Why Knocked Up?: The Paradox of Sex, Magical Thinking, and Accidental Pregnancy in This Age of Contraception

Copyright © 2015 by Carol Cassell PhD.

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Rev. date: 01/29/2016

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Table of Contents

Introduction: The Knocked Up Paradox

PART ONE. STORK REALITIES, MAGICAL

THINKING AND ACCIDENTAL PREGNANCY

Chapter One: A Pregnant Pause

Chapter Two: I Didn’t Think It Would Happen To Me

PART TWO. WHAT DRIVES THE KNOCKED UP PARADOX?

Chapter Three: A Scarcity Of Sexual Intelligence And An Abundance Of Shame And Guilt

Chapter Four: The Cabal And The Great Anti-Contraceptive Crusade

PART THREE. THE DOMINO EFFECT

Chapter Five: Who’s Your Daddy?

Chapter Six: Single Moms And Fragile Families: Life Under A Cloud Of Economic Insecurity

PART FOUR. OPTIMISTICALLY ONWARD:

PUTTING SCIENCE TO WORK

Chapter Seven: What We Can Learn From More Sexually Sane Countries

Chapter Eight: The Optimists’ Cliff Notes For Bold Agendas, Brave Actions

Addendum: The Aca Contraceptive Mandate V. Freedom Of Religion

Notes And Sources

Acknowledgments

About The Author: Carol Cassell Phd

Dedication

To Bob Cassell… and the beat goes on.

Introduction

THE KNOCKED UP PARADOX

Years ago I worked for Planned Parenthood of Bernalillo County, a small Planned Parenthood affiliate in Albuquerque, New Mexico. We offered pregnancy testing in the mornings, and often I was the person who sat down opposite the client to announce the results of her test. I scanned their faces—bright, pretty, some teens, a few women of white collar jobs, mostly college students or pink collar workers. As a woman settled down in the chair to hear the results of her test, her face reflected a sea change of emotions anticipating what it would reveal—from the optimism that this whole thing was a mistake to awareness that she probably hadn’t dodged the pregnancy bullet. Still, even though she might have good reasons to suspect she might be pregnant, I could see her clinging to the slenderest of hopes that the test would be negative. When her paperwork showed the results were positive, I gently announced in the most neutral tone of voice I could muster, Your test is positive. You are pregnant.

What should have been happy news was anything but for most of those women. Yes, there were joyous moments shared with women who were thrilled to hear that they were pregnant. Most just crumbled; they appeared to be shocked and distressed. Disoriented.

I never have shaken off those memories of women struggling to deal with a gut-wrenching situation of being pregnant when they didn’t want to be. Some told me they felt so alone; the man involved wasn’t in the picture. But even if he was, they said they felt they couldn’t count on him for support. Others, especially the teens and young adults, felt that they could not count on their families as they were either sure they would be too shamed or too shocked to be much help.

Desperate doesn’t begin to describe their emotional state.

What is dumbfounding, ironic actually, is that those long ago stories about women facing up to the harsh realities of an unwanted pregnancy are just as salient today. Yes, today. Almost all women facing an unwanted pregnancy still express dismay and disbelief that it would happen to me. Although our birth rate is at historic lows and there have been advances in contraceptive technology with a lot more availability, the rate of Knocked Up—unplanned and unwanted—pregnancy has remained nearly flat since the 1980s. And this is true even though The Centers for Disease Control and Prevention (CDC) has proclaimed modern contraception as one of the ten greatest public health advances of the entire 20th Century.

***

In this book, Why Knocked Up?, I’ll peel back the layers of conflict, denial, hope, dreams, and myths about pregnancy and motherhood to reveal what I identify as the Knocked Up Paradox: Despite more than 50 years of The Pill, a healthy dose of sexual freedom, and a dazzling array of contraceptives, about 50 percent of all pregnancies—some 3.1 million a year—are accidental, unplanned. Simply put: In this age of contraception, why are our rates of Knocked Up pregnancies still sky-high?

Given the magnitude of unintended pregnancies, it should be front and center of our country’s concerns about social and economic critical issues, but it isn’t. My hope in writing this book is to jump-start a serious national discussion about the causes and the far-reaching consequences of unintended pregnancies. A dialogue which includes a resolute will to actually do something to prevent more Knocked Up pregnancies that have a reasonable chance to work.

