Jon Snow, Reproductive Health Hero?

Image via HBO.
Image via HBO.

Last week, I tuned into the Game of Thrones Season 7 finale with a host of expectations. Jon Snow revealing himself as a champion for trustworthy sexual health information, though, was not one of them.


After Jon refuses Cersei’s offer of a truce because he can’t serve two queens, the King of the North and Mother of Dragons share an intimate moment in which Daenerys tells him she can’t have children. “Who told you that?” he says. “The witch who murdered my husband,” she says, and he responds, “Has it occurred to you she might not have been a reliable source of information?”

Jon’s question had me mentally fist-pumping. You see, Dany isn’t alone among young women in thinking she’s infertile. A 2009 survey of 1,800 unmarried Americans aged 18-29 found that 59% of women thought it was “at least slightly likely” that they were infertile, and 19% said it was quite or extremely likely. The actual number of women in this age group who likely can’t conceive? Just six percent. Since other research has shown that thinking you’re infertile makes you less likely to use contraception, perceived infertility could be a contributor to the fact that about half of pregnancies in the US are unintended. While an unintended pregnancy on Game of Thrones might serve as a dramatic plot point, in real life, it’s a major reason why young women drop out of high school, and can deal a serious hit to women’s lifetime earnings.

There’s not much research on why so many young people think their fertility is impaired. (Presumably, witch prophecies aren’t a factor.) However, the survey showed that three-quarters of women who said they might be infertile were basing their assumption on factors other than information from a doctor. Some researchers have suggested that sex education imploring young people to use contraception every time they have sex because “it only takes once” to get pregnant may have an unintended effect: when someone has unprotected sex that doesn’t result in a pregnancy, they may interpret this as a sign that they’re infertile.

In reality, your chance of getting pregnant from unprotected sex on any given day ranges from less than 1% to 30% over the course of a menstrual cycle. This is the biological rationale behind “fertility awareness methods” (FAM) of family planning, which provide different ways of calculating which days your risk of pregnancy is high and avoiding having sex (or using a condom) on those days. Even though your risk of pregnancy on any given day is low, these methods are hard to use correctly. On average, out of 100 women using FAM for a year, around 24 of them will become pregnant, though this number drops to five if the method is used perfectly. For comparison, the equivalent numbers for the pill are nine for typical use, and 0.3 for perfect use. More effective fertility awareness methods can approach the effectiveness of modern methods, but these involve extra steps beyond period tracking, like taking your temperature every day using a special thermometer and tracking the consistency of your cervical mucus. Of course, whether or not you’re at risk of pregnancy, the only way to protect against sexually transmitted infections is to use a condom.

I can forgive Daenerys for trusting a witch on reproductive health matters; Thrones is set in a medieval-esque fantasy universe without modern medicine, sex education or the internet. But the fact that so many American women are making sexual health decisions based on misconceptions about basic reproductive biology is troubling. Educational solutions are unlikely to come from the federal government; the Trump administration recently cut $213 million in funding for the Obama-era Teen Pregnancy Prevention Program, which supported efforts to replicate and evaluate educational initiatives designed to reduce teen pregnancy. Until we see a federal course correction towards comprehensive, medically accurate sex education, we’ll need alternative education efforts to fill in the gaps.

Luckily for us, we don’t live in Westeros, and excellent initiatives abound. Google’s recent partnership with the National Campaign to Prevent Teen and Unplanned Pregnancy is a good example: when you search for a method of birth control, the results page now displays a handy box with comprehensive information, including effectiveness, side effects, and how it’s used. An unintended pregnancy may be in the cards for Jon and Dany, but with a little innovation and ingenuity, it doesn’t have to be for young people in the United States.


Aleka Gürel works in reproductive health research and is based in San Francisco, California.



I think I’m super-fertile, actually. My mom was the youngest of 10, I’m the youngest of 4. My sister had three with one being a surprise. I just assume I’ll be poppin’ ‘em out like Pez dispensers when my time comes.