Pleasure, Prophylaxis, Procreation: more on “jumping the life to come” and unintended pregnancy

This post two weeks ago about contraception and adolescent risk-taking sparked some rather heated discussion. In an effort to shed light rather than merely generate heat, reader Kate sent me an article (not available online, she sent the PDF): Pleasure, Prophylaxis and Procreation:
A Qualitative Analysis of Intermittent Contraceptive Use
And Unintended Pregnancy, which appears in the September 2008 issue of Perspectives on Sexual and Reproductive Health.

The study looks at what the authors call “pregnancy ambivalence”. It hasn’t been studied before:

Indeed, reflecting the field’s general neglect of the
role of sexuality in reproductive behaviors, few researchers
have examined whether unprotected sex or
ambivalence about pregnancy may heighten the sexual
experience, or whether the romantic notion of creating
a child with someone may deter the use of contraceptives.
We know little about the emotional, physical
and cognitive states that contribute to situations in
which lack of contraceptive use is pleasurable or purposeful
to women and men.

The study makes clear that the availability of safe and legal abortion has little bearing on the decision couples make to “spontaneously” avoid the use of contraception. Indeed, the idea of abortion as a “back-up” is never mentioned in the study. Rather, the triggers for intermittent contraceptive use, in addition to the phenomenon of “pregnancy ambivalence”, are three distinct types of pleasure both women and men may derive from unprotected intercourse:

1. Active eroticization of pregnancy risk. The least common
but most direct articulation of the pleasures of pregnancy
ambivalence took form in the eroticization of pregnancy
risk. In these cases, participants described increased
sexual arousal at the prospect of conception.

2. Passive romanticization of procreation. In many cases,
ambivalence manifested not as heat-of-the-moment
arousal, but as a less dramatic romanticization of the
general idea of a pregnancy with a particular partner.
Certain respondents flirted with pregnancy in the form of
a subtle romantic fantasy that also contributed to intermittent
use or non-use of contraceptives. While these
respondents did not actively intend to conceive, they did
not stringently avoid pregnancy, either.

3. Escapist pleasures. Even when they were not planning
or hoping for a baby, several respondents came to
embrace an unintended pregnancy as a way to foster
a relationship, cultivate a new family and potentially
escape the hardships of their lives. Not surprisingly, only
less socially advantaged women—especially those who
had become pregnant at a young age—described this
phenomenon. Pregnancies represented temporary hopes
that things would get better and that their unborn
children would enjoy brighter futures.

As I wrote in the post linked above, I certainly engaged in “active eroticization of pregnancy risk” with my high-school girlfriend; as I recall, her reasons for occasionally avoiding contraceptives were the same. Our experience jives with this study, driving home a basic point that ought to be clear to anyone concerned about young peope and reproductive health: encouraging contraceptive use by warning of the dangers of an unwanted pregnancy ignores the complex matrix of reasons which inspire at least a fleeting fantasy of conceiving a child.

When one of my older cousins found out I had gotten my high school girlfriend pregnant, he asked me, indignantly, “Didn’t you know how babies are made?” His bewilderment reflected the bewilderment of many folks who assume that sex education and widespread availability of contraception ought to be sufficient to end unintended pregnancies. But education isn’t enough. Distributing condoms isn’t enough. What’s needed is honest, explicit, early conversation about the various cultural and psychological factors that trigger risk-taking behavior and feed the fantasies that lead to “pregnancy ambivalence.”

The “abstinence-only” movement misses the mark with its presumption that sex is designed for heterosexual marriage alone; purity advocates are unwilling to embrace the simple idea that our sexuality belongs not to a partner but to ourselves (and, if we are religiously inclined, to God.) The abstinence movement refuses to acknowledge that our sexuality is designed to bring us joy throughout our whole lives, from puberty to old age, and that the experience of joy is not contingent upon the presence of a heterosexual spouse. But the “sex education” movement, such as it sometimes is, often makes the mistake of building an idol out of education itself; it assumes that giving young people access to contraception and knowledge about how contraceptives work will be a sufficient prophylaxis against unintended pregnancy and disease. That approach, though it has much to commend it, also falls short of the mark.

The study concludes with a sobering, and intuitively accurate remark:

Women and men benefit
psychologically and socially from sexual risking-taking—a
notion missing from the family planning literature, which,
like public health literature more broadly, tends to ascribe
qualities of future orientation, rationality and safety consciousness
to people’s reproductive health behaviors.

Effective sex education must embrace the idea that for many of us — particularly but not exclusively the young — reconciling sexuality and “rationality” is difficult if not impossible. That’s not a sufficient argument for confining intercourse to the presumed safety of the marriage bed. But it is a powerful argument that we need to do more to address the extraordinary influence desire and fantasy and longing have on our thought processes. Real sex education must confront the fundamental irrationality that frequently undergirds our sexual decision-making, and it must do so confident that through open and honest discussion, we can begin to give people the tools to make better decisions, even in their most emotionally and hormonally charged moment.

Many, perhaps even most, young people eroticize risk. That’s axiomatic. But that doesn’t mean all will engage in risk-taking behavior. Focusing as much of our attention on the illusions that make risk “sexy” and “romantic” as we do on education about prophylaxis is a good place to start.