Features of an ideal family planning method

December 30, 2005 | 62 comments
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Before posting on natural family planning (NFP) or any other family planning methods specifically, I think it is worthwhile to consider a more general question: What would you consider the features of an ideal method of family planning? I am talking here about features, not about any specific method. For reasons that may become apparent below, I prefer the broader term “family planning” to the terms “birth control” or “contraception.”

First, here are some features of an ideal method of family planning that various colleagues have expressed to me, and that can easily be found in the writings of family planning advocates, not necessarily in priority order:
1) Highest possible effectiveness to avoid pregnancy.
2) Requires little or no thought or effort to use.
3) Is “forgiving”- if you make a mistake and forget to use it, it still works.
4) Can be used by women in any reproductive situation, including irregular cycles, breastfeeding, premenopause.
5) For teenagers or other “high-risk” groups, can be applied in such a way that it is difficult NOT to use it.
6) Can be used up to several days after the fact (after intercourse), if you forgot to use it before.
7) Can be used by the woman even if the man doesn’t want her to, or without the man knowing.
8) Prevents sexually transmitted infection as well as pregnancy.
9) Low cost.
10) Is reversible. If pregnancy is sought, there is no “left over” inhibition of fertility.
11) Has no side effects, whether minor or serious.
12) Has medical benefits apart from the family planning effects.

Second, here is my list of an ideal method of family planning, based not only on personal experience, but that of many friends and patients, not necessarily in priority order:
1) Does not interrupt early human development; i.e., does not cause a loss of an embryo after conception (fertilization).
2) Use requires the mutual commitment, communication, and cooperation of the woman and the man.
3) Highest possible effectiveness to avoid pregnancy.
4) Highest possible effectiveness to conceive; including assistance for those having difficulty conceiving.
5) Helps women and men understand and respect their bodies, sexuality, and fertility.
6) Can be used by women in any reproductive situation, including irregular cycles, breastfeeding, premenopause.
7) Enhances marital intimacy.
8) Encourages faithfulness and chastity.
9) If pregnancy is sought, there is no “left over” inhibition of fertility.
10) Has no side effects, whether minor or serious.
11) Has medical benefits apart from the family planning effects.

These are not purely academic questions. Multiple surveys and studies show that a majority of women and men are dissatisfied with their current method of family planning, and high percentages switch methods in search of something that suits them better. In considering what the ideal features of a family planning method would be, it may be useful for some folks to say what they see as advantages and disadvantages of specific methods. Obviously, some ideals are unattainable in reality. However, I would like to encourage everyone to not be unduly bound by what you know about specific methods. If medical science could come up with a great breakthrough and the (nearly) perfect family planning method for you, what would its features be?

Joseph Stanford

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62 Responses to Features of an ideal family planning method

  1. Julie M. Smith on December 30, 2005 at 5:12 pm

    OK–I’ll bite: I’d like to take a pill once per month that would be 100% effective and then 0% effective the next month. There would be no other effects of the pill on my body and I could use it safely while nursing.

  2. sam brown on December 30, 2005 at 5:51 pm

    I think many of Joe’s expectations are reasonable, both in the general column and in the Joe column. One place where he quibbles with what appears to be the “world” column is about whether the woman should have power over the method without requiring the involvement of the man. (#7 on the first list vs. #2 on the second list).
    I feel that in a healthy, balanced, equal marital relationship, Joe’s perspective makes good, basic sense. The problem is whether maintaining that standard outside of such a constrained setting makes good sense given the long history of abuses of female sexuality by men.
    While I don’t want to bring up the abortion debate, the problem with #2 on second list relates to one argument made in favor of legalization of a practice that is morally opposed. In many if not most societies, there is a historical/traditional culture that emphasizes the power of men over women in ways that are destructive and unfair to women, particularly as, in their powerlessness, they are left pregnant and caring for the child. The most vulgar example is the man who refuses to wear a condom for his impoverished wife because it detracts from his pleasure while simultaneously infecting her with HIV and refusing to allow her to use OCPs because it would limit the visible evidence of his virility. She cannot use them for fear of abuse.
    A less vulgar and less malign, though possibly still hurtful example would be the LDS priesthood holder (or devout Catholic or Baptist) who instructs his wife that she must have additional children. In religious patriarchal settings, this may represent spiritual coercion to have children, and having established that contraception can only be activated by mutual consent may further limit the woman’s ability to make the right decision about having children.
    There are other examples, primarily if not exclusively applicable outside a “model” marriage, but the reality is that people do not all live in model marriages, and I would think that we ought to emphasize the woman’s control in this particular setting given the long history of huge asymmetry in control of reproduction.
    I think if men were the ones to get pregnant, there would be a little less rhetoric about broad applications of fully equal control of contraception

    Still I’m not trying to be dogmatic. I would like to have equal voice in deciding about reproduction with my wife and feel that in a truly equal marriage this is a possibility that should be embraced. But let’s not get ahead of ourselves.

  3. Adam Greenwood on December 30, 2005 at 5:53 pm

    Very interesting contrast.

    Your 11 are great. I doubt hardly anyone would disagree with them. At the same time, hardly anyone would disagree with the ease of use and reliability factors from the first list. But can they be reconciled, even theoretically?

    Is “requires little or no thought or effort to use” really compatible with “use requires the mutual commitment, communication, and cooperation of the woman and the man?” In other words, if I’m correctly teasing out what you’re saying here, the easier it is to use and the less thought required to use it, the less mutual effort from the couple?

    Interestingly, while the implications of your previous sex and procreation thread appeared to cut against artificial conception, artificial conception efforts would normally appear to require quite a bit of mutual sustained attention on the part of the parents.

  4. Adam Greenwood on December 30, 2005 at 5:56 pm

    “the reality is that people do not all live in model marriages”

    Given your definition of a model marriage–one in which the husband does not knowingly infect his wife with HIV or unilaterally decide on childbearing–I feel safe saying that everyone reading this blog has a model marriage.

