Some thoughts on pregnancy.

I Find Karma (adam@cs.caltech.edu)
Mon, 10 Aug 1998 00:12:12 -0700


It's interesting that informed adults still have debates like the
following one: A couple of my friends this weekend were trying to
convince me that coitus interruptus is a perfectly good form of birth
control. They claim that as long as a man does not orgasm inside a
woman, then there is no threat of pregnancy. I say they are wrong, that
any coital intercourse -- even one interrupted before the male orgasm --
has the possibility of pregnancy because some sperm escapes before
orgasm. My friends laugh at me and say this is ludicrous.

Our esteemed diva cleared the myth in a private email to me:

> Did your friends skip sex ed classes in Jr. High? *sheesh* I can not
> believe that there are adults out there who do not know that sperm
> is indeed contained in pre-ejaculatory fluids and that it is even
> possible to get pregnant without penetration (rare, but possible).
> I taught sex ed for three years to seventh and eighth graders and I
> know for a fact that withdrawal is a risky form of birth control
> at best.
>
> Will your friends still be laughing when they find that they have
> an unwanted/unplanned pregnancy staring them in the face! No form
> of birth control is 100% effective (the Pill has a failure rate
> of 3%, mostly due to user error) and I believe that the failure rate
> for withdrawal is around the 25% mark (but don't quote me upon this
> until I verify it as it has been a few years since I gave this spiel
> to a classroom full of embarassed pre-pubescent teens). As well,
> sometimes a man plans to interrupt the coitus but the gun goes
> off early (so to speak) and then the theory of withdrawing becomes
> a moot point.
>
> You are most definitely right -- I do not need to consult any
> source to know this. When you are given the duty of teaching
> sex ed to the youth of your nation, you learn your facts and
> learn them well... that is why I can be so confident in my
> answer before I consult a book.
>
> I believe that the basic facts about the failure rates of different
> forms of birth control can be found in the classic book
> "Our Bodies, Our Selves", which is a "bible" for women wanting
> answers to all things sexual. It was first published in the 1960's
> and has recently been re-issued and updated. My library has a
> copy in the reference collection. I will verify my facts tomorrow
> and e-mail them to you with complete citations.

Let's probe a little on the web and see what we can find. The National
Governors Association recently discussed a policy to prevent teen
pregnancy wherever possible

http://www.nga.org/Pubs/Policies/HR/hr21.asp

Some factoids from that writeup:
1. The United States has the highest teenage pregnancy, birth, and
abortion rates in the Western world.
2. Each year about 1 million adolescent girls become pregnant. About
one half of these pregnancies end in birth, one third end in abortion,
and the rest end in miscarriages.
3. More than half a million babies were born to teenagers in 1993.
4. About 20 percent of sexually active teenage girls become pregnant
each year. The vast majority of these pregnancies are unintended.
Although contraceptive use among teens has increased over the past
decade, primarily because of AIDS prevention efforts, 22 percent of
sexually active teens currently are not using any method of
contraception. Others fail to use contraceptives correctly or
consistently.

Okay, but that's just information about teen pregnancy. What about in
general?

http://www.fertilityuk.org/nfps20.html

Fact file on sperm:
1. Sperm are produced by the testes continuously.
2. At ejaculation, between two and five millilitres of seminal fluid
is released, containing around 100 million sperm per millilitre.
3. Sperm will survive for 3-5 days or longer in a womans cervix in the
presence of fertile mucus.
4. Sperm penetration is impeded by a thick sticky mucus plug blocking
the cervix during the infertile phase of womans menstrual cycle.
Sperm remaining in the vagina are destroyed within hours by the acidity
of the vaginal secretions.
5. Sperm may be contained in the small amount of lubricating fluid a
man releases prior to ejaculation. For this reason genital contact or
withdrawal method (being careful) could cause pregnancy if fertile mucus
is present at the vaginal entrance.
6. A man is always potentially fertile, whereas a womans fertility
recurs on a cyclical basis. For this reason we have to look in more
detail at the womans physiology to understand the phases of fertility
and infertility.

