Contraception Works: Debunking 1Flesh, Episode 1

Welcome to the first installment of my series dedicated to debunking the lies and myths being propagated by 1Flesh, one post at a time. Please note that all paragraphs in all italics are taken directly from 1Flesh’s site, here

Today’s topic concerns their rather brash statement that contraception doesn’t reduce the rate of unintended pregnancy.

Answer: FALSE.

Now that wasn’t really any fun, was it? Instead, let’s take a detailed look at their “logic”:

While it seems to make sense that the widespread use of contraception would lead to at least something of a decrease in the rate of unintended pregnancy, the evidence points elsewhere. According to a study published in Human Reproduction, two thirds of unintended pregnancies occur among women using contraception.

Point of order: Not to be a spoilsport, but how can you tell whether or not something has caused a decrease if you don’t compare it to anything? If we want to know whether or not the rate of unintended pregnancy has declined, shouldn’t we know what that rate is, and what it was? In other words (putting aside for a moment the fact that access to contraception in general, the most effective forms of contraception specifically, and information about contraception is highly dependent upon socioeconomic status), what was the unintended pregnancy rate BEFORE contraception was widely available, and what is the contraception rate NOW? Unlike 1Flesh, I have some (relevant) facts for you:

In the 60’s the US did not keep track of unintended pregnancy rates for unmarried women, but they did for married women, and this is what we have from then (Please keep in mind that Griswold v. Connecticutwas decided in 1965, and that’s what made contraception available to married women. Eisenstadt v. Baird wasn’t decided until 1972, which is what extended the right to privacy applied in Griswold to unmarried couples, as well):

In 1961–1965, 20 percent of births to married women in the U.S. were unwanted. By 2002, only nine percent of births to married women in the United States were unwanted. Further, in 1961–1965, 45 percent of births to married American women were mistimed; in 2002, only 14.1 percent of births to married women in the U.S. were mistimed.

In addition, between 1987 and 1994, the unintended pregnancy rate in the US (this distinction will be important in just a moment – stick with me) declined by 16%, from 54 to 45 per 1,000 women of reproductive age.

By 2001, however, the unintended pregnancy rate had risen to 50; by 2006, it was up to 52 per 1000. What, I wonder, could have caused such an uptick in the unintended pregnancy rate? Particularly an uptick in the unintended teen pregnancy rate? Possibly the fact that between 1996 and 2006 (and even more so during the George W. Bush presidency), funding for abstinence-only programming grew exponentially? You know, the programming that has been proven time and time again to be not only ineffective at preventing teen pregnancy, but actually to be harmful, particularly to women and girls, and to the LGBTQ community. Though the funding leveled out between 2006 and 2009, and then was reduced significantly in 2010 by the Obama administration, between 1996 and federal Fiscal Year 2010, Congress spent more than one and a half BILLION tax-payer dollars on abstinence-only-until-marriage programs, and funding continues today.

Seems to me like there was a clear drop in the unintended pregnancy rate that was interrupted by the wasteful spending of tax dollars on programs proven to have the opposite effect. But then I’m a sucker for actual facts.

Also, let’s be a little more truthful about what this study actually is, shall we? (This is what I told you we’d come back to.) The study 1Flesh cites was conducted in France, not in the US, and not worldwide. And given the differences in access to contraceptive services, the difference in attitudes towards sex, and in access to comprehensive sexual health and sexuality education between France and, for instance, the United States, claiming that this provides any information whatsoever about the effect of contraception on unintended pregnancy rates anywhere EXCEPT France is ignorant, at best, and willfully disingenuousness at worst.

Though we’ve acknowledged that this study has nothing to do with the US, I suppose we can take a few moments to delve a little deeper (and actually read the entire study) to find that among the total of 65% of the reported unplanned pregnancies occurring among women using contraception, 21% were using the pill, 9% an IUD, 12% condoms, and 23% an “other method,” of which 22% were using various forms of natural family planning (NFP). It’s important to mention here (take note, 1Flesh) that of the condom failure rate, 28% said they weren’t actually using a condom at the time of conception! That’s because (again, take note, 1Flesh) because use effectiveness / typical use rates include ALL individuals who indicate an INTENTION to use that form of contraception, not just those who are actually using that form of contraception. Also, maybe I’m misremembering, but isn’t a form of NFP what 1Flesh is suggesting we all move to?

 

Finally, when we take the time to actually read the entire study, we also come across this interesting finding:

“A Norwegian survey showed that some women, although they had in fact stopped using their pill before their last menstrual period, reported the use of this contraceptive method at the time of conception (Skjeldestad, 2000). The same phenomenon, which overestimates the failure rate of the pill, may be at work in our study, and this may explain some part of the observed contraceptive failures linked to pill use.”

