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Sex, Drugs, and Reproduction

Birth Control Is a Messy, Messy Business

by Ken Brown

That sexual love can climax in new life—"sweet, screaming, pooping life," as the film Juno put it—has always been seen as both a blessing and a curse, so it is no surprise that contraception continues to spark fiercely divergent reactions. To some, it's almost an agent of salvation, freeing humanity—and especially women—from being the "unwitting slave of biological fecundity," in the words of Rosemary Ruether. To others, it's merely a new kind of bondage, trading the positive connections of family and community for a harmful dependency on pharmaceutical companies and government-imposed "rights." Whether ultimately seen as a blessing or a curse, however, the history and impact of contraception has been every bit as messy as any baby.

How Did We Get Here?

Birth control has been practiced to varying degrees for at least 5,000 years. In the Greco-Roman era, it was quite pervasive, accomplished mainly through abortion-causing herbs and devices—variously effective, dangerous, or both—despite their condemnation in the Hippocratic Oath. The early and medieval church was firmly opposed to the practice, for it not only saw procreation as a divine gift, but it also had good reason to perceive such "contraceptives" as destructive and dangerous—to the woman, her child, and society as a whole. By the end of the Middle Ages, not just the practice but also the knowledge of traditional birth control had greatly declined, and both infanticide and illegitimacy reached new lows.

The modern era of contraception began in the 1800s with the development of new barrier methods such as the rubber condom (1844) and the diaphragm (1880). Though holding the potential to simply replace older abortifacient forms of birth control, the rise of such true contraceptives was in fact accompanied by increases in sexual license, illegitimacy, and surgical abortion. Urbanization also resulted in the expansion of birth-control use well beyond previous levels, leading as it did to the slow breakdown of traditional communities and to a sharp increase in extramarital sex. In the nineteenth century, laws against both contraception and abortion were passed in most states, but both continued to be practiced in secret and agitated against publicly through the mid-twentieth century.

Ironically, the US government's first foray into contraception technology—distributing condoms to WWII soldiers—was not aimed at birth control so much as an attempt to diminish the spread of sexually transmitted diseases (STDs) from foreign prostitutes, hardly a triumph for women's liberation. But it was the development of the birth-control Pill in 1960 and its legalization through two Supreme Court decisions in 1965 (Griswold v. Connecticut) and 1972 (Eisenstadt v. Baird) that made contraceptive use both widespread and mainstream. The Pill was the fuel that drove the sexual revolution.

"Safe Sex"

Today, about 70 percent of all teenagers have sex at least once before they turn twenty, resulting in more than 820,000 teenage pregnancies a year, just under a third of which end in abortion. These figures are down from their peak in the late 1980s, but they are still shockingly high. Meanwhile, casual sex and "serial monogamy" have become the cultural norms among college students and twentysomethings, among whom the abortion rate remains above 30 percent. Only 59 percent of the adult population is now married; only 35 percent consider children an important component of marriage; and fewer than a third of all marriages reach their 25th anniversary.

Yet, rather than recognizing a tragic degree of sexual immorality in all this, the response from many quarters has been to turn these facts on their heads: Since casual sex has now supposedly been freed of negative consequences, it no longer qualifies as immoral. If it is pointed out that even "safe sex" is anything but safe—that despite widespread condom usage, there are nearly 19 million new STD cases a year in the U.S. alone, more than half of them among 15- to 24-year-olds—this is no longer seen as proof that we might need to learn sexual restraint after all, but merely as evidence that we need better methods to reduce those risks. Ignored is the fact that near-universal acceptance of contraception is what established casual sex—ostensibly free of consequences—as normal and acceptable, and thus created this situation in the first place.

Now that sex has become recreational and "safe," it shouldn't surprise us that when pregnancy does result, more and more men deny their responsibility and either press for an abortion or disappear. Nor are such pregnancies as rare as the media would have us believe; a year's worth of "typical" Pill usage results in one to eight pregnancies per 100 women, while typical condom usage results in ten to eighteen pregnancies per 100 women. The end result is that about twenty percent of all US pregnancies now end in abortion (also down from twenty years ago, thankfully), and more than a third of all children are now born out of wedlock (36.9 percent, a new high, up from just 8.2 percent in 1930). It is noteworthy that more than half of the women who seek abortion (54 percent) claim that they were using birth control when they became pregnant. Contraception alone cannot be blamed for all the sexually illicit elements of our society, but its availability did make such a culture possible.

Of course, the family has never been perfect. Oppression, abuse, infanticide, illegitimacy, and other ills have all existed in fluctuating degrees throughout history, and not all of them are attributable to contraceptive use. In fact, even Christians disagree on the permissibility and value of contraceptive use within marriage. But even if there are valid reasons to practice birth control, it remains true that its widespread acceptance has changed the nature of the family in our society. To get married or merely to live together, to have children or to focus on careers, even to remain faithful or to have a more "open" relationship: All of these are now considered valid options, a situation directly enabled by the availability of contraception. Too often lost in the shuffle is any deep appreciation of sex and marriage as a sacred institution, which can draw us out of our selfishness and into self-giving love, true intimacy, commitment, support, and the gift of life. More typical is the kind of relationship described by the hapless girl who wrote the following "Dear Abby":

I am a twenty-three-year-old liberated woman who has been on the pill for two years. It's getting pretty expensive and I think my boyfriend should share half the cost, but I don't know him well enough to discuss money with him.

