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Saturday, October 20, 2018

To Protect Women’s Health—And Drastically Reduce Abortion—There Is Only One Choice

To Protect Women’s Health—And Drastically Reduce Abortion—There Is Only One Choice

We are American women with careers long devoted to women’s health who have been watching this election for many months, and we are not easily fooled.

Mitt Romney has asked us to give him a second chance. He now blithely asks us to forget his past pledges to “get rid of” Planned Parenthood, to eliminate Title X, the federal program that subsidizes contraceptive care for millions of low-income American women, and to overturn the Affordable Care Act, which promises historic increases in access to contraception and other critical preventive women’s health services. He now says all women deserve access to family planning, just not to have the government cover the costs, conveniently ignoring that who pays is precisely what this controversy is all about.

To us, federal funding for women’s health and especially for family planning is an issue of such importance that it alone should determine our votes. The choice is plain.  One candidate offers to build on the historic achievement of the Affordable Care Act in providing access to health care, with its many special provisions to preserve and advance the health and rights of women. The other vows to undo those gains on day one and reverse decades of progress.

A breakthrough clinical study of a large cohort of women in Missouri demonstrates just how high the stakes are and why the matter is critical not just to women but to the country as a whole. Released several weeks ago in the journal Obstetrics & Gynecology, the study shows conclusively that if Americans are serious about reducing unintended pregnancy and abortion, we must be willing to provide a range of  contraceptive choices to women at no or low cost. There has simply never been more compelling evidence that providing free contraception leads to positive outcomes and not to riskier sexual behaviors, as all-too-familiar conservative canards would have us believe.

The Contraceptive CHOICE Project, directed by researchers at Washington University in St. Louis, enrolled about 10,000 women ages 14 to 45 (with a mean age of 25) identified as being at risk of unintended pregnancy and desiring contraception. Each was given the reversible contraceptive method of her choice, at no cost, for two or three years.

The results are nothing short of remarkable. Contraceptive efficacy among participants increased significantly, and abortion rates fell to less than half the regional and national rates, even though the study participants were poorer, less educated, and therefore considered at greater risk than the overall population. The impact on the rate of births among teens was the most pronounced, with pregnancies falling dramatically to a rate of only 6.3 per 1,000, compared to a national average of 34.3 per 1,000.

The study contains a second dramatic finding. A majority of American women overall today use birth control pills or condoms for contraception—both low-cost methods but ones with a high rate of user error or failure. Most women in the CHOICE study, however, opted for longer acting and more reliable methods when cost was not a factor—75 percent selected an IUD or hormonal implant, and the greater efficacy of these methods is what accounts for the dramatic gains in the success rate across the group.

These are simply stunning outcomes. The study estimates that universal provision of contraception and the promotion of more effective contraceptive methods would result in fewer unintended pregnancies and would lower the number of abortions across the country by 62 to 75 percent every year.