Better Birth Control Hasn’t Made Abortion Obsolete

Has modern birth control made abortions a thing of the past? The lawyers for the state of Mississippi want to accuse the US Supreme Court of this. In a brief in the pending case that could overturn abortion rights nationwide, Mississippi attorneys wrote“[E]While abortion was once viewed critically as an alternative to contraception, changing circumstances are undermining that view.” Access to contraception has improved, they noted, and failure rates for some methods are “now approaching zero.” Effective birth control means people no longer need abortions, according to Mississippi attorneys.

But Sarah, a professional living in the Washington DC suburbs, did. She had always wanted four children, but they had four. After their fourth child was born, she and her husband researched birth control options and ended up with the seemingly foolproof one: a vasectomy. “We’re very thorough people, very by the book,” she said. “We wanted to be really, really sure that we didn’t have an accident.”

Then, on Mother’s Day, Sarah found herself in her bathroom looking at two lines of a pregnancy test. She knew almost immediately that she was going to have an abortion.

Statistically, Sarah’s experience was very unlikely. There’s a reason vasectomies are touted as one of the most reliable forms of contraception: They have a failure rate less than 1 percent, in contrast to something like condoms, which has a failure rate closer to 13 percent. But because a 1 percent chance isn’t zero, some vasectomies fail every year, just like any other form of birth control. As a result, thousands of Americans who took steps to avoid pregnancy will still seek abortions. A Report of the Guttmacher Institute found that about half of abortion patients used contraception in the month they became pregnant. Presenting abortion as a procedure that can be avoided through personal responsibility does not prevent abortions from happening, experts tell us. Instead, it just blames women more.

Americans need better access to contraception. Countries where birth control is cheap or free and more readily available to more people have far fewer unwanted pregnancies, he said dr Emily Godfrey, Professor of Obstetrics and Gynecology at the University of Washington. The unwanted pregnancy rate in the United States is about 21 percent higher than in the average Western country, where Social Security or other universal health programs are common. Also a big one Decrease in unwanted pregnancy rates in the US was between 2008 and 2011 correlated with an increase in the use of long-term, reversible methods of contraceptionlike IUDs or implants that have low failure rates. And this big drop in unwanted pregnancy rates has led to it fewer abortions.

But that’s not the same as saying that using birth control eliminates the need for an abortion, Godfrey said. Yes, Americans can vote 16 forms of contraception, two types of emergency contraception or the morning-after pill; and three methods of sterilization. But there are many reasons why she says access to abortion remains necessary.

The simplest and most inevitable reason is that contraception can – and does – fail. This applies to even the most reliable birth control methods such as IUDs, implants and sterilization.

Many abortions also take place after using contraceptives

Percentage and estimated number of out-of-hospital abortion patients in 2014 who reported using different types of birth control during the month of their pregnancy

contraceptive method number (estimated) percent (weighted)
Used some form of birth control 471,300 50.9%
condom 224,400 24.2
Short-acting hormonal methods 131,300 14.2
pill 116,400 12.6
ring 12,700 1.4
patch 2,200 0.2
retreat 79,400 8.6
injections 14,900 1.6
Reversible methods with a long effect 9,500 1.0
spiral 7,700 0.8
Implant 1,800 0.2
sterilization 1,600 0.2
Miscellaneous 10,100 1.1
Didn’t use birth control 454,900 49.1

Based on a survey of a nationally representative sample of 8,177 women who underwent an out-of-hospital abortion in 2014. The number of abortions was rounded to the nearest hundred.

Source: Guttmacher Institute

According to the study by the Guttmacher Institute quoted in the graphic above, it is around 51 percent Abortion patients in 2014 reported using some type of birth control the month they became pregnant. The proportion of patients in this study who reported using a long-lasting, highly effective method of birth control was small – far more respondents reported using a condom in the month they became pregnant, which of course doesn’t necessarily mean that they used one when they got pregnant. But small percentages still represent thousands of individuals. Just 0.8 percent of respondents said they had used an IUD in the month they became pregnant, but that 0.8 percent resulted in an estimated 7,700 abortion patients that year. Even the 0.2 percent who reported having used either sterilization or implants represented an estimated 1,600 and 1,800 people, respectively, who ultimately needed access to an abortion.

But the political abortion rhetoric doesn’t count on it, he said dr Christine Dehlendorf, Professor of Family Medicine at the University of California, San Francisco. “The ‘safe, legal and rare’ mantra is stigmatizing,” she said. “It’s called [abortion is] a bad outcome to avoid as opposed to a healthcare service to which you should be able to access.”

And as a result, people are getting the message that abortion is a purely avoidable problem — something a person can avoid When You are responsible enough. Sarah’s story comes from a collection of abortion experiences that readers shared with FiveThirtyEight. Our database has hundreds of entries, and a common theme is that people reported getting pregnant while using birth control – and then felt that way you were the ones who had failed. The contributors said they did everything right but still felt responsible.

User error contributes to unintended pregnancy, Godfrey said. This is especially relevant when it comes to methods like birth control pills, which need to be taken correctly every day, or physical methods like condoms, which rely on using the right thing in the moment. But neither can user error be dismissed as sexual irresponsibility, she added. It’s just normal human behavior. “There is research that shows people skip a pill or two a month on average. That is not just birth controlit is all long-term pills … depression, diabetes, everyone,” she said. “No one uses a drug perfectly for 25 years. It is not possible.”

Over and over again, contributors described struggling with the feeling that abortion should be something they should only need if they were victims, young and uninformed, too poor for birth control, or just too irresponsible to take it properly. The stigma attached to this stereotype made Sarah uncomfortable with her decision, even though she knew it was the right choice for her. “Society tells you to feel bad, so I felt bad,” she said. “But ultimately I realized that if you can’t control when you have an abortion, you can’t control when you’re going to have kids either,” she added. “Because I literally did everything I could to not get pregnant.”

And any attempt to portray abortion as preventable through birth control must consider the many reasons people may not be able to get birth control — and even reasons some may not want it. After all, not all sex is consensual. And even for People who can plan aheadbirth control can get expensive – an IUD can cost up to $2,000 until you include both the device and doctor fees, Godfrey said. Add to that the fact that the contraceptive methods that work the least are also those over which patients have the least control. Some doctors have refused to give patients IUDs they demanded and in other cases refused to take out spirals patients are no longer wanted. “Black and Latino women are more likely advised and encouraged to use IUDs to limit family size rather than encouraged to use a [birth-control] Method that they don’t want,” said Dehlendorf.

The reality is that birth control might reduce the need for abortions—but it can’t make abortions go away. That’s because the need for an abortion exceeds the possibilities of birth control, Godfrey said. people can be to attempt becoming pregnant and still find themselves in situations where they wish to have an abortion. There will always be people who don’t get reliable birth control. There will always be people who cannot or do not want to use certain contraceptives. And there will always be people whose birth control just didn’t work.

CORRECTION (May 19, 2022 10:04 am): A previous version of this article misreported the condom failure rate. It’s about 13 percent, not 24 percent — that’s the percentage of out-of-hospital abortion patients in 2014 who reported using a condom during the month of their pregnancy.

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