The Contraception Gap

I recently read an amazing report by The National Campaign to Prevent Teen and Unplanned Pregnancy called The Fog Zone: How Misperceptions, Magical Thinking, and Ambivalence Put Young Adults at Risk for Unplanned Pregnancy (PDF). It’s a thorough and impressive bit of research about the gap between what young adults know about contraception and their practices. Here are some of the highlights:

Among unmarried women in their 20s, fully 7 in 10 pregnancies are unplanned, reflecting the fact that a significant proportion of sexually active, unmarried young adults—who themselves say they do not want to be parents right now—are not fully protecting themselves from pregnancy by the careful, consistent use of contraception.


Most unmarried young adults feel strongly that pregnancy should be planned. In fact, “94% of men and 86% of women believe pregnancy should be planned. Further, 86% of men and 88% of women say it is important—74% of men and 80% of women describe it as very important—to avoid pregnancy in their lives right now.”

At the same time,

[A]mong those unmarried young adults who are currently in a sexual relationship and who are not trying to get pregnant or cause a pregnancy, 19% use no contraception at all and 24% use contraception inconsistently (contraceptive use is unknown among 7% of unmarried young adults).

Further, “17% of women and 19% of men surveyed freely admit it is either extremely or quite likely that they will have unprotected sex in the next three months.” And even those who say that it’s very important to not get pregnant right now, “34% say it is likely they will have unprotected sex in the near future (12% say it is extremely likely, 5% quite likely, 17% slightly likely).”

Clearly, there’s a significant gap between intentions and actions, so it’s not a surprise that 31% of the women reported that they have had an unplanned pregnancy and 69% of women report that many of their friends have had an unplanned pregnancy.

What’s Going On?

There seem to be a number of factors causing this situation and I’ll admit that I was surprised by some of them.

First, many young adults know little about how contraception works. Given the appalling state of sex education in the US, this isn’t a shock. There are also a lot of myths and misunderstandings about how contraception works (also not a big surprise), which makes it more likely that people won’t use it correctly.

Another reason is that many young women fear side effects from hormonal contraception. According to the report, many of these women’s fears are based on exaggerations of the risks, and I suspect that a lot of that can attributed to the scare tactics that abstinence-only anti-sex propaganda uses. Similarly, many young adults believe that contraception isn’t as effective as it actually is, so they figure that it’s not worth using. Since ab-only often uses disinformation techniques, that’s also not unexpected.

Having said all that, I was a bit startled to read that “59% of women and 47% of men say it is at least slightly likely they are infertile (19% of women and 14% of men describe it as quite or extremely likely),” even though only 8.4% of women age 15-29 have fertility issues. Apparently, this is due to the perception that pregnancy is more likely from a single sexual experience than it actually is. So when they don’t get pregnant, they figure that there must be something impairing their fertility, in which case, contraception becomes less important.

I have a sense that the overestimation of the odds of pregnancy can also be attributed (at least partially) to the ab-only tactic of misrepresenting risk in order to inspire fear. If that is the case, this is woefully ironic.

I was also rather shocked to read that “38% of men and 44% of women believe ‘it doesn’t matter whether you use birth control or not; when it is your time to get pregnant it will happen.'” I’m not sure why this surprised me so much, but it did. Perhaps if you think that contraception doesn’t work and know a lot of other people who got pregnant unintentionally, it fosters the idea that you can’t control when it’ll happen to you. After all, if you don’t have a sense of control, then there’s no point in trying to exert control, is there?

Along with that, some groups are openly suspicious of family planning. Some people of color believe that contraception is a government plot to limit birthrates in their communities. Others think that “government and public health institutions use poor and minority people as “guinea pigs” to try out new birth control methods.” Given the troubling history of the intersection of racism, medicine, technology, and experimentation, I can certainly understand that. And it adds to the barriers to using contraception among these communities.

There are many influences that have come together to create these trends. And one of the most injurious has been our legacy of disinformation and propaganda that we know as “abstinence-only education.” I’ve always believed that if you have to lie to get someone to comply with your rules, there’s something wrong with what you’re doing. And we’re beginning to see more and more effects of the ab-only legacy. I can only hope that we get over that someday.

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