  5. Nate Oman on December 30, 2005 at 6:01 pm

    Sam: It seems to me that the points you bring up are less about mutual involvment in contraception than they are about mutual involvment in the decision to have intercourse, ie all of the cases of abuse that you cite involve a situation where the male has control over intercourse. It seems to me that if one assumes a background norm of mutual control over intercourse, then it isn’t necessarily problematic to assume that there should be a norm about mutual control over birth control. Of course, one may think that as a second best solution one should give up on the second norm because you have little faith in one’s ability to firmly establish the first norm. I am not sure that I have a dog in the fight over mutual consent to birth control methods, and obviously, I think that there has been and is a huge amount of male abuse of female sexuality. However, it seems to me that the problems of abuse that you invoke are really problems of mutual consent to intercourse rather than birth control per se.

  6. greenfrog on December 30, 2005 at 6:53 pm

    If medical science could come up with a great breakthrough and the (nearly) perfect family planning method for you, what would its features be?

    For a person in my situation, medical science has already come up with the perfect family planning method for me. My wife and I have engendered all the children we want to engender.

    I have had a vasectomy.

  7. Ann on December 30, 2005 at 7:06 pm

    #6 Greenfrog: Amen.

  8. Rosalynde Welch on December 30, 2005 at 7:16 pm

    Because the sexual culture we live in is so very far from ideal, I’m not sure that an “ideal” contraceptive is called for in most circumstances.

    But leaving that aside, here’s what I’d like, acknowledging that it is almost certainly a physiological impossibility (hey, you told us to dream big!):

    –does not involve a daily regime of any kind

    –completely and immediately reversible

    —is under the woman’s complete control (the idea of mutuality is sweet and all, but because women bear virtually 100% of the physical risk and burden of pregnancy and childbirth, she should also have virtually 100% control of contraception—though of course she then incurs the obligation to communicate honestly and respectfully with her partner. And of course if there’s a way that the woman can have all the control while the man does all the work, that would be fine, too! )

    –includes all the benefits of nature’s contraceptive, extended breastfeeding, i.e.: complete amenorrhea, anovulation, metabolic burden (which is protective against type-II diabetes postmenopause), protection against breast cancer and ovarian cancer

    –BUT does not require the substantial social and psychological burden of extended breastfeeding, and does not impair the woman’s sexual function as breastfeeding does

  9. Ariel on December 30, 2005 at 7:31 pm

    Perhaps there is a system that would work well for ideal marriages (whether NFP or otherwise), but we should still have other systems available for non-ideal situations?

    The morning after pill might not be appropriate in an ideal marriage- should it be available as part of medical treatment after a rape?
    Condoms in marriage? Condoms available to teens who would be doing it either way?
    Norplant in marriage? Norplant for a single woman who will be working in [insert dangerous country without women's rights] for several years?
    BC pills in marriage? BC pills to regulate a single woman’s painful and irregular cycle?
    Vasectomy for twenty-somethings? Vasectomy for twenty-somethings when pregnancy would kill the wife?

    I don’t think the solution is to eliminate “bad” methods. Maybe the solution is to encourage the best method for the situation? Having said that, I respect doctors who do not give their patients BC. I do believe that in situations where the patient would be better off if they had BC, that doctor should point them toward another doctor who will give it to them.

    When I’m done having all the kids I think I can handle, I would like a BC method with the following “features,” in this order:
    1) Won’t increase my already high risk of stroke
    2) Won’t decrease sensation during sex
    3) Won’t have lasting effects on fertility (although I’d be fine with risks here, since I would already have all the kids I want)
    4) Won’t cause major side effects, although I’m willing to deal with minor side effects.
    And it would be nice, although not necessary, if it also regulated my cycles. In short, I would like a BC pill without the blood clotting problems.

  10. Adam Greenwood on December 30, 2005 at 7:35 pm

    “the idea of mutuality is sweet and all, but because women bear virtually 100% of the physical risk and burden of pregnancy and childbirth, she should also have virtually 100% control of contraception—though of course she then incurs the obligation to communicate honestly and respectfully with her partner. And of course if there’s a way that the woman can have all the control while the man does all the work, that would be fine, too!”

    Is marriage chopped liver? the idea of mutuality in marriage isn’t just *sweet*, it’s required. It’s the whole point.

    #6:
    It should be about how many kids *God* wants.

  11. Adam Greenwood on December 30, 2005 at 7:36 pm

    “2) Won’t decrease sensation during sex”

    I think we’ve found another consensus candidate.

  12. greenfrog on December 30, 2005 at 8:35 pm

    It should be about how many kids *God* wants.

    And, apparently, it should also be about how you think my wife and I should go about making the decision.

    All kids are God’s kids.

    And, FWIW, we conferred with God. Our proposal received no objection that we could discern. We proceeded.

    And, ultimately, if God wants us to have more children, I understand He can arrange it, notwithstanding our (putative) misunderstanding and preferred family planning method.

  13. sam b on December 30, 2005 at 9:35 pm

    re: 4, a potentially cute response to my hyperbole that I assume is playful. Short of the stereotyped African truck driver (a standard trope in public health/HIV literature) I adduced, there are a wide variety of less-than-model marriages in which huge power differentials contribute to inequality that makes common control of birth control ill-advised. As a physician I have been sufficiently often surprised by the silent but horrifying traumas that people live through that I have given up making sweeping generalizations such as #4, particularly given their potential to embed rock salt in exposed flesh. I personally feel safe in asserting that a woman so treated would be welcomed to participate in this blog, regardless of any perceived safety in asserting her absence.

    re: 10, I wonder whether the answer to the question is fully predicted on the basis of biological sex (or self-proclaimed feminism as in my case). Unless Adam’s wife is posting under his name? The suggestion that the woman should have final say over whether intimacy with her partner will be allowed to result in pregnancy somehow chops the marriage’s liver presupposes a false dichotomy. And what about “no higher calling” and the cult of domesticity and the neo-Victorian woman? If she’s the center of the family and the center of the universe and salvation’s Plan, why can’t she as the goddess of the hearth be the final arbiter of God’s will for her womb?

    re: 5, I disagree. This is a common point in the public health literature. There are women who don’t mind having intercourse with their husbands but would strongly prefer it to be performed with condoms but do not have the cultural resources to allow them to protest unprotected intercourse. Closer to home, what about the Mormon woman who feels that God is satisfied with her offering but her husband feels it his patriarchal duty to multiply his offspring further? Should he be allowed to wield his priesthood power (reinforced by longstanding and potent cultural traditions, as exemplified by the *God* comment) over her objections in the interest of “mutual commitment, cooperation” etc.?

    re: 11, amen, as long as above concerns are recognized.

    as a post-script it occurs to me that perhaps what is most required is that either partner have the right of veto to conception (before the fact–I’m not implying that a man should be able to force his partner to swallow post-coital contraception tablets). Maybe that’s a way to express the sentiment that recognizes the huge disparities in safety that have been and are present around conception while still emphasizing the hopeful mutuality of the decision to have children.

