Referencing a study comparing continued use of the pill between women who could buy it over the counter in Mexico vs. matched women who received it through standard U.S. insurance or health-clinic plant, blogger Emmma of The Well-Timed Period says
Researches wanted to test the hypothesis that making access to the Pill more convenient — by 1)removing the prescription requirement, and 2) providing users with more Pill packs — could increase Pill use and continuation.
They recruited 1046 current Pill users living in El Paso, TX, a setting where low-income women can obtain the Pill without a prescription by crossing the border into Mexico and buying the Pill OTC from a Ciudad Juarez pharmacy. [532 women received Pill packs with a prescription from an El Paso clinic and 514 women purchased the Pill OTC from a Ciudad Juarez pharmacy.]
The study found that discontinuation was significantly lower for women who used the pharmacy to buy the Pill than for clinic users. When the number of Pill packs was taken into account, discontinuation rates were higher…for clinic users who received one to five pill packs. Only clinic users receiving 6+ pill packs had continuation close to pharmacy users.
If you’re talking about medications with short-term use like antibiotics or
pain killers there might be an excellent case for distributing only limited supplies. For most women who take the pill it’s a long-term proposition. And while many women discontinue use because they have side effects they don’t enjoy, studies like this one (see also) suggest inconvenience is a big factor as well.
I mean, it would be bad enough if you could only by a month’s worth of toothpaste or floss at a time… and then you could only get new supplies at the store you bought it the first time.
Bwahaha, listen to me talking about it as though it was a hypothetical instead of how it works basically everywhere in the U.S.
Sheesh!
Sungold of Kittywampus has some interesting, and cool, news about new uses for IUDs
Actually, this isn’t a truly new option, just one that has gotten no press up to now: using an IUD for emergency birth control:
“A copper intrauterine device was 100 percent effective at emergency contraception in a study of almost 2000 Chinese women who had the device implanted up to 5 days after unprotected sex.”
Sungold adds that she thinks IUDs would be…
Especially for anyone who’s a repeat customer for EC, the IUD seems like a highly sensible choice. While IUD insertion can cause cramping (which can persist for a few days), Plan B can inflict pretty intense nausea. Having to chase down EC repeatedly is stressful for body and soul. Where 1 in 100 women will still get pregnant on Plan B, it’s fewer than 1 in 1000 with the IUD as EC. And in the long run, a woman who chooses the IUD is highly unlikely to face an unwanted pregnancy.
That’s not a panacea. But it’s a pretty excellent option.
I think that’s about right. But then of course I’ve always been a big fan of post-Dalkon-Shield-debacle IUDs, going back to the original low-impact copper Ts of the 1970s. But then there’s the bit about how healthcare providers remain reluctant to provide IUDs… even caregivers who use and swear by them personally. And since I’ve got a vasectomy I’m not exactly a candidate for IUDs, and so my enthusiasm has always been muted with a great deal of deference.
Which is why I was happy to see Sungold’s update based on comments on her post by MomTFH. MomTFH said
According to a midwife who taught me about birth control, the reason why IUDs were not recommended for women [who haven’t been pregnant] were because so many of them successfully sued over the Dalkon shield. The company had to pay a much higher settlement to women who never got to have children due to their injuries than they did to those who already had children. The indications for the newer IUDs, including the copper T, originally said the ideal candidates were parous women, but that is no longer the case. New recommendations say that pretty much any woman who does not have active pelvic inflammatory disease is a good candidate.
The Dalkon shield was a completely untested, unresearched, unregulated piece of scrap metal. The copper IUD is a much more carefully created and substantiated device. It has a higher rate of continuance of use than any other form of birth control. Not only do I have an IUD, but the IUD is an incredibly popular form of birth control among female ob/gyns I have very unscientifically surveyed.
That makes a little more sense. Not in the conspiracy-theory sense, just in the practical institutional-memory-informs-practice sense. With the benefit that institutional memory will shift as people in the medical industry, like MomTFH, begin speaking out.
Final note: I’m not sure anti-choice wingnuts are going to be cheery about IUDs as emergency contraception. But then again they already oppose IUDs anyway. So… cry wolf much?
Scott Lemieux of TAPPED is logically correct but, I think, tactically mistaken for dismissing pro-choice efforts to look for “common ground” with anti-abortion conservatives.
To follow up on Monica’s post about Dana Goldstein’s terrific article about the coming battle over contraception, it’s also important to emphasize what Republican opposition to contraception reveals about cultural conservatism.
