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My present thoughts on the "contraception prevents abortion" study

No doubt quite a few of my readers have now heard about this study, deliberately released just now with the intent of influencing the election (!), that purports to show that free contraception reduces abortions.

I've entitled my post "My present thoughts," because I anticipate that there will be more analysis on this subject from others as time goes on. However, I have gotten hold of the paper itself (thanks to Serge at Life Training Institute) as well as this Powerpoint PDF from the study author.

Before getting into criticisms of the methodology and conclusions of the study, I want to ponder something that I haven't seen discussed elsewhere. The celebratory article on the study from NBC says this:

The results were so dramatic, in fact, that Peipert asked the journal of Obstetrics & Gynecology to publish the study before the Nov. 6 presidential election, knowing that the Affordable Care Act, and its reproductive health provisions, are major issues in the campaign.

“It just has so many implications for our society,” he told NBC News.

Since when are professional scientific journals openly and proudly attempting to influence political elections by their decisions about publication? Isn't there something a tad unprofessional about that? More than a tad? The study's author, Jeffrey Peipert, tells a news organization unabashedly that he expressly asked the journal, Obstetrics and Gynecology, to hasten the publication of his article in order to influence this fall's presidential election. Frankly, if I ever tried such a thing on a philosophy journal editor, even an editor who had already accepted an article of mine, I hope (and still believe) I'd receive a sharp rebuke. (Not that my philosophy articles have political implications anyway; the scenario is hypothetical.) Such a request should be taken as an insult to the professionalism of the editor. Regardless of whether the article was accepted independently of political considerations, the timing of its release should be decided on the basis of academic and professional considerations, including time for possible revisions and the courtesy owed to other authors whose articles were submitted and accepted longer ago. The utterly unashamed announcement that author and editor colluded to time the article to influence the U.S. presidential election should leave a bad taste in everyone's mouth, especially in the mouths of scientists and scholars, and should even cast a small amount of doubt on the objectivity of the review process itself.

Now, on to content issues.

There are some major methodological questions about and problems with this study, and in my opinion they should have influenced its publication negatively. At a minimum, the journal should have required the article's revision, as a condition of publication, to clarify some things that are right now quite unclear and to include more raw data and more explicit calculations for public evaluation. But the problems go deeper than that.

The Biggies

The abortion data for study participants may have been estimated rather than collected directly.

As a matter of fact, the article says that the abortion rate for study participants was estimated:

We also estimated abortion rates in our metropolitan area and in our cohort and compared these rates with U.S. and regional abortion rates. (Peipert et. al. "No-Cost Contraception and unintended Pregnancies," Obstetrics and Gynecology, December, 2012, p. 2.) [Side note by me: "December, 2012"? That's what the PDF says. Maybe in later years we're all supposed to forget that it was deliberately released in October to influence the 2012 election?]

Any reviewer worth his salt should have read that sentence, and the absence, there or elsewhere in the paper, of an explicit statement of how such an estimate took place, and said, "What?" At a minimum, the authors should have been made to answer the following questions: Was that a misstatement, or do you really mean to say that you did not collect raw data on abortions among study participants but rather estimated abortion rates in your cohort? If so, why? You were interviewing participants repeatedly throughout the study. Why estimate the data? If that isn't what you meant, then change the sentence. If that is what you meant, you need to explain precisely how you estimated abortion rates in your study group. (Another possibility is that the reference to estimating the abortion rate in the cohort refers to the standardization/weighting of the data, which I will discuss below. But this is an implausible interpretation. Estimating an actual rate of abortion in a group is one thing. Standardizing data from the group is another. It doesn't seem that this is what the sentence refers to, but if that is what the sentence means, again, it is radically unclear.)

Obviously, if the actual abortion rate among the participants was merely estimated, while we are not told how it was estimated, the article's statistical value is highly questionable from the outset.

The abortion rate, however collected or estimated, was altered by a weighting factor, and the raw data are not given.

However the researchers obtained their rates of abortions for study participants in the first place, they are quite explicit that they then renormed the data in an attempt to take into account the group's unrepresentative nature in terms of race and age.

(The acronym CHOICE refers to the study group. Cute, huh?)

Because the CHOICE cohort represents a higher-risk population (median age of 25 years and 50% black) than the general population, we standardized the CHOICE abortion rate to the age and racial (black and white) distribution of females who reside in the St. Louis region using data from the 2010 U.S. Census (direct standardization). We compared the CHOICE standardized rate with the St. Louis regional rate...(p. 3)

Translation: Because our study group was unrepresentative of the St. Louis female population by race and age, we expected to get more abortions among our study group than we would have gotten if the group had been representative demographically. So the abortion numbers we're giving you aren't the real abortion numbers, even if we did collect the real abortion numbers to begin with. They are numbers which have been massaged by a weighting factor to give the number of abortions we believe would have occurred if more of the study participants had been white and over 25 years of age.

The raw data are given nowhere in the article. Neither, ipso facto, is the precise calculation showing the weighting factor and the derivation of the stated "abortion rates" among study participants from the initial data.

Let me be clear: I am not saying that using weighting factors is per se an unethical thing to do. Nor am I saying that the weighting factors in this case were designed with malice aforethought to get a low abortion number for political ends. Maybe the number of abortions they report in the paper is a fair indication of the number of abortions per thousand that there would have been in their study sample if it had had a different demographic makeup. Weighting factors of this kind are often applied in statistical contexts. However, they can be quite contentious, and social scientists should also supply the raw data and tell precisely how the numbers they want to use were derived.

