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IEET > Rights > Privacy > Life > Access > Contributors > Valerie Tarico

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Dramatic Drop In Teen Pregnancy Really a Technology Tipping Point


Valerie Tarico
By Valerie Tarico
Ethical Technology

Posted: Nov 9, 2012

By now many Americans have read the basics: 9000 St. Louis women are offered their choice of contraceptives for free. Two years later, the teen birthrate rate is at 6 per 1000 instead of the country average of 34. The abortion rate is 4.4 to 7.5 per 1000, less than half the rate of other St. Louis women.

The researchers—whooping like miners who have just struck the public health mother lode—go national with their story.

But the real story is even bigger. What got triggered when 9000 women were offered free birth control was a technology shift in a microcosm. When presented with comprehensive information and a buffet of no-cost options, a majority of the study’s participants, almost 75%, shifted from 1960’s contraceptive technologies to state-of-the-art long acting reversible contraceptives known in the industry as LARCs. And they liked them!

It was a perfect example of how private philanthropy combined with government action can seed a market for new technologies that benefit the public at large. The benefits accrue both to taxpayers, who see their joint investment produce dividends in public wellbeing, and to risk-taking innovative businesses that serve the public interest.

The most widely used contraceptive in the U.S. is the Pill, released almost half a century ago and refined in intervening years to reduce the hormone load and side effects. The Pill has been a game changer, but it is far from perfect, especially from a human factors standpoint. Very few human beings are able to take a daily medication with perfect consistency, and that fact alone largely accounts for an annual pregnancy rate of 1 in 12 for women on the Pill. (For couples using condoms, the rate is 1 in 8. With no contraception it is over 8 in 10.)

The limitations of the Pill were recognized almost immediately, but early stage contraceptive research is a risky, low-return endeavor, not very interesting to most pharmaceutical companies that have stockholders to please. The gap was filled by, among others, the Population Council, a global not-for-profit that channels money into research around reproductive health technologies and programs. (Their latest contraceptive technology, now in clinical trials, is a ring that lasts a year and also protects against HIV.) In the 1970’s, the Pop Council pioneered two IUD’s, one copper and one hormonal, which they then licensed to pharmaceutical companies. These two went on to become the Paragard and Mirena, the only two IUD’s currently available on the U.S. market. In the 1980’s they developed the first widely adopted implant, now sold internationally (but not in the U.S.) as Jadelle.

In the real world, long acting reversible contraceptives have 1/10 to 1/50th the failure rate of Pills, and they are cheaper in the long run. But the upfront cost is substantial, as much as $1000 for the device and insertion. The result is that women who are living month to month often choose old technologies and then pay the price, and even middle class women with health insurance may balk at the lump sum. Taking the money out of the equation changes the bottom line.

America’s high rates of teen pregnancy and unintended pregnancy (and consequent abortion) have been attributed to a number of factors: Puritan sexual sensibilities that interfere with candid conversations about sexuality; a “virginity myth” that inclines teens to prefer impulsive, unsafe sex over “premeditated” sex; a wobbly ladder of opportunity combined with welfare incentives that make it more enticing for some young women to get pregnant than to pursue financial independence. All of these may be real, but it is striking that a simple shift in access to better technologies trumps them all, producing a teen pregnancy rate on par with that in Europe’s most thriving social democracies.

Why?