Maybe I’m crazy (actually, I’m not, multiple studies support this assertion), but it sure seems like remedying user failure, which could largely be accomplished by more education and greater access to more efficacious and long-lasting reversible forms of contraception, could fix a lot of the problems 1Flesh cites.

 According to the National Center for Chronic Disease Prevention and Health Promotion, 58% of women who undergo abortion “reported that they “currently used” contraception during the month of their last menstrual period.” That is to say, they were using contraception when they got pregnant.

First – LOLZ! Sorry, but really? Just because you were using contraception during the month of your last menstrual period does NOT mean that you were using contraception when you got pregnant. Did someone miss high school biology class?

Also, this data is from 1998. Were you guys even born then? Okay, that was low, but seriously, though, perhaps using some more recent data would be helpful. Like this, from the Guttmacher Institute in 2009:

“Nonetheless, contraceptive use can and does dramatically reduce women’s odds of having an unintended pregnancy. Among all US women at risk of an unintended pregnancy, the two-thirds who consistently and correctly practice contraception all year account for only 5% of unintended pregnancies…The remaining 95% of unintended pregnancies occur among the one-third of women at risk who did not use contraceptives at all during the month of conception or who used a method inconsistently or improperly.”

Damn, yo. Seems like contraception really DOES reduce the rate of unintended pregnancy.

In 2011, The Center for Disease Control and Prevention reported that, despite the near-universal use of contraception, 49% of pregnancies are unplanned. It’s a similar story when considering out-of-wedlock pregnancies: The use of contraception has increased since its introduction in the 1960’s, and the rate of out-of-wedlock pregnancies has increased along with it, from 89,500 in 1940 to 1,240,172 in 1993. Whatever contraception is doing, it isn’t helping.

Seriously? 1Flesh’s inability to properly conduct research is starting to hurt my head. If they had bothered to check the source for that stat they cite, they would have realized that the numbers came from a study in Contraception, and reflected 2006 rates of unintended pregnancy.  A more recent study, using more recent data, was just released, indicated an unintended pregnancy rate of 37%. Unlike certain other organizations ::cough:: 1Flesh ::cough:: I will be intellectually honest and share that this more recent study was REALLY measuring unintended BIRTHS, so the numbers are a bit off (the previous study developed an unintended pregnancy rate that included live births, miscarriages, and abortions).  Without an analysis of more recent data, though, it’s difficult to determine what is actually happening with the unintended pregnancy rate. And, as noted above, using 2006 numbers is problematic given that rates of unintended pregnancy are highest among teens, i.e. those with less access to contraception in general, long-lasting reversible contraception specifically, and information about effectively using contraception – and those for whom sexual education was comprised primarily of abstinence-only.

Also, I’m not exactly sure what the point of including out-of-wedlock pregnancies was here, as the previous study didn’t differentiate between married and unmarried women, but I will point out that, again, 1Flesh is using data from 1993. That is to say, EXTREMELY outdated data. Further, can someone please get 1Flesh some information on what “rate” actually means? The numbers 1Flesh cites here indicate that the total NUMBER of out-of-wedlock pregnancies has increased, but does not indicate rate. Finally, what in the world does the number of out-of-wedlock pregnancies have to do with whether or not contraception is working? Not everyone who is married wants a child, and not everyone who has a child wants to be married. And not everyone in either of those two groups is using contraception. Mind boggling, the mental gymnastics 1Flesh is using.

One last comment, just a heads up that contraception wasn’t actually introduced in the 1960’s, it was just made legally available to married women that year (again, please see Griswold v.Connecticut).

But why does contraception lead to an increase in unintended pregnancies? As always, more research is needed, but scientists have established two major reasons for the failure of contraception to reduce the rate of unintended pregnancies.

1. Habit persistence. Contraception allows young people to get into the habit of sex who otherwise would remain abstinent, a habit difficult to stop. Since contraception does not eliminate the risk of pregnancy, but merely reduces it, unintended pregnancies inevitably result. Thus the 2011 Duke study “Habit Persistence and Teen Sex” concluded that “programs that increase access to contraception are found to decrease teen pregnancies in the short run but increase teen pregnancies in the long run.”

Once again with the ever-so-slightly dishonest reporting on a study. When we read the entire study, we see this quote:

“These effects are so strong that policies which increase access to certain types of contraception such as condoms, while lowering teen pregnancy rates in the short run, may raise teen pregnancy rates in the long run.”

Hmmmm….seems like this is really just calling out one form of contraception – condoms – not all forms of contraception.

