Commentary Contraception

How America’s Obsession With ‘Bad Birth Control’ Harms Women

Valerie Tarico

Many women know more about the risks of birth control than about how the right contraceptive might improve their lives.

For busy women, making good health decisions and actually taking care of ourselves can be a challenge, especially when practical factors such as complicated schedules, finances, and competing demands are taken into consideration. Well-balanced, well-presented information can empower women to make smart decisions about reproductive health care. Unfortunately, thanks in part to how the American legal system works, many women know more about the risks and side effects of birth control than about how the right contraceptive might improve their health and well-being.

In general, pharmaceutical companies tailor drug inserts to limit liability. Consequently, they list health issues reported by participants in clinical research whether they were caused by the drug or not, which may not be known. Pharmacists tick off possible side effects to customers based on these lists; personal injury attorneys use them to ply network television and social media with scary “bad medication” advertisements. Meanwhile, doctors or other care providers, anxious about being sued, echo similarly lengthy warnings to patients. When harms do happen, even if the cause is in question, investigative journalists often weave together tragic stories—as the saying goes, “If it bleeds, it leads.”

It is important for consumers to be aware of the potential consequences of their medications. When it comes to birth control, however, what can get lost in all the alarm-sounding is the fact that—with important known exceptions—the benefits of contraceptives vastly outweigh any risks for most women. Women who get overwhelmed by fear or faulty information forfeit these advantages, sometimes with costly ramifications.

Modern Contraceptives Keep Women Safe

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To be sure, no one method works for every woman; even the most effective options have potential side effects or inconveniences that individuals must weigh. That said, in addition to preventing pregnancy, the positive consequences of modern contraceptives abound:

  • Estrogen-Containing Contraceptives, which include most common forms of “The Pill,” along with “The Ring(Nuvaring) and “The Patch,” improve acne, reduce benign breast disease, reduce premenstrual syndrome, and regulate or eliminate periods. Some also protect against ovarian or endometrial cancer.
  • Condoms, as most of us know, prevent a wide variety of sexually transmitted infections. Some of these are surprisingly common among young people, such as chlamydia, which can cause infertility, and HPV, which causes cervical cancer.

Fourteen percent of American women taking birth control pills use them exclusively for non-contraceptive reasons like those stated above; another 58 percent use them for mixed reasons. Similarly, many women use hormonal IUDs to control problem periods. But the biggest health benefits of contraceptives come from the fact—pure and simple—that birth control allows women to manage their fertility.

Most pregnancies turn out well; in fact, a wanted pregnancy and childbirth can be a peak life experience. Even so, pregnancy is often inherently dangerous. According to the Bixby Center for Global Reproductive Health, half of pregnancies trigger some kind of medical problem such as a serious cut or tear, the need for a C-section, infection, excessive bleeding, a blood clot, high blood pressure, or gestational diabetes. This doesn’t include mental health issues, such as postpartum depression, which can be triggered by hormonal changes and physical stress. And although maternal mortality is admittedly rare, approximately 650 American women die each year from pregnancy.

A woman who wants a child may take her chances willingly, even gladly. Given that half of all U.S. pregnancies are unintended, however, we can infer that women are being put in danger by pregnancies they never sought.

Last year, former congressional candidate Darcy Burner went public with her near-death story to explain why abortion access can be a lifesaver. But birth control saves lives, too, by preventing unwanted pregnancies and making it easier for women to space out childbearing in ways that are healthiest for them and their families. That’s why it’s so important that we advocate for everyone’s ability to access contraception—and for accurate information about it to be made widely available.

Increased Risk Doesn’t Mean High Risk

Unfortunately, there exists a media, legal, and social climate of alarmism around reproductive health care that can make it difficult for women to make fact-based, potentially life-improving choices about contraceptives.

For example, in recent years, several dramatic news stories have broken about some kinds of birth control increasing a woman’s risk of blood clots, inspiring terror in many users of Yaz, Yasmin, and the Nuvaring, among others. It turns out that the alarm about these methods in particular was unwarranted—in fact, all hormonal contraceptives appear to double the risk of a blood clot. But before you panic, keep reading.

All women have some risk of blood clots, but that risk is quite low: The chances of developing a clot are around 5 in 10,000 per year. And while clots can be dangerous—even deadly—most heal without long-term effects. Without any other risk factors at play, doubling this low number means the annual risk of a clot while on an estrogen-containing contraceptive is still extremely low. To quote a common refrain, Two times a very small number is still a very small number.

To put this danger in perspective, let’s compare the risk of a clot from contraception with the risk of a clot from pregnancy. During pregnancy, the risk of a clot reaches approximately 30 in 10,000. In the six weeks after giving birth, clotting skyrockets to as high as 300 in 10,000, or 60 times the normal rate.