  1. Traditional contraceptives have a big gap between “perfect use” and “real world.” Short acting hormonal methods like pills and patches, and barrier methods like diaphragms and condoms all have major gaps between how well they work under “perfect use” or laboratory conditions, and how well they work in the real world. For timing methods like Natural Family Planning, withdrawal, and abstinence the gap can be enormous, because they require a level of knowledge, self-awareness, control and communication that is beyond most people. By contrast, with a LARC, what you see is what you get. Once a LARC is in place, it works in the real world just like it works in the research.
  2. LARCS are better at blocking pregnancy.— If you keep in mind that 85 women out of 100 will get pregnant in a year of unprotected sex, the contraceptive effect of the Pill is dramatic. In a perfect world where pill-taking never got disrupted by bounced checks, marital disputes or forgetfulness only two women out of every hundred would get pregnant on the Pill. Not bad, unless you’re one of the two. Even so a well settled LARC leads to far fewer. It’s anywhere from 2/800 (copper IUD) to somewhere around 2/4000 (implant).
  3. Fewer side effects means higher continuation.— In the St. Louis study, 85 percent of the women who chose a LARC were still using it a year later, compared with about half of those who had chosen a short acting method like the Pill or ring or patch. Part of the difference may be the hassle factor, but also short acting methods like the Pill or ring or patch require a larger dose of hormone than an IUD. No contraceptive works the same for everyone, but on average a lower dose means fewer side effects. And fewer side effects means women are less likely to go through risky gaps when they are changing methods.
  4. LARCs toggle the fertility default. Imagine if the light switches in your house all turned themselves back on after a certain amount of time whether you wanted them on or not. That’s how fertility works. It turns on at adolescence and stays on for the next forty years whether a woman wants it on or not. During that time she may want to have one child or four or none. The rest of those forty years, some 400 reproductive cycles, she has to either switch it back off or avoid having a fertile egg come in contact with sperm. The Pill requires her to flip the switch off every day. A LARC means she can hit it as infrequently as once every twelve years –and still flip it back on when she wants to have a child. In recent years, behavioral scientists have learned quite a bit about default effects—how much human behavior is driven, not by choice but by indecision or inattention or inconvenience or inertia or impulse. LARCs take these factors out of the equation for long periods of time, making pregnancy an active and more often mutual decision.

It all adds up to a technology leap that is huge, especially for people who are already up against the hard edges of life: teenage girls who haven’t quite figured out what they want for themselves, or how to say no; families that are struggling to make ends meet; fundamentalist women for whom either another baby or an abortion would feel like a nightmare; tired moms who just want to relax about sex, confident that intimacy won’t mean another 6000 diapers.

As an American, two of my cherished values are freedom and opportunity. As a woman, the ability to manage my fertility is fundamental to both, and I want that same ability for my two daughters and the other young women in my life. That’s why the St. Louis “Obamacare Simulation” is such an exciting example of how philanthropy, government, and private enterprise can team up to trigger the technology tipping points that create my dream future.  Philanthropists had seeded socially beneficial technologies. Corporations were eager to distribute them and reap a profit. And yet, without a publically funded program that lowered barriers, most women would have gone on using old technology at best. (Only five percent of contracepting women in the U.S. use some kind of LARC. Contrast that to over 25 percent in Norway.) Enter the third member of the team, government, and the equation changes. Radically.

Sometimes when I think about the Pill, I think about my old Apple IIc. It changed the way I operated, but I’m really, really glad people kept innovating.  I’m glad that dreamers drove forward ideas that otherwise would have languished. I’m glad that government invested some of our pooled resources in building and regulating the internet. I’m glad that philanthropy and government made information technology available in public universities, schools, and community centers. I’m glad that the power of the market brought information to my fingertips.  Technology change takes a village.


Dr. Valerie Tarico is a psychologist with a passion for personal and social evolution.  In 2005, she co-founded the Progress Alliance of Washington, a collective of future-oriented donors investing in progressive change.  She also is the founder of WisdomCommons.org, an interactive website that showcases humanity’s shared moral core via quotes, poetry, stories and essays from many traditions. Tarico’s book, Trusting Doubt:  A Former Evangelical Looks at Old Beliefs in a New Light, offers personal insight into how we can apply “constructive curiosity” to our most closely guarded beliefs. 

