William M. Briggs

Statistician to the Stars!

What Happens If You Take Away Women’s Birth Control?

From the paper: circles are PP counties, triangles are non-PP counties.

From the paper: circles are PP counties, triangles are non-PP counties.

The titular question is in earnest, dear reader, just as it was for Amanda J. Stevenson and four others. Yes, those fine academics were just as perplexed as you probably are, but they, unlike you, were in a position to research the question, whereas you and I can only guess.

And research it they did, leading to the peer-reviewed paper “Effect of Removal of Planned Parenthood from the Texas Women’s Health Program“, found in that prestigious organ the New England Journal of Medicine. Thanks to reader Gail Finke for uncovering this treasure.

The paper’s abstract opens with “Texas is one of several states that have barred Planned Parenthood affiliates from providing health care services with the use of public funds.” Now this is very strange, because, at least for us civilians, health care meant those acts done to preserve human life. Yet Stevenson uses the term in the precise opposite sense: the killing and prevention of human lives. I have no explanation for this except to admit that academic minds are in a class far above our own.

Let’s press on. Texas cut off state funds from PP offices commencing in 2013. PP of course still received federal and private monies, and I can’t see from this article that any PP office was forced to close because of lack of state monies. Still, it is obvious that if any PP office had less money to spend because of these cuts, they would spend less money.

Before the cuts only 23 Texas counties had PP offices, and 231 did not. Women in Texas do venture outside their home counties, so it’s unknown how many who lived in “dry” countries went for “wet work” in PP counties. Stevenson does’t say. She and her co-authors did note that about 8.2% of women 18-44 who took money from Medicaid had babies in non-PP counties before the state’s ban on funding. About 9.1% of women in PP counties had babies before the ban. About women paying their own way Stevenson is mute.

After the ban, how many babies born? I have no idea. Stevenson did not see fit to report the raw numbers and instead present some sort of statistical regression, probably because she and her co-authors were under the delusion that changes in counts cannot be “real” until they are certified by wee p-values.

Yes, sir. This happens time and again in research. I’m making these numbers up, but if in 2011 there were 28,000 babies born, and in 2014 there were 30,000, it is true (contingent on accurate counting) that in 2014 2,000 more babies were born. No p-value is needed to make this claim. It matters not one whit whether this difference was “statistically significant.” The difference is there and true regardless.

Anyway, Stevenson suggests, via an unnecessary and complex model that (government-funded) births increased in PP counties after Texas ceased their funding.

Why might this be so? We’re right back to the question posed in the post’s title. (It’s starting to get exciting, isn’t it?)

Stevenson also tracked, and this time actually reported the raw numbers, that Medicaid claims for injectable and short-acting hormonal contraceptives decreased, both in PP counties and non-PP counties, after Texas cut off funding. Don’t forget, women are allowed to cross county lines.

The authors commented: “Among women using injectable contraceptives, fewer women who received an injection in the quarter preceding the exclusion continued to receive an injection through the program than did those in an earlier cohort.” Probably nobody saw this coming, which is why Stevenson says Texas “abruptly excluded Planned Parenthood affiliates” from the public teat.

Are you sitting down? Here is the stunning conclusion: as a result of taking few contraceptives there was an “increase in the rate of childbirth covered by Medicaid”!

There’s the answer! Isn’t science amazing?

Don’t answer yet, because it gets better. Stevenson said, “it is likely that many of these pregnancies were unintended”.

We’re right back at another mystery. How did these women get pregnant if they didn’t intend to? Yes, you’ve heard that question before, but its answer remains elusive, an imponderable scientific conundrum. Somehow—the clues lead in all directions—women are non-pregnant one day, and, without any intention whatsoever, are pregnant the next. More research is clearly needed.

23 Comments

  1. This deserves a question for the Scientific Ethicist.

  2. Here’s the bottom line conclusion from the actual report:

    “In conclusion, the implementation of the 2013 exclusion of Planned Parenthood affiliates from a Medicaid waiver program in Texas was associated with adverse changes in the rates of provision and continuation of contraception and with increases in the rate of childbirth covered by Medicaid.”