    As a final nod to the essence of what I understand to be Joe’s point, I do believe that mutuality in sex, conception, and childrearing is one of the highest goals of life, and we should all strive to love our partners in every wonderful and heavenly way, but I believe that trying to force that goal into contraception (rather than having that as a framework for approaching many issues, including contraception) is not an appropriate societal or community decision.

  14. jjohnsen on December 30, 2005 at 9:59 pm

    My requirements.
    The ability to have intercourse when my wife and I are in the mood. No planner or calender should be necessary unless we are trying to get pregnant.
    No major side-effects for either of us.
    No permanent effect on fertility.
    Low cost.

  15. Rosalynde Welch on December 30, 2005 at 10:39 pm

    Mmm, Adam, yes. Preferably a nice fat duck liver, with some shallot and garlic in a pate on a toasted baguette.

    I’m not sure that affective mutuality is in fact the point of marriage. Making babies would be tops, I’d think. But even granting your premise: marriage provides a unique social oppportunity for developing emotional and psychological mutuality, and that is precisely the sort of mutuality that should be involved in family planning decisions. A woman who’d trick her husband into another baby or otherwise withhold or manipulate her husband emotionally or psychologically with regard to family planning decisions is abusing the power her ovaries and uterus give her; she shouldn’t do that. But until marriage can somehow distribute the physiological risk of pregnancy and childbirth between the partners, the woman should enjoy the physiological prerogative of contraception.

  16. Kingsley on December 30, 2005 at 10:45 pm

    “Preferably a nice fat duck liver, with some shallot and garlic in a pate on a toasted baguette.”

    Now I am suicidally depressed. Please someone tell me where you can get one of those in Provo at 9 p.m.

  17. Adam Greenwood on December 30, 2005 at 10:59 pm

    “But until marriage can somehow distribute the physiological risk of pregnancy and childbirth between the partners, the woman should enjoy the physiological prerogative of contraception.”

    I just don’t see it, Rosalynde. Mutual means mutual. Either decisions are joint, or they’re not. Childbearing decisions affect both husband and wife–in fact, they affect the whole family. You’re making a fetish of physiology. Should I unilaterally volunteer for the Iraq war without consulting my wife, on the grounds that the physical risk is mine alone? I shouldn’t, and I won’t, because acting like that would diminish our marriage. Just as our marriage would be diminished if we stopped making our decisions in union about sex and birth. Marriage that consists of a series of independent spheres, with the dictators of those spheres staring at each other across barbed wire barriers of prerogatives, isn’t much of a marriage at all, no matter how much communication is shouted back and forth.

    One can believe in ‘my body, my choice’ or one can believe in ‘the twain shall be one flesh’ but not both.

  18. Julie M. Smith on December 30, 2005 at 11:30 pm

    Re #17: very good work. I like it.

  19. sarebear on December 30, 2005 at 11:44 pm

    I don’t think either partner having veto right is contrary to mutual cooperation and the marriage.

    Obviously, there are many single parents out there, and I’m not saying single parents cannot raise children, and raise them well.

    But in a marriage, they will BOTH be raising them. Either spouse being able to veto, even if the other spouse wants children, is the same as saying they need to AGREE and cooperate in this most important of matters. If they DON’T, if they don’t agree, then individual veto should be implemented. Individual veto actually SUPPORTS cooperation.

    It is a responsibility they BOTH take on, and so they should BOTH be in agreement to PROCEED with trying to conceive intentionally. You might say, well they are not cooperating if one is vetoing the other’s wish to have children, or more children, but it is not ONLY the decision of the person who wants to proceed, either. You may then say, well in effect it then becomes ONLY the decision of the veto-er, but unless both parties agree on either proceeding, or not proceeding, there WILL NOT be any agreement, but they are still a partnership, and still a mutual cooperative couple. There is nothing that says that spouses have to always agree with each other, in order to have a good marriage. In order to cooperate with each other. Cooperation does not always end in agreement. Cooperation does not always ASSUME agreement, even though I think it’s been used as such in this thread.

    Just MHO.

  20. sarebear on December 30, 2005 at 11:46 pm

    Actually, if they don’t agree, then individual veto IS being implemented (except where one is coerced or goes along even if they don’t want to, but we’re assuming, at least I am, a marriage where they discuss things, and agree to disagree when it comes to that).

  21. Rosalynde Welch on December 30, 2005 at 11:47 pm

    Kingsley, darling, first of all stop reading T&S threads on contraception at 9 p.m. on Fridays. That alone should make spam on Wonder toast a good enough substitute.

    Adam, yikes, I certainly don’t want to make a fetish of anyone’s physiology, especially not on a Mormon blog on a Friday night! I don’t think we’re really arguing over anything, if all you’re saying is that wives and husbands ought to reach complete accord on decisions about sex and family planning.

  22. Adam Greenwood on December 30, 2005 at 11:58 pm

    That is all I’m saying, Rosalynde Welch. If that’s what you’ve been saying, then your Blog Dean here has serious, serious problems with his reading comprehension. Almost as bad as Julie in A..’s reading comprehension problems, who appears to think she agrees with something I wrote.

    Sarebear,
    I hear what you’re saying–marriages aren’t perfect and so sometimes a husband and wife just will not agree on something, though they should. But I think you’re way of looking at childbearing decisions isn’t right, at least not generally speaking. The problem with saying that both spouses exercise a veto is that it presumes that not having children is the default and it gets us back to the independent spheres idea that I don’t like much.

  23. Phouchg on December 31, 2005 at 12:13 am

    Since parenthood is such an all-encompassing job, both parties have to completely agree 100% on choices regarding the number of children (that number could include zero). Kind of like having two keys turned at the same time on a submarine to launch a nuclear missile. If one party votes NO – it should not happen. End of discussion.

    Every child should be a wanted child.

