(VIDEO): Q: What Do Young Men Know About Birth Control? Scary Answer: Very Little

Bianca I. Laureano

Interviews with young men in Washington, DC reveal huge gaps in education for men about contraception and pregnancy prevention.

Growing up in the Washington, DC area, (Silver Spring, MD to be exact) and living in DC for a good part of my life, the Washington City Paper was one of the staples of my childhood. Now that I’ve lived in NYC, I have not spent as much time checking out the paper online as I used to, but when I came across a particular post on the paper’s site about how men in the DC area talk about birth control, my interest was piqued again.

A new part of the paper for me is a section called “The Sexist” which is written by Amanda Hess. Honestly, I chose not to spend much time looking past what was posted on the first page after I watched the video (included below) even if the tagline of the blog is “Sex and Gender in The District.” This was mainly because I didn’t see any writing/articles/themes that were written targeting me as a reader.  The blog post I did read, Men Explaining Birth Control, contains interviews with men on the street and in their homes in the DC area being asked about various birth control and contraceptive methods: oral birth control pills, emergency contraception (aka morning after pill), the patch, and the ring. They share what they know about the method and how it works.

I will warn you, I didn’t find this funny; I found it rather scary.

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If ever there were evidence of why “teen” pregnancy prevention programs do not work, this is it! Often pregnancy prevention programs, efforts and resources are focused on cisgender (young) women. There is this assumption that it is only women–but not the men with whom they are (hopefully) having consensual sex–who need the information on contraception and pregnancy prevention. It is not often that men (transgender or cisgender) are included in such conversations, or even envisioned to be a part of them.

With some sexuality education programs still separating classes by gender, limiting conversations about birth control and contraception (and the difference between the two), and with education focusing just on male condom use among men, are we really surprised that pregnancy prevention efforts are not working as well as they could? I’d be interested in knowing if the men interviewed could discuss how to properly use a male condom, demonstrate how to do that, and/or discuss the difference between the male condom and the female condom and how they are used.

Then there is the assumption that youth who identify as gay or lesbian do not need to know the same information regarding contraceptives and birth control. This cannot be further from the truth. Gay and lesbian youth may or may not want to have children, some may choose pregnancy to avoid coming out, and others may end up having sex with cisgender partners.

I wasn’t too surprised by the results of this video, but I also wasn’t entertained. Instead I found it extremely odd that in “Chocolate City,” with a huge international population, there were no men of color to speak with or interview. I’m not sure if there would be a difference in the knowledge men of various racial, ethnic, national origin, and/or documentation status would have in comparison to the very white presumed-U.S. participants in the video.

Other thoughts I’m having about this video: would younger men today know a little more? Will young men know more in another few years? The language used in the video was very telling, anti-choice, and specific. So much to unpack, does someone else want to do that? What can I do right now as a form of direct action to reach men of all ages and help them understand how birth control and contraceptives work? I’d love to hear what readers think and if you can suggest any websites that are dedicated to the sexual and reproductive health of (young) men.

Culture & Conversation Family

Breastfeeding, Bias, and Men Who Give Birth: Q&A With Trans Activist Trevor MacDonald

Britni de la Cretaz

In his new parenting memoir, Trevor MacDonald talks about pregnancy and breastfeeding as a trans man—and why we must dislodge the idea that bearing children is only women's labor.

Pregnancy, birth, and breastfeeding are acts often associated with womanhood. We talk about pregnant women and nursing mothers, but this language—which depends on the male-female gender binary—seems inadequate as trans and nonbinary folks are increasingly visible in the parenting sphere.

With his first book, Where’s the Mother?: Stories From A Transgender Dad, Trevor MacDonald hopes to blow the conversation wide open. MacDonald is a Canadian author who has been blogging about his journey as a nursing man on his blog, Milk Junkies, since 2011. He also facilitates a Facebook group for trans folks who nurse, and he initiated and helped design a University of Ottawa study focusing on the experiences of transmasculine individuals with pregnancy, birth, and infant feeding.

MacDonald’s book explores his transition from living as female to living openly as a man, and how that transition ultimately led to his decision to carry and birth a child with his partner.

By sharing his experiences and documenting the many challenges he faced as a man who planned to give birth and nurse his baby, MacDonald asks readers to reconsider everything they think they know about what it means to be a gestational parent. By the end of the book, readers come away understanding that despite a person’s gender, pregnancy and nursing are universal experiences and valid regardless of how they happen. MacDonald’s voice is an important and necessary one in the birthing community, and there are surely many more people out there like him.

