Be responsible: Don't do it or use contraceptives

 Obviously, the solution to unwanted pregnancies is to avoid sex or use contraceptives. With our sex laden culture and media, the genie is out of the bottle. Sex between 13 and 30 is just too appealing for many of us to resist until we marry at age 30. The old line "save yourself for marriage" just ain't going to work any more. The "have sex" message, however, has overshadowed the "protect yourself" message. TV has prohibited birth control ads. We are real retarded in learning how to use contraceptives. Science has provided us with many highly effective birth control methods but we don't use them. But religion keeps telling us that premarital sex is a sin. 20% to 25% of singles in their twenties use no contraception. 40% of divorced men use none. How can we take control of our reproductive lives? The concept of the family--a monogamous union with one or two well cared for, very loved, carefully planned children--is a cherished, commendable ideal. What do we need to learn to achieve it? A lot.

 First, many attitudes need to change. Males must stop believing that women are responsible for avoiding pregnancy... and for the pregnancy, if it occurs. As a society, we must hold males, even 12 or 13-year-olds, partly responsible for their impregnations. As a teenage male, you must think of the problems and pain inflicted on the girl if she gets pregnant. If she chooses to have the baby, you may be morally obliged to partly support that child for the rest of your life beginning at conception. As the father of a child, that has many implications for your relationship with your parents, for your education and career, for your relationships with all other women if you don't stay with the mother of your child, etc. Fatherhood is an awesome responsibility time-wise, money-wise, and emotionally, not just until the child is out of college, but forever. The woman--your child's mother--is responsible for your child forever, so why shouldn't you be? She and the child need you for more than four hours every other weekend. I urge every unmarried person, male and female, to read the section about the effects of divorce on children. The harm of bitter break-ups and fatherlessness affects the children of divorce seriously for decades. Think deeply about the consequences to you, your partner, and the possible child before "going all the way." This is no time to be entirely emotional and impulsive.

 Second, similarly but even more importantly, young girls must never think that young boys and men are the "sexual experts" who will "know what they are doing" and take precautions against pregnancy. Every female must become an expert in birth control and sex, equal to any man, and far superior to any man in terms of knowing her body, her preferences, her morals, her sexual plan-for-life, etc. Every female must constantly realize that she is responsible and in charge of her body at all times. Every female must be familiar with the ignorant, irresponsible, selfish, inconsiderate kind of male who often objects to using a condom. Even an anxious, excited 13-year-old girl with a crush on a hunk of a guy must be strong enough to say in advance, "I must be protected or we aren't doing it" or better "we must both be responsible and use some protection (from pregnancy and disease). I will use a diaphragm with spermicide and you must use a condom!" She must know what she is doing; she must know that petroleum jelly (not KY jelly) deteriorates rubber (not latex) in 60 seconds, that her placement of her diaphragm must be checked by a doctor, and much more. She must practice handling this I-demand-protection scene over and over in her mind (or with friends) long before getting sexual with any guy. Our lives don't work out well if we don't plan and prepare.

 Every human being, male and female, who isn't ready right now for marriage and children, must learn to say, "I must stop the baby before I start the sex." If the male's hands have gotten to the woman's breasts or on her panties before birth control is on hand, they are both sexually irresponsible, inconsiderate of their partner, and a menace to each other's well being. We must learn to control ourselves. People uncomfortable with sex are not good at birth control. So, learn about and practice birth control methods until you are comfortable.

 Ask yourself: "Am I mature enough to have sex?" If you are too shy to buy a condom and some spermicide, too poor to get a diaphragm or cervical cap, too embarrassed to get on the pill or have an IUD inserted, too uninformed to know about DEPO-PROVERA or when pregnancy can occur, or too irresponsible to do anything to avoid pregnancy, you should never (or let anyone) get close to a breast, let alone touch panties. There are so many reliable and convenient contraceptives available for about $30 a month that there should be very few unwanted pregnancies. If you have trouble remembering to use a contraceptive every time, consider Norplant ("the implants") or Depo-Provera ("the shot"--there are some reports of bad side-effects). Both deliver hormones that effectively prevent pregnancy for a few or several weeks. Or, consider a reliable IUD. See Web sites below for information about the risks of failure with each method.