How about from

http://www.fertilityuk.org/nfps01b.html

Factoid:
Any time a woman has intercourse there is a chance of pregnancy.
The only 100% sure way of not getting pregnant is not to have
intercourse. It is only possible to conceive from intercourse during
the fertile time, which is determined by ovulation, and sperm survival
in fertile mucus.

Okay, one more and then I'll stop:

http://www.cmhc.com/psyhelp/chap10/chap10v.htm

> Be responsible: Don't do it or use contraceptives
>
> Obviously, the solution to unwanted pregnancies is to avoid sex or use
> contraceptives. With our sex laden culture and media, the genie is out
> of the bottle. Sex between 13 and 30 is just too appealing for many of
> us to resist until we marry at age 30. The old line "save yourself for
> marriage" just ain't going to work any more. The "have sex" message,
> however, has overshadowed the "protect yourself" message. TV has
> prohibited birth control ads. We are real retarded in learning how to
> use contraceptives. Science has provided us with many highly effective
> birth control methods but we don't use them. But religion keeps telling
> us that premarital sex is a sin. 20% to 25% of singles in their twenties
> use no contraception. 40% of divorced men use none. How can we take
> control of our reproductive lives? The concept of the family--a
> monogamous union with one or two well cared for, very loved, carefully
> planned children--is a cherished, commendable ideal. What do we need to
> learn to achieve it? A lot.
>
> First, many attitudes need to change. Males must stop believing that
> women are responsible for avoiding pregnancy... and for the pregnancy,
> if it occurs. As a society, we must hold males, even 12 or 13-year-olds,
> partly responsible for their impregnations. As a teenage male, you must
> think of the problems and pain inflicted on the girl if she gets
> pregnant. If she chooses to have the baby, you may be morally obliged to
> partly support that child for the rest of your life beginning at
> conception. As the father of a child, that has many implications for
> your relationship with your parents, for your education and career, for
> your relationships with all other women if you don't stay with the
> mother of your child, etc. Fatherhood is an awesome responsibility
> time-wise, money-wise, and emotionally, not just until the child is out
> of college, but forever. The woman--your child's mother--is responsible
> for your child forever, so why shouldn't you be? She and the child need
> you for more than four hours every other weekend.
>
> Second, similarly but even more importantly, young girls must never
> think that young boys and men are the "sexual experts" who will "know
> what they are doing" and take precautions against pregnancy. Every
> female must become an expert in birth control and sex, equal to any man,
> and far superior to any man in terms of knowing her body, her
> preferences, her morals, her sexual plan-for-life, etc. Every female
> must constantly realize that she is responsible and in charge of her
> body at all times. Every female must be familiar with the ignorant,
> irresponsible, selfish, inconsiderate kind of male who often objects to
> using a condom. Even an anxious, excited 13-year-old girl with a crush
> on a hunk of a guy must be strong enough to say in advance, "I must be
> protected or we aren't doing it" or better "we must both be responsible
> and use some protection (from pregnancy and disease). I will use a
> diaphragm with spermicide and you must use a condom!" She must know what
> she is doing; she must know that petroleum jelly (not KY jelly)
> deteriorates rubber in 60 seconds, that her placement of her diaphragm
> must be checked by a doctor, and much more. She must practice handling
> this I-demand-protection scene over and over in her mind (or with
> friends) long before getting sexual with any guy. Our lives don't work
> out well if we don't plan and prepare.
>
> Every human being, male and female, who isn't ready right now for
> marriage and children, must learn to say, "I must stop the baby before I
> start the sex." If the male's hands have gotten to the woman's breasts
> or on her panties before birth control is on hand, they are both
> sexually irresponsible, inconsiderate of their partner, and a menace to
> each other's well being. We must learn to control ourselves. People
> uncomfortable with sex are not good at birth control. So, learn about
> and practice birth control methods until you are comfortable.
>
> Ask yourself if you are mature enough to have sex. If you are too shy to
> buy a condom and some spermicide, too poor to get a diaphragm or
> cervical cap, too embarrassed to get on the pill or have an IUD
