What do we know about teen parents? Take a moment to make a mental list (or, if you’re motivated to get out a pen and paper, I won’t stop you) of all the facts and statistics you’ve heard.

In case you’re coming up short, I’ll give you a few:

• Most teen parents drop out of high school.
• Only 2% of teen parents will graduate from college by age 30.
• Many teen parents will end up on welfare, costing tax payers billions of dollars nationwide.
• The children of teen parents are more likely to fail a grade in school. Their sons are more likely to go to jail. Their daughters are more likely to become teen mothers themselves.
• The relationships of teen parents almost always fail, leaving teen mothers to be single parents.

You can read more here or here or here or watch any episode of 16 and Pregnant that features Dr. Drew. He’ll usually cover most of these points before the hour is up – while interviewing young people who are actually parenting.

Beyond these “facts”, we hear plenty of other messages on what The Candie’s Foundation calls “the devastating consequences of teen pregnancy;” their print ads tell teens they won’t move out of their parents house if they have a teen pregnancy; they’ll be spending $10,000 a year on their baby; they’ll have to breastfeed every two hours or come up with money for formula. The Candie’s Foundation isn’t the only organization putting out these types of messages – most teen pregnancy prevention, sex education, or public health organizations presume that their audience will immediately understand that teen pregnancy is harmful to young people, their children, and their communities as a whole.

Even the National Campaign to Prevent Teen Pregnancy says that teen pregnancy is:

...risky for all of those involved. Compared to women who delay childbearing, teen mothers are more likely to end up on welfare. The children of teen mothers are at significantly increased risk of low birthweight and prematurity, mental retardation, poverty, growing up without a father, welfare dependency, poor school performance, insufficient health care, inadequate parenting, and abuse and neglect. (From Halfway There: A Prescription for Continued Success in Preventing Teen Pregnancy)

And if the National Campaign to Prevent Teen Pregnancy says it’s a huge problem, they must be right… right?

Well… not really. You might have heard the saying that "there are three types of lies: lies, damned lies, and statistics." When it comes to teen parents, the statistics’ metaphorical pants are definitely on fire. First, we have to recognize that the young women who become teen mothers are different from some other young women. Not radically different, not different in a way that means we can marginalize or demonize them, but different in that: a) they chose to have sexual relationships as a teenager (most of them – some pregnancies are the result of sexual abuses or assaults; b) they probably didn’t use birth control when they were having sex (maybe they didn’t learn about it, maybe they couldn’t access it, maybe they couldn’t afford it, maybe they wanted to get pregnant, or maybe they did use it and it failed, as all methods can); c) they chose not to have an abortion (again, presuming they made this choice themselves, and had affordable access to safe abortion if they had wanted one).

Of all the teenaged women in the country, which young women are most likely to meet all of these criteria? Demographically, we know that it’s women and girls who grew up in low-income communities that have the highest likelihood of becoming young mothers.

Why is this? As I said earlier, it takes money to avoid parenthood if you’ve decided to have sex: you have to be able to afford birth control (and/or abortion), and sometimes that can be really expensive. It also helps if you went to a good school with a comprehensive sex education program, and we know that schools in low-income communities rarely have the resources needed to give students the educations they deserve. (Surprisingly, not all teens know they can get a ton of free sex education here at Scarleteen – provided they can afford or access a computer.)

But there’s also something else, and that's the extent to which young people have big plans for themselves that will conflict with parenthood. Are you planning on going to college? For some young people, the answer is an immediate "Yes!" because their parents went to college, their older siblings went to college, all their friends are going, and between their family and financial aid, they will be able to afford a post-secondary education that will help them pursue their dreams and find a decent job. However, for some young people, the answer is "I don’t know" or an ambivalent shrug, or even a straightforward "no." Maybe no one in their family has gone to college, maybe their school doesn’t have a college counselor that can talk to them about the application process and financial aid, maybe they just know they can’t afford it or what it might be able to offer them. They see their parents working jobs that don’t require a college degree. They expect to have a mid- to low-paying job, because that’s the type of job everyone around them has.

Now imagine there are two 16 year-olds, one who knows she’s going to college – she’s got a whole plan mapped out, and she didn’t even have to map it out all by herself. That’s just what she expects because that’s what everyone she knows does, and that’s what her parents expect of her. Then there’s the other one, who doesn’t expect to go to college, but she does expect to work hard at a job so she can contribute some money to her parents. That’s just what she expects because that’s what everyone she knows does, and that’s what her parents expect of her.

