This piece was originally published on the Blowfish Blog.
So how effective — really — is abstinence as a birth control method?
Bristol Palin, Sarah Palin’s famously “unmarried and pregnant at 17 and an unmarried mother at 18″ daughter, went on a tour of the TV talk shows earlier this year, advocating — in an irony so massive I feel puny standing next to it — abstinence for teenagers.
And one of the arguments she made — with her baby on her lap — was that abstinence is the only 100% effective way to prevent pregnancy.
Now, if Bristol Palin, or anyone else, had gone on the TV talk show circuit arguing that, say, birth control pills were the only 100% effective way to prevent pregnancy — and theyâd done so with their unplanned baby on their lap — they’d have been laughed off the stage. But people tend to see abstinence as different. People — and not just right-wing ideologues — tend to see a failure of abstinence as a failure of the people practicing it… not as a failure of the method.
So today, I want to talk about how we do — and do not — measure the effectiveness of any given method of birth control.
Many years ago, I worked as a counselor and educator at a birth control and abortion clinic. And I learned a standard way of measuring the effectiveness of any birth control method that’s absolutely crucial to this discussion. It’s this:
When you’re evaluating how effective a birth control method is, you have to look at the difference between how effective it is in theory… and how effective it is in practice. You have to look at the difference between how often women using this method would get pregnant if they used it perfectly every time… and how often women who use this method actually do get pregnant.
And the reason you have to do that is the reality of human imperfection.
Example. A diaphragm is about 95% effective if it’s used perfectly every time. But humans aren’t perfect. We can, in our haste to start fucking, put the diaphragm in wrong, or not put in enough spermicidal goop, or something. And we can also, in our haste to start fucking, decide, “To hell with it, just this once let’s not bother.” A diaphragm that gets left in the nightstand drawer while its owner boffs is a diaphragm with a very good chance of, shall I say, bringing down the effectiveness rate of diaphragms. Therefore, while they’re 95% effective in theory, diaphragms are only about 85% effective in practice.
Ditto with every other birth control method. People can forget to take birth control pills; put condoms on wrong; miss their appointment to get their Depo-Provera shot. Even supposedly foolproof birth control methods have some degree of disconnect between theory and practice. (How many women with IUDs actually check the string every month like they’re supposed to? I know I don’t.)
In fact, when you’re deciding which birth control method is best, this gap between theory and practice is one of the most important things to pay attention to — whether you’re a birth control educator or just a person using birth control. For people who are highly self-motivated and organized, methods like diaphragms can work very well, and the gap between theory and practice won’t be all that wide; for people who are more impetuous or whose lives and schedules are more unpredictable, methods like the pill and the IUD, which are less likely to be used incorrectly or not at all, are generally a better choice.
Fine. So what does all this have to do with abstinence?
I bet you can see where I’m going with this.
In theory, Bristol Palin is absolutely right. In theory, abstaining from penis- in- vagina intercourse is the only 100% effective method of preventing pregnancy.
But in practice?
It’s difficult to find hard numbers on this. While other birth control methods have had their practical failure rates studied extensively, abstinence hasn’t received the same attention, and most of the sources I found just said “We know it fails a lot, but we don’t know exactly how often.” But the one source that I found with hard numbers puts the “in practice” failure rate of abstinence among teens at between 26 and 86%.
That’s huge. Even the lowest number on that scale is huge. That’s one of the highest failure rates of any birth control method we know of. That ranks just above “crossing your fingers.”
Of all the birth control methods available, abstinence is probably the one that’s most likely to be left in the nightstand drawer. Sex is, among other things, a fundamental and powerful physical drive, deeply ingrained in us by millions of years of evolution. If your birth control method depends on your ability to just say no to sex until you’re ready to have kids… it’s a bit like having a birth control method that depends on your ability to refuse to eat. For a week. In a bakery.
So where does this idea come from that abstinence is 100% effective, even though it fails more than just about any other method of birth control?
It comes — I think — from the fact that people tend to see a failure of abstinence, not as a failure of the method, but as a failure of the people practicing it.
If you put the condom on wrong or forget to take your birth control pill, people tend to see that as a human mistake that could happen to anyone. But if you go ahead and have sex when you swore to yourself that you wouldn’t, people are more likely to see that as a personal failure, a failure of will power and self control.
Now, from a purely philosophical perspective, I suppose you could make that argument. I certainly wouldn’t — I consider it grossly sex-negative to think that abstaining from sex until you want kids is a reasonable thing to expect people to do. But in an abstract, “angels fucking on the head of a pin” sense, I’d be happy to debate the question of whether the failure of a birth control method that relies entirely on the free will of the people practicing it should be seen as a failure of the people or the method.
But from a practical viewpoint?
It makes no sense at all. From a practical viewpoint, if what you care about is preventing unwanted pregnancy — especially unwanted teenage pregnancy — then we need to treat abstinence like a condom that rips 26-86% of the time; like birth control pills where, out of every four packets, one to three packets is filled with placebos. We need to treat abstinence like what it is: a birth control method that results in pregnancy in 26-86% of the teenagers who practice it.
And when it comes to making sure that teenagers don’t get pregnant?
I, for one, don’t give a damn about philosophy.
I want them to not get pregnant.
(P.S. Apparently, the Obama administration agrees. The new budget eliminates funding for the conspicuously failed abstinence- only sex education programs, and re-directs it towards evidence- based programs to prevent teen pregancy. Yay!)