Human Nature: Science, Technology, and Life.

Female Condoms

Liberals want fewer unintended pregnancies and more empowerment for women. Conservatives want fewer abortions. Everybody wants to reduce HIV and other sexually transmitted infections. We can keep yapping about these things, or we can do something constructive.

Here's something constructive: female condoms. If you don't know what they are, read about them here, here, and here.

Yesterday, the Female Health Company announced FDA approval of its latest female condom. The company's previous condom was being sold for $2.80 to $4 a pop. The new one, which is made of different material (nitrile polymer instead of polyurethane) in a more automated process, will cost less. Projections range from 30 percent less to just 60 cents per condom at high volume. If a charity can cover the 60 cents, women can get it free.

With billions of male condoms in circulation, why are female condoms such a big deal? For starters, women are generally more responsible about birth control than men are. Even in the United States, 10 percent of women who end up getting abortions because they neglected contraception say their partners objected to using protection. I haven't checked the data lately, but I assure you that overseas the problem is even bigger. The more we take this decision away from men and give it to women, the more unintended pregnancies we'll prevent. That's the first thing female condoms do. They "put the power of protection in women's hands," says the Female Health Company. The director of the Center for Health and Gender Equity agrees that these condoms give "women another option in negotiating safer sex with their partners or husbands."

Second, because these condoms are designed around the vagina rather than the penis, they're unaffected by erection status. This is a big deal. Look at the company's "product" page and scroll down to the blue box outlining differences between male and female condoms. Female condoms "can be inserted prior to sexual intercourse, not dependent on erect penis," says one line of the box. Another adds: "Does not need to be removed immediately after ejaculation." Think about all the pregnancies that happen because the guy was in a rush or because the condom wasn't removed till the erection had subsided and the sperm had leaked. The female condom removes these timing problems. You put it on in advance, it's there for the duration, and you don't have to worry about the awkwardness of removing it before the guy goes limp.

In short, we're talking about a technology that compensates for human error.

Technology won't solve the whole problem of unintended pregnancies. That still requires personal and social responsibility in using contraception diligently. But better methods can certainly help us do the right thing.

Selling Rubbers

Ross Douthat is such a sensible and honest guy, I really ought to be able to sell him on the idea that contraception can significantly lower the abortion rate.

I pontificate; he demurs. I throw data; he remains unconvinced. I feel like a shingle salesman standing in the rain at the front door of a house that has holes in its roof and 2 inches of water inside. The owner's standing there, listening, his arms folded. How am I not making this sale?

Ross and his Atlantic colleague, Megan McArdle, have persuasively challenged what I used to believe: that birth-control availability was the key to reducing abortions. Three years ago, in a careful analysis, McArdle made a case that "the monetary cost of contraception is, at best, a small contributing factor to unwanted pregnancy in this country." A friend who works in reproductive health has impressed a similar lesson on me from her own research: Use, not access, is the missing ingredient.

The data back her up. So, last Sunday, I conceded the point:

Eight years ago, the Alan Guttmacher Institute surveyed over 10,000 American women who had abortions. Nearly half said they hadn't used birth control in the month they conceived. When asked why not, 8 percent cited financial problems, and 2 percent said they didn't know where to get it. By comparison, 28 percent said they had thought they wouldn't get pregnant, 26 percent said they hadn't expected to have sex and 23 percent said they had never thought about using birth control, had never gotten around to it or had stopped using it. Ten percent said their partners had objected to it. Three percent said they had thought it would make sex less fun.

This isn't a shortage of pills or condoms. It's a shortage of cultural and personal responsibility. It's a failure to teach, understand, admit or care that unprotected sex can lead to the creation—and the subsequent killing, through abortion—of a developing human being.

Ross listened thoughtfully, as he always does. But he didn't budge:

I remain unconvinced that [Saletan's] preferred method for such reductions—a dramatic new push, whether political or cultural, to expand the use of contraception in the United States—would produce anything like the results that he envisions. Consider, for instance, the idea that the government should dramatically expand eligibility for free contraception through Medicaid. ... [T]he universalization of this program, according to its supporters, might reduce the national abortion rate by somewhere between 1 and 2 percent. That's not nothing, obviously, but it's not a whole lot ...

Whoa, there. That's the old debate: access. What I'm talking about now is the other part of the equation: use. Access is important, but pills and condoms don't work unless people use them.

There's nothing fancy about this idea. I don't have a brilliant program in mind. All I have is process of elimination: If most people in this country, including me, aren't willing to ban abortions (check), and if you can't stop people from having sex (check), and if contraception is the only other way to prevent pregnancy (check), and if providing access to contraception hasn't solved the problem (check), then the remaining factor is human failure to use the contraception. Target that problem. I don't care whether it's through the federal government, states, clinics, schools, churches, or Conan O'Brien. All that matters is sending a forceful message that if you're not prepared to become a parent, you must either avoid vaginal intercourse or use birth control religiously.

If sex-ed programs aren't getting this message across, come up with better sex-ed programs. Or go through churches, doctors, parents, Facebook, Webkinz—whatever. Keep trying until you find something that works.

On this point, I should mention an equally sincere critique from the other side. One of my proposals for getting the message across was that "reproductive-health counselors must speak bluntly to women who are having unprotected sex." (I recommended the same message for men.) Jodi Jacobson, a longtime pro-choice activist and editor at RH Reality Check, says counselors are already doing this:

[W]omen's rights advocates and reproductive health providers have always put these two issues together.  It's called "prevention" and it is the core of reproductive health services that include efforts to prevent unintended pregnancies, prevent infections, assist people who wish to get pregnant, offer pre-natal and maternal care, and much more.

What exactly does Mr. Saletan think reproductive health counselors do, but guide people toward protected sex, help them find the methods they need and which will work best for them, and counsel them on correct and consistent use?

Most counseling matches this tone. It's deferential, technical, and service-oriented. I understand the need to gain and hold each patient's confidence. But plainly, the message isn't getting across. This should be obvious from the fact that half the women getting abortions in this country are coming back for their second or third termination.

I've sat and talked with people who staff and supervise clinics. One recounted an internal staff debate over whether a woman who came in for an abortion and wasn't using birth control should be encouraged to use it next time—or whether this was too morally presumptuous. Another described moral differences between American and European clinics. In many European facilities, she explained, if you come back for a repeat abortion, the counselors will demand to know whether you were using birth control and if not, why not.

I admire everyone who works in family planning and reproductive health. But we need to do a better job of getting the message across. One measure of our failure is the national abortion rate. And if you don't accept that as a moral challenge, take it as a political one. Because if you can't do something to dry up the demand for abortions, Ross Douthat and others will be happy to target the supply.