Sunday, November 29, 2009

Why Contraception?

Since the question's been raised, and because contraception takes up significantly more of my time and energy than most peoples', we'll talk.

Because it should be said- I am fully aware that my ability to study, travel, write and advocate is contingent upon fact that I, as an educated western woman have complete and total control of my fertility and how my sexuality is expressed. I'm willing to acknowledge my bias and admit that if I lived in another place or time I might be a different person and feel differently, but I'm incredibly grateful to be a woman in the United States in the twenty-first century.

With that disclaimer-
Why do I believe contraception is so incredibly important?

1) 68,000 women per year die from complications of unsafe abortions.
2) 536,000 women per year -approximately 1 per minute-die of pregnancy complications and childbirth (90% of these are in Africa and Asia).
3) Globally, 50% of pregnancies are unplanned and 25% are unwanted.
(All statistics from UNFPA)

And then there's nutrition.... For one thing, as a fetus's bones are developing, it will leach calcium from its mothers bones and teeth if necessary. The ability to space pregnancies far enough apart that a woman's body has time to replenish calcium stores is important to both the pregnant woman and the fetus. Even in the U.S. we have remarkably high rates of spina bifida, because women of childbearing age don't consume adequate levels of folic acid- can you imagine how much worse this would be without the ability to control when pregnancies occur?

Contraception saves thousands of lives and prevents disease and disability around the world. Thus, it's critical. End of story.

Additionally, another huge effect of hormonal contraception is the impact of powerful estrogenic/antiestrogenic compounds on fish and amphibians, and what's being theorized about their impact on humans. It's going to be vital to find a way to control fertility without using powerful hormones. Yet another reason condoms are one of the world's greatest inventions.


paul bowman said...

This works something like calls for criminalizing abortion that rankle people on the left, you know. So many thousands or millions of innocent lives are being lost every year. The numbers make the moral case urgent and the social responses apparently few. Stop the killing — end of discussion. (Implicit, where not explicit, the sense that calling into question the solution said to be most effective is to reveal your underlying disregard for the Other, if not for Life in general.)

Of course, blanket criminalization of abortion is a social/political measure with vast repercussions. End of story? No, not really. A lot of innocent deaths will be prevented, certainly, but not without costs to individuals — women in particular — and their families and communities (and so on up the ladder, to economies and political systems). In fact, some numbers, possibly large numbers, of new deaths will be traceable in their causes to the social/political means we've taken to prevent the deaths of unborn children. In reality, blanket criminalization of abortion doesn't deal with the essential problem, the advocate of the Left will insist.

That would be parallel to the point I was after in reply to your contraception comment a couple of posts back. To prevent women's deaths and risks to health is a vital good, obviously. But it seems to me there are good arguments to be made that spreading easy access to contraceptives doesn't deal with the real problem. And more: that it exacerbates the real problem, actually, with women the first in line to suffer the effects. That's the line of concern I'd really like to see you take some time to discuss (as you find opportunity).

I think there's a difficulty of logic in your statement here, too, in that where nutrition and medical care are lacking, planned and wanted pregnancies bring heightened danger just as unplanned and unwanted pregnancies do. Pregnancy itself isn't the problem, of course; lack of nutrition and medical care is the (most immediate) problem. Health dangers in unplanned/unwanted pregnancy amplify the fundamental problem(s) in particular ways — I can see that — but the cause/effect relationships need to be delineated with some care, surely.

Thanks for taking up the subject. : )

charis said...

putting contraception in women's hands is a break from societal norms- because it offers a measure of control over their bodies and future that wasn't previously there. Would a program aimed at men have the same effect? Perhaps...but I'm not sure that excluding women from an aid program in order to talk to men is going to communicate the message that women are valuable.

Greg Mortenson's book Three Cups of Tea documents his discovery that the fastest way to improve village life (from sanitation to infant mortality) was to educate girls to a fifth grade level. Pakistan and Bangladesh have provided a particularly interesting contrast here- the largest difference between the two in recent years being Bangladesh's emphasis on education and healthcare for women. Bangladesh has achieved a far more stable, "progressive" society than Pakistan.

Microfinance in general has shown more promising results with female entrepeneurs.

Per Kristof, and a tenure-track prof here I respect highly, women around the world tend to be the caretakers for families.

In terms of evidence-based practice, cultural appropriateness (working with culture rather than against it) predisposing factors, and efficiency (critical when you have limited funds) I think targeting women with family programs is appropriate.

In terms of nutrition, the presence of contraception makes a huge difference. The opportunity to take a year or two to rebuild the body's calcium and folic acid reserves between pregnancies is incredibly valuable.

paul bowman said...

I'm with you in the matter of strengthening women's hands to assume responsibility & leadership within family & communal structure and beyond. Equality of access and of positive support in all the stages & aspects of participation in social & civic life, across the board — in education, in health provision, in property rights, in legal protection, in political status, & so on — that's the overwhelming task for societal well-being, both in 'traditional' and in 'progressive' cultures.

But I think you're making a category mistake in the name of health promotion by adopting this language of independence & control in the effort to describe what's good for men and women in sex & reproduction. I don't think this is the same kind of issue as the issue of, say, straightforward provision for education or legal protection. We're talking about a higher, more complex social reality here. Obviously male body/health and female body/health are distinct subjects, and distinct largely because of the natural part of each in reproductive life; but to split the matter of sex and child-bearing, with its connective relations to many other factors of social life, into separate social realities for men and women takes us into another kind of discussion, another set of practical and theoretical concerns which aren't just questions of personal, physical or mental health. Sex and reproduction isn't just an aspect of health, and it isn't male or female, it's male and female. The topic is more comprehensive than these divisions allow; and it's right at the heart of the things in which being bound together in social terms is more essential than being independent. The language of 'control' parity, in matters of sex and reproduction here, though it seems to be concerned with health, is implicitly about a kind of social theory that I'd call reductive and misleading. It requires us to think of men's and women's needs, rights, and responsibilities dividedly, by definition. It cuts out the possibility that men's and women's needs, rights, & responsibilities must be in union, crucially, at one or more places in a holistically well-functioning and well-formed society.

The serious danger I still don't think you're dealing with is that promoting contraceptive measures for 'control' parity would only cement further what various forms of tolerance for male sexual irresponsibility and aggression in damaged societies (including ours, for generations) has already been a major prop for. If it's 'understood' that men have, de facto, independence and control of their lives sexually, then equality must mean that women should have it too, by some means — artificial, technical means as necessary, though current technology does allow that they should probably be non-chemical. It doesn't enter into the discussion that this idea of individualized independence and control in the sphere of sex and reproduction may be destructive by nature, de facto or not, much less that it may be nothing but illusion even for those with whom it seems already a broadly realized social fact.

Surely you recognize that 'excluding women from an aid program in order to talk to men' is a straw man, an utterly false alternative. You know more about the world than that. You know my admiration for your insight, your intelligence and creativity. You can speak to this question more comprehensively. That's what I'm looking for in this, Charis. I have to think there are higher possibilities to reach for, and I believe you know how to reach for them. Don't stop here.