This is what the world’s lowest abortion rate1 looks like.
20120921 Free birthcontrol – Images by Sander de Wilde
And yes, free birth control works in the US, too.
Also, I think this is an interesting answer to the question, “if Doctor Who were Belgian instead of British, how would the Tardis look?”
- Or very close to the worlds lowest, depending on what year you look at and how you measure. [↩]
Free is one thing, out of a vending machine is another. The Pill is not aspirin.
What if we both educate and trust our populace? Would it be okay then?
Sure, if they have side effects or some bullshit they can look it up on the Internet or whatevs. Prescriptions are oppression!
Yes. By “educate” I of course mean, “allow them to look it up on the internet.”
Well, that’s a relief. Otherwise I might have been under the impression that, instead of wanting to have an actual discussion about the benefits and drawbacks of direct-to-consumer distribution of hormonal birth control, you wanted to get into a “if you disagree with me you hate freedom” snarkfight.
Amp is conflating free birth control (yay!) with something that is even beyond OTC access to the Pill – or, more accurately, Pills, since there is not a single Pill. I don’t trust Big Pharma to educate or empower consumers.
According to the website that these pictures come from:
“The Belgian organisation Health and Prevention has put up a pink machine in the busy centre of Brusesels distributing free birthcontrol pills. In fact it distributes flyers talking about all sorts of birthcontrol, and getting the message around that people should always talk to their docter about this.”
Which is rather unclear, but it seems that this is a machine that *looks* like it distributes free birth control, but instead gives you informational flyers. If this is the case, then that sort of alleviates Mythago’s point, but is a rather odd bait-and-switch.
In any case, this is very clearly a one-off public awareness/publicity stunt, not the actual way people get hold of birth control in Belgium.
That is extremely weird.
As of last month or so, contraceptives became free, in France, for 15-18 year olds. It has been possible for a long time to obtain free contraceptives anonymously and confidentially, but only at specialized (family planning) locations. Now it’s just a matter of a prescription that can be filled at any pharmacy. By the way, free means, of course, ‘paid by national health care’.
The Belgians are often ahead of us in these things, so I’d be surprised if they do not have a free, confidential way to get contraceptives. So ‘education campaign’ was the first thing I thought about. The phrasing on the machine (new contraceptive pills – free) is certainly a bit misleading, but the inscriptions on the distribution slot and elsewhere made me think that it was more about getting info than about getting actual contraceptives.
In the early 2000 contraceptions were free in Belgium, but they ceased to be free when a christian party became part of the government (I don’t remember if they were the ruling party or if they were a part of a coalition). The number of abortion did rise somewhat when contraception ceased to be free. I don’t know if this change has been reversed in the years since.
Emergency contraception (the so called “morning after pill”) is still free as far as I can see and it’s also prescription free (as in no doctor is needed to write a prescription).
The correlation between high availability and low cost of contraception and lower abortion rates are a no-brainer to me.
This is a dumb argument. Belgium has a low abortion rate (for countries where abortion is available for any reason) and has free contraception. But there are other examples. Belgium also has mandatory counselling, which you didn’t mention. Places where abortion is restricted, like Poland and Ireland have lower rates, which you didn’t mention. Places where contraception isn’t free like Utah have a lower abortion rate, which you didn’t mention. Places where contraception is free like England also have high rates, which you didn’t mention. Pointing to one place which happens to have both low abortion and free contraception doesn’t mean anything.
I didn’t know about the mandatory counseling, but I’d be interested in hearing more about it. I didn’t mean to imply that free birth control is the sole and only trait; actually, I thought the photo also indicated how determined they are to educate people about using birth control. (Even more so, now that I know it was actually a bait-and-switch.) Education about birth control is essential – availability alone isn’t enough.
It’s a mistake to cite Poland as a pro-life success story. It’s true that Poland claims to have almost zero abortions, but it’s also true that statistic is a measure of legal abortion, not a measure of all abortions. Of course, legal abortion numbers are low in Poland; that’s because women are either getting illegal abortions or going to other countries.
It should also be noted that even women who are having a serious medical crisis are in effect banned from getting abortion in Poland, in some cases leading to terrible health consequences. Ditto in Ireland, where a hospital recently allowed a pregnant woman to die rather than give her an abortion.