Both young women want to be mothers one day. Both are having sex with a boyfriend.

The first young woman has that college plan, though – and having a baby would really get in the way. It’s really hard to go to college with a new baby, and she knows that. Plus, she doesn’t know anyone who had a baby in high school. Her parents would be mortified if she got pregnant. Having a baby now would change the trajectory of her life. It’s an unacceptable risk. One night, when her boyfriend’s condom breaks, she goes to the pharmacy and buys emergency contraception. She decides if she’s pregnant, she will have an abortion. She talks to her doctor about going on the birth control pill so that she won’t have to worry should the condom break in the future.

The second young woman has a different plan. She’s going to graduate high school and get a job in the preschool where she now works part-time, and maybe eventually become a teacher there. It’s an hourly wage job, and she knows most of the women who work there already have children. Her cousin was a teen mom, and her mother had her older brother when she was 17 years old. She knows teen moms work hard and pinch pennies, but she’s going to be doing that anyway. If she has a baby now, she can count on her parents’ begrudging acceptance, and she knows that her mother would help with babysitting. She doesn’t want to live with her parents forever, but she’s not planning on moving out when she turns 18, anyway. One night, when her boyfriend’s condom breaks, she decides to wait and see. She doesn’t know much about emergency contraception, and she doesn’t have $60 to spend on it anyway. She doesn’t think much about abortion – she doesn’t think she’d be comfortable with the idea, but since she doesn’t know if she’s pregnant yet, she won’t stress about that at the moment. It’s a risk she’s willing to take: she definitely wants to be a mother someday, and if she is pregnant now, she knows she’ll find a way to deal with it.

Not-so-surprise ending: A few weeks later, the first young woman breathes a sigh of relief when her period arrives on time. The second young woman takes a test, and the plus sign appears. She’s pregnant.

Now, don’t over generalize: if you’re having vaginal intercourse, there’s a chance you’ll get pregnant, even if your dad has a vault the size of Bill Gates’. And, of course young women in low-income communities have hopes and dreams for their future. But the material privilege that a person has, the likelihood that they feel they’ll be able to achieve their goals, and the examples provided by people in their community – each of these things contributes to the decisions that they’ll make, the risks that they’ll take, and the different paths they’ll choose when faced with the same dilemma. We can conclude one thing very clearly and concretely: low-income women are more likely to become young mothers than middle and upper-income women.

What does this have to do with all those statistics we hear about teen pregnancy? It means that when we compare teen mothers to all other mothers and say, "Hey! Look how badly they’re doing!" we’re not really being fair. A woman who grew up in poverty in the United States is likely to live in poverty as an adult, too (despite what we hear about The American Dream) – and poverty itself is a huge risk factor for many adverse outcomes, including the outcomes listed in those statistics at the top of this page. When we compare teen mothers to older mothers, we’re also almost always comparing poor or poorer mothers to mothers with more resources, and that’s a problem. So, let’s look at some better comparisons:

• When we compare sisters (one who was a teen parent, one who was not), there is no association between poor infant and child outcomes based on maternal age. 1,2,5,8
• In low income communities where teen motherhood is common, young maternal age is a protective factor against low birthweight and infant mortality – the children of teen moms do better! 3,4,9,10
• When comparing women who became teen moms and women who had miscarriages as teen, there was no effect on future martial status, future hourly wages, and teen moms were less likely to live in poverty. 7
• Once young mothers are over the age of 22, they are less likely to receive public assistance than peers who were not teen parents – teen parents do not necessarily increase the burden on taxpayers. 6,7
• While young mothers are slightly less like to earn a high school diploma, they are more likely to complete a GED than peers who don’t complete high school, and they seem to work more hours in early adulthood to compensate. 7

None of this means that being a teen parent isn’t really, truly, incredibly hard. But hey – all parenting is a challenging. Newborns need to be fed in the middle night no matter how old their mothers are. Toddlers need to be constantly chased around just as much if their mom is 37 or if their mom 19. Some teenagers might not be up to the task – some adults in their thirties or forties aren't either. Let’s not ridicule, stereotype or misrepresent young parents as a justification for preventing teen pregnancy!