  24. Phouchg on December 31, 2005 at 12:15 am

    #6 – I concur completely.

  25. Patriarch on December 31, 2005 at 12:52 am

    Why is a vasectomy viewed as rebelling against God’s will any more than any other method of family planning? If you should trust in God to provide you with the children he wants to bless you with and no more, then why should you do any family planning at all?

  26. sarebear on December 31, 2005 at 1:29 am

    “sometimes a husband and wife just will not agree on something, though they should.”

    Adam, this would be like saying, the husband wants to rob a store, the wife disagrees, but they “should” agree on it! You probably weren’t trying to globally apply that to EVERYTHING, though, even though it could come across that way. Perhaps you just intended that there are SOME decisions that a husband and wife “should” agree on.

    I actually, in my statement that it would be a good idea for spouses to be in agreement before proceeding with attempting conception, is in a way saying I think they “should” agree before taking action.

    Your “should”, to me, seems to be a different kind, in a different sense.

    I don’t think, even in a perfect marriage, or even necessarily with perfected beings/spouses, that they would agree on everything. One may have a preference for blue flowers, and the other thinks the “best” flower is red. But then, that’s a fairly trivial matter. (Unless you are contemplating blanketing a planet with all blue flowers, but then you wouldn’t, cause that would be boring, and unbalanced anyway).

    Your “should” seems to be saying that if a married couple doesn’t agree on something, no matter what it is, that there is a flaw in the marriage, or the partners’ attitude(s) towards the marriage, or a lack of desire to cooperate on one or both of their parts, or something.

    We are each individual beings, with the rights to our own views on things. I do understand that getting married involves much in the processes of compromise, discussion, coming towards each other on various issues, give and take, etc., and not just promoting one’s own best interests. Marriage goes beyond that. But it does not subsume the individual into a rigid model of always arriving at agreement with the other partner, in my opinion. I feel that a good marriage respects each other’s individuality, and has room for disagreement and respect for each other’s different opinions and feelings.

    Anyway, I’m sorry if this has thread-jacked anything, although I am not sorry for this discussion of this issue because it has helped me clarify my thinking on the subject.

    I appreciate your views and feelings on the subject, Adam, even though I disagree with them.

  27. sarebear on December 31, 2005 at 1:46 am

    My “argument” is completely aside from the issues of the woman’s body, health issues, her capacity and even right to make decisions about herself and her own body, and how much weight that should have in the marital reproductive discussions between herself and her husband; the absolutes that I feel men tend to place on women, especially sometimes in reproductive matters, and the extent to which that results in a controlling attitude or effect, unintentionally or not, towards and of the woman; the lifelong health effects of a “normal” pregnancy, let alone ones that have a few bumps along the road, let alone greater difficulties; the mental, emotional, spiritual, physical, financial, social, familial, and other effects of having another child, and how the experience of these factors is much different for each party in the marriage, particularly when there is a disagreement as to how many children to have, when one spouse wants to continue having more; the issues of one spouse generally doing alot more of the physical, emotional, spiritual, social caring for, teaching, and rearing of the child than the other spouse . . . . all of these issues, and more, make it a LOT more complicated than just a 50/50 thing, or a we MUST both go forward with it if one wants to, kind of thing. That if one partner wants more children, and one doesn’t, that there must be something wrong with the reluctant person’s attitude towards marriage, childbearing, etc.

    I don’t know. Perhaps I’m reading much more into what you are saying, than you meant. As well, alot of what I am saying here, regarding the issues I am setting aside in order to address just the one aspect of the issue that was raised, are just MY ideas of other things that play a factor, that would be far too much to go into, but wanted to mention.

  28. sarebear on December 31, 2005 at 1:51 am

    Sorry to add yet ANOTHER addendum, but this last addition has really made me want to take a look at things from the male perspective, and perhaps play devil’s advocate to myself and argue how men are often sidelined and trivialized in the reproductive decision making process. Actually, I feel the whole discussion has really opened my eyes to a scope and nature of the issues that is really more . . . . well, I can’t pull up the word I want, but I hope you can sense what I am saying. Anyway, I appreciate the stimulating debate, and respectful treatment of my opinions, as I also respect others’.

    (Ugh; I used to be able to pull up the very word that would perfectly encapsulate the sense, feeling, and expression of what I wished to convey; this has been stolen from me in large measure by years of mental illness, but I hope to regain some of it back)

  29. sam b on December 31, 2005 at 9:42 am

    re: Adam’s Iraq reference, I think he inadvertently has made the point. In the case of a soldier, imagine a situation where wife is card-carrying John Bircher and feels strongly that family a) needs income from soldiering and b) soldiering is absolute patriotic, moral, and religious duty. Husband has moral reservations but is often second guessing himself as a Mormon pacifist. Bishop and cultural milieu confirm wife’s impression, and considerable pressure is applied to the husband.

    At the end of the day, should the man have the right to veto the decision that his wife, cultural and religious milieu feel strongly about? Should he be able to say, at the end of the day, “I want to agree with you but I can’t, and when push comes to shove, I’m the one who would be risking his life”?

    I think there are special instances where part of the mutualism of marriage requires allowing one member to have a special need. Requiring perfect uniformity without exceptions is a tyranny of its own. I think Adam is presenting (with good will and without advertence) a false image of marriage that is pushing out to one side in order to counteract the perceived encroachments of feminism. I think that the true answer lies between those extremes. I asked my wife what she thought, trying to phrase the issue in neutral terms, and she felt the same way I did (I guess not a shock that we married).

    PS: I think a family planning method should also smell good and be slightly aphrodisiac.

  30. Nate Oman on December 31, 2005 at 10:16 am

    The thread has moved on a bit, but seeing as I am always a little giddy when Sam Brown acknowledges my existence….

    He writes: I disagree. This is a common point in the public health literature. There are women who don’t mind having intercourse with their husbands but would strongly prefer it to be performed with condoms but do not have the cultural resources to allow them to protest unprotected intercourse. Closer to home, what about the Mormon woman who feels that God is satisfied with her offering but her husband feels it his patriarchal duty to multiply his offspring further? Should he be allowed to wield his priesthood power (reinforced by longstanding and potent cultural traditions, as exemplified by the *God* comment) over her objections in the interest of “mutual commitment, cooperation� etc.?