    I.E., policy cuts in one area (contraception) resulted in costs in another (Medicaid). The paper does not discuss how these are offsetting — net gain/loss in expenditures from the public dole.

    A qualified explanation was provided:

    ““After Texas abruptly excluded Planned Parenthood affiliates from its fee-for-service family-planning program, the number of claims for LARC (long-acting reversible contraceptives; contraceptive implants and intrauterine devices) methods declined, as did the number of claims for contraceptive injections. … there was a disproportionate increase in the rate of childbirth covered by Medicaid. Although data are lacking on intendedness of pregnancy, it is likely that many of these pregnancies were unintended, since the rates of childbirth among these women increased in the counties that were affected by the exclusion and decreased in the rest of the state.”

    That qualification included some discussions of three (at least) limitations in the study approach.

    So there’s some food for intelligent thought there:

    Do the actual cuts to contraception (via PP) offset the increased Medicaid expenses incurred, or, did the policy cuts increase actual costs?

    Not to mention the costs of raising these unwanted kids — those not put up for adoption.

    Etc.

    Briggs, again, exploits misinformation & innuendo as presentation tools to concoct an essay that grossly misrepresents the actual paper: He overgeneralizes about ‘funds cut from Planned Parenthood’ & dovetails that with PP’s recent public relations controversies associated with abortions — abortion has nothing whatsoever to do with the referenced article’s content! He also asserts “peer review” to imply the analyses were presented as more credible than they were to argue the analyses were not credible — omitting that the study authors address their own analyses limitations in some detail.

    Shameful.

  3. Hahahahahahah! Hey, maybe you can get a government grant to study this imponderable happening!

  4. Ken: Every single baby out there could be put up for adoption and there would still be families going overseas because of the shortage of babies available. The only reason they are not given up is the mother decides not to give them up. She can get payments from the government from her little money maker, so who needs a man, except for the sperm? If she’s finicky enough concerning whom she copulates with, she can use the little money maker for checks from the sperm donor. It’s a choice she makes, limited only by whether the woman wants a money maker or give the child to someone who actually wants it and can afford it.

    As for which is cheaper, how about NOT paying for the kid the woman CHOSE to have and keep. It’s not the middle ages—women do know that sex creates babies. The simple fact that they DO NOT CARE does not matter at all. Reality says sex leads to babies. Don’t want a baby, can’t afford contraception, don’t have sex. It’s 100% effective (don’t go by Bristol Palin, though—she’s too stupid to follow her own advice). Rewarding those who deny reality is morally wrong. Trying to avoid consequences via science is wrong. Just because we can do something does not make it right.

  5. 1. Don’t reward behavior you don’t want.
    2. Don’t punish behavior you do want.
    3. Don’t tell the kids rules one and 2

    God help you if you get rewards and punishments mixed up.

    Codifying optimizes the chances that the rules will not work.

    Becoming an adult means accepting that other people have to become adults. Part of becoming an adult requires that I let other people become adults and make their own mistakes and live with the consequences of their mistakes.

  6. We’re right back at another mystery. How did these women get pregnant if they didn’t intend to?

    Why is it a mystery? Is this a trick question? These women got pregnant, intended or not, they probably didn’t use any method of contraception and men impregnated them.

    What happens if you take away women’s birth control? Possibilities –
    (1) Consider methods of birth control for men.
    (2) People would either play Vatican roulette or think twice or at least twice before having intercourse.
    (3) There might be more abortions. However, this possibility maybe offset by the fact that being a single mom is now more acceptable now.

  7. Briggs

    February 16, 2016 at 1:40 pm

    JH,

    “These women got pregnant, intended or not, they probably didn’t use any method of contraception and men impregnated them.”

    Yes, but what is the p-value for this?

  8. I am the person who sent Briggs the paper — thank you!!!

    It’s absurd to say, as the authors imply, that because a woman does not have injectable contraception, she has no other way to avoid getting pregnant.

