Preventing Unwanted Pregnancies

In my post on Abortion's Common Ground, I suggested that everyone should agree that it would be better if there were fewer unwanted pregnancies. However, it seems there remains disagreement over how best to achieve this.

Serge of Imago Dei writes:

It should be self evident that any effort to "Put Prevention First" should concentrate on the methods most effective in decreasing pregnancy... The most effective way to decrease pregnancy for those not wishing to be pregnant is to educate individuals on remaining sexually pure if they do not desire pregnancy.

I fully agree that we should be employing the most effective educational methods. That's precisely why I'm opposed to the abstinence-only approach: Serge's wishful thinking aside, all the evidence suggests that it simply doesn't work. After outlining a recent scientific study, Ed Brayton explains:

This is only the latest of multiple studies that have shown that abstinence-only programs, which are forbidden to mention condoms at all except to discuss failure rates, have little or no effect on whether students have sex or not. At best, abstinence only programs have been shown to delay having sex for a short time. But studies have also shown that those who go through such programs are much less likely to use birth control, especially condoms, when they do start having sex and that actually leads to an increase in teen pregnancy and STDs.

The relevance of this evidence to the sex-ed debate is clear. The same cannot be said of the statistics Serge cites in an attempt to discredit contraception. His first bit of evidence is that "a majority (53.7%) of women who had abortions in the years 2000-2001 used contraception". So what? No doubt the majority of people who die in car accidents were wearing seatbelts at the time. This in no way implies that seatbelts are ineffective. It is entirely irrelevant to the point at hand - as should be clear to anyone with an elementary understanding of statistics. (It would only be meaningful if accompanied by further information about the 'base rates', e.g. 'what proportion of the population uses contraception?' From that we could work out and compare the relative abortion rates of contraceptive users vs. others, which is the far more important statistic. But even then we might ask whether those who forego contraception are more likely to keep an unwanted child rather than seek an abortion, etc.) The bottom line is, this statistic alone tells us nothing about the reliability of contraception (except that it isn't perfect, but we already knew that!). But I'll grant it's an effective rhetorical device for those without a mathematical background - the phrase "lies, damned lies, and statistics" springs to mind.

Serge cites two other statistics:

1. Women who had free access at home to emergency contraception had the same pregnancy rate as those who had to obtain from a clinic or pharmacy.

2. [T]he women in this study... had exactly the things that Reid believes should be the primary strategy in preventing pregnancy. What were the results? 8% of women became pregnant and 12% contracted a sexually transmitted disease!

The second result is disheartening but still rather empty because we have no basis for comparison. (If those women had instead been lectured on 'sexual purity', the results could well have been even worse.)

So really Serge has only provided one relevant statistic, which seems to show that making contraceptives commercially available is just as good as having home access to them. I guess that's good to know. But how that's supposed to support his case for 'sexual purity' over education, I'm not quite sure.

But enough evidence already, the rhetoric is much more fun:

The idea that increasing contraceptive use as the major strategy in reducing pregnancy is severely flawed. Pregnancy is not a pathological disease that indiscriminately strikes unsuspecting women. Pregnancy is the natural consequence of chosen human behavior [...] I suggest that we treat pregnancy like other behavior related issues, and concentrate not on the flawed pharmacological means of decreasing pregnancy, but on the behavioral aspects of human sexuality. In other words, our [best] way to decrease pregnancy is to discourage behavior that results in pregnancy.

Something needn't be an indiscriminate "pathological disease" for precautionary measures to be worthwhile. Let's return to the car analogy. Driving a car is, presumably, "chosen human behaviour". We all know the risks - if you drive, there's a chance you'll crash. We can take precautions to reduce the risk, such as wearing a seatbelt, but of course the only 100% safe method is to avoid roads entirely. Nevertheless, most people consider the benefits of driving to outweigh this risk, and if you told them to get off the road they'd be unlikely to listen. So, if we really care about their safety, we'd do better to educate them about transport safety - "flawed" though this may be. We should certainly discourage reckless behaviour. So, on the sensible reading of the claim that we should "discourage behavior that results in pregnancy", I entirely agree - we should discourage unsafe sex. As to the more extreme claim, that we should discourage all behaviour that has any chance whatsoever of resulting in adverse consequences, that doesn't seem nearly so reasonable.

Conservatives sometimes hint that sexually active women 'deserve' what they get - whether STDs or unwanted pregnancies. I think such rhetoric is reprehensible. It amounts to (thinly veiled) blaming the victim, at least for those who took reasonable precautions. Sure, they knew the risks - but so do you when you drive, and that doesn't make you 'deserve' to be in an accident. Some people behave recklessly, and we should do all we can to change this. But telling people to stay off the roads entirely just isn't realistic - regardless of whether we consider that a desirable end. If we want to prevent accidents, we should look past utopian ideology and do what the evidence suggests will do the most good in the actual world. In the case of accidental pregnancy, the answer seems to be comprehensive education and accessible contraceptives.