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Q: what’s two inches long and has NEVER RAPED ANYONE?

Posted by pocochina on August 3, 2010

A:  An IUD.

Apparently, doctors in Scotland are following some new sexual health guidelines, concerning the discussion long-term contraceptive options with young teenage patients who ask about the contraceptive pill, “as long as the doctor does not suspect exploitation or coercion.”  The Express, the paper which originally reported on this, stressed the sex panic angle, claiming that Scots are “up in arms” in terror about the prescription of a safe, legal medication by a doctor for a patient.  (I’m kind of the opinion that anyone who goes to the Catholic Church for a quote about sexual exploitation of minors shouldn’t be allowed to report on the grand opening of a supermarket, but whatever.)  RH Reality Check took a more pragmatic line, saying that if someone is too young for sex, she’s definitely too young to be a parent.  And Jezebel, in a rather spectacular example of trading point for sensationalism, argues that capacity to consent to sex is an individual thing and therefore concern is misplaced, and besides, the contraceptives won’t be given to anyone doctors suspect is being coerced or exploited.

Most of this argument seems to basically be a red herring.  As Tracy Clark-Flory points out in a related post on Broadsheet, any contraceptive use by British young teens and tweens is extremely rare.  Moreover, doctors do not seem to be expected to push children into getting contraceptive shots or IUDs, but rather, are reminded to express the benefits of easier, more reliable options for all of their patients, including girls.  I don’t actually see this particular guideline going into use all that often.

But I think the Jezebel article very much misses the point in (a) treating the exploitation conversation as a good-faith argument and (b) discussing the hypothetical (and indisputably rare) tween who is capable of fully and enthusiastically consenting to sex, rather than discussing the impact of this ruling on sexually abused girls, which on rational examination can only be seen as positive.

The exploitation argument is not a good-faith argument.  It is coming from the Catholic Church and from “families’ rights” groups who only seem to care about exploitation when someone is doing something consensually. Perhaps tellingly, much of the “fury” is stoked by the idea that the contraceptives can be administered without the patient’s parents’ consent.  At this late date, anyone who pretends that telling a girl’s family about concerns of abuse is some kind of failsafe against physical and sexual mistreatment is simply playing at ignorance.  People who argue against reproductive autonomy for girls are, as a general rule, not arguing against exploitation, but in favor of greater vulnerability to it.  And no reporting – to parents or the government – will necessarily result in protection of the victim or prosecution of the perpetrator.  Less than 4% of reported rapes in Scotland result in a conviction.

That’s because contraception is not the cause of rape.  Abusers do not refrain from abuse in fear of impregnating their victims; rather, they frequently coerce their victims into pregnancy as an expression of their control. Female controlled birth control is exceptionally important because of the possibility of reproductive abuse.  And methods such as the IUD and shot are wonderful tools for vulnerable girls.  While condoms (male and female) can be pricked and a daily pill can be flushed down the toilet, an IUD or shot can be used without the knowledge of an abuser.  In fact, I would argue that the most medically, ethically, and socially responsible thing for a doctor to do if faced with a patient who’s being abused, in conjunction with fulfilling the duty to call social services, is to offer the patient discreet female-controlled birth control, in order to spare her the emotional, physical, and financial pain of a coerced or abuse-filled pregnancy.

Moreover, the proposed guidelines actually place doctors in a position to discover, and therefore be in a position to better prevent, abuse.  Remember, these guidelines affect doctors dealing with patients who have asked for a prescription for the daily pill.  People who are being abused are generally not forthcoming with this information, for a multitude of reasons.  An honest, supportive conversation about birth control options and healthy sexuality between a teenager and her doctor, if done properly, would enable the doctor to collect enough information to decide if the patient is being exploited; a doctor who shrugs and writes a script will never get enough information to accurate gauge a patient’s situation.

This situation will be different for each and every teen patient, but will usually reveal some abuse, and I think that this reality is erased by the Jezebel article.  A third of reported rape victims in the UK are under 16, and young women who would not recognize their experience as forcible or drug-assisted rape per se may still be experiencing exploitation by someone who is much older, solely based on age and power differentials.  When we concern ourselves overwhelmingly with the theoretical idea of very young teens who are capable of consenting to sex, this contributes to rape culture excuses made for child rapists.

But that doesn’t mean that young women should be denied contraceptive options.  It concerns me that the post accepts uncritically that girls who may be experiencing abuse should experience sub-standard medical care, when they are the ones most in need of reproductive protection.  The existence of abuse has nothing to do with available reproductive technologies, except make their availability even more urgent.  We cannot buy into the idea that all consensual, protected sex and the tools which allow people to engage in it safely are tainted by exploitation.

Rapists rape.  IUDs do not.

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