Reading and ranting: when theory doesn't meet practice

So I'm reading this paper. It's about desired and actual fertility levels in developing countries. And it's written by...an economist.

No offense to any economists reading this, but y'all say a lot of funny things. You base a lot of your reasoning on the idea that people make "rational decisions" and everything else follows logically from there, but underneath that you have a very restricted sense of what rational decisions might be.

An example: this paper posits that there is "a very small influence of contraceptive access on fertility levels .... The decision to have another child is simply too important and too costly for contraceptive costs to play a major role." 

I kind of hesitate to name this paper and author, because in fact it's a very interesting paper with some thoughtful research behind it and some good points to make. But I just need to say it: are you fucking kidding me? 

Sure, it's easy for you to say from your armchair, "It just doesn't make sense to behave any other way; if a woman can't afford birth control, she certainly can't afford a child, so she should be sure to get on birth control because it's a tiny investment compared to the cost of a kid." Well, duh. 

But I mean: has this guy EVER spoken with an actual woman of reproductive age (as they say) during his career? Here in the first world, where theoretically there is a pharmacy around every corner and Medicaid for poor people, I have met SO MANY women who would have loved to buy contraceptives in the month they got pregnant, but couldn't afford it because diapers or seizure medication or a new (used) tire had to come first. The thing is, if you can't afford birth control this month, the fact that you could even less afford to have a child doesn't matter -- you still can't afford birth control right now. And then accidents happen. 

This doesn't even get into all the pseudo-consensual sex that occurs even in the U.S. -- not to mention more resource-poor countries -- meaning you may be afraid of getting pregnant and unable to get birth control but you may also have little agency in sexual decisions. Your abusive partner is actively trying to get you pregnant as a control tactic. The guy you depend on for child support comes around every few weeks and maybe gets a little pushy. You support your four siblings by trading sex for food. You live on the street and cops routinely harass you until you'll fuck them! 

I'm just saying. The fact that it's cheaper doesn't always mean birth control is cheap enough. 

The paper goes on to use other, more sound arguments to propose that the well-known idea of "unmet need" for contraceptives is more or less moot, because "actual fertility" levels are nearly identical to "desired fertility" levels in most developing countries. Really, they are interesting points, but then he doesn't even address the extremely high rates of unsafe abortion in those same countries -- a pretty strong indicator of desperately not wanting to be pregnant, I'd say, and of a need (an unmet need, if you will) to avoid pregnancy in the first place. I mean, stuff like that: WTF, economists?

So I am still trying to understand how a person can write about the real-life problems of real-life individuals, overlook critical aspects of the situations many of them are in, and write off an entire sub-field of health as irrational or unnecessary. I mean, I feel like if someone asked the author about the abortion thing, he'd dismiss it by saying he is only looking at the "big picture" of births per woman, and his point is that women on average are still having as many children as they say they desire and that point still holds, and micro-level issues such as death and disability due to unsafe abortion are only details to be worked out by someone else who takes an interest in that stuff. And that's as may be -- perhaps you just wanted to show something interesting about these national-level birth-related indicators -- but really, even if it's just carelessness, you shouldn't let your theory errantly piss all over others' actual practices. 

Better strategies:
1) Acknowledge that there is an unmet need for contraception so long as unsafe abortion is widespread, or
2) Acknowledge that abortion is an important part of your finding that women are meeting their "desired" fertility levels, and include in your recommendations section that it be made safer and more accessible.

To put it less wordily -- those women your science can't understand: they are nevertheless real and you haven't managed to math them away.