Sex and Lies

Perhaps the most disturbing aspect of the rise of modern contraception has been the degree to which its potentially harmful effects have been downplayed or ignored. From the beginning, the pharmaceutical industry and pro-contraception organizations have been repeatedly guilty of selling and distributing poorly tested, dangerous, and misrepresented contraceptive products—from the original high-estrogen Pill, which stayed on the market for nearly 30 years despite well-known dangerous and even deadly side effects, to the "Dalkon Shield" Intrauterine Device (IUD), which caused serious harm to thousands of women and killed at least eighteen in the few years it was available. More recently, the manufacturer of Norplant discontinued the product in 2002 after facing lawsuits involving more than 50,000 women. In all this, pharmaceutical companies and the organizations that support them have failed the trust given them, pushing and misrepresenting insufficiently tested contraceptives only later to discover their dangers.

A revealing example is the Ortho Evra Patch, which is still on the market despite being accused of causing hundreds of life-threatening blood clots and the deaths of as many as 23 women—most in their teens and early twenties. Both the US Food and Drug Administration (FDA) and Ortho McNeil, which makes the Patch, have known about the problem since at least 2002, but they dismissed it as an acceptable risk while quietly settling the many lawsuits that have resulted. A 2003 internal Ortho McNeil memo even justified the refusal to fund a study comparing the side-effects of the Patch with those of the Pill on the grounds that there was "too high a chance that the study may not produce a positive result for Evra."

If this is disturbing, the FDA's own reaction is illuminating: Though it is now known that the Patch is at least twice as likely as the Pill to cause blood clots, the agency approved it for use on the grounds that "the risks of using this product are similar to the risks of using birth control pills, including an increased risk of blood clots, heart attack, and stroke. The data is not precise enough to tell whether there is an increased incidence [with the patch]." In other words, since other hormonal contraceptives are also potentially dangerous, the Patch's (insufficiently known) dangers were acceptable.

Admittedly, many other medications also carry serious risks, which must be balanced against those of the disease or disorder that they are intended to treat. But pregnancy is not a disease, and to accept these risks solely to avoid getting pregnant means treating it as such.

Equally troubling is the fact that many contraceptives include at least the possibility of spontaneously aborting a child. Only barrier and behavioral methods, such as condoms and periodic abstinence, completely lack this risk. This is because virtually all chemical contraceptives, whether pills, patches, shots, implants, or inserts, work in three primary ways: to suppress ovulation, to make conception more difficult, and/or to make implantation of a conceived embryo (that is, continued pregnancy) less probable. It is this third function that is problematic, for if human life begins at conception—which is scientifically indisputable, though sometimes denied philosophically—then all hormonal contraceptives hold at least some risk of expelling a newly conceived human being.

Estimates vary widely as to how likely it is that a contraceptive will act as an abortifacient, or with what frequency, but no one really knows. That is because not enough testing has been done on these things, which are admittedly difficult to measure. But the indications are disturbing.

For instance, though it is no longer believed that IUDs work primarily by inducing abortion, this possibility cannot be eliminated, especially with non-hormonal IUDs, which do not prevent ovulation. It is thought that they induce an immune response that kills sperm, but the possibility that the same response can and does also kill conceived embryos cannot be ruled out. How often conception does occur is unknown, but the risk is certainly there. What we do know is that among those women who occasionally do get and stay pregnant with an IUD in place, the risk of miscarriage is increased to between 20 and 50 percent, depending on how soon the device is removed.

In the case of hormonal contraceptives such as the Pill, the issue is even less clear because there is such a wide range of formulation and delivery method. Thus, hormonal contraceptives have been shown to allow ovulation between 1.7 and 65 percent of the time (the progestin-only "mini-Pill" represents the high end of this range). This means that at least some of the time, the only thing hindering conception is a more hostile uterine environment, and no one is sure how effectively this works. Recent meta-studies have found plenty of clinical evidence that hormonal contraceptives could cause medical abortions if conception -occurs, but hardly any research has been done to determine how common this is, nor do the manufacturers seem eager to find out. Perhaps the chance is very small; perhaps it is large—it probably varies from product to product. But is any chance at all worth the risk when we are talking about the lives of our children?

Technology and Virtue

Though there is, of course, far more involved in the decision whether or not to use contraception, these observations illustrate an important underlying truth: the impossibility of solving a fundamentally moral set of problems—in matters of sex as in all others—through purely technological means. The use of contraception may enable one to avoid the physical consequences of promiscuity, for example, but not the moral ones. In fact, it exacerbates the moral problem while potentially causing adverse physical effects of its own.

This does not mean that we could, or should, return to the days when contraception was legally proscribed. Even if the risks and dangers of contraceptive usage were more clear-cut, we live in a pluralistic society, in which not even Christians agree on these matters. But while the law grants us the freedom to decide for ourselves, it does not free us, as individuals, from the obligation to choose well.

Beneath all the risks and statistics, the real questions we each must face are these: Will we treat reproductive technology as something to be used in accord with moral principles or as a way around them, in a fruitless attempt to undo the consequences of our actions? Will we hold it subordinate to virtue or as a substitute for it? And most fundamentally, will we choose to treat our fertility as a disease or a gift—our sweet and screaming children as a threat or a blessing? 

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