    I ask: I am not sure that I understand what you are saying here. Are you saying that we have situations where women have the cultural resources to resist intercourse but not to resist intercourse without condoms? It seems like the lesser ought to be included in the greater. On the other hand, if we are talking about women who do have the cultural resources to resist intercourse but don’t have the cultural resources to resist intercourse sans condoms, then we are not talking about involuntary pregnancies, only the involuntary absence of sex. I am not a big fan of the absence of sex, but it seems to be a different issue than lack of control over pregnancy.

    I really think that your priesthood/patriarch example is beside the point. I think that the answer is no, he shouldn’t be able to wield power over his wife in order to force her to become pregnant when she does not wish to become pregnant. But again, I am confused as to your claim: Are you suggesting that such a woman can resist intercourse but not intercourse without a condom?

    Of course, if both parties (1) want to have sex with one another; and, (2) have a complete veto over the other party’s access to sex with themselves, then functionally we have a consensus rule on birth control, as each party can deprive the other party of sex in the absence of agreement on birth control.

    Under these conditions would we want a rule that gave one party control over birth control, while letting both parties maintain control over intercourse? I am not sure. It seems like we have a nice little problem in game theory here. I wouldn’t be surprised if there are strategic dynamics in situations with very different preferences with regard to birth control and very different costs associated with its success or failure (both of which seem like reasonable conditions to me) that would counsel in favor of giving one party an absolute veto on the birth control issue. However, I am pretty sure that the math involved in solving the problem is well beyond my abilities.

  31. Rosalynde Welch on December 31, 2005 at 10:50 am

    Nate, the condoms are a red herring, precisely because they are *not* in the woman’s control. It is not at all difficult for me to imagine a scenario in which the woman does not have the resources to resist intercourse per se, but does have the resources (a monthly appointment for a depo shot at a free clinic, for example) to prevent conception. Thus the lesser (avoiding conception) is not always included in the greater (avoiding intercourse).

  32. Sam F. on December 31, 2005 at 10:52 am

    Multiply and replenish the earth! So is a family that uses NFP and avoids children for eight years morally superior to a family that spaces 4 children over 8 years using the pill and barrier contraception? I don’t think so.

    However, self restraint has other moral merits but contraception isn’t one of them.

    IMO

  33. Matt Evans on December 31, 2005 at 11:37 am

    Rosalynde,

    The lesser (avoiding conception) *is* always included in the greater (avoiding intercourse) because avoiding intercourse always avoids conception. (Because Nate believes men would be willing to wear condoms were the alternative no intercourse, he concludes women’s power to veto sex includes the lesser power to veto condom-less sex, but that premise is not necessary for the validity of my previous sentence.) As I see Nate’s primary question, or at least the one I’m interested in after reading his comment, is why the woman needs exclusive control over the lesser (birth control) if she has veto-power over the greater (having intercourse in the first place).

  34. Nate Oman on December 31, 2005 at 11:41 am

    RW: I don’t think I am being clear, since I thought that is what I said.

    My point is that I can understand the argument for giving a woman unilateral control over birth control in situations where the woman cannot resist intercourse. This is what you are saying, right? Where is the red herring. In such a situation, I have no problem with a woman having control over birth control methods (I don’t really have a problem with the woman having control over birth control methods period.) However, it seems to me that control over birth control is a second best response to the real problem, which is lack of control over intercourse.

    On my (no doubt mistaken) reading of sam b., however, he seems to be arguing that this is not the paradigmatic case with which we should be concerned. Rather, we should be concerned with the case of the woman who can refuse intercourse, but whose partner has strong opinions about different birth control methods. This strikes me as an odd case, and as one that presents thorny problems but not really the same ones as the poor and oppressed women that sam invoked in his initial response.

  35. Nate Oman on December 31, 2005 at 11:57 am

    RW: Maybe this is clearer. Imagine that we have 4 sets of rules regarding sex and birth control:

    Rule 1: Both parties must consent to intercourse; both parties must consent to any birth control mechanism.

    Rule 2: Both parties must consent to intercourse; the method of birth control is fully controled by the woman.

    Rule 3: The woman’s consent is not necessary for intercourse; both parties must consent to birth control.

    Rule 4: The woman’s consent is not necessary for intercourse; the method of birth control is fully controled by the man.

    Now ask yourself a couple of questions:

    First, is there any meaningful distinction between Rule 1 and Rule 2?

    Second, is there any meaningful distinction between Rule 3 and Rule 4?

    If we assume that the default position is no birth-control (ie in cases requiring agreement, the absence of agreement means no birth control), then there is no meaningful distinction between Rule 3 and Rule 4. I take it that this is your point. I agree.

    My point is that I am doubtful that there is a meaningful distinction between Rule 1 and Rule 2.

    If we are concerned about women being forced to bear the burdens of pregnancy without their consent, then Rules 1 and 2 are both fine. We ought to be indifferent between them based on the pregnacy criteria. On the other hand, both Rule 3 and Rule 4 are unacceptable. Hence, we would want to insist on either Rule 1 or Rule 2 (ie both parties must consent to intercourse), or baring that we would want a Rule 5 stating:

    Rule 5: The woman’s consent is not necessary to intercourse; the woman has unilateral control over methods of birth control.

    I would simply point out contra sam and the health literature that he invokes, that the real travesty of Rules 3 and 4 is not that they are not Rule 5 but that they are not Rule 1 or Rule 2. Rule 5 is a crappy response to a crappy world. Perhaps the best we can do in some situations, but nevertheless not a morally desirable end point.

  36. Nate Oman on December 31, 2005 at 12:00 pm

    Another, more elliptical and pithy response to sam, might be:

    Preference is not a substitute for consent.

  37. Adam Greenwood on December 31, 2005 at 12:33 pm

    “Adam, this would be like saying, the husband wants to rob a store, the wife disagrees, but they “shouldâ€? agree on it!”

    Yes, that’s exactly what I’m saying. When it comes to robbing banks, the husband and wife should be in agreement (and, it goes almost without saying, their agreement should be not to rob banks). When it comes to sex and conception, the husband and wife should be in agreement.

    What I object to is your and Phouchg’s idea that in the absence of agreement the default should be not to have children. This seems to me both anti-child and anti-marriage. There should be no defaults in the absence of agreement when it comes to sex and children. There should just be agreement.

