The Corner

Re: Abortion and the Pill: The Numbers

I’m a bit late on this, but I did want to weigh in on the issue of contraceptive pills and abortion. Michael New points out that programs designed to increase access to contraception have generally failed to reduce unwanted pregnancies and abortions in the population as a whole. My focus here is narrower, specifically on what Jillian wrote about: selling birth-control pills over the counter. Robert makes a good case that it’s easy to overestimate the reduction in abortion that would result from this deregulation. But I’m not sure it would be quite as minor as he suggests.

First of all, as Robert points out, OTC sales could potentially reduce abortions by 10,000 a year or so. Even if it’s only half that, 5,000 lives is hardly nothing.

Second, Robert writes:

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.

I don’t really think that pills and condoms are interchangeable. They achieve the same result, but each has its own specific advantages and disadvantages. A single woman with a busy social life might think: “I have the self-discipline to take a pill every day, but not to make sure I always use a condom, particularly when my judgment is impaired or the need arises unexpectedly. So the pill would be ideal for me, if I could just go and buy it. Unfortunately, the hassles and discomfort of a doctor visit, followed by standing on line at the pharmacist, discourage me. So I’ll rely on condoms and take my chances.” Or, without reasoning it out like that, she could just keep postponing her visit to the doctor, as we all postpone unpleasant tasks.

The key, I think, lies in Robert’s admirably concise summary of the question:

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.

Leaving aside the question of whether “rather” is the correct term in (A) and (B) (sometimes unavailability, embarrassment, forgetfulness, passion, insouciance, or a recalcitrant partner are responsible for unprotected sex), well, I wouldn’t guess that it’s “a high number,” but I wouldn’t call it negligible either.

Logically, Robert is right: If a woman isn’t on the pill, all she has to do is use a condom and she’ll be pretty safe (though the pill is more effective, so if you substitute condoms, you will have more unplanned pregnancies through “slippage or breakage”). But economists assume that people always do the logical thing when it comes to money, and we’ve all seen how well that works out. Does it make any more sense to apply the same assumption to sex?


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