them, and counsel them on correct and consistent use?

Most counseling matches this tone. It's deferential, technical, and service-oriented. I understand the need to gain and hold each patient's confidence. But plainly, the message isn't getting across. This should be obvious from the fact that half the women getting abortions in this country are coming back for their second or third termination .

I've sat and talked with people who staff and supervise clinics. One recounted an internal staff debate over whether a woman who came in for an abortion and wasn't using birth control should be encouraged to use it next time—or whether this was too morally presumptuous. Another described moral differences between American and European clinics. In many European facilities, she explained, if you come back for a repeat abortion, the counselors will demand to know whether you were using birth control and if not, why not.

I admire everyone who works in family planning and reproductive health. But we need to do a better job of getting the message across. One measure of our failure is the national abortion rate. And if you don't accept that as a moral challenge, take it as a political one. Because if you can't do something to dry up the demand for abortions, Ross Douthat and others will be happy to target the supply.

 

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