    Moreover the point of publishing the paper in the first place is to imply that a) there is a SIGNIFICANT increase in births among poor women who previously got injectable contraceptives, and that b) that increase should probably be attributed to women no longer getting injectable contraceptives.

    But neither part of this this conclusion follows from the paper because the authors did not say how many births there were before or after the grant money was cut, or what the variation was in previous years. In other words, what is the normal variation from year to year in this population and births to poor women as a whole? We don’t know! And for that particular population, they CAN’T know (there’s no annual table of “women who stopped using injectable contraceptives and then had babies” anywhere).

    Moreover, unless there was a significant increase in births, there is no way to know whether or not this is even a problem. Are we talking 5 extra births? 100? 5000? How many “extra” Medicaid births are a problem in a state the size of Texas???? As they did not publish this information, it’s reasonable to conclude that it’s not a significant number.

    We do not even know that the women who stopped using injectable contraceptives are the ones who had babies. It’s a reasonable inference, but it’s by no means the only possible or likely explanation. Maybe the people who use injectable contraceptives all made sure they used a different form of contraceptives, and the increase was due to some other group — younger people, immigrants, drug addicts, or perhaps even a group of women who actually wanted to have babies??

    Even if it is significant and was entirely due to the women who stopped using injectable contraceptives (of which, again, there is NO proof given) the solution might be as easy as helping women switch to a different form of contraception before the injectable one wore off, or– I don’t know — encouraging people who don’t want to have children not to have sex in the first place.

    In any case, being poor does not mean that you may not have children. Medicaid is FOR medical expenses for the poor, including childbirth. The article is eugenics in disguise, and not a very good disguise at that.

  9. Oh JH, the P value was just big enough to be significant.
    A solution on this general topic is not about to be solved here.
    I think we can all agree on that at least.

    Why did they think they needed to collect this information? Given that number crunchers would know or ought to know that whatever figures appeared would not help them one bit with the moral questions.

    JH makes an important point about single parents and shame.
    I knew someone who killed himself at aged 21 because his mother gave him up for adoption at a time, in Ireland, when strict, frankly wicked judgement at the time made life impossible for girls in her position. Not many years before the story would’ve been the same in England.
    That was not ideal.
    Nor is it ideal that society has gone the other way, too far the wrong way.
    If we are all made in God’s image it includes everyone.

  10. JH: “Men impregnated them?” Well, yes, but not from across the room without physical contact. Women participated, knowing what the outcome could be.

    One would hope people would think more before having intercourse, but I’m not sure the evidence is with me on that one.

    Birth control for men would be great, but no one’s actually figured that one out. Planned parenthood lists abstinence (again, 100% effective), condoms (not perfect but better than nothing), outercourse (tricky at best), vasectomy (permanent) and withdrawal (very tricky and not effective).

    Of course, the whole point is that the study was not needed. If women have sex without birth control (and sometimes with), they can and do get pregnant. Sex makes babies—it’s what it does. As Gail said, the study was pretty much a waste since no actual causes and few measurements were made and factors ignored. Why didn’t they take the money from the study and use it to dole out injectable contraception? It would have been more useful that way.

  11. Briggs, since p-value = probability value, the probability that my statement is correct is 1.

  12. Oh, Briggs, of course, your p-value question doesn’t make sense.

  13. Next stage – promote same sex marriage as a national contraception strategy.

  14. and everyone includes unborn babies.

  15. Considering that several thousand of women die each year in the US because of complication cause by pregnancy and child birth, I find your position asinine.

    you are not pro-life, you are for men overpowering women. According to you raped does not exist in white Christians country. Only Muslim assault women.

    You are against euthanasia, and pro-gun even though over 10,000 people euthanized themselves and often bring others with them using gun.

    You are against gun that could not be shot by someone other than the owner, because is wife my not be able to shoot the gun to protect him or herself. While the reality shows that hundreds of people are killed by their own gun while in the hand of the bad guy.

    That you are pro-life is joke you like people when they are dead. Black, Muslim should all die because they inferior to your eugenics views of the world.

