Writing in the National Catholic Reporter in early August, Nicholas Cafardi made the provocative assertion that between Mitt Romney and Barack Obama, the president is the more pro-life candidate. A significant part of the Duquesne law professor’s argument is that Obama favors “support for vulnerable pregnant women and alternatives to abortion [which] will make abortions much less likely, since most abortions are economic.” A few weeks later, just thirty-four days before the election, that argument became even stronger.
On October 3, researchers at the Washington University School of Medicine published a study with profound implications for policy making in the United States. According to Dr. Jeffery Peipert, the study’s lead author, abortion rates can be expected to decline significantly—perhaps up to 75 percent—when contraceptives are made available to women free of charge. Declaring himself “very surprised” at the results, Peipert requested expedient publication of the study, noting its relevance to the upcoming election.
As most observers surely know, the Affordable Care Act (a.k.a. “Obamacare”) requires insurance coverage for birth control, a provision staunchly opposed by most of the same religious conservatives who oppose legalized abortion. If Peipert is correct, however, the ACA may prove the single most effective piece of “pro-life” legislation in the past forty years.
Before teasing out the implications of this claim, it’s important to understand the conditions that make such a claim possible. Drawing on a sample of 9,000 St. Louis women—many of whom were uninsured—Peipert and his colleagues covered the costs of birth control, making a variety of options available free of charge. Once price was no longer a concern, many of the women opted for relatively expensive intrauterine devices (IUDs) which are among the most effective forms available:
The effect on teen pregnancy was striking: There were 6.3 births per 1,000 teenagers in the study. Compare that to a national rate of 34 births per 1,000 teens in 2010.
There also were substantially lower rates of abortion, when compared with women in the metro area and nationally: 4.4 to 7.5 abortions per 1,000 women in the study, compared with 13.4 to 17 abortions per 1,000 women overall in the St. Louis region, Peipert calculated. That’s lower than the national rate, too, which is almost 20 abortions per 1,000 women.
Encouraging as these results are from both a women’s health and, ostensibly, pro-life perspective, they become even more so in light of their economic benefits. Author Brian Alexander notes that, according to a 2011 study from the Guttmacher Institute, “unplanned pregnancies cost the United States a conservatively estimated $11 billion per year,” money that may be saved simply by covering the cost of birth control.
Peipert himself touted this benefit. “The way I look at it as a gynecologist with an interest in women’s health and public health and family planning, is that this saves money,” he said. “When you provide no-cost contraception, and you remove that barrier, you finally reduce unintended pregnancy rates. It doesn’t matter what side one is on politically, that’s a good thing.” Dr. James T. Breeden, president of the American College of Obstetricians and Gynecologists, called the data “an amazing improvement,” adding, “I would think if you were against abortions, you would be 100 percent for contraception access.”
But it remains the case that, by and large, those most opposed to abortion are not “100 percent for” contraception access. In fact, Peipert’s study comes at a time when more than thirty federal lawsuits have been filed by social conservatives bent on overturning the ACA’s contraception mandate. In many cases, these suits are “religious freedom” complaints, arguing that requiring religiously-affiliated organizations to include contraception in their health care plans violates their rights of conscience. These claims are, in most cases, dubious given that the ACA offers a religious “accommodation” whereby the onus of contraceptive coverage is placed on insurance companies rather than organizations.
Such efforts by social conservatives to oppose the ACA betray both an unseemly partisanship and a nervous insecurity. It seems entirely plausible that, in the contraception mandate, leaders of these groups see not a violation of their own freedom so much as a weakening of their ability to dictate the terms by which their members live.
It’s also worth noting that, as a premise for political arguments, religious freedom has become strikingly promiscuous in recent years. Now cited as a justification for opposition to same-sex marriage, anti-discrimination laws, and—stunningly—anti-bullying initiatives, conservative activists are finding they may apply religious freedom to any number of disparate issues. Apart from trivializing what ought to be a sacred liberal right, the widespread deployment of religious freedom arguments indicates a weak rhetorical posture. In each of the cases mentioned above, opponents of a particular piece of legislation embraced religious freedom only after other strategies failed to persuade. Such arguments thus served as a sort of fallback position, allowing their advocates to re-frame the debate on terms entirely separate from the practical merits of the policy at issue.
In providing strong documentation that no-cost contraception is successful in dramatically limiting abortions, Peipert has placed the ACA’s opponents in a potentially difficult position. Fierce resistance to abortion is a central plank in the social conservative platform, and has for decades served as one of the standards around which millions of activists and voters have rallied. That a path to the drastic decline in abortions that these individuals have so desperately sought has suddenly been provided them by a president they so openly despise is, at the very least, a political puzzle.
But by addressing the problem of unintended pregnancy—rather than the politically fraught problem of abortion—“Obamacare” addresses the issue at its root. Though abortion has served as the central locus of the “culture war” for nearly forty years, it has always been a secondary concern—a problematic solution to a deeper and less sensational problem. By insisting on mere illegality, pro-life forces have turned a blind eye to the troublesome side-effects of illegal abortion even as they dedicated themselves to a largely symbolic political victory. And since the political divisions accompanying the debate have become so intractable, hope for a deliberative resolution has long ceased to exist.
In the Affordable Care Act’s contraception mandate, we have a previously unimaginable opportunity for satisfying compromise on abortion. In accordance with liberal demands, the procedure will remain safe and legal, and reproductive choices will be extended to those who have been unable to afford them in the past. In exchange, conservatives will see abortion rates plummet, achieving a result comparable to that of illegality but without the fierce controversy or government imposition in the lives of individuals.
I am not so naïve as to believe that this conclusion is likely to be reached soon, or without further contest. Nor do I anticipate that Tom Minnery or Bryan Fischer will embrace President Obama as a pro-life hero. But it seems to me that, if conservatives really believe in the evil of abortion, they are morally obligated to embrace a policy that stands to limit it so impressively.