Over on the homepage, Jillian Melchior makes the case for selling the pill over the counter. I couldn’t agree more; women should not need a doctor’s permission to take a birth-control pill (or just about any other pill, for that matter). But regarding the argument that this measure will reduce abortion, I was compelled to check the data.
As I argued two years ago, abortions by and large aren’t the result of poor access to birth control. Instead, most abortions happen because people intentionally engage in high-risk sexual activity and use abortion as a backup. But this is a country with a million abortions a year, so even a small change can save a lot of lives. We need to bear all of this in mind when trying to reduce abortion in the context of Roe v. Wade.
This survey of women having abortions — conducted by the Guttmacher Institute, a think tank strongly supportive of abortion rights — is highly instructive.
Forty-six percent of respondents didn’t use any form of contraception at all in the month they became pregnant. Perhaps they didn’t use the pill because it would have required an expensive visit to the doctor — but if that’s the problem, it’s awfully difficult to explain why they didn’t use condoms either. The potential improvement here is in situations where people (A) would rather have unprotected sex than use a condom; (B) would rather have unprotected sex than take a pill every day if that pill requires a doctor’s visit; and yet (C) would rather take a pill every day than have unprotected sex if that pill is sold over the counter. I won’t guess how often these three categories overlap, but I doubt it’s a high number.
The other 54 percent of respondents used birth control of some kind — 14 percent of respondents used the pill, 28 percent condoms — but most did not use it well. Only 13 percent of pill users and 14 percent of condom users said they got pregnant despite “perfect” use.
Only 10 percent of pill users reported that their supply ran out, a situation that might be remedied by over-the-counter sales. (If this category disappeared entirely, it would eliminate only 1.4 percent of all abortions. Still, that’s more than 10,000 lives a year in the U.S.) The others forgot to take their pills on time, didn’t bring their pills when they left the house, and so on.
In my view the most promising data are from the condom users. About half said they didn’t always bother with the condom, and 42 percent (the categories overlap) reported slippage or breakage. Perhaps some of these women would use the pill in addition to condoms if the pill were available without a prescription. Then again, the morning-after pill — which has been available without a prescription since 2006, will now be available off pharmacy shelves for women 15 and up, and doesn’t require daily responsibility — might be a simpler solution for occasional lapses. (The Guttmacher data were collected in 2000 and 2001.)
In short: Expanding access to the pill is a worthwhile endeavor from a pro-life perspective, but we shouldn’t expect too much.