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Scott Black: What if all reproduction was voluntary? This is the question we'll be considering today on the Virtual Jewel Box Podcast of the Tanner Humanities Center.

I am Scott Black, director of the Tanner, and today we'll be discussing Margaret Pabst Battin's new book, Sex and the Planet: What Opt-In Reproduction Could Do for the Globe. Dr. Battin is Distinguished Professor of Philosophy at the University of Utah, and she will be joined in conversation with Dr. James Tabery, Professor of Philosophy as well at the University of Utah.

James Tabery: Well, it's my pleasure to participate in this discussion with Professor Battin about her new book that came out last spring from MIT Press, titled Sex on the Planet: What Opt-In Reproduction Could Do for the Globe. Professor Battin, the first question I wanted to ask you is about the method you employ in the book, which is that of a thought experiment.

I can imagine many listeners, when they hear the term experiment, they think of a collider in physics or an oncologist studying a new cancer drug. That's not what we're talking about here. You use a thought experiment throughout the book, and I thought before we dove into the actual meat of the book, you could just reflect for a second on the method itself.

What is a thought experiment, and why do philosophers use them?

Margaret Pabst Battin: Philosophers and all sorts of other thinkers have used thought experiments, but I think it's useful to distinguish two kinds. First kind is what you might call the airhead variety. This is what philosophers are often known for—thought experiments like, well, what if we were brains in a vat controlled by some external power?

All our thoughts, experiences, and so forth are externally controlled, and that's the way we are. That's a classic thought experiment in philosophy. There's another that's used widely in bioethics. This is due to Judith Jarvis Thomson. And here the thought experiment is: supposing you find yourself kidnapped by the Society for Music Lovers and now located in a hospital bed with a famous violinist hooked up to your kidneys for nine months.

May you kick him out of your bed? That’s a more practical-sounding thought experiment, although it's not very realistic. I'd call that something a little more like a real-world thought experiment—except that it's still actually airheady. Now, the big difference between that kind of thought experiment and the one we're doing is that the one we're doing has actual real-world implications.

I like to call it normative force. So contrast the one we're going to do, which is about opt-in reproduction, with those two philosophical ones. What if we were brains in a vat? Well, what difference would it make? We'd still be sitting here talking into our respective microphones, and you, the audience, would be out there listening to this program in whatever chair you're sitting in, drinking whatever—coffee or, you know, whatever it is you're doing while you listen to podcasts.

And nothing in your experience would be different. So the bottom line there is: it doesn't really make any difference whether we're brains in a vat. We wouldn't be able to tell, and we wouldn't be able to do anything to change it. It's an enormously challenging conceptual thought experiment, but it has no normative value.

Think about the Judith Jarvis Thomson famous violinist case. Here the question is: can you kick this guy out? You were kidnapped, you were hooked up to his kidneys, you're to be there for nine months. This is obviously a thought experiment used in the context of debates about abortion. Could you kick him out?

He'd die. Well, that's the theoretical version. But the real-world answer is: sure you can kick him out, cut the tubing, kick him out—but make sure he gets dialysis. There's no real-world problem there. So the thought experiment we're going to try here is about opt-in contraception. What if you had to make a positive choice to contribute to pregnancy?

That is, to try to have a child. You had to make a positive choice. And this starts from the background fact—remember this number—that 45%, and just to make sure we understand: 45% is almost half, 45% of all human pregnancy—that’s true in this country and around the world on average—is unintended.

That is, defined as two or more years in advance of when a pregnancy might have been wanted, or not wanted at all. So what would the world be like if virtually all human pregnancy were intended by the parties to it? That's the kind of thought experiment we're going to explore, and it's not unreasonable or impossible.

James Tabery: And so that's the thought experiment of the book. You title it the Opt-In Conjecture. And so I guess what I'd be curious to hear is how you see the world we live in as different from that thought experiment world you're asking us to imagine as we work through the book. And what do you think are the best-case arguments for why that world—where the Opt-In Conjecture is in effect—is a better one than the world we live in?