It would perhaps be uncharitable to say that a publication of study results that gives results derived by standardization without providing this information is statistically worthless. But only a little uncharitable.

Again, this is the kind of thing that the peer review process should have caught. A reviewer should have asked that the article be revised to include fuller information.

Implants and IUDs were aggressively up-sold to study participants.

This point is less geeky than the first two but just as big a deal, if not bigger. From the news reports one would have gathered that the study participants were simply offered their choice of "a range" (the exact range is an interesting question I'll discuss later) of contraceptive devices or methods, all free-free-free, and that it was simply the removal of cost that induced such a surprisingly high number to choose implants and IUDs. Conclusion: Ah, many women out there are just yearning for contraceptive implants and IUDs if only, tsk-tsk, they didn't cost so much. Were the "cost barrier" removed, all else (including the alleged reduced abortion rate) would follow as the night the day. A typical statement is this one, from the Washington Examiner story:

When price wasn't an issue, women flocked to the most effective contraceptives — the implanted options, which typically cost hundreds of dollars up-front to insert.

[snip]

"As a society, we want to reduce unintended pregnancies and abortion rates. This study has demonstrated that having access to no-cost contraception helps us get to that goal," said Alina Salganicoff, director of women's health policy at the Kaiser Family Foundation.

This impression is quite misleading. One of the study's express objectives was

...to promote the use of the most effective contraceptive methods (IUDs and implants) (p. 2)

This objective was promoted actively:

Contraceptive counseling included all reversible methods but emphasized the superior effectiveness of LARC methods (IUDs and implants). (p. 1)
All participants were read a brief script informing them of the effectiveness and safety of LARC methods at initial contact and completed an in-depth, evidence-based contraceptive counseling session at enrollment. (p. 2)
In addition, the project provided education to promote the use of the most effective contraceptive methods, IUDS, and implants in an effort to alter population outcomes. (p. 5)

In other words, cost was by no means the only factor in the participants' decision to choose IUDs and implants--essentially, to sterilize themselves for a fairly long period of time quite effectively. Rather, those methods were expressly and deliberately pushed as the best methods, with researchers making a quite unabashed attempt to "alter outcomes" by this up-selling method.

The article implies that dramatic reductions in unintended pregnancies and abortions can be expected nationwide if only the study methods are generalized as a matter of policy, and it explicitly likens these methods to the Obamacare mandate for free contraception:

The Institute of Medicine recently recommended that eight primary preventive health services for women be covered without cost to patients under the Patient Protection and Affordable Care Act of 2010. Among these eight services, the Institute of Medicine recommended "a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes." As a result, all FDA-approved contraceptive methods would be covered without cost. The Contraceptive CHOICE Project essentially simulated this recommendation in our region for reversible contraceptive methods. (p. 5)

Are we to believe that it is part of the Obamacare contraceptive project that all women, or even all women seeking contraception, will be read a special script up-selling IUDs and long-term implants? As far as I know, this is not part of the present plan, though perhaps we shouldn't give the Obamacrats any bright ideas. And how would one induce all women (all women of childbearing age? all women of childbearing age who were not presently trying to get pregnant?) to listen to such a script, anyway?

It seems highly probable that the deliberate pushing to participants of these specific methods, rather than their mere provision at no cost, was in no small measure responsible for any subsequent reduction in unintended pregnancy rates that did occur.

Unless we are willing to envisage a program under which American women generally receive a high-pressure sales pitch for having an IUD or implant inserted, we shouldn't be too quick to imagine any straightforward generalization of this study's methods via Obamacare's contraception diktat.

And Furthermore

The study participants were unrepresentative in other specific ways, and these ways were features, not bugs, of the study.

--All study participants had to be willing to use contraceptive devices and/or hormones of some kind. Yes, this may sound like a too-obvious point, but there are women in the world, even women who are sexually active and would prefer not to get pregnant, who don't want to use contraceptive devices, hormones, or implants. Some prefer just to "take their chances." Others use NFP. Others, with their male partners, might count on the method of conception-avoidance used by Onan in Holy Writ, on which I won't expand further just here.

--All study participants who were already using contraception had to be willing to change their method of contraception. This is stated expressly on slide 15 of this presentation. It's unclear exactly how this willingness was measured. Does this mean that they actually had to change their method or only to say that they were willing in theory? What changes were acceptable? For example, if they said they were willing to "try a new contraceptive method" but then, after counseling, chose to have an implant removed and to switch to contraceptive pills, which were not one of the methods the study authors were especially pushing, would this have taken them out of the study? None of this is clarified in the paper itself. But I think we can say pretty definitely that it is not in general characteristic even of all sexually active American women that they are "willing to try a new contraceptive method." So the study was unrepresentative in this way, and this aspect of the study was a fundamental part of its design. Since it was designed to promote the use of IUDs and implants, which participants might not have been using before, women who were definitely satisfied with their method of birth control and were not "willing to try a new contraceptive method" were deliberately excluded.

--It looks as though options offered at no cost to study participants may have excluded over-the-counter items such as spermicides, condoms, and sponges. This is not absolutely clear, which is one reason I did not include it among the "biggies." In some places the paper says things like, "All participants received the reversible contraceptive method of their choice at no cost" (p. 1) and "Participants were offered all U.S. Food and Drug Administration (FDA)-approved contraceptive methods and could choose any method." (p. 2)

That seems pretty unequivocal. Yet there is some reason to suspect that this only means methods that require a prescription, not simpler, non-hormonal, over-the-counter contraceptives. This Washington Times article from March of this year, for example, describes the study like this:

Called the Contraceptive CHOICE Project, the study is providing those options [IUDs and implants] and a range of others for free. Participants also can choose from birth control pills, a monthly patch, a monthly vaginal ring and a once-every-three-months shot.