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The problem with this line of reasoning is that it ignores the broader set of assumptions about women and sexuality on which actual opposition to abortion is based. Consider anti-choice Republicans, who consistently opposed expanding contraceptive use: Given the choice between reducing abortion rates and controlling female sexuality, they will always choose the latter. Thus the idea that contraception can be a means of achieving a ceasefire in the culture wars has always been a fantasy. Liberals and conservatives aren’t just divided by abortion but by broader questions of female equality and sexual freedom.
I agree strongly that there’s a hard core of social conservatives who just flat-out hate the idea of women having sex (or possibly instead hate the idea of men having sex with women) and “getting away with it.”
And for those people abortion is virtually a red herring, relevant only to the extent that abortion, like contraception, amounts to a get out of jail card on the “wages of sin.”
Fine. You’ll never reach compromise with those people.
The trick, though, is that the hard core hides behind a heck of a lot of people who are squishy on abortion, sometimes really squishy, but 100% fine with contraception.
Those people you can find common ground with. And for logical and tactical reasons it’s extremely important to do so.
The point of engaging in “common ground” rhetoric isn’t about getting to compromise with the acid right. It’s to flush them out, to drive a wedge, to starkly separate them from their nominal allies in the squishy middle.
Maybe 20 years ago someone from Operation Rescue very bluntly said it was their policy to oppose initiatives that only reduced abortions because, in his opinion, unless abortions continued in big, big numbers the majority of opponents would lose interest in the issue.
“Common ground” solutions like contraception availability amounts to calling their bluff.
Would it be great if the majority of people were willing to back abortion rights 100%? Oh yeah, definitely. But the bad guys wish the majority were as enthusiastic about letting women die of preventable pregnancy-related complications. Since neither side seems likely to get such support, it becomes a question of who can provide intermediate solutions that are most appealing to the majority in the middle.
I happen to think the most appealing intermediate, a.k.a. “middle ground” solution is pressing hard on contraception. First of all because all but the fanatics are comfortable with it, and second because while nearly all the squishy middle are squishy about the boogeyman of “abortion on demand” they’re actually extraordinarily tolerant of abortion as a backup when contraception fails. That’s exactly Terry Randall and the American Bishop’s worst nightmare and… I just can’t see any reason why we shouldn’t give it to them.
So. Bottom line: you can’t compromise with fanatics, but by appearing reasonable (heck, by being reasonable!) you can peel off millions and millions of their nominal supporters.
I say go for it.
Amanda Marcotte of Pandagon has another one of those silly moments where she forgets that anti-feminists know so much more about feminism and what it really means.
[Kathryn Jean Lopez of National Review Online] is the first to line up to explain to all the stupid feminists why we’re so stupid thinking we actually enjoy contraception, sex, and having choices.
In an otherwise largely celebratory forum on the pill at CNN’s website, Republican strategist and book publisher Mary Matalin cleverly and jarringly wrote: “Packages of portable liberation ushered in a generation of women determined to break free from their inferior patriarchal oppressors. And how did they manifest their superiority? Their freedom? Thanks to The Pill, by casual, drive-by sex. Whoa. That really showed those stupid boys.”
They can keep telling us that feminism is about hating men, and therefore we’re breaking our own rules by having good relationships with them and (if we’re straight) enjoying sex with them, but it’s not sticking. Perhaps they’re wrong about what feminism is? I don’t know; I’m just an actual feminist. So when I say that feminism is about women’s equality and creating a non-patriarchal world where men and women are freed get along as equals, I don’t know what I’m talking about. The only people who get to define feminism are people who oppose it.
Say what you like about Sigmund Freud but I think the world is a better place for his articulation of projection — the tendency to see in others the evils one perpetrates, or at best most wishes to perpetuate, oneself.
I mention this because for all that anti-feminists claim they’re standing up for the definition of men as… well… by-definition superior to women, they’ve got some seriously, seriously man-hating tendencies.
I mean yeah, Lopez is dumping on women for having Teh Sex with men but… but… some times you just gotta ask yourself why she’d think that would be a problem. And the answer, I’m pretty sure, boils down to one of three possibilities:
1) she thinks men are disgusting creatures who’s penises by their very existence sully women. Or
2) she thinks men are lazy animals who can’t be persuaded to do anything at all, let alone anything productive, couth, or genteel, unless they’re positively starved for sex. Which starvation will never take place if women succumb to their own “animal” instincts and “give it up” for free. Or
3) both #1 and #2.
