Men's reproductive choices: children and rape

photo credit: bondidwhat via http://photopin.com cc

A father discovers birth control, and wants to keep using it to limit his family size to five (five!).  His wife wants more children, but will please her husband by refraining from more children.  He goes to the rabbi, expressing anxiety about providing for more than five children, and the rabbi says that money comes from heaven.  When he lies, and says that his wife is stressed out with five children, the rabbi allows birth control.

I love how this story makes five children seem so natural, like a small number, when that's more children than most people would ever consider.

The idea that someone could not know about birth control is strange to me, and I wonder if he's exaggerated his story, or told it in a way that parallels the stories we've heard so often about women's constrained reproductive choices.  Chassidic men's lives are often more sheltered than chassidic women's, but are they really so sheltered not to know that most people in American society have fewer than 3 children?  He had access to the internet, so how could he have gone so long not knowing about birth control?  


Meanwhile, in evangelical 9th grade English teacher has an important piece on how she taught her students not to rape.  The classroom dynamic seemed to change from initial doubt that high school athletes close to their age could be rapists and that consent was always necessary, to a clear recognition of these facts among most in the class.   It's easy to speak about these issues in the abstract.  I'm so grateful that courageous teachers raise these issues again and again, when it's still possible to impact adolescents' thoughts.  I'm grateful that my teachers did. 

Media coverage of "Cash, cars, and condoms" paper in Journal of Adolescent Health

Our newest paper on women getting money from their sexual partners was just published in the Journal of Adolescent Health, and covered by
ABC News, the
Health Behavior News Service (by Laura Kennedy), the
Empowerher blog (by Susan Cody), and in Latvian (?).

Birth control and the sexual revolution

Birth control, something practiced by nearly 100% of women, was once uncontroversial. Now, almost inexplicably, opposition to birth control has exploded.

Once upon a time, there were pro-choice Republicans. Now, not only has this breed become extinct, but it's no longer enough to oppose abortion. Birth control is now considered suspect.

It seems baffling to see such a reversal so suddenly. Social conservatives accept the standard narrative about the sexual revolution --- oral contraception allowed premarital sex, which caused the sexual revolution --- and they oppose it. Next step will be to reduce condom access, not just in schools, but also in stores, such as requiring them to be behind the counter and perhaps having age limits.

Telling kids to act as though the sexual revolution had not occurred, and teaching them that contraception is dangerous and ineffective --- abstinence only sex education --- didn't reverse the sexual revolution. The Congressionally mandated evaluation found that abstinence-only sex education did not decrease premarital sex. That failure was particularly embarrassing because some comprehensive sex education programs that teach about birth control decrease premarital sex.

Social conservatives' assumption may be that if birth control caused the sexual revolution, reducing birth control access might reverse the sexual revolution.

Unfortunately, they're wrong. Even before the advent of birth control, attitudes began to favor sex within loving non-marital relationships in the late 1940s and 1950s, as documented by sociologist Ira Reiss in his 1967 book, The Social Context of Premarital Sexual Permissiveness. (The entire book is available online for free at that link, and I highly recommend it.)

Even if there had been no oral contraceptive, there would have still been a sexual revolution. After all, in a society where sex within loving relationships is accepted, certainly people will find a way. For instance, withdrawal is only slightly less effective than condoms. The modern IUD is safe and effective. Diaphragms are safe and effective, if they are used without spermicide which could increase STI risk. And these methods may even be superior to hormonal contraception.

Elsewhere in this blog, I have spoken about shortcomings of oral contraception, according to my Second Wave feminist bias towards non-systemic, barrier methods of contraception. And I've spoken about problems with hookups, or as Reiss would say, permissiveness without affection.

Even if the conventional narrative were true, and birth control somehow caused the sexual revolution, it is not necessarily possible to reverse course and return to no premarital sex. How far will social conservatives go in attempting to reverse gains from the feminist movement?

Contraception and Casual sex

Gail Collins writes about the uneasy relationship between social conservatives and contraception. She cites two arguments that social conservatives make about contraception: the first relies on incorrect biology and the second reflects uneasiness with casual sex.

