A Free Lunch

I have great news for those of us who would like to keep our uteruses vacant for the time being.  This past week, the Institute of Medicine released a much-anticipated report defining contraceptives as "prevention," categorizing birth control along with such services as mammograms or childhood immunizations.  No shit, Sherloch, right?  But the awesome implication of this classification is that, if the federal government accepts the report's findings, birth control, IUDs, and birth control injections will now be offered by insurance companies without copays.  Free at last, free at last.

http://philip.greenspun.com/images/pcd0155/gay-parade-19

The IOM now recommends that birth control methods be made available free of charge in order to stem the high number of unintended pregnancies (and yes, abortions) that occur in the US each year.  And shockingly, according to a recent poll, about 71% of Americans agree with this suggestion.

http://moneywatch.bnet.com/economic-news/blog/daily-money/will-new-health-care-bill-mean-free-birth-control/1473/

Childhood immunizations are one of the primary intro economics examples of a positive externality:  protecting the majority against infection will lessen the overall population's risk of infection, making us all healthier as a result. Thus, immunizations are offered without copays and are considered to be worth the cost.  Preventing unwanted pregnancies, by comparison, is a positive externality in the same vein.  Fewer unwanted pregnancies spell lower Medicaid costs, better career prospects for women, and fewer kids with shitty childhoods.  According to a 2010 Norwegian study, free birth control greatly decreases the rate of unintended pregnancy, and halves the abortion rate.  If these projections hold true in America as well, then both the pro-life and pro-choice sides should have something to celebrate.  This, America, is compromise.

Now, let's not get too excited just yet:  we are already hearing from the Catholics, and I have no doubt that the chronically pugnacious Republicans will soon be chiming in.  But nevertheless, I am elated, and not only because I might soon be saving around sixty bucks a month.  First, maybe mainstream attitudes towards contraceptives are not as medieval as my Negative Nancy self had believed.  Second, this report forecasts a very positive and palpable shift in women's health.  No-cost birth control will not only save taxpayers an enormous amount in the long run, but will also produce a profoundly positive trickle up, down, and around effect.  Margaret Sanger is smiling.

The Culture of Death

“The Culture of Death” is a phrase that gets tossed around a lot in certain circles.  Very creepy circles, to be fair, so you might not have heard this particular turn of phrase if you don't spend a lot of time researching reproductive rights.  First coined by Pope John Paul II, this emotionally-laden and contrarian saying refers to the prevalence of birth control, abortion, and euthanasia in Western society.  It is also used as the official Root Of All Evil by those who hold to the belief that we somehow desperately need more people in the world.

http://xfinitytv.comcast.net/blogs/2010/tv-news/peta-takes-a-dig-at-the-duggars/

Last July, during the commemoration of “the Pill’s” 50-year anniversary, a coalition of Evangelicals hosted an enormous conference in San Antonio, TX, called "The Baby Conference:  A Historic Family Summit on the Triumph of Life Over the Culture of Death."  Highlights of the conference included discussion on the Pill’s adverse effects on society, a vigil for the pre-born victims of abortion and miscarriage, a lecture on "not believing the lie of overpopulation," and a speech by Michelle Duggar on accepting God’s gift of children. The convention center was bedecked with images of chubby white babies and of Terry Schiavo, who has become the unofficial “face” of euthanasia (though her actual cause of death was withdrawal of care, not euthanasia or assisted suicide).  At the root of the discussion was the theme that creepy crawly secular culture was diffusing its “fascination with death” throughout America.

http://www.visionforum.com/news/blogs/doug/2010/04/

This terrifying alternate reality is brought to you by 

Toys R Us & George Orwell

I doubt that attendees ran out of conversation during the conference.  Fifty years after the release of the Pill in America, 88% of sexually active women report having taken hormonal contraception at some point in their lives, and the average fertility rate is 2.04 children per woman.  Ninety-five percent of Americans have had premarital sex, and 43% of women have had at least one abortion.  With all these insults against "pre-born lives," it seems like the "culture of death" may truly be pervading the US.