Lopez, who hates men, projects this hatred onto feminism. Which she also hates. Furthermore, she then hates feminism worse for “contradictions” she perceives between how feminists behave and how she thinks feminists ought to behave.
The problem being that Lopez confuses “patriarchy,” which feminists rightly oppose, with “men,” who feminists can get a little impatient with but with only the occasional exception feminists don’t hate at all.
Clue time? Patriarchy is not limited to men. Patriarchy is a coed enterprise. Lopez isn’t a dupe or a thrall of patriarchy, nor a collaborator with it, nor is she a “useful idiot” of patriarchy (though, sorry, she is an idiot!) Instead she’s a fully-invested, active agent of it, a would-be architect of it. And as part of the patriarchy she hates men even worse than she hates women who have sex with them.
Now as to the substance of Lopez’s claim I’m going to go out on a limb here and say that if you go on the pill just so you can let men have “casual” sex with you then… then I think it’s a good idea to maybe rethink both your relationship to men and your relationship to sex and who your sexuality it’s really for. And about. But I don’t think it’s a good idea to rethink your relationship to the pill, as Lopez would have you do. The main thing the pill does, or any other contraception does, is help couples, of whatever duration, avoid pregnancy. Who one has relationships with, and why, is an issue contraception really isn’t going to help, except possibly to the extent it helps avoid obstacles that make exiting an unfortunate relationship very much more difficult.
Oh and can I just add one more thing about Lopez and the pill in particular but contraception in general? Who does she thinks uses contraception here? It’s at least as common among married and/or partnered women as it is among “casual” sex-having single women. And if you take into account the married women who are currently actively seeking planned, wanted pregnancies I’m… pretty sure married women who aren’t trying to get pregnant are even more likely to use contraception. So WTF with her implication that the pill primarily enables casual sex? As opposed to sex inside established and even long-term committed relationships.
When you see patriarchal framing you probably want to call it. Lopez is a patriarch. Framing contraception in terms of “casual” sex and “letting” boys have sex with you? That’s patriarchal framing.
Anna N of Jezebel, in a post on the general state of “men’s reproductive rights” activism, raises a persistent point that… I wonder… well, let’s go with the quote first
But sometimes it’s men who shut women out. In her thorough article for The Nation on reproductive coercion (which we’ve also discussed), Lynn Harris writes of “the striking frequency with which it is in fact young men who try to force their partners to get pregnant. Their goal: not to settle down as family men but rather to exert what is perhaps the most intimate, and lasting, form of control.” She cites one study finding that 15% of sexually active young women who visited reproductive health clinics had suffered birth control sabotage by a partner, and another in which 26% of a sample of teens in abusive, sexually active relationships said their partners were “actively trying to get them pregnant.”
So…
I’m wondering…
Y’know how all those “pro-life” types will do just about anything to stop women from getting an abortion… or even avoiding pregnancy in the first place… except, y’know, make it actually safe, easy, inexpensive, and socially acceptable for women to, y’know, actually stay preganant, have, and raise their unplanned, unwanted pregnancies?
And how instead they try and make it, and keep it, as close to social, economic, moral, even corporal punishment as possible? How they present it as the ultimate in dependency? In sacrifice? In pain, and exhaustion, and tedium, and frustration, and helplessnes? In stigma? In shame?
So…
I’m wondering…
How much do you think all that plays into this notion of coerced pregnancy as intimate control (a.k.a. as a form of partner abuse?)
I mean…
Not to put too fine a point on it but it’s well within society’s capacity to make unplanned, unwanted children (if not pregnancy itself) not just not just not punishment, and not just easy, but downright enjoyable. In the grand scheme of things it involves beginning social investment in children’s lives just a few years earlier than we do now — call it 3-6 months before birth instead of 3-4 years after.
And it’s not like the returns on that social investment wouldn’t be appropriate — I mean, even after 18 years of exacting all those “wages of sin” from the mother on behalf of traditionalist/conservatives, those same children will spend somewhere between four and seven decades as real adults — equal with all other adults for responsibility for the world. To invest in children as future fellow citizens instead of present punishments for parents would be to reap fantastic benefits in the future.
And…
Finally…
Not to put too fine a point on it but just how enthused might callow youths be to sabotage their partners pills or to pinhole their condoms if the outcome was not lasting “who’ll love you now, bebbeh?” control but a little more respectability, more rather than less independence, and a whole lot more support?
I’m not saying let’s all go out and encourage teen pregnancy. I am, however, saying that to the extent society would like to avoid teen pregnancy and, especially to also avoid pregnancy terminations, the incentives are currently… perverse.