Collins spends more time on the incorrect biology argument, but I think that the social conservatives are more motivated by their unease with casual sex. The incorrect biology is not literally true in any way, but social conservatives may believe that the biology is metaphorically true. That is, many forces within the modern world are inhibiting committed relationships and family formation, and they hypothesize that one of the forces is contraception, which is a logical fallacy, but the emotional argument is understandable.

Social conservatives are terribly troubled by the state of modern sexual ethics, or the lack thereof. Their nostalgia is to some extent false: premarital sex and casual sex were not invented with the birth control pill, and the decline of marriage is explained by a myriad of social, economic, and demographic factors.

Nonetheless, their argument has a real kernel of truth that few deal with because it violates third wave feminism: casual sex is more common than it used to be, and all the research I'm aware of finds that casual sex has more negatives than positives (click on the casual sex label for my earlier summaries of that research).

Casual sex occurs between closed doors, both liberals and conservatives have casual sex, and I know of no policy that would decrease casual sex. Given its murky origins, it's not surprising that social conservatives are indiscriminate in the policies and theories that they scapegoat to explain casual sex. Sex education, family planning, emergency contraception, abortion, and Arnett's theory of emerging adulthood do not cause casual sex, and casual sex probably does not inhibit family formation. Social conservatives just cannot think of better explanations, especially given the relative paucity of research on casual sex. Liberals fear that attacks on casual sex are disguised attacks on reproductive rights, rather than seeing that for many the opposite is true: casual sex is the enemy, and reproductive rights are the scapegoat.

And so we have these repeated battles that really all stem from the same thing: unease with casual sex and delayed family formation.

Most people having this dialogue are married, and most married people have long been insulated from the world of singles and their sexual decisions. Instead, they take sides based on their other political beliefs.

The married social conservatives believe that casual sex comes from liberals, not realizing how much exists organically among conservatives and how many liberals have wholesome sexual ethics and are eager to marry. The married liberals believe that casual sex does no harm as long as both the sex and its casualness are consensual, as if such consent were truly possible. My understanding of the qualitative research (Bogle's Hooking Up) is that women may freely consent to casual sex only within limited circumstances (e.g., experimentation), but see it as second best outside those circumstances; conversely, women create the circumstances that enable casual sex by discounting many men, artificially narrowing their dating pool, giving more power to the few men considered "good catches."

Both married liberals and conservatives have apparently forgotten, or maybe they never experienced, the dating market that makes all of these issues so complicated. We can agree on one thing: most people want to get married and have extremely high expectations for marriage, but the path to marriage is murky for myriad reasons. Until we know otherwise, probably the best we can do is practice good sexual ethics and help individuals wherever we can.

At a policy level, the marriage and family formation research indicates that economic factors inhibit marriage among lower income groups, and the decline of unions, widening income inequality, and reduction in good jobs are likely responsible. If we invested the trillions of dollars needed to upgrade our infrastructure from a D to a B, providing jobs for lower income groups, that could help the country both economically (e.g., improved productivity due to reduction in accidents and water main breaks) and socially (by giving income and good jobs to (mostly) men, some of whom would marry their female companions.)

Hormonal contraception makes women less attractive and choose worse partners, says review paper

A few months ago, I said that hormonal contraception (the pill, Depo, etc.) messes up women's choice of mates because of results we knew that women choose differently and asked whether that's responsible for higher divorces in those couples. We still don't know that information, whether divorce is more likely among women who chose their partners using hormonal contraception.

But a review paper has come out solidifying that finding that women choose partners differently on hormonal contraception than off and adding that women are less attractive while they're taking it because it suppresses ovulation (during which women are more attractive to men).

That's another reason to add to the book that just came out saying that women ought to consider other methods besides the pill.

Hormonal contraception is a standard, and evidence probably won't change that, but there are other equally reliable methods of pregnancy prevention such as intrauterine contraception (IUC) that currently have miniscule proportions of women using them. I wonder whether we'll see even a slight shift.

(Conflict of interest disclosure: I have a very nice pen given to me by the company that makes an IUC device that I happen to have used this morning, but really that's not why I wrote that. This is just the first time I've ever had one of those legendary conflicts of interest.)

Is the Pill worth it?

Birth control pills are the default contraception method to such an extent that many people use the word "contraceptives" to mean birth control pills to the exclusion of all other methods, not realizing that diaphragms, condoms, sponges, IUDs, and withdrawal, among others, also count as contraceptives.