***

First of all, a majority of women will spend approximately five years pregnant, postpartum or trying to have a child, but thirty years–more than three-quarters of her reproductive life—trying to prevent a pregnancy. That is a long time to be vigilant about not getting Knocked Up. As a result, one out of two women will have at least one unintended pregnancy in her life. A disquieting number no matter how you do the math.

In contrast to the conventional folklore, I’ll be clear that getting accidentally pregnant isn’t just the plight of so-called slutty or unlucky women or is only a teenager’s nightmare. While some racial and low-economic groups bear more of the burden of unintended pregnancy than others, it crosses income, education, marriage, and racial lines. Although higher-income women, white women, and college graduates are comparatively successful at planning their pregnancies, they experience unintended pregnancy at the rate of one out of five pregnancies.

Despite teen birth rates being at an all-time low, teens still have a very high rate of unintended pregnancy. But a fact about unintended pregnancy-–one that that garners little media attention—is that it is adults who make up the largest percent of unintended pregnancies. Seven out of ten unintended pregnancies occur to single women in their twenties or thirties, many of whom are white, aren’t poor, and have at least some college education. Although unintended pregnancy rates are lowest among women more than 30 years of age, they still represent about one-third of pregnancies in this age group. Among married women, about one out of four pregnancies is not only unplanned, it is unwanted.

As pregnancy is a deeply personal and complex experience, this book cautions that it is a mistake to assume that all unintended pregnancies are unwanted. Many are mistimed. The woman wanted to get pregnant someday, just not that day; getting pregnant now is more of an inconvenience than a problem. And there are those twists of fate when an unintended pregnancy turns into the best mistake ever and a loved child.

Notwithstanding the Hollywood breathless obsession with surprise baby bumps and the celebrity-driven mythology that everything works out just dandy, in real life it doesn’t often turn out that way. If a pregnancy is truly both unplanned and not wanted, it presents a complicated personal dilemma with significant consequences, for all concerned. For the woman—and the man if he is involved—it is situation wrought with conflict and stress about deciding what to do next. Whether a woman decides to end a pregnancy or see it through is as complex an emotional and moral decision as she may ever face. There are no simple answers, no quick fixes. Every option, from abortion to adoption to considering raising the child, plays out as its own unnerving drama.

The Perspective from Two Views

Zoom in to get a clearer picture of why we have so many Knocked Up pregnancies and you will likely see that the siren song of sex is so seductive and powerful that most of us have thrown caution out of the bedroom window at least once or twice and risked getting pregnant. You will also see other combinations of feckless sexual behaviors and personal irresponsibly, a wide swath of ambivalence about pregnancy itself, and even a bit of magical thinking. About one out of four woman facing a Knocked Up pregnancy–lacking any evidence of infertility–say they didn’t think they could get pregnant. Even more a cause for eye-rolling is that among the women who said they didn’t want to get pregnant when they did, 37 percent were not using any contraception at all. None at all.

But when you zoom out to get a wider view you can see a kaleidoscope of complex patterns formed by the cultural, social, economic, and political forces that color our values and behaviors, creating the Knocked Up world in which we live. Unconsciously we breathe in messages about sex, love, pregnancy, birth control, marriage, and children like dust in an old hotel. We rarely notice what we are absorbing from those messages or ponder how we originally learned what we believe.

For decades, the divisive anti-abortion politics of religious groups comingled with the U.S. congress has tainted and virtually stymied meaningful dialogue about the tangle of personal dilemmas and far-reaching consequences of our high rates of Knocked Up pregnancies.

Just a few years ago, media attention was focused on the congressional hearings and other forms of political circus around The Affordable Care Act’s mandated insurance coverage for contraception. However, the media and the legislators disregarded (and still do) an inconvenient truth: one of the most obvious consequences of unwanted pregnancy is abortion. Almost all abortions—about a million a year—are linked to unintended and unwanted pregnancy. And that is a lot of women: one in ten women will have an abortion by age 20, one in four by age 30 and three in ten by age 45. Yet, there was (and still is) an eerie silence about the simplest of solutions to the problem: reducing unintended pregnancies reduces the need for abortion.

Because preventing an unwanted pregnancy is the evident and ultimate antidote to abortion, it would be logical to assume that ensuring access to affordable contraception would be a humongous national priority among those against abortion rights. As ludicrous as it seems, that it is not the case. In fact, organized groups against abortion work overtime lobbying our government to eradicate the very programs (like Title X Family Planning Services, Planned Parenthood and sex education initiatives) that are proven to reduce unwanted pregnancy. All of which, as duly noted, reduce the need for abortion.