That list of options which participants could receive free corresponds almost exactly to the list of "what do women choose" on slide 21 in the Powerpoint presentation. The only difference is the inclusion on the slide of the diaphragm, chosen by less than .1 of participants. (A diaphragm also requires medical involvement and a prescription.) The complete absence of non-prescription methods from the methods actually chosen is especially suspicious considering the known high popularity of condom use among contraception-minded couples. (See, for example, the charts on p. 7 and p. 27 of this document.)

If in fact study participants could not choose a non-prescription method of contraception as their designated form of contraception to receive for free, this makes the study sample all the more unrepresentative. And if that was the case, it fits extremely well with the study's overall emphasis on getting away from less effective, more compliance-requiring methods of contraception.

All of these major issues of non-representativeness in the study group are relevant to the politicized and over-the-top conclusions of the study. The article actually states,

In fact, based on our calculations in Table 3, changes in contraceptive policy simulating the Contraceptive CHOICE Project would prevent as many as 62-78% of abortions performed annually in the United States. (p. 6)

How, exactly, are policy changes going to simulate on a nationwide scale the highly artificial situation created in this study? Besides the matter of subjecting everyone to sales pitches for IUDs and implants, mentioned above, how would policy by itself be able to bring about a national situation in which all sexually active women who do not wish to become pregnant are

a) willing to use contraception
b) willing to change their method of contraception, and
c) willing to use a prescription-type method of contraception?

The promotion of liberal policy approaches to sexual issues for "reducing abortions" ignores the funding of abortions and the opposition to abortion restrictions.

This point concerns not the study per se but the use which the study authors and other liberals wish to make of its results. Since the study authors are quite blatant about the desire to influence people, including pro-lifers, to endorse President Obama's policies, we should ask ourselves what other liberal policies are making a difference in the world right now that are relevant to abortion statistics. We could start by talking about the instantaneous Obama revocation of the Mexico City Policy, but hey, let's stick to domestic issues only. So far, using threats of loss of federal money, outright lawsuits against states, and direct grants to Planned Parenthood when states stopped funding PP, the Obama administration has foiled or attempted to foil state attempts to defund PP in

*New Jersey,
*Indiana,
*New Hampshire,
*Texas,
*Tennessee, and
*North Carolina.

The study authors actually admit that lessened government funding for abortion might be relevant to a downturn in abortion statistics:

[T]he analysis comparing repeat abortion in the St. Louis region with that in Kansas City and nonmetropolitan Missouri is essentially an ecological study. There may be several factors that affect the rates of repeat abortions, such as the economic recession, federal changes in Title X funding for family planning, and Missouri state laws that limit access to abortion. (p. 6, emphasis added)

Then, of course, there are those state laws limiting access to abortion. It should go without saying that the Democrat position on such laws is opposition of the strongest kind.

This study is clearly supposed to have a political take-home message: If you're pro-life, you now have an excuse for supporting Obama with his contraception mandate, and you can point to "science" as having "shown" that Obama's policies will reduce the numbers of abortions, maybe even dramatically. If someone is so taken in by this as not to make the obvious retort concerning Obama's and the Democrats' overall policies on abortion, he probably was looking for an excuse to be taken in. But for the record, let's not allow ourselves to forget the manic support of this administration for unfettered access to abortion and the fact that such a mania is scarcely calculated to decrease the number of abortions in the country.

*************************************************************
I won't go quite so far as to say that this study is another example of how to lie with statistics. I will, however, say that it is an example of sloppy publication, probably sloppy because of political motivation, and seriously over-hyped results, results that are not, pace the study authors, readily generalized to the population at large nor a simple model for public policy. (And that is, of course, even waiving all the obvious moral objections to the public policies in question.)

There is a kind of casual and unnerving blindness-tending-to-totalitarianism in the study authors that causes them not to bat an eyelash at the prospect of a propaganda campaign, nationwide, to induce all sexually active women who do not wish to become pregnant to use IUDs and implants. (In fact, they do seem to envisage such a campaign. See slide 28 here which, in describing their study as a model, says that these methods should be "FIRST LINE.")

Then there is the sloppiness that apparently prevents their wondering whether women generally, who have not signed up for a free contraception study, stated that they are willing to use contraception, to choose from one of the methods offered, and to "try a new method," are going to be greatly influenced by the campaign they envisage (if it is not backed up by actual coercion). They seem to assume that all or most women secretly want what they, the elites, want them to want and are just looking to have costs taken on by someone else to make those desires come to pass. This is hardly a known scientific fact. Indeed, it is in the general neighborhood of what the study was supposed to support, making their argument, if not precisely circular, something near to a closed curve in space. But the study authors don't seem to realize this.

Ideologically committed leftism is blinding. It is blinding not only morally but also scientifically, which is why initial skepticism about such studies is always warranted until they have been investigated. We live in a world in which the "other side," especially the conservative side, is always asked to respond to any new claim instantaneously. If one does think of a pertinent instantaneous response that, one can be sure, would not be undermined by further investigation, there is nothing wrong with making it. But better still, if possible, to take some more time, get as close to the actual data as you can, and make your responses after further thought. That is what I've tried to do here, and I am grateful for the copy of the paper and the other links permitting me to do so.