On the other hand, let me introduce you to the Culture of Life.

http://www.stolenchildhood.net/entry/child-soldiers-recruitment-flourishing-in-democratic-republic-of-congo/

In the DR Congo, abortion is illegal, contraception essentially unheard of, and the fertility rate 6.7 children born to each woman.  Infant mortality is the second highest in the world, at 7.8%, female literacy is 55%, and about 5% of the adult population is HIV positive.  What lesson are we to take from a culture which really truly knows how to accept God’s precious little gifts?

The "culture of death" conversation is laden with both a flippant disregard for real-world problems and a sinister attack on individual freedom and fulfillment.  There is plenty of inherent misogyny, yes, but even deeper than that is the notion that we, all of us, are nothing more than breeders.  There is an outright rejection of humanity and quality of life, a lack of concern for the planet or for the plight of others, a denial that there are some things worse than death.  Absent is any desire to better the world, to create a world worth living in.  Though this group typically dismisses evolutionary theory, they have nevertheless completely co-opted natural selection by making procreation the greatest possible good.  Furthermore, the proponents of the "culture of life" blatantly ignore the fact that the philosophy is completely untenable.  Being able to stand in a sanitary auditorium in front of your nineteen healthy children would not be possible if everyone followed the calling to reproduce as much as humanly possible.  Barring an actual Rapture occurring within the next 50 years, the problems of unrestrained reproduction are going to have to be addressed by scientists who put education and the pursuit of a greater good ahead of procreation.

Worst of all, the sentiment behind the "culture of death" conversation isn't confined to a few Bible-thumping breeder weirdos in a convention center in Texas.  It's behind the House's latest decision to defund the UNFPA, behind abstinence-only sex education, behind bans on condom advertising:  in short, the religiously-fueled idea that we live to procreate is inherent in everything I've ever discussed on this blog.  Rise up, secular world.  We are more than the sum of our parts, and so too should we be more than the fruit of our loins.

"Population," or "The World Is Not Enough"

When the Supreme Court delivered its famous Roe v. Wade ruling in 1973, it upheld a woman's right to choose based on the Constitution's guarantee of a right to privacy.  This makes perfect sense:  the prevention or termination of pregnancy is, and should be, a private matter, and thus the decision to end a pregnancy belongs to the woman alone.  I contend, however, that the opposite does not hold true:  the decision to give birth is not a matter of privacy.  A woman who has an abortion affects only herself; bringing another human being into the world, on the other hand, immediately impacts the mother, the newborn individual, the larger community, and the very fate of the planet.

The concept of a population's carrying capacity is something we all learned about in high school.  The idea is that a population of organisms will increase in size until it reaches a set number, determined by resource availability and competition pressure.  After this point, large scale death will prevent further population growth.  population size will oscillate around the point of the carrying capacity, but increased death rates and reduced reproductive fitness will not allow population size to increase further.

http://www.goldiesroom.org/Note%20Packets/22%20Ecology/00%20Ecology--WHOLE.htm

We usually discuss such concepts of population in relation to yeast cells, mice, deer, etc.:  organisms to which we have no particular emotional attachment.  We have to be a lot more careful, though, when talking about the growth of the human population, since most of what we do is already an effort to deny that we are, by definition, animals, constrained by biological precepts.  The notion that we are somehow different from yeast cells, mice, or deer is enforced by the observation that our population's growth curve currently shows no indication of approaching a carrying capacity limit.

http://www.bbc.co.uk/schools/gcsebitesize/science/aqa/evolution/humansrev1.shtml

The fact that our population's growth curve has so far been uninhibited by starvation or disease seems to be testament to our high level of "success," reproductively speaking.  Nevertheless, though our world population will reach 7 billion this year, hunger, disease, and conflict are still taking their toll, killing millions each year even as new births more than compensate for this loss.  A little less than half of the world's 7 billion people currently live on under 2 USD a day.  And these are the communities whose populations are growing the fastest.