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Rewire: You talk a lot about struggling to find literature that you related to because pregnancy, birth, and breastfeeding are typically only associated with women—and motherhood. Can you tell me about the kind of language you’d like to see used to talk about these experiences and why it’s important?

Trevor MacDonald: I think I was a bit naive at first when I was reading those materials. I felt like, “If only the authors knew, I’m sure they would have used different language. They just didn’t know about people like me.” And that’s definitely been the case for some of those authors. Many are starting to change language and using words like “parents” or “pregnant people.” It’s a simple shift, really.

Where I was naive, though, is that there are some people who really don’t want to use inclusive language. Ina May Gaskin is one. I had read her book [Ina May’s Guide to Childbirth] during my first pregnancy and had been so inspired by her writing, and the birth stories are so valuable and needed. I was so hungry for information about what others had experienced. I love that book so dearly, and to realize she really was opposed to including gender-diverse people in her writing was really upsetting. [Gaskin signed this open letter by Woman-Centered Midwifery, a group of “gender-critical” midwives who believe that biological sex determines gender and were concerned about the Midwives Alliance of North America’s use of gender-neutral language to talk about pregnancy and birth.]

It’s also really important to me to point out that no one needs to throw out the words “mother” or “woman”; you just need to include more words. So you could say “women and men and gender-nonconforming people” or “parents.” It’s nice to have more than one word to mix things up a little bit.

Rewire: What was the decision to carry a baby like for you?

TM: It was something I’d never thought I would do until after I transitioned and after getting together with my partner. For me, transitioning in the medical way that I did [through hormone therapy and top surgery involving breast removal] made me comfortable enough with myself to contemplate carrying a baby. Before that, there was so much stress and constant background noise in my thoughts and in my life to do with gender, with bathrooms, and with all the ways I really wasn’t comfortable. When I transitioned and so much of that fell away, I started to consider things I never had before. It helped that I was able to present as male throughout my pregnancies because I had taken testosterone [before pregnancy]. Those things enabled me to express my gender and present myself during pregnancy in ways that were comfortable for me.

Rewire: Did you experience any gender dysphoriathe distress or discomfort that occurs when the gender someone is assigned does not align with their actual gender—during your pregnancy?

TM: For sure, but for me it was more around medical stuff than around everyday living. In my everyday life, I was still presenting as male. But with health-care providers, especially providers who specialize in prenatal care, they’re so used to everything being woman-centered, and it’s really important to some providers to use woman-centered language.

I didn’t have any providers who had worked with an openly trans client before, so people certainly had trouble with the language. One midwife offered a blanket apology that she was going to have trouble remembering to use the right words and that she didn’t mean to be offensive. For me, I think I would have preferred if she had made more of a commitment to trying to change her language—going beyond apologizing, but trying to do something to remember to use my pronouns. I think it must be hard when it’s your first client who has asked you to use new language. It’s a new skill that has to be practiced and learned, like any other.

Another place where I sometimes experienced challenges was when people at work who had previously been using the correct pronouns for me switched to using the word “mom” and female pronouns when they found out I was pregnant.

But for me personally, in my body, I didn’t feel like the experience of being pregnant triggered dysphoria. It was more the way society responded to me that did.

Rewire: Birthing at home was something important to you. Can you talk a bit about why that option felt safest?

TM: I think the difference for me was that care is different. In Canada, we have midwifery care that is part of the health-care system, and it is covered by insurance. We still have a shortage of midwives, so not everyone who wants one can get one. I was fortunate to get midwives for both my births. For me, the continuity of care that they provide and that you get with a home birth is important.

At a hospital birth, there is no way to meet all your providers before you go there and labor, and I felt like there might be a lot of explaining that I might have to do. I did go to a hospital during pregnancy and another time when I had a miscarriage. I had to come out to every provider there, starting with the first nurse and every subsequent person that I saw. Each person needed to hear the same story about how I, a man, was pregnant. One doctor even had a lot of questions about how I could no longer be taking testosterone and still have facial hair. I couldn’t imagine having to explain those things and educate during labor.

Even with midwives, though, it’s not a magical recipe for getting exactly the kind of care that you need. I still had midwives at my first birth that I hadn’t met before.

Rewire: How do you think care providers—whether they’re doctors or midwives, or lactation consultants—can best support families like yours, or people who are not women but may be giving birth or nursing their babies?