In a news roundup Katy of Jezebel passes along news about contraception in the U.S.
Out of married U.S. women, only 16% are currently on the pill, compared to 29% in the UK and more than 40% in the Netherlands and France. Surprisingly, sterilization is a much more popular option in America.
1 in 4 married ladies here have had their tubes tied, while most other countries that reported figures have sterilization rates below 10%. These patterns also appear to apply to all women – not just the ones who have tied the knot.
Statistics for contraceptive use by men is surprisingly sketchy — since virtually all the focus around contraception and pregnancy is on women, including focus on statistics-gathering, virtually all information about men and contraception has to be extrapolated from assumptions that women who use contraceptives tend to have male partners. Oh, and I say “surprisingly” because men still have direct access over three kinds of contraception: condoms, withdrawal, and vasectomies, with the most recently invented (vasectomies) still being nearly 200 years old! So how long would that questionnaire be anyway? But I digress…
The best… or at least most frequently-cited estimate for male sterilization in the U.S. is one in six men over age 35 or, I think, a little more than 15%.
Great sentence from Matthew Yglesias
The social convention that birth control is the financial responsibility of the female member of a heterosexual couple has long been problematic, and classifying family planning as a preventive health service will in effect do away with it.
It’s about the recently-passed Affordable Care Act, which despite the major disappointments of the Bart Stupak debacle and the lack of a public option looks like it’s going to start treating contraception as medical care instead of ZOMG!!!TEH!!!SEX!!!
Anyway, I just excerpted one good sentence. The rest of his analysis, including his remarks on the difference between how men and women categorize family planing, is also good.
Via Tyler Cowen of Marginal Revolution an article in The Economist points out yet another unforeseen consequence of restricted reproductive choice
Today, four out of ten married Mexican women are sterilised, a radical measure that partly reflects the continuing lack of other contraception in some areas as well as strict laws against abortion everywhere but the capital.
Cowen adds “Mexicans in the United States are now more fertile than Mexicans in Mexico.”
Two points I’d like to add
Second, this makes a lie of, oh, dozens of myths, stereotypes, and outright racist slurs about “irresponsible” population inevitabilities in “third” world, particularly “third world” highly-religious countries.
Second, the sterilization option makes perfect sense to me. For instance he continuing lack of other contraception for me, a man is why I got a vasectomy back when I was 21. And because, years later and after a painful, expensive, and statistically risky reversal, the same continuing lack of other contraceptive options let me to get sterilized yet again after the birth of our last planned, wanted child.
Presumably if they had other options the women of Mexico would choose less drastic, less medically risky*, and possibly less irreversible means of contraception.
As, presumably, would men if we had less drastic, less medically risky, and less difficult-to-reverse means.
I think that latter point, by the way, ties nicely into dozens of myths, stereotypes, and outright sexist slurs about “irresponsible” reproductive behavior in men.
* Note I only said more risky — tubal ligation is still relatively low-risk. Other methods just happen to be lower risk… but also happen to be easier to block distribution and use of.
Summary: The way “reducing abortions” is almost always framed distracts us from the more legitimate, and legitimately pro-choice issue of reducing the number of unplanned, unwanted pregnancies. Here’s what we should be doing instead. And why. And why.
Silvana Naguib, who’s now blogging at TAPPED says…
Ever since President Bill Clinton introduced his succinct position on abortion: “safe, legal, and rare,” the goal of reducing the number of abortions has been a stated aim of abortion rights as well as anti-abortion groups. Last year, then-presidential candidate Barack Obama promised the pope that he would make efforts to reduce the number of abortions in the United States.
But should decreasing abortion rates be a stated goal of the reproductive-justice movement? Aimée Thorne-Thomsen says no. She makes the case that we should instead focus on increasing all options for women, expanding their liberty to make the right choice for them.
I say no too, for basically the same reasons. Framing the issue in terms of numbers of abortions avoided is going about it completely backwards.
Back before Roe was handed down our argument was that abortion was necessary as a fallback for contraceptive failure and/or failure of personal autonomy and/or failure to use contraception due to lack of education, access, affordability, safety, or usability of contraception.
And the reason we framed it that way back then is that we knew that even when it became legal, is that abortion is more expensive, more time-consuming, more uncomfortable, and medically more risky than any other method of avoiding unplanned, unwanted pregnancies.
Point being that making abortion “rare” should only be a highly-desirable outcome of making unwanted, unplanned pregancies rare.