In The Selfish Gene, Richard Dawkins advanced the idea that exercising moderation in reproduction could actually be evolutionarily advantageous.  Producing many more offspring than can survive under certain environmental conditions is, evolutionarily speaking, wasteful.  Likewise, reproducing at an unchecked rate will quickly deplete resources and is also a terrible evolutionary strategy.  For these reasons, the population of a certain organism will stay relatively constant over time, and when population pressure begins to increase, the organism will (unconsciously, of course) curb its rate of reproduction to avoid a dangerous scarcity of resources somewhere down the line.  

Human reproduction, however, has proceeded at an explosive rate, which Dawkins attributes to modern medicine, the welfare state, and complete failure to look to the future.  We may have been reproductively successful during the last five hundred years, but that is small change in the span of evolutionary time.  Our current reproductive strategy is, to say the least, unsustainable, and may prevent us from seeing another five hundred years.  As Dawkins says, "The one thing animal populations do not do is go on increasing indefinitely."

http://www.coverbrowser.com/covers/ballantine-books/14

Unfortunately, population discussions are not politically correct, and tend to conjure up dystopian images of calculated killings and mass sterilization programs.  Furthermore, the discomfort with the issue belongs to those at every stage along the entire political spectrum.  Regardless of the environmental or societal impact, argue conservatives and liberals alike, the human right of reproduction is too sacrosanct to curtail.  Thus we talk about population growth in positive, rather than normative terms:  "How will we emend farming techniques and colonize other planets to keep up with the human race's inevitable increase?" Yet the human population has the potential to double in less than a hundred years; we can't afford to be so magnanimous forever.  In a stand-off between biology and political correctness, biology will always prevail in the end.

A Hole in Our Rubber Soul

The simple mechanics of pregnancy prevention are straightforward and, luckily, cheap.  Nevertheless, though condoms are plentiful, easy to use, and ribbed, scented, and flavored, about fifty percent of American pregnancies are still unintended.  This is not, as many religious sources would have you believe, due to the incredibly high rate of condom failure.  Not surprisingly, it's the result of layer upon layer of prejudice and misinformation.  Several centuries after its invention, the rate of condom failure is still much lower than the rate of condom ignorance.

It begins with the way that the media depicts condoms, and the way that it presents sex.  Sex is everywhere on TV, including on the Disney Channel and the Food Network.  Yet condom commercials are much harder to come by. You certainly haven't seen them on ABC, home of the wholesome "Gray's Anatomy" an "Desperate Housewives," which refuses to air any condom advertising.  Other networks may allow condom advertisements, but most have restrictions on the types of commercials that can be shown, and the times that they can run.  Perhaps most egregiously, Fox and CBS mandate that any condom advertising shown on the network "must not focus on pregnancy prevention."  In the same way, birth control pills can be advertised, as long as they are marketed as primarily as treatments for acne and PMS.  Interestingly, these same restrictions do not apply to commercials for products such as Viagra or Cialis.

Condom Ad Rejected by Fox

I am certainly not belittling the importance of HIV prevention. Yet mandating that condom commercials focus only on disease prevention, and not on unwanted pregnancy, seems a bizarre dichotomy to draw.  In fact, prior to the emergence of the AIDS crisis, condom advertisements were not allowed on TV at all.  Focusing on HIV risk makes sex dirty and dangerous, while advocating pregnancy prevention would imply that fun, non-procreative sex is something to be celebrated.  I guess that Fox executives can congratulate themselves on having made pregnancy prevention an obscenity, and one even greater than sex itself.