  38. annegb on December 31, 2005 at 1:46 pm

    And the agony continues…..

    Okay, I will join this party. With a story.

    My husband had a vasectomy and ended up back in the hospital with major surgery. He was hospitalized for 4 days and spent two months recovering.

    Well, we’ve found out now that he’s a bleeder. He’s ended up back in the hospital after a paper cut.

    But anyway, right after Princess Buttgold was born, he went for a vasectomy. I mention the birth because it’s relevant. So I bring him home and he starts complaining about pain. Now during the birth, I was a total basket case and he made fun of me. So I say “oh suck it up, honey, you’ll be all right. I just gave birth to a small watermelon and I survived.” Then he really started complaining, and I said, “honey, just breathe, here, woo, woo, woo.” I was enjoying this.

    THEN he went into transition, women will understand, and we both wigged out. It was such a Three Stooges moment.

    The upshot is he had to go back in for major surgery and I’ve been apologizing every since. And worrying every time my period is late.

    And I just grossed myself out. Anne out on this discussion

    Hey, happy new year, guys.

  39. Kristine Haglund Harris on December 31, 2005 at 3:32 pm

    re: comments 30-36–I always think I couldn’t be any more grateful that I didn’t marry a lawyer, and then you guys move me to even greater heights of gratitude.

    Good grief!!

  40. sarebear on December 31, 2005 at 3:39 pm

    It would be IDEAL if the husband and wife were in agreement, and it is a worthy goal to work towards agreement in any area of conflict in the marriage, although one VIABLE solution to a deadlock, is agreeing to disagree. That CAN be an acceptable solution, and is, in my opinion, and demonstrates a respect for each other’s differences. Still, to rest on that alone would be to abandon any attempt to come together on issues where spouses differ, and so I am not saying tor est on that alone. Working towards agreement, compromising at times, but eventually coming together with something both can agree on regarding an issue, is always a good goal. But not lessened by accepting each other’s differences, and agreeing to disagree, at times, on various issues, either.

    In some ways, I think we are, at least partially, arguing the same side of the coin, Adam. Yes, I also believe that the man and woman “should” (I’ll substitue the word, ideally, instead) agree on their robbery philosophies, pro or con (ha, pun intended). Although generally, such would be known before marriage. Still, it was an example. Generally, procreative philosophies ideally would be discovered before marriage, as well. Ideally, I feel, being a more neutral, less implying of imposition word, than “should”. Still, many couples do not do more than briefly mention in passing any ideas on the subject.

    When it comes to sex and conception, ideally the spouses would be in agreement; that would be a desirable outcome. The most ideal outcome. I think this may, perhaps, be part of what you mean when you say they should agree? Even when in disagreement, and disagreeing to agree, it would be ideal, and desirable, to still each be open to further discussion and have as much of an open mind to what the other is saying, as is possible.

    But I feel there is more to your should; that it implies it is wrong, to not be in agreement, and to also have that disagreement result in a “default” of no children.

    It seems to me that you are, perhaps, giving lip service to the notion of them both agreeing, as you feel that there being disagreement resulting in a default of no children, is a reprehensible situation, and thus perhaps possibly mean, untintentionally perhaps, that if one spouse desires children, that the other SHOULD, or MUST? come around to their point of view. That only the two agreeing to NOT have children, is the only situation you’d find acceptable for no children. That should they disagree on children, that you feel it isn’t fair, or desirable, for the non-child-desiring, or non-additional-child desiring spouse, to want the other spouse to come around to their point of view>

    3 possibilities: They both agree to have children (or more children), They both agree to NOT have children (or more children), or they disagree on having any (or more) children.

    You seem to be saying, the first two optionos are fine, the third option NEEDS to result in the reluctant party agreeing with the gung-ho party, or there is something . . . wrong, bad, something (ugh, there goes my brain on vacation, again) if that doesn’t happen. That the flip side of the coin, of this third option, of the gung-ho party being persuaded to the reluctant party’s point of view, is not fair or right? Perhaps you MIGHT say, well, if they, in the end, come to agreement with the reluctant party, then it is mutual agreement, and so good.

    But what about if the disagreeing spouses do NOT come to an agreement, they agree to disagree, and recognize that this situation results in not moving forward with attempting to conceive. You seem to have a HUGE problem with that . . . you seem to be saying that they MUST agree.

    I am saying that I feel they MUST only agree if they are going to try conceiving; it would be best for the spirit coming to earth, that both parties actively want the child.

    “What I object to is your and Phouchg’s idea that in the absence of agreement the default should be not to have children. This seems to me both anti-child and anti-marriage.”

    I am not talking, for the most part, about not having children at all, although my arguments certainly apply to that situation as well. For most people, I think these arguments would most commonly apply to disagreement on number, and/or timing of children; spacing, perhaps.

    I think, in the church, it is rare for fertile couples to choose not to have any children at all (although, there are quite possibly and probably situations where it would be better for the spirits coming to earth, for certain specific couples to choose this route).

    I don’t feel my arguments are anti-child and/or anti-marriage at all. In fact, I think my arguments promote a mutual respect that will eventually lead to a greater closeness, a greater empathy and capacity to understand the other’s point of view, and come together on issues, especially those of such great import/impact. And, as I say, I believe that for the most part these issues mostly come up in regards to having additional children beyond a certain number that the spouses may disagree on, and not regarding whether or not to have any at all. So I don’t see it as a default childless position, although it could certainly result in that, from time to time.

    Even when couples don’t discuss much involving procreation prior to getting married (although it would be ideal if they would), I would think that the desire to not have any children at all, on one or both of their parts, would be almost inevitable to come up before marriage, and so the no children default situation ideally would be avoided that way. If one of the spouses did NOT bring up their desire to remain childless, before becoming married, then I would posit that their marriage has a whole raft of other problems, in addition to the disagreement on reproductive choices, and in fact, that such a marriage would at LEAST need some classes in communication and marital skills.

    Respectfully, Sara

  41. Adam Greenwood on December 31, 2005 at 4:11 pm

    Sarebear,

    I’m not saying that in the absence of agreement the default should be to have children either. I saying there shouldn’t be a default in the absence of agreement. Failure to agree on children and so on is simply unacceptable (which is why, as you point out, this should be discussed before marriage. I for one made sure to stay away from girls who didn’t want kids).