And the obvious way to get there has no, zero, none relationship to restrictions on abortion. Instead it has everything to do with making a variety of contraception options safe, legal, available, reliable, usable, and affordable for women and men. It has everything to do with comprehensive sex education that includes not just “birds and bees” biology, anatomy, and technique but also appropriate modeling of negotiation and respect for decision-makers not just regarding sex but regarding relationships as well. Heck, for extra credit you can even toss abstinence advocacy on top of all that.
And the result of those policies (ok, except maybe the abstinence part) really would make abortion rare. But as a result, not a goal.
Of course no matter how well all of the above might work there will still always be a need for the fundamental right to fall back on abortion. So no matter how rare it becomes abortion will always need to be safe and legal and there.
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Can I just add one more thing about reframing the question away from abortion (where secular and lay opponents work hard to keep it) and towards preventing unplanned, unwanted pregnancy (where they really, really don’t want to go?)
When the issue is framed in terms of abortion then an increase in the raw numbers is considered a “failure” and a decrease is considered “success.” That’s great for Popes and the rest of the nopes, so you can see why they love that way of looking at it.
If instead you start looking at it in terms of education, autonomy, and in terms of safe, affordable, available, useable, and reliable birth control then an increase in the number of unplanned, unwanted pregnancies becomes the point of failure and a corresponding decrease becomes success. And an increase or decrease in abortion becomes a sideshow.
Popes and other nopes prefer to keep the focus on abortion rather than unplanned, unwanted pregnancies because with the former they can pretend they’re part of the solution. With the latter there’s no way they can pretend they’re not part of the problem.
Amanda Marcotte of Pandagon really jumps hard on anti-contraception feminist Laura Eldridge.
Not so much for Eldridge’s concern about the health impacts of hormonal contraception per se. Those are very real and (after serious lapses in the 1960s and early 1970s) pretty well-documented. Though those health impacts also somewhat overemphasized in relation to some of the major alternatives for sexually active heterosexual women, like, unwanted, unplanned pregnancy — whether avoided with Plan B, medically or surgically ended, or carried to term.
Instead Amanda calls out Eldridge for turning contraception into just one more venue for performing purity.
I found this passage surprisingly enlightening as to what’s going on when it comes to categorizing methods as more or less “natural” and therefore good. The goodness of a method appears to go up as the effectiveness goes down and the pain in the assness of it goes up. “Fertility awareness” is clearly — if you read to the end — Eldrige’s preferred method, because she says it’s the most green. I find the obsession with making sexuality “green” to be a leftist way of being puritanical without coming out straight with it.
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This need to make sexuality painful or unpleasant underlies a lot of leftist hand-wringing over modern conveniences relating to sex.
Amanda makes the case that there’s a strong distinction between performing purity and actually being green. The former often requires quite a lot of personal self-discipline to get sometimes very-incremental additional benefit. The latter can leverage sometimes small amounts of self-sacrifice… or even just minor changes of habit… into sometimes surprisingly large environmental benefits.
Specifically…
If only we could get people to give the same level of attention that they give to reducing waste from pills, condoms, and tampons to reducing waste from far more frequent (and wasteful) activities like eating or driving! If you think I’m overstating the case, consider the amount of feminist greenie energy expended on waxing poetic about menstrual cups and reusable pads, two methods that 99% of American women will reject out of hand. And imagine if that energy was redirected towards the far more attainable goal of getting women to stop using tampon applicators. If we did that, we could actually reduce the amount of waste produced by menstruating women, but that doesn’t have the same emotional satisfaction, because there’s still the sense that women using applicator-less tampons aren’t suffering enough when they get their periods.
Far be it from me, a prudish libertine if ever there was one, to scorn someone else for encumbering their own personal sexuality with either greater self-denial of pleasure or higher-than-necessary personal risk of pregnancy. But far be it for me, a libertine prude, to condone trying to extend one’s personal pleasures or pleasure at the lack thereof, into general principles.
If Eldrige was more serious she’d leave more room for latitude.
Update: And if she’d leave more room for longitude. And altitude.
It just occurred to me that her issue is just one dimension in a space bounded by at least two others. She’s most focused on the hazards of using contraception vs. not using contraception. Amanda points out (and I agree) that another dimension would be the hazards of not getting pregnant vs. getting pregnant. And Amanda, and I, and maybe Hugo Schwyzer also points out a third dimension would be the hazards, or at least the obstacles, of including heterosexual sexual activity with reproductive potential vs. not including it in one’s sex life.
It also occurs to me that quite a lot of the conflicts about sex and reproduction are a result of factoring only one or two rather than all three of those dimensions.