Birth Control

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Printed in the United States of America
Birth Control
We should not delude ourselves: The population explosion will come to
an end before very long. The only remaining question is whether it will
be halted through the humane method of birth control, or by nature
wiping out the surplus.
—Excerpt from The Population Explosion, by Paul & Anne Ehrlich, 1990,
Simon & Schuster.
Over 75% of American married women use contraception
(Seager, 2003), and as a result, the average age at which
American women have their first baby is 25 (National
Center for Health Statistics, 2010). Unfortunately, consistent use of contraception is apparently not as common
among teens. While over 85% of teens say that they want
to avoid pregnancy (see Gibbs, 2010), the teenage pregnancy rate in the United States is the highest of any developed country in the world (see Table 1). It is eight
times higher than in Japan, seven times higher than in
Sweden and Denmark, over five times greater than in
France, and three times greater than in Canada (United
Nations, 2007).
As a result, the teenage birth rate in the United States
is also higher than in other developed countries. This is
not a recent phenomenon. Births to teenagers in the
United States reached a peak in 1957. What is new is the
proportion of births to unwed teens. Only 15% of teenage
births were out of wedlock in 1960, but this figure rose to
49% by 1980, and reached 76% in 1991. The percentage
of children born to unwed mothers (of all ages) reached a
peak of 40.6% in 2008 (the last year recorded as of this
edition) (National Center for Health Statistics, 2010). The
greatest increase in pregnancy rates has been among
young teens aged 14 to 17 without a high school education. About 78% of pregnancies to teens are unintended,
and nearly half of these are terminated by abortion
(Henshaw, 1998a). Over one third of woman who have
had an unintended pregnancy have another unintended
pregnancy (Wildsmith et al., 2010), and repeat unintended pregnancies may be increasing (Collier, 2009).
When you have finished studying this chapter,
you should be able to:
■
Discuss the teenage pregnancy problem in the
United States and understand the worldwide need
for effective contraceptive techniques.
■
Explain the lactational amenorrhea method as a
temporary method of birth control after childbirth.
■
Explain how the various fertility awareness methods
of contraception are supposed to work.
■
Compare and contrast the various barrier methods
of birth control and their effectiveness.
■
Discuss the latest developments in intrauterine
devices.
■
Describe the various hormonal methods of
contraception, how they work, and their potential
side effects.
■
Understand how emergency contraception works.
■
Describe the various sterilization procedures and
explain their advantages and disadvantages.
■
Discuss the various methods of abortion.
■
Discuss the contraceptive methods that also help
to prevent sexually transmitted infections.
■
Determine which contraceptive technique is right
for you.
From Chapter 6 of Human Sexuality Today, Seventh Edition. Bruce M. King. Copyright © 2012 by Pearson
Education, Inc. Published by Pearson Prentice Hall. All rights reserved.
125
Birth Control
TABLE 1
Yearly Teenage (15–19 Years Old)
Pregnancy Rate (per 1,000 Women)
in Developed Nations
United States
41.2
Russian Federation
28.5
England and Wales
26.7
Australia
16.3
Canada
13.3
Spain
11.5
Germany
10.1
Finland
9.4
Norway
8.7
France
7.8
Italy
7.0
Sweden
5.9
Denmark
5.9
Japan
5.1
Netherlands
3.8
Source: Adapted from the United Nations Demographic Yearbook 2006,
Dept. of Economic and Social Affairs. Copyright © 2006 United Nations.
Reprinted by permission.
The high teenage pregnancy rate in the United
States comes in spite of significant improvements since
the early 1990s. The percentage of high school students (all grades) who had ever engaged in sexual intercourse decreased from 54.1% in 1991 to 46.0% in
2009 (Eaton et al., 2010). The U.S. teenage pregnancy
and birth rates also began to decline after 1991, and
by 2005 had reached their lowest levels since 1976
(Gavin et al., 2009). The teen birth rate increased
slightly in 2006 and 2007, but dropped again in 2008
(National Center for Health Statistics, 2010).
The birth rate is much higher for AfricanAmerican and Latino teenagers than it is for white or
Asian-American teens (Eaton et al., 2010). However,
the birth rate for African-American teens has also
decreased substantially since 1991, and the rate for
unmarried black teens is the lowest it has been in
40 years. On the other hand, the rate for Latino teens
is increasing. White teens are much more likely than
black or Latino teens to “hide” an unintended pregnancy by getting married. Because the divorce rate for
couples married as teenagers is much higher than average, many of these prematurely married white teens
end up as young single parents anyway (see Coley &
Chase-Lansdale, 1998).
