89% of sexually active women of
reproductive age "at risk" of becoming pregnant use contraception,
and 98% have used it in their lifetime2. Among teenagers who
are sexually active and do not want to become pregnant, all but 7% are using
In the first 12 months of
contraceptive use, 16.4% of teens will become pregnant. If the teen is
cohabiting, the pregnancy (or "failure") rate rises to 47%. Among
low-income cohabiting teens, the failure rate is 48.4% for birth control pills
and 71.7% for condoms.4
Forty-eight percent of women with
unintended pregnancies5 and 54% of women seeking abortions were
using contraception in the month they became pregnant.6
Contraception expert James Trussell
of Princeton says: "The Pill is an outdated method because it does not
work well enough. It is very difficult for ordinary women to take a pill every
single day."7 Pregnancy is so likely from even a slightly
delayed dose that government guidelines advise women to use "emergency
contraception" if they had unprotected intercourse within two days after
taking their daily progestin-only pill 3 hours late.8
Contraceptive effectiveness is often
estimated on a misleading per-use basis, or as failure rates over 12 months of
typical use for all women of reproductive age. This greatly understates failure
rates among teens, and fails to account for cumulative risk from more frequent
Risk compensation: Numerous studies
examining sexual behaviour and STD transmission have demonstrated risk
compensation behaviour, i.e., a greater willingness to engage in potentially
risky behaviour when one believes risk has been reduced through technology.9
Increasing access to contraception
gives teens a false sense of security, leading to earlier onset of sexual
activity and more sexual partners, which counteracts any reduction in
Researchers in Spain examined
patterns of contraceptive use and abortions in Spain over a ten-year period
from 1997-2007. Their findings, published in the journal Contraception in
January 2011, were that a 63 percent increase in the use of contraceptives was accompanied
by a 108 percent increase in the rate of elective abortions.10
In July 2009 results were published
from an expensive three-year program at 54 sites, funded by England's
Department of Health, seeking to "reduce teenage pregnancy" through,
among other things, sex education and advice on access to family planning
beginning at ages 13-15. "No evidence was found that the intervention was
effective in delaying heterosexual experience or reducing pregnancies."
Young women who took part in the program were more likely than those in the
control group to report that they had been pregnant (16% vs. 6%) and had early
heterosexual experience (58% vs. 33%).11
David Paton, author of four major
studies in this area, has found "no evidence" that "the
provision of family planning reduces either underage conception or abortion
rates."12 He sums up the U.K. experience: "It is clear
that providing more family planning clinics, far from having the effect of
reducing conception rates, has actually led to an increase…. The availability
of the morning-after pill seems to be encouraging risky behaviour. It appears
that if people have access to family planning advice they think they
automatically have a lower risk of pregnancy." 13
K. Edgardh found that despite free
contraceptive counselling, low cost condoms and oral contraceptives, and
over-the-counter emergency contraception (EC), Swedish teen abortion rates rose
from 17 per thousand to 22.5 per thousand between 1995 and 2001.14
Peter Arcidiacono found that among
teens, "increasing access to contraception may actually increase long run
pregnancy rates even though short run pregnancy rates fall. On the other hand,
policies that decrease access to contraception, and hence sexual activity, may
lower pregnancy rates in the long run."15
Twenty-three studies published
between 1998 and 2006, and analysed by James Trussell's team at Princeton
University, measured the effect of increased EC access on EC use, unintended
pregnancy, and abortion. Not a single study among the 23 found a reduction in
unintended pregnancies or abortions following increased access to emergency
contraception.16 For more information, including the
conclusions of individual studies and researchers on this point, see "Fact
Sheet: Emergency Contraception Fails to Reduce Unintended Pregnancy and
1 Centers for Disease
Control and Prevention, Advance Data No. 350, Dec. 10, 2004: "Use of
Contraception and Use of Family Planning Services in the United States:
2 Guttmacher Institute, Abortion in Women's Lives, www.guttmacher.org/pubs/2006/05/04/AiWL.pdf,
3 Id., "Facts on Contraceptive Use," January 2008; www.guttmacher.org/pubs/fb_contr_use.html.
4 H. Fu et al., "Contraceptive Failure Rates: New
Estimates from the 1995 National Survey of Family Growth," Family Planning
Perspectives 31 (1999): 56-63 at 61.