Here is another way of saying it: Women who got worried and discontinued their birth control in response to the media frenzy about Yaz, Yasmin, or Nuvaring—especially those who did not use other contraceptives instead, or chose less effective ones—may have put themselves in danger of the very thing they wanted to avoid.

Making Good Decisions Easier

For a woman to make the best possible decisions, she needs accurate and balanced information about the available options. What are the pros and cons of different options? How do they compare to each other? How common are the best and worst scenarios? After making a choice, what would be reasonable to expect? What might signal that something could be going wrong?

Simple changes in how doctors, journalists, and advocates talk about birth control could help women answer these questions.

  1. Warnings about birth control method should be based on what is likely and what is important, not simply what is new or statistically significant. Well-intended messengers must recognize that by triggering unwarranted or disproportionate fears they can actually cause harm.
  1. Information about any single birth control method should be paired with information about other methods and none at all, including the odds of becoming pregnant, and related health impacts for each. The most relevant and important information should stand out, such as in this excellent poster by Bedsider.org and this interactive graphic from Healthline. Furthermore, the “Paling Palette” can be a valuable tool for comparing risks quickly and simply.
  1. Discussion of risks should include what researchers call absolute risk (how likely is it?) and relative risk (how does it compare to other options?) so that women can put the possibilities in perspective and weigh different courses of action against each other. Comparisons with other everyday risks can also help to put things in perspective. For example, a short airline flight of one to two hours more than doubles blood clot risk during the following eight weeks; a minor injury like a sprain or pulled muscle increases the risk even longer. Yet we choose to travel and play sports—among other activities—because that’s part of what makes life rich.

Fortunately, most of the time, both birth control and well-managed pregnancies turn out fine. But in order to help keep women safe and healthy, we must push back against hyperbole and continue to publicize all the risks and benefits of contraceptives—so that every decision individuals make about their bodies can be a well-informed one, and women can live the lives of their choosing.

Update: This article has been updated to clarify that all hormonal contraceptives have been found to double the risk of blood clots.

The author would like to thank Dr. James Trussell for reviewing this article, and Contemporary Forums and Contraceptive Technology for providing an overview of contraceptive risks and benefits. 

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

News Abortion

Study: United States a ‘Stark Outlier’ in Countries With Legal Abortion, Thanks to Hyde Amendment

Nicole Knight Shine

The study's lead author said the United States' public-funding restriction makes it a "stark outlier among countries where abortion is legal—especially among high-income nations."

The vast majority of countries pay for abortion care, making the United States a global outlier and putting it on par with the former Soviet republic of Kyrgyzstan and a handful of Balkan States, a new study in the journal Contraception finds.

A team of researchers conducted two rounds of surveys between 2011 and 2014 in 80 countries where abortion care is legal. They found that 59 countries, or 74 percent of those surveyed, either fully or partially cover terminations using public funding. The United States was one of only ten countries that limits federal funding for abortion care to exceptional cases, such as rape, incest, or life endangerment.

Among the 40 “high-income” countries included in the survey, 31 provided full or partial funding for abortion care—something the United States does not do.

Dr. Daniel Grossman, lead author and director of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California (UC) San Francisco, said in a statement announcing the findings that this country’s public-funding restriction makes it a “stark outlier among countries where abortion is legal—especially among high-income nations.”

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The researchers call on policymakers to make affordable health care a priority.

The federal Hyde Amendment (first passed in 1976 and reauthorized every year thereafter) bans the use of federal dollars for abortion care, except for cases of rape, incest, or life endangerment. Seventeen states, as the researchers note, bridge this gap by spending state money on terminations for low-income residents. Of the 14.1 million women enrolled in Medicaid, fewer than half, or 6.7 million, live in states that cover abortion services with state funds.

This funding gap delays abortion care for some people with limited means, who need time to raise money for the procedure, researchers note.

As Jamila Taylor and Yamani Hernandez wrote last year for Rewire, “We have heard first-person accounts of low-income women selling their belongings, going hungry for weeks as they save up their grocery money, or risking eviction by using their rent money to pay for an abortion, because of the Hyde Amendment.”

Public insurance coverage of abortion remains controversial in the United States despite “evidence that cost may create a barrier to access,” the authors observe.

“Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services,” Grossman said in the statement. “This research indicates there is a global consensus that abortion care should be covered like other health care.”

Earlier research indicated that U.S. women attempting to self-induce abortion cited high cost as a reason.

The team of ANSIRH researchers and Ibis Reproductive Health uncovered a bit of good news, finding that some countries are loosening abortion laws and paying for the procedures.

“Uruguay, as well as Mexico City,” as co-author Kate Grindlay from Ibis Reproductive Health noted in a press release, “legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”