Thursday, April 22, 2010

The WSJ Takes on Unplanned Pregnancy, In Its Way

The Wall Street Journal has an interesting take on the problem of unwanted pregnancy.
Next month marks the 50th anniversary of the birth-control pill in the U.S. The dawn of dependable contraception not only ended the post-war baby boom, it also ignited the sexual revolution and helped millions of women to enter the work force.

Nowadays, women can choose from a bevy of birth-control options, including pills, patches and rings that allow them to have as few periods as they like, even none. Implants and intrauterine devices (IUDs) can prevent pregnancy for years at a time and eliminate the need to refill and remember. Morning-after pills that can decrease the risk from unprotected sex are available without a prescription even to teenagers. Women who want to end their fertility permanently can do so in a doctor's office without undergoing surgery. Abstinence is still taught in many schools and homes as being 100% effective if followed diligently.

Yet despite all these options, the rates of unplanned pregnancies remain high: Almost half of all pregnancies in the U.S.—some 3.1 million a year—are unintended, according to the most recent government survey, from 2001. One out of every two American women aged 15 to 44 has at least one unplanned pregnancy in her lifetime. Among unmarried women in their 20s, seven out of 10 pregnancies are unplanned. The Birth-Control Riddle

There is something funny about that statement that abstinence is 100% effective if followed diligently. It seems to me that the word "abstinence" is one of those binary things, you are either abstinent or you are not. If you are abstinent five days a week, or twenty-three hours a day, you are not abstinent. It's not that abstinence hasn't been "followed diligently," there just ain't none. "Trying to be abstinent" is known to most people as "not using any birth control," and in itself it is not effective in preventing pregnancy.

Why are the numbers so high?

The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors. Many of those unplanned pregnancies become wanted babies. About a million are aborted each year and others are miscarried.

Almost half (48%) of unintended pregnancies involve contraceptive failures. In 52% of the cases, couples used no birth control at all. Cost is a factor for some of them. Even though most insurers now cover contraceptives, co-pays and deductibles can still present obstacles.

There is something obvious about the Wall Street Journal assuming that the monetary cost of contraception is what drives someone's decision whether to use it.

Interesting that they say nearly half of the unintended pregnancies resulted from "contraception failures." What can that mean? If a couple is using condoms for birth control and one night they have sex without it, is that a "contraception failure?" Because really, if half the unintended pregnancies were conceived using contraception and half were conceived without, what would be the point? Obviously contraception does not work. In this study, it sounds like contraception -- whatever that means -- gives you about a four percent edge, and that might not even be bigger than the margin of error.

I am pretty sure they do not mean "contraception used correctly." If you take your pill every other day, use a condom when there's one handy, you are not using contraception correctly. But you might report in a survey that you use contraception.

It's like, how many unintended pregnancies result from abstinence? Obviously, zero, at least in the last couple thousand years. And how many follow from "abstinence not followed diligently?" I bet it's a bunch.

There is just something screwy here.
And many young people are in "the fog zone" in which their beliefs about pregnancy don't match their behaviors, according to a 2009 report by the National Campaign to End Teen and Unplanned Pregnancy. In a survey conducted by the Guttmacher Institute of 1,800 single men and women aged 18 to 29, more than 80% of both sexes said it was important to them to avoid pregnancy right now, yet 43% of those who are sexually active said they used no contraception or used it inconsistently.

Some population experts say the rates of unintended pregnancy would be far lower if more women used IUDs and implants that prevent pregnancy for years at a time. Only about 3% of American women currently do.

These are hard questions. First of all, young people need to understand how to use their contraceptive methods correctly. There is a big difference, for instance, in the effectiveness of condoms with ordinary use and correct use. Then the harder problem is for young people to learn to see the sexual context as one where they can make important decisions that affect their lives and their futures, you can't just get carried away with the passion of the moment, you have to use your head, too.

Now this article takes a sudden change of direction. I'm not going to quote it, but I recommend it. The author goes through and summarizes all the current forms of contraception. Section titles are:
  • The New IUDs
  • The Implant
  • Hormone Pills, Patches And Rings
  • Condoms, Caps And Sponges
  • Emergency Contraception
  • Permanent Birth Control

Then there is a lovely full-color chart of the various methods in magazine-y format, with factoids and information -- you could print it out and put it on the wall outside your daughter's bedroom.

There is one interesting comment here, regarding condoms:
Effectiveness is still an issue. Roughly two of every 100 women whose partners use condoms correctly become pregnant each year, as do 15 of 100 women whose partners don't use them correctly.

Let's assume that someone using condoms is on the youngish side, we'll say these people have sex twice a week. That is 104 condoms per year -- the statistical statements uses a one year reference period. A hundred couples will use 10,400 condoms in a year. And of those, we're told, there will be on average two mishaps resulting in pregnancy, in other words, there is a 2/10,400 or 0.019 percent chance of condom usage resulting in pregnancy.

Certainly some condoms break or leak or whatever during an infertile part of the woman's cycle, when it doesn't matter, as far as pregnancy is concerned, so the failure rate is higher than 0.019 per cent, probably four times that, maybe 0.0769 percent. That doesn't really sound so bad. I think new couples tend to use condoms, and then as they form a commitment and trust their exclusiveness it is common to switch to oral contraceptives, or some other form that does not also protect against infections. Let's not get the idea that condoms don't work, or they fail two percent of the time, they do what they're supposed to do, they block pregnancy and sexually transmitted infections quite well.


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