What is responsible for the decline in teenage
pregnancies in the last decade? According to Sarah
Contraception ■ The prevention of conception.
126
Brown, director of the National Campaign to
Prevent Teen Pregnancy: “There are only two ways
these rates could have gone down. Kids are having
less sex and they’re using contraceptives better”
(quote by Pitts, 2001). In fact, among sexually active
teens, about 60% (girls) to 80% (boys) reported
that condoms were used during their last sexual
intercourse, and 19.8% reported that birth control
pills were used (Eaton et al., 2010; Fortenberry
et al., 2010; Reece et al., 2010a). Condom use was
highest among black and Hispanic teens (Dodge
et al., 2010; Reece et al., 2010a; Sanders et al.,
2010). Nevertheless, the high pregnancy rate among
U.S. teens compared with that of other developed
countries reflects that there is still widespread
nonuse or inconsistent use of contraception.
Why do some people have sex without using contraception? Some of the most common reasons are
method-related difficulties and side effects, infrequent
sex and leaving it to chance, or just plain not really
caring (Frost et al., 2007; Richters et al., 2003b).
Teens with repeat pregnancies generally have a history of behavior problems (school problems, drug
and alcohol use, etc.) (Gillmore et al., 1997).
Among young teens, ignorance about reproduction and contraception is common.
“As a paramedic I’ve delivered more babies than
I can count. Once I responded to a person with
‘rectal bleeding.’ To my surprise, a young girl greeted
me saying that ‘she has something coming out her
rectum and she is bleeding all over.’ The 15-year-old
was scared to death, still clothed in underwear,
bleeding, with a large mass between her legs,
inside the underwear. I gained information from
the family that no one had any inclination that this
15-year-old was even pregnant. What an education
for a 15-year-old. Is this really what we want for our
children, or do we want to provide the availability
of more classes such as Human Sexuality? I vote
for the latter.”
(from the author’s files)
However, most teens know about contraception,
and also know that if they have sex without contraception they are taking a chance. But if they have
already taken that chance without having it result in
pregnancy, they are likely to take the chance again.
Eventually, they begin to feel that they cannot get
pregnant—that it will not happen to them.
“I have been having sex since I was 16. I have had
different partners and unprotected sex with all of
them. I always believed that I couldn’t get pregnant.
It only happens to bad girls and people who wanted
it to happen. There were a couple of late periods and
worrying, but it never made me want to try birth
control. . . . I found out I was 2 months pregnant.
I was completely shocked.”
(from the author’s files)
Birth Control
The teenage pregnancy rate in the United States is
related to social and economic status (B.C. Miller,
2002; Singh et al., 2001). Teenage pregnancies are
much more likely to occur among those with low
income or low levels of education, and/or who live
with a single parent. Thus, the teenage girls most
likely to have babies are generally the ones least prepared to take care of them—teens who are already
living in poverty and with low educational aspirations (Coley & Chase-Lansdale, 1998; Harden et al.,
2009; Letourneau et al., 2004). Teenage mothers are
much more likely to have high-risk babies with health
problems, problems often made worse because many
pregnant teens never seek prenatal care (Hein et al.,
1990). As a result, the United States has one of the
highest infant mortality rates among developed countries (Singh & Yu, 1995).
Being an unwed teenage mother does not guarantee that she will be locked into poverty with no
job skills and little education, but most will experience long periods of hardship because of early
childbearing (see Coley & Chase-Lansdale, 1998,
for a review). Teens who become mothers complete
about two fewer years of schooling than women
who delay giving birth (Hofferth et al., 2001).
In addition to not being economically or physically
ready to have children, teenagers are generally not
emotionally ready to have children either. Studies of
children who grew up unwanted reveal that most suffered from long-term psychological and physical
health problems (David et al., 2003; Sigal et al., 2003).
Children of teenage parents are also much more likely
than other children to be victims of child abuse and
neglect (Goerge & Lee, 1997). The children of teen
parents who later become young teen parents themselves often report that they experienced emotional
deprivation at an early age, have had significant
depressive symptoms, and “seek emotional closeness through sexual activity and early parenthood”
(Horwitz et al., 1991).
© Jimmy Margulies
Who are the male partners responsible for these
teenage pregnancies? Half of the fathers of babies born
to girls aged 14 to 17 are at least 20 years old, and
27% are at least 5 years older (Lindberg et al., 1997;
Taylor et al., 1997). Nevertheless, many male teenagers
also become fathers. Only about half of these fathers
spend any time with their children and only one fifth
contribute money (Rangarajan & Gleason, 1998).
