[Greta Christina] Abstinence, Birth Control, and the Difference between Theory and Practice
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, recently went on a tour of the TV talk shows, 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 they’d 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!)
This entry was posted on Friday, 15 May 2009 at 12:00 am and is filed under Culture. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
on Friday, 15 May 2009 at 7:41 am hoverFrog wrote:
The irony of Bristol Palin advocating abstinence only sex education actually hurts my “irony sense”, it’s more than a tingle, more like gong.
I think this topic raises the question about what we want from our children or the next generation of children. I want them to be healthy, wealthy and wise, to enjoy their childhood and grow at their own pace. I want them to know more than me in time, to appreciate more, understand things better and get more out of life than me. i say this from the position of someone who makes a conscious effort to get the most out of this one life that I can. Above all I want them to be safe.
That means that they should choose the time when they want to have sex and be able to choose when and if they have children of their own. They should avoid the emotional turmoil of having or even having to consider an abortion. They should remain free from disease and infections that might limit their lives or reproductive abilities.
As a parent my role in sex education for my children is to ensure that they have choices and information. Abstinence is a choice and they are welcome to opt for it but it is one of many. The pill and condoms are the most common contraceptives and these should be available. Two forms of contraceptive are more effective than one and mitigate the “I forgot” circumstance if they only forget one. There’s a new male contraceptive injection that will hopefully be available soon as well. Simply put, don’t leave your eggs in one basket. That is what abstinence only education does except it limits access to other preventative methods.
on Friday, 15 May 2009 at 7:59 am NiroZ wrote:
I think that this study http://www.associatedcontent.com/article/216628/new_study_proves_abstinence_only_education.html pretty much settles the debate.
on Friday, 15 May 2009 at 8:37 am Fez wrote:
P’raps the wrong audience to toss this question out to but my google-fu is failing me. Then again there’s a huge intersection between the “abstinence only” crowd and those who claim to have an answer. How does one go about reconciling claims that abstinence is 100% effective with the birth of Jesus?
on Friday, 15 May 2009 at 8:47 am arensb wrote:
Just to throw more confusion onto the fire, I tried to see where Sex, Etc. got their figure of a 26-86% failure rate for abstinence, but unfortunately they fail to give a proper citation.
The most likely candidate seems to be “Disease-Specific Sexual Abstinence User Rates: The Role of Science in Policy Making” by Clara S. Haignere, Health Educ Behav 2001;28;21. But that article doesn’t have any original research. Rather, it’s a commentary on “A Relative Risk�Based, Disease-Specific Definition of Sexual Abstinence Failure Rates” by Steven D. Pinkerton, Health Educ Behav 2001;28;10. But unfortunately, neither article seems to contain the 26-86% failure rate figure.
It looks to me as though Pinkerton isn’t measuring abstinence failure directly. (I imagine the direct data on that is lacking. For that matter, I bet it’s hard to measure how often condoms rip “in the field”.) Instead, he’s using rates of STD infection and unwanted pregnancy as a proxy (which, I guess, is good, since that’s what we’re ultimately interested in).
And that’s where math comes into play: if you have sex 100 times, and condom rips 10 times, that’s a 10% failure rate of the method, but that doesn’t equate to a 10% chance that your partner will get pregnant; or that 10% of your partners will catch your STD. For instance, you might have to engage in unprotected sex 70% of the time to have a 10% chance of being infected with chlamydia.
What I’m getting at is that the 26-86% figure is meaningless if we don’t know what it means. Is it referring to people who pledge abstinence but wind up having sex anyway? People who pledge abstinence but wind up catching an STD?
on Friday, 15 May 2009 at 9:20 am chanson wrote:
I don’t think it’s ironic at all. I think she’s the perfect person to illustrate abstinence-only sex education and its relation to reality.
on Friday, 15 May 2009 at 11:03 am Blake Stacey wrote:
Where was that 14% chance of not screwing when I was a teenager, goddammit?
on Friday, 15 May 2009 at 11:05 am Jen R wrote:
I want to know what pressure was applied to Bristol Palin to get her to go on an abstinence-only promotion tour, given that just a few months ago she was saying that it was unrealistic.
on Friday, 15 May 2009 at 1:16 pm Dologan wrote:
I must admit that, for all the effectiveness/failure rates for contraception methods thrown around, I never quite seem to fully grasp what it stands for in every case…
The accepted/most common definition for failure rate seems to be the expected number of pregnancies per year per 100 women using (or claiming to use, I guess, in the case of abstinence?) the method, but that strikes me as an awfully vague way to do it. How often are these women having sex? Daily? Weekly? Once a month? Twice per year? Unless an average frequency of intercourse is provided, the number is almost meaningless, yet this information is never provided or suggested.
on Friday, 15 May 2009 at 2:10 pm Kagehi wrote:
Well, yes, in a sense. Its like having a garage some place that says, “26-86% of cars that come through our doors have to have their tires replaced.” This says nothing about “why”. If its a tire replacement place, this makes sense. If its a normal garage, which deals with all types of problems, you have to ask, “What is causing the problem with tires here?” On the other hand, if its a garage in a small town, there are only 500 cars in the entire town, and 26-86% of them are having to replace them “per year”…. Well, now you really have a *huge* problem, because its not just that a lot are needing tire replacements, its that something is happening to 100% of all the cars, which just “happens” to only result in 26-86% needed an immediate replacement.
