The Washington PostDemocracy Dies in Darkness

Mississippi is wrong. Even with birth control, abortion access is necessary.

Expecting women to use contraceptives consistently through their reproductive years is unrealistic

Types of birth control on display at the American College of Obstetricians and Gynecologists' museum in Washington in 2017. (Carolyn Van Houten/The Washington Post)

Last week, the Supreme Court heard oral arguments in a highly significant abortion case that concerns the constitutionality of a Mississippi law that bans abortions after 15 weeks of pregnancy. Since the arguments, discussion has revolved around the grim likelihood that the law will be upheld, even though it conflicts with prior rulings on abortion, and the many questionable assertions raised in the chamber about women, our lives and our reproductive choices, including the use of birth control.

Mississippi’s lawyer, Scott G. Stewart, claimed that upholding the law need not affect women’s lives, because “contraception is more accessible and affordable and available than it was at the time of Roe or Casey” and “it serves the same goal of allowing women to decide if, when and how many children to have.” In a July brief, Mississippi officials argued that “even if abortion may once have been thought critical as an alternative to contraception … changed circumstances undermine that view.” The changed circumstances? Lower out-of-pocket costs for contraceptives, changes in contraceptive failure rates and the availability of more-effective birth-control methods.

While there is no doubt that contraceptive access has improved, which is good for reproductive autonomy, contraception is not a viable alternative to abortion. Put simply, people who have abortions use contraception and people who use contraception have abortions. That’s not hard to believe when the average woman spends upward of three decades of her life trying to prevent pregnancy. Most women do practice some sort of birth control over their reproductive years, and yet 1 in 4 of them in the United States will have an abortion in their lifetime.

Only a tiny percentage of sexually experienced reproductive-age American women have never used any form of birth control. Women have overwhelmingly chosen to use an effective method such as the pill, a shot or an intrauterine device, or IUD, at some point in their lives (with almost 9 in 10 having done so). When examining contraceptive use more generally, 88 percent of sexually active, reproductive-age women who were not seeking pregnancy reported that they were using some kind of contraception during the month of the survey in 2016. And when looking solely at women seeking abortion, on the other hand, about half reported using contraception in the month that they became pregnant in 2014.

At some point, many people stop using birth control even when they don’t necessarily want to become pregnant. Why? Because tolerating birth control isn’t easy, especially when women often have to carry that burden alone. Some people may begin using a method like the pill but switch to a method that doesn’t require a prescription, because clinic access is difficult. Some people have challenges managing side effects. Some people grow tired of trying method after method for years without being able to find one that works for them, so they take a break from hormonal birth control altogether. As one woman I spoke with for my research put it: “I wish I didn’t have to take a pill every day. I know there’s other options, but I don’t want to take those other options, either.”

One study found that 91 percent of women seeking abortion reported that not a single method had all of the features that they believed were extremely important. All of this is sobering when you consider that women are expected to use contraception for so long. Expecting that they will be able to do so — without ever stopping — is simply unrealistic.

Just as importantly, even when people intend to use birth control consistently and correctly, they can face unwilling partners. In my research, young women reported that while some partners often wanted them to use hormonal methods, others pressured them not to do so because they worried about side effects. Partner cooperation with condoms also posed serious obstacles. Some partners would outright refuse to wear condoms or even remove them during sex without women’s consent. Emergency contraception provided a vital backup for women facing such experiences, thankfully, but women can’t always count on it to work.

Women’s experiences with nonconsensual condom removal point to the broader ways that the existence of contraceptive coercion undermines the availability of contraception as an alternative to abortion. A review article examining reproductive coercion found that women described experiences with partners preventing them from getting birth control or from being able to get refills of their pills. In these kinds of cases, women might become pregnant despite their interest in using effective birth-control methods (and the widespread availability of such methods), because they simply do not have the ability to freely use them. Abortion is a crucial resource for them to maintain reproductive autonomy if they find themselves facing a pregnancy as a result.

Effective contraceptives are vital for helping people achieve reproductive autonomy, despite numerous imperfections and various challenges with consistent use. Even as we fight to ensure that people have access to abortion, so too must we fight to ensure that they have access to a wide range of birth-control methods to help them prevent pregnancy for as long as they want to do so. Increasingly aggressive attacks by anti-birth-control activists pose even more obstacles for people already trying hard to prevent pregnancy. Contraception is not a viable alternative to abortion, but it is crucial that it exists alongside it so that everyone can realize reproductive freedom. They should have the right to shape their futures and their families, freely using all of the methods constitutionally available to them.