The mere logistics of purchasing condoms is further testament to the disconnect between our views of contraception and our appetite for sex.  In most drugstores, condoms are segregated to a special shelf, usually right below the pharmacist's watchful eyes; in other cases, they are locked up, and store patrons must have an employee assist them in their embarrassing purchase.  It is awkward enough to remove condoms from their glass prison when you're in your twenties or thirties; I can only imagine how difficult it is for a 16-year-old to ask someone to unlock a condom case.  Unfortunately, condoms have been locked up primarily because they are so often shoplifted, likely by those too embarrassed to bring them to checkout.  Then the condoms are locked up, the awkwardness increases, and an infinite cycle begins.

http://thecurvature.com/2009/02/12/cvs-limits-condom-access-for-some/

These magical locked cases can only be opened with a wedding ring.

To better promote safe sex amongst teenagers, progressives such as Joycelyn Elders have advocated dispensing condoms in high schools.  Massachusetts has implemented this practice in many of its schools, with great significant reduction in teen pregnancy rates.  Yet I doubt that other states will take the cue from Massachusetts any time soon, because I'm just not that naive.  Indeed, the "War on Condoms" is being waged full-force in high schools, as well as in our drugstores an on our airwaves.

http://www.zazzle.com/if_used_correctlynot_100_effective_condoms_e_tshirt-235300270078506145

Seriously, ya'll!  If used correctly, not 100% effective condoms everytime!  Wait, what?

In the abstinence-only programs served up to most of America's teenagers, condoms are only mentioned as being so ineffective that they are not worthy of discussion.  This is the direct of the widespread fear that frank discussion of condoms will incite premature sexual activity, in the same way that not teaching teens about condoms has successfully kept sex a complete secret.  For this reason, teenagers educated in abstinence-only programs are far less likely than their more savvy counterparts to use condoms when they inevitably become sexually active.  I feel like it's understood that essentially all products have some non-zero failure rate, yet condoms, with their 98% rate of effectiveness, are held to the highest standard and get by far the worst rap.  Notice how we never see "Chemotherapy:  Not 100% Effective" or "Prayer:  Not 100% Effective"?

Amid the shame, secrecy, and slander surrounding condoms, thousands of lives are still being ruined each year by unintended pregnancies in tragic and needless accidents that could have been prevented by a 25-cent piece of latex.  I expect that someday I'll get around to making the choice to have a child, and when I do, I will love that child enough not to value an arbitrary standard of morality over his or her safety.  My kid will get a big gift-wrapped box of condoms on its 16th birthday.

The Rosaries in the Ovaries

In spite of the Catholic Church's continued and unwavering stance against birth control, it turns out that most American Catholics are, not surprisingly, hypocrites.  According to the National Survey of Family Growth, about 98% have used a form of contraception banned by the Vatican at some point in their lives, and 40% identify as pro-choice.  No word yet on whether these sins come up during Confession.

http://puzzledponderer.wordpress.com/2010/04/28/most-ridiculous-catholic-clothing-ever/

Yet in the developing world, particularly in Latin America and Africa, the Pope's anti-birth control, anti-condom opinions are taken more seriously.  In Catholic nations such as the DR Congo, Peru, and Haiti, rates of birth control use are negligible, and are inversely correlated with rates of HIV infection and unwanted pregnancy.  In Kenya, there have even been widely-reported instances of condom-burnings at the behest of Catholic bishops.

Now, even Pope Paul VI, composer of the treatise Humanae Vitae, acknowledged that couples might "decide not to have additional children" after giving due consideration to "physical, economic, psychological, and social conditions."  And so, to "keep up with the times," ta-da! - thus was born the Catholic institution of Natural Family Planning.  NFP is a complicated system of tracking fertility by taking one's temperature, recording daily levels of cervical mucus secretions, and filling out charts.  This enables a Catholic couple to attempt to avoid pregnancy by abstaining from sex on likely fertile days, while not "perverting the purpose of the marital act."

http://www.learkentfool.com/?p=1678

First, let's be honest:  NFP is birth control.  It's just complicated and ineffective birth control.  Second, Catholicism seems to be very arbitrary with its endorsement of all things "natural:" naturalness is something to be embraced in contraception, but to be shunned when keeping PVS patients alive for decades via ventilators and feeding tubes.