Men who do poorly in school, lack long-term goals,
come from impoverished backgrounds, and engage
in other socially deviant behaviors (e.g., drugs) have
the most irresponsible attitudes about reproduction.
In fact, many of these men consider getting a woman
pregnant a sign of masculinity.
“I am an admitted ’serial monogomist.’ One of these
types of relationships led to pregnancy right after
high school. . . . My ex and I no longer speak to each
other and he has never been a part of his own child’s
life (by choice).”
(from the author’s files)
Perhaps the most unfortunate part of all this is
that the high rate of births to teens continues to occur
in a day and age when highly effective means of birth
control are available. This was not always the case.
The prevailing attitude toward sex during Victorian
times and throughout the history of the Christian
church, as you recall, was that it was for procreation
only, and thus birth control was opposed. In many
states it was against the law to sell or distribute contraceptive devices. As a result, women generally had
several children, and many poor women who worried that they could not feed another child died during crude and often self-attempted abortions. It was
as a result of watching one of these poor tenement
women die from a self-induced abortion attempt in
1912 that Margaret Sanger gave up a nursing career
and founded the Birth Control League (later changed
to Planned Parenthood). The work of reformers and
the changing attitude about the role of women in
general gradually had their effect.
The last of the state laws prohibiting the sale of
contraceptive devices to married couples was finally
repealed in 1965 (by a U.S. Supreme Court decision in
the case of Griswold v. Connecticut), and laws preventing the sale to unmarried persons were struck
down in 1972 (Eisenstadt v. Baird). By then, 81% of
the public approved of the availability of birth control
information. The birth control pill was introduced in
1960, but until recently condoms and other birth control devices that did not require a visit to the doctor
were kept behind the counter in drugstores, which
inhibited many people from purchasing them.
Today, worldwide (each year), “Family planning
programs prevent an estimated 187 million unintended pregnancies, including 60 million unplanned
births and 105 million abortions, and avert an estimated 2.7 million infant deaths and 215,000 pregnancy related deaths” (Amy & Tripathi, 2009).
127
© Bettmann/CORBIS
Birth Control
FIGURE 1 Margaret Sanger, a founder of the birth
control movement, was forbidden to talk about birth
control, so in 1929 she voluntarily had her mouth
taped and wrote about the subject on a blackboard.
Unfortunately, in the United States there has been a
major decline since the mid-1990s in government
funding for family planning programs (Bongaarts
& Sinding, 2008). In the private sector, health insurance covers Viagra so that men can get erections,
but doesn’t cover birth control for women.
PERSONAL REFLECTIONS
Are you prepared at the present time to assume the
responsibilities of being a parent? Why or why not?
How would your life change if you or your partner were
pregnant (consider your relationship, finances, career
goals, etc.)?
WORLD POPULATION
In addition to personal reasons, there are other reasons why a society as a whole should practice birth
control. Imagine two shipwrecked couples on a
small South Pacific island in the year 1700. The island has a small supply of fresh water, some animal
life but no predators, edible vegetation, and a small
amount of land suitable for farming. For these four
people, the island is Utopia—it has more than they
will ever need. Each couple is fertile and has four
children (probably an underestimate without birth
128
control), and the children in turn pair off in their
late teens to form four couples, each of which has
four more children. Thus, in each generation there
would be twice as many people as in the previous
generation. If there were no accidental deaths and
the people lived until age 65, there would be at least
224 people living on the island by the year 1800.
For those people, the island is no longer Utopia.
The animals have all been killed, the edible plant
life is consumed within days of becoming ripe, and
there is not nearly enough farmland to support a
population of this size. What is worse, even the
water supply must be rationed, and the population
continues to increase. Soon there will be large-scale
death from starvation and dehydration.
Wildlife experts are used to seeing this happen to
populations of deer in areas where there are no predators, but is this scenario too far-fetched for humans?
Consider that the world is really just an island. We
have a limited amount of natural resources, including water. Should these resources become exhausted,
we would find ourselves in the same situation as the
inhabitants of our hypothetical island. The world
population has been increasing at an alarming rate
(see Figure 2), and it is now more than 25 times
greater than in the year a.d. 1. It was about 800 million in 1760, reached 5 billion in 1987, and reached
6 billion at the end of 1999. By July 2010 it was 6.83
billion, and was projected to reach 7 billion in 2012.
