"I Don't Want to be Pregnant" is Reason Enough

As I said Friday, I'm really tired of hearing about how abortion should be rare. In that post I demonstrated that even if you're careful and use two methods of birth control (or practice abstinence), the cumulative risk of pregnancy over many years of use is pretty high. As a result, we should expect a fairly substantial demand for abortion.

Since writing Friday's post, I've had a couple conversations with people who identify as pro-choice, yet maintain that even with the fairly high birth control failure rates, abortion should be rare. Which means they think that abortion is okay in some circumstances but not others (and we're not talking about trimesters here.)

That's not exactly what I'd call "pro-choice." It's more like begrudging choice. Like, "I'll let you get this abortion, technically, but I'm totally going to judge you and shame you for it." That's not cool. And it's going to scare some folk out of getting an abortion who want one.

"I don't want to be pregnant" is a good enough reason. It will be my reason, should I ever get pregnant. I'm healthy. I'm financially comfortable. I even think I'd be a decent parent. But I do not want to give birth, and so I'm not going to. Please keep your judgment to yourself. It's my medical decision to make, and implying that I shouldn't have an abortion is, frankly, anti-choice.

The Typical Use Failure Rate of Abstinence

Last Friday I wrote a post about birth control effectiveness. I wished to demonstrate that even a careful user of birth control has a fairly high probability of becoming pregnant, and the assumption that all persons seeking abortions are pregnant because they screwed up their birth control is just plain wrong.

If you missed the last few paragraphs, though, you might think I was building up to some sort of abstinence-only argument. Even if its failure rate were zero, I would not argue that abstinence is a good birth control method. If you want to have sex, I am sure as hell not going to tell you not to.

But the typical use failure rate for abstinence is definitely not zero. Good statistics are hard to come by, but most attempts at quantifying the failure rate of abstinence rank it worse than condoms.

The most optimistic non-zero value cited for the failure rate is 26%. Time for another plot!

With these numbers (which are admittedly much more poorly constrained than the failure rates I discussed on Friday), a person using abstinence as their main form of birth control has a roughly 70% chance of getting pregnant within 5 years. Definitely not a great method for preventing pregnancy. I cannot emphasize enough how useless I find abstinence-only sex ed.

Birth Control Math

I learned about contraception at a reasonably early age (around 12, I think); I know that many kids are not so lucky. I don't recall where I got my information, but it was probably a combination of health class, my parents, and these pamphlets I got in the mail along with feminine hygiene product samples. In any case, I knew about condoms and the pill and that they could protect against pregnancy.

On the other hand, there was relatively little discussion of the odds. Numbers are important; to make informed reproductive decisions, you need to know how likely you are to get pregnant from a single sexual encounter, how likely you are to get an STD, and how effective the various forms of prevention are.

I still don't have the answers to all of these questions, though I have been able to find some other usable data (odds of getting pregnant in one year of unprotected sexual activity? 85%. Scary.) When I first saw exactly how effective the various birth control measures were, it took my breath away. If you use condoms, for instance, you've still got a 15% chance of winding up pregnant by the end of the year. This means that "use a condom" is woefully inadequate advice.

It gets worse when you consider the cumulative probability of getting pregnant over multiple years. Let's stick with condoms for the moment. The probability that you're going to avoid getting pregnant that first year is 85% (or 0.85). But the probability that you're going to avoid getting pregnant two years is 0.85 x 0.85. Each year, multiply by 0.85 again. That number gets small fast. After 5 years, it's more likely than not that you will end up pregnant at least once. The longer you play the odds, the worse it gets. In fact, if a person with a uterus of average fecundity uses only condoms for the 30 or so years they are ovulating, they can pretty much count on getting pregnant at least once:

Of course, we all know that condoms are not the only way to prevent pregnancy. Let's next compare a few different methods, the effectiveness of which I have simply copied from Wikipedia:

Method	Failure Rate
Nothing	85%
Condom	15%
The pill	8%
Copper IUD	0.8%
Tubal ligation	0.5%

The failure rates listed above are "typical use failure rates", or the percentage of the time that people using each method get pregnant after a year. With so-called "perfect use", the effectiveness of many of these methods improve, but are you really going to choose your birth control assuming that you're going to be better at it than everyone else? I'm sure as heck not.

Anyway, for each method, you can repeat the analysis I did above:

Or, if you prefer equations, for a birth control method with a failure rate of x% used for y years, the probability that you'll get pregnant at least once during those years is given by P%, where:

If you're just trying to delay pregnancy or not get pregnant quite so often, then great, these methods should work for you, but if you are, like me, dedicated to childlessness, these odds are not good enough. So, the next obvious thing to try is doubling up on methods:

I realize that most of my readers are adults and thus probably have made their birth control decisions. But if you're in a position to educate youngsters, please share this information with them. The more you know, etc.