Third, I don't see how this birth control method stands up even to Catholic logic.  The line of reasoning seems to go:  "Sex that isn't open to procreation is wrong.  If I use a condom then God will be displeased, because I'm trying to prevent pregnancy.  But if I have sex according to an intricately-designed calendar, God won't be able to see through my intention.  God wants me to have babies whenever he chooses.  God can do anything.  But he can't surmount a latex barrier even when he really, really wants to."

http://babymakingmachine.blogspot.com/2009/04/natural-family-planning-techinique.html

Sure gets me all hot and bothered.

Anyway.  Couples hoping to marry in a Catholic church are now required to attend four-month classes in Natural Family Planning, to learn the ins and outs of cervical mucus charting and the evils of secular methods of birth control.  For those unable to attend a class, the marriage requirement can be fulfilled with a "home study" class for just $161.  Nevertheless, NFP use is not very common in the developed world, even among Catholic women.  In fact, only about 3.6% of Catholics practice NFP.  Still, for the very high and holy, Natural Family Planning is the one and only way to go.

Given that the Catholic stance against birth control is so often criticized for the plight of starving, HIV-ravaged third world countries, I was curious to see whether NFP had made its way to Latin America and Africa.  Surely, since the Church acknowledges that everyone might not want to procreate constantly, and since it is so concerned with preserving human life, it would try to promote its one approved method of birth control in the third world.  I discovered, however, that NFP courses are available - in English and Spanish only - in all of fifteen nations worldwide.  The majority of these nations (the US, Canada, Great Britain, Ireland, Argentina, Spain, South Africa, and inexplicably, China) are already highly developed.  NFP classes are taught in just six countries total in Africa and Latin America.  Furthermore, according to Natural Family Planning International, current efforts are focused on bringing NFP to the Czech Republic, a country with a fertility rate of 1.24 births per woman, whose people have suffered from "secularism and immorality."  In third-world majority Catholic nations, however, I suppose that the "suffering" has not been so great.

One rare instance I could find of Catholics promoting NFP in the third world comes from my very own Jesuit Georgetown.  A cohort of Jesuits affiliated with the Institute for Reproductive Health is attempting to dispense "cycle beads," rosaries for counting days of the menstrual cycle instead of Hail Marys, in Rwanda, Guatamala, and the DR Congo.  The sad fact is, though, that in the DR Congo, the so-called "rape capital of the world," where girls are often married off at puberty, even a woman's husband is unlikely to respect her wishes to abstain from intercourse during a fertile period.

If Catholic couples truly want to practice Natural Family Planning, then of course that is their right and their choice.  What I'd like to see, however, is some admission that this form of birth control is an elitist luxury, akin to buying organic food or running in Nike Nakeds.  For reasons logistical, economic, and societal, NFP is available almost exclusively in the developed world, while those without easy access are still told that condoms and other forms of "artificial" contraception will drag them down into the depths of Hell.  Yet even faced with these criticisms, the Vatican is as determined as ever not to waver in its resolve.  Pope Benedict XVI, speaking in 2008 on the 40th anniversary of Humanae Vitae, firmly supported his predecessor's treatise, and reminded the world's one billion Catholics that the Church's stance against birth control is "so crucial for humanity's future."

And I would have to agree with him there.

Dividing Cells, Splitting Hairs

In his 1968 encyclical Humanae Vitae, a treatise condemning the use of contraceptives, Pope Paul VI famously established the Catholic church's official stance on all matters procreative.  In the 40-odd years since the publication of Humanae Vitae, the Church has not budged it its contra-contraception position, and Pope Paul VI's treatise has been lauded as "prophetic"for how it anticipated today's issues of reproductive ethics.  These aren't just echoes of the "be fruitful and multiply" argument, however.  Supporters of the Church claim that the Pope's views on birth control are even more relevant given that chemical contraception is "known" to induce abortions through preventing implantation of a fertilized embryo.  Thus contraception is not a lesser, separate evil, but is tantamount to abortion itself.

http://stemcells.nih.gov/info/scireport/appendixa.asp

A life begins... OR WILL IT????