Margaret Pabst Battin: Well, let's take five global-sized reproductive problems. These are five big kinds of problems—social problems—that exist everywhere in the world. That’s why we’re thinking about the planet.

Well, what about the problem of abortion? What about the problem of early pregnancy? That’s teen pregnancy—it’s usually called that in developed countries. In some traditional cultures, this is early marriage, often arranged marriage, and early childbirth.

What about pregnancy following rape—mass rape, forced sex of every kind, right? There are many, many ugly stories of this sort, where sexual forcedness results in pregnancy for the person who has been forced.

What about high-risk pregnancy? It's estimated that maybe 20 to as many as 30% of women have some kind of medical condition that is either affected by the pregnancy, or where the pregnancy affects the woman’s medical situation, or where the drugs used to respond to the medical condition affect the pregnancy—or where external factors, toxins in the environment, affect or can affect the pregnancy. This is not infrequent, and it's also a universal problem. Can we do something about that?

And finally, of these five big global-sized problems, there is the one that used to be very much in focus: global population growth—and is now, in some countries, perceived to be a problem of global population decline.

So that’s where we’re heading. These are five real problems. Can we do something to solve—or at least partly solve—them with the kinds of change in thinking, and also in practice, about how pregnancy begins?

James Tabery: I wanted to ask, I guess, about the “opt” part of the Opt-In Conjecture. And when I hear talk of a world where population-level reproduction is controlled, I can't help but think of the history of sterilization—coercive sterilization—the way that reproductive control has been used in the past, largely by people in power to control people who have less power.

And so I'm curious to hear—when you're imagining that Opt-In Conjecture alternative world—are you worried about abuse? Are you worried about coercion? Are you worried about the possibility that something, even on the face of it, could have the label “opt-in,” but when you look under the rug, you see something that is not so obviously in that vein?

And how would we guard against that in this thought experiment world that you're sharing?

Margaret Pabst Battin: That's a really important question, Jim, and it has been the focus of much of your own scholarly work—your emphasis on non-voluntary sterilization. And you're to be enormously praised for the energy you've put into exploring that situation.

Here is where we distinguish between a thought experiment and a proposal. This isn't a proposal. We’re not saying, “Go out and do this right away.” And if we were to say, “This is a proposal,” then it sustains the kinds of objections that you’re, quite appropriately, concerned about.

So this is a thought experiment in the sense that it asks the question: What would it be like if everybody—or virtually everybody—everybody who was a user of what we might call long-acting reversible contraception, or some modality that made it the case that in order for pregnancy to commence, you had to make a positive choice?

That's all.

So, the history of reproductive activity has involved enormous abuses. Think about Ceaușescu of Romania. His view was that they needed more people, and women should have five children each. Abortion was prohibited. Contraception was not available. Women were required to have that many.

Skip forward to India, when the early concerns about global population growth—and remember, India is one-fifth of the world’s population—led Indira Gandhi to institute a program of semi-voluntary and often non-voluntary male sterilization—vasectomy. There were camps set up all over the country. In some towns, the unit arrived in the middle of the night, dragged the adolescent boys and men off, sterilized them.

Think about China. China is another fifth of the world's total population. It instituted, in the same era of concern about global growth, the one-child policy—very rigorously enforced. You had to get a birth permit. You had to satisfy certain conditions. If you had a second child, you were fitted with an IUD after the first one. If you had a second child, you would be sterilized. Forced abortion was not uncommon. There was no joking or fooling around about this.

You think about—well, there are so many examples, and you're much more familiar, I think, with examples in this country: the treatment of Native American women, of Puerto Rican women, of minority groups everywhere. Everywhere where the state or some policy tries to control the reproductive behavior of individuals—either for more children or fewer children.

So this thought experiment—the bottom line is: what if every person with reproductive capability could choose to try to have the children they wanted, and not otherwise?

That’s it. Full personal reproductive control for everyone.

That seems like a better world to me than Ceaușescu’s, or China’s, or India’s, or any of those cases.

James Tabery: When you review the lineup of really awful incidences from the past, a pattern emerges. And it's often not just people in power, but the state enacting some vision of what they want their population to look like and trying to use some element of reproductive control to make that happen.