    What an liar you are.

  16. Briggs

    February 16, 2016 at 8:06 pm

    Sylvain,

    Dude. If I were you I’d consider switching to a decaffeinated brand.

  17. Briggs (or whatever your name really is), Sylvain is right. How can anyone consider themselves to be ‘pro-life’ if they are against the regulation of firearms? Your position regarding this is, as always, utterly inconsistent.

    I would also really like to know why you – a male – is so concerned with limiting access to birth control. Perhaps the answer lies within that last word there – control. Religious fanatics the world over have at least one thing in common, regardless of the particular brand of idiotic superstition they promote, and that is that they like to control the lives of others, particularly women. The world would be a much better place if they just stopped sticking their nose where it clearly doesn’t belong.

  18. How can anyone consider themselves to be ‘pro-life’ if they are against the regulation of firearms?

    For the same reason anyone in favor of self protection might consider themselves ‘pro-life’. Or those in favor of locking their doors, even. Are you equally as daft as our Northern Cousin?

    What would cause such a question? Would your mere access to a gun lead to a rampage — because it’s the gun after all that would cause it? If so then consider the question about being daft a rhetorical one.

  19. There are many reasons to reject the dogma that the state has an interest in preventing healthy childbirth. One of the most base reasons offered by the proponents of “reproductive health” is financial.
    According to the Texas Women’s Health Program TWHP each “averted pregnancy” saves the state $10,869 in Medicaid and other pubic funding.
    (“estimates that from 2007
    to 2009 the Women’s Health Program averted 16,837 Medicaid-paid births and saved nearly $183 million (all funds)” from: THWP application to CMS for 2012-2013 funds. page 4
    at: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/tx/tx-womens-health-waiver-pa.pdf)
    What incredibly poor logic.
    Who only accounts for the cost of an investment without considering the return? Would it be wise to not buy a house because the down payment requires some financial sacrifice? Why given that logic, think of the money one would save if one didn’t purchase housing, food, clothes, transportation, etc..

    Those with such myopic view fail to consider how much the state actually loses from the averted lives. Each life, which on average would have made on average $46,000/yr in Texas would add almost $430,000 to the state over their 45 year career. Save $11,000 and lose the $430,000 return. Only a progressive government would proffer such a deal. Of course there is the lost richness added to the lives of the parents, siblings, extended family, and community that matter as well.

    On the whole the Texas legislation affecting TWHP is consistent with the designed change in care outlined by the affordable care act. Texas has reduced TWHP’s funding by only one third, diverting women from what is really a group of boutique medical providers including Planned Parenthood, to comprehensive care centers to continue their contraceptive/reproductive care.

    No woman has been denied appropriate care, though the change in pregnancy prevention techniques has been significant. Those expensive techniques that interrupt implantation of a human zygote in the wall of it’s mother’s uterus are becoming much less common, while those much less expensive techniques that interrupt ovulation preventing fertilization, have become more common. This is no small matter. Human life, even in the zygote is genetically distinct from it’s mother, and has a right to life, bestowed by the Creator even according to the US Constitution.

  20. Briggs, I would have to take coffee to begin with.

    You should watch “the hunting ground” on Netflixmaybe you woul learn something.

  21. Peter A (or whatever your name really is): You made it to your local library again. How nice!

    Only an idiot would equate gun violence to the murder of innocent babies. But wait, I know, progressives emote, so idiocy follows. You are at least consistent in your idiocy.

    Again, you return with the “I hate religion” mantra, translating to “no one is going to tell me what to do, I favor ANARCHY, dammit, so shut up about religion and rules”. We all know you love anarchy, immorality and violence in the name of the preservation of no rules. Try a different approach. This is one getting very, very old. What you actually believe is controlling everyone through slavery to the government, as seen with the “free birth control” doled out by the government. You favor slavery to a government in order to achieve anarchy. How insane is that??

    Note that women do agree with Briggs, yet you address Briggs and claim sexism. Cowardly.