It's not just the Catholics who have voiced this condemnation of the "abortifacient" properties of birth control.  The Evangelicals who fill the ranks of the pro-choice movement are similarly quick to criticize any use of "unnatural" hormonal contraceptives.  There is the outstanding example of the Duggar family, who believe that their use of the Pill caused the miscarriage of one of their pregnancies back in the '80s, and have spent the past two decades atoning for this crime by pushing the limits of human reproductive capacity.  Just a quick Google search will yield a bevy of emotionally-charged, poorly-researched, and often blatantly deceptive websites devoted to defaming all birth control use and equating contraceptives with murder.  (Notable examples including Birth Control is a Sin, Birth Control Causes Abortions, AbortionFacts.com, and perhaps most horrifying, PoisonedByThePill).  A common thread throughout these websites is that of deliberate deception at the hands of doctors and pharmacists.   Readers are urged to "read the fine print" and "wake up" - as if the entire medical profession were aligned in some giant conspiracy to kill Evangelical embryos for the good of Science and Atheism and Richard Dawkins.

From this movement has grown a plethora of misconceptions and taboos about the "Morning After Pill" and oral contraceptives.  Many women worldwide are misinformed about emergency contraception and its mechanism of action:  some actually mistake the Plan B pill with RU486, the "abortion pill."  Pro-life lobbying on this issue has also spawned “the Pharmacist’s Conscience Clause,” a provision which allows a pharmacist to withhold oral contraceptives and the "morning after pill” on moral grounds. A recent study estimated that 6% of American pharmacists actually withhold contraception - which probably makes it pretty difficult to purchase birth control in Kansas.  This poor understanding of emergency contraception deters many genuinely well-meaning women and couples from choosing Plan B following unprotected intercourse - which, of course, is the intended effect of the religious fear-mongering. 

Now, Pope Paul VI was not a doctor or a biologist, so I was interested in how he arrived at his understanding of the mechanism of action of birth control pills and emergency contraception.  So I popped on over to PubMed to see what relevant (and unbiased) information medical researchers had discovered on the topic.

But first, a little background on early embryonic development: the human embryo typically implants in the uterine wall at the blastocyst stage, approximately one week after fertilization, when it consists of 32 cells.  To prevent a subsequent pregnancy, the ovaries begin secreting progesterone, a hormone which inhibits further ovulation.  Progesterone also inhibits the process of sperm capacitation, which enables a sperm to fertilize an egg.  In addition, this hormone thins the lining of the endometrium - just like it does during the luteal phase, i.e. a menstrual period.

Both oral contraceptives and older versions of the Plan B pill (which is essentially a higher dose of the same thing) rely on progestrin, a synthetic form of progesterone, essentially to trick the body into believing that it is already pregnant.  Thus, ovulation and sperm capacitation do not occur, and the endometrial lining thins.  It is this capacity of progesterone which has conservatives jumping down throats and splitting hairs about what constitutes prevention vs. termination of pregnancy, and losing sleep over the fate of the human blastocyst.

http://www.glowm.com/?p=glowm.cml/section_view&articleid=2&SESSID=evpji2lnn7ah65gbjah4bgnc40

So let's see what a few decades of medical research have to say on the matter.  First, newer Levonorgestrel-based contraceptives (such as Plan B One-Step) can apparently only prevent ovulation, and cannot prevent pregnancy once ovulation has occurred.  No studies indicate that Levonorgestrel has any "abortifacient" capabilities.  Thus, Levonorgestrel is only 80% effective at preventing pregnancy.  The results of studies on progesterone-based pills are a little bit hazier:  some report "with mild confidence" that progesterone prevents implantation, while others deny this to be the case.  Most review articles state that the prevention of implantation is "possible in theory," but do not provide relevant statistics.  In contrast, the post-coital insertion of an IUD has been shown to prevent implantation of an embryo; Mifepristone, the "abortion pill," can be taken in small doses to produce the same effect.

