Why do people get pregnant (when they don’t want to be)?

The 2010 BPAS annual lecture was given by Kristin Luker, the foremost American sociologist researching contraceptive use and risk taking around unplanned pregnancy in the USA.

The second in BPAS’s programme of annual lectures was given by Kristin Luker, Elizabeth Josselyn Boalt Professor of Law and Professor of Sociology at the University of California, on 21 June at the British Library in London. 

Ann Furedi, chief executive of BPAS, and Ian Hammond, BPAS chair of trustees, introduced the lecture, thanking Professor Luker, and also the British Library for hosting the event. Furedi explained that in addition to BPAS’ role as leading provider of abortion services in Britain, it has a public education remit to educate politicians and policymakers and the public about the causes and consequences of unwanted pregnancy.

Professor Luker is the foremost American sociologist researching contraceptive use and risk taking around unplanned pregnancy and sex education policies in the USA. She has advised the White House on issues in teenage pregnancy, and published five ground-breaking books, including Taking Chances: Abortion and the decision not to contracept (1975), Dubious Conceptions: The politics of teenage pregnancy (1996), and When Sex Goes To School (2006). Her 1985 book Abortion and the Politics of Motherhood was nominated for a Pulitzer Prize.

Professor Luker began by speaking of her honour at being able to share her research and experience with an audience of activists and abortion care practitioners. ‘Somebody once said to me many years ago that activists worry about waves and scholars worry about tides,’ she said. ‘I’ve had the luxury, for 40 years, of worrying about the tides but it would be all irrelevant if those of you here were not worrying about waves, and what’s happening on a day to day basis.’

The question that Luker set out to address was, ‘why do people get pregnant when they don’t want to be?’ This, she noted, seems like a straightforward question – but when opened up, it becomes enormously complex. She first became interested in the question while volunteering at Planned Parenthood in 1969, at a time when California had liberalised its abortion law before the United States had done so as a whole. Over the course of the summer, she saw three different women coming in who had recently had abortions and were returning because they thought they might be pregnant again.

‘I didn’t know much about abortion, but I thought I knew that if you’d had an abortion reasonably recently normal people would try to avoid another one,’ she said. ‘So I saw these three people and, as I say to my students, one person is a flake, two people are a flake and a friend, and three people are a social trend. So that got me interested in this notion of unplanned or unwanted pregnancy – and pregnancies that end up in abortion.’

The first points that Luker stressed were that abortion is not just about women; and that it’s not just about teenagers. ‘If you’ve read much of the American social science literature, you would think women had sex all alone, got pregnant all alone, had abortions all alone and raised children all alone,’ she noted; and her research addresses this balance by also looking at decision-making within couples. And while America, like Britain, is ‘obsessed’ with teenage pregnancy, in fact ‘American adults are remarkable in our capacity to get each other pregnant when we don’t want to be, and to give each other sexually transmitted diseases’.

The key question is, for all adults, ‘why should there be so much abortion in countries where contraception is legal, it’s accessible, and it’s subsidised?’ After four decades of research, Luker has concluded that ‘there are three levels of forces impinging on people: at the level of the individual, at the level of the couple, and at the level of society.’ Recognising this situation raises ‘some very difficult and awkward questions’ to do with unplanned and unwanted pregnancy: ‘unplanned by whom? And more subtly, and more deeply, unwanted by whom?’

Contraception, decision-making and abortion

When it comes to decision-making about pregnancy and contraception, explained Luker, ‘there’s an individual person engaged in a decision-making process that ends in a pregnancy that ends in an abortion. There’s a couple, for however briefly that couple exists, and they’re engaged in negotiating and assigning meanings and making decisions. And then there are some larger social forces’. Understanding the process involves examining all three of these dynamics, and how the relate to each other.

Luker explained that ‘individuals define for themselves what it means to contracept – or not. Couples, and the dynamic between the couples, define what using contraception means – or not. And most importantly, the larger-changing political, social and cultural forces that define and redefine the meaning of sex, pregnancy, marriage and birth’. This latter process is what has come to interest her particularly in recent years, as ‘the world has changed enormously’ since she first began researching these issues.

