Science Ignored: Dissecting Pregnancy as a Disease


pregnancy-testLast week, the United States Supreme Court decided Burwell v. Hobby Lobby, and ruled the federal government could not require closely-held corporations to provide no-cost contraception for their employees. Although that was the question before the Supreme Court, there were many things the Supreme Court didn’t have the jurisdiction to rule on yesterday.  And the most important of these issues–the basic premise at the root of the case’s ideological divide–was not up for debate: that contraception is preventive health care.

Yes, contraception prevents pregnancy–that’s the whole point–but why is pregnancy considered to be a disease? It is an odd disease that is frequently welcomed by women.

Contraception as preventive care was not actually written into the Affordable Care Act (ACA). The ACA simply states that health insurance must cover ‘‘such additional preventive care and screenings” as are ordered by the Health Resources and Services Administration (HRSA). The HRSA didn’t define contraception and sterilization as preventive care either. Instead, they consulted the Institute of Medicine (IOM), which wrote a 250 page report entitled “Clinical Preventive Services for Women.” This report recommended that the HRSA adopt contraception and sterilization as preventive care to be provided under the Affordable Care Act.[1]

The 250 page IOM report included a page on the “prevalence/burden” of unintended pregnancy and concluded with: “Recommendation 5.5: The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.”

Noticeably, the report doesn’t consider all pregnancies as an ailment to be avoided. The report doesn’t mention hemorrhaging, pre-eclampsia, or any significant maternal health problems. Ignoring legitimate maternal health issues, the IOM only considers unintended pregnancies an ailment. Their prescription? Contraception and sterilization.

Women whose pregnancies are unintended, the report states, “are more likely than those with intended pregnancies to receive later or no prenatal care, to smoke and consume alcohol during pregnancy, to be depressed during pregnancy, and to experience domestic violence during pregnancy.”

The IOM ignores the fact that many women who experience unintended pregnancies belong to demographics that disproportionately suffer from domestic violence. No amount of condoms in the world will end domestic violence. Nor is synthetic progesterone a magic pill that will prevent immoral men from harming their partners. No matter–the Institute of Medicine has prescribed contraception and sterilization to those women suffering from domestic violence.

The report also blissfully ignores the fact that sex can result in pregnancy even if partners are using contraceptives. According to a study published in Perspectives on Sexual and Reproductive Health: “Contraceptives were used during the month of conception for 48% of the unintended pregnancies that ended in 2001”[2]. That is, almost half of all unintended pregnancies in the United States occur among women actively using contraception during the month of conception. This puts the IOM report in the awkward position of recommending as a remedy the contraceptives that allowed half the unintended pregnancies in the first place. (Ironically, this study is selectively cited several times in the Institute of Medicine’s report.)

Unintended-ness is different from unwantedness. Even the Institute of Medicine’s report acknowledged the fact that: “Unintended pregnancy is defined as a pregnancy that is either unwanted or mistimed at the time of conception” [Emphasis added]. Among the other half who hadn’t been using contraception before they had an unintended pregnancy, 23% (about 1 in 4 women) said they weren’t using contraception because they “didn’t really mind if [they]got pregnant”[3].

If a child is wanted, the health system should help women to have a healthy pregnancy. Instead, doctors and Washington bureaucrats wag their fingers at women, saying “You’re pregnant earlier than intended? Tsk. tsk. You should have been contracepting.” The facts about what women actually want are being shamelessly misinterpreted for ideological political ends.

The heart of the U.S. controversy around government-funded birth control is the question of whether contraception is preventive health care. Those who claim that it is have every right to argue for their position. But they should stop buttressing their assertions with bad science and skewed statistics. America’s healthcare policies need to be based on facts–not ideologies.


[1] IOM (Institute of Medicine). 2011. Clinical Preventive Services for Women: Closing the Gaps. Washington D.C: The National Academies Press.

[2] Finer, Lawrence B., and Stanley K. Henshaw. “Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.” Perspectives on sexual and reproductive health 38.2 (2006): 90-96.

[3] Trussell, James, Barbara Vaughan, and Joseph Stanford. “Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth.” Family Planning Perspectives (1999): 246-260.


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  • Pax

    I liked the article accept the last quote “America’s healthcare policies need to be based on facts–not ideologies. – See more at:

    There is no law that is NOT based on someones idea of what is moral and immoral (aka ideology.) . Facts are only useful in so much as they inform the decision about what is right or wrong. ( which is why they are so blissfully ignored by most people when they don’t want to agree with you).

    For instances one assumption in your last statement is the ‘ideology’ that factual based actions should be favored over ‘how we feel’. As near as I can tell there are at least three members of the supreme court who disagree with that ideology as they always favor, ‘what feels modern and correct’ over facts like what the constitution they interpret obviously meant when it was written.

    The reason I say this is because you can’t expect win a battle when you show up in the wrong place to fight. For much of the population the battle ground is the heart, not the mind. If political success is what you want , you need to start creating add campaigns and getting them on the radio and TV. There is a reason Jesus choose the term ‘sheep’ to describe humanity.

    • goral

      I think the author was using the word ideology as synonymous with agenda. It sometimes gets used that way because ideologues presuppose the result. Facts are a stubborn thing, more stubborn than political ideologues.

      • Pax

        So you would read the sentence ‘America’s healthcare policies need to be based on facts–not agendas’?

        Hmm, i guess that makes a bit more sense but my point was more that many people in our society are guided by principles of godlessness ( and therefore selfishness) they then presume to ’empower’ people by both providing them with opportunity and encouragement to be selfish and self interested.

        It all however happens on an emotional level , not an intellectual level. Why do so many women view birth control as a ‘need’? It certainly isn’t because they have good scientific understanding about birth and controlling it. There is something they (selfishly) want ( usually false sexual freedom and/or economic prosperity), they turn that want into a need. No amount of scientific data will win they day when the battle ground is in the heart. Only prayer and Love and conversion of heart. That is why preaching things like the theology of the body is so essential. We need to show there is a better way to love and be happy then the one the world provides.

        That being said, i don’t mean to in any way disparage attempts to divest people of the idea that what they are doing is good or healthy. Needs to be both of coarse though, not exclusively one or the other.

        • goral

          “No amount of scientific data will win the day when the battle ground is in the heart”.
          I take that to mean that they are guided by selfish passions which are then encouraged by the enablers. Currently it’s mostly the democrat party enabling but even the church has some culpability here.
          If the unwashed masses are told that they are entitled to gov’t largesse and all sorts of “charity”, then why not extend it into contraceptives.
          We lost the war, godlessness is lay of the land.

          • Pax

            We lost the battle my friend, not the war. The war was won long ago on a hill called Galgetha.
            I wouldn’t count the good people wholly out on this one just yet. We need to pray more, sacrafice more, show more joy and love and bring it to the street. We need to insist it be preached from the pulpit. In the end , even if we are beaten, sentenced to death and die on a cross. We win.