Catholics, contraception and choice

Could choice architecture help nudge millions of poverty stricken Catholics to consider artificial contraceptive and family planning as a feasible choice?

First I’m going to start with a disclaimer. I am a lapsed Catholic. That isn’t strictly true, ‘lapsed’ implies I drifted away, but I didn’t, I consciously left and in true Catholic style too. First I tortured myself over the decision and then spoke to the church who also tortured me over it. The fact that I have spent this intro desperately explaining myself probably indicates that I am still riddled with pointless guilt over the decision.

I lost faith in the Catholic teaching 20 years ago when I heard Pope John Paul II address the over populated, under nourished hillside favelas of Rio de Janeiro. He said that using any artificial form of contraceptive is sinful. I, as a privileged, educated Catholic simply did not understand this. Family planning would help these people break away from poverty and get children off the streets. In my view it was an unforgivable waste of an opportunity to do so much good. Thus I voted with my heart, soul and feet.

Vilma Lopez

Pope Benedict XVI has just visited the UK. The visit has reignited the debate over, among other things, the Church's position on artificial contraception and family planning. Here a meagre 4% of British Catholics believe that artificial contraception is wrong according to a recent YouGov survey. Some progress has been made in the developing world as shown by the Bayer Schering Pharma survey on Latin America but the Church's decision still impacts on millions of poor Catholics worldwide.

In 'The Trouble with the Pope' Peter Tatchell interviewed Vilma Lopez, a Filipino mother of eleven children with another on the way. Vilma and her family scavenge for plastic in the Manila city dump. She will not use family planning because the Pope says it is wrong and what he says is the unshakable truth - it is the word of God. How do you change faith as ingrained as this? I'm not sure you can or even should but perhaps we can change how she perceives the choices she has before her.

Behavioural economists Thaler, Sunstein and Balz developed the idea of choice architecture. They noted that decision makers don't make choices in a vacuum but in an environment with many recognised and unrecognised features that influence their decisions. Using choice architecture a choice architect can manipulate this environment to help nudge people to make better choices (as judged by themselves) without forcing certain outcomes upon anyone. The three call this libertarian paternalism. If we could nudge Vilma or her daughters in the right direction we could change the decisions they make on family planning.

In a summary paper the three economists analyse six tools at an architect's disposal and I'll have a stab at reviewing these and look at which could help women in Vilma's situation. Of course without the relevant research and analysis, this post will remain rather theoretical, but I hope to get the opportunity to spend more time on this problem in the future.

Defaults
The principle behind this first tool is that people tend to stick with the default option as it requires the least contemplation and there exists the assumption that it's the best, or at least not a detrimental, option. (Hence the ubiquity of the Nokia ringtone that contributed to Dom Jolly's fame.)

Right now the default choice for Wilma is not to use artificial contraception, whether she wants another child or not. In fact she sees no other choice. The only thing a choice architect could do to change this default is to mandate that Wilma be given the choice of contraception every time she has sex. Clearly this is not viable.

Expected error

When I was on my HTML and CSS course our tutor told us to mistrust any data that users input and to put checks in place to minimise mistakes. This tool is pretty much based on the same theory. It assumes that people make decisions in error. For example, most people don't choose to leave their car headlights on all night or to leave the ATM without their bank card. That's why choice architects put in annoying alarms to force us to make conscious decisions about what we do.

In our case, I am pretty sure Vilma doesn't need an annoying alarm reminding her that sex could lead to another baby. So again, this isn't a particularly effective tool in this architecture.

Give feedback
The idea behind this is to tell people how they are doing so they can distinguish between the 'good' and 'bad' choices. Currently the only feedback Vilma is getting is that she is making the right choice by not using birth control because it is a sin. However, she does admit to considering family planning once before. Perhaps I could support the influencers who got her to even consider the subject. I could give them the ability to highlight the negative consequences of having so many children and to communicate the upsides for her and her family if there were fewer mouths to feed on $4 a day? This may just work as the Bayer Schering Pharma survey shows young people in the Asia Pacific region have an appetite for change. 62% of them want better sex education at school, 53% would like to have someone to talk to in confidence, whilst 44% would like a change in cultural attitudes.

Understand Mappings: From Choice to Welfare
A mapping is the relationship between a choice and what you get out of it or the welfare you get from it. In some cases the mapping is straight-forward, rather like looking down a Roman road. You know exactly what you're going to get, or where you're going to get to if you choose it. But in countless decisions the mapping is more difficult to do as the consequences of choices are less easy to decipher.Thaler, Sunstein and Balz said that a good system of choice architecture helps people improve their ability to map and hence to select options that will make them better off.