Luker noted that how individuals think about contraception, birth, pregnancy and abortion is ‘actually an enormously complicated risk analysis’. Individuals calculate the costs of contraception, the benefits of getting pregnant, the probabilities of pregnancy, and the probabilities of reversing the ‘decision’ – as she said, ‘I put “decision” in quotes because it’s much too formal a word for what I think really happens’. She explained:

‘The way this process works out is somebody says, “you know, it’s really a bother to ask him to get out of bed on a cold night and put on a condom. I probably won’t get pregnant. If I got pregnant he might marry me. And worst coming to worst, I can always get an abortion”.’ This, according to Luker, is a rational way of thinking about things – even if events do not turn out this way in reality.

Luker discussed the research she conducted for her 1975 book Taking Chances. Her research was with a group of people who had successfully shown that they knew how to use contraception in the past, yet had not used it to prevent the pregnancy they were currently experiencing. ‘When I talked to them, it turned out that it was because contraception brings social, physical and emotional costs,’ she explained. ‘The social cost is, you have to acknowledge that you’re going to be sexually active. A surprising number of people in my very first study, and a surprising number of young people I talk to today, go off the pill when they break up with a boyfriend, because they’re not “looking to have sex” and they don’t want to look like a woman who’s “looking to have sex”. So it was a common pattern many years ago and it’s still common.’

Luker mentioned other reasons that women give for not taking the pill, for example weight gain. ‘Now to you and me, gaining weight weighed against an unwanted pregnancy that ends in an abortion isn’t a very big deal, but given anything else that’s going on – you don’t know if you’re going to get pregnant, you don’t know what pregnancy means to you, you don’t know whether or not you’ll go ahead and end the pregnancy – all of those things affect how people think about the cost of contraception,’ she said. Similarly, some women talked about pregnancy bringing a ‘pay-off’. For example, one woman talked about how her father would hit her, but that ‘nothing, not even him, can ever take away the experience of being pregnant’; while others talked about being reassured that they could get pregnant.

Trying to calculate the odds of getting pregnant, explained Luker, is ‘a statistician’s nightmare, and it’s not surprising that individual people have a hard time with it’. A common statistic used is that healthy women in a regular sexual relationship have an 80 per cent chance of pregnancy over the course of a year. ‘But it only takes a moment’s reflection to realise that you don’t get 80 per cent pregnant – it’s zero or one. So calculating your aggregate risk is very difficult, and many people will just sort of use a condom during what they thought was the unsafe time of the month, or they’d use a diaphragm or maybe some foam, and when nothing happened they’d stop using it a little bit more, and more, and more. And finally the last step in this process is that people said to themselves, worst coming to worst, I can always get an abortion.’

In this way, the existence of legal abortion has transformed the situation of 40 years ago, when ‘abortion was such a taboo topic that people didn’t actually use the word’ and the risk attached to unwanted pregnancy were much higher. As such, ‘the existence of legal abortion lowers the entrance cost into this decision-making process’.

Luker went on to talk about risk-taking at the level of the couple. In almost all cases, pregnancies occur within a couple, no matter how brief the existence of that relationship is’. Both individuals bring individual assessments to the idea of risk taking, but they also bring ‘couple assessments’, where men and women try to figure out what contraceptive risk-taking and a possible pregnancy means in a relationship. ‘What does this relationship mean to my partner? Where is this relationship going? What does it mean that he or she is not using contraception? What will a baby mean for our relationship?’

The different meanings that individuals within couples whom she interviewed would bring to contraceptive risk-taking are, explained Luker, ‘very poignant. Because the man was saying, “I know she’s not using contraception, but it’s her body”. And the woman was saying, “I know we’re not using contraception, but it’s his baby”’.

The decision-making process, both on the level of the individual and the couple, is affected by broader factors: gender dynamics, and, most importantly in Luker’s view, ‘the changing meaning of sex and pregnancy’.

The changing status of marital motherhood

Reflecting on the social changes since she began her research, Luker argued that ‘marriage is increasingly becoming a luxury good’ - something that ‘the well-to-do engage in’. She suggested that the USA was emulating a pattern previously seen in less affluent societies, where couples in all kinds of relationships would have babies, but only the ‘top tier’ would marry. People ‘aspired to marriage as their ideal, but they didn’t hold off their childbearing until they had achieved that’.