So now you’re probably scratching your head and asking: why, then, should we prevent teen pregnancy? For that, I invite you to stay tuned.

Gretchen Sisson is the author of Finding a Way to Offer Something More: Reframing Teen Pregnancy Prevention. You can follow her on Twitter @gesisson.

1. Furstenberg, F., Brooks-Gunn, J., & Morgan, S. P. (1987). Adolescent mothers in later life. New York: Cambridge University Press.
2. Geronimus, A. (2003). Damned if you do: culture, identity, privilege, and teenage childbearing in the United States. Social Science and Medicine, 57, 881–893.
3. Geronimus, A. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: the role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56(4), 1–5.
4. Geronimus, A. (1996). Black/White differences in the relationship of maternal age to birthweight: a population-based test of the weathering hypothesis. Social Science and Medicine, 42(4), 589– 597.
5. Geronimus, A., & Korenman, S. (1993). Maternal youth or family background? On the health disadvantages of infants with teenage mothers. American Journal of Epidemiology, 137(2), 213–225.
6. Hoffman, S. (2008). Updated estimates of the consequences of teen childbearing for mothers. In S. Hoffman & R. Maynard (Eds.), Kids having kids: economic costs and social consequences of teen pregnancy (2nd ed.). Washington: Urban Institute Press.
7. Hotz, V. J., Williams Elroy, S., & Sanders, S. (2005). Teenage childbearing and its life cycle consequences: exploiting a natural experiment. The Journal of Human Resources, 40(3), 683–715.
8. McCarthy, J., & Hardy, J. (1993). Age at first birth and birth outcomes. Journal of Research on Adolescence, 3, 373–392.
9. Rauh, V., Andrews, H., & Garfinkel, R. (2001). The contribution of maternal age to racial disparities in birthweight: a multilevel perspective. American Journal of Public Health, 91, 1815–1824.
10. Rich-Edwards, J., Buka, S., Brennan, S., & Earls, F. (2003). Diverging associations of maternal age with low birthweight for Black and White mothers. International Journal of Epidemiology, 32, 83–90.

In case you haven't already heard, the female condom (FC) has had a recent redesign. Yippee! (And how much do I love "put a ring on it" as a slogan for female condom use? I love it a whole lot.)

I was able to catch up with Mary Ann Leeper, the Female Health Company's Senior Strategic Advisor and past President/COO to ask her a few questions people seem to have about it. Check it out!

The FC has recently been redesigned! Can you tell us about the changes?
What’s new about the FC2 condom is the material. Our first-generation product was made with polyurethane. The second-generation female condom is made with a synthetic rubber called nitrile. Nitrile delivers at least two benefits to consumers. The first is that it lets us make FC2 with the same cost-efficient “dipping” process used to make male condoms. The second is that nitrile is softer than polyurethane, which means that FC2 feels softer and it doesn’t make noise when you use it.

Why did you make those changes?
We made FC2 because we realized that the first-generation female condom simply cost too much, and we knew that we couldn’t make it more affordable to HIV prevention programs and consumers unless we changed the material and introduced a more cost-effective manufacturing process. So we made the switch to a new material with the goal of expanding affordable access to HIV prevention to women and men around the world.

It's great to have another option besides male condoms for condom use, but having the FC isn't so simple as just having a different style of condom. Can you talk a bit about why?
The short answer is that it’s easier to put something “on” a penis than it is to put something “in” a vagina. That’s just the basic difference between male and female anatomy. But if he doesn’t want to put a male condom “on,” what do you do then? We think it’s better for women to have their own option. And we’ve invested a lot of our resources in creating programs that teach women the simple steps to insert and use the female condom.

We know that this kind of grassroots education pays off because we have a great example. The tampon was first developed in the early 20th century, but it took decades of grassroots education and outreach before enough women used it and could spread the word to their friends. We’re confident that we can achieve the same awareness and use with the female condom.

What myths have you encountered around female condoms: what things do people think about them that just aren't true?
The most frustrating and damaging myth is that “women don’t like female condoms.” We have dozens of published, peer-reviewed studies that show they do. And the research shows that user acceptability of the female condom – among women and men – is comparable to the male condom. And if you are a man, what’s not to like? She’s the one wearing protection!

