PREGANCY AND THE SINGLE WOMAN – Why unplanned births are a bigger problem than unmarried parents.
Two recently published books deal with this problem:
“Generation Unbound: Drifting Into Sex and Parenthood Without Marriage” By Isabel V. Sawhill Brookings
“Pro: Reclaiming Abortion Rights” By Katha Pollitt Picador
What’s the policy shift with the most power to make children’s lives better? For decades, the answers have been variations on similar themes. Early cognitive growth is crucial, so parenting education and high-quality preschool should be priorities. Social and emotional skills are essential for success, too, so classrooms need to incorporate what now often goes by the name of character education. Since stressful environments take a toll, children should be raised in stable homes in safe neighborhoods. Depending on whom you talk to, that means policies to help parents find good, steady jobs, or to encourage couples to marry and then stick together. Or both.
There’s another answer, which dates back even further but doesn’t get broadcast so loudly these days: for children to thrive in all of the above ways, their best bet is to be born to mothers and fathers who didn’t just slip up but intended to have them. Imagine a world in which every child is wanted and planned for sounds trite. The promise of intentional motherhood has become a fraught enough goal that public rhetoric generally skirts it. We should accept that it’s good for everyone if women have only the children they want and can raise well. Acceptance, and what it entails, carries a charge, because it means helping women end pregnancies they aren’t ready to continue.
For more than 40 years, the debate over family values has divided not just the left and the right but also the women’s movement, which has been criticized for driving a wedge between an affluent elite, focused on abortion rights and liberating careers, and a broader socioeconomic swath of women with more-traditional views of family and female roles. By now, however, the domestic landscape has shifted. Top earners and college-degree holders bequeath their children the benefits of conventional nuclear households. Meanwhile single parenthood (which prevails in nearly a third of all families in the United States) is concentrated among lower-income, less-educated Americans, whose marriage rates have plummeted. The time may be ripe for a new rapprochement on intentional parenting. Children pay a high price for the decline of marriage, which has overtaken divorce as the main engine of single parenthood. There isn’t much good to say about divorce either, kids generally don’t fare so well in the face of the instability that is likely to ensue. But it’s “wishful thinking” to try to bring marriage back. Instead, try to boost children’s prospects by different, bracingly down-to-earth means: converting single parents from “drifters” into “planners.”
Drifters slide into having children. Planners make a conscious choice. There is good reason to think this can make a real difference in sparing kids the worst effects of what researchers call “the family-go-round.” Here’s one bit of evidence from the sorry annals of family unhappiness: children who experience the death of a parent—a random event—are better off than those who weather ruptured adult relationships, which may result from “the same underlying conditions, attitudes, behaviors” that make life hard for kids.
So what distinguishes planners from drifters? All kinds of complicated, intangible factors, and one basic, concrete variable: reliance on long-acting birth control. Two forms of contraception, by knocking out the need for short-term planning, have unmatched power to transform family trajectories. They are the IUD (intrauterine device, available in either progesterone-releasing or copper form) and the implant, a matchstick-size, hormone-injecting rod inserted beneath the skin of a woman’s upper arm. Once in place, both methods do the job for years. No prescription to refill, no shot to get, no device to put in or on (and little risk, with current IUDs, of pelvic infection or septic miscarriage).
Among contraceptives, IUDs and implants are uniquely “forgiving of human frailty,” in practice, to be about forty times more effective than condoms and twenty times more effective than the pill at reducing the incidence of unplanned pregnancies.” If you’re stunned by those statistics, that condoms aren’t as good as the pill, which is in turn not quite as good as the IUD, but that each method works most of the time. Wrong, according to the only measurement that matters—a method’s effectiveness based on typical use over time. Over the course of 10 years, more than eight out of 10 women who rely on condoms to avoid childbearing will find themselves pregnant. So will more than six out of 10 who use the pill. Only two of 100 women with a hormonal IUD, and eight of 100 with the copper version, will get pregnant. The rate is one in 100 for implants.