The United Nations estimates that the world population will be 9.1 billion in 2050. The Population
Reference Bureau predicts 9.4 billion (Energy
Bulletin, 2009). In that year, the three most populated countries are expected to be India (1.529
billion), China (1.478 billion), and the United
States (349 million).
Many experts predict that unless this world
population explosion is substantially slowed, the end
result will be widespread starvation, poverty, and
political instability. Already, half the children born
today are at poverty levels. Robert Repetto of the
World Resources Institute estimates that if the present population doubles, all of the current cropland in
the world would have to produce 2.8 tons of grain
per acre per year, equivalent to the most productive
American farms. Read again the warning by Paul
and Anne Ehrlich, authors of The Population
Explosion (1990), at the beginning of the chapter.
They add:
We realize that religious and cultural opposition to
birth control exists throughout the world; but we
believe that people simply do not understand the
choice that such opposition implies. Today, anyone
opposing birth control is unknowingly voting to have
the human population size controlled by a massive
increase in early deaths.
David Pimentel (1998) of Cornell University
adds that unless something is done soon, by 2100
Birth Control
natural resources have been strained? I do
not know, but our average lifestyle could not
2050
possibly be as good as it is today.
9.0
What prevented the United States from
having this population explosion? Quite
8.0
simply, it was the use of birth control,
which has made it possible for people to
limit the number of children they have.
7.0
2010
The birth rate started to fall in the early
1960s, and by 1970 the average American
6.0
1999
woman had 2.0 births in her lifetime. In
2006, the U.S. birth rate increased to 2.1
1987
5.0
births in a lifetime, the figure that the
government says is necessary for the
4.0
1971
population to replace itself (National
1960
Center for Health Statistics, 2007). The
3.0
fertility rate is now below the replacement
level in 20 developed countries, and as low
1930
2.0
as 1.3 in southern and central Europe (see
Longman, 2009). In eastern and western
1.0
Africa, on the other hand, the fertility rate
is 6.2, and 3.8 to 4.2 in western and south0
central Asia (Potts, 2000). Accessible birth
500
1000
1500 1800 2010
control in developing countries could
Year (A.D.)
avoid 76 million pregnancies every year,
which according to some experts, could
help the environment by slowing climate
FIGURE 2 World population growth. Notice how rapidly the
change (The Lancet, 2009).
world population has increased since the beginning of the 20th
Stop and think about it for a minute:
century.
Would you really like to see us in a situation where our population doubles every generation? We might be able to continue to live
“12 billion miserable humans will suffer a difficult life
comfortably during our lifetime, but what would
on Earth.”
life be like for our grandchildren?
In some parts of the world, mass starvation is no
longer hypothetical, but already a reality. It is happening in Ethiopia, Somalia, and in many other
parts of Africa and in Asia. In India, infanticide (the
killing of children, especially newborn girls) is not
uncommon (Cohen, 2000). China, presently the
world’s most populated country with about 1 billion
If all fertile couples practiced unprotected sexual
people, has much less farmland than the United
intercourse (no pills, condoms, diaphragms, etc.) and
States. There is only one fifth of an acre of land per
did not abstain from having sex at any time of the
person, which is just enough to provide food for one
month (no fertility awareness methods), about 85%
person. Any additional increase in the population
of them would conceive within a year. In judging
will mean starvation for millions. As a result, the
the effectiveness of the various birth control techChinese government was forced in 1982 to order
niques, we need to know how many couples using a
mandatory birth control. For the next 100 years,
particular contraceptive method would conceive in
couples will be told not to have more than one child.
a year’s time. There are actually two figures here
As a result of this policy, China’s fertility rate has
that are important: the perfect-use pregnancy rate
fallen dramatically from about 6 children per
and the typical-use pregnancy rate.
woman in 1970 to about 1.8 to 2.1 children in 1997
For a particular contraceptive technique, the
(Attané, 2000).
perfect-use pregnancy rate is the percentage of
During the “baby boom” years (following the end
couples who would conceive if all couples who
of World War II through 1960, there was an average
were using the technique used it consistently and
of 3.5 babies born to each American couple (Gibbs,
2010). If that rate had continued, the population of
the United States today would be around 500 million,
Perfect-use pregnancy rate ■ For a particular birth control
nearly twice what it actually is. Just imagine what the
technique, the percentage of pregnancies during the first year of
congestion and pollution would be like. Would our
use by couples who use the technique properly and consistently.
Billions of persons
10.0
EVALUATING DIFFERENT
BIRTH CONTROL METHODS
129