Thursday, February 17, 2005

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.

9 comments:

  1. Richard, I certainly agree that abstinance only lessons are not as helpful as more comprehensive ones. Not just because of teenage sex but because I think married couples need to know the choices available to them as well.

    Having said that though I think I cringed a bit at your final couple of paragraphs. For one, I think we do hold responsibility for the activities we engage in. For instance until recently getting married, I used to rock climb and mountaineer extensively. I remember free soloing a mountain in the rain one day. It was an easy ice climb up a glacier but while descending I biffed it and fell more than 1000 feet, literally stopping a few inches away from a boulder field. How I walked away uninjured amazes me. Not the brightest of things to have done. But were I injured I'd certainly not be blaming rangers or others. It's my choice.

    Likewise one of my best friends froma few years ago was rather reckless sexually. He had dozens of partners, including a fair number of one night stands. He rarely used protection. In my opinion had he contracted a sexual disease it would have been his fault.

    I honestly don't quite see the problem with attributing personal responsibility in all this. Especially in this day and age where the dangers of AIDS, herpes, and numerous other SDTs abound.

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  2. I basically agree with you there, Clark. We are responsible for our actions, and blameworthy for reckless ones. But sometimes people are unlucky through no great fault of their own. That's not to say we should be blaming others. I think there are some situations where there really isn't anyone to blame. Your climbing anecdote sounds like that; if you had been injured, it would both callous and unreasonable for others to deny you treatment on the basis of it being "your own fault".

    (P.S. I'm glad you came through it all right - it sounds like a terrifying experience!)

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  3. Since I might be removing Haloscan trackbacks soon, I'll note here that Imago Dei has responded to my criticisms, though he's still failing to grasp why his statistics don't actually show what he wants them to.

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  4. I would not be surprised if pregnancy rates for abstinance programs started low and tended towards the rates of the popualtion as the parents influence becomes weaker.
    the way this person presents the statistics sounds like he has an adgenda but he may have a point.

    I think the country comparisons are probably rather weak evidence because I expect other factors to dominate "sex exucation" on a national level.

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  5. I think my point is Richard that part of living is taking responsibility for ones acts. Part of that is going out and seeking information. In this day and age discussions about condoms and birth control are fairly ubiquitous. Likewise the internet is always just a click away. It's hard to think that too many people don't know about birth control simply because it wasn't taught in school. I know it happens, so don't take me as saying we ought not teach it in school - merely that there's a strong sense of personal responsibility for ones ignorance at work, in my opinion.

    Likewise even birth control is no guarantee. Condoms break or come off. If you are engaging in risky behavior, part of being responsible is recognizing that.

    The point of my example was that I was engaging in risky behavior and had an accident. I came out of it all right, but it was definitely my responsibility to see to my safety. Likewise in terms of sexual behavior the same thing happens.

    I don't think anyone is arguing that people ought not be treated. I've never heard a conservative say that people shouldn't be able to receive anti-biotics for instance. Merely that on one level we reap what we sow.

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  6. "Genius" I'd be very surprised if abstinance only classes changed that much. The fact is that there is at least a sizable portion of the population who will simply have sex. The question is what to do about them. Merely telling them not to do it won't stop them. The wisest course of action is to get them to protect themselves so that they don't have kids. That'll typically break the cycle and will also avoid a lot of costs to the community. Not just in the cost of raising kids - who often are at highest risk since they are born into difficult family environments. But also in terms of parents getting cut off from learning and progressing and becoming better contributors to society.

    It's very hard, as young single woman who is pregnant at say 15 to go to college, get educated and get a great job. It happens, but those who manage it definitely are the exceptions.

    The problem is that social conservatism and economic conservatism definitely are at odds in this issue. I don't think they need be since the main worry of social conservatives is that teaching birth control promotes sex. I don't think there is evidence for that.

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  7. throwing a monkey into the works...
    If those people who actually listen to education programmes had more children earlier it might be good for the country.
    If we reversed the trend to a declining population we could handle population growth in NZ ourselves without having to migrate in people to work in order to pay for our elderly's superanuation.
    the problem then is just a cultural issue we have with "adult" and flexible education

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  8. Richard,
    Can I ask why you think it would be a good thing if there were less abortions? Or why it would be a good thing to have less unwanted pregnancies, if all of them were simply terminated by abortion? What, in your view, are the negatives of abortion?

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  9. Unwanted pregnancies are bad precisely because they are unwanted.

    I think abortions are unfortunate for the mother. Some may not care, but for others it is a very difficult decision/experience. And of course the morality of abortion is questionable - though I don't think there is anything wrong with it, I could be wrong. My mild doubt is not nearly strong enough to justify restricting women's freedom by banning abortion entirely, but it can contribute to my general desire that we avoid the need for them in the first place.

    Most of all, abortions are inefficient. If you compare having an abortion with avoiding getting pregnant in the first place, what's not to prefer about the latter? It's like choosing between getting a (dental) filling or avoiding holes. Prevention is better than cure - one needn't hate medicine to believe that.

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