Atul Gawande had a very clear, concise, mostly very smart and only partially problematic op-ed in yesterday’s New York Times about how to reduce the number of abortions in the US (TimesSelect registration required). He started out by dispelling some of the myths we have about who has abortions and why. For example, on the upsetting side, roughly half of pregnancies are unintended, and four in 10 unintended pregnancies end in abortion. On the optimistic side, teens are getting the message about contraception:
“Pregnancies at age 15 to 17 are down 35 percent since 1995, according to federal data; one-fourth of the drop is from delaying sex, and three-fourths is from increased use of contraceptives. Today, just 7 percent of abortions occur in minors.”
“Forty-five percent of abortions occur in adults ages 18 to 24; 48 percent occur after age 25. Most are in women who have already had a child. The kids are all right. We are the issue.”
Consistent and correct use of contraception appears to be the biggest problem:
“92 percent of abortions occur in women who said they used birth control. Six in 10 used contraception the month they got pregnant. The others reported that they had used birth control previously but, for one reason or another, not that month. (Many, for example, say they didn’t expect to have sex.)
Gawande then asserts that the “trouble appears to be blindness to how easy it is to get pregnant and what it takes to make birth control really work.” I would disagree: the trouble is not blindness to how easy it is to get pregnant. It is wishful thinking of the “it won’t happen to me” variety, and a difficulty accepting one’s own likelihood of having sex. It is also fear of the stigma attached to being willing to have sex without a committed relationship. Another problem is the difficulty women have with requiring their male partners to use condoms, and the difficulty some men have using them. Then there is the forgetting of the many ways to have sex that can’t result in pregnancy in the first place! Lets get more creative with our hands and our mouths and the rest of our bodies! Lets buy sex toys. (Wow, did I actually just recommend a consumer-based solution to a problem? Yikes!)
Gawande is right, though, that the number of unwanted pregnancies in the United States — and thus the number of abortions — could be dramatically reduced if we were a more sexually honest and open society. If we — men and women — were honest with ourselves and with each other about the situations in which we are willing to have sex, and about the degree to which we do not want to be responsible for a child, I think we would have an easier time consistently and correctly using contraception. Imagine….
…if we were more honest with ourselves about how the contraception we do use makes us feel, and more willing to talk to each other about our contraceptive methods, we would be better able to find the methods that would work best for us.
…if we were more willing to admit that we simply won’t stop having sex just because we aren’t ready, able or interested in raising children.
…if we could acknowledge sexual pleasure as a basic human right and not a privilege for the middle and upper classes.
Then perhaps we would — as a society — realize our moral imperative to improve access to contraception and safer sex education and supplies for those who need them.
Gawande believes that politics precludes government from helping to create that society and that ultimately we need a “do it yourself” approach. I’m not willing to let government or the politicians who control it off the hook quite so quickly, but I agree that there is much we can change about this society if we “do it ourselves.” And among the things we can change through grassroots community-based activism is, in fact, the government.
Among the things the government could do better, or do at all:
- Offer incentives for research and development of long-lasting contraceptives that have fewer risks and side effects.
- Provide contraceptives free, and without any burdensome monitoring, to women and men who want them.
- Require that sex education programs offer clear, accurate information about the effectiveness of contraceptives and about their correct use.
- Support programs that help parents learn how to talk to their kids about sex.
But Gawande is right that, absent some sea change in what we as individuals and communities demand of our government, these things are not going to happen quickly. We need to take up the lead of organizations like Planned Parenthood which already offer workshops on how to talk about sex, and start branching out in our communities and among our friends to “do it ourselves.” Imagine if we each had at least one conversation a week with someone about the right to sexual pleasure, or he right to sex without fear of pregnancy or disease.
Try it out. Start with yourself and make a list that honestly accounts for the ways you like to have sex, the people you like to have it with, and your own risks of pregnancy. (Yes, this applies to men too. Women don’t get pregnant on their own!) Any unpleasant surprises on your list? If so, acknowledge them and make a plan to reduce your risks. Then, be courageous: share your list with someone. And share this post. Next week try a conversation with someone else. Ask someone how they feel about the right to have sex because it feels good. Discuss whether we should take a punitive attitude toward sex for pleasure.
And stay tuned here. This blog has been part of my attempt to create more open space for reasonable and productive conversations about sex. But you’ve inspired me to do more, and I’ve decided to expand the public square:
Coming soon to a computer near you: SexInThePublicSquare.org!