I started reading romance novels after my daughter was born. I had always been an avid reader, but with two small kids and a full-time job, I was sleep-deprived and had the attention span of a fly. Romance novels were the perfect solution. They had predictable story lines, happy endings, and far more graphic sex than I imagined (I had the stereotypical sex life of a new mom, which is to say not much of one, so the fictional sex was appreciated).

The first book I read was Virgin River by Robyn Carr. The first in a long series Carr set in Northern California, it features Mel, a young, widowed nurse fleeing sad memories and a high-intensity job in Los Angeles. Mel ends up in Virgin River, a tiny rural town with a bar, a doctor’s office, and an inordinate number of attractive men. Mel meets Jack Sheridan, the lone bar’s owner, and quickly falls into bed with him.

At the time I started my diet of romance novels, I was working as a project director of a large study on the effects of unintended pregnancy on women’s lives. I was thinking intensely about contraception, abortion, and pregnancy. And I, like many of you, had some preconceived notions about the inclusion of contraception in romance novels. One of which was that there wasn’t any! I now have nearly 350 romance novels under my belt, and I have come away from this immersion with a few observations.

First, there is lots of consequence-free unprotected sex. But the truth is, there is in real life too. One of the leading reasons women give for not knowing they were pregnant is that they didn’t think they could get pregnant. Why don’t women think they can get pregnant? Because they often have unprotected sex and nothing comes of it. Of course, the United States also has the highest rate of unintended pregnancy in the developed world and nearly half of pregnancies are unintended. So, clearly, there are also many times when the chips come down differently for real women.

In Romance Novel World, however, contraception must work flawlessly because given how much sex people are having in their pages, it is pretty impressive how rarely people get pregnant.

I can think of one example, and it’s not a surprise that it also comes from Robyn Carr, whose website biography says she trained as a nurse. Her novels reflect that training, with pregnancy, contraceptive use, childbirth, and other reproductive events occurring far more frequently than in the books of many other authors I’ve read.

Carr’s A Summer in Sonoma, one of the most interesting books I’ve read for its treatment of reproductive health issues of all kinds (and which will be reissued in June), centers on four close friends, all with their own dramas. Julie, one of the four friends, got married young to her high school sweetheart and had a few kids. The couple is in dire financial straits when Julie gets pregnant even though she’s using an intrauterine device (IUD), something that is actually extremely rare.

Julie visits the medical practice of her close friend, Beth, to share her concerns about the pregnancy. “I can’t have another child, I just can’t,” Julie laments. Beth encourages Julie to talk to her husband and tells her that the pregnancy carries additional risk because of the presence of the IUD. “We can take it out,” Beth says. “We do that from time to time. Usually a little later, with an ultrasound to guide. But that carries a risk—it could compromise the pregnancy.”

Let’s pause for a moment and remember that this is a romance novel! Julie considers her options, and insists, over Beth’s protestations, that Beth take it out right there and then. Julie subsequently miscarries the pregnancy, tells her husband the whole story, and is able to both heal the wounds to her marriage, and her precarious financial situation.

Julie’s predicament is far from uncommon. Forty percent of women considering abortion for an unplanned pregnancy cite financial circumstances as the main reason for wanting to end the pregnancy. In addition, it is clear that women’s concerns on this score are warranted. The study I worked on, called the Turnaway Study, found that women denied a wanted abortion had four times greater odds of falling into poverty compared to women who were able to obtain an abortion. Despite the frequency of unplanned pregnancy, Carr’s novels are a notable exception in the romance genre in that they often address the topic. The consequences of all the torrid sex going on in romance novels are rarely addressed.

That said—and I haven’t done a systematic study—contraception appears much more often than one would think in romance novels. In at least half the romance novels I’ve read, pills, condoms, and even IUDs are mentioned as noted above. Even romance novels set before the existence of modern contraceptives mention withdrawal and early forms of condoms, with regularity. Pregnancy prevention is on people’s minds, even when they are being swept off their feet (sometimes literally).

In E.L. James’ best-selling erotic romance Fifty Shades of Grey, mousy virgin and college senior Anastasia falls for rich, powerful Christian Grey. While that could fuel any number of romance novel plots, Fifty Shades diverges when Christian reveals that he is into BDSM and wants Ana to be his subordinate. As part of the contract she must sign, she agrees to start taking a birth control method of her choosing and Christian even arranges for a doctor to make a house call to take care of it. For all its flaws, and it has many including appalling writing (sorry!), Fifty Shades tackles topics that we rarely see in popular culture’s depiction of sex and sexuality—negotiation of boundaries, the centrality of female pleasure, and the use of sex toys. In terms of contraception, however, while there is probably more discussion of birth control in Fifty Shades than in most other novels, it is by no means alone in its portrayal of couples’ desire to avoid pregnancy.

Even in very mainstream romance, condoms are pretty run-of-the-mill. In Nora Roberts’ suspense-romance, The Villa, the action centers on Sophia Giambelli and her rival/love interest, Tyler. However, Sophia’s divorced mom, Pilar, gets in on the romance action too. Heading out for what might be a first date, Pilar checks her purse and finds that her daughter has provided her with a surprising gift.

Nervous, she opened her bag at the top of the stairs to make certain she’d remembered everything. She blinked in shock as she dipped her fingers in and closed them over two packs of Trojans.

When the time comes (hard not to go crazy with the puns when writing about romance!) for Pilar and her beau to consummate their relationship, Pilar isn’t prepared, despite her daughter’s efforts. Luckily, her love interest is. “Sweetheart, I’ll take care of that,” he says.

Condom use in the romance world is sometimes sexy, sometimes awkward, and present more often than not—very like reality.

Not so when it comes to abortion. Despite the fact that one in four women will have an abortion in her lifetime, this particular reproductive health experience is all but absent in romance novels. In A Summer in Sonoma, worried Julie admits to having considered abortion. But unlike in movies and TV, genres in which storylines about abortion are on the increase, the romance world seems not to want to touch abortion with a ten-foot pole. TV and movies get a lot wrong about abortion; for example, 9 percent of fictional women having abortions die as a result of the procedure, whereas the risk of death from abortion is statistically 0 percent. But at least TV and film try to take on the issue.

Romance writers have never been accused of truth in storytelling. Their medium is fantasy. Actions often don’t come with consequences, and people like it that way. But in many ways, romance authors do tend to reflect many of the issues that their primarily female readership faces. Sexual assault, financial problems, infidelity, infertility, sexual harassment, balancing demanding jobs, and the demands of family are all common romance themes. According to Romance Writers of America, three-quarters of romance readers discuss what they are reading with friends, so it is clear that romance plots resonate with the women who read them.

So why not take on the full spectrum of reproductive health? It is time for romance novelists to join screenwriters and movie producers to address the full range of reproductive health issues women grapple with daily and throughout their lives.