Where’s the Controversy in Saving Lives?

I have to admire Melinda Gates’ chutzpah. In her recent TED talk and on her blog, Impatient Optimist, she insists that “contraception is not controversial”–when, in the last year, it has been explosively controversial, with many Christians (not just Catholic Christians) seeing the “contraceptive mandate” as a real threat to religious freedom. Yesterday, the law took effect, meaning that most employers must now provide free birth control coverage in their health insurance policies. Whether it constitutes a threat to religious liberty remains to be seen: faith-based groups with religious objections to the law have a “safe harbor” until Aug. 1, 2013. Whether HHS will create an extension of this harbor remains to be seen.

Regular readers of this blog know where I stand on health insurance. As to the contraceptive mandate specifically, I’d prefer not to wade in those particular waters–David Gibson at Religion News Service has a good piece if you’re interested in the question of whether the mandate kills religious freedom. However, I do want to consider two small points about contraception that leans me toward the (self-identified Catholic!) Melinda Gates point of view:

Point 1: contraception doesn’t take life

Point 2: women want contraception

Frequently, discussions of birth control come back to the question of eugenics and attempt to suggest that Margaret Sanger and other early birth control advocates wanted to keep poor people and immigrants from having babies. While it’s always dangerous to speak in general terms, it seems to me that Sanger (and others) were attempting, in good faith, to answer a need, a call for help–not to impose their will on less-educated, less-wealthy women. Here is the tri-lingual (English, Yiddish, Italian) poster from the early days of the movement:

Despite these efforts, the very unfortunate discrimination in Sanger’s (and others in the early birth control movement) thinking seems to taint contemporary discussions of birth control, perhaps understandably so.

But even that history doesn’t change this: just meeting current demand for contraception could cut maternal deaths by 1/3. Which means maybe 100,000 lives per year–or more–just by meeting the unmet, self-identified needs of women.

Where my family and I are headed–Malawi–the contraceptive prevalence rate is just 40%; recently, Malawi’s Vice President pledged to try and raise the rate to 60% by 2012, partly by raising the legal age of marriage and partly by enacting policies which–with help from organizations like the Gates Foundation–will increase access to contraception.

This is not the wealthy, white, West forcing the Pill–much less sterilizations or abortion–on Africans, Indians, or anyone else. We are talking about working in partnership to help women meet their self-identified needs. It’s not about rejecting God’s gift of fertility. It’s about stewarding it well in a complicated world.

I just don’t see the controversy–religious or otherwise–in that.