IUDs and implants are effective because they’re empowering, they change the default setting: rather than having to take action to prevent pregnancy, women have to take action to become pregnant. Put differently, long-acting contraception is a means to “help poorer and less-educated women align their behavior with their intentions.” Framed in those terms, increasing access to IUDs and implants is a way to avoid the paternalistic policing of poor women’s reproductive choices—and the abortion fight.
Abortion is a difficult choice for almost anyone and morally wrong in the eyes of many, and, paraphrasing Bill Clinton, it should be “safe, legal, and rare.” Yet, continued access to abortion is in fact crucial, at least until an IUD-and-implant campaign becomes a reality—and that isn’t likely to be soon (though there’s good news: the American Academy of Pediatrics recently endorsed long-acting devices as “first-line” defenses against pregnancy among teenage girls, only 4.5 percent of whom currently use them). Without abortion, there would be nearly twice as many unplanned births as there currently are.
Some are impatient with such skittishness among liberals, and put abortion rights front and center in the quest for reproductive justice. Rooting for parental forethought and responsibility will prod supporters on the left to get off the defensive and also appeal to a wider constituency. Crusaders on the right have cannily co-opted concerns about women’s safety to justify their latest push for restrictions that shut clinics. Abortion is arguably more stigmatized than it was when Roe was decided. A pro-family stance views abortion not as a necessary evil or an inevitable source of deep sadness and shame, but as often a deeply moral decision. It is beyond a woman’s right to privacy or even autonomy to challenge those who portray abortion as anti-child and anti-motherhood. Abortion is part of being a mother and of caring for children, because part of caring for children is knowing when it’s not a good idea to bring them into the world. And it’s not a good idea to just drift into parenthood.
The right’s conflation of abortion and birth control is “mystifying.” It is indeed, if the goal is to reduce unintended pregnancies. But the anti-abortion movement is also a protest against women’s growing freedom and power, including their sexual freedom and power—which are prerequisites to the planned childbearing that makes for happier, healthier, better educated, and more prosperous families. Birth control has been history-altering, and it is hoped that it will continue to be as women gain better access to better methods. Still, it’s far from perfect and that is what makes legal abortion essential to the gender-equal way of life.
Even pro-life Republicans are showing signs of awareness that their extremism may be alienating a constituency they urgently need: women. Buoyed by this summer’s Hobby Lobby victory in the Supreme Court—which allowed the craft chain and businesses like it to refuse, on religious grounds, to cover certain forms of birth control (IUDs at the top of the list)—the religious right has been riding high, only to face recent pushback within conservative ranks. For the midterm elections, Republican strategy swerved, and candidates in close Senate races suddenly urged over-the-counter access to the pill. But there’s a subtext: unless they have a prescription, many women can’t claim insurance coverage for birth control, precisely what the Affordable Care Act has guaranteed without a co-pay. Conservatives will have to do better to speak forthrightly to the left, right, and middle. Empowering people to have children only when they themselves say they want them, and feel prepared to be parents would do more than any current social program to reduce poverty and improve the life prospects of children.
THE PULL-OUT METHOD – Pull and pray.
We all know the basic concept of birth control. The purpose: Lower your risk of pregnancy by as much as humanly possible. Of course, no form of contraception is foolproof. But if you put the condom on properly (and choose the right one), take your pill regularly, and generally use birth control correctly, your chances of getting knocked up are indeed significantly lower. But not using any barrier (literal or hormonal) and just trusting he’ll pull out before any of his swimmers have made their way out and upstream? Well, there’s a reason they call it “pull and pray.” Yet a shocking number of women are relying on what is the contraceptive equivalent of keeping your fingers crossed. A new survey from Glow, a menstrual cycle tracking app, found that 18 percent of women use the withdrawal method as their primary form of birth control. Other research suggests the number may be even higher: A 2013 study from Duke found that 31 percent of women have used pulling out as their primary form of contraception at least once, while theCDC estimates that 60 percent of women have done so. And that same Glow survey found that pulling out was the third most popular form of birth control—more than an IUD!