There are two methods that choice architects can employ, firstly to put the 'stats' in context for the decision maker and secondly by standardising the unit of comparison so that weighing up different choices is made easier. An example of the latter method is the Annual Percentage Rate (APR) used to price borrowing in the UK. It takes into account the interest rate charged as well as fees incurred when borrowing money. This makes it easier to compare totally different borrowing facilities such as credit cards and overdrafts. To illustrate the first method, choosing the difference between a four mega pixel or a seven mega pixel camera is hard especially when there is £200 in it. But choosing between a camera that takes crisp pictures up to poster size versus one that is crisp up to a 5x7 inches puts the mega pixels in context of how it could be used. This makes it easier for the decision maker to choose the one most suitable to their needs.

Vilma told Peter Tatchell that she buys a kilo of rice a day. Everyone has breakfast from it, then a little lunch and if there is some left over, the children will have it for dinner, whilst the adults drink black coffee. Unfortunately on these rations she's already lost three of her eleven children.

If we were to go to a family with three children and put them on the same rice rations as Vilma's eleven, I wonder if it would be a better way of bringing home the stark realities of not using birth control?

Structure Complex Choices
People often adopt simplifying strategies when the decision to be made is important to them, or there are numerous, complicated paths to choose from. For example if a family has decided to move out of London they will have certain minimum criteria that a new town would have to reach for them to choose to live there. It has to be under an hour's train ride into London, it must have nice schools etc. They will eliminate towns that don't meet this criteria until they get to a simplified short list. Choice architects have more opportunity to influence choices for better or for worse when the decision is a complex one.

The problem I see with Vilma is that she doesn't believe she has other choices. She hasn't developed a criteria list that she can use in life-changing decisions like whether or not to have yet another baby. Perhaps this is where a choice architect could help. I could give her influencers the resources and the money to educate women like Vilma and help them to build a list of what she wants out of life for her and her family, and then to help her make her decision against what she wants, not solely on what the Church tells her to do. As the three behavioural economists say in their paper: public-spirited choice architects know that it's good to nudge people in directions that they might not have specifically chosen in advance. Structuring choice sometimes means helping people to learn, so they can later make better choices on their own.

Incentives

Prices and incentives are important in any economic system. Choice architects can use this to their advantage when designing a system by putting the right choices to the right people. The three behavioural economists argue that the way to start thinking about incentives is to ask four questions about a particular choice architecture. Who uses? Who chooses? Who pays? Who profits. If you look at Wilma's current architecture; the Church uses her to keep its numbers up, it chooses for her to have children, it profits from the size of its following and the only thing Vilma does is pays. That just isn't fair.

So how do we begin to make her see this? By directing her attention to the price she pays thus the incentives she foregoes. In behavioural economics this is called making the incentives more salient. Take a taxi ride for example. You are continuously reminded of how much it is costing by a ticking meter so its price is very salient. If you were to take your car instead you are less likely to comprehend the real cost of that journey. In reality the price of you driving yourself is probably higher than that of a taxi once you include the cost of buying the car, the petrol, wear and tear, insurance etc.

If we go back to Wilma's $4 daily budget. Her influencers would need to show her how much a child costs to bring up and ask if she believes she could afford it. To make the consequences more salient, you could even persuade her to save the cost of having another child, so she understands on a daily basis the hardships that comes with having more children. I realise this sounds like a Draconian measure, so we would have to persuade Vilma to try it voluntarily by giving her an added incentive to save. Maybe we could match the money she puts away? A measure like this is truly in the spirit of libertarian paternalism.

In this post I have summarised my understanding of choice architecture and some of the tools at an architect's disposal. Where relevant I have gone on to suggest ways in which the tools could be applied to help nudge poor Catholics to come to better choices, as judged by themselves, on the subject of family planning. I have shown how understanding mapping, giving feedback, structuring complex choices and creating incentives could help in this cause. I do not believe this to be a comprehensive interrogation of choice architecture or the problem of encouraging birth control amongst poor Catholics. But I do hope that this post has shown how taking a fresh look at the problem from a choice architect's viewpoint can lend a new perspective on finding a solution to the problem. With this I hope that I can begin to effect the change I believe is needed.