Comments (38)

An even bigger problem than those you mention is the definition of "abortion" to exclude non-implantation, which both IUD's and implants are known to produce (in fact, that's what IUD's are designed to produce). To me, that omission alone tells me that this article is irrelevant from the outset to actual pro-life concerns--which means (to me) that it's scientifically irrelevant as well, since a contribution to a scientific debate does actually need to address a question that someone is actually, seriously, asking. Sure, we can reduce the rate of later abortions by aggressively promoting earlier abortions--does this really surprise anyone at all?

It seems pretty clear to me that the target audience for this study was never actual pro-lifers, or even the scientific community (beyond those already convinced of its premise). The target audience is the media, and indirectly the voters; the thing is an electoral talking point masquerading as science.

Peace,
--Peter

Peter, I also have real questions about the mechanism of action of IUDs. I have not been able to find clear evidence that IUDs work by non-abortifacient mechanisms. I suppose the fact that they also include hormones which are presumably distributed to the body through the tissue of the uterus (that is, some IUDs have a hormonal component to them) could also prevent ovulation, but for a long time there has been quite a bit of ambiguity about whether IUDs regularly and normally work by preventing implantation as a primary mechanism. This is of course partly because of their location directly in the uterus.

I deliberately didn't include that in this piece, though, because I was concerned that to include it would instigate a long discussion in the comboxes about, in general, the mechanism of action of all hormonal methods of contraception, including pills, etc. I think that there are more profitable and interesting things for us to discuss about this study than that very broad question and would prefer that there not be a debate on that here and now. However, I agree that the question should at least have been mentioned or raised in the study--again, especially for IUDs.

I live in St. Louis, just fyi.

Here is something that is not discussed so far as I can see. What is the effect of STD rates on the major use of surgical contraceptives in this study? Did STD rate of infections go up, stay the same or go down? What is the relative cost of treating STD's relative to pregnancy via abortion compared to the benefits of taking the pregnancy to term to society at large (future tax payer, soldier, etc.) relative to the lack of material benefit with STD's? What are the infection rates of STD's with condoms compared with those who use surgical methods? Which prevents more pregnancies and costs society less?

And lastly, what is the profit margin for Big Pharma for subsidization of Plan B and similar surgical or medically administered methods compared to condoms?

Given that the US has once again slipped even further below replacement rate, don't u think we have had enough contraceptives? How does falling below replacement rate affect future tax revenues? Social security, etc?

Perry, good point, and one that I believe Michael J. New brought up, though it may have been a different conservative response. Other public health consequences were not discussed in the published paper, though it does have a chart showing the number of participants who had STD's at the beginning of the study. Obviously, those public health consequences would have cost implications.

I do know that the Powerpoint presentation mentions continuing to tell participants that they should use condoms in addition to their hormomonal or implant methods, presumably to prevent STDs. It didn't say whether the condoms were provided free, and it is quite clear that this is supposed to be *in addition to* the other methods, which are the primary methods of interest. *No* participants are listed as choosing condoms as their method of contraception per se.

But we aren't told whether, in fact, STD rates went up. It would seem not far-fetched to think that they might go up, since the contraception aspect was being taken care of in another way.

the benefits of taking the pregnancy to term to society at large (future tax payer, soldier, etc.)

This, by the way, is worth hammering on in general for these alleged cost-benefits analyses. The point comes up repeatedly: Leftists insert into everything they do the assumption that the existence of people is a net loss to society. That such an assumption is blatantly wrong, in fact, insanely wrong, that there wouldn't even be such a thing as "society" if there were no people, doesn't seem to faze them. Consider Nancy Pelosi's claim that providing contraception is always cheaper to insurance companies than people's having babies. Really? Even in the medium-short-term, what about the possibility that a company would or could charge more in premiums over the succeeding years for larger numbers of dependents, or, if they didn't want to do that, raise the family premium across the board if family sizes start to increase? But no: Insurance companies are treated in Pelosi's "analysis" as sheer dolers-out of benefits, so that the fewer people in existence, the lower the cost to the company. People are never treated as profitable or beneficial to society. The focus is strictly on people as consumers of benefits, as costly and wasteful by means of their very existence. This is an incredibly short-sighted view even in utilitarian terms, but you will never or rarely these days see a liberal acknowledge that.

Lydia,

Not that I am ignorant of your answer, but what do you think the likelyhood is of people using these methods AND a condum is? I think the natural reaction would be, I got this so I don't have to use a condom so I'll just roll the dice.

I think the conservative response should be to point out that none of these methods prevent STD's and only condoms do, so this isn't about contraception, but just profits for Big Pharma doners to the DNC.

of course why we would need to subsidize contraception for everyone is beyond me since homosexuals can't get pregnant. Only condoms are useful for them.

The whole thing totally misses the point anyway.

The problem isn't that contraception in itself causes abortions. Obviously it prevents pregnancy, it's designed to.

The problem is the contraceptive mentality that as long as you're protected it's okay to have sex outside of marriage, leading to more sex, more unwanted pregnancies, and more abortions. Of course in a group having sex outside of marriage where more contraception is available there will be less abortions. You want to know where there will be even LESS abortions? When people abstain from sex.

It's the mentality that it's okay to have sex outside of marriage that leads to more abortions, and contraception that promises to "protect" you feeds into this big time because people think it will eliminate their chances of getting pregnant. Well sure, contraception will get you pregnant less often, but people who think it eliminates all consequences have more sex and consequently will end up having more children outside of marriage, leading to more abortions.