I'm wondering—grant the point about the difference between a thought experiment and a proposal—but I take it even just to get the thought experiment up and running, there has to be some sense that this is an alternative world worth exploring.

And so, do you have examples in the book of a sort of counter-narrative, where maybe we don't live in the world with the Opt-In Conjecture in place, but when we give more people control over reproduction, look how much better it is?

So, is this a story about the pill? Is it a story about long-acting reversible contraception? Do you have examples of that—where they're not horror stories from the past, but examples of success stories—and the thought is that the Opt-In Conjecture is sort of running with that theme?

Margaret Pabst Battin: Yeah. So, if you look at some of the Scandinavian countries, or say, the Netherlands, or places where the rate of unintended pregnancy is lower, that's on the way to this thought experiment.

Or look at something like teen pregnancy. So teen pregnancy, which had hit a high spot—if you can call it that—in 1990 to 1991. That rate, partly because teens are having somewhat less sex, but they're also using much more reliable contraception, has dropped by 60%.

That’s a big drop. That's the kind of picture we might expect to see if people—including teens—have the ability to decide whether or not to try to reproduce.

So if we go back to these five global things, imagine that everyone had—and let’s assume this is free, we can talk about cost later on—free, voluntary, and because this assures you of your own personal control over reproduction, it’s something that people would want, that it’s side-effect free, risk-free.

All of these are assumptions we can make about future technologies. Supposing everybody had that—it’s just the way people are. You know, in the same way that people with, say, limited eyesight wear glasses. Nobody makes you wear glasses. You don’t have to. Well, there’s actually one circumstance in which you do have to, and that’s if you want to drive a car. But otherwise, it’s entirely up to you.

This is the same kind of thought experiment: you don’t want to be involved—either as male or female—in a pregnancy you didn’t choose. So that begins to look like an attractive world.

James Tabery: The book came out in May of 2024. I know—because we’re colleagues—that you put a lot of work into this book, and it was something that was a long time coming. And I think it shows. It is so rich and deep in the examples and the medicine and the science and the reflection. It makes it very clear that this was something you were working through in a really sophisticated way over a long period of time.

I'm curious to hear now—with, you know, there’s a vulnerability involved with publishing a book. Before it’s out, you can always adjust things, even up to the index at the end. But once it’s out there, it’s out there. And it’s been out there for a number of months now. So I’m curious what your sense is of how it’s been received.

In talking with people about the material, have you gotten new insights on this topic that you didn’t anticipate? Are you thinking about the Opt-In Conjecture world differently? Do you wish you did something different? Right—there’s always the reception piece, and that’s what we’re in the midst of, and I just want to hear a little bit about that.

Margaret Pabst Battin: Well, it’s a hard question to answer because, of course, you don’t know what every reader has thought of it.

The reception I get most—and this was both while I was working on it and after it’s been out there—is that people are initially skeptical. They have the same reaction that you've been expressing: “Aren’t you worried about abuse? What about the history of all these ways in which states and parties and religious groups—and you name it—have tried to control human reproduction? Aren’t you worried about that?”

But then, when they digest the thought experiment and realize it’s a thought experiment about a possible world, they say, “Oh. I get it. I get it.”

So that’s the kind of response that I hear. A lot of it is hard to convey—this notion of a thought experiment—without having it seem like a proposal.

Proposals always elicit objections: “We couldn’t do that. It’s too expensive. Where would you get people? How would you make people agree?”—note the emphasis on “how would you make them agree”—all this stuff.

And this is just to say: what if this were just normal in the world? Everybody had their own full personal reproductive control.

James Tabery: The last question I’ll ask you sort of runs with that theme of what you were just discussing there about the reader experience. We don’t live in the world where the Opt-In Conjecture could reasonably be rolled out without the concerns.

So I’m wondering: what do you hope that the reader experiences by undertaking that adventure with you—to imagine that alternative universe where the Opt-In Conjecture could roll out? Should they be thinking about reproduction differently at the end? Should they see power dynamics in the space of sexual relationships that they didn’t notice before?