And this:

“Taken together, the policy simulations suggest making contraception more attractive may lead to higher pregnancy rates, particularly in the long run. However, increasing the efficacy of contraceptive use (yet somehow not affecting access) is likely to result in decreases in pregnancy rates both in the short and long run.” (emphasis mine)

So, what this study ACTUALLY says is that increasing the efficacy of contraception (or increasing access to more efficacious forms of contraception) would result in decreases to pregnancy rates both in the short and long term.

2. Risk compensation, a basic psychological principle that holds that individuals will behave less cautiously in situations where they feel safer. (The use of sunscreen makes people stay longer in the sun, and seatbelts make people more comfortable with reckless driving.) When people believe they are having “safe” sex, they are more likely to engage in riskier activities, thus disproportionately reducing the benefits of contraception use.

Hmmm…In terms of risk compensation, I’ve only found one study actually conducted on the hypothesis that risk compensation plays a role in contraception usage and unintended pregnancy rates, and that study only talks about one specific form of episodic contraception: condoms. Not exactly a ringing endorsement of that hypothesis given the myriad of other forms of contraception available.

And, of course, the simple fact that no form of contraception is 100% effective. The condom’s use-effectiveness rate is 85%.  This means that, under real-world conditions, a woman whose sexual partners use condoms for every act of sexual intercourse has a 15% chance of becoming pregnant in a year.

Please do not tell me 1Flesh was actually using about.com as a source on their numbers. Wait, they were. ::headdesk::  At least the numbers were close to accurate on this one…well, sort of.  It would be great if they could learn what terms actually mean. “Typical use,” or “use-effectiveness,” does NOT mean that a condom is used for every act of intercourse. “Typical use” numbers are gathered for all individuals who indicate that they INTEND to use that form of contraception, whether or not it is actually used.  A woman whose sexual partners use a condom CORRECTLY for every act of sexual intercourse has a ~2% chance of pregnancy, annually. A woman who INTENDS for her partners to use a condom for every act of sexual intercourse has a ~15% chance of becoming pregnant within any given year.

And while oral contraceptives are more effective, studies have shown that after three years of use, the failure rates of oral contraceptives was 4.7% for 24-day regimen pills and 6.7% for 21-day regimen pills. The FDA’s conclusion is that the use-effectiveness of oral contraceptives is 95%. A 2011 study, Contraceptive failure in the United States, found the Pill’s actual failure rate to be 9%, for a 91% success rate.

You know what has a really atrocious typical use failure rate? Natural Family Planning. Exhibit A (from Contraceptive failure in the United States):

Though the numbers shift in various studies, in every case, natural methods of family planning — specifically the Creighton Model FertilityCare System — are more effective at preventing unintended pregnancies, with a use-effectiveness of 96.8-98%

Oh, the lengths people will go to to lie to women (and apparently to make money). Unfortunately, the study 1Flesh cites here uses a completely different form of statistical analysis than any of the other studies of contraceptive effectiveness. To wit, the study they cite uses the “unique” Hilgers method (developed by the founder of the Creighton Model), which SEVERELY underestimates failure rates.

Want to hear more about this “unique” method? From a comprehensive review of methods of analyzing the effectiveness of natural family planning:

“Hilgers argues that conceptions occurring from intercourse during identified infertile days are the only ones that can be classified as unplanned and conceptions from intercourse during fertile days are achieving-related (Doud 1985, Hilgers et al 1980). Hilgers definition of unplanned pregnancies results in almost no unplanned pregnancies, and pregnancy rates which use this definition of unplanned pregnancy cannot be compared with rates using the standard definition.”

As an example of just how skewed the numbers can get, in a previous re-analysis of a study on the Creighton Model (CrM) conducted in 1985, researchers found that while the study boasted a 96.2% effectiveness rate, when the data was analyzed using standard statistical analysis (read: the form of analysis used to analyze all other forms of contraception) and not the Hilgers method, the actual effectiveness rate was 65%. Interesting, is it not?

Further, I’d like to point out here that you cannot participate in CrM unless you participate in an AT LEAST 8 session training course, conducted by a CrM teacher, over the course of the first year (which, of course, you must pay for), and then have follow-up training sessions every 6 months or so after the first year (which, again, you must pay for). Is this sounding like a CrM marketing scheme to anyone else?

The idea that the widespread use of contraception will help end the stressful incidence of unintended pregnancy — while hopeful — has been debunked. The answer is not pill or a rubber. It’s having a true understanding of a woman’s body and cooperating with it.

And the last link in the article is once again to a piece on the Creighton Method, complete with a link to CrM’s website, where you can sign up to find a teacher. Yep. Definitely sounding like a marketing scheme.

Until next time…

– H

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