Commentary Contraception

Why Are So Many Young Adults Cavalier About Birth Control?

Amanda Marcotte

Forty percent of adults ages 18-29 don't really believe birth control matters, and you'll get pregnant when fate decrees. They're underestimating their fertility and the effectiveness of contraception. The real question is why?

Recent news that the teen birth rate is down due to increased contraceptive use might make some of us believe that attitudes about contraception are improving among younger people, and that we don’t really have to worry about them. Unfortunately recent research published in Perspectives on Sexual and Reproductive Health suggests we have a long road ahead when it comes to people in their twenties really having the tools to take care of their reproductive health and futures. Researchers interviewed a cross-sample of 18 to 29 year-old respondents and found that widespread myths about contraception and fertility were incredibly common with this age group.

Researchers found that women who had a good understanding of how contraception works and how effective it is were far more likely to use contraception regularly. Unfortunately, understanding of the effectiveness of contraception was shockingly low. More than half of the male and female respondents had low scores on a test of their contraception knowledge, and 60 percent underestimated the effectiveness of contraception. Forty percent seemed to believe that birth control was inevitably going to fail them, almost as if there’s some magical force that decides for them when they’re going to get pregnant, instead of basic biology. As previous research has shown, many people continue to labor under the illusion that their avoidance of pregnancy is more about luck — fate even — than about effective use of contraception. They also tend to underestimate how fertile they are without it. Because of this, they run a high risk of getting pregnant without wanting to, because they really underestimate how much control they really have over the situation.

Nona Willis Aronowitz described the situation beautifully:

A full 40 percent of them agreed that birth control really doesn’t matter—”when it is your time to get pregnant,” they agreed, “it will happen.” In other words, a significant number of young people’s “commitment” to remaining childless involves crossing their fingers, not wearing condoms or swallowing pills.

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Indeed, on Dan Savage’s new MTV show “Savage U”, the audience got to see this attitude on full display when Dan interviewed a young man in a health clinic about his use of contraception, only to find out that this young man and his girlfriend used nothing. Dan was surprised, as was I, but these numbers clarify things. This young couple seems to be fairly normal in believing pregnancy is somehow a matter of fate and that birth control just provides the illusion of control. This is a message that the anti-choice movement promotes heavily, both in making false claims about the failure rates of contraception and underestimating how frequent pregnancy is if you don’t use birth control. It seems that message has an audience.

In reality, of course, modern contraception methods are very effective, and pregnancy is a biological process, not a magical process that results from fate.

While these depressing numbers suggest some policy responses — especially beefing up sex education in public schools and on college campuses — it also suggests there’s deeper cultural problems afoot in the U.S. I think it’s a combination of two factors. One is that strong streak of anti-intellectualism and suspicion of science in our culture. The other is the sin-and-punishment frame that’s so frequently applied to sexuality. Both of these problems are exacerbated by a Christian right that willfully exploits these tendencies to deprive people, especially women, of control over their own sexualities and lives.

I probably don’t need to work too hard to convince you that this country has serious problems accepting scientific facts, but a short list of evidence: Anti-vaccination nuttery, homeopathy, global warming denialism, creationism. All these have high levels of popularity, or at least some amount of influence over ordinary people. This kind of suspicion of science affects how people understand the effectiveness of contraceptio. To make it worse, people’s understanding of how these things works relies so much on word of mouth. The problem is that a lot of people who misuse or don’t use contraception and then get pregnant claim to family and friends that they were using contraception, which reinforces the false belief that it’s less effective than it is and that you can’t stop fate when it comes to getting pregnant.

The second reason that there’s an overemphasis on this “fate” narrative is that Americans still just aren’t completely comfortable yet with sex for pleasure, especially when it’s women having it. Hard to believe in a culture drenched with porn, but yet there we are. The notion that a woman can go for years, decades, even her entire life having all the sex she wants without necessarily having to pay for it with an unintended pregnancy doesn’t make sense in the sin-and-punishment narrative that lingers in American attitudes about sex.

Better education can help, of course. If people are presented with the correct information at the right age, they are more likely to retain and understand it. But information without illustration is notoriously hard for people to fully understand and remember. Perhaps one way to help would be to use more story-based methods of education when it comes to teaching about contraception. Use examples of women who were able to avoid unintended pregnancy, and who were therefore able to have babies when they made an active choice to do so. Modeling alternatives to “leave it to fate” would be worth the citation of a million statistics about contraception effectiveness.

But ultimately, we as a culture have to change our thinking about science and sexuality. We have to stop seeing science as a subversive force or putting more emphasis on word of mouth information than on scientific information. We also need to stop seeing sex as dirty and sinful. Until we stop seeing sex as a sin, the idea that women should “pay” for it with unintended pregnancy will linger. 

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Law and Policy

Wisconsin GOP’s Voter Restriction Law Suffers Another Legal Blow

Imani Gandy

In blocking many of Wisconsin's elections restrictions, the lower court ruled that the state must reform how it deals with voters who have difficulty obtaining the required photo ID to vote.

A federal appeals court yesterday refused to stay a lower court order blocking several Wisconsin voting restrictions, allowing election officials to move forward with early voting in the state next month.

Attorneys on behalf of the state of Wisconsin filed the request for a stay with the Seventh Circuit Court of Appeals after a lower court judge last month issued an injunction that blocked parts of Wisconsin’s sweepings elections laws.

The lower court ruled that the justification for the laws did not justify the burden on voting rights that they impose. And this week a three-judge panel of the Seventh Circuit declined to stay that ruling, without explaining.

The ruling comes days after elections officials in Madison and Milwaukee announced their intention to kick off early voting in late September, a month earlier than would have been allowed had the lower court not struck down the restrictions on early voting, according to the Milwaukee-Wisconsin Journal Sentinel.

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The Republican-backed elections law created state-imposed limitations on the time and location for in-person absentee voting, a provision requiring absentee ballots be sent by mail instead of fax or email, the requirement that dorm lists—a certified list provided by the university of the students living in college housing, which student voters may use as proof of residence—must include citizenship information, a ban on using expired but otherwise qualifying student IDs to establish proof of residency, and a 28-day durational residency requirement.

In blocking many of Wisconsin’s elections restrictions, the lower court ruled that the state must reform how it deals with voters who have difficulty obtaining the required photo ID to vote. Gov. Scott Walker (R) and the GOP-controlled Wisconsin legislature had implemented a system under which people who don’t have birth certificates or who have problems with gathering documentation needed to obtain the proper identification would still be able to vote.

The lower court noted that the Walker administration’s system did not provide a viable long-term solution for those voters who could not obtain their birth certificates because they were destroyed in fires or misplaced by bureaucrats.

The court later stayed that portion of the ruling, stating that the system created by Walker’s administration—which provides people with temporary voting credentials while they await a decision about whether they qualify for an ID—was sufficient to allow people to vote during the upcoming November election and therefore does not need to be immediately reformed.

The ruling comes on the heels of a ruling in another voting rights case in Wisconsin, Frank v. Walker, about the state’s voter ID law. In that case, a three-judge panel of the Seventh Circuit stayed a ruling that would have permitted anyone eligible to vote in Wisconsin to an accommodation that would permit that voter to cast a ballot after signing an affidavit stating that they could not easily obtain an ID.

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