But, only in the first instance does it mean that the problem is exaggerated. In the other two cases, it means you have a *much* bigger problem, which is simply not being reported, since not every car “happens” to need tires at the same time. This is an equivalent case to pregnancy and STD. Not everyone is going to report them, not everyone is going to be affected in a way that results in a report, but its pretty certain that the number of “failures” is much higher than the numbers *can* indicate. In that sense, its not just meaningful, its scary.
on Friday, 15 May 2009 at 3:41 pm absent sway wrote:
Thank you, thank you, thank you for talking sense! A lot of people seem to prefer young women to be raising surprise babies than to confront the possibility of them having sex. They need to grow up.
on Friday, 15 May 2009 at 7:29 pm Mary wrote:
What I’m getting at is that the 26-86% figure is meaningless if we don’t know what it means. Is it referring to people who pledge abstinence but wind up having sex anyway? People who pledge abstinence but wind up catching an STD?
“Typical use” contraceptive failure has a fairly standard definition. Firstly, you believe any person who says they are using a given method. So the woman who takes the pill when her alarm goes off every day, the woman who takes it when she remembers in the morning, the woman is only remembering it two days in three, and the woman who got the script and didn’t get it filled? As long as they tell researchers they use the pill for contraception (and, I think, that they don’t want to get pregnant: not all couples using contraception are actually committed to avoiding pregnancy), they’re counted in the pill stats.
Then you follow these couples (I think they’re usually supposed to be long term relationships that have regular sex) for a full year from the time of beginning to use that method of contraception (failure tends to drop when people are practised users for various reason, so it’s the first year for comparison purposes). The percentage that gets pregnant is the typical use failure rate. Normally they rely on reported pregnancies, that is, they do not have the participants take pregnancy tests regularly, it has to have got to the point where the woman has noticed it. So failure rates are actually an underestimate, since 25% or so of pregnancies will miscarry unnoticed.
“Perfect use” is similar except you discard any couple who reports mis-using the method. (I do not know how that’s enforced.)
So abstinence would be tricky, because couples using it aren’t supposed to be having regular sex. But the closest comparison would be to get long term couples who claim to be beginning abstinence, believe them, and find out how many have had a pregnancy by the end of a year. For perfect use I guess you would have to drop everyone who reported sex.
For reference, my understanding of how contraceptive failure is measured comes from Trussell, James, Contraceptive failure in the United States, Contraception, 2004, 70(2):89-96
on Friday, 15 May 2009 at 7:42 pm Mary wrote:
Incidentally, the low end figure, 26%, may actually be the typical failure rate for the various periodic abstinence birth control systems: rhythm method, Fertility Awareness Method (basal body temperature and cervical fluid), and so on. People who are using these methods aren’t at all the same as abstinent folks: they have regular sex but not (well, in perfect use) when they think the woman is near ovulation.
This was pointed out at the Volokh Conspiracy (which may not be to everyone’s taste as a blog, but it does seem to be correct in noting that people should be careful to check that they’re not using the periodic abstinence figure).
For those who don’t know, the “regular sex, no contraceptive use at all” figure involves about 85% of heterosexual couples with the woman in the right age group having a pregnancy within a year.
on Saturday, 16 May 2009 at 2:47 am littleblackdress wrote:
I’ve always been of the opinion that the more knowledge and information one has, the better one can make a decision. Even those under the age of consent. Abstinence-only education is not only patronizing, it holds an unrealistic and unscientific ideal regarding the lives of teenagers. I’m glad that the Obama administration is looking towards science as the basis of which programs to fund.
on Sunday, 17 May 2009 at 10:31 am Mike wrote:
Excellent essay! There is so much subtext and hidden agenda in the abstinence debate. Reading this has made me think: Does abstinence qualify as a form of birth control any more than the celibacy practiced by Catholic nuns and priests?
Abstinence ed is primarily aimed at preventing sex, not preventing pregnancy. Otherwise, abstinence education would include detailed instruction about sexual activities that won’t get you pregnant.
While we’re at it, let’s look at other ways of behaviorally influencing people to reduce the likelihood of pregnancy.
Let’s encourage high school girls to only have sex with men over 30. Hell, 40. These men are very likely to be careful to not knock her up.
How about encouraging same-sex experimentation in teens? Maybe we can figure out how to modify sexual orientation temporarily! This would be something the religious right should get behind, because they could then use the technology to make gays straight later in life!
on Sunday, 17 May 2009 at 11:03 am Viktorja wrote:
Teaching abstinence only is a disgusting form of misinformation. It should be taught as an option NOT a one-size-fits-all solution. I was lucky enough to get a good sex education in school, but I know that is not the case in the majority of schools.
Ann Fessler wrote a wonderful book called “The Girls Who Went Away”, and I’m finding that the thinking in this day and age, for all the open mindedness of some of it, is nearly the same as it was back then. There is still a social doublt standard which supports the males sowing their wild oats, and when abstinences fails it is still the girl who is looked down upon for “allowing it to happen”.