  42. Kristine Haglund Harris on December 31, 2005 at 5:39 pm

    Adam, did you actually meet any LDS women who said a priori that they didn’t want kids? Just curious.

  43. Adam Greenwood on December 31, 2005 at 6:17 pm

    Yes, but not very many. And some of it might have been a matter of interpretation.

  44. Ann on December 31, 2005 at 6:43 pm

    Adam, there is the element of time involved. Also, heaven forbid, what if somebody CHANGES THEIR MIND? I am reminded of friend who wanted five kids. Then they had one and they said, “Well, maybe just four.” After two they said, “Definitely just three.” I used to joke that after the third, they thought, “Should’ve stopped at two…”

    Experience is a very good teacher, and the man and woman who agree on “all the Lord wants to send us” might feel, after three kids in four years, that it might be a good idea to pause for station identification, so to speak.

    Or, one decides “let’s take a break” and the other says, “but we decided…” Should a woman who said, in the dewy-eyed cluelessness of her late teens, “I want a dozen kids!” be held to it by her husband when, in her mid-20′s, with four children, she changes her mind? What if he STILL wants a dozen kids?

    The decision to have children is not just yes/no. It’s also “how many” and “when.”

  45. Christian Y. Cardall on December 31, 2005 at 7:45 pm

    I may be getting ahead of things, since Bro. Stanford hasn’t yet posted on natural family planning per se… Sorry for the premature enunciation, but a reading of Bro. Stanford’s article in First Things has already brought me to the point that I can no longer restrain my response.

    I sympathize with a woman not wanting the invasiveness of tampering with her body’s hormonal cycles an so on. But I wonder why in his First Things article complete abstinence during the fertile period is the only option presented. He seems to think that the “honeymoon effect” uniquely contributes to points (2), (7), and (8) of his ideal list above. But might it not be that for many couples these same “closeness” objectives might be better achieved by alternate forms of mutual sexual expression during the fertile period that have zero risk of pregnancy, rather than abstinence?

  46. S. on December 31, 2005 at 8:24 pm

    Does Stanford want us to create the perfect birth control for perfect people in a perfect world, or the best possible birth control technology for our own imperfect world?

    Based on Stanford’s lists, it seems pretty clear that he asking for the former (perfect birth control for perfect world) and not the latter. I gather this from the fact that Stanford replaces the following highly sensible (for an imperfect human begins in imperfect — and often downright terrible — relationships) worldly requirements

    2) Requires little or no thought or effort to use.
    3) Is “forgiving�- if you make a mistake and forget to use it, it still works.
    5) For teenagers or other “high-risk� groups, can be applied in such a way that it is difficult NOT to use it.
    7) Can be used by the woman even if the man doesn’t want her to, or without the man knowing.
    9) Low cost.

    with the wildly utopian

    2) Use requires the mutual commitment, communication, and cooperation of the woman and the man.

    Obviously, if the only birth control method available were one satisfying Stanford’s requirement 2), we’d have a whole lot more unwanted pregnancies.

    Would somebody like to clarify the exercise?

    S.

  47. Phouchg on December 31, 2005 at 9:55 pm

    Adam-What I object to is…Phouchg’s idea that in the absence of agreement the default should be not to have children.

    Phouchg-A child should not be in a family where it would be 100% wanted. That is an incredibly unfair burden to place on the child. It is also an unfair burden to the unwilling parent. This is appropriate for those who have no kids, or those who already have several. How would you feel if one of your parents secretly resented your very existance?

    Adam-This seems to me both anti-child and anti-marriage.

    It is pro-child in that a child should be in a home where it is entitled to the love and caring of both parents. Placing a child in a home where it would not be loved 100% by both parents is not optimum.

    It is pro-marriage in that the burden of an unwanted child would place a great deal of stress on the marriage relationship.

    Adam-There should be no defaults in the absence of agreement when it comes to sex and children. There should just be agreement.

    Phouchg-Is absence of agreement a form of agreement itself? Maintaining the status quo is a form of a decision.
    Here is what happened in my case. When I met the lady who would soon be my bride, I told her on our first date that I was not interested in having children. I gave her the chance right there to back out if she was looking to have children with her husband. She replied that her chance of bearing children is decreasing since entering her 30s, so it really didn’t matter to her either way whether or not she had children. So she did agree that we would not have children. Birth control pills worked for a while, but apparently were affecting her health, so I went ahead and had a vasectomy. She knew of my desire to get snipped since college, and she was fine with it. And it was only $10 on our HMO! :)
    It was the best decision for our family.

  48. Phouchg on December 31, 2005 at 9:56 pm

    oops please correct above sentence to

    A child should not be in a family where it would not be 100% wanted.

  49. S. on January 1, 2006 at 1:31 am

    One more word on Stanford’s requirement 2) for ideal form of birth control:

    2) Use requires the mutual commitment, communication, and cooperation of the woman and the man.

    My feeling is that in an ideal world, birth control would be simple and easy for both men and women, but actually getting pregnant would be impossible without 2).

    Any way to arrange that?

  50. Ariel on January 1, 2006 at 4:19 pm

    #46: “Does Stanford want us to create the perfect birth control for perfect people in a perfect world, or the best possible birth control technology for our own imperfect world?”

    My concern exactly. I respect his decision not to support “artificial” BC, but it seems very utopian.

  51. Adam Greenwood on January 1, 2006 at 8:26 pm

    Ann,

    I am not shocked to find that people change their minds. Would you be shocked if I suggested that women who go into marriage wanting large families are more likely to continue wanting large families then those who don’t? Everybody I know has at least some continuity in their character and identity.

    PhouchG,

    Children change you and most parents, no matter how reluctant, aren’t ogres. All this talk of unwanted children doesn’t bear much connection to the real world experience of people who had kids when they weren’t planning too. Most of the time they turn out to be just as loved and well-taken care of as otherwise.

  52. Stephen M (Ethesis) on January 1, 2006 at 10:45 pm

    did you actually meet any LDS women who said a priori that they didn’t want kids? Just curious

    My wife when we met. She changed her mind, I was supportive. Given the disproportionate burden women bear, it only seems right to me that they should get the final decision on the issues.

