Contraception: why are women still paying the price?
By Annabel Chadwick / 9 April 2021
On the 11th of May 1960, a revolutionary date in the history of reproductive rights took place: the FDA approved the contraceptive pill.
Over the 61 years that followed, alongside sexual liberation, women’s reproductive agency has been exploited for the preservation of social compliance. Between 2019 and 2020, it was recorded that over 1.9million women were on some form contraception, with 60% of these using user dependent contraceptives (like the combined pill and the progestogen-only pill), and 40% using long acting reversible contraceptives (the coil, implant and contraceptive injection).
There are currently 15 different methods of female contraception, with over 20 different brands of birth control pills. Men have four options: condoms, vasectomies, ‘outercourse’ (sexual acts that don’t involve penetration), and pulling out.
Recently, a domino effect of European countries suspending the rollout of the AstraZeneca vaccine dominated our news feeds. The vaccine was labelled unsafe and within hours officials were pulling it from distribution. This was all due to the now disproven link between AstraZeneca and the risk of blood clots. In fact, experts have since stated that the benefits of the vaccine outweigh the risks. For any person taking the contraceptive pill, the conundrum over this lack of risk is laughable. 1 in 1,000 women per year who take the contraceptive pill develop a blood clot. It’s one of the many health risks that women sign up to if they choose to take the pill.
In addition to risks of the pill, its common side effects include weight gain, decreased libido (which seems counterproductive), and changes to mood, which has actually been linked to causing depression. The emotional and physical side effects of the pill are essentially the toll women pay to a pregnancy-free sex life.
An IUD (the coil) can cause pelvic infections, ectopic pregnancies and damage to the womb. It can also be rejected by the womb (which is extremely painful) or become misplaced inside the cervix. And do we even need to touch on the discussion of its insertion? These examples are just a drop in the ocean of the physical and mental sacrifices that women and people who use birth control make to avoid unwanted pregnancies. I’m forced to wonder if basic reproductive biology has been swiped from all text books. Men are exactly half of the action. Avoiding unplanned pregnancies is a shared decision, and yet there’s a seemingly unchallenged ideology that men can opt out of condom use because “it doesn’t feel as good”.
We also eagerly await the long-promised ‘male-pill’. Research behind this began over 40 years ago. In 2016, one trial of this pill was dropped due to the number of side effects, the most common being acne, mood swings, weight gain, and decreased sex drive… Sound familiar? Aside from the huge mental and physical burden that women and people who use birth control take on, the most concerning effect of this remarkable imbalance is its social impact.
Research conducted by i news found that 56% of women said that they are responsible for covering the full cost of condoms, the contraceptive pill and the morning-after pill in their relationships. Meanwhile, according to The British Pregnancy Advisory Service, there’s been a huge decrease in funding from Clinical Commissioning Groups for vasectomies, with some GP surgeries even restricting referrals to just one patient a year for NHS-funded vasectomies.
Not only are men sidelining the financial contribution towards birth control, they are continuously told by the lack of means for effective male contraception to happen that avoiding unplanned pregnancies is not their duty.
Women and people using birth control determine men’s futures as fathers. Yet, the power is very much in their hands. Dr Lisa Campo-Englestein is a feminist bioethicist, and one of the BBC’s “inspiring and influential” Women of 2019. Her research specialises in reproductive ethics and sexual ethics, with one of her main projects focusing on the ethical and public health need to develop long-acting reversible contraceptives for cis-gendered men. She tells me about the impact that the development of more male contraceptive methods could have.
“Contraception has a host of financial, social, and health-related burdens and it is unfair that women are the ones who shoulder most of this. Men often rely on their female partner to use contraception if they want a highly effective, reversible form of birth control.
But this arrangement means that men's reproductive autonomy is diminished. New forms of male contraception would empower men to control their fertility.”
I asked Lisa why she thinks women have held the burden of contraception for so long, despite its many health risks.
"A significant reason for this is social reasons, not scientific reasons. Femininity and reproduction are often conflated, so it seems "natural" for women to be the ones responsible for contraception, therefore it seems "unnatural" for men to use contraception. Consequently, fewer resources have been devoted to creating male contraception.
Despite any negative side effects, women continue to use birth control because their ability to control their fertility is an important aspect of their reproductive and bodily autonomy. If there were new forms of male contraception, contraceptive responsibility could be shared.”
Describing an ideal future in terms of contraception, Lisa added:
“It’s one in which there is a range of good and effective contraceptive methods for everyone. This would allow men in monogamous couples to share contraceptive responsibility rather than it falling disproportionality on women.
Men engaging in casual sex who may want to consider future genetic fatherhood would have more and better options than just condoms, which would enhance their reproductive autonomy.”
An egalitarian conversation needs to be had to address the clear gender imbalance here.The mental, physical, financial and social gap between women and men in regard to contraception seems, in 2021, so dated, unfathomable and wrong. Yet, we’ve yielded to a mirage of ‘normal’. The panic felt across Europe when the AstraZeneca vaccine was alleged to cause blood clots speaks to a broader problem. It is anger-inducing to watch the world, to watch men, panic about a ‘risk’ that women are told is essentially unavoidable. Would Governments halt the use of the pill if they really understood the side effects? Probably not. It would cause too much damage. That is the real injustice of contraception.
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