Commentary: Things Planned Parenthood's 'Truth Team' Forgot to Mention
By Susan E. Wills

Planned Parenthood Federation of America (PPFA) has dispatched a "Truth Team" to rally opposition to the Pence Amendment (H.R. 1, sec. 4013), a measure to stop federal funding of PPFA and its 102 affiliates. But not everything said by PPFA officials and sympathetic media has been the whole truth and nothing but the truth.

In the interest of an informed debate about taxpayer funding of PPFA, a few omissions and potentially misleading statements are addressed below.

Claim: "This is about women's health more than abortion" (Cecile Richards, PPFA President)

This was quoted by Jonathan Alter in a March 14 opinion piece posted on Bloomberg Opinion. But Congress already spends billions every year for women's health care, through Medicaid, Medicare and other programs. Defunding PPFA is about no longer coercing taxpayers to contribute to the nation's largest abortion chain.

In its last reported fiscal year (2008-2009), PPFA clinics aborted 332,278 children, a number equal to the entire population of Cincinnati. Since 1970, PPFA has aborted an estimated 5,300,000 children, equivalent to the entire population of Colorado.

In an interview published March 17 in the Texas Tribune, Ms. Richards spoke at length about all the healthcare PPFA provides: "We see 3 million patients each year across the country. For 97 percent of them, we provide preventive care. Three percent are abortions."

Yet according to PPFA's own March 2011 Planned Parenthood Services fact sheet, 332,278 abortions were performed on some of PPFA's three million clients in the year ending June 30, 2009.  This suggests that eleven percent of their clients had abortions in that year, not three percent. But the best measure of how important abortions are to PPFA's bottom line is the fact that abortions produce at least 37 percent of PPFA revenues "by very conservative estimates."[1]

PPFA has also expanded these lucrative abortion services, adding surgical or "medical" (RU-486) abortion to the services offered at an additional 75 clinics between 2005 and 2009. In that period, PPFA's total annual abortions grew 25 percent,[2] while other services declined. For example, prenatal care clients numbered 7,021 in the most recent year (down 60 percent in the last five years),[3] and adoption referrals to other agencies numbered only 977, compared to 4,912 in 2007, (see page 7) a remarkable 80% drop in adoption referrals in only two years.

Due to this increase in abortions and decrease in prenatal care and adoption services, 97.6 percent of PPFA "services" for pregnant women in 2009 involved killing their children, and only 2.4 percent involved prenatal care or adoption referral.

Abby Johnson, former director of the Planned Parenthood clinic in Bryan, Texas and author of the new book Unplanned, confirms the key role abortion plays in Planned Parenthood's services. She quotes her regional director as telling her to increase abortions at her clinic in order to "get her revenue up."[4] Only affiliate clinics that provided abortions were profitable. The director reminded Abby that "non-profit" is just "a tax status, not a business status."[5] Sure enough, when the Bryan clinic began offering RU-486 abortions every day, profits rose.

Ms. Johnson's account was borne out in December 2010, when news media reported on a PPFA directive that all affiliates should begin offering abortion services within the next two years.

Claim: Without funding for PPFA, women will lack access to mammograms, primary health care, and other necessary services

In truth, Planned Parenthood clinics [sic] provide no mammograms. They offer only referrals to health centers, doctors, hospitals and labs for mammograms. PPFA breast exams are done by manual palpation, similar to a breast self-exam. But as a National Institutes of Health MedlinePlus fact sheet states: "There is no evidence that doing breast self exams saves lives from breast cancer." For that, mammography is needed.

As for primary health care services, PPFA clinics performed fewer than 20,000 such services in its last reporting year, an insignificant part of the total of 11.4 million services nationwide. Through state and federal Medicaid programs, low-income women already have access to contraception, as well as needed health care services-including testing and treatment for sexually-transmitted diseases (STDs), Pap tests for cervical cancer, and mammograms-at countless hospitals, doctors' offices, and over 1,000 federally-funded community health centers.

Claim: "Planned Parenthood cannot survive without federal funds"

So states Jonathan Alter. Really? PPFA has almost one billion dollars in net assets ($994,700,000), and in its most recent filing reported $737 million in revenues for the year, not counting the $363 million from taxpayers (see page 29). Any untaxed corporation should be able to scrape by on $737 million in revenues.

Claim: "Without funding, PPFA won't be able to provide contraceptive services that prevent more than 612,000 unintended pregnancies every year"

Mr. Alter and many others repeat the "pregnancies averted" figure[6] to justify funding PPFA. This claim remains one of the more imaginative "statistics" devised by abortion advocates.  Equally creative is the claim that widespread access to emergency contraception (EC) would cut abortions by half, when a definitive meta-analysis of 23 studies in 2007 showed that EC has had "null" effect on abortion rates.[7]

The "pregnancies averted" figure depends on two assumptions, neither of which has been demonstrated empirically: first, that contraceptive use reduces abortion rates overall; second, that young people are inherently "unable" to control their sexual behavior, and will therefore engage in sex to the same extent whether or not they have access to contraception.