Another myth that we need to overcome is that “There is no need for female condoms if male condoms are available.” Research shows that when couples have access to more prevention choices, the rate of unsafe sex decreases and the rate of new sexually transmitted infections declines. What’s wrong with having more choices?

How easy (or hard) is it for people to get the FC? Where can everyone find them?
Currently in the U.S., FC2 is available only through public sector distributors – like community based organizations, health clinics, and AIDS service organizations. The exciting exception is DC, where CVS/pharmacy has taken real leadership in making sure that women and men have 24/7 access. We are a manufacturer, not a marketing company, so we need to recruit retail partners and distributors to expand access. We’re convinced that grassroots education and access will stimulate demand to the point where we can secure more retail partners. And we’re working hard to convince more retail outlets to carry FC2.

What's your favorite FC success story?
This is the story that inspires me most: I was working long hours to finish up the detailed dossier that the FDA requires for all of its product approvals. It was tough, draining work, and just when I was starting to ask myself whether it was worth the effort, my phone rang. A young woman had participated in an FC study at Columbia University and she wanted to thank me for helping her. She told me that she was in an abusive relationship, that her boyfriend was HIV positive, and that he was refusing to use a male condom. Then she told me that having the female condom allowed her to protect herself without his knowledge. She’d insert it before he came home, usually high on drugs and alcohol, and she knew that she’d be OK. She called to thank me for helping her and other women have a way to stay free of HIV and other STIs. I should be thanking her, because she showed me that all the effort made a difference.

What special tips can you give FC users for how to use them best?
Practice makes perfect! Research shows that it can take up to three tries for women to become fully comfortable inserting and using a female condom. That’s why access to education and outreach, delivered by trusted peer educators and user-oriented materials is so important. And we have evidence that this approach works.

A P.S. from Scarleteen: some things we like to remind people about with the female condom that they might not know are:

• For those sensitive or allergic to latex, the FC is one way to still be able to use condoms
• Non-latex condoms like the FC can also conduct heat better than latex condoms, so some people may find that as far as pleasure goes, they prefer a non-latex condom
• The FC can be used for anal sex as well as for vaginal sex
• It covers more of the vulva (or rectum) than male condoms can, so it may provide extra protection from Herpes and HPV than male condoms
• Unlike male condoms, FCs can be inserted into the vagina hours before intercourse
• Some female-bodied people may even find that the external ring provides additional clitoral stimulation
• Even if a male-bodied partner loses his erection, or it gets a bit softer (or a couple wants to start intercourse without a full erection), that's not a problem with the FC like it is/can be with male condoms
• For male-bodied partners who complain the base of male condoms feel too tight, the FC solves that problem: no penis is as wide as the base of the FC
• If you already use or have used a menstrual cup or a cervical barrier, learning how to use an FC is likely to be easy.

That question probably either sounds like a really important one or a really stupid one, depending on your view. But I want the answer regardless, and am seriously tired of waiting for it.

As an organization that provides information on all methods of contraception and other aspects of sexual decision-making, we include talking about abstinence (or celibacy, or not having certain kinds of sex, terminology we prefer because they're more clear) as a method. We are supportive of our users who choose to be celibate, in whole or in part, as their method of birth control, just as we're supportive of our users choosing any other method of contraception. We know full well that there is no one best method of contraception for all people and would never suggest that there is.

For every other method, we provide perfect and typical use rates of effectiveness. Those are two pieces of information, combined with additional info on each method, we provide for those making choices about contraception; two pieces of information that play a big part in most people's decision-making process when choosing a method or methods.

That given, it really sucks that I can never provide a typical use rate for celibacy.

...or can't I?

The people promoting abstinence clearly haven't wanted to study effectiveness and failure of abstinence as a method of contraception so we can all know what the typical use rates are. They want to frame it as contraception, which is already problematic, because contraception is defined as things we actively do or use to prevent pregnancy, not as things we don't do or avoid using: contraceptive reference books won't show rates for abstinence because people not having sex don't need contraception. But if you're going to put it out there as a method of birth control, you have to also treat it like one when it comes to the kind of study we have for all other methods. Alas.

For all the promotion of abstinence, we still don't have studied, published typical use rates for abstinence as a method: the rate that shows us, for every method of contraception, how frequently a method does and doesn't result in pregnancy when used by people in daily life.