    What is interesting, as a side note, is developments in inoculations against pregnancy. If they were only more reversible, they would have already been released.

  53. Tim Jacob on January 1, 2006 at 10:53 pm

    I had a young men’s leader whose wife did want kids. They ended up having a son, and she divorced him a year or so later.

  54. Phouchg on January 2, 2006 at 12:56 am

    Adam – “Everybody I know has at least some continuity in their character and identity.”

    Adam – “Children change you.”

    Where is the continuity if you are changed?

    For me, I like my life as it is right now. A child would be the worst possible thing to happen to me. Fortunately, I am now sterile.

  55. Jim F. on January 2, 2006 at 1:36 am

    Phouchg: If there isn’t continuity in change, then there isn’t life. Surely there is continuity between the person you are now and the person you were two years ago, but there has also been change. In fact, had there not been change, if you were exactly the same then and now, it would be odd to speak about continuity between then and now.

  56. annegb on January 2, 2006 at 11:36 am

    Jim, guess what? I understood that. And I agree.

  57. Joseph Stanford on January 2, 2006 at 6:38 pm

    #32- I agree. NFP use is not inherently moral independent of the underlying intentions.

  58. Joseph Stanford on January 2, 2006 at 6:42 pm

    #46 neither necessarily. I want to encourage everyone to think about what they want in a family planning method, first in an ideal sense, and then hopefully in a practical sense. Ultimately, I hope it will also help identify contradictions between different desires or criteria, as well as contradictions between desires and biologic reality. I did mean to focus the question on a reasonably functional marital relationship, as opposed to solving the problems for all the dysfunctional and exploitive relationships that exist in the world. (As far as those go, I agree with comments by Nate et al that the underlying problem is really the coercion and exploitation, not the birth control method.)

  59. Brian B. By... on January 2, 2006 at 7:00 pm

    Slight threadjack….

    What is a higher morality:

    1. Using standard hormonal and barrier contraceptives to space 4 children over 8 years or
    2. using natural methods to avoid having any children at all?

  60. sam b on January 2, 2006 at 7:54 pm

    re: 39: Amen, Kristine. Amen.
    re: Nate’s prior. Nate, I am always glad to acknowledge your existence. I just sometimes rely on others to do my handiwork.

    I will hereby reject a game theory approach to the question, largely because I like to have conversations that are not informed by contemporary economic theory. That, and I worry that game theoretic approaches miss the point that there are subtle and sometimes pervasive but occult limits on the exercise of choice that is presumed by game theory (as I understand it, and I will confess to having only a superficial and somewhat jaundiced view of game theory).

    If I can attempt to explain my impression (and my analogy between the archetypal Tanzanian woman and a mother in Zion) in lay terms:

    There is a certain intimate pleasure in sexual relationships that women may enjoy, particularly with their chosen partner. Each individual encounter contributes to an overall relationship and it can do so without substantial consequence beyond the experience of pleasure and intimacy.

    Conception and childbirth are absolutely huge commitments of energy, time, emotional, spiritual and temporal resources far greater than those expended in the act of intimacy. In difficult circumstances they can contribute (however much we don’t want to talk about it) to powerlessness, abuse, depression, marginalization, and despair. Women bear the burden disproportionately, however strenuously we object to the implications of this fact. The fact that control over intercourse does NOT equate to control over conception speaks to the difficult complexity of this issue.

    For various reasons, ranging from threats of abuse to institutional sexism with economic dependency (this is the classic public health description in the archetypal African family) to a religious culture discordant with a woman’s own vision of her life, body, and family (this is my take on the Mormon case), a woman may not be or feel able to express her desire to not be impregnated or her conviction that she ought not to, whether by abstinence or more complexly by refusing to engage in procreative sex.

    This seems to me more momentous than questions of the timing of sexual intimacy per se (I am bracketing the horrifying issue of rape within marriage). If I have understood Nate correctly, I believe it is the association between sex and conception that is the crux of the matter. And I do believe that at least at some level the capacity to decline intimacy and the capacity to decline conception are disjoint, if confusingly so.

    Particularly in this case, I think a 2X2 matrix or equivalent approach misses the point that the two questions overlap with each other and with other issues.

    And I think both partners should have veto power over sexual intimacy and over conception.

    re: the parenthetical close to 58, I think the problem is that in the initial presentation, there appeared to be an attempt to unite the relationship and the birth control method. It is that invocation of a long history of coercion within the very discussion of birth control that incited my first post.

  61. S. on January 2, 2006 at 10:31 pm

    Adam Greenword writes “All this talk of unwanted children doesn’t bear much connection to the real world experience of people who had kids when they weren’t planning too. Most of the time they turn out to be just as loved and well-taken care of as otherwise.”

    In the real world I live in, as far as I know, people who use birth control often have a very good reason for doing so (unstable relationships, poverty, drug addiction, lack of interest in caring for children, lack of ability to care for children, etc.) For example, a third of children are born to single mothers — most of them unplanned — and these children are statistically far more likely to experience poverty, abuse, neglect, etc. Do you believe otherwise? Perhaps you intended to limit your remarks to kind, loving, happy, comfortably middle class Mormon married couples without any health problems that would make having children dangerous. In this limited context, I agree that even children conceived by accident are likely to turn out just fine.

    Sam Brown’s real world is populated with sad, cowering Mormon women who have children simply because they are afraid to say that they don’t want and ought not to have children. Do women like this really exist? I’m a little skeptical. If they do, then there is no question that they need better bishops, better friends, better husbands, and a whole lot more backbone. But solving their problems seems like a lot to ask of a “family planning method.”

  62. b bell on January 3, 2006 at 11:27 am

    Couple of quick points.

    1. No perfect BC method besides the old shave and snip
    2. If you discover one let me know.
    3. I think that men in happy marital relationships should have some input on when/how to have kids.
    4. I live in a ward with lots and lots of children. Average family size is 3-7 kids. My wife had a long BC discussion yesterday at lunch with 8 fellow ward sisters. They all used artificial BC at various times without guilt. 3 were currently pregnant and 2 others wanted a baby this year and were trying to get preggers right now. I sense no weak women in this group who are being forced to have kids by evil husbands and PH leaders.
    5. How do people that intentionally decide not to have kids survive in wards like mine?
    6. In my little LDS world the default position is to have kids.

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