Catholic doctors respond to local contraceptive study
A group of area Catholic physicians is responding to a recent Washington University study that shows offering free contraception contributes to a decrease in abortions.
The Contraceptive CHOICE Project provided more than 9,000 women and adolescents in the St. Louis area with free birth control, including intrauterine devices (IUDs), birth-control pills, patches and rings, between 2007 and 2011. The results of the project, which were published online Oct. 4 in the medical journal Obstetrics and Gynecology, showed that providing these methods to women cut abortion rates by a range of 62-78 percent, compared to the national rate.
Members of the Catholic Medical Association's St. Louis Guild, however, have concerns about the study, ranging from how these contraceptives will be paid for in the long run to the disregard it shows for the dignity of women and unborn human life.
"The study, at best, demonstrates that supplying widespread 'chemical sterilization,' paid for by someone else, reduces population-wide birth rates and repeat abortion rates," said Dr. Michael Dixon, president of the St. Louis Guild and an OB/GYN and founder of St. Gerard Obstetrics and Gynecology at St. Anthony's Medical Center. "Eliminating abortion is the ultimate goal here, but it cannot be achieved at the cost of early human life, and while trampling on patient consent rights and religious liberty."
Free or not?
In the past few weeks, secular media reports have made the correlation between the results of the Washington University study and the need for the U.S. Department of Health and Human Services' contraception mandate, which would require most employers to offer health care plans that would provide free sterilizations, contraceptives and abortion-inducing drugs.
The study also specifically addressed that it simulated the Institute of Medicine's recommendation that eight primary preventive health services for women be covered free under the Patient Protection and Affordable Care Act of 2010. The study found that "providing no-cost contraception and promoting the use of highly effective contraceptive methods has the potential to reduce unintended pregnancies in the United States."
However, a 2012 survey by Reimbursement Intelligence, a health insurance industry consulting firm, showed that none of the 15 companies surveyed felt the HHS health care mandate would result in a net cost savings by preventing unintended pregnancies. Other state-level studies have shown its unclear how much cost savings there would be by preventing unplanned pregnancies through the use of a contraception mandate.
Mickey Herbert, former CEO of health insurance provider ConnectiCare, told the Connecticut Mirror newspaper in February that the federal mandate "is not the way insurers operate. If we know contraceptives cost $600 a year, that $600 by all rights needs to be built into the premiums," he told the newspaper. "I take offense at the president or anyone else who says (contraceptive services) are free."
Contraception can still cause abortions
Participants in the Washington University study were offered all FDA-approved methods of contraception and could choose whatever method they preferred. About 75 percent of the participants chose long-acting reversible contraception (LARC), which include both copper- and progestin-secreting intrauterine devices (IUDs). These methods have proven to be more effective in preventing pregnancy compared to the birth-control pill, but they also have the ability to cause an early abortion, said Dixon.
FDA-approved information notes that one of the mechanisms of IUDs and implants in preventing pregnancy is to thin or change the lining.
The instructions that come with the IUD ParaGard, for example, state that "Possible mechanism(s) by which copper enhances contraceptive efficacy include interference with sperm transport or fertilization, and prevention of implantation."
The prevention of implantation, said Dixon "is called an abortifacient mechanism -- because it prevents the early human zygote or early embryo from implanting in the uterine lining, which is essentially an early abortion." He also questioned whether medical professionals who prescribe these methods of birth control are properly counseling patients about their abortifacient properties.
"One cannot justify a policy of reducing abortions by a mechanism that simply causes earlier abortions," he added.
The study data
Initially labeled as a "cohort" study, the goal of the Contraceptive CHOICE Project was to follow the group of women in search of a variable -- in this case, the study analyzed abortion rates, percentage of repeat abortions and teenage births. Participants for the study were recruited from two abortion facilities in the St. Louis region, provider referral, advertisements and word of mouth.
The outcome of the study showed that there was a significant reduction in the percentage of repeat abortions in the St. Louis region compared to elsewhere in Missouri. Abortion rates in the study group also were less than half of the regional and national rates. And the rate of teenage births within the study group was 6.3 per 1,000 compared to the national rate of 34.3 per 1,000.
The study later acknowledges its own limitations. It described its anaylsis comparing repeat abortions in St. Louis compared to elsewhere in Missouri as "essentially an ecological study."
"It is not possible to conclude that the changes observed in repeat abortion were due solely to the Contraceptive CHOICE Project," the report also noted. Dixon said that possible contributors to a decline in repeat abortions in St. Louis can include the efforts by local crisis pregnancy centers and sidewalk counselors outside abortion facilities.
There also was no detailed analysis within the study on sexually transmitted infections, which the contraception methods used do not protect against. A 2010 survey by the Centers for Disease Control noted that St. Louis has one of the highest STI rates in the country.
Respecting the dignity of women
The Washington University study and the HHS contraception mandate also raise a bigger-picture question of whether the dignity of women is being respected, said Dixon.
With eliminating abortion as the goal, there are other ways to achieve the same end but respecting a woman's gift of fertility. By essentially "chemically sterilizing" women, the need for them to know how their body functions is removed.
Dixon said he also found it disappointing that natural fertility awareness methods, such as the Creighton Model FertilityCare System, were not offered as choices to those participating in the Washington University Study. These methods give women the knowledge and power to understand how their bodies function, he noted.
"Fertility awareness methods empower women with knowledge of their fertility, promote respect for a woman's body while fostering responsible behavior," said Dixon, who added that these methods do not use synthetic hormones and come with no adverse side effects.
"Widespread chemical sterilization of women is not the way to reduce abortions," he said. "Women deserve better."
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