Birth Control—Orphan Child of Sex?

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Millions of Americans have a bizarre attitude toward pregnancy: “If it happens, it happens.”

I do understand people who want a child. I also understand people who don’t want a child. I even understand people who definitely want a baby someday, but not now. This is all true regardless of whether people already have kids.

Whether or not to have a baby is the single biggest decision an adult can make. It affects you—male or female—during pregnancy, for 18 years after that, and actually, for most people, until they die. It affects your primary relationship, your sex life, your job/career, your finances, where you live, and who your friends are.

The difference between having a child and not having a child is huge. It’s not like the difference between, say, coffee and tea. Or a PC and a Mac. It’s huge, right?

So I always find it disconcerting when a patient says, “If it happens, it happens.” They usually explain, “We’re not trying to make it happen, but we’re not preventing it, either.”

While I’m working to keep my feelings off my face when I’m told that, I do ask people to amplify. Here are some typical things men and women say:

“I’m not so sure I/she can get pregnant anyway.”
“Birth control is such a hassle.”
“We’re just letting nature decide.”
“Talking about it is totally unromantic—it just ruins the mood.”
“It’s unfair that it’s all on the woman. Why isn’t there a really good male method?”

There is a ‘really good male method,’ of course. Vasectomy is incredibly effective, incredibly safe, and incredibly practical. And while a half-million American men get one each year (generally middle- and upper-class men), that number could be much higher with just a bit of cultural support.

It’s amazing to me that people put so much effort into controlling their lives—watching their diet and exercise, tracking their finances, protecting their passwords—and then pretend they’re powerless in this crucial area.

To paraphrase, they’re saying “We aren’t comfortable making a decision, so we’re leaving the outcome to chance. We’ll accept whatever chance hands us–even though the two outcomes (pregnancy and not) are wildly different.”

People who say some version of this are telling the truth: they aren’t comfortable making this enormous decision. They’d rather tolerate the ambiguity and unpredictability than experience the discomfort of confronting this serious adult stuff: Maybe we want two different futures. Maybe it’s time to say goodbye to a dream. Maybe I/we won’t have everything I/we want. Maybe my desires have changed—maybe I’m not who I’ve always been.

Playwrights and other artists tell us that people have tried to cope with (and avoid) these feelings for thousands of years. Today, various strategies include buying lots of stuff, getting a new partner, changing countries or careers, and getting involved in spirituality or religion. Some people even find peace through one of these methods, whether short-term or long-term.

Trying to avoid facing complicated existential truths (like ‘no one can have everything’) using a sexual vehicle puts a person at risk for the most serious consequences—having an unplanned child. If someone isn’t going to confront their life head-on, they’re probably better off, say, buying a Porsche, growing dreadlocks, changing careers, or learning to play the flute. Becoming a Life Coach or a politician are also options.

* * *

Some cultures resist the idea that people should actually shape their own fate. In most Muslim countries, health workers have learned that most people reject the idea that “You can choose how many children to have.” It’s more acceptable to say “God, of course, chooses how many children we will have. But we can decide when to have them.”

Some Americans resist family planning because it isn’t “natural.” Interestingly, they don’t apply that same reasoning to other health issues—like cancer, the common cold, chronic pain, or cataracts. There’s nothing “natural” about intervening to ameliorate these things and improve our lives. There’s a double standard about what’s “natural” that only applies to sex.

In fact, that neatly describes the Religious Right’s position about sexuality—a double standard.

Ultimately, social conservatives and political Christians are against birth control for the same reason that they’re against abortion, the morning-after pill, adult entertainment, comprehensive sex education, and marriage equality.

They’re against sexual autonomy. They’re against people using common tools to make sex safer, more comfortable, or more enjoyable. Limiting sexually-oriented information, health care, and entertainment is their way of limiting how much people can control their lives—and, by the way, separate sex from reproduction.

When people say “Pregnancy? If it happens, it happens,” they’re buying into a narrative of powerlessness—one promoted relentlessly by social conservatives. Not surprisingly, of America’s six million pregnancies each year, half are unintended.

Unintended pregnancies are as “natural” as car accidents—and even more preventable. Prevention would start with people being honest with themselves about who they are and what they want, and then discussing that with their partner. Prevention continues with the understanding—sad but true—that adulthood involves closing door after door. After that, a variety of contraceptive technologies await.

Meanwhile, let’s remember that intercourse is the only kind of sex that requires birth control. Regarding possible conception, ambivalent couples take note: there are lots of ways to make love where the outcome is absolutely predictable.

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