But that doesn't mean we can't get a good idea of what that rate is ourselves. This rate won't be as sound as we could get with a specific study, but I think we can use plenty of data we have on abstinence, as well as on other methods and use of no method, to get a good idea of what typical use probably is.

Before I get started, let me explain what a typical use rate for any method is. This is confusing, even though it's referenced all the time for methods. What "typical use" means is that a group of people, in a study, are asked what method they used in the last year. They reply that they used X method. Then they are asked about if a pregnancy or pregnancies occurred in the last year with that method. A rate is then figured from that data.

We call this typical use because this isn't study done in a lab or in a way where we can have any idea of how well a given person was using that method: this is what people are reporting with uncontrolled use. Additionally, as you probably know, when someone says they use a given method, they don't necessarily mean all the time or properly. Some people may say they use condoms, and yet only used them once or twice in the last year, only put them on halfway through intercourse or didn't use them at all. Non-use, weird as it may seem, is factored into typical use for every contraceptive method's rates. And yes, ease of use or comfort with using is obviously part of that equation: in other words, if a method is really tough to use or access, that's going to be reflected in the typical use rate: it's harder to use some methods perfectly than it is with others. For instance, the Depo-Provera injection has a near-identical perfect and typical use rate, because it's pretty goof-proof. But the pill's two rates have just over a 7% difference between them; condoms' typical and use rates differ by around 11%: these methods are easily to mess up. We always have to consider how hard or easy a method is to use when looking at typical use rates, and the rate alone often tells us something about that.

Perfect use of abstinence, as a method of birth control, is, at most, not having any kind of sex at all in the year one is using this as a method, or, at least, not having ANY of the kinds of sex which can pose a risk of pregnancy. That's genital intercourse and/or direct genital-to-genital contact between two (or more) people where one has a uterus and fallopian tubes and the other has testes.

Perfect use isn't only having anal sex, nor is it mostly not having vaginal intercourse, but having it every once in a while. There is no technical virginity at play when we're talking about abstinence per the prevention of pregnancy. Typical use of abstinence, per the definition of abstinence, can only mean that you're not abstaining completely in that same year. While with most other methods, what's typical use and what's perfect can be a bit blurry sometimes: with abstinence from the standpoint of abstinence-as-contraception, it's crystal clear. Using abstinence perfectly isn't about what may or may not be part of your values around sex, it's about biology, not psychology. As well, we're not going to consider that condom use sometimes, but abstinence other times, should be factored into typical use rates, because adding a second method isn't factored into typical use rates for any other methods.

Okay, then. Here's sound and relevant data we can look at to help provide the answer to this burning question of typical use:

1) The typical (and perfect) use rate for using no method at all when having intercourse and/or other direct genital-to-genital contact between opposite-sexed and fertile people is 10 - 20%. (AHRP, FWHC, Contraceptive Technology)

2) The typical use rate for using natural family planning without another method as a backup, which includes abstaining from direct genital-to-genital contact and intercourse during fertile times as well as tracking fertility in at least one of several ways, is 75 - 80% (Merck, AHRP, FWHC, Contraceptive Technology).

3) We know that most people, on the whole, have sex. And that the vast majority do and have always done so before or without marriage, and the majority, regardless of orientation, will have sex that poses a risk of pregnancy. The average age of first marriage right now in the states is 26-27. By ages 22-24, 92% of women have had vaginal intercourse (Mosher, Chandra, & Jones, 2005).

Abstaining from intercourse or other genital-to-genital contact before marriage is something very few people have ever done. "Trends in Premarital Sex in the United States, 1954–2003," (Lawrence B. Finer, January/February 2007, Public Health Reports) found that even among women born in the 1940s, nearly nine in 10 had sex before marriage. Using data from several rounds of the federal National Survey of Family Growth, Finer found that by age 44, 99% of respondents had had sex (intercourse), and 95% had done so before marriage.

It's stating the obvious, but we also know that pregnancy being unwanted or untenable isn't something that only happens to nonmarried or unmarried people. In the United States, over 30% of unintended pregnancies occur to married women (Unintended Pregnancy in the United States, Stanley K. Henshaw, Family Planning Perspectives, Volume 30, Number 1, January/February 1998). So, if abstinence is framed only as a method to use until marriage, and once married, those who chose to use abstinence both no longer abstain from sex and do not choose to use other methods of birth control, we can apply the typical use rate for using no method to married people who are not abstaining, but are also not using any other method.