Birth control pills come with a raft of side-effects including weight gain, depression, and potentially fatal blood clots (such as deep vein thrombosis and strokes), but their popularity seems to improve their perceived safety. A new book looks at the risks of birth control pills, given the big and small health risks of them.

Of course this view is not new at all. The Boston Women's Health Collective famously recommended in Our Bodies Ourselves using barrier methods only: you know exactly what they're doing and their effects end once you remove them from the body. The ultimate transparency. Plus they prevent STDs.

Unfortunately barrier methods besides condoms are rarely used: diaphragms are used by less than 1% of contracepting women and the only company making the cervical cap discontinued it due to lack of demand.

Perhaps this book will convince some of its readers into looking into barrier methods instead. Plus condom plus diaphragm is at least as effective as the pill in typical use. (Here's the math: effectiveness of each alone is 80% in typical use, so effectiveness of both together is 96% (1-(1-.8)^2=.96), which is better than the 94% typical use effectiveness of the pill cited in the article.)

"Hey, Lloyd, let's run a sloppy study": FDA female condom advisory panel

The STD Center visited the FDA advisory panel on the new female condom in mid-December 2008, and a good time was had by all. The FDA makes the transcripts available, though they're somewhat difficult to find. Here is the main site for all the transcripts prior to the current year, and this site is for this year.

My favorite moment is at the very end of this transcript and at the very beginning of this one: Ralph D'Agostino expresses concern about approving devices supported by "sloppy" studies. He makes a very good argument earlier on (right before this quote) that people having difficulties with the female condom might drop out and that could affect the final results, and asks whether they usually impute for missing data and why they didn't do that here. His final conclusion is a policy conclusion:

DR. D'AGOSTINO: Yeah, but what I'm concerned about is that somebody reading this transcript may say, hey, Lloyd, let's run a sloppy study; we already have approval, already have, you know, precedent for it. I think that what we want is just, you know, give an impression that there are better ways of getting interview data. There are better ways of chasing down the dropouts and so forth, and I'm concerned that we're not emphasizing that. I may not differ from the bottom line where we're going. It's just that the signal may be that we have a better, more positive view of the study than we probably should have...I'm not arguing with the final vote, the way the final vote might go. I'm arguing with the sense that this study has more merit than it actually has, and getting that across is what I think we should need to do.

Decreased contraceptive use among teens

I was pleased that the NYT editorial board highlighted the recent study by John Santelli, Mark Orr, Laura Lindberg, and Daniela Diaz about decreased use of contraception in an analysis of the Youth Risk Behavior Survey. As the media reports it, Santelli and collaborators found that fewer teens are using contraception than previous highs a few years ago, and the speculation is that the decrease is from abstinence-only sex education.

Other research certainly indicates that abstinence is one plausible explanation for the decrease in contraceptive use. The trouble is that there are many other possible explanations, but the trend data on teen sexual decisions is so poor that we'll never know which explanation is responsible for this particular decrease in contraception use. The survey used by Santelli has at most a dozen relevant questions, and any information beyond that gets lost to the mists of time.

Some teens get pregnant because they want to. It's not a question of not knowing how to use birth control; they want someone to love them or to establish themselves as adults. Other teens get pregnant because they are in coercive relationships with older men who support them financially --- perhaps especially relevant in insecure economic times --- and the men want babies. I heard a story from a Maryland public school teacher about a 14 year old girl in her class who recently got pregnant because her 20+ year old boyfriend and his mother wanted her to; the boyfriend's mother wants to take care of the baby and the girl's mother is indifferent to the situation.

These stories represent more fundamental social problems than simply inconsistent or incorrect condom use, but the current data is so poor that if one reason for the lower contraceptive use was that more girls are being coerced by older partners to get pregnant, we would have no way of knowing. Such issues of teen pregnancy are not liberal or conservative, but some conservatives are opposed to funding surveys that would collect data to better understand the issues because they are uneasy about asking questions about sex to teenagers. If they could better understand the implications of their opposition, and what a good investment it would be to understand teen pregnancy better by funding an annual survey that monitors issues exclusively relevant to teen pregnancy and STD prevention, perhaps we could start to decrease the rate of teen pregnancy.

Hare-brained idea of the day

I'm a total non-biologist, but I'm just putting this idea out there.