    DAV: It is entirely possible that progressives demand gun control because they fear they themselves would commit atrocities. It’s not an unfounded fear, considering they run on emotional and not reason.

  22. Bert, Not “healthy childbirth” just “childbirth”.
    Medical research faces the usual ethical questions with regard to experimentation, including or excluding input.

    My objection is that people making decisions on public matters like this seem to lack decision making abilities. They must have a paper trail, they need to say that studies have shown because without that safety net they feel the full burden of their own decisions.
    It’s as much a tool for managing guilt and conscience and liability as anything, never mind the quality. Financial controllers are a separate category and should be separated from clinical matters in my view.
    It costs what it costs and if there’s no money it’s someone else’s job to sort that out. Healthcare and business don’t mix. It matters not whether the government or a company is trying to provide it. Healthcare IS expensive. Politicians don’t want to admit the REAL costs involved.

    Peter A
    “pro-life” is a clumsy term. Not to be pro life is to be pro death. Given a different world view the argument would be frame differently. There is no solution.

    Pro-life or pro gun is a false argument. One is about self defence, the other ending innocent life. No one can argue that it isn’t innocent, no one can argue it isn’t being ended whatever their world view.

    There are cases where continuing a pregnancy would cause danger to the life of the mother and In my view this is a different matter. When the mother is unconscious a decision has to be made.

  23. Let me add a bit of knowledge and expertise to these discussions.

    “Smart” guns are only as good as the wireless network that allows the owner to enable the weapon. They only really delay unauthorized use by a few minutes. And they fail a LOT. They have failure to fire rates as high as 20%. Would you equip an ambulance with a theft-control system that prevented the driver from starting it once in five attempts? Would you have a car that shut down and would not restart once in every one hundred red lights?

    Guns save lives. Handguns ESPECIALLY save lives. In 91.7% of the 2.5 MILLION cases of annual defensive gun uses estimated by Kleck and Gertz, the defensive gun user did not fire. And that includes about about a half-million cases where somebody almost certainly or probably would have died without having a gun to point at the bad guy. By contrast, about 33,000 people die from gunshot wounds annually. Of those, about 19,000 are suicides, so smart guns are NOT going to save them. That means there are about 14,000 homicides a year where one might imagine that the criminal disarms an armed defender and shoots him down. The vast majority of people who shoot other people bring their own gun to the fight. If 10% of homicides were shot with their own guns, I would be absolutely astounded. But even if I conceded that, it’s 1400 people a year whom one might imagine were disarmed and shot to death with their own guns (and it’s probably closer to 140), compared to nearly a half-million cases a year where a life was probably or almost certainly saved because somebody protected themselves or others with guns. Guns save a lot more lives than they cost.

    Now, as for “unintended pregnancies”. I’ve recently said that the vast majority of these depend on the woman having a regular sex partner, and ignoring inconvenient truths about contraceptives.

    1. They only reduce the risk of pregnancy. Approximately nine in a hundred women who use contraceptives get pregnant every year, anyway. Start your calculator software, and enter 1.09 ^ (years) for the cumulative risk. “But that is so much higher than the clinical efficacy!” you may protest. Indeed it is, but if a woman is kind of late with a dose (eight hours, perhaps?) then any resulting pregnancy is not due to lack of efficacy but patient noncompliance. And the actual failure rate decreases with age, with education, and as you go from “cohabiting” to “single” to married. For example, among girls in the 16-20 age bracket, who didn’t finish high school and lives with her boyfriends, 48/100 get pregnant while contracepting annually.

    2. It’s really easy to stop the Pill, and really hard to stop having sex. Side effects of the Pill include decreased libido, water retention, weight gain, and acne. Adverse events include deep vein thrombosis, pulmonary embolism, and cardiovascular accidents. It’s no wonder that doctors prefer to prescribe the absolutely lowest possible effective dose (which makes them MUCH more likely to fail in cases of imperfect compliance). Did the authors study at what rate women stopped contracepting, and at what rate other behaviors were substituted? I bet the answer is no.

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