4) For the first time in ten years, after consistent decreases since the 70's, unintended pregnancy rates for teens are up. Abstinence-only got it's start in the states in 1996, but only began to become as widespread as it did...umm, around 10 years ago. That may be coincidental, but probably not, especially since abstinence-only education programs not only state abstinence until marriage is the only acceptable choice, they often state that other methods of contraception are ineffective (which is a pretty wacky thing to do when your method has no published typical use rate), and other countries without these programs aren't seeing this kind of increase. Experts on teen pregnancy, contraception and sexuality near-unilaterally agree that abstinence-only education likely has played a key role in this change.

5) Studies which have been done about those who pledge abstinence have found that those who pledge abstinence do not have intercourse at lower rates than those who do not pledge, nor do they have lower rates of pregnancy and STIs. Based on interviews with more than 20,000 young people who took virginity pledges, one study found that 88 percent of them broke their pledge and had sex before marriage (Brückner H, Bearman P. After the promise: the STD consequences of adolescent virginity pledges. Journal of Adolescent Health 2005; Bearman PS, Brückner H. Promising the future: virginity pledges and first intercourse. American Journal of Sociology 2001). Bearman did also find that in his study, those who pledged often delayed vaginal intercourse, some for even as long as as 18 months. Now, for those who do NOT have any kind of sex which poses a pregnancy risk (important, as "sex" in this case doesn't include anal intercourse) for one full year, abstinence would be 100% effective. However, that's not typical according to studies as a whole.

A study by Janet Elise Rosenbaum, PhD, AM (Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers, PEDIATRICS Vol. 123 No. 1 January 2009) found that teens who pledge to abstain from sex have just as much sex as those who don't, and that those who pledge not to have sex until marriage don't wait longer to have sex than those who don't make that pledge. Pledgers did not differ in lifetime sexual partners and age of first sex. Fewer pledgers than matched nonpledgers also used birth control and condoms in the past year and birth control at last sex. She also found that five years after the pledge, 82% of pledgers denied having ever pledged at all. Central to the information we're looking for, on typical use in a year, "pledgers reported an average of 1.09 past-year vaginal sex partners, 0.11 fewer than nonpledgers." In other words, on average, those who report using abstinence are not using abstinence perfectly each year.

Rosembaum's study was fantastically done, by the way, with a far sounder and stricter methodology than the Bearman and Brückner studies. She even ensured, via 128 different factors, that her samples of those who pledged and those who didn't had similar attitudes towards sexual activity to begin with.

Lastly, of the ten studies identified by the Heritage Foundation as providing proof that their respective programs reduced early sexual activity, nine of them failed to provide credible evidence that they delayed the initiation of sex or reduced the frequency of sex ("Do Abstinence-Only Programs Delay the Initiation of Sex Among Young People and Reduce Teen Pregnancy?," Douglas Kirby, Ph.D, The National Campaign to Prevent Teen Pregnancy).

Here are a few of the studies on abstinence (mostly on ab-only sex ed programs) and reports on them:

• Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers
• Understanding 'Abstinence': Implications for Individuals, Programs and Policies
• Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact
• Many Teens Don't Keep Virginity Pledges
• Taking The Pledge
• What the Research Shows: Government-Funded Abstinence-Only Programs Don’t Make the Grade
• How Effective is Abstinence Education?

If you want to look at what's published by those who strongly support not just abstinence, but abstinence being put forth as the only right method of birth control, I'll give you a few links. I would, however, encourage you to consider that the studies above do this funny thing where they create and explain a methodology, something you'll note tends to be conspicuously absent from the links below. You also may notice that some of them report things from other studies linked above which are dubious, incomplete or suggest the studies were incorrect without putting forth any sort of sound critique, or offering up their own controlled study.

