When a pilot program in Colorado offered teens state-of-the-art long acting contraceptives—IUD’s and implants—teen births plummeted by 40%, along with a drop in abortions. The program saved the state 42.5 million dollars in a single year, over five times what it cost. But rather than extending or expanding the program, some Colorado Republicans are trying to kill it—even if this stacks the odds against Colorado families. Why? Because they insist, wrongly, that IUD’s work by killing embryos, which they believe are sacred. This claim, which is based in bad faith and scientific ignorance, undermines fiscal prudence and flourishing families.
Excellent Family Planning Transforms Family Life
Research from around the world shows that children and families are more likely to thrive when women are able to delay, space, and limit childbearing. The benefits are enormous: healthier moms and babies, less infant mortality and special needs, more family prosperity, higher education, less domestic conflict and abuse—even lower crime rates. Whole communities gain as women (and men!) become more productive, creating a virtuous economic cycle. Public budgets become easier to balance, and more revenues can be invested into infrastructure instead of basic needs.
Despite mountains of evidence showing that family planning empowers family flourishing, early and unwanted pregnancy has been a tough pattern to change, even in the United States. Until very recently, half of U.S. pregnancies were unintended, with over a third of those ending in abortion. For single women under the age of 30, 70 percent of pregnancies are unintended. For teens that’s more than 80 percent. This pattern has many causes, but part of the problem is antiquated family planning technologies that are highly prone to human error. In any given year, 1 out of 11 couples relying on the Pill will end up with a surprise pregnancy. For couples relying on condoms alone, this rises to 1 out of 6!
By contrast, state-of-the-art IUD’s and implants drop the pregnancy rate below 1 in 500 while allowing a prompt return to normal fertility when they are removed. With a modern IUD in place, a woman enjoys he same level of protection as with tubal sterilization. In other words, we now have the technology to make surprise pregnancy truly surprising. It is easy to understand why advocates for children like the American Academy of Pediatrics, and advocates for healthy families like the California Family Health Council and CDC are eager to see these top tier birth control methods become the new normal.
People who care about flourishing families, including those who see themselves compassionate conservatives, should be doing everything in their power to help facilitate a transition to these new technologies. Above all, compassion and prudence dictate that these tools should be available to young and poor women, who (along with their children) are most likely to be harmed by an unexpected pregnancy.
But opponents to modern contraception—led by conservative Catholics—are instead spreading misinformation, insisting that highly effective contraceptives are not actually contraceptives but instead are like “having an abortion mill in your body.” They further insist that each embryo is precious and merits the protections of “personhood.” Colorado has been a battleground in which fetal-rights advocates have repeatedly tried to pass legislation that gives legal standing to fertilized eggs and later embryonic stages of life.
Most recently these same conservative advocates and politicians have come out fighting against programs that would make IUD’s and implants available to young women, even those who already are teen moms, desperately trying to take care of the children they already have and relying on public support to do so.
How Modern IUD’s Actually Work
In reality, all family planning methods available in the U.S. today are true contraceptives: they prevent fertilization of an egg by a sperm.
Pregnancy can be stopped at four points: 1. preventing the production of gametes (eggs and sperm), 2. blocking fertilization (conception), 3. preventing implantation of a fertilized egg, or 4. aborting an implanted pregnancy. Modern IUD’s are designed to prevent fertilization:
- A nonhormonal copper IUD releases copper ions that interfere with sperm motility. The presence of copper may also change the surface of the egg so that it is less easily penetrated by a sperm. In addition, inflammatory cells evoked in the uterine cavity in response to the IUD kill sperm before they can ascend to the fallopian tubes, where fertilization occurs. In this regard, one can view the copper IUD as in intrauterine spermicide.
- A hormonal IUD releases a mostly local dose of levonorgestrel, a hormone in many birth control pills. It causes the mucus at the opening to the cervix to thicken so that sperm can’t get through. Thus, this IUD can be considered a barrier contraceptive, like a cervical cap.
A modern IUD can be thought of as a drug delivery system which has the potential to deliver a variety of drugs to a small target: the cavity of the uterus. The primary and intended mechanism of existing copper and hormonal IUDs, by design, is to prevent conception, and that is what each of these does.
But What If . . . .
What if a sperm got past that mucus plug or despite the spermicidal effects of copper managed to swim up the fallopian tube? What if a sperm and egg did unite? Could the IUD interfere with implantation? Yes. However, since fertilization is rare with either modern IUD, a fertilized egg failing to implant and flushing out is also rare. By contrast, when a sexually active woman is not using contraception, she may flush out a fertilized egg most months until she gets pregnant. Best estimates suggest that 60-80 percent of fertilized eggs never become babies. All of this adds up to a counter-intuitive fact: women who are using contraceptives to prevent pregnancy kill fewer embryos than women who are trying to get pregnant, and the more effective the contraception is, the fewer embryos die.