It’s not just “one place.” If you look at the overall trends, it is clear that countries with highly available contraception have lower abortion rates than countries with less available contraception.
There are some individual exceptions – as there always are – but that doesn’t erase the trend.
Moreover, birth control is a policy that can be applied pretty much anywhere. The low rate in Utah is a result mainly of the majority of people in Utah being Mormon; I don’t think that either converting most Americans to Mormonism, or kicking out the non-Mormon majority, is a viable policy option, but if we aren’t going to do that then Utah’s example isn’t exportable.
How about we point to a Washington University study that demonstrates free contraception cuts the abortion rate by 41%-71%?
—Myca
Utah isn’t exportable (it does an expanding US founded religion though). But the liberal north European / Catholic culture you get in Belgium is a bit of a one off too. If you want a US + free contraception examples the UK and Canada are good examples and they’re not much lower than the US. They are certainly not Belgium.
As I said, it’s not just being free; the education and promotion aspect is important, too. UK birth control residents complain that there have been enormous cuts to this aspect.
The studies actually done in the US, with us populations, show that offering free high-quality birth control has a big effect on Americans. Do you really see no difference between the chance of birth control working, and trying to convert the country to be mostly Mormon?
I can’t help but think that you know perfectly well that there’s an enormous difference, but you’re just being argumentative for argument’s sake.
No it doesn’t. The studies assumptions (no selection bias, validity of historical controls) are ridiculous and patently wrong. The response they’re proposing is absurd, it is a stunt to get headlines. We’ve had a major expansion of free contraception do you expect any major shift in abortion rates in a years time?
If large numbers of people were little above animals and were unwilling to pay for contraception and unable to regulate sex based on contraception status (but strangely determined to access abortion), free contraception would have a huge impact. That’s not the case.
The big driver of abortion is abstinence and acceptance of unwanted pregnancies. A 2% failure rate over 20 years of active sex gives a 1/3 chance of an unwanted pregnancy (roughly current US lifetime abortion incidence). High levels of abortion are totally compatible with high levels of contraception use.
I think it’s probable that Amp, by inclination if not by deliberate choice, is inclined to overestimate the positive impact of contraception on abortion rates. His ilk (I wish I had an ilk, I just have a cohort), probably the same.
That said, incentives matter. I hold this more or less as an object of religious faith, but the evidence of the general truth of the proposition is massive. Free or cheap contraception will be used more than expensive or forbidden contraception. Now, it is possible that free contraception will lead to more sex, causing more pregnancies as a matter of statistics, leading to some more abortions. But my Analysis Fu is strong, and intuitively tells me that a small increase in (say) condom use is going to swamp a small increase in sex, in terms of the abortions resulting or not resulting from either side of the equation.
And THAT intuition is based on looking at mature, reasonable, rational optimizing people with a decent grasp of the odds and the costs of babies. Here’s the thing. Those people (being humans, we’re a horny lot) have a pretty decent amount of sex.
Young people have insane amounts of sex. I remember; I was there once. Young people are not mature, reasonable or optimally rational. Young people will stick their dick in the cheese slicer, if the cheese slicer smiles at them. (Old joke, sorry.) They are GOING to have sex; almost the only question is whether they’ll use contraception. (OK, there are lots of other questions, but this is the operative one for this discussion.)
And (being young, dumb, etc.) whether they use contraception will depend, in very large part, on how hard the contraception was to get. Which really means that the less-abortions side of that equation above SWAMPS the more-sex part; giving teenagers contraception doesn’t cause them to have more sex. Nothing could cause them to have more sex. They’re having as much as they possibly can.
So – while I think that there is still a very strong argument that adults can pay for their own birth control without economic stress, and the Sandra Flukes of the world are just absurd caricatures of liberal cradle-to-grave neediness, the idea that free birth control could really hit abortion rates is, in fact, very plausible, on the edge of compelling. I would want to see a lot more evidence, and evidence that has a bipartisan source, before I’d be willing to buy the idea that “and therefore, lets give free birth control to everyone to cut abortion”…but the idea is plausible, the incentives are pretty obvious, and the data, while imperfect, doesn’t undermine the idea.