A previous commenter mentioned the male contraceptive injections; I can’t wait for those to come out on the market. It will be nice to share the responsibility and have pregnancy become a mutual decision. I’ve always used the pill and a condom, and one more method can’t hurt as far as I’m concerned.
on Sunday, 17 May 2009 at 1:03 pm Sex and Abstinence « Life Without a Net wrote:
[…] Sex and Abstinence 2009 May 17 tags: abstinence, abstinence only education, atheist sex, healthy sex, sex, sex negative, sex positive by hambydammit In my last post, I approached sex-positive living from the perspective that we should not arbitrarily exclude another person from our sex life simply because their presence doesn’t conform to the cultural myth that sex is meant for long term monogamous relationships. I’ve decided to run with the theme of sex-positive living for a while after being inspired yet again by Greta Christina’s insightful thoughts on abstinence. […]
on Sunday, 17 May 2009 at 8:07 pm Libby O'Neil wrote:
In regards to reconciling Jesus’ birth with abstinence- My friend mentioned that (quite humorously, might I add) in a morality presentation at our Catholic School. The teacher yelled at her and said something about the Holy Spirit.
Yeah.
on Sunday, 17 May 2009 at 11:37 pm Seth Manapio wrote:
“In theory, Bristol Palin is absolutely right. In theory, abstaining from penis- in- vagina intercourse is the only 100% effective method of preventing pregnancy.”
This isn’t even true in theory, according to the good folks at teen advisor.
on Tuesday, 19 May 2009 at 3:41 am Christina wrote:
Christians don’t want teenagers to have sex, not because they may get pregnant, or catch an STD, but because God doesn’t like people to have sex unless they are married. Seriously. The point of abstinence is not to avoid pregnancy, but to avoid sex. Because sex outside marriage is a sin. The pregnancy prevention message is just clever window dressing to get this Christian moral teaching into American schools, IMO.
I was a spirit-filled, Bible believing, church attending Christian teenager and my fervent belief that God didn’t want me to have sex was the ONLY thing that prevented me from having actual intercourse with my boyfriend (though we did everything else but - an excellent way for girls to learn the pleasures of extended foreplay and for guys to learn to give really good oral, in my experience). However, there was at least one couple in my church youth group who didn’t develop our repertoire of ‘workarounds’, got pregnant and felt they had to marry at 18.
The point being that not having sex is REALLY HARD - because those rampant teenage hormones just make it feel so damn good (evolution rocks!). Without an exceptionally strong personal belief system and/or punitive social sanctions (’fallen women’, forced adoptions etc) I doubt that abstinence will ever be an effective method of preventing unplanned pregnancies.
on Sunday, 31 May 2009 at 7:08 am ernieson wrote:
Abstinence and birth control are ultimately individual choices.
How would legislation and subsequent laws about them be enforceable?
These issues are insolveable and politicians want it that way.
It gives them something to raise during perpetual campaigning.
The abortion issue could have legally been put to rest when the Republicans controlled all branches of govt under Bush 43.
Unsolved abortion policy is needed by the Republicans as a campaign issue. They have little beyond that to offer to stir their base.
on Monday, 1 June 2009 at 11:13 am Stats wrote:
The failure rate of any method of birth control is the pregnancy rate of its users. Thus, in the case at hand, we need to know how many members are in the specified cohort (female U.S. residents from 16 to 19 years of age who do not use birth control), and how many of them get pregnant each year. Divide the annual number of pregnancies by the number of girls, multiply by 100 to get a percentage, and that is your failure rate. I suspect it is quite low.
On the other hand, if the specified cohort is female U.S. residents between the ages of 16 and 19 who have a steady boyfriend and do not use birth control, I suspect the failure rate is quite high, but still nowhere close to 26%, much less 86%.
I would guess that the 26-86% range refers to the number of teenage girls who have unprotected intercourse and not to the number of preganacies.
on Wednesday, 3 June 2009 at 3:28 am Measuring the effectiveness of birth control. « Dating Jesus wrote:
[…] 3, 2009 · No Comments You measure it by how well it works, says Greta Christina at BlowfishBlog. […]
on Sunday, 28 June 2009 at 5:12 am pacific_waters wrote:
then it’s not abstinence, is it?
on Friday, 7 August 2009 at 8:42 am Don wrote:
The problem with teaching abstinence is not in saying that abstinence is the only sure method of birth control, but that those teaching it do so without teaching anything about sexuality. They assume that by teaching abstinence, people will be abstinent–although the data shows this is false. Since their false assumption results in the idea that people aren’t having sex, there’s no need to teach about sex, including both the wondrous pleasures and potential pitfalls. The result is actually the increase of STDs, the increase of unwanted births, the increase of child abuse, the increase of abortion. This is what happens when real research and factual evidence are submerged in archaic theology.
Speaking of which, a note to Christina: it has NEVER been that God didn’t want you to have sex. Rather, it has always been that small, vocal groups of individuals wanting power over others have said that there version of God didn’t want you to have sex. Control a person’s sex life and you control them.