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Slate (http://www.slate.com)
Human Nature (http://www.slate.com/articles/health_and_science/human_nature.html)
Science, technology, and life.
Oct. 3 2014 12:57 PM

How Choice Can Stop Abortions

Long-acting reversible contraceptives can cut the teen abortion rate by 75 percent.
By William Saletan (http://www.slate.com/authors.william_saletan.html)

Want fewer of these? LARCs are the only scientically proven method we have.

Photo by KatarzynaBialasiewicz/Thinkstock

F
or some time, scholars and partisans have been ghting over two ways to reduce the abortion rate. One side favors
contraception; the other favors abstinence. Each side has its logic. If you adequately design and deploy technology to block
conception, itll work. And if you dont have sex, you wont get pregnant. But the devil is in the ifs. If you fall o the abstinence
wagon, and if you dont take your pill or properly use your condom, youre not just screwed. Youre knocked up.

William Saletan

(http://www.slate.com/authors.william_saletan.html)

Will Saletan writes about politics, science, technology, and other stu for Slate. Hes the author of Bearing Right (http://www.amazon.com/dp/0520243366/?tag=slatmaga-20).
(http://www.amazon.com/dp/0520243366/?tag=slatmaga-20)

(http://www.slate.com/authors
(https://twitter.com/sale
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So the debate boils down to this: Which approach can overcome the weakness of human nature? Can the
abstinence crowd nd a way to keep people chaste? Can the contraception crowd nd a way to make people stick to their birth control?
Can either side deliver the bottom line: fewer abortions?

A study (http://www.nejm.org/doi/pdf/10.1056/NEJMoa1400506) published Thursday in the New England Journal of Medicine

(http://www.nejm.org/doi/full/10.1056/NEJMoa1400506) (and outlined in Slate by Darshak Sanghavi
(http://www.slate.com/articles/health_and_science/medical_examiner/2012/07/preventing_unwanted_pregnancies_forget_sex_e
and Amanda Marcotte
(http://www.slate.com/blogs/xx_factor/2014/10/02/st_louis_choice_project_provide_free_iuds_and_no_one_gets_pregnant.html
strikes a major blow for the contraception camp. It shows that women prefer long-acting reversible contraceptives (LARCs), that these
methods can almost eliminate birth-control failures, and that they shrink the abortion rate by a margin that far exceeds anything oered
by the other side.

Why should we believe that people who cant stick to pills or condoms can stick to chastity?

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Heres how the study ts into the debate. Conservatives often cite the failure rate of contraception to discredit it as a means of
preventing abortions. They dont deny that programs to promote contraception can increase its use or that when its used perfectly, it
works. What they question is the reliability of the whole chain of events. They point out, for example, that 99 percent of women who
have undergone an abortion have, at some point, used contraception (http://downloads.frc.org/EF/EF14A37.pdf) and that half of
U.S. pregnancies are unintended even though 89 percent of women who might get pregnant claim to use birth control
(https://www.lozierinstitute.org/the-overlooked-key-to-the-drop-in-u-s-abortions/). Just because somebody tries the pill or
buys a condom doesnt mean theyll stick to it.

The same is true of abstinence. Conservatives have studies indicating that when teens are taught not to have sex, many of them say
theyll abstain (http://www.lifenews.com/2012/04/11/credit-abstinence-with-helping-reduce-teen-birth-rates/) and some
follow through. They also have data to show that when teens postpone or avoid sex, the pregnancy rate goes down
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1716232/). But no study conrms the integrity of the whole causal chain.
Abstinence, after all, is just another method of birth control. And its the hardest one to comply with. Why should we believe that people
who cant stick to pills or condoms can stick to chastity? And even if abstinence-only education reduces the likelihood of sex, how do we
know that this eect isnt washed out by the higher probability of pregnancy (because the sex is unprotected) in the resulting
encounters?

To settle this argument, we need the whole sequence, from beginning to end. We need to see an abstinence or contraception program
that cuts the abortion rate.

Thats what the new study delivers. More than 1,400 teenage girls in the St. Louis area were oered a range of free contraceptives.
Seventy percent chose LARCs. The beauty of LARCs is that they bypass the problem of inconsistent use. Once the implant or IUD is
inserted, you dont have to think about it every time you have sex.

After three years, researchers counted the pregnancies. For hormonal IUDs and injections, the annual failure rate was ve per 1,000
women. For hormonal implants and copper IUDs, the failure rate was zero. These methods wildly outperformed contraceptive rings (52
failures per 1,000), pills (57 per 1,000), and patches (61 per 1,000).

During the study, the abortion rate among teenage girls nationwide was 15 per 1,000 women. Among sexually experienced teens, it was
42 per 1,000. But among the girls in the study99 percent of whom were sexually experiencedit was 10 per 1,000. Thats a 75 percent
reduction in the expected abortion rate.

You can argue with the methodology. There was no control group, and the sample wasnt random. But the odds were stacked against
success. The girls were found at or through community clinics. Nearly three-quarters (compared with one-quarter of teenage girls
nationwide) said theyd had intercourse in the previous month. Forty-eight percent had been through an unplanned pregnancy, 25
percent had given birth, and 18 percent had undergone an abortion. Sixty percent had been relying on condoms, withdrawal, or no birth
control at all.

Abstinence proponents have nothing like this. Not one study has shown an eect of abstinence education on the rate of abortion. The
best thats been oered is a decade-old rough calculation (http://www.jillstanek.com/2009/08/abstinence-education-makes-
made-a-dierence/) that states that accepted federal money for abstinence-only education
(http://104babcock.wordpress.com/2009/07/07/abstinence-only-states-more-eective/) had greater reductions in teen
pregnancy. But that crude index was trumped by a study that measured what the states were actually teaching
(http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0024658). It turned out that the correlation between
abstinence education and teen pregnancy was, if anything, positive.

Pro-lifers also claim that the laws theyve enacted in many statesparental involvement, waiting periods, restrictions on public funding
have prevented abortions. But even using their methodology and calculations, from ages 13 to 17, the asserted reduction is just four
abortions (http://www.heritage.org/research/reports/2007/02/analyzing-the-eect-of-state-legislation-on-the-incidence-of-
abortion-among-minors) per 1,000 girls. The LARC study beats that result by a factor of eight.

This study wont end the policy debate. It certainly wont silence the ideologues. But for sensible people who consider themselves pro-
life, it ought to inspire reection. Contraceptive advocates are oering you a 75 percent cut in the abortion rate. What are advocates of
abstinence oering you? For that matter, what are you getting from any of the laws enacted by the right-to-life movement? For 40 years,
activists and politicians on the right have sold you an agenda of piety without results. Now you have another choice.

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