In a perfect world, a new pregnancy is likely the source of joy. That world probably isn’t experiencing a zombie apocalypse.
This season of The Last of Us has featured all sorts of scary things: new and speedy mushroom zombie variants, a fanatical Luddite cult, aerosolized Cordyceps, a flamethrower showdown with a supersized monster, that freaking golf club. But the most terrifying of all might have been when Dina dumped fistfuls of positive pregnancy tests in front of Ellie in Episode 4.
“I’m gonna be a dad?” Ellie asks, confused but then thrilled that Dina’s hookups with Jesse have led to a tot-to-be. Dina, too, is excited. Sure, she and Jesse are dunzo, and she’s happily with Ellie now instead, but hey! A baby! What’s not to like?
I don’t know—everything? And that would be true even under less cataclysmic circumstances.
“Pregnancy is still incredibly dangerous today,” says Alice Domar, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. “It is far, far safer to have an abortion than it is to go through labor and delivery. Women die in the U.S. every single day from pregnancy and childbirth.”
That’s before the HBO series’ vicious hordes of zombies enter the picture. Domar, who’s also the chief compassion officer at the fertility treatment company Inception, does not like the odds for an expectant mother in the midst of societal breakdown, with a side of bloodthirsty undead, in which even electricity is considered a spectacular rarity; hospitals and rigorous maternal care are relics of the distant past. “You’re not going to have a lovely anesthesiologist come in and give you an epidural,” she says, ticking off the many niceties likely unavailable to moms in the world of The Last of Us: genetic testing, ultrasounds, the option of a C-section, and a NICU if needed, among others. “You’re basically going back 200 years, probably before the invention of ether. A lot of women are going to die in childbirth.”
And yet: In postapocalyptic hellscape after postapocalyptic hellscape, people keep putting their uteruses to work, to the point that it’s become something of a bleak genre trope. (Dear FBI, I have located 46 likely serial killers; please do with that you will.) Take The Walking Dead, in which Lori’s dalliance with Shane leads to a pregnancy that ends in a horrific, fatal emergency C-section on a prison floor; she is then shot by her young son to prevent a zombie transformation before being gobbled up by a particularly husky walker. A Quiet Place didn’t have zombies, but the planet-wide invasion by noise-hunting aliens didn’t stop Emily Blunt’s character from growing her brood—leading to a nightmarish labor scene in which she can’t make a sound. Even Ellie is the product of a deeply cursed pregnancy: Her immunity to the Cordyceps virus that steamrolled humankind 20 years before the events of The Last of Us is apparently the result of her mother getting infected just as she was minutes from delivery.
Dina is happy, though, and that’s nice. And indeed, through Season 1 and the front half of Season 2, there have been few small children or pregnancies featured, suggesting that fertility rates among The Last of Us’s various ragtag bands of survivors are low. That could be a reflection of the cold calculus of life in a wasteland—I for one am not trying to put a bun in the oven while fungal ghouls are on the prowl—or it could be something else: a stark reflection of what life among rocks and hard places does to the humans who dwell there.
“If you actually look at pretty much every study done on animals and a number of studies done on humans, in general, when a population is stressed physiologically or psychologically, fertility decreases in both men and women,” Domar says. (Interesting!)
“If you look at human reproduction, it looks like some people, both men and women, are reproductively sensitive to stress, and some people not,” Domar says. “Women who were raped get pregnant; women in concentration camps got pregnant. We know that women under extreme stress can conceive, which means a sperm worked and an egg worked and a uterus worked. And so we know that you can’t say that everybody is reproductively negatively impacted by stress.”
But let’s say that theoretically you were Dina—20 years old, give or take, and apparently plenty fertile—and just did not want to share an abdominal cavity with a calorically needy, nausea-inducing critter whose stay will end in a potentially life-threatening health event. What do you do?
Well. The CDC’s formal advice is that condoms “should not be used beyond their expiration date or >5 years after the manufacturing date,” which puts anything that can be found in the remnants of Seattle's or Jackson’s drugstores solidly out of bounds. Oral contraceptives, too, would be out of date, assuming they could even be located. IUDs might be an option—“If one could find a sealed, sterilized IUD and the equipment needed to insert it, it would probably be somewhat effective, because the IUD itself would still be effective even though the medication probably would have expired,” says Domar—but we know that both medical resources and knowhow are few and far between.
What’s left if you’re sexually active but not interested in welcoming Junior? The olden ways.
Randi Hutter Epstein is the author of Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank and the writer-in-residence at Yale School of Medicine. “If you go back to ancient times, people used natural things,” Epstein says. “Condoms weren’t a new invention when we started having factories that can make these things that come in tiny, little packets and stretch over a penis. People were using things in nature that weren’t perfect, but blocked sperm and egg—whether it was covering a penis, whether it was shoving something up in a vagina.”
What might you shove? Funny you should ask: “What women did hundreds and hundreds of years ago was they would take sponges and soak them in vinegar and use them as, in effect, diaphragms,” Domar says. “I believe the first condoms were actually sheep intestines.”
Simply going without, Epstein says, is absolutely not the answer in a zombie apocalypse—particularly if it’s one filled with the kind of dashing actors who get hired by HBO. “Abstinence isn’t going to work,” Epstein says. “No matter what society, we’re not good at that. This situation might be even less inclined to be abstinent, because there’s not much else going on, and if it’s a television show, there’s got to be some really attractive looking people.”
But whatever else happens, Epstein thinks some things are never going to change, even if the world is so upside-down that evil mushroom men want to eat your brain. “Every now and then, there’s a little media blitz of, ‘Oh, my god, this study shows that we might be able to have a male contraception,’” she says. “And my feeling is that even if there were a major apocalypse, even if a fungus swept the world and killed almost everyone, even if people were faced with the most dire of circumstances, you’re never going to have a man take a contraception that might make him feel slightly bloated or a little headachy or maybe feel kind of fat.”
Roger that. Just don’t tell the sheep.
