“99% of sexually active women have used birth control in their lifetime. Our lawmakers must hear from us. We won’t allow an extreme anti-woman agenda to undermine birth control access.”
— Planned Parenthood Action Fund, in a tweet, June 2, 2017

“99% of sexually active women have used birth control in their lifetime. It’s not optional. A leaked memo shows the Trump admin wants to let your employer come in between you & no-copay birth control.”
— Planned Parenthood Action Fund, in a tweet, May 31, 2017

These tweets and the graphic caught our attention, as we’ve looked into this figure in the past and found it to lack context.

According to a draft regulation obtained by Vox, the Trump administration wants to overhaul the birth control mandate under the Affordable Care Act, also called Obamacare. Reproductive rights groups opposed these proposed changes, and Planned Parenthood Action Fund used this statistic in its tweets about the draft regulation.

It’s worth noting that Planned Parenthood’s wording for this statistic includes the caveat “sexually active,” which other organizations don’t always do. Still, it needs more context, especially when juxtaposed against Obamacare’s birth control mandate.

The Facts

Under the ACA, employers are required to offer insurance coverage for contraceptive methods and counseling for all women. These contraceptive methods include: barrier methods (diaphragms, sponges), hormonal methods (birth control pills, vaginal rings), implanted devices (such as intrauterine devices, or IUDs), emergency contraception and sterilization.

In May, President Trump signed an executive order “promoting free speech and religious liberty,” directing the executive branch to “vigorously enforce” religious freedom protections. Among other things, the order directed Cabinet secretaries to “consider issuing amended regulations” consistent with current federal law for groups that have religious objections to providing their employees insurance coverage for contraceptive care.

Currently, certain religious employers are exempt from this mandate, including churches, houses of worship and some nonprofit religious organizations, such as religiously affiliated hospitals. In Burwell v. Hobby Lobby Stores, the Supreme Court ruled that “closely held,” for-profit corporations with religious owners are also exempt.

The draft regulation aims to expand exemptions to all for-profit entities, allowing them to decline providing free contraceptive coverage based on religious or moral grounds.

With that in mind, let’s look at the 99 percent statistic.

The statistic comes from a February 2013 study by the Centers for Disease Control and Prevention.

This study looked at contraceptive methods among women from 1982 to 2010. So the data predate Obamacare, which was enacted in 2013. The study is based on interviews with a national representative sample of 12,279 women in 2006 to 2010 from the National Survey of Family Growth (NSFG).

Researchers found 88.2 percent of women age 15 to 44 had used contraception. Some women used contraceptive hormones for health benefits unrelated to pregnancy, whether or not they have had intercourse.

Of the women they interviewed, age 15 to 44, 86.6 percent had had vaginal intercourse. These women were counted as “sexually experienced.” Among this population, 99 percent had used one contraceptive method at some point in their lifetime.

The necessary context is that “contraception” refers to any method that women and men use to prevent a pregnancy, under the CDC definition. It includes female and male sterilization, birth control pills, intrauterine devices (IUDs), emergency contraception, condoms, withdrawal method and periodic abstinence (also known as the rhythm method).

In 2006-2010, among women age 15 to 44 who have ever had sexual intercourse, 81.9 percent had ever taken the pill; 93.4 percent had ever used a condom; 59.6 percent had used withdrawal method; and 18.1 percent had used the rhythm method.

So a woman having sex regularly and receiving free coverage for her IUD or birth control pills through her employer is counted the same as a woman who had sex only once and used the withdrawal method or used a condom.

When advocates use this statistic, they’re using the term “birth control” as synonymous as “contraception,” and referring to any method used to prevent pregnancy, regardless of whether it is something that is covered under Obamacare.

That’s not always made clear. It can create a misleading picture, as if 99 percent of sexually active women would be affected by the Trump regulation to overhaul the Obamacare birth control mandate. Of course, condoms, withdrawal and rhythm method are not covered under Obamacare.

Planned Parenthood said the organization is not using the graphic to illustrate what’s at risk under the specific draft regulation, but to show that efforts to prevent pregnancy is a ubiquitous experience among sexually active women, and that the Trump administration “seems to be acting with a complete disregard for” this shared experience. Spokeswoman Erica Sackin also noted that given the access to contraceptive coverage under Obamacare, the primary method of contraception could have changed since the CDC study.

The CDC study, “along with a few that showed how women have struggled to afford the cost of birth control, helped illustrate why the increased access under the ACA (and that’s at risk with the Trump rule) is just so important,” Sackin said. “Women won’t stop trying to prevent pregnancy if this rule goes into effect, they’ll just be less able to have the full range of options to do so. We would argue that the Trump administration’s new rule is fairly cruel in its disregard for what women want, need, or the realities of how they live their lives.”

The Pinocchio Test

In the past, we’ve found issues where reproductive rights advocates used CDC research to make fishy claims about the use of birth control methods. Each time, we’ve awarded Two Pinocchios (here, here, here), because the same underlying issues arise: The statistic is used to refer to contraception coverage under Obamacare, yet the research includes methods of family planning.

The same issue exists here. Planned Parenthood used the statistic that “99% of sexually active women have used birth control in their lifetime” in a debate over Obamacare coverage and proposed regulations under the Trump administration that would roll back the free contraception. Yet the study, again, includes methods of natural family planning or condom use, neither of which is included in contraceptive coverage.

Planned Parenthood says it was using this statistic to illustrate the ubiquity of family planning among sexually active women; we find this point needs to be made extra clear in the group’s tweets.

Two Pinocchios

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“99% of sexually active women have used birth control in their lifetime."
in a tweet
Friday, June 2, 2017