The Reproductive Funnel
We now know that nature or nature’s god designed reproduction as a big funnel. More eggs and sperm get produced than will ever meet. More eggs get fertilized than will ever implant. More fertilized eggs implant than will be carried to term by a female body. Genetic recombination is a highly imperfect process, and nature compensates by rejecting most fertilized eggs.
In some animals, the mother’s body aborts or reabsorbs an embryo if her stress level is too high or her protein level is too low. Alternately, her body may hold the fertilized eggs in a sort of suspended animation until conditions improve. Human bodies also have several ways to reduce the number of unhealthy babies, by decreasing fertility and increasing spontaneous abortion under bad circumstances. But like genetic recombination, this process is imperfect. Perfectly healthy embryos flush out, while some with birth defects—even horrible defects—get through.
Since spontaneous abortion is a natural and common part of human reproduction—one could say that every fertile woman has an abortion mill in her body—contraceptives actually reduce the number of fertilized eggs that fail to become babies, and the more effective they are at preventing conception, the more embryonic death they prevent. IUD’s are some of the most effective contraceptives available, on par with sterilization. A woman who believes that embryonic life is precious, either to her or to her god, should use the most effective contraceptive available.
Violating Their Own Values and Public Trust
Given these realities, Colorado politicians who undermine access to state of the art contraceptives are neither minimizing embryonic death nor promoting family values.
To reiterate, the research is global and clear: When women are forced to rely on less effective family planning methods, more spontaneous and therapeutic abortions result. So do more ill-timed and unhealthy births. More unhealthy infants suffer and die. A greater percent of children are born to single moms or unstable partnerships. Family conflict increases. More children suffer abuse or struggle with developmental disabilities. More families get mired in poverty. More youth engage in antisocial behavior, including early, indiscriminant childbearing. Public costs associated with teen pregnancy, maternal health, special education, poverty and criminal justice swell. State budgets become more difficult to balance.
This is what conservative Republicans who undermine family planning programs are putting in motion, despite the fact that all of these trends run directly counter to their expressed values.
Ins and Outs of Rabbit-Hole Reasoning
The upside-down priorities of some Colorado legislators illustrate how unquestionable, ideology-based beliefs coupled with motivated reasoning can lead even decent people to violate their own values, while still believing they are doing the right thing.
Republican legislators live in an information web that has been shaped by the Vatican’s opposition to family planning–now picked up and echoed by some conservative Protestant sects and repackaged as “religious freedom.” Another set of dogmas come from Neo-liberalism, for example the belief that the least government is the best government.
Once foundational assumptions like these take root, each acts as a filter, allowing in certain types of evidence and ideas, and excluding others. On Being Certain, by neurologist Robert Burton lays out this process in detail, and Michael Shermer’s book, Why Smart People Believe Weird Things, explains why intelligence provides painfully little protection against rabbit-hole reasoning.
All of us engage in processes known as confirmatory thinking and motivated reasoning to defend a priori positions. For true believers of any stripe, whether political or religious, contradictory information gets attacked by the ideology’s “immune system.” Social networks exaggerate this tendency by screening incoming information and identifying trusted messengers or sources, with any belief endorsed by a competing tribe automatically suspect. Oppositional thinking sets in: if my enemy thinks this is good; then it must be bad. And smart people caught in this spiral simply apply their intelligence to the task of defending what they already believe—or want to.
A Conservative Legislator Beats the Odds
Thanks to the power of ideology coupled with rabbit hole reasoning, the data about family planning and family flourishing create a huge challenge for some conservative legislators. Acknowledging that excellent family planning could help Colorado families to flourish (as it does everywhere else) puts an evidence-based Republican at odds with colleagues who are determined to shut down government programs or co-religionists who seek to prevent “artificial family planning.” By contrast, they may find themselves unexpectedly aligned with people they don’t much like. And so, instead of doing the hard work of questioning assumptions, some do the slightly less hard work of convincing themselves this isn’t necessary.
Fortunately, even tightly defended groups like fundamentalist sects or small countercultural cults or extreme political movements or ideologically motivated wings within political parties fail to completely close off inquiry, and individuals do buck the current. At the beginning of February, Colorado Representative Don Coram co-sponsored a bill that would expand IUD access among low income women. Coram is fiscally conservative and opposed to abortion, and in public statements he cited both of these values in support of his bill. “If you are against abortions and you are a fiscal conservative, you better take a long hard look at this bill because that accomplishes both of those,” he said. Research with 10,000 women in St. Louis provides further confirmation that he is right. Coram’s willingness to follow the evidence and buck party line for the sake of his constituents is something we could use more of on both sides of the aisle.
The author would like to thank Dr. David Grimes of the University of North Carolina for his input on medical aspects of this article.