 As stated above, a good rule would be for both sexual partners to each assume responsibility for one contraceptive, so that two birth control methods are always used, say a condom (with spermicide) and the pill. I recognize this advice will not be taken by many but it should be. About 60% of sexually active college students do not use birth control at all or only occasionally. How stupid and inconsiderate! Remember, college students with negative attitudes towards sex (and the opposite sex?) use birth control even less than those with positive attitudes. Conversely, a sexually responsible partner is more likely to have a healthy, positive, thoughtful attitude towards sex. The failure to use condoms is not due to intellectual ignorance, it is due to psychological and sexual hang-ups (guilt and denial of reality and/or responsibility) and a lack of consideration for others. Having unprotected sex is very mean to the person with whom you are gratifying yourself.

 Several Web sites provide information about birth control methods. See Protection and How to Use a Condom. Also consider Health Central. For more complete information about birth control go to Planned Parenthood or, for women, Birth Control Methods. Planned Parenthood is especially good.

 Women assume men's sexual response is much greater than it is and they minimize their own response. In women, sexual guilt (resulting from taboos and religion), inhibitions, and morals seem to be associated with a denial of one's own sexual arousal, e.g. when watching erotic films or when petting. For guilt prone people, their erotic arousal is greater than they realize. Thus, there may be some truth in the old joke, "Religion doesn't stop you from sinning, but it sure keeps you from enjoying it!" Guilt may also keep you from being safe too. Don't let fear and shame (or uncontrolled horniness) dominate your good sense about birth control.

 Beyond guilt, denial of sexual intentions, and avoidance of contraceptives, we are astonishingly misinformed about sex as well. Only one third of young mothers knew when during their menstrual cycle they could get pregnant. Almost 10% of 15 to 19-year-old women think they are too young or have sex too infrequently to get pregnant. Wow! Some people believe they can't get pregnant if the female doesn't have a climax or douches with pickle juice or if sex is done standing up. Wow! People try to make condoms out of Saran wrap. Men have told women, "I have fantastic control, so don't worry I won't come inside you." And the ignorance goes on and on. It is sad that we (parents, schools, and media) have ignored these uninformed young people. The social-religious taboos keep us from being honest and teach teenagers exactly how to wisely undertake their sexual activity (if and when they decide to have sex). The result is they are unprepared for this critical aspect of life. And, we--the older folks--are largely to blame. Sex is a very important part of life. Important enough for young people to learn to take charge of their own lives and use the knowledge they need for a good life.

 This avoidance of explicit sexual guidance by almost everyone--this burying our heads in the sand--results in young people feeling that it is more acceptable if they have sex by "falling in love" and getting unexpectedly "swept away" by overwhelmingly intense sexual urges. (This way they can keep their minds pure and innocent--"like good girls"--as long as possible and avoid the responsibility for what happens.) But, if they plan for sex (by getting and using a contraceptive), then intercourse might be considered less romantic and spontaneous or more sinful. They might even feel "planned" sex is less loving and more unnatural, cheap, or immoral, sort of like "using someone for self-gratification." In truth, the most loving sex is when you avoid unwanted stresses of all kinds, including pregnancies, and make sex play comfortable, safe, meaningful, and satisfying --one of life's great moments. These things don't happen without planning and preparation.

 The most common reasons for not using a contraceptive are "I didn't expect to have intercourse" (20%) and "I wanted to use something but couldn't" (8%), according to Zelnik and Kantner (1979). The same authors report that only 36% of whites and 22% of blacks had been using contraceptives (obviously only part-time) before their unwanted pregnancy occurred. Furthermore, while teenagers and college students are having more sex, they are, in recent years, using more unreliable contraceptive methods. Fewer are using the pill (37% of blacks, 15% of whites), about the same use condoms sometimes (35%) but many more than previously are attempting to withdraw (13% of blacks, 42% of whites). No wonder there are so many unwanted pregnancies. Single mothers produce about half of all babies born in Chicago.

 There are many more situational factors and attitudes that interfere with good birth control practices. Examples: getting state aid for having a child, escaping a dysfunctional family of origin by getting pregnant, trying to find someone to love by having a baby, knowing a happily married teenager but knowing little about the difficult experiences of an unwanted pregnancy, believing birth control is racial genocide, assuming that all a woman can do is raise babies, assuming your buddies can tell you everything you need to know about sex and contraception, having intercourse for months before going to a birth control clinic, being unable to talk with our partner about sex and birth control, having little interaction with our parents about sex, assuming wrongly that you aren't going to have sex so there is no need to prepare, having low self-esteem and low self-control, overlooking the pleasures and gratitude of your partner when you use contraceptives, etc.

