Richard Doerflinger, deputy director of the Secretariat for Pro-Life Activities for the U.S. Conference of Catholic Bishops.

A widely reported three-year study of women purporting to show that free contraceptives dramatically reduce rates of abortion and unintended pregnancy is flawed in its methodology and conclusions, critics recently said. 

Researchers particularly promoted the use of IUDs and hormonal implants, which were chosen by 75 percent of the 9,256 St. Louis area women in the study. That compares with approximately 5 percent of the general population in the United States, a U.S. bishops’ pro-life advocate said. 

“What’s new about this study is that they essentially sterilized these women. These are long-lasting methods that cannot be reversed without a doctor,” said Richard Doerflinger, deputy director of the Secretariat for Pro-Life Activities for the U.S. Conference of Catholic Bishops. “What they’ve proved is if a woman has been sterilized, she will not get pregnant or have an abortion.” 

A flawed method

“Preventing Unintended Pregnancies by Providing No-Cost Contraception,” published in September in Obstetrics and Gynecology journal, stated that abortion rates were less than half the national and regional rates among participants in the Contraceptive CHOICE Project.  

According to “A Pocket Guide to Managing Contraception,” as published in the amicus brief filed by Women Speak for Themselves on behalf of two religious colleges, long-term methods and their risks include: 
◗ ParaGard© Intrauterine Copper IUD, which “can result in uterine perforation,” “increased bleeding or pain, and injury or damage to the surrounding organs.”
◗ Mirena© levonorgestrel-releasing IUD, which releases steroidal hormones into the uterine area. It has a risk of perforation that was the subject of a warning letter sent by the Food and Drug Administration to manufacturer Bayer. Mirena has been linked to ovarian cysts, a higher profile for pelvic inflammatory disease, and irregular bleeding, the brief said, quoting the “Pocket Guide.” In rare cases of conceiving while using Mirena, there may result in a loss of pregnancy and possible permanent loss of fertility.
◗ Implanon© is a plastic implant rod containing the hormone etonogestrel. According to the manufacturer, risks include ectopic pregnancy and serious thromboembolic events, including stroke.

In addition, “The rate of teenage birth within the CHOICE cohort was 6.3 per 1,000, compared with the U.S. rate of 34.3 per 1,000,” said Jeffrey Peipert of Washington University and his co-authors. They concluded, “Unintended pregnancies may be reduced by providing no-cost contraception and promoting the most effective contraceptive methods.” 

However, all participants were volunteers who had an apparent interest in avoiding pregnancy and received free contraception, and there was no control group used in the study, said Michael New, professor of political science at University of Michigan-Dearborn, who published an analysis at National Review Online. 

“The second thing is they have not made the actual data available,” New told Our Sunday Visitor. 

“In the spirit of full disclosure, the authors should publicly provide the raw, unweighted data on the birthrate and abortion rate of study participants. That would provide a much better measure of the effectiveness of this program,” he wrote Oct. 10 at National Review Online. 

The study’s much-touted drop in the number of abortions and unintended pregnancies relies on weighting and statistical formulas, data from a St. Louis abortion clinic, demographic data from Kansas City and St. Louis and national data, as well as information from study participants, which was also weighted, according to the study. 

In addition, the fact that 75 percent of the women received long-term surgically implanted forms of contraception makes the study less generally applicable since many physicians refuse to implant IUDs due to their health risks and because of liability fears, said New. 

Fifty-eight percent chose some form of IUD and 17 percent chose another form of long-term contraception, according to the study.

Necessary skepticism

Authors of the study said they devised it to mimic what they believed would happen if the Department of Health and Human Service’s contraceptive mandate were in place and women would have free access to all forms of contraception, including IUDs and hormone implants, which have upfront costs of more than $500. 

The goal of the study was to increase the number of women using IUDs and implants because they “are more than 20 times more effective at preventing pregnancy” than other methods.  

The failure rate of oral contraceptives is 8 percent to 9 percent a year, according to the study. 

“On top of the usual skepticism one should have toward any scientific study touted as the final word on a complicated issue, one should view with even more suspicion a study as conveniently timed as this one.”  

Fifty-one percent of the study participants were African-Americans, 35 percent had high school or less education, 37 percent were receiving public assistance, 42 percent reported having had an abortion, and 41 percent reported having had a sexually transmitted disease. 

“One of the items that stood out for me was that the researchers used IUDs for a large portion of the women enrolled,” said Kristan Hawkins, president of Students for Life of America. “IUDs are much more dangerous than the birth-control pill and work often to cause medical abortions. So, in effect, they are trading surgical abortion for medical abortion.” 

Lack of control group

Further, Hawkins said, the study did not address what happened to the sexually transmitted disease rate among the study participants. In addition, a study reported in Lancet Infectious Diseases journal, and reported October 2011 in The New York Times, found a doubling of the rate of HIV among women who had hormonal implants, and their male partners. 

Kristan Hawkins, president of Students for Life of America

The study participants were volunteers who responded to ads and fliers, including 16 percent referred from local abortion clinics. The participants were then strongly counseled to choose long-term contraceptives, according to the study. 

“A better idea would have been to randomly select some percentage of the volunteers, inform them that they were not going to receive free contraception, but continue to track their births and abortions in exchange for some compensation. That would have allowed for a meaningful comparison between a treatment group and a control group,” New wrote. 

“On top of the usual skepticism one should have toward any scientific study touted as the final word on a complicated issue, one should view with even more suspicion a study as conveniently timed as this one,” said Katie Short, attorney for Life Legal Defense Foundation, which has filed amicus briefs on behalf of Women Speak for Themselves against the contraceptive mandate in support of lawsuits by Belmont Abbey College and Wheaton College. 

The health consequences of the long-acting methods will be more available if the HHS contraceptive mandate takes effect, according to an amicus brief filed by the foundation. Risks of the IUD include perforation of the uterus and ectopic pregnancies, while implants have been linked to greater risk of heart attack and stroke (see sidebar). 

“The fact is these methods make the woman’s intent irrelevant. Even if she changes her mind, she can’t discontinue these devices without getting a doctor to take them out,” Doerflinger told OSV. “I think this is putting more control into the hands of the population-control people to talk women into meeting their goals … without regard for the changeability of a woman’s own wishes of whether to have a baby.” 

Valerie Schmalz writes from California.