The Atlantic has an interesting piece up about a surprising trend in birth control. As the article puts it:
If recent trend stories are to be believed, such as one from Ann Friedman at New York Magazine, some heterosexual women—particularly those in long-term, monogamous relationships—are giving up on the default birth control options. Synthetic hormones come with side effects, condoms don’t feel great, intrauterine devices are kind of scary. And so they turn to what seems to be the only method left for avoiding pregnancy: “pulling out.” A study by Duke University Medical Center resident Dr. Annie Dude found that 31 percent of women ages 15 to 24 had relied on the withdrawal method at least once.
I’d heard this statistic before, but usually I’d seen it packaged as a failure of people to plan for sexuality and use birth control. Sometimes sex “just happens” (the argument goes) so a scarily high proportion of teens and young-adults have had what I’d call unprotected sex at least once. But this article paints it in a different light. This isn’t just a failure to plan on those people’s parts, it’s a conscious choice, a rejection of what the author calls “the whole black-box approach to their reproductive systems.” According to the author, this updated version of family planning – called fertility awareness-based methods, or FABM – involves measuring the physiological signs like temperature, cervical mucus, even chemical tests to test hormonal levels. Done properly, it’s apparently just as effective as methods like the pill and condoms.
Now, I want to see more about this statistic before I accept it. It’s just a little too convenient. I also have problems with a fertility method that tells women that they can avoid pregnancy if they just do this complicated set of calculations correctly (with the implication that pregnancy traces back to a failure on their part). But what really interests me here is the ethics. Is FABM really more ethical than contraception? Or more precisely, as I don’t really have any ethical problem with contraception myself, would the people who object to things like condoms and hormonal birth control pills, still have those objections for FABM?
In discussing birth control I’ve come across three main arguments against it.
1. Sex is for baby-making, and contraception makes this impossible (or at least not its main purpose) – which is bad.
2. Sex should be just between a married man and woman. Pregnancy provides natural pressure to keep people from having sex before they’re ready to start a family. So contraception enables promiscuity.
3. Contraception actually leads to more abortions because it prevents pregnancy even when conception occurs. If the zygote doesn’t implant it’s flushed out, leading to its death. So at least some kinds of contraception are really abortifacients.
So let’s take these one by one.
Sex is for baby-making, and contraception shuts that whole thing down.
Here’s Aquinas’s argument from Summa Contra Gentiles (tr. Vernon Bourke; here)
Now, it is good for each person to attain his end, whereas it is bad for him to swerve away from his proper end. Now, this should be considered applicable to the parts, just as it is to the whole being; for instance, each and every part of man, and every one of his acts, should attain the proper end. Now, though the male semen is superfluous in regard to the preservation of the individual, it is nevertheless necessary in regard to the propagation of the species. Other superfluous things, such as excrement, urine, sweat, and such things, are not at all necessary; hence, their emission contributes to man’s good. Now, this is not what is sought in the case of semen, but, rather, to emit it for the purpose of generation, to which purpose the sexual act is directed. But man’s generative process would be frustrated unless it were followed by proper nutrition, because the offspring would not survive if proper nutrition were withheld. Therefore, the emission of semen ought to be so ordered that it will result in both the production of the proper offspring and in the upbringing of this offspring.
It is evident from this that every emission of semen, in such a way that generation cannot follow, is contrary to the good for man. And if this be done deliberately, it must be a sin. Now, I am speaking of a way from which, in itself, generation could not result: such would be any emission of semen apart from the natural union of male and female. For which reason, sins of this type are called contrary to nature. But, if by accident generation cannot result from the emission of semen, then this is not a reason for it being against nature, or a sin; as for instance, if the woman happens to be sterile.
This is a little complicated, but the gist is this:
(1) Things are good when they can actually reach the purpose (end) they’re aiming for. And it’s sinful when you use something in a way that frustrates this purpose.
(2) The purpose of the excretion of semen is to create new human life.
(3) When you have sex (at least setting aside between two lesbians) you know that at least one of you will be excreting semen.
(4) If you’re having sex in a situation where you know conception won’t happen, you’re frustrating its natural purpose.
(5) Which is sin.
(6) So it’s immoral to have sex in those situations.