There's a second point I want you to take away from these plots. Many of the most effective methods, such as IUDs and sterilization, are regularly withheld from young and/or childless women by doctors who won't believe their patients really don't want children. This is a symptom of our reluctance to let women make their own reproductive decisions, and it means that the most effective methods (and the methods that are most difficult for a partner to tamper with) are the hardest to obtain. The pill and the condom, both temporary methods that must be continually reapplied, are thus the most common choices in the U.S.

Many a cautious individual will choose to use both the pill and condoms. Even if these methods are continually used from menarche to menopause, the purple curve in the above plot shows that there is a 30% chance at least one pregnancy will occur during that period. At that point, to remain nulliparous, they will need to obtain an abortion.

To continue this thread of logic, this means that even if everyone doubles up on birth control methods, there will still be a not-insignificant need for abortion. And that assumes everyone can double-up; in reality, not everyone can take the pill or use latex condoms. Even if everyone in the country is extremely responsible about using birth control, there will still be a substantial need for abortion. I do not want to hear about how abortion should be rare. Unless your ideal involves widespread, compulsory sterilization, I just don't see how that's possible. Abortion is an important health service for everyone with a uterus, and should not be "rare" unless significant advances are made in birth control technology.

I Fucking Love Greg Proops, You Guys

If you don't listen to Greg Proops's* show, The Smartest Man in the World, you're truly robbing yourself of one of the most hilarious twice-monthly hours of comedy ever. Below, a rough transcript of part of his National Lady's Day show, Lines (yes, it's International Women's Day, but the US doesn't recognize it. Proops does, so there you have it, he can call it what he wants, I guess). Anyway, I have spent some time transcribing my favorite part of his most recent podcast. It sometimes takes me forever to get to things like podcasts, so it's a bit late, forgive me. Please enjoy, and go listen to the podcast, because I can transcribe the words but not the sneering, nasal, affected voice I love so much.

"I don't know if it's come to your attention, but the Senate is about to vote on all women's healthcare in this country by closing Planned Parenthood, and it brings me to this point: You really don't see women legislating against men's reproductive organs. For some reason, the pink and perfect caves of mystery that women possess are the most trepidatious threatening thing that could ever happen to an ugly, fat, icky man** that's never been inside them. Now, men go on and on and on and on about how mendacious and horrible women are, because women want to kill babies, or women want to look after themselves. It's always 'you can't have women blah blah blah women are evil.' You think, 'I know, it's a great argument, you've really made your point.' The whole issue of abortion is not controversial in any way, let me just clear that up for you, people who are listening, and people who have tweeted me because I'll tweet about, you know, Stop the Senate's attack on Planned Parenthood. And I'll get 'Women's health! Why don't you just call it what it is! Abortion! Haha!' And I think, you've really thought this out. Abortion's not controversial. It's biological. If men got pregnant instead of women, abortions would not only be free and on demand, there'd be a clinic on every corner, you'd be in and out in five minutes like fucking Jiffy Lube, okay? There'd be coupons in the phone book, there'd be all-night infomercials - 'Are you a boy in trouble?' Men can't stand any pain whatsoever and have no endurance to carry anything for nine months. We can't even watch a show we like on TV the whole way through without flipping around. So the idea in any way that abortion is controversial, AB-solutely biological. Men have the fucking ball, and men don't want to give the ball up, and men don't want to give anything to the people who aren't men. And that's how that fucking works. I wish that was funnier, but it kind of started to be, and then it kind of faded out at the end. Women have every right to do what the fuck ever they want with anything that's inside their body at any goddamn time, end of fucking story. And don't e-mail me and disagree, because I'm not entertaining dissent. I am the Smartest Man in the World, and I have adjudicated...

"To all the men out there, and even the women, who are opposed to Planned Parenthood because you have no idea what Planned Parenthood does, you have a mother, you have a sister, you have a daughter, you have a cousin, you have a niece, you have a girlfriend, you have a wife, you have a significant other. Think about that. I mean, it always comes back to personal politics, because everything in the world is personal... If you disagree with me and you think, 'Well, abortion is wrong and babies are killed and dodododo,' you have a mother, you have a sister, think about their health. Think about that, too."

* Yup, that's the guy from both the British and the American versions of Whose Line is it Anyway?
** For the record, I don't like his use of "fat" here, but he's The Smartest Man in the World, not the Most Perfect Man in the World.