Reality: Access to contraception does NOT reduce abortion rates

Anyone who finds that statement shocking has not been paying attention. A study published earlier this year found that a 63 percent increase in the use of contraceptives in Spain over a ten-year period was accompanied by a 108 percent increase in the rate of elective abortions.[8] This counter-intuitive reality has also been documented in peer-reviewed journals in the U.S. and Western Europe. Studies by Peter Arcidiacono in the U.S., K. Edgardh in Sweden, and David Paton and Sourafel Girma as well as M. Wiggins et al. in the U.K., are reviewed in a USCCB fact sheet "Greater Access to Contraception Does Not Reduce Abortions."

Planned Parenthood leaders have known for a half century that when access to contraception increases, abortion rates can rise or, at least, remain unchanged.[9] The correlation between contraceptive use and recourse to abortion was noted in a 1932 article in the British Medical Journal, by a PPFA doctor in 1936, in a study done by the Margaret Sanger Clinical Research Bureau in 1940 (finding 41 percent of pregnancies of contracepting women terminated in illegal abortion, while only 3.5 percent of the pregnancies of non-contracepting women did), and by Malcolm Potts, MD, then medical director of International Planned Parenthood Federation in 1981.[10]

There are many reasons why access to contraception does not reduce abortion rates (and often is associated with higher pregnancy and abortion rates): method failure, user error, cumulative risk, and risk compensation, as well as discontinuation of a method due to unpleasant side effects.

Method failure and user error

Method failure refers to the inherent ineffectiveness of the contraceptive (in the case of condoms, strength, reliability, correct size) and also depends on the age, experience and maturity of the user. A large national study in France, for example, found that adult couples with more than five years' experience using condoms had a total method failure rate (from breakage and slippage) of only 1.4 percent, but couples with less than five years' experience had a method failure rate of 7.8 percent.[11]

User failure can result from any seemingly minor discrepancy in use, including inconsistent use. Method failure and user failure add up to "typical use."

With typical use, especially among teenagers, contraceptives often fail to prevent pregnancy.

Among low-income teenagers, the 12-month "failure" (i.e., pregnancy) rate for condoms is 23.1 percent; but if the teens are cohabiting, the pregnancy rate is 71.7 percent because of the higher frequency with which they're having sex. For low-income teens using oral contraceptives, the 12-month failure rate is 12.9 percent; among cohabiters, 48.4 percent will become pregnant.[12]

Cumulative risk

Cumulative risk is nicely illustrated by the differential pregnancy rates for teens who have sex occasionally versus those who cohabit: 23.1 vs. 71.7 percent pregnancy rates for condom users, and 12.9 vs. 48.4 percent pregnancy rates for those taking oral contraceptives. It's a lot like tossing a coin. The odds of getting heads with one toss are 50 percent, but toss the coin five times and the odds of getting heads once are almost 97 percent. Only instead of "heads," you may get a baby-or an incurable STD.

Risk compensation

People show a greater willingness to engage in potentially risky behavior when they believe that their risk has been reduced through technology. For example, studies report an increase in melanoma among sunscreen users because, believing themselves protected from UV rays, they stay in the sun far longer than those who don't use sunscreen.[13]

One way to measure the effect of risk compensation in the context of sexual risks taken by teens and young adults (i.e., more frequent and casual sex, more partners and promiscuous partners) is to examine rates of STDs.

Examining the impact of free, over-the-counter EC for teenagers in England, researchers reported: "The EBC [emergency birth control] scheme had no impact on conception rates." However, "the presence of a pharmacy EBC scheme in a local authority is associated with an increase in the rate of STI [sexually transmitted illness] diagnoses amongst teenagers of about 5%. The equivalent figure for [children under 16] is even larger at 12%." This "is consistent with the hypothesis that greater access to EBC induces an increase in adolescent risky sexual behavior."[14]

The United States is awash in contraceptives, yet the Centers for Disease Control and Prevention estimates that "there are approximately19 million new STD infections each year-almost half of them among young people 15 to 24 years of age". The cost of STDs to the U.S. health care system is estimated to be as high as $15.9 billion annually. And 60 million Americans have the incurable virus that causes genital herpes.

Claim: Kids Aren't Capable of Abstaining from Sex

In 2009, 54 percent of high school-aged teens were sexually abstinent (had never had sex); that figure includes 70 percent of 9th graders and 60 percent of 10th graders (at Table 61). [15]

The percentage of girls 15 to 17 who ever had sex dropped from 38 percent in 1995 to 27.7 percent  in the reporting period 2006-2008. Even among girls 15-19, the majority were abstinent: 49.3 percent had ever had sex in 1995, compared to 41.6 percent in the reporting period 2006-2008.

Among males 15 to 17, the percentage who ever had sex was 43.1 percent in 1995 and dropped to 28.8 percent in the reporting period 2006-2008. In 2002, a majority of males 15 to 19, had ever had sex (55.2 percent), but in the reporting period 2006-2008, only a minority of males had (42.6 percent).  If all these teens can remain abstinent despite pressures from the culture and peers, why can't the rest?  Especially if we remove from the situation authority figures like Planned Parenthood officials who insist that no one can.

