The Washington PostDemocracy Dies in Darkness

The Trump administration’s assault on contraception

A misguided policy will hurt women — and increase abortions.

Birth control pills revolutionized contraception for millions of women. But some activists still oppose modern contraceptives. (Photodisc)

Although abortion has generated intense debate in the United States in recent decades, contraception has received widespread acceptance. But that is about to change. Anti-contraception activists such as Valerie Huber, who oppose birth control as part of their larger evangelical agenda, occupy the highest echelons of the Trump administration. They have helped craft the new Trump administration proposals for the Public Health Service Act’s Title X, which provides federal funding for contraception for low-income women and families.

The new guidelines prioritize natural family-planning methods — notably those such as the “fertility awareness method,” which has a failure rate of 24 percent, over other methods of contraception. Even more shocking, the new proposal will not require Title X providers to offer all forms of medically approved birth control.

Encouraging the rhythm method over scientifically proven contraceptives not only amplifies outdated medical science but also makes unwanted pregnancies more probable. It is a misinformation campaign aimed at women who can least afford an unplanned child and, in the end, increases the likelihood of abortion, the very thing evangelicals want to prevent.

In the early 20th century, the Catholic Church deemed the rhythm method — based on a regular menstrual cycle, a woman calculates sexual activity around the number of fertile, infertile and unlikely fertile days during that time — the only acceptable form of birth control. In the United States, it was also one of the only readily accessible and legal forms, since it was illegal to dispense contraceptive information until 1936.

Reform efforts helped physicians and reproductive scientists prove that natural family-planning methods were the least reliable form of contraception. Hannah Stone, the medical director of the Birth Control Clinical Research Bureau in the early 20th century, noted that it was “general medical consensus” that the rhythm method was “not a dependable method of contraception.” “We have no means of determining for the individual woman the exact period when her sterile days occur,” she wrote. “This renders the calculation of the safe period quite uncertain and makes the method quite unsafe.”

Over a decade later, in 1940, the obstetrician-gynecologist and fertility researcher John Rock confirmed these ideas in a clinical study. He found that at least 11.5 percent of patients had periods “so irregular that no reasonable safe period could be calculated.” The study concluded that the rhythm method could constitute a “workable form of contraception for a selected group of women,” but that for most, “it is doubtful if the method is reliable enough.”

With studies proving the ineffectiveness of natural family planning, Planned Parenthood warned patients about using it as a form of contraception. In a directory dating to 1947, the organization explained: “The ‘Safe Period’ (Rhythm Method) is based on the theory that in every woman’s menstrual cycle there is a period when conception cannot take place. To be at all reliable, the ‘safe period’ must be carefully calculated. Even then, anxiety, a cold, a journey, or other simple causes may throw the calculation into error.”

But Planned Parenthood still included the rhythm method in information pamphlets, simply because there were few other options. In the 1930s and 1940s, women used diaphragms that could be fitted only with the assistance of a physician. Spermicidal jellies were also used in conjunction with the diaphragm, but these items were not readily available to all women, particularly poor women, at the time. The organization’s mission was to bring these contraceptives to patients who had little access to standard medical care, let alone information on birth control.

Planned Parenthood’s advice on natural family planning predated the advent of the pill, IUDs and even spermicidal foams, which were not invented until the 1950s and brought onto the market in the 1960s. But contraception changed significantly as medical knowledge advanced. It was in the 1950s that two women, birth-control pioneer Margaret Sanger and wealthy financier Katharine McCormick, commissioned doctors Gregory Pincus and John Rock (a devout Catholic) to invent a “magic pill” that would have a high rate of contraceptive success.

They succeeded. After drug trials in Puerto Rico, the Food and Drug Administration approved Enovid, the first birth control pill, in 1960. As historian Andrea Tone has noted, this was the first time in history when “otherwise healthy women took a ‘medicine’ unrelated to the prevention or treatment of a disease.”

Despite reports of harsh side effects and the feminist critique that women had become unwitting test subjects for dangerous pharmaceuticals, by 1965 nearly 6.5 million women were using the pill in the United States. More important, the pill changed the way women and doctors discussed contraception with each other. This paved the way for the use of IUDs and other LARCs (long-acting reversible contraception) such as Norplant and Depo-Provera in the following decades.

Although Christian leaders continued to vocally oppose birth control, most Americans strenuously disagreed with this religious interference in public health and medical practice. The federal government has funded all forms of contraception since 1970, when President Richard M. Nixon signed Title X into law.

The Trump administration threatens to undo these advances with its proposed Title X guidelines, which actively misrepresent medical research by promoting natural family planning as equally effective as contraception. The new Title X guidelines state that “family planning is not limited to, or synonymous with, access to various methods of contraception.” This statement is in stark contrast to past administrations, which believed that “birth control” and “contraception” were synonymous with “family planning.” Although population-control rhetoric led to troubling state overreach in some cases, the government poured millions of federal dollars into creating greater access to medically sanctioned contraception in clinics nationwide.

The ramifications of this policy are clear: Crisis pregnancy centers and religiously affiliated clinics can now legally ask for and receive taxpayer money to fund information on a form of birth control that will result in more unintended pregnancies, while refusing to allow that money to pay for more reliable methods. This is not only religious interference but also allows the Trump administration to cut budgets in the false name of “women’s health.”

Further, given the statistics about women who use Title X-funded clinics for their contraceptive needs — more than 6.2 million women, according to a recent study — this will disproportionately affect poor women and women of color and reduce their access to all forms of birth control. Instead of freely choosing their preferred method, women seeking contraceptive advice could be coerced by their Title X provider to use a method that has been proven — for decades — to be unreliable at best.

If the proposed revisions to Title X are approved, the government’s religious conservatives will reverse nearly a century of reform efforts and research on family planning. There will be more unintended pregnancies and more abortions. Given the Trump administration’s vocal opposition to abortion, their simultaneous opposition to funding reliable contraception for the most vulnerable populations is not merely incongruous, but ludicrous.