“Jane Galt”, a libertarian economics-motivated political blogger, has an interesting discussion of contraception policy from the point of view of price theory:

[F]ree contraception programs produce only very modest results where they are tested. Consider these highlights from Planned Parenthood:

* The most successful adolescent pregnancy prevention programs in the U.S., which combine sexuality education with direct access to or information about contraceptive services, have increased contraceptive use among participants by up to 22 percent (Frost & Forrest, 1995).

* More boys who participated in a high school condom availability program in Los Angeles reported using condoms every time they engaged in vaginal intercourse during the past year (50 percent) than the year before (37 percent), and more boys reported condom use for recently initiated first vaginal intercourse (80 percent) than the year before (65 percent) (Schuster et al., 1998).

* Condom use among students in New York City public high schools that have condom availability programs is five percentage points higher than in Chicago, where no such programs exist (Guttmacher et al., 1997).

In other words, if we give birth control to students for free, and tell them how to use it, and urge them to do so, we might increase the number of students using birth control regularly by 22% [memo to study neophytes: that 22% figure does not mean that out of 100 students, 22 more of them are now using contracpetion; it means that whatever smaller group were previously using contracption is now larger by 22% of itself--so if 50% were previously using contraception, 11 more students are now using birth control than were before.]. That’s pretty damn underwhelming. And that’s the best study Planned Parenthood can come up with, the one that is probably the outlier on the normally distributed bell curve of such study outcomes. I’ve no doubt that the abstinence folks have grabbed whatever study lies at the other end of the bell curve, and are using it to claim that contraception-based sex ed actually increases the number of pregnancies by teaching students that it’s okay to have sex.

I do believe that educating people about sex and giving them contraception for free increases contraception usage somewhat, and lowers unwanted pregnancy. But how much it reduced unwanted pregnancies depends on how many of today’s unwanted pregnancies result from ignorance or lack of access to contraception; if these are not the primary cause of unwanted pregnancy, then the effect of such laudable programmes will be modest. And based on the studies so far done, that effect seems to be pretty trivial–too small to make more than a small dent in the number of unwanted pregnancies.

This leads me to conclude that the monetary cost of contraception is, at best, a small contributing factor to unwanted pregnancy in this country. . . .

My primary argument, based on that tired old UChicago price theory, is that the reason that we will not significantly reduce abortions is that the non-monetary costs of birth control–acquiring and remembering to use it, and the unpleasant side effects, medical or otherwise (insert “raincoat in the shower” jokes here), so far outweigh the monetary costs that even giving people birth control for free has only a limited impact on their usage.

This is part of a running argument she is having over William Saletan’s much-criticized Op-Ed on abortion. One of her conclusions (it’s a long post) is that we need to find some policy other than contraception distribution to address abortion, because contraception distribution makes only a small contribution to changing abortion rates.

She makes a good case. However, there are a few things to note:

• As she points out later in the post, one reason increased contraception usage wouldn’t affect abortion rates even in areas with currently very low rates of contraception use is that those are also areas with virtually no access to abortion. But this is hardly a satisfying point. She notes that assuming large-scale changes in social mores or public policy as a component of smaller policy prescriptions (“distribute condoms and create more support for abortion access!”) are pipe dreams, but she seems to accept too readily the barriers currently in place, then cites them as reasons why changes in policy can’t work. If the reason contraception does not reduce abortion is that (essentially) nobody is permitted to get an abortion at all, that is not a reason to oppose contraception, or to simply accept the fact that abortion access is blocked.

  Further on this point, if the question is what policies we should support in regard of sexual health, it is worth noting that contraception and abortion are conceptually linked issues in the minds of many activists. That is, the people who oppose contraception are the same ones who oppose abortion, and vice versa for the group that supports access to each. So, changing contraception policy both requires and is part of changing the entire complex of attitudes and policies that affect abortion policy as well. And if we have to work on both those issues together – and if we can do so with at least some success – the barriers to abortion that undermine contraception’s impact on abortion are not reasons to oppose contraception distribution, but simply part of the large and difficult project of supporting it.

• Similarly, she seems to overlook the question of access (and of public support for abortion rights) as a contributor to abortion rates. She cites a list of the states that are above the national mean for abortion rate, noting they are all decidedly liberal – with “dense populations, and high levels of spending on public health, as well as lots of Planned Parenthood clinics” – as evidence that contraception availability and sex education do not reduce abortion. But this comes immediately before noting that the low-abortion-rate states have unsupportive social mores and few abortion clinics! So her list tells us nothing other than that states that are anti-contraception are also anti-abortion-rights, and similarly for states that are pro-contraception – certainly nothing about how the relative degree of contraception availability in those states is a factor influencing unplanned pregnancies in those states.
• She buys into Saletan’s priority of reductions in abortion alone as the goal of contraception policy – putting her (despite her denials) strongly in the punitive wing of the anti-choice camp. To be fair, this is a discussion of Saletan’s article, so perhaps she is not required to explore broader policy issues. But to conduct the entire discussion in terms of contraception as a contributor to abortion rates, with virtually no recognition of the benefits of contraception as prevention of unplanned pregnancy and a factor in safer sex, takes sexual health and sexual autonomy out of the picture and casts the entire issue as merely a matter of discouraging a particular disapproved health option – exactly as the anti-choice campaign does. (She says, rather snidely: “If you want to go ahead and start another clinic to give kids the Pill, be my guest. Add a shuttle service, education classes, and for all I care a pedicure station. I’ll applaud your efforts, and throw in a little of my own hard-earned cash to boot, since I think it’s a worthy cause. But I will be surprised indeed if we see a meaningful drop in abortions as a result.” She then immediately states: “I’m not denigrating providing contraceptive access as a project . . . .” Oh, no?)
• She ignores secondary effects. Making contraception more widely available, and thus somewhat more used, also increases the social expectation that it will be used (by changing people’s thinking; by making it seem the usual or expected thing; by giving girls a choice of boyfriends who will use it if others refuse . . .). Providing universal and appropriate sex ed destigmatizes sex and contraception. Creating clinics and other forms of sexual health access where there were none not only provides needed services but makes those services come to be expected and seem normal. Thus adopting policies with limited effectiveness lays the groundwork for increases in effectiveness as those policies become more widespread – a tipping point I think we haven’t reached even in liberal areas of the country.

Galt is smart, argues well, and has some useful points to make. Her libertarian-indifference streak surfaces too often for my taste, but she is worth reading most of the time. On this issue, however, narrowly defining successful policy in terms only of satisfying the demands of the anti-sex reactionaries (i.e., reducing overall abortion statistics), and not in terms of expanding sexual safety and autonomy for women or providing the best opportunity for safe sexual development for girls in their exploratory phase, not only plays into conservatives’ hands but ignores the moral values at the heart of policy development. It’s the reason “that tired old Chicago price theory” misses so much of what economics is about.

Jill at Feministe hits the nail on the head with this post on healthcaregiver “conscience clauses” – with regard both to their basic conflict with the duty to the patient, and the truly frightening extremes many of these new laws go to.

I couldn’t have said it better myself, so I didn’t.