5 Abortion in Women's Lives, note 2 supra, at 7.
6 Guttmacher Institute, "Facts on Induced Abortion in the
United States," July 2008, www.guttmacher.org/pubs/fb_induced_abortion.html.
7 D. Rose, "The Pill 'has had its day as an effective
contraceptive'," The Times (UK), June 26, 2008; www.timesonline.co.uk/tol/news/uk/health/article4215441.ece?articleid=4215441.
8 National Guideline Clearinghouse, "The use of
contraception outside the terms of the product license" (2005),
Recommendation No. 18; www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7488&nbr=4433.
9 J. Richens et al., "Condoms and Seat Belts: the
Parallels and the Lessons," The Lancet 355 (2000): 400-403; M. Cassell et
al., "Risk compensation: the Achilles' heel of innovations in HIV
prevention?", British Medical Journal 332 (2006): 605-607; for extract see
10 J. Dueñas et al., "Trends in the Use of Contraceptive
Methods and Voluntary Interruption of Pregnancy in the Spanish Population
during 1997-2007," 83 (2011) Contraception 82-87.
11 M. Wiggins et al., "Health Outcomes of Youth
Development Programme in England: Prospective Matched Comparison Study,"
British Medical Journal 339.72 (2009): b2534; advance online publication (7
July 2009): 1-8 at l; www.bmj.com/cgi/reprint/339/jul07_2/b2534.
12 D. Paton, "The Economics of Family Planning and
Underage Conceptions," J. of Health Economics, 21.2 (March 2002): 207-225;
abstract at www.sciencedirect.com/science/article/B6V8K-4537PJR-3/2/7b0ac0ed4b84065fae3119e1663e50bc.
This study examined 16 regions of the U.K. over a 14-year period, and also
focused on the effect of the Gillick ruling, which from 1984 to 1985 required
parental consent for girls under 16 to obtain contraception in England (but not
in Scotland). Predictably, a heavy drop in clinic visits occurred among English
girls under 16. Many expected to see increased pregnancies and abortions in
this group, compared to older girls in England and girls under 16 in Scotland;
instead the study found no increase in pregnancies or abortions in the former
group, and no decrease in underage pregnancies or abortions overall from
greater access to contraception.
13 Quoted in K. Ahmed, "Abortions rise in under-age sex
crisis," The Observer (UK), 17 March 2002; www.guardian.co.uk/uk/2002/mar/17/medicalscience.socialsciences.
14 K. Edgardh et al., "Adolescent Sexual Health in
Sweden," Sexually Transmitted Infections 78 (2002): 352-6; available at http://sti.bmjjournals.com/cgi/content/full/78/5/352.
15 P. Arcidiacono et al., "Habit Persistence and Teen Sex:
Could Increased Access to Contraception Have Unintended Consequences for Teen
Pregnancies?", Working Paper, Duke University Department of Economics
(Oct. 3, 2005): 1-38 at 31; www.econ.duke.edu/~psarcidi/teensex.pdf.
16 E. Raymond et al., "Population Effect of Increased
Access to Emergency Contraceptive Pills: A Systematic Review," Obstetrics
& Gynecology 109.1 (January 2007): 181-8.
17 J. Mohn et al., "An analysis of the causes of the
decline in non-marital birth and pregnancy rates for teens from
1991-1995," Adolescent and Family Health 3.1 (Spring 2003): 339-47 at xx.
18 J. Santelli et al., "Can Changes in Sexual Behaviors
Among High School Students Explain the Decline in Teen Pregnancy Rates in the
1990s?", Journal of Adolescent Health 35 (2004): 80-90 at 80.
19 D. Halperin et al., "The time has come for common
ground on preventing sexual transmission of HIV," The Lancet 364.9449 (27
November 2004): 1913-1915 at 1913. 3/17/11
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