So basically if you have sex in a way that couldn’t lead to procreation (or, as Aquinas argues in the following section, where you wouldn’t be prepared to raise and provide for any resulting offspring), that’s a bad use of sex. So any kind of contraception would seem to turn sex on its head. The Catholic church allows the rhythm method, where couples chart when they’re likely to be fertile and avoid sex then, but that always seemed counterintuitive to me. I’ve actually discussed this view with a bioethics prof who specializes in Catholic approaches to sexuality and contraception, and he agreed that the Catholic teaching allowing the rhythm method was a pretty radical departure from what the Catholic church had said in earlier centuries. That doesn’t make it wrong, of course, but if you’re going to defend it.
FABM is basically an updated, more scientifically-driven version of the rhythm method. So if you think there’s a real difference between using a bit of latex to keep sperm and egg apart and using knowledge of your fertility to keep sperm and egg apart, FABM is better on this count than artificial contraception. And I’m sure some Catholics could explain the reasoning behind this distinction better than I can. But if the problem is sex used fo some purpose other than procreation, I really struggle to see why having sex when you know it’s not likely for reason A (contraception) is wrong, whereas having sex for reason B (you know you’re not fertile) is okay.
(Btw, this idea apparently isn’t just for Catholics anymore. For instance, 1flesh.org, a popular anti-contraception site, was started by a Catholic blogger but I’ve seen links to it from more than a few Protestant evangelicals.)
Birth control makes people promiscuous
This view was satirized excellently by That 70s Show a few years back. If you haven’t seen the scene, check it out:
We saw this view in real life last spring, with Rush Limbaugh’s calling Sandra Fluke a slut for using birth control. The idea seems to be that when you buy medication letting you have sex without risk of pregnancy, what you’re really doing is buying lots of sex. As part of his first comment on Sandra Fluke, Rush said of her parents, “Your daughter goes up to a congressional hearing conducted by the Botox-filled Nancy Pelosi and testifies she’s having so much sex she can’t afford her own birth control pills and she agrees that Obama should provide them, or the Pope.” Then in the following day’s broadcast he described her as “the Georgetown student who went before a congressional committee and said she’s having so much sex, she’s going broke buying contraceptives and wants us to buy them,” and asked, “what would you call someone who wants us to pay for her to have sex — what would you call that woman? You’d call them a slut, a prostitute.”
The prostitute line almost makes some kind of logical sense, at least if people purchased prostitutes for the month and kept them on retainer. (Also if the people paying for birth control were actually buying the right to have sex with her, which they’re not.) But the slut remark is completely in left field, because there’s nothing about birth control that says the woman having it will have sex more than the woman not on birth control. All birth control says is you have the ability to have sex even once, with any one guy (or any number of guys, but it costs just as much and works just the same if there’s only the one) without running the risk of getting pregnant.
(And in case my dry humor doesn’t translate well online: I don’t think having insurance pay for your BC makes you a prostitute. There’s a kinda-sorta similarity there, enough that I can at least understand the argument, but… just, no.)
This whole line of argument is actually beyond insulting. I’m not sexually active, but that reason has nothing to do with fear of pregnancy. Women aren’t sex-crazed sluts who only turn guys away because we don’t want to get knocked up. Birth control involves taking responsibility for your sexuality and its likely consequences. It’s used within marriage and committed, monogamous relationships, not just as a way to enable commitment-free sex. And suggesting otherwise strikes me as really taking a low view of how women approach sexuality and relationships.
But, for the record, if artificial contraception makes women into sluts, and if FABM is just as good at mitigating the effects of promiscuous sex, FABM would do just as thorough a job of making women open for business. Because it also would let women have sex without having to worry about getting pregnant.
Birth control causes abortions.
There’s a lot of bad information out there about contraception and abortion, and it would take a full blog post on this one issue to do it justice. Maybe someday. But as I understand it the gist of the argument goes like this. Setting aside barrier methods like condoms, most BC performs two functions: it prevents fertilization and, if fertilization occurs, mucks up the uterus so implantation is less likely. The first isn’t really a problem, abortion-wise, since you don’t have a human life until sperm actually penetrates egg. But in the second case, you have a newly-created life that’s slipping away because you’ve done something to keep it from implanting. Which, if you believe a newly-fertilized zygote is just as human as you and me, starts to look like murder.
