Why Access to Birth Control Is No Substitute for Abortion Rights

We have reached a dangerous new place in the battle over bodies and birth control in the United States. After years of attacks, this month Texas effectively made most abortions illegal, when a law took effect—after the Supreme Court declined to block it—that prohibits abortion as early as six weeks into pregnancy, and allows private citizens to sue anyone who facilitates one after that.

I empathized with the instant expressions of fear and grief that many people committed to abortion rights expressed at the news. But, having studied the history of birth control in the U.S., I also grew worried about what was likely to come next: calls for people who can get pregnant to find a long-term form of birth control. Indeed, when Amy Coney Barrett was confirmed to the Supreme Court, one commentator suggested that focusing on access to long-acting reversible contraceptives for women could be a solution to impending abortion restrictions. Others have championed contraceptive access for women in the wake of bans.

These suggestions are part of a larger social approach that often redirects attention to women’s use of contraception when support for abortion comes up. This is familiar for many menstruating people who already bear the burden of preventing pregnancy, especially when facing partners who won’t wear condoms. It’s all a predictable cycle at this point—one in which, as is so often the case, individual American women end up asked to take responsibility for something that is really a society-wide problem.

It may seem reasonable to position long-term prescription birth control for birthing bodies as a solution to impending abortion restrictions. But the pill and other forms of long-acting reversible contraception must work alongside abortion, not as an alternative to it.

For one thing, there are important reasons why people may choose not to use that form of contraception. While almost half of sexually active American women ages 15-44 who were not seeking pregnancy reported using a reversible prescription method in 2016 (and another 22.4% were sterilized), the reality is that those contraceptives aren’t perfect. Side effects are the leading cause of stopping them because of dissatisfaction. One study of contraceptive preferences among women seeking abortion found that 78% of them deemed it extremely important that the method have no side effects. That’s a tough proposition with prescription methods. Condoms, however, are an accessible alternative that protect users against both pregnancy and sexually transmitted infections, and without side effects—though, with typical use, they are more likely to fail to prevent pregnancy. Perhaps not coincidentally, the condom was the method most commonly used by abortion patients in 2014, according to a 2018 analysis conducted by a researcher at the Guttmacher Institute. When the average American woman’s reproductive life span can last over 30 years, abortion availability is a necessary option.

Just as importantly, encouraging prescription birth control use as the solution to the loss of abortion rights is a continued reflection of the feminization of contraceptive responsibility. If there’s anything that I’ve learned from my research on the burdens of preventing pregnancy, it’s that women need both birth control and abortion. The U.S. has a nasty history of choosing birth control to solve issues understood as social problems instead of addressing those issues head on. We need practices that maximize reproductive freedom, not practices that condone uneven responsibility.

Though we as individuals can’t change what the Supreme Court has done, we can change the ways that we perpetuate gender inequality in our relationships, whether friendly or intimate. There’s no way to fulfill the promise of the pill without wholeheartedly rejecting suggestions that people who can get pregnant must use prescription birth control to remedy a system that failed them. Promoting abstinence won’t work because many young people who plan to abstain don’t actually do so. Instead, it’s time for partners and others in our society to step up.

The data don’t look good on that front. The percentage of men who consistently take contraceptive responsibility via condom use is strikingly low. A 2017 report from the Centers for Disease Control and Prevention found that only 23.9% of men aged 15-44 used a condom every time they had sexual intercourse in the month before the survey. This pales in comparison to the 69% of women aged 15-44 who reported successfully accomplishing the much harder task of never missing a pill over the same time period. Indeed, the pill is only as effective as it is (91%, in practice) because users commit to taking it every single day despite lack of recognition for their efforts.

Partners finally accepting their share of responsibility for preventing pregnancy is only one solution, however. Concerted social action to halt the erosion of reproductive rights is also vital. Texas is not the only state that will try to enact this kind of legislation. Florida has already signaled that it will follow suit and others will too. Rather than uncritically calling for menstruating people to use contraception, those of us worried about giving Americans control over pregnancy should focus on activities that bear directly on improving access to abortion. This includes getting in touch with elected representatives to demand action, contributing to funds for people in need of care, and dedicating time to local reproductive justice organizations that agitate for change on the ground. Each of these activities supports people’s reproductive freedom. Peddling prescription birth control without considering people’s needs does not.

To be clear, contraceptive access and affordability are still important issues, and the nation should not ignore people’s desires to have the full spectrum of contraceptive options available to them, including long-term methods. There are many people who want them and they should get them. The challenge is to remember that the fight for reproductive freedom must always center the right to both contraception and abortion—because that’s also what people want. Indeed, that’s what they need. The hallmark of American society is supposed to be maximizing people’s chances for better lives for their families. If we want to see this dream realized, we have to protect abortion.