Birth control for everyone: Instead of scolding about alcohol, the feds should promote contraception for everyone

Instead of piecemeal recommendations about sex and drinking, the CDC should recommend contraception for all women

By Amanda Marcotte

Published February 5, 2016 12:59PM (EST)

 (<a href=''>mediaphotos</a> via <a href=''>iStock</a>)
(mediaphotos via iStock)

After 2006, when feminists exploded in outrage after the Centers for Disease Control recommended that every woman of reproductive age treat herself like she's "pre-pregnant," you'd think the agency would have learned not to release healthcare information that frames women as something closer to walking uteruses than full-fledged people in their own right. But now they've gone and done it again, releasing a report recommending that any woman of reproductive age who is not using birth control should refrain from drinking alcohol altogether. Yes, even if you are not actively trying to get pregnant.

The anger was, if anything, even greater this time, showing how much feminism online has really grown. Ruth Graham of Slate writes, "it’s the kind of swath-yourself-in-bubble-wrap thinking that has turned modern pregnancy into a nine-month slog of joyless paranoia."

"Women, your body is a ticking time bomb in which the bomb is a fetus, so get on birth control or stop drinking—that’s the way it’s going to be," Jia Tolentino of Jezebel sarcastically wrote.

Salon's own Mary Elizabeth Williams writes, that "yet again," the CDC puts "the entire burden of responsible behavior upon women."

The outrage was perfectly understandable, of course. The fact that women can have babies has been, for millennia really, used as an excuse to police women's bodies and choices, implying that our entire sex is meant to stay at home knitting chastely and soberly while the more earthly pleasures of screwing and partying are reserved for the menfolk. Despite the noble intentions in play, it's clear this is more of the same.  It's easier to scold women more about drinking or having any kind of fun, really, because if women push back, we run the risk of looking like sluts, whereas men who let 'er rip on occasion are just "boys being boys."

But what's especially frustrating is that this controversy is only happening because that same kind of puritanism prevents us from having a larger conversation about a much bigger problem underlying these narrow recommendations: the fact that so many women aren't using birth control in the first place.

The reason that the CDC keeps circling around this idea of "pre-pregnancy" is because, of course, half of pregnancies in the United States are unintended, and women keep the baby more than half the time in those cases. Unintended pregnancies tend to have higher rates of bad outcomes, in no small part because women experiencing unintended pregnancy engage in less prenatal care, on average, than women who were planning on getting pregnant.

And while birth control does fail, the main reason that the U.S. has such a high unintended pregnancy rate is that we're still pretty bad at using contraception. While nearly all women who have had heterosexual sex have used contraception at some point, a whopping 38 percent of women of reproductive age are not doing so right now. According to the CDC, that means that over 7 percent of women of reproductive age are having sex and not using contraception. Some of those women are trying to get pregnant, but not all.

Under the circumstances, it seems the simpler, more straightforward public health message would be to encourage women who aren't actively trying to get pregnant to always have a birth control plan in place, even if you are not having sex right now. (After all, tomorrow is another day, one that might have Mr. Right or at least Mr. Sexy in it.) It doesn't have to be something as intense as the pill or the IUD. A package of condoms always in your dresser drawer or a commitment to lesbianism works. Just having a plan and sticking to it is the big issue here. Instead of scolding women not to drink unless they're on birth control, why not make being on birth control a norm, so that the only time you have to worry about this stuff is if you deliberately start trying to get pregnant?

To be fair, most public health experts already see it this way, which is why there's a push to get young women to embrace long-acting methods like IUDs and why Obamacare mandated that contraception be covered as basic preventive care under insurance plans. But going to the next level and pushing the idea that everyone who isn't actively trying to get pregnant should be on some form of birth control? That remains a third rail in healthcare politics: something hinted at, but rarely spoken out loud.

The reason for this is obvious enough: Admitting out loud that all women, or near enough that the exceptions don't count, have sex continues to be untouchable in American politics. Look what happened when the CDC rolled out the recommendation that the HPV vaccine, which prevents a common STD that nearly everyone who has sex — which is to say that nearly everyone — is at risk of getting, be given to every girl in the country. The Christian right had a meltdown. Many parents freaked out. How dare you suggest that it's a near-certainty that this 12-year-old girl will grow up and have sex? Not their little angels!

It's easy to scoff, but the deep offense taken at the idea that your little girl will become a non-virgin at some point is so out of control that a whopping 40 percent of girls don't even get the first dose of the HPV vaccine. While access is a reason, research shows that parental fear that it's seen as "permission" to have sex is the No. 1 reason that parents cite for being hostile to the vaccine. This is true even though studies show that the vaccine has no impact on sexual activity. This is because, and it's sad this has to be stated out loud, that having sex is a near-universal behavior. When 99 percent of people were already doing something, you're an idiot to think there's anything you can do to make the behavior even more popular.

Same story with the conservative reaction to Obamacare making contraception coverage mandatory for insurance companies. The outcry was based, in no small part, on this belief that contraception is a luxury item, instead of something that a woman can and should be incorporating into her life on a day-to-day basis.

And yet here we are. The most straightforward move the CDC can make, one that is both non-sexist and addresses the issue of promoting better prenatal behaviors, would be to stop nipping around the edges with these "if you're not using birth control messages,"  and instead issue a recommendation that all women have a birth control plan in place, unless they are currently trying to get pregnant. Not "if" you're having sex, because it's really just a matter of time in the vast majority of cases anyway. Being "on" birth control, whether it's the pill or an IUD or just a couple of condoms in your purse (or lesbianism, of course!), should be considered the norm, only to be deviated from when you're trying to get pregnant.

Amanda Marcotte

Amanda Marcotte is a senior politics writer at Salon and the author of "Troll Nation: How The Right Became Trump-Worshipping Monsters Set On Rat-F*cking Liberals, America, and Truth Itself." Follow her on Twitter @AmandaMarcotte and sign up for her biweekly politics newsletter, Standing Room Only.

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Cdc Birth Control Cdc Pregnancy Contraception Hpv Vaccine Pregnancy Alcohol