Anything works better when you know how to use it!

This columnist argues that teenagers shouldn’t be taught about contraception because studies show that younger, poorer, unmarried people using oral contraceptives or condoms are more likely to get pregnant than older, more affluent, married people using the same devices.  It’s an interesting attempt at logic, but it leaves out a crucial point:

Any contraceptive method that requires action by the user (that is, anything except surgery) works better when used correctly.  How do you learn to use it correctly?

  1. Somebody explains it to you.  (This may be your doctor, the instructions that come with the package, your well-informed parent, and/or your sex education teacher.  The more sources of information, the more likely it is to sink in.)
  2. You listen to the explanation and take it seriously.
  3. You follow the directions perfectly.

On the average, younger people are less likely to take instructions really seriously, more likely to be swept away by the impulse to disregard the instructions, and less likely to do things consistently, than are older people.  Those are factors in the difference in effectiveness.  People roughly 17-27 years old are simply more fertile than older people, which also is a factor.

However, the most likely explanation for a contraceptive failure is that the user didn’t know that taking antibiotics might stop the pill from working, or that a condom has to be used the whole time during intercourse and not just at the moment of ejaculation, or that condoms alone just aren’t all that effective at pregnancy prevention and are best used in combination with another method…or was aware of these things but didn’t understand why they are important.

For contraceptive methods that have to be prescribed, the doctor or clinic counselor should explain all about how to use the method and why.  But for contraceptives that can be purchased over the counter, there isn’t anybody to sit you down and make sure you listen to the instructions.  If you’re like me, you won’t use it until you have read every word of the instruction pamphlet, and you wouldn’t have bought it if you hadn’t already researched it thoroughly…but if you’re a less nervous person, or you’re not fully literate, or you’re thinking “I just put it on my penis; how difficult can it be? and if I look like I don’t know what I’m doing, she might laugh at me!” then you don’t read the instructions.  That’s your fault–but it would be great if you had that information from another source, too.

Well-informed parents are the best sex-ed teachers for their own children.  But when it comes to contraception, in particular, how many parents of teenagers are well-informed about the current technology and safety practices?  Parents in a stable, monogamous relationship may not be up-to-date on contraception, especially if they’ve been sterilized or are past menopause or want to have a large family.  Some parents are willing to do research so they can provide accurate, complete information to their kids, and that’s terrific!  But a lot of parents aren’t in that position…and some are parents because of their lack of knowledge about contraception!

Thus, sex education has a valuable role in teaching kids how contraceptives work and how best to use them.  I say “kids” because I started reading about contraception and discussing it with my mother and grandmother when I was not even a teenager–I was around 11–and I think that was very good for me.  It gave me 6 years to think about how I would prevent unwanted pregnancy, to plan for consistent and correct use of contraception, and even to include contraception in my sexual fantasies.  By the time I was ready to have sex, I was very accustomed to the idea of contraception and ready to use it…and I took it very seriously because I also was fully informed of the odds of pregnancy and the effect that an early pregnancy would have on my life.

It’s ironic that the columnist argues in favor of getting rid of comprehensive sex ed in favor of preaching abstinence because “at least abstinence actually works.”  Well, yeah: Like contraception, it works if you use it absolutely correctly, every single time!  Even her reviled Planned Parenthood cites abstinence as the #1 form of birth control.  The primary reason abstinence programs are not very effective is that many teenagers who vow to abstain actually don’t, for the same reasons that many teenagers who say they use condoms actually use them inconsistently.

In fact, the Guttmacher Institute, source of the two papers she cites, also published this paper summarizing research on abstinence-only programs.  Notable excerpts:

The second study, by researchers from Guttmacher and Columbia University, analyzes the relative contributions of abstinence and contraceptive use to the 24% decline in the U.S. teen pregnancy rate seen during the same 1995–2002 period. This study, published in the January 2007 issue of the American Journal of Public Health, finds that the decline occurred primarily because teens were using contraceptives better. Examining data from two rounds of a large-scale national survey, the researchers conclude that the vast majority of the decline (86%) was the result of dramatic improvements in contraceptive use, including increases in the use of individual methods, increases in the use of multiple methods and substantial declines in nonuse. Just 14% of the decline could be attributed to a decrease in sexual activity.

According to Douglas Kirby, a senior research scientist at ETR Associates who has analyzed hundreds of program evaluations, there is strong evidence that comprehensive sex education can effectively delay sex among young people, even as it increases condom and overall contraceptive use among sexually active youth. This is in sharp contrast to what can be said about the effectiveness of abstinence-only education. A recent, congressionally mandated evaluation of federally funded abstinence-only programs by Mathematica Policy Research—conducted over nine years at a cost of almost $8 million—found that these programs have no beneficial impact on young people’s sexual behavior.

According to research by Hannah Brückner and Peter Bearman published in the Journal of Adolescent Health in 2005, the majority of teens enrolled in grades 7–12 in 1995 who pledged to remain virgins until marriage had sex before marriage or by the time of a follow-up survey in 2001–2002. Furthermore, compared with those who never took a pledge, “pledge breakers” were less likely to use condoms and to seek testing and treatment for STIs, and just as likely to test positive for STIs.

I’m all for abstinence by people who are not ready to face the risks of sexual activity with complete responsibility for protecting themselves and their partners and determination to take good care of any child who may result.  I think children should be taught, by as many sources as possible, that waiting to have sex (or never doing so) is a fine choice, and that sex is a very powerful experience that brings great responsibility.  I also think they should be taught about all the methods of contraception, their risks and benefits, and how to use them.  Parents should teach their children their values regarding when to have sex and which practices are morally acceptable, but that doesn’t mean the children should reach adulthood believing that the morally unacceptable practices don’t exist.  Then how would they know how to recognize offers to engage in those practices, or why to decline?

To me, the idea that knowing how to use a condom correctly means kids will rush out and have sex makes about as much sense as the idea that knowing how to use a fire extinguisher means kids will set fires.  If your child has no impulse control, that’s the problem!  Don’t blame knowledge.

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