• Virginity Pledges Are Highly Effective, Study Says
• The Effectiveness of Abstinence Education Programs in Reducing Sexual Activity Among Youth
• Abstinence-only programs effective in protecting teens from consequences of unwed sex
• Study Claims Abstinence Classes Don't Work

I want to make a distinction between abstinence-only education and programs and abstinence used as a method of birth control. Because of the billions of dollars which have gone into ab-only education (more money than has ever gone into developing or honing any birth control method), and the breadth of what ab-only programs can impact, including STI rates and GLBT invisibility and discrimination, much of the study and reporting we have on abstinence is about abstinence-only education or pledge programs. By all means, some people choosing abstinence as a method are doing so via abstinence-only or abstinence-pledge programs. Some people are choosing abstinence based in moral or religious beliefs. But not everyone choosing to be celibate or abstain from sex that poses the risk of pregnancy is a member of any or all of those groups. There are also people who choose to be abstinent for other reasons and with different motivations, and they may well present very different outcomes.

But let's get back to the main question at hand. Considering all that data, what is the typical use rate for abstinence at preventing pregnancy?

At first glance, the rates for natural family planning/periodic abstinence may look plausible as the typical use rate for abstinence. However, FAM/NFP is a method all by itself of which abstinence is only one part. Someone who was using abstinence as a sole method isn't using NFP/FAM: if they're not doing any kind of fertility awareness, they're only using abstinence. If they are doing any kind of fertility awareness, they're using NFP/FAM, not abstinence. Using NFP and FAM, includes, and is centered around calculating fertility in some way: either by the calendar method, or more efficiently, with daily tracking of cervical mucus and/or basal temperatures, then fertility predictions based on charting one or both over time. That's not part of how abstinence is defined.

However, in that method there is a shared motivation to those using abstinence, which is the motivation to abstain from sex, even though it's not a constant. I don't think that typical use rate is irrelevant, because motivation isn't irrelevant in typical use, and NFP rates do give us some information on abstinence: but it's also only part of the picture.

Given the study we have on abstinence shows us the amount of sex and lifetime partners had appears to be no less than those who don't report using abstinence as a method, we can presume that when it comes to figuring out the typical use rates, we're not considering a group of people whose sex lives -- when it comes to having sex, and to frequency of sex -- are that different than we'd find when considering any other group. In other words, if someone who is using abstinence doesn't use it perfectly, but typically, meaning they did not abstain from sex or the kinds of sex which have the potential to create a pregnancy, and we are ONLY considering abstinence as a sole method, not other methods they may use (which would then be about rates for combining methods), then they may be the same, practically speaking, as those who do not use any method at all.

It may be sound and accurate to state that the typical use rate for abstinence as a sole method is probably the same as the typical use rate for no method: 10-20%. However, I'm not willing to dismiss that intention of use, and motivation to use, is a factor in the use of any method, including abstinence. I also can't dismiss that rates for NFP, while they involve a built-in backup method abstinence alone does not, do also take some abstinence into account. Using abstinence sometimes in a year, but not all the time or for the whole of a year, is consistent with the studies we have on abstinence, and what I hear from young people who have been using it as a method or taken a pledge.

My theory is that the typical use rate for abstinence is the average of the typical use rate for using no method at all, and the typical use rate for periodic abstinence, which lands us at a rate of 42.5 - 50%. I may be overly generous in that estimate, but I don't think so. If you think I am, and want to play it as safe as possible, then you'll want to consider it to be the 10-20% figure, instead. (I'd also be really interested in reading your own comments on this, and seeing your own theories.)

Even with that potentially generous estimate of 42.5 - 50%, abstinence has the lowest effectiveness rate in typical use of all methods. That's important information for people considering any method to have, especially if this method is touted as being foolproof by someone who says condoms, with around an 85% typical use rate, are said to never or only infrequently be effective.

For the record, I know that some people have a beef with abstinence being assigned a 100% perfect use rating, arguing that even in perfect use, all other methods fail. I don't share that beef. The complaints about that claim are usually a) that we have no studies to show that (I disagree: we have plenty of study to show how pregnancy happens, so can know clearly that with no sex, it won't), b) that plenty of people don't understand what perfect use of abstinence even means (yes, but plenty of people don't know that for all methods), and c) that we know full well abstinence fails (true, but in typical use, since perfect use means not having sex, so unless you're counting Mary and Jesus, who we're told abstinence failed in perfect use, it's 100% in perfect use). The reason all other methods fail even with perfect use is that those perfect use rates still include people who are having genital intercourse: perfect use for those methods does not require or account for a lack of any intercourse whatsoever.

