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A Political Plan B



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Mirabile dictu! Kathleen Sebelius, the most pro-abortion secretary of the Department of Health and Human Services in memory in the most pro-abortion administration in memory has shocked the pro-abortion Left by overriding the FDA’s recommendation to allow the Plan B morning-after pill to be sold over the counter without restriction to women of all ages, a pet cause of the pro-abortion forces. “We are outraged that this administration has let politics trump science,” said Kristen Moore of the Reproductive Health Technologies Project. “There is no rationale for this move … Unbelievable.” Nancy Keenan of NARAL was also exasperated: “We had every confidence that this Bush-era policy would come to an end. The Obama administration has broken a key promise to the American people that it would base its decisions on sound science and what’s in the interest of women’s health.”

How is this possible? The general consensus seems to be that the Obama team is sufficiently worried about the 2012 election to be willing to enrage an important segment of his loyal base over an issue everyone thought was squarely in the bag in order to avoid a culture-war controversy with the rest of the country.

The general outline of the controversy is familiar enough. Plan B and similar drugs are controversial because in addition to their contraceptive effects they are known to have abortifacient effects by preventing fertilized embryos from implanting in the uterine wall. Advocates for wider availability of the drug decry those who stand in the way of a simple means of decreasing the number of abortions and out-of-wedlock births, all for the sake of very early fetal life. Imagine the “scramble — often in late-night or weekend panics after having sex without protection.” Opponents of trivializing sex, on the other hand, think that we should be concerned about how we treat all, even inchoate, human life, and, moreover, wonder why on earth we would want to decrease the caution in that late-night scenario. Do we really want to make it easier to have irresponsible sex and then run along to the nearest 24-hour retailer to pop a pill?

It is a well-worn debate, and probably worth having. But another discussion is prior to it, and more important. Do we know the answer to this simple question: Will it work? That is, will easier access to the morning after pill reduce the number of pregnancies, abortions, and out-of-wedlock births?

Scientifically speaking, the answer is no.#more# The religious faith in contraception espoused by those on the Left is quite unshakeable, but conservatives who have no problem with contraception should be wary about accepting their premises. Science, friend of all who value truth, has been applied to the question and yielded an as yet undisputed answer: Increased access to emergency contraception has no beneficial effect.

In December of 2010, The Journal of Health Economics published an article by Sourafel Girma and David Paton of the Nottingham University Business School titled “The Impact of Emergency Birth Control on Teen Pregnancy and STIs.” The authors begin by noting that no study to date has been able to show that access to emergency contraception has a measurable effect on either the abortion rate or the pregnancy rate among teens. This can be for one of two reasons, the authors argue: either the effect is so small that it is not measured by the statistical methods thus far applied, or the increased availability of emergency contraception causes at least some adolescents to increase their level of risk taking behavior, such that “the reduction in pregnancies from greater use of EBC [emergency birth control] is being countered by additional pregnancies resulting from this behavior change.” By measuring the effect of emergency contraception access programs not only on the abortion and pregnancy rates but also on the sexually transmitted infections rate, the authors hypothesize that they can elucidate which of the possible explanations is more likely. The authors use both a robust difference-in-differences analysis and a more robust difference-in-difference-in-differences analysis to compare areas that offered free emergency contraception to minors with areas that did not.

The result: The difference-in-differences approach showed an increase both in pregnancies and in STIs, and the difference-in-difference-in-differences approach showed no effect on pregnancies and an increase in STIs. The conclusion Girma and Paton reach is not one that should be surprising to someone who has been paying attention. The authors note the long tradition of scholarly analysis indicating that access to contraception and abortion causes behavior change which leads to increases in unplanned pregnancies, abortions, and out-of-wedlock births, beginning with the seminal article by Nobel-prize winning George Akerlof and his colleagues Yelen and Katz, “An Analysis of Out-of-Wedlock Childbearing in the United States” (which a blogger at Salon dismissed as “bad economics” and “conservative economics”; apparently they don’t use Google at Salon).

It is a bit counterintuitive at first that something which clearly will prevent or terminate a pregnancy in any individual case fails to do so in the aggregate, but on further reflection it makes sense: It happens for the same reason that increased tax rates bring in less tax revenue, and is driven by the same factors that lead insurance companies to charge higher premiums for lower deductibles. The simple fact is that people change their behavior based on the risks and costs they perceive their behavior will entail. If the state mandates seat belts, more people will drive faster. If the government finds a way to decrease the perceived risk of irresponsible teenage sex, more teenagers will have irresponsible sex. If we make it so that a teenager will be able to run in to a CVS, grab some Plan B, and exit via the self-checkout lane in the wee small hours of the morning, more of them will do dumb things than now do dumb things.

No doubt an important conversation can and should be had regarding what criteria are used to determine whether a drug should be available over the counter or only with a prescription, and to what extent politics and policy should be allowed to influence that determination. No one I know is advocating for the outlawing of contraceptive drugs (though drugs which have the potential to act as abortofacients present a more complex question), but none of us should be fooled by the worn-out canard that access to contraception and abortion will decrease the abortion and out-of-wedlock birth rates. If liberals and libertarians want to argue that the radical autonomy of the individual demands unimpeded access to all contraceptive drugs and devices, fine. But the argument that it promotes a public good is a farce. It is bad policy and it will have bad outcomes. Thankfully, Sebelius made the right decision, though probably not for the right reasons.

— Greg Pfundstein is the executive director of the Chiaroscuro Foundation.



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