Contraception is an ‘us’ problem

Megan Clarke discusses how we can achieve a just contraceptive arrangement, with a focus on technological advancements and our conceptions of gender:

Artwork by Daisy Whittle (IG: @Daisydrawn).

The notion that contraception is not just a women’s health issue seems to be one that our society finds difficult to grapple with.

The development of the contraceptive pill became a significant milestone in the women’s rights movement, a symbol of bodily autonomy. Initially introduced in 1961 for married women only, by 1967 the Family Planning Act made the contraceptive pill readily available to the wider population through the NHS. However, one of the unspoken consequences of this development is how the burden of contraceptive responsibility came to fall disproportionately upon women.

Due to the effectiveness of existing female birth control methods, little impetus has existed to produce sufficient male contraceptive alternatives. The dominant rhetoric of female empowerment both clouds and sidelines the injustices of our current contraceptive arrangement.

A lack of contraceptive options for men ultimately leaves women with a lack of choice, as they are forced to bear the majority of the financial and health related burdens of contraception. Additionally, women carry out much of the ‘invisible’ work related to birth control. Dedicating time and energy to medical appointments, and conducting adequate research into available birth control options, alongside experiencing the anxiety and pain that concerns invasive procedures, and the stress of the possibility of an unintended pregnancy, is taxing. Contraception affects both women’s physical and mental health.

Rather than the combination of oestrogen and progesterone found in the combined pill, it is a combined change in ideology and technology that I suggest will assist in the realisation of a just contraceptive arrangement.

The female experience of contraception:

7/10 of all women in the UK have used the contraceptive pill at some point in their lifetime, and recently, women have begun to publicly voice their experiences. Photos of the patient information list that is included in prescriptions of the pill have been circulating on social media, with the ‘shock-factor’ being the seemingly never-ending list of potential side effects.

The list of side effects includes migraines, nausea, breast tenderness, acne, and weight changes; further, it has been linked to an increased risk of blood clots, breast cancer, and cervical cancer. The pill can affect women’s mental health too, and in some cases it has been associated with depression and anxiety attacks.

This may feel overwhelming, however, the purpose of this article is not to wage war on the contraceptive pill, as for many women it is a highly effective and safe birth control method. Rather, by focusing on the pill, I have sought to provide a very small snapshot of the female experience of contraception, which can come with a plethora of injustices and disadvantages.

Unfortunately, whether it be through the pill, coil, implant, or injection, it is expected that women alone dramatically alter their hormones in an effort to prevent pregnancy; they are expected to ‘put up’ with any side effects in an agreeable manner, and to be grateful for the number of options available to them. It is these expectations that can lead to women feeling trapped, without control, and frustrated, with many now opting for non-hormonal methods and natural family planning (fertility awareness), which is listed as a viable method by the NHS.

This disproportionate intervention of the female body unfortunately proves rather unsurprising in a culture in which those without uteruses are the first in line to dictate what those with uteruses should do with their bodies. Moreover, it is highly reflective of the power imbalance that exists between men and women in society at large.

The overturning of Roe v Wade is an alarming example of such a pattern. Safe, legal abortion was a federal constitutional right nationwide for almost 50 years in the U.S., until women’s reproductive autonomy was usurped by lawmakers. With three relatively new Supreme Court justices - Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett - records hostile to reproductive health and rights were brought to the court. Years of precedent were erased, despite 80% of Americans believing that abortion should be legal, and despite estimates that nearly 1 in 4 women in America will have an abortion by the age of 45. The denial of both the female voice and experience is enacted by the overturning of Roe v Wade, as giving states the right to outlaw abortion is synonymous with giving middle-aged, white men the primary right to intervene with women’s bodies, especially women from Black, Latino, and Indigenous communities, for whom systemic racism has continually blocked access to opportunity and healthcare.

The gendered imbalance of contraceptive responsibility:

Women are at the mercy of our current contraceptive arrangement. There is an illusion of choice in heterosexual relationships, for despite an array of different contraceptive options for women, choice is remarkably absent when you ask the question of whether you or your male partner bears the burden of responsibility.