My understanding is that a woman's sense of smell allows her to figure out who is a good immune match --- men who smell good to her have complementary immune function and she would have healthier children with them. Oral contraceptives (OCs) interfere with this function so that a woman on OCs might marry someone who isn't genetically complementary and doesn't smell good to her after she goes off them. The number of women who chose their husbands while taking oral contraceptives has increased enormously since their invention. I wonder whether this has any social or medical implications: are the children of women who met their husbands while taking OCs less healthy in some way? Are these couples more likely to get divorced?

Anyone know any research on this idea?

Palin supports abstinence-plus, but doesn't call it that

The LA Times reports that Sarah Palin supports teaching condoms in sex ed. Although she declared herself to be a supporter of abstinence-only sex education, Palin said during a debate in 2006, "I'm pro-contraception, and I think kids who may not hear about it at home should hear about it in other avenues."

The political orthodoxy is that teaching any contraception cancels out any message of abstinence (e.g., the Abstinence Clearinghouse's statement in the article), but Palin seems not to believe that. It's possible for a conservative Evangelical Christian to agree that it's important to make sure all kids have accurate information about contraception.

Much has been made of the "small town values" and "common sense values" discussed during the Republican convention (see the third segment of Friday's Daily Show for an attempt to define them).

Is it possible that one of the "common sense values" is a pragmatism about the limits of values in affecting behavior?

A Catholic Church contraception counterfactual

An op ed from a former Catholic priest on Pope Paul VI's anti-birth control encyclical 40 years ago, and how it might have been different:

In traditional Catholic morality, the nature of a human act, the intention and the circumstances must be all considered in weighing its rightness or wrongness.

But as Pope Paul presented his case, intention and circumstances are irrelevant. The nature of contraception is so heinous, so intrinsically evil that alleviating circumstance and good intention don't count.

We can all acknowledge that contraception is on a different level from, say, killing a human being. Yet killing is an act that may not be determined good or bad until we know intention and circumstances. The placing of absolute judgment on contraception itself—by pill, condom or whatever—raises the bar to a level that seems to many responsible and thoughtful people to be irresponsible.

Killing is not always wrong. But contraception always is?
...
The problem with Humanae Vitae is rigidity. The pontiff was correct in seeing what strange fruits the revolution would produce, but his cure was as bad or worse than the disease.

He could have acted differently. He could have said that the world is facing an unprecedented challenge in human history that requires careful study and expert inquiry. He could have said that selfish, non-generative lifestyles are not acceptable, that thoughtless contraception cheapens sex, that circumstances count very much and that people have an obligation to weigh carefully what they do.

He could even have praised the values of natural family planning. He could have become a respected conversant among national and world bodies seeking credible answers. But because of the absolute ban, popes, bishops and theologians have had little to offer except a repeated no, no, never!

Church leadership left the table 40 years ago, painting itself into this corner.

Within the church itself the saddest byproduct is what has been happening to its membership. Many parents of the 1960s retained an overall confidence in the church while dissenting on the contraception issue. Their children widened the sense of separation, and the grandchildren may not even realize there ever was a religious institution that had wisdom and a sense of real community to share.

I've never known very much about Catholicism, so I've never thought that the pope's decision on contraception could have been any different from how it was. Many religions have confronted issues of modernity, especially sexual, with barriers rather than moderation. The possibility that the Catholic response could have been more moderate raises the question of whether the American political landscape and even other religions' stances might have also been more nuanced.

On the other hand, an issue that the author does not consider is that as a religious policy issue, people are generally not very good at moderation. Moderation can be interpreted as outright acceptance.

So on one hand, the religious authorities can decide to maintain credibility by proclaiming a moderate position, but risking that the public would be too liberal with the position. Or the religious authorities can risk losing credibility with the public by proclaiming a clear-cut ban. If the religion's major objective is to ensure that people follow the law, is it possible that there might be more compliance in the first scenario? As much as I would like to say that there would be more compliance under a liberal stance, I don't have any information that would lead me to conclude one way or the other. Obviously the solution is that in cases where the religious authorities just want a specific outcome, they should conduct randomized policy experiments before they decide on religious law. It's a pipedream, I know, but I'm mostly serious. Many religious decisions turn on predicting outcomes that are unknowable without formal study.