When The Rubbers Hit The Road, or Why Don’t People Use Birth Control?

We all worry about the population explosion, but we don't worry about it at the right time. ~Arthur Hoppe

In the US, almost half of all pregnancies are unintentional.   Women in the United States are almost twice as likely as women in Great Britain and three times as likely as women in the Netherlands to face an unplanned pregnancy. Despite the plethora of choices for birth control, such as the Pill, IUD, condoms, diaphragms, Depo-Provera, etc. women are  getting pregnant, despite their stated intentions not to do so.  Why is this the case?  Almost 99% of sexually active women have used some form of birth control at some point, so why aren’t couples more diligent about using birth control consistently?

There seem to be several reasons why birth control is not used consistently for many couples.  An intriguing article I read recently blamed the romanticization of condom-less sex as the reason why so many decide to forgo birth control.   The author posits that many people perceive condoms as being reserved for the beginning stages of the relationship, but once the relationship has become “real”, the couple abandons condoms, and uses other forms of birth control, many of which may not be as good of a contraceptive match for the couple as condoms. I think this theory has a lot of merit to it.  I can't remember the last time I saw someone actually use condoms in a movie.  I can only think of one off the top of my head where they even mentioned it pre-hookup, only to not use it in the end (Knocked Up).We have closely tied in our culture romance, and the lack of condoms, to our detriment.

For others, it seems to be a matter of simple ignorance.  An amazing number of teen mothers claim that they thought that they could not get pregnant.  Thanks to the lack of sex education and abstinence-only instruction in many states, scores of people are unaware of the birth control options available, and the biological process of how their bodies work.  There is also undoubtedly a lot of magical thinking here at work as well, when so many think (hope?) they can't get pregnant, even during their most fertile years.  There seems to an unwillingness to take charge of one's own fertility.

Others state that the cost of birth control is a major factor as to why there isn’t more consistent birth control use.  All birth control controlled by women (the Pill, IUD, Depo-Provera, etc) must be prescribed or administered by a doctor, as none of them are available over the counter.  For someone who is uninsured, that is a big barrier to access to birth control right there.  The ongoing cost, or big upfront cost for things like an IUD can take a major chunk out of the budget, and may be a big reason why many poorer women do not use them, despite their reliability.  While the Right froths at Planned Parenthood’s abortion services, they provide much more birth control  and women services than they do abortions.  Even some insurance companies’ attempts to provide free birth control pills to women has met some serious opposition.

In the end, I think it seems to be a mix of a lot of different factors which account for why the U.S. has such a large amount of unplanned pregnancies.  At this point a multi-pronged point of attack is needed to keep the number of pregnancies down.  In an optimal world, every pregnancy should be an intended pregnancy, something I think we could all agree on.