> inserted, too uninformed to know about Norplant or when pregnancy can
> occur, or too irresponsible to do anything to avoid pregnancy, you
> should never (or let anyone) get close to a breast, let alone touch
> panties. As stated, a good rule would be for both sexual partners to
> each assume responsibility for one contraceptive, so that two birth
> control methods are always used, say a condom (with spermicide) and the
> pill. I recognize this advice will not be taken by many but it should
> be. About 60% of sexually active college students do not use birth
> control at all or only occasionally. How stupid and inconsiderate!
> Remember, college students with negative attitudes towards sex (and the
> opposite sex?) use birth control even less than those with positive
> attitudes. Conversely, a sexually responsible partner is more likely to
> have a healthy, positive, thoughtful attitude towards sex. The failure
> to use condoms is not due to intellectual ignorance, it is due to
> psychological and sexual hang-ups (guilt and denial of reality and/or
> responsibility) and a lack of consideration for others. Having
> unprotected sex is very mean to the person with whom you are gratifying
> yourself.
>
> Women assume men's sexual response is much greater than it is and they
> minimize their own response. In women, sexual guilt (resulting from
> taboos and religion), inhibitions, and morals seem to be associated with
> a denial of one's own sexual arousal, e.g. when watching erotic films or
> when petting. For guilt prone people, their erotic arousal is greater
> than they realize. Thus, there may be some truth in the old joke,
> "Religion doesn't stop you from sinning, but it sure keeps you from
> enjoying it!" Guilt may also keep you from being safe too. Don't let
> fear and shame (or uncontrolled horniness) dominate your good sense
> about birth control.
>
> Beyond guilt, denial of sexual intentions, and avoidance of
> contraceptives, we are astonishingly misinformed about sex as well. Only
> one third of young mothers knew when during their menstrual cycle they
> could get pregnant. Almost 10% of 15 to 19-year-old women think they are
> too young or have sex too infrequently to get pregnant. Wow! Some people
> believe they can't get pregnant if the female doesn't have a climax or
> douches with pickle juice or if sex is done standing up. Wow! People try
> to make condoms out of Saran wrap. Men have told women, "I have
> fantastic control, so don't worry I won't come inside you." And the
> ignorance goes on and on. It is sad that we (parents, schools, and
> media) have ignored these uninformed young people. The social-religious
> taboos keep us from being honest and teach teenagers exactly how to
> wisely undertake their sexual activity (if and when they decide to have
> sex). The result is they are unprepared for this critical aspect of
> life. And, we--the older folks--are largely to blame. Sex is a very
> important part of life. Important enough for young people to learn to
> take charge of their own lives and use the knowledge they need for a
> good life.
>
> This avoidance of explicit sexual guidance by everyone--this burying our
> heads in the sand--results in young people feeling that it is more
> acceptable if they have sex by "falling in love" and getting
> unexpectedly "swept away" by overwhelmingly intense sexual urges. (This
> way they can keep their minds pure and innocent--"like good girls"--as
> long as possible and avoid the responsibility for what happens.) But, if
> they plan for sex (by getting and using a contraceptive), then
> intercourse might be considered less romantic and spontaneous or more
> sinful. They might even feel "planned" sex is less loving and more
> unnatural, cheap, or immoral, sort of like "using someone for
> self-gratification." In truth, the most loving sex is when you avoid
> unwanted stresses of all kinds, including pregnancies, and make sex play
> comfortable, safe, meaningful, and satisfying --one of life's great
> moments. These things don't happen without planning and preparation.
>
> The most common reasons for not using a contraceptive are "I didn't
> expect to have intercourse" (20%) and "I wanted to use something but
> couldn't" (8%), according to Zelnik and Kantner (1979). The same authors
> report that only 36% of whites and 22% of blacks had been using
> contraceptives (obviously only part-time) before their unwanted
> pregnancy occurred. Furthermore, while teenagers and college students
> are having more sex, they are, in recent years, using more unreliable
> contraceptive methods. Fewer are using the pill (37% of blacks, 15% of
> whites), about the same use condoms sometimes (35%) but many more than
