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The Birth-Control Chief Who Opposes Birth-Control


Tuesday, Nov. 28, 2006

Earlier this month, President Bush appointed Massachusetts obstetrician and gynecologist Eric Keroack to be the Deputy Assistant Secretary for Population Affairs (the chief of family-planning programs at the Department of Health and Human Services (HHS)). The position, which does not require Senate confirmation, involves oversight of the $283 million of Title X funding designed to provide information about, and access to, contraception for anyone who is interested, with an emphasis on the low-income population.

The appointment was controversial, because Dr. Keroack has been a vocal opponent of contraception. How can we trust a person who opposes birth-control to be in charge of fairly distributing it? Beyond the immediate impact of the appointment, however, it could have more subtle effects on the reproductive rights of women in this country. It is on these effects that I will focus in this column.

Dr. Keroack's Views

Dr. Keroack has served for over ten years as the medical director of a Christian nonprofit organization that, in its statement of faith, expresses a commitment to "help[ing] women escape the temptation and violence of abortion." The organization also opposes contraception, it says, because it believes that birth-control increases out-of-wedlock pregnancy and abortion rates. In addition, the organization "is persuaded that the crass commercialization and distribution of birth control is demeaning to women, degrading of human sexuality and adverse to human health and happiness."

Dr. Keroack gave a speech earlier this year in which he stated that promiscuous women use up the "bonding hormone" in their brains during casual sex and therefore are later unable to form long-lasting relationships that require this hormone. (Interestingly, the doctor apparently did not caution women against "using up" the bonding hormone by having many children during marriage - the natural consequence of unprotected sex - even though having a large number of babies could just as easily exhaust the supposedly scarce supply of the hormone -oxytocin - necessary to support a healthy mother-child bond).

The organization's claim that access to contraception increases the odds of out-of-wedlock pregnancy is unpersuasive on its face. It plainly assumes that people who do not have access to contraception will simply abstain from having sex. If this assumption were accurate, of course, then it would be difficult to explain the fact that states where people are most opposed to premarital sex (and where contraception is difficult to get) tend to have higher rates of abortion.

It appears that the lack of available contraception does not deter pre-marital sex. It does, however, increase the incidence of unwanted pregnancy (and therefore of abortion), not to mention the spread of sexually transmitted diseases. The fact that a doctor who heads an important division of HHS has dedicated his career to an agenda based on factually inaccurate premises is very troubling.

The View Of Women's Reproductive Lives That Animates Dr. Keroack's Views

But the notion that contraception is bad for women does not rest simply on a factually flawed understanding of reality. It also reflects a normative view of women's reproductive lives that could have a lasting impact on abortion debates in the United States.

Consider for a moment what it would mean if women and girls stopped using contraceptives altogether, a state of affairs that Dr. Keroack would presumably view as desirable. Some would embrace the abstinence ideal. Given human nature, however, many people would continue to have sex as they did before and would therefore end up facing unplanned pregnancies.

At this point, some of the pregnant women would have abortions, an unfortunate outcome from both pro-choice and pro-life perspectives. Others would take the alternative route of carrying their pregnancies to term, despite their misgivings.

Given that these are the predictable consequences of a move away from contraception, it is difficult to avoid the sneaking suspicion that Dr. Keroack, a man who openly opposes sex outside of marriage and birth-control, would feel that these consequences are the proper wages of sin. In other words, his effort to dissuade and prevent people from engaging in "safe" sex might not be quite so oblivious to reality as it pretends to be; it might be grounded in the view that those who violate religious prohibitions against pre-marital sex ought properly to face the painful consequences that God intended, just as some religious conservatives have said that AIDS is God's punishment for homosexuality.

Anchoring: Why Dr. Keroack's Anti-Contraception Agenda Matters

Might it be that because of his extreme and off-putting views, Dr. Keroack is a marginal figure who therefore cannot do much damage in the long term? Most people in the United States, after all, would categorically reject the notion that contraception is "demeaning" or immoral. Accordingly, the promotion of an anti-contraception agenda might appear to have few likely long-term effects.

Consider, though, the impact of what psychologists call "anchoring." Anchoring is what happens when someone presents us with a range of possibilities that serves, without our necessarily realizing it, to constrain our vision of what we believe is right and fair. To illustrate, if I walk into a furniture store and ask about the cost of a particular wooden table, I might initially be shocked to learn that it is $2000. That number, however, can unconsciously alter my expectations so that when I come across another wooden table that costs "only" $900, the latter price might strike me as a good deal, moreso than if I had not first heard about the $2000 table. If I had been asked what I was willing to spend before entering the store, I might have said "at most $250," but rather than motivating me simply to leave the store and head to Ikea, the first price quotation had the effect of shifting my vision of what I would - even enthusiastically - be willing to spend for a table.

The anchoring effect can occur in the political sphere as well. If prominent people, for example, argue that the police should be able to shoot at any fleeing criminal, then the position that only fleeing felons should be subject to summary execution may begin to seem like a "liberal" position.

Consider now the potential impact when a doctor like Eric Keroack - as head of family planning programs - disseminates the message that birth-control and pre-marital sex are immoral and reprehensible. Most people in the United States will probably continue to disagree with this view. Because of our repeated exposure to such an extreme perspective, however, a position that initially seemed worthy of ridicule might lose its ability to shock people and could ultimately appear - like the high price of wooden furniture - more reasonable than it did before. This shift could subtly lead people who previously supported a right to abortion to believe that because even birth-control is "controversial," abortion bans should perhaps be viewed as a "compromise" or "moderate" position worth considering.

People who feel that abortion should become a crime in the United States would find the prospect of this development a welcome one. But for those who believe that women's lives and freedom require that abortion remain a safe and legal option, Dr. Keroack's appointment should generate alarm - not only because he will likely frustrate women's present interest in unbiased information about, and access to, birth-control, but because he may subtly affect future debate about reproductive rights more generally.

Sherry F. Colb, a FindLaw columnist, is Professor and Frederick B. Lacey Scholar at Rutgers Law School in Newark. Her other columns, including those on reproductive rights issues, may be found in the archive of her work on this site.

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