Exactly, Perry--that's why I think STD rates would be likely to go up. The study authors show a pretty serene confidence in their ability to get people to do whatever they want them to do by "education." Hence, they think that if they just "educate" them about using condoms in addition to the hormonal method, they will do it. People are so much manipulable material. This is foolish and creepy on many levels. Just one level is the sheer naivete about unintended consequences, as in the case of a rise in STDs.

As for "Big Pharma," I'm a lot less inclined than you are to think of the study authors as somehow being in league with Big Pharma. Naturally, what they are recommending will tend to benefit these companies. But I think they are sheer ideologues. They've got their own ideas about what they think are the solutions to all earth's woes (what Sowell calls the Vision of the Anointed), and they are going to find some way to "educate" everyone to follow the present five-year plan. No doubt the companies that benefit from a particular fad are all too eager to downplay any possible disadvantages, but I regard the researchers in this case as advocating this for their own reasons. Those reasons involve a combination of a particular view of man and the sheer political desire to keep a Democrat in the White House in secula seculorum. And it's not entirely clear where one of those ends and the other begins.

Lydia,

I think the study authors are either too dumb or blind to be in cahoots with Big Pharma, But the lobbyists in the DNC certainly aren't too blind or stupid to be so. there was an article a while back in the press noting the Big Pharma connection. This whole thing is a ploy to get big pharma a fixed clientel for Plan B and similar more expensive products.

In any case, my solution is just to have another kid to outpopulate these people in the next fifty years.

Lydia: "I have not been able to find clear evidence that IUDs work by non-abortifacient mechanisms."

The hormonal IUD works by suppressing ovulation, like an implant, and creating a foreign body reaction, which kills sperm in the uterus before conception.

The Copper IUD adds copper ions, which make the environment even more hostile.

Although it is theoretically possible for an IUD to have an abortifacient effect, this has not been observed in several studies. The studies concluded that such an effect is very rare, if it happens at all. The links are in the Wikipedia article.

http://en.wikipedia.org/wiki/IUD_with_copper

There are plenty of reasons that IUDs are a really bad idea, including that they make pregnancy very high risk if conception does happen, sometimes they need to be surgically removed, and all the expected complications of putting an foreign object in a uterus to create a hostile environment. But there is no evidence that they work as an abortifacient.

Perry, that's a great response, but remember: the public schools are mechanisms for turning *your* kids into *their* kids: people with the same mentality and short-sighted mistakes they have. So those with wholesome attitudes about having children need to have a long-range view about educating them as well.

Well sure, contraception will get you pregnant less often, but people who think it eliminates all consequences have more sex and consequently will end up having more children outside of marriage, leading to more abortions.

Not to mention the fact that the rampant sex outside of marriage leads to emotional illness, depression, and a host of other social damages that ALSO cost money. Of course, those costs are nearly impossible to tally up in full. And playing with a woman's hormones is going to lead to a certain difficulties in relationships, which can have costs that can't be measured in money. (That's all aside from the costs to eternal life. We aren't trying to add those in.)

By the way, I want to go back to something I said above about researchers considering people manipulable. I should qualify that: They consider people manipulable in areas where their ideology does not prevent them from even trying. In fact, there is a lot of inconsistency here. Contrast, for example, liberals' approach to smoking with their approach to premarital sex and even early teen sex. In the name of public health, they are willing to engage in all sorts of heavy pushing, teaching, and social pressure across the whole spectrum of society to try to prevent people from smoking, even though smoking remains officially legal. In particular, they aim to prevent minors from having any access to the means of smoking or any connection to it. Yet when it comes to sex, they run in exactly the opposite direction, making highly explicit sex education available to minors and trying to require it as part of a class or classes in college, making sexual materials available to minors, and so forth. The very suggestion that for public health reasons we might try to make a nationwide effort to promote abstinence--a _real_ nationwide effort, a multi-faceted approach--is met with derision and scorn.

So when it comes to not smoking, or, for that matter, consenting to having an IUD inserted, girls ages 15-19 are the subjects of pressure, which liberals assume will have enough effect to be worthwhile. When it comes to not having sex, fuggedabahtit. In fact, when it comes to having sex, liberals won't even admit that their policies and approaches are making this _more_ likely, preferring to pretend that the amount of sexual activity young people are engaging in is a constant and that their efforts are merely making that sexual activity "less risky."

Since when are professional scientific journals openly and proudly attempting to influence political elections by their decisions about publication?

Probably since the federal government became one huge "research grant" piggy bank.

It seems to me that they are starting from an unquantified premise that there are hordes of women out there who would jump on the contraception bandwagon if only contraceptives were provided at no cost. As things stood pre-mandate, there are places that offer low-cost contraceptive options, besides the factors you mentioned about over-the-counter options.

I read a study (it was a while back and I don't remember where to find it, or I would provide the source) that actually showed an increased correlation between contraceptive use and abortions. Hormonal contraceptives have a statistically predictable failure rate, and if offering contraceptives at no cost leads to wider contraceptive use, then it only stands to reason that it would also lead to more unplanned/unwanted pregnancies. I think it requires quite the logical leap to assume that women will automatically choose IUDs or implants over the pill.

Lydia also brought up an excellent point about how IUDs work. My wife tried hormonal contraceptives (the pill) a few years ago, and the behavioral side-effects were more than we could cope with. We have been considering a copper IUD, but I wasn't so sure it was the best idea after reading about how it works.