 Another crazy aspect of the sex scene is the single-minded focus on intercourse, even when birth control is not available. Our anti-masturbation attitudes seem to permeate all our sexual behavior. If a wonderful sexual opportunity unexpectedly occurs and no contraceptive is available, why not have "outercourse" (mutual masturbation) rather than intercourse? It would be much more considerate and loving (and even more likely to produce intense pleasure for both). Outercourse doesn't produce babies but certain STD's are still possible, especially if one has oral sex. Can you imagine our supposedly sexually liberated society discussing these matters openly?

 Beyond changing our attitudes towards birth control, every young person must learn to do very specific acts: (1) read at length about contraceptives, (2) visit a drug store and look carefully at the birth control methods and supplies, (3) role-play important situations (should we have sex? how will we prevent pregnancy? what if a pregnancy occurs? what will I say to Mom and Dad if I get pregnant?) with a friend before the actual problem arises (see method #1 in chapter 14), (4) learn about and actually practice, when appropriate, using several birth control devices, such as condoms, diaphragms, cervical caps, vaginal suppositories, sponges, Norplant, and an IUD, and (5) discuss with a counselor which birth control methods you think you would prefer for both preventing pregnancy and STD, and why. Preventing unwanted pregnancies is one of our major responsibilities in life. Don't sell it short; don't laugh it off.

If we don't change, we will keep on having millions of unwanted pregnancies and abortions, and we will continue the cycle of poverty and "poor babies having babies."

 We need to improve our sex education in schools, in the home, and in the media. An excellent reference for this is Byrne, Kelley, & Fisher (1993). Research shows that the right kind of practical, realistic sex education course can reduce unwanted pregnancies and does not promote sexual activity (Fisher, 1990). It is foolish to believe that realistically planning how to prevent babies and disease causes you to have sexual intercourse. Rather, it is love, needs, and sexual attraction that lead to sex (with or without protection). Hopefully, you will have enough common sense to plan your sexual activities when your needs and your head tell you that having sex is a wise, desirable course of action. Actually, well informed sexual planning does not promote sexual activity; it does, however, help you skillfully avoid unwanted sexual behavior. There is also evidence that the simple "don't-do-it programs" don't work (Scales, 1987).

 The sexual attitudes of young people about contraceptives need to become more positive, so there is increased self-awareness and self-control by every young person. Research has shown that teenagers with close relationships with their parents, especially if they communicate well with mother, have intercourse later than those with poor relationships. Books dealing with avoiding pregnancy include Calderone & Johnson (1990), Watkins-Ferrell & Robinson (1990), Foster (1986), and Howard (1991). Planned Parenthood Web site and Hotline is a good source of information, call 800-230-PLAN.

The Morning-after Pill and Abortion

 While it is so much better to prevent the pregnancy than to abort it, the TV propaganda by anti-abortion zealots must be corrected. They, in effect, threaten pregnant women with guilt, shame, and depression for years after an abortion. That is a lie, as shown by careful research. Brend Major recently published (August, 2000, Archives of General Psychiatry) a 2-year follow-up of 442 abortions; she found no increase in depression. Most women were satisfied with their decision to abort. Earlier research also showed that women's overwhelming psychological reaction to having an abortion was relief, not guilt. There is less anxiety, depression, and distress after an abortion than before. Of course, occasionally a person does have serious psychological problems after an abortion (just like after a birth), but this occurs more often when there was a history of depression or emotional problems and/or when the abortion was long delayed by doubts or denial. Also, having opposition, criticism, and neglect, instead of sympathy and support, from your relatives, your religion, and/or your male partner make the abortion situation much more traumatic and depression more likely (Adler, David, Major, Roth, Russo, & Wyatt, 1990).

 Birth control should, as I've said ad nauseam, be planned in advance. But, in an emergency, as mentioned above, a "morning after pill" has finally become available in this country after being available for several years in Europe. If you aren't educated or told about all the before and after pregnancy options, how are you going to know what to do? A recent study of 14 and 15-year-old girls found that perhaps 75% of their unplanned pregnancies could be avoided by a single lesson in emergency contraception (BTW the lesson did NOT make them more likely to have sex). Physicians refer to these pills as PREVEN--the Emergency Contraceptive Kit. See your physician if he/she is acceptable to you and if he/she will prescribe these drugs, some won't do it. (I am told--don't take my word for it--the pills are fairly convenient, usually effective, and have few side effects). PREVEN must be taken within 3 days after having sex (so the "morning after" is a bit misleading). If you don't know where or how to get the emergency contraceptive pills, link to or call (1-888-NOT-2-LATE) the national Emergency Contraception Hotline for local physicians who will prescribe the pill. Please contact the physician within two days, giving him/her another day to act.