Reality: Planned Parenthood's Fail-Safe Business Plan

Intentionally or not, Planned Parenthood has put in place a business plan that is certain to generate repeat business for a wide variety of services throughout the client's lifetime:

Planned Parenthood combines compelling marketing (kids, you can enjoy "safe sex" without consequences!); location (often low-income neighborhoods where most services are paid for by a third party, such as state or federal Medicaid or Title X, eliminating any financial barrier to using their services); and products that don't live up to the promise of protection from STDs and pregnancy, due to method and user errors. In 2005, Consumer Reports ranked dead last (among 23 brands) two of the condom brands that PPFA affiliates offer free to customers, due to their rating of "poor" in strength and reliability.

All this adds up to a revolving door of customers, constantly returning for the pricier services: emergency contraception; pregnancy tests; STD testing and treatment, including Pap tests for cervical cancer (100 percent of which is caused by certain persistent strains of the sexually transmitted human papilloma virus [HPV]), diagnostic colposcopies and LOOP/LEEP procedures; cryotherapy; HIV testing; and, of course, the big money-maker, abortions.

Why haven't supporters of PPFA funding in Congress and the press noticed that something is amiss?  Here is an organization that offers contraception (35 percent of 2009 services)[15] for "safe sex," yet also reports that 35 percent of its services deal with the failure of "safe sex" to protect against STDs (testing and treatment), and 11 percent of clients undergo abortions. Is it not likely that some of the same clients going to Planned Parenthood for contraception are returning for these other services when PPFA and contraception fail them? After all, 54 percent of women seeking abortions report they were using contraceptives in the month they became pregnant (see Table 61, p.98).

Abstinence before, and monogamy within, marriage are the only sure ways to prevent STDs. But Planned Parenthood can't afford to recommend such a lifestyle: if adopted widely, it would quickly put them out of business.

Susan E. Wills, Esq. is Assistant director for education and outreach, U.S. Conference of Catholic Bishops' Secretariat of Pro-Life Activities www.usccb.org

[1] Planned Parenthood puts the cost at between $350.00 and $950.00. Also, not all of their abortions are performed in the first trimester.

[2] PPFA Annual Report 2005-2006, p. 4, reported 264,943 abortion procedures in 2005, while the PPFA Services Fact Sheet reports 332,278 abortions.

[3] PPFA Annual Report 2004-2005, p. 4, showing 17,610 prenatal clients in 2004, and PPFA Services Fact Sheet  showing 7,021.

[4] Abby Johnson, Unplanned (San Francisco: Ignatius Press, 2010), p. 114.

[5] Unplanned, p. 114.

[6] See also PPFA Fact Sheet, "By the Numbers," February 2011 which also include this figure of 612,000 pregnancies averted.

[7] E. Raymond et al., "Population Effects of Increased Access to Emergency Contraceptive Pills: A Systematic Review," Obstetrics & Gynecology 109.1 (Jan. 2007): 181-8.

[8] J. Dueñas et al., "Trends in the Use of Contraceptive Methods and Voluntary Interruption of Pregnancy in the Spanish Population during 1997-2007," 83 Contraception (2011): 82-87.

[9] Kenneth D. Whitehead has assembled many early statements by the "fathers" of the U.S. reproductive rights movement, in his article "Do Sex Education and Access to Contraception Cut Down on Abortion?"  He quotes, for example, the concluding statement of a 1955 PPFA conference: "It was recognized by conference participants that no scientific evidence has been developed to support the claim that increased availability of contraceptive service will clearly result in a decreased illegal abortion rate." Among the signatories were Alan Guttmacher, MD (an early President of PPFA), Christopher Tietze, MD (PPFA's principal researcher for years), John Rock, MD (co-developer of the Pill), and Louis M. Hellman, MD (a Deputy Assistant Secretary for Population Affairs and administrator of the Title X program).

[10] See text accompanying endnotes 37-42 in Whitehead, note 18.

[11] A. Messiah et al., "Condom Breakage and Slippage during Sexual Intercourse: A French National Survey," American Journal of Public Health 87 (1997): 442.

[12] H. Fu et al., "Contraceptive Failure Rates: New Estimates from the 1995 Survey of Family Growth," Family Planning Perspectives 31 (1999): 56-63, at 61.

[13] See, e.g., P. Autier et al., "Melanoma and Use of Sunscreens: An EORTC Case-control Study in Germany, Belgium, and France," International Journal of Cancer 61 (1995): 749-755 and others cited in note 37 of S. Wills, "Condoms and AIDS: Is the Pope Right or Just ‘Horrifically Ignorant'?" The Linacre Quarterly 77(1) [2010]: 17-29.

[14] S. Girma and D. Paton, "The Impact of Emergency Birth Control on Teen Pregnancy and STIs," Journal of Health Economics (2011), doi:100.1016/j.healeco.2010.12.004.

[15] See also PPFA "By Numbers" Fact Sheet, at bulletpoint 8
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