Regardless, thank you for breaking down this study. It was very informative.

I would also point out that Jim notes other reasons to hesitate to have an IUD inserted--health reasons for the woman. All such concerns were swept aside in this study as they urged young teenage girls to consent to the procedure. Obviously, parental consent was considered unnecessary.

What exactly is wrong with moving up the publication date to influence the election? Suppose candidate A claims that seatbelt requirements save lives and candidate B claims that they don't. Then if there's a study showing that seatbelt requirements do in fact save lives, this study should obviously be published before the election so that voters can make a more informed decision.

Same here: Obama supports the Affordable Care Act and Romney wants to repeal it. The Peipert study suggests that free contraception as provided through Obamacare would decrease abortions. Obviously, voters concerned about abortion should have this information before the election since, all else being equal, it's evidence that Obama's policy will be more effective in combating abortion than Romney's.

Of course, it's alright to question the integrity of the study. But assuming that the results are sound, it's obviously appropriate to have them published in time to give abortion opponents an opportunity to change their vote.

What exactly is wrong with moving up the publication date to influence the election?

I do a lot of publishing in scholarly journals. I can speak to journal publication procedures in the area of philosophy across a fairly wide array of journals and also single-author books and anthologies. There are scholarly considerations that go into when an article is published. Generally there is, in effect, a "line." Other people are in line ahead of you, and articles are published in the order accepted, unless the journal is running a special issue. Publication date is also influenced by the time that needs to be taken for an article to be revised, if revisions are requested, and for proofs to be corrected.

These things shouldn't be rushed. It's rude to other scholars whose articles were accepted earlier to bump them for political reasons. The business of a journal, for the sake of scholarly integrity, should carry on according to its own rhythms and priorities. Mixing this with political considerations taints the process.

Journal editors should not be amenable to purely political appeals. If they are, this also casts doubt on the objectivity of the initial acceptance process.

As I have noted, there were several places where the article needed to be revised. Important statistical information was left out. That statement that the abortion rates were *estimated* is, frankly, jaw-dropping. The article definitely should not have gone to press with that statement in there, unclarified and unexplained. If they did indeed estimate their data in the first instance, a rigorous explanation should be given of how they did so. Please note that this is the data on the *very point* which they intend to use to influence policy. Yet the article contains an unexplained statement that this very data was estimated, which prima facie would seem to mean that abortion rates were not actually collected from study participants! My best guess, and the most charitable guess, is that the sentence was a mis-statement, but if so, it should have been reworded or removed. When there are both problems in the article and a clear indication of *haste* to publish the article for political reasons, it is difficult to avoid wondering if those two things are connected!

A journal editor should be careful to show that his journal is *not* lowering its standards for political reasons, but in this case they don't seem to have cared. That's a Bad Thing.

The Peipert study suggests that free contraception as provided through Obamacare would decrease abortions.

Except that I just wrote a whole bunch of words arguing, in meticulous detail, that it doesn't suggest that. I don't know if you bothered to read them, but I'm not going to re-copy the entire article above here for your benefit. Try thinking things through a little instead.

"I should qualify that: They consider people manipulable in areas where their ideology does not prevent them from even trying. In fact, there is a lot of inconsistency here. Contrast, for example, liberals' approach to smoking with their approach to premarital sex and even early teen sex. In the name of public health, they are willing to engage in all sorts of heavy pushing, teaching, and social pressure across the whole spectrum of society to try to prevent people from smoking, even though smoking remains officially legal. In particular, they aim to prevent minors from having any access to the means of smoking or any connection to it."

I've always said that if liberals were consistent they would distribute low tar and nicotine cigarettes free of charge to teens who smoke. After all, we "know" they're going to smoke anyways, and since they are, it would be much better for them to smoke Carltons than Marlboros or Lucky Strikes.

But of course the problem is that liberalism, being an idealist ideology, cannot but be inconsistent. When it smacks up against reality, reality's gotta move, dammit!

I should qualify that: They consider people manipulable in areas where their ideology does not prevent them from even trying.

Brilliant. Thank you for that!

I noticed the study included girls as young as 14. Can we assume the researchers secured parental consent? Missouri law allows minors some consensual power, but I'm not clear on the details.

Kevin, good question. I know that I've seen a number of stories to the effect that minors can receive even full sterilization without parental consent under Obamacare!

I know that many states have special exceptions to parental consent requirements for medical care for birth control and treatment for STDs. It's an area of law that definitely needs to be changed. Essentially, all sexually related areas are deliberately set outside of the parent-child relationship, and healthcare providers are even bound in these states not to reveal to parents that their child has an STD or has received some contraception treatment. It's quite striking to think what this means regarding implants. Your minor daughter could be walking around with an IUD, and the medical professionals could be forbidden even to tell you. Most of the time parents find out that something is up when their insurance records payment for services for the minor, but of course that wouldn't apply where the services were being given at no cost.

Then there's the small issue of statutory rape laws. What has happened in the rush to provide contraception to minors is that statutory rape laws have become a joke--utterly unenforced. And not necessarily only when dealing with a "Romeo and Juliet" relationship (minors within two years of each others' age). Was there any investigation at all into whether these 14 and 15-year-old girls were having sex with thirty-year-old men? Somehow, I doubt it.

The reason I asked is that there might be stricter standards for researchers on informed consent than there are for contraception / sterilization provision.