Once you review the totality of their actions, it becomes obvious that the anti-reproductive rights movement—one best characterized as a Far-Right Extremist Cabal (or as I also identify them in this book, The Far-Right Cabal aka The Cabal)—is not only about getting rid of abortions. As evidence, I’ll offer just the tip of the iceberg of their actions: the pompous-toned congressional hearings belittling women’s need for contraception and shaming them as girls gone wild; the Hobby Lobby-inspired court challenges to the ACA contraceptive mandate; the non-medically based restraints on access to emergency contraception; state-wide punitive legislation on abortion despite that it is a legal medical procedure; and, the rabid anti-women proclamations of far-right radio hosts and TV evangelist preachers.

Actually, as I argue in this book, The Far-Right Cabal-led anti-rights movement is a scorched earth movement, one fundamentally unconcerned about why people find themselves having to seek an abortion, i.e., an unwanted pregnancy. And it is, and always has been, against contraception being widely available—especially to teenagers and adult unmarried women. Less obvious, although they have waged war on sex education for years, are their local and state wide efforts to keep young people ignorant about S.E.X. and the facts of life: Tab A > Slot B = Baby unless you use birth control.

Actually, any sexuality education that doesn’t discourage young people from wanting to do it, or even thinking about doing it, finds the far-right social conservatives sputtering into a tail spin of shock and alarm. Not surprising, the result is a nationwide pervasive lack of sexual intelligence along with a good measure of naiveté about conception and pregnancy. In one research survey, for instance, almost half of the adults aged 18-24 said, It doesn’t matter whether you use birth control or not, when it’s your time to get pregnant you will. And that myth goes a long way in explaining why young adults have such high rates of Knocked Up pregnancy.

Why It Matters: Black Elephants, Black Swans and the Elephant in the Bedroom

Most Americans don’t have a clue that we have the highest rate of unintended pregnancy among all industrialized countries, even higher than Mexico and Spain, and just how far behind we are in doing something about it. Undoubtedly, turning a blind eye to the ramifications of unintended pregnancy has quashed any serious dialogue about what can be done to prevent it—in both our personal lives and in the public arena—including what we can do to reduce the impact of its predictable outcomes.

Therefore, throughout this book, I take off the kid gloves to deliver an argument that the Knocked Up Paradox has all of the characteristics of a black elephant. That term is one most often heard in the environmental community to warn of future global calamities, but I believe that it works equally well to describe the eventual consequences of so many unplanned and unwanted pregnancies in the U.S. A black elephant is a cross between a black swan (an unlikely, unexpected event with huge complications) and the elephant in the room (a problem that is visible, yet no one wants to admit it is there).

Even if it is ignored, it is probable that a "black elephant’’—such as the one residing in our bedrooms—will eventually have vast, negative black swan-like outcomes. To put this into context, consider the probability that our high rates of unintended pregnancies, specifically those which result in unplanned and overwhelmed parenthood, are a factor in pushing our society over its tipping point to cope with adequate employment and education. And if, as a result, the resources of schools and communities become stressed to the max, is it likely that we, as a society, will claim that the problem was a black swan no one could have predicted? When, in fact, the domino effect of so many unintended and unwanted pregnancies is actually a black elephant, very visible right now if we admit it exists.

Unfortunately, the reality of Knocked Up pregnancy as a contributor to substantial social-economic difficulties is so far off our national radar, that the common link between unplanned and unwanted pregnancy—fragile families living in poverty, the high rate of school dropouts, the rise in homelessness, along with the continuing controversy and even violence over abortion—is underestimated or is swept under the rug. What is undeniable, however, is that in many ways, large and small, we—all of us—pay a high price to deal with problems created when children are born to people who are unprepared to raise them. The economic costs, which are considerably costly, include providing food security programs, subsidized housing, and medical care, play a role in the diminishing capacity of both the public and private sectors to deal with our ever-deepening social and economic unequal opportunities.

But the economic costs don’t begin to compare to the real human cost of family upheavals and lost opportunities for a better future. I believe the most emotionally daunting reason for us all to care about the consequences of unprepared parenthood is that it casts a long shadow over the lives of about 650,700 vulnerable children who are found to be abused or neglected every year, including 40,000 infants! A majority of those kids end up in foster care and are never permanently reunited with their biological family again. It is heartbreaking: all of it.