 About November, 2000, chemical or medical abortion pills, RU-486 or MIFEPREX, became available in this country (about 10 years later than it should have been available). To be effective, this series of pills must be taken within 7 weeks of the beginning of the woman's last menstrual period. So, you can miss only one period. The way the pills are used is strickly controlled, so only selected doctors will prescribe Mifeprex. Three visits to the doctor's office are required. RU-486 (called Mifeprex in this country) has been 92% to 95% effective. It can be painful, causing bleeding and nausea, but it is quite safe. Like the morning-after pills, Mifeprex may not be available from your doctor. One way to find a prescribing doctor in your area would be to contact Planned Parenthood. The cost will be almost the same as a surgical abortion, about $300 to $500. The Planned Parenthood site has a good but brief description of both the chemical and surgical abortion procedures. It also describes STD and how to prevent disease.

 Sex education books also describe sexually transmitted diseases, something else that should be high on every sexually responsible person's priority list. In addition, there are hotlines: National AIDS Hotline, 800-342-2437; National STD Hotline, 800-227-8922; National Herpes Hotline, 919-361-8488. Always protect yourself and your partner.

Guard against date rape

 About 25% of college women have experienced a rape or an attempted rape since they were 14. Half of rape victims are under 18. Almost 85% of rapes are by people the victim knows; 60% occur in a dating situation. Mary Koss of the University of Arizona says many women are raped but then deny it, saying "I'm not sure what happened" or "he lost control" or "things got out of hand" but not "he raped me." In fact, only 24% of women actually raped called it rape. Only 5% of rapes are reported. Even more astonishing, Professor Koss reports that 1 in 12 men admit they have raped someone (see discussion of rape and abuse in chapter 7). In addition, males and females look at the seduction situation differently: the man is marching forward, checking off the steps as he progresses--deep kissing, touching breast, unbutton blouse, feel up legs, massage crotch, etc., etc. The woman is trying to decide how far to go and resisting at some point the fondling hands. He expects the woman to put up some resistance, even if she "wants it." If, in the end, he forces her to go "all the way," he calls it a successful seduction; she considers it a rape or wonders if it was (Warshaw, 1988).

 What can be done to avoid date rape? Know the person you go out with. Ask others what they think of him/her and listen for clues, such as "he is all hands" or "watch out when she gets drunk." Ask about and observe his/her drinking habits; 75% of date rape offenders and 55% of victims have been drinking. So, watch how much you drink too. If you do not want to have intercourse, be cautious about going to isolated places, do not "lead him/her on" or imply that you are "wild" or joke about being raunchy or sexually aroused. If you are certain that you don't want (or that it would be unwise) to have intercourse, stop the sexual activity early in the process. For instance, while either person--male or female--has every right to stop the sexual seduction at any point, it does not make sense to let the male expose your breasts, take off your panties, and stroke your clitoris, without indicating clearly from the start that you are not going to have intercourse. Under the circumstances I just described, it looks to the male like you, the female, are approving "going all the way." Without an explanation of why you are stopping at this point and without an understanding that you will masturbate him or have intercourse with him later when birth control is available, the male may feel so frustrated, angry, and confused that a date rape is more likely to occur. Of course, no rape is ever justified under any circumstances, but we shouldn't put ourselves into dangerous situations. Even in these very emotional "hot" situations, we still have to use our brain and common sense. Of course, many rapes occur even when the victim has been very cautious. You can lower the risks, however.

 If you are ever raped, report it and get medically examined immediately (see chapter 7--Rape for handling any sexual assault).

 Based on a major study involving 150 interviews of women victims, Warshaw (1994) offers the best self-help information about how to prevent date rape and how to recover after being assaulted. Males, too, should benefit from realizing the serious aftereffects of acquaintance rape; it is not a conquest, date rape is a cruel crime. Books by Rue (1989) and Jackson (1996) suggest ways of coping with dating violence and acquaintance rape.

 Several Web sites provide good coverage of acquaintance rape: Friends Raping Friends is excellent; Acquaintance Rape is a serious academic, research-based article; Trust Betrayed is a good site for people in a controlling, abusive relationships; When Love Hurts focuses on dealing with abusive, disrespectful partners; Rape, Abuse, & Violence (click on this page, then click on Coercion, Rape, and Surviving) helps women gain some understanding of men's ways of getting their way; Sexual Abuse deals with a variety of rape related problems, including one's recovery, which is also the focus of Becoming Whole Again. Lastly, there is a site that addresses how loved ones might interact with a rape victim, If Someone You Love is Sexually Assaulted. Also, take a look at Surviving Rape.

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