> previously are attempting to withdraw (13% of blacks, 42% of whites). No
> wonder there are so many unwanted pregnancies. Single mothers produce
> about half of all babies born in Chicago.
>
> There are many more situational factors and attitudes that interfere
> with good birth control practices. Examples: getting state aid for
> having a child, escaping a dysfunctional family of origin by getting
> pregnant, trying to find someone to love by having a baby, knowing a
> happily married teenager but knowing little about the difficult
> experiences of an unwanted pregnancy, believing birth control is racial
> genocide, assuming that all a woman can do is raise babies, assuming
> your buddies can tell you everything you need to know about sex and
> contraception, having intercourse for months before going to a birth
> control clinic, being unable to talk with our partner about sex and
> birth control, having little interaction with our parents about sex,
> assuming wrongly that you aren't going to have sex so there is no need
> to prepare, having low self-esteem and low self-control, overlooking the
> pleasures and gratitude of your partner when you use contraceptives,
> etc.
>
> Another crazy aspect of the sex scene is the single-minded focus on
> intercourse, even when birth control is not available. Our
> anti-masturbation attitudes seem to permeate all our sexual behavior. If
> a wonderful sexual opportunity unexpectedly occurs and no contraceptive
> is available, why not have "outercourse" (mutual masturbation) rather
> than intercourse? It would be much more considerate and loving (and even
> more likely to produce intense pleasure for both). Outercourse doesn't
> produce disease or babies. Can you imagine our supposedly sexually
> liberated society discussing these matters openly?
>
> While it is so much better to prevent the pregnancy than to abort it,
> the TV propaganda by anti-abortion zealots must be corrected. They, in
> effect, threaten pregnant women with guilt, shame, and depression for
> years after an abortion. That is a lie. Research shows that women's
> overwhelming psychological reaction to having an abortion is relief, not
> guilt. There is less anxiety, depression, and distress after an abortion
> than before. Of course, very rarely a person does have serious
> psychological problems after an abortion (just like after a birth), but
> this occurs more often when the abortion was long delayed by doubts or
> denial. Also, having opposition, criticism, and neglect, instead of
> sympathy and support, from your relatives, your religion, and/or your
> male partner make the abortion situation much more traumatic and
> depression more likely (Adler, David, Major, Roth, Russo, & Wyatt,
> 1990).
>
> Beyond changing our attitudes towards birth control, every young person
> must learn to do very specific acts: (1) read at length about
> contraceptives, (2) visit a drug store and look carefully at the birth
> control methods and supplies, (3) role-play important situations (should
> we have sex? how will we prevent pregnancy? what if a pregnancy occurs?
> what will I say to Mom and Dad if I get pregnant?) with a friend before
> the actual problem arises (see method #1 in chapter 14), (4) learn about
> and actually practice, when appropriate, using several birth control
> devices, such as IUD's, condoms, diaphragms, cervical caps, vaginal
> suppositories, sponges, Norplant, etc., and (5) discuss with a counselor
> which birth control methods you think you would prefer for both
> preventing pregnancy and STD, and why. Preventing unwanted pregnancies
> is one of our major responsibilities in life. Don't sell it short; don't
> laugh it off.
>
>
>
> If we don't change, we will keep on having millions of unwanted
> pregnancies and abortions, and we will continue the cycle of poverty and
> "poor babies having babies."
>
> We need to improve our sex education in schools, in the home, and in the
> media. An excellent reference for this is Byrne, Kelley, & Fisher
> (1993). Research shows that the right kind of practical, realistic sex
> education course can reduce unwanted pregnancies and does not promote
> sexual activity (Fisher, 1990). It is foolish to believe that
> realistically planning how to prevent babies and disease causes you to
> have sexual intercourse. Rather, it is love, needs, and sexual
> attraction that lead to sex (with or without protection). Hopefully, you
> will have enough common sense to plan your sexual activities when your
> needs and your head tells you that having sex is a wise, desirable
> course of action. Actually, well informed sexual planning does not
> promote sexual activity; it does, however, help you skillfully avoid
