Trump’s Dishonesty to Justify Pulling Contraception Mandate

The Trump administration last week repealed the requirement in the Affordable Care Act that all health insurance policies include coverage for contraception without a co-pay. In order to justify that, they had to lie and distort the evidence about the effectiveness and importance of birth control.

Because this was an administrative rule that was justified by a set of “findings,” in order to repeal it they had to issue a similar analysis of the matter to counter those findings. In order to do that, they had to pretend that there’s no good evidence that greater access to birth control would have positive benefits, especially for women. chief among those benefits is a far lower rate of unintended pregnancies.

According to the White House, there isn’t good evidence linking access to birth control to lower rates of unintended pregnancies. More specifically, we don’t actually know that giving more women birth control reduces the risk of unwanted pregnancies at the population level, the new regulations say: “In particular, association and causality can be hard to disentangle.”…

Just take a look at the research from the CHOICE Project, out of Washington University in St. Louis. For this work, researchers gave out free contraceptives to local teenagers, and followed them for up to three years to see what happened to their rates of pregnancy and abortion.

They published the results in a study in the New England Journal of Medicine: CHOICE participants were significantly less likely to get pregnant and have abortions compared to their American counterparts. As you can see in the chart above, women enrolled in CHOICE had birth rates, abortion rates, and pregnancy rates that were less than half that of the average American. (You can read all about the project here and here.)

“What this shows is that when you take away costs, when you take away barriers, you see increases in the use of more effective methods of birth control and a substantial decline among adolescent pregnancies,” said Megan L. Kavanaugh, principal research scientist at the Guttmacher Institute, adding that the CHOICE research is some of the best data out there on the effect of birth control on unwanted pregnancies.

The White House’s claim about correlation and causation also ignores one very basic thing about birth control: It works!

On the individual level, birth control is extremely effective at stopping women from getting pregnant. “If there wasn’t any use of methods of birth control, 85 percent of reproductive-age women would get pregnant every year, and we’re not near that,” said Leslie Kantor, vice president of education at Planned Parenthood and a professor at Columbia University’s Mailman School of Public Health. “So [this administration] is ignoring a lot of evidence to suggest we don’t know really well what birth control does.”

Or look at a similar project in Colorado, which provided free contraception to a group of teenagers and poor women over six years and saw a 40% drop in pregnancies and a 42% drop in abortions. One would think that the anti-abortion zealots that Trump appointed that had a hand in writing this new policy would be all for that, wouldn’t you? But no, they are also anti-contraception. Why? Because reducing abortion is not really their primary goal at all, it’s the control of women’s lives and reproduction, so they oppose birth control as well.

They also had to pretend that greater access to birth control will lead to more risky sex, or as they put it, “affect risky sexual behavior in a negative way.” You can read that as “will make women be all slutty and stuff.” But even if this were at all relevant, the evidence contradicts this.

Studies have looked at whether giving people access to contraception encourages people to have more sex. It doesn’t. Most women in the CHOICE study reported no change in their number of sexual partners after gaining access to free birth control. They were also no more likely to be diagnosed with sexually transmitted infections.

What’s more, the introduction of the Obamacare birth control mandate in 2012, which expanded access to contraception, has actually coincided with a period of less risky sexual behavior among Americans…

The latest federal data also shows that the teen birth rate has plummeted in recent years, from 41.5 births per 1,000 teenage girls in 2007 to 20.3 births per 1,000 teenage girls in 2017. And what contributed to the change? Birth control.

As Vox’s Sarah Kliff reported in September, “The percentage of sexually active teens who used at least one type of birth control the last time they had sex rose from 78 percent in 2007 to 86 percent in 2012.” More youngsters are also using more effective types of birth control, such as pills, IUDs, or implants.

Forget having health insurance policies cover contraception, it should be free and available to everyone, anonymously (as should STD testing). If you actually want to reduce unwanted pregnancy and abortion, you should be demanding this. And it should include every form of birth control, from condoms to IUDs to implants to tube-tying and vasectomies. Whatever method a person prefers, they should be able to get it easily, anonymously and free. That’s how countries like the Netherlands do it and they have a rate of both teen pregnancy and abortion that is 1/7th of ours.

This is just a bone thrown to the Christian right, whose goal is not to reduce abortion but to control women and enforce an iron age moral code that treats women as property and as “ruined” if they dare to have sex in an unapproved manner.

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