Forty years after the U.S. Supreme Court ruled that married women have the right to use birth control, many Americans still have problems obtaining contraceptives and preventing unwanted pregnancies. Increasing and improving contraceptive use can prevent unwanted pregnancy and reduce the need for abortion, according to "Promoting Prevention to Reduce the Need for Abortion: Good Policy, Good Politics," by Cynthia Dailard, which appears in the May 2005 issue of The Guttmacher Report on Public Policy (TGR). However, even though most people would agree that reducing the need for abortion is a step in the right direction, state and federal policies increasingly threaten to limit women’s access to contraceptive information and services.

The typical American woman wants only two children; she spends roughly five years pregnant or trying to become pregnant, and three decades trying to avoid unwanted pregnancy. There are many contraceptive methods available, and those most widely used are highly effective. Yet many women find it difficult to practice contraception consistently or correctly over the course of their entire reproductive lives and lack the information and services that would assist them in doing so. As a result, roughly one in three American women will have had an abortion by age 45.

In this era of intense polarization around the issue of abortion, prevention should be a consensus-building issue, Dailard argues. However, instead of putting resources toward prevention efforts, federal and state policymakers are placing increasingly burdensome restrictions on abortion, promoting abstinence as the only option for anyone who is not married and creating barriers that make it more difficult for women to obtain contraceptives.

Rachel Benson Gold discusses a particularly troubling aspect of state laws in "The Implications of Defining When a Woman is Pregnant," which appears in the same issue of TGR. According to both the scientific community and long-standing federal policy, a pregnancy is established when a fertilized egg has implanted in the wall of a woman’s uterus. However, definitions of pregnancy in state law vary widely. And although they have not yet been used to impede women’s access to legal hormonal contraceptive methods, such restrictions are a goal of at least some antiabortion and anticontraception activists.

To date, 22 states have enacted one or more laws that include a definition of "pregnancy." The definitions found in 18 of these laws are based on the idea that pregnancy begins at fertilization or conception. The ongoing debate around emergency contraception–a concentrated dosage of the same hormones found in birth control pills–has brought the question of when pregnancy prevention ends and disruption of an existing pregnancy begins to the forefront of public discussion. Attempts to define pregnancy as beginning before implantation could have serious implications for women’s access to both emergency contraceptives and other hormonal contraceptive methods.

"The fact is the majority of Americans have sex before marriage; virtually all U.S. women (98%) use a contraceptive method at some point in their lives; and most women rely on contraception, not abstinence, to help them responsibly manage their sexual lives in the long term," says Dailard. "As long as politicians continue to ignore the realities of women’s lives, the United States will continue to have the highest rates of unintended pregnancy and abortion in the developed world–a dubious honor that most Americans would prefer not to have."

Also in this issue:

"Prevention Challenges: Reflections on the Roles of ‘Fatigue’ ‘Disinhibition’"

"Condoms, Contraceptives and Nonoxynol-9: Complex Issues Obscured by Ideology,"

Griswold v. Connecticut

In the 1965 Griswold v. Connecticut decision, the Supreme Court recognized the constitutional right of married couples to use contraceptives. The case addressed a Connecticut law that criminalized the provision of counseling and medical treatment to married persons for the purpose of preventing pregnancy. Importantly, the Griswold decision recognized a constitutional right to privacy that served as the foundation for future decisions expanding reproductive rights.