> unwanted sexual behavior. There is also evidence that the simple
> "don't-do-it programs" don't work (Scales, 1987).
>
> The sexual attitudes of young people about contraceptives need to become
> more positive, so there is increased self-awareness and self-control by
> every young person. Research has shown that teenagers with close
> relationships with their parents, especially if they communicate well
> with mother, have intercourse later than those with poor relationships.
> Books dealing with avoiding pregnancy include Calderone & Johnson
> (1990), Watkins-Ferrell & Robinson (1990), Foster (1986), and Howard
> (1991). Planned Parenthood Hotline is a good source of information, call
> 800-230-PLAN.
>
> Birth control must be planned in advance. But, in an emergency, Consumer
> Reports says that oral contraceptives may serve as a "morning after"
> pill. According to them, taking four Ovral tablets, two at a time, 12
> hours apart, within 72 hours of having intercourse may prevent
> pregnancy. Ask your OB-GYN doctor about this. Soon the abortion-causing
> pill should be available.
>
> Sex education books also describe sexually transmitted diseases,
> something else that should be high on every sexually responsible
> person's priority list. In addition, there are hotlines: National AIDS
> Hotline, 800-342-2437; National STD Hotline, 800-227-8922; National
> Herpes Hotline, 919-361-8488. Always protect yourself and your partner.
>
> Guard against date rape
>
> About 25% of college women have experienced a rape or an attempted rape
> since they were 14. Half of rape victims are under 18. Almost 85% of
> rapes are by people the victim knows; 60% occur in a dating situation.
> Mary Koss of the University of Arizona says many women are raped but
> then deny it, saying "I'm not sure what happened" or "he lost control"
> or "things got out of hand" but not "he raped me." In fact, only 24% of
> women actually raped called it rape. Only 5% of rapes are reported. Even
> more astonishing, Professor Koss reports that 1 in 12 men admit they
> have raped someone (see discussion of rape and abuse in chapter 7). In
> addition, males and females look at the seduction situation differently:
> the man is marching forward, checking off the steps as he
> progresses--deep kissing, touching breast, unbutton blouse, feel up
> legs, massage crotch, etc., etc. The woman is trying to decide how far
> to go and resisting at some point the fondling hands. He expects the
> woman to put up some resistance, even if she "wants it." If, in the end,
> he forces her to go "all the way," he calls it a successful seduction;
> she considers it a rape or wonders if it was (Warshaw, 1988).
>
> What can be done to avoid date rape? Know the person you go out with.
> Ask others what they think of him/her and listen for clues, such as "he
> is all hands" or "watch out when she gets drunk." Ask about and observe
> his/her drinking habits; 75% of date rape offenders and 55% of victims
> have been drinking. So, watch how much you drink too. If you do not want
> to have intercourse, be cautious about going to isolated places, do not
> "lead him/her on" or imply that you are "wild" or joke about being
> raunchy or sexually aroused. If you are certain that you don't want (or
> that it would be unwise) to have intercourse, stop the sexual activity
> early in the process. For instance, while either person--male or
> female--has every right to stop the sexual seduction at any point, it
> does not make sense to let the male expose your breasts, take off your
> panties, and stroke your clitoris, without indicating clearly from the
> start that you are not going to have intercourse. Under the
> circumstances I just described, it looks to the male like you, the
> female, are approving "going all the way." Without an explanation of why
> you are stopping at this point and without an understanding that you
> will masturbate him or have intercourse with him later when birth
> control is available, the male may feel so frustrated, angry, and
> confused that a date rape is more likely to occur. Of course, no rape is
> ever justified under any circumstances, but we shouldn't put ourselves
> into dangerous situations. Even in these very emotional "hot"
> situations, we still have to use our brain and common sense. Of course,
> many rapes occur even when the victim has been very cautious. You can
> lower the risks, however. If you are ever raped, report it immediately
> (see chapter 7). Rue (1989) and Jackson (1996) suggest ways of coping
> with dating violence and acquaintance rape.

Any thoughts, anyone?

----
adam@cs.caltech.edu

Ambiguous headline: SEX EDUCATION DELAYED; TEACHERS REQUEST TRAINING