Friday, August 25, 2006

I Get So Weary...

...of ignorant lies and misinformation promulgated by people who are informed about matters of public health and biology only by Christian far-right religious fundamentalist twaddle. These folks want to live in a theocracy, not a democracy; but instead of moving to one of the already-existing theocracies -- like Iran or Saudi Arabia, for example -- they want to turn the United States into one.

It's so easy to rant when it comes to fundamentalist totalitarians like Sister Toldjah, who never, ever, let a fact get in the way of religious prescription (pun fully intended). Luckily for me (not to mention my readers), Scott Lemieux has written about Sister Toldjah's post on the FDA's decision to make Plan B available without a prescription (to adult women) so I don't have to:

Because the blogosphere tends to skew toward the opinions of educated elites, it's relatively hard--even among conservative blogs--to find nice, chewy wingnuttery on the subject of the decision to make Plan B available over the counter. Even Josh Trevino doesn't seem to have written anything, although admittedly I may have missed a number of the blogs he's undoubtedly joined and left in the past week.

But, fortunately, there are exceptions that can provide some amusement. Sister Toldjah gives the standard reactionary boilerplate, claiming that if Planned Parenthood were serious about stopping teenage pregnancies, it would be trying to promote abstinence programs that are demonstrably useless [also see BlondeSense for a school system that started including information on how to prevent pregnancy and STDs after their "abstinence-only" program resulted in an explosion of pregnancies -- Kathy] rather than prov[id]ing teens with tools that can actually stop pregnancies: "Imagine if PP were to change its tune and devote as much time now to promoting abstinence as it has in the past promoting 'safe sex' and 'alternative ways to engage in sexual activity that doesn't involve the actual act.' We wouldn't have to worry about that high teen pregnancy rate that Richards mentioned." You read that right--she seriously seems to believe that teens would stop having sex if Cecile Richards were more vocal on the subject. Because if there's anything besides moral instruction from teachers that teens are thinking about when they're about to get it on, it's the words if the head of prominent interest groups. The logic is airtight!

After reading that MSNBC article linked from Scott's blog, check out the related Reuters piece about a Harvard study that found teenagers who take abstinence pledges are more likely to lie about prior sexual activity; and also more likely to deny they ever took an abstinence pledge if they break it. These findings imply more than teenage dishonesty; they have serious public health implications:

These findings imply that virginity pledgers often provide unreliable data, making assessment of abstinence-based sex education programs unreliable. In addition, these teens may also underestimate their risk of exposure to sexually transmitted diseases.

"Teenagers do not report their past sexual activity accurately, with virginity pledgers giving more inaccurate reports of their past sexual activity," study author Janet Rosenbaum, of Harvard University in Cambridge, Massachusetts, told Reuters Health.

Consequently, rather than rely on self-reports, "studies of virginity pledges must focus on outcomes where we know we can get good information, such as medical STD tests," she added.

Previous research shows that survey respondents tend to answer questions about sexual activity according to their current beliefs, particularly if their current attitudes conflict with their past behaviors. Survey respondents may also underreport or overreport their health risk behavior.

Religious fundamentalists in the U.S. are against teenage sexual activity, not teenage pregnancy. Of course: no sane and rational person wants teenagers under the age of 18 to have sex, because in most cases teenagers are emotionally unready for such a profound and consequential adult activity. But the actual fact of the matter is that pledges of abstinence, abstinence-only "sex-education" programs, and laws that prevent teenagers from obtaining contraceptives do nothing to reduce teen pregnancy. Rates of teenage sexual activity are similar in all industrialized countries -- but pregnancy and birth rates in the U.S. are much higher. And even though teenage birth rates in the U.S. have decreased significantly in recent years, they are still far higher than those in other industrialized countries.