When I'm doing a contraception consult with someone, be that online or in-person, a tactic I often suggest when choosing a method is for people to figure that as someone who is getting good education on using a method with me, but also has a harried life like anyone else where we'll goof things sometimes, they'll probably wind up with an effectiveness rate somewhere between perfect and typical use. So, for example, if we were taking about the pill, used alone, I'd ask them to think about if 96% effectiveness (the average between perfect and typical use), was a rate they felt comfortable with. If it wasn't, then I'd bring up both other methods which are more effective as well as how combining more than one method can increase effectiveness. For example, even with just typical use for both, adding condoms to the pill would net them 98.8% protection.

So, I'd pose the same proposition to anyone considering abstinence as their sole method. If perfect use is 100%, and typical use is, in fact, 45-50%, then we're talking about an average between them of 72.5-75% effectiveness at preventing pregnancy. Are you okay with those levels of protection/risk? If so, okay: I'm not going to say that's not okay for someone who tells me that's a level of protection they're okay with, just like I wouldn't for any other method. (But if, for instance, I see someone at one of the clinics or other sites I do consultations for, or on the site, who is saying they're okay with it, but either keeps having pregnancies they don't want, or keeps freaking out worrying about pregnancy all the time, I am going to suggest they rethink, since it seems clear they're really not okay with it, after all.)

If you're not okay with that level of protection against unwanted pregnancy, and want a higher one, then just like with the consideration of any other method you have two choices: you can either choose a more effective method, or you can combine abstinence with a second method. In practice, what the latter would mean is that if there are times you choose not to abstain, and you want to prevent unwanted pregnancy at those times, that you use a second method of contraception, like a condom, a pill, a ring, an injection, withdrawal or natural family planning.

I also want to share an observation about celibacy as a method that I've made over the decade-and-change I've been doing my job. What I've observed is that celibacy seems to be more effective at preventing pregnancy for those who choose it without making pledges to g-d some other authority figure, or making a big to-do about it and without feeling that it is their only right, moral, or religiously-sanctioned contraceptive choice to make. If a study was done which compared those making abstinence pledges until marriage versus those people choosing celibacy for now, without those kinds of conditions, I think we'd find the latter group had lower rates of pregnancy and more positive sexual outcomes. I don't think we'd see, as we did in the Rosenbaum study, the latter group outright denying they had chosen to be celibate, either. The people I've spoken with in work and in life who just choose not to have sex, or certain kinds of sex, as a way to prevent pregnancy (or just because they don't want to have those kinds of sex), and do so feeling they'd be supported if they chose a different method, seem to be pretty relaxed about it, and not at all ashamed or defensive around that choice. They also don't seem to make that choice out of fear.

In other words, I think if the folks pushing abstinence so freaking hard would stop pushing and shoving the way they do, and would treat it like any other method, giving every method the respect and plausibility they give it, doing studies on it like the kind done with other method, including providing some studied typical use rate, not only would the typical use rate of abstinence likely be higher in time than I theorize it is now, the rate of unwanted pregnancy -- something they say they really want -- would also start declining again, the way it was before the advent of abstinence programs. There are other potential bonuses with that change of approach: for instance, treating abstinence differently would support more folks who want to decline sex for any number of reasons in doing so better, would likely help get our STI rates down, would result in less shame and fear (which never helps with sound decision-making, sexual or otherwise), would address people who can't get married at all or just don't want to, and a whole plethora of positive outcomes. If what many abstinence-proponents tend to say they want -- lower STI and unwanted pregnancy rates and happier, healthier people -- isn't a pile of hooey to mask a religious or political agenda, they'll hop right on board with that.

But I expect to be waiting as long for that to happen as I expect to continue waiting for them to give me a typical use rate.

P.S. Should you read this and strongly disagree with my theory, thinking abstinence as a method is far more effective in typical use, I encourage you to lobby abstinence organizations to do some actual study on typical use of abstinence as a method. I would far rather have sound data from study on typical use to post here, too. The only reason I'm doing this the way that I am if that I've got no other options, and I don't find "?" an acceptable permanent answer for an effectiveness rate for any method of contraception. Especially one that's gotten billions of our tax dollars, so goodness knows they can certainly afford to do the studies.

Thanks to Dr. Logan Levkoff for letting me toss these ideas at her and for her helpful input!