Margaret Pabst Battin is the author of the new book Sex and the Planet: What Opt-In Reproduction Could Do for the Globe. Her other books include The Least Worst Death. She is Distinguished Professor of Philosophy at the University of Utah.
Q: What inspired you to write Sex and the Planet?
A: The idea occurred to me on May 7, 1992. I was listening to a lecture by Jared Diamond about how biologists were managing the animal population in the Rockies and thought, why can’t we humans manage our population ourselves?
You begin to think about what might make a difference for the human population. How could you hope that population rates would decline without interfering with anyone’s reproductive rights?
You think about global reproduction problems—issues of abortion, teen pregnancy, child bride pregnancy—a dangerous custom when there’s very early marriage, and pregnancy and childbirth follow immediately after; the female reproductive tract isn’t developed enough for pregnancy at very young ages. By 18, 19, 20, childbirth is favorable and much safer.
Then you think about pregnancies that are unwanted or unintended—after rape, incest, some kinds of sex work, when people are trafficked. There’s sexual violence, but it’s important to recognize that reproductive violence as a different, distinctive thing.
Then there’s an issue about high-risk pregnancies in women who want a child, how to make that safer. It’s a frequent occurrence that a woman shows up in a doctor’s office with a background health condition that could be threatening in pregnancy.
It is the doctor’s problem to try to find a way to have a safe pregnancy for her and for the fetus, and sometimes that’s not possible, or not possible if she doesn’t come in until too late in the pregnancy.
If she came in pre-conception, it would make a huge difference: she and the doctor might have been able to work together to find the safest way for her to have a successful pregnancy, whether by waiting for a remission in her background medical condition, or changing the medications used to treat that condition, or avoiding a toxic environment that makes the risks to her pregnancy higher, and so on.
Q: You said you first had the idea for the book in 1992—how did it evolve over the years?
A: You start with a lightbulb-on kind of idea—why couldn’t we humans do a better job of managing our reproductive lives—and explore one area of relevance after another.
Each area has its own complexities, whether it’s high-risk pregnancy or global population growth and decline, and the trick is to keep up with the science and policy evolution in each of these areas as you work on the whole book.
You think about one issue at a time. The speaker was talking about population control for deer in the mountains. It had been a concern in the popular press from the time of the “population bomb”—Paul Ehrlich’s book from the 1960s. It was a very widely read book, and his claim was that the population was growing so rapidly around the globe that it was like a bomb going off. The population has more than doubled since then.
We worry about climate change, sustainability issues, water access—the thing we don’t talk about is population growth. It got politicized as a negative thing to talk about; there had been aggressive population control like Indira Gandhi’s vasectomy program directed towards males in India, or the Chinese one-child rule.
Non- or semi-voluntary measures produced a response from largely feminist groups, who opposed (as one should) attempts to control women--and men-- this way.
Q: How would you define “opt-in” reproduction?
A: Many of the things we’re accustomed to having for birth control require reapplication, redosing, resupply—the pill every day, the patch every week, a shot every month or three months. They all have to be acquired and used, and they all cost money. And the condom, male or female? You need one every time.
Even if they’re covered by insurance, resupply contraceptives can have high failure rates because having to get them and use them, and use them correctly, is a problem. About half of women who’ve had unintended pregnancies were using contraception at the time they got pregnant--but contraceptives of these resupply types or still other forms, like withdrawal or natural family planning, i.e., the rhythm method.
There are two other kinds of contraception for females now on the market—the subdermal implant, which comes in various sizes—three years, five years; and the intrauterine device, the IUD, in both hormonal and non-hormonal versions. There are various types and sizes, including a non-hormonal version lasting 10-12 years. They are called Long-Acting Reversible Contraceptives, or LARC.
The book argues that LARC contraceptives are different from the resupply contraceptives. LARC are called “forgettable” or “set-and-forget”: that’s a major distinction. The crucial background fact is that 45 percent of all human reproduction is unintended: either two or more years earlier than you would have wanted a pregnancy, or not wanted at all. Almost half of unintended pregnancies end in abortion.
In this book, Sex and the Planet, we pursue a thought experiment: What would it be like if almost everyone had long-acting reversible contraception, or LARC—reversible on demand or self-reversible, under three moral conditions: no targeting of people, no force, and guaranteed reversal on request—no questions asked, no delays, no fees, no obstacles at all, you can have it out anytime you want.
This thought experiment effectively reversible the default in human reproduction: it’s not that you have to practice contraception in order to avoid having a children when you don’t want—that’s a negative choice, so to speak, opting-out of reproduction; you have to make a positive choice, opt-in, when you do want a child.
One partial analogy is that it’s normal for people whose vision is not perfect to wear eyeglasses or contact lenses. Nobody can make you wear them unless you want to drive a car.
What would the world be like if it were simply normal to have long-acting but reversible contraception—nobody can make you do it, it just what people generally do? The new normal is this: you choose when to have a baby, not just put up with pregnancy or abort it if it happens to happen to you.
Q: So you’re describing this as a thought experiment—could it come to pass?
A: In many ways it has—teen pregnancy and the teen birth rate have dropped more than 60 percent since 1990-1991. That’s normally attributed to teens having a little less sex, and especially using more reliable birth control. LARC long-acting birth reversible birth control is now available to teens; they have way fewer “accidents” and unintended pregnancy. And it’s way less in vogue to have a baby.
That’s one example of something that doesn’t involve force or a requirement—just making available to teens more reliable birth control. When teens are taking the pill, she gets on the pill as long as the boyfriend is around, but when the boyfriend is gone she stops, and then if she has a boyfriend again, she’s off the pill, and it takes a while to get on. Irregular patterns are where accidents happen.
The book works to isolate problematic assumptions we make in our everyday thinking about sex and reproduction, for example, that “you only need contraception if you’re sexually active,” but plenty of teens and adults who don’t think they are at risk end up with pregnancies they don’t want.
Q: Given the current political climate, what do you hope readers take away from the book?
A: I hope they take away that personal reproductive control is essential, and that we want it for females and also for males.
A particularly important but often overlooked part is male contraception. Males have just three forms of contraception that are fully under their own individual control: the condom; vasectomy (though that’s not good for young men who might later want a child); and withdrawal, which has an even higher failure rate than a condom. None of these are great.
The Dobbs decision has unleashed a new wave of interest in male fertility control. After all, males can now be identified by DNA analysis if they have contributed to a pregnancy; suddenly males have a more acute interest in reliable contraception fully under their own control: they don’t have to worry about whether their partner has remembered to take her pill, have her shot, etc.
Now there’s quite a lot of research into male contraception—a good place to look for this is at the Male Contraception Initiative, malecontraceptive.org.
And if people would prefer to invite pregnancy by chance, they can take their LARC contraceptive out; that’s still under your own personal control.
Safe, effective, long-acting reversible protection is new, radically new not only for females but males (not quite on the market yet but on the way).
The ideal end picture would be double coverage, so the female has long-acting reversible coverage and so does the male. These techniques have very low failure rates—and the chance of an unintended pregnancy with both partners having LARC is close to zero, though they can together choose to try to have a child at any time.
It’s important to think in a long-range way and ask what our long-range reproductive future might look like. Full personal reproductive control for both women and men, what could be better in the reproductive world than that?
--Interview with Deborah Kalb
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