"A League Table of Teenage Births in Rich Nations," published by the United Nations Children's Fund, lists among its key findings:
  • The United States has the highest birth rate in the developed world.
  • Korea, Japan, Switzerland, the Netherlands, and Sweden have the lowest teenage birth rates in the developed world.
  • Adolescents are sexually active at comparable rates in most developed nations.
  • The factors associated with delayed childbirth are increased levels of education and career choice for women and access to contraception.

More: Figure 4 in the League Table publication shows that when countries are compared on the basis of how aggressively or actively their governments intervene to control teenagers' fertility, the countries in which intervention is a matter of minor or no concern are the countries with the lower teenage birth rates. There is also a strong trend of abortion rates going down in countries that stress the use of contraceptives and that make contraceptives easily available.

Bottom line: The countries that have low teen pregnancy and childbirth rates relative to their rates of sexual activity are the countries that have an open, accepting attitude toward sexuality in general; that view sex as something that has to do with being human, not something that's tied to religious notions of morality. These are the countries that make comprehensive, science-based sex education an intrinsic part of education from the earliest age; that discuss sex, pregnancy, and childbirth openly and realistically and without moral judgments; that see the use of birth control and contraception as a public health issue, and make contraception widely and easily available, regardless of age or marital status.

Here is a passage toward the end of the League report (this was copied and pasted from a pdf file, so some of the line breaks are weird. I tried to fix it, but couldn't):

Overall, any examination of different levels of teenage births in the industrialized nations must conclude by re-emphasizing the central role played by contraception. Contraceptive behaviour may be strongly influenced by motivation; but it is through the ability to manage contraception successfully, often over an extended period of time, that motives, attitudes, and decisions find practical expression.

In particular, those countries that have been in the forefront of the socio-sexual
revolution are today reliant on some combination of contraception and abortion to bridge an unprecedented gap between average age at first sex and average age at first birth. And what determines the position of such countries in the league table of teenage birth rates is not any significant difference in the number or age of teenagers involved in sexual activity but the level of effective contraception and the degree of recourse to abortion.

In France, for example, the proportion of under-eighteens who give birth has been more than halved in the last 20 years while the average age at first sex has
remained stable for many years, as has the number of abortions.This has only been made possible by an increase in contraceptive use and effectiveness. In 1970, for example, about 50 per cent of French women used no form of contraception at first sex. By 1993 that figure had declined to 16 per cent. Similarly, it is not the difference in the average age at first sex or fewer abortions that gives the United Kingdom a higher rate of teenage births than other European nations but lower rates of contraceptive use (only about 50 per cent of under-sixteens and two thirds of 16 to 19 year-olds in the United Kingdom use contraception at first sex).

The point may be made more graphically by imagining the effect of removing modern contraceptives from the scene altogether. In the United States alone, it has been estimated that this would result in a trebling in the annual number of teenage births from today's 494,000 to approximately 1,650,000. Even if teenagers responded to this unlikely scenario by having less frequent sex, or using rhythm or withdrawal
methods, the decline in contraceptive use and effectiveness would result in an extra
1 million pregnancies, 400,000 abortions, and 120,000 miscarriages every year. Arguments in favour of abstinence education must therefore take into account that the prevalence of sexual activity among US teenagers would have to decline by more than 80 per cent to prevent the same number of pregnancies as are today prevented by modern contraceptive methods.

Finally, it should be noted that contraception is essentially in contention with abortion and that, all other things being equal, abortion tends to recede as
contraception advances. In South Korea over the last 30 years, for example, total
fertility has been reduced from 4.5 to 1.5 births per woman -- largely by a
combination of contraception and abortion. But while the percentage of Korean women aged 15 to 44 using contraception has risen from 25 per cent to almost 80 per cent over the period, the abortion rate has been more than halved.

The facts are incontrovertible. Abstinence education does not stop sexual activity or teenage pregnancy; if the Christian Taliban were indeed interested in advancing young women's sexual, emotional, and reproductive health, they would be taking positions based on the reality and truth of human sexual behavior, not on their narrow religious ideas of what human sexual behavior should be.

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