TM: I think considering the topic, doing reading and practicing using the language ahead of time, before they ever meet their first trans or gender-nonconforming client is really important. There are more and more resources available now and places to go to read about people’s experiences, and there are a number of different medical associations who have called on their members to do exactly that. This is so they are not asking their individual patients to educate them, particularly when that person needs care and is in a vulnerable position. That’s not the time to be asking questions that they could learn about in other places.

Rewire: Finding donor milk for your son Jacob seemed to be quite a challenge. You mention that you produce about a quarter of the milk your baby needed, and the rest had to come from donors. Can you talk about what some of the challenges to finding donor milk are? Do you think protocols that see milk sharing as “risky” keep babies from being breastfed who might otherwise benefit from receiving breast milk?

TM: I think some of the taboo against milk sharing is really starting to shift in our culture right now. Currently, a lot of regulatory bodies—for example, the Food and Drug Administration and Health Canada—have a position against peer-to-peer milk sharing—like through Facebook groups like Human Milk 4 Human Babies, where we found many of our milk donors.

But La Leche League (LLL) has actually changed their position on it. LLL’s leaders, who facilitate their local support groups, used to not be allowed to discuss peer-to-peer milk sharing in any way, but last year the organization released a statement with a new policy. Leaders are allowed now to share information and can say that these milk sharing websites exist. It would be a great shift if other groups start to take a position more like LLL, where they can provide information. It would be awesome if medical professionals started to tell patients that these networks exist. Karleen Gribble has written papers about the ethics of peer-to-peer milk sharing and the ethical implications of letting patients know about it and how care providers could discuss risks and benefits, not just of peer-to-peer milk sharing, but of using formula.

In pop culture, when people talk about being worried about milk sharing, the fear most often brought up has to do with diseases like HIV. But something we had to consider as well was the medications that people were taking and whether it could be passed through breast milk. Many people who donate milk through peer-to-peer sharing do so because formal milk banks have such strict requirements around who can donate to them. Formal milk banks are not necessarily in competition with peer-to-peer milk sharing, which is important to understand.

Rewire: You talk a lot in the book about milk donation and the community that sprung up around you to help your family achieve your breastfeeding goals. Can you speak about the support you received and how it affected your breastfeeding journey?

TM: We met people that we otherwise never would have met and never would have become friends with. Many of our milk donors are still our friends, and they were such a diverse bunch of people. From a Mormon donor to a military family to a Mennonite family, all these different kinds of families from different backgrounds came together to help us feed our baby. It was amazing to meet these different people and to realize that despite us being a different kind of family in this one particular way, what was most important to all these people was that a baby needed breast milk.

Rewire: It sounds like prior to having your son, you didn’t know any other trans people who had nursed their babies. Has that changed? Are their experiences similar to yours?

TM: Before Jacob, I only knew about the guy, Thomas Beatie, who went on Oprah. I didn’t know anyone in person. I knew a few trans people who had children prior to transition. Through writing my blog, that’s how I first started to connect to a lot of other trans parents and people who were carrying babies while being out as trans. People asked me questions through my blog about how I navigated the medical system and a lot of questions about breastfeeding.

I also got a lot of questions from cisgender women as well, who were grappling with all kinds of different breastfeeding challenges. Many people deal with low milk supply and try to use a supplementer, like I use to nurse my baby (since I only make about a quarter of the milk my baby needs, I use a supplementer to deliver the milk at my chest, which allows me to feed my baby at my chest). So many people can relate to these challenges. A lot of the time, it’s a private struggle that people have, and it’s intense but you don’t necessarily talk about it that much. All kinds of people reached out to me because they could relate to these issues.

Rewire: What do you wish you had known before giving birth to Jacob?

TM: I wish I had trusted my own instincts a little bit more, and given myself more space to just see what my body would want to do in labor. I felt like I was looking to my care providers and my doula for suggestions, and I’m sure a lot of people have that experience when they’re going through something they’ve never been through before.

Rewire: What do you hope people take away from your book?

TM: I really hope that it will open up conversations. I hope it will provide opportunities for people to talk more about gender diversity, not just generally, but in parenthood and related to pregnancy and breastfeeding. If this book contributed to a conversation that way and opened up discussion, that would be amazing. I would be really thrilled.

This interview was conducted by email and by phone. It has been lightly edited for length and clarity. 

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.