As a social commentator, Tarico writes and speaks on issues ranging from religious fundamentalism to gender roles, to reproductive rights and technologies. A primary focus is on improving access to top tier contraceptive technologies.  To that end, she serves on the board of Advocates for Youth, a D.C. based nonprofit with wide-ranging programs related to reproductive health and justice.  Tarico co-chairs of Washington Women for Choice, serves on the Planned Parenthood of the Great Northwest Board of Advocates, and is a Senior Writing Fellow at Sightline Institute, a think tank focused on sustainable prosperity. Her articles appear at sites including the Huffington Post, Jezebel, Salon, AlterNet, and the Institute for Ethics and Emerging Technologies, and at her blog, AwayPoint


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COMMENTS


Interesting that “technology change takes a village,” and yet the “level of knowledge, self-awareness, control and communication” required to stay dressed in appropriate situations “is beyond most people.”

(1) Why sell humanity short?  We’re expected to exercise self-control against commiting rape, theft, overeating, and general rudeness.  To throw the rest of sexuality under the bus as beyond us is disingenuous.

(2) To believe girls incapable of self-control, and to expect no improvement from the boys, is to cast America into a slavery on par with Auschwitz and the American South.





“To believe girls incapable of self-control, and to expect no improvement from the boys, is to cast America into a slavery on par with Auschwitz and the American South.”

Did I really just read that? Are you mansplaining birth control to people by comparing the alleged ethical dimensions of its use to genocide and the slave trade? I say ‘alleged’ because there is no actual reason to think LARCs imply that women and men have no self-control. Or is the ‘improvement’ you expect in boys in an area other than self-control, since you juxtapose the two genders?

That aside, I’m also not sure why you set up a similar juxtaposition between that assertion that technology change takes a village and the assertion that birth control by the use of timing methods, withdrawal, and abstinence (what you disingenuously reframe as simply ‘staying dressed’—yes, I am sure married couples trying to share the intimacy of sex without getting pregnant just need to stay dressed while they do it) require a level of knowledge, self-awareness, control and communication that is beyond most people. The two assertions have nothing to do with each other. For the sake of your humanity, I can only hope you’re having fun trolling and not, in fact, so abysmally lacking in knowledge, self-awareness, communication skills and most importantly the control required to refrain from making irrelevant and offensive comments.





Staying dressed might be the easiest way to succeed during the NFP abstinence period, so I don’t see your point.  The author has erred by placing NFP in the same genus as contraception by calling them both “birth control”.  Contraception implies no control:  I am at the mercy of Group I carcinogens, risky implants, and dehumanizing shots, precisely because one appetite—sex—is so unpopular (pun intended) to control.  As Chesterton pointed out, it’s real name should be “Birth Prevention.”  But that won’t sell well.

Contraception is intrinsically evil, a grave evil, whether its users are religious or not, because it entails a contra-life will; because of the untold good of a human life coming-to-be (for only rational creatures can perform the laudably good), it is always against all reason to oppose the coming-to-be of human life; once human life is recognized to be an irreducible good — good for it’s own sake, and for which we run out of reasons to pursue and sustain it — it becomes against all reason to oppose such a good.  Contraception is a deliberate act, separate from the coital act, which intends to oppose the coming-to-be of a child.  NFP, on the other hand, can (but doesn’t necessarily) oppose the bad consequences of welcoming an additional child, when welcoming an additional child would be against all reason.  If there are no such consequences, however, NFP = contraception = evil.  The distinction to highlight is that contraception actively wills a good not to come-to-be, while NFP properly practiced simply doesn’t will a good to come-to-be.  When the child is conceived despite contraception, he exists in a hated position, which is unreasonable; the parents must change their attitude toward him if he is to survive abortion and abuse; with NFP, however, the parents need not change their attitude, since the child was never opposed or hated in the first place, but simply not-willed; his arrival is a surprise, albeit a hardship, but not directly contrary to the NFP choice for abstinence during fertile periods.

