I’ve probably studied contraception more than you have. Part 1.

As usual, someone has managed to piss me off on the internet. I posted this video from the Guttmacher Institute

Guttmacher is a reproductive and sexual health organization/advocacy group that carries out research, policy analysis and education activities, mostly social science, and a lot of surveillance data (tracking numbers like number of abortions performed, rates of contraceptive use, etc). This is meant to be a short educational video, a general overview on the benefits of hormonal contraception from an American perspective (kind of like an advert). A facebook acquaintance (henceforth referred to as F) has quite a few issues with the video (although it has been clarified to me that his issue is with the video making the case for contraception, and not against contraception). I’ve reposted his complaints below (with his permission) in green. As there are so many, I’ve split them in two posts. Part 2 focuses more on the economic issues, and will post it when ready  posted here.

NB: The term “contraception” refers to hormonal contraception – the pill, intrauterine devices, the implant, injectables, NuvaRing (TM), etc.

It confuses facts with ideology a lot. “pregnancy that follows too soon from a previous one, or one that occurs after a family is complete”. These are not scientific statements.

A fact doesn’t necessarily have to be a scientific statement, just something that exists in truth. Anyways, the former is a scientific statement, as birth spacing can be an influential factor in family planning. Putting aside the fact that it takes awhile to recover from pushing out 2.5-3 kg out of a 10 cm hole (even if it was an uncomplicated pregnancy), there’s evidence that inadequate time between pregnancies can increase the risk of birth defects like gastroschisis (intestines sticking out of umbilical cord), increased risk of preterm birth, and less cognitive development in the previous child. Additionally, there are social and family reasons for waiting in between children, including having enough financial resources…babies are ridiculously expensive.

“women whose pregnancies are planned are more likely to receive prenatal care, etc” Correlation is not causation. I’m not familiar with this literature so it may well be that family planning is causal in this manner, however judging the video by its own merits, the facts it presents do not support this conclusion.
The use of the word “likely” is not considered causal, since you’re fairly limited in the randomized controlled trials run in pregnant women, so you can’t definitively link Effect X to Outcome Y. However, based on best available evidence, you can say someone is more likely to have experienced/exposed to this and had this outcome. Women who plan pregnancies in the first place generally have better outcomes as the sooner a woman knows that she’s pregnant, she can start monitoring her pregnancy, taking folate supplements to prevent neural tube defects, stop consuming alcohol, etc. This is also indicative of health care access. Contraception enables women to plan their reproductive health until they’re in a position to properly care for a child.

“Contraception use is universal… all religions, etc”
How is this a ‘benefit of contraceptive use’? Sounds like an argument from popularity to me.

Not sure why every line in the video has to be a benefit…this is just a comment on how religious groups are often against contraception but then their members use it anyway. About 90% of Catholics use contraception.

Note that the video moves immediately from saying “the impact (or this policy)…could be substantial” to “rolling back this major gain would be a huge loss”. In the latter statement they are making a presumption that the policy would be effective and helpful, which they themselves seem to have admitted in the former statement is, at best, premature to say. Again, lacking in evidence and overselling their case.
Contraceptive use varies between the states in the US, from that “Comparable population-based information on contraceptive use for states can be used to guide the development of state programs and policies to decrease unintended pregnancy and the spread of sexually transmitted diseases”. Using this data can tell us a lot about the effect of the policy but like a proper public health organization, they don’t deal in absolute statements.

“Isn’t it time we stopped playing politics with contraception?”
A loaded question that is irrelevant and also silly. If contraception is not a political question, then what is? If contraception is not a political issue, why do we need the law about insurance coverage for contraception just mentioned? Indeed, why need the video at all?
Not sure if F has been following the health care debate in the US recently but the Republicans demonize those who use contraception, like Rush Limbaugh calling Sandra Fluke a slut and a prostitute. Religious employers have been trying to insert a provision that exempts them from paying for contraception. The irony is that a lot of health insurance in the US covers Viagra, but not contraception. Let the men have their erection, but women can’t have a say in their own family planning. Don’t even get me started on the ridiculousness of a Congressional panel that included a bishop and a rabbi but not a single woman.

“contraception as … essential health care”
I find it interesting how they keep trying to sell contraception as health care. I can see the argument, but on the other hand it seems to me to be very different from the type of things we more traditionally think of as health care. This issue of things being ‘healthicised’ (to coin a word based on the concept of securitization) is more of an issue for sociologists of health and medicine than for me, but I find it interesting. Again, this is more about branding than providing evidence.
Ok. I’m calling penis privilege on this. The major difference between men and women’s health is that women can carry babies, and it always, always falls on the woman in a relationship to be the one concerned about pregnancy. And I don’t understand why it can be argued from a social science perspective makes it any less essential. One of the biggest issues in the developing world is the unmet need for contraception, where it would reduce the number of unplanned births, reduce the number of abortions and decrease maternal mortality. In the U.S., contraception has been linked to declining rates of teenage pregnancy. I think what confuses F here is that contraception is considered to be preventative health care, to avert bigger problems down the track for an individual. Is that really a hard concept to grasp – that preventative health is part and parcel with health care? In a check-up, doesn’t the doctor check your blood pressure, glucose levels, weight, eyesight, hearing, etc to prevent other problems? Also, contraception can be used for its non-pregnancy medical effects, like treating polycystic ovarian syndrome.

NB: I asked a male friend today if he knew anything about contraception, and his response was that he only knew what I told him. To be fair, hormonal contraception is somewhat irrelevant to him, as he is gay, and could only knock up a female-to-male transsexual.