To the extent that the dream of marriage is ‘iconic’ in most societies, Luker argued that it is ‘quite worrisome’ that marriage is declining in the United States. As she noted, ‘the evidence suggests that it’s not my generation of women here who didn’t want to get married because we didn’t need a piece of paper to prove to the state that we were with a partner, but increasingly includes people who would marry if they could but they can’t. And that’s an incredibly complex process.’

Luker devoted the remainder of her lecture to unravelling what the decline in marriage means for abortion and the politics of motherhood. This raises a series of difficult and challenging questions.

Luker’s 1985 book Abortion and the Politics of Motherhood argued that abortion divided women over the issue of motherhood: between ‘those women who were socially situated to be on equal terms with men, and women who couldn’t’. What has become increasingly apparent since the book’s publication, she argued, is ‘the class dimension of that divide’. She presented a graph showing the rapid increase in the percentage of female first-year students in professional programmes such as medicine, law, MBA, and dentistry since 1973. Acknowledging that this reflected cultural change too, she said ‘I believe it’s abortion that finally commits women to invest human capital in themselves and, more importantly, changes the expectations of others that that’s what she would do’.

Addressing the question of why this big change was not seen in 1965, when the Pill was widely used in the USA, Luker stated that the gap between the Pill and abortion is, in fact, a ‘chasm’. ‘When I was in graduate school, an advisor actually told me that he could not give me a fellowship because I might get married and have children,’ she recounted. ‘That would be so unthinkable after 1973: not only because there’s a women’s movement, but because there’s an exit option’. Consequently, a group of women went on to become professionals – but that ‘left behind’ those women who were not so situated.

Luker explained that the argument of Abortion and the Politics of Motherhood was that ‘for many of those women, being a mother was the best job they could aspire to. It had moral meaning, it had social cachet, it was something that was respectable, and that what abortion did was in some ways undercut the social and moral meaning of motherhood.’ However, she reflected, this analysis did not take account of the signficance of marital motherhood.

Presenting graphs showing the proportion of people married or cohabiting in the USA, broken down by education level and by poverty, Luker noted that ‘marriage increases at each level of education, cohabitation decreases’. Similarly, the more affluent people are, the more likely they are to be married. Thus, ‘marriage is becoming less common – but not childbearing’. In 2008, 40.6 per cent of all births in the United States were to unmarried women. This is a ‘racialised phenomenon’. As she argued, ‘marriage is becoming the purview of the reasonably affluent upper middle class – mostly white’. A similar trend of greater proportions of babies being born out of wedlock, noted Luker, is taking place in most Western democracies.

‘Ticklish questions’

These trends, argued Luker, raise a number of ‘ticklish questions’: the first of which is, what does it mean for pregnancies to be unwanted? ‘It seems to me that one of the things that we have not been as forthright in confronting as perhaps we should have been are the taken-for-granted assumptions that babies born to young people, to poor people, and to non-white people, are in some ways problematic babies a priori,’ Luker argued. As she has argued in her books, ‘the rhetoric of teenage pregnancy universalises what is in fact a classed and racialised situation. That is, most women do not say, “Well, I could be a teenage mother or I could go to Harvard Medical School – I think I’ll be a teenage mother!”’

Given the process by which women are ‘sifted apart’ by class and race, Luker argued, ‘it’s extremely important – and I say this as someone who became a feminist the very first time she heard the word – not to universalise women’s experience, to call into our awareness that what it means to undergo sex, pregnancy or abortion is very much a product of your background and not just your gender.’

Another question relates to the changing social circumstances under which abortions take place. Luker argued that the women who were having abortions in the early 1970s were women who didn’t want to be pregnant. ‘If you talked to people in those days, they said it was a relief. They said that it gave them something they would not otherwise have,’ she explained. Today, by contrast, ‘we are increasingly seeing a population of women who would rather be pregnant, but cannot continue the pregnancies for reasons not having to do with their own volition’.

This again raises the question of what it means for a pregnancy to be ‘unwanted’. Luker argued that for an increasing number of women, it’s a ‘lottery ticket’: ‘if you win, you win big; if you lose, you don’t lose that much. So unintended pregnancy may well be a way of exploring for yourself whether or not motherhood, with or without a partner, is a viable option’. This trend, she argued, is extremely worrisome – especially for those working in the field of reproductive choice. As she argued:

‘I’m old enough to remember illegal abortion, and the idea then that you could get a safe, clean, legal abortion was amazing. But if abortion becomes the mechanism by which women’s dreams become smashed, these are not women who are going to support choice. These are people who say, “I really don’t believe in abortion but my case is different”. And I worry that that group is growing’.