The general medical consensus:  certain forms of emergency contraception (Mifepristone and IUDs) have the secondary effect of preventing embryonic implantation.  However, the most commonly-used form of emergency contraception (Levonorgestrel), does not act in this way.  In regards to the Pill, it is possible in theory that these contraceptives prevent the implantation of a fertilized embryo, but no study to date has strongly indicated that this is the case.  I speculate that the findings of such studies are complicated by the fact that, even in the absence of birth control, at least half of fertilized human ova do not successfully implant.  Here's a little graph I threw together about the prevalence possible fetal fates in the U.S.:

Needless to say, these stats are going to make Georgia Rep. Bobby Franklin's job very difficult if he in fact intends to investigate and press charges for every miscarriage that occurs in his state.  The majority of fertilized oocytes to not make it to be full-fledged humans, even without medical or chemical interventions.  Ultimately, it is difficult to determine how often emergency contraception prevents an embryo from implanting when God Himself is already doing such a good job of it.

Globally Pro-Choice

Last week, I was walking across Georgetown's campus when I was stopped by an acquaintance and asked if I would give a minute for "Global Health Day."  Behind her, a large banner proclaimed "Half the world lives on less than $3 a day... that is what we spend on a cup of coffee."  After filling me in on several additional depressing statistics regarding starvation, malaria, and infant mortality, this well-meaning girl asked if I would help global health awareness by writing down something that I believed everyone in the world deserved.  Without pausing, I wrote "access to birth control."

My response was met at first with a smirk, then with irritation, as she suggested that I write something else. "Please take this seriously," she pleaded, implying that my answer had deliberately mocked the plight of millions of starving children worldwide.  It was as if I had suggested sending vibrating cock rings and flavored lube to the war-torn Congo.

http://www.foogle.biz/starving_world/starving.htm

Poverty and global health are issues that we love to talk about.  Starving children in China/Africa/Southeast Asia are eternally the subjects of guilt-tripping rhetoric.  Droves of celebrities and well-meaning high schoolers descend on developing nations each year, all seeking to "combat hunger" and "fight AIDS" in fairly non-specific ways.  Images of barefoot toddlers crying in the muddy streets of Delhi and Lima rouse us to donate to a myriad of international charities.  Yet in all of this discussion of child poverty, there is no mention of the children themselves being a compounding factor.

The correlation between high fertility rates, poverty, and low life expectancy is well established.  According to the UN TFR Ranking (2009), the top twenty nations in terms of fertility rate per woman include Niger, Yemen, Somalia, and Afghanistan; each of these countries has a fertility rate more than three times that of the U.S. and Western Europe.  The UN TFR has also provided this helpful visualization of average fertility rates worldwide:

http://en.wikipedia.org/wiki/Fertility_rate

Anyone who has taken a class in logic knows that correlation does not imply causation.  With a little imagination, though, it's not difficult to picture how a rapidly growing population coupled with a finite number of resources keeps literacy rates low and poverty rates high, fuels political unrest, and greatly facilitates the spread of disease.  And that's not even touching the impact on the women who are actually bearing these children.

http://www.glpinc.org/Web_pages/Illiteracy_Globally.html

Unfortunately, the international community is unlikely to embrace worldwide family planning measures any time soon.  For one thing, one of the world's most powerful men, Benedict XVI, would not approve.  A large number of charities aimed at alleviating poverty are religiously affiliated, and these groups prefer to combat world hunger by collecting canned food, building new churches, and praying.  Contraception, of course, is not in the Catholic or Evangelical vocabulary.  This view has played no small role in the House's recent defunding of the United Nations Population Fund.