There are a lot of wrinkles here worth discussing. Like I said, this really needs its own post, really more than one. But as a start: As Libby Anne pointed out in her now-viral blog post “How I Lost Faith in the Pro-Life Movement,” women’s bodies are actually really bad at this implantation thing, and a woman having unprotected sex is far more likely to create a zygote that fails to implant than a woman using hormonal birth control is – because women on hormonal birth control are so much less likely to create said zygotes. Now, I can imagine someone arguing that death through birth control is intentional whereas death through the zygote just not implanting on its own is outside our control, but really, that seems like a hyper-technical distinction. Especially given that most people who take hormonal birth control don’t understand its mechanism at this level, meaning that implantations like this are more like a rare side effect of a medication they take: foreseeable, perhaps – it’s listed right there in the drug information pamphlet – but not really foreseen if you don’t take the time to wade through all that information.
The bigger question: does the pill actually do this second function? If things break down along the first lines, egg meets sperm, and a zygote (meaning a unique human life according to the pro-life movement) forms, will the body actually keep it from implanting? First, as Libby Anne points out in the post I linked above, the pill is far more effective at blocking fertilization than the pro-life movement usually claims. But there’s also not much evidence at all that the birth control pill actually prevents implantation. Last summer the NY Times ran a very thorough piece looking at whether the morning-after pill blocks implantation and discovered there was no evidence it did, and that the FDA’s including of language warning of that was entirely speculative – and even with the daily, non-morning-after kind of birth control pill, there still wasn’t evidence it actually caused this effect:
Experts say implantation was likely placed on the label partly because daily birth control pills, some of which contain Plan B’s active ingredient, appear to alter the endometrium, the lining of the uterus into which fertilized eggs implant. Altering the endometrium has not been proven to interfere with implantation. But in any case, scientists say that unlike the accumulating doses of daily birth control pills, the one-shot dose in morning-after pills does not have time to affect the uterine lining.
“It takes time for an endometrium to change, for its cells to divide,” said Susan Wood, a biochemist who, shortly after Plan B’s approval became the F.D.A.’s top women’s health official and later resigned, frustrated with the delay in making the pill available without prescription.
Implantation also likely wound up on the label because of what Dr. Gemzell-Danielsson called wishful thinking by some scientists, who thought that if it could also block implantation, it would be even better at preventing pregnancy.
So essentially: daily hormonal birth control does thin out the endometrial lining over time, but this hasn’t been shown to actually make implantation less likely, and doesn’t apply to the most controversial kinds of birth control medication (the morning-after pill) in any event. The implantation problem, if it exists at all, is starting to seem much more like a bug than a feature. I understand the moral concerns pro-life people have with something that lets a human life begin and then stops the natural process that lets it flourish – but surely the solution is to work for more effective birth control medication, not spread fake-science nonsense that taking the pill amounts to baby-killing?
Now, to its credit, the FABM method doesn’t run into this problem by itself. It teaches women to chart when their body is fertile (with much more success than you’d get from the old-style rhythm method), and if you’re only having sex when you’re infertile, fertilization’s obviously not going to happen. But in FABM’s zeal to be secular it doesn’t actually say you have to abstain during your fertile period – it just says you should use secondary birth-control methods on those days. So I can see an uptick in morning-after pill usage on these days. If the morning-after pill is an abortifacient, and if even one failed implantation is too many, seems like that’s still a problem that needs to be addressed.
All of that said: there are some ways that FABM is better than artificial birth control. It’s natural, for one thing: it doesn’t mess with a woman’s hormone levels so you wouldn’t have the problems with side effects. It’s certainly cheaper, once you get through the initial cost of training and equipment to measure hormonal levels. And for some women, not treating their bodys’s natural process like something that must be regulated and commodified may be reason enough to take a long hard look at FABM. Natural is in these days, at least in certain circles. I’ve got no objection to women who choose to use FABM (as long as they’re not being pressured or taking on the blame for fertility on themselves – which is a real concern), and I certainly think it’s better to do this more scientific version than the old-school method of counting days since your last period.
But from a moral perspective, I’m not sure it should be that much better than traditional, artificial birth control. FABM is just as likely to lead to promiscuity. It’s only better on the whole “sex should be for baby-making” count if you think there’s a difference between having sex when you know latex or artificial hormones makes you infertile, and when you know your naturally-occuring hormonal cycle makes you infertile. And on the abortion score… well, there’s just not much proof at all that traditional birth control does this to begin with.
If women want to use FABM for these practical reasons, that’s their own choice and I’ll have no objection, if it really is their choice. And if it’s actually as effective as this article claims. But I think it’s a mistake to think FABM would be any less morally contentious than the pill is. (How did the pill get to be an issue again, anyway?) At least not if people are consistent in how they treat the two.