Monday, May 27, 2019

Reducing Abortions With Harm Reduction: A Common Sense Guide

Harm reduction doesn't just apply to drugs.  When applied to Sex Ed, it can greatly reduce the number of sexually transmitted diseases, rapes, unplanned pregnancies & other negative outcomes.  With all the recent abortion bans, there's been a lot of talk about what it means to be pregnant & give birth against one's will.  This is indeed a volatile & important topic, but there's been relatively little discussion about how to prevent those unwanted pregnancies in the first place.  And that's a shame.  While we'll never be able to prevent ALL abortions, it's possible to greatly reduce the number by spreading harm reduction information to people who need it.  Incidentally, that's not just teens & young people but anyone having sex who doesn't know exactly how pregnancy occurs.

The point of this post isn't to debate the correctness of these abortion laws but to empower people who want to avoid unplanned pregnancy.  (Which is something pro-lifers should be doing already if they truly want to reduce abortions...but that's another topic for another day).  I'm all about practicality.  What's more practical than giving people real, actionable ways to take control of their own reproductive futures?


Sex (Mis)Education & Family Planning


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Repeat after me:  IF YOU ARE HAVING SEXUAL INTERCOURSE & NOT USING CONTRACEPTION EVERY TIME, YOU ARE ACTIVELY TRYING TO ACHIEVE PREGNANCY.  

Sex Ed in America is woefully inadequate in many places.  Abstinence-only classes fail to offer any practical harm-reduction options for teens who choose to have sex, which we know a percentage will do.  The same is true with drug education--while abstinence is the only 100% way to avoid ALL risk, there are things you can do to reduce the risks should you decide to partake.  Those who choose to experiment with sex or drugs don't deserve to die or end up ruining their lives as a result of something that's an innate drive.

Teens aren't the only ones who suffer the consequences of crappy Sex Ed.  My own parents didn't know that pregnancy could occur with the pull-out method & ended up with an unplanned child as a result.  They were in their late 30s at the time.  This is a common theme in rural & inner city America, sadly.  Preaching at kids to "save themselves until marriage" works about as well as telling them to "Just Say No" to drugs, which is to say, not very well at all.  It's a great goal to aspire to but as for preventing disease & pregnancy it just doesn't work.  In fact, teen pregnancy rates tend to be the highest in conservative states where abstinence-only messages are the predominant form of Sex Ed.

Part of the problem lies in how we view having children.  Many folks never consider that having kids is a CHOICE in the first place, let alone the most important one they'll ever make.  Pregnancy should not be viewed as a punishment for having sex or some inevitable chore.  Babies are human beings who should be wanted & loved by a stable family unit--not seen as a mere consequence of sexual activity.  Unwanted children do not generally have bright futures whether they are raised by their biological parents or end up in foster care.  Abuse, neglect, poverty & other serious stressors are a constant for these kids, which increases their risk of ending up in prison or on the streets as adults.  That's not to say that they can't overcome adversity or have less innate value than children who were planned for.  It's just the bare facts.

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Teen pregnancy awareness PSA from New York
But it doesn't have to be this way.  Family planning is a common sense way to ensure that all children have the best possible futures.  Waiting until you're financially & emotionally stable enough to give a child your all is the best gift you can give both the child & society.  Abstinence can & should be a part of this discussion but realistically it will never be the ONLY part.  Sex isn't evil or dirty & our aversion to talking openly about it is hurting our children (and all children).


Empowering Women 


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The female of the species has both the biggest responsibility & the most agency when it comes to reproduction in that the pregnancy occurs in her body.  She will bear all the health burdens (weight gain, risks such as ectopic pregnancy, pre-eclampsia, death in childbirth, post-partum depression, injury to the genital region during birth & permanent incontinence afterward) while at the same time having the ability to decide whether to continue or terminate the pregnancy, whether to breastfeed & other decisions relating to how the fetus interacts with her body.

The impact of these things is immeasurably complex & life-altering.  Besides a terminal illness, pregnancy is the hardest thing a woman's body will ever go through.  Each one ages her DNA by approximately 11 years.  It's not a given that all women are willing to devote themselves physically to such an undertaking, and certainly not before they've had the chance to experience life & mature emotionally.  So what are some practical things women & girls can do to prevent unwanted pregnancy?  First, it's vital to know HOW pregnancy happens in order to prevent it.  This sounds simple but there are many myths that can muddy the water.

First, a female can get pregnant any time a penis enters the vagina for any amount of time.  Ejaculation is not required.  There are sperm present in pre-ejaculate (pre-cum) which means the pull-out method is not reliable for preventing pregnancy.  If ejaculation does occur near the vaginal opening, pregnancy may also result.  Sperm are resilient & it only takes one to fertilize an egg.  Secondly, the idea that a woman can't get pregnant her first time having sex, during her period or while having sex underwater are all myths.  And those ugly claims that pregnancy can't result from rape because the woman's body "shuts it down" if she's not turned on?  Absolute bull.  Finally, some young men claim to be "sterile" to goad girls into unprotected sex but this is a lie 99.9999% of the time.  Do not fall for it.  You are responsible for your reproductive health.  Don't leave it in the hands of someone who wants to put you at risk by having unprotected sex.  On the off chance he is infertile, STD's like genital herpes & HIV are still incurable and certain strains of HPV can cause cancer down the line.