Withdrawl is a form of contraception, an active opposition to the coming-to-be of life, instead of an opposition the coming-to-be of new baby consequences.  I defend my slavery comment because women are enslaved to the chemical and men-behaving-badly, as I mentioned, which insults their intelligence, their powers, and the brilliance of femininity, but moreover all of society will be enslaved when we decide that forced contraception before age 21 just makes good economic sense, as does forced sterilization after the 2nd baby, and that any attempts to protect women from this commodization is mysogynistic, and any attempt to help men act virtuously is a hate-crime.





Well, we’ve got a rich mix at IEET: you, Henry, march to the beat of a different drummer. What you don’t get is how with all the mess sexuality causes, it still provides a nexus; religion can provide the nomos but not necessarily a nexus.





If events in the life of Christ are what they’re claimed to be, they’re a nexus par excellence.

Now, don’t scold me for mentioning religion, Intomorrow, because I’m following your lead.  smile





“If events in the life of Christ are what they’re claimed to be, they’re a nexus par excellence.”


If only 1,975 years later Christ’s flock would beat their swords into plowshares then Christ would not have died in vain.
I think of sex as I do holidays: we don’t know what life would be like without holidays so we retain them; in the same way we don’t know what life would be without escapist sexuality: would men kill more women or hit them harder because they cannot have sex with them as much? It is an open question. You may have noticed there’s a linkage between sex and violence, and sex and death.





Henry,
am going to proceed on the assumption you really want to communicate on this- not merely pontificate. What we possibly share is a focus on the negative; can’t speak for you and even if we knew each other it wouldn’t be right to presume one could read your inner thoughts.

I’m negative due to backward-lookingness, thinking that there’s no hard evidence life can be better—only different (however when life is radically upgraded the meaning of life changes which changes my premises on life.. a topic for another discussion). But I do not think we can ever live in a virtuous world, a virtuous substrate, and if I did think we could live in a state of virtue, be truly moral, then religion would be a waste of time. Yet since we wont IMO know virtue, true virtue as we define it at this time, I take religion/spirituality seriously as escapism if nothing else because in an unvirtuous substrate escaping from unseemly realities is valid. And unfortunately for a prudish outlook, sex is escapist as well and ought to be taken seriously for that reason. One can’t escape escapism!
Realistic would be attempting, perhaps not succeeding in any way, but trying nevertheless to ameliorate the negative consequences of sexuality. By your own lights, though, men are so rebellious that even a mild attempt in lessening negative consequences of sexuality results in a greater interest in pursuing reckless behavior (call such behavioral brinkmanship).





I understand how sex could be a form of escapism, but let me ask this:  if we had the chance to hook our bodies to a machine that simulated real-life achievements, pleasure, hard work, and victory, keeping us unconsciously suspended from the outside world for the rest of our lives, would any of us voluntarily connect to it?  And if anyone did, would the rest of us esteem him?  I think only the saddest of us would answer “yes” to either option, and this shows that we inherently value what is fulfilling and perfective of man; and I’m not sure the instrumentalization of sex advances us in that perfection:  otherwise there would be no such thing as sexist jokes, or disappointed young women who feel duped, or men who notice with growing terror the power of their addictions.





Well, Henry, no one can accuse you of being too liberal- wont catch you placing flowers on Ted Kennedy’s grave.

“let me ask this:  if we had the chance to hook our bodies to a machine that simulated real-life achievements, pleasure, hard work, and victory, keeping us unconsciously suspended from the outside world for the rest of our lives, would any of us voluntarily connect to it?”

Yes; old people, the paralyzed, cripples, etc. Not everybody is in good physical condition, and as the line in the song goes:
“when you’ve got nothing you’ve got nothing to lose.”





...“And if anyone did, would the rest of us esteem him?  I think only the saddest of us would answer ‘yes’ to either option”


If it were someone you cared about, someone in your family, you would esteem him or her. When it comes to those you care about, all of a sudden you are a transhumanist. When it comes to someone you care about, you advocate spending large amounts to keep them alive longer via advanced medicine.





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