Is it a kind of call to arms to say, “We don’t live in the world where this could happen, but here are some things it exposes that we’d have to do if we wanted to get there”?

What do you want the reader to feel they’ve gained—or want to do next—when they read the last page?

Margaret Pabst Battin: Well, that’s a great question. Let me supply another question before we come to an end here. But to answer this one: I think a thought experiment of this particular kind has three functions.

One is to show that specific kinds of problems—there are conceivable solutions or partial solutions to certain kinds of actual real-world problems.

The next thing is to identify values that are at stake—try to protect those.

But the third—and I think this is the most important one, and this book spends a lot of time doing this—is to identify problematic assumptions that never get questioned.

Here’s one out of the twelve that this book identifies: the assumption that contraception is only for people who are sexually active.

Well, this is how teens get in trouble. There’s a boyfriend on the scene, and as long as they have the boyfriend, they are using some kind of contraception. Many of them—that might be the pill, it might be the condom (failure rate, first year of use: 12 to 18%), it might be some form of shot or—

But when the boyfriend leaves, they stop. Then either that boyfriend comes back, or some other boyfriend comes along, and now this teen is not protected.

Because the assumption was that during a period of sexual inactivity, you don’t need to be using contraception.

So there’s an underlying assumption that this kind of protection, I think you’d call it, is only relevant if you’re sexually active.

What about nuns? What about loyal widows? What about—you can name whole groups of people who aren’t normally or usually sexually active. Why wouldn’t they still want protection against contributing to—or experiencing—a pregnancy they didn’t want?

But before we quit—do we have time for one more?

Because one of the foci of this book is on something that gets discussed never enough. It’s about men.

After all, every pregnancy involves a sperm contributor as well as an egg contributor. That’s just the way nature works.

Why don’t we attend to the situation of men?

So it seems to me that we need to realize how disadvantaged men are in this context.

Men have—and you can ask any group of men this—what three forms of contraception do you have available to you that are entirely under your own personal control?

Three?

Hmm.

Guys will sit and look around, kind of, you know, in an embarrassed way, and hem and haw. They can usually get two.

“Well, there’s the condom.”

Sure. Failure rate: 12 to 18% in the first year of use. But we’ll look aside from that.

“Well, there is withdrawal.”

Fewer men in this country, for instance, will mention that—although this is widely used in Eastern Europe during the Soviet period.

And vasectomy—which, because it cannot be guaranteed reversible, might not be appropriate for young men who might change their minds or want to do so in the future.

This is appalling—that that’s all the control there is for men.

Everything else requires reliable information from the female. If you’re doing cycle tracking or natural family planning, you need to know whether she’s actually taken the pill or had a shot or has a diaphragm or any of those things.

Those are all things that are not within the control of the male.

So this picture about long-acting reversible contraception trades on two modalities that are currently available for females: the subdermal implant and the IUD—the hormonal or non-hormonal variety. And both of those are long-acting. The copper IUD is good for as much as 12 years, maybe more. But they’re both reversible and involve return to fertility right away.

There is nothing like that yet for males.

There are some—there’s suddenly, since the Dobbs decision, been a huge explosion of research in male contraception. Because, after all, one of the effects of Dobbs is it also takes control—any sense of control—away from men as well.

So that’s the picture: supposing both males and females had reliable, side-effect-free, safe, reversible contraception that they could use pretty much all the time—except when they actively wanted to have a child.

That’s a really different picture. But it’s not impossible.

James Tabery: Well, Professor Battin, I really enjoyed reading the book. I think embarking on the journey of imagining that Opt-In Conjecture world with you is a fascinating literary experience, and I hope listeners will take it and gain the insights that you offer.

Margaret Pabst Battin: Well, I thank you, Jim Tabery, for your reminder that our world—the world we live in and have been living in—is very imperfect in the matter of reproduction. Unfortunately, that's the case.

So we both want to see that be different. And thanks to our host here, the Tanner Humanities Center.

Scott Black: You’ve been listening to the Virtual Jewel Box Podcast from the Tanner Humanities Center at the University of Utah.