June 4, 2015

Re: Jillian Kay Melchoir's Claims on OTC Birth Control

I generally believe that the "Pill" is responsible for, or part of (depending on how one construes correlation v. causation), a great deal of social upheaval in the United States, centering around the "sexual revolution." I use the term "Pill" as shorthand to refer to any number of different chemical combinations that have the effect of preventing ovulation (and perhaps, implantation of the fetus).

I should also note that, generally, I share some sympathies with points of view espoused by National Review, Heritage Foundation, The Federalist blog, and similar "neocon" groups, as do I with Front Porch Republic, American Conservative, and similar "paleocon" ideas. I am not sure these labels are entirely useful, but I throw them out to indicate a disclosure of my own leanings. I am also a Catholic, and an orthodox one, at that, so that influences all of my thinking.

With all of that said, I am not going to take issue in this post with the conclusion of Ms. Jillian Key Melchior's article in National Review Online. Rather, I would like to explore some of her premises.

I would tend to disagree with the idea that over-the-counter access to the Pill is a good thing. In some versions, the Pill is a known Group A carcinogen. Some newer forms also double the risk of blood clots (see also here). As such, Melchior's suggestion that the Pill is safer than other OTC medications that "bear higher health risks" leaves me feeling doubtful. She references acetaminophen. Presuming we're not referring to overdose situations, looking over the risks of acetaminophen, we find from Wikipedia (I know...usually not the best source, but nonetheless): "Healthy adults taking regular doses of up to 4,000 mg a day show little evidence of toxicity." This is the maximum daily dose. There is little evidence that paracetamol, used normally (like the Pill) causes clots, cancer, or anything remotely resembling the results of the Pill. Given this, I am not at all sure that Ms. Melchior's easy dismissal of any medical exam (though a pelvic exam may be overkill) requirement before using the Pill holds much water. (This is not to consider in-depth the potential connection between STDs and use of the Pill.)

Another interesting premise. Ms. Melchior asserts that: "Making birth control over-the-counter would also vastly expand access, resulting in fewer unplanned pregnancies and abortions." She cites a study in the journal "Contraception" which she claims (no doubt correctly) concludes that "unwanted pregnancies could decline as much as 25 percent." However, what makes this study interesting is that the claims may not hold up in practice (perhaps due to slippery slope or hasty conclusion problems). Apparently, making birth control more widely available and used by any given population often results in more unwanted pregnancies and more abortions. For instance, in the same "Contraception" journal, a study in Spain published in 2011 found that:
During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women.
 Some studies also posit a long-term link between increased access to contraception and increased teen pregnancy rates and that contraception may increase risk for pregnancy and STDs based upon "risk compensation" (see also here).

I recognize Ms. Melchoir's need (and the general need) to show that Liberals are in the process of hypocritical denunciation of some project that should have their overwhelming support. I also recognize that contraception, particularly the Pill, is likely here to stay, absent some odd cataclysm causing the earth to swallow factories where the Pill is made. However, we do ourselves no favors by glossing over real science showing that the Pill is not "safe" in that it increases the potential for cancer and blood clots (and death, for that matter), and that we accept claims made by the contraceptive industry and others than easy, cheap, and widespread access to contraception will decrease pregnancy, STD, and abortion rates - the reverse may be true, and has been true. Such glossing is often the tactic of the Left, and we ought not use it here to make quick points.

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