Oral birth control pills are highly effective when taken as directed, but they can be made less effective when combined with certain other medications.  It's vital to check the interactions between ALL meds & supplements you take to ensure that your birth control is working optimally.  If you have questions about a medication, ask your doctor or pharmacist.  An additional method like a condom or diaphragm can provide another layer of protection against both pregnancy & STDs.  IUD's & injected hormonal contraceptives like Depo Provera or Nexplanon offer long-lasting protection against pregnancy that doesn't require daily dosing like pills.  These methods may be more suitable for teens & other young people who have trouble remembering to take a pill daily.  Other birth control methods include the vaginal ring, spermicide, patch, cervical cap, sponge, female condom & tubal ligation.  Ask your doctor about the benefits & drawbacks of these methods to decide which are right for you.

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CDC's comparison of contraceptive effectiveness

If something goes wrong & you suspect you may be pregnant, don't panic.  The Plan B pill is available at major retailers in all 50 states without a prescription to women of every age.  It can be taken up to 3 days after unprotected sex to prevent pregnancy.  It is not an abortifacient; it merely prevents the egg from implanting in the uterus.  There is no harm in taking it if you're not pregnant.  To find out more, check out the Plan B website here.  There are also other options in this category like Ella & Paragard (see chart below) that work up to 5 days after unprotected sex.

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Tips for Men


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And what about guys who want to reduce the risk of impregnating someone accidentally?  Unplanned pregnancy can be a huge burden for men as well.  Even if a guy wants no part of being a father, he can be forced to financially support a child if a DNA test shows he is the biological father.  Since pregnancy occurs in the woman's body, a man has no ability to force her to terminate the pregnancy--even if they've agreed on that previously.  This is why it's so vital for men to communicate with their sex partners beforehand & know their options for protecting themselves.  While there aren't as many birth control options available for men (yet), there are some classic tried-and-true methods that will give you some measure of control over your reproductive future.

Avoiding random hookups with strangers who may want to keep the baby should they end up pregnant is an important option to consider.  If you don't feel comfortable communicating about such serious issues, you might not be ready to sleep together.  Imagine every sex partner being a potential mother of your child & having 18 years of forced interaction with her because, realistically, this is what can happen if pregnancy occurs.  Talk about your wishes regarding children upfront before being intimate & leave at the first sign of deception or disagreement.  This is an irreversible, life-changing decision & no amount of sexual pleasure is worth the risk.  (Not pushing abstinence here; just choosiness about who you sleep with).  Trust is vital.  While it's possible for a woman to break your trust or change her mind, you're still reducing the risk of unwanted pregnancy by screening your sex partners for reproductive compatibility.

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Talk about contraception & pregnancy BEFORE hooking up
Avoiding penis-in-vagina sex & opting for other sexual activities like mutual masturbation or oral sex is another way to completely avoid pregnancy risk with women you don't fully know or trust yet.  Get creative.  In general, it's a good idea to avoid drinking or using drugs when having sex with any partner you're not in a committed relationship with, as this can lead to an increased risk of pregnancy due to contraception slip-ups.  Having a sober mind also enables you to make the best decisions possible when it comes to things like gaining consent & avoiding misunderstandings or accusations of sexual misconduct.

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How to put on a condom correctly
Condoms are a highly effective form of contraception provided they're latex & not dried out or expired.  Make sure to choose a brand that fits well & leave some room at the tip rather than pulling it tight.  Avoid using more than one condom at a time ("double-bagging") or applying spermicides that contain nonoxynol-9, as both can lead to perforations.  If you are certain you don't ever want kids, consider a vasectomy.  This outpatient procedure doesn't interfere with sexual pleasure at all (and often enhances it due to removing the fear of pregnancy!) and can sometimes be reversed if you change your mind about wanting kids down the line.  A new drug called Vasalgel is in testing that will provide the benefits of vasectomy for 10 years & is fully reversible.  All it requires is an injection into the vas deferens (yes, probably painful but less so than surgery).  The more men who show up & demand these treatment options, the more options men will get.

Combining condoms & other male contraceptive methods with female contraception doubles your protection, hence the importance of discussing your partner's birth control status before hooking up.  Never depend solely on the other person to protect YOUR wishes not to have children--that's on you.  Aside from deception, there are many other things that can reduce the effectiveness of female birth control so don't ever leave such an important decision in someone else's hands.


Conclusions

Abortion is a last resort when all other options have failed.  Nobody takes it lightly or desires it as a primary contraceptive method.  Despite their safety, both the surgical & pharmaceutical abortion methods cause unpleasant side effects like cramping, bleeding & nausea (in addition to the emotional burden that's often present when making that decision).  It's much easier to prevent pregnancy than to deal with it down the line, even if you support a woman's right to choose.  Knowing how to do that is vital for controlling your bodily autonomy.  The abortion issue is not just a woman's issue--it affects everyone.  Pregnancy, both planned & unplanned, requires two people & will affect those two people profoundly for the rest of their lives.

I challenge you to share this post somewhere you think this info is lacking.  It just might help someone prevent an unwanted pregnancy.

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