Alex:
They selected for a group that was especially likely to be “at risk” for having abortion (and said that’s what they were doing). In this context, that seems like a valid approach.
Similarly, the numbers they used for comparison don’t seem problematic. Can you spell out your objections, please?
Obamacare won’t set in instantly (most people insured under Obamacare won’t even start until 2014), and it doesn’t replicate the educational aspect of the study. I’m also not sure that it effectively makes high-quality birth control as available as it should. So I don’t expect it to have an impact that is as large, or as fast, as what that study showed.
But I do expect that IF the result of Obamacare is to make the most effective long-term birth control methods significantly more popular, then yes, that will lower the abortion rate. In a more reasonable world, we could deliberately work on increasing this effect, for instance through campaigns to increase awareness of how much more effective birth control like the IUD and the implant are and how affordable they are (if they are) with Obamacare.
The expected failure rate of the implant or the IUD is 1%; of the pill is 5%; and of condoms is 10% to 15%. So yes, if the more expensive and effective birth controls become more widely used, it’s reasonable to think that would lead to a reduction in abortion. What’s not reasonable is thinking it would have no effect.
No. There are two effects. You’ve got it the wrong way round – the pill and condoms are expensive, iuds and implants inexpensive (assuming you stick with them for the duration) but with high up front cost. Free contraception favour ineffective methods and switching off long term methods, as it removes the price incentive to use effective methods and stick with them. Maybe some people have financing trouble, so use ineffective methods as a proxy for a loan, but that’s a separate effect. I don’t know how you can be so sure the financing effect dominates.
So given two choices, both free, you assume that people would flock to the less effective methods (which are also, generally speaking, more of a pain to use)?
In any case, a high upfront cost is a barrier that many people in low-income groups can’t cross, even if it’s cheaper on the long run. And better access to health care professionals who can address the various choices will also make a difference, like the educational component in the study Amp’s discussing.
Free contraception favour ineffective methods and switching off long term methods, as it removes the price incentive to use effective methods and stick with them.
Alex, I am not sure this is anywhere near accurate. First of all, ‘free’ really isn’t, unless you are talking about the baskets of condoms we had hanging in the stairways at the Institute. Usually, free is understood as ‘included in your medical coverage’, which is most countries means ‘paid through your taxes’.
In the US, my experience with birth control has been rather limited (I have had the same girlfriend, now wife, since my first few months in the US) But in France, almost any girl I knew (my sisters, my friends, my girlfriends) all used long term, relatively cheap, low failure solutions. The pill may be popular amongst older women, but for high school and college students, it’s injection or implant, unless there are medical contraindications. This is because the bureaucrats can do math, and would rather pay for something that works and is cheap.
From a press release about that study we’ve been discussing (emphasis added):
That’s an enormously higher percentage choosing IUD or implant than can be found among the general population.
Finally, I was using “expensive” to refer to up-front costs. You’re right to say that I could have been clearer. But for many women and teens, up-front costs do matter.
Women who have not given birth may still have trouble obtaining an IUD in parts of the United States.
Though, in fairness, that’s not all because of the idea that they’re supposed to change their minds and want children. It’s also more difficult for the doctor, more painful for the woman, and not as likely to be successfully inserted.
OK, Kelly, but you said:
which doesn’t take into account the ways in which long-term methods may be unavailable to large swaths of people anyway
That was Alex, not Kelly.
Thanks, Robert. I was just jumping in with a tangential little sidenote about IUDs.
Aha! Sorry.
“That’s an enormously higher percentage choosing IUD or implant than can be found among the general population.”
Why would you expected it to be the same. These women self selected into the study after recruitment from abortion clinics. Of course you’d expect them to be highly motivated to use very effective, long term and difficult to reverse methods.
Alex, only 16% of the women in the study were patients recruited from abortion clinics. If we exclude those women, we’d fine that 72.9% of the women in the study chose IUD or implant, compared to 6.2% among the general population. It’s pretty ridiculous of you to pretend that’s not a significant difference.
The women recruited from patients at abortion clinics were more likely than other women to have a history of three or more unintended pregnancies. So even if you were right, surely a program that demonstrates effectiveness among a population that’s proven to be more at-risk for unintended pregnancies is worth supporting.
No problem! :)