So if the researchers conformed to Planned Parenthood standards rather than their professional standards enacted to prevent non-consensual sterilization, etc., then they could conceivably face ethics charges.

The paper says, "Before initiating recruitment, we obtained approval from the Washington University Human Research Protection Office." And, "Each participant provided written informed consent[.]"

I must admit to finding it very odd that a minor can provide written informed consent that is both relevant for legal purposes and for professional ethics standards purposes.

It raises questions such as,

--Did American law and ethics practice go through a period in which a 14-year-old could not give written informed consent?

--If so, when did this change? Was the change a result of statutory law or merely a result of things flying under the radar?

--Isn't fourteen still rather young for that level of informed consent? How does that tally with, for example, age cut-offs for child labor laws?

Those of us mildly interested in these things know that a couple hundred years ago and more young people under the age of eighteen could enter into legally binding arrangements. Hey, it used to be that a 14-year-old could bind himself as an apprentice for seven years! But wasn't all that supposed to have been reformed some time between then and now? Somehow it doesn't seem like progress to go in the opposite direction and allow 14-year-olds to be giving binding informed consent to having elective, highly invasive medical procedures with possible negative health consequences performed on themselves.

And how would one induce all women (all women of childbearing age? all women of childbearing age who were not presently trying to get pregnant?) to listen to such a script, anyway?

I don't know if it's a luck thing, but with both girls the OB/GYNs and their nurses, after I gave birth, tried to get me on to birth control. Lots of lecture. The second time, I rather coldly suggested that even if it wasn't against my religion, I have objections to hitting my reproductive system with a sledge hammer voluntarily.

Yes, in "developing countries," as they are politely called, post-childbirth is often used as a place for heavily lecturing and pushing women to accept birth control or even sterilization. There are even stories of doctors having women sign a consent to have their tubes tied in a moment of crisis when the woman needs an emergency C-section.

Women who already have several children have had it implied to them that they may not be able to get healthcare for existing children if they don't agree to contraception or sterilization.

Population Research Institute has published various things of this sort.

For whatever reason we Americans have thus far been somewhat shielded from the heavy hand of government in such population control pushes, but that immunity may be coming to an end, especially as the distinction between government and healthcare establishment becomes increasingly invisible.

I would find it very surprising to find that Missouri has explicitly written laws that confer on 14-year-olds the power of consent over that kind of medical determination, without the approval of a judge saying "OK, for reasons given we don't have to ask your parents." This is a state that repeatedly over the last decade tried to curtail the Roe v Wade regime in different ways.

Most likely, the program didn't ask and pretended to not care whether such young teens have legal capacity for that consent. They probably considered that a signed form will get them out of trouble even if the kids don't actually have legal capacity - a nicely crafted "gray area" (or a pretense of it in which a prosecutor has enough wiggle room to wink) in which they get off scot-free. That's my guess.

This document from Guttmacher seems to imply that only married minors are _explicitly_ permitted to consent to "contraceptive services" in Missouri:

http://www.guttmacher.org/statecenter/spibs/spib_MACS.pdf

However, Guttmacher's note at the beginning of the document definitely confirms the idea of a legal grey area and implies quite clearly that doctors are forging ahead on the assumption that minors will be allowed to be old enough to consent if the matter should come into court, etc. Apparently some SCOTUS ruling (which they do not cite by name) has been a partial culprit in this "development."

Over the past 30 years, states have expanded minors’ authority to consent to health care, including care related to sexual activity. This trend reflects U.S. Supreme Court rulings extending the constitutional right to privacy to a minor’s decision to obtain contraceptives and concluding that rights do not “come into being magically only when one attains the state-defined age of majority.” It also reflects the recognition that while parental involvement is desirable, many minors will remain sexually active but not seek services if they have to tell their parents. As a result, confidentiality is vital to ensuring minors’ access to contraceptive services. Even when a state has no relevant policy or case law or an explicit limitation, physicians may commonly provide medical care to a mature minor without parental consent, particularly if the state allows a minor to consent to related health services. (emphasis added)

I'm guessing the court decision is http://en.wikipedia.org/wiki/Carey_v._Population_Services_International

Is there an appropriate ethics watchdog who can investigate further whether professional ethics standards were maintained? As we know, many of the consent standards were put in place precisely because scientists started sterilizing people for the sake of progress.

Yeah, Lydia, I saw that. I suspected that Guttmacher, like the above investigators, are themselves pushing the envelope by choosing to describe the overall situation that way. Nobody really thinks that having parents help a minor child decide medical questions implies simply that the child's constitutional rights don't exist during that phase, so their comment is pretty doubtful on its face.

I went and looked for the court case, and sure enough, Guttmacher got the concept DEAD WRONG. The Supreme Court used the quoted phrase "come into being magically only when one attains the state-defined age of majority" in Bellotti v. Baird - 443 U.S. 622 (1979). In that case, the Court decided (against the MA Supreme Court) that WITH the approval of a judge, a kid did not have to get approval of parents - did not even have to seek such approval. But the US Supreme Court pretty much made absolutely clear that the qualifier is necessary: with a judge's approval. By no means can any portion of the decision support the theory that a minor can be considered automatically constitutionally competent to decide - even for abortion, of which much more definitive right is held than other decisions that are not so time sensitive - on their own without either a parent or a judge. A state may grant such a right in law, but minors don't have the right simply as a constitutional right. And in a state where the general law says providing medical care is under a parent's authority, without making explicit exception for contraception, you will have a really tough time trying to turn Belloti v. Baird into a rule that supports the kid having carte blanche. No way. Guttmacher, like others, is out to overturn the law by getting general practice to ignore the law.