Putting Science To Work

In spite of the many obstacles—I don’t sprinkle them with fairy dust to make them appear to be smaller than they are—to preventing or at least reducing our high rates of unintended pregnancy, it isn’t a hopeless whack-a-mole challenge. I’ve headed up many effective and innovative pregnancy prevention projects with Planned Parenthood, The Centers for Disease Control and Prevention (CDC), and The Centers for Health Training. I’ll bring those experiences, along with those of my colleagues and other experts, to the pages of this book to show that it is possible to make contraceptives and sex education more accessible and user-friendly. Essentially, this means adopting the evidence-based principles of CDC’s Winnable Battles Initiatives because those efforts are most likely to have a large-scale impact on improving a critical public health concern.

Using the CDC’s Winnable Battles’ research framework to reduce Knocked Up pregnancy doesn’t mean those science-based efforts could end up being, frankly, too academically dense. That isn’t an issue. Without losing the benefits of science, we can, for example, support national edgy media campaigns based on the successful European savvy style of sex education for adults (yes, even though it will likely make Americans blush.) I’ll recommend innovative, effective programs-college campuses, neighborhood centers, workplaces—that reach out to young adults to offer straightforward information about contraceptives and ways to avoid an unplanned pregnancy. And I’ll recognize some of the efforts which take advantage of social media, such as Bedsider, a saucy web-based site offering light-hearted yet solid messages about why sex is better when you aren’t worried about getting pregnant. And thus, why using contraceptives is a really good idea.

What Lies Beneath

The underlying heartbeat of this book is, as my heroine Margaret Sanger, said: No woman can call herself free until she can choose consciously whether she will or will not be a mother. Well said, Maggie. And, of course, that same sentiment applies to men and fatherhood as well.

The other guiding principles—beliefs, philosophy, opinions—which form the framework of this book include:

We are all in this together. First and foremost, this book rejects the misguided notion that preventing a Knocked Up pregnancy is a woman’s issue. My belief is that both women and men gamble against the odds of a pregnancy or experience contraceptive failures that can result in an unintended pregnancy. With rare exception (the most obvious exception, of course, is forced sex), both men and women are responsible for an unintended pregnancy. Although what to do about the pregnancy is ultimately up to the woman, I recognize that both women and men struggle with how to resolve the problem. Abortion is often sought by both women and men as the solution. Thus, I contend that demanding reproductive rights and justice is the responsibility and a commendable goal for both women and men.

Sex is a force that is with us—always. Throughout the book, I make the point that unintended pregnancy is explicitly connected to sex—passion, sexual desire, and the craving for intimacy. One of my ambitions in writing this book is to put sex back into the Knocked Up picture. To ignore, as our society does, the primal pull and power of sex in any dialogue about contraception is foolhardy. And we, as a nation, have the rates of unintended pregnancy to prove it.

We each, in our own way, tiptoe through the political gardens of good and evil when it comes to reproductive rights. Although I would like to sugar coat it, in a sense this book is a political polemic; one spoken from the pulpit of progressive/liberal/populist dogma because the feminist movement’s rallying cry the personal is political still rings loud and true. In that light, I do my best to make the case that the nationwide merging of religion and politics has created a formidable, national, and indefatigable Far-Right Extremist Cabal; a group that never slacks or stops in their efforts to limit access to reproductive health care—and one apparently immune to public approval.

However, as author Jonathan Haidt, avows in his book, The Righteous Mind: Why Good People Are Divided by Politics and Religion, the reason why people are divided by politics and religion, . . . is not, as Manicheans would have it, because some people are good and some people are evil. Of course, the anti-reproductive rights movement includes sincere and well-meaning individuals adhering to their own deeply felt moral beliefs. And considering Haidt’s research showing that liberals exhibit the least accurate perception of those with opposing political views, I recognize that it may be off base to jump to conclusions about others’ intentions. Yet, despite Haidt’s cautionary and wise advice, and at the risk of being labeled bigoted, I have to wager that there are a number of scalawags primarily interested in election mischief or fattening up the collection plate among those in the anti-reproductive choice movement. And yes, no doubt the pro-choice advocates include some of the same.

