Editor's Note: This article first appeared on rraudit.org on April 8, 2014.
Reproductive Research Audit (RRA) was recently contacted by Politifact, a Pulitzer prize winning project of the Tampa Bay Times that examines the validity of political statements made by public figures and organizations.
As a research methodologist in public health policy, I was asked to evaluate Sen. Barbara Boxer’s statement that “Women take birth control, more than half of them, as a medication for other conditions.” Politifact labeled the comment half-true based on selective wording and clever omission. While the comment appears half-true, it is actually completely false. Furthermore, for women like myself who actually have such medical conditions, this statement is also completely offensive.
The whole truth is that 86 percent of women who take the oral contraceptive pill (OCP) take it for its intended purpose: contraception. Given that only 18 percent of women use OCP, this means that only 2.52 percent of all women rely on oral contraceptives for medical conditions, and those women are not denied coverage by religious employers.
As Politifact pointed out, Sen. Boxer validates her claim with a fast and loose finding from this GI study which found that although 95 percent of sexually-active women use OCP for contraception, 52 percent cite advantageous side effects (like relief from menstrual cramping or for menstrual regulation) as one reason they choose OCP. This means that while 95 percent of sexually-active women use the pill for contraception, 48 percent of those use OCP exclusively for contraception, and report no other benefit or purpose. In fact, OCP is used at the risk of developing life-threatening conditions like blood clots, hypertension, heart attacks, and stroke. It seems particularly dishonest to posit and promote an elective drug as a health treatment, especially when the consequences it may cause are not obviously worth the risks its entail to women’s health and welfare. This is especially alarming when we consider that the number of women reporting usage of OCP for non-contraceptive purposes is higher among teenagers, who consume hormones to treat things like common acne. It is a judgment call for parents if preventing a pimple is worth risking a blood clot.
Sen. Boxer’s statement is predicated on misinformation, as the interview in which she expressed it regarded the Hobby Lobby case in which the she was one of 18 senators to file an amicus brief. RRA filed a brief as well which I myself helped author, and it is common knowledge that Hobby Lobby provides OCP to employees and objects only to intrauterine devices and emergency contraceptives (i.e. the morning-after pill) on the grounds that these agents cause early abortions, to which the plaintiffs have moral and religious objections. Sen. Boxer’s claim is erroneous because those insured by Hobby Lobby already have coverage for these pills. Furthermore, even those with moral or religious objections to contraception do not object to the use of these agents for medical conditions, therefore the mention of women like myself who have suffered from the pain of endometriosis appears to be a distasteful smokescreen.
According to the GI study that Sen. Boxer’s office cited, women like myself would be only 14 percent of OCP users. That's far fewer than half, let alone “more than half” that the senator stated. This means that 91 percent of women who use OCP are sexually active and 95 percent of these women use OCP primarily or exclusively for contraception.
Clearly, women who choose OCP find the adverse side effects minimal or tolerable (although they are not immune from health risks). A 2013 study from a pilot project found that 47 percent of OCP users discontinue within the year, and another more recent study released in February 2014 found that a quarter of the sample discontinued use of OCP due to its adverse side effects. Even when studies like this one show that side effects are minimal, nearly 60 percent of new oral contraceptive users discontinued within six months. In fact, among even the 9 percent of OCP users who are not sexually-active (but have been in the past) 65 percent still cite contraception as the reason for using OCP, either because they were sexually active when using OCP or intend to become sexually active again.
Sen. Boxer’s figure of “over half” is less than half-true, since 95 percent of sexually-active women age 18-44 sought and use OCP specifically for contraception— and 48 percent exclusively for contraception (the 48 percent who did not mention any side-effects). Non-sexually active women who use or continue using OCP for non-contraceptive purposes (i.e. who did not seek the OCP for this purpose) cite side effects of convenience like planning or subverting natural menstrual periods and avoiding temporary, normal menstrual pain or discomfort. Some contraceptive manufacturers who advertised their product as having additional benefits like treating moderate acne or pre-menstrual disorders are currently embroiled in over $1.4 billion in lawsuit settlements due to harm and even deaths (23 in Canada alone). In the case of Yaz/Yasmin, these beneficial side effects were denounced by the Food & Drug Administration.
Women with actual medical conditions like endometriosis and poly-cystic ovary syndrome who have severe pain, often more frequently than once per month, seek out treatment and pain relief, rather than list it as an afterthought. For women like myself who’ve actually suffered from such ailments, the misrepresentation that a majority of women use OCP for medical conditions is not only completely false, but an exploitation of my condition and the condition of women like me. Exploiting our medical necessity to finance elective drugs, and elective drugs that carry significant health risks, is degrading to us and particularly distasteful to women who could endure future health problems due to OCP usage.
In sum, contraception is overwhelmingly the reason why women use contraceptives, while any secondary and tertiary side-effects are a mere afterthought of most users, according to the study that the senator herself hides behind to authenticate her statement. While Sen. Boxer’s choice to pull one figure from a larger study makes her carefully-worded statement appear half-true, it is completely false. Truly, it is also completely offensive.