Growing up, many of us heard our parents say, "It takes two to tango." Yet we hear from men and women that the responsibility of contraception lies more on women than men. Why is that? Well, if we look at the overall picture in the U.S., sexually active women of reproductive age have many methods of contraception to choose from--the female condom, the implant, the pill, the ring, two IUDs, etc--to protect themselves from unplanned pregnancies, while sexually active men have one method: condoms. And let's face it, the failure rate of condoms is unacceptably high at 15% with typical use*. It's no wonder people say contraception is a woman's responsibility.

Yet, why can't men have equal responsibility? Why can't they protect themselves from an unplanned pregnancy by having a variety of contraception to choose from? (Especially considering that men never go through menopause.) I know some of my male friends would love to have a variety of methods to choose from to protect themselves and not have to wonder or second guess whether or not their partner is using contraception.

Well--good news is here!

As the U.S. Department of Health and Human Services (HSS) implements Section 2713 of the Affordable Care Act that requires women's preventive health services to be covered at no cost, a new survey, conducted by Hart Research Associates and commissioned by Planned Parenthood Action Fund as part of Planned Parenthood's "Birth Control Matters" campaign, found overwhelming and widespread public support for national policies that would provide prescription birth control approved by the U.S. Food and Drug Administration (FDA) at no cost to all women with health insurance. Nearly three-fourths of American voters (71 percent) believe insurers should be required to fully cover the birth control pill and other forms of prescription contraception as they will be required to do for other preventive health care services under the new health care reform law, according to new data released on October 12. HHS' Health Resources and Services Administration has asked the Institute of Medicine to develop recommendations on which women's preventive services should be covered and included in women's health guidelines. HHS is expected to finalize the guidelines by August 2011.

The survey shows a number of important specifics about what people think about coverage of contraception:

• 71 percent of all voters, including men and women, say prescription birth control should be included as preventive health care services, covered without any out-of-pocket costs. This includes three in five male voters (60 percent) and four out of five female voters (81 percent).
• Seven in 10 Republican women (72 percent) said that birth control should be included as preventive health care, covered without any out-of-pocket costs.
• 77 percent of Catholic women voters said that birth control should be covered as preventive health care without any out-of-pocket costs.
• One in three women voters (34 percent) report having struggled with the cost of prescription birth control at some point in their lives. Among younger women (ages 18-34), 55 percent have struggled with the cost of prescription birth control.

Covering the full range of FDA-approved contraceptive prescriptions and devices and related outpatient care will go a long way to help reduce unplanned pregnancy and improve the well-being of families and children. For women who experience unplanned pregnancy there is reduced opportunity to pursue pre-conception care as well as care in between pregnancies. In addition, unplanned pregnancy provides less opportunity for optimal child spacing. With overwhelming public support behind it, the Administration has a real opportunity to help millions of women and make a difference in the lives of children and families by covering contraception with no copays.

A new book on how the nine months before our birth shape the rest of our lives (Origins, by Annie Murphy Paul) is getting a lot of attention. It reviews the evidence that our mothers' lifestyles while they were pregnant with us influence our physical and mental health later in our lives, not just our own stupid choices.

As Jerome Groopman, MD, puts it in his book review for The New York Times, the idea behind the emerging field of fetal origins research is "The food the mother eats, the air she breathes, the water she drinks, the stress or trauma she experiences -- all may affect her child, for better or worse, over the decades to come."

I think the most interesting part of the new research is the impact of stress and emotional distress. First, the public service announcement: the author suggests that pregnant women and fetuses do fine with a manageable amount of stress.

But there is also evidence that greater amounts of stress can have deleterious effects like premature labor, low birth-weight, or even increased incidence of mental health issues later in life. Of course, some sources of stress described in the book, such as natural disasters and political strife, cannot necessarily be avoided by careful planning. But the evidence emerging from fetal origin research thus far presents yet another compelling reason for potential parents to take all possible measures to avoid pregnancy until they have the emotional and economic stability to ensure minimal stress for mom and baby.

Some may recall the Fog Zone report published by The National Campaign in December of 2009, which looked at the knowledge, attitudes, and behavior of unmarried young men and women (ages 18-29) regarding pregnancy planning, contraception, and relationships.

In a nutshell, findings from The Fog Zone suggested that many young adults are ambivalent about pregnancy, misinformed about contraception, and probably over-confident about their ability to avoid unplanned pregnancy. These findings are important in helping us better understand why half of all pregnancies in the U.S. are unplanned, and why that proportion is even higher among unmarried twenty-something women (7 in 10--yikes!).

Since releasing the report, The National Campaign has been thinking a lot about what we can do to address the attitudes and behavior brought to light in the report. We're trying a variety of approaches. By far the biggest step we're taking is to create a birth control support network for young adults, bedsider.org (currently in beta with a national launch planned for early 2011). Bedsider aims to make birth control easy and to help people choose a contraceptive method that fits their lifestyle.

In addition to Bedsider, we've been tackling findings from The Fog Zone on SexReally and elsewhere. Wanna see how we've addressed some of the findings so far?

I must be a glass-half-empty kind of person. A newly released study summarized in The New York Times and elsewhere on the sexual health of our country states that condoms are the new norm for sexually active teenagers. OK. Nothing wrong with condoms -- if used correctly and consistently, they are highly effective in preventing pregnancy and sexually transmitted infections. The study finds that 80% of teen boys and 69% of teen girls used a condom the last time they had sex. So, clearly the condom is the go-to method of choice.

But here's the problem from where we sit -- if roughly one in three teens is getting pregnant by age 20, obviously using condoms is not as normal as it needs to be. And using a condom the last time they had sex isn't the same as using a condom (or other form of contraception for that matter) every time they have sex. Results from another recently released report, The Odyssey Years (PDF), indicate that only 40% of sexually active teens ages 18 to 19 use contraception consistently -- that is, every time. Teens who started off using condoms reported lots of reasons for dropping them later -- or skipping them from time to time -- such as alcohol, not wanting to "blow the moment," or wanting to make it "a little more special."

Don't get me wrong -- I'm not criticizing the report. I'm just saying that until careful, consistent use of contraception (every time) is the norm for all sexually active teens, we still have a lot of work to do.