Following that train of thought, I propose that reproductive rights would be better served if our political-religious culture adopted a more empathetic and tolerant philosophy devoted to the systematic examination of basic concepts such as truth, existence, reality, causality, and freedom. E.J. Dionne Jr., who teaches a course in Religion and Politics at Georgetown University, observes that Pope Francis is moving in the right direction, . . . by simultaneously conveying a certainty about what his faith teaches him and a confident openness to those who are seeking answers along other paths. Dionne also makes a predication, based on the teachings of Rabbi David Saperstein, that . . . religious freedom will thrive and religion itself will be a force for good only if religious people can convey this sort of empathetic understanding of the truths that others hold dear. Amen.

I believe that President Obama’s stance on reproductive rights offers a maneuverable path through the bespoke political gardens. He said that he supports abortion rights but hopes the procedure will be rare. In a commencement address given at Norte Dame (yes, that Notre Dame), he called for Open minds. Open hearts. Fair-minded words in the public debate over the abortion issue. He said, We can still agree that this is a heart-wrenching decision for any woman to make, with both moral and spiritual dimensions. And he asked those on both sides of the debate to work together to reduce the number of women seeking abortions by reducing unintended pregnancies and making adoption more available, and providing care and support for women who do carry their child to term.

We need to judge less and work more upstream. The fallout from Knocked Up pregnancies is hard on women, hard on men, and really really hard on kids. Equally obvious is that rather than dealing with problems downstream, it makes more sense to start upstream: help women and men avoid unintended pregnancy in the first place. For example, although the Gates Foundation does not fund abortion, it now is funding contraceptive research. As Melinda Gates, reports, . . . we always try to work upstream. With contraceptives, you don’t put a woman in a situation where she needs to make that decision.

One of the points this book makes is that once an unwanted pregnancy has already happened and a child is born, a humane option (as also argued by President Obama) is to support strong economic and social safety nets to keep families from going under. Being a moral scold about the fecklessness of a single mom, one who cannot adequately provide for the needs of a child, doesn’t do anything to solve the problem. (Not to mention my mantra: she didn’t do it all by herself.)

We are sailing into the unexplored territory of couple-hood. Notwithstanding the lessons taught by Frank Sinatra in the once popular ode to Love and Marriage, it turns out he was wrong: you can have one (love) without the other (marriage). And you can don’t have to be married to have a baby either (no matter what you learned in mid-school.)

Often I hear that the simplest solution to preventing the problems linked to Knocked Up pregnancy, especially fragile families, is that, we, as a society, return to the ideal of expecting people to be on the solid ground of marriage before venturing out to the uncertain hills and valleys of parenthood. As much as I believe that is one excellent piece of advice, I doubt we will see a large-scale revival of traditional marriage before parenthood. Although marriage (usually before parenthood) remains strong among the college educated, overall about 50 percent of kids born today are born to unwed parents.

Although the ship of the traditional family appears to be sailing into the fog of extinction, I believe the eulogies for marriage are premature—or at least overwrought. Much in the same way, as Mark Twain memorably put it, The reports of my death have been greatly exaggerated. What I observe in this book is that the long-time premise of the institution of marriage—one based upon men’s overwhelming economic dominance as head of the household—is in transition. As women bring home more bacon, men are expected to eat more quiche.

To build a more secure marriage, should we, as it is often suggested, embrace a new societal norm roughly based on the Scandinavian style of family life? That is, some couples marry; some married couples have children, others do not; and, some couples form committed partnerships and hang in for the long haul of parenting their children. But, as I’ll point out, those Scandinavians have government safety-nets we can only dream about. So, in this book, I’ll appraise the merits of seeking answers to a different question: How can we make more room in our American ethos for a sweet spot which allows for the variety of ways people become good parents and raise kids?

How This Book Is Put Together

Why Knocked Up? is built upon a foundation of research studies and surveys drawing from sources as diverse as behavioral economics, sex education, reproductive health, family and child welfare, psychology, moral psychology, demographics, and social science. It is especially enriched from a multiplicity of insights from reproductive health practitioners, sex therapists, counselors, and educators about the inner workings of sexual risky behaviors and the circumstances of unplanned and unwanted pregnancy. Listening to personal stories and points of view from both men and women helped me clarify befuddling issues about sexual responsibility. Those very gracious people appear in these pages under fictitious names and identifications to protect their privacy.

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My arguments about the roots and complications of the Knocked Up Paradox are presented in four parts. Although each part tackles different aspects of those factors, they are all inter-connected. Unlike the cheese, none stands alone.

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Part I. Stork Realities, Magical Thinking, and