Feminism cannot be a license to offer partial, imbalanced or flat-out wrong medical advice to women whenever elitist feminism’s two holy grails, contraception and abortion, are at issue. This should be evident to anyone with a care for women’s health, let alone to the editorial board of a prestigious medical journal and a professor of bioethics at a large university.
Nevertheless, The New England Journal of Medicine has published an editorial by bioethics professor R. Alta Charo attacking various women within the Trump administration, which reads more like an advertisement for birth control and abortion than a serious medical opinion. Ironically enough, its theme is the claim that women in the Trump administration are promoting “alternative” facts and science.
Enough. I cannot imagine another area of medicine in which anyone would dare to pass off as medicine what is rather cheerleading for a surgery (abortion), or drugs and devices (contraceptives) even as they have become outsized symbols in the culture wars. But women are supposed to put up with this. In the New England Journal of Medicine no less.
The truth is far more nuanced than Charo is willing to disclose. But unless I drafted a book instead of an essay, I could not take on all her misstatements or overstatements. Allow me to address a few, however, which have the potential to cause women considerable grief.
Charo overstates contraception’s effectiveness, by citing overall effectiveness rates for hormonal and long-acting contraceptives (91 percent and 99 percent respectively). But real women using contraceptives in the real world have real consequences which are quite different.
The National Institutes of Health reports, for example that the pill’s failure rate ranges from 9-30 percent. They also acknowledge that 40 percent of women are dissatisfied with their contraceptive method for a variety of reasons including side- and health-effects. This is likely related to their further report that “hormonal contraceptives are associated with adverse events,” especially for smokers (more than 13 percent of women) and women who are obese (40 percent).
The Centers for Disease Control reports that one-third to nearly one-half of women discontinue a variety of hormonal methods over 12 to 18 months. The Department of Health and Human Services continues to pay researchers to figure out the scope of the claim that Depo-Provera increases HIV transmission, and publishes warnings about its risks especially to adolescents’ bone density.
In other words, I would remind Charo that while it’s true that an individual contraceptive drug or device will work to prevent pregnancy most of the time, that’s not all the information women need or want. They want to know the side- and health-effects, as well as the contraindications. A blithe reciting of 91 percent and 99 percent effectiveness rates is insufficient in the extreme.
Women also deserve to know the difference between a drug or device which acts as a true “contraceptive” and one which may act to ensure that a genetically unique human life will be denied implantation and growth in his or her mother’s womb. No one has put this better than feminist author Germaine Greer in her book “The Whole Woman.” She writes:
Whether you feel that the creation and wastage of so many embryos is an important issue or not, you must see that the cynical deception of millions of women by selling abortifacients as if they were contraceptives is incompatible with the respect due to women as human beings.
What’s more, both the drugmakers and federal medical authorities have repeatedly acknowledged the abortifacient possibilities of some drugs and devices labeled “contraceptives.”
Charo deems this information irrelevant, claiming that physicians and the federal government define pregnancy as beginning after implantation. She chooses not to reveal, however, that this definition is neither universally accepted in medical sources, nor long-held.
At the very least, she should have disclosed that a thorough review of medical dictionaries reveals no medical consensus in favor of an “implantation-based” definition of pregnancy, and rather the more common acceptance of a “fertilization-based” definition.
It was in the 1960s that medical groups began moving the definition forward to implantation following the advice of a doctor seeking to make the pill more acceptable. He remarked how “the social advantage of [the pill] being considered to prevent conception rather than to destroy an established pregnancy could depend on something so simple as a prudent habit of speech.”
Finally, respecting Charo’s general conclusions that contraception reduces unwanted pregnancy rates or abortion, this is so much more complicated than her brief treatment acknowledges. Suffice it to say that between the way contraception has changed the markets for sex and marriage, the way it has encouraged “risky behavior,” and its failure-rates and side-effects, it’s no wonder that following its ubiquitous dissemination (from the 1970s to today), nonmarital pregnancy rates have skyrocketed, unintended pregnancy rates remain largely unchanged, and abortion rates climbed a long time before settling at rates still exceeding 1970s figures.
In a nutshell, it is about time that federal officials began honestly acknowledging some of the complexities and downsides of our federal contraception policies. I am not the least surprised that female federal officials are leading the charge. And in the interests of all American women, leading bioethicists and medical journals should be engaging with the new federal authorities to draw out the whole truth, not simply mouthing the press releases of the contraception-abortion-industrial-complex.
Helen Alvaré is a contributor to the Washington Examiner’s Beltway Confidential blog. She is a professor of law at the Scalia Law School at George Mason University and the founder of WomenSpeakForThemselves.com.
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