It's not just the right wing that's to blame, however.  Even liberal and pro-choice groups shirk from advocating contraceptive use abroad, less they be accused of promoting eugenics or forcing Western practices and culture upon the developing world.  Additionally, the realm of international charity seeks to project itself as bipartisan, eschewing controversial issues such as contraception.  Food, water, health, and education are all hot topics of conversation, but one of the best long-term solutions remains, for now, grossly overlooked.

At the end of the day, it's touching and inspiring to see a a picture of volunteers building a school abroad or serving food to little brown children.  It's very difficult to evoke the same feelings with a picture of a couple using a condom.

The Barren Middle Ground

I am glad that I have access to adequate dental care should I need a cavity filled.  That said, having a tooth filled is a pain in the ass:  it's expensive, time-consuming, and just generally unpleasant.  This is why I floss.

Stripped of its surrounding controversy, abortion is essentially the same as a tooth filling or root canal:  it is a medical procedure you're glad is available, but you hope you won't have to take advantage of.  No matter how pro-choice you are, I can guess that you aren't hoping to be put in a position that requires you to choose an abortion.

This is a perfect example of the often-overlooked middle ground between the typically so starkly-divided choice and life camps.  Both sides agree that abortion is not an inherent good, and that the fewer that are needed, the better.  From religious, social, economic, and medical perspectives, limiting the need for and occurrence of abortions, both legal and illegal, should be a common goal.  In place of debates on the legality of late-term abortions, technicalities of "forcible rape," and issues of spousal and parental notification, discussions of preventative measures against unintended pregnancy - contraception and education - might bring us farther in the effort to improve women's health.

But those interested in achieving any degree of compromise in  are few and far between.  Instead, discussion gives way to incoherent shouting, and polarizing rhetoric fuels the fight on both sides.  Arguments addressing "a woman's right to choose" are shot down with appeals to "a child's right to life."  Clever and incendiary bumper stickers stare each other down in the nation's parking lots while accomplishing absolutely nothing.    Ultimately, the issue has polarized us so much that the idealism on both sides - but particularly on the right - refuses to bend for the sake of practicality.

http://www.bible.ca/oral-birth-control-NO.gif

The pro-life movement is generally disinterested with preventing the need for abortion through access to birth control and education, because as I've said before, this movement is as much about sex as it is about abortion.  Sex is a sin, as is abortion:  religion is not a relativist institution, and it knows not how to choose "the lesser of two evils."  For many, the sole measure acceptable for the discussion of pregnancy prevention has long been, and continues to be, abstinence.  Efforts to increase access to birth control, to develop programs for comprehensive sex education, and even to provide the potentially life-saving HPV injection to adolescent girls have all been viewed by the right-wing as an invitation to, and tacit approval of, premarital sex. Statistics that show abstinence before marriage to be an unreasonable expectation do little to change religious arguments, and sexuality continues to be discussed only in normative terms.  Pro-life leaders are too idealistic to compromise, and no solution can be acceptable if it acknowledges the inevitability of extramarital sex.

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Accordingly, numerous family-planning measures have recently been felled before the unwavering sexual idealism of the right wing.  In addition to the widely-publicized defunding of Planned Parenthood, and last year's decision to continue funding abstinence-only education programs, a measure to provide monies to the the United Nations Population Fund also floundered in the House just last week.  Interestingly, this organization does not provide funds for abortion.  Instead, it grants access worldwide to family planning resources, sex education, and maternal care, with the expressed goal of decreasing the number of unsafe abortions.  This is a cause we could, and should, all get behind.  Unfortunately, this extending of the olive branch is unlikely to happen any time soon, since it would mean acknowledging that sex does not necessitate marriage, and that pregnancy need not follow sex.  Lest you were wondering, the Ten Commandments are ever-present in our legislature... though I know not of any measures based on the presumption that we do not covet.