'Abortifacant' Birth Control

In our paper on Colorado's "personhood" initiative, Diana Hsieh and I pointed out that many common forms of birth control, including the pill and IUD, may act to prevent the implantation of a fertilized egg. The implication is that, if a fertilized egg were defined as a "person," with all the legal rights of a newborn, such birth control logically would have to be banned.

Now the Colorado Catholic Conference illustrates that our concerns were warranted. In a March 31 e-mail, the group warns:

Senate Bill 225 the Birth Control Protection Act concerning the definition of contraception. Senate Bill 225 defines contraceptive or contraception as a medically acceptable drug, device, or procedure used to prevent pregnancy.

This bill is dangerously broad and sweeping with the generic definition it provides for the terms “contraceptive” or “contraception.” This definition could have the effect of making a “drug, device or procedure” that is actually an abortificant a contraceptive or contraception in Colorado.

I criticized the bill on other grounds. But at least debate over the bill has clarified this important issue, as well as the Catholic opposition to birth control that may prevent implantation. Few Catholics seem interested in banning birth control across the board, though the Church opposes it in all cases.

Green On Condoms and AIDS

Recently I discussed the hoopla over the Pope's comments on condoms and AIDS. He said condom distribution does not reduce AIDS in Africa and may increase it. I said it's a mistake to think that condom distribution is a key issue, but that the Pope's general view on condom use is nevertheless wrong.

Frank Pastore has written a column in which he quotes a National Review Online interview with Edward C. Green, director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies. Here's what Green had to say:

We have found no consistent associations between condom use and lower HIV-infection rates, which, 25 years into the pandemic, we should be seeing if this intervention was working.

The pope is correct, or put it a better way, the best evidence we have supports the pope’s comments. He stresses that condoms have been proven to not be effective at the level of population. There is a consistent association shown by our best studies, including the US-funded Demographic Health Surveys, between greater availability and use of condoms and higher (not lower) HIV-infection rates. This may be due in part to a phenomenon known as risk compensation, meaning that when one uses a risk-reduction technology such as condoms, one often loses the benefit (reduction in risk) by compensating or taking greater chances than one would take without the risk-reduction technology.

I also noticed that the pope said monogamy was the best single answer to African AIDS, rather than abstinence. The best and latest empirical evidence indeed shows that reduction in multiple and concurrent sexual partners is the most important single behavior change associated with reduction in HIV-infection rates (the other major factor is male circumcision).

But Patore is not quite revealing the full picture. Just yesterday, the Washington Post published an article by Green in which he adds:

In a 2008 article in Science called "Reassessing HIV Prevention" 10 AIDS experts concluded that "consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa."

Let me quickly add that condom promotion has worked in countries such as Thailand and Cambodia, where most HIV is transmitted through commercial sex...

The problem, then, is not the distribution of condoms, but the failure to use them. The overwhelming problem, though, writes, Green, is that "in significant proportions of African populations, people have two or more regular sex partners who overlap in time."

But of course the Pope's position is not merely that condom distribution in Africa doesn't work: his position is that condom use is inherently immoral. But Christians who cite Green for some religious purpose are going to have difficulty with Green's general views: "'Closed' or faithful polygamy can work as well. ... All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship."

By coincidence, I agree with the Christians that "faithful polygamy," while it might reduce the spread of AIDS, is nevertheless inappropriate. I say "by coincidence" because, while Christians offer religious reasons against polygamy (though some argue the Bible endorses it), my case against polygamy rests on the inherent difficulties of maintaining a true romantic relationship with more than one other person at a time.

Green has even more to say in a BBC interview (as with the earlier link via Wikipedia).

Pastore is right that throwing condoms at the AIDS problem is not likely to solve it. But throwing religious dogma at the problem will produce no better results.

Condoms Increase AIDS?

Not only do condoms not limit the spread of AIDS in Africa, the Pope claims, but condom distribution "increases the problem."

Huh.

Apparently the reason for this is that condom distribution encourages sex, and some of those encouraged to have sex will either not use a condom or contract AIDS despite condom use.

Of course, that doesn't explain the rise of AIDS prior to condom distribution. Obviously condom distribution was a response to the problem, not the cause of the problem.

I don't know much about the spread of AIDS in Africa, but I get the idea that it largely has to do with sexual irresponsibility, rooted in mystical beliefs and primitive machismo. Time writes of a "wife... branded a whore when she asked her husband to use a condom, beaten silly and thrown into the streets."

So let us grant that condoms are not anything like a comprehensive solution to the problem. Does the Pope seriously believe that Catholic abstinence will fare better?

What is needed is not cultural relativism that dares not criticize African cultural forces that contribute to AIDS (and many other ills), nor faith-based calls to forsake sex. Instead what is needed is a cultural movement that emphasizes reason and ethical views consonant with life on earth, including healthy sex.

Contraception 'Medically Acceptable'

It is unbelievable that we're even having this discussion:

[Colorado] Sen. Betty Boyd, D-Lakewood, introduced the measure [Senate Bill 225] to protect birth control from being banned by amendments to the constitution. Of most recent concern was a ballot initiative last year that would have defined a fertilized egg as a person in the state constitution. Coloradans overwhelmingly rejected the initiative.

Critics had pointed out that there could have been unintended consequences to the measure, such as banning birth control.
The theory was that because birth control alters the lining of the uterus where a fertilized egg would be implanted, routine birth control could have been made illegal.

Boyd's measure would prevent birth control from being banned by amendments by defining contraceptive or contraception as a "medically acceptable drug, device, or procedure used to prevent pregnancy."

Two Republicans wanted to change the word "pregnancy" to "contraception," which would open the door to bans on all forms of birth control, such as the pill, which may act to prevent implantation of a fertilized egg in the uterus (as discussed).

Why are we even debating whether contraception is "medically acceptable?" It obviously is. Do we really need the state's constitution to state as much? Should the constitution also point out that aspirin and eye glasses are "medically acceptable?" More to the point, would Boyd approve of an abortion ban that nevertheless allowed people to use birth control?

Boyd's exercise is pointless. If the faith-based anti-abortion crowd wants to ban birth control that may prevent implantation, it will simply propose to change Boyd's language. Boyd should focus her energies on defending the right to get an abortion, not playing semantic games around the margins.