Here are 2 other sites that pretty much say that in Missouri kids don't have the rights claimed. Both of them are contraception-friendly, so they have no incentive to say that in MO the law is against kids having carte blanche, if it isn't really so.

http://www.contracept.org/minorsaccess.php

(See table at end).

http://sexetc.org/states/missouri/

Yes, in "developing countries," as they are politely called, post-childbirth is often used as a place for heavily lecturing and pushing women to accept birth control or even sterilization. There are even stories of doctors having women sign a consent to have their tubes tied in a moment of crisis when the woman needs an emergency C-section.

Developing, *bleep*, I was being pushed to get sterilized after baby #2 in SEATTLE!

I'm also still pissed that they asked, again, while I was in labor but before pain killers, if I was sure I didn't want to be sterilized. I wasn't very polite.

Kevin, that's one heck of a court ruling. What a disaster. In fact, I'm not entirely surprised if the leftists have taken that to give them carte blanche to give minors contraceptive procedures without parental consent.

Foxfier, sorry to be unclear. What I meant to say was that really _heavy_ pressure to be sterilized is standard in developing countries and that therefore it is not surprising that some degree thereof is also coming to the U.S.

The actual response from the study author, to an e-mail question about abortions, doesn't even say that they asked the participants if they'd had an abortion. What it says is that they interviewed them on the phone and asked them if they had gotten pregnant or had a missed menstrual period. I guess we're supposed to presume that they also asked them over the phone if they'd had an abortion in the interview time-frame, which would at least be an attempt directly to measure the crucial piece of data among study participants, but why didn't they say so in so many words? And as the medical student whom New cites says, how could this all not have been laid out in the original paper? (And I add, why was the paper published without having these things made clear?)

that's one heck of a court ruling. What a disaster. In fact, I'm not entirely surprised if the leftists have taken that to give them carte blanche to give minors contraceptive procedures without parental consent.

You're right. But the very same court, 2 years later, SAID that the constitution doesn't give that carte blanche right. But what is especially shocking in Carey is the blatant manner in which the Supreme Court arrogated to itself absolute judgment over what goods constitute acceptable state interests. They were simply out-of-control despots deciding on behalf of the US public what constitutes the public good. Which the Chief Justice pointed out in his dissent.

"Then there's the small issue of statutory rape laws. What has happened in the rush to provide contraception to minors is that statutory rape laws have become a joke--utterly unenforced. And not necessarily only when dealing with a "Romeo and Juliet" relationship (minors within two years of each others' age). Was there any investigation at all into whether these 14 and 15-year-old girls were having sex with thirty-year-old men? Somehow, I doubt it."
They are a joke. What modernism giveth, modernism/postmodernism taketh away.

"Those of us mildly interested in these things know that a couple hundred years ago and more young people under the age of eighteen could enter into legally binding arrangements. Hey, it used to be that a 14-year-old could bind himself as an apprentice for seven years! But wasn't all that supposed to have been reformed some time between then and now? Somehow it doesn't seem like progress to go in the opposite direction and allow 14-year-olds to be giving binding informed consent to having elective, highly invasive medical procedures with possible negative health consequences performed on themselves."
The only thing we can hope for is that eventually this idiocy collapses in on itself.

Excuse me, the link in my screen name I just gave was incorrect.

Yes, contraqcpetives DO prevent abortions, and have in fact prevented countless abortions since becoming available to the public. One reason why abortion unfortunately remains common is that many young people are foolsih, heedless and irresponsible and FAIL to use them.
And there is no such thing as a pill which can "cause an abortion". An abortion is the surgical removal of a partly formed and VISIBLE fetus . You cannot abort and "murder" a cell, or a few of them, which can only be seen with a microscope .
And women's bodies routinely eject fertilized cells, yet we do not call this miscarriage.
The opposition of the Catholic church to contraceptives is unbelievably foolish .
And it has absolutely no right to demand that non-catholics be deinied the right to use them,merely because it disapproves of them.
You cannot have it both ways. If you are opposed to abortion, you MUST NOT be opposed to contraceptives. Every year in the poorest parts of the world, thousands of desperately poor women die from botched illegal abortions because they have no access to contraceptives , and so many children they have already borne are left motherless.

Yes, contraqcpetives DO prevent abortions, and have in fact prevented countless abortions since becoming available to the public.

A little poorly typed foot-stomping does not empirical evidence make.

And there is no such thing as a pill which can "cause an abortion". An abortion is the surgical removal of a partly formed and VISIBLE fetus . You cannot abort and "murder" a cell, or a few of them, which can only be seen with a microscope .

I expressly refused to get into the sheerly empirical question of what anti-implantation effects there might be on early embryos from hormonal birth control, but the above is a set of utterly scientifically ignorant statements. As usual, the left thrives on scientific disinformation, which is oh, so ironic. The fact that an embryo is too small to be visible without the aid of a microscope hardly implies that it is not a member of the species homo sapiens. It would be laughable to see modern, allegedly scientifically educated, people imply such nonsense if it did not have such serious consequences. As it happens, there are indeed such things as "medical abortions" as opposed to surgical abortions, and they can be carried out at an earlier stage in pregnancy than would be typical for a surgical abortion, typically prior to the time when the embryo is deemed a fetus (at 8 weeks gestation). Go google it. RU486, for example, is one such medical abortion cocktail, though it was not involved in the study discussed in the main post.

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