Finally, Luker raised the concern that, as shown in US public opinion polls, ‘abortion is one of the few issues where younger women are more conservative than older women’ – in contrast to where they stand on most other social issues. Because young people lack any sense of a world in which safe, legal abortion was not available, she argued, they are more likely to adopt the view that ‘I guess abortion is ok for some cases, really hard cases, but I’m not like all those other people who get casual abortions’.

In conclusion, Luker said:

‘So I think the future is worrisome. It’s invigorating, it’s challenging, luckily there are people in this room like you to do something about it, but I think there are some storm clouds on the horizon that we need to think about very deeply, and need to build into our tidal thinking at the same time that you are thinking about the waves.’

Discussion

Professor Luker’s lecture was followed by a lively discussion amongst attendees of the lecture. Ann Furedi thanked her for challenging much of assumptions and assumed standards that exist in the UK, at the policy level and in relation to service delivery – for example, the assumption that teenage pregnancy is the result of insufficient or inadequate sex education, or to do with access to, or the effectiveness of, contraception. If the issues are reducible to this, the implication is that there can be ‘a quick fix’ – whereas Luker’s research suggests the ‘rich tapestry’ of this area.

David Paintin FRCOG, Emeritus Reader in Obstetrics and Gynaecology at Imperial College School of Medicine at St Mary’s, London, and one of the doctors who helped to bring the 1967 Abortion Act into being, reflected on the impact of Luker’s book Taking Chances on the discussion of abortion in the UK, at the time of its publication in the mid-1970s. At this time, noted Paintin, doctors had begun to interpret the 1967 Abortion Act liberally, and it was becoming clear that women who wanted an abortion would be permitted to have one. Consequently, he said, there was a big demand for lectures to students and medics about abortion, and why unwanted pregnancies happened. The approach taken by Taking Chances, said Paintin, provided a way of understanding and explaining this issue that he continues to rely on today.

Referring to a study that she had been involved in conducting for the Department of Health about Early Medical Abortion, Dr Ellie Lee of the University of Kent asked about the extent to which changes in methods of abortion impact upon attitudes to risk-taking. She discussed how increased access to, and acceptability of, abortion through EMA did seem to indicated that women were more likely to have abortions – but that this was very difficult to talk about in policy circles.

Lisa Hallgarten, director of Education for Choice, asked Professor Luker how sociologists deal with the fact that ‘it’s all about story telling’, noting that when talking about abortion, young people develop a story after the event which helps them affirm their decision. Lesley Hoggart of the University of Greenwich referred to a research project she had recently conducted with teenagers who had had an abortion, and discussed how moralistic many of them seemed nonetheless. While they told stories, she said, they weren’t seeking to affirm their own decision – they were going against their own moral framework, and feeling bad. She stressed the importance of understanding the context in which teenagers make their decisions. 

Other questions related to young people’s perceived reluctance to use contraception because of an ‘anti-science’ perspective, which made them worry about putting chemicals into their bodies, what ideas might be behind notions of a ‘post-abortion syndrome’, and what the social causes of the drift away from marriage might be.

Professor Luker summed up her argument as: ‘abortion freed a certain class of women from marriage and motherhood on any other than their own terms, but it consigned another group of women to motherhood on less advantageous terms’. She reiterated the importance of understanding the context in which individuals made their decisions about motherhood. ‘If nothing exciting is happening in your life, pregnancy at least holds the promise that things could be different,’ she said. ‘And let’s face it, babies are wonderful, babies are compelling.’ While individuals do make up narratives, she said, ‘if you hear the same piece of the story many times it shows there is something reliable and socially relevant there’.

In conclusion, Ann Furedi picked up on an observation from one audience member that some of the discussion had sounded more familiar to conservative circles than those generally associated with the liberal left. ‘It’s interesting how much we all have to take a step back from preconceived ideas that we have associated with the pro-choice movement and look at what likes behind them,’ said Furedi. For example, ‘it’s very easy for us to think about unplanned sex in terms of risk but many young people think about it in terms of opportunity’. Attempting to bridge the gap between the way that individuals think about contraception and pregnancy, and the way that policymakers, service providers and some academics think about it, is an important challenge.

Report by Jennie Bristow.