Sunday, March 11, 2012

Hey, Where'd That Baby Come From?

Dear George,

I don’t understand all this political fuss about contraception. It’s like we’ve fallen into a time warp and returned to the early 60’s. Whatever the case, it has reminded me othat Katja was a pioneer of sorts in the whole birth control enterprise. The pill was developed in the 1950’s and initially tested on women in Puerto Rico in 1956. In May 1960 the FDA approved its use in the U.S. Katja and I got married that year and moved to Ann Arbor which turned out to be one of the early sites for American distribution and further testing of the pill. Katja signed up for the research as soon as they announced it. Our fantasy at the time was that she was the very first mainland user of the pill, but that’s not exactly true. Actually, the first U.S. research was done in Massachusetts. Katja did agree to being a research subject as part of her receiving the pill. We’d go over to the local Planned Parenthood clinic which occupied a second floor suite down a narrow alley near downtown. It was dark and secluded, with just a tiny sign near the door, a sort of secret, back alley place. I’d escort Katja up to the reception area, then go back downstairs and wait in the shadows, smoking cigarettes and fidgeting. I was nervous about Katja being a test subject for such a new, powerful drug, but she was fearless.

The pill, of course, was revolutionary in that it provided women newfound security and unprecedented control over pregnancy. Katja took the pill faithfully during our stay in Ann Arbor, then continued when we moved to Cincinnati for my university job. After a couple of years we went to a holiday party for grad students and faculty at our close friends Clyde and Ann M’s apartment. In the midst of the revelry, Katja quieted the crowd and said she had something important to tell everybody. She paused, blushed a bit, then came forth with her stirring announcement: “Nobody knows this yet, but I’m pregnant!” The group broke into applause. Nobody was more astonished than I. “But you’re on the pill,” I stammered. “No I’m not,” Katja said. “I stopped taking it months ago.” She reminded me that I’d suggested that we might want to think about adding maternity insurance to our university health insurance plan. She’d taken that as a cue that I thought it was time for us to have a baby. I mildly protested that perhaps we could have talked about it more explicitly. But Katja was certain that I would be happy. I mulled it over and decided I was.

Though she wasn’t enthusiastic about being pregnant in and of itself, Katja gritted her teeth and nature proceeded on course. Katja ate lots of pickles and chocolate ice cream. We went to natural childbirth classes every Tuesday night, and I was trained to help Katja regulate her breathing. When the moment finally arrived, we rushed off to Christ Hospital. I sat next to Katja’s bedside, repeating “breathe, breathe” as I’d been taught to do. “I am breathing, God*** it!” Katja shouted. The doctor decided it might be better if I retire to the waiting room. Katja was in there for a long time, sixteen hours in all. When she saw women being carted off to give birth who she knew had arrived after she, she’d holler out, “It’s my turn, it’s my turn!” Finally it was her turn, and, before we knew it, there was our tiny infant son. We’d debated between Barnaby and J*** if it were a son. I thought Barnaby had a lot of pizzazz, but Katja went for J***. We soon learned that her decision to discontinue the pill was the best of all times. Since it takes me forever to work through these big questions, it’s good that somebody opted to take action.

Contraception has advanced a lot since those early days, and there are many facts relevant to the current debate about health insurance coverage. Below are some of the details I’ve run across (the numbers in parentheses refer to sources listed at end). There are, of course, complex issues about religious freedom and women’s health rights. Nonetheless, I think one can make a strong case that all women should have access to contraception covered by their health insurance.



  • Each year in the US there are about 4 million births, 1 million miscarriages or stillbirths, and 1.2 abortions. About 50% of pregnancies in the US are unintended. (5)
  • Rates of unintended pregnancies per 1000 women per year vary by racial/ethnic group: 35, Non-Hispanic whites; 98, African Americans; 78 Hispanics. These differences correspond closely to patterns of contraception use. (5)
  • On average, US women want only two children. To achieve this outcome, women must use contraceptives for roughly three decades. (3)
  • Over 99% of US women of child-bearing age (15-44) who have ever had sexual intercourse have used at least one contraceptive method during their lives. This rate is virtually identical for Catholic women (98%). 93% of sexually experienced US women have relied on male condom use. 82% have used the pill. (5)
  • 68% of sexually experienced Catholic women of child-bearing age, 73% of Mainline Protestants, and 74% of Evangelicals are using highly effective methods of contraception (i.e.., sterilization, the pill or another hormonal method, or the IUD). (2)
  • More than 40% of Evangelicals rely on male or female sterilization, the highest rate among the various religious groups. (2)
  • The most frequently used contraceptive methods by US women (2006-2008) are: the pill (28%), tubal sterilization (27%), male condoms (16%), vasectomy (10%), IUD (6%), and withdrawal (5%). (3)

· According to a recent CBS New Poll (May 2010) 52% of the public believes that the birth control pill has been one of the country's most significant medical developments; has made women's lives better (56%; vs. 9% worse), has made it easier for women to have careers (57%; vs. 1% harder); has made American family life better (50%; vs. 11% worse); can be used safely (64%; vs. 25%, No); and is effective (85%; vs. 5%, No). (1)

  • Typical-use failure rates (i.e., unintended pregnancy) over a 12-month period vary by type of contraceptive: spermicides, 29.0%; periodic abstinence, 25.3%; withdrawal, 18.4%; male condom, 17.4%; pill, 8.7%; male and female sterilization, less than 1%. (5)
  • Contraceptive choices vary sharply by age. The pill is the leading method for women under 30. Women 30 and older rely more on sterilization. (3)
  • The costs of birth control vary by method, insurance coverage, and the type of drug or device. Recent estimates from US News (Mar. 5, 2012) are: the pill, $160-$600 per year; birth control patch, $160-$600 per year; condoms, averaging $150 per year; diaphragm, $60 a year, plus the initial doctor’s visit ($20-$200); IUDs, upfront cost of $500-$1,000, then $100 per year; sterilization, $1,500-$6,000. (4)
  • Federal employees are guaranteed insurance coverage for contraceptives. (3)
  • 90% of employer-based insurance plans cover a full range of prescription contraceptives (three times as many who did so a decade ago). (3)
  • 27 states have laws requiring insurers to provide coverage for the full range of contraceptive drugs and devices approved by the FDA. (3)


(1) CBS News Poll, "The Birth Control Pill: 50 Years Later." (

(2) Guttmacher Institute. “Contraceptive use is the norm among religious women” (Apr. 13, 2011) (

(3) Guttmacher Institute. “In Brief: Fact Sheet (June 2010)” (

(4) US News and World Report. “The Real Cost of Birth Control” (

(5) US Dept. of Health & Human Services, Centers for Disease Control and Prevention. “Use of Contraception in the United States: 1982-2008.” (

G-mail Comments

-Gayle C-L (3-11): David, You are too much. I apologize for not responding to your letters ( which I Love ) But thankfully I have been very busy w the Princeton Spring Market. Finally closing some long over do properties. Lets talk soon. Lots of love... G

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