A just contraceptive arrangement depends on the development of male LARCs (long-acting reversible contraceptives), but also on reconceptualising the responsibility for contraception as shared between men and women. This imbalance has been traced back to the pill, the rapid popularity of which established women’s role as contraceptive consumers. Indeed, this continues to be evident today, with TV and social media AD campaigns for Hana, an over-the-counter oral contraceptive brand. Despite being hailed by Havas’ chief creative officer (the advertising company) for its ‘democratisation of contraception’, I suggest its positive impact is limited, for when such developments are not accompanied by similar advancements in the field of male LARCs, they normalise and further entrench the expectation that women should bear the responsibility for birth control. The outreach of such AD campaigns merely perpetuate the message that men can subtract themselves from the birth control equation, whilst also often glamorising the experience of birth control too.

It is imperative that men begin to take on a greater level of initiative when it comes to contraception. Self-reflecting on the health inequalities affecting the women in their life, engaging in open conversations rather than operating on the assumption that their partner is ‘taking care of it’, contributing to costs, and offering support, are just a few of the ways that men could begin to help alleviate some of women’s contraceptive burdens.

Newsflash: asking a woman if she can take the morning after pill after coming inside her, does not count as taking on a shared responsibility.

In his argument for ‘Why contraception isn’t just a women’s health issue’, Justin Myers asserts how ‘even responsible men, once settled in a relationship, feel we’ve earned the right to come freely’. It is this ‘right’, and the prioritisation of men’s sexual pleasure, that often leads to guilt-tripping, and women enduring contraceptives for their partner’s benefit – cue the oh so familiar line of “but it feels nicer without a condom …”. It is evident that many men value their sexual pleasure over the potential side effects that come with the birth control use of their partners.

Looking towards the future, with male LARCs on the horizon:

The struggle for contraceptive equality seems impossible when men themselves have limited reproductive autonomy due to the current technologies. The contraception guide provided by the NHS lists 14 different forms of contraception, only two of which are options for men - how can we mitigate the existing pressure placed on women when condoms and vasectomies are the only male alternatives?

When used correctly every time you have sex, male condoms are 98% effective; however, this has been estimated to be 87% with typical use. The lower effectiveness rate of condoms and the risk of ‘stealthing’ (the illegal act of removing a condom during sex without consent), highlights the need to devote more resources to developing male LARCs. Although vasectomies are very effective in preventing pregnancy (99%), with variable success rates for reversal, there is still a need for an effective contraception option for men that is intended to be temporary, in order to grant greater flexibility.

With laws restricting abortion access after Roe v. Wade was overturned in the US, public demand for more male contraceptive options has increased.

According to GlobalData’s Pharma Intelligence Centre, there are 10 investigational male contraceptives; both hormonal and non-hormonal pills are being researched, topical gels and injections, to name a few. In 2019, a male birth control pill (DMAU) passed its first round of clinical testing. Further, an ultrasound-based and reversible approach to contraception, COSO, recently won an innovation award, and in France, a thermal ring called Andro-Switch has made headlines as a natural, non-invasive, and hormone free method of male contraception.

The catch? Not one of these options are ready for the market yet.

Despite 33% of men insisting that they would happily take the contraceptive pill if offered, and despite favourable safety profiles and effectiveness rates, progress is continually halted by a modest rather than major interest from private companies. Further, trials of hormone-adjusting treatments often stall because of a low tolerance for the side effects, despite women being expected to take these in their stride.

The pervading rhetoric that somehow male contraceptives make you ‘less of a man’, that abstaining from using contraception is a way of assuring your masculinity, also negatively impacts the response to proposed male LARCs.

The impact of a male contraceptive pill would be twofold, promoting both a shared accountability for contraception, and endowing men with a more active role in their reproductive health.

Conclusion:

In short, while there are of course many positives to women being in charge of contraceptive decisions and of their bodies, the notion of female empowerment does not take away from the pressing need for shared contraceptive responsibility; essentially, a just contraceptive arrangement.

As epitomised by the procedure of a vasectomy, the existence of a particular technology is not enough; the development of male LARCs must be accompanied by an ideological shift, with men acquiring a genuine desire to share and thereby alleviate some of the contraceptive burden, and to thus have greater control over their reproductive autonomy.

Useful links:

CERT is a policy group campaigning for contraceptive empowerment in Scotland. Many of the team are students at the University of Edinburgh, possessing a shared passion for improving contraceptive care and education in Scotland.

“At the heart of our work is our deep commitment to listen to the experiences of contraceptive users and amplify their voices to reform current frameworks of contraception to make experiences positive and supported.”

Website: https://www.certscotland.com/

Instagram: @certscotland