People do think of this as being contraception—but it’s not, by definition, is a method used to prevent pregnancy, but pulling out has such a high failure rate, you can’t even really consider it a viable option.
But there are some perks: The pull-out method is free of hormones (strike one against the pill for many) and always available, no drugstore run required. Participants of the Glow survey said their top reasons for relying on it is that it feels the best and is the easiest contraception to use. And spermine, the compound found in sperm, is actually pretty good for your skin: It’s believed to smooth out wrinkles and prevent acne.
But would you rather pay the price of a condom and a nice face cream or that of an unwanted pregnancy or a lifelong STI?
What the Stats Say
According to Planned Parenthood, among couples who pull out perfectly every time (read: before any semen comes out), only 4 percent of those women will become pregnant over the course of one year. Not too bad, right?
That’s in a perfect world, though. There’s another kind of failure rate, called the “actual” rate, that takes into account user error (in other words: not pulling out in time). Among couples who don’t time it perfectly, the actual failure rate for withdrawal is estimated to be around 27 percent over the course of one year.
Condoms, meanwhile, have an actual failure rate of 18 percent, according to the CDC. Compare those numbers side by side and pulling out doesn’t seem that far off from rubbers. In fact, a 2014 study found that withdrawal is “about as effective as condoms” at preventing pregnancy.
But consider this: Typically a condom fails because guys don’t put it on until after intercourse starts or don’t put it on correctly. While you and your guy can’t control things like the condom breaking, most responsible adults can eliminate those two other reasons right away, making your personal actual failure rate much lower by using a condom than pulling out.
The Real Problem With Pulling Out
When you compare pulling out to the pill (only a 6 percent failure rate) or an IUD (less than a 1 percent failure rate), it seems crazy to take such a chance just to have the pleasure of sex without a condom. Withdrawal is at the bottom of the barrel when it comes to methods of not getting pregnant.
The failure rate is so high for two reasons: One, most people just don’t pull out fast enough (it takes only one little swimmer, after all). But even before a guy finishes, he typically releases pre-ejaculate—that clear fluid at the tip of the penis during an erection. When British researchers tested this stuff, one third of pre-ejaculate contained live sperm. The idea that anyone can pull out fast enough to prevent a pregnancy is just not true, making withdrawal not an appropriate form of contraception. So you may want to consider an emergency contraception pill, i.e. Plan B, if you’ve used the pull-out method as a last resort, especially if you’re mid-cycle and ovulatory.
But pregnancy isn’t the only problem. Withdrawal is in no way going to protect you from STIs—period. You’re exposing yourself both to those transferred from skin-to-skin contact, like herpes, as well as those spread through the semen, like gonorrhea and chlamydia. (It’s imperative to get tested regularly if you use the pull-out method.)
The other risk? Having a general shitty sexual experience. When you’re constantly worried about pulling out in time—or if the guy will pull out in time — that doesn’t make for satisfying sex. And to top it all off, you have the post-coitus stress of not being 100 percent sure no sperm escaped or if you’ve exposed yourself to an STI.
If it’s so risky, why are so many people relying on pull-and-pray to keep them baby-free? In addition to theoretical ease of use and feeling good, it’s a combination of someone not planning well — a lot of people pull out as a last resort if they weren’t planning on having sex but have no other contraception available — and wishful thinking that they’re going to be able to get away with it.
However, while it may not be the most reliable method for all couples, I wouldn’t want to discourage people from using it as opposed to using nothing at all. Plus, as men age and become more experienced, they become more in tune with their sexual response cycle and may pull out with greater accuracy before ejaculating.
Still, it’s not worth relying on the old got-away-with-it-before reasoning. That’s playing with fire. If someone is doing pull-and-pray, they have to be fine with the consequences of getting pregnant. If an unplanned pregnancy would be catastrophic, then you have to get a more reliable method of birth control—plain and simple.