This week marks the 50th anniversary of Humanae Vitae: On the Regulation of Birth, an encyclical signed by Pope Paul VI that re-affirmed the Catholic understanding of married love, its relation to parenthood, and his opposition to most artificial birth control. Now with the deliberations over the appointment of another Catholic justice to the Supreme Court, the future of the Affordable Care Act (ACA) and the legality of abortion are in the balance. It is worth contemplating how our understanding has changed the past half-century about the relationship between health care, pregnancy, abortion, and the moral life.
The publication of Humanae Vitae on July 25, 1968 was the culmination of an eight-year process that led to the pope's instruction that Catholics must not use contraception if their sole intent was to prevent pregnancy. Many lay people made the case that helping women regulate their fertility was good for the family, and not inconsistent with the Catholic Social Justice tradition. Famously, a Harvard gynecology professor named John Rock, who attended daily Catholic Mass, published an early scientific paper (Science Magazine, in 1956) showing the plausibility of hormonal contraception -- and subsequently made the case in his widely-read 1963 book, The Time Has Come, that the Church should accept oral contraceptives as a scientifically-controlled version of the rhythm method. Indeed it has been argued that Rock's advocacy of the 21-day routine with a 7-day placebo, as is still practiced by most women taking the pill, was his attempt to duplicate the normal hormonal cycle in order to make the case that contraceptive use should be permitted morally.
The Church has always unequivocally opposed abortion, but contraception and abortion are intrinsically linked. Anti-abortion groups have focused on some studies that showed parallel increases in contraceptive use and the number of abortions, particularly during the 1970s. There were some predictions during the 2010 debate over the ACA that the number of abortions would "explode" if it became law. My own New England Journal of Medicine study of the earlier expansion of health insurance under Massachusetts Governor Mitt Romney showed a significant decrease in abortions -- particularly among teenagers -- when people had wider access to healthcare. For the first time, major prospective studies -- in Missouri and Colorado -- have shown dramatic decreases in abortion among women with access to long-acting hormonal contraception.
With the substantial expansion of preventive care and contraception access under the ACA, women are seeking abortions now at a rate that is below that recorded in 1973, when the Roe-vs-Wade decision legalized abortion nationwide. Despite a growing population, the number of abortions is now below a million per year for the first time, at 14.6/1,000 women, and with a ratio of abortions to live births (26/100) that's also historically low. Consider too that there are much higher abortion rates across the developing world where abortion is illegal, and suddenly illegality is not the solution to the problem that some have long argued.
The Trump administration is now launching a bold social experiment: by undermining access to Medicaid and other ACA-associated health insurance, along with efforts to scale back access to contraception, they will soon show us what affect restricting access to care and contraception will have on abortions. Throw in the potentially severe restrictions on legal abortion that would ensue if Roe-vs-Wade is overturned, and you have a perfect storm of three factors that are virtually guaranteed to drive up the total number of abortions.
In 2006, Pope Benedict XVI signed an encyclical entitled Deus Caritas Est, in which he acknowledged that the Church had not always taken a positive view of human sexuality: "Nowadays Christianity of the past is often criticized as having been opposed to the body; and it is quite true that tendencies of this sort have always existed." But he went on to refer to eros as a life experience that aspires to "authentic grandeur," and a source of "joy which is the Creator's gift (that) offers us a happiness which is itself a certain foretaste of the Divine." No longer is eros simply a means of procreation, but rather also a bond between married persons offering a window on God's love for humanity.
I believe it is now unreasonable to argue that opposition to effective contraception is a "pro-life" position. Data from the only prospective studies shows that effective contraception reliably prevents unintended pregnancy, and can result in substantially fewer abortions. Armed with knowledge that Paul VI did not have in 1968, and a view of human sexuality that has evolved even within the Church, our representatives will now debate the role of the law in addressing the abortion question through the confirmation process of a Supreme Court nominee. I hope they will contemplate the possibility that undoing the ACA and overturning Roe-vs-Wade could actually lead us down a path to reversing the decades-long progress in decreasing the number of abortions.
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Patrick Whelan MD PhD is a pediatric specialist at UCLA and is on the Academic Advisory Board for the Institute for Advanced Catholic Studies at the University of Southern California.
